? Jester's latest labs

@Chris & China suggested I ask if @Marje and Gracie look over Jester's labs.

Currently I'm completely freaked out by what she's Chris is telling me, as opposed to what the vet said to me after looking them over.

 

I’ll be happy to this evening. We are cooking dinner right now and getting ready to eat but then I’ll do it.

Where is the post that Chris wrote that worries you? Can you link it please? Thank you. Deep breath!!!!

 

It was in a PM on Facebook. We were discussing the labwork.

The vet said, after talking with a specialist at the lab, that all Jester has is an intestinal infection that's affecting his liver and pancreas. He also said Jester has beginning CKD.

Chris says Jester's numbers for CKD are off the chart and that she thinks he's also has pancreatitis.

I'm low income so the vets haven't been as willing to listen or do tests because of the costs. Now my baby is sicker than he should be because I couldn't afford to have him taken care of.

I just don't want to lose him this soon.

 

The vet only has him on Metronidazole and Cerenia for nausea.

Chris wants me to take him to another vet for a second opinion.

 

Thank you, by the way.

 

Thanks for taking a look @Marje and Gracie

DCIN is trying to help her decide what the best thing to do next is and I like to have as many opinions as possible, especially when it's yours and labs like these.

I think with the SDMA being so high, sub-Q's are probably a good idea, and that she may want to consider trying ondansetron for the nausea (either along with the cerenia or in addition to...whatever works)

With the Spec fPL being high too, I don't understand why her vet thinks there's no pancreatitis either

 

The vet thinks the costs for treating pancreatitis will be in the thousands.

He also needed to consult w/ the people at the lab in order to understand the labwork.

I'm wondering if he doesn't know much about pancreatitis.

 

Shelaghc, my heart goes out to you. You did nothing wrong. Don't beat yourself up over this!
Vets just don't listen. Look how long and demanding I had to be to get the appetite stimulant. I don't even have the Bupe yet. They are stubborn.

If I'm not mistaken @Djamila vet didn't think pancreatitis was painful to cats. They don't have sufficient knowledge in one area IMHO.

It is manageable . . . just like FD.

 

I’m not sure what you are looking at, Chris, but, insofar as CKD, I’d say he’s in Stage 1. The SDMA is not that high and the creatinine is only 1.3. BUN is still normal as is phosphorus, potassium, and calcium. So, no, he doesn’t need subq fluids for CKD by a long shot. For CKD, subqa are not usually started until the creatinine is above 3.5. In addition, the hematocrit is lower than we’d like to see but he’s not anemic yet.

The two things I see that throw up an immediate red flag are:

• Really elevated creatine kinase (CK)
• Pancreatitis

Regarding the CK, I recently wrote this about elevated CK for Jenks’ Caregiver (here is the condo link and there’s a lot of good info).

I wonder if this is why your vet thinks there is intestinal infection? Systemic bacterial infection has been correlated with increased CK but, from the labs, I’m not sure how your vet knows it’s intestinal. His liver values are perfect.

Pancreatitis can usually be treated at home so I’m not sure why your vet says treating it will cost thousands of dollars. My post on Pancreatitis can give you information on home treatment.

Please tag me if you have questions.

 

Thanks Marje.....some of what I had said to her got twisted around, but that's OK

I totally agree with you on the pancreatitis.....We're hoping the 2nd opinion DCIN will pay for will be more help to Shelagh and Jester

 

You’re in good hands here, Shelagh.

 

Pancratitis isn't super expensive to treat. It's generally treated with cerenia for nausea, bupe for pain and sub q fluids.

 

Shelagh, @Djamila has a lot of experience with pancreatitis.

 

Vet told me himself he wasn't sure about the numbers and consulted with the people at the lab.

@Chris & China - how much might DCIN be able to help with treatment costs?

Oh, and Jester is eating a little on his own this morning so I guess the antibiotic is doing *some* good.

@Marje and Gracie do you think I should print out and offer your instructions from the primer to either vet?

 

Thank you Janet.

Any idea how long it might take until Jester is doing better after he starts treatments

 

@JanetNJ @Chris & China @Marje and Gracie
I have a call in today to Jester's current vet to see if he's willing to look at Marje's pancreatitis primer.
He has stated in the past that I'm doing a good job on Jester's BG and I've credited this site each time. I'm willing to see if he's willing to learn. He also read a paper from a medical journal that I sent him a link for which was all about pancreatitis.
(On the meh side, he admitted after reading the paper that he didn't realize how high the percentage is of diabetic cats who get pancreatitis...... But he *did* read it.)

