3/4 Ruby Ultrasound results PMPS 85/+2 61

Yesterday on Ruby Dooby Doo.

In happy kitty news, last night I saw Ruby jump from the floor onto the kitchen table without jumping onto a chair first. I don’t think she’s done that since she was a kitten because of her substantial girth. Now that she’s all trim, she’s doing all sorts of nifty things.

Healing thoughts for all of the sick kitties and hugs to you beans. Happy Thursday.

 

Yay Ruby! She gets a gold medal in the floor-to-table jumping event. Butters has never been able to do that!
Have a great day!

 

Way to go, slim and trim Ruby!

 

Ha ha, I'm the same! I get so happy for Cargo when he feels good enough to jump! Who knew we could be so excited over a cat just doing a cat thing? LOL!

 

My civvie Olive was always the hunter and pro jumper. She has walked a two inch wide banister with grace and confidence. Ruby however has a reputation for being her gentle lumbering sister who preferred naps and kibbles over tightrope walking. It's not entirely a surprise to me that she became diabetic. Any show of physical fitness is a wonder to me with Ruby!

 

After 5 phone calls, I finally have received the ultrasound report from Blue Pearl. It is as the doctor had mentioned, but I would love for someone here with the lab eagle eyes to take a look at the report from September 2020 and the one done last week as well as I don't trust this doctor to communicate with me properly.

With the reports, I finally received discharge papers from the internist that states that I should take Ruby off insulin: "Lantus: please discontinue this medication as Ruby has had persistently low blood glucose levels while on insulin suggesting that Ruby is now in remission with her diabetes mellitus." This was NEVER brought up during Ruby's visit last week, and she came to this conclusion after I shared with her Ruby's spreadsheet. I am not going to be taking her off insulin yet because I don't believe she will have a strong remission if I did, but also, WHY DIDN'T SHE TALK TO ME ABOUT IT, but instead passive aggressively inserted it into discharge papers that were never sent to me until a week after the appointment and after I asked for them?

Still waiting for the GI labs from Texas A&M.

Sorry for the frustrated venting, but I have spent so much time and money on this doctor and I never feel like I am treated as I should be.

Bringing Ruby to her primary vet (who is nicer and calls me back) to have her kidney values checked out this afternoon. Wish us luck!

 

ooooooh boy. Sorry but these vets just astound me sometimes. FWIW, Ruby's numbers are so good because she is on insulin. If it were me, I would ignore the note on the discharge papers.
Butters's internal medicine specialist said (and wrote) the exact same thing about Butters being in remission. She withheld insulin from Butters when she was in the hospital and it (and the pancreatitis) set off a series of events that sent butters into higher numbers that I had to chase for over two months.

Oh and funny enough it took almost two months of me calling and emailing the hospital to get her U/S report, too. So weird, right. And I know her primary care vet thought it wasn't very well done. So I empathize with you big time.

Good luck with the labs this afternoon. Sending many vetty vines to Ruby

 

Thanks, Lyla! Your experience sounds terrible! I really hope that I never have to admit Ruby again to Blue Pearl for more than a few hours because they will definitely withhold insulin from her. Something to think about. I fully intend on ignoring. I'm sure her primary vet will give me a prescription for more insulin if I need it.

 

Good grief . . on that remission note that was snuck into the paperwork. I would have a lot of hope they are correct with their interpretation on the sonogram.

Good luck at the nice communicative vet's office this afternoon

I think it's great you caught the creatinine and BUN while just slightly elevated. That way, you can control it for years with your TLC and knowledge.

 

Lyla, it seems like quite a few people here on FDMB have had bad experiences at Blue Pearl. I'm so confused. There is a Blue Pearl in Atlanta that would be my closest Blue Pearl specialty hospital, and I've occasionally been at the point of taking a cat there, but haven't had to go there yet. Now, I'm concerned. I do know a few people who have had good experiences at Blue Pearl in Atlanta though... one person was there with a cat that had a vaccination site sarcoma from a Leukemia vaccine. They had a great experience with their cats chemo treatments. I guess each Blue Pearl is different, and it probably varies as well by which specialists you see.

Is that the "scare" that people refer to when Butters was so sick? It was set off by the lack of insulin and her pancreatitis? How long ago was that?

