7/26 Shooter AMPS 378, +8 276, PMPS 378

Were you saying that Shooter is drinking a lot of water regardless of his BGs. Have you had labs done on him in the last few months. I'm sorry he's not seeming to feel well! I hate that!!
 
Suzanne & Darcy said:
Were you saying that Shooter is drinking a lot of water regardless of his BGs. Have you had labs done on him in the last few months. I'm sorry he's not seeming to feel well! I hate that!!
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Oh shame on me! I should know better than to trust the vets! I had his bloodwork done on 4/17/21 and the ONLY thing they mentioned was that he was diabetic. Now that I look at his bloodwork it shows several things - chloride is low 107 (114 - 126mmol/L), anion gap is high 29 (12 - 25mmol/L), albumin is high 4.2 (2.6 - 3.9g/dL), AST is high 69 (16 - 67U/L), ALP is high 87 (12 - 59U/L), Reticulocytes is 102 (3 - 50K/L). Although I don't know what a lot of this stuff means and need to do some research, I think the alp & ast are liver related. Are you able to tell me more? @Marje and Gracie I think people tag you in a lot of bloodwork stuff if I remember right.
 
Heather82372 said:
Oh shame on me! I should know better than to trust the vets! I had his bloodwork done on 4/17/21 and the ONLY thing they mentioned was that he was diabetic. Now that I look at his bloodwork it shows several things - chloride is low 107 (114 - 126mmol/L), anion gap is high 29 (12 - 25mmol/L), albumin is high 4.2 (2.6 - 3.9g/dL), AST is high 69 (16 - 67U/L), ALP is high 87 (12 - 59U/L), Reticulocytes is 102 (3 - 50K/L). Although I don't know what a lot of this stuff means and need to do some research, I think the alp & ast are liver related. Are you able to tell me more? @Marje and Gracie I think people tag you in a lot of bloodwork stuff if I remember right.
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On the SS, there is a “lab” tab. If you could please put all his lab values on that tab (be sure to check the normal ranges and change them if they are not what is on your lab report), I’d appreciate it. Then just tag me again and I’ll look at it.
 
Marje and Gracie said:
On the SS, there is a “lab” tab. If you could please put all his lab values on that tab (be sure to check the normal ranges and change them if they are not what is on your lab report), I’d appreciate it. Then just tag me again and I’ll look at it.
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@Marje and Gracie The SS lab is done. Looks like he might have liver issues. Can't believe the vet didn't mention it! And high reticulocytes seems to be anemia. :( Please LMK what you find and what you think I should do.

Thank you!
 
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Don't be too downcast. This was bloodwork taken when he was first diagnosed. It is not uncommon to see elevated liver enzymes when a cat if first diagnosed with diabetes. The cat has been trying to compensate for the lack of insulin or inability to utilize insulin from body stores of fat. This can be irritating to the liver. I would ask my vet about it if I were concerned. You can also try Denamarin or Milk Thistle to aid the liver. There's really no downside to doing it.

I don't see the retics on your labs but it does not look like Shooter is really anemic. His hematocrit and hemoglobin are fine. Reticulocytes are immature red blood cells. So at least you know that his bone marrow is working well. It may be that his body is trying to compensate by producing a lot of red blood cells. Vets often describe what they call the "Anemia of Chronic Disease" - diabetes is a chronic disease and is taxing on the body, sometimes resulting in anemia . If you are concerned a fairly easy thing to do is to give a B-Complex supplement to Shooter and to give B-12 injections. However, I would talk to my vet first if I were you. His blood work may have even improved since last time. If you are taking Shooter to the vet soon, you can ask them a lot more in detail about this stuff and see what they say.

A high anion gap usually indicates that the body is more acidic than it should be. Do you test for ketones?

I know Marj will come along and give you some good observations! If you want to, can you add in a row for a few of those values that aren't on the labs tab... like anion gap and retics (which should go under the total red blood cells - RBC - and it looks like your reference range for chloride is different than the one on the labs tab. Did you check to see if your reference ranges are the same as those that are pre-filled in?
 
