Very Concerned About Possible Misdiagnosis

[SammyM]

Elvis was started on 3 units b.i.d.after his initial diagnosis when the test came back at 356. Knowing what I know now, I would have never agreed to this and would have insisted first on dietary intervention since he had been on C/D for ten years.

After two weeks, they raised it to 4 because his #s were very high when he was in their care for a day's curve. Elvis hates leaving the house so he was very upset both times. (white coat syndrome I think)

Elvis did not show much improvement...was still lethargic, was sneezing, and not eating very much. I decided to start doing my own BGs at home and changed his food to low carb can food...he still wasn't eating very much when I noticed a missing upper canine and what seemed to be a discomfort when he tried to eat. I asked if his teeth were checked on first examination, but wasn't happy with the response. I'm thinking he has teeth issues.

Based on the #s I was getting at home, I chose to lower his doses to 1.5 b.i.d., and put him on Young Again Zero Carb since I wasn't having much success with the soft foods. His numbers started to improve a lot, but something still just wasn't right. He sleeps most of the day and his appetite has been sparse.

Here's my concern....the last shot Elvis received was 1 unit this past Sunday morning. Since then his #s every 12 hours (with a couple of extra ones) were as follows: 74, 92, 87, 93, 87, 87, 87, 70, and just now....51!!! Monday I took him to the vet to check his teeth and in addition to the missing upper canine on the right, the lower one was missing too, but more worrisome was very red and inflamed gums on the left side so the vet gave him an antibiotic shot of Convenia. Elvis seems a little better, is eating a little more than he had been, but this last # and the fact it is steadily going down has me very concerned. BTW, when I was at the vet I had them do a BG just so I could calibrate with mine the difference...my ReliOn Prime # was 87, their's was 146.

Can someone give me some insight here? I'm feeling it was Elvis' mouth all along and now with all the insulin, there's damage to his pancreas. Any guidance would be greatly appreciated.

Thank you.

 

[Deb & Wink]

First, I want to reassure you that without insulin, Elvis is in no danger of going into hypoglycemia (low blood sugar). He's safe from that.

If his pancreas was damaged, it would not be producing insulin on it's own. We know it is producing insulin since you have been getting some wonderful BG (blood glucose) test numbers in the 40-120 mg/dL range for the last 4 days.

The issue with his teeth could have caused what is called 'transient diabetes'. That means a temporary rise in the BG readings due to infection/inflammation, steroid use, pancreatitis, etc.

The better BG readings you are getting for Elvis may also be due to the change in his diet. That can make a big difference.

For now, I'd recommend that you keep testing him at least twice a day. We want to see his BG readings remain between 40-120 for at least 14 days.

My second recommendation would be to try to get a dental done on Elvis if at all possible.

Just a note. Convenia was developed to treat skin infections. Not sure it's the best choice for dental inflammation, but it's already in Elvis and you can't take it back out. That antibiotic persists for several weeks.

 

[SammyM]

Oh thank you so much for your quick reply...I thought I was going to have to sleep with one eye open again tonight. This whole ordeal has stressed us out so unnecessarily I feel, plus I'm $800 in the hole. I asked them about the food initially, but they only changed it from C/D (38% carbs) to W/D (37% carbs)...big deal. Now you tell me about Covenia...he was going to give me a pill or liquid to give him every day for a week, but when I told him how difficult it was for me to give him anything orally, that's when he suggested a one-time antibiotic shot that lasts a week. Is there another one? Could he have given Elvis the wrong medication?

To be truthful, I am really disappointed with what they've done. If they had looked in his mouth on initial examine when I first brought him in on March 10th, and with the initial BG test reading of 356 (which to me isn't off the charts ridiculous), AND knowing about this 'transient diabetes', am I wrong in my accusation that the initial course of action to administer 3 units b.i.d. of ProZinc was too aggressive? And every time I tried to suggest lower carb foods, I received resistance; even when I suggested doing the BGs at home I was told that wasn't advisable. After nearly 3 weeks I took matters into my own hands on both counts. I dropped the dosage to 1.5 b.i.d. at first, and when I saw how Elvis was at certain levels and times of the day when I did a BG every 4 hours, regardless of the # I decided to treat the patient and not the #.

Elvis has been on Young Again Zero Carb dry food since April 17th, and it's no coincidence to me that his numbers are dropping so significantly. I just never thought he would be off insulin in just one month which is another reason I felt he was misdiagnosed.

Many MANY thanks again.

 

[BJM]

Had you continued with a high carb diet, he may have needed 3 units or not. Spitzer needed 3, then dropped to 1 unit for a while, after switching to low carb.

 

[SammyM]

Had you continued with a high carb diet, he may have needed 3 units or not. Spitzer needed 3, then dropped to 1 unit for a while, after switching to low carb.

