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Honeybear 97-05-23 Vetshark I have a question regarding a patient of mine.... Honeybear is a 12 yr FS lab mix. She is a diabetic controlled on 13.5 U Humulin N SQ q12hr. She is still PU/PD. Additional laboratory data: alk phos = 506 urine cortisol to creat = 182.27 X 10^6 resting cortisol = 12.7 mcg/dL cortisol 2 hr post ACTH = 19.6 mcg/dL plasma ACTH = 33.5 pmol/L My interpretation is she has PDH as well as DM. Am I correct? If so, how should I begin mitotane therapy in regards to the insulin dosing? I am affraid of inducing hypoglycemia. Can you give me some suggestions on how I can regulate both of these diseases? Thank you, Jim

What are the normals for the plasma acth?

Or eod previcox and eod tramadol (on alternate days) as a way to cut costs?

Honeybear 97-05-23 Vetshark I have a question regarding a patient of mine.... Honeybear is a 12 yr FS lab mix. She is a diabetic controlled on 13.5 U Humulin N SQ q12hr. She is still PU/PD. Additional laboratory data: alk phos = 506 urine cortisol to creat = 182.27 X 10^6 resting cortisol = 12.7 mcg/dL cortisol 2 hr post ACTH = 19.6 mcg/dL plasma ACTH = 33.5 pmol/L My interpretation is she has PDH as well as DM. Am I correct? If so, how should I begin mitotane therapy in regards to the insulin dosing? I am affraid of inducing hypoglycemia. Can you give me some suggestions on how I can regulate both of these diseases? Thank you, Jim

How much does the dog weigh?

With the preinsulin only 97-maybe no insulin tonight and go down to 3u bid and recheck curve next week?

Honeybear 97-05-23 Vetshark I have a question regarding a patient of mine.... Honeybear is a 12 yr FS lab mix. She is a diabetic controlled on 13.5 U Humulin N SQ q12hr. She is still PU/PD. Additional laboratory data: alk phos = 506 urine cortisol to creat = 182.27 X 10^6 resting cortisol = 12.7 mcg/dL cortisol 2 hr post ACTH = 19.6 mcg/dL plasma ACTH = 33.5 pmol/L My interpretation is she has PDH as well as DM. Am I correct? If so, how should I begin mitotane therapy in regards to the insulin dosing? I am affraid of inducing hypoglycemia. Can you give me some suggestions on how I can regulate both of these diseases? Thank you, Jim

Are there any signs of cushings other than the pu/pd?

/spanwhat diet is he on- you indicate metabolic, but is it dry or canned?

Honeybear 97-05-23 Vetshark I have a question regarding a patient of mine.... Honeybear is a 12 yr FS lab mix. She is a diabetic controlled on 13.5 U Humulin N SQ q12hr. She is still PU/PD. Additional laboratory data: alk phos = 506 urine cortisol to creat = 182.27 X 10^6 resting cortisol = 12.7 mcg/dL cortisol 2 hr post ACTH = 19.6 mcg/dL plasma ACTH = 33.5 pmol/L My interpretation is she has PDH as well as DM. Am I correct? If so, how should I begin mitotane therapy in regards to the insulin dosing? I am affraid of inducing hypoglycemia. Can you give me some suggestions on how I can regulate both of these diseases? Thank you, Jim

How well regulated is the dog in terms of serial bg's?

Are the total number of calories given per day being measured and are they reasonable for a cat this size?

Re: 16 yr. cat heart failure 97-05-19 PDP1 Lisa, Sorry to hear about Smokey's problems -- he is a lucky cat to have you all! I think you are doing great -- sounds like his clinical signs are resolving with the diuretic alone. I'd like to know more about the physical exam: wt loss, murmur, etc. Then, what I'd do in the meantime is: 1. recheck his BUN/creat on diuretic 2. recheck chest radiograph -- give us an idea of heart size 3. is an echo possible? We need a diagnosis. 4. R/O hyperthyroidism/hypertension Keep the faith -- sounds like you're doing great. Teach the staff to record his HR and RR daily so you can detect recurrance of failure before it becomes a problem -- and alter his meds as needed -- up or down.

Lisa asks: is it ok to keep him on lasix twice daily indefinitely?

Age?

Re: 16 yr. cat heart failure 97-05-19 PDP1 Lisa, Sorry to hear about Smokey's problems -- he is a lucky cat to have you all! I think you are doing great -- sounds like his clinical signs are resolving with the diuretic alone. I'd like to know more about the physical exam: wt loss, murmur, etc. Then, what I'd do in the meantime is: 1. recheck his BUN/creat on diuretic 2. recheck chest radiograph -- give us an idea of heart size 3. is an echo possible? We need a diagnosis. 4. R/O hyperthyroidism/hypertension Keep the faith -- sounds like you're doing great. Teach the staff to record his HR and RR daily so you can detect recurrance of failure before it becomes a problem -- and alter his meds as needed -- up or down.

Does that help?

What glucometer does the owner have?

Re: 16 yr. cat heart failure 97-05-19 PDP1 Lisa, Sorry to hear about Smokey's problems -- he is a lucky cat to have you all! I think you are doing great -- sounds like his clinical signs are resolving with the diuretic alone. I'd like to know more about the physical exam: wt loss, murmur, etc. Then, what I'd do in the meantime is: 1. recheck his BUN/creat on diuretic 2. recheck chest radiograph -- give us an idea of heart size 3. is an echo possible? We need a diagnosis. 4. R/O hyperthyroidism/hypertension Keep the faith -- sounds like you're doing great. Teach the staff to record his HR and RR daily so you can detect recurrance of failure before it becomes a problem -- and alter his meds as needed -- up or down.

(cats?

Anorther question, what do i do with the helicobacter in the stomach?

Arrhythmia 97-05-28 CNDDVM Here's a fun one: a 14 year old diabetic, cushingoid dachshund who has had a heart murmur presented for weakness. He has a IV/VI systolic murmur, cardiomegaly on rads with mild interstitial pattern, an echo showed mitral valve disease with good contractility, and and ECG (sent to cardiopet) showed PVC's with P waves present - diagnosed as an av block with a ventricular rhythmn. The recommendation was theophylline and probanthine, but the drugs did not alter the arrhythmia (rate has stayed at about 60 -80), and the dog became anorexic and began vomiting. The dog had also been placed on lasix and enalpril. The antiarrhythmia drugs were tapered off since they weren't helping, and now the dog is on 10 mg lasix bid and 2.5 mg enalapril bid (I know these are wimpy doses but the dog still vomits about 3 hours after its meds). We tried to get isopropamide but it's impossible. A pacemaker was suggested but this dog is high high risk...do you have any other medical alternatives? PS the dog weighs 24#

Does it respond to atropine by capturing?

Have you watched the owner administer the insulin or administered it yourself before a curve to r/o admin plems?

Arrhythmia 97-05-28 CNDDVM Here's a fun one: a 14 year old diabetic, cushingoid dachshund who has had a heart murmur presented for weakness. He has a IV/VI systolic murmur, cardiomegaly on rads with mild interstitial pattern, an echo showed mitral valve disease with good contractility, and and ECG (sent to cardiopet) showed PVC's with P waves present - diagnosed as an av block with a ventricular rhythmn. The recommendation was theophylline and probanthine, but the drugs did not alter the arrhythmia (rate has stayed at about 60 -80), and the dog became anorexic and began vomiting. The dog had also been placed on lasix and enalpril. The antiarrhythmia drugs were tapered off since they weren't helping, and now the dog is on 10 mg lasix bid and 2.5 mg enalapril bid (I know these are wimpy doses but the dog still vomits about 3 hours after its meds). We tried to get isopropamide but it's impossible. A pacemaker was suggested but this dog is high high risk...do you have any other medical alternatives? PS the dog weighs 24#

Accelerated rate?

How many calories/day does he get?

Arrhythmia 97-05-28 CNDDVM Here's a fun one: a 14 year old diabetic, cushingoid dachshund who has had a heart murmur presented for weakness. He has a IV/VI systolic murmur, cardiomegaly on rads with mild interstitial pattern, an echo showed mitral valve disease with good contractility, and and ECG (sent to cardiopet) showed PVC's with P waves present - diagnosed as an av block with a ventricular rhythmn. The recommendation was theophylline and probanthine, but the drugs did not alter the arrhythmia (rate has stayed at about 60 -80), and the dog became anorexic and began vomiting. The dog had also been placed on lasix and enalpril. The antiarrhythmia drugs were tapered off since they weren't helping, and now the dog is on 10 mg lasix bid and 2.5 mg enalapril bid (I know these are wimpy doses but the dog still vomits about 3 hours after its meds). We tried to get isopropamide but it's impossible. A pacemaker was suggested but this dog is high high risk...do you have any other medical alternatives? PS the dog weighs 24#

Have you rechecked the bun/creat since beginning them?

So, probably pretty high in carbs if it is calorie dense, lower protein and lower fat?

Re: FIV+/Diabetic 97-05-11 K9DOC Lucia: Most cats with LPS have elevated serum proteins and hyperglobuliemia so I expect that's what's causing the increased protein not dehydration. I agree that dental extraction of all the cheek teeth (leave canines and incisors) can be very beneficial in some cats with primarily gum disease. If they have those horrendous lesions in the posterior pharyngeal region, it doesn't seem to help as much. Supposedly, AZT helps some of these FIV + cats with oral disease so you might try that short term. The drop in PCV from 31 to 28 isn't statistically significant and may fluctuate easily in this range from day to day so I wouldn't be too concerned about it now but watch for trends.

I wonder if it's any coincidence that the brownsnake of australia is one of the deadliest and most aggressive?

What has happened to the bg curves since the pred started?

Re: Sort of..Sudden Death 97-05-30 Jwilsondvm Any possibility of ruptured bladder---how long had the cat been outside without being seen? , DVM

Trauma?

Using u100 syringes?

Re: Sort of..Sudden Death 97-05-30 Jwilsondvm Any possibility of ruptured bladder---how long had the cat been outside without being seen? , DVM

Toxin?

Does he get the same number of calories each day?

Re: Sort of..Sudden Death 97-05-30 Jwilsondvm Any possibility of ruptured bladder---how long had the cat been outside without being seen? , DVM

Bacteremia?

Spot checks?

Feline Diabetes 97-05-30 Jwilsondvm Cat presented 5/27 with complaint of FUS. Did UA===strong glucose. Did in clinic panel using the Kodak (J & J) units (BUN=32, Creat.=1.0, ALKP=63, ALT=132, TP=8.0, and glucose was>450 which is the max without dilutions. 5/28/97 started cat on 7 units of ultralente, (cat's wt.=9.2#). PM glucose >450. 5/29, gave 9 units in a.m. & 13 units @ 5:00PM. after glucose was still >450. Cat is acting normal, eats, fe w/d canned & dry OM or w/d readily. Came in at 6 am today to see if cat was ok--->fed canned w/d. Glucose at 8:45 this a.m. >450. Should I just continue to increase the ultralente until I get her down or should I use something to bring it down faster, then switch back to ultralente. Other than that she appears ok, but has mod. to severe perio/ on some of her teeth. p I know---about doing the curves, etc. but that is not always practical, and we have always been able to regulate this way for the past 27 years.

Any other ideas?

Was an sdma on the panel?

Re: Big Dog Amputations 97-06-22 FELCANBONE In my opinion the quality of life for large breed forelimb amputees depends on several factors : The guts possesed by the individual dog, the dogs' age, the ability to manage stairs prior to the amputation, lifestyle of the dog and general musculoskeletal soundness especially the hips. A year ago I went thru what you are struggling with now. Our thirteen year old bull tinny ( a fabulous dog with an unmatched personality) sustained a pathological Fx. of the distal radius/ulna due to fibrosarcoma metatasis. He was sound elsewhere but coped with stairs with effort, mostly due to age, prior to the Fx. Three years prior to the met induced Fx. he was treated by excision and chemo to combat a primary fibrosarcoma in the cevical musculature. Due to the previously mentioned considerations we laid our 'Willie' to rest. Others may differ with oue decision but at best I have provided, on the average, an additional year of quality lifestyle by amputation/chemo, in the presence of Osteosarcoma. The large breeds, in my experience, are on the lower portion of the life expectancy curve. Tough problems for you to address. May the force be with you. Sincerely, Felcanbone,

If limb is minimally painful and giving good function, why not leave it there until it become hinderence?

Ps: could you complete the 5minute diabetes treatment survey?