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Suzanne & Darcy said:
Don't be too downcast. This was bloodwork taken when he was first diagnosed. It is not uncommon to see elevated liver enzymes when a cat if first diagnosed with diabetes. The cat has been trying to compensate for the lack of insulin or inability to utilize insulin from body stores of fat. This can be irritating to the liver. I would ask my vet about it if I were concerned. You can also try Denamarin or Milk Thistle to aid the liver. There's really no downside to doing it.

I don't see the retics on your labs but it does not look like Shooter is really anemic. His hematocrit and hemoglobin are fine. Reticulocytes are immature red blood cells. So at least you know that his bone marrow is working well. It may be that his body is trying to compensate by producing a lot of red blood cells. Vets often describe what they call the "Anemia of Chronic Disease" - diabetes is a chronic disease and is taxing on the body, sometimes resulting in anemia . If you are concerned a fairly easy thing to do is to give a B-Complex supplement to Shooter and to give B-12 injections. However, I would talk to my vet first if I were you. His blood work may have even improved since last time. If you are taking Shooter to the vet soon, you can ask them a lot more in detail about this stuff and see what they say.

A high anion gap usually indicates that the body is more acidic than it should be.
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I didn't see a place for retics on the SS. Is that something I should just write in anyway?

Thank you so much for your input! I REALLY appreciate it! :)
 
Oh yes... I was just editing my post above (something I shouldn't do, I think) asking if you could just add in the few extra things like retics (under RBC) or can you add cells to this sheet? I usually do my labs in a google doc and I can add rows, etc. Anion gap isn't on there. And I think that the reference ranges you gave us aren't the same as the pre-filled ones on the labs tab. Check and see if you need to change any of those... look at the ref. range for chloride first.

ETA: your ref. range for chloride is fine! my eyes are bad!
 
I take it back, chloride ref. range is okay (although he's a little low). I think my stupid eyes keep veering off onto a different row!!

A lot of times vets don't get all worked up about some of these values being only a little low or a little high. They are looking for a pattern, or looking for several indicators together instead of just one in isolation. If you ask them about it, a lot of them will tell you (but some of the annoying ones just say ... nothing to worry about... I like the ones that TALK!)
 
Heather82372 said:
@Marje and Gracie The SS lab is done. Looks like he might have liver issues. Can't believe the vet didn't mention it! And high reticulocytes seems to be anemia. :( Please LMK what you find and what you think I should do.

Thank you!
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Hey Heather! I know Marje will give you great advice. Just an additional comment from me. High liver values can be part of Triaditis if Shooter has IBD and Pancreatitis (did you test for Pancreatitis?). The high levels could also be a liver infection. I've had success putting my cat who has gotten slightly higher liver values on Veraflox, a course of that and the liver values went down to normal. Not sure if he is on antibiotics or if you've tried this before, but thought I would share.

I am also not sure which of those labs could be influenced (if any) by the high glucose. But, Marje is on the case so you are in good hands!
 
Suzanne & Darcy said:
One more thing. I am really pleased to see such nice kidney function values for your Shooter. That always makes me smile. I hate kidney disease.
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Margaret (and Pearl) said:
Hey Heather! I know Marje will give you great advice. Just an additional comment from me. High liver values can be part of Triaditis if Shooter has IBD and Pancreatitis (did you test for Pancreatitis?). The high levels could also be a liver infection. I've had success putting my cat who has gotten slightly higher liver values on Veraflox, a course of that and the liver values went down to normal. Not sure if he is on antibiotics or if you've tried this before, but thought I would share.

I am also not sure which of those labs could be influenced (if any) by the high glucose. But, Marje is on the case so you are in good hands!
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Oh geez! You scared me for a minute because shortly after Shooter being diagnosed with diabetes my Koda kitty was diagnosed with Stage 2 kidney disease and pancreatitis. So, I've been dealing with him and trying to figure out what to do while dealing with Shooter. Unlike Koda though, Shooter doesn't have cycles of vomiting or EVER turn away from food. Neither one has diarrhea. If anything even with all the wet food these kitties seem to struggle more with constipation. Recently I just added a little Healthy Gut to their wet food. It sure probably wouldn't hurt to have the fPL checked on Shooter though!
 
