9/28 Chewie AMPS 419/ +3 298/ +5 251/ +7 222/ PMPS 264/ +2 324

Vet call went well, she was very impressed by the amount of data, and agrees that Chewie's insulin-resistance needs to be addressed, as she is very uncomfortable (predictably) with Chewie getting such a high dose. She specifically expressed concern about the stress of traveling increasing her insulin resistance, and a high dose being dangerous in that context. I assured her that we would adjust her dose accordingly to keep her safe during our road trip.

Things we are doing before the move:
- bringing Chewie in for a urinalysis and urine culture tomorrow morning
- bathing her sebaceous cysts with warm compresses and soapy water to try to drain them a little bit and reduce irritation

If no hidden infection is found, and getting the cysts better doesn't have an impact on her numbers, she said she would start with testing for pancreatitis (seems unlikely as Chewie has a solid appetite and no GI signs whatsoever, but you never know I guess with cats) and doing full body X-rays to look for cancer. Only then, if those were negative, would she test for IAA and acromegaly, since she feels the ratio of benefit provided by treatment and financial/medical burden of that treatment for the cat and owner isn't very favorable.

She suggested twice to give her a convenia injection for the cysts, but I declined, as I don't want to risk any long term side effects, especially during our trip. Chewie is allergic to clavamox and gets really despondent and anorexic with it, so not risking a weird reaction to injected antibiotics.

Thoughts?
 
Virginie said:
She suggested twice to give her a convenia injection for the cysts, but I declined, as I don't want to risk any long term side effects, especially during our trip. Chewie is allergic to clavamox and gets really despondent and anorexic with it, so not risking a weird reaction to injected antibiotics.

Thoughts?
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I think you made the right choice re: Covenia. It is a very long acting antibiotic, making it extremely difficult to deal with any adverse effects (like an allergic reaction) because it takes a long time to wear off (weeks to months). If your cat has had reactions to other antibiotics I would be very cautious with Covenia. I hope Chewies urinalysis doesn’t show any sign of infection- but if it does you might want to ask for a culture and sensitivity test to make sure that she is prescribed the correct antibiotic. Wishing you the best and good luck with your move :bighug:
 
Kyle & Simon (GA) said:
I think you made the right choice re: Covenia. It is a very long acting antibiotic, making it extremely difficult to deal with any adverse effects (like an allergic reaction) because it takes a long time to wear off (weeks to months). If your cat has had reactions to other antibiotics I would be very cautious with Covenia.
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My thoughts exactly! I have heard all kinds of horror stories with convenia. I have refused it every time a vet has offered it in the past, I don't understand why they always suggest it first, without enquiring whether the cat is good with oral meds. Getting oral meds in is never an issue with my brood, so there's really no basis for trying some injectable that we can't take back should they react to it.

Kyle & Simon (GA) said:
I hope Chewies urinalysis doesn’t show any sign of infection- but if it does you might want to ask for a culture and sensitivity test to make sure that she is prescribed the correct antibiotic. Wishing you the best and good luck with your move :bighug:
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Thank you so much. I actually kinda hope that the urinalysis shows a hidden/asymptomatic infection, as that would be the easiest option to treat... I know they will be doing a culture no matter what, I hope they get results before we have to leave. It would be a dream if resolving her insulin resistance was as simple as a long course of antibiotics!
 
Virginie said:
Thank you so much. I actually kinda hope that the urinalysis shows a hidden/asymptomatic infection, as that would be the easiest option to treat... I know they will be doing a culture no matter what, I hope they get results before we have to leave. It would be a dream if resolving her insulin resistance was as simple as a long course of antibiotics!
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I totally get that! Simon was having weird urinary issues for a while and I kept hoping we would find an infection so that we could treat it! I will keep my fingers crossed that you can track down an easy fix for Chewie! :cat:
 
