05/17 Shmee PMPS 133! Vet visit tomorrow

Previous condo

Good morning,

I woke up for a +8 last night thinking I might catch a blue since he has been inconsistent with his nadirs, and it was another pink. He gets pill pockets at +10.5 AM & PM. I thought that might be causing some pinks but who knows now since +8 was very far away from that...

On Tuesday, I think I missed a green, so I was going to keep the dose for 5 days. But Wendy was saying that we only go off of what we see, so she suggested 4 days instead of 5. So he is getting his increase today, unless there are any objections. With those pinks I think it is ok to increase. His lime greens came from this dose last time, but last time I accidentally increased too soon. So hopefully it goes a little more smoothly..

Tomorrow Shmee has a checkup for his teeth (two weeks post-dental). The vet previously expressed concern for the high amount of insulin he is on; she thinks his numbers are still way too high. She said before that if he doesn't start coming down she wants an ultrasound, so I am worried she is going to say she wants one when we go tomorrow. I know a lot of people on this board are on higher doses, and I believe someone mentioned in a previous condo that we I should not express concern until he goes over 6 units. Do you think this is still the case, post-dental? The reason she wants an ultrasound is because of his previous high liver levels. You can see the labwork and drastic improvement after the Denamarin in my SS.

Thoughts? If the vet suggests an ultrasound, can I hold off on that for now? Maybe until that 6 units someone previously mentioned? The ultrasound technician is an hour away and he has to sit still for a half hour. I really do not see this happening. Someone suggested I ask if I can hold him - I will definitely ask about this if it comes down to it. He absolutely hates the car too... I do not want to do this ultrasound until you all think it is really necessary.

 

I did not give the Denamarin this morning. Unless there are objections I think I am going to stop the Denamarin for the next few weeks to see if he still needs it like the vet suggested, and bonus - see if taking away the pill pockets help his numbers. The only way he would eat the pill is if it was divided into 3 pill pockets. So he usually gets 6 a day.

 

I think you are OK to take the dose up.
He needs as much juice as he needs. We have had kitties on more insulin that eventually hit the right dose and then start moving down the dosing scale.

I think the 1/2 unit decrease was too much (with the benefit of hindsight), so you had a failed reduction, often when a reduction fails we find you have to come back up in dose before you start to go down again. While he is under 5units I would stick to 0.25u changes, unless we start to see something changing.

What is she worried about that she wants to check with the ultrasound?

The tests we recommend for high dose conditions (acro/ IAA) are blood tests, often kitties will have no other signs of the disease.

Good luck with the new dose.

 

Denamarin is a supplement more than a drug, it’s just SAMe and milk thistle extract. If it is helping Shmee, I would wait and see what your vet says about discontinuing it. If Shmee is taking it in pill pockets, that could cause the BG to go up a little, so you could discuss that concern with the vet and see if they think denamarin was a short term fix or something that should be maintained for liver support. It does take weeks to show improvement with it.

An unltrasound is not going to happen without your okay, so if your vet thinks he needs it, be open to the concerns and you can always save it as a future option if need be. My vet initially wanted to get one for Asia to diagnose pancreatitis, I asked if the u/s would change how we would go about treating the pancreatitis and he said no, so I opted to hold off.

It’s been such a short time since the dental, it’s hard to evaluate the effect of BG until the dose is a good one and a little more time has past. Like Gill says, he needs what he needs and I wouldn’t be concerned about high dose conditions just yet. I know your vet is antsy about the numbers and the dose, but it will work itself out in due time.

I would, however, ask for a senior panel or something similar to get a full blood workup and urinalysis, it can tell you a lot, but if for no other reason than to have a baseline, so many values missing and at Shmee’s age it makes sense to have a more complete profile every time IMO.

 

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Thank you, yeah that was a long night and I needed to get some sleep, plus my first limes for hours and I was really nervous about the next dose. I am trying not to be a BCS next time! haha

I think the reason she has mentioned getting an ultrasound is because she thinks there might be something wrong with his liver, or just something going on internally that we can't see. I don't think she has much experience with this "higher" dose of insulin, so she thinks there may be another problem, especially since his liver levels were very elevated on Dx (but they have come down since then).

I will talk to her about it tomorrow, she may not think he needs an ultrasound yet, hopefully..

Yes I know it is like a liver enzyme, he was on it 4 weeks and it improved his numbers significantly! She had mentioned the last time we talked a few weeks ago that I can take him off the Denamarin as a test, to see if he will need it or if it was ok short term. Since he is still seeing pinks, I think it is a good idea to try so we can also see if that is causing his higher numbers. I will be sure to talk to her more about it tomorrow.