 

Looking at those ultrasounds... it looks like what they say, possible IBD or SCL. The muscularis layer cannot be reached without a full surgical biopsy, you can't use an endoscope. I am interested in the fact that they say the intestinal walls are slightly improved. Did they start Ruby on any pred or budesonide (which of course would definitely make her BG go up.)

In Darcy's two ultrasounds, they also said his liver was hyperechoic and had a "moth eaten appearance." Of course, there were other areas that they sampled with FNA and the results came back that it looked like it was just from the hepatic lipidosis. I am wondering how his liver looks now... I guess I'm going to have to get another ultrasound. Fortunately, my regular vet can do them. Anyway, this is why I started Darcy on the Denamarin. I hope to see that his liver looks better after having been on this for months.

 

Good girl Ruby on the jumping! It’s a kitty Olympic year, keep on practicing.

Where is the rest of the report? There should be measurements of bowel wall thickness, and by area of bowel, duodenum, jejunum and ileum. Without that, how can you say how much or where is improved.

 

Thanks for looking at the ultrasounds, Jan. We're waiting on the results of a GI panel sent to Texas A&M before deciding how to proceed. It could be IBD or SCL or pancreatitis. If those tests come back negative, then it might be Ruby's CKD affecting her appetite. That's what the blood panel we're doing today will tell us since the last one was done about two months ago.

The doctor never addressed the hyperechoic aspect of her liver with me. I assumed it was from her DKA from September, but I will ask her about it when we discuss the GI labs.

 

Thank you, Wendy, for looking at the reports. You're so right. I thought it was strange that he states that there is "subjective" improvement but then provides no other details. Isn't he a board certified radiologist?? I will ask.

 

I believe if you have placed an order with Mark's Marine Pharmacy before, they will allow you to purchase insulin from them indefinitely. At least that's what I understood from talking to the pharmacist there. Hopefully you won't ever have to worry about getting a hold of some Lantus for your kitty.

 

Yes. I thought is was kind of vague. And to actually use the word "subjective!"

 

Include me on that list. I had my primary vet provide recommendations for two other 24/7 ER hospitals with specialty internists which are privately owned and not part of a nationwide chain. And the BP charges...e.g. $270 to apply the Freestyle Libre CGM vs $39 at my vet

 

My experience wasn't at Blue Pearl. I'm not even sure we have Blue Pearl in Canada. I'll respond to your questions about Butters in my condo so I don't take over Ruby's.

 

I wish I didn’t have to take Ruby to Blue Pearl but since she was seen there in September by an internal med specialist I thought I would bring her back there when she stopped eating well. Don’t even get me started on the cost. To think that I paid $600 for the ultrasound and got that vague report really gets my goat. Sadly most larger speciality practices in the NYC area are corporate owned. In fact I believe that Mars, manufacturers of pet foods, own Blue Pearl.

 

I feel your pain. Minnie's been back to Blue Pearl 3 times since they diagnosed her and I felt like I had no choice the last time, but everything I've learned in my brief time here has convinced me to find another vet.

Well done on a jumping Ruby! Don't you feel proud? And good luck with the vet this afternoon. Interesting what she might have to say about the results.

 

As long as Ruby keeps eating and pooping, she seems to be better than ever. She just jumped onto the back of the couch where I am sitting and is head butting me and sniffing my hair. My primary vet, who is wonderful, did not see the US report or the discharge papers from the hospital yet, but I gave him a summary. He agrees that I should continue managing Ruby's diabetes with insulin as he knows I am very much on top of any potentially hypoglycemic event and trusts that I know what I am doing. He drew some blood for a renal panel so we shall see what that says.

 

dear ruby
eat, poop, jump sounds like a pretty good way to spend the day.
i also like to nap, but ecid.
kit

 

dear kit,
what about eat, poop, jump, and then vet pokes?
lots of the latter happens these days.
love, rubes

 

You know, I had a terrific experience with Blue Pearl when Fortune was first diagnosed with SCL in January 2018, but when we went THIS January and February, the internal medicine team was awful. I'm not going to derail by detailing, but the internal medicine team there aims for BG in the 150-350 range, so of course they think Ruby should be off insulin. It sounds like your GP is a gem!

It's interesting that the U/S says improved, but doesn't sound like it's normal. Are they recommending a biopsy?

