7/27 Callie AMPS 98, +2.75 78; PMPS 130( AT) - new dx, labs and request for advice

[Jessica A]

previous: https://felinediabetes.com/FDMB/threads/7-22-callie-amps-98-pmps-71-at.266171/#post-2979543

Hi all,

First, I would love some advice @Bandit's Mom @tiffmaxee - This Friday, I won't be home most of the afternoon/evening so I will miss Callie's PM shot time and her +2/+3 test. I should get home by her PM +4/ +5. Rob will be home but isn't sure he can do her shot or test bgs by himself. I thought about shifting Callie's shot time but it's pretty late so that would be too difficult.

If Callie stays in normal numbers through Friday am, do you think we could start an OTJ trial on Friday night? If we hadn't skipped her shot 7/22 PM, she may have had normal numbers on the drop dose for more than a week by then. With the skipped shot, her subsequent two AMPS readings were a little high - 119/ 124. Please let me know what you think. If not, we'll probably just skip again.


General non-FD update: Callie had a vet visit yesterday. It went well overall and lab results are good, mostly in normal range and trending in the right direction (values in spreadsheet.) Two things of some concern: the vet took Callie's blood pressure for the first time and she was running a bit high so he put her on a low dose blood pressure med. Also, her teeth have a fair amount of plaque so we're going to schedule her for a dental with a dental specialist. They are currently scheduling appointments for next March so it will be a while ... but with Callie's various medical issues (asthma, seizures, FD), I really want her to see a specialist. Fingers crossed that Callie won't have any serious tooth issues before we can get an appt.

Have a great day everyone. Surf safely kitties

 

[tiffmaxee]

I would just skip that shot and see what happens to tbe bg. There’s more blue than I would like to see for a strong remission. If it means staying on a drop dose a little longer why risk it? The fact that she was above 120 after a skip to mean means she might need a drop dose a little longer.
@Bandit's Mom Agree or disagree?

 

[Jessica A]

I would just skip that shot and see what happens to tbe bg. There’s more blue than I would like to see for a strong remission. If it means staying on a drop dose a little longer why risk it? The fact that she was above 120 after a skip to mean means she might need a drop dose a little longer.
@Bandit's Mom Agree or disagree?

We'll see what Bhooma says too but that makes sense to me. We definitely want as strong a remission as possible (if we can get there anti-jinx!!) Thanks, Elise.

 

[Bandit's Mom]

Your experience has been that the ReliOn reads higher than the AT! I see that she is dropping to the low 70s on the AT on a drop dose. Do you have enough strips to switch completely to the AT? If she were my cat, I would risk an OTJ trial starting Friday night and test only with the AT going forward (from today) and see how her numbers look.

On the non-FD front, are the hypertension and seizures linked? See this section: http://felinecrf.org/hypertension.htm. It also says that seizures can be caused by high potassium levels (http://felinecrf.org/potassium.htm#seizures_high) and calcium imbalances (http://felinecrf.org/symptoms_regulation_minerals.htm#seizures_calcium). Callie's potassium and calcium levels are both high. Though both are lower than a year ago.

ETA: I know nothing about hypertension and seizures. Just quoting what the website says!

 

[Jessica A]

Your experience has been that the ReliOn reads higher than the AT!

Yup, but weirdly this is mostly in the lower numbers, esp below 90. Between 90 and 120, the two meters are usually about the same or sometimes the Relion has been a little lower.

I see that she is dropping to the low 70s on the AT on a drop dose. Do you have enough strips to switch completely to the AT? If she were my cat, I would risk an OTJ trial starting Friday night and test only with the AT going forward (from today) and see how her numbers look.

LOL ok, food for thought... we do have enough AT strips to switch completely to AT for a bit so we'll do that starting tonight. I'll make a note on the spreadsheet.

I think what we'll do is test on AT through at least Friday morning and then see where we are... if Callie has remained in normal numbers at that point, we may try an OTJ trial. Or I may chicken out and we'll just skip and continue on a little longer. We're currently split down the middle like you and Elise - Rob would really like to give OTJ a shot sooner rather than later (pun intended) but I am really nervous about it and would rather spend a little longer at a drop dose getting rid of those higher numbers. (Our vet and Callie both vote for OTJ but we're not counting their votes atm .)

On the non-FD front, are the hypertension and seizures linked? See this section: http://felinecrf.org/hypertension.htm. It also says that seizures can be caused by high potassium levels (http://felinecrf.org/potassium.htm#seizures_high) and calcium imbalances (http://felinecrf.org/symptoms_regulation_minerals.htm#seizures_calcium). Callie's potassium and calcium levels are both high. Though both are lower than a year ago.

ETA: I know nothing about hypertension and seizures. Just quoting what the website says!