Heather82372 said:
Oh geez! You scared me for a minute because shortly after Shooter being diagnosed with diabetes my Koda kitty was diagnosed with Stage 2 kidney disease and pancreatitis. So, I've been dealing with him and trying to figure out what to do while dealing with Shooter. Unlike Koda though, Shooter doesn't have cycles of vomiting or EVER turn away from food. Neither one has diarrhea. If anything even with all the wet food these kitties seem to struggle more with constipation. Recently I just added a little Healthy Gut to their wet food. It sure probably wouldn't hurt to have the fPL checked on Shooter though!
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You don’t need vomiting or diarrhea to have pancreatitis. Nausea is a usual symptom yes. If you’re doing bloodwork it likely will get sent to IDEXX for results if so the pancreatitis fpl test add on is an extra $30. I always add it since I’ve got girls with chronic pancreatitis.
 
Heather82372 said:
@Marje and Gracie The SS lab is done. Looks like he might have liver issues. Can't believe the vet didn't mention it! And high reticulocytes seems to be anemia. :( Please LMK what you find and what you think I should do.

Thank you!
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Thanks very much for loading those and highlighting the ones that were out of range.

First, with liver enzymes, ALT values have to be about three times higher than the high end of the range to even be considered “mild”. For elevations in alkaline phosphatase (ALP), milder, persistent elevations are more concerning than they would be with ALT. The things that cause elevations in alkaline phosphatase include cholangiohepatitis and fatty liver disease. His bilirubin and GGT are normal so it’s unlikely there is an issue with fatty liver disease. Also, many other health conditions such as diabetes and hyperthyroidism (to just name two) can increase ALP and medications such as steroids can cause it to be elevated. Remember that any set of labs is just a snapshot at that moment. Do you have any other lab history?

You would absolutely know if he had cholangiohepatitis because it can make them feel really bad.

A more conclusive indication of liver health is the ALT. But his ALT is basically not elevated. As an example, for the lab my vet uses, normal is 100. My 5-year old has never had an ALT below 100. She always hovers between 108-125 and this is normal for her. I do give her milk thistle because, as Suzanne said, it won’t hurt. Denamarin is a pain to give and is not really necessary if you give milk thistle. I use Herbsmith milk thistle that I get from chewy.com. It’s a powder and so much easier to give. It does not have to be given on an empty tummy.

Insofar as the Reticulocytes, most tests for these are inaccurate unless the HCT is below 20%. I would not worry about this. I also wouldn’t worry about the chloride

Suzanne & Darcy said:
If you are concerned a fairly easy thing to do is to give a B-Complex supplement to Shooter and to give B-12 injections.
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I just would like to explain the difference here between a supplement and B12 injections.

B12 injections are almost always cyanocobalamin. I believe in all the years I’ve been here, there has been one person who could find injectable methylcobalamin. Cyanocobalamin is great for intestinal issues where the cobalamin might be low. It can also give a little boost to elderly cats. It will not have any effect on the HCT.

Methylcobalamin (also B12) is the supplement you want to improve HCT or keep it stable. It needs to be given with a multi B complex like Jarrow’s BRight. Honestly, at this time, I would not worry about his HCT. It’s fine. We usually don’t start supplementing with B vitamins until the HCT approaches 30%.

Insofar as albumin, don’t worry. It’s not an issue and I’m going to say the same thing about a singular, increased anion gap. I’m not sure why the range is so low at this lab but the typically recognized range is 8 and 33. It’s possible his is off a bit because his chloride is lower. Poorly managed diabetes can also cause the anion gap to be higher than normal. Since the labs are from April when he was dx, it’s possible his BG was really high but the SS starts after that so hard to tell. At any rate, that’s something to look at next go round.

I hope this helps!!!
 
Marje and Gracie said:
Thanks very much for loading those and highlighting the ones that were out of range.

First, with liver enzymes, ALT values have to be about three times higher than the high end of the range to even be considered “mild”. For elevations in alkaline phosphatase (ALP), milder, persistent elevations are more concerning than they would be with ALT. The things that cause elevations in alkaline phosphatase include cholangiohepatitis and fatty liver disease. His bilirubin and GGT are normal so it’s unlikely there is an issue with fatty liver disease. Also, many other health conditions such as diabetes and hyperthyroidism (to just name two) can increase ALP and medications such as steroids can cause it to be elevated. Remember that any set of labs is just a snapshot at that moment. Do you have any other lab history?

