1/15 Yum AMPS 558 +5 496 +8 534

@Stacy & Asia Thanks for being interested. I range from being upset to completely hysterical and panic stricken about Yum's numbers.

I started writing up Yum's sister's (littermate) story here but it was just too awful and painful.
My current vet had just purchased the practice from my previous vet. She failed to recognize the gravity of Yum's sister's problems and I was only too happy to believe nothing was wrong. It was the famous $$$ surgeon who failed to do a thorough workup before the surgery. Afterwards, he said he couldn't remember any of the concerns we discussed at the consult. He did discover via X-ray one of her joints was being eaten away by an infection or a cancer, in addition to the normal knee problems. I don't think it was cancer as her blood work (the analysis dated after her death) also showed a massive infection. Bottom line here is never let a surgeon decide if your pet is healthy enough for the surgery. Don't trust anyone. I made a lot of mistakes. They guy had a thank you note from the first President Bush on his wall but no cat pictures.

I have asked my vet 3 times now via emails and a phone call to test for IAA and acromegaly and once for Cushing's. They have said they will research the cost but they have never let me schedule the appointment. I need to call them one more time and put my foot down. They are very good to me. They are close by and they take my cats in on short notice. They love Yum. I don't want to ruin the relationship. I think the owner vet might not believe in these tests. She might feel no matter the cause, it all comes down to dose management. Since I discovered the forum last March, my vet has not been that involved in treating Yum's diabetes. I have a lot of experience dosing Yum but I am not a medical professional. She also hasn't been at the office much lately for some reason. This delay is my fault. I will call again tomorrow.

Yum's numbers started going bad a week ***BEFORE*** she was boarded for Thanksgiving. I had blood work done on the Tuesday of that week to test her phosphorus level. I took her in on Wednesday (the next day) to see if she was constipated, too see if that could explain her rising BG. She was not. When the Tuesday blood work came back from the junior vet with no comment, I emailed the owner vet about the elevated monocytes. The owner vet suggested I bring Yum back on Friday for a urinalysis. The substitute vet said she had a UTI. No culture was run. She gave me a choice between clavamox and convenia. I chose convenia. Her numbers continued to rise. When I boarded her the next week they did another urinalysis which was inconclusive (no culture again) and started her on Orbax because of the rising BG. The Orbax gave her severe diarrhea and I spent several weeks post Thanksgiving getting that under control. During this ordeal I had another urinalysis and culture run which came back negative. I got her diarrhea stopped just before Christmas. When I boarded her for Christmas (when I was very concerned about her rising BG) they did a full blood work up and another urinalysis. When the junior or substitute vet didn't run a culture, the senior vet did another urinalysis and culture which came back negative. The blood work appeared normal.

I believe Yum has an extreme case of insulin resistance. Maybe we aggravated it by dropping her dose while boarded and when I first brought her home. Is there a race when one is fighting insulin resistance? Does a successful dose increase the longer you take reaching it? I haven't seen an answer for that question.

Yum had a similar pattern of very high numbers when she relapsed last February, probably due to a UTI (treated with Convenia and then a few doses of Zeniquin, the latter giving her diarrhea). Of course last spring she peaked at 4.5 or 5 units and now we are at 8 units. I don't think she caught anything while boarded. She might have acromegaly or Cushing's. What would we test for besides IAA, acromegaly and Cushing's? She had a thorough scanning ultrasound last March or April. She had an echocardiogram in August. Should I do another blood work up and urinalysis? Maybe I need a second opinion. I feel I get second opinions on this forum.

I wonder if her intolerance for lamb and beef could be related to an intolerance for Lantus. I don't know if it is significant or just a coincidence that she almost went into remission when I was experimenting with feeding her raw lamb this past fall. (I did that because Radcat lamb is so low in phosphorus and thus good for CKD.) I was stopping the lamb (because I realized it was giving her soft poo) and switching her to chicken when her numbers started going up.

Yes, I fear no matter how hard I try I am still mismanaging Yum's treatment. She is my highest priority and no matter how hard I try things aren't improving. I bought some Novolin R at Walmart. If she doesn't improve after 2 days at 8 units I might start her on the fast acting insulin. Neither my vet nor the forum like that idea.

 

I don't know anything about the forum not liking that idea, but I'm not in the loop. Frankly, if I were in your shoes I would start using R also. However, don't go it alone. Get some help with it! Ask for help from those who have used Lantus and R. Change the subject line of your first post to something like "Help! Need guidance using R with Lantus".

It's also important to slow down the dose increases to every 6 cycles (if necessary) prior to incorporating the use of R. You don't want to be using 2 aggressive methods at the same time because it could lead to unwanted problems.


Edited to add:
Ideally, you'll want help from those with hands on experience with high dose conditions... not that Yum has a high dose condition... just that her dose is currently higher than some of the other diabetic kitties on the forum.

 

I’m so sorry you went through that, horrifying. I was one and done with a vet that had tons of dog photos everywhere and only a single “token” cat photo. When they manhandled Asia by putting a towel over her and holding her down just to look in her eyes and ears, that was it for me! She’s the most tolerant, docile cat I’ve ever seen and they didn’t even bother to ask about her temperament or anything. I think many of us have learned the hard way when we know something isn’t quite right and don’t listen to our gut. I am so sorry this happened to you.

I think you can have your cake and eat it too in this instance. Why not go to another vet that will do the testing, get a second opinion and keep this vet that you like for in the future or for other situations that they are more suited for? They don’t have to know about your second opinion vet unless you choose to tell them.

I did notice that it started just before Thanksgiving, but it doesn’t mean it’s unrelated to the boarding experience. If Yum was already having some issues, her immune system could have been compromised enough that whatever was floating around at boarding time she couldn’t fight off on her own. If they urinalysis was inconclusive and they gave a broad spectrum antibiotic, what if whatever was going on a) wasn’t bacterial in nature and b) if it was, wasn’t susceptible to Orbax? Did they ever test a stool sample to make sure nothing else was going on there and it was just a side effect of the antibiotics? I would think something would show up on bloodwork, but maybe some things only show up in the stool, I’m not a vet, so I just don’t really know.

I definitely do not know the answers or could even guess at the answers to these questions, hopefully someone else can.

I would make getting those tests done your top priority, it could answer many questions and at least rules those out as possibilities if they come back negative. You seem to have too many reasons to suspect one of them is at play. I would get a second vet opinion and get the tests done ASAP if it were me. The people here are awesome, but they can’t do bloodwork for you and there are pockets of deep and specific knowledge here, but not many outside of a vet would have the breadth of knowledge lacking the years of study and training a vet goes through to learn a good bit of everything about many different species.

As far as R and switching insulin goes, I think you need to prioritize things in your head and rank them as you see important, try them one at a time and not all at once: get testing done, try R, switch to Lev, change food, etc. If you have too many changes and variables at once, it will only serve to cloud the issue. I have zero experience with R, but a healthy respect for it. I would wonder if you are using it and whatever is causing these high numbers resolves for some reason, what would that look like with R in the mix? How confident are you about getting Yum’s numbers up if that is needed? Do you know, especially give her recent pattern changes, when is her onset and typical nadir with Lantus? Just go in to it as informed as you can be.

I really hope some answers come soon and Yum’s numbers can get to somewhere acceptable very soon. Please keep us informed, we all are rooting for you both and want Yum to feel bette.