I am happy you both are not too alarmed by his higher numbers yet, this makes me feel better!
As for the senior panel, what does that mean, bloodwork? He just had it done 04/04. You think bloodwork needs to be done more often? What values are missing? He has also had a urinalysis before. I did not think to upload that to the SS - I can ask my vet for a copy of it. What information would the urinalysis show? I can get my own sample of that today or tomorrow if you think this needs to be done again.

 

I don’t think he needs blood work more frequently, I just think when you go through the trouble of taking blood, might as well get a complete blood count, T4, BUN, creatinine, electrolytes, all the things missing from the abbreviated panel your vet is running. I would run a full panel on my non senior days, personally, but definitely as they age there is key information there. Seniors can be prone to kidney issues and things like hyper T so it’s good to have a baseline and be able to monitor that over time so you can be proactive at the first sign of trouble. Urinalysis can also tell you things about liver and kidney function, as well as diabetics are more prone to things like UTI. I don’t see a reason to get a urinalysis every time unless he’s prone to urinary issues, but they often are included in things like the senior profile test, depending what lab your vet uses.

 

Excellent thank you, I am so grateful for all this info. I wasn't even thinking my new vet is running an abbreviated panel, but now that you say that I do remember her saying in the beginning she didn't think a full panel was necessary. I going to call now and ask if we can get a full blood panel done tomorrow (I'll ask if they have a "senior" blood panel?), as well as ask if they can email me the results of my last urinalysis. I am going to try and get a urine sample today, in case I need a new urinalysis I can bring in the sample tomorrow. Plus its about time for me to check for keytones again so might as well get that done from the sample.

He actually did have crystals years ago, when he was maybe 4. He had to have surgery and was on the "prescription" food for years. Ugh.. if I knew then what I know now. He never had issues like that after though. I am hoping the wet food diet change has helped a lot too. All I remember from the urinalysis is that they said his kidneys were functioning properly.

 

Hope vet visit goes well

 

It’s really a cost thing, I don’t know what one panel costs vs a full one, but I wouldn’t think it’s significant, see the cost difference and weigh if that is a huge impact with the frequency of blood draws, if it’s once or twice a year, it should be well worth it. They are taking blood regardless, so I’m a fan of having more info, not less. As well, the senior profile includes the SDMA which is better at detecting kidney issues long before they would impact BUN and creatinine, cats as a species just suck at having good kidneys, many develop renal insuffiency over time as they get up in years, there is so much you can do early on to hold it off for as long as possible. The SDMA is only with IDEXX, by the way, there may be some equivalent test from Antech, I’m not sure.

 

I just updated my SS with his last urinalysis results. I don't see anything on the results about USG or MA. Are those significant? His glucose result is also 3+ .. on the SS it says it should say negative. Is this something to be concerned about or normal since he is diabetic?

Makes sense. I would like to get more data if it can be helpful. The vet tech is calling me back after she asks the vet about what full blood panel work they offer and how much it costs. I will ask about the SDMA and if they are capable for testing for that when she calls me back.

 

The date of the urinalysis, Shmee was in pinks so the 3+ makes sense for glucose. It should be negative for a non diabetic cat, it being positive indicates a potential diabetes diagnosis. It can be negative for a diabetic cat as well, as long as the numbers are below renal threshold. Having sugar in their urine is also what makes them more susceptible to UTIs and such. I'm not sure what MA is, but it's not on any of Asia's results either, so perhaps it's not run as a typical thing, or it may be another lab specific thing.

USG is urine specific gravity. It's something they can do at the vet's office with a refractometer, I'm not sure why it wasn't done on Shmee. It's an important test because it tells you how concentrated or how dilute the urine is, which can be useful information for many things. Maybe it's just listed on your sheet as specific gravity? If so, that's USG.

 

Ok yes it said "specific gravity", it has been updated - it is in normal levels.

 

. Antech doesn’t have the equivalent of the SDMA. They do have a senior panel though and it would be good to get if not much more money. The kidney numbers and USG were good in February so you could wait on that.

 

Just got the call back from the vet - they must use Antech because she said it does not include SDMA. She did say that she will look into using the other lab though, and how much it would be to send it out to them instead.

The full blood panel (not including SDMA) is $137, compared to the abbreviated one that is $70. I would pay the extra but for now I think I should probably wait to see how much the one that includes the SDMA will cost. Then I can just do it all at one time. She said she will try and get the call in to the other lab (I assume IDEXX) today or tomorrow.

 

Yes. IDEXX is the lab that has the SDMA. My vet uses Antech but can send to IDEXX I think because that’s where he gets the Spec fPL test. We sent for a urinalysis there once.

