I already have tears in my eyes just writing the title. I don't want to spend too much time detailing every test and result because after PM test/feed/shoot tonight, there's only so much time until tomorrow's vet appointment with a second under the skin hydration and some more labs. The ridiculous high BGs off & on and now for three months, today's 2.9 ketone result, heart murmur, low iron and high BUN & Creatin... he might have IMHA (immune-mediated hemolytic anemia). He didn't have an iron issue on December 19, 2023 labs. Unless a miracle happens, a decision is the only thing I can do for him. My heart is breaking.
(((Joni))) I’m sorry you are going through a difficult time. There are hopefully some things the vet can do to help with some of the issues that Leo is having, sending you lots of , and positive vines for Leo, you are my in thoughts and prayers.
I just read your notes in the SS. I disagree with the vet giving 0.5 at PMPS and then another 0.1U at +1 It is not a good idea to reduce insulin with ketones in the picture. If the potassium is low, why isn’t he giving a supplement? Does Leo need IV or Sub Q fluids? Hiw is his eating?
I like the notes in your spreadsheet this morning. Eating well and ketones down. Best Of Luck at the vet appointment today
I agree the .5U at PM and then another .5U at +1 was weird, plus it was only 1U altogether, and way off the .25 difference we follow. The AMPS wasn't too horrible today and better than it has been in seven days. Iron is low, not potassium. Leo had SQ fluids while there. Before we kept for the appointment, Leo ate 2oz baby food. Afterwards at home and with PM shot, he ate great. I forgot to mention they helped remove some bad mats under his side belly. Leo wasn't very cooperative with me trying to tackle it and I was 'skeared' to use the clippers the way they did. Guess they have practice! Eating especially well today, and no baby food!
Thank you very much. I resigned myself to accepting losing him, though that day will come to all of our sweet kitties. ♡ I did search here and found some interesting posts about the insulin effects on a problem heart. I don't remember now exactly so I need to backtrack. It was good information that seemed relevant considering the heart murmur detection. The vet mentioned this at the first visit back in December 2021, when he was diagnosed. She didn't say anything at the annual 2023, or 2023. Maybe it was still just mild, but something changed between December 2023 labs and now. The vet today was another in the office since ours was off today. They only did SQ fluids today and no tests, after all, since he seemed to be doing much better than yesterday. Another appointment on Monday with the regular vet, and she might want to do tests. We'll see. Thankfully ketones were down to 0.3 with their meter. I checked at AMPS and they were 0.5. I wonder if the difference was because of the meter or the fact this morning was before insulin and food? Anyway, he was purring first thing this morning. I know this might be temporary. And his PMPS was terrible. I'm hoping it's a bounce. Thanks, again. XOXO
Thank you. The vet office personnel that knew Leo's yesterday seemed quite surprised he looked much different 12+ hours later. I'm not so naive to think there won't be future scares & great sadness. Especially now. I just find it so weird the drastic difference between 12/2023 labs and three months later. WTW?! I guess this is diabetes.
Maybe you are thinking of sub q fluids with cats that have heart issues? I’m glad Leo is feeling better, that’s a relief to see! You mentioned anemia, has the vet suggested or implemented any treatment yet? Depending on how low the haematocrit was, there are different options. Anemia can make them feel very poorly and needs to be addressed. Not a criticism, but you have been dose hopping a little, so that’s going to affect the depot. Hope you can settle into 1.5u here, and see if that helps. Sending more positive vines for sweet Leo
A reading of ketones 0.3 or 0.5 on the blood ketone meter is not of any concern. I’m very happy to hear he is eating well again. I agree to settle on a dose and not chop and change
Not yet.Tests were Friday and we see her again, specifically, on Monday. I put his labs in the spreadsheet, but the lab results, etc doesn't flow as easily as prior labs, plus I notice the lab values are slightly different. Nevertheless, RBC=6.07 (6.55-12.20) HCT=22.8% (30.3-52.3) HGB=8.1 (9.8-16.2), which are all LOW from the range. 12/19/23 results for comparison: 7.1 10.8 31 Today's BGs look bad again. This keeps happening. Then again, you all are right.... a lot of dose hopping.
