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Please help interpreting test results - GI/Inflammatory Diagnostic

Discussion in 'Feline Health - (The Main Forum)' started by Georgiana & Perlutz, Jun 18, 2019.

  1. Georgiana & Perlutz

    Georgiana & Perlutz Member

    Joined:
    Jan 24, 2019
    As some of you might know already, Perlutz has been referred for further tests after an ultrasound at the end of May indicated a tumour on the pancreas.

    He had another ultrasound, xrays and blood tests last week. I'll copy paste part of my post last week and add today's update.

    The good news is there is no tumour on the pancreas! But there are other issues... What was initially thought to be a tumour on the pancreas turned out to be a mild enlargement of one of the ileocaecocolic lymph nodes and measures 7 mm. But there are other issues, gastro intestinal and possible very early kidney disease :( The vet will call us on Monday/Tuesday when all the results are back and tell us what the next steps are.

    So far all we've been told is to keep the current 2.5 units dose and not to change it without discussing it with her first. She said we are testing too much o_O and it's not necessary, that the dose need to be held for 5-6 days. We have to test for ketones and glucose daily and continue to keep track of water intake, food and any symptoms like vomiting and diarrhoea.

    I'll type all the notes in the discharge report and the tests that have been done.

    Physical examination - pain on abdominal palpation. A small left thyroid slip and a soft systolic heart murmur which is not always present. The rest was normal.
    under sedation, he has had the following procedures:
    -CBC to assess for signs of anaemia and infection
    -Full Biochemistry: to assess liver and kidneys
    -Fructosamine
    -TT4 to assess his thyroid levels
    -fPLI to assess for pancreatic inflammation
    -VITB12 a marker of intestinal disease
    -TLI marker of pancreatic insufficiency
    -Coagulation profile to assess his capacity to clot
    -Urinalysis and culture to assess his kidney function and reveal any infection
    -Abdominal US which stated: The GB is bilobed. There is bilateral dilatation (5mm) of the renal pelvises and milkd bilateral hyperechogenicity of the medullae. There is a mild enlargement of one of the ileocaecocolic lymph nodes which is hypoechoic and measures 7mm. There is a small amount of fluid in the colon. Liver, pancreas, spleen, stomach, small intestine, adrenal glands and urinary bladder are within normal limits. Conclusions: bilateral dilatation of the renal pelvises is considered most likely secondary to increased GFR, there is no visible dilatation of the ureters and no visible urinary calculi in this examination. Bilateral nephropathy may be considered if clinically suspected. The colonic contents are compatible with soft faeces/diarrhoea; possible colitis with mild colonic lymphadenopathy.
    -Chest xrays pending

    The vet just called with the results and after all these tests we still don't know what's going on :banghead: I've been told basically the same as last week, that there might be gastro intestinal issues and possibly early kidney disease and she can't say he has cancer but can't rule it out either. Surely all those tests should've given something? Anything? We've been told about GI and kidney disease from last week before getting the results...

    The vet now wants to either have him on Metronidazole for a couple of weeks and then do an endoscopy +biopsy and aspiration of the enlarged lymph node (also mentioned some aspiration of the liver and urine?!) or do all this straight away. I have to decide if we're doing it now or in 2 weeks times based on the financial side of things and whether we put him through more stress so soon or we wait.

    Metronidazole will be prescribed for his occasional diarrhea and vomiting but diarrhea and vomiting are common side effects of this drug among others so what the hell? Has anyone given this to their kitties? To me it seems the side effects might be worse than the benefit. He hasn't had any diarrhea for 2-3 weeks now and no vomiting since last Monday.

    They won't be checking for Cushings or Acromegaly at this point as they still believe these to be very rare cases only and will only check when everything else failed.

    My stress has gone through the roof! I'm starting to wonder if all these new tests will give us any answers or we will be asked to bring him back for further and further tests? They are not exactly cheap either, approximately £1000 for the endoscopy and extra £1500-2000 for histopathology :woot: :woot: :woot:
    At the moment I only have half of all this and even that with quite some efforts. I need to call them back tomorrow and tell them what I've decided, do this now or in two weeks' time and I have no idea what to do...
     
  2. TSP

    TSP Member

    Joined:
    May 30, 2019
    Hello. I'm not sure where you are currently receiving care for your cat, but many times, just like with human medicine, getting to a large academic health system with our furry family members can be invaluable ESPECIALLY in cases like yours. They are the experts doing the latest research regarding diagnosing & treating. Their work is what the rest follow once it trickles down to them. In addition, they also see the more complicated cases so they are more likely to diagnose these issues. They are less likely to miss diagnosis & have seen enough of the "very rare" diagnosis/cases to recognized them when they see them. In the U.S., the academic vet centers, because they receive funding, are typically cheaper with regard to tests, hospitalizations etc.. They will help diagnose & determine a reasonable treatment plan & then work with your local vet to implement it. They also work very well with communicating with the local vet if issues come up & return visits are only usually necessary if something becomes complicated again.

    I am not familiar with your location but did some Google searching & found this university hospital in London:

    https://www.rvc.ac.uk/small-animal-referrals

    It looks like it would be 1:30min drive? It sounds like a lot at first, but since sharing this info with friends, many (even those who thought the idea of driving hours to a university hospital with a pet was crazy) have remembered the advice, used it & been shocked at how different, easy & more inexpensive the experience was.
     
  3. Georgiana & Perlutz

    Georgiana & Perlutz Member

    Joined:
    Jan 24, 2019
    Hi @Amy47 ,

    I'm familiar with the RVC, I even asked my vet for a referral there a couple of months ago. We decided not to go because they charge £275 for an appointment with a student :facepalm: We would've happily went if we could see one of their specialists.

    Our vet referred us to a veterinary referral centre a bit closer to us. It's new but so far it has amassed a great reputation, having fantastic reviews.

    I've just received the report that the referral vet sent the usual vet and I will copy paste that here in a moment. Just looking through it and although I don't understand much of it, it mentions enlargement of the heart, enlargement of the liver and I am here starring at it and thinking ACROMEGALY but they don't want to test him for it yet?! :eek:
     
  4. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    Oh crikey! We had been saying how thorough all the tests were so you would expect something a bit more definitive than this in the way of test results... but then that's just the layman's view, maybe this is isn't so unusual. I don't know!

    Can I suggest something... re name this thread to make it more specific to your question, so it will catch the attention of people with experience. Most of us will look at a forum list and home in on any threads we feel we may be able to comment on. At present you aren't actually asking for comments in the title, and I'm sure you'd like to hear what people think so give it a try?

    I don't have experience of this situation but I think I'd be quite tempted to take no action at all at present. I'd be very wary about givng medication with known side effects similar to the symptoms (???). Also, if the tests haven't actually shown up anything, maybe that's because there isn't anything to show - or nothing very obvious or advanced, at least? So there "might" be gastro or "possibly" early kidney issues (neither is that unlikely) but no real diagnosis.

    I really hope you get some helpful replies, Georgiana, as I can't think of anything to say other than maybe look at introducing some kind of supportive supplement to the diet that might help. Or maybe look closely at his diet and make a note of what he's eaten before a gastric episode, and consider amending the diet. Cats can and do develop allergies so it's possible that the issues could be due to something along those lines. I'm sure there are people here who could weigh in on that front, at least.

    I know all this is about unregulated diabetes but it's just possible that if a particular food is causing some kind of inflammation, so that could be one avenue to explore. If I can think of anyone who might be able to suggest something I will let you know. Meanwhile, stressful as I agree this is, take heart - nothing really bad has shown up so despite the frustrations, there's no bad news as such to deal with...
     