 

That is quite a hike in cost. If they can send to IDEXX for SDMA that would be useful for the future. It’s tricky if you should have the whole panel run through IDEXX vs just the SDMA because if your vet uses Antech and you intend to stay with this vet, I think it’s more useful to compare numbers over time from the same lab, it’s hard to compare IDEXX numbers to Antech, IMO.

 

She just called me back and said the full blood work panel (I think that's what she said?) from the other lab (I assume IDEXX) that includes the SDMA is also $137. So I was thinking I might as well get it done there so we can have that SDMA value... but now I am a little confused if the labs numbers would be different and hard to compare in the future...

 

They will be different and different labs have different ranges. You will see in Jones SS I have the range and result together for the date as I had the same issue of different labs.


Vines for the vet visit tomorrow.

 

It's good to get the SDMA and if you do that, say yearly, you can compare it to the previous IDEXX values. Additionally, if your vet can use IDEXX labs, you could just request all bloodwork be sent there for consistency. It's not like it will be worthless, it's just harder to see trends over time if you have different labs/different lab values.

 

Ok thank you. It makes more sense to me now. Since you think it would still be helpful to get that data then I will do it. That is a good idea to just have all bloodwork sent there in the future of they can, for consistency. My poor Shmee... he is literally a screamer at the vet.. I don't want him to have to get bloodwork done but if its for the best might as well. She gave me Gabapetin but she said to sprinkle it on top of the food and he would not eat it.. I wonder if it would still work to mix it in with food..

 

Which flavour of pill pockets are you using? Both the cat chicken and salmon ones contain corn syrup (aka karo) as ingredients, along with wheat flour. If he'll eat the dog version of the allergy free Duck/Pea ones, those have less carbs. Just break off a piece and wrap it around the pill.

Good luck with the increase. Just because he went low on that dose one time, doesn't mean he will this time. It's not uncommon to have to dance up and down around a dose. He's only see upper blues since the 9th. Doesn't take long for a bit of glucose toxicity to set in.

I did bloodwork every 6 months for Neko, unless there was something we were monitoring, in which case I'd do a mini panel on that more frequently.

There is no real magic to the 6 unit number. It's just that if cats get to 6 units we suggest testing for high dose conditions. We've seen cats get close to that that have other issues, which when resolved bring the dose down. So at 6 units, there is a pretty good chance of a "high dose" condition. Note that cats can have a high dose condition and be on less than 6 units. The Royal Veterinary Study that found 1 in 4 cats has acromegaly, found some on as low as 1 unit.

 

Sorry it got busy at work then we had plans for dinner, which is why I missed that +9 too, I wish I would've seen if he went lower than 129.

He also just gave me his lowest PS yet - 133. I really hope I am not up all night, my head is killing me!

Yes unfortunately I know they are HC he never would eat the duck ones. That is why I wanted to try and get him off of them as soon as I could. I tried lots of things like a few different kinds of cheeses, poached and baked chicken, tuna, but he would either never eat the part with the pill or wouldn't eat them at all eventually. So I kept coming back to the HC pill pockets because he is stubborn and they always worked.

Thank you for all this. I was thinking that depending on how the vet visit goes tomorrow and her opinion on everything, I might just wait a few weeks on the full panel bloodwork since I just had the abbreviated bloodwork on 04/04, and just stopped his Denamarin last night to see if he really needs it all the time or if it was just needed in the beginning. Per the vets previous suggestion we could just go off the Denamarin for a few weeks and test his blood, so instead of doing the full panel now and then again in a few weeks, I might as well wait those few weeks since we don't need the SDMA value right away. Hopefully that makes sense. Do think that is a good move?

I have read about the 1 in 4 cats being acro - I thought that was staggering! Wouldn't I be able to tell if he was though? He seems to be reacting to the insulin; doesn't an acro mean they do not react to insulin?

 

The numbers are staggering. I read a paper today that said it could be as high as one in three. Same paper had an acrocat in their test group on 1 unit. Not saying Shmee is one of them, just putting it out there for others to read as well. Neko's only signs were ravenous hunger, tearing in one eye (didn't know that was a symptom at the time), and blinking in bright light. Only 35% of cats have obvious symptoms on diagnosis. Neko saw green early on, then stopped seeing it each dose, but that was due to both IAA and probably some glucose toxicity, not her acromegaly.

For now, I wouldn't worry about Shmee and what might or might not be. With the dental out of the way, hopefully he'll start on the road to recovery.

 

Wow that is really interesting though. For some reason I thought they don't react to insulin at all, but it is much more sneaky then that. Learn something new every day around here.

 

+1 164
+2 177
I'm thinking hopefully it is safe to sleep until +5