The rock's mum needs help interpreting test results-jaundice

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phlika29

phlika29

Member Since 2014
Hi everyone

@The Rock momma's boy needs help interpreting her boy's blood test results. He was diagnosed this week with diabetes , DKA and other complications and has jaundice. This is a copy of her first post in the new member section

Currently we are on the wait and see plan. The vet said with his complications he may not make it through the weekend. They gave me numbers of local clinics that are open on the weekends, just in case. They gave me a script for an appetite stimulant. I now know how to force feed and give insulin shots. He came home form the vet yesterday with "best of luck" wishes for the weekend. Well he actually ate on his own last night AND this morning. I gave him his first shot at home and now I am terrified I gave him too much. On an empty stomach 2 days in a rown his numbers were over 400. He was on IV fluids for 2 days and a/d critical care food. Now home because the vet is closed and the budget is very tight we are watching him closely. I can give him some lunch and at dinner we give the shot again. Depending on how much he eats I am to give him 2-4 units. He was 26 lbs of a big boy. He is Maine coon sized bone structure and at 18 lbs currently looks terribly skinny. My husband and I do not let him in the bedroom at night so we slept on the couch. Rock was actually semi active jumping up and sleeping on me at least 2x through the night. He cried for food this morning and ate on his own. I am scared to sleep because he may go hypo then coma and die. He is my constant companion at home. Follows me everywhere and tolerates my husband. He has been sleeping ALL morning. I keep waking him up scared he is dead...when is it safe to take a nap? I do not have a glucose meter for him, but it is so new we are still trying to stabilize him and save his liver, he was kinda yellow/orange on the lips and ears when we brought him in.
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http://www.felinediabetes.com/FDMB/threads/the-rock-aka-big-kitty-boy.131597/

She has done really well so far this weekend and has managed to get her boy to eat, drink and been able to give insulin. The vet has advised
if he eats 1/4 of a can only 2 units, 1/2 or more 4 units
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of Novolin. Money is tight but I have suggested that she go back to the vets to follow up on the jaundice as he may need additional treatment such as antibiotics. Can members have a look at the blood test results to see if they give an indication of what may be going on. I am unsure whether jaundice occurs with DKA or whether the fact that the rock is jaundiced means some type of other liver issue.
 

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Blood glucose was high at the time the test was taken; typical for an uncontrolled diabetic. Some of the others were slightly elevated or reduced, which can be impacted some by hydration levels (was he dehydrated when the tests were taken?).

Don't see any liver tests such as ALT. ETA: turns out that is due to my vision issues. They're there somewhere Miss Myopia can't see.

For liver support, milk thistle extracts such as Denmarin and Marin can be helpful.

Not seeing anything jump out at me, but I'm not a vet.
 
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BJM said:
Blood glucose was high at the time the test was taken; typical for an uncontrolled diabetic. Some of the others were slightly elevated or reduced, which can be impacted some by hydration levels (was he dehydrated when the tests were taken?). Don't see any liver tests such as ALT.
For liver support, milk thistle extracts such as Denmarin and Marin can be helpful.

Not seeing anything jump out at me, but I'm not a vet.
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Dehydrated. The tests was run Thursday morning he did fluids for Thursday brought him home and did poorly. He then had another day of fluids at the vet on Friday along with an appetite stimulant.
 
Larry and Kitties said:
The high ALP and ALT indicate liver issues as does the high total bilirubin.
Was an urinal analysis done? With the high blood total bilirubin the urine may have a brown color and bilirubin would be positive in the dipstick reading.
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They may have done urinalysis when he was there. The vet is very good for our pocket book. They only gave me blood work papers in case he was doing poorly and we had to put him down over the weekend.
 
phlika29 said:
Hi everyone

@The Rock momma's boy needs help interpreting her boy's blood test results. He was diagnosed this week with diabetes , DKA and other complications and has jaundice.
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Thank you! I am very new to forums like this, ok this is a first for me. You guys here are so wonderful. Kitty boy has been purring and moving around, I even woke up to him staring out the window. He has not watched his favorite tv channel in a few days!!
 
Hopefully with the amount of water you have been getting into him and the food it will help to sort out some of these levels and enable his body to fight against anything else that may be going on.

