9/1 Ella pmps 320

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tpr

Member Since 2012
yesterday:http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=78209

Good morning LL,

Ella licked her plate clean during all her meal this morning. She enjoyed a good brishing and is now sleeping in what DGma calls her bagel :-D
I wrote a lengthy email to the vet incorporating a few of the points everyone so kindly shared with me so we'll see what she comes back with. I really hope that Ella doesn't have smoldering pancreatitis as it sounds awful. We have been having to climb the dosing ladder lately but I'm thinking her teeth are contributing to her higher bg's although according to the specialist they aren't as bad as some other vets described. Can allergies have an impact on bg? She definitely has something going on in that department. She frequently rubs her nose and scratches the insides of her ears. She also lets out these wheezy sighs when she is sleeping deeply but whenever she goes to the vet her lungs sound clean. If a cat was allergic to their foos, wouldn't they have diarrhea

Thanks again for your thoughts and encouragment :YMHUG:
 
Re: 9/1 Ella amps 328 +4.5= 319

Glad to know that Ella has a good appy. It's always a happy sight to see them doing the plate cleaning. :-D
That doesn't looks like allergy to me. Scratch the inside of ear? Can it be ear mites? Rubbing nose? Might be dental issue instead. Some of my cats always have running nose problem but I never notice them rubbing nose.
Thankyou for visiting Rosy's condo, Tamara. Have you scheduled Ella's dental?
 
Re: 9/1 Ella amps 328 +4.5= 319

Allergies can have an effect on BG. Allergy can cause an inflammation. Any inflammatory response stresses the system and thereby has the potential to increase BG. However, there is not a great deal of research investigating this association.

I don't have an answer to your question about food allergy. It may depend on the nature of what your cat is allergic to. Gabby doesn't react well to gluten and it does give her diarrhea. She also doesn't tolerate beef and that causes her to vomit. Beef and fish are common food allergies for cats. You could try Ella on a novel protein (e.g., duck, venison) and see if the itchiness subsides.
 
Re: 9/1 Ella amps 328 +4.5= 319

I like Sienne's idea of trying a novel protein for a while. The shelter I worked at had a cat who had food allergies, but the allergy manifested as the grossest looking toenails (black and smelly), no scratching or itching was present and poop was fine. One vet wanted to amputate a toe to investigate what was happening :o :shock: but a second vet suggested novel proteins and that did it. I've also seen dogs with food allergies that only showed as red or itchy skin, poop fine.

Come on down Ella, we are all tired of that pink dress!
 
Re: 9/1 Ella amps 328 +4.5= 319

A novel protein might be a good idea if I could acutually get her to eat anything but Wellness chicken ohmygod_smile
Too bad the hypoallergenic food that Nestor is on was so high in carbs as she loves his food!

Helen, Ella is scheduled for dental next week but we may need to push it to see if we need more preliminary tests for the ticking time bomb! You can see yesterday's post for more detail on that:)

The specialist mentioned that becasue Ella likely got her pancreatitis/diabetes from a steroid shot that her treatment may need to be different than a cat who became diabetic naturally. Have there been steriod induced diabetic cats on the board who have been able to be tightly regulated?
 
Re: 9/1 Ella amps 328 +4.5= 319

Ella sent me a PM given how overloaded she was feeling. I told her I'd copy my reply here.
Did you post what the vet's response was to your questions? I didn't see it in today's condo.

Your vet may be very experienced but suggesting that you're second guessing her or you shouldn't be asking questions is not productive. When any medical professional makes a recommendation about a procedure or treatment, they are obligated by law to make sure they have communicated in a way that allows you to understand ALL of the ramifications of their suggestions. It's what's referred to as informed consent. When you take Ella in for her dental, the vet will have you sign paperwork indicating that you understand what the procedure involves and the associated risks. Saying, "Just trust me." is the way people in the medical field get sued, and rightfully so. Even with prescribing a medication, the vet should tell you about the side effects before administering any drug.

The approach I would take is to try to get across to your vet that you want to her to be your partner (and I'd word it that way) in Ella's care. I'd stress that it's important to you to understand her perspective since you value her input. Ultimately, though, it's your decision about what steps are taken to keep Ella healthy and happy. As such, you need to understand all of the implications, good and bad, of what she or the other vet are recommending. In addition, I'd let her know you're going to do your research. Rushing into decisions rarely yields a good outcome, unless the situation is critical. I don't think, from what you've said, that Ella's situation is critical. Further, feeling like you're being pressured does not contribute to your having a good relationship with your vet and it may be worth mentioning that you're feeling pressured.