Thanks so much for those links! I am going to ask the vet about this. Our first cat had kidney disease and high blood pressure (we didn't know about her pressure until she had a stroke ) and she had seizures as a result at the end of her life. But since Callie's kidneys seem to be okay and her seizures appear so different, I didn't even think about them possibly being connected to hypertension. And I had no idea about potassium and calcium levels potentially causing seizures.

The vet thinks the abnormalities in her blood work currently are likely still a result of some dehydration (even though we give her TONS of water with her meals, to the point that her meals are basically a soup of raw meat.) Working hypothesis is that the Miralax we are giving her could be at least partially to blame but it works and she really needs it because of how constipating her meds are. It can be quite the balancing act trying to get/keep these cats healthy!!

 

[Jessica A]

Not sure whether to laugh or cry - PMPS 130 AT

Callie didn't get her usual +9 snack so hopefully that's the reason for the high pre-shot bg. Guess we'll see how the next few cycles play out.

 

[Bandit's Mom]

The vet thinks the abnormalities in her blood work currently are likely still a result of some dehydration (even though we give her TONS of water with her meals, to the point that her meals are basically a soup of raw meat.) Working hypothesis is that the Miralax we are giving her could be at least partially to blame but it works and she really needs it because of how constipating her meds are. It can be quite the balancing act trying to get/keep these cats healthy!!

The higher HCT could indicate dehydration but her BUN is okay. Is she showing any clinical signs of dehydration? Are her gums tacky? What does the vet suggest to remedy the dehydration? Did the labs include SDMA? From what I've read on Tanya CKD site, certain conditions can suppress kidney values disguising the CKD. One of them is hyperthyroidism. (http://www.felinecrf.org/hyperthyroidism.htm#masking_ckd).

Budge had a similar issue where her kidney values were okay but her potassium, phosphorus and calcium were very high. Turns out she had metabolic acidosis and treating that brought down all 3 levels! Interestingly Metabolic Acidosis manifests in respiratory, neurological and cardiovascular symptoms! (http://www.felinecrf.org/metabolic_acidosis.htm).

Incidentally, CKD also causes constipation!

Not sure whether to laugh or cry - PMPS 130 AT

Callie didn't get her usual +9 snack so hopefully that's the reason for the high pre-shot bg. Guess we'll see how the next few cycles play out.

They really like to mess with our minds, don't they?

 

[Jessica A]

The higher HCT could indicate dehydration but her BUN is okay. Is she showing any clinical signs of dehydration? Are her gums tacky? What does the vet suggest to remedy the dehydration? Did the labs include SDMA? From what I've read on Tanya CKD site, certain conditions can suppress kidney values disguising the CKD. One of them is hyperthyroidism. (http://www.felinecrf.org/hyperthyroidism.htm#masking_ckd).

No clinical signs of dehydration. Gums aren't tacky. Vet says to keep doing what we are doing with adding water, try to tweak her Miralax dose down to see if that helps or hurts and we'll see what her next labs look like.

Re: hyperthyroidism: I was worried about that when he was taking her blood pressure and it was elevated, but Total T4 is in normal range. I think I read somewhere that a small % of cats can still be hyperthyroid with a normal T4 except Callie doesn't really have any other symptoms of it. She has lost weight but that's been intentional - we put her on a diet because of her weight gain in the last year. Coat looks good, no hyperactivity, no increased thirst... in fact, no drinking at all (aside from her raw food soup lol.)

Yes, SDMA: 7 (range 0-14) with footnote: "SDMA and creatinine are within the reference interval: impairment of GFR is unlikely." We didn't get a urinalysis but we will do one and another blood panel before her dental.

Budge had a similar issue where her kidney values were okay but her potassium, phosphorus and calcium were very high. Turns out she had metabolic acidosis and treating that brought down all 3 levels! Interestingly Metabolic Acidosis manifests in respiratory, neurological and cardiovascular symptoms! (http://www.felinecrf.org/metabolic_acidosis.htm).

This is interesting -- I know nothing about Metabolic Acidosis. How was Budge diagnosed -- was it just based on the high blood values? And how was she treated? I'll read more at that link.

Incidentally, CKD also causes constipation!

Apparently, so does excessive potassium. So hard to know what exactly is going on.

They really like to mess with our minds, don't they?

Ha, that they do! Callie's been surfing in the 70s on AT since our first test after PMPS. She just wanted to make it clear that she's still the one calling the shots.

 

[Bandit's Mom]

This is interesting -- I know nothing about Metabolic Acidosis. How was Budge diagnosed -- was it just based on the high blood values? And how was she treated? I'll read more at that link.

We did a blood gas analysis and the treatment was very simple. Gave her sodium bicarbonate twice a day for a week to 10 days.