Sherry & Tipper
Member
Tipper's blood glucose was 574 at a check-up on 7/6. We'd noticed she was sluggish but were surprised by that result. She had a bout with diabetes in 2006 but went into remission after a few months on insulin. At the exam I mentioned that she seemed to have some mouth pain because she does this funny thing with her lip when she eats. The main focus of the visit was the diabetes and how to best treat her. Our vet suggested we try a low carb diet for a week or so. Did that. Lowered her BG but not by nearly enough. On 7/17 we started insulin at 0.5 unit once a day, then moving to twice a day as her BG was high at +12. She went back to the vet for another glucose check on 8/6. Still losing weight and her appetite had fallen off since starting the insulin. BG was still around 300 and vet recommended an increase to 1 unit per day. We agreed to start increasing toward that, monitoring her BG levels at home. I mentioned the mouth thing again and the vet (without looking) suggested we might want to schedule a dental if she kept doing it.
Long story short, her BG has been up and down since then, sometimes in the 100s, sometimes in the 300s, but her appetite continued to diminish. We were struggling to get her to eat last weekend and by Wed. she was just picking at her food. I even offered her dry KD kibble (which she loves) but she only took a little. I caught her in the litterbox and checked for ketones -- negative but noticed her urine was bright yellow. And she started having dry heaves. Yesterday I took her to a different vet. They looked in her mouth and she has very inflamed gums in the back on both sides. One side is so bad they said it's probably painful to even open her mouth. Urine sample taken via needle at vet was also bright yellow. Vet said it looks like hepatic lipidosis and we need to get her eating again, get her liver working, get the toxins out of her and address the bad teeth. Started her on SubQ fluids (100 ml/day) yesterday, also Clavimox (62.5 mg twice a day), Cyproheptadine (2 mg per day) and Denomarin for her liver. Today she went back to the vet, had an abdominal x-ray (nothing obvious but her liver is enlarged) and the vet added Baytril (22.7 mg once per day). Said blood results show obvious liver trouble and serious infection. Speculates there may be a hepatic abcess and also mentioned that at her age (she's 18) we could be dealing with a tumor.
I'm posting the yesterday's test results and the ones from last month -- and kicking myself for not posting last month's earlier. As I type them it's obvious something was going on with her liver 6 weeks ago but our vet was totally focused on the diabetes.
Tipper is not eating much on her own, even with the cypro. She's still having the dry heaves. I'm assist feeding her, but probably not enough just yet. Trying to get myself wrapped around this. She goes to her food bowl, but then turns away so I know she's nauseous. Is there anything that might help that? I'm still testing her BG and giving her insulin (only .4 Units since she's usually in the upper 200s but is not eating much). What do I need to watch for in terms of antibiotics and how that may interact with her BG levels? I know this is very serious, but as I said, I'm having trouble getting my head around this -- a week ago she seemed to be doing just fine except for being a little picky about her food. And most important, does anyone see anything else in the bloodwork that we should be paying attention to?
Thanks for listening,
Sherry
Tipper’s bloodwork from 8/19/11 and 7/6/11 (different vet offices) is below. The 7/6 results are in [brackets.] The 8/11 was done by Antech and the 7/6 by an IDEXX VetLab in-clinic lab.
Total protein: 7.9 g/dL (5.2-8.8) [9.1 g/dL (High) (5.7-8.9)]
Albumin: 3.1 g/dL (2.5-3.9) [3.1 g/dL (2.3-3.9)]
Globulin: 4.8 g/dL (2.3-5.3) [6 g/dL (High) (2.8-5.1)]
Albumin/Globulin ratio: 0.6 (0.35-1.5) [0.5]
AST (SGOT): 237 U/L (High) (10-100)
ALT (SGOT): 725 U/L (High) (10-100) [185 U/L (High) (12-130)]
Alk Phosphatase: 183 U/L (High) (6-102) [339 U/L (High) (14-111)]
GGTP: 5 U/L (1-10)
[GGT: 3 U/L (High) (0-1)]
Total Bilirubin: 7.1 mg/dL (High) (0.1-0.4)
[TBI: 0.3 mg/dL (0-0.9)]
Urea Nitrogen: 33 mg/dL (14-36) [45 mg/dL (High) (16-36)]
Creatinine: 2.5 mg/dL (High) (0.6-2.4) [2.5 mg/dL (High) (0.8-2.4)]
BUN/Creatinine ratio: 13 (4-33) [18]
Phosphorus: 4.0 mg/dL (2.4-8.2) [5/1 mg/dL (3.1-7.5)]