First off I want to say that I am not giving advice here just passing on information that I have picked up along the way :)

If it is pancreatitis (I don't see a spec fPL test result on there and if the blood test was done in house it wouldn't be) the treatment is to issue supportive meds much has been done ie anti nausea and or anti sickness medication, fluids, pain medication,etc. http://www.idexx.co.uk/pdf/en_gb/sm...pec-fpl-treatment-for-feline-pancreatitis.pdf

It is important to continue with the regime and not to withdraw supportive meds too early.

One thing you haven't mentioned is whether the rock is moving about okay. Is he meatloafing (head down, sat all hunched up, face pinched) or is he moving freely?

If the jaundice is down to other issues related to the gall bladder or liver then other treatments can be given in addition to the supportive meds. They run from drugs that thin the bile in the gall bladder (destolite also known as Ursodeoxycholic acid) to antibiotics to kill of bacteria if the suspected cause is neutrophilic cholangitis and even steroids to suppress if lymphocytic cholangitis is suspected, etc. Remi ended up on all of the medication that has been mentioned above a couple of summers ago.

Then the diabetes itself could also affect the liver and from what I have read be a cause of jaundice. Getting rocks's blood glucose under better control will hopefully help there.

May I ask what the happened in the weeks up to his vet visit last week. Did he suddenly become unwell, did he stop eating beforehand, was he vomiting?
 
phlika29 said:
dFirst off I want to say that I am not giving advice here just passing on information that I have picked up along the way :)

One thing you haven't mentioned is whether the rock is moving about okay. Is he meatloafing (head down, sat all hunched up, face pinched) or is he moving freely?

May I ask what the happened in the weeks up to his vet visit last week. Did he suddenly become unwell, did he stop eating beforehand, was he vomiting?
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I thank you greatly for the info and understand you are not giving advice.
He is still pretty lethargic but he does move around to different places and sleep in various positions. He used to sleep a ton before he fell ill.
Hind sight his urine became different about 3 weeks ago. He slowly became uninterested in food. I was able to coax him to eat for a while, but then he would not even take treats or wet food. He has always had a crazy appetite. But he is Maine coon sized and I always cared for petite cats. My 23 year old Smokie would go through periods of not eating for a weekend or so and I would coax her to eat then she would be fine. I made an appointment when he was just barely eating, for him. There were a few times that I thought I forgot to give fresh water but hind sight he was drinking a lot too!
 
So he sort of went off his food. I don't know if this is common with diabetes as from what I have read here most cats get hungrier as there body isn't getting then energy from the food. From what you describe it does sound like he has nausea /inappetence whether this is from another co existing condition we don't know.

I do think you need to get that food and water into him and think you need to pursue that with your vet. An ongoing lack of food can cause a cat to develop hepatic lipidosis and this shows up as jaundice alongside other things and is a serious condition.

Will you be going back to the vet tomorrow? I often just speak to my vet over the phone and ask him to put out medication we discuss. If he were my cat I would ask about whether you can have an anti nausea drug to give at home on an ongoing basis such as ondansteron or alternatively another injection as per Friday as from your previous posts this did seem to help him. I would ask whether he thinks that the rock is in pain at all (this can prevent them from eating). Whether he needs ongoing subcutaneous fluids (you can do this at home).

Perhaps as he has survived the weekend they might further investigate possible other underlying conditions.

Did you manage to get ketostixs and have you managed to get a pee test from him?

You can check to see if he is dehydrated by pulling up the skin on the back of his neck. If it falls back quickly then that fine. If not then keep trying to get water into him.

Forgot to include this pancreatitis link earlier

http://www.felinediabetes.com/FDMB/threads/a-primer-on-pancreatitis.83108/
 
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They mentioned hepatic lipidosis, but since he is not doing poorly and have to be put down by today....we are going to be in contact with the vet and go from there. The vet on Friday was concerned he would deteriorate so much, we would have to consider putting him down. We have not tested at home for ketones because I started with the water every 45 min, (I understand it is probably not enough, but we He is no longer dehydrated, I pull his skin and it goes back quickly. He is very responsive to noises and his name, even when sleeping. I think they will be excited to see kitty boy on Monday. I made them a new "Happy Tails" sign for their cork board.

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The vet opens at 8:30am less than 9 hours!!!! Should I bring him in on a fast so they can do a sugar curve? It was all a blurr on Friday and they expected him to be so poor we would have to put him down. He is improving, but I feed him every 6 hours...6:30 am is breakfast must eat at least 1/4 of a can and get insulin, 12:30 pm snack what ever he eats is fine (does not eat a bunch), 6:30 pm dinner must eat 1/4 of a can and get insulin, 12:30 am snack. Suggestions?
 
