Kitty Lab results--trickling in...Dx pancreatitis

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kse

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Only 1/3 of the results are in, But so far so good---

Fructosamine 431--my vet says that is good control-- I actually am finding some info that supports that 431 is Good for a Diabetic---it cant be ---GOOD, how can Kitty be Good?!!!


T4 1.9--same as Feb.
The free T-4 negative
Liver enzymes normal
creatinine 1.9--- We will gladly take that!
BUN 51---- We will take that too! Hydration plays a role there
Potasium normal--- Great, very common to be low with Neuropathy
Urine -----everything normal--very good--no ketones, no bacteria

The test also shows any acidosis activity over a pd of time--(DKA)--completely negative--interpretation--not even flirting with DKA

This is all that was back--I realize the bottom could still fall out.....But, so far so good!


One question for you gurus--- I looked at the SS this morning and noticed, both times (there has only been 2) that I shot 4.7 I ended up with a lower and good amps the next morning. Do you think I am reading too much into that....could it be that this additional insulin is getting her longer duration?
 
Re: Kitty Lab results--trickling in..

Good results and since I'm not a guru, I have nothing to add. :smile:
 
Re: Kitty Lab results--trickling in..

Not a guru.......not even one of those young people who follow the gurus around and hold their robes......

The lab results look very good. I guess one thing we tend to forget is that many diabetic cats do not go off the juice but do stay regulated. 200s at preshots, 100s at nadir. Since Kitty has been there and below in a few cases, and frutosamine is an average, guess that could be part of the results?

I don't know about the 4.7 Some day when you are around and feeling brave, you could test the theory?
 
Re: Kitty Lab results--trickling in..

Yay...so glad test results are coming back good for Kitty!
 
Re: Kitty Lab results--trickling in..

Lots of information from your lab tests! I usually only get....everything looks ok. I'm gonna start asking for a copy of the report.
 
Just got off the phone with the vet--- Kitty has full blown pancreatitis. The lab reference is anything above 5.4 is positive--- Kitty is 13.4.

Everything else checked out ok.

She will start bupe tomorrow and we have a consultation with the vet hospital for a treatment regiment.

This probably gives some validation to why the fluids were helping the bg-- as sub qs are in the protocol for pancreatitis treatment.
The vet kind of wants to go the Lantus route, but I told her one step at a time. First we will work on the pancreatitis, unless the vet hospital says differently. The prozinc was okay until recently-- so, I see no need in changing until we help the pancreatitis.

I was Hoping everything would check out okay. But, I knew something was wrong-- that us why I took her. My gut feeling is -- it could have been a lot worse. Now we have something to work on.

When the day comes that I can pay it forward-- I will have one more area I can help with!

Going to find Laura and Harley....
 
I would guess it's good to have a diagnosis. Lots of diabetic kitties seem to develop pancreatitis. So you will be able to get some good advice on health for it.

And it does seem to make things more difficult to regulate. When they are in pain, it raises the numbers. Her quirky numbers maybe make more sense now.

The other values look good. At least you just have this one variable. The vet hospital should have some good resources for you.

Good for you, Kim, continuing to advocate for her until you got results.
 
Never suspected that one....not that I know anything anyway! Good to have a diagnosis though & there's lots of people here who have kitties with it. And, you already do fluids, which I gotta tell you scares the crap outta me. I've wondered how in the world I would handle having to give fluids. I'm sorry Kitty has it but like I said at least now you know & you're right it could be worse! :YMHUG:
 
Sorry to hear about the additional complication, but I don't doubt that you will do everything in your power to help Kitty.
 
As much as it is a bummer and an additional worry, I am sure you are glad you know how to proceed now.
All the best to you and Kitty as you move ahead on this next path. I have no doubt you will do well.
Hugs! :YMHUG:
 
I am sorry to hear that Kitty has pancreatitis. Good thing is you can treat a little differently now that you know. Pain meds will help. Take a look at the food charts and try to find a flavor of food you have been feeding that is the lowest in fat. Lower fat diets tend to help too.