Re: Big Dog Amputations 97-06-22 FELCANBONE In my opinion the quality of life for large breed forelimb amputees depends on several factors : The guts possesed by the individual dog, the dogs' age, the ability to manage stairs prior to the amputation, lifestyle of the dog and general musculoskeletal soundness especially the hips. A year ago I went thru what you are struggling with now. Our thirteen year old bull tinny ( a fabulous dog with an unmatched personality) sustained a pathological Fx. of the distal radius/ulna due to fibrosarcoma metatasis. He was sound elsewhere but coped with stairs with effort, mostly due to age, prior to the Fx. Three years prior to the met induced Fx. he was treated by excision and chemo to combat a primary fibrosarcoma in the cevical musculature. Due to the previously mentioned considerations we laid our 'Willie' to rest. Others may differ with oue decision but at best I have provided, on the average, an additional year of quality lifestyle by amputation/chemo, in the presence of Osteosarcoma. The large breeds, in my experience, are on the lower portion of the life expectancy curve. Tough problems for you to address. May the force be with you. Sincerely, Felcanbone,

If painful take it off; if not leave it on until painful then revisit the issue?

Any clinical improvement at this dose?

Re: Difficult diabetic 97-06-24 K9DOC Stacey: I personally prefer NPH insulin but if you want to continue with Lente, you will need to keep increasing the dose until you get the effect you need. If the cat is looking thin, then you may want to increase the caloric content by changing to c/d or some other diet, add 1/8 tsp of unflavored metamucil to get the fiber effect.

Am i understanding that you are using the insulin sid?

What should she weigh?

Diabetic Neuropathy 97-06-26 Lboggs Kitty seen for 2nd opinion. Was diagnosed as diabetic early this year -- weight loss/PU/PD/plantigrade stnace on rear limbs/high blood glucose/glucosuria. Excellent workup done. On 2.0 units ultralente sid. Glucose varies from 215 to 309 on glucose curve. Owner spot checks of urine glucose vary from + to ++. So what's the problem? Cat is still walking on his metatarsals. Cat is still PU/PD. Blood work normal except for high glucose. Now what?

Is there a solid reason for kitty being on sid insulin?

Any signs of problems?

Cystadenoma and Aldactone 97-07-01 M I am treating a 15 year old mc diabetic with extensive hepatic cystadenoma. The hepatic cystadenoma was discovered in 1995, and the patient has been asymptomatic. He was hyperthyroid recently, and was treated with radioactive iodine. He has developed progressive ascites over the last 6 months. He was on lasix, 12.5 mg per day and developed mild azotemia. Presently he is on 4 mg of lasix with 12.5 aldactone BID. The ascites is marked now. How much can I increase his aldactone and/or lasix? When should I perform paracentesis? Thanks p

What is his sap like?

How were those glucoses measured?

Cystadenoma and Aldactone 97-07-01 M I am treating a 15 year old mc diabetic with extensive hepatic cystadenoma. The hepatic cystadenoma was discovered in 1995, and the patient has been asymptomatic. He was hyperthyroid recently, and was treated with radioactive iodine. He has developed progressive ascites over the last 6 months. He was on lasix, 12.5 mg per day and developed mild azotemia. Presently he is on 4 mg of lasix with 12.5 aldactone BID. The ascites is marked now. How much can I increase his aldactone and/or lasix? When should I perform paracentesis? Thanks p

Alt?

The owner is moving the injections around on the dog's body every day?

Renal D.I. 97-06-11 Fixapet I am currently working with a 12 year old, spayed female, Boykin Spaniel. She was presented for urinating in the house. U/A at that time showed S.G. of 1.005 but with an active sediment which cultured out E.coli. We began with trimethoprim/sulfa as indicated on the culture. She responded by no further accidents. A follow up culutre was negative but the S.G. was still 1.008. A blood profile was normal as was a CBC. She failed a water deprivation test, only concentrating to 1.012 before dehydrating by 5%. A urine cortisol was normal. I did an ADH response test to which she only concentrated to 1.010. When this last test was done she was not actively urinating in the house so the owner elected no further treatment. Curiously, she began the accidents again about 10 days later for which the owner only wanted to try antibiotics. I sent home Baytril and she stopped the accidents, I know she is still hyposthenuric though. Now she has been off the Baytril for about 5 days and the accidents are back. (note: early on we checked her water consumption which was around 1 ounce per pound per 24 hours). In my research I have not seen anything very helpful for Renal D.I., do you have any suggestions and do you agree that this is what I appear to be dealing with? Is a renal biopsy the only route or are there some empirical things I can try since the owners only really mind the problem when she urinates in the house? They have been made aware of the possibility of medullary washout Thank you,

Have you checked for stones or other underlying bladder lesions as a cause of recurrent infections?

How long has he been on the trilostane?

Vacuolar hepatopathy 97-07-10 DogtorKC I saw a 8 yr old FS dalmatian for elevated liver enzymes (ALP 224, ALT 102) and hyposthenuria (USG 1.005 - 1.016 , 4 UA's over a period of 5 weeks). The owner's presented the dog initially for urine incontinence when lying down. No evidence of urinary tract inflammation or infection, no proteinuria. BUN 22, creat 1.5 Vacuolar hepatopathy was found on a liver biopsy. No abnormalities were recognized on abdominal ultrasound. Due to the biopsy results a LDDST was run (pre 5.9, 6hr 0.8, 8 hr 0.4) What would be other causes of vacuolar hepatopathy? The dog is not and has not been on any medications. The only other loose end is the owner reports occasional regurgitation when lying down for the last few months. No cervical/thoracic rads done at this time.

Any others out there with comments on this pathologic diagnosis and what to make of it?

Makes sense?

Diabetic with Pain 97-07-27 HPuck A 13 yr old MN Poodle with DM (for 2 years) has been suffering from back pain. This dog does not tolerate any NSAIDS even when we piggyback Misoprostol or Famotidine he still develops melena and gastritis. We had tried using Adequan until we queried the mfr. about this drug in a diabetic and discovered that they feel it is contraindicated. Rimadyl is not yet avail in Canada. The o is considering Acupuncture now. Any other ideas?

Any neuro signs?

Does this happen if the owner showers at other times of the day or if other people use the shower?

Glucosuria w/o diabetes? 97-07-22 CanVet Can a dog have glucose in the urine (5.5 mmol/L) on a dipstick (and repeatable) from a free flow sample collected by the owners in a used and washed pill vial that used to store Penicillin? The blood glucose is normal (not diabetic) and the USG is 1.040, and BUN is low normal and creatinine is normal. What could cause spillage? The dogs Dx was endocardiosis, with mild pulmonary edema, and also possible liver cirrhosis, as the liver enz were mildly elevated, and the BUN, albumin, cholesterol was low. Thyroid pending. Kris PS. He is a 10 yr MN cocker cross with the hx of pancreatitis two yrs ago.

Can you repeat this in your clinic with a cysto sample?

What exactly did the last malignancy panel look like?

No Good Deed Goes Unpunished 97-07-17 JRZTMADA A six-year old spayed female cat was brought to me by an elderly client. When it was diagnosed with diabetes mellitus the client was certain she would never be able to meet the responsibilities of insulin treatment. We tried glipizide at 2.5mg BID but the cat wasn't doing well and glucoses rarely got below 350. The client requested that the cat be put to sleep. Feeling a need for a cat to hang around my office I asked her to let me keep it, which she did. The cat was pu/pd and has had an excellent appetite throughout her stay (she's eating w/D) with me. I started out at 1, then 2, then 4, then 7, then 10, then 15, then 20 units of ultralente insulin. Each dose is given for four or five days then a serial glucose is run, checking every two hours for at least twelve hours for each dose. She is clearly feeling better and is less pu/pd but her glucose never drops below 330 and often rises gradually to around 400 over the course of the day. Any suggestions of what else to look at? (Her bloodwork is pretty unremarkable at this point) Should I keep raising the insulin? Try something other than ultralente? Your comments are anxiously awaited. Thanks,

Are you giving the insulin bid?

What was the cat's blood pressure?

Hypertriglyceridemia/Diabete 97-07-19 dm Help, help. I have a 10 yr old miniature Schnauzer who is diabetic. He has been very difficult to control. I've done multiple tests for Cushing's disease, hypothyroidism, uti's, etc. I talked w/Dr Nelson at UCD who feels he has hypertriglyceridemia. His triglyceride level is 610 mg/dl, even on soloxine. His fructosamine levels have decreased since being on soloxine, but is still having glucosuria and high blood glucose levels (in the 300's-400's). (...we've already been through trying different formulations of insulins in the past....). Dr Nelson recommended we try the dog on Astromid-s at this point. HOwever, it may be off the market now. Has anyone used Atorvastatin (Lipitor)? The dog is feeling fine, but has cataracts from his chronic hyperglycemia. Do you have a dose for Lipitor? Thanks for your input!

What dose and type of insulin is the dog on now?

Are there stones now?

Atypical Diabetes 97-07-23 Snorkel 10yr M/C Norwegian Elkhound This dog presented in seizures blood glucose approx800- responded well to regular insulin - quickly got back to 'normal'. Required very small amounts of NPH ins. to regulate. The owner cut back on the NPH because urine readings are negative..........the dog gradually got back to the same state - presented in seizures/inc Temp/responded quickly again. It is not the typical case where the glucose gradually goes up/ this dog's blood glucose seems to go from quite low to quite high without the normal ability to monitor with urine glucose... What is the mechanism here?

Any other lab work plems or neuro exam abnnormalites?

Any chance of evaluating the pth?

Atypical Diabetes 97-07-23 Snorkel 10yr M/C Norwegian Elkhound This dog presented in seizures blood glucose approx800- responded well to regular insulin - quickly got back to 'normal'. Required very small amounts of NPH ins. to regulate. The owner cut back on the NPH because urine readings are negative..........the dog gradually got back to the same state - presented in seizures/inc Temp/responded quickly again. It is not the typical case where the glucose gradually goes up/ this dog's blood glucose seems to go from quite low to quite high without the normal ability to monitor with urine glucose... What is the mechanism here?

What dose of insulin was it on and did you have serial sugars?

Or necropsy?

FeLV, Uveitis, Ulcers 97-07-04 Hypurr Repost from feline medicine. Thanks! :-) >M> From: DrKAT17653 I was recently presented a 3 year old, male neutered cat for a second opinion Re: eye trouble. Cat was determined FeLV positive at 4 months of age, repeat testing 6 months later still positive. been fine until sudden onset epiphora and blepharospasm about 2 weeks ago. Was seen by first vet and put on triple antibiotic ointment only. I first saw 6 days ago. Signs included severe blepharospasm, miosis, iriditis, bilateral corneal ulcers involving entire ventral half of each cornea! I sure felt like I was in between a rock and a hard place! So I opted for 'try to make the kitty comfortable while covering as many bases as possible' approach. I gave 2 mg Azium IM, then started cat on atropine ointment BID -->SID, chloramphenicol oint BID, Antirobe 25 mg BID and aspirin 81mg q. 72 hrs.. Re-examined the cat 3 days later; now he will open his eyes if light not too bright, pupils are well dilated (have now decreased atropine to every other days), IOP has been at high end of normal range since first presentation. I know uveitis Tx is steroids, steroids, steroids, but I am concerned about the tremendous (although not deep) corneal ulcers. What else can I do for this cat? I am also wondering about long-term therapy, assuming we will get some control over the eyes. Should I consider interferon, nutritional supplements (client already has cat on VitaminC) or other long term immune system support/suppression? Last but not least, could I impose on one of you to post this to optho board? It's been too long since I took Nate's course, and I've run out of time to look up or figure out. Many thanks in advance for any and all suggestions. (a.k.a. DRKATOC)

Is this the first incidence of ocular problems in this cat?

Is this opacity a possible met?

