New vet, new blood test

[Tilou]

Been to see a new vet today with Bob following a horrendous week that has seen his sneezing, runny eyes/nose and respiratory problems reoccur - just one week after seeing our old vet who gave him three shots, supposedly 2x antibiotics and 1x painkiller.

The new vet runs a small pets practice (no farm animals) and she is very attentive. She was mortified by the state that Bob was in and after careful examination of him, and my BG records, she took a blood test as she was worried his symptoms might have been CEDAR. Fortunately they weren't and his diagnosis is a respiratory tract infection, along with mouth infection due to gingervitis, that he now has a 10 day course of antiobiotics for. She also prescribed him to take HerpeLysine (which coincidentally I took delivery of today from a purchase made online) to boost his immune system. She feels that it is his erratic BG that is causing the persistent reoccurence of the infection.

However, one thing that she was not happy with was, as discussions took place re his treatment last week, is that the supposed two types of AB we were led to believe had been given (via injection) actually comprised of one shot of AB and another of cortizone - a short term solution (in her words "magic" solution), which our old vet is known to use to make it look like all is well only to have the patient returned a week or so later for further "treatment"! I am not a happy bunny.

She wasn't entirely enthralled with our use of Lantus either - she's yet another French vet who prefers Caninsulin - but once I showed her the problem I was having previously with the latter she was happy for us to continue with Lantus, but wants us to incrementally increase the dosage as Bob starts to get his appetite back to try and reduce his numbers.

I have tried to fill in some details of the blood tests on Bob's SS, but as they are in French I haven't a scooby what some of the codes are related to on the original documents. I did have a link once that explained French pet blood results, but have lost it - so if anyone can point me in the right direction it would be appreciated.

Meanwhile if anyone is interested in his full results, I can photograph them and add as an attachment on this thread.

Anyway, that is the latest in our saga. I hope everyone else is doing well.

 

[tiffmaxee]

You can add the labs to your spreadsheet. Just click on the labs tab at the top. What exactly were the injections given ?

 

[Sienne and Gabby (GA)]

@Stephanie & Quintus may be able to help out with the annotations that are in French.

I'm more than a little astounded that your old vet gave a diabetic cat a steroid shot and didn't ask you, let alone tell you about it. It does put those high numbers in perspective. Yeesh!

 

[Tilou]

You can add the labs to your spreadsheet. Just click on the labs tab at the top. What exactly were the injections given ?

Thank you. I have added some of the numbers onto the Labs sheet. Today the vet gave Bob one (small) injection of antibiotics. Last week the old vet have one AB, one cortizone and one Metacam (for pain relief).

 

[Tilou]

@Stephanie & Quintus may be able to help out with the annotations that are in French.

I'm more than a little astounded that your old vet gave a diabetic cat a steroid shot and didn't ask you, let alone tell you about it. It does put those high numbers in perspective. Yeesh!

I'm not happy about the steroid. He's done it with other cats (& Bob) in the past to stimulate their appetites but I wouldn't expect it to be given to a diabetic cat.

 

[Stacy & Asia]

She feels that it is his erratic BG that is causing the persistent reoccurence of the infection.

My two cents is it could be quite the opposite, infections and teeth are notorious for causing erratic (and high) BGs. If it’s possible to get Bob in for a dental, you might see a huge change diabetes wise. Sometimes they have infection below the gum line that is impossible to see with your eyes and only show up on dental X-rays. Asia had to have many teeth extracted (prediabetes) and the difference it made was night and day, she was like a kitten again after the teeth came out.

I’m so sorry the other vet gave steroids without telling you!

I don’t know why Caninsulin is so pushed in France and Europe, it’s tragic, really. It was developed for dogs and I haven’t heard great things about it’s use in cats. Glad your new vet accepted that Lantus is a better fit.

 

[Tilou]

My two cents is it could be quite the opposite, infections and teeth are notorious for causing erratic (and high) BGs. If it’s possible to get Bob in for a dental, you might see a huge change diabetes wise. Sometimes they have infection below the gum line that is impossible to see with your eyes and only show up on dental X-rays. Asia had to have many teeth extracted (prediabetes) and the difference it made was night and day, she was like a kitten again after the teeth came out.