Glucose: 273 mg/dL (High) (64-170) [574 mg/dL (High) (71-159)]
Calcium: 9.1 mg/dL (8.2-10.8) [10.3 mg/dL (7.8-11.3)]
Magnesium: 2.0 mEq/L (1.5-2.5)
Sodium: 148 mEq/L (145-158) [161 mmol/L (150-165)}
Potassium: 4.1 mEq/L (3.4-5.6) [4.8 mmol/L (3.1-7.5)]
Na/K ratio: 36 [34]
[OSM calc: 356 mmol/kg]
Chloride: 114 mEq/L (104-128) [277 mmol/L (112-129)]
Cholesterol: 332 mg/dL (High) (75-220) [277 mg/dL (High) (65-225)]
Triglycerides: 112 mg/dL (25-160)
Amylase: 1227 U/L (High) (100-1200)
Lipase: 68 U/L (0-205)
CPK: 105 U/L (56-529)
WBC: 19.1 10**3/microL (High) (3.5-16) [10.03K/microL (2.87-17.02)]
RBC: 5.45 10**3/microL (Low) (5.92-9.93) [6.78 K/microL (6.54-12.2)]
Hemoglobin: 9.1 g/dL (Low) (9.3-15.9) [11 g/L (9.8-16.2)]
Hematocrit: 27.4 % (Low) (29-48) [32.6% (30.3-52.3)]
MCV: 50 fL (37-61) [48.1 fL (35.9-53.1)]
MCH: 16.7 pg (11-21) [16.2 pg (11.8-17.3)]
MCHC: 33.2 g/dL (30-38) [33.7 g/dL (28.1-35.8)]
[RDW: 20.7% (15-27)]
Platelet Count: 464 10**3/microL (200-500) [318 K/microL (151-600)]
Platelet EST: Adequate
[Retics: 12.9 K/microL (3-150)]
[%Retics: 0.2%]
Neutrophils: 14898 10**9/L (High) 78% (2500-8500) [5.95 K/microL (1.15-10.29)]
[%NEUT: 59.3%]
Bands: 0 /microL 0% (0-150)
Lymphocytes: 2674 14% (1200-8000) [3.01 K/microL (0.92-6.88)]
[%LYMPHS: 30%]
Monocytes: 955 (High) 5% (0-600) [0.62 K/microL (0.05-0.67)]
[%MONOS: 6.2%]
Eosiniphils: 573 3% (0-1000) [0.36 K/microL (0.17-1.57)]
[%EOS: 3.6%]
Basophils: 0 0% (0-150) [0.09 K/microL (0.01-0.26)]
[%BASO: 0.9%]
T4: 1.0 mg/dL (0.8-4.0) [0.8 microg/dL]
Urinalysis
Color: Dark Yellow
Appearance: Slightly Hazy (Clear)
Specific Gravity: 1.020 (1.015-1.060)
pH: 6.0 (5.5-7.0)
Protein: 1+ (High) (Neg)
Glucose: 3+ (High) (Neg)
Ketone: Negative (Neg)
Bilirubin: 2+ (High) (Neg)
Urine bilirubin verified by Ictotest
Blood: Trace (Neg)
WBC: None (0-3)
RBC: None (0-3)
Casts: None seen
Bilirubin crystals: 2-3
Amorphous Crystals: 11-20
Bacteria: None seen (None)
Epithelial Cells: None seen
Long story short, her BG has been up and down since then, sometimes in the 100s, sometimes in the 300s, but her appetite continued to diminish. We were struggling to get her to eat last weekend and by Wed. she was just picking at her food. I even offered her dry KD kibble (which she loves) but she only took a little. I caught her in the litterbox and checked for ketones -- negative but noticed her urine was bright yellow. And she started having dry heaves. Yesterday I took her to a different vet. They looked in her mouth and she has very inflamed gums in the back on both sides. One side is so bad they said it's probably painful to even open her mouth. Urine sample taken via needle at vet was also bright yellow. Vet said it looks like hepatic lipidosis and we need to get her eating again, get her liver working, get the toxins out of her and address the bad teeth. Started her on SubQ fluids (100 ml/day) yesterday, also Clavimox (62.5 mg twice a day), Cyproheptadine (2 mg per day) and Denomarin for her liver. Today she went back to the vet, had an abdominal x-ray (nothing obvious but her liver is enlarged) and the vet added Baytril (22.7 mg once per day). Said blood results show obvious liver trouble and serious infection. Speculates there may be a hepatic abcess and also mentioned that at her age (she's 18) we could be dealing with a tumor.
I'm posting the yesterday's test results and the ones from last month -- and kicking myself for not posting last month's earlier. As I type them it's obvious something was going on with her liver 6 weeks ago but our vet was totally focused on the diabetes.
Tipper is not eating much on her own, even with the cypro. She's still having the dry heaves. I'm assist feeding her, but probably not enough just yet. Trying to get myself wrapped around this. She goes to her food bowl, but then turns away so I know she's nauseous. Is there anything that might help that? I'm still testing her BG and giving her insulin (only .4 Units since she's usually in the upper 200s but is not eating much). What do I need to watch for in terms of antibiotics and how that may interact with her BG levels? I know this is very serious, but as I said, I'm having trouble getting my head around this -- a week ago she seemed to be doing just fine except for being a little picky about her food. And most important, does anyone see anything else in the bloodwork that we should be paying attention to?
