Taking Pepper to new vet today

Julia78

Julia78

Member Since 2020
Good afternoon,
Pepper's glucose numbers are not responding to increased Lantus doses. I am taking him to a new vet today and they have received his medical history from the animal hospital I had been taking Pepper to. It breaks my heart that I won't be able to accompany Pepper into the vet per Covid rules. I'm very nervous but feel I have to bring him. Any advice about what I should ask / tell the vet?

Thank you, as always.
 
Wendy&Neko said:
Is the vet going to do general blood work and an exam? If it's been a last while since his last blood work, that's a good idea. I'd also ask that they take a good look at his teeth. Needing a dental is a common contributor to a hard to regulated cat.

Here is the link to your last post here, for continuity: https://www.felinediabetes.com/FDMB/threads/lantus-increase-not-effective.236932/
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Wendy&Neko said:
Is the vet going to do general blood work and an exam? If it's been a last while since his last blood work, that's a good idea. I'd also ask that they take a good look at his teeth. Needing a dental is a common contributor to a hard to regulated cat.

Here is the link to your last post here, for continuity: https://www.felinediabetes.com/FDMB/threads/lantus-increase-not-effective.236932/
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Thank you so much.
 
:bighug: I feel for you not being able to accompany him. Try not to let Pepper know you’re stressed if you can avoid it or he will be more stressed too.

Infections can cause BG to rise so that is a possibility, it’s also possible that you just haven’t hit the right dose for him yet.
 
Nope, a kitty needs what a kitty needs and 3U isn’t particularly high. We don’t start thinking of cats in terms of high dose unless they get to about 5-6U.
 
Wendy&Neko said:
Is the vet going to do general blood work and an exam? If it's been a last while since his last blood work, that's a good idea. I'd also ask that they take a good look at his teeth. Needing a dental is a common contributor to a hard to regulated cat.

Here is the link to your last post here, for continuity: https://www.felinediabetes.com/FDMB/threads/lantus-increase-not-effective.236932/
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Thank you : )
Olive & Paula said:
Any update on Pepper?
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Thanks for asking, Olive and Paula. The vet is running a lot of lab tests including ones specifically for geriatric cats. A urinalysis was completed as well. She mentioned a few things that could be causing Pepper’s glucose to be rising including Cushing’s disease, which she said is rare, and inflammatory bowel disease. When I told her I’ve been using a ReliOn meter she said I should consider getting an Alpharack instead. I’m sure those are way more expensive than ReliOn. She said it looks like Pepper has periodontal disease which could be contributing to his high numbers and that he should have a cleaning under anesthesia, which really scares me. She asked what I’ve been feeding him and when I told her Fancy Feast under 6 grams of carbs, she multiplied that by 4 or 5 cans and said it is too many carbs for him. She said he has seen excellent results from diabetic cats on a Purina Pro Plan DM (pate) diet so I bought some and Pepper actually ate it. I had to temper it with tuna juice the second time I offered it to him, though. One of the things that impressed me was her encouragement in testing Pepper’s blood before giving insulin. I told her about my experience at the other animal hospital where the ‘specialist’ there discouraged me from testing saying it would hinder Pepper’s chances of remission. This new vet agreed that it would be dangerous to give insulin without first checking BG. So now I’ll wait for the lab results and her interpretation of them. Is there a place on this site where I could/should post Pepper’s lab results and/or vet notes?
Sorry for rambling. Thanks again. : )
 
Julia78 said:
Thank you : )
Is there a place on this site where I could/should post Pepper’s lab results and/or vet notes?
Sorry for rambling. Thanks again. : )
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Julia, there is a tab on Pepper's spreadsheet called LABS. Enter that info there. Do you see it? Down at the very bottom left on his sheet, next to the tab that says, "2020."
 
Julia78 said:
Should I enter his results under the C column?
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Yes but you'll need to update the reference values if they are different from your vets values.

Julia78 said:
Purina Pro Plan DM
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If you're feeding the DM merely for the carb content, it's 6% carbs per the food chart (linked here)...so carb-wise it's no different than your FF pates and flaked...and in fact most of the FF pates/flakes are less than 6%. Just food for thought (no pun in tended lol).
 
JaxBenji said:
Yes but you'll need to update the reference values if they are different from your vets values.


If you're feeding the DM merely for the carb content, it's 6% carbs per the food chart (linked here)...so carb-wise it's no different than your FF pates and flaked...and in fact most of the FF pates/flakes are less than 6%. Just food for thought (no pun in tended lol).
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I don’t see Purina pro plan DM listed in the chart, but in looking at the can’s label, I definitely don’t like that the very first ingredient is meat by-products!
 
Julia78 said:
I don’t see Purina pro plan DM listed in the chart, but in looking at the can’s label, I definitely don’t like that the very first ingredient is meat by-products!
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It's on page 61 under "PURINA Pro Plan Veterinary Diets". But ya generally the prescription foods don't have the greatest ingredients. Plus the cost $$$
 
JaxBenji said:
It's on page 61 under "PURINA Pro Plan Veterinary Diets". But ya generally the prescription foods don't have the greatest ingredients. Plus the cost $$$
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I really hate that the vet prescribed DM. She told me to keep Pepper’s daily carbs under 3 mg. ??? I just wrote to her and attached a screen shot from the form you referred me to and also told her I’m really unhappy that the first ingredient is meat by-products! How I wish I could afford to take Pepper to a naturopath! As it is, the bill yesterday was over $600. Thanks again for your help.
 
First kudos to vet for testing before insulin shot. Human meter is just fine to use. Food -you can take back the DM and say kitty refuses it now.
 
