02/13/18 Texas Gizmo PMPS=227, +2=220, +11=227

02/12

AMPS=325

Could it be the Amlodipine that is keeping his BG high?

Saying a prayer for Carla and Simba that they get good results today.

 

I hope Gizmo comes down today. I don't know about the amlodipine. Maybe put amlodipine? in your subject line. Thanks for the prayer.

 

Good question Lizzie, I don't know anything about Amlodipine.

How is Gizmo eating for you today?

 

Maggie was on amlodipine before FD, so IDK.

 

Hope he gives you some better numbers when you get home, pink doesn't look good on the Tex

 

Sorry Gizmo's numbers are higher. C'mon Gizmo.

 

Looks like Gizmo and Asia planned color coordinated outfits for today.

Hope they both come down. I don't know about the med, but I agree, put it in your subject line so it will be noticed. You might also ask in feline health since there are others and not just L&L that may have experience with that med and insulin.

 

Interesting. So she isn't on it anymore? I thought it was probably a "rest-of-his-life" thing.

I have a ton of questions and don't know where to post them - they are related to his BP, GI lab, Ultrasound - should I post here or on the main forum or over on Tanya's ckd site because they are more related to ckd/pancreatitis than FD?

How long before the amlodipine has some impact on his BP? I am trying to decide when to take him back for his follow up and would like his meds to have started working before I take him in so he doesn't have a kitty heart attack. Follow up plan includes retesting BP. It also includes *BNP (IDEXX)

What do they test for - or what can I expect to learn from the GI panel (TAMU)? The follow up plan shows this test "*TLI/PLI/COBALAMIN/FOLATE (TAMU GI LAB)"

I am opting for the GI panel/labs vs. Ultrasound at this time (he just had US in 11/2017) - the vet at the new office doesn't like the way they did it (something about not enough measurements) and wants to redo the US - and I have to pick what I can afford and what is most beneficial for him at this time - opinions? I am also wondering if there might be a way to get a copy of the US from Blue Pearl to take to new vets.

Anemia - The follow up will also include a re-test for HEMATOCRIT/ PLASMA PROTEIN and based on those result *RETICULOCYTE COUNT if necessary and starting ESAs - has anyone used any ESAs? If so, which ones. The vet told me that they do not carry Aranesp and would have to order it (I checked GoodRX and pricing for a vile is $3000+, I can't do that). There are other ESA's on Tanyas site but they have a greater risk of causing antibodies in kitties so I am nervous about that. What was your cost?

ETA - labs "tab" has been updated with most current labs (02/03/18 from vets in-house lab)

 

Or a boy

 

Yes, she still on it, I meant she was already taking it so I don't know if starting it raised her BG.

 

Well, obviously it is not affecting her too much - with the "drop" dose and almost all greens . Thanks for the reply.

 

Gizmo has a new picture! Enjoying a sun spot in late winter. He looks happy.

 

Amethyst too!

 

We waited a week when we started with Quintus. He was on it before FD and all through FD. I'm not sure why it would have an effect on BG, honestly.

PLI will tell you if there is a risk of pancreatitis or not (imho a very useful information to have when dealing with FD)
TLI I can't remember, I know that when we tested it with Quintus the vet said something about it being an indicator for tumoral possibility, but I can't remember in what direction (I think high was not good, but Quintus's was high, and he's still around, and it came down)
cobalamin is B12, folate is B9 (IIRC), when those are low it points to some malabsorption thingy going on in the gut (again, iirc).

FWIW: I'm with you on the "blood first" strategy. Twice now I've had ultrasounds telling me very worrisome things that didn't come to be. For Quintus his pancreas looked so nasty it was thought there was a tumor (he wouldn't be around if it was). For Erica, a bunch of stuff almost led us to open her up for a biopsy. It may still be necessary at some point, but not with the degree of urgency the ultrasound led us to believe. So ultrasounds are great (and for Quintus, the flip side is that we were able to see his gallbladder was acting up, and treating that agressively is imho one of the things which helped us get over his nasty pancreatitis and allow FD remission), but take care who is interpreting...

 

The TLI is related to pancreatitis and intestinal inflammation. It's usually done to rule out pancreatic exocrine insufficiency which would cause an elevated TLI level. Folate and B12 are related to absorption in the gut although, methylcobalamin levels can drop with kidney issues, too.. (And you probably know all of this!)

Gabby didn't have a great response to amlodipine. In fact, her appetite was nonexistent with it and loss of appetite is a common side effect. We switched her over to telmisartan which has good research behind it's use for BP control in cats. She was taking amlodipine for about 2 mos before we changed meds. I would have changed her sooner but I didn't realize that the loss of appetite was a side effect. There wasn't an appreciable change in her BG numbers with either of the BP meds.

Just out of curiosity, is the amlodipine in pill or liquid form? If liquid, are you sure it's not in a syrup base?

I think you need to sort out what the question is. Did the first US show any intestinal thickening? If so, then the typical question is IBD vs lymphoma. I just went through this with my Gizmo. What is your (or your vet's) biggest concern? The BNP will give you some info on heart function. It sounds like you're trying to sort out GI vs BP issues.

FWIW, I did feel a sense of urgency based on US. I wanted to know if my cat had IBD or lymphoma since the treatments differ. (The good news was that it was IBD but the only way to confirm the diagnosis was a surgical biopsy.)

 

PMPS=227

Dose increase - shot 1.25U

History:
AMPS=325, +1.5=324

 

@Stephanie & Quintus
Thank you so very much

It is pill form.

