Tom the Cat - back from the Falls 2/27 - 3/2 PMPS 392

[Ilkka and Tom]

Hi guys..

Well I am heartbroken to tell you Tom the Cat is back from Iguazu & into high glucose.. . I am not taking it well.

Tonight's PMPS on 1.5u Levemir, 392... nadir in previous cycle was 147. I've posted a couple of condos on Lantus, but I am still reeling.

Could be my fault for being less than 100% vigilant about carb intake...all these cats around... he has not been looking good in general. On the other hand I think there is something else going on -- in other words, not just pancreatic diabetes but some other causal aspect. Not sure what that is yet. Had some bloodwork done, nothing conclusive. Will look into thyroid later this week.

The difference from last time is he is looking worse, I am busier and more distracted, and my wife is not here at the moment ... so I've been not exactly "shooting blind," but getting much less data than I would like. It is really uncomfortable.

Just in case anyone here understands about bloodwork, I am attaching Tom's from Monday. It's a PDF, so you can change zoom to see the small print.

A big wave of the paw from Tom to all his friends...

 

[Sheila & Beau GA & Jeddie GA]

I had heard the bad news. I am sorry to hear that Tom is not doing well "otherwise" as well. I hope you can find a cause that is fixable. I know hyper-T effects BGs, but not sure in what way (higher or lower). With Beau, it seemed to lower his BG, but I wasn't exactly making a study of it.

How old is Tom? (ETA: saw he is 11 on PDF - prime age for start of hyper-T) And what have you been feeding? I feed all five of mine the same diet so I know that Jeddie and Beau are getting low carbs all the time. It seems like the only way to go with multiple cats and a diabetic (or two).

I understand the heartbreak and "reeling", but it is what it is. I was disappointed that Jeddie didn't stay OTJ and that I can't get him back there, but I have to deal with what I am dealt, so to speak. I know I would feel defeated if Beau ever goes back on insulin (knock wood, anti jinx).

But.... it is good to see you again, Ilkka.

ETA: just looked at blood work - I'm no expert, but it looks like he has a bit on infection or inflammation (higher granulocycte %) that could be a bit of pancreatitis (higher ALT) and he has slightly elevated "kidney" values (BUN) - I wonder if he is a little dehydrated? And that could be early hyper-T and/or reemergence of FD both causing increased PU.

Is Tom prone to pancreatitis? Beau's ALT was always raised when he was in a flare.

 

[Vicky & Gandalf (GA) & Murrlin]

Hi Ilkka, good to see you here again, but not under these circumstances I understand. If anyone can figure out what's going on for Tom, I have faith in you!

Both ALT and TP, total protein, are elevated and those both may indicate liver/kidney issues or even infection in the case of TP, although from his WBC & monocytes, probably not infection.

How are his eating & comfort level? I don't know that it's time for a fPLI test unless you're seeing inappetence.

Hang in there, at least you know what you're doing regarding the insulin. Not that that makes it easier, but you understand Levemir and have a good shot at getting him under control. No pun intended ohmygod_smile

 

[pamela and tigger]

What did the vet say about his higher than normal ALT level? Did he just recommend re-checking it in a while?

Tigger had very high ALT levels when he had liver disease, much higher than Tom's is, but that doesn't mean there may not be a problem here.

Can you start him on Denamarin in the meantime?

How is his appetite?

It is nice to see you back but wish it weren't for this reason.

 

[Ilkka and Tom]

What did the vet say about his higher than normal ALT level? Did he just recommend re-checking it in a while?

Tigger had very high ALT levels when he had liver disease, much higher than Tom's is, but that doesn't mean there may not be a problem here.

Can you start him on Denamarin in the meantime?

How is his appetite?

It is nice to see you back but wish it weren't for this reason.

Hi Sheila, Vicky, Pamela,

Thanks for your thoughtful and kind replies. A few answers (in no particular order):

I don't know how old Tom is -- he joined us in 2002, but at that time he was 2, 3 or 4 yrs old. So he is now 11 or older. I am guessing 12. You bring up good points.. dehydration... he drinks like a horse (and etc.) and his fur is dryer and the skin less flexible. Am paying more attention now to making sure his water intake is kept up. Pancreatitis... I don't really see the symptoms. The early hyper-T theory... yes, will look into that.

