Please help interpreting test results - GI/Inflammatory Diagnostic

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Georgiana & Perlutz

Georgiana & Perlutz

Member Since 2019
As some of you might know already, Perlutz has been referred for further tests after an ultrasound at the end of May indicated a tumour on the pancreas.

He had another ultrasound, xrays and blood tests last week. I'll copy paste part of my post last week and add today's update.

The good news is there is no tumour on the pancreas! But there are other issues... What was initially thought to be a tumour on the pancreas turned out to be a mild enlargement of one of the ileocaecocolic lymph nodes and measures 7 mm. But there are other issues, gastro intestinal and possible very early kidney disease :( The vet will call us on Monday/Tuesday when all the results are back and tell us what the next steps are.

So far all we've been told is to keep the current 2.5 units dose and not to change it without discussing it with her first. She said we are testing too much o_O and it's not necessary, that the dose need to be held for 5-6 days. We have to test for ketones and glucose daily and continue to keep track of water intake, food and any symptoms like vomiting and diarrhoea.

I'll type all the notes in the discharge report and the tests that have been done.

Physical examination - pain on abdominal palpation. A small left thyroid slip and a soft systolic heart murmur which is not always present. The rest was normal.
under sedation, he has had the following procedures:
-CBC to assess for signs of anaemia and infection
-Full Biochemistry: to assess liver and kidneys
-Fructosamine
-TT4 to assess his thyroid levels
-fPLI to assess for pancreatic inflammation
-VITB12 a marker of intestinal disease
-TLI marker of pancreatic insufficiency
-Coagulation profile to assess his capacity to clot
-Urinalysis and culture to assess his kidney function and reveal any infection
-Abdominal US which stated: The GB is bilobed. There is bilateral dilatation (5mm) of the renal pelvises and milkd bilateral hyperechogenicity of the medullae. There is a mild enlargement of one of the ileocaecocolic lymph nodes which is hypoechoic and measures 7mm. There is a small amount of fluid in the colon. Liver, pancreas, spleen, stomach, small intestine, adrenal glands and urinary bladder are within normal limits. Conclusions: bilateral dilatation of the renal pelvises is considered most likely secondary to increased GFR, there is no visible dilatation of the ureters and no visible urinary calculi in this examination. Bilateral nephropathy may be considered if clinically suspected. The colonic contents are compatible with soft faeces/diarrhoea; possible colitis with mild colonic lymphadenopathy.
-Chest xrays pending

The vet just called with the results and after all these tests we still don't know what's going on :banghead: I've been told basically the same as last week, that there might be gastro intestinal issues and possibly early kidney disease and she can't say he has cancer but can't rule it out either. Surely all those tests should've given something? Anything? We've been told about GI and kidney disease from last week before getting the results...

The vet now wants to either have him on Metronidazole for a couple of weeks and then do an endoscopy +biopsy and aspiration of the enlarged lymph node (also mentioned some aspiration of the liver and urine?!) or do all this straight away. I have to decide if we're doing it now or in 2 weeks times based on the financial side of things and whether we put him through more stress so soon or we wait.

Metronidazole will be prescribed for his occasional diarrhea and vomiting but diarrhea and vomiting are common side effects of this drug among others so what the hell? Has anyone given this to their kitties? To me it seems the side effects might be worse than the benefit. He hasn't had any diarrhea for 2-3 weeks now and no vomiting since last Monday.

They won't be checking for Cushings or Acromegaly at this point as they still believe these to be very rare cases only and will only check when everything else failed.

My stress has gone through the roof! I'm starting to wonder if all these new tests will give us any answers or we will be asked to bring him back for further and further tests? They are not exactly cheap either, approximately £1000 for the endoscopy and extra £1500-2000 for histopathology :woot: :woot: :woot:
At the moment I only have half of all this and even that with quite some efforts. I need to call them back tomorrow and tell them what I've decided, do this now or in two weeks' time and I have no idea what to do...
 
Hello. I'm not sure where you are currently receiving care for your cat, but many times, just like with human medicine, getting to a large academic health system with our furry family members can be invaluable ESPECIALLY in cases like yours. They are the experts doing the latest research regarding diagnosing & treating. Their work is what the rest follow once it trickles down to them. In addition, they also see the more complicated cases so they are more likely to diagnose these issues. They are less likely to miss diagnosis & have seen enough of the "very rare" diagnosis/cases to recognized them when they see them. In the U.S., the academic vet centers, because they receive funding, are typically cheaper with regard to tests, hospitalizations etc.. They will help diagnose & determine a reasonable treatment plan & then work with your local vet to implement it. They also work very well with communicating with the local vet if issues come up & return visits are only usually necessary if something becomes complicated again.

I am not familiar with your location but did some Google searching & found this university hospital in London:

https://www.rvc.ac.uk/small-animal-referrals

It looks like it would be 1:30min drive? It sounds like a lot at first, but since sharing this info with friends, many (even those who thought the idea of driving hours to a university hospital with a pet was crazy) have remembered the advice, used it & been shocked at how different, easy & more inexpensive the experience was.
 
Hi @Amy47 ,

I'm familiar with the RVC, I even asked my vet for a referral there a couple of months ago. We decided not to go because they charge £275 for an appointment with a student :facepalm: We would've happily went if we could see one of their specialists.

Our vet referred us to a veterinary referral centre a bit closer to us. It's new but so far it has amassed a great reputation, having fantastic reviews.