Thanks for listening,
Sherry
Tipper’s bloodwork from 8/19/11 and 7/6/11 (different vet offices) is below. The 7/6 results are in [brackets.] The 8/11 was done by Antech and the 7/6 by an IDEXX VetLab in-clinic lab.
Total protein: 7.9 g/dL (5.2-8.8) [9.1 g/dL (High) (5.7-8.9)]
Albumin: 3.1 g/dL (2.5-3.9) [3.1 g/dL (2.3-3.9)]
Globulin: 4.8 g/dL (2.3-5.3) [6 g/dL (High) (2.8-5.1)]
Albumin/Globulin ratio: 0.6 (0.35-1.5) [0.5]
AST (SGOT): 237 U/L (High) (10-100)
ALT (SGOT): 725 U/L (High) (10-100) [185 U/L (High) (12-130)]
Alk Phosphatase: 183 U/L (High) (6-102) [339 U/L (High) (14-111)]
GGTP: 5 U/L (1-10)
[GGT: 3 U/L (High) (0-1)]
Total Bilirubin: 7.1 mg/dL (High) (0.1-0.4)
[TBI: 0.3 mg/dL (0-0.9)]
Urea Nitrogen: 33 mg/dL (14-36) [45 mg/dL (High) (16-36)]
Creatinine: 2.5 mg/dL (High) (0.6-2.4) [2.5 mg/dL (High) (0.8-2.4)]
BUN/Creatinine ratio: 13 (4-33) [18]
Phosphorus: 4.0 mg/dL (2.4-8.2) [5/1 mg/dL (3.1-7.5)]
Glucose: 273 mg/dL (High) (64-170) [574 mg/dL (High) (71-159)]
Calcium: 9.1 mg/dL (8.2-10.8) [10.3 mg/dL (7.8-11.3)]
Magnesium: 2.0 mEq/L (1.5-2.5)
Sodium: 148 mEq/L (145-158) [161 mmol/L (150-165)}
Potassium: 4.1 mEq/L (3.4-5.6) [4.8 mmol/L (3.1-7.5)]
Na/K ratio: 36 [34]
[OSM calc: 356 mmol/kg]
Chloride: 114 mEq/L (104-128) [277 mmol/L (112-129)]
Cholesterol: 332 mg/dL (High) (75-220) [277 mg/dL (High) (65-225)]
Triglycerides: 112 mg/dL (25-160)
Amylase: 1227 U/L (High) (100-1200)
Lipase: 68 U/L (0-205)
CPK: 105 U/L (56-529)
WBC: 19.1 10**3/microL (High) (3.5-16) [10.03K/microL (2.87-17.02)]
RBC: 5.45 10**3/microL (Low) (5.92-9.93) [6.78 K/microL (6.54-12.2)]
Hemoglobin: 9.1 g/dL (Low) (9.3-15.9) [11 g/L (9.8-16.2)]
Hematocrit: 27.4 % (Low) (29-48) [32.6% (30.3-52.3)]
MCV: 50 fL (37-61) [48.1 fL (35.9-53.1)]
MCH: 16.7 pg (11-21) [16.2 pg (11.8-17.3)]
MCHC: 33.2 g/dL (30-38) [33.7 g/dL (28.1-35.8)]
[RDW: 20.7% (15-27)]
Platelet Count: 464 10**3/microL (200-500) [318 K/microL (151-600)]
Platelet EST: Adequate
[Retics: 12.9 K/microL (3-150)]
[%Retics: 0.2%]
Neutrophils: 14898 10**9/L (High) 78% (2500-8500) [5.95 K/microL (1.15-10.29)]
[%NEUT: 59.3%]
Bands: 0 /microL 0% (0-150)
Lymphocytes: 2674 14% (1200-8000) [3.01 K/microL (0.92-6.88)]
[%LYMPHS: 30%]
Monocytes: 955 (High) 5% (0-600) [0.62 K/microL (0.05-0.67)]
[%MONOS: 6.2%]
Eosiniphils: 573 3% (0-1000) [0.36 K/microL (0.17-1.57)]
[%EOS: 3.6%]
Basophils: 0 0% (0-150) [0.09 K/microL (0.01-0.26)]
[%BASO: 0.9%]
T4: 1.0 mg/dL (0.8-4.0) [0.8 microg/dL]
Urinalysis
Color: Dark Yellow
Appearance: Slightly Hazy (Clear)
Specific Gravity: 1.020 (1.015-1.060)
pH: 6.0 (5.5-7.0)
Protein: 1+ (High) (Neg)
Glucose: 3+ (High) (Neg)
Ketone: Negative (Neg)
Bilirubin: 2+ (High) (Neg)
Urine bilirubin verified by Ictotest
Blood: Trace (Neg)
WBC: None (0-3)
RBC: None (0-3)
Casts: None seen
Bilirubin crystals: 2-3
Amorphous Crystals: 11-20
Bacteria: None seen (None)
Epithelial Cells: None seen
