8-16 Gizmo +9.5=306; PMPS=343; +2=374 Vet Results - I'm crazy, cat fine!

[Chubba (GA)]

Condo - http://www.felinediabetes.com/FDMB/...54-10-186-pmps-210-2-410.182309/#post-2022043

PMPS = 210
+2 = 410

AMPS = 344
+2 = 327

Gizmo has a vet visit this morning for a second opinion on his hyperthyroidism before starting meds. Also hoping for some answers (testing) for his high dose. Fingers crossed this visit isn't just another waste of money!

Hey Gizmo, it's Maverick...you got room on your trampoline...move on over, here I come

Gizmo says there is always room for friends! But mama bean is encouraging both boys to get off the trampoline and try something new. It looks like a nice day to visit the beach and maybe even go swimming in the lagoon.

 

[Christie & Maverick]

I'm hoping for you to have a very informative and useful vet visit, and hope all goes well

 

[carfurby (GA)]

I hope you get some answers. Sending good vetty vines.

 

[Marvin's Mom - Nat]

Good luck at the Vet, hope all goes well.

 

[Doodles & Karen]

Good luck at the vet today.

 

[Wendy&Neko]

Good luck with the vet. I got stalling too, and finally had to say"humour me, do the tests, it's my money".

Giazmo, your trampoline privileges are revoked!

 

[Bronx's dad (GA)]

Vetty vines for Gizmo...

 

[Chubba (GA)]

Thanks everyone for the good vet vines. However, this guy is very old school. Doesn't seem to understand diabetes in cats and wasn't willing to listen to me. No changing his mind. Within a few minutes of meeting us and discussing Gizmo, he asked how often I tested his BG. As I was responding he cut me off and asked if I had a job. I laughed it off as he apologized and thought ok just his sense of humor. Checked Gizmo all over ... very thorough . Asked if he could do X-rays and bloodwork (T4 and ft4 - not entire panel). We agreed. He knew about MSU for other high dose testing, but didn't seem like he realized he could ship blood there. Just said msu only place that tests for those. So it was after they took Gizmo that I started thinking, would the hyperT even show up on an X-ray? Doubtful. That's why I agreed ... I thought he was checking for a tumor. So long story short ... I have no answers. X-rays were normal. He is worried about kidney disease and wants a urine sample (hoping to just be able to take one to gizmo's normal vet). Thyroid testing will be back Friday or Monday, but he doesn't think he has hyperT. He said I will never get Gizmo's sugar flat and steady ... that just doesn't happen with cats. Basically said Gizmo is perfectly healthy and I just need to get over trying to micromanage his diabetes because it isn't going to happen. By this point, I was getting very good at smile and nod ... smile and nod. My husband said he was wondering what the heck was going on and then realized I didn't really care what this guy was saying anymore. He only wants me to check preshot and +4-5 cause that is his lowest point (despite actually looking at his readings and seeing it clearly isn't). Back in 2 weeks for the fructosamine test ... not happening. I did question the usefulness of this test and he restated why we were doing it (daily ups and down don't matter ... average does). This is where I gave up. When we were leaving, he said to my husband ... take her to dr. Phil. She needs medication not the cat, he is perfectly fine.

Sorry for long post ... needed to vent to people who know I'm not the one who needs dr. Phil. Lol

@Marje and Gracie ... could you glance at his labs again? Or if you just want to wait until I get the thyroid results on Friday or Monday that would probably be easier for you. Thanks.

 

[rhiannon and shadow (GA)]

I hate medical people who pat me on the head..... i choose to beouttathere.....

 

[Tuxedo Mom]

YIKES!! What a nightmare of a vet visit. The old smile and nod certainly was put to good use with this vet!!

 

[Marvin's Mom - Nat]

When we were leaving, he said to my husband ... take her to dr. Phil. She needs medication not the cat, he is perfectly fine.

WTF ....oh man, I would have lost it

 

[LizzieInTexas]

he said to my husband ... take her to dr. Phil. She needs medication not the cat, he is perfectly fine.

