Please help interpreting test results - GI/Inflammatory Diagnostic

[Georgiana & Perlutz]

Since they are considering that he's at risk or with early signs of CKD (chronic kidney desease) it would really help you monitor him and stay on top of things if they could give you the exact value he got on the SDMA, creatine and phosphorus even though they may still be within the normal range is better to start actions early to help his kidneys

Well here’s the thing, his blood tests from his usual vet done on the 22nd of may shows SDMA, creatine and inorganic phosphorus as being within normal levels

SDMA - 11 ug/dL (reference range 1-14)
Creatinine - 155 umol/L (reference range 80-203)
Inorganic phosphorus - 1.31 mmol/L (reference range 0.90-2.20)

When we went to this referral vet she mentioned “the kidney issues” and I asked what issues? His kidneys are fine! And I was told his vet put in the records that there are issues with the kidneys but the above results show otherwise and when the vet and I went through the results the first time, he said loud and clear that the kidneys are fine but there are some alarm bells regarding the liver.

I will request the test results today, hopefully they won’t say no.

 

[Georgiana & Perlutz]

I am a little surprised that the ultrasound did not show thickening of the bowels. Note that an endoscopy cannot reach all parts of the bowel for sampling. A surgical biopsy is needed if sampling needed in jejunum. You might want to consider getting testing of B12 and folate levels, which can be off if GI issues present.

His vitB12 was supposedly elevated but I can’t see anything about folate levels anywhere.

The vet would like to do the endoscopy and a biopsy but as I’ve said, I’m putting that aside for now and try to find out more about this all.

 

[Georgiana & Perlutz]

No luck in getting the blood test results I called in the morning but I was told only the vet herself can send them and they were going to pass the message to her and have her email them to me but it's EOB and nothing. They were really surprised that I am asking such and "outrageous" thing

I called the usual vet as well to check when the prescription will be ready and found out no one even bothered to read the email the referral vet sent them with the report and prescription request

 

[Diana&Tom]

No luck in getting the blood test results I called in the morning but I was told only the vet herself can send them and they were going to pass the message to her and have her email them to me but it's EOB and nothing. They were really surprised that I am asking such and "outrageous" thing

I called the usual vet as well to check when the prescription will be ready and found out no one even bothered to read the email the referral vet sent them with the report and prescription request

Sorry to hear of these frustrations, Georgiana. I must say, it's disappointing that they don't seem to be acknowledging the extent of your interest in getting the results. Why wouldn't you be interested to follow up the test results for goodness' sake? I think if it was me I'd be gearing up to writing a rather stiffly worded email expressing my disappointment... you've paid a lot of money for all this and if their "customer communications" side is lacking, you have a right to point this out.
Maybe tomorrow...

 

[Georgiana & Perlutz]

Sorry to hear of these frustrations, Georgiana. I must say, it's disappointing that they don't seem to be acknowledging the extent of your interest in getting the results. Why wouldn't you be interested to follow up the test results for goodness' sake? I think if it was me I'd be gearing up to writing a rather stiffly worded email expressing my disappointment... you've paid a lot of money for all this and if their "customer communications" side is lacking, you have a right to point this out.
Maybe tomorrow...

Yes, maybe tomorrow...

I don’t think I’m being unreasonable to hope to have them the same day since it’s just adding an attachment to an email but I’ll give them the benefit of the doubt and wait until tomorrow.

 

[Diana&Tom]

Yes, maybe tomorrow...

I don’t think I’m being unreasonable to hope to have them the same day since it’s just adding an attachment to an email but I’ll give them the benefit of the doubt and wait until tomorrow.

Not unreasonable at all! Fingers crossed they'll get their act together soon.

 

[Georgiana & Perlutz]

The fPLI results are back and it states "it's within normal limits but on the upper end, that would indicate that most likely there is no significant inflammation on the pancreas".

Still no signs of the actual results But I'm not giving up lol

Perlutz has vomited most if not all his breakfast this morning, soon after eating it. But he seemed well and he was hungry, he was trying to eat it while I was cleaning so I gave him half a can as he already got his full dose of insulin and he ate and he was fine an hour later when I left to work

 

[Diana&Tom]

The fPLI results are back and it states "it's within normal limits but on the upper end, that would indicate that most likely there is no significant inflammation on the pancreas".

Still no signs of the actual results But I'm not giving up lol

Perlutz has vomited most if not all his breakfast this morning, soon after eating it. But he seemed well and he was hungry, he was trying to eat it while I was cleaning so I gave him half a can as he already got his full dose of insulin and he ate and he was fine an hour later when I left to work

Well, neg for pancreatitis is good, as it can be tricky to treat.
Ref the vomiting - does he eat too quickly sometimes, when he's hungry? That could be a cause, if only at times.

