7/25 Howie AMPS=180, +5=235(6R), +9=259, +10=241

Howiesmom

Howiesmom

Member Since 2020
7/22 thread about his possible UTI he’s being treated for https://www.felinediabetes.com/FDMB/threads/7-22-howie-rapidly-rising-bgs-concern.250233/

Howie’s BGs (for him) are still rising for no apparent reason. His normal for the past several months have been 70-120 but as of last week he’s been 140-210 range mostly. I have a vet appt (unfortunately with the one I don’t like) tomorrow as I was told to bring him back in after a few days on the Enroflxin if his urination and BGs are not getting better (he’s finished the Onsior). He is still only peeing about once/day when his normal is 2-3 times. He is still eating fine and having bowel movements. The vet last week said if he wasn’t improving to have his kidney levels checked as his last SDMA in April was 17 and the threshold is 19 for early kidney disease. I have so much fear that this is what it is and to have the vet I don’t like have to be the one to tell me all this. I had a CKD kittie previously and it was heartbreaking to see him go through all that.

Before my mind goes to the worst, are there any other things people recommend I ask about or have checked on besides kidneys? 2 weeks ago he had a nice slide down the dosing scale and nice numbers. Now he is racing back up and has abnormally high BGs. He has no teeth so it’s not a dental issue!

@Wendy&Neko in case you are around, could this just be the tumor pulsing possibly? I thought we were having a breakthrough with his IAA but I guess not! I appreciate any perspective you could provide if you have time before I go to this vet appt tomorrow!
 
While I do not have Wendy's expertise with acro kitties, this could easily be the tumor pulsing. In addition, with IAA, there can be ups and downs, as well. You may have a breakthrough and for whatever reason, the antibodies may start to build up again.

Looking at Howie's labs, his kidney values are fine -- at least as of April. SDMA can be a bit higher in larger cats. Also, the higher end of normal is still normal. Kidney issues would not be a stand alone reason for BG to be a bit higher.
 
In your previous thread, it sounded like a urine culture and sensitivity was not done, so if there is an infection, the type of bacteria was not identified. Meaning the vet was just guessing on how to treat him. And might not have guessed right.

I'm also wondering if you are missing some action at night. You are only testing at +2 at night, which is before Lev onset, so the only idea you have about his night time nadirs is the AMPS data. Any chance of getting some spot checks from PM+2 to AMPS?
 
Sienne and Gabby (GA) said:
While I do not have Wendy's expertise with acro kitties, this could easily be the tumor pulsing. In addition, with IAA, there can be ups and downs, as well. You may have a breakthrough and for whatever reason, the antibodies may start to build up again.

Looking at Howie's labs, his kidney values are fine -- at least as of April. SDMA can be a bit higher in larger cats. Also, the higher end of normal is still normal. Kidney issues would not be a stand alone reason for BG to be a bit higher.
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Thank you so much! That is reassuring to know about his levels. I appreciate the response and some confidence going into this appt tomorrow!
 
Wendy&Neko said:
In your previous thread, it sounded like a urine culture and sensitivity was not done, so if there is an infection, the type of bacteria was not identified. Meaning the vet was just guessing on how to treat him. And might not have guessed right.

I'm also wondering if you are missing some action at night. You are only testing at +2 at night, which is before Lev onset, so the only idea you have about his night time nadirs is the AMPS data. Any chance of getting some spot checks from PM+2 to AMPS?
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I don’t believe a culture was done but am not totally sure. Because his WBCs were higher than normal but not completely alarming and his urine sample showed some cloudiness but nothing that could be conclusive, he was put on a general antibiotic to try and nip whatever caused the higher WBCs in the bud. I will definitely ask about this tomorrow. Yes, I know I need to get another PM sample. My personal issue is that he doesn’t sleep with me so getting up in the night/pre-dawn hours means waking up, going downstairs to the back of the house, turning on lights, testing, etc. I will NEVER go back to sleep after that. His AMPS is right when I get up to get ready for work. I’m sure this sounds selfish but it is my reality and there is no one else but me. I stay up as late as I can to get the +3. I appreciate your help, Wendy!
 
