Xuxu, 3/26/13, 362 negative tests

We got the test results back and no real new information. The fPLI says he has pancreatitis again, and the TLI says he doesn't have EPI ( think I got the initials straight). His Eso was halfway between normal and his regular high. So it's back to the specialist. My vet called Virginia Tech again and got a resident endocrinologist. Now they won't talk with a owner directly on the phone, only the vet. So she is asking questions, my vet is asking me and then translating my answers back to the resident. What this one came up with was insulinoma, saying he had both DM and Hypoglycemia concurrently. She said there were only 5 cats that had been diagnosed with it, and they would like to see him in clinic. However, there is no clinical trial going on, so there would be no reduction in price. Blacksburg, VA is 4.5 hours from here (Fredericksburg, VA) , which is why I have not been willing to take him there, plus you never know who you are going to see. My vet told her I would bring him but only if I had an appt with her, and time to go over his case history and discuss Dx and treatment. I wasn't driving that far for a 15 min appt with a vet student who didn't really care if he lives or dies, and then wants me to leave the body with them when he goes so they can LEARN..

But, she wants to rule out human error first, so I have to take him into the vet for a 12 hr curve. Even the vet tech standing there said I was probably better at doing ear pricks with glucose strips because they didn't do them very often. But oh well, it's scheduled for Fri.

Now at first what I was hearing from her on insulinoma sounded good, until I read up on it tonight. First, the cat goes into hypoglycemia without insulin injections, so that doesn't jive, the siezures get worse with glucose to treat the hypoG, NO NO NO. and in all cases, they found islets of langerhans tumors. He's had 2 ultrasounds and the radiologist when over the scans again with a magnifying glass and said there were no tumors. The papers said the tumors might be so small that they couldn't be seen during surgery, but that an ultrasound would pick them up. So if he has insulinoma, then where are the dam tumors!!!

His URI is definitely back and he's coughing a lot. Tonight he is very lethargic and not eating well. I gave him another mirtazipine, but it doesn't seem to be working yet. I started him back on the metronidazole even though my vet wanted to wait to talk with the specialist at Antech who suggest putting him on steroids. If he's not eating tomorrow, I'll have to start him back on syringe feeding.

 

Oh, and if you look at his SS, either I'm not really getting insulin in him the last couple of days or he's not reacting as well or I did give him a couple of DM dry kibble as a treat to get him off the Iams kibble. Could that have pushed his BG up this much???

I've found that the number of drops per 1 unit is different with each syringe, some do little drops sliding down the needle, the next might do one big drop that just hangs there. So I'm just guessing how much I'm getting in him. How much is the first line on a U100 syringe with the half unit marks? Even with the magnifying glass, I don't see how anyone is measuring .1U.

Has anyone ever diluted PZI? At least dilution would help me know how much I'm getting in him.

 

Is there a compounding pharmacy near you? Yes, it is possible to have a prescribed dilution made. You have to trust the pharmacy, so check them with Better Business Burea, etc.

Did you read any of the EPI site for dogs over? - tests aren't perfect.
One thing to ask regarding the tests is sensitivity and specificity.
- Sensitivity - how well does the test find a problem if a problem exists.
- Specificity - how well does a test identify a given problem if that problem exists.
Some tests are not specific for a condition; some are not very sensitive. What happens is you take a number of different tests and try to see if there is a profile.

If any type of malabsorption is occurring, the Z/D diet might help because the protein is partially hydrolyzed (digested).