I'm also going to call Jester's previous vet, Dr. Bebko - he had been our primary vet through September of last year, but because of my financial situation Dr. Gerson took over - and see if they're willing to do a second opinion.
These vets know each other, so I don't know if that's necessarily the best route.
@dian and wheezer - not sure if you'll see this, but do you have any recommendations for vets in the immediate Pittsburgh area who are familiar with pancreatitis and/or the FDMB and all the dedicated sugar parents as an alternate to Dr. Bebko if I need one?

 

::::sigh:::::

I was just almost yelled at for about ten minutes by the current vet. He's very upset with me because he claims he told me it was pancreatitis.

He also believes that the only way to treat it is in an emergency vet hospital with IV fluids and 24/7 care and doesn't believe that pain meds would be a good idea because he said they'll upset Jester's stomach.

He said that all of this is to help me keep costs down. He doesn't think that subq fluids would help because he said they aren't necessarily absorbed by well by the body.

He's upset because he said he spends a lot of time trying to help me and my cats including 30 minutes on the phone with the people at the lab yesterday. I told him I appreciated all the time he spends and he got kind of sarcastic with me about that.

He wants to wait and see if the antibiotic and cerenia help first. He also said the staff was supposed to give me injectible B vitamin along with all the other things, but I don't remember seeing that in the bag they gave me.

I asked if he would read what @Marje and Gracie put together and he is not interested in doing that.

And now my stomach is in knots.

 

Time for you to back away and let the pancreatitis-experienced members here help you.

 

I'm at work and nearly in tears about this.
There's no privacy - we don't even have cubes - but I'm in a desk against the back wall with two monitors so people sometimes don't even know I'm here.....

 

I just spoke with the Cat Clinic - they asked me to send over the labwork and Dr. Bebko will look it over when he's able. Not sure how long that might take though.

 

Well, I'll give him this - the current vet provided a one-use B12 injection for Jester at no cost.
He's stated in the past that he didn't believe B12 was effective, but because I'd asked about it I guess he was willing to let me give it a try.

The staff didn't notice it when I picked up the meds yesterday (because it wasn't on the invoice) but they have it for me when I can next stop by.

 

Gosh....that’s not very professional. He shouldn’t unload on you when you are just being Jester’s advocate. No one is right 100% of the time.

I’m trying to remember if anyone here has ever had their kitty get an upset stomach from buprenorphine which is the best pain med for pancreatitis. I won’t say never, I just don’t recall that there has been one. What it can do is cause constipation and that’s what he might mean. It doesn’t in every cat and short term use shouldn’t cause it.

It’s possible your vet is thinking this is acute pancreatitis. Before I knew anything about it, I had a kitty, Gus, who had a bout with acute pancreatitis. He had a lot of abdominal pain and nausea/vomiting. I took him to the ER and he was on IV fluids 24 hours and made a big turnaround. If I had known then what I know now about pancreatitis, I would have taken him to the vet but treated him at home. However, I have all the stuff I need to do that and a vet who is willing to give me more if I need it.

You have to decide how bad Jester is feeling and whether you can treat him at home but you have to find a vet willing to give you the meds and fluids. I did this video (with Gus) on how to do subq fluids at home which might help you. But I would get on top of it and treat him.

Did the vet say what the lab said about the elevated CK? I’d like to know what tells him it isn’t an intestinal infection because I don’t see it in the labs.....his liver values are just fine.

 

Considering he's semi-retired and doesn't charge me for visits with him or any of his time otherwise, I guess he may have been a bit defensive. I think that because he spent so much time with the people at the lab, it was frustrating to him to have to go over things with me again. Generally, he's been a pretty patient vet for Bastian and Jester - in fact he's never taken a dime from me for Bastian's treatment from day one.
While he's in great shape physically, he is still nearly 70 and probably isn't used to people questioning his diagnoses. He also claims that he said it was pancreatitis which was what I asked about last week, but he never actually said. Nor did he say it this week.
He seems to think we would normally need an ultrasound. He apparently believes what he's given me to do is the best first course.

I didn't know the name of the pain meds so I didn't say it when we spoke. Not sure what he would have said if I did suggest it. But the moment is lost now and I don't think I can call him again on this.
tbh, I was hoping I'd get one of the other vets there when I called. They're all younger and may have been willing to converse a bit more.

I think you're right on this. With his admission that he didn't realize how often diabetic cats get pancreatitis, he likely is not familiar with levels, so to speak, of pancreatitis.
I wish I could just get the meds and take care of Jester myself too.

It's been a while, but I had a kitty a long time ago who was on subq fluids for several months, but that was at the end of her life. I'm sure I could use a refresher though.

No. I didn't know to ask him about that.

 

@Marje and Gracie or @JanetNJ
Can you give me any suggestions for what to do for Jester while I'm waiting to speak to another vet?
This whole thing is literally making me jittery. It's been so hard to concentrate at work knowing what I need to do for my baby and having no way to do it.

 

When Zimmy had pancratitis it was over in about a week, but we fortunately caught it fairly early.

