11/9 Hershey ER this AM - Q - edit to labs

11/6 Hershey

HAPPY CATURDAY!

Let me apologize, in advance, for how lengthy this may get and hope I can keep it coherent. I come today with a mess of questions and kind of a mess myself....

A little catch-up...

10/31 DEC to .25u. Moving shot time each day to get back closer to the 7/7 schedule. Yesterday, decided it was a failed reduction as planned to INC at PMPS. Delayed returning from Jessica's birthday dinner, so lost some of the time we had gained toward getting back on schedule.

Home at +12.58 (89). Decided to delay INC to 11/9 AM. Shot/CPC. PM+3.25 CPC. So, this was about 12:30ish AM. Reading my Bible about 2AM and lamenting that it's supposed to be in the 20's overnight and I'm worried about the kitties in the backyard. Doug speaks of maybe building a box or something they can huddle in. I tell him I'm going to ask on the forum for any inexpensive ideas of things we might can do for them. (QUESTION #1)

I was tired and Doug has been running on less than 4 hours of sleep each night for about a week. Thinking it would be good to sleep until shot time, I decided to go ahead and test Hershey at PM+5 (110). But, Hershey was a lot less compliant than usual. He was kind of jerky...well, he has a tendency to pull out his hair and he was jerking his head kind of like when he's trying to spit out the hair. I talked to him and rubbed him, clearly something was wrong. I called Doug. Hershey was like licking his tongue around and would occasionally make a clicking sound. A loose tooth? Doug got a flashlight and looked around in Hershey's mouth. Said both sides looked the same and he couldn't see the problem. Put him down, rubbed him. He stopped - briefly! Thought maybe he had something stuck in his mouth, so offered a tiny bit of food mixed with water. He wanted no part of it. It was pretty scary to watch him so pitiful and be so useless to him. Doug looked in his mouth again, down his throat, touched each tooth and around on his gums, but got no reaction of pain. Put him down. Hissed at Oreo. Retreated behind the chair with this 'Leave me alone' look. Doug stroked his neck and said he thought he could feel something different. Had he swallowed something?!?! Called animal hospital. No help on the phone - want to bring him or not?

Vet examined and said he was clearly nauseated. Sudden onset not the norm. Most owners say it's sudden but they miss something. Said may swallowed something that upset his stomach. May be teeth? kidneys? pancreatitis?? (You have no idea how many awful thoughts and condos went whizzing through my mind...okay, maybe you do know...) I told her I had been concerned about his teeth because he'd never had anything done to them. That I had asked the vet tech at last appt and she seemed surprised I was asking. Said the vet would check at next appt. Planning to take him in the next month or so. Need new Lev script, too.

Vet said teeth bad, some worn down to gums! :cry: and that while that could clearly cause pain, shouldn't be sudden onset. Offered BW or could follow-up cheaper at our vet. Doug said do it all while here, that he knew I'd feel better knowing something. She said either way he needed something for nausea - Cerenia (10mg/ml per ml). Wanted to do a shot, but I asked for pill. Knew had read something on here about shot - seemed like it started with a "C" - honestly, why couldn't I think clearly enough to recall the name!!!! (Question #2 - What was the shot?) Doug opted for them to go ahead and do the shot. She said it'd last for 24 hours. Take him home. If he was better this morning, make appt with our vet. If not better, see vet or them today.

She said to schedule dental. What are we looking at as far as recovery time, etc. Trying to figure out how to plan/when to do it. I guess I should also do a forum search for info. Honestly, I'm running on fumes today... (QUESTION #3)

BW - She said his organs looked good. She said cats with bad teeth will have GLOB elevated (and his aren't) if it has gotten really bad/infected. But, what does the BW mean? See below) What should I be paying attention to or asking?? (QUESTION #4)

Home early morning. Still hissing at Oreo who is following him around step for step. Pooped almost as soon as we got home. No longer doing the jerky actions, but seems out of it. Bless his heart, it's been traumatic for all of us. In bed at 6AM.

8:40AM - AMPS (194) - Had enough to deal with. Delaying INC to tomorrow PMPS, unless his numbers really go up. Ate without hesitation.
+3 (274) - fed, ate almost all of it and snuck a little of Oreo's. Jessica said he deserved it. Didn't have the heart to fuss about it.
+5.67 (250)

PMPS (263) +12 - Shot .25u at 8:40pm + 1/8th tsp Miralax
+2.5 (268) - fed

Not playful or anything, but alert and looks like he's feeling better, even purring a little when we rub him.

So, that's our day. Thank you for visiting and answering any questions you can.

