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Occult Diabetes? 97-12-19 Vetgroup I have a very strange diabetic case. I saw a dog last month for increased frequency of urination. The dog has Calcium Oxalate calculi which were removed. Pre op bloods only showed a mild increase in Alkaline Phos. We started feeding U/D and the dog developed severe Pu/Pd. We reran serum chemistries and the Alk Phos was 1150. Abdominal rads showed hepatomegaly. A low dose dex supp. test was normal. Blood glucose was 165 at this time and urine glucose negative. Culture of the urine was also negative. The owner stopped the U/D and the Pu/Pd stopped. Several weeks later the Pu/Pd started again, and now the dog is hyperglycemic. Could this dog have been only intermittantly hyperglycemic during the early episodes of Pu/Pd? I have never seen a diabetic present this was. Thanks

What was the bg and is there glucose in the urine?

Also the problem you face now: if it doesn't work, how long before we can use another steroid....?

Poodle seizures 97-12-23 PIGMS I recently saw a 5 year old FS poodle that had been treated by the local emergency hospital for a cluster of seizures. The dog had no history of seizures and had been fed Pedigree all of its life. No toxin exposure. It ate one hour before the first seizure and also before the cluster of seizures. The dog had an ammonia level of 289 (0-98) with other lab values of SAP 83 (30-400), ALT 54 (8-80), BUN 39.3 (7-27), Ca 8.64 (7.9-12) and glucose 225 (77-125). The WBC count was within normal limits. They made a tentative diagnosis of hepatic encephalopathy with possible liver shunt. They treated the dog with IV valium and fluids overnight and sent the dog home on lactulose, ampicillin and recommended a low protein diet. Recheck ammonia 12 hours post was 133. The owners saw me when the dog had two more seizures the day it was sent home. They had fed it turkey, eggs and Pedigree one hour before each seizure. The owners are not able to work up the dog for a shunt and cannot afford surgery. Do you feel that this may be a shunt in a 5 year old dog with normal liver enzymes and BUN? How long will medical management with lactulose and antibiotics help the dog? Are phenobarbital or KBr practical choices to manage the seizures if a low protein diet and lactulose do not? The dog had 2 seizures the day after I started her on a K/D diet and has been seizure-free for 2 days now. Thanks. Bonnie

What do you make of the hyperglycemia?

Also, what was cell morphology like?

Poodle seizures 97-12-23 PIGMS I recently saw a 5 year old FS poodle that had been treated by the local emergency hospital for a cluster of seizures. The dog had no history of seizures and had been fed Pedigree all of its life. No toxin exposure. It ate one hour before the first seizure and also before the cluster of seizures. The dog had an ammonia level of 289 (0-98) with other lab values of SAP 83 (30-400), ALT 54 (8-80), BUN 39.3 (7-27), Ca 8.64 (7.9-12) and glucose 225 (77-125). The WBC count was within normal limits. They made a tentative diagnosis of hepatic encephalopathy with possible liver shunt. They treated the dog with IV valium and fluids overnight and sent the dog home on lactulose, ampicillin and recommended a low protein diet. Recheck ammonia 12 hours post was 133. The owners saw me when the dog had two more seizures the day it was sent home. They had fed it turkey, eggs and Pedigree one hour before each seizure. The owners are not able to work up the dog for a shunt and cannot afford surgery. Do you feel that this may be a shunt in a 5 year old dog with normal liver enzymes and BUN? How long will medical management with lactulose and antibiotics help the dog? Are phenobarbital or KBr practical choices to manage the seizures if a low protein diet and lactulose do not? The dog had 2 seizures the day after I started her on a K/D diet and has been seizure-free for 2 days now. Thanks. Bonnie

Was the dog given iv dextrose or is it a diabetic?

Is the dog bleeding from the penis or is blood noted only upon urination?

Painful westie 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

Is there any muscle atrophy?

Any other abnormalities on biochem?

Painful westie 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

Is there any proteinuria?

What is emily's bcs?

Lipemia in diabetic cat 98-01-16 NCVH1 Has anyone had problems with very high lipemia levels in diabetic cats, even when insulin therapy is getting serum glucose levels well down within normal limits? Is it an indication of other problems or that control is not as good as glucose levels would indicate? Note: The blood is so lipemic that is can be seen in the whole blood.

Is the cat on a low fat, high fiber diet?

Your thoughts?

Diabetic Gypsy Rover 98-01-20 Petsdoc4 Gypsy was diagnosed with diabetes about 2 weeks ago. I started her on Lente insulin at .75 units /kg (she's 39lbs). Her blood glucose dropped from 446 to 200 after the first dose. Since then its been only occasionally responsive to the insulin with the BG staying in the 300-400 range However, over one weekend the glucose stayed below 200 without any insulin in 36 hours. Since then glucose has stayed high and I have increased the insulin to 20 units and not much response. I know I need to check for Cushings, but her alk phos has been only about 70. What gives? Would you try a different type of insulin? Which one? Or would you continue to increase the dose of Lente. Any advice is greatly appreciated. Thanks, Grif

How are the clinical signs doing?

Do you know the cat's bp while awake?

Cushings Kitty 98-01-05 ELMACVETCL We have a fat diabetic kitty that does not respond to any type of insulin injections with an abnormally high ACTH response test. Is anyone using deprenyl in kitties with Cushings disease? Thanks for your input.

How old is this cat?

Does she have a play schedule with the cat?

Cushings Kitty 98-01-05 ELMACVETCL We have a fat diabetic kitty that does not respond to any type of insulin injections with an abnormally high ACTH response test. Is anyone using deprenyl in kitties with Cushings disease? Thanks for your input.

How long have you been treating?

And how is she now?

Cushings Kitty 98-01-05 ELMACVETCL We have a fat diabetic kitty that does not respond to any type of insulin injections with an abnormally high ACTH response test. Is anyone using deprenyl in kitties with Cushings disease? Thanks for your input.

What are the clinical signs other than apparent insulin resistance?

Have there ever been clinical signs of hypoglycemia?

Cushings Kitty 98-01-05 ELMACVETCL We have a fat diabetic kitty that does not respond to any type of insulin injections with an abnormally high ACTH response test. Is anyone using deprenyl in kitties with Cushings disease? Thanks for your input.

Skin fragility?

Was the prednisone discontinued for at least 12 hours before the ldds?

Cushings Kitty 98-01-05 ELMACVETCL We have a fat diabetic kitty that does not respond to any type of insulin injections with an abnormally high ACTH response test. Is anyone using deprenyl in kitties with Cushings disease? Thanks for your input.

Hair loss?

Do you see that where you are?

Cushings Kitty 98-01-05 ELMACVETCL We have a fat diabetic kitty that does not respond to any type of insulin injections with an abnormally high ACTH response test. Is anyone using deprenyl in kitties with Cushings disease? Thanks for your input.

Loss of muscle mass with pendulous abdomen?

Because i need to put my kids through college?

Feline Diabetes 98-01-20 SPYGEN This 15 lb cat was dx w/ diabetes on 10/28/97. Started on lente (humulin) Insulin at 3 units sid. No significant change in b.g. increased dose to 3 units bid on 11/4/97. Eventually i increased dose to 4 units bid. No change in b.g's Range 450-600. On 12/6/97 changed to pzi insulin- (cinad) exemption. Presently on 4 units bid-also no change in b.g. plan on checking cortisol levels on tuesday (acth response test). Do you think this dose is too conservative? Any other test rec for ruling out concurrent cushings? I had the client demo her technique for injections-no major flaws. Rec any other type of insulin? This cat is difficult to handle and may be causing the b.g. to go up some but it appears this cat is refractory to insulin. THANKS SPY

Is there unusual facial characteristics?

Although he sounds less likely an fic cat....consider at least some feliway?

Re: Salt toxicity? 98-01-22

Can the owner quantitate the water consumption at home to give you a better idea of magnitude?

What brand of glucometer did they get?

Re: Salt toxicity? 98-01-22

Any chance the owner can use some aquarium gravel or the like in the litter pan and get you a urine sample to at least check for specific gravity?

Is his weight stable?

Cushings Disease In Cats 98-01-23 ELMACVETCL We have a diabetic cat that tested positive on the ACTH stim for Cushings (Cortisol high prior to stim and very high after) So now what to do? Owners do not want to remove adrenals and treat Addison kitty. Has anyone used Anipryl in kitties? Thanks

First question, is this cat significantly insulin resistant?

I was concerned with the high value in the morning and the low value in the evening just prior to his next dose being due - i thought maybe he could be overswinging at night which would account for the higher value in the morning?

Cushings Disease In Cats 98-01-23 ELMACVETCL We have a diabetic cat that tested positive on the ACTH stim for Cushings (Cortisol high prior to stim and very high after) So now what to do? Owners do not want to remove adrenals and treat Addison kitty. Has anyone used Anipryl in kitties? Thanks

What has made you suspect hac?

How was the cholangiohepatitis diagnosed?

Wheezing Diabetic 98-01-26 SASDVM I have a 9 yr old cat that presented a week ago for wheezing/sneezing at home. PE was WNL with no discharges from eyes or nose and clear lungs. Owner also reported Increased thirst. Bloodwork, rads and u/a declined. Returned today for same problem. Chest rads - wnl. Has hyperglycemia (511) and glucosuria with hemturia and pyuria. FeLV/FIV neg. Started Clavamox and w/d with owner wanting to talk to husband about Insulin therapy. Cat did not wheeze all day in hospital. Owner got cat home and wheezing started again!! Considering starting antihistamines (chlorpheniramine) and/or Theo Dur. Other diagnostic and therapeutic suggestions appreciated. p

Do the owners smoke?

Are there any retics or nrbs's?