OH.NO.HE.DIDN'T!! O.M.G.

I am so sorry you didn't get anywhere. How completely frustrating.

 

[Bobbie And Bubba]

OMG! What a horrible thing for him to say to you as you were leaving! I'm pulling my hair out for you!

Guessing you'll be looking for a new vet!

 

[carfurby (GA)]

I'm so sorry you had to deal with that. I'm glad you were able to smile and nod.

 

[Chubba (GA)]

I hate medical people who pat me on the head..... i choose to beouttathere.....

Yep, told Gizmo not going back there again!

YIKES!! What a nightmare of a vet visit. The old smile and nod certainly was put to good use with this vet!!

it was a nightmare, but maybe we will find out that he either does have hyperT or he doesn't when the bloodwork returns. Something good may still come of it ... I'm forever hopeful I guess.

WTF ....oh man, I would have lost it

I was close a few times, but don't think it would have done any good.

OH.NO.HE.DIDN'T!! O.M.G.

I am so sorry you didn't get anywhere. How completely frustrating.

I know. He was joking (I think), but still ... how unprofessional.

OMG! What a horrible thing for him to say to you as you were leaving! I'm pulling my hair out for you!

Guessing you'll be looking for a new vet!

He was my new vet. Think I'm going back to the old vet. They are at least professional and listen. I will just have to put my foot down there and demand what Gizmo needs. I just don't have any other options in our area.

I'm so sorry you had to deal with that. I'm glad you were able to smile and nod.

Thanks. We'll keep marching on ... on a positive note Gizmo's bg was 185 at the vets. I didn't think we would see blues again for awhile after the 410 bounce last night.

 

[Tanya and Ducia]

He said I will never get Gizmo's sugar flat and steady ... that just doesn't happen with cats. Basically said Gizmo is perfectly healthy and I just need to get over trying to micromanage his diabetes because it isn't going to happen. By this point, I was getting very good at smile and nod ... smile and nod.

For the moments like this I only wish we had invented an invisible helping hand to reach to the vet's pocket and take at least half your money back . Outraged. I dealt with one just like that . He didn't invoke Dr. Phil actually but looked very inquisitively and a bit longer than needed, the MD style, into my eyes checking my sanity I suppose.. I was naive enough to show him my SS.

 

[Chubba (GA)]

For the moments like this I only wish we had invented an invisible helping hand to reach to the vet's pocket and take at least half your money back

This would be a wonderful invention!

 

[Olive & Paula]

WOW is all I can say.

 

[Bronx's dad (GA)]

Time to find another vet...

 

[Chubba (GA)]

Time to find another vet...

We are going to try again at our regular vet. I really don't know where else to go ... but I know we aren't going back here to this guy. I guess we might have to look into vets a bit farther away, but Gizmo starts panting in the carrier and that scares the heck out of me. I thought about just holding him with his harness, but he pees almost everytime he is in a vehicle so that pretty much rules out that option. From what I researched, there are no mobile vets that service our area.

 

[Marvin's Mom - Nat]

We are going to try again at our regular vet. I really don't know where else to go ... but I know we aren't going back here to this guy. I guess we might have to look into vets a bit farther away, but Gizmo starts panting in the carrier and that scares the heck out of me. I thought about just holding him with his harness, but he pees almost everytime he is in a vehicle so that pretty much rules out that option. From what I researched, there are no mobile vets that service our area.

Marvin is the same way, meowing the whole way. I tried the feliway spray and that helped a bit last time I had to take him to the vet... no pee

 

[Chubba (GA)]

Marvin is the same way, meowing the whole way. I tried the feliway spray and that helped a bit last time I had to take him to the vet... no pee

I'll have to try that. I take him to the box before we go, but of course he looks at me like I'm nuts. Then he usually pees on the way home.

 

[Christie & Maverick]

Well, I'm bummed for you that it didn't go as well as we all had hoped for you and Gizmo, but if it is any consolation, I read your post when I was at work, and actually snorted since I laughed at your "I'm crazy" then went on to see the Dr. Phil comment . The vet was a moron, I think we all agree on that.