Thank you. I agree with you. At 2U, he would go under 50 too many times, and 1.75 wasn't quite enough.
Impressed Leo came over to where we're sitting and started grooming himself... at 600! Too bad I cannot attach pics from my Android.
Hi. I was really upset when I started reading this thread very early this morning. I'm looking at his labs. Is he on an antibiotic for the high white count? Please forgive me if you mentioned that somewhere and I missed it. His blood results indicate an infection so he needs an antibiotic (not Convenia.) Are you giving B-Complex vitamins and Methylcobalamin for the anemia? That can help a lot of times. Did the vet say he has/may have immune mediated hemolytic anemia? Did he have a convenia shot? Does he have CKD? I don't see that in your signature? What kind of heart problem? Has he had an echo (ultrasound) done on his heart? I have a heart kitty who will not be able to take sub-q fluids -- her heart is BAD according to all the measurements, but she's still alive and happy and pretty normal with the meds she's taking. But anyway, are you saying that the reference ranges for your last two labs are different? The ALT is mildly elevated and is not a cause for concern at this point. The anemia is getting to the point of needing to be addressed but is not critical. My vet usually will not start ESAs to boost hematocrit until it drops below 20 (I may not agree with this, but my cats have all been okay with an HCT of 20 -- she does it to give them more time as some cats will develop an antibody reaction to the ESAs -- although none of my cats have.) I have had some success in keeping the anemia under control with the Jarrow B Right, B-Complex daily and Cyanocobalamin injecitions or oral methylcobalamin. Are you on Tanya's felinecrf site? I check in there only a little as it's very overwhelming and I spend so much time here already. His creatinine isn't that bad... has he lost weight recently? Muscle loss? Was he dehydrated at the time the bloods were drawn? It looks like he was somewhat dehydrated. That could explain some of the elevation in BUN although it looks like he was elevated previously (and I see his SDMA was elevated before). It would be good if a urinalysis had been done so you could see the specific gravity. That would tell how well his kidneys are concentrating urine.
Does the lab work paper say if the sample was hemolyzed? It's usually in the notes at the bottom. Does it say non-regenerative anemia. Any reticulocyte count on the labs? (retics)
@Suzanne & Darcy I'll see if I can take a decent photo of the 3 pages of lab results and attach to the SS after I write this reply. I previously noted about Friday... '...2.9 ketone result, heart murmur, low iron and high BUN & Creatin... he might have IMHA (immune-mediated hemolytic anemia). He didn't have an iron issue on December 19, 2023 labs.' His weight on Friday is the lowest documented. The heart murmur hasn't been classified, but it was only slight December 2021...until she noticed it more 3/22/2024. He perked up after the first SQ fluids, plus yesterday's SQ. Now I'll see if I can get decent pics and attach to the Lab tab of the SS.
Maybe there's a best way to populate an image in or on the cell, but I tried. Not sure if useful or not. I have some B12; one is a lozenge of Hydrox-Adeno B12, and the other is a capsule of B12 (methylcobalamin) & Folate (L-5-MTHF). After I ended up with B6 toxicity, I stopped all supplements with B6, so no B-Complex around here. However, dessicated liver powder provides B12, which I haven't used enough, apparently. He snarfed (gobbled) his food after I found out his anemia on Friday afternoon, and used the liver powder on his food. The thing with cats is they decide one time they love it, gobble their food, and the next minute, meh, and won't eat.
Any antibiotics? His white count is elevated. It’s safer to assume an infection in a diabetic cat with an elevated white count so you don’t risk a DKA.
Have you read this from Tanya’s CKD page on the importance of B Vitamins? http://felinecrf.org/vitamin_b.htm
I have not! Thank you! The other B-vitamin food I've used to encourage eating is nutritional yeast which has B vitamins, but not B12. I need to be more diligent in offering it, too. I'll have to join that FB group you mentioned.
Yeah. As you can see, his white count is definitely elevated on those labs. I will be interested to see what they say. It’s true that WBC can be elevated by inflammation too, but you cannot just ignore it and just assume it’s not some sort of infection.