I've just received the report that the referral vet sent the usual vet and I will copy paste that here in a moment. Just looking through it and although I don't understand much of it, it mentions enlargement of the heart, enlargement of the liver and I am here starring at it and thinking ACROMEGALY but they don't want to test him for it yet?! :eek:
 
Oh crikey! We had been saying how thorough all the tests were so you would expect something a bit more definitive than this in the way of test results... but then that's just the layman's view, maybe this is isn't so unusual. I don't know!

Can I suggest something... re name this thread to make it more specific to your question, so it will catch the attention of people with experience. Most of us will look at a forum list and home in on any threads we feel we may be able to comment on. At present you aren't actually asking for comments in the title, and I'm sure you'd like to hear what people think so give it a try?

I don't have experience of this situation but I think I'd be quite tempted to take no action at all at present. I'd be very wary about givng medication with known side effects similar to the symptoms (???). Also, if the tests haven't actually shown up anything, maybe that's because there isn't anything to show - or nothing very obvious or advanced, at least? So there "might" be gastro or "possibly" early kidney issues (neither is that unlikely) but no real diagnosis.

I really hope you get some helpful replies, Georgiana, as I can't think of anything to say other than maybe look at introducing some kind of supportive supplement to the diet that might help. Or maybe look closely at his diet and make a note of what he's eaten before a gastric episode, and consider amending the diet. Cats can and do develop allergies so it's possible that the issues could be due to something along those lines. I'm sure there are people here who could weigh in on that front, at least.

I know all this is about unregulated diabetes but it's just possible that if a particular food is causing some kind of inflammation, so that could be one avenue to explore. If I can think of anyone who might be able to suggest something I will let you know. Meanwhile, stressful as I agree this is, take heart - nothing really bad has shown up so despite the frustrations, there's no bad news as such to deal with...
 
Full report from the vet:

18-06-2019
Diagnosis:
- Not well controlled diabetes mellitus
- Possible chronic gastroenteropathy
-An enlarged ileociecocolic lymph node
Treatment:
- Insulin Prozinc 2.5iu SC BID
- Diabetic diet (I must note that he is not actually on a diabetic specific diet? he eats Thrive, Applaws and Purina Gourmet Pate)

Perlutz presented at the medicine department of The xxx on the 12th of June for further investigations of a possible pancreatic mass
and not well regulated diabetes mellitus. The carers have reported signs compatible with chronic gastroenteropathy (occasionally going
off food, vomiting and soft faeces). There were no other concerns.
On physical examination he was very stressed but BAR. The MM were pink and CRT was <2s. Oral inspection showed some mild tartar
but no other abnormalities were seen . The peripheral lymph nodes were not palpable. There was a small thyroid enlargement on the
left side of the thyroid. The HR was 240 and a soft heart murmur I/VI was audible but not present all the times. The femoral pulses
were not possible to be examined. The RR was elevated at >40/min but there were no changes during auscultation and percussion. The
rectal temperature was 38.7. The abdomen was painful and palpation was not rewarding. The rest of the examination was
unremarkable.
The identified problems were the previously identified mass in the pancreas, the chronic gastrointestinal signs, the not well controlled
DM, the mild thyroid enlargement and of less concern the soft systolic heart murmur.
Perlutz was hospitalised and under general anaesthesia the following tests were performed:
- CBC: mild elevation of the platelets, that could be secondary to inflammation or secondary to gastrointestinal ulcers or hornomal
disease (e.g Cushings, hyperthyroidism etc)
- Full biochemisty: mild elevation of urea and creatinine (pre renal azotaemia or primary renal problem), mild elevation in ALP (diabetes
mellitus, pancretitis, GI problem, liver disease, hormonal disease), the rest was within normal limits
- Fructosamines: elevated at 524mmol/l which would indicate
- TT4: within normal limits
- fPLI: pending
- VITB12: elevated
- TLI: within normal limits but towards the low end of normal
- SDMA: mildly elevated which could reflect very early signs of renal insufficiency
- Coagulation profile: within normal limits
- UA+CS: PH5, SG>1050 which would indicate good kidney function , urinary culture was negative
- Thoracic radiographs in three views which report stated:
1. Mild bronchial pulmonary pattern. Pulmonary metastatic disease is not seen at this time.
2. Mild generalized cardiomegaly without radiographic evidence of vascular, pulmonary, or pleural space changes.
3. Geriatric thorax with redundant aorta.
4. Mild sternal lymphadenopathy most likely secondary to hepatic changes.
5. Mild hepatomegaly as with clinical history of vacuolar hepatopathy secondary to endocrinopathy.
6. Degenerative intervertebral disc disease with ventral spondylosis deformans.
7. Pancreatic enlargement, left lobe of the pancreas.
- Abdominal US which report stated
"The GB is bilobed. There is bilateral dilatation (5 mm) of the renal pelvises and mild bilateral hyperechiogenicity of the medullae. There
is mild enlargement of one of the ileocaecocolic lymph nodes which is hypoechoic and measures 7 mm There is a small amount of fluid
in the colon. Liver, pancreas, spleen, stomach, small intestine, adrenal glands and urinary bladder are within normal limits.
Conclusions: Bilateral dilatation of the renal pelvises is considered most likely secondary to increased GFR, there is no visible dilatation
of the ureters and no visible urinary calculi in this examination. Bilateral nephropathy may be considered if clinically suspected. The
colonic contents are compatible with soft faeces/diarrhoea; possible colitis with mild colonic lymphadenopathy"
We have not identified a mass in the pancreas, however an enlarged ymphonode was identified along with signs of possible colitis and
dilation of the both renal pelvis. We also believe Perlutz has a possible chronic gastroenteropathy creating inflammation which could be
responsible for some clinical signs that were reported and be causing or contributing to the diabetes being unstable. The liver appeares
mildly enlarged but that could be the direct effect of the diabetes and the heart also appears to be enlarged on radiographs. A cardiac
ultrasound to assess his heart would be indicated. The sternal lymph node is also mildly enlarged, which could reflect inflammation.
We have discussed all these changes with the carers. There are signs of inflammation in several parts of the body. The most
important seems to be within the gastrointestinal tract, creating inflammation possible to the local lymph nodes,
however without further investigations and biopsies/FNA's more sinister causes, such as cancer, cannot be completely
ruled out. We have discussed the possibility of performing another general anaesthetic and an upper GI endoscopy with
biopsies. While under anaesthesia FNA from the lymph nodes will be attempted. The heart will need to be investigated
further with a cardiac scan to rule out a cardiomyopathy before the general aneasthetic. The carer will consider
carefully all options in the next few days and will let us know how she would like to proceed. In the meanshile I would be
very grateful if you could provide the following medications to the owners:
- Metronidazole 50mg tablet twice dialy for 4 weeks (this is for the immunomodulatory effect on the
gastrointestinal mucosa)
-Omeprazole 5mg table twice daily on an empty stomach for 2 weeks, then stop slowly (this for any
possibility of gastric acid erosions)
-Panacur 1.8gr : 1/2 sachet once daily in his foor for 5 days (this is for deworming )
Perlutz recovered well from his anaesthetic and was discharged home on his normal dose of insulin for now. A diary for monitoring of
the diabetic patient was also provided along with some recommendations of how to manage the diabetic patient.
We will keep you up to date with the further plan.
Thank you for referring this very beautiful boy to us, please do not hesitate to contact us if you would like to discuss further this case.
 