Libby (& Hershey, too!)


Here's what the Lab Report said:

LaserCyte (November 9, 2013 - 4:06AM)
RBC 8.05 (5.0. - 10.00)
HCT 40.2% (30.0 - 45.0)
HGB 13.2 g/dL (9.0 - 15.1)
MCV 50.0 fL (41.0 - 58.0)
MCH 16.4 pg (12.0 - 20.0)
MCHC 32.7 g/dL (29.0 - 37.5)
RDW 19.1% (17.3 - 22.0)
%RETIC .4%
RETIC 31.1 K/uL (3.0 - 50.0)
WBC 11.65 K/uL (5.50 - 19.50)
%NEU 80.3%
%LYM 8.0%
%MONO 7.1%
%EOS 4.1%
%BASO .5%
NEU 9.36 K/uL (2.50 - 12.50)
LYM .93 K/uL (.40 - 6.80)
MONO .82 K/uL (.15 - 1.70)
EOS .48 K/uL (.10 - .79)
BASO .06 K/uL (0.00 - .10)
PLT >274 K/uL (175 - 600)
MPV 11.6fL
PDW 18.4%
PCT .32%
WBC Abnormal Distribution (WD)
PLT Aggregates Detected (PA)

Catalyst Dx (November 9, 2013 – 4:07AM)
GLU 180 mg/dL (71 - 159) HIGH
BUN 26 mg/dL (16 - 36)
CREA 2.2 mg/dL (.8 - 2.4)
BUN/CREA 2.2 mg/dL
PHOS 3.8 mg/dL (3.1 - 7.5)
CA 9.0 mg/dL (7.8 - 11.3)
TP 7.4 g/dL (5.7 - 8.9)
ALB 2.8 g/dL (2.3 - 3.9)
GLOB 4.6 g/dL (2.8 - 5.1)
ALB/GLOB .6
ALT 72 U/L (12 - 130)
ALKP 80 U/L (14 - 111)
GGT <0 U/L (0 - 1)
TBIL .3 mg/dL (0.0 - .9)
CHOL 145 mg/dL (65 - 225)

VetStat (November 9, 2013 – 4:00AM)
pH (ven) 7.39 (7.24 - 7.4)
HCO3 (ven) 20.8 mmol/L (22.0 - 24.0) LOW
PCO2 (ven) 37.4 mm/Hg (34.0 - 38.0)
AnGap 26 mmol/L
tCO2 (ven) 21.9 mmol/L (27.0 - 31.0) LOW
Na 163.0 mmol/L (150.0 - 165.0)
K 3.7 mmol/L (3.5 - 5.8)
Cl 120.0 mmol/L (112.0 - 129.0)
Specimen Type = Blood
Specimen Source = Venous
SamType = Ven
Temp = 37.0C

Handwritten on results:
PCV 45
TS 7.4

She said weight was about 12 pounds but didn’t give anything written with vitals.

Re: 11/9 Hershey ER this AM and mess of questions

I'm so sorry about Hershey. Big bundles of healing vines coming your way. ((((Libby))))

Re: 11/9 Hershey ER this AM and mess of questions

poor baby - and you and doug too. it's scary to have them not feeling well.

no ideas on a shelter, although i have a friend who uses those igloos. basically any box would work, you could do a box inside of a box for insulation.

the shot that you don't want is Convenia. it was developed for skin issues and mostly that's not what it's being offered for. the risk is that it lasts in the system for 2 weeks and if the cat is allergic to it, that's a mighty long time to try to work with an allergic response.

cerenia is awesome - at least in our experience. punkin had the shot a couple of times to deal with the initial nausea, then we followed up with pills. the idea with the shot is to get it in their system with the risk that a nauseated cat might throw up the pills . . .

i believe the post you are looking for on dentals is on the New to the Group sticky, at the bottom of the post. there are a bunch of good info posts and i think it's there.

i will leave it to someone more experienced with bloodwork to interpret the numbers.

Re: 11/9 Hershey ER this AM and mess of questions

Oh how horrible of a night! BIG HUGS!!!

Q1 - Winter animal shelters used by lots of TNR groups - VERY cheap too: http://www.erubbermaid.com/roughneck-homes

Q2 - Covenia

Q3 - KT was eating well within about 3 days.

Q4 - sorry, can't help there...

Hope this helps a bit thru the sleep fog!!

BIG HUGS Again!

Re: 11/9 Hershey ER this AM and mess of questions

What a night Libby! :YMHUG: cat_pet_icon

Hope everyone gets some rest tonight, and Hershey stays feeling better

Those Roughneck Homes are great idea! Hope your outside kitties are able to stay warm, 20 degrees, brrrr!