Bashful Bernie 97-12-31 Kjrdvm 'Bernie' is a 10 year old neutered Cocker Spaniel. Owner noticed that he is losing weight (5 lbs), but with a good/increased appetite. PU/PD. No Tachycardia or palpable thyroid (hyper rare in dogs) PE: NSF, thin, 2x2 inch lipoma-like mass on R shoulder, 1x1 inch on sternum. Collar that owner uses every 6 weeks for training is noticably loose (on last 'hole' and still loose!) CHEM: amylase 1624 (N= 500-1500), otherwise WNL, Na:K 26:1 CBC: WNL, normal differential U/A: 1.021, +/-10wbc/field, otherwise WNL Discussed rare hyperthyroidism in dog, SAP normal for Cushings, No evidence of diabetes mellitus. Discussed Diabetes insipidus?, cancer (somewhere) cachexia?, Cushings?, Renal: Consider empirical deworming, urine protein:creat/cortisol:creat, Ultrasound, needle aspirate of masses/thoracic/abdominal radiographs. Any suggestions? Empirical considerations? Diagnostic workup? Thanks for you valued consult on this case....Happy New Year!! Dr. G

Was the calcium normal?

But i am wondering if that is to soon?

diabetic cat 98-01-14 G a 9 yr old neutered male taking 7 U ultralente twice daily. patient recieved 7 units at 8 am. 10:00 229 11:00 244 12:00 278 again 10:00 229 12:00 244 2:00 278 4:00 284 6:00 233 patient recieves 7 U BID ultralente. I know being in the 200's isnt that bad at all but i don't understand why the curve or lack of one? The client notices differences in concentration in the begining and end of bottles of insulin. should we switch to the new PZI. .thanks

It is always important to interpret your curves in light of the clinical signs...is the cat still pu/pd and losing weight?

Are you monitoring bun and creatinine as well as the tt4 falls?

Accessory Pancreatic Tissue 98-07-28 PBGDVM I'm treating a 7 year old cat who had an acute presentation of anorexia and vomiting. Blood work was unremarkable, and the cat didn't respond to medical treatment. I did an ultrasound and then an abdominal exploratory. On abdominal exploratory, there was white spotted tissue in the gastrosplenic ligament. Below the spleen, there was a thickening in the fat, running all the way down. I biopsied the intestines in 3 places, the stomach, the liver, the kidney and this abnormal fatty tissue. The histopathology report came back accessory pancreatic tissue with a raging pancreatitis. The normal pancreas in the duodenal loops looked completely normal. While awaiting the histopath results, I put in an esophageal feeding tube, and am treating with antibiotics and metoclopramide. Has any one else seen this accessory pancreatic tissue? The cat seems to be feeling better, no vomiting, but will not voluntarily eat, and is still a little lethargic. If I removed the accessory pancreatic tissue, I would have to remove the spleen. Should I just keep going with supportive care? Any thoughts would be greatly appreciated. ruth

Did they really see acinar cells and beta cells?

How many kcals/day is this cat eating?

Acromegaly - Hypoglycemia 98-02-16 Vet The following is quite an interesting case: In summary a diabetic male neutered Main Coon presented yesterday a.m. with the chief complaint of seizures over night. This cat is a presumed acromegaly case (diagnosed by the need for 48 units of NPH bid and a Somatomedin C level run at MSU of 268 normal 5-70 nmol/L) Never confirmed by CAT can. Physical examination revealed a lethargic mildly dehydrated cat. Blood chemistry values showed an elevated amylase 2467, BUN 82, Crea 4.0 total Protein 8.6. the cat also has a cyst like structure hanging from its ventral neck. This cyst has been present for years but now appears infected. Today I performed a blood glucose curve. I actually did not give any insulin. 9am 92, 11:30am 75, 1:30pm 153, 3:30pm 53, and 5:30 pm 26! this cat ate throughout the day. I suspect a few things may be going on. First, I think my client was noticing pu/pd with this cat and raised the insulin dose thinking the diabetes was not under control, and it was probably kidney disease contributing. Also I'm wondering if this cat truely has acromegaly (which I believe it does -big brows large frame etc.) could there be a paraneoplastic process causing the hypoglycemia or an insulinoma?Any suggestions on this one? Thanks

What was the urine sg?

What makes you think the dog has cushing's?

DM & Greasy Coat 98-02-22 Gatovet We have a diabetic kitty, 9 yr old, doing great on 6IU Lente bid, but the coat still is greasy & the owner would like to do something about it,. Would it be safe to give Derm Caps (EFA), I think it would be OK, but I thought I'll ask. Is there any other thing that may help the cat's coat? Thanks

Is this kitty still obese?

So, to clarify, you have 5 meq/l kcl?

Nasty Diabetic Cat 98-02-27 Smild Any ideas on how to treat a diabetic cat that hates everybody? Regulating this feline is going to be nearly impossible due to its attitude, and the stress effect on results, not to mention that it is highly likely that someone on my staff will get hurt. The owners so far get along with the cat at home, although with 1-2x daily injections, etc, that could change. It had a fasting glucose of 476. We sent them home on w/d, instructing them to wait a couple of days, then sneakily catch a non-stressed urine. It was 1000+ glucose, no ketones. They might be able to use oral meds, but it seems the reccs are mixed on that. Howeve, with this sweetie, what to you think is best? Don't you just love a challenge?

(now is that really a good thing?

What is this cat's current glargine dose?

FIV/Diabetic/Gingivitis 98-02-28 DFSCOTTON Kittyblank is a 10 yr old FIV positive Diabetic that has severe Plasmacytic gingivitis. We have tried metronidazole, Amox, Antirobe and were able to control things with Depo shots until he became diabetic. We have not used steroids since. He is doing reasonably well but we feel sorry for him because it hurts and hurts us seeing it. Owners will not allow us to pull his teeth. They think it will take away part of his only pleasure (eating). I was interested in others experiences with oral interferon or Gold salts. Other suggestions have been AZT or Ambucil(?). I have not used any but the owners have the means and we have the ..........nerve? Kittyblank is counting on us : )

Would they allow you to radiograph the mouth and assess roots and bone?

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 he currently get?

Vaccine Reminders 98-03-23 MPGatorVet I have been tossing this idea around with mixed responses ans would like to see how others feel. I am frustrated at sending out detailed vaccine reminders only to have clients use them as a menu to order vaccines from feed stores, catalogs or the roadside vaccine clinics. My proposal is to send out 'annual physical' reminders with a reference to vaccines due without giving out details as to what vaccines may be necessary for each pet. This is partially because vaccine needs change with age and exposure of our patients, and partially because of the aforementioned frustrations. [a little background: we had a Humane society clinic open 2 miles="" away="" and="" a="" plethora="" of="" mobile="" clincs="" at="" feed="" stores,="" pet="" stores,="" shopping="" centers="" etc="" hawking="" low="" prices]="">/2> My employers fear any change in the 'lifeblood' of vaccine reminders but I think we could still remind without spelling out what should be done. If the feed store, catalog or roadside vaccine stand wants to take time to discuss risks, exposure and vaccine protocols then let them earn the business but I don't feel that we are getting our 'fair share' by discussing which vaccines each pet needs, keeping the records and sending reminders only to have our patients go elsewhere to save a few bucks after we have done all of the work. Is it any wonder that they can charge less? I like to think that this is more saavy business than sour grapes, but I would be willing to hear opinions either way. Has anyone tried something similar and seen a decrease in reminder response? Thanks!

If the kids weren't sick, would you take them to the doctor for a physical exam each year if they were perfectly healthy?

Have you gone over insulin injection technique thoroughly with the owner?

Vaccine Reminders 98-03-23 MPGatorVet I have been tossing this idea around with mixed responses ans would like to see how others feel. I am frustrated at sending out detailed vaccine reminders only to have clients use them as a menu to order vaccines from feed stores, catalogs or the roadside vaccine clinics. My proposal is to send out 'annual physical' reminders with a reference to vaccines due without giving out details as to what vaccines may be necessary for each pet. This is partially because vaccine needs change with age and exposure of our patients, and partially because of the aforementioned frustrations. [a little background: we had a Humane society clinic open 2 miles="" away="" and="" a="" plethora="" of="" mobile="" clincs="" at="" feed="" stores,="" pet="" stores,="" shopping="" centers="" etc="" hawking="" low="" prices]="">/2> My employers fear any change in the 'lifeblood' of vaccine reminders but I think we could still remind without spelling out what should be done. If the feed store, catalog or roadside vaccine stand wants to take time to discuss risks, exposure and vaccine protocols then let them earn the business but I don't feel that we are getting our 'fair share' by discussing which vaccines each pet needs, keeping the records and sending reminders only to have our patients go elsewhere to save a few bucks after we have done all of the work. Is it any wonder that they can charge less? I like to think that this is more saavy business than sour grapes, but I would be willing to hear opinions either way. Has anyone tried something similar and seen a decrease in reminder response? Thanks!

Leaving geriatrics aside (whenever geriatrics begins) do you think your clients will bring in perfectly healthy dogs year after year when there is nothing wrong with them and keep paying for it?

Did you mean lowest or highest usg?

Re: Is this cat sick? 98-03-06 K9DOC Noreen: I'm assuming that the T4 was also normal. You say 'UA is normal'... what was the urine SG? I think this cat could be an early diabetic. You could have a fructosamine run on your most recent blood sample... that should tell you whether the hyperglycemia is consistent at home. Or you might consider trying Glucotrol and rechecking the sugar in a few weeks to see how kitty is doing.

You mentioned that kitty has lost 0.6#....is she thin?

The owner can accurately measure and then inject the insulin--using u40 syringes?