FeLV, Uveitis, Ulcers 97-07-04 Hypurr Repost from feline medicine. Thanks! :-) >M> From: DrKAT17653 I was recently presented a 3 year old, male neutered cat for a second opinion Re: eye trouble. Cat was determined FeLV positive at 4 months of age, repeat testing 6 months later still positive. been fine until sudden onset epiphora and blepharospasm about 2 weeks ago. Was seen by first vet and put on triple antibiotic ointment only. I first saw 6 days ago. Signs included severe blepharospasm, miosis, iriditis, bilateral corneal ulcers involving entire ventral half of each cornea! I sure felt like I was in between a rock and a hard place! So I opted for 'try to make the kitty comfortable while covering as many bases as possible' approach. I gave 2 mg Azium IM, then started cat on atropine ointment BID -->SID, chloramphenicol oint BID, Antirobe 25 mg BID and aspirin 81mg q. 72 hrs.. Re-examined the cat 3 days later; now he will open his eyes if light not too bright, pupils are well dilated (have now decreased atropine to every other days), IOP has been at high end of normal range since first presentation. I know uveitis Tx is steroids, steroids, steroids, but I am concerned about the tremendous (although not deep) corneal ulcers. What else can I do for this cat? I am also wondering about long-term therapy, assuming we will get some control over the eyes. Should I consider interferon, nutritional supplements (client already has cat on VitaminC) or other long term immune system support/suppression? Last but not least, could I impose on one of you to post this to optho board? It's been too long since I took Nate's course, and I've run out of time to look up or figure out. Many thanks in advance for any and all suggestions. (a.k.a. DRKATOC)

Is there any evidence of self trauma to the corneas which might be perpetuating the problem?

Is the dog eating any jerky treats that were manufactured in china?

FeLV, Uveitis, Ulcers 97-07-04 Hypurr Repost from feline medicine. Thanks! :-) >M> From: DrKAT17653 I was recently presented a 3 year old, male neutered cat for a second opinion Re: eye trouble. Cat was determined FeLV positive at 4 months of age, repeat testing 6 months later still positive. been fine until sudden onset epiphora and blepharospasm about 2 weeks ago. Was seen by first vet and put on triple antibiotic ointment only. I first saw 6 days ago. Signs included severe blepharospasm, miosis, iriditis, bilateral corneal ulcers involving entire ventral half of each cornea! I sure felt like I was in between a rock and a hard place! So I opted for 'try to make the kitty comfortable while covering as many bases as possible' approach. I gave 2 mg Azium IM, then started cat on atropine ointment BID -->SID, chloramphenicol oint BID, Antirobe 25 mg BID and aspirin 81mg q. 72 hrs.. Re-examined the cat 3 days later; now he will open his eyes if light not too bright, pupils are well dilated (have now decreased atropine to every other days), IOP has been at high end of normal range since first presentation. I know uveitis Tx is steroids, steroids, steroids, but I am concerned about the tremendous (although not deep) corneal ulcers. What else can I do for this cat? I am also wondering about long-term therapy, assuming we will get some control over the eyes. Should I consider interferon, nutritional supplements (client already has cat on VitaminC) or other long term immune system support/suppression? Last but not least, could I impose on one of you to post this to optho board? It's been too long since I took Nate's course, and I've run out of time to look up or figure out. Many thanks in advance for any and all suggestions. (a.k.a. DRKATOC)

Eyelid position,etc okay?

Are you monitoring with a post-pill t4 at a commercial lab or in-house?

FeLV, Uveitis, Ulcers 97-07-04 Hypurr Repost from feline medicine. Thanks! :-) >M> From: DrKAT17653 I was recently presented a 3 year old, male neutered cat for a second opinion Re: eye trouble. Cat was determined FeLV positive at 4 months of age, repeat testing 6 months later still positive. been fine until sudden onset epiphora and blepharospasm about 2 weeks ago. Was seen by first vet and put on triple antibiotic ointment only. I first saw 6 days ago. Signs included severe blepharospasm, miosis, iriditis, bilateral corneal ulcers involving entire ventral half of each cornea! I sure felt like I was in between a rock and a hard place! So I opted for 'try to make the kitty comfortable while covering as many bases as possible' approach. I gave 2 mg Azium IM, then started cat on atropine ointment BID -->SID, chloramphenicol oint BID, Antirobe 25 mg BID and aspirin 81mg q. 72 hrs.. Re-examined the cat 3 days later; now he will open his eyes if light not too bright, pupils are well dilated (have now decreased atropine to every other days), IOP has been at high end of normal range since first presentation. I know uveitis Tx is steroids, steroids, steroids, but I am concerned about the tremendous (although not deep) corneal ulcers. What else can I do for this cat? I am also wondering about long-term therapy, assuming we will get some control over the eyes. Should I consider interferon, nutritional supplements (client already has cat on VitaminC) or other long term immune system support/suppression? Last but not least, could I impose on one of you to post this to optho board? It's been too long since I took Nate's course, and I've run out of time to look up or figure out. Many thanks in advance for any and all suggestions. (a.k.a. DRKATOC)

Any possibility of contact with caustic materials?

Any chance the 135 was a spurious result?

FeLV, Uveitis, Ulcers 97-07-04 Hypurr Repost from feline medicine. Thanks! :-) >M> From: DrKAT17653 I was recently presented a 3 year old, male neutered cat for a second opinion Re: eye trouble. Cat was determined FeLV positive at 4 months of age, repeat testing 6 months later still positive. been fine until sudden onset epiphora and blepharospasm about 2 weeks ago. Was seen by first vet and put on triple antibiotic ointment only. I first saw 6 days ago. Signs included severe blepharospasm, miosis, iriditis, bilateral corneal ulcers involving entire ventral half of each cornea! I sure felt like I was in between a rock and a hard place! So I opted for 'try to make the kitty comfortable while covering as many bases as possible' approach. I gave 2 mg Azium IM, then started cat on atropine ointment BID -->SID, chloramphenicol oint BID, Antirobe 25 mg BID and aspirin 81mg q. 72 hrs.. Re-examined the cat 3 days later; now he will open his eyes if light not too bright, pupils are well dilated (have now decreased atropine to every other days), IOP has been at high end of normal range since first presentation. I know uveitis Tx is steroids, steroids, steroids, but I am concerned about the tremendous (although not deep) corneal ulcers. What else can I do for this cat? I am also wondering about long-term therapy, assuming we will get some control over the eyes. Should I consider interferon, nutritional supplements (client already has cat on VitaminC) or other long term immune system support/suppression? Last but not least, could I impose on one of you to post this to optho board? It's been too long since I took Nate's course, and I've run out of time to look up or figure out. Many thanks in advance for any and all suggestions. (a.k.a. DRKATOC)

Have you had a look at the fundus?

The owners move the injections around on his body each time?

Icteric dog 97-08-06 SSUS Recently I saw a 5 pound min sch that presented for anorexia for several weeks. The dog had elevated SAP, ALT, GGT and bili of 9. A biopsy of the liver was read out by the pathologist as severe hepatic lipidosis and looked like a biopsy from a cat with hepatic lipidosis. The dog has no exposure to toxins, or hepatotoxic medications. The dog has no signs of cushings disease. Any ideas on this case, SSUS

Did you get an us at the same time as the biopsy?

Are you able to check blood gases?

Icteric dog 97-08-06 SSUS Recently I saw a 5 pound min sch that presented for anorexia for several weeks. The dog had elevated SAP, ALT, GGT and bili of 9. A biopsy of the liver was read out by the pathologist as severe hepatic lipidosis and looked like a biopsy from a cat with hepatic lipidosis. The dog has no exposure to toxins, or hepatotoxic medications. The dog has no signs of cushings disease. Any ideas on this case, SSUS

Bile ducts?

Has her diet changed as well - was she eating dry food before?

Icteric dog 97-08-06 SSUS Recently I saw a 5 pound min sch that presented for anorexia for several weeks. The dog had elevated SAP, ALT, GGT and bili of 9. A biopsy of the liver was read out by the pathologist as severe hepatic lipidosis and looked like a biopsy from a cat with hepatic lipidosis. The dog has no exposure to toxins, or hepatotoxic medications. The dog has no signs of cushings disease. Any ideas on this case, SSUS

How does the pancreas check out?

When does she get the food/insulin in the morning?

Diabetic/epi/hypoprotein 97-08-19 PKVET I have a mixed breed small dog that is a diabetic, has exocrine pancreatic deficiency that has been on insulin, and viokase powder for about 2 years and has done well. Most recently presented for weight loss, hypoglycemia, and diarrhrea. Owner had run out of powder and gone with tabs was the only change.. In treating the patient we did a chem and found a albumin of 1.6 a tp of 4.17 and the dog has been on iv glucose and a 2.5% drip for two days and have just today got the glucose up to 54, yesterday consistantly ran in 20 and 30's. The dog is eating withoccasional vomiting but usually holds it down. I am wondering about malabsorption or inflamatory bowel and if the dog needs biopsy also am concerned about diabetes control if dog goes on pred. ( also treating for bacterial overgrowth with flagyl. Thanks

Were the other chemistry parameters normal?

Will you be allowed to treat the diabetes?

Diabetic/epi/hypoprotein 97-08-19 PKVET I have a mixed breed small dog that is a diabetic, has exocrine pancreatic deficiency that has been on insulin, and viokase powder for about 2 years and has done well. Most recently presented for weight loss, hypoglycemia, and diarrhrea. Owner had run out of powder and gone with tabs was the only change.. In treating the patient we did a chem and found a albumin of 1.6 a tp of 4.17 and the dog has been on iv glucose and a 2.5% drip for two days and have just today got the glucose up to 54, yesterday consistantly ran in 20 and 30's. The dog is eating withoccasional vomiting but usually holds it down. I am wondering about malabsorption or inflamatory bowel and if the dog needs biopsy also am concerned about diabetes control if dog goes on pred. ( also treating for bacterial overgrowth with flagyl. Thanks

Is there any proteinuria?

How are his electrolytes?

CRF + DM 98-01-12 Nogutz I have a 13 y/o MN DSH that came in for a dentistry in August. At that time, the BUN was 37.6 and the creatinine was 3.26, but the glucose was normal. The cat weighed about 12 pounds. I saw the cat in December for constipation and weight loss. The cat weighed 10.4 pounds and was PU/PD. Glucose was 489, BUN was 59, creat: 3.8 and k:2.9. Urine specific gravity was 1.020, no ketones, +++ glucose. I started the cat on NPH insulin 1 unit BID, potassium and laxatone. I also instructed the owner to try to feed a k/d/w/d mix. The cat vomited on the k/d so currently she is just feeding w/d. Glucose curve a week later was all HI until 1 p.m. until it dipped to 530. So I increased to 2 units BID. Glucose curve today, one week later, is essentially the same. No value went below 579. I increased the cat to 3 units BID. My questions are these: 1. At what point do I call this cat insulin resistant? 2. Is the concurrent kidney disease enough to cause insulin resistance? If so, should I start home SQ fluid therapy? 3. The cat has not gained or lost any weight since starting insulin, is eating a little more,and is more active, but still PU/PD. Should I do a fructosamide blood level to make sure these high BG levels aren't just due to stress (although the cat is very good in the hospital), or can I assume these high values are real since the PU/PD and the weight hasn't changed? Thanks for your help.

What did the sediment look like?

What does he weigh?

Painful hypoalbuminemic dog 98-01-09 CanVet Signalment: 10.5 yr MN diabetic (for 3 yrs) westie. Well regulated regarding the diabetes. Clinical Signs: Waxing and waning diarrhea 2 months. 3 lb weight loss Bilateral cataracts forming. Acute pain. The owner caused it to yelp when approaching to touch the face. I caused it to yelp by manipulating the head toward the right shoulder, and at the same time the right front paw is raised. The right front paw is not very strong and sometimes the forearm is painful. The dog yelps continually and fidgets when raised carefully on the exam table. The dog whines when the food bowl is held near the right shoulder causing him to turn toward the right to eat. No neuro deficits. Very lethargic. Wants to lie all the time and sleep. Hind end quivering sometimes, and a very tiny bit of ataxia when walking...or just a weak unsteady gait. There is a hint of a right head tilt, but not always. Pupils normal, no nystagmus. TPR normal. Single Chronic ulceration (purulent and serous exudate) on plantum nasale. Appetite decreased, but still accepts canned food and water. Very rare bile vomiting (perhaps once every couple weeks or less). Present medication consists of NPH insulin and derm caps. Diet is combo of Medical Weight Control or Gastro. Findings: Normal CBC and RBC morph, and platelets Hypoalbuminemia 21 (27-48) Hypocholesterolemia Radiopaque gall bladder calculus (I don't think it is intestinal)...barium not done. Possible diffuse mass on right side of neck in soft tissue, which I cannot palpate. Disk spaces appear normal on survey rads. UA not done (I will be checking for proteinuria). My questions aRe: Can the dog have 2 problems, ie) the gallstone be unrelated, the hypoalbuminemia be unrelated to the pain, and the neck be something separate? Are diabetics or westies prone to anything I have described? I am very reluctant to place the dog on pred....have began Tolfedine (NSAID) and cefalexin (mainly for the nose). I don't wish to anethetize him to biopsy nose with his present condition....without first trying to treat a nasal pyoderma. I really think this dog may have an immune problem...but how bad is pred for diabetics? Any thoughts on this case are appreciated! Kris

Have you considered the derm caps causing the diarrhea?