    Georgiana & Perlutz likes this.
  5. Georgiana & Perlutz

    Georgiana & Perlutz Member

    Joined:
    Jan 24, 2019
    Full report from the vet:

    18-06-2019
    Diagnosis:

    - Not well controlled diabetes mellitus
    - Possible chronic gastroenteropathy
    -An enlarged ileociecocolic lymph node
    Treatment:
    - Insulin Prozinc 2.5iu SC BID
    - Diabetic diet (I must note that he is not actually on a diabetic specific diet? he eats Thrive, Applaws and Purina Gourmet Pate)

    Perlutz presented at the medicine department of The xxx on the 12th of June for further investigations of a possible pancreatic mass
    and not well regulated diabetes mellitus. The carers have reported signs compatible with chronic gastroenteropathy (occasionally going
    off food, vomiting and soft faeces). There were no other concerns.
    On physical examination he was very stressed but BAR. The MM were pink and CRT was <2s. Oral inspection showed some mild tartar
    but no other abnormalities were seen . The peripheral lymph nodes were not palpable. There was a small thyroid enlargement on the
    left side of the thyroid. The HR was 240 and a soft heart murmur I/VI was audible but not present all the times. The femoral pulses
    were not possible to be examined. The RR was elevated at >40/min but there were no changes during auscultation and percussion. The
    rectal temperature was 38.7. The abdomen was painful and palpation was not rewarding. The rest of the examination was
    unremarkable.
    The identified problems were the previously identified mass in the pancreas, the chronic gastrointestinal signs, the not well controlled
    DM, the mild thyroid enlargement and of less concern the soft systolic heart murmur.
    Perlutz was hospitalised and under general anaesthesia the following tests were performed:
    - CBC: mild elevation of the platelets, that could be secondary to inflammation or secondary to gastrointestinal ulcers or hornomal
    disease (e.g Cushings, hyperthyroidism etc)
    - Full biochemisty: mild elevation of urea and creatinine (pre renal azotaemia or primary renal problem), mild elevation in ALP (diabetes
    mellitus, pancretitis, GI problem, liver disease, hormonal disease), the rest was within normal limits
    - Fructosamines: elevated at 524mmol/l which would indicate
    - TT4: within normal limits
    - fPLI: pending
    - VITB12: elevated
    - TLI: within normal limits but towards the low end of normal
    - SDMA: mildly elevated which could reflect very early signs of renal insufficiency
    - Coagulation profile: within normal limits
    - UA+CS: PH5, SG>1050 which would indicate good kidney function , urinary culture was negative
    - Thoracic radiographs in three views which report stated:
    1. Mild bronchial pulmonary pattern. Pulmonary metastatic disease is not seen at this time.
    2. Mild generalized cardiomegaly without radiographic evidence of vascular, pulmonary, or pleural space changes.
    3. Geriatric thorax with redundant aorta.
    4. Mild sternal lymphadenopathy most likely secondary to hepatic changes.
    5. Mild hepatomegaly as with clinical history of vacuolar hepatopathy secondary to endocrinopathy.
    6. Degenerative intervertebral disc disease with ventral spondylosis deformans.
    7. Pancreatic enlargement, left lobe of the pancreas.
    - Abdominal US which report stated
    "The GB is bilobed. There is bilateral dilatation (5 mm) of the renal pelvises and mild bilateral hyperechiogenicity of the medullae. There
    is mild enlargement of one of the ileocaecocolic lymph nodes which is hypoechoic and measures 7 mm There is a small amount of fluid
    in the colon. Liver, pancreas, spleen, stomach, small intestine, adrenal glands and urinary bladder are within normal limits.
    Conclusions: Bilateral dilatation of the renal pelvises is considered most likely secondary to increased GFR, there is no visible dilatation
    of the ureters and no visible urinary calculi in this examination. Bilateral nephropathy may be considered if clinically suspected. The
    colonic contents are compatible with soft faeces/diarrhoea; possible colitis with mild colonic lymphadenopathy"
    We have not identified a mass in the pancreas, however an enlarged ymphonode was identified along with signs of possible colitis and
    dilation of the both renal pelvis. We also believe Perlutz has a possible chronic gastroenteropathy creating inflammation which could be
    responsible for some clinical signs that were reported and be causing or contributing to the diabetes being unstable. The liver appeares
    mildly enlarged but that could be the direct effect of the diabetes and the heart also appears to be enlarged on radiographs. A cardiac
    ultrasound to assess his heart would be indicated. The sternal lymph node is also mildly enlarged, which could reflect inflammation.
    We have discussed all these changes with the carers. There are signs of inflammation in several parts of the body. The most
    important seems to be within the gastrointestinal tract, creating inflammation possible to the local lymph nodes,
    however without further investigations and biopsies/FNA's more sinister causes, such as cancer, cannot be completely
    ruled out. We have discussed the possibility of performing another general anaesthetic and an upper GI endoscopy with
    biopsies
    . While under anaesthesia FNA from the lymph nodes will be attempted. The heart will need to be investigated
    further with a cardiac scan to rule out a cardiomyopathy before the general aneasthetic. The carer will consider
    carefully all options in the next few days and will let us know how she would like to proceed. In the meanshile I would be
    very grateful if you could provide the following medications to the owners:

    - Metronidazole 50mg tablet twice dialy for 4 weeks (this is for the immunomodulatory effect on the
    gastrointestinal mucosa)
    -Omeprazole 5mg table twice daily on an empty stomach for 2 weeks, then stop slowly (this for any
    possibility of gastric acid erosions)
    -Panacur 1.8gr : 1/2 sachet once daily in his foor for 5 days (this is for deworming )

    Perlutz recovered well from his anaesthetic and was discharged home on his normal dose of insulin for now. A diary for monitoring of
    the diabetic patient was also provided along with some recommendations of how to manage the diabetic patient.
    We will keep you up to date with the further plan.
    Thank you for referring this very beautiful boy to us, please do not hesitate to contact us if you would like to discuss further this case.
     
    Last edited: Jun 28, 2019
  6. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    I think sometimes if you have a gut feeling about something, follow it up. Yes, enlargement of organs is a sign of acro, although not always. But maybe at this stage it should be ruled out? I'd say you were within your rights to ask for the test if you feel it could give you the answer. Or, you could post on the high dose forum here and ask how other people discovered that their kitty had acro, and at what point did they get the test done? Sorry, I don't want to keep suggesting that you do things like that, but there is just sooooo much experience on this board and there is usually some kind of help to be had if you keep asking.
     
  7. Georgiana & Perlutz

    Georgiana & Perlutz Member

    Joined:
    Jan 24, 2019
    Any ideas of a new title? I have none :oops:
     
  8. TSP

    TSP Member

    Joined:
    May 30, 2019
    I'm sorry you are going through this. You will get answers! Hopefully you feel confident with the center & the vets you are with & they will make recommendations based on the report. Check directly with RVC. I'm not sure how your system works but ours has a resident or fellow do the initial intake but he internal medicine specialist then comes in right after them. Our human teaching hospital/academic system works the same...you never meet just with a resident or fellow.
     
  9. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    Just something like "Help please with interpreting hospital test results" ?
     
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  10. TSP

    TSP Member

    Joined:
    May 30, 2019
    Anyone with previous experience with Complicated GI/Inflammatory Diagnostic Process?.....just a thought
     
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  11. TSP

    TSP Member

    Joined:
    May 30, 2019
    Sorry to post again, but inflammation will cause issues with BG. It looks like quite a bit of inflammatory process going on based on the report. The one really good thing is they did not start any Prednisolone or prednisone so that if you decide to move forward with the endoscopy etc. you won't have to go through the process of getting him off (which typically makes them feel awful again if it was helping) to do the testing. The drug would mask issues.
    You are heading in the right direction, albeit frustrating & anxiety provoking.
     