Diet? don't ask. I am so at fault.

The elevated ALT - vet said he should be rechecked in maybe three weeks or a month, as he has seen these numbers change. In other words, it may or may not be meaningful. I don't know much about Denamarin -- anything I should be aware of, other than what I will find by googling?

Eating - healthy appetite... in fact very healthy appetite.

In general, I feel a little better this morning than yesterday, when the AM (392) alarmed me; I thought it must have been a furshot, and since I had no intra-cycle numbers, no nadir, there was no way to know. But here is an example of this kind of synchronistic thing with him -- he threw exactly the same number for the PMPS: 392. It was as if he was saying, "in case you were wondering if that was a fluke ..."

I now think I am interpreting the numbers correctly, which is that the 392s are the result of him having been at elevated levels for a while before I caught it, and therefore, even though the Levemir is clearly working (as evidenced by blue nadirs), his homeostatic "all-data-in" level, to which he returned after the blue surfing, was 392.

I am leaving a few issues unaddressed here.. but will return later.

Ilkka

 

[Ilkka and Tom]

Hi Ilkka, good to see you here again, but not under these circumstances I understand. If anyone can figure out what's going on for Tom, I have faith in you!

Both ALT and TP, total protein, are elevated and those both may indicate liver/kidney issues or even infection in the case of TP, although from his WBC & monocytes, probably not infection.

How are his eating & comfort level? I don't know that it's time for a fPLI test unless you're seeing inappetence.

Hang in there, at least you know what you're doing regarding the insulin. Not that that makes it easier, but you understand Levemir and have a good shot at getting him under control. No pun intended ohmygod_smile

Vicky,

the protein thing is something I need to understand a lot better.. thank you so much for pointing out that particular aspect. Since there are out of bounds numbers with both liver and kidney, it is even more important...

Thanks for your confidence regarding my insulin mgmt.. I do feel comfortable about that aspect, but can make errors just the same.

The fPLI -- well like I said, he is eating well, but unless this starts getting regulated (as in no pinks at all and no yellows either) fairly soon, I am going to get more testing done, and am very open to any and all suggestions.

Ilkka

 

[Sheila & Beau GA & Jeddie GA]

One thing to consider is that at this age (11-12-ish) they get "out of balance" more easily. For instance, Beau was prone to pancreatitis. He had two full blown, life-threatening bouts when he was 3 and 4. Then, (I said with my head in the sand) nothing for years until he was dx with FD. Then he seemed to flirt with the edges of it and had one more serious bout a year after he was diagnosed. Looking back, I can remember times when he ate less. A lot less. And I chalked it up to him being satisfied with less. Now that he is OTJ, the only time his appetite has been off was when he was overdosed on methamizole for his hyper-T.

So, I think having BG under control is helping to prevent pancreatitis and vice versa. So, if Tom had some little upset like a UTI that raised his BG a little, it made him a little dehydrated, and that makes anyone a little nauseated so they feel crappy and BG goes up a little more, so the dehydration sets in and kidneys are working harder raising those numbers... and so on.

We read all the time here about people saying their cat is "like a kitten again" after a few weeks on insulin and a better diet. I think the rough around the edges look is so common in newly dx and clears up pretty fast with consistent management - and probably has some corresponding blood numbers that improve as well. Their coats get soft and eyes get brighter... Tom will do the same.

 

[Ilkka and Tom]

One thing to consider is that at this age (11-12-ish) they get "out of balance" more easily.

[...]

We read all the time here about people saying their cat is "like a kitten again" after a few weeks on insulin and a better diet. I think the rough around the edges look is so common in newly dx and clears up pretty fast with consistent management - and probably has some corresponding blood numbers that improve as well. Their coats get soft and eyes get brighter... Tom will do the same.

You're right.. that is actually a big worry.. he is two years older (in 5 days is the two year anniversary of his original dx) and everything is just a little bit more sensitive.