I’m so sorry the other vet gave steroids without telling you!

I don’t know why Caninsulin is so pushed in France and Europe, it’s tragic, really. It was developed for dogs and I haven’t heard great things about it’s use in cats. Glad your new vet accepted that Lantus is a better fit.

It's an interesting one re the teeth. Bob had lovely teeth until last year and I just presumed their decay was age related. I now suspect it's the diabetes, which was undiagnosed for quite a while.

We had another cat, Molly, who had all her teeth removed when she was 8 as she had terrible problems with gingervitis and infections. Sadly Molly didn't fare well even after their removal and had to be euthanized when she was only 9 years old due to various associated complications. Our vet in the UK thought she was probably born with the problem, inheriting it from her mother, Blue, who had similar issues with her teeth and eventually contracted terminal mouth cancer. Cats - heartbreakers, aren't they?

I shall speak to the vet about Bob's teeth when we go back, as she wants to do a follow-up blood test. Bob's pancreas number was high today and she wants to make sure it was just his high BG and not anything else causing the raised level.

The Caninsulin obsession here is a strange one - but we always joke that living in France is like stepping back in time

 

[Ella & Rusty & Stu(GA)]

When I was starting out on the FDMB (in 2010) there was a great deal of discussion about the dangers of Metacam and how it should not be given to cats. In fact, the US Food and Drug Administration issued a Black Box Warning on it. Here is a more current link that you should read and share with your vet (especially the old vet!):
https://www.fda.gov/animalveterinary/safetyhealth/productsafetyinformation/ucm472976.htm

I hope Bob is on the road to recovery.

 

[Stacy & Asia]

Pancreatitis can also make wacky numbers, it’s very painful as well. Asia had elevated labs for pancreatitis which we confirmed as pancreatitis with an ultrasound.

The teeth issues are so tough, Asia had tooth resorption and they just don’t know what causes it. It would be nice to know why so we could try to prevent it, but whatever the reason, once the teeth are bad, it’s a problem.

Hope the vet can help come up with some answers and Bob is feeling better soon.

 

[Steph & Quintus & L & O]

@Stephanie & Quintus may be able to help out with the annotations that are in French.

I can definitely do that. PM me or post the docs here, and let me know what you need a translation for.

She wasn't entirely enthralled with our use of Lantus either - she's yet another French vet who prefers Caninsulin - but once I showed her the problem I was having previously with the latter she was happy for us to continue with Lantus, but wants us to incrementally increase the dosage as Bob starts to get his appetite back to try and reduce his numbers.

It might reassure her to check out this French article in Le Point Vétérinaire referencing the AAHA guidelines which recommend starting out with Lantus or Prozinc. You'll also find a bunch of translated stickies and articles from FDMB here. Let me know if other French ressources would be helpful.

I don’t know why Caninsulin is so pushed in France and Europe, it’s tragic, really. It was developed for dogs and I haven’t heard great things about it’s use in cats.

I think it's a combination of three things:

• medical advances often take time to cross the Atlantic and the language barrier
• Vetsulin/caninsulin was recalled at some point in the US, forcing people to look at other options, including Lantus; no such thing happened in Europe
• the company behind caninsulin is very aggressive marketing at veterinary professionals in Europe -- at least in France

When I was starting out on the FDMB (in 2010) there was a great deal of discussion about the dangers of Metacam and how it should not be given to cats.

Regarding the US "panic" about metacam, check out this thread in Think Tank and the write-up I added at the bottom which IMHO explains the historical context very well and put things into perspective.

 

[Kathy and TiTi]

I can definitely do that. PM me or post the docs here, and let me know what you need a translation for.



It might reassure her to check out this French article in Le Point Vétérinaire referencing the AAHA guidelines which recommend starting out with Lantus or Prozinc. You'll also find a bunch of translated stickies and articles from FDMB here. Let me know if other French ressources would be helpful.