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Georgiana & Perlutz said:
Hi @Amy47 ,

I'm familiar with the RVC, I even asked my vet for a referral there a couple of months ago. We decided not to go because they charge £275 for an appointment with a student :facepalm: We would've happily went if we could see one of their specialists.

Our vet referred us to a veterinary referral centre a bit closer to us. It's new but so far it has amassed a great reputation, having fantastic reviews.

I've just received the report that the referral vet sent the usual vet and I will copy paste that here in a moment. Just looking through it and although I don't understand much of it, it mentions enlargement of the heart, enlargement of the liver and I am here starring at it and thinking ACROMEGALY but they don't want to test him for it yet?! :eek:
Click to expand...

I think sometimes if you have a gut feeling about something, follow it up. Yes, enlargement of organs is a sign of acro, although not always. But maybe at this stage it should be ruled out? I'd say you were within your rights to ask for the test if you feel it could give you the answer. Or, you could post on the high dose forum here and ask how other people discovered that their kitty had acro, and at what point did they get the test done? Sorry, I don't want to keep suggesting that you do things like that, but there is just sooooo much experience on this board and there is usually some kind of help to be had if you keep asking.
 
Diana&Tom said:
Can I suggest something... re name this thread to make it more specific to your question, so it will catch the attention of people with experience. Most of us will look at a forum list and home in on any threads we feel we may be able to comment on. At present you aren't actually asking for comments in the title, and I'm sure you'd like to hear what people think so give it a try?
Click to expand...

Any ideas of a new title? I have none :oops:
 
Georgiana & Perlutz said:
Hi @Amy47 ,

I'm familiar with the RVC, I even asked my vet for a referral there a couple of months ago. We decided not to go because they charge £275 for an appointment with a student :facepalm: We would've happily went if we could see one of their specialists.

Our vet referred us to a veterinary referral centre a bit closer to us. It's new but so far it has amassed a great reputation, having fantastic reviews.

I've just received the report that the referral vet sent the usual vet and I will copy paste that here in a moment. Just looking through it and although I don't understand much of it, it mentions enlargement of the heart, enlargement of the liver and I am here starring at it and thinking ACROMEGALY but they don't want to test him for it yet?! :eek:
Click to expand...

I'm sorry you are going through this. You will get answers! Hopefully you feel confident with the center & the vets you are with & they will make recommendations based on the report. Check directly with RVC. I'm not sure how your system works but ours has a resident or fellow do the initial intake but he internal medicine specialist then comes in right after them. Our human teaching hospital/academic system works the same...you never meet just with a resident or fellow.
 
Sorry to post again, but inflammation will cause issues with BG. It looks like quite a bit of inflammatory process going on based on the report. The one really good thing is they did not start any Prednisolone or prednisone so that if you decide to move forward with the endoscopy etc. you won't have to go through the process of getting him off (which typically makes them feel awful again if it was helping) to do the testing. The drug would mask issues.
You are heading in the right direction, albeit frustrating & anxiety provoking.
 
How frustrating to get all that testing done with no conclusions! I like Diana's suggestion of looking at diet to see if a change there might perhaps calm down any of the GI issues.

I'm also in agreement that you should go with your gut on this one. With all the enlarged organs and various systems being affected I would absolutely insist of getting the test for acromegaly done before pursuing any or all of the recommendations the vet has put forth. Frankly, I'm surprised the vet doesn't want to pursue that avenue.

Acromegaly is far more common than many vets think it is. While many cats with acro need copious doses of insulin, that is not always the case. Testing is relatively inexpensive and non-invasive and no anaesthetic is required (unless Perlutz is particularly fractious at the vet). It either solves the mystery or takes a big question out of the picture.

