12/20 ambg 444 +4 521 +6 513 +8 470 - IM vet results

[saltycat]

last condo

Eek, I have no idea where these red's and icky blacks came from. I upped his dose a hair yesterday and gave .1u R after seeing that black. I went a bit conservative with the R since his lev requirements are so low these days. I didn't want to skip today, but vetty wanted no food or insulin.

The visit with the IM doc was good. I spent almost an hour and a half with her. She absolutely loved the SS and wanted to know how to get a copy. She parroted what we say that it is a great tool to quickly and visually see how he is doing. Jack even managed to confuse her a bit with his symptoms.

Interestingly, she did not see major signs of Acro, some thickening of the intestinal walls, but no major teeth, facial feature changes or other signs she commonly sees in more advanced cases. She could feel a small nodule on his thyroid, but wasn't overly concerned about it. She mentioned some of the symptoms are consistent with Cushings, but the coat and skin somewhat rule that out. Without some pricey tests, it can not be completely ruled out though. She mentioned the IGF-1 test is good, but can give false readings occasionally and does not necessarily describe how fast the acro will progress. It could be he just hasn't progressed far enough to show more definitive signs/symptoms.

I got lots of good info from her and my head was full after that visit! Right now the treatment plan is to discontinue the budesonide, start prednisolone 5mg bid and either feed him pancreas from a butcher or get the pancreatic enzymes from the vet. The pred is to treat not only any GI inflammation, but also potential inflammation of other organs. If no improvement in 2 weeks we will most likely start Leukerin.

No food restrictions, let him eat as much as he wants... I think Jack will take this as a challenge... I've only been able to get him to turn down food once or twice in 13 years

Overall the visit went better then I had envisioned and at least we have a treatment plan. We discussed how much more weight he could lose, and she said the thing to watch for are more behavior symptoms then a hard number like 2lbs.

He either lost a bit more weight or was "empty" in the rear end. He has some big pee's and bm's these days.

The Diabetes Insipidus did come up, but as long as he is drinking and peeing good, she didn't feel it was necessary to do tests and treat it at this time. It would not affect the current issues.

Off to call some butchers and confuse them by asking for a pancreas and go get some more meds filled.... This cat keeps me busy that is for sure.

Hope all are doing good and the fur babies are behaving

 

[Mandy & Rex (GA)]

Good information here .. I just looked at the old labs and found it very interesting that Jack's T4 was always low. But I wonder if there is a possibility for hyperthyroidism?? That could explain the weight loss.

 

[Wendy&Neko]

She mentioned the IGF-1 test is good, but can give false readings occasionally and does not necessarily describe how fast the acro will progress.

The latest research from RVC (of course) is that 1/3 of acro cats show false negatives on IGF-1, if the test is done too early, an average of 73 days after start of insulin treatment. And other than being positive for acromegaly, the actualy IGF-1 number doesn't mean much. I haven't heard much on false positives. Given Jack's highest dose, IGF-1, and fondness for food, I'd say acro.

Neko also had few signs of acromegaly until the end. Her T4 was also on the lower side. There is something called euthyroid sick syndrome that can cause temporary low T4 numbers. Neko had that a couple times, but retesting showed normal T4. @Mandy & Rex Low T4 can mean hypothyroidism, not hyperT. Weight loss is not an issue with hypoT.

No ultrasound? I'd be hestitant to start Leukeran without at least that, much less without a biopsy/endoscopy. Unfortunately you can't biopsy if pred is on board as it can change the results. You have to be off pred at least a couple of weeks. But I have heard some get better results with pred, and you can always work the insulin dose around it.

Tagging @Marje and Gracie for her thoughts on the pancreatic enzymes.

 

[Mandy & Rex (GA)]

Low T4 can mean hypothyroidism, not hyperT. Weight loss is not an issue with hypoT.

@Wendy&Neko, yes I know low T4 is hypothyroidism and the tendency to gain weight. I thought perhaps something happened and the thyroid is now running high=hyperthyroidism+weight loss.