It probably won’t be a lie either often kitty’s eat it once or twice and then turns their noses up. Alphatrack is way more expensive to run, your vet would prefer that because they are the numbers she understands. Fortunately you don’t need her to understand the numbers so much - that’s what we’re for :)
 
Vyktors Mum said:
It probably won’t be a lie either often kitty’s eat it once or twice and then turns their noses up. Alphatrack is way more expensive to run, your vet would prefer that because they are the numbers she understands. Fortunately you don’t need her to understand the numbers so much - that’s what we’re for :)
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Thank you : )
 
Julia78 said:
She said it looks like Pepper has periodontal disease which could be contributing to his high numbers and that he should have a cleaning under anesthesia, which really scares me. She asked what I’ve been feeding him and when I told her Fancy Feast under 6 grams of carbs, she multiplied that by 4 or 5 cans and said it is too many carbs for him.
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Is there a particular reason this concerns you? If a cat has inflammation or infection from bad teeth, a cleaning, or if needed extraction, can often help get them into better numbers.
Julia78 said:
She mentioned a few things that could be causing Pepper’s glucose to be rising including Cushing’s disease, which she said is rare, and inflammatory bowel disease.
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Did she say why she though Cushings? We don't see it very often and it's not something we'd be considering unless there are clinical signs. Inflammation/infection or some other secondary conditions are more likely. It could also be that you just haven't hit a good dose yet for Pepper. He's not on that high a dose yet.
 
Wendy&Neko said:
Is there a particular reason this concerns you? If a cat has inflammation or infection from bad teeth, a cleaning, or if needed extraction, can often help get them into better numbers.

Did she say why she though Cushings? We don't see it very often and it's not something we'd be considering unless there are clinical signs. Inflammation/infection or some other secondary conditions are more likely. It could also be that you just haven't hit a good dose yet for Pepper. He's not on that high a dose yet.
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Having him put under anesthesia scares me. It seems very risky, especially since he’s not well. Of course I’ll have it done if it will make him feel better. Im not sure why she suggested Cushings but she did say it’s not common. Would it be inappropriate to place the vet’s note I received here? Or is there another place for things like this?
 
You can copy and paste the note if you want. The blood work that the vet did will help to say if he's a candidate for anaesthesia. Hopefully she also checked his heart, which is another consideration for anaesthesia. Is there anything else other than diabetes that is making him unwell now?
 
Here is the note I received from the vet today.

Hello Julia,

It was nice "meeting" you yesterday. I have the results of Pepper's blood work. There are just a couple of things to discuss - first, he has a history of protein in his urine, which is also present on yesterday's sample. I saw in the records from VCA that they were planning on doing a Urine Protein/Creatinine Ratio, but I didn't see anywhere in the record where they actually did it. Do you recall them doing this? If it wasn't done I would recommend that we do this. He does have an elevated white blood cell count, with high neutrophils and eosinophils. The neutrophils can be elevated due to stress, inflammation, or infection. Eosinophils tend to be elevated in allergic diseases and parasitic diseases. There were no parasites seen in his stool, but it is recommended to give a broad spectrum dewormer called Profender (I can dispense), to cover for false negative stool samples (parasites do not continuously shed eggs, so a negative does not rule them out). We already have a low level of suspicion for allergies as a possible cause for the stool changes, so if you find that you aren't having luck with the DM (either not helping BG numbers or just won't eat it consistently) we will try the hypoallergenic canned Rabbit to see if there is any improvement with the stool. At some point we will want to recheck the CBC to see if we've improved the counts. The urine culture is still pending. I would like to try an antibiotic once we get those results, but my choice of antibiotic may vary depending upon those results, so we'll hold off until then. Lastly, his blood glucose is elevated, which we were expecting, of course. Let me know what happens over the next few days with the DM. It sounds like you are already having to doctor it to get him to eat it.
 
I read D-Mannose is a good natural remedy for feline urinary tract infections. I purchased some and am thinking of giving it to Pepper.
 
If he does have a history of protein in his urine and urine protein/creatinine ratio (also called UPCR) is a good idea. Protein in urine can be an early indicator of kidney disease, and there are medications that can help. Neko had proteinuria.

Julia78 said:
so if you find that you aren't having luck with the DM (either not helping BG numbers or just won't eat it consistently) we will try the hypoallergenic canned Rabbit to see if there is any improvement with the stool.
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I have a much cheaper and lower carb suggestion. There are a few commercially available low carb canned rabbit foods out there. The stuff she is mentioning is probably high carb and high price. Totally not needed to buy the vet food. There are actually quite a few commercially available novel proteins you can get, like lamb, venison, duck. basically you want some protein he hasn't eaten yet.
 
Wendy&Neko said:
If he does have a history of protein in his urine and urine protein/creatinine ratio (also called UPCR) is a good idea. Protein in urine can be an early indicator of kidney disease, and there are medications that can help. Neko had proteinuria.


I have a much cheaper and lower carb suggestion. There are a few commercially available low carb canned rabbit foods out there. The stuff she is mentioning is probably high carb and high price. Totally not needed to buy the vet food. There are actually quite a few commercially available novel proteins you can get, like lamb, venison, duck. basically you want some protein he hasn't eaten yet.
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I bought Fresh Pet rabbit cat food a couple times and he wouldn’t eat it. Can you suggest something a very finicky eater might approve of?
 
Rawz and Nature's Variety Instinct have rabbit options. If he doesn't like rabbit, try one of the other meats I mentioned above.
 
Wendy&Neko said:
Rawz and Nature's Variety Instinct have rabbit options. If he doesn't like rabbit, try one of the other meats I mentioned above.
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I will. Thank you! I just entered Pepper’s lab results. The vet didn’t test for everything listed here, though.
 
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