I guess it depends on what you want the vets to check although I have to say i would be wary of fasting a cat with possible hepatic lipidosis. It is all about getting calories into them and then you can also give the insulin.

If sounds like the vet is not open until after you are due to feed and give the insulin and so if you want them to check how well he is doing on the current insulin dose I guess you would go ahead and feed and then shoot the dose.

Fasting would be a good idea if you think they will knock him out to X-ray /ultrasound but maybe he is still too poorly for that. The only time I have fasted remi before a vet visit is for surgical procedures otherwise I have fed and given his usual food.

Ideally you would check with the first ofcourse.
 
Just to add that a cat who is ill needs more calories than normal to recover and a cat with hepatic lipidosis needs a lot of calories so if this is suspected then he really does need as many calories as you can get into him

http://en.m.wikipedia.org/wiki/Feline_hepatic_lipidosis

What I am saying is that if he manages more than 1/4 can when you feed him that is great and if you can assist him in that with the syringe (without making him throw up) that is also good.
 
I will load up the car and call them when they open. Chances are they will want to see him. Is there a place I can go to give them recognition for their outstanding work?
 
They gave him another appetite stimulant pill. Will last 3 days and helps with nausea too! We are just trying to get full insulin shots 4 units, which means he has to eat at least a half of a can. I can slowly decrease the assisting of the water as he begins eating more. Also as he eats more the 6 hour snack, which is really him just licking the food, will go away. I do not force feed during snack time. In 3 weeks we will do a sugar curve. The jaundice has decreased and he is hydrated. His 3 rd eyelid is back to normal, meaning electrolytes are good! He even smells like 1/2 sweet boy and 1/2 kitty boy. At one time he was sweet smelling. He now comes in the kitchen when I am in there again! He is more playful and interested in looking out the window! He is getting his spunk back and more reluctant to the water and grumbles during force feeding. They were happy to see him improvements! But we are not out of the woods yet.
 
How is the rock doing today. Hopefully eating and drinking well. I wouldn't ease off the food or the water for quite a while. The reason he wasn't dehydrated was because off all the additional water you got into him. It helps to flush things through and ward off ketones. Even if he is drinking by himself I would still give him more in the syringe as before.

As I said before if hepatic lipidosis is suspected he needs a lot of food to get him better and so keep trying. There are assisted feeding groups that are fantastic at offering support if need be.

When you back to the vets you might like to discuss a longer acting insulin for the rock. Lantus, levimer are two popular choices that will allow longer control of his blood glucose.
 
He is eating better, we gave him another 3day pill for appetite. He is getting reluctant for the water, so I have eased off to every hour. He ate 3 good meals yesterday. I do not force feed for the midday meal. He is hungry for breakfast and tells me. He is back to following me around, rubbing the legs as he weaves around. He becomes alert and moves to the door when my husband comes home. He saw a mouse toy and was playing with it on his own. He is engaged when string is presented to him. He watches out the window and is attentive when sleeping waking up at little noises.
 
This is really great news. You must be so pleased:)

You could always add a little water to his food to help keep his intake up. Did they retest anything on Monday? Do you have to take him back before the weekend? Is his jaundice going?

Now that he is feeling better do you think the vet will continue with this insulin. Ideally the rock would be having a longer acting insulin like lantus or levimer.

I think I would still get those ketostix and test his urine. Have you ever tested his blood glucose? I know it's still a lot to take in but knowing his blood glucose would be really helpful to keep the rock safe and find out what the insulin is doing.

Keep up your fantastic work.
 
They did not retest anything, just a hands on mini physical. His jaundice is definitely decreasing. He is pinking up and acting normal. I began force feeding just a little during snack and I think it is helping the jaundice a lot. We will be going back for a 3 week sugar curve. The insulin we have is in our long term price range. I asked about an 8 hour feeding schedule and 3 shots per day but for now we are doing 2x shots and we will look into it for the sugar curve appointment. My mom is looking for her old glucose meter and will send it to us. I know testing it is going to be a challenge because he was very resistant at the vet's giving them a challenge every time. They had to draw blood once just to get a sample. He is feisty to say the least. When he is feeling good he grumbles at me when I give him more food.
 