Any lepto where you are?

Resistant Diabetic Cat 97-08-11 Ancl303 Bear is a M-N 8 year old DSH who was diagnosed with Diabetes Mellitus in March of this year. Initially Bear did well with insulin regulation. He was initially started with NPH SID but was changed at first follow up glucose curve to BID. This seemed to do well for 14 days then PU/PD again. Glucose curve showed short duration and effect of 3 hours. Switched at this time to Ultralente insulin bid. This seemed to do ok for a while but slowly had to keep increasing dose to control PU/PD. June 23 Bear was in for a 24 hour glucose curve which never dropped below 408 mg/dl glucose. this time owner ok'd further workup. ACTH stim was done with normal results. Discussed poss. causes of resistance with owner. Since cat is obese wanted to try diet. Started on R/D, with 2 cat household owner could not control and gave up. We have just changed insulin to Humulin L(lente) due to reports of poor absorption with Ultralentes. Any other suggestions? Cat seems happy and healthy, no ketoacidosis just PU/PD. Thank you for any help or thoughts.

Is there any reason why all of the cats in the house couldn't be on free choice high fiber diet and supplement the two non diabetic kitties with bid 'their food' in the bed/bathroom?

Sounds like he may not be salvagable though - can he go to an emergency hospital so you don't have to worry about him all night?

Resistant Diabetic Cat 97-08-11 Ancl303 Bear is a M-N 8 year old DSH who was diagnosed with Diabetes Mellitus in March of this year. Initially Bear did well with insulin regulation. He was initially started with NPH SID but was changed at first follow up glucose curve to BID. This seemed to do well for 14 days then PU/PD again. Glucose curve showed short duration and effect of 3 hours. Switched at this time to Ultralente insulin bid. This seemed to do ok for a while but slowly had to keep increasing dose to control PU/PD. June 23 Bear was in for a 24 hour glucose curve which never dropped below 408 mg/dl glucose. this time owner ok'd further workup. ACTH stim was done with normal results. Discussed poss. causes of resistance with owner. Since cat is obese wanted to try diet. Started on R/D, with 2 cat household owner could not control and gave up. We have just changed insulin to Humulin L(lente) due to reports of poor absorption with Ultralentes. Any other suggestions? Cat seems happy and healthy, no ketoacidosis just PU/PD. Thank you for any help or thoughts.

How high did you go with insulin dose?

Have chest radiographs been taken?

Disseminated Cryptococcus 97-08-15 AltheaVet This is a bad disease and I think we are going to need some help. Patient is 12 yo FS Siam mix. Recently had a well-diff mct removed incompletely from her face. A month or two later she reprresent for weight loss & not eating. One kidney is enormous. It aspriates cryptococcus. Blood work is surprisingly normal. CBC is normal. BUN is 66 & creat is 2.8, phos 7.4 (My associate didn't get a UA), FeLV &FIV testing are pending. Blood glucose is 517 but there is no PUPDPP history so I am thinking this is probably stress related. I have never treated cryptococcus in this location. I can't imagine how it got there though the cat has more than the usual bird exposure (owner has some kind of aviary at home). I am thinking of Fluconazole as it is supposed to be better on crypto & is even excreted in the urine (though I imagine the big kidney isn't doing too much excretion these days). Do you think we should be thinking in terms of nephrectomy after stabilization on Fluconazole, & general CRF support? Or is this cat's entire body likely to be a bag of fungus? I was going to rec. euth if the cat is Felv or FIV + If negative, though, what sounds like a reasonable plan? (Yes, I know how much Fluconazole costs) Thanks for any help, AltheaVet

Can you get us on the kidney?

Bun and creatinine?

Diluting Insulin? 97-08-28 BecksterEP I have a kitty that is down to 1 unit of NPH insulin SID. On the curve it will have a BG of 52mg/dl at 10am (about 3 hours post inj), 12pm - 68mg/dl, 3pm - 111mg/dl; 5pm - 69mg/dl 7pm - 62mg/dl. The owner does not feel the kitty is lethargic but I'd prefer the BG's a little closer to 100mg/dl. I tried just taking him off insulin, but the BG shot up again to 364mg/dl and the kitty lost weight. So...diluting insulin? I need a phone number for Eli Lilly - can not find the diluent here. Or should I just try saline dilution first or change to Humulin U? Thanks!

How much does your cat weigh?

Was he not on the low carb foods prior to diagnosis?

Diluting Insulin? 97-08-28 BecksterEP I have a kitty that is down to 1 unit of NPH insulin SID. On the curve it will have a BG of 52mg/dl at 10am (about 3 hours post inj), 12pm - 68mg/dl, 3pm - 111mg/dl; 5pm - 69mg/dl 7pm - 62mg/dl. The owner does not feel the kitty is lethargic but I'd prefer the BG's a little closer to 100mg/dl. I tried just taking him off insulin, but the BG shot up again to 364mg/dl and the kitty lost weight. So...diluting insulin? I need a phone number for Eli Lilly - can not find the diluent here. Or should I just try saline dilution first or change to Humulin U? Thanks!

How about trying the oral glipizide?

Is there a special diabetic diet without any of the ingredients you listed?

Diluting Insulin? 97-08-28 BecksterEP I have a kitty that is down to 1 unit of NPH insulin SID. On the curve it will have a BG of 52mg/dl at 10am (about 3 hours post inj), 12pm - 68mg/dl, 3pm - 111mg/dl; 5pm - 69mg/dl 7pm - 62mg/dl. The owner does not feel the kitty is lethargic but I'd prefer the BG's a little closer to 100mg/dl. I tried just taking him off insulin, but the BG shot up again to 364mg/dl and the kitty lost weight. So...diluting insulin? I need a phone number for Eli Lilly - can not find the diluent here. Or should I just try saline dilution first or change to Humulin U? Thanks!

Or, have you checked with human pharmacies for the insulin diluent?

What is ideal body weight?

Pimagedine 97-08-14 Capn

Since what i've seen suggest that the complications being addressed are the vascular complications leading to renal disease in humans --- which i thought was not a problem in k9/fel diabetics?

Check urine for glucosuria?

Pimagedine 97-08-14 Capn

Anyone?

The owner is only feeding at mealtimes, when the insulin is given, using a measuring cup and the amount is reasonable for a dog this size (sometimes when the weight is falling off of them they panic and start really over-feeding the dog---which means we have to chase after them with an ever-increasing amount of insulin)   how many calories/day does she currently get?

Pimagedine 97-08-14 Capn

Anyone know more?

Were you able to assess blood glucose at anytime?

NME in a cat 97-09-16 Nlvets I am treating a cat with necrolytic migratory erythema associated with a non-specific chronic hepatopathy. The dermatosis has been diagnosed by a dermatohistopatholgist and exploratory laparotomy and biopsy showed no neoplasias but the severe hepatopathy. The cat is currently quite well in itself. Has anyone any experience of nutritional treatment in similar cases; I understand that amino acid supplementation might be of benefit? Suggestions for any other treatments that I could try would be appreciated.

Did this cat happen to get dipped or bathed with a limonene product?

What is the current job market, especially in the pacific northwest?

Non-Insulin Dependent Diabet 98-02-11 Katydoc Need some help with a m-c 8 yrold cat who was presented for no pu/pd, never heavy who has been losing weight. Serial bg's ran between 200-260 early on ( most were low-mid 200's). CBC/chem was otherwise normal, had a UTI and was placed on clavamox. A fructosamine level was run to determine whether we were truely dealing with diabetes. Result=470. The consulting clin. pathologist explained that this was a non-insulin dependent form of diabetes i. and to try a month of vanadium supplementation and then recheck the fructosamine level. Two weeks into this the cat is showing increased weight loss, and more pronounced pu/pd/pp ... and the BG's are on the rise - low 300's (280-340), so I'm assuming we are no longer in the non-insulin dependent stage/form. I don't know much about the latter syndrome so could you explain it to me - and is the vanadium supplement an acceptable treatment when it occurs...and how does a cat go from non-insulin dependent to dependent.? And now do I start insulin?

What is normal for fructosamine in the lab?

What is the albumin and tp?

PEI/DM in GShep Pup 97-08-25

Does the dog eat a meal in the evening of equal calories to the am meal?

Can you post all your cbc and chem results for us - even if they look normal?

Cushings? 97-09-20 KeBrErLuLa Was presented this afternoon with a 26 lb., 10 year old, castrated male beagle, that a kennel brought in because they found it flat out in their kennels this morning. He is hypothyroid and on .2 mg Thyroxin bid t= 102.2, mm=PINK, CRT=2 SEC., reported to be pu/pd, distended abdomen/negative on abdominalcentesis, sunken face, skin ok, HR=140, recumbant, but could stand up but not for very long before he just slid down and back down and onto his side again. Palpated an enlarged liver. Thorax ausculated ok. mild dyspnea. BLOOD WORK.......cbc...WBC= 20,570, NE= 9470, LY=11,060, MO=elevated, EO=40, HCT=50.5, Plats=375,000. Urine SG=1.014 with trace of blood/sugar. Neg ketones, Ph=7.0. BUN=121.3, Phos=>16.6 and get this.....creat=1.73 and I double checked that one. Alt=117, SAP=1917, T.Bili=.32, alb=2.89, Chol=209.2, Glucose=192.2, Ca=9.96, TP=6.41, Glob=3.52. Chest rads showed cardiomegally, and no real signs of pleural effusion or pulmonary edema. Abdominal rads showed no real ascites, but confirmed hepaegally.... the rest appeared within normal limits. To me at least, these signs/symps, blood work, at least most of them, appear to be consistant with cushings disease... but because of a few stray ones, I'm confused with what to do. This dog is flat out, but I can't find anywhere as how to treat a flat out cushniod..... or is this something else. Can I begin treating without confirming this with a Low Dex Test, or ACTH Stim Test. It's saturday evenig now, no lab pick-up today, or even orrow. What can I do for this poor dog in the meantime.. He's just on IV fluids for now. Any help will sure be appreciated.

Are the kidneys enlarged on the radiographs?

Have you submitted a fructosamine, to corroborate whether this is longstanding glucosuria?

Carprofen and ACE inhibitors 97-09-25 JRDVM72 I recently received a forwarded message from a Pfizer DVM concerning the precaution of using carprofen very cautiously with ACE inhibitors. Does the NSAID interfere with the ACE inhibitor or make the NSAID more toxic. Please could anyone describe the pharmacology involved. Thanks

Heart failure resolved?

Do you have a chem & ua?

Diabetes/Cushings 97-10-14 StevVet I have a 14 year old poodle cross, 8.5 kg, that was diagnosed with Diabetes at the local emerg clinic 5 weeks ago. We ran a LDDS and ACTH stim to rule out cushings prior to initiating treatment with Insulin. The LDDS was weird (0-189, 4-212, 8-69) and the ACTH stim was excessive (0-45, 2-749). The Clinical pathologist at our lab told me that 10% of the dogs she sees with PDH have a LDDS similar to this - she called it a trickle down effect - where inadequate supression occurs but the levels gradually decrease. She felt that on the basis of this result alone a dx of PDH could be made, but I did the stim to convince myself. The dog was started on anipryl 15 mg sid and 4 iu NPD insulin sid. The dog has been wasting away over the last few weeks. She has lost 1.5 kg in the last 4 weeks, and has continued to be pupd at home. Her insulin has gradually been increased and last week we rechecked an ACTH stim. I chose to check the stim rather than the LDDS because I was uncomfortable rechecking the test that gave the weird result - at least the stim result was conventional for a cushingoid dog. Of course, the dog excessively stimmed again. She is now on 5 iu NPH bid and I am unsure what to do to control the cushings - continue for another month at 2 mg/kg or switch to lysodren? TIA - Steve

How is the diabetic control doing?

What is this 'snack' in the middle of the day?