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  12. MrWorfMen's Mom

    MrWorfMen's Mom Well-Known Member

    Joined:
    Feb 18, 2015
    How frustrating to get all that testing done with no conclusions! I like Diana's suggestion of looking at diet to see if a change there might perhaps calm down any of the GI issues.

    I'm also in agreement that you should go with your gut on this one. With all the enlarged organs and various systems being affected I would absolutely insist of getting the test for acromegaly done before pursuing any or all of the recommendations the vet has put forth. Frankly, I'm surprised the vet doesn't want to pursue that avenue.

    Acromegaly is far more common than many vets think it is. While many cats with acro need copious doses of insulin, that is not always the case. Testing is relatively inexpensive and non-invasive and no anaesthetic is required (unless Perlutz is particularly fractious at the vet). It either solves the mystery or takes a big question out of the picture.

    My cat has a different high dose condition called IAA. My vet thought it so rare she tried to persuade me not to spend my money on the test. I insisted and told her to humour me. I was vindicated and my vet was gobsmacked.
     
  13. Georgiana & Perlutz

    Georgiana & Perlutz Member

    Joined:
    Jan 24, 2019
    Please suggest anything! I'm so lost right now, I only have you guys here for suggestions so any are much appreciated!
     
  14. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    Yes, I'm quite surprised that the vet hasn't suggested testing for acro. It seems one of the obvious things to rule out. It's true, it's not uncommon at all, and why vets seem to think it is, I don't know. Before my Tom was dx the vet had barely heard of it and it was only from what I'd read about it here that made me think it was a possibility and ask for the test. Perlutz's vets know that his bg is erratic and that could be for various reasons, one being acro. Nobody wants to think their kitty has it, but at least if you know, you can start to manage treatment more appropriately.
     
  15. Georgiana & Perlutz

    Georgiana & Perlutz Member

    Joined:
    Jan 24, 2019
    I have been on and on for months with the acromegaly testing, that was the reason we got the RVC referral in the first place. So yes, as you and Diana also suggested, I will need to have this test done! If it comes back negative, happy days for Perlutz and us and the vets can tell me "I told you so" as much as they wish, I'll at least have an answer.

    I'll have to think and ask for some more advice here as I am not sure what to do with the endoscopy at the moment. If we go ahead with it, I will request an acromegaly test as well since he will be under sedation anyway. If we don't do it, or at least not for now, I'll check with our usual vet and see what are our options to have this test (they don't do it). I wouldn't say Perlutz is an aggressive cat, he is just a massive stress ball (runs in the family :oops:) and once he is taken away from me, he might hiss a lot. I just wish they'd let me hold him while they take a sample...

    In the meantime, what does everyone think - should I start him on the medication they prescribed him? I've only looked into the first one and doesn't make much sense to me, it's for diarrhea and vomiting but the drug itself may cause these? He hasn't had diarrhea for few weeks and no vomiting for 1 week, I don't want him to have both and possible more as side effects from this!
     
  16. Olive & Paula

    Olive & Paula Well-Known Member

    Joined:
    Sep 6, 2015
    When I had Smokey he had daily vomiting (always had most of his life), kept losing weight even though he ate ravenously, when the really stinky poo started I finally pushed for more tests even though vet said he didn't think it necessary, p'titis, EPI tests etc. While waiting for that, had ultrasound done, confirmed p'titis, suspect IBD. Was started on metronidazole for possible overgrowth bacteria and it has anti inflammatory properties. Also cerenia. He did well on it. That's when I started homemade food for him.

    Olive here being totally different. Insulin just wasn't helping her at all. In first 3 weeks I had her, I knew there was more than FD going on. She had a lot of abdominal discomfort and rock hard belly. You couldn't touch her because it hurt. Her front feet didn't look right to me. So against vets advice I got abdominal ultrasound done. Although no p'titis at that time or IBD the IM did find a mass and said to increase her gab because she has a lot of pain. Cardiologist had to been seen because he picked up galloping heartbeat. I also switched insulin against his advice. So we worked on getting her more comfortable. 4 months after getting her I asked for acro and IAA tests. He wasn't to keen on it saying you can't doing anything if she had them. I said humor me, it makes a difference knowing why insulin isn't working and if IAA how we dose her. So he did the acro and not the IAA. He at first said she didn't have it, but when I got the report and saw she did, I had him revisit it and he needed to convert the numbers from U.S. to UK or reverse, either way she had it. He was so surprised she did. But against medical treatment since "it doesn't work". Had to find new vet willing to try.

    Go with your gut. If acro, soft tissue overgrowth can affect esophagus and trachea as well as all organs can or will be enlarged, there is excess bone growth. I don't know about endo should acro be a case. It's something I haven't had to face as of yet.
     
  17. Veronica & Babu-chiri

    Veronica & Babu-chiri Well-Known Member

    Joined:
    Aug 5, 2016
    I'm sorry to hear all you've been through, I really understand your frustration , I've had my share of very rare cases and It can drive one nuts that the people that are supposed to know just dismiss things just because they haven't had cases like that, just wanted to say hang in there and keep insisting on the things you already know are necessary and yes keep questioning if meds or treatments are the right thing for your boy, just because you are not a vet doesn't mean you can not be well informed
     
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  18. Olive & Paula

    Olive & Paula Well-Known Member

    Joined:
    Sep 6, 2015
    Georgiana & Perlutz likes this.
  19. Georgiana & Perlutz

    Georgiana & Perlutz Member

    Joined:
    Jan 24, 2019
    Well I can definitely relate to the stinky poo! Perlutz has had his share of them for years now, sometimes there's a sulfur smell? Was that Smokey's case too? Quite frankly I never thought the smell could have anything to do with all this, although it has been mentioned to the vet during routine appointments.

    I've read that metronidazole tastes awful, how did your kitty take it? I dread to think of giving any medication to Perlutz, he hates anything that affects the taste of his food...

    You mentioned acro affecting the esophagus and trachea... they seem to be right next to the thyroid which the vet said she felt it's enlarged so I'm wondering if it wasn't actually the oesophagus or trachea that she felt? I'm not wishing for acro, God forbid, but I'm starting to really think he has it :arghh:

    Thank you so much for sharing your experience!
     
  20. Georgiana & Perlutz

    Georgiana & Perlutz Member

    Joined:
    Jan 24, 2019
    I know, right? Even when Perlutz was still a young, healthy cat I read few articles about cat diabetes and kidney disease and whatever else I ran into just out of curiosity (came in handy when he started drinking more water and I knew immediately what could be the cause and that he needs the vet ASAP). You'd think professionals would read all the new research on Acromegaly for example as it's nowhere near as rare as it used to be believed to be...

    I don't know if others have had this with their vets, but I feel they think I'm a smart ass when bringing up something like acro for example. I still remember the first time I brought up the Somogy effect, my vet's eyes went like this :eek: :woot: o_O This is why last week I didn't push for the acro test, I thought it's a new vet, she says she is convinced he doesn't have it, she already asked me if I'm a nurse and if I'm not why do I know so many things and I just didn't want to push and push and then have her annoyed with us. I don't care what anyone would think of me or the cat daddy, but I fear if this could potentially affect Perlutz's treatment so I keep my mouth shut :oops:
     
  21. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    Stinky poo can be a sign of chronic gastric inflammation so it does all start to fit together. Also parasites can cause stinky poo - I'm sure you worm Perlutz regularly but I think the vet at the Ralph prescribed another round of Panacur, might just help.
     