My cat has a different high dose condition called IAA. My vet thought it so rare she tried to persuade me not to spend my money on the test. I insisted and told her to humour me. I was vindicated and my vet was gobsmacked.
 
Diana&Tom said:
I think sometimes if you have a gut feeling about something, follow it up. Yes, enlargement of organs is a sign of acro, although not always. But maybe at this stage it should be ruled out? I'd say you were within your rights to ask for the test if you feel it could give you the answer. Or, you could post on the high dose forum here and ask how other people discovered that their kitty had acro, and at what point did they get the test done? Sorry, I don't want to keep suggesting that you do things like that, but there is just sooooo much experience on this board and there is usually some kind of help to be had if you keep asking.
Click to expand...
Please suggest anything! I'm so lost right now, I only have you guys here for suggestions so any are much appreciated!
 
MrWorfMen's Mom said:
How frustrating to get all that testing done with no conclusions! I like Diana's suggestion of looking at diet to see if a change there might perhaps calm down any of the GI issues.

I'm also in agreement that you should go with your gut on this one. With all the enlarged organs and various systems being affected I would absolutely insist of getting the test for acromegaly done before pursuing any or all of the recommendations the vet has put forth. Frankly, I'm surprised the vet doesn't want to pursue that avenue.

Acromegaly is far more common than many vets think it is. While many cats with acro need copious doses of insulin, that is not always the case. Testing is relatively inexpensive and non-invasive and no anaesthetic is required (unless Perlutz is particularly fractious at the vet). It either solves the mystery or takes a big question out of the picture.

My cat has a different high dose condition called IAA. My vet thought it so rare she tried to persuade me not to spend my money on the test. I insisted and told her to humour me. I was vindicated and my vet was gobsmacked.
Click to expand...
Yes, I'm quite surprised that the vet hasn't suggested testing for acro. It seems one of the obvious things to rule out. It's true, it's not uncommon at all, and why vets seem to think it is, I don't know. Before my Tom was dx the vet had barely heard of it and it was only from what I'd read about it here that made me think it was a possibility and ask for the test. Perlutz's vets know that his bg is erratic and that could be for various reasons, one being acro. Nobody wants to think their kitty has it, but at least if you know, you can start to manage treatment more appropriately.
 
MrWorfMen's Mom said:
How frustrating to get all that testing done with no conclusions! I like Diana's suggestion of looking at diet to see if a change there might perhaps calm down any of the GI issues.

I'm also in agreement that you should go with your gut on this one. With all the enlarged organs and various systems being affected I would absolutely insist of getting the test for acromegaly done before pursuing any or all of the recommendations the vet has put forth. Frankly, I'm surprised the vet doesn't want to pursue that avenue.

Acromegaly is far more common than many vets think it is. While many cats with acro need copious doses of insulin, that is not always the case. Testing is relatively inexpensive and non-invasive and no anaesthetic is required (unless Perlutz is particularly fractious at the vet). It either solves the mystery or takes a big question out of the picture.

My cat has a different high dose condition called IAA. My vet thought it so rare she tried to persuade me not to spend my money on the test. I insisted and told her to humour me. I was vindicated and my vet was gobsmacked.
Click to expand...
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 :oops:) 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!
 
When I had Smokey he had daily vomiting (always had most of his life), kept losing weight even though he ate ravenously, when the really stinky poo started I finally pushed for more tests even though vet said he didn't think it necessary, p'titis, EPI tests etc. While waiting for that, had ultrasound done, confirmed p'titis, suspect IBD. Was started on metronidazole for possible overgrowth bacteria and it has anti inflammatory properties. Also cerenia. He did well on it. That's when I started homemade food for him.

Olive here being totally different. Insulin just wasn't helping her at all. In first 3 weeks I had her, I knew there was more than FD going on. She had a lot of abdominal discomfort and rock hard belly. You couldn't touch her because it hurt. Her front feet didn't look right to me. So against vets advice I got abdominal ultrasound done. Although no p'titis at that time or IBD the IM did find a mass and said to increase her gab because she has a lot of pain. Cardiologist had to been seen because he picked up galloping heartbeat. I also switched insulin against his advice. So we worked on getting her more comfortable. 4 months after getting her I asked for acro and IAA tests. He wasn't to keen on it saying you can't doing anything if she had them. I said humor me, it makes a difference knowing why insulin isn't working and if IAA how we dose her. So he did the acro and not the IAA. He at first said she didn't have it, but when I got the report and saw she did, I had him revisit it and he needed to convert the numbers from U.S. to UK or reverse, either way she had it. He was so surprised she did. But against medical treatment since "it doesn't work". Had to find new vet willing to try.

Go with your gut. If acro, soft tissue overgrowth can affect esophagus and trachea as well as all organs can or will be enlarged, there is excess bone growth. I don't know about endo should acro be a case. It's something I haven't had to face as of yet.
 
I'm sorry to hear all you've been through, I really understand your frustration , I've had my share of very rare cases and It can drive one nuts that the people that are supposed to know just dismiss things just because they haven't had cases like that, just wanted to say hang in there and keep insisting on the things you already know are necessary and yes keep questioning if meds or treatments are the right thing for your boy, just because you are not a vet doesn't mean you can not be well informed
 
Olive & Paula said:
When I had Smokey he had daily vomiting (always had most of his life), kept losing weight even though he ate ravenously, when the really stinky poo started I finally pushed for more tests even though vet said he didn't think it necessary, p'titis, EPI tests etc. While waiting for that, had ultrasound done, confirmed p'titis, suspect IBD. Was started on metronidazole for possible overgrowth bacteria and it has anti inflammatory properties. Also cerenia. He did well on it. That's when I started homemade food for him.