Re: Is this cat sick? 98-03-06 K9DOC Noreen: I'm assuming that the T4 was also normal. You say 'UA is normal'... what was the urine SG? I think this cat could be an early diabetic. You could have a fructosamine run on your most recent blood sample... that should tell you whether the hyperglycemia is consistent at home. Or you might consider trying Glucotrol and rechecking the sugar in a few weeks to see how kitty is doing.

Cats can hide their stress pretty readily, though, so even the bg of 299 could be stress....she did come by car, did she not?

What diet is he eating?

Diabetic? DKA? 98-03-07 FELDOC Since you all know so much about felines... how about some help with this one... Suspect diabetes..... 500 mg/dl blood glucose with max glucosuria, ketonuria, PU/PD, weight loss.... So I schedule him for insulin regulation and he comes in, we check his Blood glucose hourly and it's between 220 and 320 mg/dl. He is sick and still has ketonuria, glucosuria, now anorexic, PU/PD. I have been treating him with tube feeding, IV fluids and the ketones are decreasing in urine, but his blood sugars are rarely over 250 with no exogenous insulin. In my hands this is a pretty well regulated cat, and I would be afraid to give him insulin..... But most of my experience with diabetic ketoacidosis cases has involved insulin and severe hyperglycemia. Any recommendations? Thanks, p Sylvester

Help me out here....you were doing this hourly bg check with him on insulin, right?

Bacterial cystitis...what was cultured?

Diabetic? DKA? 98-03-07 FELDOC Since you all know so much about felines... how about some help with this one... Suspect diabetes..... 500 mg/dl blood glucose with max glucosuria, ketonuria, PU/PD, weight loss.... So I schedule him for insulin regulation and he comes in, we check his Blood glucose hourly and it's between 220 and 320 mg/dl. He is sick and still has ketonuria, glucosuria, now anorexic, PU/PD. I have been treating him with tube feeding, IV fluids and the ketones are decreasing in urine, but his blood sugars are rarely over 250 with no exogenous insulin. In my hands this is a pretty well regulated cat, and I would be afraid to give him insulin..... But most of my experience with diabetic ketoacidosis cases has involved insulin and severe hyperglycemia. Any recommendations? Thanks, p Sylvester

How much and what type?

Are you using tail or limb measurements and, if limbs, which one(s)?

Diabetic? DKA? 98-03-07 FELDOC Since you all know so much about felines... how about some help with this one... Suspect diabetes..... 500 mg/dl blood glucose with max glucosuria, ketonuria, PU/PD, weight loss.... So I schedule him for insulin regulation and he comes in, we check his Blood glucose hourly and it's between 220 and 320 mg/dl. He is sick and still has ketonuria, glucosuria, now anorexic, PU/PD. I have been treating him with tube feeding, IV fluids and the ketones are decreasing in urine, but his blood sugars are rarely over 250 with no exogenous insulin. In my hands this is a pretty well regulated cat, and I would be afraid to give him insulin..... But most of my experience with diabetic ketoacidosis cases has involved insulin and severe hyperglycemia. Any recommendations? Thanks, p Sylvester

How long has he been on insulin and when was the diabetes diagnosed?

Has medical management of the ureteroliths been trialed?

Diabetic? DKA? 98-03-07 FELDOC Since you all know so much about felines... how about some help with this one... Suspect diabetes..... 500 mg/dl blood glucose with max glucosuria, ketonuria, PU/PD, weight loss.... So I schedule him for insulin regulation and he comes in, we check his Blood glucose hourly and it's between 220 and 320 mg/dl. He is sick and still has ketonuria, glucosuria, now anorexic, PU/PD. I have been treating him with tube feeding, IV fluids and the ketones are decreasing in urine, but his blood sugars are rarely over 250 with no exogenous insulin. In my hands this is a pretty well regulated cat, and I would be afraid to give him insulin..... But most of my experience with diabetic ketoacidosis cases has involved insulin and severe hyperglycemia. Any recommendations? Thanks, p Sylvester

Any chance of concurrent infection?

If not, what's the normal times?

Diabetic? DKA? 98-03-07 FELDOC Since you all know so much about felines... how about some help with this one... Suspect diabetes..... 500 mg/dl blood glucose with max glucosuria, ketonuria, PU/PD, weight loss.... So I schedule him for insulin regulation and he comes in, we check his Blood glucose hourly and it's between 220 and 320 mg/dl. He is sick and still has ketonuria, glucosuria, now anorexic, PU/PD. I have been treating him with tube feeding, IV fluids and the ketones are decreasing in urine, but his blood sugars are rarely over 250 with no exogenous insulin. In my hands this is a pretty well regulated cat, and I would be afraid to give him insulin..... But most of my experience with diabetic ketoacidosis cases has involved insulin and severe hyperglycemia. Any recommendations? Thanks, p Sylvester

Mouth?

What should he weigh?

Diabetic? DKA? 98-03-07 FELDOC Since you all know so much about felines... how about some help with this one... Suspect diabetes..... 500 mg/dl blood glucose with max glucosuria, ketonuria, PU/PD, weight loss.... So I schedule him for insulin regulation and he comes in, we check his Blood glucose hourly and it's between 220 and 320 mg/dl. He is sick and still has ketonuria, glucosuria, now anorexic, PU/PD. I have been treating him with tube feeding, IV fluids and the ketones are decreasing in urine, but his blood sugars are rarely over 250 with no exogenous insulin. In my hands this is a pretty well regulated cat, and I would be afraid to give him insulin..... But most of my experience with diabetic ketoacidosis cases has involved insulin and severe hyperglycemia. Any recommendations? Thanks, p Sylvester

Chest?

Were helicobacter seen on the gastric biopsy specimens?

Diabetic? DKA? 98-03-07 FELDOC Since you all know so much about felines... how about some help with this one... Suspect diabetes..... 500 mg/dl blood glucose with max glucosuria, ketonuria, PU/PD, weight loss.... So I schedule him for insulin regulation and he comes in, we check his Blood glucose hourly and it's between 220 and 320 mg/dl. He is sick and still has ketonuria, glucosuria, now anorexic, PU/PD. I have been treating him with tube feeding, IV fluids and the ketones are decreasing in urine, but his blood sugars are rarely over 250 with no exogenous insulin. In my hands this is a pretty well regulated cat, and I would be afraid to give him insulin..... But most of my experience with diabetic ketoacidosis cases has involved insulin and severe hyperglycemia. Any recommendations? Thanks, p Sylvester

Liver?

Is this pug intact?

Diabetic? DKA? 98-03-07 FELDOC Since you all know so much about felines... how about some help with this one... Suspect diabetes..... 500 mg/dl blood glucose with max glucosuria, ketonuria, PU/PD, weight loss.... So I schedule him for insulin regulation and he comes in, we check his Blood glucose hourly and it's between 220 and 320 mg/dl. He is sick and still has ketonuria, glucosuria, now anorexic, PU/PD. I have been treating him with tube feeding, IV fluids and the ketones are decreasing in urine, but his blood sugars are rarely over 250 with no exogenous insulin. In my hands this is a pretty well regulated cat, and I would be afraid to give him insulin..... But most of my experience with diabetic ketoacidosis cases has involved insulin and severe hyperglycemia. Any recommendations? Thanks, p Sylvester

(liver could give you the ketonuria alongside stress hyperglycemia and glucosuria, but this is a red herring.) what do the rest of his bloods look like?

When did april have her cataract surgery?

Diabetic? DKA? 98-03-07 FELDOC Since you all know so much about felines... how about some help with this one... Suspect diabetes..... 500 mg/dl blood glucose with max glucosuria, ketonuria, PU/PD, weight loss.... So I schedule him for insulin regulation and he comes in, we check his Blood glucose hourly and it's between 220 and 320 mg/dl. He is sick and still has ketonuria, glucosuria, now anorexic, PU/PD. I have been treating him with tube feeding, IV fluids and the ketones are decreasing in urine, but his blood sugars are rarely over 250 with no exogenous insulin. In my hands this is a pretty well regulated cat, and I would be afraid to give him insulin..... But most of my experience with diabetic ketoacidosis cases has involved insulin and severe hyperglycemia. Any recommendations? Thanks, p Sylvester

How bout a fructosamine?

Why did you us the abdomen?

Hypoglycemia 98-03-09 G an adult male cat 6kg hyperglycemia and glucosuria treated with ultralente 4 U bid for one month. presented friday with bg of 35. now taking 2 U bid but glucoses are so far today 75-100. was this a transient diabetic. what tests are in order. what are the possible explainations. thanks

Any history of exogenous steroids?

How many cories/day does she currently get?

Old dog weakness 98-03-02 Avvet I have a 15 year old male castrated miniature poodle who is also a diabetic. He presented five days ago for an acute onset of weakness. He can stand if placed in standing position and can walk sometimes if the floor is not slippery but for the most part both front and hindlimbs give out and his chin hits the ground. Neuro exam unremarkable. Bloodwork unremarkable. Glucose well regulated. Question: Any suggestions on diagnostics I should pursue or symptomatic treatment for geriatric weakness(i.e. winstrol, creatinine supplement). Also I should not the radiographs of the hips, shoulder and spine unremarkable(mild DJD in hips.) Thanks Chris

Possible myasthenia?

Is picky the norm?

Re: INSULINOMA THERAPY 98-04-04

Would streptozotocin be a good idea for this dog?

The owners can accurately measure and then inject the insulin each time?

Re: INSULINOMA THERAPY 98-04-04

Could you email me or post the protocol?

Please give us more information if you can: rads, u/s, retic, more?

Re: INSULINOMA THERAPY 98-04-04

How expensive is it?

What doses of clavamox and cephalexin were used initially?

Re: INSULINOMA THERAPY 98-04-04

Would this be something that would be better done at a referral center or the university?

