? SOMETHING ELSE GOING ON?

[DevilPup]

Spike began using Lantus on 8/12/18 at .5 unit. We kept him there for one week. When his numbers were not in ideal range and after a curve, we increased a quarter unit to .75 on 8/19/18. He didn't respond to that increase, ideally, but we felt there was another issue going on. SS attached.

He also has chronic rhinitis/sinusitis which appears to be current going on.
He has chronic pancreatitis, which is seems to be calm at this point. Asthma which is controlled with aerokat and Flovent.
We usually treat his sinusitis with visits to our cat carrier "steam room." We will give him 2-3 sessions per day and that seems to work. Well, it didn't this time.

So the Vet we confer with from Cornell University prescribed cefpodoxime. He prescribed this antibiotic because it works well with the azithromycin Spike take daily (and will forever for his microplasma). Spike spent 3 days of testing at Cornell in December 2017 for his sinus issues.

What I'm concerned with is.....we started giving him the cefpodoxime 3 days ago. We can already see a great improvement in his sinus issues. HOWEVER, his BGs (we test at home) seem to be higher. He appears to be hungrier and thirstier. We were planning on doing another curve on Sunday, then depending on the results, increasing his Lantus dose to 1 full unit BID.

A few other issues I have noted. He has issues with sight. (noticeable for a few months) It's like he can't focus in or "make things out." We took him to a leading animal ophthalmologist last year (the sight issue has been noticeable for awhile now--but usually it comes and goes) who assured us there was nothing wrong other than normal aging affecting his sight. He now also become very angry and very nasty at times with both husband and me and the other cats. He gets totally unhinged. Since last spring, all he wants to do is sleep...no one can tell me why other than me guessing the diabetes...but it "just" showed up recently. (believe me, I get blood tests all the time...)

We are between regular vets. We see the new vet on Wednesday, 8/29. We will get full blood workup and discuss possible ultra sounds? But for what? When I called the soon to be ex-vet today for his records, he started going on and on about insulin resistance, changing insulins, acro, etc. I told him he has only been on insulin for less than 2 weeks. I can't make a judgment call that fast.

Spike has been in a small dose of insulin (SLGS) for not even 2 full weeks. I thought for sure once the new AB kicked in (now) his numbers would start coming back down. I don't believe he will ever see remission (I will always hope for it) but at this point I would just like to get him somewhat regulated in a good range. I know his other illnesses will always have an effect on his numbers. But with the sight issues, increased appetite/thirst, heavy duty anger.....I am missing something. Does it appear he may be resistant? Is it pancreas or diabetes related? What else can I ask the new vet to test for? Is something jumping at you? What am I missing? Sorry to be so long winded.... TY!

 

[Noah & me (GA)]

This won't be of much help and I can see you clearly have a handle on meds, testing, blood work.
How old is Spike? The anger issues concern me partly because I can't help you with anything else. We had a dog with dementia but she became more timid and it was certainly not a sudden onset thing. This is a weak analogy but like a thorn in your side or my arthritis I can get grumpy but not like what you're describing. Has he had any falls, something orthopedic where a hairline fracture suddenly bothers him to the point where he can't be touched? If you've ever had an abscessed tooth that flares up you'll also know what sudden onset pain is. Maybe even an ingrown claw. It doesn't always have to be a major issue or medical mystery.
If you go down the neurological road be prepared for a lot of guessing and spending. I have been there both personally and with animals. Sometimes it can be something obvious, other times you can drop $2,000 on an MRI only to find out there's nothing you can do.
Finally, you are not long winded. This is why we are here and you get straight to the point.

 

[DevilPup]

This won't be of much help and I can see you clearly have a handle on meds, testing, blood work.
How old is Spike? The anger issues concern me partly because I can't help you with anything else. We had a dog with dementia but she became more timid and it was certainly not a sudden onset thing. This is a weak analogy but like a thorn in your side or my arthritis I can get grumpy but not like what you're describing. Has he had any falls, something orthopedic where a hairline fracture suddenly bothers him to the point where he can't be touched? If you've ever had an abscessed tooth that flares up you'll also know what sudden onset pain is. Maybe even an ingrown claw. It doesn't always have to be a major issue or medical mystery.
If you go down the neurological road be prepared for a lot of guessing and spending. I have been there both personally and with animals. Sometimes it can be something obvious, other times you can drop $2,000 on an MRI only to find out there's nothing you can do.
Finally, you are not long winded. This is why we are here and you get straight to the point.

