9/15 Revson AMPS 440, +5 245 - Newbie Help Needed!!

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Amy & Revson

Member Since 2011
Here is the gist of the world according to Revson.

On 8/30 Revson tested for white blood count at 5.8.
Yesterday 9/14 he retested at 10.8.

On 9/2 he began treatment for Pancreatits of:
Clavamox Drops 1ml given 2x daily for either 7 or 10 days
plus
Baytril 22.7mg given 1x daily for either 7 or 10 days

On 8/29 Revson began Lantrol insulin at 1 U 2x daily.
On 9/8 Revson was increased to 1.5U 2x daily
On 9/14 Revson was increased to 2U 2x daily

His BG numbers are generally in the mid to high 300s (338, 392, 347, 377 etc.) tested before his insulin. Sometimes in the morning they are as high as 442, 492, 464, etc. Once in a very rare while they dip into mid to high 200s approximately 4-7 hours after his insulin (299, 256, 290, etc). But the broad stroke: he is most consistently in the mid to higher 300s.

His ketones remain negative on the test strip.

As his insulin is increasing, his white blood count is also increasing. He remains happy, content, naps a lot, and urinates frequently in large quantities, with a strong, pungent odor. He eats 3/4 to not quite a full can total of wet food per day offered in small portions 3x daily. He has constant access to dry DM food and water.

***My ex-husband has been taking care of Revson while I've been away for the past two weeks. The plan is for me to pick Rev up today.
The new fPLi (?) test results are concerning and our vet has no idea what to do.

We have not yet filled out an "grid" but I can give more exact numbers if necessary.

I have to be away for the next couple of hours but will check back as soon as possible.
Thank you in advance for any ideas you may have.


Help?!
 
Hi there Amy,

Nice condo you got here, I like what y ou've done with the place ;-)


I'll comment on what I can, at this point. Others will be along to fill in the gaps.
I know not of white blood cell counts and pancreatitis - others do.

Need to clarify - the insulin is Lantus, correct?
Glad to hear ketones negative. Is he intact or neutered? How much does he weigh? when was he diagnosed?
Did he have a recent go round with DKA?


Dump the dry It's best to feed all wet food, in the under 5% carb range. This change alone is likely to make a big positive difference in his BGs. Here is a list -
http://binkyspage.tripod.com/canfood.html

fill in your spreadsheet as soon as you can. It's important that we can see the whole picture at glance.

see you later!
 
i also don't know anything about pancreatitis/white blood cells. but there are a number of people on here that do and will be able to help you with it. would you go to the first post you've got here, click to edit it and edit the subject line to say something about pancreatitis help. that will get the eyes you need.

sandy's right about the food, but i recall you saying you were going to wait til you picked up Revson to make the food change. that alone will help his numbers come down. is the canned food he's getting already low carb?

also, just fyi, it seems to be common for cats to be highest in the morning test. that's usually the last one to come down.

the spreadsheet really does help - it's not just the numbers that tell a lot of information, it's where they are in the cycle. having it laid out on a spreadsheet lets a person see a lot of info at a glance.
 
Hi Amy:

The wbcs will not tell you if he has pancreatitis.....it shouldn't be used to make a definitive dx. The fPLI or specPLI are the tests used to determine pancreatitis. I'm not sure why your vet is confused by the number. The fPLI is not as "fail proof" on the results as the specPLI but it's a good indicator; the best thing is to combine it with an ultrasound of the pancreas. However that costs $$ and so if you are only left with a dx based on the test, that's what you have to go with. As with other tests, it has a range and if he's above the range, it is likely he has pancreatitis; if he's below, it is likely (but not absolute) that he doesn't. Was he fasted prior to the test and for how long?

I agree that the dry DM must go and know you are addressing that. I also do not know anything about a correlation between wbcs and amount of insulin a cat needs. Wiser minds will have to address that for you but I'm not aware of any correlation. I'm also concerned that your vet is giving him clavamox AND baytril. That's overkill ...if he has something more wrong than just one type of infection, it seems one broad-spectrum AB might be a better choice. I find it odd he's getting two.