I have to disagree on the fructosamine number being ok. When Oscar was diagnosed his fructosamine was 460. The normal range is 142 - 450. Your score for Kitty indicates that she averages numbers right at the threshold of text book diabetic numbers, or around 200. We all know that better control is eventually achievable - so why settle!!!! :lol:
 
I agree the fruct level could be improved--but, from my test I am shocked it wasn't higher.

The good was not the top of the scale I was shown-- the scale started at non-diabetic, excellent, good, fair and poor control.

The very idea that Kitty was not poor shocked me!

Always room for improvement....
 
Glad you have a diagnosis even if its not one you wanted and will be able to treat it and get Kitty's pain controlled.
All the rest of her labs looked good.
You were right to be persistent until you got them to run more tests and get answers.
So it seems ProZinc is probably not the problem. I wouldn't switch insulins either until the pancreatitis is under control more, you may start getting some consistent better numbers when shes out of pain.
Prayers and well wishes to cool sweet Kitty.
 
Definitely not a guru, but I saw with Bix that higher doses seemed to give him better duration. When he got regulate, it was because the dose was high enough (for him) to keep the end of cycle zoom craziness under control, and that let him get good PSs until his zoom factor settled down and then that was a non-issue. So I would say the 4.7 is probably shooting through the rebound and keeping her lower at the next PS. Liver training rebound you actually want to shoot through if you can safely, but rebound from the dose being too high can be riskier. Her numbers are no where near low though so I don't think it's a terrible thing to shoot through her rebound, but still it would be better not to trigger it, if the steep drops can be avoided.

There's a fructosamine conversion chart, as the numbers mysteriously don't correlate directly to BG #s. I will see if I can find it and post it if I do.

Yay for Bupe!!! Sorry about the diagnosis though, what a bummer. Hopefully though now that you know, you'll be able to treat it more directly and she will do better. I'd still consider the Lantus if the vet is game. I think she could potentially get softer curves and better numbers, and it seems like you've really been struggling for some time now with PZI and even though she's seen some better numbers recently, it's come at the cost of likely rebound. Just my 2c. :)
 
kse said:
Just got off the phone with the vet--- Kitty has full blown pancreatitis. The lab reference is anything above 5.4 is positive--- Kitty is 13.4.

Everything else checked out ok.

She will start bupe tomorrow and we have a consultation with the vet hospital for a treatment regiment.

This probably gives some validation to why the fluids were helping the bg-- as sub qs are in the protocol for pancreatitis treatment.
The vet kind of wants to go the Lantus route, but I told her one step at a time. First we will work on the pancreatitis, unless the vet hospital says differently. The prozinc was okay until recently-- so, I see no need in changing until we help the pancreatitis.

I was Hoping everything would check out okay. But, I knew something was wrong-- that us why I took her. My gut feeling is -- it could have been a lot worse. Now we have something to work on.

When the day comes that I can pay it forward-- I will have one more area I can help with!

Going to find Laura and Harley....

Hi Kim & Miss Super Kool Kitty Kat!

Thanks for PMing me to let me know about Kitty. I'm sorry I wasn't here sooner and sorry that you both had to join the P-titis club. :sad: I've not been on the board for about 2 weeks now due to 24/7 caring for both Harley & my civvie, Princess. I won't jack your thread with their story though.

I'm glad someone pointed you towards the Yahoo Feline Pancreatitis Support Group. That was the first thing I was going to suggest. They are a great group, very knowledegable, and they have links to articles and resources on the latest treatment protocols.

Regarding the tests that were run, did they also run the cobalamin (vitamin B12) and folate absorption and TLI tests? These are fasting blood tests so if you didn't fast her then it's not likely they did. I ask because the first two, cobalamin and folate, are useful to hep point the way to see if she also has IBD. Many cats that have pancreatitis are also at risk for IBD, diabetes (which we already know she has) and cholangialhepatitis. Thank goodness her liver enzymes are good so as long as she keeps on eating enough, you should be good with Mr. L. It's not necessary to do those tests right now, but if your vet is suggesting starting prednisolone, I'd hold off on it until you find out whether or not she might have IBD. Simple, uncomplicated pancreatitis "should" respond to treatment without resorting to pred. It's when it's continuously being fueled by something chronic like IBD that pred. or budesonide could be useful.