Hi. thank you! Spike was 13 in May. He seemed to start losing patience with the other cats since the Spring, it seems like. Not terrible, but noticeable. We attributed it to "not feeling well and just getting cranky because of it" and because he had lost a few pounds (we believe due to the diabetes coming on) and felt he could now defend himself.
He was 20# but is now 15. He does not have lipidosis. We weigh the cats every week now with a baby scale. He also liked to be brushed, but then since I think last fall, he can't tolerate much of it. I did make it a point today to brush him....he did okay!
Cornell examined him pretty well, dental, ears, they scoped his throat, nose and sinuses. He had a CT scan of his sinuses and brain. They noted a very small spot on his brain that they weren't concerned about. But you know, whenever an animal starts acting like this... I always think some type of brain issue. Ingrown claw, no..were on those once a month. We do assembly lines, one cat at a time. Get it done. Although lately, his left ear seems to be bothering him too. He will absolutely "freak" if I go digging in his ear. I think I will leave that for the new vet!!

 

[Noah & me (GA)]

I know it's Cornell and not some junior college but how can they not be concerned about a spot on his brain?
As the day goes on more members will see this and better advice and experience will start flowing.
The other members have heard this before (sorry everyone) but I had a SPECT scan, two CT's and four MRI's that seven neurologists could make no sense of. The eighth, a woman because men don't listen, figured it out in five minutes. It doesn't have to be tragic. I had a brain aneurysm fixed with a scope through an artery in my leg and I could have driven home the next morning. Neurology is a very strange place.

 

[Noah & me (GA)]

You should put more of Spike's medical history, past and present, in your profile. People can see things without asking you the same questions over and over again. It's something only members can see.

 

[DevilPup]

No, you shouldn't feel you need to apologize. Not everyone has heard that before. And the others than have will just pass by it. Everyone's experience can be helpful to others. I totally get what you're saying. I agree about the spot. They did say a repeat CT scan should be ordered if his personality changes. However, I can't take him back to Cornell. It is a four hour drive, one way and he cries the entire distance. It will stress him out terribly and most likely drive him into a new panc flare or drive his BGs thru the roof. I don't mind the drive, it's him!
We have just heard about CT scan available here in my area. It is costly, but in lieu of the travel time, we will most likely get him in. We figured we would start with blood workup and ultrasounds.
I will add some additional history in my profile. TY and I'm glad someone was able to help you!

 

[Noah & me (GA)]

TY and I'm glad someone was able to help you!

The doctor who finally figured it out is my Angel. The kind of person who is happy with a tiny office and loves her work. Wanna' see? She sometimes looks like a 12 year old and is now teaching neurology.

Okay, I am well known for getting off track so... We have six cats and one of them can be just miserable. There are times when you may lose a finger if you stroke his back. It turned out to be 'stud tail' or 'tail gland hyperplasia'. Noah has something, maybe PTSD, and lived in our walk-in closet for 3 years. It's not us, the cats here pretty much do what they want. They are just the worst patients because they cannot tell you where it hurts and usually never complain.
One thing you'll never hear from me is to "just accept it". I already know you're not that person. Modern medicine and the right vet can solve a lot of problems. Finding the right combination is the hard part. Our vet is the daughter of a vet and will accept when she doesn't know why, then researches it day after day.
And the things that sound scary like aneurysm were only scary because before CT and MRI you would only see them in an autopsy. That's my thought of the day. Best wishes for all of you, this site has saved so many cats and has an incredible knowledge base. Just be patient.

 

[JoyBee&Ravan]

Did you get him off Dry food yet? If you read the yellow sticky info Dry Food (it's by Dr. Pierson) you'll understand why it's important not to feed "any" dry food.
You mentioned about Kitty getting angry. My cat Ravan really hates to ride in the car. He's 16 yrs old & has always been really laid back,calm kitty.
In the past I rarely ever took him to a vet,but now with the diabetes he goes more often. I noticed a change in his personality. He's more easy to anger & even went after his sister the other day.
I'm sure it's from the stress of the car & tests at the vet. I've decided no more car unless it's an emergency. I want his life to be calm & happy.

Best of luck with your Kitty. Sounds like you've done a lot to help him.

