? 7/26 Howie PMPS=208 +1.25=220

[Howiesmom]

Yesterday’s thread https://www.felinediabetes.com/FDMB/threads/7-25-howie-amps-180-5-235-6r-9-259-10-241.250357/

This morning he is still high so I bumped up the R even more (but not back to the April 20 scale since that was when he was at 43 units and he’s currently at 22). He goes to the vet today so will report back on what she says about the possible UTI/infection, meds, and if she has any idea for why the higher BGs.

One thought I had: I’m trying to change food as his current food switched formulas which sent their carb %s higher than I can have. so was trying out the Tiki based on Dr. Lisa’s food chart (and have an email in for updated nutritional data). The Tiki food actually has better carb counts than his current food so didn’t think that would do anything to upset the apple cart here. But could it? I tried him on the Tiki food on Sat (7/24) but his raised BGs started well before Saturday.

 

[Howiesmom]

@Wendy&Neko @Sienne and Gabby (GA) @Suzanne & Darcy
Just got back from the vet and I am more confused than ever. I updated all his labs in his SS. I thought they were running a full blood panel but I see I’m missing quite a few numbers compared to what I got in April at his wellness exam. This vet (who I don’t like) was so focused on testing him for pancreatitis. I put my foot down and said that I was here to figure out why he’s still not peeing and this sudden spike in BGs. He doesn’t have any classic signs of pancreatitis right now. So we did another urinalysis and blood work. I couldn’t get a C&S done as he has to be off antibiotics for 3-4 days from what she said. All his kidney values are still in normal range but are creeping up. They did not run an SDMA so I don’t know if it is above 17 (what he was in April). The BASO is high (and was in April too) so that is what we’re focusing on (apparently). It could be from GI issues, allergies or some other stuff. Again…I was so confused by what she was saying I couldn’t track a whole lot. In the end, he is finishing out 7 days (Thursday) of the antibiotic to kill off anything there might be and she gave me 8 days of Cerenia pills to see if that helps the elevated BASO and associated issues. If his BGs are not getting better, then we could run the pancreatitis test next week when I see my regular vet (Thank God!). There is a reason why this vet always has openings!

I don’t begin to understand lab results besides the kidney values from my old CKD kittie. So I would appreciate Any thoughts on what anyone sees. And what should I be asking my normal vet to do or what should I talk to him about next week that you see as concerning it potentially concerning? I don’t know anything about pancreatitis to know if this is a viable issue. Today’s vet goes to pancreatitis anytime a cat has GI issues (Howie puked once while at the vet lodge and called me to say she thinks he had it!).

Also, since Howie doesn’t drink water (from a dish or fountain), she suggested Hydra Care from Purina to stimulate thirst. Has anyone used this or know about it?

 

[Suzanne & Darcy]

Well, he has red blood cells in his urine. That's probably indicative of inflammation and irritation. I'm happy to see the platelet count back up to normal. Have no idea why it was so low before... but this is good. A lot of the blood work looks really good. His urine alkalinity is trending downward from last time so that is also good. You already know a lot about the kidney values as you said.. and they are not bad at all. I would be leary of switching to the Tiki
Cat foods if you are concerned about his kidneys because they are pretty high in phosphorus (I hated this because Darcy loved them for a long time). But if you want to wait on thinking about lowering the phosphorus if his kidneys deteriorate (which we hope will not happen) then I understand.

It's interesting how his overall blood WBC does not show an elevation and never really has in these last several bloods on your spreadsheet. I hope the Cerenia will help with overall inflammation and will help his urinary tract to heal. Let me think about those basophils for a minute.

 

[Suzanne & Darcy]

You know, I've never been able to get my vets very excited about elevated Basophils when I've asked them about it before. They never thought it was a "significant finding." From the reading I did in the past, I know they can be elevated for asthma, allergies, insect bites, parasitic infections, etc. -- just like eosinophils (and Howie's EOS are not elevated.) I do not know HOW elevated they need to be for your vet to get really concerned about them. I wonder if acro cats have more of a tendency toward high basos? Or IAA cats? From what I have read Basophilia can occur in cats with an altered lipid metabolism from many causes and that includes diabetes... so it may not be anything to worry about. I'm attaching a really short thing on Basophilia only because it is short and does mention diabetes at the end.

