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Got a 14 yr old S/F Abysinian non-azotemic cat with recurrent hematuria and pyuria and several posative urine cultures (E.Coli)
Also has intermittant neutophilias (like 22,000), Urine S/G (like 1.020) Been ultasounded 2X very accomplished ultasonographer/internist with no major serious findings! The cat always seems to respond to antibiotics.
Question is: any reason NOT to place cats on a 'chronic low dose', AB similiar to the 1/3 dose, at night, on an empty bladder, as done in dogs?
Thanx, br/ | If so, any other signs of concurrent illness that might suggest pyelonephritis? | What was the size of the contralateral adrenal gland that was not called a mass? |
Got a 14 yr old S/F Abysinian non-azotemic cat with recurrent hematuria and pyuria and several posative urine cultures (E.Coli)
Also has intermittant neutophilias (like 22,000), Urine S/G (like 1.020) Been ultasounded 2X very accomplished ultasonographer/internist with no major serious findings! The cat always seems to respond to antibiotics.
Question is: any reason NOT to place cats on a 'chronic low dose', AB similiar to the 1/3 dose, at night, on an empty bladder, as done in dogs?
Thanx, br/ | Are you able to post the full bloodwork (cbc, chemistries, urinalyses and culture/senstivity profiles? | Did we do a complete biochemical profile too? |
Got a 14 yr old S/F Abysinian non-azotemic cat with recurrent hematuria and pyuria and several posative urine cultures (E.Coli)
Also has intermittant neutophilias (like 22,000), Urine S/G (like 1.020) Been ultasounded 2X very accomplished ultasonographer/internist with no major serious findings! The cat always seems to respond to antibiotics.
Question is: any reason NOT to place cats on a 'chronic low dose', AB similiar to the 1/3 dose, at night, on an empty bladder, as done in dogs?
Thanx, br/ | The ultrasonographer has never documented any pelvic dilation or stones during any exams, i assume? | No treats..just the gi low fat diet? |
Got a 14 yr old S/F Abysinian non-azotemic cat with recurrent hematuria and pyuria and several posative urine cultures (E.Coli)
Also has intermittant neutophilias (like 22,000), Urine S/G (like 1.020) Been ultasounded 2X very accomplished ultasonographer/internist with no major serious findings! The cat always seems to respond to antibiotics.
Question is: any reason NOT to place cats on a 'chronic low dose', AB similiar to the 1/3 dose, at night, on an empty bladder, as done in dogs?
Thanx, br/ | It's going to be critical for us to try and figure out why this kitty keeps getting infections: are we dealing with recurrent infection (different e colis each time) versus relapsing infection (same e coli that we just can't successfully clear)? | Was this cat showing signs that could be attributed to hypert4 at the time that value was taken? |
Got a 14 yr old S/F Abysinian non-azotemic cat with recurrent hematuria and pyuria and several posative urine cultures (E.Coli)
Also has intermittant neutophilias (like 22,000), Urine S/G (like 1.020) Been ultasounded 2X very accomplished ultasonographer/internist with no major serious findings! The cat always seems to respond to antibiotics.
Question is: any reason NOT to place cats on a 'chronic low dose', AB similiar to the 1/3 dose, at night, on an empty bladder, as done in dogs?
Thanx, br/ | Playing the odds, i would bet that this kitty has stage i ckd (as usg is inappropriately low for a cat), and that the dilute urine is predisposing to recurrent ascending utis. how is her anatomy - any hooded vulva appreciated? | Potentially depending the na+? |
"Georgie" is a 9 yo, intact male beagle these owners rescued last year. He came to them with a history of ear infections, having been hit by a car and having a weak left rear leg. At the time of adoption he weighed 27.3#.
He's been doing generally well until the last few months. We first saw him in Feb of 2012 at the above weight. In Sept of 2012 we saw him for vaccines and his weight was 21.6. The owner was unaware he had dropped that much. Attitude good, behavior normal. Earlier this week we saw Georgie again for increased appetite, weight loss and increased problems with left rear leg. His weight this time was 21.2. He is eating everything according to the owner, his food, others if he can get it, books, licking floors, whatever he finds.
On exam I found normal vitals, 1 hookworm egg on fecal(is current on his Iverheart Max), owner says he is fecallly incontinent at times, his stool is foul smelling and theres lots of it!! I did x-rays, baseline bloodwork and a TLI to Texas.
Nothing seems out of normal, TLI came back 14.8 (5.7-45.2) and rest of bloodwork normal except for Mg being .1 low.
His Albumin is still in normal range but low normal at 2.8(2.7-4.4).
I believe his left rear leg problem is an old ACL tear, not repaired surgically. His stool is large, pasty and a grayish color.
I am still highly suspicious of pancreatic insufficiency but wondered if I was overlooking something. Thanks for the help and have a great Easter!!
☼ | Polyphagia and weight loss, any pu/pd at all? | Do you have any bg curves? |
"Georgie" is a 9 yo, intact male beagle these owners rescued last year. He came to them with a history of ear infections, having been hit by a car and having a weak left rear leg. At the time of adoption he weighed 27.3#.
He's been doing generally well until the last few months. We first saw him in Feb of 2012 at the above weight. In Sept of 2012 we saw him for vaccines and his weight was 21.6. The owner was unaware he had dropped that much. Attitude good, behavior normal. Earlier this week we saw Georgie again for increased appetite, weight loss and increased problems with left rear leg. His weight this time was 21.2. He is eating everything according to the owner, his food, others if he can get it, books, licking floors, whatever he finds.
On exam I found normal vitals, 1 hookworm egg on fecal(is current on his Iverheart Max), owner says he is fecallly incontinent at times, his stool is foul smelling and theres lots of it!! I did x-rays, baseline bloodwork and a TLI to Texas.
Nothing seems out of normal, TLI came back 14.8 (5.7-45.2) and rest of bloodwork normal except for Mg being .1 low.
His Albumin is still in normal range but low normal at 2.8(2.7-4.4).
I believe his left rear leg problem is an old ACL tear, not repaired surgically. His stool is large, pasty and a grayish color.
I am still highly suspicious of pancreatic insufficiency but wondered if I was overlooking something. Thanks for the help and have a great Easter!!
☼ | Would you be able to post your bloodwork in full? | Do you think this pet could have an indolent lymphoma, or is something else more likely? |
"Georgie" is a 9 yo, intact male beagle these owners rescued last year. He came to them with a history of ear infections, having been hit by a car and having a weak left rear leg. At the time of adoption he weighed 27.3#.
He's been doing generally well until the last few months. We first saw him in Feb of 2012 at the above weight. In Sept of 2012 we saw him for vaccines and his weight was 21.6. The owner was unaware he had dropped that much. Attitude good, behavior normal. Earlier this week we saw Georgie again for increased appetite, weight loss and increased problems with left rear leg. His weight this time was 21.2. He is eating everything according to the owner, his food, others if he can get it, books, licking floors, whatever he finds.
On exam I found normal vitals, 1 hookworm egg on fecal(is current on his Iverheart Max), owner says he is fecallly incontinent at times, his stool is foul smelling and theres lots of it!! I did x-rays, baseline bloodwork and a TLI to Texas.
Nothing seems out of normal, TLI came back 14.8 (5.7-45.2) and rest of bloodwork normal except for Mg being .1 low.
His Albumin is still in normal range but low normal at 2.8(2.7-4.4).
I believe his left rear leg problem is an old ACL tear, not repaired surgically. His stool is large, pasty and a grayish color.
I am still highly suspicious of pancreatic insufficiency but wondered if I was overlooking something. Thanks for the help and have a great Easter!!
☼ | And was there also folate and cobalamin on your texas panel by chance? | And, if they can, if another episode occurs, maybe they can record it? |
"Hunter" is an obese (39lb) MN Boston Terrier. Hw test was positive (occult & microfilaria) on 1/28/13. No symptoms of hw disease. He was presented for pre-hw tx workup on 3/25/13. Serum was very lipemic (pt not fasted), had to sent out to get results. CBC wnl. Chem shows high ALT (332) & ALKP (5083)--there was also moderate hemolysis present. Thyroid Profile was wnl. Was able to get liver on chest rads, and may be a little enlarged. O says no cortisone-type meds (topical or oral), only rx is Tri-Heart Plus to kill the mf. O thinks he may be polydipsic. UA done on 1/28/13 after o said he had some urine accidents showed a USG of 1.050.
I understand that Immiticide treatment shouldn't be a problem with concurrent elevated liver enzymes. What would you do? Go ahead & treat, then pursue further diagnostics? Bile Acids or LDDST first, then treat hw? Which would have more value in this case, Bile Acids or LDDST?
Thanks,
☼ | Age? | Currently using u40 syringes? |
"Hunter" is an obese (39lb) MN Boston Terrier. Hw test was positive (occult & microfilaria) on 1/28/13. No symptoms of hw disease. He was presented for pre-hw tx workup on 3/25/13. Serum was very lipemic (pt not fasted), had to sent out to get results. CBC wnl. Chem shows high ALT (332) & ALKP (5083)--there was also moderate hemolysis present. Thyroid Profile was wnl. Was able to get liver on chest rads, and may be a little enlarged. O says no cortisone-type meds (topical or oral), only rx is Tri-Heart Plus to kill the mf. O thinks he may be polydipsic. UA done on 1/28/13 after o said he had some urine accidents showed a USG of 1.050.
I understand that Immiticide treatment shouldn't be a problem with concurrent elevated liver enzymes. What would you do? Go ahead & treat, then pursue further diagnostics? Bile Acids or LDDST first, then treat hw? Which would have more value in this case, Bile Acids or LDDST?
Thanks,
☼ | Any protein in the urine? | Description of clinical signs? |
"Hunter" is an obese (39lb) MN Boston Terrier. Hw test was positive (occult & microfilaria) on 1/28/13. No symptoms of hw disease. He was presented for pre-hw tx workup on 3/25/13. Serum was very lipemic (pt not fasted), had to sent out to get results. CBC wnl. Chem shows high ALT (332) & ALKP (5083)--there was also moderate hemolysis present. Thyroid Profile was wnl. Was able to get liver on chest rads, and may be a little enlarged. O says no cortisone-type meds (topical or oral), only rx is Tri-Heart Plus to kill the mf. O thinks he may be polydipsic. UA done on 1/28/13 after o said he had some urine accidents showed a USG of 1.050.
I understand that Immiticide treatment shouldn't be a problem with concurrent elevated liver enzymes. What would you do? Go ahead & treat, then pursue further diagnostics? Bile Acids or LDDST first, then treat hw? Which would have more value in this case, Bile Acids or LDDST?
Thanks,
☼ | How do you assess his stage on his thoracic radiographs? | Was the cholesterol run after a 12 hour fast? |
Good morning. There's a case I've been working on this past week for which I'd love a second opinion (details below):
History:
- Maxi is a 11y FS Maltese mix (5.3#) who presented shortly after a seizure on 3/26
- H/o of diabetes mellitus - hasn't been to DVM for 3 years, no rechecks (don't know how he's been getting insulin, but anyway...). On 1.5 units NPH BID SQ.
- Seizure on 3/24 and 3/26 BEFORE eating/insulin dose in afternoon.
- H/o of weight loss x 2-3 months (7# in 2010 -> 5.3# now)
- H/o pu/pd, "bad smelling urine" x 2 weeks.
Diagnostics:
- IH bloodwork on 3/26: Alb 1.9 (L), ALP 1276 (H), Alt 182 (H), BUN 6 (L), Creat 0.2 (L), Gluc 397 (H), Na 137 (L). No ketones on UA, 4+ glucose.
- - - Chem to Antech (slightly diff from IH but same basic trends): Alb 2.6 (L), AST 89 (H), ALT 177 (H), ALP 1253 (H), BUN 8 (LN), Phos 1.8 (L), BG 370 (H), Ca 8.1 (L), Corrected Ca 9 (LN), Chol 236 (N).
- CBC: Mono 1200 (H).
- T4: 0.7 (L).
- UA: 3+ glucose, USG 1.034, bili 2+, blood 3+, WBC 11-20, RBC 4-10, rods > 100, protein trace. UCS positive for E. coli 100,000 colonies/ml, sensitive to all ABs tested.
- Fructosamine: 463 (good regulation range).
- In my opinion, her abd xrays showed microhepatica with a cranially tilted gastric axis. No obvious neoplasia on chest/abd xrays.
Assessment 3/26:
- R/o liver insufficiency/cirrosis/PSS/HE, PLN, PLE, diabetic hepatopathy, neoplasia, UTI, pancreatitis, hypoglycemia with rebound hyperglycemia, other (intracranial) as source of BW changes and seizure activity.
- AUS scheduled.
Further diagnostics/plan:
- AUS on 3/28 was wnl except for mild pancreatitis and cystitis. Liver/gall bladder grossly normal size, etc - no macroscopic PSS seen. IM ultrasonographer rec'd bile acids response test (BART). In the meantime, treat for cystitis and pancreatitis and lower insulin dose to 1 unit SQ BID as suspect transient hypoglycemia causing siezures (rebound hyperglycemia accounting for high BG in hosp and normal fructosamine).
- Lowered insulin to 1 unit SQ BID, started P on amoxicillin x 4 weeks for complicated UTI, and provided cerenia/pepcid as needed for nausea/vomiting (P had vomited a couple times overnight at 3/27).
- BART done 3/29, results received today: pre = 118, post = 120!
My thoughts:
- I suspect hepatic microvascular dysplasia (MVD) given the normal AUS and significantly elevated BART, although a macroscopic shunt is still on my list given how high the BART values are - but none was seen on AUS, hmmm.. My understanding is that MVD usually doesn't cause significant issues/clinical signs and dogs can lead a normal life. BUT the dogs that do get issues/clinical signs tend to be the geriatric patients especially if there's a concurrent disease process (diabetes mellitus).
- I guess I could do a protein C (cornell) level which for MVD tend to be normal, but I'm not sure it would change the treatment plan except potentially referral to a specialist if it indicates a macroscopic shunt liklihood and the O's are willing to pursue rectal scintigraphy scan and surgical correction.
- Would you start this P on lactulose/metronidazole, denamarin, L/D (or any combo of such) keeping in mind that she's also diabetic (she's currently on w/d)?
- I guess I should also have them stop the Cerenia since it's processed through the liver and can have prolonged metabolism in such cases.
Thanks for taking the time to consult on this interesting case. I appreciate your thoughts!!
Sincerely,
☼ | Can put on abs (on them already for uti?) and liver supplements? | The owner can accurately measure and then inject the insulin...is the owner pulling the 1.5 units out of the levemir pen with a u100 syringe? |
Bill is 3 yr m/c dsh, relatively new to us, with a 6 month hx of semiformed stools. We initially found roundworms, treated x 3 (pyrantel), with minimal response. Owner has tried several different diets for 1-2 months each, novel protein but over-the-counter; none made much difference, chicken seemed to make worse. One other cat in house, no symptoms (also dewormed)
We just submitted giardia/crypto stains (neg/neg), and cultures. Culture report salmonella-neg, campylobacter-neg; comment: no gram negative flora present.
What does it mean to have no gram negative coliforms? Would this make a metronidazole or tylosin trial a reasonable option? Or should we think probiotic or fecal transplant instead? (owner has put some $$ constraints on us, of course)
thanks for any thoughts! | I this small or large intestinal diarrhea? | Has it been checked for accuracy? |
Bill is 3 yr m/c dsh, relatively new to us, with a 6 month hx of semiformed stools. We initially found roundworms, treated x 3 (pyrantel), with minimal response. Owner has tried several different diets for 1-2 months each, novel protein but over-the-counter; none made much difference, chicken seemed to make worse. One other cat in house, no symptoms (also dewormed)
We just submitted giardia/crypto stains (neg/neg), and cultures. Culture report salmonella-neg, campylobacter-neg; comment: no gram negative flora present.
What does it mean to have no gram negative coliforms? Would this make a metronidazole or tylosin trial a reasonable option? Or should we think probiotic or fecal transplant instead? (owner has put some $$ constraints on us, of course)
thanks for any thoughts! | What other diet is being fed to the other cat? | How much does this dog weigh? |
Thanks for any help with this 18 year old f/s Persian, recently diagnosed with intestinal small cell lymphoma.
She also has grade 3 IRIS renal (creat 3.0, urine sp g 1.012) and a thymic cyst (that has been drained in 2008 and 2011, never showed clinical signs from). Has chronic ibd (chronic intermitt soft stools, weight loss, poor appetite)/ cholangiohep history(chronic rise ALT in 150s). Is also hyperthyroid. Intestinal loops started feeling thickened on exam and is what prompted another U/S evaluation (last one had been done 1 year prior).
Tiny cat 2.4 kg, very sensitive to medications.
Diagnosis of small cell lymphoma done in Feb 2013 via ultrasound findings of infiltrative small bowel mass ( portion of small bowel circumferenitally thickened 0.6 cm with no discernible wall) w associated lymphadenopathy( enlarged mesenteric lymph nodes 1.6 cmx 1.6 cm). Aspirate of small bowel wall=granulated small cell lymphoma with dysplastic/hyperplastic epithelium.
Chronic meds= subqs w B vits 50 mls 3 times a week, Pepcid 2.5 mg sid, Felimazole 2.5 mg am, 1.25 mg pm, Zentonil Plus1/2 sid ( SAMe).
Started Prednisolone at 2.5 mg bid (1 mg/kg bid) and Chlorambucil at 2 mg every 3 days on 2/20/2013. Cat became very agitated/anxious and not eating and definitely feeling worse. Dropped dose of meds to 2.5 mg prednisolone sid and Chlorambucil 1 mg every 4 days and cat did great, eating much better, more active, normal bm, and actually gained some weight. Liver was happier on sid pred, cat was happier on sid pred, but then BG rose to 207 and glucosuria developed so I lowered pred to 2.5 mg eoday to try and avoid diabetes developing. (Has had negative fPLs, Have never identified pancreatic inflamm along w the ibd/liver chronic hx).
At recheck last night back to not doing so well, drop in appetite, lost weight, liver enzyme back up (230s), only good news is negative glucose in urine and normal bg. So she is back on 2.5 mg sid pred and if diabetes develops so be it and I will deal with that.
I am hoping she feels better with that increase to sid pred so I can challenge her better with 2 mg chlorambucil (hoping to try 2 mg M/R schedule to start and if doing well than increase to MWF schedule like the rest of the world.)
Only wrinkle is that her WBC last night was 53720(on eoday pred). She has no fever. 2 weeks prior (on sid pred) the WBC had risen to 26780 so I started a 2 week course of Zeniquin antibiotic, even though I could not find source of infection (urine normal, chest rads clear except for presence of the thymic cyst, recent U/S certainly showed no abscess in liver, etc...). So WBC rose higher despite antibiotics, suggesting not right spectrum antibiotic or not bacterial source of the rise in WBC.
I looked at blood smear last night and do not see lymphoblastic cells. Both lymphs and neutrophils are up (19560 lymphs=36%, 33550 neuts=62%, no toxic neutrophils), platelets normal, red cells normal.
So I am thinking the rise in WBC is from the lymphoma and am on right track w raising Pred back to sid and raising the Chlorambucil to 2 mg M/R. I am also wondering about adding in Metronidazole in case rise of wbc is from bacteria from intestinal tract disease as well as some benefits from its antiinflamm effects. In past she has not tolerated Cerenia well, but she has done well w metronidazole.
And if she does not respond to those changes then maybe she is a case that will not respond to the Pred/Chlorambucil and will need the full WI/Madison protocol to try and fight this instead.
My thoughts anyway.
I'll listen to any others thoughts though.Thank you!
☼ | Was this an in-house cbc or one sent to a reference lab? | Do you have the record? |
Thanks for any help with this 18 year old f/s Persian, recently diagnosed with intestinal small cell lymphoma.
She also has grade 3 IRIS renal (creat 3.0, urine sp g 1.012) and a thymic cyst (that has been drained in 2008 and 2011, never showed clinical signs from). Has chronic ibd (chronic intermitt soft stools, weight loss, poor appetite)/ cholangiohep history(chronic rise ALT in 150s). Is also hyperthyroid. Intestinal loops started feeling thickened on exam and is what prompted another U/S evaluation (last one had been done 1 year prior).
Tiny cat 2.4 kg, very sensitive to medications.
Diagnosis of small cell lymphoma done in Feb 2013 via ultrasound findings of infiltrative small bowel mass ( portion of small bowel circumferenitally thickened 0.6 cm with no discernible wall) w associated lymphadenopathy( enlarged mesenteric lymph nodes 1.6 cmx 1.6 cm). Aspirate of small bowel wall=granulated small cell lymphoma with dysplastic/hyperplastic epithelium.