Great video by Dr. Becker & Dr.Pierson. They talk about cats quality of life & stress ( and a whole lot more) near the end of the video

 

[Noah & me (GA)]

Your profile mentions bupre. Do you mean Buprenorphine? Noah will be on BUPE forever and on occasion I have either missed a dose or run out. If you've ever seen someone in serious withdrawal it's very unpleasant. I've researched this already, cats do not experience the same symptoms as humans nor do they get addicted in exactly the same manner as humans. Just one thing you can rule out.
If it is Buprenorphine what is it for? Noah hated the oral so much it made him miserable. He is now on transdermal paste.

 

[DevilPup]

Your profile mentions bupre. Do you mean Buprenorphine? Noah will be on BUPE forever and on occasion I have either missed a dose or run out. If you've ever seen someone in serious withdrawal it's very unpleasant. I've researched this already, cats do not experience the same symptoms as humans nor do they get addicted in exactly the same manner as humans. Just one thing you can rule out.
If it is Buprenorphine what is it for? Noah hated the oral so much it made him miserable. He is now on transdermal paste.

Yes, I had to abbreviate it so much, that I was hoping folks would catch on. That list of meds "as need" is for pancreatitis flares. I don't always give him buprenorphine and I am very careful not to dose too much or for too many days. He hasn't been on bupe since probably early July and I probably only gave it to him a maybe 3 or 4 times. I don't think that's it. But thank you for your idea.

 

[DevilPup]

Did you get him off Dry food yet? If you read the yellow sticky info Dry Food (it's by Dr. Pierson) you'll understand why it's important not to feed "any" dry food.
You mentioned about Kitty getting angry. My cat Ravan really hates to ride in the car. He's 16 yrs old & has always been really laid back,calm kitty.
In the past I rarely ever took him to a vet,but now with the diabetes he goes more often. I noticed a change in his personality. He's more easy to anger & even went after his sister the other day.
I'm sure it's from the stress of the car & tests at the vet. I've decided no more car unless it's an emergency. I want his life to be calm & happy.

Best of luck with your Kitty. Sounds like you've done a lot to help him.

Great video by Dr. Becker & Dr.Pierson. They talk about cats quality of life & stress ( and a whole lot more) near the end of the video

I understand completely about the dry food, I've done all the "stickies" reading and Dr. Pierson, and other research. I have not totally weaned him off. But to assist, I have mixed his regular dry with Young Again and Origen. I have four other cats. I am working on the issue, but it is not going to happen overnight. He has never eaten wet in the past. So 13 years eating dry and I now have him up to 90% wet, low carb. I think I'm doing pretty good. We will get there in due time.
I'm sure all the poking, prodding, weighing, testing, temperature taking, pill taking...gets him cranky.
Thank you. I really appreciate your assistance. I will view the video!!

 

[JoyBee&Ravan]

 

[DevilPup]

The doctor who finally figured it out is my Angel. The kind of person who is happy with a tiny office and loves her work. Wanna' see? She sometimes looks like a 12 year old and is now teaching neurology.
View attachment 38431
Okay, I am well known for getting off track so... We have six cats and one of them can be just miserable. There are times when you may lose a finger if you stroke his back. It turned out to be 'stud tail' or 'tail gland hyperplasia'. Noah has something, maybe PTSD, and lived in our walk-in closet for 3 years. It's not us, the cats here pretty much do what they want. They are just the worst patients because they cannot tell you where it hurts and usually never complain.
One thing you'll never hear from me is to "just accept it". I already know you're not that person. Modern medicine and the right vet can solve a lot of problems. Finding the right combination is the hard part. Our vet is the daughter of a vet and will accept when she doesn't know why, then researches it day after day.
And the things that sound scary like aneurysm were only scary because before CT and MRI you would only see them in an autopsy. That's my thought of the day. Best wishes for all of you, this site has saved so many cats and has an incredible knowledge base. Just be patient.

Cats are so hard to figure out. Not only do they outwardly hide things, but their test results do too. Spike has had something "off" for at least 3 years. I have taken him to several vets who run test after test without any substantive conclusions. My gut tells me otherwise. We will continue the fight/challenge/day to day events..I will be patient.

I am still looking for that "right vet." Wednesday is our appointment with the "next" vet. I hope it is worth the stress Spike will endure being out of his comfort zone.
Thank you, best wishes to you, too and your crew!