http://vetbook.org/wiki/cat/index.php?title=Basophilia

 

[Howiesmom]

You know, I've never been able to get my vets very excited about elevated Basophils when I've asked them about it before. They never thought it was a "significant finding." From the reading I did in the past, I know they can be elevated for asthma, allergies, insect bites, parasitic infections, etc. -- just like eosinophils (and Howie's EOS are not elevated.) I do not know HOW elevated they need to be for your vet to get really concerned about them. I wonder if acro cats have more of a tendency toward high basos? Or IAA cats? From what I have read Basophilia can occur in cats with an altered lipid metabolism from many causes and that includes diabetes... so it may not be anything to worry about. I'm attaching a really short thing on Basophilia only because it is short and does mention diabetes at the end.

http://vetbook.org/wiki/cat/index.php?title=Basophilia

Thank you so much for your thoughts! It is really helpful! I will check out the link you sent. I will see how the cerenia goes and have a good chat with my regular vet next week.

I’m not sold in the Tiki food. I bought some at a pet store to try but it was the shredded chicken. With no teeth, he struggled with it and my food processor couldn’t grind it up. So I’m returning the rest I bought and try Weruva. The problem is that most of their food that has good carb counts and phosphorous under 300 has fish in it. I know Dr. Lisa says no fish. He needs food free from Carrageenan so I’m limited on food options that meet all his needs!

 

[Suzanne & Darcy]

Thank you so much for your thoughts! It is really helpful! I will check out the link you sent. I will see how the cerenia goes and have a good chat with my regular vet next week.

I’m not sold in the Tiki food. I bought some at a pet store to try but it was the shredded chicken. With no teeth, he struggled with it and my food processor couldn’t grind it up. So I’m returning the rest I bought and try Weruva. The problem is that most of their food that has good carb counts and phosphorous under 300 has fish in it. I know Dr. Lisa says no fish. He needs food free from Carrageenan so I’m limited on food options that meet all his needs!

If he has no teeth, I would try the Weruva BFF PLAY foods. They are a really soft pate with quite a bit of water/broth in them. My cats like the Lamb Laugh Out Loud one. Howie isn't allergic to chicken or anything is he? A lot of them have chicken in them (or turkey). I see they do have a lot of fish offerings, but the ones I buy (mostly the lamb one and the chicken and turkey Topsy Turvy one have no fish, I think).

 

[Suzanne & Darcy]

And like I said, you've seen a few good things in his bloodwork (and kidneys still within normal limits.) So hopefully this urinary tract problem can get better. He must have been hurting. I wonder if he needed pain meds? I hope the Cerenia helps overall. Is he allergic/sensitive to carageenan? I'm trying to cut it out of all my cats foods, but only because I fear it will contribute to GI inflammation.

 

[Sienne and Gabby (GA)]

I just looked over Howie's labs. Did anyone happen to mention that those very low platelet counts were likely due to clumping? His labs look good -- although I asked Marje to stop by and take a look, as well. I strongly suspect that the elevated basophils may be due to the acro. It's a source of stress and that may be an explanation for the elevated level.

Did the vet say anything about the RBCs in Howie's urine? If it is cystitis, glucosamine and chondroitin may be helpful. It would also be good if the vet suggested what to do given the lab result.

And good job putting your foot down!!

 

[Suzanne & Darcy]

I just looked over Howie's labs. Did anyone happen to mention that those very low platelet counts were likely due to clumping? His labs look good -- although I asked Marje to stop by and take a look, as well. I strongly suspect that the elevated basophils may be due to the acro. It's a source of stress and that may be an explanation for the elevated level.

Did the vet say anything about the RBCs in Howie's urine? If it is cystitis, glucosamine and chondroitin may be helpful. It would also be good if the vet suggested what to do given the lab result.

And good job putting your foot down!!

That’s correct about the clumping. I can’t see the actual lab reports from just looking at a cell on the spreadsheet, but usually if you read them carefully you will see the caveat about not getting an accurate platelet count due to clumping and it suggests that a manual count be done. That always frustrates me but it does happen a lot. Good point, Sienne!

 

[Marje and Gracie]

Yesterday’s thread https://www.felinediabetes.com/FDMB/threads/7-25-howie-amps-180-5-235-6r-9-259-10-241.250357/

This morning he is still high so I bumped up the R even more (but not back to the April 20 scale since that was when he was at 43 units and he’s currently at 22). He goes to the vet today so will report back on what she says about the possible UTI/infection, meds, and if she has any idea for why the higher BGs.