Chronic meds= subqs w B vits 50 mls 3 times a week, Pepcid 2.5 mg sid, Felimazole 2.5 mg am, 1.25 mg pm, Zentonil Plus1/2 sid ( SAMe).
Started Prednisolone at 2.5 mg bid (1 mg/kg bid) and Chlorambucil at 2 mg every 3 days on 2/20/2013. Cat became very agitated/anxious and not eating and definitely feeling worse. Dropped dose of meds to 2.5 mg prednisolone sid and Chlorambucil 1 mg every 4 days and cat did great, eating much better, more active, normal bm, and actually gained some weight. Liver was happier on sid pred, cat was happier on sid pred, but then BG rose to 207 and glucosuria developed so I lowered pred to 2.5 mg eoday to try and avoid diabetes developing. (Has had negative fPLs, Have never identified pancreatic inflamm along w the ibd/liver chronic hx).
At recheck last night back to not doing so well, drop in appetite, lost weight, liver enzyme back up (230s), only good news is negative glucose in urine and normal bg. So she is back on 2.5 mg sid pred and if diabetes develops so be it and I will deal with that.
I am hoping she feels better with that increase to sid pred so I can challenge her better with 2 mg chlorambucil (hoping to try 2 mg M/R schedule to start and if doing well than increase to MWF schedule like the rest of the world.)
Only wrinkle is that her WBC last night was 53720(on eoday pred). She has no fever. 2 weeks prior (on sid pred) the WBC had risen to 26780 so I started a 2 week course of Zeniquin antibiotic, even though I could not find source of infection (urine normal, chest rads clear except for presence of the thymic cyst, recent U/S certainly showed no abscess in liver, etc...). So WBC rose higher despite antibiotics, suggesting not right spectrum antibiotic or not bacterial source of the rise in WBC.
I looked at blood smear last night and do not see lymphoblastic cells. Both lymphs and neutrophils are up (19560 lymphs=36%, 33550 neuts=62%, no toxic neutrophils), platelets normal, red cells normal.
So I am thinking the rise in WBC is from the lymphoma and am on right track w raising Pred back to sid and raising the Chlorambucil to 2 mg M/R. I am also wondering about adding in Metronidazole in case rise of wbc is from bacteria from intestinal tract disease as well as some benefits from its antiinflamm effects. In past she has not tolerated Cerenia well, but she has done well w metronidazole.
And if she does not respond to those changes then maybe she is a case that will not respond to the Pred/Chlorambucil and will need the full WI/Madison protocol to try and fight this instead.
My thoughts anyway.
I'll listen to any others thoughts though.Thank you!
☼ | How did the intestinal abnormalities and lymph nodes look on the recent ultrasound? | Does water still have to be restricted when the electrolytes balance out? |
I need some advice on a 7.5 year old MN maltese I've been treating for the last year for presumed PLE. We worked him up about 1 year ago after he presented with dyspnea and pleural effusion. He was hypoalbuminemic/ hypoglobulinemic with normal urine and a normal GI panel. The owners went as far as abdominal ultrasound but declined biopsies.
He had been doing well up until January 2013 on Hills I/D low fat and then albumin started dropping againand he began having loose stools. He is about 7.25 lbs. I started him on prednisone, intially 5 mg BID. We have weaned him down to 1/2 tab BID but at last check alb 2.4 alkp319 bun 36 creat 0.7. He is currently 8.7 lbs, eating well, no pu/pd reported by owners. Stool is not completely formed but best it has been in a while.
Is it OK to keep him at current dose of prednisone long term? Is it worth trying another drug like budesonide?
Thanks | Did albumin respond to pred? | Pyuria? |
10 yo MN 11.5 pound maltese
Treted for DKA since end of last week. ketones mostly resolved. Has actually been eating pretty well this entire time. No vomiting. Transitioned to NPH, now at 6 units BID. White cells got up to 60,000 over weekend... now back down to 35,000. HCT and platelets starting to drops some...doing a manual count soon. HCT around 26 %...plt on cbc about 26,000. ALP has been off the chart high. Glucoses hae been hard to get into a good range...usually 400-500's.....but do get to 200's some.
Eating w/d pretty well. Will somtimes offer i/d
Ultrasound by internist today: diabetes mellitus, pancreatitis - mildly swollen, possible pyelonephririts of left kidney, cholelithiasis, possible pdh cushings.
A few questions:
From my knowledge....this diabetes mellitus will never resolve....since likely secondary to pyelo/pancreatitis?
Any chance that with improvement of pyelo/pancreatitis...that the current insulin dose will need to be lowered in the future?
I now have him on 125 mg (was at 62.5) clavamox BID, and 68 mg baytril at 1/2 BID.
Also just added 25 mg vitamin K SID (said that d-con is in garage, but no exposure...)
Sending home....hopefully tomorrow....on 6 units NPH BID
If eating w/d....I am happy. Internist mentioned low residue diet....but isn't w/d all around good in a case like this....especially if eating?
I am going ahead and getting a culture on urine today...even though on these AB's. Not done this yet.
I hope he is not thinking about DIC/SIRs....with last evenings HCT and platelets.
This dog never needed dextrose with fluids when I did an insulin CRI....ate the entire time.
Thoughts on my plan/adjustments would be really helpful with this case
Thanks
☼ | Have you had a path review and retic count done with the anemia to gather more information about the anemia or are the owners tapped financially? | Have you checked for acromegaly or done a urine culture? |
10 yo MN 11.5 pound maltese
Treted for DKA since end of last week. ketones mostly resolved. Has actually been eating pretty well this entire time. No vomiting. Transitioned to NPH, now at 6 units BID. White cells got up to 60,000 over weekend... now back down to 35,000. HCT and platelets starting to drops some...doing a manual count soon. HCT around 26 %...plt on cbc about 26,000. ALP has been off the chart high. Glucoses hae been hard to get into a good range...usually 400-500's.....but do get to 200's some.
Eating w/d pretty well. Will somtimes offer i/d
Ultrasound by internist today: diabetes mellitus, pancreatitis - mildly swollen, possible pyelonephririts of left kidney, cholelithiasis, possible pdh cushings.
A few questions:
From my knowledge....this diabetes mellitus will never resolve....since likely secondary to pyelo/pancreatitis?
Any chance that with improvement of pyelo/pancreatitis...that the current insulin dose will need to be lowered in the future?
I now have him on 125 mg (was at 62.5) clavamox BID, and 68 mg baytril at 1/2 BID.
Also just added 25 mg vitamin K SID (said that d-con is in garage, but no exposure...)
Sending home....hopefully tomorrow....on 6 units NPH BID
If eating w/d....I am happy. Internist mentioned low residue diet....but isn't w/d all around good in a case like this....especially if eating?
I am going ahead and getting a culture on urine today...even though on these AB's. Not done this yet.
I hope he is not thinking about DIC/SIRs....with last evenings HCT and platelets.
This dog never needed dextrose with fluids when I did an insulin CRI....ate the entire time.
Thoughts on my plan/adjustments would be really helpful with this case
Thanks
☼ | Were the adrenals enlarged? | Did you cortrosyn for the acth stim? |
10 yo MN 11.5 pound maltese
Treted for DKA since end of last week. ketones mostly resolved. Has actually been eating pretty well this entire time. No vomiting. Transitioned to NPH, now at 6 units BID. White cells got up to 60,000 over weekend... now back down to 35,000. HCT and platelets starting to drops some...doing a manual count soon. HCT around 26 %...plt on cbc about 26,000. ALP has been off the chart high. Glucoses hae been hard to get into a good range...usually 400-500's.....but do get to 200's some.
Eating w/d pretty well. Will somtimes offer i/d
Ultrasound by internist today: diabetes mellitus, pancreatitis - mildly swollen, possible pyelonephririts of left kidney, cholelithiasis, possible pdh cushings.
A few questions:
From my knowledge....this diabetes mellitus will never resolve....since likely secondary to pyelo/pancreatitis?
Any chance that with improvement of pyelo/pancreatitis...that the current insulin dose will need to be lowered in the future?
I now have him on 125 mg (was at 62.5) clavamox BID, and 68 mg baytril at 1/2 BID.
Also just added 25 mg vitamin K SID (said that d-con is in garage, but no exposure...)
Sending home....hopefully tomorrow....on 6 units NPH BID
If eating w/d....I am happy. Internist mentioned low residue diet....but isn't w/d all around good in a case like this....especially if eating?
I am going ahead and getting a culture on urine today...even though on these AB's. Not done this yet.
I hope he is not thinking about DIC/SIRs....with last evenings HCT and platelets.
This dog never needed dextrose with fluids when I did an insulin CRI....ate the entire time.
Thoughts on my plan/adjustments would be really helpful with this case
Thanks
☼ | Liver was hyperechoic i assume? | Would get a bile acids and recheck usg -- first of am sample? |
Hi All!
I am have a 9 yr old F(S) Schnauzer, Tia, that has a very very lengthy history...
She originally presented in October 2012 with vomiting, diarrhea, anorexia and lethargy. She does have a history of pancreatitis so I ran her bloodwork suspecting that this might be the cause or at least a factor.
Her bloodwork was as follows:
WBC 21.35 (6-17) 10^9/L
LYM 2.05 (1-4.8) "
MON 0.76 (0.2-1.5) "
NEU 18.41 (3-12) "
EOS 0.09 (0-0.8) "
BAS 0.05 (0-0.4) "
RBC 8.10 (5.5-8.5) 10^12/l
PLT 406 (200-500)
WBC morph : mature, rare immature
RBC morph: Normochromic, Normocytic, Occ target cell
CPLi snap test negative
ALB 35 (25-44) g/L
ALP 2397 (20-150 U/L
ALT 688 (10-118) U/L
AMY 735 (200-1200) U/L
TBIL 12 (2-10) umol/L
BUN 3.1 (2.5-8.9) mmol/L
CA 2.4 (2.15-2.95 ) mmol/L
Phos 1.02 (0.94-2.13) mmol/L
CRE 57 (27-124) umol/L
GLU 8.0 (3.3-6.1) mmol/L
Na 129 (138-160) mmol/L
K 3.7 (3.7-5.8) mmol/L
TP 70 (54-82) g/L
GLOB 35 (23-52) g/L
CHOL 380 (125-270) mg/dL
T4 29 (14-52) nmol/L
I suspected a hepatitis (possibly suppurative) and possible concurrent pancreatitis even with a negative CPLi because of her history. I started this pet on Clavamox, Metronidazole, Ursodiol, Zentonil, Cerenia, Zantac and a bland low protein/fat diet. I recommended an ultrasound +/- biopsy but the owner wanted to wait and see how she did.
Tia did very well and was responding to her medications. Her repeat bloodwork (liver panel) in 10 days .....
ALP 597 (20-150)
ALT 305 (10-118)
GGT 11 (0-7)
BA 25 (0-25)
TBIL 4 (2-10)
ALB 35 (25-44)
BUN 7.1 (2.5-8.9)
Chol 253 (125-270)
PCV 51%
The owner said she was back to herself and was feeling great. I stopped the zantac and cerenia but kept the other liver meds on board (Clavamox, metronidazole, ursodiol, and zentonil).
Long story short...Tia's values have just not improved (but she feels great) and tend to go up when the meds are discontinued. I did however, stop the clavamox because the owners did not think she was tolerating it. We finally were able convince the ownerrs to do an ultrasound (not a biopsy no matter what the findings). The ultrasound showed a hyperechoic liver with no masses or nodules. The gall bladder was thin with a uniform wall and had contents with a hyperechoic speckling. The pancreas was mildly hypoechoic. No other abnormalities were found.
We were pretty much in the same boat, a hepatopathy of unknown cause...possibly suppurative, necroinflammatory or emerging lymphoma. We decided to add baytril and do triple antibiotic therapy and if no improve, will try prednisone. After a month of Baytril, clavamox, and metronidazole, + all her previous liver meds, her liver values did not improve. I added Prednisone (about 0.7mg/kg bid) and she became profoundly pu/pd and began having a decreased appetite. I rechecked her bloodwork
Her liver values were elevated again (similar to those at the start of her treatment), diabetic, and elevated WBC. I told the owners that the only way to solve this is to do a biopsy (this has been the most impossible task for some reason), but they finally agreed to now repeat the ultrasound and do the darn biopsy. The ultrasound showed an enlarged liver, with a hyperechoic parenchyma, surrounded by hyperchoic fat. There was a thin walled cyst in the pancreas and the pancreas was hypoechoic with hyperechoic surrounding. The gall bladder wall was thickened and had hyperechoic luminal content, with no evidence of duct obstruction.
The liver biopsy showed a
-Diffuse glucogen and lipid vacuolar hepatopathy with nodular regeneration
-moderate subacute suppurative cholangiohepatitis
I cultured e. coli that is resistant to clavamox and metronidazole but is sensitive to baytril.
The pathologist commented that the biliary infection may be secondary to obstructive billary disease. Possibly sclerosing choledochitis secondary to chronic pancreatitis.
I currently have her on Ursodiol, Zentonil, Baytril and Caninsulin, w/d diet. She is doing really well. I plan to keep her on the baytril for about 8 weeks and then recheck her liver values. I am not sure if there is any underlying billary obstruction and if there is, how that can be treated. Her TBIL is not elevated.
I know this was a very lengthy history and I commend you if you have made it this far! Thanks in advance for any comments,
☼ | What was your glucose level in this dog? | How does the cbc look? |
Hi All!
I am have a 9 yr old F(S) Schnauzer, Tia, that has a very very lengthy history...
She originally presented in October 2012 with vomiting, diarrhea, anorexia and lethargy. She does have a history of pancreatitis so I ran her bloodwork suspecting that this might be the cause or at least a factor.
Her bloodwork was as follows:
WBC 21.35 (6-17) 10^9/L
LYM 2.05 (1-4.8) "
MON 0.76 (0.2-1.5) "
NEU 18.41 (3-12) "
EOS 0.09 (0-0.8) "
BAS 0.05 (0-0.4) "
RBC 8.10 (5.5-8.5) 10^12/l
PLT 406 (200-500)
WBC morph : mature, rare immature
RBC morph: Normochromic, Normocytic, Occ target cell
CPLi snap test negative
ALB 35 (25-44) g/L
ALP 2397 (20-150 U/L
ALT 688 (10-118) U/L
AMY 735 (200-1200) U/L
TBIL 12 (2-10) umol/L
BUN 3.1 (2.5-8.9) mmol/L
CA 2.4 (2.15-2.95 ) mmol/L
Phos 1.02 (0.94-2.13) mmol/L
CRE 57 (27-124) umol/L
GLU 8.0 (3.3-6.1) mmol/L
Na 129 (138-160) mmol/L
K 3.7 (3.7-5.8) mmol/L
TP 70 (54-82) g/L
GLOB 35 (23-52) g/L
CHOL 380 (125-270) mg/dL
T4 29 (14-52) nmol/L
I suspected a hepatitis (possibly suppurative) and possible concurrent pancreatitis even with a negative CPLi because of her history. I started this pet on Clavamox, Metronidazole, Ursodiol, Zentonil, Cerenia, Zantac and a bland low protein/fat diet. I recommended an ultrasound +/- biopsy but the owner wanted to wait and see how she did.
Tia did very well and was responding to her medications. Her repeat bloodwork (liver panel) in 10 days .....
ALP 597 (20-150)
ALT 305 (10-118)
GGT 11 (0-7)
BA 25 (0-25)
TBIL 4 (2-10)
ALB 35 (25-44)
BUN 7.1 (2.5-8.9)
Chol 253 (125-270)
PCV 51%
The owner said she was back to herself and was feeling great. I stopped the zantac and cerenia but kept the other liver meds on board (Clavamox, metronidazole, ursodiol, and zentonil).
Long story short...Tia's values have just not improved (but she feels great) and tend to go up when the meds are discontinued. I did however, stop the clavamox because the owners did not think she was tolerating it. We finally were able convince the ownerrs to do an ultrasound (not a biopsy no matter what the findings). The ultrasound showed a hyperechoic liver with no masses or nodules. The gall bladder was thin with a uniform wall and had contents with a hyperechoic speckling. The pancreas was mildly hypoechoic. No other abnormalities were found.
We were pretty much in the same boat, a hepatopathy of unknown cause...possibly suppurative, necroinflammatory or emerging lymphoma. We decided to add baytril and do triple antibiotic therapy and if no improve, will try prednisone. After a month of Baytril, clavamox, and metronidazole, + all her previous liver meds, her liver values did not improve. I added Prednisone (about 0.7mg/kg bid) and she became profoundly pu/pd and began having a decreased appetite. I rechecked her bloodwork
Her liver values were elevated again (similar to those at the start of her treatment), diabetic, and elevated WBC. I told the owners that the only way to solve this is to do a biopsy (this has been the most impossible task for some reason), but they finally agreed to now repeat the ultrasound and do the darn biopsy. The ultrasound showed an enlarged liver, with a hyperechoic parenchyma, surrounded by hyperchoic fat. There was a thin walled cyst in the pancreas and the pancreas was hypoechoic with hyperechoic surrounding. The gall bladder wall was thickened and had hyperechoic luminal content, with no evidence of duct obstruction.
The liver biopsy showed a
-Diffuse glucogen and lipid vacuolar hepatopathy with nodular regeneration
-moderate subacute suppurative cholangiohepatitis
I cultured e. coli that is resistant to clavamox and metronidazole but is sensitive to baytril.
The pathologist commented that the biliary infection may be secondary to obstructive billary disease. Possibly sclerosing choledochitis secondary to chronic pancreatitis.
I currently have her on Ursodiol, Zentonil, Baytril and Caninsulin, w/d diet. She is doing really well. I plan to keep her on the baytril for about 8 weeks and then recheck her liver values. I am not sure if there is any underlying billary obstruction and if there is, how that can be treated. Her TBIL is not elevated.
I know this was a very lengthy history and I commend you if you have made it this far! Thanks in advance for any comments,
☼ | Did this dog show signs of dm (pu/pd, polyphagia, weight loss)? | Have you documented this when the patient has presented to you in hospital? |
Hi all,
Need some advice re a feline diabetic case I've got that is proving very difficult to control. Apologies for the convoluted nature of the case, its been a roller coaster.
13yo DSH, 5kg not overweight Mn cat.
Older lady owner got from deceased friend in Nov 2012. Was a diabetic and was on diabetic dry cat food. Came in for a check up - Advised wet diabetic foods instead, no other high carb treats etc and advised some weight loss (back then he was overweight). Seemed to be settling in ok but did like to hide in cupboard. Advised feliway and O got house dosed up on feliway.
Dec for check up: Gluc normal (5.8mmol/l), NAD physical exam and O had started him on some weight loss.
Dec -Jan had some allergy issues that was treated with dexafort. Also had a urinalysis showed USG (refract) 1.025, no glucose detected. Incidental finding of a 3cm mass under neck.
I saw him Feb for poss PU/PD, still allergy issues. Found: mass under neck- no change. Heart murmur (2/6 holosystolic, PMI left/sternal, HR 200, regular). Alopecia over eyes, very symmetrical, mild hyperpigmentation of area (mottled). Advised bloods. Allergies poss related to kitty litter change.
Bloods were all WNL except v mild increased hematocrit and v mildly elevated retics.
Gave depo-med - good response to it, and once litter removed seemd to not return.
Cat still not right. Seems more grumpy, growls when handled now, hides in cupboard all the time (even after seeming to settle in well). Got O to measure water intake, PD turned out to be normal amount for size of cat.
Urinalysis now showed +++ glucose, USG refract 1.033. everything else NAD. (was free catch immediatley after vet visit, and cat v stressed) so advised to monitor gluc by providing clomicalm and repeat in 2 weeks. Was fairly 'vague' on clomicalm, took awhile to adjust. No change in hiding behaviour though, and didn't seem to be anymore relaxed about the house.
Check up - grumpy, weight loss, still alopecia over eyes, Couldn't deeply palpate due to fractious nature, a bit dehydrated, seems a bit weak, is a bit snuffly in URT.
Rads for throat and abdo as O worried about masses. Throat mass was hematoma like mass that deflated upon FNA, but has since returned (and not resorbed at all?!). NAD abdo. NAD chest.
All in all, seems to just be the diabetes.
Started 1iu BID, only wet low carb food.
Cat still not right, spoke deeply with O re food, was still feeding dry go-kat. Gave list of foods that cat was allowed and nothing else.
Cat still not right.
Gluc curve showed very low BGL (down to 1.93), never showed any hypoG signs, and eating ok.
Stopped insulin, BGL next day was normal.
