4/9 Indigo AMPS 187, +2 156, +4 152, +6 130, +9 254, PMPS 281

[Carole & Indigo]

Yesterday

Got his results back today from his blood work and urine, vet says he has some elevated numbers but she is not concerned. She believes he was probably a touch dehydrated the morning of his tests, the elevated Spec fPL is due to his diabetes since he has never shown symptoms of pancreatitis and the elevated protein is due to his raw diet. I'm going to attempt to post them here for a second opinion but I have also added them to his spreadsheet.
She also tried to tell me that I should think about putting a Libre on him to avoid the stress of testing so frequently, I told her shaving, gluing on a monitor and making him wear a shirt 24 hours a day will be way more stressful than a tiny poke. Also it is less accurate and more expensive.
Then she said she had looked at the sheet I sent her (not his live sheet just a copy) and I'm very organised although I'm changing his dose too often since he is well regulated I should be decreasing to see if he is going into remission. I told her we are following TR not changing his dose randomly, he is nt showing ANY signs of being ANYWHERE close to remission he would have to be in normal numbers for at leat a week!!! I invited her to look on my sheet to see the study and why I'm doing what I'm doing, don't know if she will but oh well. She tried to tell me to keep him at 1.50 for a week and we can talk about his dose then, I told her as politely as I could thanks but no thanks I am managing his diabetes.
I do like her, she is misinformed but I honestly think she means well and has Indi's best interest in mind which is more than I can say for the last vet, he was like a drive through.

 

[Bandit's Mom]

Did the vet think that Indi has a UTI? There's no bacteria in the urine but there is blood and WBC. I believe a UTI can show a false positive of proteinuria. Has he shown any symptoms of urinary issues? The higher HCT and BUN could indicate that he is dehydrated. I'm going to tag more experienced members for help with his labs:

@Bron and Sheba (GA)
@tiffmaxee
@Marje and Gracie
@Wendy&Neko

 

[Carole & Indigo]

Has he shown any symptoms of urinary issues?

There was no mention of a UTI and he hasn't shown any symptoms, he has actually had a great few days

 

[tiffmaxee]

I do think he was likely slightly dehydrated. You mention high protein but I don’t see that. Are you

refectory protein in the urine? I think that could be due to the blood which could be from the way the urine was collected and not from the diet. I do know that other factors can elevate the SpecfPL so if no symptoms I would not worry about that.
Good you stood your ground on fd treatment. Did she get defensive?

 

[Carole & Indigo]

I do think he was likely slightly dehydrated. You mention high protein but I don’t see that. Are you

refectory protein in the urine? I think that could be due to the blood which could be from the way the urine was collected and not from the diet. I do know that other factors can elevate the SpecfPL so if no symptoms I would not worry about that.
Good you stood your ground on fd treatment. Did she get defensive?

I'm looking on the second page under chemistry, Urine protein:Creatinine ratio is 3.8 and the reference value is 0.0-0.2. the vet said she believes it is due to the raw diet (which she is not a fan of) and she's not worried.
She was much better when I spoke to her on the phone yesterday than she was the other day in the office. I think she took a look at his sheet and can at least see I'm putting in effort and I'm not a crazy person. I think she is just genuinely concerned. In the office was a struggle, she seemed legitimately and visibly horrified at the amount of testing we do but I think she actually believes we are causing him stress and inflammation so I can deal with that because she at least cares and shows actual concern for his well being. Unlike our last vet.
I want to take a video and show her how he comes running when I shake his container of strips and waits in his spot to be tested so she can see it's not all bad it just sucks in the beginning. The idea that she would suggest a Libre to someone who clearly has no issue testing is just mind blowing to me! Hopefully she will take a look at the links on his sheet and maybe rethink her methods, that's really the only reason I sent it

 

[Amy & Herman]

I'm looking on the second page under chemistry, Urine protein:Creatinine ratio is 3.8 and the reference value is 0.0-0.2. the vet said she believes it is due to the raw diet (which she is not a fan of) and she's not worried.
She was much better when I spoke to her on the phone yesterday than she was the other day in the office. I think she took a look at his sheet and can at least see I'm putting in effort and I'm not a crazy person. I think she is just genuinely concerned. In the office was a struggle, she seemed legitimately and visibly horrified at the amount of testing we do but I think she actually believes we are causing him stress and inflammation so I can deal with that because she at least cares and shows actual concern for his well being. Unlike our last vet.
I want to take a video and show her how he comes running when I shake his container of strips and waits in his spot to be tested so she can see it's not all bad it just sucks in the beginning. The idea that she would suggest a Libre to someone who clearly has no issue testing is just mind blowing to me! Hopefully she will take a look at the links on his sheet and maybe rethink her methods, that's really the only reason I sent it

I can totally relate to this! Herman is an excellent example of a cat who can be extremely difficult and affected by stress. The little bugger doesn't tolerate ANY grooming or matt removal of ANY kind except for around his shoulders and neck. Literally goes berserk....

Pick him up? You must prepare to pay the consequences - although he will smother you with snuggles at night on HIS terms.

