12/30 Oberon PMPS 357/2.9 (1.75 R), +2 311, +4 320

Wishing the best with the increased dose and with the lab results when you get them today or tomorrow. One of my least favorite things is waiting for labs!
 
Paws crossed for a dose that moves him again.

I had Neko's vets office (with the vet's approval of course), organized to forward labs to me as soon as they got them. Hated that waiting!
 
Got the basic lab stuff back and I'm playing phone tag with the vet to follow up. Everything's normal other than glucose (obviously), fructosamine (high, but much lower than previously), and glucose in the urine. Precision PSL was normal. Everything's in the labs tab of Oberon's SS. I also emailed the other vet, because I realized I never got an actual copy of the September IGF results there, and I don't know if my regular vet has seen that test at all.

In his message the vet said that labs all look good for dental; the main concern would be if Oberon ends up needing a lot of extractions and has to be under for a long time. He mentioned that we might want to discuss going to a specialist. I've already looked up the three or four board certified dentists in the area, so I can ask if he has any experience with any of them and can recommend any in particular.

Still need to find out about the IGF test and TAMU GI panel. I mentioned them in my message when I called him back. The office closes soon, so maybe he'll return calls at the end of the day.
 
And five minutes later he called. :) Good conversation. He doesn't want Oberon under for too long. Options are to do it there, but if it turns out he needs a lot of extractions cut it short and send him to a specialist, or just start with the specialist to begin with. Upsides to the specialist: they're faster and more experienced, so less time under anesthesia. Downsides: more expensive and might be booked up for a while, and they're further away. I asked for recommendations, and he gave me a few. His favorite is furthest away (about an hour and a half), but takes all his scary cases and works with a board certified anesthesiologist. I'm going to email him and get more info.

The TAMU GI panel can be scheduled as soon as I can figure out a good time (he has to be fasted for 6 hours). On the other hand, he said he has no experience with the IGF test, and suggested I go back to the internist for it. Sigh.
 
Ketones are up again (2.9, grr), so he got R again this evening. Yesterday 1.75 U brought him down by about 70 points so I thought about bumping it up to 2 U, but given that he also just got a Lantus increase this morning I thought maybe I should hold off on that.
 
Another couple advantages to dental specialists - they are used to dealing with pets with issues. Second, they often have someone whose entire job is the anaesthesia and monitoring of vitals. Having a board certified anesthesiologist on board gives a lot of comfort. The initial x-ray before surgery will tell the specialist if there are many extractions and what to prioritize.

I had to coach my vet how to get the IGF-1 test done. I'm sure your vet must have some experience in sending blood out to specialized labs. It's the same thing, just to MSU. Instructions are on the MSU website. Or maybe the vet could call the IM vets clinic on how to do it. Heck, we even had one member here who got the blood from her vet and shipped it herself. MSU don't normally like to deal with individuals, but it can be done. Given how many diabetic cats actually have acromegaly, it's a good skill for a vet to have.
 
Morning data: +8 337, AMPS 436/1.5 (dose increase), +2 385, +5 402, +9.25 337

Had a chance to look more at the dentist my vet recommended. It's actually an entire practice that does nothing but dental work. I think I'm totally on board with this. I'll give them a call tomorrow and get more information about scheduling, costs, etc.

I'll also look at the MSU site. Hopefully my vet can do it and save me a trip up to the ER hospital.
 
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