Is he on thyroxine?

Increased water intake 98-04-23 S449 Recently removed a Grade 2 Mast cell tumor from between digits of a 12-yr-old MN Lab/Newfoundland cross. All visual evidence of tumor removed at time of surgery, but mass did extend to level of tendons, so good margins impossible. Radiation tx/oncology referral strongly recommended to client. One week post-op, dog is more active and alert than in months, but appetite has decreased while water intake & urination have increased dramatically. Urine S.G. is 1.003 on repeated samples. BUN=6, creatinine=0.6. Abdominal & thoracic radiographs clear. My primary question: I am having a hard time linking the increased water intake and urination with mast cell disease. Hepatic insufficiency, HAC, diabetes insipidus all on rule-out list. Would like to priorize testing on likelihood, as $ is somewhat limiting. Thanks for the guidance!!!!

What was it?

Also, would you test for cushing's dz?

Hyperadrenal Diabetic 98-04-13 Sl1ck Opie is a 11 year old 5 kg. dsh with insulin resistant diabetes mellitus. His present dose is 16 units PZI bid. He has a neuropathy in the hind legs , but is reasonable controlled now on that dose. His resting cotisol is 17.2 mcg/dl and 90 minute post cortisyn is 22.9 (4.5 - 15.0 from Antech). Does this suggest hyperadrenal? Anything new in treatment? There are no clinical suggestions of acromegly. Regards,

Is the dog pu/pd?

How many calories/day does he currently get?

Hyperadrenal Diabetic 98-04-13 Sl1ck Opie is a 11 year old 5 kg. dsh with insulin resistant diabetes mellitus. His present dose is 16 units PZI bid. He has a neuropathy in the hind legs , but is reasonable controlled now on that dose. His resting cotisol is 17.2 mcg/dl and 90 minute post cortisyn is 22.9 (4.5 - 15.0 from Antech). Does this suggest hyperadrenal? Anything new in treatment? There are no clinical suggestions of acromegly. Regards,

Clinical peripheral neuropathy is rare in dogs with dm so what did you see on the neuro exam?

Does the owner move the injections around on his body every day?

Hypocalcemic Kitty 98-10-09 BRIANVET I have a 14.5 year old dsh calico/tabby with many problems. She has a great appetite but is constipated. After a DSS enema and some subcu fluids she is defecating like a trooper. She's lost her teeth (but still tries to bite me), has lost weight (1 pound in the last month), has a natty fur coat and hepatomegaly. She has been vomiting and straining (tenesmus). From bloodwork taken 10-6-98 her glucose is 500, Ca 8.0 (8.2-10.8), Na 140 (145-158), chloride 83 (104-128); wbc is 39. x 1000 polys 26,268, eos 5174 (0-1000), and monos 796 (0-600) Her urine sg is 1.041, positive for a small growth of Proteus mirabilis and a cortisol/creat ratio of 12. She is on 100 mg amoxi bid (weighs 9.5#). Her thyroid is normal at 2.4 (0.8-4.0). Her serum osmolality is normal at 306 and albumin is normal at 2.8 (2.5-3.9). I am curious about the high blood glucose in the absence of urine glucose. She has been on nph insulin 3 u bid which was cut down to sid 3 weeks ago. She has been on insulin for a total of 2 months. She is very difficult to hospitalize so I haven't done the glucose curves. I noticed she was down on her hocks (diabetic neuropathy?) 1 month ago and since I cut her insulin to sid she has been walking better on her back legs. I am wondering if this cat might be addisonian, or a, I barking up the wrong tree. I also wonder if the high bg is from diabetes or just stress. Her appetite is great, either that or pathologically voracious! Help! Thanks-

If the cat is not pu/pd but is polyphagic, something else is probably causing the polyphagia -- any diarrhea or signs suggestive of ibd?

E.g. were you suspicious about cushing's well before the diabetes developed?

Hypocalcemic Kitty 98-10-09 BRIANVET I have a 14.5 year old dsh calico/tabby with many problems. She has a great appetite but is constipated. After a DSS enema and some subcu fluids she is defecating like a trooper. She's lost her teeth (but still tries to bite me), has lost weight (1 pound in the last month), has a natty fur coat and hepatomegaly. She has been vomiting and straining (tenesmus). From bloodwork taken 10-6-98 her glucose is 500, Ca 8.0 (8.2-10.8), Na 140 (145-158), chloride 83 (104-128); wbc is 39. x 1000 polys 26,268, eos 5174 (0-1000), and monos 796 (0-600) Her urine sg is 1.041, positive for a small growth of Proteus mirabilis and a cortisol/creat ratio of 12. She is on 100 mg amoxi bid (weighs 9.5#). Her thyroid is normal at 2.4 (0.8-4.0). Her serum osmolality is normal at 306 and albumin is normal at 2.8 (2.5-3.9). I am curious about the high blood glucose in the absence of urine glucose. She has been on nph insulin 3 u bid which was cut down to sid 3 weeks ago. She has been on insulin for a total of 2 months. She is very difficult to hospitalize so I haven't done the glucose curves. I noticed she was down on her hocks (diabetic neuropathy?) 1 month ago and since I cut her insulin to sid she has been walking better on her back legs. I am wondering if this cat might be addisonian, or a, I barking up the wrong tree. I also wonder if the high bg is from diabetes or just stress. Her appetite is great, either that or pathologically voracious! Help! Thanks-

Any possibility of a tumor hiding somewhere?

Can you post the chest films?

Re: second opinion please 98-04-08 Hypurr 1) How long has this kitty been voimiting and straining? 2) Did you bx the stomach? 3) This might include helicobacter, but the tenesmus is puzzling 4) if the tenesmus is persistent, then I'd wonder whether it is due to hard feces (dehydration) or diarrhea 5) if diarrhea, as this is a large bowel sign, I'd run rectal cytology to see if there are bacteria or parasites involved or non suppurative inflammation 6) amyloid can plump up kidneys as it occupies space 7) many cats live with normal renal and pancreatic function with amyloid being found as an incidental finding on necropsy; I agree that the pancreas should be monitored (but how). 8) good for you for bx'g the pancreas. :-) You might get amyloid on FNA of the kidney, but be SURE to ask the pathologist to stain for it. 9) How is kitty doing? If probs are persisting, you might try metronidazole and a bland diet. Cheers! >M>

Has vomiting stopped since you let the bad spririts out of the abdomen?

What about borrowing any from a referral practice?

Re: second opinion please 98-04-08 Hypurr 1) How long has this kitty been voimiting and straining? 2) Did you bx the stomach? 3) This might include helicobacter, but the tenesmus is puzzling 4) if the tenesmus is persistent, then I'd wonder whether it is due to hard feces (dehydration) or diarrhea 5) if diarrhea, as this is a large bowel sign, I'd run rectal cytology to see if there are bacteria or parasites involved or non suppurative inflammation 6) amyloid can plump up kidneys as it occupies space 7) many cats live with normal renal and pancreatic function with amyloid being found as an incidental finding on necropsy; I agree that the pancreas should be monitored (but how). 8) good for you for bx'g the pancreas. :-) You might get amyloid on FNA of the kidney, but be SURE to ask the pathologist to stain for it. 9) How is kitty doing? If probs are persisting, you might try metronidazole and a bland diet. Cheers! >M>

Is there significant proteinuria?

Did you do a fructosamine?

Humalog Insulin 98-04-25 FELDOC I have a diabetic feline patient who is owned by an ER nurse who insists on treating based on what ER docs tell him (I guess they are real docs) His latest is to put his cat on Humalog (insulin lispro), which I gather is a rapid acting insulin (within 30 minutes) which people use in conjunction with their maintenance insulin. He then gives him the Ultralente that we have his cat regulated on bid. He is monitoring blood glucoses (once or twice daily) with system made by Bayer that he uses to bleed his cat's ears to get capillary blood. Anyone have any experience with this combination of insulin, or this monitoring system? (I can't even touch the cat's ears now) I'm afraid he's going to kill his cat with hypoglycemia. Thanks, p Sylvester

If he insists on doing whatever he wants to do based on advice from non-dvms, who needs him?

Who has ever heard of a 50lb dog neeng 1mg of soloxine bid?

Humalog Insulin 98-04-25 FELDOC I have a diabetic feline patient who is owned by an ER nurse who insists on treating based on what ER docs tell him (I guess they are real docs) His latest is to put his cat on Humalog (insulin lispro), which I gather is a rapid acting insulin (within 30 minutes) which people use in conjunction with their maintenance insulin. He then gives him the Ultralente that we have his cat regulated on bid. He is monitoring blood glucoses (once or twice daily) with system made by Bayer that he uses to bleed his cat's ears to get capillary blood. Anyone have any experience with this combination of insulin, or this monitoring system? (I can't even touch the cat's ears now) I'm afraid he's going to kill his cat with hypoglycemia. Thanks, p Sylvester

Once or twice daily testing won't tell you unless you know exactly when the insulin activities peak?

About 20#?

Re: Traumatic hyperglycemia? 98-04-25 ANDIDVM since she's="" doing="" well="" and="" i'm="" pretty="" darn="" sure="" there's="" free="" blood="" in="" there,="" i="" see="" no="" point="" in="" tapping="" at="" this="" point.="" (other="" opinions?)="">> I'd tap the belly. U/S would also be a very useful diagnostic at this point. Funny thing, if I saw this animal I would probably assume envenomation instead of trauma, but my treatment would have been essentially the same!

Concerned about pancreatitis?

What should she weigh?