Olive here being totally different. Insulin just wasn't helping her at all. In first 3 weeks I had her, I knew there was more than FD going on. She had a lot of abdominal discomfort and rock hard belly. You couldn't touch her because it hurt. Her front feet didn't look right to me. So against vets advice I got abdominal ultrasound done. Although no p'titis at that time or IBD the IM did find a mass and said to increase her gab because she has a lot of pain. Cardiologist had to been seen because he picked up galloping heartbeat. I also switched insulin against his advice. So we worked on getting her more comfortable. 4 months after getting her I asked for acro and IAA tests. He wasn't to keen on it saying you can't doing anything if she had them. I said humor me, it makes a difference knowing why insulin isn't working and if IAA how we dose her. So he did the acro and not the IAA. He at first said she didn't have it, but when I got the report and saw she did, I had him revisit it and he needed to convert the numbers from U.S. to UK or reverse, either way she had it. He was so surprised she did. But against medical treatment since "it doesn't work". Had to find new vet willing to try.

Go with your gut. If acro, soft tissue overgrowth can affect esophagus and trachea as well as all organs can or will be enlarged, there is excess bone growth. I don't know about endo should acro be a case. It's something I haven't had to face as of yet.
Click to expand...
Well I can definitely relate to the stinky poo! Perlutz has had his share of them for years now, sometimes there's a sulfur smell? Was that Smokey's case too? Quite frankly I never thought the smell could have anything to do with all this, although it has been mentioned to the vet during routine appointments.

I've read that metronidazole tastes awful, how did your kitty take it? I dread to think of giving any medication to Perlutz, he hates anything that affects the taste of his food...

You mentioned acro affecting the esophagus and trachea... they seem to be right next to the thyroid which the vet said she felt it's enlarged so I'm wondering if it wasn't actually the oesophagus or trachea that she felt? I'm not wishing for acro, God forbid, but I'm starting to really think he has it :arghh:

Thank you so much for sharing your experience!
 
Veronica & Babu-chiri said:
I'm sorry to hear all you've been through, I really understand your frustration , I've had my share of very rare cases and It can drive one nuts that the people that are supposed to know just dismiss things just because they haven't had cases like that, just wanted to say hang in there and keep insisting on the things you already know are necessary and yes keep questioning if meds or treatments are the right thing for your boy, just because you are not a vet doesn't mean you can not be well informed
Click to expand...
I know, right? Even when Perlutz was still a young, healthy cat I read few articles about cat diabetes and kidney disease and whatever else I ran into just out of curiosity (came in handy when he started drinking more water and I knew immediately what could be the cause and that he needs the vet ASAP). You'd think professionals would read all the new research on Acromegaly for example as it's nowhere near as rare as it used to be believed to be...

I don't know if others have had this with their vets, but I feel they think I'm a smart ass when bringing up something like acro for example. I still remember the first time I brought up the Somogy effect, my vet's eyes went like this :eek: :woot: o_O This is why last week I didn't push for the acro test, I thought it's a new vet, she says she is convinced he doesn't have it, she already asked me if I'm a nurse and if I'm not why do I know so many things and I just didn't want to push and push and then have her annoyed with us. I don't care what anyone would think of me or the cat daddy, but I fear if this could potentially affect Perlutz's treatment so I keep my mouth shut :oops:
 
Georgiana & Perlutz said:
Well I can definitely relate to the stinky poo! Perlutz has had his share of them for years now, sometimes there's a sulfur smell? Was that Smokey's case too? Quite frankly I never thought the smell could have anything to do with all this, although it has been mentioned to the vet during routine appointments.

I've read that metronidazole tastes awful, how did your kitty take it? I dread to think of giving any medication to Perlutz, he hates anything that affects the taste of his food...

You mentioned acro affecting the esophagus and trachea... they seem to be right next to the thyroid which the vet said she felt it's enlarged so I'm wondering if it wasn't actually the oesophagus or trachea that she felt? I'm not wishing for acro, God forbid, but I'm starting to really think he has it :arghh:

Thank you so much for sharing your experience!
Click to expand...
Stinky poo can be a sign of chronic gastric inflammation so it does all start to fit together. Also parasites can cause stinky poo - I'm sure you worm Perlutz regularly but I think the vet at the Ralph prescribed another round of Panacur, might just help.
 
Georgiana & Perlutz said:
Well I can definitely relate to the stinky poo! Perlutz has had his share of them for years now, sometimes there's a sulfur smell? Was that Smokey's case too? Quite frankly I never thought the smell could have anything to do with all this, although it has been mentioned to the vet during routine appointments.

I've read that metronidazole tastes awful, how did your kitty take it? I dread to think of giving any medication to Perlutz, he hates anything that affects the taste of his food...

You mentioned acro affecting the esophagus and trachea... they seem to be right next to the thyroid which the vet said she felt it's enlarged so I'm wondering if it wasn't actually the oesophagus or trachea that she felt? I'm not wishing for acro, God forbid, but I'm starting to really think he has it :arghh:

Thank you so much for sharing your experience!
Click to expand...


I wrap my pills in a small piece of Greenie Pill Pockets. They come in Salmon & Chicken flavor so theres no taste left behind
 
Georgiana & Perlutz said:
I know, right? Even when Perlutz was still a young, healthy cat I read few articles about cat diabetes and kidney disease and whatever else I ran into just out of curiosity (came in handy when he started drinking more water and I knew immediately what could be the cause and that he needs the vet ASAP). You'd think professionals would read all the new research on Acromegaly for example as it's nowhere near as rare as it used to be believed to be...