 

[Marje and Gracie]

Wes

@Wendy&Neko is thinking on the same lines I am. I am wondering if all this water drinking is because he is hyperT but has euthyroid sick syndrome. I’ve seen it in one of my own cats. Since they haven’t checked his thyroid in a few months and he has a thyroid nodule, I might suggest that you look into having a full thyroid panel done at Hemopet. I’ve worked with Dr. Dodds before an she is an expert on thyroid issues. There are instructions for how your vet would draw the blood and which tubes to use. You can then mail it to Dr. Dodds with Jack’s history and ask for a consult indicating that you are concerned he could possibly have euthyroid sick syndrome. She is really excellent and very helpful.

Did the IM specialist say why he needs pancreatic enzymes? I also have experience in this area and typically these enzymes are only given to cats with exocrine pancreatic insufficiency. These enzymes are very harsh, even caustic and they are expensive. It seems to me a more cautious approach would be to have a full GI Panel done at Texas A&M University. You’ll get a specfPL, a cobalamin, a folate, and a fTLI which is the test for EPI. If you don’t want to go that route, I’d read about pancreatic enzymes and EPI and then question the vet as to why he needs them. Just because he’s lost weight doesn’t mean it’s EPI or malabsorption. If he has a nodule on his thyroid, no matter how small, it could be hyperT that’s causing the weight loss and PU/PD.

There is a difference between pancreatic enzymes and digestive enzymes. I am a full supporter of digestive enzymes for every single cat no matter how healthy. Even my kitten gets them. But pancreatic enzymes are a totally different matter and should be used with caution. I have also had a vet prescribe them to a cat I had when they were not necessary....she did not have EPI. I elected to not use them and, instead, used digestive enzymes. I am not trying to undermine your vet but I believe you need to know and understand on what basis she is prescribing them and push a little on the non diagnosis of EPI. IMHO.

 

[LizzieInTexas]

No food restrictions, let him eat as much as he wants... I think Jack will take this as a challenge... I've only been able to get him to turn down food once or twice in 13 years

Hope you can get some weight on him and his numbers come back down. Glad you found a vet that will work with you.

 

[saltycat]

We discussed doing an ultrasound. Due to financial concerns and his candidacy for anesthesia to do a biopsy, I/we decided against it at this time. She also commented he would need to be off the bude/pred before doing a US since it can mask the inflammation.

The US would obviously help, but then require a biopsy to get a more definitive answer. Given the length of time he has been losing weight, she did not think it was large cell leukemia. She mentioned his skinniness in the flank area is commonly related to cancer(not sure if in general or GI/lymphoma specific).

At this point, financials are unfortunately becoming a real concern. An ultrasound,biopsy and potential other tests are hard.. I'm doing the best I can with what I have sadly. 2 more prescription refills today, plus enzymes mean no presents for Jack under the tree... Maybe an empty lev pen and prescription bottles, he doesn't play much anymore, so maybe some extra fuds.

 

[Wendy&Neko]

I understand that things can become expensive with multiple conditions. If you do go Leukeran, instead go for the generic compounded - way cheaper in the US. In Canada of course we can't get compounded and Leukeran is much cheaper. I've heard BCP on line makes a tasty chlorambucil chew, as well as pred chews. And they'll send you sample flavour blank chews so you can see which one Jack likes best - though he's probably not discriminating.

 

[carfurby (GA)]

I'm glad the IM vet was a good doctor. I hope the new treatment plan helps put some weight on Jack. Sending prayers.

 

[saltycat]

I might suggest that you look into having a full thyroid panel done at Hemopet.

I'll have to look into this, he has not had a full thyroid panel, just the tests in the CBC. He did have the TAMU GI panel done(in labs tab), cobalamine and folate were high, but he gets supplements that have those. TLI was 78.9, on the high end of normal. Original vet did not think it was EPI.

I mentioned OTC enzymes versus the stronger pancreatic enzymes and she felt a 2 week test was a good idea for the pancreatic enzymes. Another option was feeding him raw pancreas from a butcher, not sure if that would be a little gentler on him.
It was mentioned that the pancreatic enzymes HAD to be in food, never directly into the mouth, like you mentioned it is caustic.

THe PU/PD has never gone away after the original DM diagnosis even after he became controlled, not sure if that plays into the possiblility of hyperT.

I don't recall if the specifics about the enzymes were mentioned, but I think it was her trying a few things before leukerin to see if they helped since no ultrasound or biopsy was done. A little unconventional I would guess, but her trying to help with what information we have available. She did review labs from the SS, so she should have seen the GI panel results.

