12/21 Blue 67 AMPS

https://www.felinediabetes.com/FDMB/threads/12-20-blue-amps-48-is-70.240281/

Good Morning,

Blue tested at 67 AMPS and I did mark the food on the SS.

I have to say, he's acting a little weird. Sitting and staring and sometimes he starts
swaying. Kind of like he's napping sitting up. He also hissed at someone and he's never
done that. I read the chemo could cause some personality changes.

That's all for now.

 

Hi Patty,

I see that Blue's BG is in the normal range again this morning.

On the weird behaviour, I have no idea what might be influencing that. I very much think it would be wise to ring the oncologist ASAP to report your observations and ask for their advice, especially as what you've seen is so unusual/uncharacteristic for Blue - and because they might be knocking off soon for the Christmas break.

((((Blue))))




Mogs
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BTW, did you hear back anything about the oncologist's assessment of the results of Blue's blood tests?


Mogs
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No, I haven't heard anything from them on blood test. Today is the first day they are back so I will give them a call.
As for behavior, I read in their paperwork about personality changes but I will ask about it when I speak to them.
Bug better today?

 

No, she's not, Patty. She was very quiet and subdued this morning. She has perked up a bit since she had her bupe and she's hungry but she'll only eat 3 or 4 kibbles and then turn her nose up at the food, even with the Fortiflora. BP was still only in the 130s on the last couple of checks. Wish she'd eat. I'm starting to panic about it. (((Noodle)))

I hope the call to the oncologist is helpful.

Just a thought: the Noodle gets cranky when she's hungry. Could Blue be a bit hungry? (Just throwing speculative ideas out here, not based on anything.)




Mogs
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LOL Blue is always hungry!

I'm sorry Noodle isn't eating yet. Did you try the mix? I wouldn't let her not eat for long. You might have to get creative again. Poor baby.

I did call the oncologist but she's out all week.
I'm waiting on one of her techs to call me back.
It's so frustrating. When I phoned, the receptionist called the techs who are working at a different location. They said my primary vet should advise on the blood work. What? How is that possible since she didn't treat Blue for his cancer??? Very disappointing. They should be better organized than that!

 

Good morning, Patty. Is blue eating well? Did the oncologist give you a copy of the labs run last week? Looks like we might be on an OTJ trial.

 

I had the lab work done at my vet. They gave me the option. I do have a copy. They forwarded it to Blue Pearl.

He still eats the same. Like he's never full. Glad I bought an appetite stimulant.

Is there anything I need to do for the OTJ trial?

 

I’m waiting to see whether to make it official. I will give you the directions but basically you get an AMBG and a PMBG and if green that’s it for two weeks. You feed normally. If you get a result much over 100 you then test about 3 hours after eating to see if the bg comes down. You start on a green so today would be day 2 of the OTJ trial. When you don’t give any juice it’s bg rather than ps.

 

By feeding normally, you mean low carb, correct?

 

Yes. Low carb. He would be a diet controlled diabetic.

 

He's at 61 this afternoon....many hours after his last insulin.

 

How has Blue been behaving since, Patty? Less wobbly/spacey? More like himself?

I'm sorry you're being given a bit of a runaround on the vet side of things. I'm of the same view as yourself, namely that the oncologist instructed you to get Blue's blood tested specifically to check for any effects related to the chemo and therefore that it is the oncologist (and team?) who should be interpreting the results and advising you. Frustrating indeed.


Mogs
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Let’s continue as is a few more days because he was over 120 a few days ago. Keep this same testing schedule so if he should go up we catch it early. Okay with you?
Is he still acting strange? How’s your knee?

 

He's still "different" I would say. He sits for long periods of time and stares. No one returned my call about the blood work and I was going to mention his change of personality. It's very disappointing.

My knee is not good and I'm going to a new orthopedic doctor January 6 and it can't come soon enough.

Yes, we can continue for a few more days. I'm actually worried about his next chemo treatment because he was slightly elevated after his first.

He's over testing and giving me a hard time. What is the same testing schedule? I have been testing before his three meals only.

 

I think that’s enough testing unless one of them is blue. If that happens I would get a test 2-3 hours after eating.

 

A thought: the blood results in the Blue Pearl PDF you uploaded a while back indicated that Blue was anaemic. I think that's something else that perhaps you should ask about. I'm just wondering whether that is something that might potentially be contributing to Blue being a bit spacey. (Again, just throwing out ideas here, but anaemia can cause tiredness.)

Sorry to hear about the continuing pain in your knee, Patty. I hope the new doctor will be able to do more to help you. Chronic pain is not only sore but can be incredibly debilitating - physically and mentally.




Mogs
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I wasn't aware he was anaemic Mogs. I don't know much about reading blood tests. Good to know that could be a contributing factor. Is there anything I can do to help that?

I will call Blue Pearl again tomorrow. I'm so disappointed in them.

Yes, chronic pain is the worst. It makes me grouchy and I don't like that. I have missed 2 tennis seasons already and getting FAT from no exercise.

Yes, the testing schedule is good and I'll test more if he goes back into the blue. Hopefully he won't. I am surprised at where we are. Seems not long ago he was HI.

