Vines for my civvie + info on lymphoma? + BG question (310mg/dl)

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Steph & Quintus & L & O

Steph & Quintus & L & O

Member Since 2017
Hope you'll excuse me a post about my civvie, Erica. She spent the day at the clinic today and came back with a suspicion of intestinal lymphoma (did bloodwork and ultrasound, spoke to the vet who did the US, not looking good). Biopsy planned for Tuesday (lymph nodes, intestine, kidneys).

Vines most welcome, but also info about lymphoma which I don't know much about. If you have stories to share...

Thanks.
 
If small-cell-intestinal lymphoma then the treatment is prednisolone and chlorambucil. It is less expensive to get compounded chlorambucil from either Roadrunner or Diamondback internet pharmacy, I do not remember which. But I will know next Friday.
My Mario has small-cell-intestinal lymphoma and lived a good live for two years after diagnosis. If diabetic, like my Mario prednisolone is frequently not used.
Here is the Yahoo group
https://groups.yahoo.com/neo/groups/feline_lymphoma/info
 
To diagnose small cell lymphoma, either endoscopy or biopsy of the bowel is needed. Not the lymph node or kidney unles there is some complication there. If it SCL, not sure you can get meds compounded, we can't in Canada, but Leukeran is a reasonable price here. There is a very knowledgeable Feline SCL group in groups.io, that has an IM vet who participates. PM me if you can't find them. A large number of SCL cats go into remission, often for years.
 
:bighug::bighug::bighug::bighug::bighug: vines and prayers for Erica :bighug::bighug::bighug:
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Thanks everybody! She seemed reasonable herself last night after a day on I.V. (forgot to ask what she got, but definitely bupe). This morning she is completely apathetic. I gave her her meds (omeprazole and metoclopramide) and am waiting 30 Minutes to try and get her to eat. She’ll get metacam with her food. Fingers crossed she will eat...

The reason for the multiple biopsies is they want to check the various tissues that look abnormal/concerning on the US.
 
So, here's a BG question about her. At the vet, they checked pretty much everything, and her BG was 198. High, but with a cat in pain and stressed, not necessarily alarming. Glucose in urine, however, rated "3+" -- preoccupying. So, fructosamine test. 302 mmol/l (boundaries: 191-349). Normal. Ultrasound-vet explained that in this context she would interpret the high glucose in urine as a kidney problem (tubular issues?). The kidneys are on the large side of normal on the US.

As she was so crappy this morning I decided to measure her BG with the AT2. 17.2 mmol/l = 310

Her total lipase is 1113U/l (boundaries: 500-1500) and the ultrasound for the pancreas was good, so they ruled out pancreatitis and didn't do an fPLi.

Questions:
  • how does the fructosamine number relate to the BG numbers we're familiar with?
  • is pancreatitis with "normal" totale lipase and "normal" US plausible, or are we effectively comfortable ruling it out?
  • she is clearly in pain, can 310 be due to pain? I'm going to check in another hour
  • the measures at the vet were done when she hadn't eaten in over 24 hours. Could that explain a "low" 198? She ate yesterday during the day and last night, HC (="normal") food.
  • can 310 be making her feel so crappy she is off her food? what do we know about when diabetes "brutally starts"? can diabetes "brutally start"?
What do we do/think of with elevated BG like this but what seems to not be a diagnosis of FD (ie, the fructosamine test)?

If she continues not eating I'm going to take her to the ER (I don't see myself waiting until Monday with a cat who seems in pain and not eating) so any "baggage" I can have to have intelligent discussions with the vet there is most welcome.
 
245 yet two hours later. Still hasn’t eating. Going to take her to the ER.

But interested in what you think about the BG. Does this look like an OK pancreas, or not? Would it go down faster in a « healthy » cat?
 
I'm sorry your civvie is having such a rough time :(.

I'm not sure about the BG, but there have definitely been people who have come here with a cat who was diagnosed as diabetic during a health crisis, and then went instantly into remission when the crisis resolved. Hard to say for sure (you don't always get 100% of the details on timing, etc.), but I think it's certainly possible that Erica's high BG is just from all the other stressors she's feeling right now, poor thing.

Just in case (and if you haven't already) do have the ER vet check for ketones. And, speaking of the pancreas, did they test for pancreatitis during the previous work-up?

Good luck at the ER. :bighug:
 
They checked for ketones yesterday, negative. Not panc as US was negative. Called the on-call vet and going there in a bit. They'll do the snap panc test, vet I talked to also thinks it's worth checking given the evolution.

I also think the high BG is transient. But wondering how it can be used as a "symptom" to evaluate what else is going on.
 
Don't know the answer to a lot of your questions, and specifically when a high bg makes a for sure diabetes diagnosis, vs not, but regarding the fructosamine... from what I understand an elevated BG at a vet can be brushed off up to a certain number because of vet stress. I inquired about this with Asia, she was in the 400s, they considered that a slam dunk as it was too high for vet stress. Typically an elevated BG that is concerning but perhaps not too high for a slam dunk diagnosis, you would get a fructosamine. All the fructosamine tells you is an average over a period of time, so if that average points to high numbers at home, diabetes is the culprit. Perhaps other things are going on, like pancreatitis, but I don't understand how that would rule out or negate the diabetes or why they would decide not to treat it.