I don't know if others have had this with their vets, but I feel they think I'm a smart ass when bringing up something like acro for example. I still remember the first time I brought up the Somogy effect, my vet's eyes went like this :eek: :woot: o_O This is why last week I didn't push for the acro test, I thought it's a new vet, she says she is convinced he doesn't have it, she already asked me if I'm a nurse and if I'm not why do I know so many things and I just didn't want to push and push and then have her annoyed with us. I don't care what anyone would think of me or the cat daddy, but I fear if this could potentially affect Perlutz's treatment so I keep my mouth shut :oops:
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Absolutely understand! Some vets think they're next to God and their knowledge is all embracing, not appreciating that caring pet owners can and do their own research these days thanks to the internet. I try to ask questions based on what the vet says and then maybe continue by asking "what about something called....? What would you say about that?" And see what they say. A good vet will respect the fact that you're interested.
 
I gave the liquid metro to Smokey. I really don't remember if it was a struggle or not. The poo smell was like rotten eggs, sulfa, grey greasy looking. You had to scoop and get it outside to garbage, open doors and windows immediately to clear the stench.
 
Maybe this will be helpful....2015 Conference at Cornell in NYC, Dr. Stijn did a lecture titled "Feline Acromegaly: More common than we think" and he was from RVC. Trying to figure out where he went! So, he opened a company called VetCT & they do 2nd opinions to offer vets help that typically only U setting have. Your vets would need to be willing to call for consult

VetCT in Europe

St John's Innovation Centre, Cowley Road,

Cambridge, CB4 0WS, United Kingdom

Ltd. Co: 06955449

info@vet-ct.com

Tel: +44 (0)1223 422251

http://veterinarymedicine.dvm360.com/feline-acromegaly-more-common-we-think
 
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Amy47 said:
Maybe this will be helpful....2015 Conference at Cornell in NYC, Dr. Stijn did a lecture titled "Feline Acromegaly: More common than we think" and he was from RVC. Trying to figure out where he went! So, he opened a company called VetCT & they do 2nd opinions to offer vets help that typically only U setting have. Your vets would need to be willing to call for consult

VetCT in Europe

St John's Innovation Centre, Cowley Road,

Cambridge, CB4 0WS, United Kingdom

Ltd. Co: 06955449

info@vet-ct.com

Tel: +44 (0)1223 422251

http://veterinarymedicine.dvm360.com/feline-acromegaly-more-common-we-think
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I remember reading various articles from Dr Stijn and being very impressed. I didn't know he had left the RVC but a quick search brought up this

https://www.vet-ct.com/gb/
 
When I was looking into RVC, he was still listed as their director for small animals medicine in the Hatfield campus. I think he runs both the referral vet and the rvc...

When I was looking into the referral at RVC, I was hoping to see him, that would’ve been the ideal case, him or one of his colleagues he ran the feline diabetes clinic with. I mean, he has a PhD in feline diabetes! We were only put off RVC when we were told we will see a student and that the specialist only ever see the very complicated cases (at that time we were unaware of all these issues Perlutz has). He might now qualify as a complicated case but I fear if we go there, they will want to run all these tests again themselves and as much as I hate saying this, we simply cannot afford it... I know they are the best in the world for acromegaly, Stijn and his team have performed more surgeries on acro cats than all the other vets in the world combined. But that costs upwards of £8000 which we just don’t have...

The vet is waiting for my call tomorrow whether we do the endoscopy mow or later. I think I will put it on stand by for now and try to inform myself more on all this, try to find out how we can test for acro. I believe the RVC are taking in blood samples sent by vets and test, they have a very comprehensive blood tests package for around £350. As you know, English is not my first language. I’ll post a print screen and maybe someone can help me, maybe I misunderstood that this is the way to do it. If it is, I’ll try to persuade his usual vet to do it, he is much cheaper than the referral one we’ve seen. I’d rather pay £35 for an appointment with him to collect a blood sample than the £225 that I’d have to pay at the referral vet. Again, please don’t think I don’t want to do everything for Perlutz, I would take his diabetes on me if I could, it’s just that everything is expensive and we don’t have all the money...
 
I'd do the same, Georgiana - don't make any decisions just yet, inform yourself as best you can and invesigate the acro test. BUT don't assume that's what it is, we're suggesting do the test because it's a possibility, not an almost certainty. Sure, if the test comes back positive it would be upsetting, but it would lead you down a different road which could actually be a good thing. But cross that bridge when you come to it.

We know you'd do anything for Perlutz and it's a shame that so many of us have to base our decisions on cost. But you're doing your very very best and we know that and he knows that.
 
I know he might not have acro and I know no one here says he has it. Bit this acromegaly has been like an earbug for months now and my gut tells me to get it tested.
 
Georgiana & Perlutz said:
When I was looking into RVC, he was still listed as their director for small animals medicine in the Hatfield campus. I think he runs both the referral vet and the rvc...

When I was looking into the referral at RVC, I was hoping to see him, that would’ve been the ideal case, him or one of his colleagues he ran the feline diabetes clinic with. I mean, he has a PhD in feline diabetes! We were only put off RVC when we were told we will see a student and that the specialist only ever see the very complicated cases (at that time we were unaware of all these issues Perlutz has). He might now qualify as a complicated case but I fear if we go there, they will want to run all these tests again themselves and as much as I hate saying this, we simply cannot afford it... I know they are the best in the world for acromegaly, Stijn and his team have performed more surgeries on acro cats than all the other vets in the world combined. But that costs upwards of £8000 which we just don’t have...