Diabetes/Cushings 97-10-14 StevVet I have a 14 year old poodle cross, 8.5 kg, that was diagnosed with Diabetes at the local emerg clinic 5 weeks ago. We ran a LDDS and ACTH stim to rule out cushings prior to initiating treatment with Insulin. The LDDS was weird (0-189, 4-212, 8-69) and the ACTH stim was excessive (0-45, 2-749). The Clinical pathologist at our lab told me that 10% of the dogs she sees with PDH have a LDDS similar to this - she called it a trickle down effect - where inadequate supression occurs but the levels gradually decrease. She felt that on the basis of this result alone a dx of PDH could be made, but I did the stim to convince myself. The dog was started on anipryl 15 mg sid and 4 iu NPD insulin sid. The dog has been wasting away over the last few weeks. She has lost 1.5 kg in the last 4 weeks, and has continued to be pupd at home. Her insulin has gradually been increased and last week we rechecked an ACTH stim. I chose to check the stim rather than the LDDS because I was uncomfortable rechecking the test that gave the weird result - at least the stim result was conventional for a cushingoid dog. Of course, the dog excessively stimmed again. She is now on 5 iu NPH bid and I am unsure what to do to control the cushings - continue for another month at 2 mg/kg or switch to lysodren? TIA - Steve

Have you done a glucose curve yet?

When are you doing the stim in relation to the administration of trilostane?

Yeast, pseudomonas cystitis 97-10-03 LJMT I've a 16 yr old Cushingoid diabetic Chihuahua with chronic renal disease, horrendous dental disease and mild heart disease with cystitis which grew out Pseudomonas and yeast. Suggestions for treatment or should I ignore the repeated cultures of yeast? :) Other than recent problems with keeping her sugar in-line that I've been attributing to the cystitis and rotten mouth, she' 'fine'. Owner wants me to do the dentistry soon. I'm looking forward to it. She was anesthetized around a year ago for cataract removal/lens implant at Cornell and they stopped after one eye cuz of anesthetic complications.

Best tx if real (candida?

Cortrosyn was used?

15-Year-Old 'ADR' Cat 97-10-09 Rhidvm This is my first foray onto the boards, so please bear with me folks. 'Linus' is a fifteen year old m/n cat I first saw on 9/3/97. Current on FvrCP, Felv, FIP, and Rabies. The entering complaint was 'O says lethargic and isn't moving too well. Possibly lost 4-5 lbs. over summer.' Further questioning reveals O thinks there has been a chronic increase in water turnover. No v/d. Linus's current weight (9/3/97) was 12# 2oz. His weight eleven months earlier had been 15# 13oz. -- for a loss of 3# 11oz. Temp = 103.2 I/VI systolic murmur loudest on left. Bilateral otitis externa. Severe ginvivitis/periodontal disease. No palpable thyroid masses. HR ~ 200/min. Skin turgor difficult to assess due to age, but suggests moderate dehydration. Kidneys feel small and firm. I gave 150cc LRS S.Q., and 100mg Amoxi S.Q., then drew blood for a feline geriatric panel which was run in-house the next morning. 9/4/97: The blood results, including T4, and Felv/FIV, were entirely normal. I left message on O's machine and suggested we scale and polish Linus's teeth and place him on Antie. O agreed to this and said she would call within 48 hrs to schedule. 9/11/97: Linus was admitted for dentistry. O reported that he was still lethargic. I was not present in the AM to evaluate him. He was started on clavamox (rather than Antie). I did examine him prior to dentistry. T=101.0, HR = 280, still moderately dehydrated. His weight was down to 11# 14.5oz.! Administered 125ml LRS SQ and 100mg Amoxi SQ prior to procedure. He was given .1 cc diazepam IV then induced via chamber on Isoflurane and O2. During recovery, I drew a blood sample for a free T4 which I submitted to Phoenix Lab in Seattle. 9/16/97: The free T4 came back 'normal' (2.70). Dr. Sandy Willis at Phoenix advised that hyperthyroidism was very unlikely, but not out of the question. She suggested we try to r/o cardiac disease. I called O to discuss same, but no answer. I left a message for her to call the clinic. I formally handed the case over to one of my colleagues and departed on a 10 day vacation/CE-trip to California, Colorado, and New Mexico. 9/18/97: Another associate called O and left a message on machine suggesting that she bring Linus in for a chest x-ray and ECG. The clinic heard nothing more from the O until: 10/9/97 (Yesterday five minutes AFTER our 8:00PM closing time): Linus and his owners came in for a recheck with me. His weight had come back up to 12# 2oz., and his general condition actually seemed somewhat improved. His appetite had also increased some. His O had changed his diet to 'lamb and rice' which he seemed to prefer to his old ration. His gingivitis was now almost completely resolved. His oral mm were pink, his HR was 210, NSR with no audible murmur, a regular femoral pulse, and T=101.6. The owners primary concern was that his PU/PD had become even more pronounced. I obtained urine for U/A by cystocentesis, and drew blood for a standard T4 -- both of which I submitted to Phoenix Lab. I briefly discussed the possibility that, pending the results from same, I might want to either further pursue the possibility of 'occult hyperthyroidism' my means of further diagnostics, rule out other endocrine/metabolic plems, or perhaps even try a low-dose regimen of Tapazole. (For the time being, or at least until I get the U/A and T4 results back, we decided to hold off on the ECG and chest films.) I also mentioned that I would be running Linus's case up the VIN flagpole to see who salutes -- or more pably boos and hisses at my less than perfect work-up. 10/10/97: I wasn't at the clinic today, so I just called and got the U/A and T4 results from Phoenix. T4 = 2.4 (Phoenix's normal range is 1.8 to 4.5) U/A: ph = 5, S.G. = 1.016, glucose: neg., protein: trace, blood: trace, everything else NEGATIVE. Let 'er rip, Gang! I have a few more ideas of my own, but I think I'll let you folks have the floor. I'll welcome any suggestions. p

So...the most common causes of pu/pd with dehdration and weight loss would, of course, in cats be renal insuffiency (maybe), cushing's (unlikely), diabetes mellitus (not), hyperthryoidism (maybe), hypercalemia (not), liver disease (maybe...serum bile acids would tell), pyelonephritis (no?

How's his usg?

15-Year-Old 'ADR' Cat 97-10-09 Rhidvm This is my first foray onto the boards, so please bear with me folks. 'Linus' is a fifteen year old m/n cat I first saw on 9/3/97. Current on FvrCP, Felv, FIP, and Rabies. The entering complaint was 'O says lethargic and isn't moving too well. Possibly lost 4-5 lbs. over summer.' Further questioning reveals O thinks there has been a chronic increase in water turnover. No v/d. Linus's current weight (9/3/97) was 12# 2oz. His weight eleven months earlier had been 15# 13oz. -- for a loss of 3# 11oz. Temp = 103.2 I/VI systolic murmur loudest on left. Bilateral otitis externa. Severe ginvivitis/periodontal disease. No palpable thyroid masses. HR ~ 200/min. Skin turgor difficult to assess due to age, but suggests moderate dehydration. Kidneys feel small and firm. I gave 150cc LRS S.Q., and 100mg Amoxi S.Q., then drew blood for a feline geriatric panel which was run in-house the next morning. 9/4/97: The blood results, including T4, and Felv/FIV, were entirely normal. I left message on O's machine and suggested we scale and polish Linus's teeth and place him on Antie. O agreed to this and said she would call within 48 hrs to schedule. 9/11/97: Linus was admitted for dentistry. O reported that he was still lethargic. I was not present in the AM to evaluate him. He was started on clavamox (rather than Antie). I did examine him prior to dentistry. T=101.0, HR = 280, still moderately dehydrated. His weight was down to 11# 14.5oz.! Administered 125ml LRS SQ and 100mg Amoxi SQ prior to procedure. He was given .1 cc diazepam IV then induced via chamber on Isoflurane and O2. During recovery, I drew a blood sample for a free T4 which I submitted to Phoenix Lab in Seattle. 9/16/97: The free T4 came back 'normal' (2.70). Dr. Sandy Willis at Phoenix advised that hyperthyroidism was very unlikely, but not out of the question. She suggested we try to r/o cardiac disease. I called O to discuss same, but no answer. I left a message for her to call the clinic. I formally handed the case over to one of my colleagues and departed on a 10 day vacation/CE-trip to California, Colorado, and New Mexico. 9/18/97: Another associate called O and left a message on machine suggesting that she bring Linus in for a chest x-ray and ECG. The clinic heard nothing more from the O until: 10/9/97 (Yesterday five minutes AFTER our 8:00PM closing time): Linus and his owners came in for a recheck with me. His weight had come back up to 12# 2oz., and his general condition actually seemed somewhat improved. His appetite had also increased some. His O had changed his diet to 'lamb and rice' which he seemed to prefer to his old ration. His gingivitis was now almost completely resolved. His oral mm were pink, his HR was 210, NSR with no audible murmur, a regular femoral pulse, and T=101.6. The owners primary concern was that his PU/PD had become even more pronounced. I obtained urine for U/A by cystocentesis, and drew blood for a standard T4 -- both of which I submitted to Phoenix Lab. I briefly discussed the possibility that, pending the results from same, I might want to either further pursue the possibility of 'occult hyperthyroidism' my means of further diagnostics, rule out other endocrine/metabolic plems, or perhaps even try a low-dose regimen of Tapazole. (For the time being, or at least until I get the U/A and T4 results back, we decided to hold off on the ECG and chest films.) I also mentioned that I would be running Linus's case up the VIN flagpole to see who salutes -- or more pably boos and hisses at my less than perfect work-up. 10/10/97: I wasn't at the clinic today, so I just called and got the U/A and T4 results from Phoenix. T4 = 2.4 (Phoenix's normal range is 1.8 to 4.5) U/A: ph = 5, S.G. = 1.016, glucose: neg., protein: trace, blood: trace, everything else NEGATIVE. Let 'er rip, Gang! I have a few more ideas of my own, but I think I'll let you folks have the floor. I'll welcome any suggestions. p

What do others think?

What should she weigh?

15-Year-Old 'ADR' Cat 97-10-09 Rhidvm This is my first foray onto the boards, so please bear with me folks. 'Linus' is a fifteen year old m/n cat I first saw on 9/3/97. Current on FvrCP, Felv, FIP, and Rabies. The entering complaint was 'O says lethargic and isn't moving too well. Possibly lost 4-5 lbs. over summer.' Further questioning reveals O thinks there has been a chronic increase in water turnover. No v/d. Linus's current weight (9/3/97) was 12# 2oz. His weight eleven months earlier had been 15# 13oz. -- for a loss of 3# 11oz. Temp = 103.2 I/VI systolic murmur loudest on left. Bilateral otitis externa. Severe ginvivitis/periodontal disease. No palpable thyroid masses. HR ~ 200/min. Skin turgor difficult to assess due to age, but suggests moderate dehydration. Kidneys feel small and firm. I gave 150cc LRS S.Q., and 100mg Amoxi S.Q., then drew blood for a feline geriatric panel which was run in-house the next morning. 9/4/97: The blood results, including T4, and Felv/FIV, were entirely normal. I left message on O's machine and suggested we scale and polish Linus's teeth and place him on Antie. O agreed to this and said she would call within 48 hrs to schedule. 9/11/97: Linus was admitted for dentistry. O reported that he was still lethargic. I was not present in the AM to evaluate him. He was started on clavamox (rather than Antie). I did examine him prior to dentistry. T=101.0, HR = 280, still moderately dehydrated. His weight was down to 11# 14.5oz.! Administered 125ml LRS SQ and 100mg Amoxi SQ prior to procedure. He was given .1 cc diazepam IV then induced via chamber on Isoflurane and O2. During recovery, I drew a blood sample for a free T4 which I submitted to Phoenix Lab in Seattle. 9/16/97: The free T4 came back 'normal' (2.70). Dr. Sandy Willis at Phoenix advised that hyperthyroidism was very unlikely, but not out of the question. She suggested we try to r/o cardiac disease. I called O to discuss same, but no answer. I left a message for her to call the clinic. I formally handed the case over to one of my colleagues and departed on a 10 day vacation/CE-trip to California, Colorado, and New Mexico. 9/18/97: Another associate called O and left a message on machine suggesting that she bring Linus in for a chest x-ray and ECG. The clinic heard nothing more from the O until: 10/9/97 (Yesterday five minutes AFTER our 8:00PM closing time): Linus and his owners came in for a recheck with me. His weight had come back up to 12# 2oz., and his general condition actually seemed somewhat improved. His appetite had also increased some. His O had changed his diet to 'lamb and rice' which he seemed to prefer to his old ration. His gingivitis was now almost completely resolved. His oral mm were pink, his HR was 210, NSR with no audible murmur, a regular femoral pulse, and T=101.6. The owners primary concern was that his PU/PD had become even more pronounced. I obtained urine for U/A by cystocentesis, and drew blood for a standard T4 -- both of which I submitted to Phoenix Lab. I briefly discussed the possibility that, pending the results from same, I might want to either further pursue the possibility of 'occult hyperthyroidism' my means of further diagnostics, rule out other endocrine/metabolic plems, or perhaps even try a low-dose regimen of Tapazole. (For the time being, or at least until I get the U/A and T4 results back, we decided to hold off on the ECG and chest films.) I also mentioned that I would be running Linus's case up the VIN flagpole to see who salutes -- or more pably boos and hisses at my less than perfect work-up. 10/10/97: I wasn't at the clinic today, so I just called and got the U/A and T4 results from Phoenix. T4 = 2.4 (Phoenix's normal range is 1.8 to 4.5) U/A: ph = 5, S.G. = 1.016, glucose: neg., protein: trace, blood: trace, everything else NEGATIVE. Let 'er rip, Gang! I have a few more ideas of my own, but I think I'll let you folks have the floor. I'll welcome any suggestions. p

What do *you* think?