@Marje and Gracie What are your thoughts about raw pancreas from a butcher?

Thank you for your input, with these conditions I am out of my league with my current knowledge and greatly appreciate the advice from others who have more experience then I do.

Off to do some homework on euthyroid sick syndrome and some other cat stuff. By the time I get done, I might as well go to vet school as long as I can cheat off Marje's tests and homework

 

[saltycat]

I've heard BCP on line makes a tasty chlorambucil

I read up a bit on this in the yahoo scl group. Seems they are not too fond of the liquids due to possible contact with the human. Strange that an cancer treatment drug is also a carcinogen, go figure. Not sure how well Jack would deal with it in pill form(the one thing I've never been able to do is pill him). The chlorambucil is what I would get for sure. No need for brand name when a generic is available.

 

[Marje and Gracie]

I'll have to look into this, he has not had a full thyroid panel, just the tests in the CBC. He did have the TAMU GI panel done(in labs tab), cobalamine and folate were high, but he gets supplements that have those. TLI was 78.9, on the high end of normal. Original vet did not think it was EPI.

I mentioned OTC enzymes versus the stronger pancreatic enzymes and she felt a 2 week test was a good idea for the pancreatic enzymes. Another option was feeding him raw pancreas from a butcher, not sure if that would be a little gentler on him.
It was mentioned that the pancreatic enzymes HAD to be in food, never directly into the mouth, like you mentioned it is caustic.

THe PU/PD has never gone away after the original DM diagnosis even after he became controlled, not sure if that plays into the possiblility of hyperT.

I don't recall if the specifics about the enzymes were mentioned, but I think it was her trying a few things before leukerin to see if they helped since no ultrasound or biopsy was done. A little unconventional I would guess, but her trying to help with what information we have available. She did review labs from the SS, so she should have seen the GI panel results.

@Marje and Gracie What are your thoughts about raw pancreas from a butcher?

Thank you for your input, with these conditions I am out of my league with my current knowledge and greatly appreciate the advice from others who have more experience then I do.

Off to do some homework on euthyroid sick syndrome and some other cat stuff. By the time I get done, I might as well go to vet school as long as I can cheat off Marje's tests and homework

DUH I looked on his lab tab and it was staring me right in the face but I was focused on in-house labs in Oct. So very sorry. Now I remember looking at those results before. EPI would be present if the TLI is below 8 so he is in the normal range which would really make me about giving the pancreatic enzymes.

Yes, the pancreatic enzymes have to be mixed into food and allowed to sit for a bit. I don’t know if giving pancreas from a butcher would be gentler on him but my guess is that it would be and it would be much less expensive. Jack’s labs do indicate that he’s had pancreatitis or he has/has had inflammation of an organ near his pancreas that is causing his specfPL to be elevated. This happened with Gracie....her IBD caused her liver values and specfPL to be elevated but she never had pancreatitis. Dr. Becker discusses giving pancreas to pets who have had pancreatitis but in the same article, she discusses giving them digestive enzymes as an alternative which is what I definitely think could help Jack either way. I will say that I tried Dr. Becker’s digestive enzymes and my cats wouldn’t eat them so I used Animal Essentials until the balanced powder I add to raw came out as it has digestive enzymes in it.

Again, I’m not suggesting that you disregard your vet’s advice and go a different route. I think you should read about pancreatic enzymes and then discuss it with her and why you are concerned about it; you could then ask if digestive enzymes might be an alternative approach.

Off to do some homework on euthyroid sick syndrome and some other cat stuff. By the time I get done, I might as well go to vet school as long as I can cheat off Marje's tests and homework

Absolutely!!! You are doing awesome for him, Wes. I know how very much you love this little guy. BTW, I have found Dr. Dodds’ tests to be less expensive than having all those done at the vet although you will have to pay your vet for the blood draw and I don’t know what they charge. Mine charged a reasonable $15.

 

[Wendy&Neko]

Oral is the only way we can get chlorambuicil compounded here. Besides the increased risk of contact for the bean - it's only got a 3 day shelf life. Chew treats would be the way to go if you can get them. You might also have to get ondansetron to go with it for nausea. Fortunately it's available in an injectible.

the one thing I've never been able to do is pill him

Yup, I can relate to that. Neko forced me to take my pilling technique to the next level. I was fine when she'd eat pills in pill pockets, or bits of meat, but eventually I had to pill. In the mean time, I looked for as many alternatives as possible.