 

[Ilkka and Tom]

What did the vet say about his higher than normal ALT level? Did he just recommend re-checking it in a while?

Tigger had very high ALT levels when he had liver disease, much higher than Tom's is, but that doesn't mean there may not be a problem here.

Can you start him on Denamarin in the meantime?

How is his appetite?

It is nice to see you back but wish it weren't for this reason.

Pamela,


Thanks -- his appetite is healthy. Did Tigger's liver heal?

I ordered the Denamarin -- anything I should know about it?

Ilkka

 

[pamela and tigger]

What did the vet say about his higher than normal ALT level? Did he just recommend re-checking it in a while?

Tigger had very high ALT levels when he had liver disease, much higher than Tom's is, but that doesn't mean there may not be a problem here.

Can you start him on Denamarin in the meantime?

How is his appetite?

It is nice to see you back but wish it weren't for this reason.

Pamela,


Thanks -- his appetite is healthy. Did Tigger's liver heal?

I ordered the Denamarin -- anything I should know about it?

Ilkka

Yes, his liver did eventually heal. His ALT was waaay over 1000 at one time. He was a pretty sick kitty but it took a while. He had cholangiohepatitis and quite possibly Triaditis.

The Denamain - I knew you would look it up so didn't give a link - is small (the one for small dogs and cats) so it fits nicely in a pill pocket. Do you have some of those? No problem giving it to Tigger with the pill pocket - you can't crush them. You do have to give it on an empty stomach though. I usually gave it about an hour before his dinner.

When do you take him back for a re-check? I am glad he is eating. That is a very good sign.

 

[Ilkka and Tom]

Yes, his liver did eventually heal. His ALT was waaay over 1000 at one time. He was a pretty sick kitty but it took a while. He had cholangiohepatitis and quite possibly Triaditis.

The Denamain - I knew you would look it up so didn't give a link - is small (the one for small dogs and cats) so it fits nicely in a pill pocket. Do you have some of those? No problem giving it to Tigger with the pill pocket - you can't crush them. You do have to give it on an empty stomach though. I usually gave it about an hour before his dinner.

When do you take him back for a re-check? I am glad he is eating. That is a very good sign.

Wow. What a story. These cats can be so fragile, and then again so resilient. Our cat Wendell -- the only feline Tom accepts -- was missing for more than two weeks. I had given up. But he had been trapped in a neighbor's garage while they were out of the country on their honeymoon. He was in there for something like 16 days with no food or water -- a one car detached garage with no exits. The neighbors came home, opened the garage door, and out slinks Wendell. He was weak and upset when he showed up here later the same day. Unbelievable.

I meant to take Tom to the vet today, but we're having all this work done and I couldn't get away. My wife will be here next week so it will be easier to get it done. I now have an angle and some questions for the vet. I researched denamarin and couldn't really find anything negative on it... the biggest thing will be getting Tom to eat it. With other hard pills I either popped it in, or often ended up dissolving it in water and then secreting the liquid into his food. You think that might work? I've never used the pill pockets, actually.

Ilkka

 

[Sheila & Beau GA & Jeddie GA]

Pill pockets are great! Beau loves them. Charlotte loves them. Jeddie, not so much. I use half a pocket for Beau's thyroid med. With Jeddie's prozac, I use about a fourth of one and just "coat" the piece of the pill with it. If he tastes that med, he starts frothing at the mouth. I have to still pill him, he won't eat it by himself any more, but at least he can't taste the med.

 

[Blue]

only the Duck and Pea pill pockets have NO SUGAR.... the others do, so be sure to get the ones with no sugar ingredients.

Did anyone mention teeth? When you go to the vet, maybe a look-see at the teeth and gums would be good.

 

[Ilkka and Tom]

only the Duck and Pea pill pockets have NO SUGAR.... the others do, so be sure to get the ones with no sugar ingredients.

Did anyone mention teeth? When you go to the vet, maybe a look-see at the teeth and gums would be good.

Hi Gayle

Yes - his teeth need some work, but not urgent.. but definitely want to have it done. Vet wanted to delay it while we brought the bg down to regulated levels.

Ilkka