Does ma refer to microalbuminuria?

Friable Skin 97-10-19 MLPVETDIVE I have a 16 yr old neutered male siamese cat. He was presented depressed and anorexic for 3-4 s. P.E. showed him to be very thin, severe tartar and gingivitis, 10-12% dehydrated, eyes sunken in, ophthalmic exam normal, & colon very full with feces. Owner reported he has had bowel movements consistently but not as large as usual. Gen. chemistry normal except for hypoalbuminemia. UA was normal execept for a S.G of 1.020(low esp since cat was dehydrated) CBC has WBC at 57,000 with a neutrophilia with a left shift, lymphocytosis, & monocytosis. Morhpology of WBC's noted nothing unusual. Also a thrombocytosis. PCV=32. Started on fluids S.Q. and injectable antibiotics. By Sat. evening was acting more alert was much better hydrated. Sun. am after giving more fluids noticed blood around neck. Looked more closely and about 4 inches of skin had torn with very little bleeding. Skin was very red with little feeling to it. It was very friable. I sutured skin without anesthesia and cat did not feel anything. Suture would pull through if too tight. Tried to give enema. Was able to evacuate about 4 inches of feces in colon. Unable to pass a Fr ench catheter very far into colon. Did a rectal exam and felt what appeared to be a stricture with feces on the other side of it but could not get my finger through it. I have never had skin do this before. Why would it do this? I did not do IV fluids because it was the weekend and the cat was responding well to what I was doing. If it had not I had told the owner I would have her take him to the emergency clinic so cat could be given IV fluids and monitored more closely. With such a high WBC I am of course concerned about a severe bacterial infection but am not sure where. Gen chem normal. So left with bone marrow and GI tract as most likely areas of the problem. If bacterial in nature could the skin be a reaction to toxins in the blood stream causing vasocontriction to the skin and thus the presence of fluids SQ futher compromised the skin? Or what? With the constipation and possible stricture, the colon is a suspect area. Since I can't evacuate the feces and I can't even get water passed the stricutre, I wouldn't thing a barium enema would be very helpful. Any other ideas? I will be taking a rad of abd in am and doing a feline infectious panel. I also include a myeloproliferate disease on my differential. Any suggestions? Why the skin reaction? At this point my prognosis is poor. Please respond asap.

Has the cat seen exogenous steroids chronically?

Perhaps there was something causing insulin resistance before that had resolved?

High Feline TLI 97-10-03 Catdoc I have a poorly controlled diabetic, 10 yrs, m/n, on 14 units BID of a 60% humulin/40%regular insuling mix. I have tried other insulins on the cat, but not the new PZI. Cat has been on insulin for a year. Cat is poorly regulated, and owner compliance with diet is questionable. I sent blood in for a TLI and it came back 187 ug/L (normal 17-49). Is there any treatment for chronic pancreatitis that I should consider? No other blood value abnormalities. Cat's weight goes up and down. Very difficult to convince this client to treat cat or agree to other diagnostics. Any suggestions?

Did you ask him for an interpretation?

The owner is only feeding at mealtimes, when the insulin is given, using a measuring cup and the amount is reasonable for a dog this size (sometimes when the weight is falling off of them they panic and start really over-feeding the dog---which means we have to chase after them with an ever-increasing amount of insulin) what's the current number of calories/day that he gets?

High Feline TLI 97-10-03 Catdoc I have a poorly controlled diabetic, 10 yrs, m/n, on 14 units BID of a 60% humulin/40%regular insuling mix. I have tried other insulins on the cat, but not the new PZI. Cat has been on insulin for a year. Cat is poorly regulated, and owner compliance with diet is questionable. I sent blood in for a TLI and it came back 187 ug/L (normal 17-49). Is there any treatment for chronic pancreatitis that I should consider? No other blood value abnormalities. Cat's weight goes up and down. Very difficult to convince this client to treat cat or agree to other diagnostics. Any suggestions?

Is the insulin humulin nph or ultralente?

Painful when the probe was over that area?

High Feline TLI 97-10-03 Catdoc I have a poorly controlled diabetic, 10 yrs, m/n, on 14 units BID of a 60% humulin/40%regular insuling mix. I have tried other insulins on the cat, but not the new PZI. Cat has been on insulin for a year. Cat is poorly regulated, and owner compliance with diet is questionable. I sent blood in for a TLI and it came back 187 ug/L (normal 17-49). Is there any treatment for chronic pancreatitis that I should consider? No other blood value abnormalities. Cat's weight goes up and down. Very difficult to convince this client to treat cat or agree to other diagnostics. Any suggestions?

What has a glucose curve shown you lately?

How does his heart sound?

Cushings/Diabetic Old Poodle 97-10-10 LVET i've got a 10-12 yr old f/s poodle, cushings & diabetic. she's controlled well with lysodren once-a-week, and nph insulin is doing pretty well but the past 3 weeks she has been getting constipated and then starts vomiting. she has a subluxated hip with severe djd, and i think this is causing her a lot of pain. started on rimadyl, and it helped for a few days. what i don't know is--is the pain causing her constipation ( i had her on canned w/d) or there some other motility problem do to the diseases and/or treatment? she is also on hydrocortisone bid, and soloxine. now she won't eat the canned w/d. only wants to eat chicken sandwhich meat. Any suggestions? we are doing a barium series today. so far the barium is moving just fine!! thanks. L, york

Any signs of obstruction?

My question is, is it possible that if the t4 levels are extremely high that they are causing a kind of insulin resistance or are we likely dealing with two independant disease processes?

Cushings/Diabetic Old Poodle 97-10-10 LVET i've got a 10-12 yr old f/s poodle, cushings & diabetic. she's controlled well with lysodren once-a-week, and nph insulin is doing pretty well but the past 3 weeks she has been getting constipated and then starts vomiting. she has a subluxated hip with severe djd, and i think this is causing her a lot of pain. started on rimadyl, and it helped for a few days. what i don't know is--is the pain causing her constipation ( i had her on canned w/d) or there some other motility problem do to the diseases and/or treatment? she is also on hydrocortisone bid, and soloxine. now she won't eat the canned w/d. only wants to eat chicken sandwhich meat. Any suggestions? we are doing a barium series today. so far the barium is moving just fine!! thanks. L, york

Any lab abnormalities?

If so are they not over-feeding her more calories for her weight?

Hyperestrogenism 97-10-24 Vmd3ho Have a spayed female diabetic poodle, 11 years old, blew a TL disc several months ago, and is now paretic behind. Owners opted against surgical repair, and she has slowly regained minimal neuro control behind. Has had repeated UTI's, presumed by me to be associated with constant urine stasis - bugs getting frighteningly more resistant. Owner suggests (insists?) that we measure her blood estrogen level because when she (the owner) continually got UTI's that's what her doctor did. Her estrogen level was too high, her MD treated that, and the UTI's stopped. Well, her dog's estrogen is approximately double the high end of normal reported by my lab (don't have exact numbers in front of me). What does this mean? Have tried to prove this dog is also Cushingoid for years, but tests are repeatedly normal, despite pretty typical clinical signs. Everything I read on hyperestrogenism has to do with Sertoli cell tumors or exogenous toxicity. I'm pretty confused. Thanks in advance for comments.

Where did you measure the estrogen level and what were the results and the normal range?

Anyone remember?

Hyperestrogenism 97-10-24 Vmd3ho Have a spayed female diabetic poodle, 11 years old, blew a TL disc several months ago, and is now paretic behind. Owners opted against surgical repair, and she has slowly regained minimal neuro control behind. Has had repeated UTI's, presumed by me to be associated with constant urine stasis - bugs getting frighteningly more resistant. Owner suggests (insists?) that we measure her blood estrogen level because when she (the owner) continually got UTI's that's what her doctor did. Her estrogen level was too high, her MD treated that, and the UTI's stopped. Well, her dog's estrogen is approximately double the high end of normal reported by my lab (don't have exact numbers in front of me). What does this mean? Have tried to prove this dog is also Cushingoid for years, but tests are repeatedly normal, despite pretty typical clinical signs. Everything I read on hyperestrogenism has to do with Sertoli cell tumors or exogenous toxicity. I'm pretty confused. Thanks in advance for comments.

Did you also measure other sex steroids?

What diet is she eating?

Diabetic Extremes 97-10-28 JRZTMADA A few weeks ago I asked (see: 'No good deed goes unpunished') what I might be missing with a cat who was very carefully increased in her insulin dosage starting at 2 units ultralente and over a course of a couple of months was still not regulating at something like 25 units daily. We continued to raise the dosage and she is now at 45 units. Clinically this cat is doing great and clearly better than any of the lower doses. She's still somewhat pu/pd. Her serial glucose tests never show a reading below 300. This happens to be our hospital cat. (go figure...) One recent , our techs accidentally gave her two injections on the same , so she got 90 (ninety) units of ultralente. Realizing the mistake, her glucose was checked every hour or two over the next 36 hours. It never went below 300. She doesn't appear cushenoid. Is there something else I should be doing or looking for? The other end of the spectrum is a cat that remains hyperglycemic and loses weight on one unit. We've tried adjusting the dose by fractions of a unit, but regardless of the dose we maintain her at, after about ten s she has an hypoglycemic crisis. We stop the insulin for a couple of s then she starts being pu/pd, etc and we start out again at one unit. This cat happens to be extreeeemely fractious, so I'm not sure how valuable our in-house tests are, and it is very difficult to get a series on her. Any input on either of these creatures would be greatly appreciated. Thanks,

How much does the cat weigh and how old is the cat?

Are you a single parent, or is the father in the picture?

Diabetic/Protein-losing k9 97-11-10 MattyAH I need help! 6 1/2 yr. F/S Beagle has been diabetic for 2 years, is on NPH BID. Had 2 episodes of presumptive pancreatitis this summer (AMylase>9000, vomiting, etc.) that responded to supportive care (IVs ,etc). Has had good glycemic control until recently (glycos. Hb was 7.5 in 6/97). Recurrence of vomiting 3 weeks ago. Gluc-601, Cholest-2890, Albumin-1.8, Alk Phos-2244, Amylase-2396, Lipase-285, ALT-266. (the Alk Phosp had been 335 in June and a LDDST was normal then). A u/a showed 4+ protein, Uspgr-1.040, and 2+ ketones. I repeated the LDDST which showed N suppression and performed a Urine P:C ratio which is 10.16. Ugh!! There is no signif wt. loss (wt in 10/95-33#, now 30#) and she's home and doing well again on her insulin at dose of 20 units NPH BID. She also has extensive degen changes of both hips. So, where do I go from here? Have I ruled out Cushing's interfering with her diabetic regulation? Is this just a dog with multiple immune-related diseases? Assuming the owners don't pursue a renal biopsy to dx amyloid/GNP, what's left other than K/D diet and aspirin therapy? I appreciate all input. She's a very happy dog right now... Liz Dole

Is the dog heartworm negative?

Can you post the images?

Hepatocutaneous dermititis? 97-11-12 TRISK9DOC I am treating a 60 lb. mixed breed dog with a severe case of interdigital dermititis, It has been unresponsive to antibiotics and steroids and seems to be getting worse. The only abnormality I can find is highly elevated liver enzymes. Other than the dermititis the dog seems fine. . Most of the information on hepatocutaneous dermititis includes concurrent diabetes which this dog does not have and the pads affected, which is not the case here. Biopsies showed no indication of autoimmune disease. I am going to do a c/s in the next few days if I can talk the owners into it ( $ problems ). I remember Alice speaking about resistent ( unencapsulated?) bacteria infections at the AAHA meeting in San Diago but can't find the reference. Is there a special culture tech for this? Any other ideas?

However, could the dog have canine cushing's disease which is not allowing the skin to heal properly?