  22. TSP

    TSP Member

    Joined:
    May 30, 2019

    I wrap my pills in a small piece of Greenie Pill Pockets. They come in Salmon & Chicken flavor so theres no taste left behind
     
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  23. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    Absolutely understand! Some vets think they're next to God and their knowledge is all embracing, not appreciating that caring pet owners can and do their own research these days thanks to the internet. I try to ask questions based on what the vet says and then maybe continue by asking "what about something called....? What would you say about that?" And see what they say. A good vet will respect the fact that you're interested.
     
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  24. Georgiana & Perlutz

    Georgiana & Perlutz Member

    Joined:
    Jan 24, 2019
  25. Georgiana & Perlutz

    Georgiana & Perlutz Member

    Joined:
    Jan 24, 2019
    I used to think so too, but not all did sadly :(
     
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  26. Olive & Paula

    Olive & Paula Well-Known Member

    Joined:
    Sep 6, 2015
    I gave the liquid metro to Smokey. I really don't remember if it was a struggle or not. The poo smell was like rotten eggs, sulfa, grey greasy looking. You had to scoop and get it outside to garbage, open doors and windows immediately to clear the stench.
     
  27. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    No there are some who feel threatened! It's a shame as vet and owner should work together.
     
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  28. TSP

    TSP Member

    Joined:
    May 30, 2019
    Maybe this will be helpful....2015 Conference at Cornell in NYC, Dr. Stijn did a lecture titled "Feline Acromegaly: More common than we think" and he was from RVC. Trying to figure out where he went! So, he opened a company called VetCT & they do 2nd opinions to offer vets help that typically only U setting have. Your vets would need to be willing to call for consult

    VetCT in Europe

    St John's Innovation Centre, Cowley Road,

    Cambridge, CB4 0WS, United Kingdom

    Ltd. Co: 06955449

    info@vet-ct.com

    Tel: +44 (0)1223 422251

    http://veterinarymedicine.dvm360.com/feline-acromegaly-more-common-we-think
     
    Last edited: Jun 18, 2019
  29. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    I remember reading various articles from Dr Stijn and being very impressed. I didn't know he had left the RVC but a quick search brought up this

    https://www.vet-ct.com/gb/
     
  30. Georgiana & Perlutz

    Georgiana & Perlutz Member

    Joined:
    Jan 24, 2019
    When I was looking into RVC, he was still listed as their director for small animals medicine in the Hatfield campus. I think he runs both the referral vet and the rvc...

    When I was looking into the referral at RVC, I was hoping to see him, that would’ve been the ideal case, him or one of his colleagues he ran the feline diabetes clinic with. I mean, he has a PhD in feline diabetes! We were only put off RVC when we were told we will see a student and that the specialist only ever see the very complicated cases (at that time we were unaware of all these issues Perlutz has). He might now qualify as a complicated case but I fear if we go there, they will want to run all these tests again themselves and as much as I hate saying this, we simply cannot afford it... I know they are the best in the world for acromegaly, Stijn and his team have performed more surgeries on acro cats than all the other vets in the world combined. But that costs upwards of £8000 which we just don’t have...

    The vet is waiting for my call tomorrow whether we do the endoscopy mow or later. I think I will put it on stand by for now and try to inform myself more on all this, try to find out how we can test for acro. I believe the RVC are taking in blood samples sent by vets and test, they have a very comprehensive blood tests package for around £350. As you know, English is not my first language. I’ll post a print screen and maybe someone can help me, maybe I misunderstood that this is the way to do it. If it is, I’ll try to persuade his usual vet to do it, he is much cheaper than the referral one we’ve seen. I’d rather pay £35 for an appointment with him to collect a blood sample than the £225 that I’d have to pay at the referral vet. Again, please don’t think I don’t want to do everything for Perlutz, I would take his diabetes on me if I could, it’s just that everything is expensive and we don’t have all the money...
     
  31. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    I'd do the same, Georgiana - don't make any decisions just yet, inform yourself as best you can and invesigate the acro test. BUT don't assume that's what it is, we're suggesting do the test because it's a possibility, not an almost certainty. Sure, if the test comes back positive it would be upsetting, but it would lead you down a different road which could actually be a good thing. But cross that bridge when you come to it.

    We know you'd do anything for Perlutz and it's a shame that so many of us have to base our decisions on cost. But you're doing your very very best and we know that and he knows that.
     
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  32. TSP

    TSP Member

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  33. Georgiana & Perlutz

    Georgiana & Perlutz Member

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    I know he might not have acro and I know no one here says he has it. Bit this acromegaly has been like an earbug for months now and my gut tells me to get it tested.
     
  34. Georgiana & Perlutz

    Georgiana & Perlutz Member

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    Thank you, I’ll get some tonight
     
  35. TSP

    TSP Member

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    I would never think you weren't trying to do everything for Perlutz :(. I was actually hoping the RVC would be less money because in the U.S., more often than not, the "specialty" vets & clinics are outrageously expensive & sometimes, the quality of their imaging can even be subpar because it is mobile or they just can't afford what our U setting have.

    Maybe call RVC & see if they will help direct you as far who your vet needs to call etc.. Sometimes when you call you can get someone helpful. I'll try to pull up the RVC & see what it says
     
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  36. Georgiana & Perlutz

    Georgiana & Perlutz Member

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  37. TSP

    TSP Member

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  38. Georgiana & Perlutz

    Georgiana & Perlutz Member

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    His vet won't be happy to see us again :smuggrin: He had nearly 2 months break from us, we've seen a locum vet they've had and then the referral vet. He is about to get some scratches :D
     
  39. Veronica & Babu-chiri

    Veronica & Babu-chiri Well-Known Member

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    Is clear you care about Perlutz very much otherwise you wouldn't be here and asking and investigating unfortunately we are all restricted to what is available either because of where we live, laws, regulations or costs because vet costs can be really outrageous there's just so much we can do so hang in there

    And if you can when you have the results of all the tests they made post them here for everyone to take a look at them who knows maybe someone can catch someting they've missed
     
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  40. TSP

    TSP Member

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    Is there another vet or is yours nice? My local vet is amazing & that has been KEY. You definitely want someone who will work with you.
     
  41. TSP

    TSP Member

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    Yes, please post. Either someone may catch something &/or know that you are not only helping Perlutz but also helping many others who will see your post now or in the future & know what to look for, ask, testing etc..:)
     
  42. Georgiana & Perlutz

    Georgiana & Perlutz Member

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    @Veronica & Babu-chiri this is all, it seems just the fPLI for pancreatitis is still pending
     
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  43. TSP

    TSP Member

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    Thats key. You need that fPLI
     
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  44. Georgiana & Perlutz

    Georgiana & Perlutz Member

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    He is alright, he got a bit intimidated once by Perlutz's hissing and Perlutz "smelled" his fear and now does it to him every time! He is not an aggressive cat, just gets very, very stressed and lets everyone know he is not happy to be there. He is a big boy as well, 5.9 kilos and to be fair, he has been intimidating vets since he was a kitten :rolleyes:

    He knows basic diabetes as well and he humours me with most if not all my requests for referrals, tests etc. He knows I test at home, he is not against it at all although I know he doesn't recommend it to everyone. He doesn't demand useless curves done in the practice just to charge me. He is willing to listen to me and doesn't have that attitude of "he knows everything, I know jack s**t and it;s his way or no way" which I found at a different vet in our town.
     
  45. Georgiana & Perlutz

    Georgiana & Perlutz Member

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    Yup, I was surprised to see this is still pending and yet there was no mention of when I can expect this result or anything. I'll wait maybe until Thursday-Friday and then give them a call about it.
     