 

[Georgiana & Perlutz]

Well, neg for pancreatitis is good, as it can be tricky to treat.
Ref the vomiting - does he eat too quickly sometimes, when he's hungry? That could be a cause, if only at times.

Very glad that we don't have pancreatitis to worry for too

He does eat faster sometimes but I don't think he pukes when he does. I was still asleep when he had breakfast this morning but according to the boyfriend, he didn't eat faster than normal but he did eat half of a peony leaf and he seems to believe that whenever he manages to munch on a flower leaf, he vomits

EDIT: Just to be safe, I chucked the peonies in the bin just in case he'd get tempted again during the day as he doesn't have his planted cat grass yet, we're waiting for it to grow.

 

[Diana&Tom]

Very glad that we don't have pancreatitis to worry for too

He does eat faster sometimes but I don't think he pukes when he does. I was still asleep when he had breakfast this morning but according to the boyfriend, he didn't eat faster than normal but he did eat half of a peony leaf and he seems to believe that whenever he manages to munch on a flower leaf, he vomits

EDIT: Just to be safe, I chucked the peonies in the bin just in case he'd get tempted again during the day as he doesn't have his planted cat grass yet, we're waiting for it to grow.

That's interesting about the peony leaf. Cats do sometimes seek out grass or other greenery when they feel the need to expel something in their stomach. Hairball season???

Also see this:.https://animals.mom.me/are-peonies-poisonous-for-cats-12253269.html

Says if you suspect your pet has ingested any part of the peony plant you could see symptoms like Perlutz has...

 

[Georgiana & Perlutz]

That's interesting about the peony leaf. Cats do sometimes seek out grass or other greenery when they feel the need to expel something in their stomach. Hairball season???

Also see this:.https://animals.mom.me/are-peonies-poisonous-for-cats-12253269.html

Says if you suspect your pet has ingested any part of the peony plant you could see symptoms like Perlutz has...

I've read in the morning that it's the bark of a peony that is poisonous for cats and even that in large quantities. He vomited 5-10 min after munching on half leaf, I don't think it would happen so fast if it was related? But I'm just guessing here and hoping that is the case. I know cats reach for grass when they have some tummy troubles so I am hoping the vomit wasn't due to the peony leaf. I am going home shortly to check on him and I'll be at the vets in the afternoon to pick up his prescription and I will ask.

I've also just got a call back from reception at the referral vet and getting those blood test results it's proving to be quite some work, apparently the vet ignored that request and only mentioned the fPLI, just like in the voicemail she left me. It was an awkward call, I got the feeling the poor lady was just hoping I'll drop it and say it's fine, I don't want them anymore. I've never had this before, everytime I requested some results, reception offered to either print or email them to me, no further questions....

 

[Diana&Tom]

I've read in the morning that it's the bark of a peony that is poisonous for cats and even that in large quantities. He vomited 5-10 min after munching on half leaf, I don't think it would happen so fast if it was related? But I'm just guessing here and hoping that is the case. I know cats reach for grass when they have some tummy troubles so I am hoping the vomit wasn't due to the peony leaf. I am going home shortly to check on him and I'll be at the vets in the afternoon to pick up his prescription and I will ask.

I've also just got a call back from reception at the referral vet and getting those blood test results it's proving to be quite some work, apparently the vet ignored that request and only mentioned the fPLI, just like in the voicemail she left me. It was an awkward call, I got the feeling the poor lady was just hoping I'll drop it and say it's fine, I don't want them anymore. I've never had this before, everytime I requested some results, reception offered to either print or email them to me, no further questions....

Yes I think it's probably mostly peony bark that's poisonous, but the link above says if your pet has ingested any part of a peony plant to be aware of potential symptoms, so it's probably just as well you've binned the flowers now (shame though!)

It is rather strange that the referral vets are stalling on the blood test results. Maybe they aren't used to people wanting to be kept informed or are concerned that you'll have more questions and they don't want to engage with you on that level. They obviously see that you're pretty clued-up, more than the average pet-owner. Sigh... if they ask why you want them you could say that it's no different to any other member of the family having tests done, you want to know the outcome and surely there's nothing wrong with that...

 

[Georgiana & Perlutz]

Yes I think it's probably mostly peony bark that's poisonous, but the link above says if your pet has ingested any part of a peony plant to be aware of potential symptoms, so it's probably just as well you've binned the flowers now (shame though!)

It is rather strange that the referral vets are stalling on the blood test results. Maybe they aren't used to people wanting to be kept informed or are concerned that you'll have more questions and they don't want to engage with you on that level. They obviously see that you're pretty clued-up, more than the average pet-owner. Sigh... if they ask why you want them you could say that it's no different to any other member of the family having tests done, you want to know the outcome and surely there's nothing wrong with that...