I quickly glanced at the blood tests, I know more experienced people will give you feedback soon, but just my thoughts from when I dealt with CRF (a long time ago), it seemed like Gizmo's BUN was only just a bit over normal (37 on a range of 16-36), while creatinine was normal. If I recall from what I remember, both BUN and creatine would be elevated, and they aren't. Those are key indicators in kidney disease. Gizmo's BUN could be elevated if Gizmo was a bit dehydrated? Phosphorus and calcium were within normal, though I see they didn't run potassium?

It's been a while since I've considered blood tests around CRF, but hope it helps a bit until you get more feedback

 

[Marje and Gracie]

I looked at his labs and there are some very, very curious numbers on it considering that he just had labs done less than a month ago. Are the tests done through the same lab (e.g. Antech or IDEXX)? Here are a few red flags:

• his total bilirubin is up indicating a liver issue “if” the current labs are correct
• his ALT is way up and even if the current lab has the same upper range of 130 (most are 100), I have to wonder why it jumped like that
• his phosphorus, which I wasn’t that crazy about in July, is really high now. Even if he is totally healthy, that P needs to be down about to 4.5 (are you giving him bone broth because that raises the P even in a healthy cat)
• his Ca x P is in the 60-70 range which means he is at risk of tissue calcification if the numbers are correct
• are you sure it says “RETRIC” and not “RETIC” on his labs? Reticulocytes can give an idea, if a cat is anemic, if its regenerative or non regenerative anemia but Gizmo isn’t anemic so I would disregard that number.

Wouldn’t it be nice if hyperthyroid could be diagnosed by an X-ray? Has anyone palpated his thyroid and said they felt a “slip”? That’s what should be done. Of course, that’s not diagnostic but it would give you more of a basis for testing than an X-ray. Interesting that, based on these labs, he thinks Gizmo might have kidney disease. I’m not saying he doesn’t but there is nothing in these labs that would indicate that unequivocally. Yes, his creatinine “could” indicate Stage 2; yes, his P is way too high; yes, is BUN is slightly elevated but there are so many things that can cause that. I would not trust a dx of CKD just based on those parameters.

A urine test would help, but again, it needs to be the first pee of the day if you want an absolute best answer. As an example, my Gracie would occasionally have a USG in the afternoon that was more dilute but she was a really good water drinker so, just like humans that drink a lot of water, the urine becomes more dilute as the day progresses. The question was “can the kitty concentrate urine” because a cat with CKD cannot; even the first pee sample of the day would be dilute in a cat with CKD. Gracie’s first pee of the morning was always very concentrated so we knew her kidneys were functioning and could concentrate her urine. OTOH, my kitten, Livia, pees once a day eek:) in the evening and so her evening urine sample is concentrated. We are back to ECID!!

Let me know if you have questions and/or when the thyroid tests come back.

 

[Squalliesmom]

Wow. How incredibly unprofessionally you were treated. I think I would lodge a complaint with the state board that governs veterinarians. He should NOT speak that way too, or about, you! I would also call or email them and tell them you felt greatly insulted and will not continue on at that practice. I think my former vet probably felt the same way about me but at least she had enough sense not to say it!

 

[Chubba (GA)]

I looked at his labs and there are some very, very curious numbers on it considering that he just had labs done less than a month ago. Are the tests done through the same lab (e.g. Antech or IDEXX)?

Even though it was a different vet than previous lab work, the lab was the same (IDEXX).

• his total bilirubin is up indicating a liver issue “if” the current labs are correct

• so, how would you pursue this concern? Is it possible for the bloodwork to be incorrect? I'm wondering because he made the comment that they now send away both the T4 and ft4 because they were getting skewed results. This practice isn't at all up to date. They used an "adding machine" for billing. I don't know if that is what it is called, but I remember my mom bringing something like that home from work when I was younger and she worked in payroll.