One thought I had: I’m trying to change food as his current food switched formulas which sent their carb %s higher than I can have. so was trying out the Tiki based on Dr. Lisa’s food chart (and have an email in for updated nutritional data). The Tiki food actually has better carb counts than his current food so didn’t think that would do anything to upset the apple cart here. But could it? I tried him on the Tiki food on Sat (7/24) but his raised BGs started well before Saturday.

Sienne asked me to stop by and give you some thoughts on his labs.

First, I, personally am a big proponent of running a superchem, CBC, and UA at least twice a year even in younger cats. Of course, if a vet is monitoring something, like liver values, because they were elevated, and is checking them every month, a liver panel alone is enough. But, even when I had CKD cats, if they needed labs every three months, I’d get it all done because the organs don’t work in a void. I don’t know about IDEXX but Antech has a Senior Panel which is less expensive and includes all of the above plus tT4 for thyroid. Of course, if $$ are a factor, then you have to decide what’s going to give you the biggest bang for your buck. For example, there is no P value on this test and I find that info always important even in healthy cats.

On his serum chemistries, I’m not seeing anything that is a red flag. I agree with Sienne that low platelets are often due to clumping and it will state that on the lab report so pls check it, and if it is, you can write it in on the lab SS by the platelet value. The basophils don’t worry me because the eosinophils are also up which is likely some kind of allergic response to something. I see this in my kitties from time to time. My vet is a stickler on getting into the weeds on labs because she knows how I am and if the basophils & eosinophils are elevated, she’s not worried.

On the urine….also agree on the blood which can indicate a UTI or a kidney infection. Typically if it’s a kidney infection, it won’t show up as having bacteria in the urine…even with a c&s….but these are more common in CKD cats and usually the creatinine will pop up. Usually but ECID. My vet only has faith in an ultrasound for really diagnosing kidney infections. It’s just so far up in the kidneys that it’s not uncommon to not see any bacteria in the urine or urine culture. For my last CKD cat, if he had blood in his urine, we came to know that it always meant a kidney infection.

I’m not suggesting Howie has one but if they decide he has a UTI based on the blood and it doesn’t clear up with the regular antibiotic, I’d push harder. It takes bigger gun antibiotics for an extended time to wipe out kidney infections.

 

[Wendy&Neko]

Glad to see Marje stopped by and took at look at the labs. Just a FYI, if you highlight the out of range values with red text or something like that, it's quicker for us to evaluate.

. I wonder if acro cats have more of a tendency toward high basos? Or IAA cats?

Nope, my girl never had high numbers there except her very last set of labs, and it was just one point out of range. And it's not something I recall other caregivers of acros comment on. I agree with Marje on the importance of P (phosphorus). Since it was increasing last time, you do want to keep an eye on it, so surprised it's missing from these labs. Were they done in house?

Neko also got labs at least twice a year, more frequently later. Things can change quickly with acros.

she suggested Hydra Care from Purina to stimulate thirst. Has anyone used this or know about it?

Might want to search on this forum for that name. I recall someone mentioning it a while ago, but can't remember who.

 

[Howiesmom]

If he has no teeth, I would try the Weruva BFF PLAY foods. They are a really soft pate with quite a bit of water/broth in them. My cats like the Lamb Laugh Out Loud one. Howie isn't allergic to chicken or anything is he? A lot of them have chicken in them (or turkey). I see they do have a lot of fish offerings, but the ones I buy (mostly the lamb one and the chicken and turkey Topsy Turvy one have no fish, I think).

Yes, Howie is very sensitive to Carageenan. He had many bowel/GI issues last summer and so did some research and found that to be a culprit. Once I got food without it, he got so much better. I found a lot of the BFF Play foods today to try. I ended up getting ones with chicken or turkey mixed with tuna as they have protein greater than 50%, fat around 40%, carbs around 5%, and phosphorous under 300. We’ll see how he does. I know they have food without fish, but many of them have lower protein and higher fat despite the good carb counts. Fingers crossed this works for him!