....Put a Libre on him? Well, HE THOUGHT IT WAS THE END OF THEW WORLD! He was BEYOND stressed and ripped it off along with some skin within 4 days. He was beside himself.

So I honed my poking skills using minimal restraint and within a week of practicing it became a non-issue 99.9% of the time (the 0.1% of the time that it was an issue I can say I could have looked at him the wrong way and it would have been an issue and wasn't specific to the ear poke). I could do it while he was sleeping, sometimes it would make him purr. While he was eating. No problem! While he was playing outside with his friends - OK, mom! This is a cat that resents being handled in any way - but ear pokes (again, without restraint of any kind) clearly did not hurt or upset him in anyway. And I poked ALOT (too much in fact but that was me being an over-worrying momma) - check out my SS!

It just goes to show two things, one, ECID. Some cats don't mind the Libre. Some cats don't mind the pokes. Some cats hate both! And, two, do your own due diligence regarding caring for your pets - sometimes vets aren't as up to speed on a condition as you might hope - vets shouldn't fear monger about home testing - and they most certainly shouldn't make one feel guilty about it! It seems to happen so much!

 

[Carole & Indigo]

I can totally relate to this! Herman is an excellent example of a cat who can be extremely difficult and affected by stress. The little bugger doesn't tolerate ANY grooming or matt removal of ANY kind except for around his shoulders and neck. Literally goes berserk....

Pick him up? You must prepare to pay the consequences - although he will smother you with snuggles at night on HIS terms.

....Put a Libre on him? Well, HE THOUGHT IT WAS THE END OF THEW WORLD! He was BEYOND stressed and ripped it off along with some skin within 4 days. He was beside himself.

So I honed my poking skills using minimal restraint and within a week of practicing it became a non-issue 99.9% of the time (the 0.1% of the time that it was an issue I can say I could have looked at him the wrong way and it would have been an issue and wasn't specific to the ear poke). I could do it while he was sleeping, sometimes it would make him purr. While he was eating. No problem! While he was playing outside with his friends - OK, mom! This is a cat that resents being handled in any way - but ear pokes (again, without restraint of any kind) clearly did not hurt or upset him in anyway. And I poked ALOT (too much in fact but that was me being an over-worrying momma) - check out my SS!

It just goes to show two things, one, ECID. Some cats don't mind the Libre. Some cats don't mind the pokes. Some cats hate both! And, two, do your own due diligence regarding caring for your pets - sometimes vets aren't as up to speed on a condition as you might hope - vets shouldn't fear monger about home testing - and they most certainly shouldn't make one feel guilty about it! It seems to happen so much!

Thanks Amy! Hope you and Herman are well and enjoying the Falls! It’s good to hear from you

 

[Wendy&Neko]

Urine protein:Creatinine ratio is 3.8 and the reference value is 0.0-0.2. the vet said she believes it is due to the raw diet (which she is not a fan of) and she's not worried.

Garbage. Neko was on a raw diet, it did not raise her UPCR, but the emerging kidney disease did. A high positive UPCR, if verified, absolutely needs to be treated. A repeat test in a couple weeks could be done. Thankfully Indigo is concentrating urine well, so kidney disease less likely.

How was the urine collected? Did the vet say whether in was free catch or cysto? Neko once peed on the exam table as they were getting her ready for a cystocentesis. They grabbed it but must have had some contamination as her UPCR was really high (over 8). Next test, urine taken properly, was 0.03.

As for the vet and testing, the "smile and nod" response is one many of us learn. Or "thanks for your input". You know your cat.

With TR, we hold doses with green nadirs for 10 cycles. Today is cycle 15. You could try an increase to see if you can flatten him out.

 

[Carole & Indigo]

Garbage. Neko was on a raw diet, it did not raise her UPCR, but the emerging kidney disease did. A high positive UPCR, if verified, absolutely needs to be treated. A repeat test in a couple weeks could be done. Thankfully Indigo is concentrating urine well, so kidney disease less likely.

How was the urine collected? Did the vet say whether in was free catch or cysto? Neko once peed on the exam table as they were getting her ready for a cystocentesis. They grabbed it but must have had some contamination as her UPCR was really high (over 8). Next test, urine taken properly, was 0.03.

As for the vet and testing, the "smile and nod" response is one many of us learn. Or "thanks for your input". You know your cat.

With TR, we hold doses with green nadirs for 10 cycles. Today is cycle 15. You could try an increase to see if you can flatten him out.

His urine was collected by cysto, do you think we need to retest in a couple of weeks to be safe?
We could put him up in the morning .25u, I’m home for 3 days so I can keep an eye on him

 

[Wendy&Neko]

I read a lot about urine protein when Neko was first diagnosed with it. My vet agreed with all I read, which was a retest in a couple weeks to see if it was a false positive. It absolutely needs to be treated if it's really that high. It can make kidney disease progress quickly if not.

Has Indigo ever had his blood pressure tested? That's one of the diagnostic tools if you get a high UPCR. There are a few causes of high UPCR and you need to determine cause to figure out treatment.