Sienne, the US "results" are in this summary. They said there was some thickening but didn't seem to be concerned.


Radiology:
On Monday, November 27, 2017, Gizmo Cuellar was presented for an ultrasound due to inappetent. The following is
a summary of the imaging findings:
Liver: The liver appeared diffusely hyperechoic but normal in echotexture; the liver margins were smooth.
Gallbladder: The gallbladder appeared normal - the visible biliary tree is not dilated.
Spleen: The spleen appeared small / poorly visible.
Right Kidney: The right kidney had fair corticomedullary distinction, hyperechoic cortex; Slightly irregular capsule;
there were no nephroliths and the renal pelvis was not dilated. The right kidney measured: 3.79 cm
Left Kidney: The left kidney had fair corticomedullary distinction, hyperechoic cortex; Slightly capsule; there were no
nephroliths and the renal pelvis was not dilated. The left kidney measured: 3.44 cm
Urinary Bladder: The urinary bladder appeared normal.
Right Adrenal Gland: The adrenal gland was well encapsulated and subjectively appeared normal in size. The right
adrenal gland measured: 3.4 mm
Left Adrenal Gland: The adrenal gland was well encapsulated and subjectively appeared normal in size. The left
adrenal gland measured: 4.0 mm\
Stomach: The stomach appeared normal.
Small Intestines: The small intestine had normal wall layering measuring: 3.6 mm
Colon: The colon appears normal.
Pancreas: The pancreas is hypoechoic and prominent.
Lymph Nodes: There was no obvious mesenteric or sublumbar lymphadenopathy.
Impression:
1. Hyperechoic liver parenchyma - this may be secondary to diabetes mellitus. An alternative consideration would be
hepatic lipidosis.
2. Hypoechoic large pancreas consistent with pancreatitis.
3. Hyperechoic irregular kidneys consistent with preexisting CKD.

 

Sending vines for Gizmo and for you. Feel better soon Gizmo.

 

He is feeling pretty good. His coat indicates (to me) he is hydrated. It is soft and smooth again. Interactive, loving, purry - he is just very lethargic and I think that is the anemia. Oh, and eating all of his fudz (with binder).

 

Great

http://www.felinecrf.org/potassium.htm#potassium_citrate

How do I get potassium in him and give phos binder?

 

Lizzie , you are amazing Praying for you to have wisdom to sort this all out . Glad he is eating

 

Lizzie, glad Gizmo’s appy and beautiful coat returning and that, lethargy aside, he’s feeling on-the-mend.

Idk about the bp meds (never used them) but a quick look at possible side effects of amlopidine and taking into consideration what @Sienne and Gabby (GA) shared about it (and her other insights), a talk with vet about it and other bp options (along with your other concerns) certainly worthwhile.

Re your info and concerns about anemia and the US results: given that the pancreas, liver, spleen, kidneys were noted as affected in one way or another and that colon, intestines and lymph nodes were looking normal, I’d focus on adding to furthering gut health, immune support and glandular support, all of which I’d link in some way with the anemia. And prioritize what the most essential and beneficial meds are for the now and along with the B12 support, include glandular supports whether liver shake or other (such as standard process feline whole body support their immune, enteric, renal, hepatic [or hepatrophin], pancreatrophin Pmg). This is where having a homeopathic or alternative vet in your corner is an asset, even if one you consult with only by phone and send labs test results to. She/he can really help to sort out which supplements/remedies and protocol will enhance recovery and complement whatever meds are in the mix. I’m always looking for ways to minimize the number of remedies etc and maximize what helps best for underlying conditions.

Another supplement thought is msm(organic, vegan version), ubiqenol (bioavailable version of coQ10) and/or dmg. Digestive enzymes essential (I think Marje suggested in an earlier condo the one she uses), too.

I’ll mention this also as food for thought and in relation to supporting gut heath and assimilation/nutrient absorption: poo pills. Pricey and I was skeptical (mostly about safety) at first but, after doing my own research on it, I started Azalea on them. I’ve found that her poo’s more normal, she eats with more sense of satifisfaction, her chronic bouts of gingivostomatitis have lessened as well as the chronic fur pulling, and her coat has been growing back and lookin’ pretty good. Idk with any personal experience if it’s helped other cats, but I do think for Azalea, the poo pills have helped, big picture-wise. The animal biome blog also includes some interesting articles about gut microbiomes too.
https://www.animalbiome.com/

Re getting potassium in and up: civie Bo (GA) had a bout of low potassium. The ER prescribed Tumil-k (potassium gluconate in protein base) that I pill crushed and mixed in food that I assist fed or he ate on his own. Bo wasn’t diabetic so, for maintenance when done with the tumil-k and his potassium level was back to normal, I added either a bit of crushed banana or a bit of Plum brand banana and pumpkin baby food to his fuds. The banana part not a good option with FD, though. At the moment, my head is spinning a bit to think of other foods that would be good sources of potassium and lgi and FD-friendly. But I’m sure they’re out there!

Idk if any of this helps or just adds to the quandaries. But I hope it helps in some way to sort through the mires that multiple conditions bring. You’re a wonderful bean and Gizmo, sweet Gizmo, is very lucky to have you in his corner.❤️

 

Is the anemia related to kidney failure? I ask, because at a certain stage , the kidneys can no longer produce erythropoietin. At such a time, epogen can be given (carefully and slowly) and the erythropoietin will "cure" the anemia. At Costco and Walmart's it cost around $180.00

I've successfully used it for some 3 of my cats. The anemia always disappeared, and my cats rallied.