I'm getting really frustrated with the blood test results, it should be such a straight forward thing! But as I told the lady I've spoken to, I'm really keen to have them and won't give up that easily

Perlutz was absolutely fine when I saw him earlier, hasn't vomited anymore and was lively and had his lunch (and a piece of mine ).

 

[CandyH & Catcat]

vet may need to be reassured that you are NOT leaving them to choose another vet, or that you will not be challenging them in court nor disputing their findings

tell them there is no elephant in the room, that the test results are for your peace of mind and need to understand what's going on with Perlutz

 

[Georgiana & Perlutz]

vet may need to be reassured that you are NOT leaving them to choose another vet, or that you will not be challenging them in court nor disputing their findings

tell them there is no elephant in the room, that the test results are for your peace of mind and need to understand what's going on with Perlutz

Well if they're not giving me the results, I will most likely not return to them. I will have to assume they either have something to hide (although I know that is really unlikely) or they simply could not care less and they're not willing to work with me in which case I'll rather give THOUSANDS of pounds somewhere else.

 

[Diana&Tom]

Well if they're not giving me the results, I will most likely not return to them. I will have to assume they either have something to hide (although I know that is really unlikely) or they simply could not care less and they're not willing to work with me in which case I'll rather give THOUSANDS of pounds somewhere else.

But surely as you've paid to have the tests done, you're 100% entitled to know the results of them, otherwise what's the point?

 

[Veronica & Babu-chiri]

Very glad that we don't have pancreatitis to worry for too

He does eat faster sometimes but I don't think he pukes when he does. I was still asleep when he had breakfast this morning but according to the boyfriend, he didn't eat faster than normal but he did eat half of a peony leaf and he seems to believe that whenever he manages to munch on a flower leaf, he vomits

Is good to know that he's negative for pancreatitis and he may need to be talked out of becoming vegan, it usually upsets their tummy, so good idea on getting them out of his reach, but the fact that he's trying to eat green and vomiting could mean something is upsetting his stomach, could be fur balls or a bit of stomach acid SEB (slippery elm bark) usually helps with that kind of mild things

 

[CandyH & Catcat]

Well if they're not giving me the results, I will most likely not return to them. I will have to assume they either have something to hide (although I know that is really unlikely) or they simply could not care less and they're not willing to work with me in which case I'll rather give THOUSANDS of pounds somewhere else.

so tell them exactly that -- 2x4 will wake up mule, maybe they need a wake up call too -- am thinking they may have been told by insurer, to keep results close; most localities have statutes and rules that say they MUST release medical info to the client if asked

 

[Georgiana & Perlutz]

SEB (slippery elm bark) usually helps with that kind of mild things

@Diana&Tom has also recommended the slippery elm bark but I haven't gotten anything yet. I'm picking up his prescription tonight and I don't know if it's a good idea to give additional supplements with it?

 

[Georgiana & Perlutz]

so tell them exactly that -- 2x4 will wake up mule, maybe they need a wake up call too -- am thinking they may have been told by insurer, to keep results close; most localities have statutes and rules that say they MUST release medical info to the client if asked

I can't imagine why would anyone recommend not disclosing the results, it simply does not make sense to me. The vet has sent me the full report, same report our usual vet got. Certainly if I can have a report that says your cat has xxx I can have the blood test results that confirm and support the xxx diagnosis? It's ridiculous...

 

[Diana&Tom]

@Diana&Tom has also recommended the slippery elm bark but I haven't gotten anything yet. I'm picking up his prescription tonight and I don't know if it's a good idea to give additional supplements with it?

Very good point! In human medicine we are usually advised to ask our doctor or pharmacist about interactions between medicines, and I don't see why feline medicine should be any different. I guess it depends what sort of person you are - maybe try the non-chemical route first, and if that doesn't work, try the prescription...

 

[Georgiana & Perlutz]

Very good point! In human medicine we are usually advised to ask our doctor or pharmacist about interactions between medicines, and I don't see why feline medicine should be any different. I guess it depends what sort of person you are - maybe try the non-chemical route first, and if that doesn't work, try the prescription...

Well the only pills I take myself are antihistamines (I'm allergic to cats and flowers among others ) other than that, unless I need antibiotics for something, I don't take much. I do believe in medication but only when it's actually needed But I don't know much if anything about medicine for pets. I will pick up the prescription today but not going to give him the metronidazole and omeprazole until Monday evening probably. I want to keep an eye and if anything, it will be easier to get in touch with a vet Monday than during the weekend. I might give the panacur straight away as it's a dewormer, I think it should be fine? And I'll read on the other 2 during the weekend.