I think it's a combination of three things:

• medical advances often take time to cross the Atlantic and the language barrier
• Vetsulin/caninsulin was recalled at some point in the US, forcing people to look at other options, including Lantus; no such thing happened in Europe
• the company behind caninsulin is very aggressive marketing at veterinary professionals in Europe -- at least in France

Regarding the US "panic" about metacam, check out this thread in Think Tank and the write-up I added at the bottom which IMHO explains the historical context very well and put things into perspective.

This is interesting. I know a vet some 30 years ago who prescribed a very small dose of aspirin for a cat that had swelling of the brain, creating neurological symptoms. It was a life saver. That said, I would use any Nsaid or aspirin with great caution, and if possible, only after a kidney panel was done. Both types of medicine are hard on the kidneys. Actually every kind of medication is hard on the kidneys and/or the liver, since both are busy clearing the system of toxins. The article you referenced, or rather the reaction to it, was a bit more emotional than I like, because it obscured the factual information which was quite good.

 

[Stacy & Asia]

the company behind caninsulin is very aggressive marketing at veterinary professionals in Europe -- at least in France

Obnoxious! If they spent half that marketing budget to develop an insulin for cats, maybe we'd get somewhere!

 

[Tilou]

I can definitely do that. PM me or post the docs here, and let me know what you need a translation for.

It might reassure her to check out this French article in Le Point Vétérinaire referencing the AAHA guidelines which recommend starting out with Lantus or Prozinc. You'll also find a bunch of translated stickies and articles from FDMB here. Let me know if other French ressources would be helpful.



I think it's a combination of three things:

• medical advances often take time to cross the Atlantic and the language barrier
• Vetsulin/caninsulin was recalled at some point in the US, forcing people to look at other options, including Lantus; no such thing happened in Europe
• the company behind caninsulin is very aggressive marketing at veterinary professionals in Europe -- at least in France

Regarding the US "panic" about metacam, check out this thread in Think Tank and the write-up I added at the bottom which IMHO explains the historical context very well and put things into perspective.

Hi Stephanie

Here are the blood results. The vet said the pancreas number was a concern but hoped it was due to Bob's increased BG. She said she'd retest once his infection was clear and BG was down. She also said that his red blood cell count was high. I tried to compare to the results I had at his dx in January but the two vets use slightly different systems.

Take a look at his SS for today - wacky numbers. I've had to give him an additional 1ui this afternoon, on vet's advice, as his BG has rocketed despite having 2ui this morning.

Just when I thought things might be calming down!

 

[Steph & Quintus & L & O]

I can't see the lipase number which would normally be the "first check" for the pancreas (it's total lipase, to get a correct reading you want to run Spec fPLi). Clearing the infection seems like a good plan. Anything in particular you need translating on those labs?

 

[Steph & Quintus & L & O]

FWIW, I showed the results to a friend who says the numbers could make us suspect an underlying pancreatitis for the FD (amylases high => do a Spec fPL). She'd also recommend doing a T4 (thyroid) test as the cholesterol is high.

 

[Tilou]

I can't see the lipase number which would normally be the "first check" for the pancreas (it's total lipase, to get a correct reading you want to run Spec fPLi). Clearing the infection seems like a good plan. Anything in particular you need translating on those labs?

I was doing a comparison on Bob's SS to his original results and realised that the vets used two different systems but I think I've worked out what's what now. Merci.

 

[Tilou]

FWIW, I showed the results to a friend who says the numbers could make us suspect an underlying pancreatitis for the FD (amylases high => do a Spec fPL). She'd also recommend doing a T4 (thyroid) test as the cholesterol is high.

Interestingly a T4 test has been mentioned before on here (apologies, I can't remember who suggested it).

The vet was concerned about possibility of pancreatitis but was hoping it was just an anomaly due to his high BG numbers. She said she is going to retest.

We've arranged to go back to the vet after Bob has completed his medication for the infection, so I will raise these issues. I popped his full set of BGs (that I've taken since his dx) into her today, but didn't get to speak to her.