I understand that, but considering the dental distress he apparently had, and the fact the first number was just 356, and that he had been on a very high carb food for so long, I just feel the initial treatment was too knee-jerk and aggressive. Maybe if the dental was corrected and the food changed immediately, he wouldn't have even needed insulin. I guess I just wish that was tried first, but I'm like that with my own health issues...let me try to correct things naturally before you start giving me prescriptions for this and that; most of the time I have been able to reverse something before needing meds. I should have used my own theory for Elvis, but when it's not your own life, you're a little less brave.

 

[Elizabeth and Bertie]

Hiya,

That 356 was certainly a diabetic number. But it's impossible to know how much of that was due to vet stress and due to the high carb diet. Did Elvis also have a fructosamine test? (That gives a sort of average of BG levels over the preceding couple of weeks.)

It may be that Elvis did need the insulin to help his little pancreas heal.
And we have seen other cats here go off insulin after just a month.

Thank goodness you changed the diet and learned to hometest, though! The result of that is that Elvis may be able to come off insulin completely (touch-wood/anti jinx!). (And I honestly wonder how many care-givers out there are unwittingly keeping their cats insulin dependent by feeding high carb and/or not hometesting...)

You've done a brilliant job with Elvis, and his numbers look fantastic now.
We're keeping fingers and paws crossed here for remission for him.

Eliz

 

[Sue and Oliver (GA)]

I certainly think you could communicate your concerns with your vet, so maybe he would think about prescribing insulin after a diet change, especially with a decent number on the one time test, and consider vet stress. We really like diagnosis after a fructosamine, not just one test in the vet office, if that wasn't done.

He may not change anything, but at least you would have tried?

 

[SammyM]

Hiya,

That 356 was certainly a diabetic number. But it's impossible to know how much of that was due to vet stress and due to the high carb diet. Did Elvis also have a fructosamine test? (That gives a sort of average of BG levels over the preceding couple of weeks.)

Not sure...I didn't see that described as such on the bill.

It may be that Elvis did need the insulin to help his little pancreas heal.
And we have seen other cats here go off insulin after just a month.

That is a bit more comforting to know.

Thank goodness you changed the diet and learned to hometest, though! The result of that is that Elvis may be able to come off insulin completely (touch-wood/anti jinx!). (And I honestly wonder how many care-givers out there are unwittingly keeping their cats insulin dependent by feeding high carb and/or not hometesting...)

It just didn't make any sense to me to give him insulin and continue him on the 38% carb food....was kind of like shoveling you-know-what against the tide. I'm afraid there may be too many caregivers who just 'do what the doctor says' without any research. Thankfully I don't follow that school of thinking.

You've done a brilliant job with Elvis, and his numbers look fantastic now.
We're keeping fingers and paws crossed here for remission for him.

Thank you...got my eyes crossed as well. :smile:

Eliz

Donna

 

[SammyM]

I certainly think you could communicate your concerns with your vet, so maybe he would think about prescribing insulin after a diet change, especially with a decent number on the one time test, and consider vet stress. We really like diagnosis after a fructosamine, not just one test in the vet office, if that wasn't done.

He may not change anything, but at least you would have tried?

I have put together a 4-page chart (critical path kind of chart), laying out from day one March 10 when I brought him in, to now. I plan on making them aware that not every animal that walks in there with an elevated BG is an automatic diabetic animal, especially when there are other red flags that should be considered too. I already tried to discuss the low-carb foods with them, but got a deadpan stare and felt my words were falling on deaf ears.

 

[Melanie and Smokey]

Giving insulin to Elvis would not damage his pancreas, insulin therapy often aids the pancreas and gives it time to heal.

You keep saying that Elvis not diabetic. The numbers say different. 356 is a diabetic number, a high one, and the fact that he continued to test high says that he is likely a diabetic cat. He is just now a diet controlled diabetic or some would say, in remission. If you wet back to feeding him high carb food and didn't take care of his mouth, his numbers may likely end right back up there. That is the difference between many of our diabetics and "normal" cats, they cannot handle those things like high carb food that other cats can. Please do educate your vet on food controlling diabetic cats in hopes they will try that first in the future, but please don't believe that Elvis is not diabetic and think that he can go back to the things he did before because it was just a misdiagnosis, he is still a diabetic and needs to be cared for as a diabetic cat so that he does stay off of insulin. You've found exactly what you needed to do to care for him, and his numbers are now beautiful, so please keep on that track. I worry when I see people talking about misdiagnosis that they will think the changes they made were unnecessary and go back to old habits.

 

[SammyM]

Giving insulin to Elvis would not damage his pancreas, insulin therapy often aids the pancreas and gives it time to heal.