 

Complete Blood Count from December 10:





RBC - LOW - red blood cell count. Anaemia marker.
HCT - LOW - haematocrit, proportion of red cells to plasma in the sample. Anaemia marker.
HGB - LOW - haemoglobin (involved in transport of oxygen in the blood). Anaemia marker.

RDW - HIGH - red blood cell distribution width - indicates that there is a wide range of cells of different sizes in the sample (e.g. cells at different stages of maturity). Anaemia marker, needs to be assessed alongside other results.
RETIC - HIGH - immature red blood cells - high count is another marker for anaemia (bone marrow producing extra).

LYM, MON - HIGH - lymphocytes and monocytes - types of white blood cell. Elevated levels may possibly indicate inflammation/infection/other systemic stressor.

Note that blood results need to be assessed in the round by someone skilled in their interpretation.

Note also that there is more than one type of anaemia and treatment needs to be specific to the type. For example, according to Tanya's Site anaemic cats with infections should not be given iron supplements (bacteria thrive on it, so much so that the body has mechanisms which may sequester iron in cells when an infection is present.) You need to get specific guidance from the vets about appropriate treatment.


Mogs
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Here are the scatter charts for the above blood results from the PDF. Beneath each there are things highlighted which should be considered by the vets (including recommendation to examine a blood film - this gives more info on the type and condition of the cells present):






Mogs
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I don't think covid is helping any these days. I've found that I need to chase a bit more with our vets when I need info, or when things are missed.


Mogs
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They had this on Thursday. I called today because I know the doctor only in M-Th. The tech should be able to ask someone else to advise.

 

The results posted above are from 10 December, so the ones from last Thursday are more recent (don't remember your having posted those).

I agree with you in thinking that there should be better cover and continuity of care.

If you look in Blue's spreadsheet, there's a LABS tab where you can record the results of each set of tests if you wish (can be very helpful for tracking changes, and also Marje is quite good at reading labs if you were to ask her to have a look at them).




Mogs
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Can you read this?

 

The anemia Blue has is either due to the cancer or infection. I never saw 12/10 results. He vets were supposed to discuss if he has an infection. Chemo can cause anemia as well which is why they test before each treatment. I would want to speak with your oncologist. I thought Blue Pearl was where the last blood tests were done and you were charged for a consult but if your vet was the one she needs to follow through. Very disappointing indeed. One would think that one vet handling it all would be better but with Tiffany that was not the case. The oncologist missed a kidney infection that I only discovered when I called my vet to find out why she could be in kidney failure.

 

I see it. The high white count is likely inflammation from the lymphoma. I remember Tiffany had a high white count when diagnosed. All other labs were normal though and she didn't have an infection. A high white count can also be from infection. With Blue having symptoms I would be asking both vets.

 

Hi there

Blues BGs are looking pretty darned good

A couple questions-
what is the chemo/treatment plan his oncologist has recommended?

Regarding food/meals/snacks and timings, according to your ss he gets a LC meal around 8:30am another LC meal 3-4 hours later (between 11:30am and 12:30pm), followed by a LC snack 8-9 hours after that (8:30pm). Then he goes 12 hours until the next meal at 830am. Did I get that right?

What constitutes a “meal” vs a “snack”.
How many calories would you say he Is consuming daily?

 

Red cell results are much better in this CBC - back in normal range.


Mogs
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Blue Pearl said I could have the blood tests run either there or my vet whichever is convenient. The oncologist ordered it so I thought they would do follow-up. My vet didn't want to treat anything because of him being on chemo.

 

He gets chemo every 3 weeks (Adriamycin). His next one is December 31.

Yes 8:30 a.m., 3:30 p.m., and 8:30 p.m. It's all LC and I've revised the meal at 8:30 as a snack just because it's smaller. It's the same LC food. I had to add it for insulin. He would eat more if I would feed him more. I was trying to cut back at night but it's probably almost as much as his meal. I'm not sure about calories. I always free fed dry food but stopped that a few months ago when I went to TR.

I think I'm rambling again. I'll check on calories.

 

This is the American Journey can. 396 Cal per can.

 

I fed early since he's not getting insulin. I measured this time and he's probably not getting 1/4 can. I probably need to make sure
he eats more because the others get dry food and he doesn't get supplemental food.

 

As a rough guide calorie-wise a cat needs about 15-20 kcal/lb of ideal weight for maintenance (varies depending on activity level, etc.), a little more for weight gain, a little less for weight loss. Dr. Pierson's catinfo.org has good info on this stuff. The best way to get a handle on an individual kitty's caloric needs is to do simple weight management:

1. Log amount fed each day.
2. Weigh cat once a week and assess against body condition chart.
3. If underweight, increase daily calories a little; if overweight, reduce them a little.

Rinse 'n' repeat.

I'm not sure how Blue's health issues might affect his calorie requirements (e.g. might he need extra?). Again, that is something I'd look to get a steer on from the specialists.


Mogs
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Hi Patty,

Is all OK with you? How is Blue feeling/acting today? Did you get any word back from Blue Pearl?


Mogs
.