 

[saltycat]

Again, I’m not suggesting that you disregard your vet’s advice and go a different route.

Not at all, but your opinion(you too Wendy) is EXTREMELY valuable to me. Vet's are great, but like the best of us, can miss certain things or have different viewpoints. All the info I can get helps in me researching specific things as well as making decisions not to mention having more productive conversations with the vet. I wouldn't even know some of the questions to ask without the help from the board.

Jack’s labs do indicate that he’s had pancreatitis

He has had a few acute flareups, but generally seems ok most of the time. We had a few days of very little to no insulin in the past week and his numbers seemed to indicate some pancreas function with the steady numbers and slight dip or steady numbers after meals. I have no idea what has happened the last few days, could be infection, acro tumor pulsing, etc. For now I am just slowing upping his dose to keep up with it. Boy it is hard to do small increases at such low doses!

Neko forced me to take my pilling technique to the next level

I can relate all too well. The last pills he had were entertaining. Buried in the food worked for 2 days, then he wised up. He sits up for treats and the next few went treat, treat, pill.... Once again, worked for a few days and he got smart quick and let the treat hit the floor first to check it. Wrapping in turkey... same thing. He can be too smart for his own good sometimes.

 

[Bobbie And Bubba]

I know your head is spinning after the vet visit. I can't offer any ideas except to give you a big virtual hug and I am sure Jack's only thing on his Christmas List is time with you and constant fuds!

 

[saltycat]

Whew, what a day for Jack. Between the IM vet visit, researching, refilling scripts, more testing supplies(bad time of the year to visit a walmart) and trying to find a pancreas I sure had a cat filled day. I really want to delete today's cycle from the SS... Red and Black, ewwww. I am giving it until tomorrow to bump him back up to ~ .25u, but boy these patience pants are pinching with these numbers.

I did manage to find a bovine pancreas but it will take a few days for the shop to get it in since it is special order. Honestly, I am kind of surprised. Most of the places I called, the conversation started with "you want WHAT?" It looks like about an ounce a meal for dosage, but I need to confirm with the vet before starting.

time with you and constant fuds!

I think that is just because I know how to open the fud cans

 

[Marje and Gracie]

Whew, what a day for Jack. Between the IM vet visit, researching, refilling scripts, more testing supplies(bad time of the year to visit a walmart) and trying to find a pancreas I sure had a cat filled day. I really want to delete today's cycle from the SS... Red and Black, ewwww. I am giving it until tomorrow to bump him back up to ~ .25u, but boy these patience pants are pinching with these numbers.

I did manage to find a bovine pancreas but it will take a few days for the shop to get it in since it is special order. Honestly, I am kind of surprised. Most of the places I called, the conversation started with "you want WHAT?" It looks like about an ounce a meal for dosage, but I need to confirm with the vet before starting.

One thing I would caution you on is start really, really slow with the raw pancreas.....perhaps just a fingernail size piece. Sometimes with cats that could potentially have any kind of intestinal issue, the raw is too rich and it causes them to immediately vomit. Since you don’t want him barfing up a whole serving of pancreas (I’m not sure how much the vet told you to give), then I’d definitely go slow. If that makes him sick, you could also discuss with the vet giving him a whole body glandular supplement, in addition to the digestive enzymes to see if that would help. Here is some good info on on glandular supplements. However, I would not give these without talking to the vet just in case there could be some thyroid issue.

Here is a great read on digestive enzymes (as if you don’t have enough to do....sorry).

 

[LizzieInTexas]

Sorry to hi-jack Wes.

you could also discuss with the vet giving him a whole body glandular supplement

Is this the same or similar to the Standard Process supplements?

 

[Marje and Gracie]

Sorry to hi-jack Wes.


Is this the same or similar to the Standard Process supplements?

No, it’s different although SP has individual...not whole body... glandulars

 

[Doodles & Karen]

I've been lurking Wes and glad Marje and Wendy are able to provide some additional insight. It's certainly out of my territory. You've always done the right things for Capt. Jack and glad you had a positive IM visit. Ugh, on the icky numbers...he'll come back down soon. In the meantime, catch up on some needed sleep.