You would absolutely know if he had cholangiohepatitis because it can make them feel really bad.

A more conclusive indication of liver health is the ALT. But his ALT is basically not elevated. As an example, for the lab my vet uses, normal is 100. My 5-year old has never had an ALT below 100. She always hovers between 108-125 and this is normal for her. I do give her milk thistle because, as Suzanne said, it won’t hurt. Denamarin is a pain to give and is not really necessary if you give milk thistle. I use Herbsmith milk thistle that I get from chewy.com. It’s a powder and so much easier to give. It does not have to be given on an empty tummy.

Insofar as the Reticulocytes, most tests for these are inaccurate unless the HCT is below 20%. I would not worry about this. I also wouldn’t worry about the chloride


I just would like to explain the difference here between a supplement and B12 injections.

B12 injections are almost always cyanocobalamin. I believe in all the years I’ve been here, there has been one person who could find injectable methylcobalamin. Cyanocobalamin is great for intestinal issues where the cobalamin might be low. It can also give a little boost to elderly cats. It will not have any effect on the HCT.

Methylcobalamin (also B12) is the supplement you want to improve HCT or keep it stable. It needs to be given with a multi B complex like Jarrow’s BRight. Honestly, at this time, I would not worry about his HCT. It’s fine. We usually don’t start supplementing with B vitamins until the HCT approaches 30%.

Insofar as albumin, don’t worry. It’s not an issue and I’m going to say the same thing about a singular, increased anion gap. I’m not sure why the range is so low at this lab but the typically recognized range is 8 and 33. It’s possible his is off a bit because his chloride is lower. Poorly managed diabetes can also cause the anion gap to be higher than normal. Since the labs are from April when he was dx, it’s possible his BG was really high but the SS starts after that so hard to tell. At any rate, that’s something to look at next go round.

I hope this helps!!!
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Ok, thank you so much! I really appreciate it! The milk thistle powder you use, does it have a taste? Can I mix it into his wet food without him noticing much? lol The B-12 kind of confuses me. Do you think at this time it's not necessary?
 
Marje and Gracie said:
Denamarin is a pain to give and is not really necessary if you give milk thistle. I use Herbsmith milk thistle that I get from chewy.com. It’s a powder and so much easier to give. It does not have to be given on an empty tummy.
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I never bothered to give Denamarin on an empty stomach to Darcy. And it helped him anyway. I think that's why a lot of cats throw it up. Darcy never did. Cast iron stomach. Anyway, as you say, the Milk Thistle is easy to give as long as your cat will eat it! A lot of my cats won't eat anything added to their food (unless you include baby food, Forti-Flora, etc. no meds or supplements though for a lot of them... only a few a piggie enough to eat with "junk" added.)

Another liver supplements that are very beneficial for cats is S-adenosylmethionine (SAMe). But I don't think you need to go there because your liver values aren't really bad. SAMe is useful in hepatic lipidosis, chronic hepatitis and a few other liver diseases. That's just an FYI, because Shooter is not diagnosed with those! I'm just a weirdo who likes to investigate this stuff!
 
Heather82372 said:
Ok, thank you so much! I really appreciate it! The milk thistle powder you use, does it have a taste? Can I mix it into his wet food without him noticing much? lol The B-12 kind of confuses me. Do you think at this time it's not necessary?
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I can't tell if anybody answered this or not (can't see it) so I'll chime in. In my cats, I do not supplement B-12 on a regular basis (i.e., weekly shots) unless the cat is deficient (you have to do the test, usually part of the TAMU GI panel), or if my cat has diagnosed kidney disease or intestinal disease such as IBD or SCL. The reason for this is that there is some evidence that excess B-12 may "feed" cancer. I've read a few papers on it. Many people will poo poo this notion because B-12 is water soluble and they supposedly urinate out any excess B-12. However, as I said I have read a few papers on it and it gives me pause. So I wait until I know they need it. You can ask your vet about B-12 supplementation when you go in. There are many different opinions on it among vets.
 