 

[Marje and Gracie]

What is interesting is that it states in the conclusions that the dilation in kidneys is due to increased GFR. GFR is glomerular filtration rate. CKD is associated with decreased, not increased GFR. It does not appear to me that they are saying he has CKD but the labs will help.

What also concerns me is his thyroid. They state his tT4 is within normal limits but what is the exact value? He’s 12, he has a thyroid slip, he’s vomiting and has diarrhea. Has he lost weight? Is he hungry a lot of the time? If the tT4 is above 2.5, then he is in the “gray” area for cats over 10. If a cat is in the gray area (even tho the number is in the normal range), kitty is over 10, and has symptoms of hyperthyroidism, they need to do more conclusive testing like a fT4 with ED at the least to be sure.

It would really be helpful when you get the labs so please tag me once you have them loaded on the lab tab. I’m not a huge fan of anti acids like omeprazole just as something they throw at him. Is he showing signs of an acid tummy like vomiting clear or foamy liquid early in the morning or after he’s not had any food for a while? If not, I question whether he needs it and whether he might do better with something like slippery elm bark syrup. The issue with anti acids is they get rid of all acid which means the cat can’t digest the food he’s given. I’m not even that fond of them for humans A better approach if he has an acid tummy is to try and give him the slippery elm syrup or just be sure he doesn’t have long periods without food especially overnight.

 

[Veronica & Babu-chiri]

@Diana&Tom has also recommended the slippery elm bark but I haven't gotten anything yet. I'm picking up his prescription tonight and I don't know if it's a good idea to give additional supplements with it?

One of the great advantages of SEB is that as long as you give at least two hours apart from meds or vitamins because it could inhibit a bit their absorption, it won't interact or interfere with any of them, what it does is it soothes the stomach lining and intestinal walls and reduces irritation which can help with stomach acid and nausea, I've found it helps also with a mild colitis and hairballs I give it to them in a syrup but some people just sprinkle it on food ( I guess it depends on how delicate the cat is for his food) as far as I know it does not require prescription. The thing I'm aware you would need to be careful about it is if your cat has high levels of calcium because it contains calcium.

Here's a link from Tanya's web page with a lot of information about SEB

http://www.felinecrf.org/holistic_treatments.htm#seb_what_is_it

 

[Georgiana & Perlutz]

What is interesting is that it states in the conclusions that the dilation in kidneys is due to increased GFR. GFR is glomerular filtration rate. CKD is associated with decreased, not increased GFR. It does not appear to me that they are saying he has CKD but the labs will help.

What also concerns me is his thyroid. They state his tT4 is within normal limits but what is the exact value? He’s 12, he has a thyroid slip, he’s vomiting and has diarrhea. Has he lost weight? Is he hungry a lot of the time? If the tT4 is above 2.5, then he is in the “gray” area for cats over 10. If a cat is in the gray area (even tho the number is in the normal range), kitty is over 10, and has symptoms of hyperthyroidism, they need to do more conclusive testing like a fT4 with ED at the least to be sure.

It would really be helpful when you get the labs so please tag me once you have them loaded on the lab tab. I’m not a huge fan of anti acids like omeprazole just as something they throw at him. Is he showing signs of an acid tummy like vomiting clear or foamy liquid early in the morning or after he’s not had any food for a while? If not, I question whether he needs it and whether he might do better with something like slippery elm bark syrup. The issue with anti acids is they get rid of all acid which means the cat can’t digest the food he’s given. I’m not even that fond of them for humans A better approach if he has an acid tummy is to try and give him the slippery elm syrup or just be sure he doesn’t have long periods without food especially overnight.

The vet won’t say he definitely has CKD, keeps saying how they can’t be certain until further testing but they suspect early CKD.

The T4 (thyroxyne) was within normal range according to his blood tests done on May 22 by his usual vet (the results are in his SS under the LABS tab maybe you could have a look please)- it was 24.4 nmol/L and the reference range is 10-60. It also states “Total T4 result consistent with normal thyroid function. Values in the upper portion of the reference interval may occur in some cats with hyperthyroidism. If clinical signs are suggestive of hyperthyroidism, free T4 by equilibrium dialysis is often elevated in these cases. Please call if this test is required.".

He has vomited the clear, sometimes foamy liquid, sometimes with some hair, but that happened in early May, I'd say 3-4 times. Since then, he has vomited once 2 days after the dental (24th May) but that was food and possibly some blood he has ingested during the dental and possibly due to the Metacam and then again he vomited this morning but it was food, not the clear liquid. The diarrhea was more or less the same time as the vomiting in May but since then most stools have been normal, well formed lil sausages.