Hi

The rocks momma (not sure I know your name). I am replying to your message you put in Patricia's thread

The Rock momma's boy said:
The Rock is acting normal today, I blended his meaty shreds food in the blender and he is gobbling it down now. He eats hard kibble, I know it is bad for the diabetes but good to get food in him for his liver....maybe I am paranoid but he seems a shade more jaundice to me today. I give him about 60 mL of water through out the day, he does drink on his own so I have been backing off but added more today. He is playing with his milk jug rings and watching the birds. He is my helper chef in the kitchen again. So I think he will make it to the 3 week sugar curve check at the vets!!! I bug him and he grumbles. He even swatted at me when I was messing with his feet, it has been a while since he has done that. He is doing good over all!
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It is easy to get paranoid but also good that you are keeping a close eye on him. You want him to eat, drink and get his insulin.

How much dry does he get in comparison to his wet? You are right in the long term it is better to remove all the dry but as you aren't monitoring his blood glucose it may not be safe to do so yet anyway as he is on a high dose of insulin and changing his food may bring his blood glucose levels a lot lower.

Would you be able to test him at home? It could save you money that you are spending at the vets. Once you are doing it You wouldn't need to take him in for a curve , could monitor him and keep him safe and tailor his treatment better.
 
phlika29 said:
How much dry does he get in comparison to his wet? You are right in the long term it is better to remove all the dry but as you aren't monitoring his blood glucose it may not be safe to do so yet anyway as he is on a high dose of insulin and changing his food may bring his blood glucose levels a lot lower.

Would you be able to test him at home? It could save you money that you are spending at the vets. Once you are doing it You wouldn't need to take him in for a curve , could monitor him and keep him safe and tailor his treatment better.
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He eats about half and half. I can test him at home once my mom sends me her old test kits. He will protest but I will test it when we get the supplies. He is eating almost enough on his own, minimal force feeding but some enticing is still needed. It was taking him an hour to eat, down to about a half hour now. How long does it take once we level out? How much long term enticing will he need, spoonfuls held to his mouth, etc.?
 
I think you will know when he is all back to normal but for remi it took a few weeks of me helping him. Then all of a sudden he was waiting for food and eating it much quicker. He got back to his old self.

Whilst every cat is different I really wouldn't rush removing the support. I guess how long he takes to eat is dependant on how he is used to feeding. I feed remi 8 small meals a day and he eats it up in a couple of minutes. When he used to eat dry he would nibble it over a longer period of time.

If you are finding that even after a few weeks he isn't eating all that well then I would suggest trying ondansetron in case he is feeling nauseous. Remi has this drug twice a day and has done for the last few years.
 
I have 2 more appetite stimulant pills, but he is eating with out force feeding. Though I am assisting to ensure he gets enough for his full insulin shot. It is taking him 15 -20 min to eat now. I feel like I should hold off on pilling him, he was supposed to get one today but is eating like a champ again. Do you think it is ok to not pill him?
 
I am not trying to advise you and maybe you could ask your vet. I will say that when remi started to get better instead on just stopping everything I eased off on the dose. So I began by cutting the dose in half and then you can see how he gets on. That way you can continue to support him for longer but on a lower dose. You don't want him to suddenly stop eating.

How does that sound?
 
phlika29 said:
I am not trying to advise you and maybe you could ask your vet. I will say that when remi started to get better instead on just stopping everything I eased off on the dose. So I began by cutting the dose in half and then you can see how he gets on. That way you can continue to support him for longer but on a lower dose. You don't want him to suddenly stop eating.

How does that sound?
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Sounds like good advice, but I think my kitty boy is back. He is his food crazy self again. If he is having trouble I will pill him. But it is a 3 day working pill so I don't think I am cutting him cold turkey. The vet was hoping I did not have to pill him at home but that I did not have to use the entire bottle if he was feeling better. He is crazy weaving between the legs again. Playing like a mad man, and begging for food again as well.
 
The appetite stimulant is not a great nausea med for extreme nausea. Just a heads up that if you give an appetite stimulant to a nauseous cat he might very well eat but might develop food aversions to whatever you are feeding and refuse to eat the food later. If the appetite wanes, you will need a good med for nausea. I learned with Max to slowly withdraw the support meds. I hope that won't be the case here but just wanted to give you a heads up. I'm glad your cat is feeling better.
 
That's fantastic news the rocks momma. I would closely record exactly how much he eats and drinks each day and then act as soon as you see it change. Personally I would still be adding water to his wet food and giving him one of two syringes of water per day for the time being.

I completely agree with Elise about the anti nausea medication. Personally I always keep some in stock so as soon as remi's appetite drops I can start it immediately. But in fact remi has been on this medication for nearly four years and whilst I reduce it right down he rarely stops it entirely.