Will now be doing a BG curve in a few days time (been 2 weeks on no insulin).
Saw today just for a check up before we go ahead with a gluc curve, cat seems weak, a bit shivery (room wasn't that cold), still very grumpy, still a little dehydrated. The behaviour and attitude of the cat hasn't changed thoughout the whole course of BG levels. He is still hiding, still grumpy, still lethargic and just not doing right.
My question is this (sorry it took so long!) - could this all be due to feeling crappy from the BG swings? or does it sound like something else is going on?
As kidneys are fine on bloods, i'm going to give him some metacam to see if there is any grumpiness related to joint pain (although no OA noted on rads), going to be doing the BG curve in a few days (2 wks not on insulin), and will send a sample of the lump/hematoma under his chin into lab.
Had the thought about a cranial mass causing issues but never has shown PLR changes or mentation changes etc.
I'm at a bit of a loss.
cheers in advance and again, srry for long post! | What type of insulin is he getting? | Is she in heart failure? |
Hi all,
Need some advice re a feline diabetic case I've got that is proving very difficult to control. Apologies for the convoluted nature of the case, its been a roller coaster.
13yo DSH, 5kg not overweight Mn cat.
Older lady owner got from deceased friend in Nov 2012. Was a diabetic and was on diabetic dry cat food. Came in for a check up - Advised wet diabetic foods instead, no other high carb treats etc and advised some weight loss (back then he was overweight). Seemed to be settling in ok but did like to hide in cupboard. Advised feliway and O got house dosed up on feliway.
Dec for check up: Gluc normal (5.8mmol/l), NAD physical exam and O had started him on some weight loss.
Dec -Jan had some allergy issues that was treated with dexafort. Also had a urinalysis showed USG (refract) 1.025, no glucose detected. Incidental finding of a 3cm mass under neck.
I saw him Feb for poss PU/PD, still allergy issues. Found: mass under neck- no change. Heart murmur (2/6 holosystolic, PMI left/sternal, HR 200, regular). Alopecia over eyes, very symmetrical, mild hyperpigmentation of area (mottled). Advised bloods. Allergies poss related to kitty litter change.
Bloods were all WNL except v mild increased hematocrit and v mildly elevated retics.
Gave depo-med - good response to it, and once litter removed seemd to not return.
Cat still not right. Seems more grumpy, growls when handled now, hides in cupboard all the time (even after seeming to settle in well). Got O to measure water intake, PD turned out to be normal amount for size of cat.
Urinalysis now showed +++ glucose, USG refract 1.033. everything else NAD. (was free catch immediatley after vet visit, and cat v stressed) so advised to monitor gluc by providing clomicalm and repeat in 2 weeks. Was fairly 'vague' on clomicalm, took awhile to adjust. No change in hiding behaviour though, and didn't seem to be anymore relaxed about the house.
Check up - grumpy, weight loss, still alopecia over eyes, Couldn't deeply palpate due to fractious nature, a bit dehydrated, seems a bit weak, is a bit snuffly in URT.
Rads for throat and abdo as O worried about masses. Throat mass was hematoma like mass that deflated upon FNA, but has since returned (and not resorbed at all?!). NAD abdo. NAD chest.
All in all, seems to just be the diabetes.
Started 1iu BID, only wet low carb food.
Cat still not right, spoke deeply with O re food, was still feeding dry go-kat. Gave list of foods that cat was allowed and nothing else.
Cat still not right.
Gluc curve showed very low BGL (down to 1.93), never showed any hypoG signs, and eating ok.
Stopped insulin, BGL next day was normal.
Will now be doing a BG curve in a few days time (been 2 weeks on no insulin).
Saw today just for a check up before we go ahead with a gluc curve, cat seems weak, a bit shivery (room wasn't that cold), still very grumpy, still a little dehydrated. The behaviour and attitude of the cat hasn't changed thoughout the whole course of BG levels. He is still hiding, still grumpy, still lethargic and just not doing right.
My question is this (sorry it took so long!) - could this all be due to feeling crappy from the BG swings? or does it sound like something else is going on?
As kidneys are fine on bloods, i'm going to give him some metacam to see if there is any grumpiness related to joint pain (although no OA noted on rads), going to be doing the BG curve in a few days (2 wks not on insulin), and will send a sample of the lump/hematoma under his chin into lab.
Had the thought about a cranial mass causing issues but never has shown PLR changes or mentation changes etc.
I'm at a bit of a loss.
cheers in advance and again, srry for long post! | Could you post the full results from the previous curve? | How long do you think the cat has been diabetic? |
Hello!
My patient is "Lance", a six year old MN chocolate lab who weighs 90 lbs. He is currently clinically doing very well.
2/18/13: DM diagnosed; BG 416 with 3 plus glucosuria and 1 plus ketonuria
2/20/13: Changed to w/d and Novolin started at 15U BID
2/27/13: BG 249 @ 6 hours post-insulin; increased insulin to 16U BID
3/7/13: BG 353 @ 6 hours post-insulin, 2 plus glucosuria and negative ketones; increased insulin to 17U BID
3/14/13: BG 183 @ 6 hours post-insulin, 2 plus glucosuria; increased insulin to 17U BID
3/29/13: BG 411 and fructosamine poor with 3 plus glucosuria
4/2/13: partial glucose curve 8:00 - 311
10:00 - 253
12:00 - 340
2:00 - 351
6:45 - 208
8:00 - 180
It seems evident that this patient needs more or different insulin, but with a nadir this late in the day how should I adjust the dose? Or should I be considering a different schedule than every 12 hours?
Thanks in advance for your comments/suggestions. | Novolin n (nph) or which type of insulin? | For some reason, i'm not seeing the cobalamin/folate results? |
We have a 12 year old NM DSH. He was diagnosed as a diabetic in January 2013. We started lantus insulin and have been adjusting dosages based on 12 hour glucoses. These had been running in the low 300’s. Slowly the cat improved with a better attitude and gained weight although he remained PU/PD. We was raised to 6 units BID on 3-14-13. Urine culture was negative in January. Although urine was not recultured, a round of amoxicillin was given during this time.
Note: Previous to this (Nov. 2012) he presented to pooping on the floor and had lost a little weight. He was also keeping the owners up at night with vocalization and after eating. There was 250+ glucose in the urine but CBC/Profile was normal (Glucose 145). T4 was 2.5. Ultrasound of the abdomen was WNL at that time. He was treated with Buspirone which did not help. A pheromone collar later helped.
OK – back to present: On 3-20, the cat presented comatose. He had not eaten well that AM and glucose was 38.8 and he responded well to glucose supplementation. We assumed the insulin had been increased too high and cut him back to 1 unit BID. He felt better after that – 12 hour glucose was 331 and he was raised to 2 units. On 3-28, he came in for recheck. Again, not eating well – 12 hour glucose was 320. We did a feline pancreatic lipase snap which was normal. A profile was done: BUN was 53, CRE was 1.2, GLU was 428, K+ was 6.1. The rest was WNL.
April 2, he came for recheck. He had kept the owners up all night (again). He had started vomiting everything, including water. He had continued to be PU/PD throughout all this and had now stopped eating. His glucose was 46.1. Urinalysis had a tiny amount of blood (cysto) but culture was negative. He was started on Baytril 10mg PO BID and Aminopentamide 0.1 mg PO BID and given SQ fluids.
April 3, he had not eaten anything. Glucose was 113 (no insulin given for 12 hours). BUN was down to 24.6 and K+ was down to 4.2. An I-stat electrolyte panel was otherwise ok. CBC was normal. We repeated the ultrasound which appeared ok except that no peristalsis was seen. We checked blood pressures which were: 160/124, 177/116, and 152/110. The cat’s dad was supposedly a Maine Coon so I checked the heart briefly on ultrasound: No obvious thickening and LA was WNL. The aminopentamide was cut in half, and I started reglan 2.5 mg PO BID and gave a dose of mirtazapine.
My question is: what am I missing? Why is this cat having difficulties regulating and why is he not eating and vomiting? What about the yeowling? We have not x-rayed yet but his breathing is ok and do not suspect tumor or foreign body. We considered cortisol testing as well. Any ideas would be helpful.
Thank you! | No ketones in the urine? | Kathi- excellent management of your patient! insulin or not? |
I have a small housecall practice with limited space and budget. Over the past ten years of practice, I have come to understand the value of urine culture, particularly with older cats whose urine may be quite dilute. Often, these patients will have a normal urinalysis run at the local laboratory, but if I concurrently incubate 1cc of urine in thiobroth, it grows out bacteria.
I'm not sure whether I'm getting false positives. I get urine by cysto whenever possible, but occasionally I'll get a very clean free catch sample that goes directly from the cat into a sterile vial without getting in contact with the cat's hair. I send some to the lab and additionally I add 1cc into a tube of thiobroth and incubate. Many patients with very normal UA show lots of cloudy growth in the tube in as little as twelve hours. When the culture tube gets sent to the lab, I usually find e.coli or enterococcus.
Am I getting false positive results? I'm seeing positive cultures paired with a normal (albeit dilute) urine sample far too often. Now there is talk of bacterial colonization of the urine which is benign and does not warrant treatment. I'm not sure whether to give up on urine cultures altogether or to change my technique. I would LOVE any useful advice! For the moment, I'm incubating the thiobroth tubes on my person; I could really really useinexpensive incubator for urine cultures as I could additionally plate out on alternative growth media. | What sort of cfu counts are you getting on quantitative urine cultures when they are sent to the lab for confirmation? | What is this dog's weight doing? |
Joey is a 14 year old m/c dsh indoor cat diagnosed with diabetes 6-10-10 and has been on glargine bid as well as fancy feast chunky chicken and turkey canned since that time. He has done well with his diabetes since starting this regimen. Yesterday he came in and the owners report he has been vomiting every third day or so at night (looks like his canned food) for about 2 weeks and 5 days ago his stool started becoming very runny. There has been no change in his routine/diet. Per the owner, he is not drinking excessively and he is not ravenous. His weight is about the same as the last time I saw him, his coat is shiny with mild dandruff and he is not clinically dehydrated. He does have moderate to severe periodontal disease and a grade I heart murmer, but otherwise appeared to be in good condition. His bloodwork is as follows (only abnormals posted):
alb high (4.7)
ALT high (152)
Chol high (263)
Triglyceride high (496)
Lipase high (301)
BG normal (118)
CBC WNL
T4 WNL
U/A: 3+ protein, no glucose, SG = 1.048
Fructosamine normal (285)
Per the labwork, his diabetes appears to be doing well. I don't like the large protein in the urine. His lipase was high and there was 2+ lipemia in the blood sample we sent in.
At this point, I'm not really sure about the cause behind the occasional vomiting and runny stools he's developed. I am reluctant to change this cat's diet because he's been doing so well with the diabetes. So . . . therapeutic options for right now are:
(1) try a course of metronidazole
(2) change diet
(3)?
This is a totally indoor cat, so I have a hard time thinking this is intestinal parasite involved. I would appreciate your thoughts on this one.
Thanks so much and sorry for being so long,
☼ | How is joey's diabetic control monitored? | What's that old saying about 10 veterinarians and 11 opinions? |
Joey is a 14 year old m/c dsh indoor cat diagnosed with diabetes 6-10-10 and has been on glargine bid as well as fancy feast chunky chicken and turkey canned since that time. He has done well with his diabetes since starting this regimen. Yesterday he came in and the owners report he has been vomiting every third day or so at night (looks like his canned food) for about 2 weeks and 5 days ago his stool started becoming very runny. There has been no change in his routine/diet. Per the owner, he is not drinking excessively and he is not ravenous. His weight is about the same as the last time I saw him, his coat is shiny with mild dandruff and he is not clinically dehydrated. He does have moderate to severe periodontal disease and a grade I heart murmer, but otherwise appeared to be in good condition. His bloodwork is as follows (only abnormals posted):
alb high (4.7)
ALT high (152)
Chol high (263)
Triglyceride high (496)
Lipase high (301)
BG normal (118)
CBC WNL
T4 WNL
U/A: 3+ protein, no glucose, SG = 1.048
Fructosamine normal (285)
Per the labwork, his diabetes appears to be doing well. I don't like the large protein in the urine. His lipase was high and there was 2+ lipemia in the blood sample we sent in.
At this point, I'm not really sure about the cause behind the occasional vomiting and runny stools he's developed. I am reluctant to change this cat's diet because he's been doing so well with the diabetes. So . . . therapeutic options for right now are:
(1) try a course of metronidazole
(2) change diet
(3)?
This is a totally indoor cat, so I have a hard time thinking this is intestinal parasite involved. I would appreciate your thoughts on this one.
Thanks so much and sorry for being so long,
☼ | Do the clients do in-home curves (best) or spot checks? | What was the total protein at the beginning and now? |
Hello;
My patient is a FS, 4 year old DSH cat, who was in normal body condition in Sept. 2012(3.3 kg.), then Dx as diabetic - developed PUPD, ravenous appetite, wt. loss to 2.55 kg. B.G. was 33(3.9 - 8.0mmol/L), with a mild elevation in ALT and ALP as well. Money is a big constraint for this client, so no other Dx tests were possible. The cat was put on Purina D.M. canned food exclusively.
Within a few weeks, the B.G., tested with a Bayer Contour was approx. 13 - 15(multiple samples), when tested at home, with improvement in PUPD, and good appetite as well.
2 weeks later, the client home B.G. values were 7 - 9 and the following week after that, they were in the range of 3.2 - 5.
We confirmed with our Bayer Contour in hospital that both units were reading around 3.3. The cat is back to 3.1 kg. and eats well, no PUPD and absolutely no signs of hypoglycemia.
We did an insulin level(Idexx > MSU) and it was 59(72 - 583 pmol) along with abd. radipgraphs, which were normal.
Any concern about the low B.G. readings? I will confirm them again with Idexx, but as mentioned, we are not able to do much more in the way of Dx testing for this patient.
Thanks;
☼ | Is the cat on any meds - insulin or hypoglycemic agents? | What site is being used for the blood collection? |
Hello;
My patient is a FS, 4 year old DSH cat, who was in normal body condition in Sept. 2012(3.3 kg.), then Dx as diabetic - developed PUPD, ravenous appetite, wt. loss to 2.55 kg. B.G. was 33(3.9 - 8.0mmol/L), with a mild elevation in ALT and ALP as well. Money is a big constraint for this client, so no other Dx tests were possible. The cat was put on Purina D.M. canned food exclusively.
Within a few weeks, the B.G., tested with a Bayer Contour was approx. 13 - 15(multiple samples), when tested at home, with improvement in PUPD, and good appetite as well.
2 weeks later, the client home B.G. values were 7 - 9 and the following week after that, they were in the range of 3.2 - 5.
We confirmed with our Bayer Contour in hospital that both units were reading around 3.3. The cat is back to 3.1 kg. and eats well, no PUPD and absolutely no signs of hypoglycemia.
We did an insulin level(Idexx > MSU) and it was 59(72 - 583 pmol) along with abd. radipgraphs, which were normal.
Any concern about the low B.G. readings? I will confirm them again with Idexx, but as mentioned, we are not able to do much more in the way of Dx testing for this patient.
Thanks;
☼ | Was she? | On this bloodwork yesterday, what are the bun and creatinine looking like? |
Hi
I diagnosed Trapper, an 8 year old, female spayed Chesapeake with diabetes in December. I started her on 10U NPH insulin bid and curved her a week later.
8am 164
10am 181
12:30 257
2:30 271
4:30 246
increased her dose to 12 U bid and curved her a week later, jan 4
Symptoms are gone, energy great
8am 110
10am 111
noon 123
2pm 140
4pm 150
Every thing going great until 2/22/13
pu/pd bad again for about 5 days owner giving 13U bid (unsure why at 13 and not 12)
8am 65
8:30 66
8:45 78
I assumed the pu/pd was from symogi effect
Fed her and sent home--decrease to 10U bid
rechecked morning bgs 4 days later 8 am bgs 84 still pu/pd
dropped insulin to 8U bid
1 week later in for curve 8am bgs 70
didn't do the whole curve as owner is getting concerned about $ | Am i seeing a symogi overswing now? | No other thyroid-lowering drugs? |
Hi
I diagnosed Trapper, an 8 year old, female spayed Chesapeake with diabetes in December. I started her on 10U NPH insulin bid and curved her a week later.
8am 164
10am 181
12:30 257
2:30 271
4:30 246
increased her dose to 12 U bid and curved her a week later, jan 4
Symptoms are gone, energy great
8am 110
10am 111
noon 123
2pm 140
4pm 150
Every thing going great until 2/22/13
pu/pd bad again for about 5 days owner giving 13U bid (unsure why at 13 and not 12)
8am 65
8:30 66
8:45 78
I assumed the pu/pd was from symogi effect
Fed her and sent home--decrease to 10U bid
rechecked morning bgs 4 days later 8 am bgs 84 still pu/pd
dropped insulin to 8U bid
1 week later in for curve 8am bgs 70
didn't do the whole curve as owner is getting concerned about $ | Should i look for something else going on in this dog? | If i identify an incipient cataract in an older dog- other than making sure the dog isn't a diabetic- if there is not inflammation, etc is there anything we should be doing at that point (i.e. beginning flurbiprofen) or should the dog be evaluated by an ophthalmologist at that time? |
Hi
I diagnosed Trapper, an 8 year old, female spayed Chesapeake with diabetes in December. I started her on 10U NPH insulin bid and curved her a week later.
8am 164
10am 181
12:30 257
2:30 271
4:30 246
increased her dose to 12 U bid and curved her a week later, jan 4
Symptoms are gone, energy great
8am 110
10am 111
noon 123
2pm 140
4pm 150
Every thing going great until 2/22/13
pu/pd bad again for about 5 days owner giving 13U bid (unsure why at 13 and not 12)
8am 65
8:30 66
8:45 78
I assumed the pu/pd was from symogi effect
Fed her and sent home--decrease to 10U bid
rechecked morning bgs 4 days later 8 am bgs 84 still pu/pd
dropped insulin to 8U bid
1 week later in for curve 8am bgs 70
didn't do the whole curve as owner is getting concerned about $ | Where should i go from here? | How well is she eating? |
Hi and thank you in advance for any and all help! I was trying NOT to post this to VIN for a few reasons a)- I thought I had things figured out OK and b)- it is a LONG history. But now I am not 100% sure if I am on the right track and wondered if maybe I could get a second opinion with some bloodwork results.
Ciara is a 13 year old female pomeranian (15.2 lbs) who came to see me for a second opinion in late February 2013. She initially presented for PU/PD and the owners old vet did not recommend doing bloodwork. The owner felt uneasy with this and sought a second opinion. He did not bring records with him and would NOT OK us to call and get the records from the other vet.
Ciara is on Thyroxine 0.2mg-1 SID and that is the only medication she is taking. She has been on the meds for a few years. I have NO idea what testing the previous vet did to confirm or diagnose the hypothyroidism. The owner told me that she had weight gain and when the previous vet started her on the thyroxine the weight did get better. That was the only clinical signs of hypothyroid that he can remember.
On her physical exam in Feb she had an occassional honking cough in the exam room but heart and lungs sounded OK. The owner said that she has been wheezing for years. She had some mild nuclear sclerosis in the eyes. She had severe (grade 4) tartar and gingivitis on the oral exam. There was a mass in the groin area and FNA confirmed lipoma. Her body condition and hair coat appeared OK. I wasn't too suspicious of Cushing's based on her apperance but possible with the history. I adv the owner I would be looking for Cushing's, Diabetes, Urinary Tract Infection as the big ones but lots of other possibilities as well.
At that appt I sent out a "senior screen" to Idexx- Chem/CBC/T4 and UA.
Here are the results:
Chemistry:
ALP 386
ALT 130
AST 30
GGT 33
ALB 3.2
BUN 32
CRE 0.9
Cholesterol 551
GLU 89
Chloride 102
Potassium 5.9
Sodium 143
Na:K 24
T4 0.5
CBC:
All within normal limits
UA:
SG 1.016
pH 7.5
Protein 4+
WBC 30-50
RBC 2-5
Marked bacteria
No epithelial cells or crystals
I called the owner with results and adv Ciara may have a few things going on. The owner wanted to move forward but was a little reluctant to do all the tests I we discussed- urine culture, urine protein:creatinine, bile acids. He wanted to go a little more step by step and I adv that I was OK with that. I adv that I would recommend a urine culture but owner only OK'd abx and recheck urine.
I adv that the T4 was low and I suspected the thyroxine was not controlling the thyroid esp because the cholesterol was so high (551). I did mention that it may be possible the the T4 could be supressed b/c of a sick euthyroid since Ciara had so much going on but wasn't sure since she was on a thyroid supplement.