 

[Noah & me (GA)]

My GA is Nigel, Noah's brother. He loved being in the car and being at the vet meant he could show off to everyone. He had no idea what stress was.

 

[Pamela & Amethyst]

It helps Amethyst anxiety alot by having a Mobile Vet come our house

 

[Jill & Alex (GA)]

What I'm concerned with is.....we started giving him the cefpodoxime 3 days ago. We can already see a great improvement in his sinus issues. HOWEVER, his BGs (we test at home) seem to be higher. He appears to be hungrier and thirstier.

Just a wild guess, but if my sinus infection was clearing up I'd be better able to smell food which would then most likely result in an increase in appetite.

His BGs *may* be related to the increase in appetite OR the higher BG numbers you're seeing may simply be a bounce from lower numbers than his body has been accustomed to seeing. I have wonder how low this dose is dropping him. Recently, a smaller dose was already dropping him into mid to high 100s... not to mention the sinus issue is now resolved/in the process of being resolved.

Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles). http://www.felinediabetes.com/FDMB/threads/the-basics-new-to-the-group-start-here.18139/
​

Since the weekend is upon us, any chance of grabbing as many mid-cycle tests as possible? They would round out the data you've recently accumulated and help you figure out what's going on.

The anger and loss of sight... too soon to tell if it's related to dosing or something else entirely.

 

[DevilPup]

My GA is Nigel, Noah's brother. He loved being in the car and being at the vet meant he could show off to everyone. He had no idea what stress was.

Just a wild guess, but if my sinus infection was clearing up I'd be better able to smell food which would then most likely result in an increase in appetite.

His BGs *may* be related to the increase in appetite OR the higher BG numbers you're seeing may simply be a bounce from lower numbers than his body has been accustomed to seeing. I have wonder how low this dose is dropping him. Recently, a smaller dose was already dropping him into mid to high 100s... not to mention the sinus issue is now resolved/in the process of being resolved.

Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles). http://www.felinediabetes.com/FDMB/threads/the-basics-new-to-the-group-start-here.18139/
​

Since the weekend is upon us, any chance of grabbing as many mid-cycle tests as possible? They would round out the data you've recently accumulated and help you figure out what's going on.

The anger and loss of sight... too soon to tell if it's related to dosing or something else entirely.

Thank you.
Yes, this is an interest concept. We will test more this weekend. We were planning on a curve on Sunday to see if we needed to raise him to 1 full unit.
Also, another thought....could this possibly be an imminent pancreatitis flare coming on? I believe he waxes and wanes with this and that he always has some level of flare ongoing at all times.....this is why I feel he will never reach remission. Between the pancreatitis and the rhino/sinusitis, he's got issues that will effect his BGs.

In seeing the new vet on Wednesday, should I request a fructosamine test if not offered or suggested?

 

[DevilPup]

It helps Amethyst anxiety alot by having a Mobile Vet come our house

Love it!! I should check that out.

 

[Jill & Alex (GA)]

Also, another thought....could this possibly be an imminent pancreatitis flare coming on? I believe he waxes and wanes with this and that he always has some level of flare ongoing at all times.....this is why I feel he will never reach remission. Between the pancreatitis and the rhino/sinusitis, he's got issues that will effect his BGs.

Anything is possible. Time will tell. Just go with the flow.

My Alex also had multiple health issues. She went OTJ twice, but eventually I knew another remission wasn't in the cards. However, given the multiple health issues, keeping her as tightly regulated as I could at any given time was the one and only thing I could control (to any extent) that seemed to genuinely help her feel better.

In seeing the new vet on Wednesday, should I request a fructosamine test if not offered or suggested?

I'm not a big fan of fructosamines because I felt like I had a good handle on what was happening with Alex since I tested so frequently, but if you're curious... have one done. It's only money.

 

[Noah & me (GA)]

It's only money

Jill recently won the pet edition of Jeopardy so you have to both pay attention and ignore her.
Or was it Wheel of Misfortune?

 

[Wendy&Neko]

Spike began using Lantus on 8/12/18 at .5 unit.

When I called the soon to be ex-vet today for his records, he started going on and on about insulin resistance, changing insulins, acro, etc.