 

[Howiesmom]

And like I said, you've seen a few good things in his bloodwork (and kidneys still within normal limits.) So hopefully this urinary tract problem can get better. He must have been hurting. I wonder if he needed pain meds? I hope the Cerenia helps overall. Is he allergic/sensitive to carageenan? I'm trying to cut it out of all my cats foods, but only because I fear it will contribute to GI inflammation.

He was on Onsior for 3 days as a pain med. no idea if he needed it or not??

 

[Howiesmom]

I just looked over Howie's labs. Did anyone happen to mention that those very low platelet counts were likely due to clumping? His labs look good -- although I asked Marje to stop by and take a look, as well. I strongly suspect that the elevated basophils may be due to the acro. It's a source of stress and that may be an explanation for the elevated level.

Did the vet say anything about the RBCs in Howie's urine? If it is cystitis, glucosamine and chondroitin may be helpful. It would also be good if the vet suggested what to do given the lab result.

And good job putting your foot down!!

She legitimately said she wasn’t concerned about the RBCs because it was in a normal range. If he was 5 or more, then she might have acted on it. She was just so fixated on the pancreatitis for some reason. I’m sure I’ll probably end up getting some more lab work again next week, so we’ll see. I’m just surprised that when he originally went in last Thursday, there were not really any RBCs detected? Again, this is why I hate seeing her!

 

[Howiesmom]

For anyone who can help, I’m not sure what to do. At +10, I gave Howie a Hydra Care supplement (recommended from vet today to help him get more fluids). He lapped it up and was fine. At +11, his BG went up to 195 (from 160 at +10) and at PMPS, he was 208. That was 30 min ago. He is always food motivated and ears all his food. However, he only took 2 licks of food and won’t eat now so I can’t give his insulin. Luckily I am starting him on cerenia tonight from the vet (see thread above) but I’m not sure what to do to get him to eat and a dose of insulin when he finally does get hungry. He’s never done this before and I’m not sure what’s going on. The hydra care was just a supplement to spur him to drink.

UPDATE: The cerenia must have finally kicked in as he finally ate at +1.25 so I could give him his insulin.

 

[Marje and Gracie]

For anyone who can help, I’m not sure what to do. At +10, I gave Howie a Hydra Care supplement (recommended from vet today to help him get more fluids). He lapped it up and was fine. At +11, his BG went up to 195 (from 160 at +10) and at PMPS, he was 208. That was 30 min ago. He is always food motivated and ears all his food. However, he only took 2 licks of food and won’t eat now so I can’t give his insulin. Luckily I am starting him on cerenia tonight from the vet (see thread above) but I’m not sure what to do to get him to eat and a dose of insulin when he finally does get hungry. He’s never done this before and I’m not sure what’s going on. The hydra care was just a supplement to spur him to drink.

That hydra care has guar gum in it as well as “natural flavoring” which always makes me suspicious. Guar gum can also upset IBD cats GI system.

I would test again and see if he will eat. How long can you stall?

 

[Howiesmom]

That hydra care has guar gum in it as well as “natural flavoring” which always makes me suspicious. Guar gum can also upset IBD cats GI system.

I would test again and see if he will eat. How long can you stall?

We just crossed our posts! He finally ate about 15 min ago. The cerenia must have kicked in. He has some food with guar gum in it that doesn’t upset his stomach, but maybe this is more concentrated. I thought it was a magic serum to get him to consume more liquids, but I don’t want to go through this again. I make sure that he doesn’t have food with carageenan for GI reasons. I was just lucky to have the cerenia! I’m still wading through your earlier post…I really appreciate it! I just don’t like this vet I had to see and have no idea why she wouldn’t have run a full blood panel today. I certainly paid for it!

 

[Marje and Gracie]

We just crossed our posts! He finally ate about 15 min ago. The cerenia must have kicked in. He has some food with guar gum in it that doesn’t upset his stomach, but maybe this is more concentrated. I thought it was a magic serum to get him to consume more liquids, but I don’t want to go through this again. I make sure that he doesn’t have food with carageenan for GI reasons. I was just lucky to have the cerenia! I’m still wading through your earlier post…I really appreciate it! I just don’t like this vet I had to see and have no idea why she wouldn’t have run a full blood panel today. I certainly paid for it!

I’m glad he ate so you can shoot.

I am not a fan of any Purina products. I am really picky about everything that goes in my cats’ little bodies…and mine. All Purina products have too many undesirable ingredients, IMHO.