To the best of my reading, there is no diagnosis of "smoldering pancreas" or "ticking time bomb" syndromes. Some cats do have chronic pancreatitis and are prone to flares. You treat when the cat is symptomatic. There may be some supplements that can help on an ongoing basis but basically, you treat when there are symptoms. Caregivers become attuned to when their cat is "off" and will initiate care before there is a full blown flare. However, if Ella hasn't had pancreatitis and her lab values are fine, there's no way to know what this vet is suggesting. The blood tests that were run for the dental would not involve a test for pancreatitis. Like I said yesterday, using amylase and lipase tests to diagnose pancreatitis in a cat is outdated and wrong. Amylase, in particular, is an unreliable test.

I know you're concerned about the dental. If either of the vets you consulted with thought there was an unreasonable risk with going forward with the dental, they should have told you. Further, if they thought the risk was unreasonable, they should not have scheduled the procedure. If they are suggesting that it's OK to proceed, then it's their judgement that there is no greater than the normal risk for a surgical procedure. You need to understand that there is always a risk when anesthesia is involved. The materials I linked for you about dentals outlines what should be involved in terms of monitoring vital signs during anesthesia in order to keep the risks at a minimum.

It's all of the other stuff that it sounds like they're trying to convince you to do that's creating confusion. And, unless they've given you their recommendations in detail, you do not have sufficient information to make an informed decision. The "Trust me." approach or trying to intimidate with the, "I'm the doctor." routine is (IMHO) a crock. The last medical person who said, "I'm the doctor." to me got an eyeball to eyeball look with my response of, "And I'm paying you so you work for me."

As an example, before I started educating myself on FD, my vet wanted me to continue feeding Gabby prescription food. As I became better informed, I came back to the office with cases of DM and MD. Of course, they were concerned. My vet discussed the value of the prescription food for managing Gabby's diabetes. My response was to ask her if the goal was to have Gabby on a low carb, good quality diet. She said that it was, in fact, her goal. I said "Good." because the the carb counts on the prescription food was between 7 - 13% and it was composed largely of by-products. I also let her know I could buy commercial food (Wellness) that was better quality and lower in carbs. What could she say?

IMHO, if you change several things all at once, you have no idea what's working or what's a problem. If you change one thing, wait and evaluate the outcome, you know if what you've done has helped -- or not. Frankly, the vets should know this. For example, if the vet has you change Ella's diet and puts her on an antibiotic and her allergies go nuts, is it the food or the antibiotic?

Not everyone is willing to stand up to their vet. I'm not saying to get into a screaming match. I'd just encourage you to quietly listen and ask questions and stand your ground. You know Ella. You should not feel like you are being pressured either by us or by your vet. I obviously have strong opinions but whatever you decide, I'll do what I can to help you evaluate the information you've been given and I'll ultimately support whatever decision you make.
 
Re: 9/1 Ella amps 328 +4.5= 319

Tamara,

Please don't let these new vets confuse or bully you. It sounds like they want to handle both diabetes and pancreatitis the old fashioned way instead of the new ways that science has proven better and more effective.

As several people said, there is really only one test you need for the pancreatitis, the spec FPL. Insist on that and nothing else. I also think you would know if Ella didn't feel well.

The prescription diets do not work! Racci was on them originally and as soon as she got on the low carb wet diet I was able to get her regulated and her bg dropped by an amazing amount. If I had listened to my vet, Racci would still be unregulated.

I couldn't swear by it but Racci had prednisolone before her diabetes so may have got it that way. No one can be 100% sure how they got it. She is now regulated. She was taking steroids pills for her asthma and still takes it in inhalant form. I would only consider pills again if absolutely necessary but if they are needed I would use them. I would want to really look for alternatives though like nasal spray or inhalants, etc. (something that does not go in the bloodstream).

Good luck with the dental.

Melanie & Racci
 
Re: 9/1 Ella amps 328 +4.5= 319

Thank you,thank you ,thank you for your responses Sienne and Melanie:)

I PM'd Sienne as I was feeling overwhelmed by all the decisions I have to make in such a short period of time and shared my disappointment that the vet seemed like I was second guessing her with all of my additional questions. In the vet's defence, she has taken a significant amount of time explaining some things but didn't seem as open to the additional questions I had regarding Ella's supposed GI issues and dosing, medical and food protocol they would find more successful. She did however answer a few questions regarding the pancreatitis test and use of pred. As it stands now, the vet has said she's spent all the time she can afford on Ella's history and needs me to make my decision and will understand if I'm not ready to proceed. Originally, I was told she could get her dental in the morning and be seen by the internist in the afternoon but when I questioned the safety of putting her under with a possible dx of pancreatitis she offered her thoughts and options below.