Re: Traumatic hyperglycemia? 98-04-25 ANDIDVM since she's="" doing="" well="" and="" i'm="" pretty="" darn="" sure="" there's="" free="" blood="" in="" there,="" i="" see="" no="" point="" in="" tapping="" at="" this="" point.="" (other="" opinions?)="">> I'd tap the belly. U/S would also be a very useful diagnostic at this point. Funny thing, if I saw this animal I would probably assume envenomation instead of trauma, but my treatment would have been essentially the same!

Concerned about diabetes?

Can you post radiographs?

Re: Traumatic hyperglycemia? 98-04-25 ANDIDVM since she's="" doing="" well="" and="" i'm="" pretty="" darn="" sure="" there's="" free="" blood="" in="" there,="" i="" see="" no="" point="" in="" tapping="" at="" this="" point.="" (other="" opinions?)="">> I'd tap the belly. U/S would also be a very useful diagnostic at this point. Funny thing, if I saw this animal I would probably assume envenomation instead of trauma, but my treatment would have been essentially the same!

Periocular contusion?

Do you have a calcium on this patient?

Lactate Questions 98-04-28 GLSpainVet I have a discussion with a colleague who thinks that ringer lactate can be dangerous to use in shock states because you can make worst the lactic acidosis by adding more lactate. I just remember that there are some theoretical concerns about how much of the lactates are metabolised to bicarbonate by the liver on shock states where the circulation to the liver can be compromised. But I am pretty sure there is no danger on the use of lactate ringer on this situation. Any one can explain me the physiologic reason of this? Speaking about lactates, I saw some time ago, on a catalogue of Boehringer a handheld machine like the ones who uses the diabetic people for glucose determinations, but for lactate levels. I think they are directed to the running people. Someone knows if they can have some utility on our patients? Someone is using it? I do not expect too much knowing how much can cost the top machines with ion selective techniques.

Does that make any sense?

Overdose?

Lactate Questions 98-04-28 GLSpainVet I have a discussion with a colleague who thinks that ringer lactate can be dangerous to use in shock states because you can make worst the lactic acidosis by adding more lactate. I just remember that there are some theoretical concerns about how much of the lactates are metabolised to bicarbonate by the liver on shock states where the circulation to the liver can be compromised. But I am pretty sure there is no danger on the use of lactate ringer on this situation. Any one can explain me the physiologic reason of this? Speaking about lactates, I saw some time ago, on a catalogue of Boehringer a handheld machine like the ones who uses the diabetic people for glucose determinations, but for lactate levels. I think they are directed to the running people. Someone knows if they can have some utility on our patients? Someone is using it? I do not expect too much knowing how much can cost the top machines with ion selective techniques.

Anyone else know about it?

Have you done a urine culture?

Emphysematous cystitis 98-04-08 ScoVetHosp I have a case of emphysematous cystitis in a 13 year old SF obese diabetic Beagle. urinary cultures shows and E.Coli sensitive only to Gentocin, Kanamycin and Tobramycin. What do I do!! We have been culturing this girl every two weeks, initially we had a sensitivity to Enrofloxin and Ceftiofur but she is now reisitant to these too. Is there another treatment eg DMSO into bladder? Corry

Was amikacin evaluated on your sensitivity profile?

Has this been noticed?

Re: Interferon as injectable 98-05-12 K9DOC Scott: Higher doses of IFN given parenterally to cats may be immunosuppressing rather than immunoenhancing. As far as I know there are no controlled studies of using parenteral IFN in naturally occurring 'fast moving' viral diseases of cats. What use did you have in mind?

Were there any oral ulcers, especially tongue ulcers on these cats?

What brand is their glucometer?

Re: Interferon as injectable 98-05-12 K9DOC Scott: Higher doses of IFN given parenterally to cats may be immunosuppressing rather than immunoenhancing. As far as I know there are no controlled studies of using parenteral IFN in naturally occurring 'fast moving' viral diseases of cats. What use did you have in mind?

Do you have any new staff?

Can the owner send you a video of the cat moving around at home?

Re: Interferon as injectable 98-05-12 K9DOC Scott: Higher doses of IFN given parenterally to cats may be immunosuppressing rather than immunoenhancing. As far as I know there are no controlled studies of using parenteral IFN in naturally occurring 'fast moving' viral diseases of cats. What use did you have in mind?

Perhaps mixed too strongly?

Can you describe the exact histopath description of the liver?

Re: Cushing's Dx 98-05-07

Is she biased?

Urinalysis: light yellow urine, trace protein, specific gravity = 1.005, was a urine c/s done?

Re: Cushing's Dx 98-05-07

Am i obsolete (out of school four years) or am i biased also?

The owner can accurately measure and then inject the insulin--they have u40 syringes?

Parvo Home Treatment 98-05-05 ERDVM1 Does anybody feel that there is benefit to offering the parvo 'home treatment' to owners with financial constraints? ( SQ fluids and antibiotcs administered by the owners) I don't offer it for many medical, ethical and moral reasons but am interested in hearing another side if there are some valid points that I am not thinking of.

Guess i might worry about all the syringes getting into the wrong hands but we do it with diabetics don't we?

How has his diabetic management been done (in-home glucose curves, in-hospital glucose curves, spot checks or fructosamines)?

Thin diabetic schnauzer 98-05-15 Alapetdr Hi, I am treating a 10 yr old very complicated diabetic now iatrogenic addisons formerly cushinoid schnauzer. She is finally controlled with a combination of nph insulin and regular twice daily with sub Q fluids twice weekly and fluoronef tabs three times a day. My problems is that she is loosing significant weight on w/d diet. We have increased amount fed but she continues to lose weight. Is there anything I can do besides put her on regular food and hope that diabetes doesn't get out of control? Thanks,

Is this dog also hyperlipidemic?

I don't suppose she knows what his gum color looks like (or has palpated his pulse quality?

Cosequin - is it safe? prt1 98-06-17 AlW1 I am impressed with the reported benefits of taking Cosequin, in both dogs and people, but I have some worries. It has been a long time since I tried to understand biochemistry so I need some help here. I have searched the literature and found some abstracts that cause me to worry about supplementation in people, and perhaps in animals too: J. Biol Chem. 1997 Dec 26; 272 (52): 33118-24. pzheimer-like changes were induced by sulfated glycosaminoglycans. The author believes that the interaction of sulfated glycosaminoglycans (which include chondroitin sulfate) with a protein called tau may be the 'central event in the development of the neuronal pathology of Alzheimer's disease.' --What happens to people who take chondroitin sulfate and glucosamine supplements? Does this increase the onset of Alzheimer's disease in those people who are destined to get Alzheimer's disease? Pathol Biol Paris. 1997 Apr; 45 (4): 305-11. They state that increased levels of chondroitin sulfate and heparan sulfate (two glycosaminoglycans) were found in greater concentration in human breast cancer tissues, compared to normal breast tissue. --Does supplementation of chondroitin sulfate and glucosamine increase the level found in breast tissue too? If it does, could this increase the development of malignancies? Nephron. 997; 76 (1): 62-71, The article explains that in diabetic rats, they found a transient early increase in chondroitin sulfate in the renal basement membrane, which could be used as an early marker for early diabetic changes in the kidney's basement membrane. --Is the increase a passive change due to other causes, or does the increase cause some or all of the early damage? Does supplementing chondroitin sulfate increase the amount found in early glomerular changes? If it does, does it increase the damage, either primarily or secondarily? Br J Urol. 1997 May; 79 (5): 763-9. The authors found that in humans, chondroitin sulfate levels increase in prostatic hypertrophy, and there is an increase in the ratio of chondroitin sulfate to dermatan sulfate in prostatic malignancy. --My question is again, if we supplement with glycosaminoglycans are we increasing the probability of prostatic malignancies? When we give chondroitin sulfate and glucosamine to increase their levels in joints, are we increasing their levels in other tissues too? If so, are we trading decreased joint problems for other potentially more serious problems? p

What made you think to look for a problem?

When you say that she "will not take" tylosin, in what formulation was this given?

To treat or not to treat 99-07-05 Have a cat that I have been treating for feline asthma with methylpred injections. At first it was every 3 months but gradually it has become every 6 - 8 weeks. Routine bloodwork revealed a hyperglycemia of 260. 1 week later a fasting BG was 243 and the urine was positive for glucose and (surprise!) a UTI. Cat is asymptomatic according to owner. No v/d not Pu/PD or polyphagic. The cat is maintaining weight. According to Feldman and Nelson's book it sort of suggests you don't treat these cases until they become symptomatic. I have moved the cat onto a hi fiber diet now and have recommended finding an alternative to pred injections to see if that will help with glucose control. Your opinion - 1) Would you treat this cat with insulin at this stage? 2) Do you think theophylline alone will treat the asthma? Do you use theophylline combined with another drug? I have seen references to cyproheptadine ... Thanks KT

How long ago was the last pred injection?

Uti ruled out?

Diabetic without glucosuria? 98-06-18 DIVACAT606 Received a cat for second opinion yesterday. Depo-medrol injection on 4/26. Started increased food intake early May. By early June client noted PU/PD and lethargy. Trip to regular vet revealed Blood Glucose at 535. No urine examined. Vet recommended waiting for steroid inj. to be metabolized. Cat re-checked on 6/15: glucose at 432, urine (strip at lab) negative for glucose. Vet confused and owner distrustful of vet and lab. We drew blood yesterday, 6/17 and sent it to the same lab (a national well-known veterinary lab). Glucose at 391 and 4+ glucose (strip at lab) in urine. We will probably begin conservative insulin therapy today, but were curious to know about the accuracy of the neg urine glucose previously. Any thoughts?

Are they pre-diabetic?

Why are you looking to use something other prednisolone?

