Charlie's doctor appt with specialist update

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EllieKozak

EllieKozak

Member Since 2014
Hello! Just got home from Charlie's appointment. Was late with insulin by one hour because of it. Hope things will be ok?!
So she thinks he has IBD and something called cholangitis and pancreatitis despite what gi lab says. She also says he has insulin resistance. Did ultrasound. We are sending out a urine culture and sensitivity and a test to rule out acromegaly. Continuing on metro and adding zeniquin (marbofloxacin) and also adding vitamin b12 injections weekly. She mentioned a fecal transplant if diarrhea dosent resolve but Leary of giving a sedative because of his weakness. She gave him a body score of 2-3/9 :(
Said there's also a chance that he might be getting too much insulin (somogyi over swing???). She says it's possible that once the diarrhea subsides that his insulin needs May change. We have to report to her in one week with a progress report. Said for right now to feed evo and we will address a possible food allergy after the acro and urine test results are back.
Thoughts? Thanks again!
 
You can shift your time back either 15 minutes per shot, or 30 minutes per day.

Anything ending with "itis" means inflammation, but it doesn't tell you why. The cholangitis is inflammation of the common bile duct. The antibiotic may be a hunch to see if it helps. It may cause GI upset - you may want to pick up some probiotic if you don't have some already. Forti Flora, Intelliflora, and so on are candidates. My cats go nuts for the Forti Flora, and it is cheaper online.
 
It sounds like you have a good vet and you're getting some very thorough help with Charlie. I hope he starts feeling better soon! You're doing a great job.

Billie is in the middle of some food allergy drama, and our vet said that Evo is a good brand for allergic kitties. It's not marketed as limited ingredient food, but they have some of the best low carb limited ingredient options (except for the cat & kitten blend). I was told to switch from chicken and turkey to a novel protein, which is venison for Billie.

Billie highly recommends Fortiflora...she was having some diarrhea but it helped with that, and it also gets her appetite going. I heard people calling it "kitty crack" and now I understand why.
 
Thank you for the input. He has been on forti flora since his dx in June. I forgot to mention that. He loves it! I just hope we can get things on track with him. His poor tummy is so distended. Any thoughts in the solowgi (sp?) thing? I've never heard of that mentioned on the board yet.
 
If the vet is sending out blood to test for acromegaly, she should also request a test for IAA (insulin auto antibodies). Both tests are only done at Michigan State University and IAA is a cheap add-on to the acromegaly test (test for IGF-1). Neko has both acromegaly and IAA, Sandy's Black Kitty had just IAA. Having IAA will change your approach to dosing.

As for symogyi, here is a quote from Sienne:
As for symogyi, this is from Tilly:

Be aware that experimental studies in human diabetics over the last 15-20 have rejected the existence of the Somogyi effect (sometimes also called rebound). In cats, no studies have ever been done which properly demonstrate that such a phenomenon exists. Therefore, adjust the dose as described above, focusing on the nadir: don't do so-called rebound checks, as they only lead to unnecessary (and unhealthy!) hyperglycemia.
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As long as you have followed the protocol and increased according to it, it's unlikely that Charlie is overdose.
 
Hi there :cool:
I have no knowledge to share around all the various 'itis' possibilities however plenty of folks around here do.

EllieKozak said:
She also says he has insulin resistance.
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Only one way to determine that - the test Wendy mentioned. It make sense to get them both done at the same time.
EllieKozak said:
Said there's also a chance that he might be getting too much insulin (somogyi over swing???).
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She is aware of the ketone situation, correct? He needs insulin.
I too think it's unlikely he is over dose (some PM+5-11 data/recent history would come in handy right about now) although I do think some of the AMPS numbers may be bounces.
EllieKozak said:
She says it's possible that once the diarrhea subsides that his insulin needs May change.
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Fingers crossed on that.

With all the health variables in play right now you should expect change to insulin needs as issues resolve.
Make sure you have plenty of HC, strips & karo handy.
The numbers will guide you- and you have a lot of eyes around here if you are uncertain.


Was there any weight change?
How many calories do you think he consumes daily?

And what the devil is a fecal transplant??? :?
 
Just to add another, "I agree" -- getting both tests at once will give you more definitive answers and not leave you guessing on whether Charlie's IAA (insulin auto-antibody) titer is in the insulin resistant range.

There are a number of posts on Somogyi that conclude that this is a concept that was based on (poor) research that was done in 1938 and has never been replicated. The original research was on humans, not cats, and was not done with a long-acting insulin. For whatever reason, some professionals seem to be wed to the concept. Chronic Somogyi rebound is also different than a bounce.
 