  46. Georgiana & Perlutz

    Georgiana & Perlutz Member

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    I forgot to mention there are some blood test results from May 22nd on his SS under the "labs" tab. These were done at the vet before his dental.
     
  47. TSP

    TSP Member

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    Thats awesome :)! I love that big boy has your vets number :joyful: & likes to rattle him!
     
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  48. Veronica & Babu-chiri

    Veronica & Babu-chiri Well-Known Member

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    Since they are considering that he's at risk or with early signs of CKD (chronic kidney desease) it would really help you monitor him and stay on top of things if they could give you the exact value he got on the SDMA, creatine and phosphorus even though they may still be within the normal range is better to start actions early to help his kidneys
     
  49. Wendy&Neko

    Wendy&Neko Well-Known Member

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    Feb 28, 2012
    The RVC research on acromegaly showed one in four diabetic cats has it, some cats on as low as 1 unit of insulin. Go with your gut, get the test done. Knowledge is power, regardless of the result. Add me to the list of those whose vet was more surprised by the positive results than I was. And also had to ask the vet to humour me to get the test done.

    I have given metronizadole before, I gave pills in pill pockets. I have also given it as a compounded liquid, supposedly flavoured and from the reaction of the cat, it truly is foul tasting. The pills were easier to give, as long as the cat doesn’t wise up. Make sure you give the occasional “blank” pill pocket as a treat so they aren’t associated with meds. In spite of the taste, it did help.

    I am a little surprised that the ultrasound did not show thickening of the bowels. Note that an endoscopy cannot reach all parts of the bowel for sampling. A surgical biopsy is needed if sampling needed in jejunum. You might want to consider getting testing of B12 and folate levels, which can be off if GI issues present.
     
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  50. Marje and Gracie

    Marje and Gracie Well-Known Member

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    I’ll take a look at all this in the morning. Thanks for your patience.
     
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  51. Georgiana & Perlutz

    Georgiana & Perlutz Member

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    Well here’s the thing, his blood tests from his usual vet done on the 22nd of may shows SDMA, creatine and inorganic phosphorus as being within normal levels

    SDMA - 11 ug/dL (reference range 1-14)
    Creatinine - 155 umol/L (reference range 80-203)
    Inorganic phosphorus - 1.31 mmol/L (reference range 0.90-2.20)

    When we went to this referral vet she mentioned “the kidney issues” and I asked what issues? His kidneys are fine! And I was told his vet put in the records that there are issues with the kidneys but the above results show otherwise and when the vet and I went through the results the first time, he said loud and clear that the kidneys are fine but there are some alarm bells regarding the liver.

    I will request the test results today, hopefully they won’t say no.
     
  52. Georgiana & Perlutz

    Georgiana & Perlutz Member

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    His vitB12 was supposedly elevated but I can’t see anything about folate levels anywhere.

    The vet would like to do the endoscopy and a biopsy but as I’ve said, I’m putting that aside for now and try to find out more about this all.
     
  53. Georgiana & Perlutz

    Georgiana & Perlutz Member

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    No luck in getting the blood test results :( I called in the morning but I was told only the vet herself can send them and they were going to pass the message to her and have her email them to me but it's EOB and nothing. They were really surprised that I am asking such and "outrageous" thing :eek:

    I called the usual vet as well to check when the prescription will be ready and found out no one even bothered to read the email the referral vet sent them with the report and prescription request :banghead:
     
  54. Diana&Tom

    Diana&Tom Well-Known Member

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    Dec 29, 2009
    Sorry to hear of these frustrations, Georgiana. I must say, it's disappointing that they don't seem to be acknowledging the extent of your interest in getting the results. Why wouldn't you be interested to follow up the test results for goodness' sake? I think if it was me I'd be gearing up to writing a rather stiffly worded email expressing my disappointment... you've paid a lot of money for all this and if their "customer communications" side is lacking, you have a right to point this out.
    Maybe tomorrow...
     
  55. Georgiana & Perlutz

    Georgiana & Perlutz Member

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    Yes, maybe tomorrow...

    I don’t think I’m being unreasonable to hope to have them the same day since it’s just adding an attachment to an email but I’ll give them the benefit of the doubt and wait until tomorrow.
     
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  56. Diana&Tom

    Diana&Tom Well-Known Member

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    Not unreasonable at all! Fingers crossed they'll get their act together soon.
     
  57. Georgiana & Perlutz

    Georgiana & Perlutz Member

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    The fPLI results are back and it states "it's within normal limits but on the upper end, that would indicate that most likely there is no significant inflammation on the pancreas".

    Still no signs of the actual results :banghead: But I'm not giving up lol

    Perlutz has vomited most if not all his breakfast this morning, soon after eating it. But he seemed well and he was hungry, he was trying to eat it while I was cleaning :eek: so I gave him half a can as he already got his full dose of insulin and he ate and he was fine an hour later when I left to work:)
     
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  58. Diana&Tom

    Diana&Tom Well-Known Member

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    Well, neg for pancreatitis is good, as it can be tricky to treat.
    Ref the vomiting - does he eat too quickly sometimes, when he's hungry? That could be a cause, if only at times.
     
  59. Georgiana & Perlutz

    Georgiana & Perlutz Member

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    Very glad that we don't have pancreatitis to worry for too :D

    He does eat faster sometimes but I don't think he pukes when he does. I was still asleep when he had breakfast this morning but according to the boyfriend, he didn't eat faster than normal but he did eat half of a peony leaf and he seems to believe that whenever he manages to munch on a flower leaf, he vomits :eek:

    EDIT: Just to be safe, I chucked the peonies in the bin just in case he'd get tempted again during the day as he doesn't have his planted cat grass yet, we're waiting for it to grow.
     
  60. Diana&Tom

    Diana&Tom Well-Known Member

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    That's interesting about the peony leaf. Cats do sometimes seek out grass or other greenery when they feel the need to expel something in their stomach. Hairball season???

    Also see this:.https://animals.mom.me/are-peonies-poisonous-for-cats-12253269.html

    Says if you suspect your pet has ingested any part of the peony plant you could see symptoms like Perlutz has...
     
  61. Georgiana & Perlutz

    Georgiana & Perlutz Member

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    I've read in the morning that it's the bark of a peony that is poisonous for cats and even that in large quantities. He vomited 5-10 min after munching on half leaf, I don't think it would happen so fast if it was related? But I'm just guessing here and hoping that is the case. I know cats reach for grass when they have some tummy troubles so I am hoping the vomit wasn't due to the peony leaf. I am going home shortly to check on him and I'll be at the vets in the afternoon to pick up his prescription and I will ask.

    I've also just got a call back from reception at the referral vet and getting those blood test results it's proving to be quite some work, apparently the vet ignored that request and only mentioned the fPLI, just like in the voicemail she left me. It was an awkward call, I got the feeling the poor lady was just hoping I'll drop it and say it's fine, I don't want them anymore. I've never had this before, everytime I requested some results, reception offered to either print or email them to me, no further questions....
     
  62. Diana&Tom

    Diana&Tom Well-Known Member

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    Yes I think it's probably mostly peony bark that's poisonous, but the link above says if your pet has ingested any part of a peony plant to be aware of potential symptoms, so it's probably just as well you've binned the flowers now (shame though!)

    It is rather strange that the referral vets are stalling on the blood test results. Maybe they aren't used to people wanting to be kept informed or are concerned that you'll have more questions and they don't want to engage with you on that level. They obviously see that you're pretty clued-up, more than the average pet-owner. Sigh... if they ask why you want them you could say that it's no different to any other member of the family having tests done, you want to know the outcome and surely there's nothing wrong with that...
     