We discussed the BUN being high and the low SG and I also addressed the high liver values and recommended bile acids before considering anesthesia for periodontal therapy. I adv that I thought the ALP may be related to the horrid teeth and the ALT may be related to the low thyroid so wasn't 100% convinced it was a liver issue....but then there is the high GGT.
This is what we did:
-Started Ciara on Baytril 68- 1/2 tablet SID for 10 days. Adv owner if bacteria still present on recheck urine then we NEED to culture (he declined culture).
-Increased her thyroxine to 0.2mg- 1/2 tablet in the AM and 1 tablet in the PM.
-Told owner to recheck urine at end of meds and get first morning urine to evaluate morning SG
-Wait on periodontal therapy for now
Owner rechecked urinalysis and also rechecked a T4 (T4 to Idexx, not MSU)
SG increased to 1.021
No evidence of bacteria
WBC normal 0-2
Protein dropped to 3+
But now there is a 3+ epithelial cell and the lab says they are in "rafts"
The T4 has not budged and is still at 0.5
I was doing some research on thyroxine and did not realize (embarassed to admit) that PU/PD can be a side effect of oversupplementing with thyroxine. I feel like her dose of thyroxine should be enough for her weight but the T4 did not budge. Now I am wondering if she is really hypothyroid or if her T4 appears low due to sick euthyroid, even though she is on a supplement. Is that possible?
Would it be advised to increase the thyroxine or should would it be best to do a bigger thyroid panel? Normally I send things to MSU but I didn't do that b/c I didn't know if it would be accurate since he was on an SID dose of thyroxine. If we were to send out a thorough panel- would it be best to pull her off of her thyroid meds and then test for most accurate results?
Since the urine protein did get better after treating the bacterial infection I recommended that we recheck another urine to see if the protein continues to go down and re-evaluate the epithelial cells if they persist. We are due to check the urine next week. If protein still high then I will recommend a UPC.
I advised the owner that I also wanted to recheck some bloodwork again to see if the BUN and/or liver enzymes improved once we had the T4 figured out and the urine issues taken care of.
Thank you for any and all advice- especially what would be recommended regarding the thyroid. I am so sorry about the length of this post...I hope it doesn't have heads spinning. Poor Ciara- I feel like these may all be individual problems or some how I can make a case for them to be related or tied to other things :)
☼ | Was this a fasted sample? | Maybe do a couple readings per day a number of days in a row? |
Hi and thank you in advance for any and all help! I was trying NOT to post this to VIN for a few reasons a)- I thought I had things figured out OK and b)- it is a LONG history. But now I am not 100% sure if I am on the right track and wondered if maybe I could get a second opinion with some bloodwork results.
Ciara is a 13 year old female pomeranian (15.2 lbs) who came to see me for a second opinion in late February 2013. She initially presented for PU/PD and the owners old vet did not recommend doing bloodwork. The owner felt uneasy with this and sought a second opinion. He did not bring records with him and would NOT OK us to call and get the records from the other vet.
Ciara is on Thyroxine 0.2mg-1 SID and that is the only medication she is taking. She has been on the meds for a few years. I have NO idea what testing the previous vet did to confirm or diagnose the hypothyroidism. The owner told me that she had weight gain and when the previous vet started her on the thyroxine the weight did get better. That was the only clinical signs of hypothyroid that he can remember.
On her physical exam in Feb she had an occassional honking cough in the exam room but heart and lungs sounded OK. The owner said that she has been wheezing for years. She had some mild nuclear sclerosis in the eyes. She had severe (grade 4) tartar and gingivitis on the oral exam. There was a mass in the groin area and FNA confirmed lipoma. Her body condition and hair coat appeared OK. I wasn't too suspicious of Cushing's based on her apperance but possible with the history. I adv the owner I would be looking for Cushing's, Diabetes, Urinary Tract Infection as the big ones but lots of other possibilities as well.
At that appt I sent out a "senior screen" to Idexx- Chem/CBC/T4 and UA.
Here are the results:
Chemistry:
ALP 386
ALT 130
AST 30
GGT 33
ALB 3.2
BUN 32
CRE 0.9
Cholesterol 551
GLU 89
Chloride 102
Potassium 5.9
Sodium 143
Na:K 24
T4 0.5
CBC:
All within normal limits
UA:
SG 1.016
pH 7.5
Protein 4+
WBC 30-50
RBC 2-5
Marked bacteria
No epithelial cells or crystals
I called the owner with results and adv Ciara may have a few things going on. The owner wanted to move forward but was a little reluctant to do all the tests I we discussed- urine culture, urine protein:creatinine, bile acids. He wanted to go a little more step by step and I adv that I was OK with that. I adv that I would recommend a urine culture but owner only OK'd abx and recheck urine.
I adv that the T4 was low and I suspected the thyroxine was not controlling the thyroid esp because the cholesterol was so high (551). I did mention that it may be possible the the T4 could be supressed b/c of a sick euthyroid since Ciara had so much going on but wasn't sure since she was on a thyroid supplement.
We discussed the BUN being high and the low SG and I also addressed the high liver values and recommended bile acids before considering anesthesia for periodontal therapy. I adv that I thought the ALP may be related to the horrid teeth and the ALT may be related to the low thyroid so wasn't 100% convinced it was a liver issue....but then there is the high GGT.
This is what we did:
-Started Ciara on Baytril 68- 1/2 tablet SID for 10 days. Adv owner if bacteria still present on recheck urine then we NEED to culture (he declined culture).
-Increased her thyroxine to 0.2mg- 1/2 tablet in the AM and 1 tablet in the PM.
-Told owner to recheck urine at end of meds and get first morning urine to evaluate morning SG
-Wait on periodontal therapy for now
Owner rechecked urinalysis and also rechecked a T4 (T4 to Idexx, not MSU)
SG increased to 1.021
No evidence of bacteria
WBC normal 0-2
Protein dropped to 3+
But now there is a 3+ epithelial cell and the lab says they are in "rafts"
The T4 has not budged and is still at 0.5
I was doing some research on thyroxine and did not realize (embarassed to admit) that PU/PD can be a side effect of oversupplementing with thyroxine. I feel like her dose of thyroxine should be enough for her weight but the T4 did not budge. Now I am wondering if she is really hypothyroid or if her T4 appears low due to sick euthyroid, even though she is on a supplement. Is that possible?
Would it be advised to increase the thyroxine or should would it be best to do a bigger thyroid panel? Normally I send things to MSU but I didn't do that b/c I didn't know if it would be accurate since he was on an SID dose of thyroxine. If we were to send out a thorough panel- would it be best to pull her off of her thyroid meds and then test for most accurate results?
Since the urine protein did get better after treating the bacterial infection I recommended that we recheck another urine to see if the protein continues to go down and re-evaluate the epithelial cells if they persist. We are due to check the urine next week. If protein still high then I will recommend a UPC.
I advised the owner that I also wanted to recheck some bloodwork again to see if the BUN and/or liver enzymes improved once we had the T4 figured out and the urine issues taken care of.
Thank you for any and all advice- especially what would be recommended regarding the thyroid. I am so sorry about the length of this post...I hope it doesn't have heads spinning. Poor Ciara- I feel like these may all be individual problems or some how I can make a case for them to be related or tied to other things :)
☼ | Was this a cysto ua which we saw bacteria? | What's the current reference range from the lab? |
I have a 12 year old FS DSH who has chronic kidney disease. Her kidneys are doing well, but she was placed on erythropoietin about 6 m ago, and did well for a while, but now has become acutely anemic. Clinically she's doing well, but her pcv has dropped to 13 to 16 the past few weeks. I transfused her 2w ago because it was 12, and last week it was 16, but this week it's back down to 14. It is non-regenerative. I'm assuming it's an anti-erythropoietin rxn. I placed her on pred 5 mg po BID when I first found it, but now her BG is 239 with some wt loss, and I'm afraid I'm making her diabetic. I dropped her pred to SID today and am planning on tapering her down and off. I gave her a shot of iron dextran 2w ago and again today, but I know that's not going to help unless she starts making RBCs.
I'm wondering if there's anything else I can do. Is darbopoietin ever helpful in this type of situation, or will the antibodies target that, too?
Thanks for your thoughts!
☼ | Is this kitty normotensive? | Are you saying that you got to 1 unit/lb of insulin (which kind of insulin?) per dose and couldn't drop the bg's? |
Hello
I am treating a 8 y old female 60 lbs doberman with diabetes probably progesteron induced as the bitch
was entire. Initially started on 30/70 insulin. Initial response was good but after couple of weeks she developed
resistance and last glucose curve had all readings between 400-500 mg/dl on 16IU 30/70 insulin bid. The bitch was spayed by a different
vet 2 weeks after initiation of insulin treatment .It has been 3 weeks since the spay and I am unable to get the diabetes under control
I recently changed the insuline to NPH 10 IU bid and week later the glucose curve readings are still in between 400mg/dl - 500mg/dl .I increased the NPH insulin to 13 IU bid and I am starting to doubt whether there all ovarian tissue was removed.
The dog is PU/PD with severe glycosuria and no ketones in the urine.I recently performed ACTH stim test with results
baseline cortisol : 3.1 ug/dl post Synactine : 21.3 ug/dl. giving possibility of Cushings disease.
The dog is not obese have no clinical signs of Cuhings disease (alopetia, abdomenomegally)
and is doing generally ok except the PU/PD and slight gradual weight loss .My question is when should the Progesteron levels subside after the spaying?Should I perform additional tests to rule/confirm Cushings?Any suggestion on insuline therapy?
Thank you very much for response
☼ | Could you possibly post the most recent curve? | Neoplasia? |
I have a newly-diagnosed diabetic dog (BG 350) who I was planning to start on insulin at 0.25 units/kg Humulin N BID.
The dog's owner says when the put the food down in the morning, the dog gobbles it up. When she offers it in the evening, though, he will only eat it half of the time. | Any advice? | Removed? |
"Colby" is a 24 pound 12 year old neutered male Westie with Diabetes since October 2009. He was very well regulated on Humulin NPH since December of 2009 on 7 units twice daily, but over time was gradually increased to 10 units as subsequent curves indicated. He had been on 10 units twice daily since November 2010. He also has hypothyroidism that is well regulated on 0.15 mg of Soloxine twice daily. In February of 2013 his owner noticed increased thirst and urination. At that time his glucose ranged from the low 200's to mid 300's and so we increased his insulin to 11 units and sent a urinalysis with culture which was negative for infection. We have been checking glucose curves on him every two weeks or so and have gradually increased him to 14 units which still doesn't seem to be regulating him. In fact his curves seem worse as we increase his dose. We considered the possibility that the change from Humulin to Novalin may have caused him to become unregulated, but we switched back to Humulin and his curve was no better. I am going to screen him for Cushing's with a UC:C, but he does not appear Cushingoid nor does he have typical Cushing's symptoms. I am wondering if we might need to try a different insulin.
Today's curve on 14 units at 5:35 am
8:25 141
10:25 364
12:25 331
2:25 417
14 units given at 5:30 pm
6:30 pm glucose was 335
I had the owner increase to 15 units. Any other suggestions?
thanks,
☼ | An additional very important point, are we sure the dog is not snacking in between meals? | Is the plan for never doing surgery on the knee? |
We are having difficulty controlling a feline diabtetic and are hoping to get some guidance. The hx is long, so if I have left any required info out, please ask.
Percy is 10 yr old M/N DSH weighing 17.8lb that was diagnosed with diabetes in October 2012. Prior to dx he had a long Hx of gastrointestinal sensitivity that was managed with hypo diets. On dx his urine was cultured and positive for E. coli and treatment with baytril initiated. Owner agreed to try Lantus insulin over Caninsulin.
Oct 9/12
Glucose = 20.4 mmol/L, initial Lantus dose 2.5 units BID, diet PVD DM canned
Oct 11/12
8am glucose=3.56
Held off giving insulin for several hrs until cat had eaten
At 10:30 administered 1.5 units Lantus
2:30pm glucose= 4.56
6:30pm glucose= 7.73
Rec to continue the Lantus 1.5 units BID
Oct 12/12
8:30am glucose = 22.63
Received 1.5 units insulin
12:30 glucose=16.29
4:00pm glucose = 11.29
Rec to continue at 1.5 units Lantus BID and recheck curve in a week
Oct 18/12
8am glucose= 13.07
Received 1.5 units Lantus
12:30 glucose=11.84
4pm glucose=10.29
Rec increase insulin dose to 2 units BID and recheck in 1 week
In hind site, I am now wondering if we already had a so mogul affect going on and should've been dosing SID?
Oct 24/12
8am glucose=19.85
Gave 2 units insulin
12pm glucose= 12.84
4pm=8.84
Rec increase insulin by 0.5 units to 2.5 units and recheck in 1 wk
Oct 31/12
8am glucose= 8.9
Gave 2.5 units of insulin
12pm glucose= 7.17
4pm glucose= 12.01
Rec leave at current dose and recheck in 4 weeks or sooner if concerns
Nov 2/12
Cat having some diarrhea. Treated with tylocine. O concerned that it is the DM diet responsible. Spoke to Hills nutrition and they suggested that d/d canned would be ok to use for diabetic.
Nov 19/12
Noting the cat has developed diabetic neuropathy
8:30am glucose= 20.7
Received 2.5 units Lantus
12:30pm glucose= 17.24
4:30pm glucose= 17.96
Discussed feeding with o. Cat is eating 1/2 cup hypo dry per day and different amts of canned depending upon the day. Rotates through hypo canned, d/d canned, DM canned, occ gastro moderate calorie canned. Explained this is not ideal and need better consistency in feeding and that the DM diet is the ideal.
Rec increase insulin dose to 3 units BID
Nov 27/12
8:30am glucose= 16.24
Gave 3 units insulin
12:30pm glucose= 6.89
4:15pm glucose= 18.35
Nov 29/12
O called concerned because Percy is now pu/pd again, has been the past 24 hrs.
Nov 30/12
O called concerned Percy not getting enough to eat. Still feels he is drinking more and out of sorts.
Dec 10/12
8:25 am glucose= 11.73
Gave 3 units insulin
12:30pm glucose= 7.17
4:15 glucose= 16.62
Fructosamine= 465. Fair control
Rec increase insulin to 3.5 units BID
Dec 14/12
O reports Percy is now drinking excessively and legs are shaky. He is urinating outside of letterbox.
Urine c/s indicates no bacterial growth
Dec20/12
8:30am glucose= 15.18
Gave 3.5 units insulin
12:50pm glucose= 15.23
4:30pm glucose= 16.57
Rec increase dose to 4 units BID
Jan 3/13
8:10am glucose= 16.62
Gave 4 units insulin
12:35pm glucose= 5.50
4:15pm glucose= 8.90
Rec continue at current dose and recheck in 4 weeks
Jan 17/13
O has observed blood in Percy's stool. He is not acting himself and hiding. Progressed to diarrhea consistency of pudding.
OPG negative
Rx metronidazole and forti flora
Jan 23/13
Stools improving
Feb 4/13
O called concerned again as Percy has diarrhea again. Rx tylosin. O now feeding gastro moderate calorie.
Feb 15/13
Stool now normal and cat receiving gastro canned and hypo dry. Contacted Royal Canin nutrition support and they advised there are no contraindications to feeding this diet to a diabetic.
Feb 26/13
8:30am glucose= 20.24
Gave 4 units of insulin
12:30pm glucose= 21.63
4:20pm glucose= 22.91
Cat suffering from severe neuropathy. Concerned that urine leaking might contribute to UTI and result in poor glycemic control
Urine c/s ID: Proteus mirabilis and E. coli
Rx baytril
March 14/13
Spot glucose 5pm= 20.85
Rec increase insulin dose to 6 units BID
April 2/13
8am glucose= 4.34
Gave 6 units insulin
12:30pm glucose= 12.12
4pm glucose= 20.07
Unusual that am glucose was so low and then increased following insulin administration although cat was fed.
Now wondering if Percy requires insulin only SID or have we messed this up along the way and seeing a somogyi affect? Or should he be on a different insulin?
Feeling a little bewildered and really hoping an outside eye can see what is going on here.
If you have read this are- thank you! We look forward to your input and advice on how to better manage poor Percy.
p /BSc, MSc, DVM
Terra Glen Animal Hosipital
Georgetown, Ontario
Canada | When you do the curves, does the owner give the insulin befoer percy comes in or do you feed in the hospital and give insulin? | Which one? |
We are having difficulty controlling a feline diabtetic and are hoping to get some guidance. The hx is long, so if I have left any required info out, please ask.
Percy is 10 yr old M/N DSH weighing 17.8lb that was diagnosed with diabetes in October 2012. Prior to dx he had a long Hx of gastrointestinal sensitivity that was managed with hypo diets. On dx his urine was cultured and positive for E. coli and treatment with baytril initiated. Owner agreed to try Lantus insulin over Caninsulin.
Oct 9/12
Glucose = 20.4 mmol/L, initial Lantus dose 2.5 units BID, diet PVD DM canned
Oct 11/12
8am glucose=3.56
Held off giving insulin for several hrs until cat had eaten
At 10:30 administered 1.5 units Lantus
2:30pm glucose= 4.56
6:30pm glucose= 7.73
Rec to continue the Lantus 1.5 units BID
Oct 12/12
8:30am glucose = 22.63
Received 1.5 units insulin
12:30 glucose=16.29
4:00pm glucose = 11.29
Rec to continue at 1.5 units Lantus BID and recheck curve in a week
Oct 18/12
8am glucose= 13.07
Received 1.5 units Lantus
12:30 glucose=11.84
4pm glucose=10.29
Rec increase insulin dose to 2 units BID and recheck in 1 week
In hind site, I am now wondering if we already had a so mogul affect going on and should've been dosing SID?
Oct 24/12
8am glucose=19.85
Gave 2 units insulin
12pm glucose= 12.84
4pm=8.84
Rec increase insulin by 0.5 units to 2.5 units and recheck in 1 wk
Oct 31/12
8am glucose= 8.9
Gave 2.5 units of insulin
12pm glucose= 7.17
4pm glucose= 12.01
Rec leave at current dose and recheck in 4 weeks or sooner if concerns
Nov 2/12
Cat having some diarrhea. Treated with tylocine. O concerned that it is the DM diet responsible. Spoke to Hills nutrition and they suggested that d/d canned would be ok to use for diabetic.
Nov 19/12
Noting the cat has developed diabetic neuropathy
8:30am glucose= 20.7
Received 2.5 units Lantus
12:30pm glucose= 17.24
4:30pm glucose= 17.96
Discussed feeding with o. Cat is eating 1/2 cup hypo dry per day and different amts of canned depending upon the day. Rotates through hypo canned, d/d canned, DM canned, occ gastro moderate calorie canned. Explained this is not ideal and need better consistency in feeding and that the DM diet is the ideal.
Rec increase insulin dose to 3 units BID
Nov 27/12
8:30am glucose= 16.24
Gave 3 units insulin
12:30pm glucose= 6.89
4:15pm glucose= 18.35
Nov 29/12
O called concerned because Percy is now pu/pd again, has been the past 24 hrs.
Nov 30/12
O called concerned Percy not getting enough to eat. Still feels he is drinking more and out of sorts.
Dec 10/12
8:25 am glucose= 11.73
Gave 3 units insulin
12:30pm glucose= 7.17
4:15 glucose= 16.62
Fructosamine= 465. Fair control
Rec increase insulin to 3.5 units BID
Dec 14/12
O reports Percy is now drinking excessively and legs are shaky. He is urinating outside of letterbox.
Urine c/s indicates no bacterial growth
Dec20/12
8:30am glucose= 15.18
Gave 3.5 units insulin
12:50pm glucose= 15.23
4:30pm glucose= 16.57
Rec increase dose to 4 units BID
Jan 3/13
8:10am glucose= 16.62
Gave 4 units insulin
12:35pm glucose= 5.50
4:15pm glucose= 8.90
Rec continue at current dose and recheck in 4 weeks
Jan 17/13
O has observed blood in Percy's stool. He is not acting himself and hiding. Progressed to diarrhea consistency of pudding.
OPG negative
Rx metronidazole and forti flora
Jan 23/13
Stools improving
Feb 4/13
O called concerned again as Percy has diarrhea again. Rx tylosin. O now feeding gastro moderate calorie.
Feb 15/13
Stool now normal and cat receiving gastro canned and hypo dry. Contacted Royal Canin nutrition support and they advised there are no contraindications to feeding this diet to a diabetic.