Just did a +9 check after giving 6 units of R at +6. Didn’t even touch it and he went from 235 at +6 to 259 at +9. My last R dosing scale I had to figure out was from April 20 when he was at 43 units BID. He’s at 22 units right now. If I followed that dosing scale, I should have given him 15 units which obviously is too much. Grrrr..this is getting frustrating and I can tell he doesn’t feel good. Outside of some bread eating incidents, he hasn’t been this high since Feb. 14. The vet I see tomorrow is not great with FD let alone the IAA and acromegaly. I pray it is not a waste of an appt. I see my regular vet on Aug 4 but that is a long ways away.
 
I don't see elevated white counts in Howie's labs. Am I missing something (I was pretty sure I was looking at April 2021 results? Was the UTI suspected because of litter box habits? I don't see elevated White Count in his blood or urine? Kidney values all look good. They didn't do a urine specific gravity at the last test so I can't comment on that. I'm concerned about Howie now though and will be checking on what you report from your visit. So you say you can tell he's not feeling well? I hope that there will be further clarification from tomorrow's visit, even though it's the non-preferred vet.

Hugs. I will be thinking about you both. Howie has been doing so well, I am distressed to hear about this... I know you will keep us all posted. :-)
 
Suzanne & Darcy said:
I don't see elevated white counts in Howie's labs. Am I missing something (I was pretty sure I was looking at April 2021 results? Was the UTI suspected because of litter box habits? I don't see elevated White Count in his blood or urine? Kidney values all look good. They didn't do a urine specific gravity at the last test so I can't comment on that. I'm concerned about Howie now though and will be checking on what you report from your visit. So you say you can tell he's not feeling well? I hope that there will be further clarification from tomorrow's visit, even though it's the non-preferred vet.

Hugs. I will be thinking about you both. Howie has been doing so well, I am distressed to hear about this... I know you will keep us all posted. :)
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Sorry, Suzanne. I didn’t get a chance to put the latest lab results in and now can’t find the sheet (but I know it’s here somewhere). They did a urinalysis on Thursday. Yes, UTI suspected due to only peeing once every 24 hrs when he was 2-3 times. As for not feeling well, he’s very lethargic right now, and doesn’t play or want to go outside his leash like he did (but it’s very warm here in MN so that could be part of it!). I soooo appreciate your message and concern. It means so much! I will post tomorrow after the vet visit.
 
The only thing I was wondering when I looked at Howie's labs was... did the vet say anything about the low platelet count (thrombocytopenia) in several different labs taken at different times? I hope they will be better tomorrow. His were low and then got a lot lower. I hope the vet can explain this and there's no suspected bone marrow problem.
 
Howiesmom said:
Sorry, Suzanne. I didn’t get a chance to put the latest lab results in and now can’t find the sheet (but I know it’s here somewhere). They did a urinalysis on Thursday. Yes, UTI suspected due to only peeing once every 24 hrs when he was 2-3 times. As for not feeling well, he’s very lethargic right now, and doesn’t play or want to go outside his leash like he did (but it’s very warm here in MN so that could be part of it!). I soooo appreciate your message and concern. It means so much! I will post tomorrow after the vet visit.
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Oh, okay... so I was looking at older labs! That explains it. It's okay. Just let us know what happens tomorrow!
 
Howiesmom said:
es, UTI suspected due to only peeing once every 24 hrs when he was 2-3 times. As for not feeling well, he’s very lethargic right now, and doesn’t play or want to go outside his leash like he did (but it’s very warm here in MN so that could be part of it!)
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Any chance he's not drinking enough in the heat? We had some ridiculous temperatures during the "heat dome" and I had to add water to the cat food.
 
Suzanne & Darcy said:
The only thing I was wondering when I looked at Howie's labs was... did the vet say anything about the low platelet count (thrombocytopenia) in several different labs taken at different times? I hope they will be better tomorrow. His were low and then got a lot lower. I hope the vet can explain this and there's no suspected bone marrow problem.
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I think I will reserve that for when I meet with my regular vet on 8/4. No one has ever said anything about it. Tomorrow’s vet talks in circles but she’s the only one available of the 4 in the clinic.
 