I do not know about csa potentially my colleagues can comment?

Proteinuria and cushing's 97-11-18 MELROSEVET I have a 7 year old scottish terrier with the following problems- initially diagnosed with adult onset demodicosis. chem profile showed elevated alk phos and cholesterol so cushing's workup performed . acth level77(normal), lo-dose dex supp: resting cortisol 4.0,4hr 0.1, 8hr 0.1, so concluded not cushings. treated demodex successfullt with oral ivermectin. new problem- generalized Malessezia pachydermatitis and pu/pd.new chem profile shows elevated alk phos,cholesterol and decreased albumin(2.1) this is approx. 3 mos after the initial workup. urine sp. grav is 1.006 and urine protein/creat ratio is13.2(normal less than 1.5) here's the questions: is this level of proteinuria compatable withj cushing's or this there another glomerulopathy going on, should I retest for cushing's? and do I restrict dietary protein?-k/d versus eukanuba renal diet with fermentable fiber? Thanks for your input- Stew

Have you cultured the urine?

How much insulin is he on and what does he weigh?

Re: insulin reaction 97-11-09 K9DOC Carol: You don't say whether the lameness correlates to the site of insulin injection or whether you have noticed any local reaction at the injection site. If so, then there would seem to be some direct correlation. If not, then I'd be concerned that there is some primary problem that may have triggered diabetes development. Infections may induce a diabetic state because if the cat becomes hyperglycemic for several days due to the infection and stress. Alternatively, infection in a diabetic cat can produce insulin resistance in a truly diabetic animal. You might consider switching insulin types for home use to see if that helps.

How long was the initial course of baytril?

Is the dog apparently well-controlled at this time?

Re: insulin reaction 97-11-09 K9DOC Carol: You don't say whether the lameness correlates to the site of insulin injection or whether you have noticed any local reaction at the injection site. If so, then there would seem to be some direct correlation. If not, then I'd be concerned that there is some primary problem that may have triggered diabetes development. Infections may induce a diabetic state because if the cat becomes hyperglycemic for several days due to the infection and stress. Alternatively, infection in a diabetic cat can produce insulin resistance in a truly diabetic animal. You might consider switching insulin types for home use to see if that helps.

Is that correct?

What dose of pred is she on?

Insulin Coverage 97-11-10 Myxomatoes I need help stabilising a diabetic kitty. (n = 3.6 -7mmol/l...Canadian) On 3 units Lente (beef/pork) twice daily. When I track the curve start in the morning at 22mmol/l, he gets down to normal level 7mmol/l but only at about 4pm , for most of the day we get this slow decline but inadequate control, ie in the 14 to 20 range.. So he is essentially not controlled. He also climbs back to the high teens by 7pm. I have added regular insulin 2units in the morning but this is still not getting the BG into the controlled range faster. Any other stategies ( I get a similar curve on Ultralente Humulin). This is a problem that I have encountered before...at 8 hours post all looks fine but they are essentially not controlled. thanks

Is he still losing weight, still pu/pd?

Fountains?

Diabetic/Hepatic Lipidosis? 97-11-11 KTSnDGS I have an 11 yr. old FeS, long term diabetic. She is somewhat poorly controlled on 2 units of Humulin U BID. In the past 2 weeks she has had intermitent vomition ( sometimes bile , sometimes undigested food, timing of episodes variable, several times in a 24 hr. period to none in a 24 hr. period) and depressed appetite (eating about 1/4 can after offers of many varieties, usually consumes one can or more in 24 hrs.) She has lost 1lb 12 oz. since August. She is a big framed cat and, although not hurting for groceries, she is not obese. Questions: 1) She has an Alk Phos of 244 with normal triglycerides, ALT , GGT, Bili, Cholesterol. Her PCV is 46 and her T.P. is 9.08 (IDEXX), Globulin 5.79, Alb., 3.9, WBC 10,550, Diff WNL except most lymphs appear large (not obviously neoplastic). U/A WNL. The Alk phos on the Idexx machine is supposedly normal up to 240 but I have been told by an Internists that he considers anything above 40 a problem, regardless of the machine it is done on, in a cat. What do you think the chances a cat with the ALP as the sole liver enzyme elevation has HL as opposed to some biliary obstruction? 2) Would the next most logical step be ultrasound/needle biopsy or would you suggest some other approach as the evidence of hepatobiliary disease is non existent if IDEXX's normals are correct. 3) Could the elevated globulin level be explained without antigenic stimulation. I know she is dehydrated but this protein level seems excessive. 4) Would ypu even consider HL in a cat that was still eating, even if in decreased quantities Thanks for your help and comments...Dave

What does a ts look like when you do a pcv?

Yes -- could be from dm, mucocele, or underlying cushings not for cushing itself?

Diabetic Chasing..... 97-11-12 Atallicat I have two cases that I am seeing that want to be diabetics but that cannot make up their minds to be and I am afraid to begin insulin therapy for fear of causing hypoglycemia... The first is a 13 year old female who came in for wheezing. No history of pu/pd/pp but does have weight loss. Cat physically was in good shape except she had a very sensitive trachea and was very wheezie on auscultation. Her chest films indicated asthma or heartworms and the ag/ab was negative. On the profile I ran, I picked up a blood glucose of 406.7 and her cholesterol was 363.3 (65-225). She was not fasted but that still is not a level I usually see even when an animal has not been fasted. Later that afternoon, which would have been about a 7 hour fast, the glucose went to 240. She was in such discomfort, I opted to give only two days of pred and manage her on theodur, cyproheptadine and antibiotics. On Monday her fasting blood glucose was 281. Of course she had glucosuria and her sg was off scale ( >1.035). Fructosamine is pending. Her chest is much improved. Is she or isn't she or what is your minimum fasting blood glucose on a cat before you call them a diabetic? Another is a cat ( don't have records at home ) who came in for PU/PD/PP and excessive water drinking. His fasting glucose is normal at times and at other times is high. If I get one high one I usually wait a day or so and confirm and when I did this it was normal. I did the T3 suppression test and he suppressed normally. Yesterday he brought urine and the sg was 1.025 with max glucose. He said he urinated like a race horse now and the symptoms are much worse. Today the fasting glucose was >400. Fructosamine pending. I have ordered PZI and am planning on starting him on it Monday. I have never had patients that fluctuated like that and need assurance that I am doing the right thing. Thank you for your help !

Meanwhile, i'd go with the history....is she pu/pd/pp and losing weight?

Does he not eat well sometimes?

Diabetic Chasing..... 97-11-12 Atallicat I have two cases that I am seeing that want to be diabetics but that cannot make up their minds to be and I am afraid to begin insulin therapy for fear of causing hypoglycemia... The first is a 13 year old female who came in for wheezing. No history of pu/pd/pp but does have weight loss. Cat physically was in good shape except she had a very sensitive trachea and was very wheezie on auscultation. Her chest films indicated asthma or heartworms and the ag/ab was negative. On the profile I ran, I picked up a blood glucose of 406.7 and her cholesterol was 363.3 (65-225). She was not fasted but that still is not a level I usually see even when an animal has not been fasted. Later that afternoon, which would have been about a 7 hour fast, the glucose went to 240. She was in such discomfort, I opted to give only two days of pred and manage her on theodur, cyproheptadine and antibiotics. On Monday her fasting blood glucose was 281. Of course she had glucosuria and her sg was off scale ( >1.035). Fructosamine is pending. Her chest is much improved. Is she or isn't she or what is your minimum fasting blood glucose on a cat before you call them a diabetic? Another is a cat ( don't have records at home ) who came in for PU/PD/PP and excessive water drinking. His fasting glucose is normal at times and at other times is high. If I get one high one I usually wait a day or so and confirm and when I did this it was normal. I did the T3 suppression test and he suppressed normally. Yesterday he brought urine and the sg was 1.025 with max glucose. He said he urinated like a race horse now and the symptoms are much worse. Today the fasting glucose was >400. Fructosamine pending. I have ordered PZI and am planning on starting him on it Monday. I have never had patients that fluctuated like that and need assurance that I am doing the right thing. Thank you for your help !

Is the wheeze on inspiration or expiration?

Where exactly on her hindlimbs has she been over-grooming?

Diabetic Chasing..... 97-11-12 Atallicat I have two cases that I am seeing that want to be diabetics but that cannot make up their minds to be and I am afraid to begin insulin therapy for fear of causing hypoglycemia... The first is a 13 year old female who came in for wheezing. No history of pu/pd/pp but does have weight loss. Cat physically was in good shape except she had a very sensitive trachea and was very wheezie on auscultation. Her chest films indicated asthma or heartworms and the ag/ab was negative. On the profile I ran, I picked up a blood glucose of 406.7 and her cholesterol was 363.3 (65-225). She was not fasted but that still is not a level I usually see even when an animal has not been fasted. Later that afternoon, which would have been about a 7 hour fast, the glucose went to 240. She was in such discomfort, I opted to give only two days of pred and manage her on theodur, cyproheptadine and antibiotics. On Monday her fasting blood glucose was 281. Of course she had glucosuria and her sg was off scale ( >1.035). Fructosamine is pending. Her chest is much improved. Is she or isn't she or what is your minimum fasting blood glucose on a cat before you call them a diabetic? Another is a cat ( don't have records at home ) who came in for PU/PD/PP and excessive water drinking. His fasting glucose is normal at times and at other times is high. If I get one high one I usually wait a day or so and confirm and when I did this it was normal. I did the T3 suppression test and he suppressed normally. Yesterday he brought urine and the sg was 1.025 with max glucose. He said he urinated like a race horse now and the symptoms are much worse. Today the fasting glucose was >400. Fructosamine pending. I have ordered PZI and am planning on starting him on it Monday. I have never had patients that fluctuated like that and need assurance that I am doing the right thing. Thank you for your help !

What about doing a tracheal wash for cytology?

As for rechecking, home curves may be approp; do the owners live close enough to come back through the day?

Re: EPI-bold statement 97-11-17 K9DOC John: I agree with you in being skeptical, John and must disagree with my fellow Texan, Gary N. I've never diagnosed EPI in any cat, diabetic or otherwise. Reports in the literature are similarly scarce. It only takes 5% of pancreatic exocrine output to have normal digestion and normal stools (lots of extra capacity there). I don't think I've ever diagnosed EPI in canine patients following severe, recurrent, pancreatitis episodes although that would be more likely. TLI is useful in the cat to help diagnose pancreatitis and pancreatitis may be an underlying cause of diabetes mellitus in some cats.

Am i really missing that many epi cats?

How long are they keeping each open glargine pen?

Feline TLI? 97-11-18 AMGVCA I have a pt that is a diabetic (controlled on ultra lente) 18yr m/n dsh. His clinical signs are chronic wt loss, dehydration, voracious appetite, voluminous grey stools, abdominal fluid and VERY BAR (not painful and no vom/diarrhea). CBC, chemistries including thyroid profile are normal except for mild elevations from dehydration. Two abdominal taps showed modified transudate with bacteria and degenerated wbc and epithelial cells. The pathologist was concerned with rupture of intestines or accidental tap of intestine! I then ran a feline TLI sent to Texas A&M that came back as 108ug/l with a normal hi of 49 which is suppose to indicate panctitis and not EPI. Where do I go from here? He clinically appears to have EPI but it doesn't fit the lab. Do I tt with Viokase? Owner does not want sx. Thanks,

Why do you think this cat has abdominal fluid?

Laboratory testing to date, including ua and urine cultures?

Feline TLI? 97-11-18 AMGVCA I have a pt that is a diabetic (controlled on ultra lente) 18yr m/n dsh. His clinical signs are chronic wt loss, dehydration, voracious appetite, voluminous grey stools, abdominal fluid and VERY BAR (not painful and no vom/diarrhea). CBC, chemistries including thyroid profile are normal except for mild elevations from dehydration. Two abdominal taps showed modified transudate with bacteria and degenerated wbc and epithelial cells. The pathologist was concerned with rupture of intestines or accidental tap of intestine! I then ran a feline TLI sent to Texas A&M that came back as 108ug/l with a normal hi of 49 which is suppose to indicate panctitis and not EPI. Where do I go from here? He clinically appears to have EPI but it doesn't fit the lab. Do I tt with Viokase? Owner does not want sx. Thanks,

Hypoproteinemia?

Any supplements (vitamin d)?