Let me know if you have questions.

 

[Howiesmom]

Sienne asked me to stop by and give you some thoughts on his labs.

First, I, personally am a big proponent of running a superchem, CBC, and UA at least twice a year even in younger cats. Of course, if a vet is monitoring something, like liver values, because they were elevated, and is checking them every month, a liver panel alone is enough. But, even when I had CKD cats, if they needed labs every three months, I’d get it all done because the organs don’t work in a void. I don’t know about IDEXX but Antech has a Senior Panel which is less expensive and includes all of the above plus tT4 for thyroid. Of course, if $$ are a factor, then you have to decide what’s going to give you the biggest bang for your buck. For example, there is no P value on this test and I find that info always important even in healthy cats.

On his serum chemistries, I’m not seeing anything that is a red flag. I agree with Sienne that low platelets are often due to clumping and it will state that on the lab report so pls check it, and if it is, you can write it in on the lab SS by the platelet value. The basophils don’t worry me because the eosinophils are also up which is likely some kind of allergic response to something. I see this in my kitties from time to time. My vet is a stickler on getting into the weeds on labs because she knows how I am and if the basophils & eosinophils are elevated, she’s not worried.

On the urine….also agree on the blood which can indicate a UTI or a kidney infection. Typically if it’s a kidney infection, it won’t show up as having bacteria in the urine…even with a c&s….but these are more common in CKD cats and usually the creatinine will pop up. Usually but ECID. My vet only has faith in an ultrasound for really diagnosing kidney infections. It’s just so far up in the kidneys that it’s not uncommon to not see any bacteria in the urine or urine culture. For my last CKD cat, if he had blood in his urine, we came to know that it always meant a kidney infection.

I’m not suggesting Howie has one but if they decide he has a UTI based on the blood and it doesn’t clear up with the regular antibiotic, I’d push harder. It takes bigger gun antibiotics for an extended time to wipe out kidney infections.

I just checked all old lab reports, and nothing noted in them about clumping of platelets. These are all run in house as it is an animal hospital and clinic. When I had labs done in April for his senior wellness exam, I had a full blood panel done including the tT4. In looking at my invoice today, apparently she did “therapeutic monitoring” which doesn’t look at all the values. I will ask my regular vet next week because the phosphorus does need to be monitored. I really appreciate having you take a look at this with a scrutinous eye. If this is allergies with the elevated basophils, she seems determined it must be food related with the 8 day course of cerenia. But it could be environmental too, right? I take him out most nights around my yard on his leash.

As for the blood in the urine, she seems convinced he doesn’t have a UTI. do I ask my vet to run ANOTHER urinalysis next week again? I’m just so confused by all these numbers. Maybe I wouldn’t feel this way if she wasn’t so distracted with pancreatitis!

 

[Howiesmom]

Glad to see Marje stopped by and took at look at the labs. Just a FYI, if you highlight the out of range values with red text or something like that, it's quicker for us to evaluate.

Nope, my girl never had high numbers there except her very last set of labs, and it was just one point out of range. And it's not something I recall other caregivers of acros comment on. I agree with Marje on the importance of P (phosphorus). Since it was increasing last time, you do want to keep an eye on it, so surprised it's missing from these labs. Were they done in house?

Neko also got labs at least twice a year, more frequently later. Things can change quickly with acros.

Might want to search on this forum for that name. I recall someone mentioning it a while ago, but can't remember who.

I will go through and update the results with some red text. Yes, all these labs are run in-house. In looking at my invoice today vs his one from April, I only got “therapeutic monitoring today”. Clearly that didn’t register with me that I wouldn’t be getting some really important data today like phosphorous. Grrr. It rued the Hydra Care tonight and it sent him into issues as he wouldn’t eat for 1.25 hours after shot time. Marie thinks it might be from guar gum. So I guess I’m out $15 since I won’t give it again!

 

[Marje and Gracie]

. But it could be environmental too, right? I take him out most nights around my yard on his leash.

Absolutely. My cats have both been tested for food sensitivities and I eliminated ones that came up positive so I know when their eosinophils or basophils are up, it’s environmental.

do I ask my vet to run ANOTHER urinalysis next week again?

Just ask your regular vet. I wouldn’t worry about previous tests but this one is over normal. Your vet you like is best to advise you.

I’m not sure if in-house labs will note clumping.