Re: 11/9 Hershey ER this AM and mess of questions

- Hey, Melissa - Thanks. I hope it was a one-time occurrence; the vet said it's possible, but kind of dreading what tonight might bring. nailbite_smile

- Hey, Julie - Thanks for the dental direction and "C" info. She didn't give us any pills to follow up with. Does that mean I can expect to feel nauseated again tonight? If so, is there something OTC I can give him to get us through until Monday. I'd rather not end up at the ER again, if we can help it.

- Hey, Lyresa - Sleep fog, indeed. I was so cold I sat in the recliner with a blanket. Bet you can guess how that worked out...Thanks for the help. I'm going to show Doug the link and hopefully we can work something out. The receptionist said she thought there was a TNR program somewhere in the area. Guess I'll look into it the first of the week. I'm always happy to add one more thing to the never ending 'to do' list. :roll: She agreed they're really cute living in the backyard...until you get a whole colony! Well, that went over with Doug like a lead balloon!

- Hey, Jane - Thanks a bunch. Yes, ma'am on the brrr! I wasn't prepared for the drop. Hershey cried all the way to the vet. I wasn't sure if it was his discomfort or rushing out into the dark COLD night - probably both - my teeth were CHATTERING! Hoping all is back to normal tonight...

Re: 11/9 Hershey ER this AM and mess of questions

(((Libby and Doug))) Sounds like a scary night but it looks like Hershey is feeling better now. :YMHUG: :YMHUG: A couple of answers from me.

More ideas on feral cat homes from some local TNR groups:
http://www.pacificanimal.org/news/Helping Feral Cats Through the Winter - final.pdf
http://www.orphankittenrescue.com/feline-care
My aunt has a feral colony that use an old home made dog house.

Cerenia: also has some pain relief properties. I second it as a good idea. My civie sometimes gets it when he's having a cystitis episode.

Regarding the dental - it is worth asking around. It's recommended to find a dental specialist vet or one who'll do X-rays before and after if there are extractions. Neko just went to her regular vet for her dental, but I've used her many a time with a previous cat who had many extractions so knew what to expect.

On the B/W, did the vetty say which ones were out of normal range?

Re: 11/9 Hershey ER this AM and mess of questions

i don't think there's any over the counter equivalent of cerenia. Pepcid AC is given for an acid tummy, but it doesn't sound like that's what you're dealing with. too bad the vet didn't send some home with you. could you call and ask for enough to get through til monday with your regular vet? shouldn't need an ER visit for that.

on punkin's ss there is a tab marked labs at the bottom of the screen. if you look on there i have the normal range included on every lab test - maybe you could compare and see what is out of range.

Re: 11/9 Hershey ER this AM and mess of questions

wow... you had quite the day there.

Ask your vet or the vet who will do your dental about FORL http://healthypets.mercola.com/sites/healthypets/archive/2012/01/17/teeth-resorption.aspx
I was wondering about that right away while reading your tale. The worn down teeth could be resportive lesions. You definitely need xrays
to confirm that.
Mine has that problem.... so does Sienne's Gabby.
One of the ways you can test for it is to scratch their chin/jaw line and see if the mouth responds by "chattering" . ( just like shivering)
That is a sign of pain in the teeth.
I also thought the other thing you were describing with his tongue sounded like it.

I may have something I can give you to keep your outdoor kitties warm....
I'm going to go locate it and make sure it's working. I'll be back.

Re: 11/9 Hershey ER this AM and mess of questions

Hi Libby -

Wow, quite the day for you. Gugfs all around for you, and all there.

I've never had to build outdoor shelters, but from what I have read anything will do, boxes, crates. wood panels. I like the suggestions Wendy had too, from someone who deals with ferals. it is so nice when one can provide our outdid furkids with some sort of protection from the winds rains snows... hey will be very grateful.

Cerenia Is what I a sure Hershey received. it does work well on nausea, and can provide some pain relief. I'd used it whit Mannie several times. As yes it is only a 24 hour things, but hope fully what Hershey received will get him past whatever was bothering him. I had some on hand for followup (pills) in case we needed them.

Good dental vines for Hershey. There is alot hat can be said on dental. The basics are in one of the sticky posts here, it has good basic info on what to expect etc. If the anticipate lot of extractions a dental specialist might be the way to go I had done several with Mannie, as once diabetic he had dental issues all the time. A plague of diabetic kitties.... bad teeth! :? My experiences have all gone well. we had a few "trying" experiences with Mannie. If you care to read about any of them you can find the inks on Mannie's SS (link in my signature line). His SS is labeled a dental day by the date column - they should be easy enough to find. Recovery time varied with each experience. One was three days, the next only one. Each trip was different. If there re extractions expect a somewhat longer recovery time, as the mouth needs to heal some.