 

[Carole & Indigo]

I read a lot about urine protein when Neko was first diagnosed with it. My vet agreed with all I read, which was a retest in a couple weeks to see if it was a false positive. It absolutely needs to be treated if it's really that high. It can make kidney disease progress quickly if not.

Has Indigo ever had his blood pressure tested? That's one of the diagnostic tools if you get a high UPCR. There are a few causes of high UPCR and you need to determine cause to figure out treatment.

I don’t believe he has ever had his blood pressure checked, if they did they didn’t give me results. We will take him back in in a few weeks to be safe.
Thanks for your help Wendy!! Once again I’m super grateful to have found LLB!!

 

[Wendy&Neko]

Out of curiosity, how long ago did he previously have a urinalysis done? And what was the urine protein number then. Big jump to 4+.

 

[Carole & Indigo]

Out of curiosity, how long ago did he previously have a urinalysis done? And what was the urine protein number then. Big jump to 4+.

His last urinalysis was done about a year and a half ago at his previous vet, unfortunately I don’t have the results. The vet said the tests were all good and I’m sad to say I trusted that. I wish I knew then what I know now

 

[Wendy&Neko]

FDMB taught us all a lot. A lot can change in a year and a half, so it's probably not as interesting as a more recent one could be.

 

[Melinda and Kitkat]

Good on ya Carole for standing your ground!!! It's not something we really want to have to do..... but we learn we gotta do it when it comes down to making our own best decisions for our furry buddies. In the beginning my vet thought my crazy hometesting equated to 'torture', but Kitkat will still to this day jump into his testing spot, lay down, purr and drool when he see's me bring out the tools. ( I didn't realize that a harmless poke and a bunch of treats equated to torture! haaaa, (either does Kitkat)

 

[Carole & Indigo]

Good on ya Carole for standing your ground!!! It's not something we really want to have to do..... but we learn we gotta do it when it comes down to making our own best decisions for our furry buddies. In the beginning my vet thought my crazy hometesting equated to 'torture', but Kitkat will still to this day jump into his testing spot, lay down, purr and drool when he see's me bring out the tools. ( I didn't realize that a harmless poke and a bunch of treats equated to torture! haaaa, (either does Kitkat)

Thanks Melinda! Happy to see KitKat is doing so well

 

[Melinda and Kitkat]

Happy to see KitKat is doing so well

He truly is! I am still so amazed and grateful for every moment I have with him. I'm proud of myself for standing my ground, it really was a difficult decision ( but only at first) . You and Indy have got this in da bag!!!! And as Wendy says so eloquently....smile and nod..... and thanks for your input I do hope these other issues get sorted soon for you.

 

[Marje and Gracie]

His last urinalysis was done about a year and a half ago at his previous vet, unfortunately I don’t have the results. The vet said the tests were all good and I’m sad to say I trusted that. I wish I knew then what I know now

I am a little late to the “show” but I agree with @Wendy&Neko on the UPC. I also feed a homemade, balanced raw diet to my two cats and, while they typically have 1+ protein which might be from the raw, they have never had proteinuria. The UPC should be tested 3 times over 2 weeks. If the UPC stays out of normal range and there are benign or normal sediments (except for hyaline casts which one would expect with proteinuria), there is likely some pathologic renal issue.

I would be very insistent about having this rechecked as is generally recommended. And a BP check. Even if the BP is not high, UPC can be treated with one of several heart medications. While his SDMA is not screaming “CKD”, I have seen some cats with UPC that did not have renal disease. And while this information on proteinuria is from a CKD website, it might give you some additional things to discuss with your vet.

Finally, I also disagree with your vet that diabetic cats have abnormal specfPL tests. The old fPLI tests were more influenced by BG but the newer one, not so much. What I have found is there can be some other comorbidity, such as an inflamed liver or GI or gallbladder issue that can cause the specfPL to be slightly elevated even in the absence of pancreatitis.

 

[Carole & Indigo]

I am a little late to the “show” but I agree with @Wendy&Neko on the UPC. I also feed a homemade, balanced raw diet to my two cats and, while they typically have 1+ protein which might be from the raw, they have never had proteinuria. The UPC should be tested 3 times over 2 weeks. If the UPC stays out of normal range and there are benign or normal sediments (except for hyaline casts which one would expect with proteinuria), there is likely some pathologic renal issue.

I would be very insistent about having this rechecked as is generally recommended. And a BP check. Even if the BP is not high, UPC can be treated with one of several heart medications. While his SDMA is not screaming “CKD”, I have seen some cats with UPC that did not have renal disease. And while this information on proteinuria is from a CKD website, it might give you some additional things to discuss with your vet.

Finally, I also disagree with your vet that diabetic cats have abnormal specfPL tests. The old fPLI tests were more influenced by BG but the newer one, not so much. What I have found is there can be some other comorbidity, such as an inflamed liver or GI or gallbladder issue that can cause the specfPL to be slightly elevated even in the absence of pancreatitis.

Thanks so much for taking the time to go over his tests, we will definitely have his UPC rechecked!

 

[Marje and Gracie]

Thanks so much for taking the time to go over his tests, we will definitely have his UPC rechecked!

You’re welcome.