Kitty vet report--updated --second vet visit

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kse

kse

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According to the vet I saw yesterday---DIABETES it is!

I do not have a report of the bloodwork--I am picking it up at 4:00 to take to the other vet.

But, here is what I remember. The T4 test was 1.something (low end of normal she said). I know from Kelly, that I probably need to request the free T 4 test and the additional test to rule this out completely. I am going to see what the actual reading is and the second's vet's opinion. Then I will post that here for guidance.

BG was 406--when I tested her 2 hours later at home it was 367. Well within the range.

The vet said her kidneys are getting taxed by the diabetes. Her creatine was 2.2 and BUN was 72. In Feb. these numbers were creatine 1.9 and BUN 49. I realize that is not a HUGE difference, and the BUN can be effected by dehydration. The vet said she was not in Kidney failure, but we needed to protect them.

So, the first vets suggestions:

Change from Fancy Feast to Science Diet wet Kitten food. She says the protein is a better quality and it would help the kidneys. (please give me your thoughts!)
Start Sub Qs twice a week to help the kidneys, until the diabetes is under better control.
Add Dasoquin as a supplement for arthritis. (said she would check and be sure there was nothing in this to effect the DM--said I can sprinkle it on the food and that it worked well)
Increase PZI dose or change to Lantus (Said she recommended trying a PZI increase first. She was not alarmed about the amout of units)

She was super nice and offered to help in any way possible. I had a lot of admiration for her, as she recommended discussing all of her suggestions with my other vet and get her thoughts. She also encouraged me to continue with the first vet and supported her findings and treatments. Either I really turned her off, or she is a rare breed!!!

So, I am off shortly to get the lab results and visit the first vet.

I will post the results when I have them in hand---but, PLEASE give me your thoughts on her suggestions. I would love to have some feedback before heading to the second vet.

Kim
 
Re: Kitty vet report

I can't find Science Diet Kitten on Janet's chart. (probably because we don't have many diabetic kittens) but their food in general runs from a low of 9 carbs to a high of 25 or so. http://binkyspage.tripod.com/CanFoodNew.html You can use the chart to find a high protein, low carb food or ask on Health. Protein is protein, IMHO, cats eat mice. But Merrick and Blue Buffalo are considered some of the more quality foods.

i would think the SubQs are a good idea. Looks like dasaquin is popular although some kitties don't like the taste. Here's a thread with more info: viewtopic.php?f=28&t=19288&start=0

So, except for the possibility of the food being too high in carbs, sounds like good ideas to me.
 
Re: Kitty vet report

Okay--found this regarding a salmon Science Diet wet kitten food---can this be translated into actual as fed numbers? 15.4 carbs--? If so, that is a BIG NO Thanks!

What is (NFE)?


Science Diet®
Kitten Healthy Development Savory Salmon Entrée Minced



Average Nutrient And Caloric Contents
Canned 1227 kcal/kg ( 104.295 kcal/per 85g can, 191.412 kcal/per 156g can)


Nutrient
Dry Matter1
%
Protein 49.3
Fat 26.4
Carbohydrate (NFE) 15.4
Crude Fiber 2.1

Calcium 1.04
Phosphorus 0.93
Sodium 0.36
Potassium 0.86
Magnesium 0.100
Taurine 0.46
References
¹The nutrient in the product after moisture is removed. It is used to make direct comparisons of nutrient profiles of products with differing moisture contents.
 
Re: Kitty vet report

This is just an uneducated thought but if they rec’d sub Q fluids, and that means Kitty needs more fluids in general, could you mix more water with her food?
I have done this since Asher had a UTI years ago and haven’t stopped. My Mom’s vet who is now my vet too recommended this to us.
I mix with water, mash with fork, and the wet canned food comes to a consistency of pudding.

Just a thought if it would help with fluid intake if that is what helps the kidneys.

Science Diet must be like the drug companies with the human docs, must take them out to dinner or something. Why do they all love it so when it’s really not that great?
 
Re: Kitty vet report

I am glad they are suggesting you start fluids. That is a marked increase in her BUN values. It could be the diabetes taxing the kidneys or it could be the very beginning of compromised kidneys. No way to tell until we get her numbers under control. The Dasoquin for the arthritis is a good thing as well.

I'd say 'no' to the Science Diet kitten food. The ingredients are really of the same quality as Fancy Feast. If she wants you to feed a higher quality protein, then you really should look at Wellness, Blue Buffalo Wilderness, EVO, Merrick, etc. If the insulin and fluids don't help her kidney values, then you can talk about a phosphorus binder and a supplement called azodyl. But more on that when we have to go that route.

I think upping the dose to a full 4u is in order. And I'd really want them to run a full thyroid panel. Oscar's T4 has always come back as 1.0 or 1.2 - low side of normal, but his free T4 equilibrium test was on the very high side of normal, which tells me I need to keep a watch on it for him.
 