Feline TLI? 97-11-18 AMGVCA I have a pt that is a diabetic (controlled on ultra lente) 18yr m/n dsh. His clinical signs are chronic wt loss, dehydration, voracious appetite, voluminous grey stools, abdominal fluid and VERY BAR (not painful and no vom/diarrhea). CBC, chemistries including thyroid profile are normal except for mild elevations from dehydration. Two abdominal taps showed modified transudate with bacteria and degenerated wbc and epithelial cells. The pathologist was concerned with rupture of intestines or accidental tap of intestine! I then ran a feline TLI sent to Texas A&M that came back as 108ug/l with a normal hi of 49 which is suppose to indicate panctitis and not EPI. Where do I go from here? He clinically appears to have EPI but it doesn't fit the lab. Do I tt with Viokase? Owner does not want sx. Thanks,

Have you radiographs (remember thin animals won't have abdominal contrast) or us support for intraabdominal fluid?

What is the rest of the curve looking like?

Low Electrolytes 97-11-25 Vet A 12 year old male neutered DSH presented 11/15/97 in lateral recumbency with rigid extension of all four limbs. the cat was panting and anxious. T 103.6, deep pain perception in all 4 limbs. The heart sounded normal. My initial thoughts were that this cat had a neurologic disorder, possibly a cervical lesion.Bloodwork was drawn and I gave the cat an iv bolus of solu delta cortef. Within one hour the cat was sternal! Also within one hour, thanks to in house blood machines, I found this cat had a BUN of 76, Creatinine of 3.3 as well as very low Na, K, and Cl. I actually thought that my elecrolyte machine was not working. U/A revealed a SpGr of 1.020, CBC:slightly elevated wbc 20,700. Radiographs appeared normal. Placed the cat on LRS with KCl and TumilK. The cat went home with Tumil K and clavamox(to cover for a possible UTI) the cat did well for a week. Came in today and the owner said that he is not eating well and vomited a few times at home. this is an outdoor cat and the owner is not sure how much more vomiting the cat may be doing outside. Todays bloodwork show a BUN of 62 and Creatinine of 2.3(0.3-1.6)Electrolytes are all low again. I suspect this cat is vomiting more than the owner sees, and maybe this moderate renal disease is more serious than I first thought. Any ideas or suggestions. Thanks

How low are we talking about?

How many calories/day does he currently get?

Diabetic With Hypothyroid 97-11-14 JDSDVM 9 year old shep cross, f/s, 100#. Presented a year ago with diabetic ketoacidosis and was also cushinoid. Lysodren therapy turned her into an addisonian. Now, dog is apparently very hypothyroid. Free t4 ed id .1, tsh="" is="" .54,="" t-4="" is="">/.1,>,5. the="" diabetes="" is="" poorly="" controlled,="" although="" she="" seems="" to="" be="" doing="" fairly="" well="" on="" 55="" u="" humilin="" l="" bid.="" the="" dog="" is="" very="" intolerant="" of="" thyrosyn="" medication.="" 2="" hours="" post="" medication="" she="" acts="" agitated,="" restless,="" panting="" etc.="" any="" ideas?="">/,5.>

Have you measured t4's post pill?

She was diagnosed with cushing's before the diabetes started?

Diabetic With Hypothyroid 97-11-14 JDSDVM 9 year old shep cross, f/s, 100#. Presented a year ago with diabetic ketoacidosis and was also cushinoid. Lysodren therapy turned her into an addisonian. Now, dog is apparently very hypothyroid. Free t4 ed id .1, tsh="" is="" .54,="" t-4="" is="">/.1,>,5. the="" diabetes="" is="" poorly="" controlled,="" although="" she="" seems="" to="" be="" doing="" fairly="" well="" on="" 55="" u="" humilin="" l="" bid.="" the="" dog="" is="" very="" intolerant="" of="" thyrosyn="" medication.="" 2="" hours="" post="" medication="" she="" acts="" agitated,="" restless,="" panting="" etc.="" any="" ideas?="">/,5.>

What brand of t4 is she on?

As we don't know what we are treating, but lsa, and ridiculously bad ibd are consideration, what about starting chlorambucil in an attempt to decrease the reliance on steroids?

Diabetic and Increased ALKP 97-11-25 JSBradKS 13yr. f/s terrier mix, 7kg. H/O: 11/95 diabetes mellitus Using Humilin N BID and monitoring with glucose curves. 2/96 Horner's syndrome right eye. Referral to ACVO...lesion between anterior cervical ganglion and the iris dilator muscle. 7/97 UTI, treated successfully. 8/97 o reports urinary incontinence, sporadic episodes. puddles are found after dog has left room. Not always same room. glucose curve:resting is 175, insulin peak at 10 hours (62mg/dl) Abd. rads=Normal bladder, kidneys. Moderate liver enlargement(ACVR) Urinalysis= inactive sediment. Therapuetic trial of PPA, not effective. DES trial also not effective CBC/Chem=ALT 178(4-66), ALKP 1020(20-150), Na 130, K 4.6 HCT 45, WBC 14,600(60seg, 2 band, 15ly, 7mono, 16%EOSIN) Low Dose Dex=resting 8.2(0.5-5.0) 4 hour 0.5; 8 hour 0.5 Urine culture negative Dog has lost 1# in last month, but has good appetite and acts clinically normally. Next step... ultrasound the liver? adrenal? Is high resting cortisols significant. Absolute eosinophilia? thanks for the help....jsb

In addition what dose of ppa and des was the dog on?

How many calories/day does he currently get?

Diabetes 97-12-14 BeastDr I'm treating a 6 year old schnauzer for a severe auto- immune arthropathy (only one knee affected) with prednisone and Imuran. He's been on the prednisone for about a year, and has been on one every other day for two weeks. Two weeks ago we diagnosed diabetes. Any suggestions on how soon we can get this dog off steriods? The steroids are making it difficult to treat the diabetes. Any relationship between the long term steroid use and the diabetes?

How was it diagnosed?

I'd be really surprised if that dose caused the dm -- have you checked his renal values, too - to make sure we don't have an issue with crf?

Diabetes 97-12-14 BeastDr I'm treating a 6 year old schnauzer for a severe auto- immune arthropathy (only one knee affected) with prednisone and Imuran. He's been on the prednisone for about a year, and has been on one every other day for two weeks. Two weeks ago we diagnosed diabetes. Any suggestions on how soon we can get this dog off steriods? The steroids are making it difficult to treat the diabetes. Any relationship between the long term steroid use and the diabetes?

Any x-ray changes?

How about the food---is the cat on the canned only version of a high protein/low carb diet?

Nasal Steroids 97-12-16 AcmeVet Has anyone ever used nasal steroids in cats and dogs? Any luck?

Should nasal mites be considered (in the dog)?

Have you found yeast on cytology?

Nasal Steroids 97-12-16 AcmeVet Has anyone ever used nasal steroids in cats and dogs? Any luck?

What are the clinical signs and your work-up results so far?

What dose is he on right now?

Lymphoma and dex 97-12-09 SKIDVM Eight yo fs dlh was diagnosed via cytology with lymphoma of an abdominal lymph node 3/97. Cat was started on Dexamethasone initially bid and is now on .375mg dex sid. Cat has done very well except is now hyperglycemic (258) and has a UTI. Two main questions. Would dex alone control a cat with lymphoma for this length of time or should the original diagnosis be suspect. What is the likelihood that this level of dex could be responsible for the hyperglycemia. I may have a true diabetic here but this glucose level seems borderline and the cat is not losing weight. The cat is doing well except has a glucose of 258. I would like to stop the dex and see if the glucose regulates. p

Are there or were there any other signs or plems on bloods to suggest diagnostics of other sites?

What diet is the cat eating?

Lymphoma and dex 97-12-09 SKIDVM Eight yo fs dlh was diagnosed via cytology with lymphoma of an abdominal lymph node 3/97. Cat was started on Dexamethasone initially bid and is now on .375mg dex sid. Cat has done very well except is now hyperglycemic (258) and has a UTI. Two main questions. Would dex alone control a cat with lymphoma for this length of time or should the original diagnosis be suspect. What is the likelihood that this level of dex could be responsible for the hyperglycemia. I may have a true diabetic here but this glucose level seems borderline and the cat is not losing weight. The cat is doing well except has a glucose of 258. I would like to stop the dex and see if the glucose regulates. p

Is the lesion still there or has it disappeared on the roids?

Are the platelets elevated?

Asympt. Bradycardia 97-12-04 CatCoach Hello, T.C. is a 7.5 yr old MN DSH. His only history includes regular vaccines, occassionaly cat bite abscesses, and two episodes of lameness (first in '94(arthritis?), second in 9/97 (abscess)). Nov 27 TC came in for his yearly vaccines and exam. T=37.8, P 120bpm (with excitement!), R-n, wt 7.75 kg = 17 lb. (oh yes, he's also a little overweight ;-) - about 3-4 lbs. T.C. is fine at home according to the owner. T4normal, BUN, Creatinine, GGTP and SGPT all normal. Xrays of chest - possibly very mild cardiomegaly, else nvl. EKG (from Cardiopet) - done 3 days later - HR: 142bpm. sedated with oxyace result: slow sinus rhythm. It is suggested that this may be due to a high vagal tone, or a metabolic disturbance. Complete blood work is recommended. My question is: what type of 'metabolic disturbances' might I be looking for from the blood work? High potassium? Addisons? Other? I'm sure the owner will ask, so I want to be able to give her a complete answer. What about an Ultrasound? Cardiopet didn't recommend it. There is no murmur. The cat is asymptomatic. Thanks,

So -- my bet is that this is either normal for this big gallump (sp?

Do you have a ua?

Re: Really tough abetic 97-12-07 K9DOC John: When is your glucose peaking and when is it lowest? I'm not a big fan of UL and it's possible that you aren't getting enough duration of activity to keep the cat from spilling much of the day. Either twice daily insulin (with some reduction in dose, 51 mg/dl is a bit too low) or change in insulin type (to NPH, Lente BID or try PZI for once daily use.

Have you ever seen a case of controlled dm in which the pu/pd d not resolve?

Is it always the same number each?

Re: Really tough abetic 97-12-07 K9DOC John: When is your glucose peaking and when is it lowest? I'm not a big fan of UL and it's possible that you aren't getting enough duration of activity to keep the cat from spilling much of the day. Either twice daily insulin (with some reduction in dose, 51 mg/dl is a bit too low) or change in insulin type (to NPH, Lente BID or try PZI for once daily use.

I have thought about medullary washout, but how could i gradually restrict a abetic cat without making her sick?

Any ideas?

Re: Really tough abetic 97-12-07 K9DOC John: When is your glucose peaking and when is it lowest? I'm not a big fan of UL and it's possible that you aren't getting enough duration of activity to keep the cat from spilling much of the day. Either twice daily insulin (with some reduction in dose, 51 mg/dl is a bit too low) or change in insulin type (to NPH, Lente BID or try PZI for once daily use.

Can i do a water deprivation test on a abetic cat safely?

Could you post the actual report?

CatsAdrenal 97-12-05 WoodburyAH I have asked some recent questions on cats and cushings onthis board so here goes the case. Nasty cats with diabetes with nasty skin dz. High index of suspision for cush - SKIN!!!. Today sedated the cat and did a HDDST (will sedation affect?). I had a good operator (ACVIM) do a sonogram - bilateral adrenal tumors. The adrenals were both large and very irregular with multiple irregular hypoechoic areas. Has anyone seen bilateral tumors in the cat? Assuming sx as tx of choice - prognosis (ballpark)? Can you try OPDDD (at what dose) to try to stabilize prior to sx? If the owners cannot afford sx then OPDDD? Prognosis without sx on OPDDD? (assuming no histopath). ?Possibility that the interpretation was wrong and that this is Macronodular Hyperplasia?

What results did you get on the des suppression and what dose of dex did you use?

What's the mcv/mchc?

Diabetic And Liver 97-12-08 PKVET have 8 yr old pug diabetic that has been on insulin since june 96. Just recently owners have noted that he has lost weight and refusing treats but eats his dog food. did workup and has very elevated blood glucose (496) and elevated liver enzymes alk phos is 8x normal, alt wouldnt register and are repeating, bilirubin was 4.32 and he does appear icturic. His alb is 2.43. could this all be from hepatic lipidosis from an unregulated diabetic or should we be looking elsewhere, also he's at 11 units nph bid and he is a 20 lb dog. how fast do you start going up? we also did a ua and no infection. he also has atopy and they give him antihistimines could these complicated matters/ they havn't noted pu/pd but would suspect it is occuring. he was negative on ketones. should a liver biopsy be done/ultrasound/etc thanks

Do you have a cbc?

How is he not doing well?