The vet is waiting for my call tomorrow whether we do the endoscopy mow or later. I think I will put it on stand by for now and try to inform myself more on all this, try to find out how we can test for acro. I believe the RVC are taking in blood samples sent by vets and test, they have a very comprehensive blood tests package for around £350. As you know, English is not my first language. I’ll post a print screen and maybe someone can help me, maybe I misunderstood that this is the way to do it. If it is, I’ll try to persuade his usual vet to do it, he is much cheaper than the referral one we’ve seen. I’d rather pay £35 for an appointment with him to collect a blood sample than the £225 that I’d have to pay at the referral vet. Again, please don’t think I don’t want to do everything for Perlutz, I would take his diabetes on me if I could, it’s just that everything is expensive and we don’t have all the money...
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I would never think you weren't trying to do everything for Perlutz :(. I was actually hoping the RVC would be less money because in the U.S., more often than not, the "specialty" vets & clinics are outrageously expensive & sometimes, the quality of their imaging can even be subpar because it is mobile or they just can't afford what our U setting have.

Maybe call RVC & see if they will help direct you as far who your vet needs to call etc.. Sometimes when you call you can get someone helpful. I'll try to pull up the RVC & see what it says
 
Amy47 said:
Yes, based on what it lists, for 271+VAT, your vet is able to submit for a comprehensive panel to be done.
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His vet won't be happy to see us again :smuggrin: He had nearly 2 months break from us, we've seen a locum vet they've had and then the referral vet. He is about to get some scratches :D
 
Is clear you care about Perlutz very much otherwise you wouldn't be here and asking and investigating unfortunately we are all restricted to what is available either because of where we live, laws, regulations or costs because vet costs can be really outrageous there's just so much we can do so hang in there

And if you can when you have the results of all the tests they made post them here for everyone to take a look at them who knows maybe someone can catch someting they've missed
 
Is there another vet or is yours nice? My local vet is amazing & that has been KEY. You definitely want someone who will work with you.
 
Veronica & Babu-chiri said:
Is clear you care about Perlutz very much otherwise you wouldn't be here and asking and investigating unfortunately we are all restricted to what is available either because of where we live, laws, regulations or costs because vet costs can be really outrageous there's just so much we can do so hang in there

And if you can when you have the results of all the tests they made post them here for everyone to take a look at them who knows maybe someone can catch someting they've missed
Click to expand...

Yes, please post. Either someone may catch something &/or know that you are not only helping Perlutz but also helping many others who will see your post now or in the future & know what to look for, ask, testing etc..:)
 
Georgiana & Perlutz said:
Full report from the vet:

18-06-2019
Diagnosis:
- Not well controlled diabetes mellitus
- Possible chronic gastroenteropathy
-An enlarged ileociecocolic lymph node
Treatment:
- Insulin Prozinc 2.5iu SC BID
- Diabetic diet (I must note that he is not actually on a diabetic specific diet? he eats Thrive, Applaws and Purina Gourmet Pate)