I will order the slippery elm syrup, so many people have mentioned it. How much should I give, when, for how long?

The vet recommended the Omeprazole twice for 2 weeks and then stop gradually. Would you say it's better to skip this entirely?

I will email them tomorrow for the lab results, maybe they will grant my request if it's in writing. I will not leave them alone until I get them and I will tag you when I do. Thank you SO MUCH for your help and sorry to ask so many questions, this is all so new to me and I don't know anything

 

[Georgiana & Perlutz]

One of the great advantages of SEB is that as long as you give at least two hours apart from meds or vitamins because it could inhibit a bit their absorption, it won't interact or interfere with any of them, what it does is it soothes the stomach lining and intestinal walls and reduces irritation which can help with stomach acid and nausea, I've found it helps also with a mild colitis and hairballs I give it to them in a syrup but some people just sprinkle it on food ( I guess it depends on how delicate the cat is for his food) as far as I know it does not require prescription. The thing I'm aware you would need to be careful about it is if your cat has high levels of calcium because it contains calcium.

Here's a link from Tanya's web page with a lot of information about SEB

http://www.felinecrf.org/holistic_treatments.htm#seb_what_is_it

Thank you for the link, I'll have a read now.

Perlutz's blood work from May shows calcium to be 2.58 mmol/l (reference range 2.05-2.95) so he should be fine it looks.

 

[katiesmom]

Katie had to take metronidazole for a week or two. It does taste horrible (I am taking it now myself).
Anyway, I bought some small #3 empty capsules and put the tablet of metronidazole in the empty cap to pill her. No taste.

 

[Veronica & Babu-chiri]

I will order the slippery elm syrup, so many people have mentioned it. How much should I give, when, for how long?

The vet recommended the Omeprazole twice for 2 weeks and then stop gradually. Would you say it's better to skip this entirely?

How much usually requires a bit of test and error you start with a minimum dose and go from there the same as how often, with one of my cyvies I give it mostly at nights like every other night (I've noticed she really doesn't need it every day) to help her with the night stomach acid and twice a day during shedding season (about two weeks), with Babu I give it to him at shedding season to help with fur balls also about two weeks twice a day or when they need some oral antibiotics

I think you could skip the omeprazole and see if he can be ok with just the SEB and see how he does if he continues then he may need the omeprazole

 

[Marje and Gracie]

How much usually requires a bit of test and error you start with a minimum dose and go from there the same as how often, with one of my cyvies I give it mostly at nights like every other night (I've noticed she really doesn't need it every day) to help her with the night stomach acid and twice a day during shedding season (about two weeks), with Babu I give it to him at shedding season to help with fur balls also about two weeks twice a day or when they need some oral antibiotics

I think you could skip the omeprazole and see if he can be ok with just the SEB and see how he does if he continues then he may need the omeprazole

Agreed.

If his tT4 was 24.4, then he’s not in the gray area bit it’s odd your vet feels a slip. That’s usually associated with hyperT. Sometimes, you can see a cat with a slip and symptoms but the tT4 is normal. I had this happen in a kitty. She eventually had an increased tT4 and elevated fT4 but we couldn’t treat until she did.

His liver enzymes are very mildly elevated in May. Wonder what they look like now.

 

[Georgiana & Perlutz]

I have the results!!!

@Marje and Gracie

 

[Marje and Gracie]

I have the results!!!

@Marje and Gracie

According to his SDMA and creatinine, it looks like early CKD. The odd thing is he is normally concentrating his urine with a urine specific gravity of 1.050. Quite often with CKD, we see the USG drop a lot before we see the creatinine rise. The other parameters we worry about with CKD like calcium, sodium, phosphorus, potassium, and PCV are still normal.

Sounds like there might be an issue with his pancreas and liver but they don’t diagnose triaditis which is an inflammation involving the liver, pancreas, and intestines. Looks like they are recommending an echo of his heart.

Now is the time to start reading as much as you can from Tanya’s comprehensive guide to CKD.

Critical to lone it’s is controlling phosphorus levels and keeping anemia at bay so I’d suggest reading that information as soon as possible.

Let me know if you have questions.

 

[Diana&Tom]

Hi Georgiana
Just had a chance to look at the documents you attached (not that they mean very much to me unfortunately) and I'm wondering why the vet's conclusions don't really address the high bg and difficulty in getting the diabetes under better control? Am I missing something? It's great to have such a comprehensive overview of Perlutz's general health but is some advice going to be available about how you manage the diabetes going forward? Or are they not able to say much until the issue with the pancreas becomes clearer?

Sorry if these are daft questions but as I've been following Perlutz it would be nice to think for his sake and yours that some kind of progress has been made with all these tests...?