Marje and Gracie said:
B12 injections are almost always cyanocobalamin. I believe in all the years I’ve been here, there has been one person who could find injectable methylcobalamin
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Yes, I get the impression that methyl injectable is hard to find (although I see it on the internet so maybe not as hard as it once was?) I know that a few people on the tanyackd support group have gotten it, but I have no idea from where!
 
Heather82372 said:
Ok, thank you so much! I really appreciate it! The milk thistle powder you use, does it have a taste? Can I mix it into his wet food without him noticing much? lol The B-12 kind of confuses me. Do you think at this time it's not necessary?
Click to expand...
I don’t know if it has a taste. My cats get several supportive supplements like probiotics and egg yolk powder that I mix together with water and syringe them as they are excellent with that method. The milk thistle goes in that slurry. Livia loves something in that mixture as she will almost suck it out of the syringe :woot:

Everyone has their own philosophy about get meds & supplements into cats. I can easily pill my cats but choose not to even I can offer a med/sup in a way they think is a treat because I don’t like to have that kind of relationship with my cats where I’m popping something down their throats and one has to be really, really careful with pilling, ensuring the esophagus is wet before & after to prevent the pill from sitting in it and, over time, causing esophageal issues like erosion. I also never put anything in my cats’ food…it’s just balanced, homemade raw. Because I can syringe them, I don’t have to worry about anything changing the taste of their food and making it off putting.

I learned eons ago that it’s worth taking the time when cats are kittens to teach them how to take something out of a syringe and also how to be calm when having their claws trimmed & teeth brushed. :)
 
Suzanne & Darcy said:
I never bothered to give Denamarin on an empty stomach to Darcy. And it helped him anyway. I think that's why a lot of cats throw it up. Darcy never did. Cast iron stomach. Anyway, as you say, the Milk Thistle is easy to give as long as your cat will eat it! A lot of my cats won't eat anything added to their food (unless you include baby food, Forti-Flora, etc. no meds or supplements though for a lot of them... only a few a piggie enough to eat with "junk" added.)

Another liver supplements that are very beneficial for cats is S-adenosylmethionine (SAMe). But I don't think you need to go there because your liver values aren't really bad. SAMe is useful in hepatic lipidosis, chronic hepatitis and a few other liver diseases. That's just an FYI, because Shooter is not diagnosed with those! I'm just a weirdo who likes to investigate this stuff!
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I didn’t like the size of the pill or popping it down Gracie’s throat when it was so much easier to give her milk thistle. :)
 
Marje and Gracie said:
one has to be really, really careful with pilling, ensuring the esophagus is wet before & after to prevent the pill from sitting in it and, over time, causing esophageal issues like erosion.
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You're a wonderful cat mom! I can tell. You've hit another my soapbox issues about dry pilling cats! I've even tried to convince vets and vet techs by showing them papers on esophageal damage. Most don't really listen. The most well known is "Clindamycin Induced Esophageal Injury." I adopted a kitty several years ago who had this problem. She was very ill to begin with (Toxoplasmosis) and then had an espohageal injury on top of this. This had been done by the vets. She couldn't swallow. We tried to have an e-tube placed to get her through it, but poor Lily didn't survive the surgery. She was such an intelligent and engaging cat that even though we only had her for a little while, we still remember he so fondly. My kids were young and she just loved them. We still have her picture on the refrigerator! Anyway ... you're right. Soap box. Well... right now I gotta go teach some kittens how to be calm when having their nails trimmed. They're at the stage of climbing up our legs! Sharp little needles. I have to catch them first! They won't stop playing.
 
Marje and Gracie said:
I don’t know if it has a taste. My cats get several supportive supplements like probiotics and egg yolk powder that I mix together with water and syringe them as they are excellent with that method. The milk thistle goes in that slurry. Livia loves something in that mixture as she will almost suck it out of the syringe :woot:

Everyone has their own philosophy about get meds & supplements into cats. I can easily pill my cats but choose not to even I can offer a med/sup in a way they think is a treat because I don’t like to have that kind of relationship with my cats where I’m popping something down their throats and one has to be really, really careful with pilling, ensuring the esophagus is wet before & after to prevent the pill from sitting in it and, over time, causing esophageal issues like erosion. I also never put anything in my cats’ food…it’s just balanced, homemade raw. Because I can syringe them, I don’t have to worry about anything changing the taste of their food and making it off putting.