Now that you have your boy back I wonder if you would consider talking to the vet about changing him over to a longer lasting insulin. The one he is currently on is unlikely to last the whole duration of the 12 hour cycle and much better control of his blood glucose can be achieved by switching him to lantus, levimer or prozinc.

http://www.felinediabetes.com/AAHADiabetesGuidelines.pdf

I know money is tight but I believe there are different type of help available to get the costs down. I know how much you care for him perhaps if you want to give it ago you could start a new thread asking which of the longer lasting insulins would be cheaper financially and what sort of financial help is there available. One way people have of keeping the costs down is by ordering from Canadian online pharmacies
http://www.felinediabetes.com/FDMB/threads/insulin-from-canadian-pharmacies.49608/
 
My vial of insulin was $25 and needles (100) were $11. The vial will last a few months, so they say, and needles 2 months. But I will inquire about other insulin products, I will research them and see what the vet thinks.
 
Yes, the NPH insulins are very inexpensive, but very few cats get long enough duration out of them to help control the BG levels. It's better than not giving any insulin, but there are better insulin choices for cats, lantus, levimir and prozinc. You might want to pop over to the Lantus (glargine)/Levimir(detimir) insulin support group and read the STICKIES at the top of the forum for info on Lantus and Levimir and the protocol for use. Prozinc/PZI has it's own insulin support group also with STICKIES at the top of the forum.

Some people that are able to monitor sufficiently, give their cats the NPH insulins 3 times a day. Take the current dose for both the daily shots and divide by 3 to get the dose. Example. If your cat gets 1U AM and 1U PM that is a total of 2 units a day. Divide 2 by 3 and you get 0.66U for each of those 3 daily shots. What we would think of here as a FAT 0.5U.
 
Lantus is definitely more expensive but I think you have a better chance of remission with it. Each pen can last until it is finished if handled gently and stored in the refrigerator. Some Targets will let you buy a single pen and use the discount coupon for humans but you have to ask as all aren't the same. If successful each pen would be $25 . You have to make sure the birthday that you put into the computer when you apply shows the age is 18 and write down the date you choose so you don't forget. I applied but forgot the date so ordered from Canada.
 
Rock has never flinched before when giving his injections. Am I doing something wrong? I pull up the skin between the shoulder blades, 45 degree angle down as to not go through the skin. Am I going too deep now? Should part of the needle go in he does not usually sit super still. But I have noticed him flinch the past 2 shots. Any tips? Thank you to all who help!!!!
 
You could perhaps try alternating the injection site. I would change where I did it each time. You could try petting him so he rolls onto his side and then lift up the skin and do it between his front and back legs. Or try further down on his back.
 
His belly side used to be a full on claws attack, playing. We have been trying to discourage this behavior. I will go up and down his back, for now. Thank you!
 
I got sort of an armpit/shoulder flab if skin, it worked like a charm. He was already on his side so I gave it to him there. No flinching today. The other day he flinched so bad I rubbed the site and I must have missed, poor guy had to be poked again.
 
phlika29 said:
Sorry I didn't mean on his tummy. Just slightly to the side of his chest. So just slightly more to the side of where you usually do it. Not very good at describing it! There is a picture and description in this link. It's about a different insulin but Just scroll right towards the bottom.

http://www.felinediabetes.com/FDMB/threads/lantus-levemir-new-to-the-group-please-read.18139/
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Just below "side of chest" on the picture worked nicely. Usually when he is on his side he thinks we are going for his tummy to play, he has been mildly broken of this habit.
 
That's great news. Hopefully if you alternate the site he won't get sensitive to it. How is the rock going overall? Is he eating better, drinking okay? How is his blood glucose levels?
 
He is eating like a champ, I do not have to offer food on a spoon to get him to finish a meal any more. He eats while I make my husband his lunch in the morning. He is hydrated, I pull his skin a few times a day. I have not had to water him him a while. We are waiting on my mom to send my belated birthday present with a meter so I can check his glucose at home. We have a vet visit next week to solidify diet and dosage of insulin.
 
That's great news Jenna. Vigilance is key, as soon as you see a change step in with the food and water. I always keep a stock of anti nausea medication as they always seem to get unwell at the weekend when the vet is closed.

Please try to test for ketones occasionally if you can with ketostix . Hope you get your birthday present soon:).
 
When is this happening ? Just when you give the shots? What do you mean bad behaviour? You don't think it means he is back to full strength?
 
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