Feb 26/13
8:30am glucose= 20.24
Gave 4 units of insulin
12:30pm glucose= 21.63
4:20pm glucose= 22.91
Cat suffering from severe neuropathy. Concerned that urine leaking might contribute to UTI and result in poor glycemic control
Urine c/s ID: Proteus mirabilis and E. coli
Rx baytril
March 14/13
Spot glucose 5pm= 20.85
Rec increase insulin dose to 6 units BID
April 2/13
8am glucose= 4.34
Gave 6 units insulin
12:30pm glucose= 12.12
4pm glucose= 20.07
Unusual that am glucose was so low and then increased following insulin administration although cat was fed.
Now wondering if Percy requires insulin only SID or have we messed this up along the way and seeing a somogyi affect? Or should he be on a different insulin?
Feeling a little bewildered and really hoping an outside eye can see what is going on here.
If you have read this are- thank you! We look forward to your input and advice on how to better manage poor Percy.
p /BSc, MSc, DVM
Terra Glen Animal Hosipital
Georgetown, Ontario
Canada | How was the current urine sample obtained and do you have a urinalysis? | Absolutely sure there's no dry food being given, and they're following the list at www.catinfo.org for which fancy feast flavors are 7% carbs on the 'calorie%' basis? |
We are having difficulty controlling a feline diabtetic and are hoping to get some guidance. The hx is long, so if I have left any required info out, please ask.
Percy is 10 yr old M/N DSH weighing 17.8lb that was diagnosed with diabetes in October 2012. Prior to dx he had a long Hx of gastrointestinal sensitivity that was managed with hypo diets. On dx his urine was cultured and positive for E. coli and treatment with baytril initiated. Owner agreed to try Lantus insulin over Caninsulin.
Oct 9/12
Glucose = 20.4 mmol/L, initial Lantus dose 2.5 units BID, diet PVD DM canned
Oct 11/12
8am glucose=3.56
Held off giving insulin for several hrs until cat had eaten
At 10:30 administered 1.5 units Lantus
2:30pm glucose= 4.56
6:30pm glucose= 7.73
Rec to continue the Lantus 1.5 units BID
Oct 12/12
8:30am glucose = 22.63
Received 1.5 units insulin
12:30 glucose=16.29
4:00pm glucose = 11.29
Rec to continue at 1.5 units Lantus BID and recheck curve in a week
Oct 18/12
8am glucose= 13.07
Received 1.5 units Lantus
12:30 glucose=11.84
4pm glucose=10.29
Rec increase insulin dose to 2 units BID and recheck in 1 week
In hind site, I am now wondering if we already had a so mogul affect going on and should've been dosing SID?
Oct 24/12
8am glucose=19.85
Gave 2 units insulin
12pm glucose= 12.84
4pm=8.84
Rec increase insulin by 0.5 units to 2.5 units and recheck in 1 wk
Oct 31/12
8am glucose= 8.9
Gave 2.5 units of insulin
12pm glucose= 7.17
4pm glucose= 12.01
Rec leave at current dose and recheck in 4 weeks or sooner if concerns
Nov 2/12
Cat having some diarrhea. Treated with tylocine. O concerned that it is the DM diet responsible. Spoke to Hills nutrition and they suggested that d/d canned would be ok to use for diabetic.
Nov 19/12
Noting the cat has developed diabetic neuropathy
8:30am glucose= 20.7
Received 2.5 units Lantus
12:30pm glucose= 17.24
4:30pm glucose= 17.96
Discussed feeding with o. Cat is eating 1/2 cup hypo dry per day and different amts of canned depending upon the day. Rotates through hypo canned, d/d canned, DM canned, occ gastro moderate calorie canned. Explained this is not ideal and need better consistency in feeding and that the DM diet is the ideal.
Rec increase insulin dose to 3 units BID
Nov 27/12
8:30am glucose= 16.24
Gave 3 units insulin
12:30pm glucose= 6.89
4:15pm glucose= 18.35
Nov 29/12
O called concerned because Percy is now pu/pd again, has been the past 24 hrs.
Nov 30/12
O called concerned Percy not getting enough to eat. Still feels he is drinking more and out of sorts.
Dec 10/12
8:25 am glucose= 11.73
Gave 3 units insulin
12:30pm glucose= 7.17
4:15 glucose= 16.62
Fructosamine= 465. Fair control
Rec increase insulin to 3.5 units BID
Dec 14/12
O reports Percy is now drinking excessively and legs are shaky. He is urinating outside of letterbox.
Urine c/s indicates no bacterial growth
Dec20/12
8:30am glucose= 15.18
Gave 3.5 units insulin
12:50pm glucose= 15.23
4:30pm glucose= 16.57
Rec increase dose to 4 units BID
Jan 3/13
8:10am glucose= 16.62
Gave 4 units insulin
12:35pm glucose= 5.50
4:15pm glucose= 8.90
Rec continue at current dose and recheck in 4 weeks
Jan 17/13
O has observed blood in Percy's stool. He is not acting himself and hiding. Progressed to diarrhea consistency of pudding.
OPG negative
Rx metronidazole and forti flora
Jan 23/13
Stools improving
Feb 4/13
O called concerned again as Percy has diarrhea again. Rx tylosin. O now feeding gastro moderate calorie.
Feb 15/13
Stool now normal and cat receiving gastro canned and hypo dry. Contacted Royal Canin nutrition support and they advised there are no contraindications to feeding this diet to a diabetic.
Feb 26/13
8:30am glucose= 20.24
Gave 4 units of insulin
12:30pm glucose= 21.63
4:20pm glucose= 22.91
Cat suffering from severe neuropathy. Concerned that urine leaking might contribute to UTI and result in poor glycemic control
Urine c/s ID: Proteus mirabilis and E. coli
Rx baytril
March 14/13
Spot glucose 5pm= 20.85
Rec increase insulin dose to 6 units BID
April 2/13
8am glucose= 4.34
Gave 6 units insulin
12:30pm glucose= 12.12
4pm glucose= 20.07
Unusual that am glucose was so low and then increased following insulin administration although cat was fed.
Now wondering if Percy requires insulin only SID or have we messed this up along the way and seeing a somogyi affect? Or should he be on a different insulin?
Feeling a little bewildered and really hoping an outside eye can see what is going on here.
If you have read this are- thank you! We look forward to your input and advice on how to better manage poor Percy.
p /BSc, MSc, DVM
Terra Glen Animal Hosipital
Georgetown, Ontario
Canada | How has his body weight been through all of this? | Amount of pu/pd? |
We are having difficulty controlling a feline diabtetic and are hoping to get some guidance. The hx is long, so if I have left any required info out, please ask.
Percy is 10 yr old M/N DSH weighing 17.8lb that was diagnosed with diabetes in October 2012. Prior to dx he had a long Hx of gastrointestinal sensitivity that was managed with hypo diets. On dx his urine was cultured and positive for E. coli and treatment with baytril initiated. Owner agreed to try Lantus insulin over Caninsulin.
Oct 9/12
Glucose = 20.4 mmol/L, initial Lantus dose 2.5 units BID, diet PVD DM canned
Oct 11/12
8am glucose=3.56
Held off giving insulin for several hrs until cat had eaten
At 10:30 administered 1.5 units Lantus
2:30pm glucose= 4.56
6:30pm glucose= 7.73
Rec to continue the Lantus 1.5 units BID
Oct 12/12
8:30am glucose = 22.63
Received 1.5 units insulin
12:30 glucose=16.29
4:00pm glucose = 11.29
Rec to continue at 1.5 units Lantus BID and recheck curve in a week
Oct 18/12
8am glucose= 13.07
Received 1.5 units Lantus
12:30 glucose=11.84
4pm glucose=10.29
Rec increase insulin dose to 2 units BID and recheck in 1 week
In hind site, I am now wondering if we already had a so mogul affect going on and should've been dosing SID?
Oct 24/12
8am glucose=19.85
Gave 2 units insulin
12pm glucose= 12.84
4pm=8.84
Rec increase insulin by 0.5 units to 2.5 units and recheck in 1 wk
Oct 31/12
8am glucose= 8.9
Gave 2.5 units of insulin
12pm glucose= 7.17
4pm glucose= 12.01
Rec leave at current dose and recheck in 4 weeks or sooner if concerns
Nov 2/12
Cat having some diarrhea. Treated with tylocine. O concerned that it is the DM diet responsible. Spoke to Hills nutrition and they suggested that d/d canned would be ok to use for diabetic.
Nov 19/12
Noting the cat has developed diabetic neuropathy
8:30am glucose= 20.7
Received 2.5 units Lantus
12:30pm glucose= 17.24
4:30pm glucose= 17.96
Discussed feeding with o. Cat is eating 1/2 cup hypo dry per day and different amts of canned depending upon the day. Rotates through hypo canned, d/d canned, DM canned, occ gastro moderate calorie canned. Explained this is not ideal and need better consistency in feeding and that the DM diet is the ideal.
Rec increase insulin dose to 3 units BID
Nov 27/12
8:30am glucose= 16.24
Gave 3 units insulin
12:30pm glucose= 6.89
4:15pm glucose= 18.35
Nov 29/12
O called concerned because Percy is now pu/pd again, has been the past 24 hrs.
Nov 30/12
O called concerned Percy not getting enough to eat. Still feels he is drinking more and out of sorts.
Dec 10/12
8:25 am glucose= 11.73
Gave 3 units insulin
12:30pm glucose= 7.17
4:15 glucose= 16.62
Fructosamine= 465. Fair control
Rec increase insulin to 3.5 units BID
Dec 14/12
O reports Percy is now drinking excessively and legs are shaky. He is urinating outside of letterbox.
Urine c/s indicates no bacterial growth
Dec20/12
8:30am glucose= 15.18
Gave 3.5 units insulin
12:50pm glucose= 15.23
4:30pm glucose= 16.57
Rec increase dose to 4 units BID
Jan 3/13
8:10am glucose= 16.62
Gave 4 units insulin
12:35pm glucose= 5.50
4:15pm glucose= 8.90
Rec continue at current dose and recheck in 4 weeks
Jan 17/13
O has observed blood in Percy's stool. He is not acting himself and hiding. Progressed to diarrhea consistency of pudding.
OPG negative
Rx metronidazole and forti flora
Jan 23/13
Stools improving
Feb 4/13
O called concerned again as Percy has diarrhea again. Rx tylosin. O now feeding gastro moderate calorie.
Feb 15/13
Stool now normal and cat receiving gastro canned and hypo dry. Contacted Royal Canin nutrition support and they advised there are no contraindications to feeding this diet to a diabetic.
Feb 26/13
8:30am glucose= 20.24
Gave 4 units of insulin
12:30pm glucose= 21.63
4:20pm glucose= 22.91
Cat suffering from severe neuropathy. Concerned that urine leaking might contribute to UTI and result in poor glycemic control
Urine c/s ID: Proteus mirabilis and E. coli
Rx baytril
March 14/13
Spot glucose 5pm= 20.85
Rec increase insulin dose to 6 units BID
April 2/13
8am glucose= 4.34
Gave 6 units insulin
12:30pm glucose= 12.12
4pm glucose= 20.07
Unusual that am glucose was so low and then increased following insulin administration although cat was fed.
Now wondering if Percy requires insulin only SID or have we messed this up along the way and seeing a somogyi affect? Or should he be on a different insulin?
Feeling a little bewildered and really hoping an outside eye can see what is going on here.
If you have read this are- thank you! We look forward to your input and advice on how to better manage poor Percy.
p /BSc, MSc, DVM
Terra Glen Animal Hosipital
Georgetown, Ontario
Canada | When was the last time we did a complete blood panel and t4 on this cat? | Is the cat obese? |
Hi there,
I have an 18 year old cat that has been diabetic for 3-4 years (i.e. in remission for about 1 year initially). She has been my patient for two years since she came out of remission and has been well controlled for the most part (i.e. home curves q 1-2 months with occasional need for adjustment to her Lantus dose). She only eats Purina DM but she won't eat much of the canned formula (unfortunate, I know). Over this time, her owner has reported gradually progressive lameness in her left rear limb. At first, she would only notice it during certain times and my exam was unremarkable. However, over time a plantar stance has developed LR. From reading other posts on VIN, I learned that diabetic neuropathy can be asymmetric.
There is bilateral hindlimb muscle atrophy although this cat is in good body condition (5/9). She is on Adequan SQ and buprenorphine PO for arthritis. Her patellar reflexes are wnl, pulses good. There is no swelling, evident area of focal pain, crepitus. or cranial drawer. I can't rule-out ligamentous damage but diabetic neuropathy seems most likely: do you agree?
She has been on cyanocobalamin SQ at 250mcg weekly for a long while. I am thinking of increasing that to 500mcg once weekly and trying cold laser since that is reported to help some humans with diabetic neuropathy. Is there anything else you would advise? With the age of the cat and other concurrent disease (i.e. hepatic cystadenoma, dilated biliary tree and periodic pancreatitis w/ chronically tortuous/dilated pancreatic ducts per ultrasound w/ ACVR), the owner is not inclined to pursue anything invasive.
Thanks, | Are you confident that this isn't a rupture of the gastrocnemius tendon? | How much does he weigh? |
Hi,
I seem to see way too many PF patients these days. This dog is a 6 year old Pug who started with crusting lesions typical of PF on 12/19/12, (and confirmed by biopsy). I had just treated her with carpofen and tramadol on 12/10 for cervical pain, so we were initially hopeful her PF was a drug reaction. She responded very well to prednisone at 10mg/day (a little more than 1mg/kg--she is 8kg). She has also been on doxy 50mg BID and Vit E 200IU/day.
We decreased her pred by 25% every 2 weeks, but when we got to 2.5mg/day, she started to develop crusts again. I know now I probably tapered too quickly, but I really thought we might get away with it if her PF was secondary to a drug reaction. Guess not. At that time (3/1/13) we added compounded liquid azathiporine from GE pharmacy at 8mg every other day and increased her pred back to 10mg/day. She has maintained a stable body weight but has occasional loose stool since starting the Aza. Recheck on 3/22 showed a normal CBC (mild neutrophilia,lymphopenia attributed to pred) but a moderate increase in her ALT at 395(14-151). We elected not to change doseages at that time and rechecked her liver enzymes only on 4/5. ALT is about the same at 406, GGT slight increase at 20(3-19). Her crusts are all sloughing off and no new ones have appeared since we increased back to 10mg and started the Aza.
I just decreased her pred to 7.5mg/day but am wondering what to do about this ALT? Her owners are very dilligent but would really rather she not be on Pred forever, and I'm worried we can't taper down far enough without a second drug to help out. I've not had much luck with cyclosporine in these cases and have not run into any issues with the azathioprine before now...
Thanks for any wisdom/tips/reassurance.
☼ | Is the alkaline phosphatase up too? | How much does fancy feast does this cat eat daily? |
Hi,
I seem to see way too many PF patients these days. This dog is a 6 year old Pug who started with crusting lesions typical of PF on 12/19/12, (and confirmed by biopsy). I had just treated her with carpofen and tramadol on 12/10 for cervical pain, so we were initially hopeful her PF was a drug reaction. She responded very well to prednisone at 10mg/day (a little more than 1mg/kg--she is 8kg). She has also been on doxy 50mg BID and Vit E 200IU/day.
We decreased her pred by 25% every 2 weeks, but when we got to 2.5mg/day, she started to develop crusts again. I know now I probably tapered too quickly, but I really thought we might get away with it if her PF was secondary to a drug reaction. Guess not. At that time (3/1/13) we added compounded liquid azathiporine from GE pharmacy at 8mg every other day and increased her pred back to 10mg/day. She has maintained a stable body weight but has occasional loose stool since starting the Aza. Recheck on 3/22 showed a normal CBC (mild neutrophilia,lymphopenia attributed to pred) but a moderate increase in her ALT at 395(14-151). We elected not to change doseages at that time and rechecked her liver enzymes only on 4/5. ALT is about the same at 406, GGT slight increase at 20(3-19). Her crusts are all sloughing off and no new ones have appeared since we increased back to 10mg and started the Aza.
I just decreased her pred to 7.5mg/day but am wondering what to do about this ALT? Her owners are very dilligent but would really rather she not be on Pred forever, and I'm worried we can't taper down far enough without a second drug to help out. I've not had much luck with cyclosporine in these cases and have not run into any issues with the azathioprine before now...
Thanks for any wisdom/tips/reassurance.
☼ | Is the dog feeling o? | How soon would you stop the antibiotics, and actigall? |
Hopi is a f/s, shep mix that currently weighs 69 lbs. Hopi presented with a previous history of arthritis managed with intermittent rimadyl and occasional excess panting. She presented 2/22/13 for pu/pd, few wks duration. At presentation she was 76 lbs (15 lbs overwt), was difficult to handle but had no abnormalities on PE. Urinalysis confirmed glucose ++++, no ketones and occasional RBC on sediment. BG = 618, alkphos = 274, Na = 136, K+=5.6, cl=93, chol=955, trigly=949, rest including T4/FT4 was WNL. Hopi was started on 13 U NPH (Novolin) BID, Amoxi 400mg BID x 14 days and DCO dry. After multiple adjustments, rechecks, examining owners ability to inject/handle insulin, making sure insulin/syringes were correct, etc...I gave up on NPH at 35 U BID when BG never changed from the 400's.
On 3/22/13, at 69.8 lbs, I started Hopi on 3 units levemir BID. By 3/27 she was becoming more lethargic, panting more, etc and she was starting to spill ketones in her urine. She was admitted for IV fluids, urine C&S (negative), abdominal rads/US WNL (except spinal arthritis) and she was discharged on 6 U levemir BID. The owners are monitoring urine glucose at home and it's consistently 500-1000. She is very difficult to get ear sticks on for BG's so the owner doesn't feel they can pursue that. They are terribly concerned that she is not regulating as am I. They elected to increase her to TID levemir and I rechecked her today on 7 U TID, 3 hrs post injection and her BG = 476. She urinated on the floor and her urine glucose was 500-1000 and no ketones were present. Her weight is maintaining at 69.3 lbs. She is also on 50mg rimadyl BID now as her mobility is worse and seems slightly improved on that - diabetic neuropathy vz arthritis? This is the first time I've used levemir and I haven't been able to find anything about TID dosing but I'm as frustrated as the owners at this point so I couldn't disagree with trying something different. I increased her to 8 U TID today and the owner will call Monday with urine glucose. She is currently being fed DCO TID now - measured amounts. I'm reading on the boards that I should be concerned about resistance at about 0.5 u/kg which is about 15 U BID for her. Is it totally crazy to continue TID then back down to BID if we get control? Should I just go up 1 unit q 3 days if urine glucose remains elevated? I know it's not ideal but the owner can't afford many more rechecks at all. Super owner so I hope there's a light at the end of the tunnel. Suggestions please? Thank you. | We're sure she's spayed? | At what site are they injecting? |
Lucy is a 13 yo, f/s, DSHC, 10 lbs 9.5 oz. She became transiently diabetic on 2/18/08 from a depo injection on 12/11/07. She was managed with 5 U PZI BID which was discontinued 3/27/08 when she was in remission. She presented for pu/pd on 2/18/13 and her BG = 466, urine glu = 2000, no ketones. I've been reading so much about lantus I thought she would be a great canidate. I started her on 1 U BID. At 3 U BID I had her in for a curve and she was totally frightened, didn't eat or drink or move all day then went home and drank a bowl of water and vomited multiple times. So she has only been in for spot BG's since.
3/4/13 on 3 U lantus BID glu = 551, 16 hrs post insulin, glu =579, 3 hrs post
glu = 397 6.5 hrs post
glu = 220, 9 hrs post
I've since checked spot BG's and they've not dropped under 401, 12 hrs post insulin. She's currenlty on 7 units BID. Her body weight has maintained. The owners have other cats so it's difficult to assess thirst/urination, but there may be an improvement? Looking for suggestions? The owners are reluctant to do a curve at home but I really think I need them to. I'm worried she's in overswing. From what I've read most cats maintain on 2-3 U BID, true? Any advise would be appreciated. | What is lucy's bcs and what diet is being fed? | Can you post the actual values of the acth incl refference of your lab? |
I am seeing an 8 year old MN schnauzer with a history of a back injury in 2008 resulting in paralysis of hindquarters. His owner expresses his bladder multiple times a day and checks his urine a few times a year by C & S. Lately he's having back to back UTIs it seems. A blood chemistry revealed elevated CHOL on a fasted sample with no other elevations (ALKP and ALT are well WNL). He does pant and drink a lot, per owner, but has for a few years.
I ran a LDDST last week with came back consistent with HAC but further testing needed to differentiate AT from PDH.