 

You're probably already doing this but add extra water to his food. Keep him very hydrated. Pancratitis can be painful, so don't pick him up if you don't have to.

 

HE'S EATING!!!!!!!!

 

Awesome. That's the most important.

 

I have to sit next to him and constantly move the food. But my baby's eaten at least half a can in just over half an hour.

UPDATE
We've finished about 2/3 of the can and I think he's probably full. Understandably since it's been so long between decent meals.

 

If you end up taking him in, we've already said we'd cover the exam fee.....at that point we'd want the new vet to send us a treatment plan. There are certain things we refuse to pay for, like Convenia and Metacam, and we like to know what's going on first. We've had a lot of kitties treated for pancreatitis and know what tests are generally necessary and what tests are mostly the vet "padding the bill"

I can't just give you a number....every case is different

 

Wow - he's working on another can.

Should I let him keep eating?

I get the feeling his BG is going to be spiking come morning.
Plus, I don't want him to throw up and make himself sick.

It's just so good to see him really chowing down again.

 

I say yes, eating is a good sign.

Glad you have DCIN to help.

 

Bastian decided Jester must be feeing well enough to attack him,
Bastian got a time out, Jester is now hiding under a chair.

I'll offer him some food soon and see if he comes out. He did eat another 1/4 can before Banzhai Bastian jumped on him.

 

Was it a playful attack? I know some kitties play fight.
I don't know the back story, so my apologies if you've shared this before.

Jester will be okay. He's a trooper!

 

I’m glad he’s eating. If he has symptomatic pancreatitis, it depends on how bad his symptoms are.

Many cats have a very mild case of it....mild enough that they just are a little inappetant and lethargic. It might just last a few days and make the caregiver think that the kitty “ain’t quite right”. It could be over before they even take them to the vet.

If it’s more marked inappetance and lethargy but you know he’s not nauseous and he’s not in pain, making sure he eats and gets lots of fluid orally (drinking or added to food) might be enough to get him through.

If he’s obviously nauseous and/ or vomiting, anorexic, hiding, and/or has a painful abdomen, then he needs a vet visit and treatment as described in the post I linked on pancreatitis.

I’m glad DCIN can help you

 

Thing is, Jester's never been what I would consider lethargic all this time. And he hasn't been vomiting nor had diarrhea at all.

He's back to not eating much this morning - so far not more than a quarter can. Although that *could* be because he ate so much last night.

AMPS was up - 122. He's under the table right now. Not exactly hiding, but less accessible for feeding. Plus he's not in his standard "feed me" sitting pretty position.

I was pretty excited last night, but obviously we're not out of the woods yet .

UPDATE
He came out for a nibble right before I needed to leave for work. Literally just a nibble though.

 

I know how frustrating this can be, but eating some (even if it is just a bite) is better than nothing at all.

Have you heard back from the "old" vet who was reviewing labs?

Gracie use to always be so affectionate 5 mins before I needed to leave for work. It drove me crazy.

 

I called them this afternoon and apparently he told the staff some things but the office was busy and it wasn't written down.
They're a nice bunch but a bit understaffed.
Vet is supposed to call me this afternoon.

 

Oh man. I hate when that happens. Keep us updated.

 

:::sigh:::
Jester's back to barely eating again .
I tried two kinds of Friskies and one jar of baby food. He licked off and on at the baby food but kept moving to different places in the room.

Two different chunky foods he usually prefers he sniffed at, tried to nibble, then walked away. I offered it to him multiple times with the same results.

Before anyone asks why I kept taking food to him when he walked away from it, Jester's habit with me is to move somewhere else in the room, sit pretty, and wait for me to bring him his bowl.
And that's exactly the behavior he's been displaying tonight, except he usually eats when I set the bowl down.
More than an hour after the Cerenia, he still hadn't eaten. I waited another half an hour and panicked. There were several syringes of pureed food in the fridge. I warmed them and fed Jester that way.

tbh, I was pretty freaking hungry myself and couldn't bring myself to eat if Jester couldn't.

 

While I was cooking my dinner, Jester came out to the kitchen and sat as though he wanted to eat. I gave him a bowl-full again and he ate a small amount. We moved around the room again and he did nibble this time, although not more than a third of the can total after more than an hour.

 

Last night Jester rallied and by the end of the day had eaten almost one and a half 5.5 ounce cans - not including the syringe food.

AMPS was 147 - obviously that's a big change.

This morning he's eaten maybe 1/2 can (2 different flavors with a lot of nudging and pushing) over almost a 90 minutes span. The vet gave me some B12 in a syringe. I was hoping it would boost his appetite more, but so far it hasn't.

Still haven't heard back from the second vet about his opinion.

And that's still more morning food than he's eaten on his own in days.