Perlutz presented at the medicine department of The Ralph on the 12th of June for further investigations of a possible pancreatic mass
and not well regulated diabetes mellitus. The carers have reported signs compatible with chronic gastroenteropathy (occasionally going
off food, vomiting and soft faeces). There were no other concerns.
On physical examination he was very stressed but BAR. The MM were pink and CRT was <2s. Oral inspection showed some mild tartar
but no other abnormalities were seen . The peripheral lymph nodes were not palpable. There was a small thyroid enlargement on the
left side of the thyroid. The HR was 240 and a soft heart murmur I/VI was audible but not present all the times. The femoral pulses
were not possible to be examined. The RR was elevated at >40/min but there were no changes during auscultation and percussion. The
rectal temperature was 38.7. The abdomen was painful and palpation was not rewarding. The rest of the examination was
unremarkable.
The identified problems were the previously identified mass in the pancreas, the chronic gastrointestinal signs, the not well controlled
DM, the mild thyroid enlargement and of less concern the soft systolic heart murmur.
Perlutz was hospitalised and under general anaesthesia the following tests were performed:
- CBC: mild elevation of the platelets, that could be secondary to inflammation or secondary to gastrointestinal ulcers or hornomal
disease (e.g Cushings, hyperthyroidism etc)
- Full biochemisty: mild elevation of urea and creatinine (pre renal azotaemia or primary renal problem), mild elevation in ALP (diabetes
mellitus, pancretitis, GI problem, liver disease, hormonal disease), the rest was within normal limits
- Fructosamines: elevated at 524mmol/l which would indicate
- TT4: within normal limits
- fPLI: pending
- VITB12: elevated
- TLI: within normal limits but towards the low end of normal
- SDMA: mildly elevated which could reflect very early signs of renal insufficiency
- Coagulation profile: within normal limits
- UA+CS: PH5, SG>1050 which would indicate good kidney function , urinary culture was negative
- Thoracic radiographs in three views which report stated:
1. Mild bronchial pulmonary pattern. Pulmonary metastatic disease is not seen at this time.
2. Mild generalized cardiomegaly without radiographic evidence of vascular, pulmonary, or pleural space changes.
3. Geriatric thorax with redundant aorta.
4. Mild sternal lymphadenopathy most likely secondary to hepatic changes.
5. Mild hepatomegaly as with clinical history of vacuolar hepatopathy secondary to endocrinopathy.
6. Degenerative intervertebral disc disease with ventral spondylosis deformans.
7. Pancreatic enlargement, left lobe of the pancreas.
- Abdominal US which report stated
"The GB is bilobed. There is bilateral dilatation (5 mm) of the renal pelvises and mild bilateral hyperechiogenicity of the medullae. There
is mild enlargement of one of the ileocaecocolic lymph nodes which is hypoechoic and measures 7 mm There is a small amount of fluid
in the colon. Liver, pancreas, spleen, stomach, small intestine, adrenal glands and urinary bladder are within normal limits.
Conclusions: Bilateral dilatation of the renal pelvises is considered most likely secondary to increased GFR, there is no visible dilatation
of the ureters and no visible urinary calculi in this examination. Bilateral nephropathy may be considered if clinically suspected. The
colonic contents are compatible with soft faeces/diarrhoea; possible colitis with mild colonic lymphadenopathy"
We have not identified a mass in the pancreas, however an enlarged ymphonode was identified along with signs of possible colitis and
dilation of the both renal pelvis. We also believe Perlutz has a possible chronic gastroenteropathy creating inflammation which could be
responsible for some clinical signs that were reported and be causing or contributing to the diabetes being unstable. The liver appeares
mildly enlarged but that could be the direct effect of the diabetes and the heart also appears to be enlarged on radiographs. A cardiac
ultrasound to assess his heart would be indicated. The sternal lymph node is also mildly enlarged, which could reflect inflammation.
We have discussed all these changes with the carers. There are signs of inflammation in several parts of the body. The most
important seems to be within the gastrointestinal tract, creating inflammation possible to the local lymph nodes,
however without further investigations and biopsies/FNA's more sinister causes, such as cancer, cannot be completely
ruled out. We have discussed the possibility of performing another general anaesthetic and an upper GI endoscopy with
biopsies. While under anaesthesia FNA from the lymph nodes will be attempted. The heart will need to be investigated
further with a cardiac scan to rule out a cardiomyopathy before the general aneasthetic. The carer will consider
carefully all options in the next few days and will let us know how she would like to proceed. In the meanshile I would be
very grateful if you could provide the following medications to the owners:
- Metronidazole 50mg tablet twice dialy for 4 weeks (this is for the immunomodulatory effect on the
gastrointestinal mucosa)
-Omeprazole 5mg table twice daily on an empty stomach for 2 weeks, then stop slowly (this for any
possibility of gastric acid erosions)
-Panacur 1.8gr : 1/2 sachet once daily in his foor for 5 days (this is for deworming )
Perlutz recovered well from his anaesthetic and was discharged home on his normal dose of insulin for now. A diary for monitoring of
the diabetic patient was also provided along with some recommendations of how to manage the diabetic patient.
We will keep you up to date with the further plan.
Thank you for referring this very beautiful boy to us, please do not hesitate to contact us if you would like to discuss further this case.
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@Veronica & Babu-chiri this is all, it seems just the fPLI for pancreatitis is still pending
 
Amy47 said:
Is there another vet or is yours nice? My local vet is amazing & that has been KEY. You definitely want someone who will work with you.
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He is alright, he got a bit intimidated once by Perlutz's hissing and Perlutz "smelled" his fear and now does it to him every time! He is not an aggressive cat, just gets very, very stressed and lets everyone know he is not happy to be there. He is a big boy as well, 5.9 kilos and to be fair, he has been intimidating vets since he was a kitten :rolleyes:

He knows basic diabetes as well and he humours me with most if not all my requests for referrals, tests etc. He knows I test at home, he is not against it at all although I know he doesn't recommend it to everyone. He doesn't demand useless curves done in the practice just to charge me. He is willing to listen to me and doesn't have that attitude of "he knows everything, I know jack s**t and it;s his way or no way" which I found at a different vet in our town.
 
I forgot to mention there are some blood test results from May 22nd on his SS under the "labs" tab. These were done at the vet before his dental.
 
Georgiana & Perlutz said:
He is alright, he got a bit intimidated once by Perlutz's hissing and Perlutz "smelled" his fear and now does it to him every time! He is not an aggressive cat, just gets very, very stressed and lets everyone know he is not happy to be there. He is a big boy as well, 5.9 kilos and to be fair, he has been intimidating vets since he was a kitten :rolleyes:

He knows basic diabetes as well and he humours me with most if not all my requests for referrals, tests etc. He knows I test at home, he is not against it at all although I know he doesn't recommend it to everyone. He doesn't demand useless curves done in the practice just to charge me. He is willing to listen to me and doesn't have that attitude of "he knows everything, I know jack s**t and it;s his way or no way" which I found at a different vet in our town.
Click to expand...

Thats awesome :)! I love that big boy has your vets number :joyful: & likes to rattle him!
 
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
 
The RVC research on acromegaly showed one in four diabetic cats has it, some cats on as low as 1 unit of insulin. Go with your gut, get the test done. Knowledge is power, regardless of the result. Add me to the list of those whose vet was more surprised by the positive results than I was. And also had to ask the vet to humour me to get the test done.

I have given metronizadole before, I gave pills in pill pockets. I have also given it as a compounded liquid, supposedly flavoured and from the reaction of the cat, it truly is foul tasting. The pills were easier to give, as long as the cat doesn’t wise up. Make sure you give the occasional “blank” pill pocket as a treat so they aren’t associated with meds. In spite of the taste, it did help.

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.
 
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