Pre: 10.9
4 hr post: 7.3
8 hr post: 14.2
That same day a recheck urine culture was performed to see if his B-hemolytic strep UTI had resolved after a course of cephalexin and it came back positive for Enterobacter spp. (resistant to cephalexin and clavamox, his more recently used antibiotics - he previously had an E.coli infection in 8/2012). The culture showed >100,000 org/ML and since we can't tell if he's symptomatic, should I treat it?
The owner just found out about the LDDST results, but I imagine she'll follow with a high-dose dex test. Do you think the UTI could constitute enough physiologic stress to get a false positive result on the LDDST?
thanks for your thoughts,
☼ | Hmmm....does this dog look like a cushing's dog with the naked eye? | Any cardiac signs that might put hyperthyroidism higher on the list? |
I am seeing an 8 year old MN schnauzer with a history of a back injury in 2008 resulting in paralysis of hindquarters. His owner expresses his bladder multiple times a day and checks his urine a few times a year by C & S. Lately he's having back to back UTIs it seems. A blood chemistry revealed elevated CHOL on a fasted sample with no other elevations (ALKP and ALT are well WNL). He does pant and drink a lot, per owner, but has for a few years.
I ran a LDDST last week with came back consistent with HAC but further testing needed to differentiate AT from PDH.
Pre: 10.9
4 hr post: 7.3
8 hr post: 14.2
That same day a recheck urine culture was performed to see if his B-hemolytic strep UTI had resolved after a course of cephalexin and it came back positive for Enterobacter spp. (resistant to cephalexin and clavamox, his more recently used antibiotics - he previously had an E.coli infection in 8/2012). The culture showed >100,000 org/ML and since we can't tell if he's symptomatic, should I treat it?
The owner just found out about the LDDST results, but I imagine she'll follow with a high-dose dex test. Do you think the UTI could constitute enough physiologic stress to get a false positive result on the LDDST?
thanks for your thoughts,
☼ | What does the sediment on a cysto sample look like? | Using u40 syringes? |
I am seeing an 8 year old MN schnauzer with a history of a back injury in 2008 resulting in paralysis of hindquarters. His owner expresses his bladder multiple times a day and checks his urine a few times a year by C & S. Lately he's having back to back UTIs it seems. A blood chemistry revealed elevated CHOL on a fasted sample with no other elevations (ALKP and ALT are well WNL). He does pant and drink a lot, per owner, but has for a few years.
I ran a LDDST last week with came back consistent with HAC but further testing needed to differentiate AT from PDH.
Pre: 10.9
4 hr post: 7.3
8 hr post: 14.2
That same day a recheck urine culture was performed to see if his B-hemolytic strep UTI had resolved after a course of cephalexin and it came back positive for Enterobacter spp. (resistant to cephalexin and clavamox, his more recently used antibiotics - he previously had an E.coli infection in 8/2012). The culture showed >100,000 org/ML and since we can't tell if he's symptomatic, should I treat it?
The owner just found out about the LDDST results, but I imagine she'll follow with a high-dose dex test. Do you think the UTI could constitute enough physiologic stress to get a false positive result on the LDDST?
thanks for your thoughts,
☼ | These cultures are on cysto samples correct? | Have you seen the dog? |
Good morning!
I am going to try to ask a simple question of a complex case -
Used at anti inflammatory doses, how likely is prednisolone to lead to DM in a large boned, moderately obese cat (i.e. cat is about 20% overweight but lean body weight would probably be 14-15#).
Or is this a completely random, non-predictive type thing?
Thank you! br/
☼ | What are you using the prednisolone for in this ient and what type of weight loss program is in effect? | Is the ckd proteinuric? |
Hi!
I've examined a 7 month old, female, spayed, highland lynx.
7 days ago (last sunday)the owners noticed a different gait, a bit awkward.
On monday: she wasn't able to jump on the furnitures.
On wednesday: she spent all her day laying on the floor, except few walks to eat and go the litter box. And when she walked, she only did a few steps and then sat or laid down.
On Tuesday: she had been presented to an other vet. She had an abscess on a digit of the left hindlimb. She is declawed (4 paws). There was a little piece of nail inside the abscess that had been removed, She had been put on Clavulin for 2 weeks and Tolfedine for 4 days. Her physical examination was normal, except for a grade II heart murmur. She has never walked on 3 legs, and her awkward gait involved her 2 hindlimb.
On Saturday (I examined her): she walked a bit more then the previous days, but still with her awkward gait and only a few steps at a time. Her abscess was recovering quite well. Her physical examination was still normal. Her neurologic examination was quite normal except for those abnormalities: slow and incomplete withdrawal reflex and hopping reactions on both hindlimbs, and maybe a pain at the palpation of the back at the level of L4, but not repeatable every times. For me, she seems weak. She walks with an arched back. She has not complete flexion of joints when walking....
Here's the video of her gait.
Today: she has the same gait, but she does more paws before sitting or laying down. She received her last dose of tolfedine today.
Do you think it's a neurological case? Junctinopathy? Myopathy? Something at the level of spine because of the pain (?) at the lever of L4 (but the reflexes were normal, and for me, she is not ataxic). Or something else? ATE because of the heart murmur (not investigated)?
Thank you very much for your help!
☼ | Wasn't the withdrawal reflex slow? | My question is why is the dog not eating well in the a.m.? |
I just need some advice on how to proceed with this patient. Griffin is a 10 y/o M/N Standard Schnauzer with hypothyroidism and h/o recurrent E. coli UTI's. He presented last week for a dental cleaning and pre-op bloodwork showed a BG of 204 (fasting sample). I obtained a urine sample and there was 1+ glucosuria. Other than newly onset cataracts OU there are NO signs of diabetes (no PUPD, polyphagia, he's actually GAINING weight). I obtained a fasted BG this morning and its 127. Post-prandial BG is 246. No glucose in the urine this morning. Should I get a fructosamine or just continue to monitor for signs and BGs? Thanks!
☼ | Coli again! i'm going to treat this and do workup to see if i can find underlying cause for these utis, but my main question is should i do anything about the on/off hyperglycemia/uria? | How did you make a diagnosis of pancreatitis? |
I have a 12-year-old MN Bichon that presented for a 3rd opinion the other day on a few ongoing issues.
The dog was bright and ert on exam, but did certainly look like the poster child for Cushing's: thin hair, thin skin stretched around a pot belly; scy skin; very PU/PD/PP, according to the owner. Other fun features: 1) ongoing sneezing - controlled well with a round of Cetirizine and antibiotics, according to the owner; 2) Seizures - started a few months ago. They are infrequent and mild, but do come in clusters. They are less frequent when the sneezing is well-controlled, according to the owner; 3) a new Grade 2/6 systolic murmur. Clear lungs on auscultation. 4) ongoing azotemia BUN 106, Cr 2.1), with significant hyperphosphatemia (14.8; N 2.5-6.8), hypoccemia (7.3; N 7.9-12.0); hyperkemia (6.6; 3.5-5.8); 5) elevated liver vues(ALT 138, ALKP 151, GGT 32), presumed due to Cushing's but he has never been Stim'd; 5) long-standing pododermatitis of the front feet. 6) Significant periodont disease.
UA shoiwed USG of 1.011, 3+ blood, 2+ protein; no growth on culture.
We did an abdomin ultrasound on Friday:
Both adren glands are enlarged and the right gland appears to grow into the adjoining vessel (CVC?). The liver is increased in echogenicity and there is a sml (3.2 cm across) solid mass effect in the right caudle liver lobe. PDH is suspected with tumor in the right gland. The right kidney has a dilated ren pelvic region and there appears to be some decreased blood supply in the ren vessels. These findings are consistent with pyelonephritis and possible occlusion of the ren vessels (right adren lesion). Solid mass effects in the liver are nonspecific in the dog and may be tumor or regenerative hyperplasia. Blood tests to rule out primary adren tumor are suggested. Long term antibiotics are recommended to treat pyelonephritis.
So, it looked like from the U/S that there was a Right adren tumor as well as possible PTH with the left adren enlarged but not abnorm looking. The vessel occlusion was impressive, though since my ultrasound skills are not great I was of no help to our ultrasonographer in sorting out which vessel it was in.
So far I have started Baytril in case of pyelonephritis and Aluminum Hydroxide for the hyperphosphatemia.
As for the Cushings, if treatment is risky, the symptoms are not such as the owner can't de with them. The dog is overl happy. The owner has had the dog for about a year and a hf - it belonged to her aunt, who died, and she took the dog as a temporary measure - but he's quite charming. :) No known history of seizures before about 1-2 months ago.
With such an involved tumor, I wasn't sure about how to treat for Cushing's, if at l. This owner is not interested in referr or surgery. Lastly - any seizure med better than another here? I'm trying to connect l the pieces and make the tumor the cause of it l - but of course I'm not sure that's true. Was thinking of Zonisamide.
Thanks, br/i | What exactly is the owner describing as a seizure? | Any pain on palpation of her muscles/bones? |
Hi All,
I am writing with the need for some support regarding recommendations/requirements for refills of amlodipine. I have a patient who is a 10 year old SF Cockapoo who has been to the cardiologist and confirmed diagnosis of the following: Second Degree AV Block, First Degree AV block, Systemic hypertension, supraventricular tachycardia, sick sinus syndrome, and chronic valvular disease back in December 2011. I last saw the patient in June 2012 for vaccines and July 2012 for otitis.
I have in the past required a blood pressure q 6 months for amlodipine refill.
The o first said she had too much stress to come at 6 months for a bp (seemed legitimate) so we gave a grace period of 2 months. Now she wants to wait until June 2013 because what is another 2 months?
Regretably, I practice where I live (mistake one) and my kids go to school with my clients kids (mistake two) and this patient is my accountant's dog (wife is the problem--husband may be ok--mistake three). Therefore, I regularly practice how to graciously and firmly tow the line. I am currently weathered as we just battled a lot of this post holiday season (when the credit card bills come in).
Any help on how to graciously and medically approach this situation? I need a boost!
☼ | Does this dog have renal disease/failure, cushings or dm? | Has that changed? |
Hi All,
I am writing with the need for some support regarding recommendations/requirements for refills of amlodipine. I have a patient who is a 10 year old SF Cockapoo who has been to the cardiologist and confirmed diagnosis of the following: Second Degree AV Block, First Degree AV block, Systemic hypertension, supraventricular tachycardia, sick sinus syndrome, and chronic valvular disease back in December 2011. I last saw the patient in June 2012 for vaccines and July 2012 for otitis.
I have in the past required a blood pressure q 6 months for amlodipine refill.
The o first said she had too much stress to come at 6 months for a bp (seemed legitimate) so we gave a grace period of 2 months. Now she wants to wait until June 2013 because what is another 2 months?
Regretably, I practice where I live (mistake one) and my kids go to school with my clients kids (mistake two) and this patient is my accountant's dog (wife is the problem--husband may be ok--mistake three). Therefore, I regularly practice how to graciously and firmly tow the line. I am currently weathered as we just battled a lot of this post holiday season (when the credit card bills come in).
Any help on how to graciously and medically approach this situation? I need a boost!
☼ | Do you know what technique was used to measure bp? | Where do they obtain the bg samples? |
Hi All,
I am writing with the need for some support regarding recommendations/requirements for refills of amlodipine. I have a patient who is a 10 year old SF Cockapoo who has been to the cardiologist and confirmed diagnosis of the following: Second Degree AV Block, First Degree AV block, Systemic hypertension, supraventricular tachycardia, sick sinus syndrome, and chronic valvular disease back in December 2011. I last saw the patient in June 2012 for vaccines and July 2012 for otitis.
I have in the past required a blood pressure q 6 months for amlodipine refill.
The o first said she had too much stress to come at 6 months for a bp (seemed legitimate) so we gave a grace period of 2 months. Now she wants to wait until June 2013 because what is another 2 months?
Regretably, I practice where I live (mistake one) and my kids go to school with my clients kids (mistake two) and this patient is my accountant's dog (wife is the problem--husband may be ok--mistake three). Therefore, I regularly practice how to graciously and firmly tow the line. I am currently weathered as we just battled a lot of this post holiday season (when the credit card bills come in).
Any help on how to graciously and medically approach this situation? I need a boost!
☼ | Do you know the numbers? | Are you sure it is pu/pd and not incontinence issues? |
Hi All,
I am writing with the need for some support regarding recommendations/requirements for refills of amlodipine. I have a patient who is a 10 year old SF Cockapoo who has been to the cardiologist and confirmed diagnosis of the following: Second Degree AV Block, First Degree AV block, Systemic hypertension, supraventricular tachycardia, sick sinus syndrome, and chronic valvular disease back in December 2011. I last saw the patient in June 2012 for vaccines and July 2012 for otitis.
I have in the past required a blood pressure q 6 months for amlodipine refill.
The o first said she had too much stress to come at 6 months for a bp (seemed legitimate) so we gave a grace period of 2 months. Now she wants to wait until June 2013 because what is another 2 months?
Regretably, I practice where I live (mistake one) and my kids go to school with my clients kids (mistake two) and this patient is my accountant's dog (wife is the problem--husband may be ok--mistake three). Therefore, I regularly practice how to graciously and firmly tow the line. I am currently weathered as we just battled a lot of this post holiday season (when the credit card bills come in).
Any help on how to graciously and medically approach this situation? I need a boost!
☼ | Do you know if anyone has ever looked for end-organ damage in this dog (usually evidence of hypertensive retinopathy)? | I.e. was it checked 10 times over 3 hours or over 3 days? |
I need help for a family with a diabetic cat. It gets complicated because the diabetic cat shares the house with 20 other very well-cared for kitties. The diabetic cat was feral and is hard to separate from the others. She would not eat if they were to separate her from the other kitties. For the past 4 months they have been feeding all the cats dry DM and are spending over $150 per week on cat food just so the diabetic cat can benefit from the prescription food.
Is there a commercial brand of dry food that might help the diabetic kitty without breaking the bank? Again they cannot separate her to feed her a separate meal.
Thanks for your help.
☼ | That is a challenge ! will something like natura evo be cost effective for them? | So she also had a dry clogged nare on the same side? |
I need help for a family with a diabetic cat. It gets complicated because the diabetic cat shares the house with 20 other very well-cared for kitties. The diabetic cat was feral and is hard to separate from the others. She would not eat if they were to separate her from the other kitties. For the past 4 months they have been feeding all the cats dry DM and are spending over $150 per week on cat food just so the diabetic cat can benefit from the prescription food.
Is there a commercial brand of dry food that might help the diabetic kitty without breaking the bank? Again they cannot separate her to feed her a separate meal.
Thanks for your help.
☼ | Otherwise, maybe just a kitten diet will suit the household? | What is the frequency of regurgitation in this patient and does this cat have a history of chronic, intermittent vomiting of digested food, fluid and/or hair? |
How do you treat medullary washout? I have a well controlled diabetic who presented recently for sudden onset of polyuria. Urine sp gr. was 1.001 and it increased to 1.018 with an overnight water deprivation. That seems to me to rule out Diabetes Insipidus and renal disease and his liver enzymes albumin and bun were all within normal limits on his chem panel. IF this is medullary washout out how can I treat it?
JK
(☼ | Did the panel include electrolytes? | Did the la look subjectively big? |
We saw "Roxie", a 14yo F(s), Terr-x, bw= 13#,about 2 weeks ago with presenting complaint of lethargy, decreased appetite and diarrhea.
Bloodwork revealed AKD with following values:
BUN 275 n=7-28
Creat 33.4 n=1.5
T prot 5.4 n= 5.3-7.7
alb 2.5 n= 2.5-4.3
phos 28.7 n=2.0-5.9
Ca= 7.5 n=8.0-11.2
Na 114 n=135-150
K 15.9 n=2.8-5.5
USG 1.020, 2+ prot, no inflammation, c&s negative
We treated with iv/supportive care for 48 hours, I did add Prednisolone 5mg sid for this period. Two days later bun, creat, phos and electrolytes had returned to normal and her clinical response was exct.
I had the lab check her cortisol levels from both submissions and cortisol levels were high normal and slightly elevated on the latter submission. I then had the client discontinue Prednisolone for 72 hours and performed acth response test with requests for cortisol and aldosterone to DCPAH.
Test results
Cortisol
Baseline = 3 (n=15-110nmol/L)
1hr post acth= 177 (n=220-550nmol/L)
Aldosterone
Baseline 0 (n=14-957 pmol/L)
1 hr post acth= 27 (n=197-2103pmol/L)
So.........based on above, esp some cortisol response with acth, we can;'t really say she's Addison's, right? I don't really know how to explain depressed aldosterone as well. I understand there are some diseases in humans, not well documented in dogs involving infiltration of kidneys ( glomerular level?) which predisposes them an Addison's crisis,etc. But where I'm at in this workup is I can't explain this dog's presentation with respect to pre-renal causes ( hypovolemic/cardiac issues,etc ) , no severe gi involvement,etc. Chest and abdominal films were unremarkable.
Today, my plan is to check her lytes, bun/creat then withdraw the sid dose of 2.5mg prednisolone gradually over the next two weeks. then recheck these numbers again. In the meantime, it would be nice if I could come up with a reasonable explanation/much less plan for this dog's issues.
Any input would be greatly appreciated.
☼ | Did you mean adrenal gland? | Do you mind posting the complete culture results? |
We saw "Roxie", a 14yo F(s), Terr-x, bw= 13#,about 2 weeks ago with presenting complaint of lethargy, decreased appetite and diarrhea.
Bloodwork revealed AKD with following values:
BUN 275 n=7-28
Creat 33.4 n=1.5
T prot 5.4 n= 5.3-7.7
alb 2.5 n= 2.5-4.3
phos 28.7 n=2.0-5.9
Ca= 7.5 n=8.0-11.2
Na 114 n=135-150
K 15.9 n=2.8-5.5
USG 1.020, 2+ prot, no inflammation, c&s negative
We treated with iv/supportive care for 48 hours, I did add Prednisolone 5mg sid for this period. Two days later bun, creat, phos and electrolytes had returned to normal and her clinical response was exct.
I had the lab check her cortisol levels from both submissions and cortisol levels were high normal and slightly elevated on the latter submission. I then had the client discontinue Prednisolone for 72 hours and performed acth response test with requests for cortisol and aldosterone to DCPAH.
Test results
Cortisol
Baseline = 3 (n=15-110nmol/L)
1hr post acth= 177 (n=220-550nmol/L)
Aldosterone
Baseline 0 (n=14-957 pmol/L)
1 hr post acth= 27 (n=197-2103pmol/L)
So.........based on above, esp some cortisol response with acth, we can;'t really say she's Addison's, right? I don't really know how to explain depressed aldosterone as well. I understand there are some diseases in humans, not well documented in dogs involving infiltration of kidneys ( glomerular level?) which predisposes them an Addison's crisis,etc. But where I'm at in this workup is I can't explain this dog's presentation with respect to pre-renal causes ( hypovolemic/cardiac issues,etc ) , no severe gi involvement,etc. Chest and abdominal films were unremarkable.
Today, my plan is to check her lytes, bun/creat then withdraw the sid dose of 2.5mg prednisolone gradually over the next two weeks. then recheck these numbers again. In the meantime, it would be nice if I could come up with a reasonable explanation/much less plan for this dog's issues.
Any input would be greatly appreciated.
☼ | Is the dog doing ok now? | Abd us? |
We have a diabetic, geriatric cat with mandibular bone loss which was found on dental xray. We sent off biopsies that came back as infectious/inflammatory. I am still concerned that it may be cancer. Any thoughts? Thanks, ☼ | Did you get bone with the biopsy? | Is it possible to get a complete bg curve? |
Hello,
I would really appreciate some help in managing this diabetic patient. LB is a 9yo FS Husky x. She was diagnosed with DM March 2012 and treated with Caninsulin & w/d dry diet. I took over her care in May 2012 and at that time, she was already blind with mature cataracts and was significantly pu/pd. Her initial screening blood work was WNL except for hyperglycemia and glucosuria. I added a urine c/s which was negative. I recommended ophtho referral but the clients declined since the cataracts were quiet and LB seemed to be coping well.
I changed her monitoring to home glucose curves and ensured the accuracy of the client's glucometer. I have attached all of the home curves (12) for completeness but am primarily concerned with the ones starting Jan2013.
She had been started on a low dose of Caninsulin so I worked on gradually increasing the dose. For the first curve she had been on ~0.5U/kg bid for 7d. For the last Caninsulin curves, she was receiving 1U/kg bid. NPH was started at just under 0.5Ukg/bid. LB is currently 27kg and has ranged b/w 25-27kg over the time of these curves.