 

[Georgiana & Perlutz]

I wish I knew what to answer, Diana I'm frustrated and angry with both vets as it seems one doesn't care and one only cares about ££ I only managed to get his results on Friday after sending a stern email and finally, hours later, the vet called me and I have the impression that it was agreed to send the results only after I confirmed that we will still take Perlutz for the endoscopy. His usual vet has received a report from the referral vet on Wednesday with a mention of providing me with the medication requested. On Thursday afternoon I called to ask when this can be collected only to find out no one bothered to read the email Zero interest...

The only thing re diabetes regulation mentioned by the referral vet was keeping the dose to 2.50 and under no circumstances change it without discussing it with her before. I did just that and in a week we went from some yellows to reds and blacks! I'm petrified to call their reception and ask for her after all the "drama" with obtaining the test results and I think I'll just adjust the dose myself.

Perlutz hasn't been himself this weekend and his appetite was weird, seemed hungry but wouldn't really eat even after going through various brand and flavours This morning I managed to make him eat some by giving him food with a teaspoon, he would lick the teaspoon but would have nothing from the bowl.

I'm trying to read about CKD but it's so much and I feel lost already and again I feel like I'm failing Perlutz I'm trying to think of few questions to ask here, just trying to compress them a little bit as right now, I have hundreds of questions

 

[Diana&Tom]

Oh I'm so sorry it's turning out like this, Georgiana. It's just not fair after all the hard work and dedication you've put into Perlutz's health and treatment. Please don't think for a second that you're "failing" him - very far from it, you are doing everything in your power. Maybe you need a change of tactic somewhere, a new game plan... if I were you I'd be very tempted to compose an email to both vets saying how very upset you are that nothing very constructive is happening other than suggestions for more tests... and say that your initial hope was that you'd get some clues on how to treat his diabetes, and you've had no advice other than a sentence about consistency of dosing.

I'm not suggesting that you do actually say that to them, just saying that that's what I'd do, as I get cross with these situations when things don't seem to be working out... that's just me being impatient. You can't afford to upset or offend the vets I know. But I would suggest that you try to find a way of tactfully expressing some degree of disappointment... not sure how.

Ref Perlutz not eating much - maybe you need to look into an appetite stimulant to get him to eat when he's a bit off his food. Or try something a bit different and tasty, tuna usually goes down well?

As for the possible/mild/early CKD, maybe all you can do for now is read a little at a time and not try to absorb it all at once, it would be too much for anyone. Do be kind to yourself, and remember you are only human and can only do so much. And yes, ask more questions here, there are always people who have been through similar scenarios. We do care!

 

[Georgiana & Perlutz]

Oh how I would like to tell the vets, both of them, how I feel right now! But I just think it will be useless and I'm really scared that it might affect Perlutz care in the future. We can't afford to get even worse care!

I wanted to book an appointment with his usual vet and discuss what went on at the referral and see what he thinks but he only works a couple of days this week and was fully booked already. I might go and see one of his colleagues, although she is not familiar with Perlutz's case, she might still be able to tell me something. I even considered going to a different vet in town but just found out they are strictly against home testing, only do curves in their practice etc so I'm not sure that will go well...

Re CKD, I read in several places that SDMA can be elevated by dehydration. Now there's obviously the dehydration from diabetes but I also think Perlutz wasn't given water for the 2 days he spent hospitalized? I have no proof of this, it's simply my gut feeling as when I brought him home, despite being scared of me and wanting to hide, the first thing he did when he got out of his carrier was to drink water and only afterwards he hid from me. I know that out of all places FDMB is the one place where people will understand me when I say I know my cat well and I know what every meow means, how there's one meow for wanting food, one before he;s about to vomit etc etc and on the day I brought him back, I immediately thought "f***ers didn't give him water"... There are also suggestions that a CKD diagnosis might only be given after at least 2 tests. I know there's a chance I'm thinking this because I'm in denial in a way, but maybe it's worth retesting and try to get the acro too perhaps? Thoughts?

 

[Diana&Tom]

You're quite right of course, getting angry with the vets won't really help. But they just don't seem to be very good at communicating with you and surely that's not too much to ask. I agree, try to speak to another vet at your regular practice and tell her about your frustrations... might help to be on the verge of tears, get her on your side. You badly need an ally that you can confide in and trust to fight your corner.

Ref the dehydration... mmm, interesting. I'd try to follow this up, maybe mention it if you have a chat with this other vet at your practice, see what she says.

Ref the acro - several of us here have suggested that it wouldn't be a bad thing to get the test done because we know how common it is. If it's ruled out, great. If not, you know where you are, and that Perlutz may well continue to need varying doses of insulin to get him into better numbers.