:bighug::bighug::bighug::bighug:
 
After she struggled and complained loudly during the blood taking, I decided to take a BG reading. Down to 9.9mmol/l = 178, an hour after last reading. Did she use up her BG in the struggle? So much for stress-induced hyperglycaemia. Waiting for Snap panc test result.
 
Snap test for panc negative, but we still opted for giving her antibiotics as her temperature is high and it clearly looks like something infectious is going on.

If she’s not eating tomorrow morning I head back. Had a great convo with the vet, including on diabetes. He says he struggles to get his clients to home test, they are scared of doing it!
 
I'm sorry to hear about the diagnosis. My previous kitty had intestinal lymphoma and was treated with prednisilone and chlorambucil plus B-12 injections. She lived about a year with this condition but started having a reaction to the chlormubucil and we had to stop treatment. I was told some kitties can go on for two years in remission with this condition but my kitty was not one of them. She never developed diabetes but did start having kidney infections due to the decreased immunity from the pred and they were getting too hard to treat. :bighug::bighug::bighug:
 
Regarding stress-related BG: the simple answer is ECID. Some cats go up at the vet, some go down. I'd put an asterisk on the vet visit tests so that you can cast them aside while looking at the fuller picture.

Something is obviously going on and if pancreatic numbers are within range, the pancreas could be reacting to the main problem by producing less insulin. (No science to back this up. I don't even know if this makes sense. Just a thought. The pancreas is a touchy beast.)
 
Stephanie & Quintus said:
What are the other kinds of lymphoma aside from small cell lymphoma?
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Large and medium cell. Large cell usually presents with a mass.

Have you asked the vet for some antinausea meds? Ondansetron and Cerenia are the common ones used. SCL is not painful - shouldn't need metacam for that. I wouldn't give it if there is a potential kidney issue. I would give anti-nausea meds to a kitty before giving an appetite stimulant.

Stress can cause high BG. My civie (who later got SCL), once registered over 220 at the vet, 53 (human meter) at home the next day. I recommend home testing. :)

Lipase isn't used in cats to diagnose pancreatitis. Primer on pancreatitis.
 
Wendy&Neko said:
Have you asked the vet for some antinausea meds?
Click to expand...

Nope, on the list if she's still not eating tomorrow and I head back.

Wendy&Neko said:
SCL is not painful - shouldn't need metacam for that.
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Clinical examination showed very important abdominal pain. She was on bupe at the vet's. She's clearly still in pain now. SCL or not, I go with treating the pain for the immediate.

Wendy&Neko said:
Stress can cause high BG. My civie (who later got SCL), once registered over 220 at the vet, 53 (human meter) at home the next day. I recommend home testing.
Click to expand...

So, 198 Friday was chalked up to "stress" (but glucose in urine nonetheless). Today, see table here https://docs.google.com/spreadsheets/d/1lji4XkT0UZ23z5xWRuQwgd9k-EXmCqwkdPoUhftaISo/edit?usp=sharing -- DOWN to 172 at the vet (from 310 at home). You bet I'm home testing ;-) even though she's my civvie.

Wendy&Neko said:
Lipase isn't used in cats to diagnose pancreatitis.
Click to expand...

Yup, I know, though they do tend to use total lipase as an indicator of whether SpecFPLi is warranted or not. That's why we did the Snap test this afternoon. Negative. But I still think it's panc (and the ER vet doesn't disagree).
 
I’m so sorry to read about your kitty. I’ve dealt a lot with kidney disease and high BG was never a symptom. Could definitely be stress. One if mine also had intermediate cell lymphoma. It’s not as easy to treat as SCL but not quite as aggressive as large. We treated like it was large cell with chemo injections. It sometimes is treated first with prednisolone and leukeran. Tiffany had a high white count and loss of appetite. She was projectile vomiting once or twice a week. Ondansetron or cerenia should help if nauseous. Hope you get good results.
 
tiffmaxee said:
The problem with the Snap is you don’t get a number so if in the gray area it will be negative. Also if just starting it can rise later in the day. It definitely could still be panc.
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Thanks, this is exactly what the vet and I were hypothesising.

Good news this morning!

As soon as I woke up I went down to the office. Erica was in her chair (last night she was sprawled on the floor like a miserable rug). She had at least nosed her kibble. I gave her her meds and by the time I reached the third one she was growling and hissing (normal behavior) and hopped off the chair to her "window seat" saying "stop shoving things in my mouth and let me out!"

She drank a bit, ate a teensy bit, did her claws on her beloved cardboard thingies, and reacted to petting instead of just putting up with it. She was sitting down and looking at me actively.

I didn't manage to get a BG reading because she growled and hissed and told me in no uncertain terms I wasn't getting the pokey thing near her ear a third time (didn't draw blood on first two pokes)!

I'll try again in a bit once she has calmed down. But clinical signs definitely seem to point to a cat who really liked antibiotics.
 
Thanks! Got two BG readings and they're going down. Last time I checked she was eating (she usually waits until I'm there to eat). Not great appetite, but still! Going to call my vet tomorrow to cancel that biopsy. No sense in opening up this kitty right now.
 
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