Hard to day on the labs without knowing the normal ranges.... were any mentioned as being out of line?

Hope the rest of the day has been better. Be well Hershey!

Re: 11/9 Hershey ER this AM and mess of questions

I'm so sorry Hershey is not feeling well! My thoughts and prayers are with you guys .. poor baby ... :sad:

thanks for putting up the normal ranges by those labs.

so the only 2 (other than glucose) which are out of the normal range are the HCO3 and tCO2. i don't know anything about those 2 tests, but i'm sure someone else will. just leave your question up there until it's answered.

Here's the dental info.

Without knowing if the labs are out of the normal range, there's not an easy way to respond to the numbers you posted. Different labs can use different reference ranges. Are any of the lab values marked as either "high" or "low"? GLOB is globulin. ALB/GLOB is albumin/globulin. Globulin levels can be elevated when there's an infection or inflammation present.

- Hey, Wendy - Thanks for the info. I'm going to check out the outdoor housing. Our first kitty died just before turning 2, so never had any dental. Last night/this morning, Doug said he wants us to start shopping for a new vet. Ours always talks about how hard it is to manage Hershey, but the ER vet talked about how good he was. He's a pretty compliant kitty and Doug thinks they're just too rough with him. So, we'll probably visit the relatively new one near our house and at least see what it looks like.

- Shucks, Julie. I was afraid you'd say there was no OTC equivalent. It's ~:30 drive for us to the ER and it's after 8pm, so I guess we'll see if we need it. It does seem to have done the trick. He had stopped the licking, etc even before we got home.

- Hey, Rhiannon - Thanks for the link; I'll read it tomorrow, after I've had some sleep. I'll check for the 'chattering.' Thanks for checking about the backyard kitties!

- Hey, Michelle - I got especially worried about the poor little ferals when we went out with Hershey and it was bone-chillin' cold. :sad: I'll check out Mannie's dental experiences, too. Just trying to schedule everything and have the upcoming holidays, plus the times we're out of town working with Operation Christmas Child...and, as soon as Doug can get a full day off, I want to go see Sammy. Haven't seen him since his birthday (~6 wks) and I'm going through withdrawals!

- Hey, Devon - Thanks. I just wish I could fix it :sad:




**I edited my original note and added what the report says are normal values. There were only notes on three values:
GLU (180) HIGH (Diabetic at the vet, expected it to be HIGH)
HCO3 (ven)
tCO2 (ven)
No idea what those are -


Thanks, everybody, for helping us through this!

Other than the blood glucose, the other values are related to bicarbonate (tCO2).

As Sienne said, those are bicarbonate tests which are usually done to determine if a cat is in metabolic acidosis which is not akin to diabetic ketoacidosis. Metabolic acidosis is associated with with chronic kidney disease. Low bicarbonate ions are usually seen when the (CKD) cat is peeing a lot and flushing the ions out of the kidneys. Blood pH becomes low (acidic). Metabolic acidosis has nothing to do with an acid tummy, though. Hershey's blood pH is normal and is not on the acidic side (which would be below 7).

TCO2 is total carbon dioxide in the blood. If it is low, it can be because the bicarbonate is depleted. It is very difficult to accurately measure and requires special equipment. From Tanya's:

TCO2 has to be measured on a special blood gas machine, which not many vets and not all laboratories have. It is also easy to make mistakes in taking the measurement because if the sample is exposed to air, the dissolved gas escapes and makes the reading look lower than it really is. Since it is a tricky test to run, some laboratories, such as Antech in the USA, may only measure it on request (with Antech, you need to ask for Test No. T115).

Click to expand...

The TCO2, HCO3 and PCO2 are usually tested as part of determination of electrolytes. Diabetic cats can sometimes show lower bicarbonate values but that is usually in uncontrolled diabetes. Since Hershey is not a CKD kitty and his other electrolyte values look fine, I wouldn't get too worried. I would, though, keep a close eye on his creatinine. It's a little higher than I'd like to see it. One test does not a dx make but once the creat starts getting above 1.9, we should start watching the kidneys IF the value stays above 1.9 on repeated tests. I have seen it up for one test and then back down into lower ranges (below 1.6 is best) for subsequent tests. So I wouldn't get too worried...especially since it was a non fasting test. But I would watch it. Did they do a urinalysis? If so, what is his urine specific gravity (USG)?