Meanwhile Bob is still snuffling and feeling sorry for himself, but he is managing to eat a little.

 

[Tilou]

Oh lord - DH panicking as Bob's BG down to 3.1 due to him not eating. DH's confidence in new vet ebbing very quickly

 

[Steph & Quintus & L & O]

Given the gingivitis and upper respiratory tract infection it could also be worth doing a FIV/FeLV test.

 

[Tilou]

Given the gingivitis and upper respiratory tract infection it could also be worth doing a FIV/FeLV test.

Vet tested for both and Cedar - got the all clear on them. I was convinced (before the test) it was FHV but she said it wasn't.

 

[Steph & Quintus & L & O]

Vet tested for both and Cedar - got the all clear on them.

That's a good thing to have out of the way!

 

[Tilou]

Ok. Update and this is a cracker...

Just had a call from our new vet... at 9.15 in the evening (totally unheard of in the 14 years we've been here). I handed in Bob's SS BG numbers to her yesterday and she's had a look at them in great detail.

First question she asked was why had we taken him to the vet in January and why did we think he was diabetic. Strange question. I told her he'd gone for his annual boosters, but as he'd been drinking a lot, lost weight and had become incontinent, the old vet decided to do a blood test and the glucose number was high enough for him to dx diabetes and put Bob on Caninsulin.

She then asked if I was aware that not all cats with high BGs in a test were necessarily diabetic and that cats could go into remission from diabetes. Naturally I was able to tell her of the information I've learned from this forum on this subject.

She appears suspicious that Bob's high BG is nothing to do with him being diabetic and has asked us to put him on 1ui am and pm for one week, then reduce it to 0.5ui for a second week. She'll then have a blood test done by a main laboratory to check his BG, thyroid and pancreas levels.

Does anyone here know if high BG levels are symptoms of thyroid problems?

cc @Stephanie & Quintus

 

[Stacy & Asia]

There are a great many things that can elevate BGs, some are temporary (like infection or fear/stress spike from being at the vet) others can actually cause the diabetes in the first place (pancreatitis). Do you have the labs for when Bob was diagnosed? What was the blood glucose level from the lab? Vets typically will confirm diagnosis with a urinalysis and see if sugar is in the urine, and some also do a fructosamine which is an average BG over a few weeks.

I asked when Asia was diagnosed if it was definitively diabetes and not stress induced or anything like that, I was told at numbers as high as she was (467), there is no doubt about it. Not entirely sure how true that is, I'm betting my cat had pancreatitis at the time, her numbers for that were through the roof, but it was never discussed, that lab value was entirely ignored. I didn't know enough to ask about pancreatitis, though I did ask how did she get diabetes because it didn't make sense (low carb raw food diet, not overweight, no steroids, etc.) and all I got were shoulder shrugs" I asked this of 3 different vets and none had answers, they all saw the labs, not one mentioned pancreatitis as a cause! She had glucose in her urine, that made it a slam dunk diagnosis.

 

[Tilou]

There are a great many things that can elevate BGs, some are temporary (like infection or fear/stress spike from being at the vet) others can actually cause the diabetes in the first place (pancreatitis). Do you have the labs for when Bob was diagnosed? What was the blood glucose level from the lab? Vets typically will confirm diagnosis with a urinalysis and see if sugar is in the urine, and some also do a fructosamine which is an average BG over a few weeks.

I asked when Asia was diagnosed if it was definitively diabetes and not stress induced or anything like that, I was told at numbers as high as she was (467), there is no doubt about it. Not entirely sure how true that is, I'm betting my cat had pancreatitis at the time, her numbers for that were through the roof, but it was never discussed, that lab value was entirely ignored. I didn't know enough to ask about pancreatitis, though I did ask how did she get diabetes because it didn't make sense (low carb raw food diet, not overweight, no steroids, etc.) and all I got were shoulder shrugs" I asked this of 3 different vets and none had answers, they all saw the labs, not one mentioned pancreatitis as a cause! She had glucose in her urine, that made it a slam dunk diagnosis.