  63. Georgiana & Perlutz

    Georgiana & Perlutz Member

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    I'm getting really frustrated with the blood test results, it should be such a straight forward thing! But as I told the lady I've spoken to, I'm really keen to have them and won't give up that easily :rolleyes:

    Perlutz was absolutely fine when I saw him earlier, hasn't vomited anymore and was lively and had his lunch (and a piece of mine :facepalm:).
     
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  64. CandyH & Catcat

    CandyH & Catcat Well-Known Member

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    Apr 23, 2019
    vet may need to be reassured that you are NOT leaving them to choose another vet, or that you will not be challenging them in court nor disputing their findings

    tell them there is no elephant in the room, that the test results are for your peace of mind and need to understand what's going on with Perlutz
     
  65. Georgiana & Perlutz

    Georgiana & Perlutz Member

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    Well if they're not giving me the results, I will most likely not return to them. I will have to assume they either have something to hide (although I know that is really unlikely) or they simply could not care less and they're not willing to work with me in which case I'll rather give THOUSANDS of pounds somewhere else.
     
  66. Diana&Tom

    Diana&Tom Well-Known Member

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    But surely as you've paid to have the tests done, you're 100% entitled to know the results of them, otherwise what's the point?
     
  67. Veronica & Babu-chiri

    Veronica & Babu-chiri Well-Known Member

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    Is good to know that he's negative for pancreatitis :) and he may need to be talked out of becoming vegan, it usually upsets their tummy, so good idea on getting them out of his reach, but the fact that he's trying to eat green and vomiting could mean something is upsetting his stomach, could be fur balls or a bit of stomach acid SEB (slippery elm bark) usually helps with that kind of mild things
     
  68. CandyH & Catcat

    CandyH & Catcat Well-Known Member

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    Apr 23, 2019
    so tell them exactly that -- 2x4 will wake up mule, maybe they need a wake up call too -- am thinking they may have been told by insurer, to keep results close; most localities have statutes and rules that say they MUST release medical info to the client if asked
     
  69. Georgiana & Perlutz

    Georgiana & Perlutz Member

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    @Diana&Tom has also recommended the slippery elm bark but I haven't gotten anything yet. I'm picking up his prescription tonight and I don't know if it's a good idea to give additional supplements with it?
     
  70. Georgiana & Perlutz

    Georgiana & Perlutz Member

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    I can't imagine why would anyone recommend not disclosing the results, it simply does not make sense to me. The vet has sent me the full report, same report our usual vet got. Certainly if I can have a report that says your cat has xxx I can have the blood test results that confirm and support the xxx diagnosis? It's ridiculous...
     
  71. Diana&Tom

    Diana&Tom Well-Known Member

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    Dec 29, 2009
    Very good point! In human medicine we are usually advised to ask our doctor or pharmacist about interactions between medicines, and I don't see why feline medicine should be any different. I guess it depends what sort of person you are - maybe try the non-chemical route first, and if that doesn't work, try the prescription...
     
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  72. Georgiana & Perlutz

    Georgiana & Perlutz Member

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    Jan 24, 2019
    Well the only pills I take myself are antihistamines (I'm allergic to cats and flowers among others :D) other than that, unless I need antibiotics for something, I don't take much. I do believe in medication but only when it's actually needed :p But I don't know much if anything about medicine for pets. I will pick up the prescription today but not going to give him the metronidazole and omeprazole until Monday evening probably. I want to keep an eye and if anything, it will be easier to get in touch with a vet Monday than during the weekend. I might give the panacur straight away as it's a dewormer, I think it should be fine? And I'll read on the other 2 during the weekend.
     
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  73. Marje and Gracie

    Marje and Gracie Well-Known Member

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    May 30, 2010
    What is interesting is that it states in the conclusions that the dilation in kidneys is due to increased GFR. GFR is glomerular filtration rate. CKD is associated with decreased, not increased GFR. It does not appear to me that they are saying he has CKD but the labs will help.

    What also concerns me is his thyroid. They state his tT4 is within normal limits but what is the exact value? He’s 12, he has a thyroid slip, he’s vomiting and has diarrhea. Has he lost weight? Is he hungry a lot of the time? If the tT4 is above 2.5, then he is in the “gray” area for cats over 10. If a cat is in the gray area (even tho the number is in the normal range), kitty is over 10, and has symptoms of hyperthyroidism, they need to do more conclusive testing like a fT4 with ED at the least to be sure.

    It would really be helpful when you get the labs so please tag me once you have them loaded on the lab tab. I’m not a huge fan of anti acids like omeprazole just as something they throw at him. Is he showing signs of an acid tummy like vomiting clear or foamy liquid early in the morning or after he’s not had any food for a while? If not, I question whether he needs it and whether he might do better with something like slippery elm bark syrup. The issue with anti acids is they get rid of all acid which means the cat can’t digest the food he’s given. I’m not even that fond of them for humans :) A better approach if he has an acid tummy is to try and give him the slippery elm syrup or just be sure he doesn’t have long periods without food especially overnight.
     
  74. Veronica & Babu-chiri

    Veronica & Babu-chiri Well-Known Member

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    Aug 5, 2016
    One of the great advantages of SEB is that as long as you give at least two hours apart from meds or vitamins because it could inhibit a bit their absorption, it won't interact or interfere with any of them, what it does is it soothes the stomach lining and intestinal walls and reduces irritation which can help with stomach acid and nausea, I've found it helps also with a mild colitis and hairballs I give it to them in a syrup but some people just sprinkle it on food ( I guess it depends on how delicate the cat is for his food) as far as I know it does not require prescription. The thing I'm aware you would need to be careful about it is if your cat has high levels of calcium because it contains calcium.

    Here's a link from Tanya's web page with a lot of information about SEB

    http://www.felinecrf.org/holistic_treatments.htm#seb_what_is_it
     
  75. Georgiana & Perlutz

    Georgiana & Perlutz Member

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    Jan 24, 2019
    The vet won’t say he definitely has CKD, keeps saying how they can’t be certain until further testing but they suspect early CKD.

    The T4 (thyroxyne) was within normal range according to his blood tests done on May 22 by his usual vet (the results are in his SS under the LABS tab maybe you could have a look please)- it was 24.4 nmol/L and the reference range is 10-60. It also states “Total T4 result consistent with normal thyroid function. Values in the upper portion of the reference interval may occur in some cats with hyperthyroidism. If clinical signs are suggestive of hyperthyroidism, free T4 by equilibrium dialysis is often elevated in these cases. Please call if this test is required.".

    He has vomited the clear, sometimes foamy liquid, sometimes with some hair, but that happened in early May, I'd say 3-4 times. Since then, he has vomited once 2 days after the dental (24th May) but that was food and possibly some blood he has ingested during the dental and possibly due to the Metacam and then again he vomited this morning but it was food, not the clear liquid. The diarrhea was more or less the same time as the vomiting in May but since then most stools have been normal, well formed lil sausages.

    I will order the slippery elm syrup, so many people have mentioned it. How much should I give, when, for how long?

    The vet recommended the Omeprazole twice for 2 weeks and then stop gradually. Would you say it's better to skip this entirely?

    I will email them tomorrow for the lab results, maybe they will grant my request if it's in writing. I will not leave them alone until I get them :spam: and I will tag you when I do. Thank you SO MUCH for your help and sorry to ask so many questions, this is all so new to me and I don't know anything :(
     
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  76. Georgiana & Perlutz

    Georgiana & Perlutz Member

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    Jan 24, 2019
    Thank you for the link, I'll have a read now.