- Hey, Sienne and Marje - Thanks for the explanations of the tests. I've been googling and getting more confused by the minute.

Marje and Gracie said:

Since Hershey is not a CKD kitty and his other electrolyte values look fine, I wouldn't get too worried.

Click to expand...

Thanks, Marje - getting a little worried with all I'm reading. Wondering about the PCV and TS, too. These are hand-written values on the lab results, with no normal values included. Found an article or two about PCV, but not fairing so well regarding TS.

Anything in particular I can do to help his values get/stay good? And, no, they didn't do a urinalysis. I think I need to make a list in case we need to go to another ER - things to take and questions to ask - because honestly, my head was almost spinning and I knew I was missing things...

PCV is packed cell volume and it's an indicator of whether anemia is present or not. Usually labs run an HCT (hematocrit) or PCV. Both of his values look great...no anemia.

I can't figure out what the TS is either. The only thing I am familiar with that is close to that is TSH which is thyroid stimulating hormone....not a test they would routinely run.

I really don't see anything in his bloodwork that would worry me....really.

We have Zener on Cerenia tablets regularly. Our vet thought this was a better choice for him to manage his IBD rather than trying prednisolone because of his FD. The cerenia helps with inflammation and pain as well as what it is usually prescribed for - nausea and vomiting. One way to give the tablets is once a day for 5 days, then a day or two off, and go again. We give 4mg cerenia to Zener three times per week and increase to daily for five days if he has a flare up. We also used two bouts of cerenia with our civvie Tillie when she had cystitis.

Paws crossed Hershey is feeling better soon! Hugs to you all. :YMHUG:

- Thanks, again, Marje, trying not to borrow trouble.

- Hey, Anne - Hershey seems to think the Cerenia is good stuff. Wish I had some on hand, but I kind of doubt the vet will give us any. We'll see. Thanks for the well wishes for Hershey. I hope it was a one-time thing, but still baffled by what caused it.


PMPS (263) +12 - Shot .25u at 8:40pm + 1/8th tsp Miralax
+2.5 (268) - fed - Didn't eat much, but it's only been about :10 and sometimes he waits until he's sure Oreo is finished before he eats. :roll:

Libby -- Could that value be T5 and not TS? If so, it's a thyroid value

you might want to open a new tab on Hershey's ss for labs. it helps to be able to compare from one time to the next so you can see any changes. i know different labs have different normal ranges, but if it helps, you can copy the column in punkin's so you don't have to re-enter all the values. i found it really helpful to be able to monitor things over time.

(((Libby & DH))) What a long few days for you guys. Looks like you're getting all of your questions answered. I'll just throw one more cat shelter website at you that has great instructions: http://thefurrybambinos.com/daddy/how-to-build-a-simple-outdoor-cat-shelter

I sure hope Hershey starts feeling better and that you and DH can get some good sleep. Hugs to you guys and scritches to Hershey & Oreo.

Sending good healing vibes to Hershey. The teeth (and the ears) can wreak havoc on many aspects of our sugar kitties. One of our Acro cat friends had a dental about the same time as SRT - and he's now OTJ. Grayson fought with ear issues for a long time, and once we got the right drops and now they get cleaned every few days, his numbers are great and he's doing well. Our friend Missy had high numbers, got ears cleaned and back in greens. Hopefully getting his dental will have a huge impact and he'll be feeling much better before you know it!

Hoping you guys got a little rest this weekend.

- Hey, Lu-Ann - Thanks for coming over. Glad to hear Grayson is doing well. I miss seeing y'all around, but think of you often. Trying to get all the dental information I can (in a timely manner) so I can decide what to do/when/where to schedule. Called our regular vet today to ask some questions and she couldn't even find our records. She's been our vet since before Hershey and he's 11 years old. Wasn't sure if maybe I should take that a sign to look elsewhere, but hate to think of changing to a complete unknown just in time for dental. :YMSIGH: nailbite_smile

Sorry, just realized I didn't respond to some of your posts.

- Sienne, that could certainly be T5. It's hand-written, so you know how that goes.

- Thanks, Julie. I will probably take you up on copying that column from Punkin's SS!

- Hey, Deborah - Thanks! Still trying to catch up on sleep and trying to understand all this dental stuff. I feel very much like when Hershey was first diagnosed, not knowing enough to even know what questions to ask...

Healing vines to Hershey! You and Doug get some needed rest.

- Hey, Elizabeth - Thanks for coming over. Still trying to catch up on sleep, though...takes longer than it used to ;-)