Since you are already doing fluids, my only suggestion there is that unless there is a medical reason why she can not tolerate them (e.g. kidney or heart function), I suggest asking your vet about daily treatments of 100ccs SubQ fluids instead of every 2 days. The pancreas requires adequate perfusion to bring down inflamation. And if she's already getting them every 2 days and still has a specfPL of +13, more fluids would be beneficial.

How often did the vet prescribe bupe? Some vets will say to give only twice a day (every 12 hours) but I've found that TID dosing or even QID dosing when pain is most severe can be necessary. If Miss Kitty's pain is not so severe that she's not eating, it's probably a non-issue. Just wanted to throw that out there in case it becomes necessary.

I believe some folks have already mentioned diet and the possible role of fat content / or lack of it in feline pancreatitis. That is very much an ECID thing. Harley and Princess are sensitive to the fat content of their diets. So the FF classics I'd been feeding for some time were actually too high in fat. Now I'm feeding them the Fancy Feast Elegant Medleys which are lower in fat but higher in carbs. and ProPlan foods that are low fat, mid carb. There is also the theory that raw food because it's low fat and low carb. can be beneficial for pancretitis and IBD. You'll have to weigh the pros and cons of the various options, experiment and see what works best for Kitty. This is uncharted territory for each kitty and mamabean and there really are no wrong answers - just what works for you and Miss Kitty.

I'm glad to hear that she's still eating despite being in pain. That is huge right there. It's when they don't eat that life gets really complicated. I know you aren't there yet, but I'm going to throw this out there on the premise that if you have all the information, you won't need to use it! C'mon Miss Kitty cooperate with Mama Bean please.

If in the future she doesn't eat for you, under no circumstances let your vet give you an appetite stimulant without addressing nausea first. Forcing a cat to eat who doesn't want to eat will create food aversions. And cats have really long memories for these...

Stomach acid reducers:
I see someone else mentioned Pepcid already, as does JoJo. These may be all Miss Kitty needs.

Pepcid AC (famotidine) - This is really useful if kitty is vomiting white foam due to too much stomach acid. It's not an anti-nausea drug though so it won't handle the really strong nausea. But if it's the only thing you have in the house it can be very helpful. A typical dose is 1/4 of a 10 mg tablet 2x daily. If you need stronger doses, it does come in injectible form as well.

Zantac (ranitidine) - Not all cats tolerate Pepcid very well. If they don't, try Zantac 75 tablets instead. Zantac also stimulates gastric motility. A typical starting dose is 1/8 - 1/4 of a 75 mg tablet 2x daily.

Options for nausea medications:
These first 2 are both human anti-nausea drugs used for chemotherapy patients. Quite frankly they are off label use for cats but they are used quite often for cats with IBD and/or pancreatitis.

Zofram (ondansetron) - comes in both injectible form or pills. If you decide to go with pills, get the 4 mg pills, not the 8 mg pills. The usual starting dose is 1/4 of a 4 mg pill (1mg) 2x per day. If you need to start somewhere, start with this drug and be sure to ask for a prescription for the generic. It's A LOT cheaper than the brand name Zofram.

Anzemet (dolasetron) - this comes as an injectible. It's mostly dosed once per day (but can be dosed twice per day if necessary) and dose is based on weight. There is no generic available so it's pretty pricey stuff but is stronger than ondansetron.

Cerenia (maropitant) - This is the drug the ER gave Kitty the night she was vomiting. It lasts anywhere from 24-36 hours. It is approved to treat nausea and vomiting in dogs but is off label use in cats. It really works well though plus I've been reading that it has some antinflamtory effects which is really helpful for GI disease. It comes in injectible and pill form. 4mg per day in the pills is a reasonable starting dose.

Options for appetite stimulants:
Cyproheptadine - comes in pills. Vets for some reason almost always overshoot the dose on these when prescribing. 1/8 to 1/ 4 of a 10 mg pill 2x daily is all that is typically needed to get a kitty eating again. This is VERY bitter so it's best to give as a pill in a gelcap (not a pill pocket) so that kitty doesn't taste it going down.

Mirtazapine - This is actually a human tricyclic anti-depressant drug (Remeron) which is used to stimulate appetite in cats. It's usually given only once every 3 days because it acts on a cats seratonin levels.