 

I actually don't mind that we don't agree about the management of Ruby's diabetes, it's more about the way it was handled and not well communicated. I have disregarded the advice of this doctor regarding FD since October when I joined this board and worked with her primary care doctor who supported me after he saw Ruby's fructosamine results. What is making me crazy right now is that I bring her in to have her IBD/SCL diagnosed and I get a vague radiology report. Before recommending a biopsy, the Blue Pearl internist drew blood and sent it to Texas A&M to the GI labs. Still waiting on that.

Half of a veterinarian's job is making the client (me) feel confident in their ability to take care of my cat (has anyone watched "All Creatures Great and Small" yet?).

 

Phew, you had a day Katherine Hugs to you and beautiful Ruby

 

I agree with you, 1000%. Bedside manner + collaboration - and not being afraid of questions and discourse - is the mark of a good doctor. At the end of the day, we ARE clients. And this is not back in the day when information was only available through research, encyclopedias, textbooks, lectures, conferences, etc. We can access clinical study and trial data at the click of a mouse, medical journals, and more to be better informed. I still will defer to a doctor's opinion - when they explain their POV and recommendation to my satisfaction. When they are unwilling to have the discussion or take questions, it's not for me.

Do you know what the blood test was for? A more thorough rule out?

I haven't! What platform is it on?

 

I agree with Wendy. I’ve never seen such a short report on an ultrasound.

Also, vacuolar hepatopathy is rare in cats and is best diagnosed with a needle aspiration. Also, I don’t get why they aren’t running a full superchem on her to check her ALP which should be elevated with that condition. It befuddles me that they remarked on that condition months ago but when her labs have been done since then, they aren’t checking all her liver tests by doing a superchem.

 

I was perplexed by the "Vacuolar hepatopathy (ie diabetes)". Perhaps this was a note left from September when Ruby was DKA? I have never even heard of ALP. They were concerned about her liver and bilirubin levels when she was discharged from the hospital in September but I believe that was resolved and her liver levels on her labs were good.

 

Yes they have improved but there is no value for alkaline phosphatase which is aka ALP.

 

The blood test is to test for pancreatitis and her B12 and folate levels.

All Creatures Great and Small is on PBS Masterpiece theater. It's a super sweet remake of a British show from the 1970s about a country vet. I binged watched it!

 

We have results for that. I think I left it off because ALP isn't in the labs template on the FDMB spreadsheet. Here's the most recent labs. ALP is normal.

 

Good grief, what a day for you and Ruby! I am almost caught up but will wait to look at labs int he morning when my eyes are fresh (well...lol, I hope fresh!) Hope you get some good rest tonight, both of you!

 

I'm so glad it's normal! FWIW ALP = Alkaline Phos, no idea why it isn't abbreviated.

 

Thanks, Rachel, I totally did not make the connection! Will fill in the missing values tomorrow.

 

Completely normal. If the dx was correct, there should be an elevation in some liver value.

 

♥

 

Our whole family has really enjoyed the "All Creatures Great and Small" series on PBS. But then, I've read the James Herriot books, too... and we also have DVDs (well... and confess to still having it on VCR) of the original series that was made in the 1970s as well...so I'm a bit of an "All Creatures" aficionado.

 

You know, the whole "chain/corporate" aspect of veterinary practice seems to be a disturbing trend. It is even affecting smaller practices around here that are general veterinarians. Well, what I mean is that investment groups are buying up a whole bunch of the veterinary practices around here. The vets who own them get paid a lot of money for their practice and they can keep practicing if they want to. However, they lose control over a lot of things like medications, procedures, prices, and just don't have any flexibility anymore since they are controlled by a group. It's all about cutting costs and maximizing profits once they have sold out. The attractive aspect of it from the vets perspective (aside from a large payout,) is that they don't have to be human resource managers anymore, which I know they like... because they really just want to practice veterinary medicine. My veterinarian, when I asked her, explained that corporate groups are buying up the veterinary practices because they are looking for income streams to fund pension plans. I really brought this up with her because I was worried that she would "sell out" too. She assured me that she was NOT going to sell out. She still has to get her two girls through quite a few more years of private school and then college!

In our area, other things are becoming chains, too. This chain called "My Eye Doctor" has bought up almost all of the optometrists around here. The service has gone way downhill. I won't go to our old eye doc anymore and am going to start going to an independent eye care practitioner.

 

Okay, I think I was confused. I thought that you were posting labs from yesterday's blood draw. I see that her liver enzymes from the 13th of January were all back down to within normal limits. Which is fantastic! I'm very happy to see this!