7/24 Spock update & opinions needed

[carolyn & jesse (GA) & spock]

Hi all - checking in with a Spock update. He was vomiting every meal so I took him to the vet on 7/14. This is a new vet (since moving to Salem) and she's seen Spock one other time - when he had a bad itchy ear. His AMPS on the 14th was 88 (.25u). The vet said it was too low (I'm pretty sure she knew I was using a human glucometer). She said the 48 he got on the 9th was dangerously low. :?

She couldn't find anything apparent regarding the vomiting and suggested blood work. She said there was no blood work in his file but I know he had blood work before his major dental in Oct. (I'm going to have to ask my old vet for that) I let her talk me into adding a Fructosamine test (in my mind just to prove her wrong). Here's the results: July blood work. According to this lab's interpretation Spock has been in prolonged hypoglycemia (although in the bar chart range it was okay). She said "a fructosamine of 210 is very low. Why don't you do a glucose curve for at least 12 hours and see what is really happening with the blood sugar throughout the day. There may be lower readings than the spot checks you are doing. My final thought is that the hyperthyroidism may be causing the low fructosamine so we can treat that and see how things are after that." I did remind her that I'm using a human glucometer and sent her the protocol.

I did a curve on the 18th. I stopped his insulin on 7/23 (four cycles so far) and his numbers are up a bit. I wanted to see if maybe even the .1u was too much (that's the way it was with Jesse before he went OTJ).

Also, his appetite is not as good as it was (maybe it was "good" only because he wasn't controlled). And he is also still living alone in his bedroom because he wants to be an only cat. But with the Feliway plug-in he's stopped being mean to me. :smile:

So, I guess I'd just like some experienced eyes on his spreadsheet and blood work to see if anyone can offer an opinion on where I should go from here.

Thanks!

 

[Marje and Gracie]

Hi Carolyn

Welllll......I actually think he still needs that 1 drop. The fruc test was in the normal range. I've seen many vets get panicky when cats are below 200. That doesn't mean the cat is regulated (Spock is) but I don't think they understand the amount of testing we do and that we know how to control low numbers.

In looking at his bloodwork, I think it would have been smart for her to get a tT4 AND a fT4. It's best not to diagnose hyperT based on just one of them. I don't know about the thyroid affecting BG levels. I do think he might be showing some early signs of chronic kidney disease. Unless you are giving him subq fluids for some reason (which would account for a low USG), his USG is low. His BUN is up and creat high normal. I'd definitely watch those numbers.

 

[carolyn & jesse (GA) & spock]

Thanks for the reply Marje. I agree regarding the thyroid and is why I asked if we should do a free T4 too. I guess I need to read up on why both are important in diagnosing so I can argue the point. I'm afraid to start treating...

 

[Karrie and Maverick]

Was the vomiting addressed? Cerenia is available as an injection but really stings. How long after eating does he vomit?

Has he had a pancreatitis test?

 

[carolyn & jesse (GA) & spock]

The vomiting was address with Pepcid and Fortiflora. The Pepcid stopped it 95% and I'm giving it only once per day now. And giving a bit (probably 1/4 packet) of Fortiflora in each meal has eliminated the vomiting. It was hard to tell how long after eating he vomited (being in his own room), but it wasn't immediately after eating. And no pancreatitis test done. He is a lot better now and is more playful and loving. I took him to the vet because I didn't want to just treat his symptoms...

He does have a grade 4 heart murmur (my last vet read it as a 6), and this vet also now hears a skipped beat every 10 beats.

 

[Sienne and Gabby (GA)]

My read on Spock's labs is the same as Marje's. The ALT is often elevated due to diabetes or hyper-T. Here's a link to Marvista vet's page on diagnosing hyper-T. You'll notice that one of the symptoms associated with hyper-T is intermittent vomiting.

All the fructosamine test tells you is that Spock's numbers are below 120. Based on the fructosamine, a nondiabetic cat would be considered in prolonged hypoglycemia. The test is useful for determining whether a cat is diabetic. Given your ability to test, it really doesn't tell you anything.

I also agree with Marje -- Spock is still needing a bit of insulin.

 

[Marje and Gracie]

Carolyn...when my Teddi had symptoms of hyperT but the tests did not show it, I worked with Dr. jean Dodds at Hemopet[ b/]. She runs free and total T3 and T4 and also specializes in deciphering results for geriatric cats or whether a cat is euthyroid sick (other illnesses mask hyperT so thyroid numbers are normal).

 

[Karrie and Maverick]

I don't know much about heart problems in cats. I wonder if someone can advise on the heart murmer. A 4 is quite serious. I lost Maverick suddenly - the vet suspects he had undiagnosed heart disease, which is common in Maine Coons. I didn't know this. I haven't researched it since he's gone. My dog fought heart disease and had the most serious murmer you could have. She was on a few heart meds and I know a number of cats are on benazepril/enapril which my dog also took.

Glad to hear there is a lot of improvement *clapping*. Sorry I missed that.