Thank you
@Suzanne & Darcy and
@FrostD - There is a lot to respond to here, but I will do my best!
Let me preface this by saying - I'm trying to find a different vet.
Does he get nauseated? Didn’t you say you give Cerenia? What was that prescribed for?
He refused food, and was vomiting foam for the first time on Monday 8/15. She asked if he seemed interested in food, and I said yes, so she prescribed Cerenia for the vomiting and presumed nausea.
How does she explain the elevated BUN? Why are those uremic toxins building up so high?
She didn't explain any of this. And I didn't think to ask for the labs to look at them myself. Even looking at them I don't know what I'm seeing...
What other notes from the lab are on the lab results?
IDEXX SDMA says normal value of 12, - "SDMA and creatinine are within the reference interval: impairment of GFR is unlikely. Recommend next step: evaluate complete urinalysis"
Hemolysis Index 1+ - "Index of N, 1+, 2+ exhibits no significant effect on chemistry values"
Lipemia Index N - "Index of N, 1+, 2+ exhibits no significant effect on chemistry values"
The only other note is that they repeated the urine glucose test to verify that yes, he really is passing a ton of glucose.
Didn’t you say you were giving fluids? What was that for if not kidneys?
Spooky is extremely dehydrated. He lost a lot of weight before we figured out he was diabetic. He went from a healthy weight of 12lbs to an unhealthy weight of 7.6lbs and falling.
I understand the need to try to understand the cause of the anemia- but why can’t your vet explain her objections to you and let you decide. If it works then you may not need the transfusion. Epogen can work quickly. If she thinks it won’t work then why not?
Her failure to explain is part of an ongoing problem. I really should have found another vet a long time ago. That's on me. All she said is Epogen might be hard on him since he is so ill, but we would discuss it at his follow up in 5-7 days.
Oh and remember he has high white cells in his urine in addition to high red cells. They probably should have sent it off for a culture. If not. At least prescribe a borax spectrum antibiotic. Has he ever had Clavamox (Amoxi-Clav) before? Unless you know he’s okay with it, I would steer away from it. It is a very effective broad spectrum antibiotic, but it can cause inappetance, vomiting and diarrhea in a lot of cats. Some of my cats are okay with it and some just can’t take it. For poor Spooky, who is probably weak, it may not be worth the risk, unless he’s taken it before and you know it’s okay. Whatever you do, don’t let them give him a Convenia shot.
I think they may have given him a Convenia shot on Tuesday when he was at the vet all day. I got all his medical records yesterday and they are woefully lacking in detail. We were never charged for Convenia, but when I spoke to the vet on Tuesday afternoon I wrote in my notes that they gave him an antibiotic shot. When I asked if he was given an antibiotic yesterday, the office said there was no record of it. So who knows? Definitely did not prescribe one.
To quickly explain the diabetes portion of this - his numbers are just slightly better. But that is likely due to fluids. If his blood volume is very low, then glucose would be more concentrated. When you give fluids, that helps blood volume and makes glucose a little more dilute.
Think of it as adding a drop of blue food dye (glucose in this analogy) to a glass of water (blood in this analogy). If the cup is half full, it will be fairly blue. But if it's completely full, it's not going to be quite as blue.
Thank you for the analogy! I agreed that his dehydration is part of why his numbers were looking worse and now better. We were originally giving him 50ml a few times a week, and now we are doing 50ml morning and evening for the last few days.
As far as timing - when are you giving fluids in relation to shot, in terms of minutes/hours? And location? Sometimes the fluids can have the effect of diluting the insulin; this doesn't seem to be the case bas d on numbers, or you got lucky and it's diluting the insulin and avoiding a possible hypo.
Nobody instructed me on this - I've been trying to do the fluids before his AMPS and PMPS blood tests because it's easier to get a little blood when he's better hydrated. Then Cerenia, then food, then insulin. Fluids go in the scruff because it's the only place with room when he's so skinny. Insulin I've been doing in his flank, where it seems to absorb better and result in better numbers. But sometimes it doesn't work out like that. This morning he wouldn't sit still for fluids, and he's a bit more nauseated so I'm waiting for him to eat a bit more and I'll do the fluids later in the day.
I was happy to see that Spooky has had some blue numbers on this dose! Very happy. Now if he would only smooth out a bit with lower AMPS and PMPS. You have my respect and admiration for trying to handle all this Rachel!
Oh my gosh me too! So happy to see some better numbers finally. And I appreciate the support and encouragement. I do also work full time but I work from home most days so that helps. But with his health this week I ended up taking a couple of sick days and have not been taking care of myself. I haven't slept a good night's sleep since Sunday night. I'm soooo tired.
In my other current thread
https://felinediabetes.com/FDMB/threads/advice-suggestions-on-how-to-find-a-new-vet.267235/ I've gotten a lot of great suggestions on how to find a new vet. My husband is going to call one that was recommended by a friend of ours when they open this morning. We'll see if they are taking new patients. If not, I have an appointment for Spooky at our current vet on Tuesday. And I'm going to call the current vet today and see about an antibiotic. Their go-to for UTIs is Baytril
Spooky's Background: Spooky was my mother-in-law's cat. She passed away in 2018 and we adopted him. He had a history of inappropriate litter box usage, UTIs, and early CRF. He was 15 lbs when we got him. Vet said, put him on a diet so we did and he got down to 12lbs by 2021. June of 2021 we brought him in for his annual and there was a lump that the vet excised and biopsied. Biopsy showed post-injection inflammation. He also had a dental cleaning at the same time. In March 2022 he had a medication recheck (he's on 2x weekly Prozac for anxiety). In April 2022 I noticed that his runny eyes had a new brown discharge, so I took him in for antibiotic eye drops. Vet found a bad tooth so we had another dental and four extractions. June of this year was the blood work that diagnosed diabetes. At that same exam, the vet found that on palpation one of his kidneys was enlarged and bumpy. She suspected cancer, to be confirmed with blood work. Blood work inconclusive for cancer I guess, or she forgot about the enlarged kidney. It is nowhere in his medical file, but my husband and I were both at the appointment and both remember her warning us that he probably had cancer. When we brought him into the vet Tuesday they ran the most recent blood work where she saw the anemia, and is thinking it is related to cancer. They did xrays and the xrays show that there is a mass pushing his intestines out of place. The mass is in the right place to be either kidney cancer or liver cancer, but since the kidneys and liver look ok (to her) she thinks it's either bone marrow cancer or blood cancer.
Sorry for the wall of text - my brain isn't at full capacity. I lost a cat in 2020 to cancer and I kept him around too long because I selfishly didn't want to lose him. I don't want to keep making that same mistake.
Edited to add the xray findings.