LB was showing significant post-prandial spikes so I asked the clients to give insulin 30-45 minutes before feeding but they would often forget or even do it in reverse, giving the insulin 30 minutes after feeding. I worked out her DER and emphasized following the recommended amounts.
Working on the management of her DM was interrupted through the fall because LB developed severe lens-induced uveitis requiring enucleation of one eye and phaco/lens implant in the other eye. She developed some complications and was on prednisone topically until the end of January.
So, I am still working to get her on track with her DM. Generally she has been well through all this time with clients reporting no pu/pd, good appetite, stable weight etc. However I was unhappy with her curves specifically that the nadir was consistently ~10hrs and never went into the ideal range, the insulin seemed to last too long etc. I decided to change from Canininsulin to NPH in February but as the curves show, no improvement in time of action or duration was noted. I realize the insulins are similar but have found some dogs do better on one than the other --not the case here though!
I would love some input on what to do next. I'm confident that clients are handling the insulin properly and administering it properly (based on Sherri's recommendations). I suspect Levamir might be worth a try but I haven't used it yet and want to be sure before I recommend another change.
Although LB has never had a good curve, the clients reported no pu/pd, however since starting the NPH they are seeing 2-3x increase in thirst & urination, which is compatible with the high glucose readings. It's just interesting that she's had high readings before but the clients subjectively thought she was doing well. I will be repeating CBC/Chem/UA & CS next week.
Thanks for any input and helping LB!
☼ | So she's no longer on any topical steroids in her eyes? | How long ago was the last chem screen? |
I know many clinics and hospitals have seen hard times, some VERY hard times. When I know the source of a client drain, I want to fix it. I just wanted to run this by and ask for opinions: am I way off base and sour grapes, do my concerns have any validity, would it be of benefit to any party to try to do something about it?
I had clients with 2 tiny dogs, both of whom had been Dx'ed with epilepsy (~3 y) but started meds ~ 9 y. A previous associate saw them. They always had subtherapeutic levels on phenobarb levels, but the o's wanted to stay where they were on dosing, since they never want to have another seizure again. OK, fine, if the low dose was working, OK. Anyway, my ex-associate was very "lenient" on requiring monitoring bloodwork per the standard of care at our hospital, would prescribe a year's worth at one time for each dog, etc.
When she left, I saw them. Tried to explain that if the phenobarb levels are subtherapeutic and they are not having seizures, that they don't need to be on it. They insisted. So I required bloodwork monitoring as per standard of care. They didn't like that--suddenly they were spending more because they did not skip tests, etc. Furthermore, I would only dispense for 2 months, which I believe is the law in human medicine with controlled substances, would also be vet because a controlled substance is a controlled substance (please correct me if I'm wrong). They became unpleasant and noncompliant. During a phone conversation for an Rx request, an ASSISTANT fired them. That's is another matter (too bad I can't elaborate to make sure her attitude leading to her actions didn't happen to someone else).
They asked for their records to be faxed to one animal hospital, but are now at another. Good riddence. Now, the fun part: they run a nel fairly nearby and we had always had a good relationship (many dogs routinely went home with URI's +/- diarrhea). It is a family business.
Apparently they all go to the third vet in the area. One of my good clients contacted me and said she loved us and we had really helped her dog and thought we were wonderful, but that she was going to change to the third vet, since they plan on more boarding and daycare at the other nel, they want to go with the vet the nel "works with". Now, we have always allowed nonpatients to board as long as they were UTD on all their preventatives. Likewise, since they are not a veterinary practice, many of their guests came to us.
I think it's incredibly unprofessional to take actively take established clients away because of personal issues. Not that they are held to any professional standards like we are. Of course, the clients can go anywhere they like, but if they like us and are advised to change vets because of some "arrangement" with another vet, real or not, I really feel that's terrible.
Sorry for the long background, any comments, advice would be appreciated, thanks,
Anon | Maybe this particular dog onle needs this small amount to control the seizures? | Are there compelling clinical signs that we feel must be treated at this time? |
"Sophie" (DSH) came in on a Saturday with a PCV 5%. Agglutination on slide was +. We did a transfusion from a tech's cat(DSH), no crossmatching. PCV was 16% 2 days later. Follow up today, PCV is 11%, non-regenerative. Coombs and PCR pending. Would blood typing at this point still be accurate? Would have to order test kits.
C. | Have you started doxycycline and prednisolone? | In this patient? |
Let me start by saying this case seems to go in lots of different directions. I maybe making a mountain out of a mole hill but I feel like I'm missing something.
Razzie is a 12 1/2 y/o, f/s 12 pound dachshund. She was diagnosed with Central diabetes insipidus in 01/2008, and has been on DDAVP since. She has had no problems since, and she does come in regularly for checkups.
The owner called on Monday and wanted to get her something for arthritis because she felt like she was having trouble getting up and down. We tried to get her to do a Senior work up which would include a full chemistry, however owner decided she could only afford a short panel. We sent her home with Novox 25mg tablets 1 SID.
Bloodwork came back: ALT 202
ALK Phos 374
BUN 37
Owner calls the next morning says she can't get her to stop vomiting. Told her about blood tests results and instructed her to stop meds. Owner brought her in that day, and upon arrival she has developed a new symptom. She is non weight bearing in left hind. She has no placing or righting reflexes in that limb, deep pain in present. I treated her with Cerenia, and famotadine but also Dex SP and DMSO IV. That night she began having odd jerking movements, of entire body. Came in the next day owner reports no vomiting and she is eating still having trouble walking on left hind. Was treated again with Dex and DMSO. Told owner to bring her in Thursday and Friday for Dex and DMSO injections. Thursday morning she came in for her injections and Thursday afternoon owner brought her back in says she is vomiting again. I pulled more blood on her and did a full work up. Today we did not give Dex and DMSO do to the blood work results.
ALT 229
AST 228
Alk Phos 416
GGTP 20
BUN 97
Phos 7.7
Na 132
Chlor 93
K 4.4
Na/K ratio 30
Lipase 2150
CPK 12726
I did put her on Tramadol and told owner to continue to rest her. I also gave her SQ fluids and sent her home on Cerenia. Would love to have put her on an IV with NaCl fluids, however owner declines do to Razzie's nature, usually Razzie is not a very good patient, especially without mom near by. Her left rear limb is improving. However this twiching/jerking that she is doing almost seems like an over reaction to stimulus. If you are standing anywhere near her and move your hand she really starts to jerk. I feel like this is why her CPK is so elevated. Now my question is what am I missing? Is this possibly an early addison case. Should we still be giving the Desmopresson? Is this just a pancreatitis type vomiting. By this way she only eats Science DIet I/D.
I feel like I am missing something, thanks for any input.
P.S. Previous to this the most recent blood work we had was 12/2008 and her liver enzymes wer actually higher then.
ALT 475
AST 69
Alk Phos 411 | What exactly did the neuro exam look like when she had no ability to move the left hind leg? | Can you post the radiographs and blood work for completeness? |
Let me start by saying this case seems to go in lots of different directions. I maybe making a mountain out of a mole hill but I feel like I'm missing something.
Razzie is a 12 1/2 y/o, f/s 12 pound dachshund. She was diagnosed with Central diabetes insipidus in 01/2008, and has been on DDAVP since. She has had no problems since, and she does come in regularly for checkups.
The owner called on Monday and wanted to get her something for arthritis because she felt like she was having trouble getting up and down. We tried to get her to do a Senior work up which would include a full chemistry, however owner decided she could only afford a short panel. We sent her home with Novox 25mg tablets 1 SID.
Bloodwork came back: ALT 202
ALK Phos 374
BUN 37
Owner calls the next morning says she can't get her to stop vomiting. Told her about blood tests results and instructed her to stop meds. Owner brought her in that day, and upon arrival she has developed a new symptom. She is non weight bearing in left hind. She has no placing or righting reflexes in that limb, deep pain in present. I treated her with Cerenia, and famotadine but also Dex SP and DMSO IV. That night she began having odd jerking movements, of entire body. Came in the next day owner reports no vomiting and she is eating still having trouble walking on left hind. Was treated again with Dex and DMSO. Told owner to bring her in Thursday and Friday for Dex and DMSO injections. Thursday morning she came in for her injections and Thursday afternoon owner brought her back in says she is vomiting again. I pulled more blood on her and did a full work up. Today we did not give Dex and DMSO do to the blood work results.
ALT 229
AST 228
Alk Phos 416
GGTP 20
BUN 97
Phos 7.7
Na 132
Chlor 93
K 4.4
Na/K ratio 30
Lipase 2150
CPK 12726
I did put her on Tramadol and told owner to continue to rest her. I also gave her SQ fluids and sent her home on Cerenia. Would love to have put her on an IV with NaCl fluids, however owner declines do to Razzie's nature, usually Razzie is not a very good patient, especially without mom near by. Her left rear limb is improving. However this twiching/jerking that she is doing almost seems like an over reaction to stimulus. If you are standing anywhere near her and move your hand she really starts to jerk. I feel like this is why her CPK is so elevated. Now my question is what am I missing? Is this possibly an early addison case. Should we still be giving the Desmopresson? Is this just a pancreatitis type vomiting. By this way she only eats Science DIet I/D.
I feel like I am missing something, thanks for any input.
P.S. Previous to this the most recent blood work we had was 12/2008 and her liver enzymes wer actually higher then.
ALT 475
AST 69
Alk Phos 411 | Patellar reflex? | Can i see a few curves? |
Let me start by saying this case seems to go in lots of different directions. I maybe making a mountain out of a mole hill but I feel like I'm missing something.
Razzie is a 12 1/2 y/o, f/s 12 pound dachshund. She was diagnosed with Central diabetes insipidus in 01/2008, and has been on DDAVP since. She has had no problems since, and she does come in regularly for checkups.
The owner called on Monday and wanted to get her something for arthritis because she felt like she was having trouble getting up and down. We tried to get her to do a Senior work up which would include a full chemistry, however owner decided she could only afford a short panel. We sent her home with Novox 25mg tablets 1 SID.
Bloodwork came back: ALT 202
ALK Phos 374
BUN 37
Owner calls the next morning says she can't get her to stop vomiting. Told her about blood tests results and instructed her to stop meds. Owner brought her in that day, and upon arrival she has developed a new symptom. She is non weight bearing in left hind. She has no placing or righting reflexes in that limb, deep pain in present. I treated her with Cerenia, and famotadine but also Dex SP and DMSO IV. That night she began having odd jerking movements, of entire body. Came in the next day owner reports no vomiting and she is eating still having trouble walking on left hind. Was treated again with Dex and DMSO. Told owner to bring her in Thursday and Friday for Dex and DMSO injections. Thursday morning she came in for her injections and Thursday afternoon owner brought her back in says she is vomiting again. I pulled more blood on her and did a full work up. Today we did not give Dex and DMSO do to the blood work results.
ALT 229
AST 228
Alk Phos 416
GGTP 20
BUN 97
Phos 7.7
Na 132
Chlor 93
K 4.4
Na/K ratio 30
Lipase 2150
CPK 12726
I did put her on Tramadol and told owner to continue to rest her. I also gave her SQ fluids and sent her home on Cerenia. Would love to have put her on an IV with NaCl fluids, however owner declines do to Razzie's nature, usually Razzie is not a very good patient, especially without mom near by. Her left rear limb is improving. However this twiching/jerking that she is doing almost seems like an over reaction to stimulus. If you are standing anywhere near her and move your hand she really starts to jerk. I feel like this is why her CPK is so elevated. Now my question is what am I missing? Is this possibly an early addison case. Should we still be giving the Desmopresson? Is this just a pancreatitis type vomiting. By this way she only eats Science DIet I/D.
I feel like I am missing something, thanks for any input.
P.S. Previous to this the most recent blood work we had was 12/2008 and her liver enzymes wer actually higher then.
ALT 475
AST 69
Alk Phos 411 | Withdrawal reflex? | Also, what was cell morphology like? |
Let me start by saying this case seems to go in lots of different directions. I maybe making a mountain out of a mole hill but I feel like I'm missing something.
Razzie is a 12 1/2 y/o, f/s 12 pound dachshund. She was diagnosed with Central diabetes insipidus in 01/2008, and has been on DDAVP since. She has had no problems since, and she does come in regularly for checkups.
The owner called on Monday and wanted to get her something for arthritis because she felt like she was having trouble getting up and down. We tried to get her to do a Senior work up which would include a full chemistry, however owner decided she could only afford a short panel. We sent her home with Novox 25mg tablets 1 SID.
Bloodwork came back: ALT 202
ALK Phos 374
BUN 37
Owner calls the next morning says she can't get her to stop vomiting. Told her about blood tests results and instructed her to stop meds. Owner brought her in that day, and upon arrival she has developed a new symptom. She is non weight bearing in left hind. She has no placing or righting reflexes in that limb, deep pain in present. I treated her with Cerenia, and famotadine but also Dex SP and DMSO IV. That night she began having odd jerking movements, of entire body. Came in the next day owner reports no vomiting and she is eating still having trouble walking on left hind. Was treated again with Dex and DMSO. Told owner to bring her in Thursday and Friday for Dex and DMSO injections. Thursday morning she came in for her injections and Thursday afternoon owner brought her back in says she is vomiting again. I pulled more blood on her and did a full work up. Today we did not give Dex and DMSO do to the blood work results.
ALT 229
AST 228
Alk Phos 416
GGTP 20
BUN 97
Phos 7.7
Na 132
Chlor 93
K 4.4
Na/K ratio 30
Lipase 2150
CPK 12726
I did put her on Tramadol and told owner to continue to rest her. I also gave her SQ fluids and sent her home on Cerenia. Would love to have put her on an IV with NaCl fluids, however owner declines do to Razzie's nature, usually Razzie is not a very good patient, especially without mom near by. Her left rear limb is improving. However this twiching/jerking that she is doing almost seems like an over reaction to stimulus. If you are standing anywhere near her and move your hand she really starts to jerk. I feel like this is why her CPK is so elevated. Now my question is what am I missing? Is this possibly an early addison case. Should we still be giving the Desmopresson? Is this just a pancreatitis type vomiting. By this way she only eats Science DIet I/D.
I feel like I am missing something, thanks for any input.
P.S. Previous to this the most recent blood work we had was 12/2008 and her liver enzymes wer actually higher then.
ALT 475
AST 69
Alk Phos 411 | Sciatic reflex? | Are traditional approaches such as food allergy trials, coricosteroids, doxycycline, and atopica not working? |
Let me start by saying this case seems to go in lots of different directions. I maybe making a mountain out of a mole hill but I feel like I'm missing something.
Razzie is a 12 1/2 y/o, f/s 12 pound dachshund. She was diagnosed with Central diabetes insipidus in 01/2008, and has been on DDAVP since. She has had no problems since, and she does come in regularly for checkups.
The owner called on Monday and wanted to get her something for arthritis because she felt like she was having trouble getting up and down. We tried to get her to do a Senior work up which would include a full chemistry, however owner decided she could only afford a short panel. We sent her home with Novox 25mg tablets 1 SID.
Bloodwork came back: ALT 202
ALK Phos 374
BUN 37
Owner calls the next morning says she can't get her to stop vomiting. Told her about blood tests results and instructed her to stop meds. Owner brought her in that day, and upon arrival she has developed a new symptom. She is non weight bearing in left hind. She has no placing or righting reflexes in that limb, deep pain in present. I treated her with Cerenia, and famotadine but also Dex SP and DMSO IV. That night she began having odd jerking movements, of entire body. Came in the next day owner reports no vomiting and she is eating still having trouble walking on left hind. Was treated again with Dex and DMSO. Told owner to bring her in Thursday and Friday for Dex and DMSO injections. Thursday morning she came in for her injections and Thursday afternoon owner brought her back in says she is vomiting again. I pulled more blood on her and did a full work up. Today we did not give Dex and DMSO do to the blood work results.
ALT 229
AST 228
Alk Phos 416
GGTP 20
BUN 97
Phos 7.7
Na 132
Chlor 93
K 4.4
Na/K ratio 30
Lipase 2150
CPK 12726
I did put her on Tramadol and told owner to continue to rest her. I also gave her SQ fluids and sent her home on Cerenia. Would love to have put her on an IV with NaCl fluids, however owner declines do to Razzie's nature, usually Razzie is not a very good patient, especially without mom near by. Her left rear limb is improving. However this twiching/jerking that she is doing almost seems like an over reaction to stimulus. If you are standing anywhere near her and move your hand she really starts to jerk. I feel like this is why her CPK is so elevated. Now my question is what am I missing? Is this possibly an early addison case. Should we still be giving the Desmopresson? Is this just a pancreatitis type vomiting. By this way she only eats Science DIet I/D.
I feel like I am missing something, thanks for any input.
P.S. Previous to this the most recent blood work we had was 12/2008 and her liver enzymes wer actually higher then.
ALT 475
AST 69
Alk Phos 411 | No spinal pain? | Has the glucometer been checked for accuracy? |
Let me start by saying this case seems to go in lots of different directions. I maybe making a mountain out of a mole hill but I feel like I'm missing something.
Razzie is a 12 1/2 y/o, f/s 12 pound dachshund. She was diagnosed with Central diabetes insipidus in 01/2008, and has been on DDAVP since. She has had no problems since, and she does come in regularly for checkups.
The owner called on Monday and wanted to get her something for arthritis because she felt like she was having trouble getting up and down. We tried to get her to do a Senior work up which would include a full chemistry, however owner decided she could only afford a short panel. We sent her home with Novox 25mg tablets 1 SID.
Bloodwork came back: ALT 202
ALK Phos 374
BUN 37
Owner calls the next morning says she can't get her to stop vomiting. Told her about blood tests results and instructed her to stop meds. Owner brought her in that day, and upon arrival she has developed a new symptom. She is non weight bearing in left hind. She has no placing or righting reflexes in that limb, deep pain in present. I treated her with Cerenia, and famotadine but also Dex SP and DMSO IV. That night she began having odd jerking movements, of entire body. Came in the next day owner reports no vomiting and she is eating still having trouble walking on left hind. Was treated again with Dex and DMSO. Told owner to bring her in Thursday and Friday for Dex and DMSO injections. Thursday morning she came in for her injections and Thursday afternoon owner brought her back in says she is vomiting again. I pulled more blood on her and did a full work up. Today we did not give Dex and DMSO do to the blood work results.
ALT 229
AST 228
Alk Phos 416
GGTP 20
BUN 97
Phos 7.7
Na 132
Chlor 93
K 4.4
Na/K ratio 30
Lipase 2150
CPK 12726
I did put her on Tramadol and told owner to continue to rest her. I also gave her SQ fluids and sent her home on Cerenia. Would love to have put her on an IV with NaCl fluids, however owner declines do to Razzie's nature, usually Razzie is not a very good patient, especially without mom near by. Her left rear limb is improving. However this twiching/jerking that she is doing almost seems like an over reaction to stimulus. If you are standing anywhere near her and move your hand she really starts to jerk. I feel like this is why her CPK is so elevated. Now my question is what am I missing? Is this possibly an early addison case. Should we still be giving the Desmopresson? Is this just a pancreatitis type vomiting. By this way she only eats Science DIet I/D.
I feel like I am missing something, thanks for any input.
P.S. Previous to this the most recent blood work we had was 12/2008 and her liver enzymes wer actually higher then.
ALT 475
AST 69
Alk Phos 411 | All else was normal in the other limbs, anal tone, cranial nerves, etc? | Is this a spayed female? |
I have been trying to sift through all of the information on VIN in regards to appropriate OTC DRY foods for cats (I realize that the ideal diet is entirely canned).
Can someone please help me out and give me the names of some OTC DRY cat foods that you recommend for diabetic cats? Evo? | What conditions are you treating with these special diets? | Does obesity --- diabetes in dogs? |
My patient is an 18 kg sheltie with elevated cholesterol and triglycerides. The rest of his blood work is normal, including a thyroid panel.
He is currently on omega 3's (20mg/kg/day) and Royal Canin low fat diet. Fasting triglycerides and cholesterol are still high.
I will increase his omegas to 30 mg/kg/day and plan to start chitosan.
It is difficult finding a recommended dose of chitosan. Is 500mg BID 30 minutes before the meal a reasonable dose for a dog of this size?
Thanks. | How high are his tg's and cholesterol level on the rc low-fat diet and omega-3 fatty acids? | Also, why doxy and why a month? |
My patient is an 18 kg sheltie with elevated cholesterol and triglycerides. The rest of his blood work is normal, including a thyroid panel.
He is currently on omega 3's (20mg/kg/day) and Royal Canin low fat diet. Fasting triglycerides and cholesterol are still high.