And yes, the SS will be very helpful to see and determine any patterns.

Glad to see you here!! I'm sure others will come along with thoughts, too.
 
just thinking out loud - if inflammation/infection/pain can cause higher BG, and white blood cells indicate infection present, then wouldn't that suggest that the WBC could be related to the higher numbers? we often see that a cat's BG numbers will settle down when infections are resolved.
 
Julie: you are right that inflammation can result in higher BGs.

This is the sentence Amy made that I'm not sure of a correlation:

As his insulin is increasing, his white blood count is also increasing.
Click to expand...
 
So many kitties start out with urinary infection. More info on the infections he is being treated for would be good.

FOOD:

The kibble is bad, but Amy, you'll want to be home, and hometesting, as you transition Revson to entire LC, soft diet. Sometimes coming off that dry food can cause an important drop in BG. You'll want to be monitoring closely.

Great work so far, and you are SO in the right place to get Revson back in shape!
 
I'm not sure of the reference range of the lab your vet is using, but everything I read about general WBC lab values in cats is roughly 4800 - 19,000....so you're well within range.

There is not a direct correlation between the increase in insulin and the increase in WBC...but I could espouse that an indirect one could be made very, very easily.

Normally there is very little or no glucose in urine. When the blood sugar level is very high, the sugar spills over into the urine. This puts our sugar kitties at a very high risk for urinary tract infections - what grows bacteria better than sugar - not too much...those pesky bacteria love it! The fact that Revson's WBC count is increasing, probably has to do with his body working harder to keep the bacteria under control in his bladder. Add water if you can to his food, etc., to help flush things out. The Clavamox is great for UTI's....but I am not convinced at this point that an infection is present. A simple urine test would confirm....do you know if your vet did this? Clavamox is not really going to "hurt" anything, but I'm not an advocate of using antibiotics unless they're needed....because there will be times when they're needed and we want to ensure that no resistance is there. Clavamox has a bad reputation of upsetting the stomach and a lot of people add a pepcid or some probiotics to keep things "working properly".

Pancreatitis is generally a sterile process in cats...so again, the antibiotics don't necessarily make sense, unless something's been diagnosed as infectious. Again, Clavamox would be a good choice if an infection was present....

What number has your vet given you in regards to the fPLI? Is this the first time pancreatitis has been suspected or has this been a recurrent problem?
 
Re: 9/15 Revson AMPS 440, +5 245 - New Pancreatis Help Need

To clarify... the commentary is from John (my ex-husband).
He's taken the info from the past 2 weeks of watching Revson and the info provided by the vet and compressed it.

DX 8/29, with DKA. In the kitty hospital for a week (IV insulin, electrolytes & potassium).
Lantus by injection began 9/1 (1U)
He weighs about 10lbs, down from 14+ (going from memory, don't have the latest vet sheets here).
Neutered male, 12 yrs old.

Vet sent home Purina DM dry, have been giving him low carb wet from Binky's list.
Will take off dry next week when he is with me full time.
He likes the wet food, will not be a problem.

Teeth are a significant issue, but have taken a back seat to FD, DKA, UTI, etc.

"The fPLI or specPLI are the tests used to determine pancreatitis. I'm not sure why your vet is confused by the number".
I'm not sure the vet is confused, we may be. He had fPLI test 2 weeks ago and re-tested yesterday.
Ultrasound suggested/offered but was waiting for the 2nd test results.
We were not told to have him fast...
$$ will become an issue soon. The week vet bill was over the moon!

Baytril was given for UTI, Clavamox was added due to high white blood cell count (presumed additional infection).

Whew. I can be on-line for at least another hour or so before I need to go!
Amy
 
WBC numbers were 32,000 14 days ago. I don't know what they were yesterday.

5.8 and 10.8 may be the fPLI test numbers. The vet only spoke to John, and is too busy this afternoon to follow up with me.