@Wendy&Neko @Suzanne & Darcy @Sienne and Gabby (GA)
I finally found the labs sheet from Thursday. The vet had a separate little print out he didn’t give me that indicated the higher WBC as he reran some if it. Unfortunately I don’t have that data. I updated the labs on my SS. The biggest changes besides WBC and RBC I can see is that pH went up from 6.5 to 8 since April and USG went from 1.027 to 1.040. I’m on an iPad so can’t upload a photo of the lab sheet. It does say bacteria was not detected so I’m not sure if the C&S would tell me anything? His appt is at 10am CST Monday in case you have any other things I should talk to the vet about or request. Thanks for everything!
 
If they got a. urine sample the same day as you got the rest of the labs, there won't be results from the C & S. It takes several days to see if there's bacteria growing.

Were there any high levels for BUN, creatinine, or phosphorus? I'm guessing those labs weren't done since I didn't see them on your spreadsheet. I'd also be surprised to see that big of a jump in 3 mos. You might ask about getting an SDMA at some point. (It predicts kidney disease.) The higher WBC suggests there's some sort of infection.

If you want more information, I'm tagging @Marje and Gracie .
 
Not much there to go on (in the urinalysis). I guess the vet has other data. With the alkaline urine, he is at risk of developing struvite crystals. We just had a discussion on this on Summer and Susie’s condo yesterday. I hope the vet will be helpful today and you can at least get copies of whatever labs were done. If his current antibiotic has not helped by now, they need to try a different one. Hopefully they did do or can do a C&S. If he had kidney disease, you would expect more urination and not less. You would also expect him to drink a lot of water, which he does not do. I hope this is a simple UTI, but he could have a partial blockage. No matter what they need to decide how to treat this as a UTI can travel up into the ureters and kidneys and damage them. Good luck today!

Get them to check Howie’s blood pressure either today or on August 4.
 
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Sienne and Gabby (GA) said:
If they got a. urine sample the same day as you got the rest of the labs, there won't be results from the C & S. It takes several days to see if there's bacteria growing.

Were there any high levels for BUN, creatinine, or phosphorus? I'm guessing those labs weren't done since I didn't see them on your spreadsheet. I'd also be surprised to see that big of a jump in 3 mos. You might ask about getting an SDMA at some point. (It predicts kidney disease.) The higher WBC suggests there's some sort of infection.

If you want more information, I'm tagging @Marje and Gracie .
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I didn’t have a CBC done on Thursday but am guessing we’ll get that done today so will update those lab results. He did have an SDMA done in April and that’s when they found him at 17 (but you said previously that bigger cats can have a higher SDMA).
 
Suzanne & Darcy said:
Not much there to go on (in the urinalysis). I guess the vet has other data. With the alkaline urine, he is at risk of developing struvite crystals. We just had a discussion on this on Summer and Susie’s condo yesterday. I hope the vet will be helpful today and you can at least get copies of whatever labs were done. If his current antibiotic has not helped by now, they need to try a different one. Hopefully they did do or can do a C&S. If he had kidney disease, you would expect more urination and not less. You would also expect him to drink a lot of water, which he does not do. I hope this is a simple UTI, but he could have a partial blockage. No matter what they need to decide how to treat this as a UTI can travel up into the ureters and kidneys and damage them. Good luck today!

Get them to check Howie’s blood pressure either today or on August 4.
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Thanks, Suzanne! I am seeing a bit more urination than I did last week when I took him in but it is definitely not normal! I’ll report back in the new thread I’m starting today. Thanks a ton!
 
Howiesmom said:
I didn’t have a CBC done on Thursday but am guessing we’ll get that done today so will update those lab results. He did have an SDMA done in April and that’s when they found him at 17 (but you said previously that bigger cats can have a higher SDMA).
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Yes. And bigger cats can have higher creatinine too!
 
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