Regarding an insulin change, for what it's worth, I think Kitty could benefit from either of the L's when you are ready to make the switch. My personal preference is for Levemir over Lantus, but if your vet will only prescribe Lantus, its a really good insulin. When you get a chance, take a look at Harley's Lev spreadsheet and you'll see how starting with a low dose, holding each dose until it settled in, and gradually raising it, resulted in improved duration and a gradual lowering of the PS's. Up until 2 weeks ago, we were getting really close to regulated, not tightly regulated but regulated. Then his IBD kicked up and %&# went wild. But his most recent spec fPL test from two weeks ago Monday was down to 4 - from a high of 40 on April 1. You might also achevie the same level of control with Lantus. I can't give all the credit to Levemir, but I believe that the longer duration in conjunction with treatment and a lower fat diet (ECID) has sure helped a lot.

Man this is WAY longer than I intended! ohmygod_smile Stepping down off my soapbox and going to get myself some wine to wet my whistle. I'm German so it'll be something white tonight.

(((((((Hugs for you)))))) and head butts for Miss Kitty from bro Harley.
 
Hey!

Whew, at least I got one thing right---I sure knew where to turn for answers! Thanks, Thanks,Thanks!

I will print this and take to my illustrious vet tomorrow!

I started feeding 9 lives flaked Tuna tonight--29 percent fat and 0 carbs--but, I don't like the high phosphorus content. I thought I would try it for a feeding or two until I could get more information.

I know I will be back in touch, but Thanks so much for this advice. The only thing I know I can do to repay you for your kindness, is not to let you drink alone. So, I will pour a glass of wine and join my German friend!!!

Scritches to Harley--I hope he is feeling better! And, Princess too!

((((((Laura))))))

Kim
 
Salute Kim & Joanna! drinking24

Awww, you are so sweet. Wow, I'm actually print-worthy. Just please don't show the ramblings of "some crazy cat lady off the internet" to the vet.

I found some links I was going to include above in case you hadn't found them yourself already. These are all vet print-worthy:

Pancreatitis in the Cat
I found this to be the single most useful page in understanding in laymans terms exactly what was going on in feline pancreatitis.

Pancreatitis: Cats Are Not Small Dogs
You may have found this one already at the Yahoo FPS group, but if not, it's the quickest most concise article on P-titis and it's written in vet-speak. The chart on page 2 is awesome and will give you and your vet a snapshot of symptoms, conditions, and possible causes if you should choose to explore them. Sometimes there is no cause, it's just idiopathic.

Treating Feline Pancreatitis: Reccomendations for managing this disease and concurrent conditions
If you are running out of paper or ink and can only print 1 article for your vet - this is it. :) Also includes a case example.

Diagnosing and Managing Feline Pancreatitis A Roundtable Discussion Sponsoered by IDEXX Laboratories
This article is interesting because it shows a roundtable discussion of different vets opinions on treatment of feline pancreatitis. They don't all agree with one another. I like it for the handy flowchart on page 10 if you want to show that to your vet.

Update on Feline Gastrointestinal Syndromes: Pancreatits and Triaditis
A great all around article that has a handy chart of medications and dosing ranges.

Thanks Joanna for the well wishes. Harley is slowly getting a little better from his bad IBD flare. Princess is recovering from a dental and a local mastectomy (1 breast) and biopsy surgery. The pathology shows she has cancer. I know you can relate.

So I'm drinking with my PZI friends tonight... drinking09
 
Oh gosh, IBD flare-up and mammary cancer sounds just a little too familiar. :evil: Hopefully with the surgery Princess will do well for quite some time - my kitty with that did ok for about a year even without the surgery (hers was pretty advanced when I caught it and would have been multiple surgeries and I opted not to go that route), so with the surgery I would think she will be ok for a while. They say it is aggressive, but it wasn't nearly as much as I expected I guess. Anyhow.... big hugs :YMHUG:
 
Oh, Laura, I am so sorry you and your kitties are going through such a tough time. You have been such a wonderful advocate and caring mom for them. Hang in there, all of you.
 
kse said:
Just got off the phone with the vet--- Kitty has full blown pancreatitis. The lab reference is anything above 5.4 is positive--- Kitty is 13.4.