    Perlutz's blood work from May shows calcium to be 2.58 mmol/l (reference range 2.05-2.95) so he should be fine it looks.
     
  77. katiesmom

    katiesmom Member

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    Mar 1, 2013
    Katie had to take metronidazole for a week or two. It does taste horrible (I am taking it now myself).
    Anyway, I bought some small #3 empty capsules and put the tablet of metronidazole in the empty cap to pill her. No taste.
     
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  78. Veronica & Babu-chiri

    Veronica & Babu-chiri Well-Known Member

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    Aug 5, 2016
    How much usually requires a bit of test and error you start with a minimum dose and go from there the same as how often, with one of my cyvies I give it mostly at nights like every other night (I've noticed she really doesn't need it every day) to help her with the night stomach acid and twice a day during shedding season (about two weeks), with Babu I give it to him at shedding season to help with fur balls also about two weeks twice a day or when they need some oral antibiotics

    I think you could skip the omeprazole and see if he can be ok with just the SEB and see how he does if he continues then he may need the omeprazole
     
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  79. Marje and Gracie

    Marje and Gracie Well-Known Member

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    Agreed.

    If his tT4 was 24.4, then he’s not in the gray area bit it’s odd your vet feels a slip. That’s usually associated with hyperT. Sometimes, you can see a cat with a slip and symptoms but the tT4 is normal. I had this happen in a kitty. She eventually had an increased tT4 and elevated fT4 but we couldn’t treat until she did.

    His liver enzymes are very mildly elevated in May. Wonder what they look like now.
     
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  80. Georgiana & Perlutz

    Georgiana & Perlutz Member

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    Attached Files:

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  81. Marje and Gracie

    Marje and Gracie Well-Known Member

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    May 30, 2010
    According to his SDMA and creatinine, it looks like early CKD. The odd thing is he is normally concentrating his urine with a urine specific gravity of 1.050. Quite often with CKD, we see the USG drop a lot before we see the creatinine rise. The other parameters we worry about with CKD like calcium, sodium, phosphorus, potassium, and PCV are still normal.

    Sounds like there might be an issue with his pancreas and liver but they don’t diagnose triaditis which is an inflammation involving the liver, pancreas, and intestines. Looks like they are recommending an echo of his heart.

    Now is the time to start reading as much as you can from Tanya’s comprehensive guide to CKD.

    Critical to lone it’s is controlling phosphorus levels and keeping anemia at bay so I’d suggest reading that information as soon as possible.

    Let me know if you have questions.
     
  82. Diana&Tom

    Diana&Tom Well-Known Member

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    Dec 29, 2009
    Hi Georgiana
    Just had a chance to look at the documents you attached (not that they mean very much to me unfortunately) and I'm wondering why the vet's conclusions don't really address the high bg and difficulty in getting the diabetes under better control? Am I missing something? It's great to have such a comprehensive overview of Perlutz's general health but is some advice going to be available about how you manage the diabetes going forward? Or are they not able to say much until the issue with the pancreas becomes clearer?

    Sorry if these are daft questions but as I've been following Perlutz it would be nice to think for his sake and yours that some kind of progress has been made with all these tests...?
     
  83. Georgiana & Perlutz

    Georgiana & Perlutz Member

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    Jan 24, 2019
    I wish I knew what to answer, Diana :( I'm frustrated and angry with both vets as it seems one doesn't care and one only cares about ££ :mad: I only managed to get his results on Friday after sending a stern email and finally, hours later, the vet called me and I have the impression that it was agreed to send the results only after I confirmed that we will still take Perlutz for the endoscopy. His usual vet has received a report from the referral vet on Wednesday with a mention of providing me with the medication requested. On Thursday afternoon I called to ask when this can be collected only to find out no one bothered to read the email :eek: Zero interest...

    The only thing re diabetes regulation mentioned by the referral vet was keeping the dose to 2.50 and under no circumstances change it without discussing it with her before. I did just that and in a week we went from some yellows to reds and blacks! I'm petrified to call their reception and ask for her after all the "drama" with obtaining the test results and I think I'll just adjust the dose myself.

    Perlutz hasn't been himself this weekend and his appetite was weird, seemed hungry but wouldn't really eat even after going through various brand and flavours :arghh: This morning I managed to make him eat some by giving him food with a teaspoon, he would lick the teaspoon but would have nothing from the bowl.

    I'm trying to read about CKD but it's so much and I feel lost already and again I feel like I'm failing Perlutz :( I'm trying to think of few questions to ask here, just trying to compress them a little bit as right now, I have hundreds of questions :arghh:
     
  84. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    Oh I'm so sorry it's turning out like this, Georgiana. It's just not fair after all the hard work and dedication you've put into Perlutz's health and treatment. Please don't think for a second that you're "failing" him - very far from it, you are doing everything in your power. Maybe you need a change of tactic somewhere, a new game plan... if I were you I'd be very tempted to compose an email to both vets saying how very upset you are that nothing very constructive is happening other than suggestions for more tests... and say that your initial hope was that you'd get some clues on how to treat his diabetes, and you've had no advice other than a sentence about consistency of dosing.

    I'm not suggesting that you do actually say that to them, just saying that that's what I'd do, as I get cross with these situations when things don't seem to be working out... that's just me being impatient. You can't afford to upset or offend the vets I know. But I would suggest that you try to find a way of tactfully expressing some degree of disappointment... not sure how.

    Ref Perlutz not eating much - maybe you need to look into an appetite stimulant to get him to eat when he's a bit off his food. Or try something a bit different and tasty, tuna usually goes down well?

    As for the possible/mild/early CKD, maybe all you can do for now is read a little at a time and not try to absorb it all at once, it would be too much for anyone. Do be kind to yourself, and remember you are only human and can only do so much. And yes, ask more questions here, there are always people who have been through similar scenarios. We do care!
     
  85. Georgiana & Perlutz

    Georgiana & Perlutz Member

    Joined:
    Jan 24, 2019
    Oh how I would like to tell the vets, both of them, how I feel right now! But I just think it will be useless and I'm really scared that it might affect Perlutz care in the future. We can't afford to get even worse care!

    I wanted to book an appointment with his usual vet and discuss what went on at the referral and see what he thinks but he only works a couple of days this week and was fully booked already. I might go and see one of his colleagues, although she is not familiar with Perlutz's case, she might still be able to tell me something. I even considered going to a different vet in town but just found out they are strictly against home testing, only do curves in their practice etc so I'm not sure that will go well...

    Re CKD, I read in several places that SDMA can be elevated by dehydration. Now there's obviously the dehydration from diabetes but I also think Perlutz wasn't given water for the 2 days he spent hospitalized? I have no proof of this, it's simply my gut feeling as when I brought him home, despite being scared of me and wanting to hide, the first thing he did when he got out of his carrier was to drink water and only afterwards he hid from me. I know that out of all places FDMB is the one place where people will understand me when I say I know my cat well and I know what every meow means, how there's one meow for wanting food, one before he;s about to vomit etc etc and on the day I brought him back, I immediately thought "f***ers didn't give him water"... There are also suggestions that a CKD diagnosis might only be given after at least 2 tests. I know there's a chance I'm thinking this because I'm in denial in a way, but maybe it's worth retesting and try to get the acro too perhaps? Thoughts?
     
  86. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    You're quite right of course, getting angry with the vets won't really help. But they just don't seem to be very good at communicating with you and surely that's not too much to ask. I agree, try to speak to another vet at your regular practice and tell her about your frustrations... might help to be on the verge of tears, get her on your side. You badly need an ally that you can confide in and trust to fight your corner.