Bottom line, in my opinion, is that you need a "friend" or ally somewhere amongst these vets who will take more of an interest in you and Perlutz. At the moment, you're not getting the support you need from them and I think you'd feel a whole lot better if they stepped up. You know that all of us here support you and heck, we're just cat-lovers who want to help each other. We'll continue to do what we can but that's limited at this point; it's the professionals' help you really need.

 

[Georgiana & Perlutz]

You're quite right of course, getting angry with the vets won't really help. But they just don't seem to be very good at communicating with you and surely that's not too much to ask. I agree, try to speak to another vet at your regular practice and tell her about your frustrations... might help to be on the verge of tears, get her on your side. You badly need an ally that you can confide in and trust to fight your corner.
.

I can't really go that route, our vet owns the practice so they'll all be on the boss' side...

I'll try to get the locum's vet opinion too, I have him on Facebook

It's funny how I rely more on this group as here I found more information and more help than at 3 vets so far. But I do agree with you, we definitely need some professional help too. And if we don't get it, I might need a different kind of professional help and a straight jacket

 

[Diana&Tom]

Glad to see that your sense of humour is intact!
Glad also that you can get hold of the nice locum guy... maybe message him and ask what he thinks you should do next?

 

[Georgiana & Perlutz]

I'm going to call the vet today and make an appointment with a different vet in the practice (she did his dental so she might have a slight idea of his condition). I'm going to ask for a blood test, I want to test him for acro and I would like to see what the kidney profile is like compared to the results above. I'm trying to make a little list with what I want done to discuss with the vet and see what they can do and what has to be sent away to other labs (acro most likely).

• IGF-1 (acro)
• fT4 and tT4
• B12 (actual value)
• Kidney profile (BUN, creatinine, SDMA, phosphorus, potassium)
• IAA
• TCO2
• PCV/HCT

Is there anything else I should ask for?

I hate to take him to the vet again, I know the poor munchkin will be stressed again, but I think it would be good to retest? And do the acro too.

Please let me know what are your thoughts. Thank you

EDIT: A week after the referral vet sent a report, my vet still hasn't bothered to read it!!!

 

[Diana&Tom]

I'm no good with thse things Georgiana but I support your organised approach... take in a list to discuss and see what they say. If they say no / not necessary to anything you've included, ask why not. And maybe ask the vet to please be sure to read the referral vet's report before your visit... there is really no point if they don't!

 

[Georgiana & Perlutz]

I'm no good with thse things Georgiana but I support your organised approach... take in a list to discuss and see what they say. If they say no / not necessary to anything you've included, ask why not. And maybe ask the vet to please be sure to read the referral vet's report before your visit... there is really no point if they don't!

The vet has just replied and it's not what I wanted to hear... I'll paste it here (I deleted the names of the referral centre and the vets).

Hi Georgiana,
We can certainly help with some of those tests but possibly not all. We send the blood away to an external lab (IDEXX) to get profiles run or for some of the more specific tests like the one for Acromegaly. Parameters like urea, creatinine, phosphorous and SDMA can all be run here but realistically it makes most sense to send all of the samples away from a cost point of view. Looking for Cushings is slightly less specific, we can rule it out by confirming a low urine cortisol:creatinine ratio, to fully diagnose it we have to do multiple blood samples a number of hours apart for either the low dose dexamethasone suppression test of for the ACTH stimulation test with tetracosactide. With IAA I don't think the lab we use will run this and for the B12 their reference range is the same as the Axiom lab that the xxx has used so I'm not sure if we would get an exact number.
What I would ideally like to do is to catch up with the clinician at the (referral centre) to discuss Perlutz and his ongoing care and decide which tests and when things should be repeated for the most information. Some tests will require an internal medic to interpret in light of the whole clinical picture so if we're doing the samples I'd still like to ask the Ralph to decide on a treatment protocol once we have results. I'm sorry we are so busy at the moment, both myself and (other vet) away over this next week so it has been very hectic in the lead up.
If you are wanting tests done within the next few days it might be sensible to ask (referral centre) directly, I'm more than happy to catch up with them later next week when I'm back and to put together an estimate for the requested bloodwork if you wanted us to do it.
I hope Perlutz is doing well,
Speak to you next week

I don't want the referral vet involved at all in these blood tests Quite frankly, I just want to have him retested to see if theirs were accurate...

I’ll call and make an appointment for whenever the vet is back. I don’t even know how I will manage to go, it will be really tricky taking any time off work the next 3 weeks

We changed the insulin vial the other day and Perlutz greeted me with a 6.1 tonight

 

[Diana&Tom]

Oh dear! It's incredibly frustrating isn't it. I don't know what the answer is, it seems you are at the mercy of these vets and the way they want to do things. Did you make contact with the nice locum via FB - just in case he has any bright ideas?