Everything else checked out ok.

She will start bupe tomorrow and we have a consultation with the vet hospital for a treatment regiment.

This probably gives some validation to why the fluids were helping the bg-- as sub qs are in the protocol for pancreatitis treatment.
The vet kind of wants to go the Lantus route, but I told her one step at a time. First we will work on the pancreatitis, unless the vet hospital says differently. The prozinc was okay until recently-- so, I see no need in changing until we help the pancreatitis. I was Hoping everything would check out okay. But, I knew something was wrong-- that us why I took her. My gut feeling is -- it could have been a lot worse. Now we have something to work on. When the day comes that I can pay it forward-- I will have one more area I can help with! Going to find Laura and Harley....

Sorry to hear this. Pancreatitis is a pain to deal with (and literally so for your poor cat) but it can be managed. Good you've been giving fluids!! The pancreatitis could be playing with the numbers. As I've said in other posts, Shaikha's BG goes nuts when she has flareups. Normal treatment for pancreatitis is fluids and pain control, in addition to anti-nausea drugs if your cat is having any problems with eating. How is Kitty behaving? With numbers that high I'd be shocked if your cat was not having a lot of pain. Buprenex is a great pain reliever. Shaikha's appetite always falls off when she has an attack, but buprenex makes a huge difference in that. Ondansetron is what I usually give for anti-nausea, though I sometimes have to ratchet up to anzemet injections if she's bad off. Unfortunately in her case we've had to treat the pancreatitis with steroids, which is why she has diabetes.

Sorry I haven't been around here. Been a crazy week! Let me know if you have questions about treatment though. Poor Kitty!

EDIT: Just read through all posts and saw Laura's very comprehensive ones. She's covered all the bases. The only thing I'd add is being wary of appetite stimulants. Many cats with pancreatitis have a lot of nausea, and too many vets prescribe the appetite stimulants too freely rather than treating the nausea, which can lead to food aversions. You don't want to go there! Go for getting pain and nausea under control first as well as ensuring good hydration. If you exhaust those possibilities, then you can try an appetite stimulant, but even at Shaikha's worst I've never had to use one. Definitely pursue checking for IBD and continue monitoring for liver and bile duct issues. If cobalamin is low, you likely are looking at IBD as well but an ultrasound would tell you the most if you can do one. Shaikha is one of those cats that needs a lower fat food. If IBD does turn out to be suspected, do be careful what you feed. Many cats with IBD have issues with common allergens like beef or fish. Shaikha cannot have fish in any form or it causes huge problems. She tends to do best with a low fat, low residue food or novel proteins. The foods are not the best for diabetes (not lowest carb) but in her case taking care of the other conditions have had to take precedence over diabetes.
 
Hey Wendy--glad you are back!

What do you feed?

I need to make some changes. Kitty is eating Great and since dx with Ptitis, I have been feeding 9 lives flaked Tuna--but, I don't like the high phosphorus level.

Thanks for the help!
 
Shaikha has IBD in addition to pancreatitis, so the foods I've focused on have been either novel protein or highly digestible and low fat. When she was first diagnosed, I fed Hills z/d, d/d, or i/d. After she developed food aversions to those, I started feeding Royal Canin. She's tried a variety of their novel protein offerings, but has been doing well on their Intestinal HE formula. It isn't low in carbs by any means, but she seems to be doing well on it and her phosphorus level is just fine so we've go no worries there. Obviously controlling dietary phosphorus is best if you can, but you can always compensate for higher content in food with using binders if you have to feed higher phosphorus foods due to other restrictions. Even my cat with severe renal failure had some periods where I had to take him off renal foods and put him on foods that would be lower in fat when he was having digestive upsets (usually z/d or d/d). I can't change her foods that much due to her IBD, so I tend to find what works and only feed that. Most fish is very high in phosphorus, so if your cat has high phosphorus levels you may wish to find an alternative. For Shaikha at least, fish just does not agree and in fact has triggered pancreatitis attacks. I can't even feed her fish oil as a supplement.
 
So sorry to hear about Kitty.
I know you will do everything you can for her.
Keeping you both in my thoughts.
((((((hugs)))))
 
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