• his ALT is way up and even if the current lab has the same upper range of 130 (most are 100), I have to wonder why it jumped like that

• I wondered this as well. That is a drastic jump. I have no idea what this even is?

• his phosphorus, which I wasn’t that crazy about in July, is really high now. Even if he is totally healthy, that P needs to be down about to 4.5 (are you giving him bone broth because that raises the P even in a healthy cat)

• I am not feeding bone broth. However, I am/was (in process of switching) feeding him food around 350 phosphorus and it was fish. Realized that is not good. Looking into tiki cat for at least some of his meals.

• his Ca x P is in the 60-70 range which means he is at risk of tissue calcification if the numbers are correct

• . What is ca x p? Sorry I'm completely lost on this one.

• are you sure it says “RETRIC” and not “RETIC” on his labs? Reticulocytes can give an idea, if a cat is anemic, if its regenerative or non regenerative anemia but Gizmo isn’t anemic so I would disregard that number.

• yep, I completely screwed that up. The numbers I have entered in RETRIC should really be RETIC. I will fix that.

Has anyone palpated his thyroid and said they felt a “slip”? That’s what should be done. Of course, that’s not diagnostic but it would give you more of a basis for testing than an X-ray.

I don't know about his normal vet, but this guy defiantly felt his thyroid and said he didn't think he had hyperT. We noticed several other animals getting X-rays also?! (Money)

Sorry for all the questions ... I am really out of my league with this stuff. I will probably have more questions tomorrow about his thyroid testing.

 

[Sandi & Chase in AZ]

Oh man. I've had Chase to few different vets. Most of them put me down for treating him at home. So DUMB!!!

 

[LizzieInTexas]

What is ca x p? Sorry I'm completely lost on this one.

Calcium x phosphorus

http://www.felinecrf.org/diagnosis_calcium_phosphorus_pth.htm

Phosphorus Multiplied by Total Calcium

Although as stated above, ionised calcium is what matters for CKD cats, you do have to take total calcium levels into account in one main regard: you have to consider the level of phosphorus multiplied by total calcium. This is because cats with a high number are at risk of a problem called calcification. Hypercalcemia in cats (2001) Chew D Presentation to the World Small Animal Veterinary Association World Congress says "The degree of interaction with serum phosphorus is important, as those with a total serum calcium times phosphorus concentration product greater than 70 are most likely to have severe tissue changes associated with mineralization."

As a rough guide, if phosphorus multiplied by total calcium is higher than around 60 in US values or 5 in international values, your cat is at risk.

Alternatively, you can multiply phosphorus by ionised calcium, and if the level is higher than 8.75 in US values or 35 in international values, there is a risk of calcification.

It is less likely to be a problem if the product is above these levels because of a higher calcium level rather than a higher phosphorus level; but I would still recommend trying to reduce these levels if at all possible.

You can get the phosphorus levels down. I did with just diet change in my Gizmo. 12/30/16 it was 5.5, 07/05/17 it was 4.9.

 

[Chubba (GA)]

Calcium x phosphorus

http://www.felinecrf.org/diagnosis_calcium_phosphorus_pth.htm



You can get the phosphorus levels down. I did with just diet change in my Gizmo. 12/30/16 it was 5.5, 07/05/17 it was 4.9.

Thanks, that makes sense now. Hopefully he will eat the lower phosphorus food. I need to get to the store to pick up a few cans to see before I order a lot. We need to get that level a lot lower!

 

[Marje and Gracie]

Even though it was a different vet than previous lab work, the lab was the same (IDEXX).

Well, that rules that out.

so, how would you pursue this concern? Is it possible for the bloodwork to be incorrect?

I wondered this as well. That is a drastic jump. I have no idea what this even is?