I will increase his omegas to 30 mg/kg/day and plan to start chitosan.
It is difficult finding a recommended dose of chitosan. Is 500mg BID 30 minutes before the meal a reasonable dose for a dog of this size?
Thanks. | Has he been checked for hypot4 (pretty common in this breed)? | Thoracic radiographs performed if this is true regurgitation versus vomiting? |
Dear Doctor
This is Bart. | I noted the high alp, alt and total bili and the glucose urine which i thought maybe stress? | Does im injection result in better absorption? |
Hi -
I have an 11 y.o. FS lab, diagnosed with DM 6 mo ago.
I feel like she is getting a lot of insulin right now and we still have poor control of the DM.
Overall the P is doing fine, but still PU, PD and continues to loose wt.
She is a 59 pound dog, getting 16 u insulin BID - which has been gradually increased over the last 6 months. She is also on W/D diet.
Blood work 2 months ago shows ALT 156 (mildly elevated) and ALKP 819 (was greater than 4000 for this dog 1 yr ago) and PCV 36% - everything else was normal.
Urine Culture was Negative several months ago.
An in-hospital b.g. curve yesterday showed the following: O gave insulin and fed her at home at 8 am:
9am - 425, 11 am - 383, 1 pm - 520, 3 pm - 431, 5 pm - 377
Is it ok to continue increasing this dog's insulin? The owner is following all proper handling and care for the insulin.
Should I look for other causes of insulin resistance?
Thanks for your help | Is it nph that you're using? | Is there any way that tyke can be hospitalized for the optimal care he needs? |
Thanks for your help!
We have a 10 year old spayed mixed breed patient who is well regulated for diabetes and hyperadrenocorticism on Vetoryl and NPH. we just removed a Grade III mast cell tumor from the chest - margins were clean, but varied from 3 - 6 mm. This owner lost another dog within the last year to an aggressive, metastatic MCT and so we are trying to get a game plan together ASAP.
Assuming no evidence of spread on staging, is there any value to vinblastine alone? Would you consider Palladia instead? Any advice on interactions of chemo meds with Cushings and glucose regulation? | I assume that you mean, in the absence of prednisone administration, given the endocrine diseases? | What is the sugar content and the carbohydrate content? |
I have a 12 year old 12 1/2 pound mn dsh with poorly controlled diabetes and severe proteinuria. Current dose inuslin is 6 units PZI bid and eats 1/2 can DM am and pm and gets 1/4 cup dry DM midday. Cat is losing weight, hungry, pupd but very active and content. Current labs fructosamine 800, BUN 45, albumin 4.5 and severe proteinuria(upc almost 20). Treated with convenia and enalapril 2.5 mg sid most recently. Appreciate feedback on whether to change to glargine or go even higher with the PZI and what to do with the diet relative to the PLN. Stay with high protein because of diabetes or change to renal diet to help protect kidneys? BP normal at 145. Cat has been diabetic since July of 2012 and has never been extremely well controlled but was reasonably controlled and not losing weight until last couple months. Thyroid was not even suspicious at 1.4 but cat does have a murmur and gallop rhythm. Most recent in hospital curve glucose never went below 280. | What is kitty's phosphorus and creatinine at this time? | What diet is the cat receiving? |
I have a 12 year old 12 1/2 pound mn dsh with poorly controlled diabetes and severe proteinuria. Current dose inuslin is 6 units PZI bid and eats 1/2 can DM am and pm and gets 1/4 cup dry DM midday. Cat is losing weight, hungry, pupd but very active and content. Current labs fructosamine 800, BUN 45, albumin 4.5 and severe proteinuria(upc almost 20). Treated with convenia and enalapril 2.5 mg sid most recently. Appreciate feedback on whether to change to glargine or go even higher with the PZI and what to do with the diet relative to the PLN. Stay with high protein because of diabetes or change to renal diet to help protect kidneys? BP normal at 145. Cat has been diabetic since July of 2012 and has never been extremely well controlled but was reasonably controlled and not losing weight until last couple months. Thyroid was not even suspicious at 1.4 but cat does have a murmur and gallop rhythm. Most recent in hospital curve glucose never went below 280. | Urine specific gravity? | Do we only have the skin signs now? |
Our pre-sample for an ACTH stim using the IV cortrosyn was spilled during transfer to a dry tube off the clot. We have already given the cortrosyn. How long do we have to wait to draw a new pre sample? | Are you doing the stim to monitor lysodren/trilostane or is this a screening test for cushing's or addison's? | Are the central lines also being used for other things? |
Hi,
Flipper is a 14 year old MN DSH who has been diabetic for over 3 years. He has been regulated nicely on 5 iu caninsulin BID.
Flipper caught a bird in the garage 3 days ago and then limped on his front right limb for a few hours. The owner then noticed him not turning to his right. He will walk straight and turn corners to the left but will not turn to his right, preferring to spin around to his left.
Blood glucose levels at time of exam were elevated . He is eating and drinking well and appears to have good strength.
The retinas appear to be intact . He does not appear to have a very good menace response in his right eye and left eye when done separately(it is intermittent in that sometimes he has a menace and sometimes he doesn't)
Blood work is pending
A referral to a neurologist and soft tissue imaging is not a possibility here.
Could you help us with a list of rule outs and possible treatments?
Please let us know,
Thanks | Could you report the findings of a complete neurological examination including: mentation, proprioception, postural reactions and peripheral reflexes and cranial nerves to us please? | Do you have a fasted cholesterol and tg? |
hi
obese cat, 18 lbs 6 ur male neutered. seen last year for the first time.
in 2010- per owner and records- blocked, xray done- no surgery. i have no xrays or urine tests to go by
placed s/o dry been fine since then.
Was thinking of putting cat on canned metobolic diet or a diabetic diet for weight loss, what are your thoughts? Should i do a ua see how things are going,.. he is a 28 lbs cat I dont know if i will be able to a sterile sample.
thanks | What amount of canned and dry s/o is this behemoth (i hope he's not named "tiny"!) currently eating? | Is she still apparently incontinent? |
hi
obese cat, 18 lbs 6 ur male neutered. seen last year for the first time.
in 2010- per owner and records- blocked, xray done- no surgery. i have no xrays or urine tests to go by
placed s/o dry been fine since then.
Was thinking of putting cat on canned metobolic diet or a diabetic diet for weight loss, what are your thoughts? Should i do a ua see how things are going,.. he is a 28 lbs cat I dont know if i will be able to a sterile sample.
thanks | Is this a multiple cat household? | Glargine? |
Hello! I have a 15 year old MN cat that we diagnosed with diabetes in March 2013. The patient weighs 13 pounds and PE is wnl. His initial BG was 410. Rest of bloodwork consisted of ALT 452, cholesterol 321, rest wnl. USG was 1.042 and sediment was quiet (did not culture yet).
We started the pt. on lantus 1 unit BIDand have had the client check BGs weekly since (still high at every check). We last checked on Saturday and the BG was 668 (owner noticing more pu/pd at home) but pt eating well. The cat is up to 5 units lantus BID.
The owner has the patient on DM but the cat only eats consistently overnight. He will eat a couple treats for her in AM so she can give insulin. I grilled her the other day and asked about schedule and she hasn;t been great about keeping to every 12 hours. She will give at 6 am then 9 pm.
I am just wondering if I should switch to another insulin even though from my understanding lantus is #1 choice in cats.....
Any help would be appreciated! Thanks!! | Is the client able to gauge the amount of food that is eaten over the course of 24 hours? | Has the owner's glucometer been checked for accuracy? |
Hello! I have a 15 year old MN cat that we diagnosed with diabetes in March 2013. The patient weighs 13 pounds and PE is wnl. His initial BG was 410. Rest of bloodwork consisted of ALT 452, cholesterol 321, rest wnl. USG was 1.042 and sediment was quiet (did not culture yet).
We started the pt. on lantus 1 unit BIDand have had the client check BGs weekly since (still high at every check). We last checked on Saturday and the BG was 668 (owner noticing more pu/pd at home) but pt eating well. The cat is up to 5 units lantus BID.
The owner has the patient on DM but the cat only eats consistently overnight. He will eat a couple treats for her in AM so she can give insulin. I grilled her the other day and asked about schedule and she hasn;t been great about keeping to every 12 hours. She will give at 6 am then 9 pm.
I am just wondering if I should switch to another insulin even though from my understanding lantus is #1 choice in cats.....
Any help would be appreciated! Thanks!! | Is this patient obese? | Dehydrated? |
Hello! I have a 15 year old MN cat that we diagnosed with diabetes in March 2013. The patient weighs 13 pounds and PE is wnl. His initial BG was 410. Rest of bloodwork consisted of ALT 452, cholesterol 321, rest wnl. USG was 1.042 and sediment was quiet (did not culture yet).
We started the pt. on lantus 1 unit BIDand have had the client check BGs weekly since (still high at every check). We last checked on Saturday and the BG was 668 (owner noticing more pu/pd at home) but pt eating well. The cat is up to 5 units lantus BID.
The owner has the patient on DM but the cat only eats consistently overnight. He will eat a couple treats for her in AM so she can give insulin. I grilled her the other day and asked about schedule and she hasn;t been great about keeping to every 12 hours. She will give at 6 am then 9 pm.
I am just wondering if I should switch to another insulin even though from my understanding lantus is #1 choice in cats.....
Any help would be appreciated! Thanks!! | Bcs? | Any invasion or metastasis? |
Hello! I have a 15 year old MN cat that we diagnosed with diabetes in March 2013. The patient weighs 13 pounds and PE is wnl. His initial BG was 410. Rest of bloodwork consisted of ALT 452, cholesterol 321, rest wnl. USG was 1.042 and sediment was quiet (did not culture yet).
We started the pt. on lantus 1 unit BIDand have had the client check BGs weekly since (still high at every check). We last checked on Saturday and the BG was 668 (owner noticing more pu/pd at home) but pt eating well. The cat is up to 5 units lantus BID.
The owner has the patient on DM but the cat only eats consistently overnight. He will eat a couple treats for her in AM so she can give insulin. I grilled her the other day and asked about schedule and she hasn;t been great about keeping to every 12 hours. She will give at 6 am then 9 pm.
I am just wondering if I should switch to another insulin even though from my understanding lantus is #1 choice in cats.....
Any help would be appreciated! Thanks!! | Any history of gi-related signs? | Would it be true that when he was noticed to have a yeast otitis on 1/14 that he was put on a topical ear med that has steroids in it? |
Hello! I have a 15 year old MN cat that we diagnosed with diabetes in March 2013. The patient weighs 13 pounds and PE is wnl. His initial BG was 410. Rest of bloodwork consisted of ALT 452, cholesterol 321, rest wnl. USG was 1.042 and sediment was quiet (did not culture yet).
We started the pt. on lantus 1 unit BIDand have had the client check BGs weekly since (still high at every check). We last checked on Saturday and the BG was 668 (owner noticing more pu/pd at home) but pt eating well. The cat is up to 5 units lantus BID.
The owner has the patient on DM but the cat only eats consistently overnight. He will eat a couple treats for her in AM so she can give insulin. I grilled her the other day and asked about schedule and she hasn;t been great about keeping to every 12 hours. She will give at 6 am then 9 pm.
I am just wondering if I should switch to another insulin even though from my understanding lantus is #1 choice in cats.....
Any help would be appreciated! Thanks!! | Recent negative urine culture? | Can you post the actual cbc/chem? |
Hello! I have a 15 year old MN cat that we diagnosed with diabetes in March 2013. The patient weighs 13 pounds and PE is wnl. His initial BG was 410. Rest of bloodwork consisted of ALT 452, cholesterol 321, rest wnl. USG was 1.042 and sediment was quiet (did not culture yet).
We started the pt. on lantus 1 unit BIDand have had the client check BGs weekly since (still high at every check). We last checked on Saturday and the BG was 668 (owner noticing more pu/pd at home) but pt eating well. The cat is up to 5 units lantus BID.
The owner has the patient on DM but the cat only eats consistently overnight. He will eat a couple treats for her in AM so she can give insulin. I grilled her the other day and asked about schedule and she hasn;t been great about keeping to every 12 hours. She will give at 6 am then 9 pm.
I am just wondering if I should switch to another insulin even though from my understanding lantus is #1 choice in cats.....
Any help would be appreciated! Thanks!! | I appreciate that it's time consuming, but can you post a few curves? | Or spot checks? |
Hello! I have a 15 year old MN cat that we diagnosed with diabetes in March 2013. The patient weighs 13 pounds and PE is wnl. His initial BG was 410. Rest of bloodwork consisted of ALT 452, cholesterol 321, rest wnl. USG was 1.042 and sediment was quiet (did not culture yet).
We started the pt. on lantus 1 unit BIDand have had the client check BGs weekly since (still high at every check). We last checked on Saturday and the BG was 668 (owner noticing more pu/pd at home) but pt eating well. The cat is up to 5 units lantus BID.
The owner has the patient on DM but the cat only eats consistently overnight. He will eat a couple treats for her in AM so she can give insulin. I grilled her the other day and asked about schedule and she hasn;t been great about keeping to every 12 hours. She will give at 6 am then 9 pm.
I am just wondering if I should switch to another insulin even though from my understanding lantus is #1 choice in cats.....
Any help would be appreciated! Thanks!! | Have you reviewed insulin injection technique with the client and is the current vial of lantus no more than three months' old? | Could the owners be using cortisone cream on themselves that the dog is licking off? |
7 yr old, neutered feline with severe gingivitis-stomatitis, pcr & combo tested ~ negative also negative for viral & infectious diseases. BW normal, Original treatment 15mg depo im & oral abx followed 30 days later with full mouth extraction. 30 days after full mouth extraction, still has tongue ulceration only partially resolved. Complicating factor - cat becomes transiently diabetic, need alternate way to help suppress his system & control inflammation. Repeat swabs, pcr, &? Other immuno-suppressive drugs/options? | Has cytology of the lingual lesion been done? | Is is phosphorus normal? |
Numbers are pre-insulin values, just prior to feeding and giving insulin. I reduced kitty to 1/2 unit BID a couple of weeks ago because his numbers were looking so good and kind of low at times. These are his current numbers. I am wondering if I should reduce him to 1/4 unit BID or take him off altogether. He's doing great, normal drinking and urinating now. I have them feeding an all canned food diet from the list of low carb foods that is online (Fancy Feast). Thanks!
Monday
133, 134
Tuesday
141, 149
Wednesday
125, 134
Thursday
141, 98 (owner did not give any insulin when he had BG 98)
Friday
138, 109
Saturday
150,128
Sunday
136, 131 | I'm not a huge fan of judging what's going on based only on pre-insulin bg's....but it's looking pretty reasonable to try stopping the insulin and see how it goes....what i used to do is have the owner use the purina glucotest granules in the litterbox during this time...but i've heard that they may have disappeared from the market? | Did you do a bile acid stimulation test, or just resting bas? |
"Candy" Rivers is a 14 year old cat that has been in and out of remission for diabetes since 2010 with DM diet and insulin. The owner monitors BG's and dose curves at home very well. During her most recent episode, she has been tapered off insulin gradually, and the owner does curves at least once weekly and spot checks most days. The owner was giving 1/4 IU BID (she says she could measure it reliably), but Candy's curves still fell too low midday. Insulin was then discontinued, and Candy was good for a while, but her BG's eventually began to rise and were conistently in the 200's. Since then, the owner has been checking BG's daily and gives insulin when it approaches 200. This results in Candy getting about 1/4 IU once daily every other day. With this dosing, Candy seems well controlled.
I haven't had any cats managed with such a small amount of insulin, usually they're diabetic or in remission. Bloodwork and PE this past February was normal. Based on the owner's curves, however, this seems to be what Candy needs. Has anyone else had cases like this? Is there any harm in allowing the owner to give 1/4 unit PRN? Thanks.
/pDVM | What is candy's bcs? | What is the "blue" diet? |
"Candy" Rivers is a 14 year old cat that has been in and out of remission for diabetes since 2010 with DM diet and insulin. The owner monitors BG's and dose curves at home very well. During her most recent episode, she has been tapered off insulin gradually, and the owner does curves at least once weekly and spot checks most days. The owner was giving 1/4 IU BID (she says she could measure it reliably), but Candy's curves still fell too low midday. Insulin was then discontinued, and Candy was good for a while, but her BG's eventually began to rise and were conistently in the 200's. Since then, the owner has been checking BG's daily and gives insulin when it approaches 200. This results in Candy getting about 1/4 IU once daily every other day. With this dosing, Candy seems well controlled.
I haven't had any cats managed with such a small amount of insulin, usually they're diabetic or in remission. Bloodwork and PE this past February was normal. Based on the owner's curves, however, this seems to be what Candy needs. Has anyone else had cases like this? Is there any harm in allowing the owner to give 1/4 unit PRN? Thanks.
/pDVM | Does this kitty have a history of gi disease, where pancreatitis might be an issue? | Chemistry is fed or fasted? |
Good afternoon,
I started using Lantus 5 years ago in all my diabetic felines, and have been awed at how easily I was able to manage DM in cats. Until now.
Tiffany is an 8yo FS DMH with an unremarkable health history until now. Had been feeding dry food, was 10.7#. She suddenly dropped to 9# and lived by the water bowl with no energey for two weeks, until her owners brought her in. She spent so much time in the water bowl that her ventral neck hair was always wet and she developed a superficial dermatitis and lost all the hair on her ventral neck! (It is since regrowing nicely.)
She presented as a dish rag about 4 weeks ago.
Severe glucosuria, no ketones, but did have blood and protein in the urine.
VetTest
Glucose = 467
ALB = 4.0 (2.3-3.9)
Glob = 5.6 (2.8-5.1)
TBil = 1.3 (0-0.9)
Chol = 262 (65-225)
Vet stat suggests Mild respiratory alkalosis.
CBC: nsf.
We started Canned Purina DM, cat has been exclusively on this food. (O apparently gives an OTC hairball remedy, which may be high in simple carbs, so that was discontinued 2 weeks ago, when I found out.)
Started Lantus at 1 U BID. based on size (0.25 u/kg) 3 days later, BG on glucometer down to 332 as a spot check, midday. Did not change dose, and found Glucose dropped no further. Started at 373 at 8a and gradually dropped through the day to 330 at 5pm.
Since then, we have raised the insulin at 1/2 unit increments and checked a midday glucose (about 4 hours after admin) every 3 days. As the glucose has not dropped below the low 300s at any of the checks, we have continued to increase at 1/2 Unit increments.
Repeat blood a week ago had a few small changes:
Idexx Lab:
Albumin 4.4 (2.3-3.9)
TP 9.1 (5.9-8.5)
BUN 35 (15-34)
Glucose 380 (70-150)
Chloride 105 (111-125)
Urine: less blood and protein, still present. Still +++ glucose. 10-15 WBCs.
Spec fPL borderline at 4.4. (3.5 is normal)
T4 = 0.7 (0.8-4.7)
Since Friday (three days ago), Tiffany has been on Lantus 5U BID, eating 2 cans of DM per day in 4 feeds. Glucose today is 9a = 359; 12p = 383; 3p = 377. Per owner, acting better. Has put almost 1# back on. No drinking or urinating nearly so much. More active, but not normal. The owner has demonstrated administration to us and his is doing it correctly.
I've never had to go above 3 units. I don't see any reason that increasing from here will help. Could she be at an excessive dose, even with the incremental increase, testing at every 1/2 unit?
Help!
Let me know if there is any information I might need. Owners are very compliant.
Thanks, | Is there a reason why this client cannot/will not learn to do in-home blood glucose curves? | As of his last blood draw he is not neutropenic with regard to your labs norm vues right? |
Hi all,
I have a question regarding a 13 yr old cat that is on methimazole and came in "not doing well". The exam was pretty normal with the exception of an unkempt coat and foot pads that at last visit were swollen and peeling and now are very soft (saggy) with large cracks, peeling skin and redness. We ran a tapazole panel and BUN and Creat were normal, ALT was low, T4 was 1.8 ug/dL (0.6-3.6). The RBC's were normal at 7.63 but HCT was 23.4%, MCV and MCH were low. I tested iron and got 25 ug/dL (53-145 ug/dL), TIBC 273 ug/dL (226-432ug/dL), and Saturation of 8% (15-49%). I'm thinking this looks like a iron deficiency anemia. I saw Dr. Gaspar's posts regarding compounding ferrus sulfate and giving at 10mg/kg sid. Is there a chance that this will make the cat feel better clinically and how do I monitor this. Do I recheck iron levels and when?
thanks,
Dr. | How is this cat "not doing well"? | You're absolutely sure that the owners aren't using any exogenous steroids on her? |