Assuming it is pancreatitis, what to do?
UTI is presumed resolved with AB, no additional test was done.
 
you're dealing with a lot, amy. and having the information all come to you second-hand where you can't get questions answered makes it doubly difficult. :YMHUG:

hang in there - hopefully all the questions and answers will help you unravel this.
 
Amy, you're doing great and before you know it, he'll be with you. I understand it must be very difficult to manage this from a distance.
You're getting great advice in regards to food and as soon as he's with you, so many can help regulate the dosing and testing which will help with the bg levels.

In regards to the pancreatitis....I can't tell you what's going on over this computer....I wish I could, but there are just too many variables at this point. If you get the testing number, let us know and please let us know if there are any additional symptoms Revson is experiencing in regards to it. So much of the treatment is supportive to get through the flare and then subsequent steps are to prevent future flares. If he's happy and not in pain or vomiting or having diarrhea...you may be in the best position you can.

In regards to the UTI:
OK, so it looks like they diagnosed a UTI around the same time as the DKA (I'm assuming this from the time frame). A true diagnosis would explain the antibiotics, yet I am very surprised his WBC was only 5.8 on the 30th if he did have one... At this point, it's really irrelevant because by now, he would have run his course on both of the antibiotics.

As mentioned before, the WBC test yesterday is a normal range...so....unless he's showing other signs of a UTI (frequency, missing the box, etc), it would be something to watch while his bg levels are high, but that's about it. You could ask for a urinalysis, because that's what's going to really tell if something is going on.

So for right now, nothing seems "critical"....so I would "get your house in order" with the food, the spreadsheet, the testing supplies....he's coming home today happy and feeling good. We can take the steps together here at FDMB to get him on track!
 
Amy & Revson said:
WBC numbers were 32,000 14 days ago. I don't know what they were yesterday.

5.8 and 10.8 may be the fPLI test numbers. The vet only spoke to John, and is too busy this afternoon to follow up with me.

Assuming it is pancreatitis, what to do?
UTI is presumed resolved with AB, no additional test was done.
Click to expand...


This must have come in after I started typing so sorry. The 32,000 makes perfect sense for UTI....

If those are the fPLI numbers, here's what I found:
Normal (reference) values:
The reference range for the fPLI assay in cats is 2.0-6.8 µg/L.

Abnormal values:
Cats with serum pancreatic lipase >6.8 but <12 µg/L may have pancreatitis that is mild or resolving. Continue supportive therapy as necessary, consider retesting in 24-48 hours depending on clinical progress.
The cut-off value for diagnosis of pancreatitis is >12 µg/L.

Find out when you can if in fact those are the numbers and let us know if there are any other symptoms (vomiting, pain, lethargy, diarrhea). Supportive therapy at this point could be nothing more than extra fluids. I"m going to send you a PM with some additional info.
 
Can you try to find out if the vet ran an fPLI or a spec fPLI. The reference ranges are different.
Idexx Labs said:
The Spec fPL reference interval, determined from the healthy cats was 0.7–3.5 μg/L. A Spec fPL result of ≥5.4 μg/L was determined to be consistent with pancreatitis. Using 5.4 μg/L as a single diagnostic cut off, the sensitivity of the Spec fPL assay for the diagnosis of pancreatitis was 79% and the specificity for ruling out pancreatitis was 80% in this group of cats.© 2009
Click to expand...

If Revson is still on antibiotics, a repeat cytocentesis (sterile urine sample) and culture and sensitivity is not possible. You need to wait until the antibiotics have clears his system in order to get an accurate result.

There are some additional things you can do to manage the pancreatitis. First, is Revson's appetite OK? Many cats with pancreatitis experience nausea. Pepsid (1/4 of a 10 mg. Pepsid AC tablet) will help with this. This link is for information on pancreatitis and was written by a vet tech who used to be very active on this board. (Given that this was from 2007, the spec fPLI has replaced the fPLI as the go to diagnostic test.) Pain meds, usually buprenorphine/buprenex is also helpful since pancreatitis is very painful. I'm also including a roundtable discussion by veterinary experts on the topic of pancreatitis. These two articles are a very good start to help you understand how to manage a pancreatitis flare.
 
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