I am unable to know the specific risk level for Ella under a general anaesthetic for a teeth cleaning/extractions but of course as a patient with a systemic disease (diabetes) and possibly undiagnosed and untreated allergies and possibly a smoldering pancreatitis then her risk is not the same as for a completely healthy individual. It is true though that Ella has painful gingivitis and at some point we need to address that problem for her and she may require multiple extractions (not known without radiographs which require a general anaesthetic)

1. Proceed with getting her teeth cleaned, if there are any to extract we can proceed and if not then we can preserve what she has and monitor her reaction to the cleaning. Of if you prefer we can be more aggressive with her extractions although as you know I am less comfortable with that. I will reiterate that I am not certain that either way that you will be able to get her regulated (which she currently is not) as a result of a dental treatment.

2. Postpone the dental treatment/evaluation for now and have an ultrasound evaluation and only after Dr. X examines Ella can we know what medical protocol she would recommend and how long she would suggest we wait (if at all) to proceed with her dental evaluation and treatment.


Please confirm for me whether you will be bringing Ella for a dental procedure on Wednesday morning. I will not schedule anything with Dr. X. You can always re-visit the recommendations we have made if at some point in the futuer you are more comfortable with those recommendations.

With regard to a couple of your questions:

Specifically: fPLI is not as highly specific a test as we used to think (meaning no false negatives). It is more sensitive that specific (meaning no false positives). An experienced ultrasonographer can better evaluate the pancreas.

All drugs have potential side effects. Prednisolone is no exception and in fact can cause diabetes (as we know from Ella's reaction to a repository steroid). However, with a complicated case such as Ella's where she has a history of pancreatitis and is an unregulated diabetic and likely has allergies also then an internal medicine specialist is better equipped to prescribed and regulate medications and that is why I have asked Dr.X to consult on Ella's case. Prednisolone is the basis for treatment of allergies and left unchecked those allergies may progress and complicate Ella's case. Ella may have a combination of GI and skin allergies based on her history.


Obviously I want the best for Ella but am not sure if I agree with her having GI issues as all seems well at the moment but I'm not a vet and perhaps I am unable to connect the dots like they can so now I'm anxious about putting her under anesthesia. I know no one can tell me what to do but it's comforting to get the support and hear about people's experiences. I want to believe that if Ella was a huge risk that she wouldn't offer the dental option at this time but as you can see I'm worried nailbite_smile. I would be totally gutted if something happened to Ella that I could have prevented. Sorry for the long response and thank you for reading. You gals and guys are truly awesome in each and every way. I think I will take Sienne's advice and relay my desire to work as partners to improve Ella's health. It makes so much sense to me and I hope she will come around.
 
I empathize with your fears.
I think anesthesia is scary no matter what the health conditions. There is always that risk.

We have been thru anesthesia 5 times. Each time I drop her off, I cry as I leave, ( I stay with her until the moment they are ready
to start the surgery every time) and then I wait the couple of hours and I call to see how it's going . And it's over and she's re-cooping
and I get her a few hours later. It will be a very difficult wait.
You sound like me in how devastated you would be if anything went wrong.

But here's the thing you have to remember. If she has gingivitis, it will only get worse. Teeth problems don't go away, they just
get worse.
So whether it is this vet or another, you do want to find the dr that you want to do the surgery.
Ask how many dentals she's done.

I think your vet would understand you saying you want to work on one issue at a time and postponing the other changes.

It's always a gamble ( and I don't gamble willingly) No one can guarantee any of us will still be here tomorrow.
But if things were bad you also wouldn't make anyone suffer.
So while things are good for Ella is the better time to deal with potential problems rather than later when things might be worse and
the risk is greater.

I recenlty realized I will have to choose one more surgery most likely in our future ( teeth again) and I will feel as you do and I'll have
to face it and do it for her sake and for her health for that possibility she might live more years. ( I've never had a personal pet that
made it past 9 yrs old and she's 12) I want every year I can be blessed with .


Good luck on deciding.
Fortunately you have a lot of support and help right here.
 
Tarragon is diabetic due to steroid shots for his asthma. He received depo shots every 4 - 6 weeks for 5 years, all the while the vet told us that there was no risk of diabetes. (We now have a new vet.). I'm not sure if treatment is different depending on how they get diabetes though.

Hugs to you with all the decisions you are trying to make. You are a great bean and Ella is a lucky kitty to have you.
 
Hi Tamara,
I'm so sorry you are dealing with all this. I tried to get caught up a bit, there's a lot going on with Ella. I sure hope the vets will do the right thing for Ella. I guess I learned something new, (not a surprise), I never knew about the steroid bring on diabetes. The minute Daphne started to sneeze, a few days ago, I took here right back in the house. I know from my own allergies, they can soon turn into sinus infections, so I didn't want that to happen to Daphne.