Virginie said:
If no hidden infection is found, and getting the cysts better doesn't have an impact on her numbers, she said she would start with testing for pancreatitis (seems unlikely as Chewie has a solid appetite and no GI signs whatsoever, but you never know I guess with cats) and doing full body X-rays to look for cancer. Only then, if those were negative, would she test for IAA and acromegaly, since she feels the ratio of benefit provided by treatment and financial/medical burden of that treatment for the cat and owner isn't very favorable.
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Depends how much you like spending money on tests that tell you nothing. Cancer isn't going to cause her to need higher doses of insulin, so I think those x-rays are a waste of time and your money, unless the vet is thinking of them in regards to the cysts. There is a reason that we suggest that people get their cats tested for acromegaly and IAA when their cat gets to 6 units of insulin, if they are on an all low carb wet/raw food diet. We have seen cats get close to six units with other conditions (eg. pancreatitis, heart disease, hyperthyroidism, infection), but not over 6 units. Some people with cats on higher doses don't get tests done. The only problem with that approach is that knowledge gives you power. If acromegaly, there are treatments that help. Especially cabergoline which is a fairly cheap daily medication that can greatly improve quality of life. Plus we've had a handful of cats go OTJ on it. I had a cat with both acro and IAA, and I don't regret for one minute the SRT (radiation) treatment we did, which was the only option at the time. There are more options now, so I might have chosen a different treatment, but it did give her several years of much better quality of life. I consider that a huge benefit. There wasn't a huge medical burden until the last part of a year when the multiple diagnoses made things more complicated.

Just so you know, it's not uncommon for vets to be reluctant to run the tests. Many vets "of a certain age", were taught that these conditions were very rare, but newer studies have show around 1 in 4 diabetic cats have acromegaly. I had to ask my vet to humour me, several times, in order to get the tests done. And tell her exactly how to get the tests done. She was very surprised by the results of the "exotic tests", but willing to work with me after that to learn what to do.

To set Chewie's dose in context with travel, Neko rode 3 days to Fort Collins on an 8.5 units dose. She saw less insulin resistance on the trip, not more. I lowered her dose for the trip back. We had one kitty who rode even longer on a car ride to Spokane WA from the east, with an 49 unit dose reduced to 45 units for the trip. No, that was not a typo. That cat was much more resistant than Chewie. Pig didn't see his first blue until 59 units. There are several additional examples of cats I could find, that travelled when their doses at the time were higher than Chewie's. A cat needs whatever dose they need.
 
Honestly @Wendy&Neko I have way more trust in this forum’s collective knowledge than in this vet’s… she is been very opinionated, generally not with a whole lot of facts to back those up. When Chewie injured her back, she pretty much told me (I’m not making it up) “well if she doesn’t improve on steroids your only other choices are an MRI and spinal surgery with a $10k price tag, and if you're not willing to do that then she will have to be put down”… way to scare the absolute crap out of me, I thought my cat was likely to die if I couldn’t get in debt to get her surgery. Fast forward, she did fine with a short course of steroids, acupuncture and laser therapy and… time. She will always shuffle a bit but the other vet she saw was super impressed with how well she moved. All of this to say this vet is pretty negative, and confuses opinion for actual science. Sigh.

I am glad that were doing the urine tests, that will be off my conscience (honestly would be relieved to find something there even), but I will have to start this process all over again in VA, so whatever this lady would or wouldn’t do is no longer going to be our problem :p
I am just so thankful I have you guys and am not easily bullied!`
 
Wendy&Neko said:
To set Chewie's dose in context with travel, Neko rode 3 days to Fort Collins on an 8.5 units dose. She saw less insulin resistance on the trip, not more. I lowered her dose for the trip back. We had one kitty who rode even longer on a car ride to Spokane WA from the east, with an 49 unit dose reduced to 45 units for the trip. No, that was not a typo. That cat was much more resistant than Chewie. Pig didn't see his first blue until 59 units. There are several additional examples of cats I could find, that travelled when their doses at the time were higher than Chewie's. A cat needs whatever dose they need.
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Holy mackerel 59 units :eek:
You know, the vet had the spreadsheet right under her eyes, she could see the numbers, but kept repeating “she shouldn’t be at this dose, normally I don’t go over maximum X units per kg, she is way too high over that”…. Literally having facts under her eyes showing her that her basic facts were incorrect in this case.
 
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wow two blues for Chewie I can hardly believe my eyes! I've been gone camping (brrrr!) in the Adirondacks just got back to see this. I really hope this is just the beginning of some further progress towards regulation.
 
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