Whoa - way to early to think about that! Spike is a very newly diagnosed diabetic who hasn't even been on insulin for two weeks. Insulin is a hormone, it takes there little bodies a while to learn how to work it. And when they have secondary conditions like pancreatitis or inflammation, it can be a little harder to get them regulated. Acromegaly or insulin resistance is always a possibility, but it's not something we suggest people getting tested for until their kitty is on much higher doses (6 units). And yes, my girl had both acromegaly and insulin auto antibodies.

You are still in very early days. There is no reason to give up hope on remission. Though I would start with setting a goal of regulation. Regulation is a prerequisite for remission. Keep following the dosing method, and you will get there. And as Jill says, whenever you can get spot checks mid cycle, they really help fill in the picture. Those night time tests before bed can really help as many kitties go lower at night.

 

[Noah & me (GA)]

going on and on about insulin resistance

Wendy is right. It's almost inconceivable he would propose that theory. It's not a very scientific way to say this but it doesn't work like that. Well, almost never.
Maybe that's why he's your soon to be ex vet.

 

[DevilPup]

Whoa - way to early to think about that! Spike is a very newly diagnosed diabetic who hasn't even been on insulin for two weeks. Insulin is a hormone, it takes there little bodies a while to learn how to work it. And when they have secondary conditions like pancreatitis or inflammation, it can be a little harder to get them regulated. Acromegaly or insulin resistance is always a possibility, but it's not something we suggest people getting tested for until their kitty is on much higher doses (6 units). And yes, my girl had both acromegaly and insulin auto antibodies.

You are still in very early days. There is no reason to give up hope on remission. Though I would start with setting a goal of regulation. Regulation is a prerequisite for remission. Keep following the dosing method, and you will get there. And as Jill says, whenever you can get spot checks mid cycle, they really help fill in the picture. Those night time tests before bed can really help as many kitties go lower at night.

Thank you. I personally think he was doing that to for another reason. People are really something sometimes.
I appreciate you giving me hope. Sometimes in the darkness it is hard to see the light. But that's why I'm here.

 

[DevilPup]

Wendy is right. It's almost inconceivable he would propose that theory. It's not a very scientific way to say this but it doesn't work like that. Well, almost never.
Maybe that's why he's your soon to be ex vet.

You're so very right.

 

[Noah & me (GA)]

Hi Lu. I have a habit of sometimes(?) inserting oh-so-clever comments and that's what the Jill/Jeopardy thing was. Jill is a moderator, one of the people who trusts us not to burn down the house while they're away. I would never have done that if you seemed like the helpless and nervous type and obviously you're not. She caught me swearing in Swedish once and I'm still on probation.
We'll just pretend it never happened.

Those night time tests before bed can really help as many kitties go lower at night.

Noah gets dosed on a sliding scale. He's a bouncer and still unregulated after all this time. I generally reduce his PM dose to 2/3 of what I would normally give him in the morning. Some people get up in the middle of the night every night to test but I just can't do that. His strange medical history is too long to post here, you're not the only one with cat problems. Cats are not really a problem though are they?

 

[DevilPup]

Dickson? I did not take it wrong. No worries! I only get crazy about lack of good care for my animals. I understand all here are working hard to help everyone and keep it as light and stress free as possible. So not to worry.
I understand about Noah's sliding scale. You speak of a cat not being a problem? To whomever said cats were easier to care for than dogs......was mistaken.
My Guy is still showing elevated numbers. I don't understand why he is going up and not down (even some)
Also drinking more water today--very noticeable.

 

[Noah & me (GA)]

Nope, no worries, life is too short. When we had nine cats and six were young at that specific moment in time cats were easier to care for than dogs. And of course I wanted a Border Collie so that's another story.
Noah's brother Nigel had textbook curves. I would spread out a beach towel on the table and thump the chair and up he'd come for his shot. And he loved being in the car. He was easy. Understanding why Noah goes up and down will give me a stroke. He has only been out of the house five or six times in his life, terrified of everything so I'm the cat owner whose cat hasn't had a blood panel in years and tonight he demanded my wife's pizza. The short story is that he has cardiomyopathy, an enlarged heart that has torn through the cardiac sac and needed every tooth pulled years ago but wouldn't survive the surgery. He is pain free but a lot scrawnier than he looks but he is loved and well cared for. I don't understand either. If you look closely he is standing in the fridge, who knows why.
Lately he's been sticking his head in the water fountain looking for something that isn't there.

 

[JL and Chip]

I'd request a blood pressure check and a thyroid panel.