Diabetic without glucosuria? 98-06-18 DIVACAT606 Received a cat for second opinion yesterday. Depo-medrol injection on 4/26. Started increased food intake early May. By early June client noted PU/PD and lethargy. Trip to regular vet revealed Blood Glucose at 535. No urine examined. Vet recommended waiting for steroid inj. to be metabolized. Cat re-checked on 6/15: glucose at 432, urine (strip at lab) negative for glucose. Vet confused and owner distrustful of vet and lab. We drew blood yesterday, 6/17 and sent it to the same lab (a national well-known veterinary lab). Glucose at 391 and 4+ glucose (strip at lab) in urine. We will probably begin conservative insulin therapy today, but were curious to know about the accuracy of the neg urine glucose previously. Any thoughts?

They have seemed to stabilize, and wheter it has been time, patience or the w/d, who knows?

Dry or canned?

Anesthesia accident? 98-06-27 NightVet I've inheireted a puzzling case over the weekend and could use some thoughts. Kitty is a 15 year old m/n domestic shorthair who presented for chronic bilious vomiting and poor appetitie and elevated liver enzymes; he is also a diabetic with reportedly poor control recently (they were doing urine glucoses). His bile acids were normal; only abnormality on profile was ast of 93 (10-50) and alt 106 (10-80). (blood glucoses have been OK here). He was anesthetized using thio and isoflorane, a trucut liver biopsy and endoscopic biopsies obtained (which were read out as early lymphocytic lymphoma of the intestine and mild microvesicular fatty change in the liver (his liver appeared fairly normal on ultrasound as well). The procedure went without problems but ever since recovery (6/23) he's been neurologically abnormal. He was blind and circling after recovery, improved after a on fluids and some steroids, then has deteriorated again (he will no longer eat on his own, moves very little, and to had what sounded like a brief seizure involving chomping and urination). This deterioration has somewhat coincided with us feeding him again, but I have a hard time believing it's encephalohy. I'll probably check his blood pressure this evening but he has no ocular changes consistent with hypertension. I'm a little at a loss as to what to do for him, I can't really even explain what's going on. Any thoughts? He's currently on fluids, IV cefalozin, and prednisone. He also has become progressively more anemic (31 % on 6/24, 16 % last night with no evidence of blood loss). Thanks Jean

What are the pupillary light reflexes, i.e. any indication of tentorial herniation?

Is she spayed?

Anesthesia accident? 98-06-27 NightVet I've inheireted a puzzling case over the weekend and could use some thoughts. Kitty is a 15 year old m/n domestic shorthair who presented for chronic bilious vomiting and poor appetitie and elevated liver enzymes; he is also a diabetic with reportedly poor control recently (they were doing urine glucoses). His bile acids were normal; only abnormality on profile was ast of 93 (10-50) and alt 106 (10-80). (blood glucoses have been OK here). He was anesthetized using thio and isoflorane, a trucut liver biopsy and endoscopic biopsies obtained (which were read out as early lymphocytic lymphoma of the intestine and mild microvesicular fatty change in the liver (his liver appeared fairly normal on ultrasound as well). The procedure went without problems but ever since recovery (6/23) he's been neurologically abnormal. He was blind and circling after recovery, improved after a on fluids and some steroids, then has deteriorated again (he will no longer eat on his own, moves very little, and to had what sounded like a brief seizure involving chomping and urination). This deterioration has somewhat coincided with us feeding him again, but I have a hard time believing it's encephalohy. I'll probably check his blood pressure this evening but he has no ocular changes consistent with hypertension. I'm a little at a loss as to what to do for him, I can't really even explain what's going on. Any thoughts? He's currently on fluids, IV cefalozin, and prednisone. He also has become progressively more anemic (31 % on 6/24, 16 % last night with no evidence of blood loss). Thanks Jean

Any cranial nerve deficits?

Do we know the circumstances surrounding the diagnosis?

Anesthesia accident? 98-06-27 NightVet I've inheireted a puzzling case over the weekend and could use some thoughts. Kitty is a 15 year old m/n domestic shorthair who presented for chronic bilious vomiting and poor appetitie and elevated liver enzymes; he is also a diabetic with reportedly poor control recently (they were doing urine glucoses). His bile acids were normal; only abnormality on profile was ast of 93 (10-50) and alt 106 (10-80). (blood glucoses have been OK here). He was anesthetized using thio and isoflorane, a trucut liver biopsy and endoscopic biopsies obtained (which were read out as early lymphocytic lymphoma of the intestine and mild microvesicular fatty change in the liver (his liver appeared fairly normal on ultrasound as well). The procedure went without problems but ever since recovery (6/23) he's been neurologically abnormal. He was blind and circling after recovery, improved after a on fluids and some steroids, then has deteriorated again (he will no longer eat on his own, moves very little, and to had what sounded like a brief seizure involving chomping and urination). This deterioration has somewhat coincided with us feeding him again, but I have a hard time believing it's encephalohy. I'll probably check his blood pressure this evening but he has no ocular changes consistent with hypertension. I'm a little at a loss as to what to do for him, I can't really even explain what's going on. Any thoughts? He's currently on fluids, IV cefalozin, and prednisone. He also has become progressively more anemic (31 % on 6/24, 16 % last night with no evidence of blood loss). Thanks Jean

Does anyone else have some ideas on this one?

Is there evidence of disease at this point (clinical and/or cytological signs)?

MiniSchnauzerAnemicDehydrate 98-06-23 BrnEyes213 Help, a male 4 month old mini schnauzer is suffering with severe dehydration and anemia, Bile acids is pending. I have seen him since he was 8 weeks old. He repeatedly presents for his puppy services appearing slightly dehydrated and quiet to depressed. He initially began to gain weight slowly, then began dropping. Vaccines have been deferred several times until SQ fluids were given. His fecal was negative. He has been treated with drontal plus or pyrantel several times. The owners reported that he seems normal at home. They report that he eats well, but does not drink much. There has been no vomit, diarrhea, coughing or sneezing. He has always presented normothermic. Until ... 3 days ago he presented for a pustular dermatitis (impetigo?). Pustule up to 7 mm in diameter. Culture yielded staph Intermedius, coag +. He presented also with a 103 fever, and severe dehydration. Lab work confirms dehydration (BUN 44H, Na+ 198H, Cl- 163H,Phos 7.8H,Osmol 398H,) Urine spG = 1.054, pH = 5.0, 30 mg protein, wbcs 3-6/hpf,rbcs 0-3/hpf, few epi cells and moderate Gran casts. Alkp = 202H, Chol =391H, Lipase 571H. All other chemistries = nsf. Bile single bile acid was sent in (he had eaten prior to presentation) The result was13.1, not exciting! I will perform regular Bile acids tomorrow. Rads to be taken tomorrow. CBC results = Red cell count 3.98L, Hgb 10.4L,Hct 32L, mcv 91H,MCH 26.1H, RDW 20.8H. He is on IV fluids.(2.5% dex/.45% NaCl + Bvit, + KCl) He initially perked up with hydration, and ate well, but he seems to be depressed again. Since he appears to have functional renal function (with a UTI), so a congenital nephritis seems unlikely. The 'scanning' bile acid was not too suggestive of PSS. His heart and lungs always sound fine (rads to be taken tomorrow, though). Help. Please, I guess I will need to schedule a hepatic and cardiac U/S.

Are there any retics or nrbs's?

The owner moves the injections around on his body each time?

Re: Eli Lilly Insulins 98-06-15 K9DOC Greg: Actually, I have personally been very happy with the Humulin insulins. I've been using them exclusively for several years because I was certain that animal source insulins were doomed to disappear at some point... looks like now. I was not thrilled with the returned PZI (which is now gone again) and we currently have a cat in the hospital that was sent in on the IDEXX compounded PZI which is not working well at all. This cat starts at 600+ at 8AM, goes to 120-150 at 4 hours, then back up to 350-450 by 6 hours post-injection. Duration of good activity is clearly the pits. We just started him on NPH Humulin.

I don't see a lot of cats, but currently have 3 cats on humulinu sid and all are well-controlled?

Since you said the cbc was normal, that to me suggests the hematocrit was well within the normal range?

Sick Non-Ketotic DM 98-06-17 FVC4 I'm treating a 9yr F/S DSH with a 5 month hx or anorexia, lethargy and wt loss. FIV+ Elisa and IFA 1/98. Has lost 3 lbs since last visit in 1/98. PE: poor coat and wt loss noted. Panel and cbc: Glu=364/150, K=3.7/3.9, WBC= 24100/19500, PMN's=21449/12500, lympho's =1205/1500. UA via cysto: glu=2 (2000) on dipstick, NO KETONES, and lots of rods on microscopic exam. My plan is to start the cat on Baytril for the UTI, but the concern is that this cat according to the owner is not eating well ( i.e. not the typically polyphagic DM). I'm hesitant to start the cat on insulin in the face of poor appetite. Should I start looking for occult neoplasia, etc. I plan to query the owner more about appetite vs. wt loss i.e assuming cause effect. Any thoughts are welcome regarding this kitty.

Why don't you run fructosamine to assess if kitty is diabetic or not?

Are there multiple cats in the home?

Sick Non-Ketotic DM 98-06-17 FVC4 I'm treating a 9yr F/S DSH with a 5 month hx or anorexia, lethargy and wt loss. FIV+ Elisa and IFA 1/98. Has lost 3 lbs since last visit in 1/98. PE: poor coat and wt loss noted. Panel and cbc: Glu=364/150, K=3.7/3.9, WBC= 24100/19500, PMN's=21449/12500, lympho's =1205/1500. UA via cysto: glu=2 (2000) on dipstick, NO KETONES, and lots of rods on microscopic exam. My plan is to start the cat on Baytril for the UTI, but the concern is that this cat according to the owner is not eating well ( i.e. not the typically polyphagic DM). I'm hesitant to start the cat on insulin in the face of poor appetite. Should I start looking for occult neoplasia, etc. I plan to query the owner more about appetite vs. wt loss i.e assuming cause effect. Any thoughts are welcome regarding this kitty.