You keep saying that Elvis not diabetic. The numbers say different. 356 is a diabetic number, a high one, and the fact that he continued to test high says that he is likely a diabetic cat. He is just now a diet controlled diabetic or some would say, in remission. If you wet back to feeding him high carb food and didn't take care of his mouth, his numbers may likely end right back up there. That is the difference between many of our diabetics and "normal" cats, they cannot handle those things like high carb food that other cats can. Please do educate your vet on food controlling diabetic cats in hopes they will try that first in the future, but please don't believe that Elvis is not diabetic and think that he can go back to the things he did before because it was just a misdiagnosis, he is still a diabetic and needs to be cared for as a diabetic cat so that he does stay off of insulin. You've found exactly what you needed to do to care for him, and his numbers are now beautiful, so please keep on that track. I worry when I see people talking about misdiagnosis that they will think the changes they made were unnecessary and go back to old habits.

Melanie, first let me be very clear that I would never jeopardize Elvis' health by going back to old habits. I was never in favor of keeping him on the Hill's C/D in the first place, but against my intuitive and better judgment, went with the vet's advice that he had to stay on it the rest of his life. I wouldn't be surprised to learn that it was that food that became his bane for his current condition.

Also, I haven't kept saying he isn't diabetic, but I have repeated that I felt he was initially too aggressively treated (6 units per day) based on a # that could have been elevated by the inflammation and infection in his mouth, being on a high-carb food for 10 years, and the fact that he is petrified to even be out of his home, let alone poked and prodded by strangers. I said I was bothered that none of that was taken into consideration before deciding a protocol. Why not try diet first? Why not treat the dental problem? That's what I am harping on. Perhaps if this was done first he wouldn't have needed insulin, or at the very least, started on a lower dose initially.

As far as educating my vet about the food...I have tried several times and have been received by cold blank stares and the feeling that everything I was saying was falling on deaf ears. If it isn't a food that has to have a prescription, apparently to them it's not good. Doctors don't have all the answers and it's good to question them...sometimes you have to treat the patient, not just a number. Elvis never responded positively to the 3 and then 4 units b.i.d.prescribed...was always lethargic, wasn't eating, and slept all day. His #s when I was told to bring him in for the day for curves were always high, yet when I finally decided to take the readings at home, wean him off the C/D and W/D and lower the doses a bit, did he start to come around. His mouth was a concern they never addressed until I demanded an exam (which should have been done when I first brought him in)...he's on the antibiotic, eating much better, purring again, and the highest his # has gone in the last 11 BGs since last Sunday night is 93. His last insulin shot (1 unit) was 9:00 AM last Sunday.

It was me who took the initiative to get him off the high carb food, me who decided to do the BG testing at home against their recommendation making sure I took one every 4 hours so I could get a good indication of how he was responding, me who had to tell them to check his mouth, me who lowered the dose amounts based on his behavior and not just the number, and he is doing 'markedly' better. If I had solely listened to them he would still be on the high carb prescription food, still have an undetected infection in his mouth, still be going to their offices once a week for those useless curves, still be getting two insulin shots a day of lord knows how much based on those skewed #s they were getting during those curves, and I don't even want to think of how bad it could have gotten because, as I said, he just wasn't improving at all under their protocol.

So if I sound a bit disenchanted with the care Elvis has received, that's because I am. Diabetic or not, they could have been more proactive than reactive, that's all I'm saying.

 

[SammyM]

Just a note. Convenia was developed to treat skin infections. Not sure it's the best choice for dental inflammation, but it's already in Elvis and you can't take it back out. That antibiotic persists for several weeks.

Something made me look up this drug and I was horrified to read what Dr. Pierson wrote about it on her site.
http://www.catinfo.org/?link=convenia

I specifically asked the vet if there were any potential side effects and he said no, but after reading this, I'm angry that I was lied to again. This med could and has caused death????!!!!!!!! If I had known this I would NEVER have agreed to it. And I read it stays in the system for months!

My question if you know the answer....Elvis received the shot Monday at noon. Is it safe to say that if he hasn't had any side effects yet, that he won't, or is there still a chance he could since the drug is in his system for so long. Damn I'm so angry with this vet.

 

[Suzanne & Cobb(GA)]

Donna, my Cobb had a dental this past Monday. They also gave him a shot of Covenia, even though I had intended to mention to them I didn't want it. The day was a rush and it slipped my mind when they took him back.

I would think that if Elvis was allergic to the medicine, it would have showed up by now. It has had plenty of time to get in his system. So I wouldn't worry too much about that now.