Hi Stacy

Thanks for the reply. Bob's BG at original dx was 421. Two weeks later he was retested at 527. He was at 473 with the new vet last week, but of course he is currently suffering from an infection/virus.

We're going to follow the new vet's instructions and give him 1ui morning and evening for a week, then reduce to 0.5ui for the second week.

As he's currently on a ten day course of antibiotics etc, the vet wants to wait until he recovers from this illness before she retests.

Bob is better than he was a few days ago. Eating quite a bit of freshly cooked chicken and fish, although still not up to his usual lively self.

 

[Steph & Quintus & L & O]

Vets typically will confirm diagnosis with a urinalysis and see if sugar is in the urine, and some also do a fructosamine which is an average BG over a few weeks.

She had glucose in her urine, that made it a slam dunk diagnosis.

Actually, cats can have sugar in their urine because of stress. This is what happened to my civvie Erica. So it's not a confirmation of diabetes. Fructosamine definitely is, because it gives you "hindsight" on the BG values.

In Bob's case, I honestly think the high BG we are seeing is not just due from bouncing due to insulin he wouldn't need. But it's true (and I've seen that trend with my little group of francophones, not many data points, but still) that vets tend to jump on one or two high readings of BG and declare "diabetes" without doing a fructosamine test. In a country where shooting caninsulin blind is the norm, I can see the wisdom in sending people home with a 2-week "food change" before putting the cat on insulin. Or... they could run a fructosamine test.

Back to Bob: as you're testing, you have way more data than most of this vet's clients. I think you'll see before a week is over if reducing the dose is making things better or worse. As he's taking ABs it's also indeed quite possible that one of the reasons for his high BG is going away.

So... what I'd tell you is to follow your gut, keep your vet in the loop (as you seem to have found somebody decent), and keep on testing.

 

[Steph & Quintus & L & O]

A comment on Bob's SS: I'm personally a bit concerned that there are never any tests in the night cycle. You want to get at least a "before bed" test, doesn't matter if it's +1 or +2 or +3 or +4, depending on when your shot and bed times are. Otherwise we're completely blind regarding night cycles (which can play out quite differently than day cycles) and, literally, missing half the data.

Is this something you could do? What time do you shoot, and go to bed? (or... get up -- if you're up a few hours before the morning shot time you can get a +10 or +11 which can be very helpful)

 

[Tilou]

I tend to test just before his evening shot generally about 22h... unless he's disappeared outside, then it might be nearer 23h, which is when we head to bed.

I've tried to get night and early morning shots but he's normally so active during those hours that he's aggressive and it ends up, literally, in a cat fight.

Update: Just got a 11+ reading of 18 following his 1ui last night. Didn't get PMPS last night as he was fighting both of us!

 

[Steph & Quintus & L & O]

well done on the +11!

 

[Tilou]

well done on the +11!

Realised as I read your post that I was in that time frame and he was dozing!

He's not been too good today. His sneezes and runny nose/eyes are back with a vengeance, after he seemed a lot brighter yesterday. He's also off his food again and is displaying something akin to a sore throat (it's not his teeth as his gums have returned to a nice pink colour from the nasty red a few days ago).

It's day four of his 10 days of antibiotics and we were really hoping to see some improvement, but so far not much change.

He had a good reading at +4 after his morning shot and I managed to tempt him into eating a little bit of fish at 5pm. It's weird, because this morning he tore into a bowl of Animonda chicken pate with no problem.

Just guess it's a waiting game.

 

[Steph & Quintus & L & O]

It's weird, because this morning he tore into a bowl of Animonda chicken pate with no problem.

Maybe he was full up?

Just guess it's a waiting game.

They don't call them "patience pants" for nothing...

 

[Tilou]

Bob had just thrown up a load of yellowish liquid. No food contained within it (he ate hiss little bit of fish about three hours ago). He's been swallowing down a lot of snot from his nose.

BG is at 4.7 mmol/L