What was his renal status (usg, bun, sc)?

What is the body contion of this dog?

Sick Non-Ketotic DM 98-06-17 FVC4 I'm treating a 9yr F/S DSH with a 5 month hx or anorexia, lethargy and wt loss. FIV+ Elisa and IFA 1/98. Has lost 3 lbs since last visit in 1/98. PE: poor coat and wt loss noted. Panel and cbc: Glu=364/150, K=3.7/3.9, WBC= 24100/19500, PMN's=21449/12500, lympho's =1205/1500. UA via cysto: glu=2 (2000) on dipstick, NO KETONES, and lots of rods on microscopic exam. My plan is to start the cat on Baytril for the UTI, but the concern is that this cat according to the owner is not eating well ( i.e. not the typically polyphagic DM). I'm hesitant to start the cat on insulin in the face of poor appetite. Should I start looking for occult neoplasia, etc. I plan to query the owner more about appetite vs. wt loss i.e assuming cause effect. Any thoughts are welcome regarding this kitty.

(pyelonephritis) get this kitty eating...have you tried cyproheptadine?

How much should she weigh?

Re: feline diabetes 98-06-06

Is there any insulin going to be marketed for the small animal patient?

Unilateral or bilateral?

Diabetic with Cushings? 98-06-17 DKVET Treating a terripoo with diabetes-that has been well controlled for awhile. Last chem profile in Feb has AP over 2000. Mild increase in ALT. Cholesterol was 430 and serum quantity was qns for t4. Did an ACTH stim yesterday. Pre=11.4 and Post=22.2. T4 is pending. The reason for doing this was a recurrent pyoderma--epithelial collerettes, erythematous bulls-eye almost looking lesions that in the past had responded to Clavamox. Dog won't tolerate Ceph. I am looking for any other underlying problems that might make this difficult to control. This time dog didn't respond to Clavamox like before. I had talked to the owner about doing a LDDS test to definitive prove Cushings if possible. Is this necessary? What if the T4 comes back low? My other question is since the diabetes is controlled, is it worth all this to try and get better control of the pyoderma? If the t4 is ok, is this ACTH stim test sufficient to diagnose Cushings and would a trial of Anapril be a good thing to do? Anapril affect the insulin dose like the Lysodren? Thanks, Doug

How much does the dog weigh and how much insulin is it on as this help us decide if the dog is insulin resistant?

What time post pill did you do the acth stim?

Diabetic with Cushings? 98-06-17 DKVET Treating a terripoo with diabetes-that has been well controlled for awhile. Last chem profile in Feb has AP over 2000. Mild increase in ALT. Cholesterol was 430 and serum quantity was qns for t4. Did an ACTH stim yesterday. Pre=11.4 and Post=22.2. T4 is pending. The reason for doing this was a recurrent pyoderma--epithelial collerettes, erythematous bulls-eye almost looking lesions that in the past had responded to Clavamox. Dog won't tolerate Ceph. I am looking for any other underlying problems that might make this difficult to control. This time dog didn't respond to Clavamox like before. I had talked to the owner about doing a LDDS test to definitive prove Cushings if possible. Is this necessary? What if the T4 comes back low? My other question is since the diabetes is controlled, is it worth all this to try and get better control of the pyoderma? If the t4 is ok, is this ACTH stim test sufficient to diagnose Cushings and would a trial of Anapril be a good thing to do? Anapril affect the insulin dose like the Lysodren? Thanks, Doug

How long has the dog been diabetic?

What  should  she  weigh?

Borderline diabetic? 98-07-07 STVDVM I've got a 5 year old female spayed Bichon w/ what appears to be a lower UTI, had sone WBC, bacteria on UA last week. But also discovered on UA was approx 250 urine glucose. Dog is PU/PD and same day as UA, blood glucose was 160. How could a BG this low be spilling over into urine. Also SG>1.040 and 1 mo ago full profile showed no evidence of renal failure. Confused in Perrysburg.

Does he have a uti?

Have you cultured the lesions?

Borderline diabetic? 98-07-07 STVDVM I've got a 5 year old female spayed Bichon w/ what appears to be a lower UTI, had sone WBC, bacteria on UA last week. But also discovered on UA was approx 250 urine glucose. Dog is PU/PD and same day as UA, blood glucose was 160. How could a BG this low be spilling over into urine. Also SG>1.040 and 1 mo ago full profile showed no evidence of renal failure. Confused in Perrysburg.

Is the dog obese?

Were you able to find anything?

Chronic allergy and diabetes 98-07-16 DKVET Have an older cat that for years has taken depo shots to control allergies--severe pruritis. Have tried several so-called hypoallergenic diets that didn't help, but none of the newer ones. Cat responded for 3+ months to one or two depo injections. Tried on various antihistamines that didn't help. Warned owner of possible side effects of chronic depo injections, but it was give the shots or euth. Diabetes is well controlled on 1.5-2 units of ultralente daily. Problem is the cat is miserable from allergy. Have told owner no more depo, etc. Any idea what else can be done to give the cat some relief? I'm afraid owner cannot take it much longer? Thanks, Doug

Make sure to keep the cat on whichever one you use for at least 10 weeks (and tell owners no cheating!) which antihistamines have you tried?

"she has the sugar." (?

Thromboemboli/Cat 98-07-09 Vetbet Hey there ! I have a 12yo m/n dsh that presented with lameness of four days duration. He had a gnarly fibrosarc (yes, vaccine rel) removed from his scapula a few months ago. Xrays, no fx. Severe pain on palp. So here is the key...paw was cool to the touch. R/O thromboemboli. This was 3 days ago. He has been getting Heparin, buprenex and ace prom eating well, urinating etc and attitude is great as long as you dont touch the leg.Some atrophy is appearing in the thigh and Quads. So here is the question. He is going home on oral meds. How long does he get them? (he got aspirin 2 days ago) The recommendation I have is to treat with Ace, torb, aspirin (every three days). For a week?month? What are the chances of recovery? No swelling has ben noted as yet. Thanks so much

Have you evaluated this cat's heart yet?

Can you provide a few representative curves?

Re: Trevor 98-07-26 PaulQ18854 Barb and Diane, What a thorough workup so far! I treated a similiar cat who ultimately was diagnosed with pancreatitis via exploratory and histopath. Presented in acute uremic crisis due to both prerenal and renal failure. It took 3 weeks before BUN and creatinine finally went back to 'normal' (with alot of intensive fluid therapy and esophageal tube feeding). Some of the mechanisms felt responsible for acute renal failure (secondary to pancreatitis) are activation of SIRS, renal ischemia from hypovolemia, and leakage of digestive enzymes and vasoactive amines into the abdominal cavity and bloodstream directly assaulting the nephrons. As you know, both kidneys would have to be affected for BUN, creat, urine spec. gravity to be affected (not just the right). The proteases released with pancreatitis could also activate the coagulation, fibrinolytic and complement cascades potentially causing thromboembolic disease of the kidneys and/or other organs. If pancreatitis activates the SIRS cascade with the release of interleukins, prostaglandins, leukotrienes, cytokines, etc. then ultimately superoxide free radicals can be released with the potential for kidney or multi-organ failure. Hyperglcemia can be seen with pancreatitis,...haven't read anything about HYPOglycemia. Your thinking on sepsis or insulinoma sounds right on. Maybe pancreatic abscess? Some people theorize that intestinal bacteria ascend up the cat's pancreatic duct causing pancreatitis (and potentially also cholangitis since in the cat the major pancreatic duct and the common bile duct enter the duodenum at a common papilla). Experimental studies in cats have shown that bacteria could also translocate from the colon to the pancreas when the pancreas becomes inflamed. Thus, bacteria may not initiate pancreatitis, but they could later become a component of morbidity. I hope your TLI can help with a diagnosis. I personally think that cats suffer from pancreatitis alot more than it is diagnosed antemortem and wish there was a FAST, accurate way to diagnose this disease. I think it can present with a variety of symptoms. Are you planning on doing a glucose/insulin ratio to help rule-out insulinoma? I know in dogs, hepatic tumors can sometimes present with hypoglycemia but not sure if this is true in cats,...besides your ultrasound would have demonstrated this. Let's see what the feline experts have to say,...very interesting case. I hope you'll let us know the outcome. Keep us informed,.....Kathy

Is he responding clinically in a positive direction?

Could you share with us the initial and second lddst results?

IBD-Anemia 98-07-28

Is this %?

Does she look hypothyroid?

IBD-Anemia 98-07-28

Corrected?

Not sure exactly how you're giving 10 mg of azathioprine...it comes in a 50 mg tablet?

Diabetes 98-07-27 Slpvet An eleven year old mixed breed slightly overweight dog being trated with BID NPH insulin. Clinicaly doing well but the Sugar curve starts at 4oomg% within six hours drops to 110mg/dl but then at eight and ten hoursrises to 275 and 300mg respextiveluy. Switched the dog to lente at same dose but same effect. The dog seems to metabolize the insulin too fast and there is too large a swing . With ther high of 400mg catatcts are starting but with a low if 110 Im afraid to raise the dosage. Has anyone used TID Insulin in a case like this. Im afraid if the cataracts go to completion they will nuke the dog.

What is the dog eating and when does he eat in relation to the insulin?

So were you doing water deprivation or doing trial therapy with ddavp?