And so Perlutz is at it again and giving you lowish numbers with a new vial...that really is a mystery but one that there should surely be an explanation for...

 

[Georgiana & Perlutz]

Oh dear! It's incredibly frustrating isn't it. I don't know what the answer is, it seems you are at the mercy of these vets and the way they want to do things. Did you make contact with the nice locum via FB - just in case he has any bright ideas?

And so Perlutz is at it again and giving you lowish numbers with a new vial...that really is a mystery but one that there should surely be an explanation for...

Yes, he's at it again!

The locum has actually wrote today to ask about Perlutz, so nice of him to do that! His biggest concern was that they haven't told us anything about controlling his diabetes. I've sent him the report and the test results and he will have a look tonight. I'm looking forward to see what his thoughts are.

 

[Diana&Tom]

Yes, he's at it again!

The locum has actually wrote today to ask about Perlutz, so nice of him to do that! His biggest concern was that they haven't told us anything about controlling his diabetes. I've sent him the report and the test results and he will have a look tonight. I'm looking forward to see what his thoughts are.

Finally! Someone who knows what it is that started you off with all this - helping the diabetes. This guy is a keeper! Let us know what he has to say.

 

[Georgiana & Perlutz]

Finally! Someone who knows what it is that started you off with all this - helping the diabetes. This guy is a keeper! Let us know what he has to say.

When he will get his full time position in a vet practice, his patients will be in good hands! How I wish he was here for longer...

 

[Margie and Jackson]

I have been on and on for months with the acromegaly testing, that was the reason we got the RVC referral in the first place. So yes, as you and Diana also suggested, I will need to have this test done! If it comes back negative, happy days for Perlutz and us and the vets can tell me "I told you so" as much as they wish, I'll at least have an answer.

I'll have to think and ask for some more advice here as I am not sure what to do with the endoscopy at the moment. If we go ahead with it, I will request an acromegaly test as well since he will be under sedation anyway. If we don't do it, or at least not for now, I'll check with our usual vet and see what are our options to have this test (they don't do it). I wouldn't say Perlutz is an aggressive cat, he is just a massive stress ball (runs in the family ) and once he is taken away from me, he might hiss a lot. I just wish they'd let me hold him while they take a sample...

In the meantime, what does everyone think - should I start him on the medication they prescribed him? I've only looked into the first one and doesn't make much sense to me, it's for diarrhea and vomiting but the drug itself may cause these? He hasn't had diarrhea for few weeks and no vomiting for 1 week, I don't want him to have both and possible more as side effects from this!

I’ve been given metronidazole for my cat and it did wonders for his stomach trouble. I gave it to him after eating to avoid additional stomach issues. It is not supposed to clear bacteria in all uses, but can reduce inflammation. It’s used for humans this way too, topically. The vet told me to keep a few days worth in the fridge in case I have problems over the weekend.

One thing, it tastes bad and your cat will spit and froth a bit. The vet said not to worry, it looks like he’s spit it out but it’s fine.

 

[Georgiana & Perlutz]

I’ve been given metronidazole for my cat and it did wonders for his stomach trouble. I gave it to him after eating to avoid additional stomach issues. It is not supposed to clear bacteria in all uses, but can reduce inflammation. It’s used for humans this way too, topically. The vet told me to keep a few days worth in the fridge in case I have problems over the weekend.

One thing, it tastes bad and your cat will spit and froth a bit. The vet said not to worry, it looks like he’s spit it out but it’s fine.

We’ve been given it as well but haven’t started it yet. I ordered some slippery elm bark and I was thinking to start with that.

Is your metronidazole tablets as well? Asking cause we weren’t told it must be kept in the fridge...

 

[Margie and Jackson]

I got a liquid. I thought Jackson was dying, running to the lb every half hour and obviously in pain. He was much better in 12 hours. His diarrhea was gone in 24.

I am interested to hear how the slippery elm bark works. Good luck helping Perlutz feel better.

 

[Georgiana & Perlutz]

I got a liquid. I thought Jackson was dying, running to the lb every half hour and obviously in pain. He was much better in 12 hours. His diarrhea was gone in 24.

I am interested to hear how the slippery elm bark works. Good luck helping Perlutz feel better.

I'm glad to hear it helped Jackson feel better

 

[Diana&Tom]

Yes, he's at it again!

The locum has actually wrote today to ask about Perlutz, so nice of him to do that! His biggest concern was that they haven't told us anything about controlling his diabetes. I've sent him the report and the test results and he will have a look tonight. I'm looking forward to see what his thoughts are.

Have you heard anything back from nice locum vet, Georgiana?