Re: Kitty vet report

I think the new vet you consulted with sounds good. She's willing to listen and work with you...important qualities. On the food, I'm with Donna. Science Diet must do something cause they sure have all the vets on board. If you're looking for a food lower in carbs, like Sue said, Blue Wilderness is a little lower than Fancy Feast and supposed to be a little better quality. Donna found a place online that sells it for cheaper than the pet store, although you might try Kitty on a couple cans from the pet store and see how she does before deciding if you want to switch. They have several varieties so you want the high protein, grain free ones. I haven't tried Merrick but understand they're good too.
 
Re: Kitty vet report

I just got back from the second vet (my primary vet that has been treating Kitty). She was not as optimistic about Kitty's condition. She does have Kitty's previous bloodwork for comparison, so maybe she has more information for guidance.

She was not as concerned about Kitty's kidneys as she was her pancreas. Kitty's Amylase was 1296 (100-1200 range) and her Lipase was 268 (0-205 range). Both of these were high on the scale and up from her last complete work in November. Different labs were used so I can't tell you the point difference, but she was low end of normal on both in November. This vet said this could effect everything, including the digestion of food etc. She seemed most concerned about it.

I told her about the suggestions the first vet made about starting fluids, she said that was a good idea. The first vet said to give them twice a week and up the insulin to 4 units and go from there. The second vet wants to give 100cc once a day for a week and increase the insulin to 4 units and see what happens.

The second vet wanted me to bring Kitty in tomorrow afternoon around 5pm and let her administer 100ccs of fluid, increase the insulin to 4 units at that time, and open a new vial of ProZinc. I told her I was not comfortable with all of those changes at one time and sending her home for me to monitor during the night. So, we agreed that I would take her in the morning to start that regiment. They will check her and see if their is any movement.

I asked if there was an endocrine specialist I could take Kitty to see. She said yes, if I wanted to go to that length. She said they would start by doing an ultrasound to be sure there was no tumor in the pancreas. She didn't indicate she thought that there was one, but that they would rule that out.


So, where we stand now is we will give fluids tomorrow, up the insulin and open a new vial.

She said we could switch to Lantus, but that she hated to do that and then get on a plane and leave for two weeks.

Probably, the most frustrating part of my day was when one of the other vets knocked on the door and told her she had another room and she said okay and left.

So please give me your thoughts about the pancreas?

For the record the specific gravity of the urine was 1.026 and the protein content was 100. The T 4 test was 1.1 (range .8 to 4.0)

I was optimistic this afternoon, but now am very aprehensive.

Give me your honest thoughts.

PMPS 433--so tired of it!
 
With your schedule, I would not advocate an insulin change just yet. I don't feel that Kitty has been given enough time post DKA on prozinc to really give it a good chance.

Pancreas stuff:

I wouldn't do an ultrasound just yet. If there is a tumor, will you do surgery? If no, then in my opinion, I wouldn't put the money into an ultrasound.

Re- the amylase and lipase values. This are indications of an issue with the pancreas - can be anything from a barely functioning one (diabetes), to pancreas inflammation (pancreatitis). Was Kitty fasting for a few hours before the blood work? Sometimes food intake can throw off blood work too. To rule out pancreatitis, you need to do a fPL test (I think that's the right acronymn). I believe anything over like 5 indicates a pancreatitis flare, which is common for some diabetic kitties. This can raise glucose values because of the inflammation, pain, and discomfort that is associated with it. The DKA could have contributed to it, but we can't know for sure. Treatment for pancreatitis includes fluids, and pain meds until the flare subsides.

The urine specific gravity looks good to me, but you shouldn't have any protein in the urine. This also points to taxed kidneys too.

I would raise the dose to 4u, start the fluids, get the full thyroid panel, and get a pancreatitis test done then go from there!
 
Kelly, your comment about the tumor in the pancreas, was my exact comment to the vet--there is no need to know, because I wouldn't do surgery.

Just an FYi-- Kitty ate yesterday about 2 hours before the blood draw.

So, tomorrow I will start the new vial of PZI, up the dose to 4 units, start the fluids, and have the remaining blood work completed. I wonder if the lab can do the pancreas test you mentioned from the serem left from yesterday?

If she begins to respond better to the insulin, do you think her kidneys might stabilize some. Do you think the fluids will be long term?

Thanks for your help!
 
There is no way to know until we cross that bridge. There is a high likelyhood that her kidney values will get better and you can at least taper down the fluids, if not completely get rid of them once the glucose normalizes. My kitty Yoda had high kidney values when I first got him and everything normalized once we got his numbers under control. BUT....he was a text book kitty in every way ;-)
 
If you start Kitty on Dasoquin and her BGs start rising you may want to skip it for a few days on see if they improve.
I tried Henry on Cosaquin for cats a while back only for a few days and his numbers shot up pre shot and throughout the cycle right after starting it. Vet told me to discontinue. I was really hoping I could give it to him to reduce the inflammation from arthritis and disc disease.
I know in human diabetics, glucosamine can raise blood sugar values.
 
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