ALT (alanine aminotransferase) is a liver enzyme with a very short half life. Which means it can change fairly quickly if whatever is causing it to increase is eliminated. If the normal range listed is correct, then he’s normal and at the higher end. Bilirubin is the an orangish pigment produced by the residue of destroyed red blood cells. This residue (oversimplifying here) is concentrated into bile and usually excreted through the stool and a tiny bit (in a healthy cat) through the urine (you would not be able to detect this small amount). High levels can be caused by obstruction of the bile flow, any kind of liver disease, exposure to chemicals, triaditis (inflammation of the pancreas, liver, gallbladder), feline hepatic lipidosis (fatty liver), etc. If you could do an at home urine catch, you could see what color it is but then run it over to the vet and let them send it in. Then they could see if there was any bilirubin (even if you can’t see it) and check his USG.

When my Gracie had a similar elevation in her bilirubin, her urine was a bright goldish/orange. That’s how I knew her liver values were probably also elevated; I got a urine sample to check ketones and I could tell right away that there was bilirubin in her urine (you should not be able to see it).

Looking into tiki cat for at least some of his meals.

Just a recommendation, but I’d really try to get rid of all the fish and get him to a much lower P food.

What is ca x p? Sorry I'm completely lost on this one.

No apologies needed and I’m sorry I wrote it like that. Ca = calcium and P = phosphorus. The Ca times the P should be less than 60. His is over 70. This puts a cat at risk of tissue calcification. Normally, as the P goes up, the regulatory system of the body should bring the Ca down but his is not (which might be another thing that leads us to wonder if he has CKD). The easiest thing to do is get his P down. If we knew he had CKD, then I would recommend starting a phosphorus binder that goes on the food and binds the phosphorus.

Important question for you: As a standard, IDEXX usually runs an SDMA which gives us a better idea, than even urine specific gravity, if we could be looking at CKD. Do you see an SDMA test result on there? If not, I am going to assume they only run it if the vet does a superchem/cbc and neither of your vets did (I really wish every single vet would do a superchem/cbc at least once a year...twice a year in a cat over 10) instead of these tests that do not allow you to look at the big picture.

Don’t ever worry about asking questions.

 

[Chubba (GA)]

Just a recommendation, but I’d really try to get rid of all the fish and get him to a much lower P food.

He was eating a food with a phosphorus value of 373 (fish). I just tried a food with no fish and slightly lower phosphorus (320) until I can get the tiki cat. I am thinking about trying the tiki cat without fish (phosphorus levels of 154 & 149). Hoping that drastic difference will lower the phosphorus. Do I need to worry about the protein being so high 70-80%? Also, it has 0 carbs. Just want to make sure it is an ok food before I switch them to it.

Important question for you: Do you see an SDMA test result on there?

. Nope, I entered every value that was on the sheet.

Thanks for all of your help. I would be completely lost!

 

[Marje and Gracie]

He was eating a food with a phosphorus value of 373 (fish). I just tried a food with no fish and slightly lower phosphorus (320) until I can get the tiki cat. I am thinking about trying the tiki cat without fish (phosphorus levels of 154 & 149). Hoping that drastic difference will lower the phosphorus. Do I need to worry about the protein being so high 70-80%? Also, it has 0 carbs. Just want to make sure it is an ok food before I switch them to it.
. Nope, I entered every value that was on the sheet.

Thanks for all of your help. I would be completely lost!

The 154 & 149 is much better for the P level. I am a proponent of higher levels of good quality protein for earlier stage CKD cats due to muscle wasting and also that some of them lose protein in their urine because the kidneys are not working properly. It doesn’t make sense to restrict protein in a cat that is losing it when the CKD is early and the kidneys can still handle it. Is 70-80% ideal for a CKD cat? Probably better is in the 60% range if the protein is high quality. I feed my cats a raw diet and they get about 70-80% protein but they are healthy (anti jinx).

Remember that there are three macronutrients that have to balance: fats, carbs, and protein and when you add them together, they have to equal ~100%. Many commercial pet food manufacturers add more fat and/or carbs because it’s cheaper than protein. Cats don’t need a lot of fat but they do need some. Many times, on a food that is low in carbs, you’ll see more fat than protein when it should be the other way around. For a CKD cat, I’d try to get somewhere in the 60% range for protein, 30-35% range for fats, and the rest in carbs. IMHO.