I'll have to check in through the week to see how Ella is.

Thanks for visiting us today!

Sending healing vines to Ella. cat_pet_icon
 
What I take issue with is that the vet is saying she does not want to take more time to help you understand the issues and weigh the pros and cons. That's her job. I don't care if it takes a month, her job is to insure that you understand every last detail of her recommendations. That is the meaning of informed consent.

I also question the vet's understanding of sensitivity and specificity. Of course there are false negatives with a spec fPL. If you test too soon or when the pancreatitis is on the wane, you'll get a negative result. The sensitivity of the spec fPLI is entirely dependent on the severity of the episode. However, even in mild cases, it is still the most sensitive test available.
Pancreatitis Roundtable said:
...the sensitivity (ability to detect pancreatitis) of the fPLI test in cats with moderate to severe pancreatitis was 100%. In cats with mild pancreatitis the sensitivity did decrease to 54%, resulting in an overall sensitivity of 67%. The specificity (ability to rule-out pancreatitis) of the fPLI test was 100% in healthy cats and 67% in symptomatic cats with histologically normal pancreas, resulting in an overall specificity of 92%.

.....Dr. Forman’s more recent prospective (ultrasound) study showed a much higher sensitivity of 80% in cats with moderate to severe disease and 62% in cats with mild disease.
From this information, the ultrasound would seem to be useful to confirm a diagnosis especially if it is a mild pancreatitis flare. I would still want the spec fPL since it seems to be more informative (and less expensive) than an ultrasound.

Here's the roundtable article I referenced:


FWIW, when Gabby was diagnosed with FD, she was in DKA, had pancreatitis and hepatic lipidosis. My vet has never suggested she had a "smoldering pancreas" and she's had several dentals (I think 3 and is due for another) with extractions since she was diagnosed.

I am curious, though. Has the vet suggested allergy meds for Ella? Gabby was having issues with allergies last summer and this is what my vet recommended:
There are several options—there is a product called Allerderm which is applied once weekly to the skin which can be quite helpful for itchy or dry skin. Additional fish oil omega-3 fatty acids, 200-250 mg daily, are often helpful, but may take up to 2 weeks to really have an effect. Antihistamines are often helpful—we seem to have the best success with Zyrtec, which is over-the-counter, or hydroxyzine which is a prescription medication.

We have Allerderm here, but you may be able to order it online. Zyrtec dosage is ½ of a 10 mg tablet by mouth (in food…) twice daily, or about every 12 hours, try for 7 days. Watch for drowsiness or restlessness, although side effects from Zyrtec are not likely or are very mild. Use plain Zyrtec, or cetirizine, only—no combo meds. The fish oil product we use is AllerG3, or you can use human products.
 

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Tamara -

I am so sorry you and sweet Ella are having to deal with this. I know it's confusing, trying to sort it all out, wanting to do what's best for Ella. I was raised to respect authority, trust the experts, but as I've gotten older and become a mother, I've found times that I had to question authority. It's okay to ask for clarification and explanation; they should want to be transparent.

I don't have any specific advice about what you're going through, but it sounds like you've gotten some solid advice today already.

Praying you'll come to a decision you can have peace with -

Libby (& Hershey, too!)
 
((((Tamara))))
Just a note on the pancreatitis tests. Your vet refers to the fPLI:
Specifically: fPLI is not as highly specific a test as we used to think (meaning no false negatives). It is more sensitive that specific (meaning no false positives). An experienced ultrasonographer can better evaluate the pancreas.

It is my understanding that the spec fPL form of this fPLI test is now the preferred test for diagnosing pancreatitis. I found the following Round Table of vets to be particularly informative when I was researching pancreatitis (when Rusty was diagnosed):
http://www.idexx.ca/pubwebresources...es/feline-pancreatitis-roundtable-article.pdf

The vets who took part in this round table also discuss ultrasound. This is excellent reading and is not too technical.

Sending you all sorts of vines: for healing, for understanding, for dealing with those vets!

Hugs to you and Ella,

Ella & Rusty
 
Thank you so much for your continued support on this matter:) I was reading part of the round table discussion on pancreatitis earlier and will take an even closer look tomorrow. I too am bothered that the vet has decided that she can't spend more time explaining her perspective on Ella's specific issues. She was particularly perturbed that I asked her to explain her thinking on why she felt Ella had GI issues as I hadn't seen evidence of any. At this point I'm kind of ticked and don't feel like seeing her at all but I know she's great at dentistry and that was the original reason for seeing her so we may go ahead as scheduled.

LL is the best place on earth. You all rock!
 
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