I'm sorry Charlie is having such a hard time. I find it odd that your vet would think he might have pancreatitis even though the fPL was normal. Was the test repeated yesterday? Max has chronic pancreatitis and whenever I suspect it is causing issues he always tests well above the positive number. I read about a lot of cats on the pancreatitis board and none of them have been diagnosed with it and not had a high fPL that I can remember. Was the test done on a 12 hour fast or at least 6-8 hours? Has she seen many/any cats with a normal fPL test done on a fast that were diagnosed with it? Has Charlie had an US by a boarded radiologist? That would be another way to tell what is going on. :YMHUG: :YMHUG: :YMHUG:
 
Ellie

I've been out of town but just trying to catch up on Charlie.

I'd like to address the cholangitis because I've been dealing with recurring cholangitis in Gracie for two years. Do you have the U/S report? There is the possibility that the specfPL can be normal but the pancreas looks inflamed on the u/s because the inflammation is possibly caused by the adjacent organs being inflamed. Gracie was the opposite. Her specfPl was elevated but her pancreas looks perfect on the u/s and she's never had any symptoms of pancreatitis.

You said his labs were normal. Typically with cholangitis, you might see some elevation of the liver values especially bilirubin if the common bile duct is infected. How did the gall bladder look? Did she mention if the bile duct is dilated and if she thinks it could be from a physical or functional obstruction? Usually with a physical obstruction, you would see very elevated liver values and a large gall bladder but if the dilation is caused by infection, the gall bladder should appear normal or even small after a meal. cholangitis can be caused by ascending bacterial infection from the intestines...but not always.

Typically the antibiotic of choice for treating cholangitis is metronidazole but Gracie is allergic to it and so we've had great luck with clavamox. She can take long courses of clavamox without being sick. The c&s will help determine what might be most effective in treating the cholangitis.

The other things that really help in treating cholangitis are ursodiol, denamarin, and water soluble liquid vitamin E like AquaE.
 
tiffmaxee said:
I'm sorry Charlie is having such a hard time. I find it odd that your vet would think he might have pancreatitis even though the fPL was normal. Was the test repeated yesterday? Max has chronic pancreatitis and whenever I suspect it is causing issues he always tests well above the positive number. I read about a lot of cats on the pancreatitis board and none of them have been diagnosed with it and not had a high fPL that I can remember. Was the test done on a 12 hour fast or at least 6-8 hours? Has she seen many/any cats with a normal fPL test done on a fast that were diagnosed with it? Has Charlie had an US by a boarded radiologist? That would be another way to tell what is going on. :YMHUG: :YMHUG: :YMHUG:
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His regular vet sent a GI panel which came back negative for pancreatitis. The cobalamin was 470 ng/l. The appointment yesterday was with a small animal internal medicine board specialist. I will scan the report now and link it. Will also start a new convo. The GI panel was not fasted Bc can't really fast him or ekse he goes ketonic quickly.
 
Marje and Gracie said:
Ellie

I've been out of town but just trying to catch up on Charlie.

I'd like to address the cholangitis because I've been dealing with recurring cholangitis in Gracie for two years. Do you have the U/S report? There is the possibility that the specfPL can be normal but the pancreas looks inflamed on the u/s because the inflammation is possibly caused by the adjacent organs being inflamed. Gracie was the opposite. Her specfPl was elevated but her pancreas looks perfect on the u/s and she's never had any symptoms of pancreatitis.

You said his labs were normal. Typically with cholangitis, you might see some elevation of the liver values especially bilirubin if the common bile duct is infected. How did the gall bladder look? Did she mention if the bile duct is dilated and if she thinks it could be from a physical or functional obstruction? Usually with s physical obstruction, you would see very elevated liver values and a large gall bladder but if the dilation is caused by infection, the gall bladder should appear normal or even small after a meal. cholangitis can be caused by ascending bacterial infection from the intestines...but not always.

Typically the antibiotic of choice for treating cholangitis is metronidazole but Gracie is allergic to it and so we've had great luck with clavamox. She can take long courses of clavamox without being sick. The c&s will help determine what might be most effective in treating the cholangitis.

The other things that really help in treating cholangitis are ursodiol, denamarin, and water soluble liquid vitamin E like AquaE.
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I will post the report shortly. She said triaditis or something like that. Working as a tech for 9 years and never heard that one before!! He's been on metronidazole and fortiflora with no response. Started zeniquin today for 7 days. :)
 
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