I learned eons ago that it’s worth taking the time when cats are kittens to teach them how to take something out of a syringe and also how to be calm when having their claws trimmed & teeth brushed. :)
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Oh man! That's awesome! These old guys are TERRIBLE with syringing. They've just never had to take any medication until recently. Pilling isn't much better but with the pill popper it's a LITTLE easier. I've never liked doing it though because I'm afraid they're gonna choke.
 
Suzanne & Darcy said:
You're a wonderful cat mom! I can tell. You've hit another my soapbox issues about dry pilling cats! I've even tried to convince vets and vet techs by showing them papers on esophageal damage. Most don't really listen. The most well known is "Clindamycin Induced Esophageal Injury." I adopted a kitty several years ago who had this problem. She was very ill to begin with (Toxoplasmosis) and then had an espohageal injury on top of this. This had been done by the vets. She couldn't swallow. We tried to have an e-tube placed to get her through it, but poor Lily didn't survive the surgery. She was such an intelligent and engaging cat that even though we only had her for a little while, we still remember he so fondly. My kids were young and she just loved them. We still have her picture on the refrigerator! Anyway ... you're right. Soap box. Well... right now I gotta go teach some kittens how to be calm when having their nails trimmed. They're at the stage of climbing up our legs! Sharp little needles. I have to catch them first! They won't stop playing.
Click to expand...


Oh yikes! I think I'm done pilling then. They're just gonna have to learn how to take the syringe. Although, can they inhale the liquid when they fight me?
 
Suzanne & Darcy said:
You're a wonderful cat mom! I can tell. You've hit another my soapbox issues about dry pilling cats! I've even tried to convince vets and vet techs by showing them papers on esophageal damage. Most don't really listen. The most well known is "Clindamycin Induced Esophageal Injury." I adopted a kitty several years ago who had this problem. She was very ill to begin with (Toxoplasmosis) and then had an espohageal injury on top of this. This had been done by the vets. She couldn't swallow. We tried to have an e-tube placed to get her through it, but poor Lily didn't survive the surgery. She was such an intelligent and engaging cat that even though we only had her for a little while, we still remember he so fondly. My kids were young and she just loved them. We still have her picture on the refrigerator! Anyway ... you're right. Soap box. Well... right now I gotta go teach some kittens how to be calm when having their nails trimmed. They're at the stage of climbing up our legs! Sharp little needles. I have to catch them first! They won't stop playing.
Click to expand...
That’s so terribly sad about Lily. I am thankful she had your love. It’s so difficult to understand why vets can’t see this as an issue. Bet they don’t take pills without water.

Heather82372 said:
Oh yikes! I think I'm done pilling then. They're just gonna have to learn how to take the syringe. Although, can they inhale the liquid when they fight me?
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There is a bit of a learning curve for them. When I teach my cats as kittens, I lightly burrito them…. Actually they just look like they have a bib on.. and they just go with it. Just remember to never, ever aim the syringe straight down the throat. You put it inside the side of the mouth and only give a tiny bit of slurry on their tongue so they can handle it themselves. Start with a light burrito and get them used to an empty syringe at the side of their mouth.
 
Heather82372 said:
Oh yikes! I think I'm done pilling then. They're just gonna have to learn how to take the syringe. Although, can they inhale the liquid when they fight me?
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You can safely pill them. Just make sure that you always get them to eat afterwards... I just give them canned food to make sure everything goes down with something moist... baby food is an awesome treat for a lot of cats... so they don't mind the pilling... mine don't anyway... or use pill pockets... but even after a pill pocket I always give more food/treats to make sure it all goes down with something nice and moist. In cats that aren't eating, this gets to be a problem... but you can syringe food/slurry into them or just water... I hate syringing water because I fear aspiration pneumonia... but it can be done safely if you are really careful to go slowly and put it in the side of their mouth (as Marj already pointed out on syringing).
 
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