I've had my fair share of anger at vets we've taken Cobb to. That is why we will now be going back to South Carolina to see a vet I trust there (Cobb's original vet when we lived there). Look around for another vet when/if you can. BJ has some excellent vet interview questions in her signature.

It's good you've taken the initiative! Hope Elvis feels better and you find someone you can work with!

~Suzanne

 

[Sandy and Black Kitty]

Hi there

Vets are 'general practitioners' sadly, there are few that know the ins and outs of FD. It can be down right dangerous. So many just blow you off when the subjects of proper diet, home testing and the TR protocol are brought up. I'm glad you found us and that your common sense guided you and prevailed. Definitely give that vet the facts and data you have collected on Elvis, then dump him.

Look for a new vet, one that understands FD and will work with you. Interview them if you can.

My Black Kittys chart is noted - No Metacam, No Covenia and No Steroids. Still, I remind them.

Regarding the teeth - has Elvis had a dental? My BKs teeth and gums were his Achilles heel and addressing them with a veterinary dental specialist took him from hopeless high dose kitty to off the juice. He was the last cat anyone thought would go into remission. Yet, 4+ years later he remains in remission.

 

[Grayson & Lu]

Hi! First I want to say KUDOS TO YOU! for researching and learning and being the caregiver that you are! Your initiative is paying off with Elvis, whether he jumps up & thanks you or not! I was fortunate to have an experienced FD mom coaching me when Grayson was first diagnosed. She suggested the food change, she suggested a 1u starting dose, rather than the 2u the vet recommended, and starting a week AFTER the food change. Having a hand-holder along the way was invaluable, so I really give you kudos for learning/deciding on your own!

You've already gotten great advice - Having an insulin-resistant Acro cat is a little different than normal diabetic kitties, but most of the same rules apply. I am convinced that a staph infection in one ear was the basis for much of his insulin resistance. The same applies to the dental issues you've identified. I've seen many cats go OTJ after a dental. I've seen even more go OTJ with just the food change. I had a foster who was on 4u ProZinc when she came. Diet change and she never had insulin again! And one of my civvies caught me off guard last year. Food change again, 1 week of insulin, and voila! Never underestimate the other variables that we can find and control.

The vet that dx Grayson rolled his eyes when I mentioned I had found info on FD on-line. I completely get the response you received. Keep in mind, much of their continuing ed on diet is sponsored by Hills and Purina. :shock: Of course they are going to promote their product.

When I had a fair amt of data, I sat down with my vet that is treating G now. We talked about food spikes, his SS, low carb foods, bringing up numbers, etc. It made a huge difference. She has since asked me for the link to Dr. Lisa's www.catinfo.org and food charts. She's THRILLED that in spite of 2 years, obscenely high doses (for the resistance), that G has never hypo'ed, a testimony to home testing, which she initially indicated most of her FD clients wouldn't be comfortable doing. Now she calls me to assist new FD parents. You CAN change them, but they need some reassurance you're not taking advise from some wacky person on-line, but you can have an impact on how your vet treats other FD kitties. Or, you can opt to find one that is already familiar with these things. That's a great value of this group - the number of animals being treated, the caring folks who hang around and advise, and the success stories of those that have gone OTJ - you can't dispute the numbers!

So, wishing you continued good luck in caring for Elvis, and welcoming any questions others and I can help with.

Lu-Ann

 

[Deb & Wink]

Just a note. Convenia was developed to treat skin infections. Not sure it's the best choice for dental inflammation, but it's already in Elvis and you can't take it back out. That antibiotic persists for several weeks.

Something made me look up this drug and I was horrified to read what Dr. Pierson wrote about it on her site.
http://www.catinfo.org/?link=convenia

I specifically asked the vet if there were any potential side effects and he said no, but after reading this, I'm angry that I was lied to again. This med could and has caused death????!!!!!!!! If I had known this I would NEVER have agreed to it. And I read it stays in the system for months!

My question if you know the answer....Elvis received the shot Monday at noon. Is it safe to say that if he hasn't had any side effects yet, that he won't, or is there still a chance he could since the drug is in his system for so long. Damn I'm so angry with this vet.

Sorry it's taken me so long to get back to answer you but I've been having a horrible time trying to get on the board and get into messages to answer people.

Someone else already said this, but it's worth repeating. If Elvis has not shown any adverse reactions to the Convenia, he should be ok.

We try to educate ourselves as much as possible and pass that information along to other members here and hopefully they can try to share some of this info with their vets. You've learned so much here already, made the changes needed to get Elvis diet controlled and we hope that continues.

One article you might want to share with your vet is the AAHA Diabetes Management Guidelines for Dogs and Cats, vet journal published back in 2010. It's jam packed with information about some of the more current information on treating diabetes.

We're all rooting for Elvis and hope he continues to do so well under your loving care.