    Ref the dehydration... mmm, interesting. I'd try to follow this up, maybe mention it if you have a chat with this other vet at your practice, see what she says.

    Ref the acro - several of us here have suggested that it wouldn't be a bad thing to get the test done because we know how common it is. If it's ruled out, great. If not, you know where you are, and that Perlutz may well continue to need varying doses of insulin to get him into better numbers.

    Bottom line, in my opinion, is that you need a "friend" or ally somewhere amongst these vets who will take more of an interest in you and Perlutz. At the moment, you're not getting the support you need from them and I think you'd feel a whole lot better if they stepped up. You know that all of us here support you and heck, we're just cat-lovers who want to help each other. We'll continue to do what we can but that's limited at this point; it's the professionals' help you really need.
     
    CandyH & Catcat likes this.
  87. Georgiana & Perlutz

    Georgiana & Perlutz Member

    Joined:
    Jan 24, 2019
    I can't really go that route, our vet owns the practice so they'll all be on the boss' side...

    I'll try to get the locum's vet opinion too, I have him on Facebook :D

    It's funny how I rely more on this group as here I found more information and more help than at 3 vets so far. But I do agree with you, we definitely need some professional help too. And if we don't get it, I might need a different kind of professional help and a straight jacket :rolleyes:
     
  88. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    Glad to see that your sense of humour is intact!
    Glad also that you can get hold of the nice locum guy... maybe message him and ask what he thinks you should do next?
     
    Georgiana & Perlutz likes this.
  89. Georgiana & Perlutz

    Georgiana & Perlutz Member

    Joined:
    Jan 24, 2019
    I'm going to call the vet today and make an appointment with a different vet in the practice (she did his dental so she might have a slight idea of his condition). I'm going to ask for a blood test, I want to test him for acro and I would like to see what the kidney profile is like compared to the results above. I'm trying to make a little list with what I want done to discuss with the vet and see what they can do and what has to be sent away to other labs (acro most likely).
    • IGF-1 (acro)
    • fT4 and tT4
    • B12 (actual value)
    • Kidney profile (BUN, creatinine, SDMA, phosphorus, potassium)
    • IAA
    • TCO2
    • PCV/HCT
    Is there anything else I should ask for?

    I hate to take him to the vet again, I know the poor munchkin will be stressed again, but I think it would be good to retest? And do the acro too.

    Please let me know what are your thoughts. Thank you :bighug:

    EDIT: A week after the referral vet sent a report, my vet still hasn't bothered to read it!!! :mad::mad::mad::mad::mad::mad:
     
    Last edited: Jun 25, 2019
  90. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    I'm no good with thse things Georgiana but I support your organised approach... take in a list to discuss and see what they say. If they say no / not necessary to anything you've included, ask why not. And maybe ask the vet to please be sure to read the referral vet's report before your visit... there is really no point if they don't!
     
  91. Georgiana & Perlutz

    Georgiana & Perlutz Member

    Joined:
    Jan 24, 2019
    The vet has just replied and it's not what I wanted to hear... I'll paste it here (I deleted the names of the referral centre and the vets).

    Hi Georgiana,
    We can certainly help with some of those tests but possibly not all. We send the blood away to an external lab (IDEXX) to get profiles run or for some of the more specific tests like the one for Acromegaly. Parameters like urea, creatinine, phosphorous and SDMA can all be run here but realistically it makes most sense to send all of the samples away from a cost point of view. Looking for Cushings is slightly less specific, we can rule it out by confirming a low urine cortisol:creatinine ratio, to fully diagnose it we have to do multiple blood samples a number of hours apart for either the low dose dexamethasone suppression test of for the ACTH stimulation test with tetracosactide. With IAA I don't think the lab we use will run this and for the B12 their reference range is the same as the Axiom lab that the xxx has used so I'm not sure if we would get an exact number.

    What I would ideally like to do is to catch up with the clinician at the (referral centre) to discuss Perlutz and his ongoing care and decide which tests and when things should be repeated for the most information. Some tests will require an internal medic to interpret in light of the whole clinical picture so if we're doing the samples I'd still like to ask the Ralph to decide on a treatment protocol once we have results. I'm sorry we are so busy at the moment, both myself and (other vet) away over this next week so it has been very hectic in the lead up.
    If you are wanting tests done within the next few days it might be sensible to ask (referral centre) directly, I'm more than happy to catch up with them later next week when I'm back and to put together an estimate for the requested bloodwork if you wanted us to do it.
    I hope Perlutz is doing well,
    Speak to you next week

    I don't want the referral vet involved at all in these blood tests :arghh: Quite frankly, I just want to have him retested to see if theirs were accurate...

    I’ll call and make an appointment for whenever the vet is back. I don’t even know how I will manage to go, it will be really tricky taking any time off work the next 3 weeks :banghead:


    We changed the insulin vial the other day and Perlutz greeted me with a 6.1 tonight :eek:
     
    Last edited: Jun 28, 2019
  92. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    Oh dear! It's incredibly frustrating isn't it. I don't know what the answer is, it seems you are at the mercy of these vets and the way they want to do things. Did you make contact with the nice locum via FB - just in case he has any bright ideas?

    And so Perlutz is at it again and giving you lowish numbers with a new vial...that really is a mystery but one that there should surely be an explanation for...
     
  93. Georgiana & Perlutz

    Georgiana & Perlutz Member

    Joined:
    Jan 24, 2019
    Yes, he's at it again!

    The locum has actually wrote today to ask about Perlutz, so nice of him to do that! His biggest concern was that they haven't told us anything about controlling his diabetes. I've sent him the report and the test results and he will have a look tonight. I'm looking forward to see what his thoughts are.
     
  94. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    Finally! Someone who knows what it is that started you off with all this - helping the diabetes. This guy is a keeper! Let us know what he has to say.
     
  95. Georgiana & Perlutz

    Georgiana & Perlutz Member

    Joined:
    Jan 24, 2019
    When he will get his full time position in a vet practice, his patients will be in good hands! How I wish he was here for longer...
     
    Diana&Tom likes this.
  96. Margie and Jackson

    Margie and Jackson Member

    Joined:
    Apr 26, 2019
    I’ve been given metronidazole for my cat and it did wonders for his stomach trouble. I gave it to him after eating to avoid additional stomach issues. It is not supposed to clear bacteria in all uses, but can reduce inflammation. It’s used for humans this way too, topically. The vet told me to keep a few days worth in the fridge in case I have problems over the weekend.

    One thing, it tastes bad and your cat will spit and froth a bit. The vet said not to worry, it looks like he’s spit it out but it’s fine.
     
  97. Georgiana & Perlutz

    Georgiana & Perlutz Member

    Joined:
    Jan 24, 2019
    We’ve been given it as well but haven’t started it yet. I ordered some slippery elm bark and I was thinking to start with that.

    Is your metronidazole tablets as well? Asking cause we weren’t told it must be kept in the fridge...
     
  98. Margie and Jackson

    Margie and Jackson Member

    Joined:
    Apr 26, 2019
    I got a liquid. I thought Jackson was dying, running to the lb every half hour and obviously in pain. He was much better in 12 hours. His diarrhea was gone in 24.

    I am interested to hear how the slippery elm bark works. Good luck helping Perlutz feel better.
     
    Georgiana & Perlutz likes this.
  99. Georgiana & Perlutz

    Georgiana & Perlutz Member

    Joined:
    Jan 24, 2019
    I'm glad to hear it helped Jackson feel better :cat:
     
  100. Diana&Tom

    Diana&Tom Well-Known Member

    Joined:
    Dec 29, 2009
    Have you heard anything back from nice locum vet, Georgiana?
     

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