Insulin Overdose! Need help 98-08-30 Pedleyvet My tech just arrived at my door saying she had accidentally given 50 units of NPH insulin instead of 5. And she did it over 7 hours ago. The patient is an 11 year old extremely obese (27+ lb) cat. She said the cat was acting perfectly normal. I ran over and checked his blood glucose -49. Gave him 5 gm dextrose bolus Iv. now am wondering what to do? How often should I monitor his blood glucose? Start an Iv of dextrose or am I out of the woods here? NPH should be just about gone by now shouldn't it? Plumb says peak effect 2-6 hours post administration. How on earth did this cat survive 50 units of insulin? My plan is to monitor his blood glucose hourly, and give dextrose as needed, since it has been so long. I had suspected his blood glucose hadn't been properly regulated, but didn't expect it to be that far off! Please anybody answer. I have never handled an insulin overdose before and the boss is out of town. thank you!

Has this cat ever had a glucose curve done?

What's the phosphorus level?

Insulin Overdose! Need help 98-08-30 Pedleyvet My tech just arrived at my door saying she had accidentally given 50 units of NPH insulin instead of 5. And she did it over 7 hours ago. The patient is an 11 year old extremely obese (27+ lb) cat. She said the cat was acting perfectly normal. I ran over and checked his blood glucose -49. Gave him 5 gm dextrose bolus Iv. now am wondering what to do? How often should I monitor his blood glucose? Start an Iv of dextrose or am I out of the woods here? NPH should be just about gone by now shouldn't it? Plumb says peak effect 2-6 hours post administration. How on earth did this cat survive 50 units of insulin? My plan is to monitor his blood glucose hourly, and give dextrose as needed, since it has been so long. I had suspected his blood glucose hadn't been properly regulated, but didn't expect it to be that far off! Please anybody answer. I have never handled an insulin overdose before and the boss is out of town. thank you!

Do you know when the nph peaks for this cat?

Are the curves being done in the hospital?

Adjusting to BID Insulin 98-08-07 AMCFTO I have an 8 year old DSH neutered male diagnosed with DM 6/25/98. Finally starting to get some control with Ultralente morning dose. Before this week's glucose curve, he was getting 18 units in the morning. Yesterday's curve: 10am=480 insulin given 11am 20 units 1pm=391 3pm=180 5pm=84 7pm=134 glucose checked with Dupont Analyst, cat didn't eat while in hospital normally eats w/d well. So, since the peak seems to be 6 hours, I guess we have to go to BID. What doses would you give. The reason I'm scared is I recently had a diabetic cat die of a hypoglycemic crisis b/c her sugar got too low overnight even though her curve the week before was O.K. The owner has been very happy with the cat's status and questions (but is O.K. with) the continuing glucose curves every 2 weeks. Any help will be greatly appreciated, Candi

How much does this cat weigh?

Has he had pancreatitis or high fasting tg's?

Ipodate Use With Normal T3? 98-08-09 TICECA Any help would be appreciated.... I've got a kitty with multiple problems: 1) FIV positive 2) Was diabetic (insulin dependent) for a couple of years, but has been fine for over a year now without insulin (maintains normal urine and blood glucose) 3) Had an elevated T4 years ago and was treated with tapazole. This kitty has also been doing great for over a year without tapazole (T4 staying well within normal range) 4) Has had a fibrosarcoma removed with no recurrence (also about a year ago) He's been fat and sassy and has had no clinical signs for over a year. Owner noticed recently that he was losing weight again and PU/PD. U/A was normal and blood panel normal except for a T4 of 4.6. I put him back on tapazole but he started to excoriate his face, so we immediately discontinued tapazole. Before we started messing around with ipodate, I did a T4 suppression test. His pre cytomel T4 was 4.6 (T3 was in the mid-normal range (sorry...I'm home and can't remember exact value)). Post cytomel T4 was also 4.6 (T3 still in mid-normal range). So....since this kitty IS polyphagic and losing weight, AND didn't suppress with cytomel, do I try ipodate? If so...if you are supposed to regulate dose based on T3, what do I do since his T3 is well within normal limits? Go by clinical signs? For a lot of reasons, this owner will not consider radiation or surgery. Thanks in advance!

Any chance that there is an element of cholangiohepatitis or ibd as well (polyphagia and weight loss)?

How has his weight his been?

Sudden Onset Of Ataxia/Pain 98-08-18 SASDVM My patient is a 5 yr DSH FS that present to the EC on 8/14/98 with above signs. PE revealed small puncture wound on tail that was treated and released on 1/2 baby aspirin x 2 d. No improvement/worse and returned to EC on 8/16. Whole body rads WNL. CBC WNL, Profile - hyperproteinemia (9.5). U/A - trace blood, pH 6.5, SG off scale, tr glucose, tr protein. EC rule outs: Neurologic (Meningitis, rabies, trauma, pain, metabolic dz.). Treated with Buprenex and IV fluids. Rec. Neuro consult for CSF tap, Myelogram, muscle biospy). Presents today depressed, dehydrated and ataxic. No nystagmus, no head tilt, no circling. Owner cannot afford the neuro consult. Rec repeat blood work, u/a, sq fluids, antibiotics and pred (with the understanding that will change results of future diagnositcs). Any thoughts appreciated. p P.S. Total proteins today are 10.37, high normal WBC (17,900, mostly grans). FIP?

What was the albumin?

Anyway you could scan those papers into adobe and share them here?

NPH insulin 98-09-22 FAH1 With NPH going off the market, what are the current recommendations for our diabetic patients? What do we switch to, do we do a direct unit for unit switch of medication, or do we need to re-curve all of our diabetics? Thanks, look forward to all input.

Are you sure nph is going off or only the beef/pork formulations?

Apparently this measures beta hydroxybutyrate?

Re: Hepatitis/Feline 98-09-21 Hypurr Bobby, I have no experience with methotrexate. In addition to the Clavamox, I would suggest fluid therapy, as aggressively as the albumin will allow, and metronidazole. For the Actigal, you can take the entire 300 mg capsule and dissolve it in 3 cc of water so that 1/2 cc is 50 mg. Ask the client to keep in the fridge. A better way for longer term use is to have it compounded as 75 mg capsules by the pharmacy (75 mg is appropriate for most cats, so a good size to keep on hand and this does won't harm this kitty) or get the 60 mg/ml suspension. Vit B Complex may be helpful. Was there any lipidosis reported? If so, I'd add carnitine to the regime. And 2-3 days of Vit K. Are you giving the 8 mg pred po once or twice a day? I'd be inclined to give 5 mg po BID. Is kitty eating? A unique protein/limited antigen diet would be adviseable. It takes sev weeks for the jaundice to resolve clinically as well as biochemically. The alt and sap should start to fall, though, within days once the trouble is being controlled/resolving. You could consider checking an SDH to see if the hepatic insult is continuing. Please keep us posted! Cheers! >M>

Why don't you try sc fluids and see if kitty absorbs them well?

Was the omeprazole added in due to changes consistent with esophagitis on endoscopy?

Adrenal Reserve 98-09-21 D Hi, Has anyone ever heard of adrenal reserve depletion? If so where can I find literature on this topic. This is not supposed to be true hypoadrenocorticism but a deletion of the adrenal secreting capacity that is due to extreme stress and is temporary, I had a consultant at a lab who mentioned this but I can't seem to find anything written on it, so I have turned to you guys for some help. Thanks, p

Have you tried a medline search?

Is the dog neutered or intact?

Re: ANYBODY HERE 98-10-20 BOMBAYVET A DKA is a good case to start with but further info is needed to answer the questions: What? How much? How do we monitor? Since the diagnosis has been made, do we have access to full profile information and blood gases or did we get the diagnosis from DextroStix and AzoStix? Secondly, what is the weight of the patient? Need to know to set fluid rate. If this patient just came in, we got the quick diagnosis and sent out blood for CBC/Profile/UA with results in the morning, we would also need to know whether this dog will spend the night attended or left on a drip by himself overnight. Certainly, the more info we get, the better we can tailor the fluid therapy and discuss the physiology of our fluid therpy choices. If I knew nothing else but that he was an 8% dehydrated DKA and it was the end of a 12 hour day and he would be spending the night alone and fluid delivery would be by gravity and all I had was a drip set that delivered 10 drops/ml, I would figure his maintenance rate plus deficit, empty a bag of LRS to that level and add KCl to equal 20mEq/L, and try to sleep well so I would be ready to fix things in the morning. DKA's are great examples for fluid therapy discussions. If we set the parameters, this will be interesting.

(in cats, i use kpo4 for 1/2 of the potassium supplementation - has hypophosphatemia been reported to be a problem in dogs?

Perhaps that will help you wrap your head around it?

Re: ANYBODY HERE 98-10-20 BOMBAYVET A DKA is a good case to start with but further info is needed to answer the questions: What? How much? How do we monitor? Since the diagnosis has been made, do we have access to full profile information and blood gases or did we get the diagnosis from DextroStix and AzoStix? Secondly, what is the weight of the patient? Need to know to set fluid rate. If this patient just came in, we got the quick diagnosis and sent out blood for CBC/Profile/UA with results in the morning, we would also need to know whether this dog will spend the night attended or left on a drip by himself overnight. Certainly, the more info we get, the better we can tailor the fluid therapy and discuss the physiology of our fluid therpy choices. If I knew nothing else but that he was an 8% dehydrated DKA and it was the end of a 12 hour day and he would be spending the night alone and fluid delivery would be by gravity and all I had was a drip set that delivered 10 drops/ml, I would figure his maintenance rate plus deficit, empty a bag of LRS to that level and add KCl to equal 20mEq/L, and try to sleep well so I would be ready to fix things in the morning. DKA's are great examples for fluid therapy discussions. If we set the parameters, this will be interesting.

Med.?

So i assume one adrenal gland was large....was the other adrenal gland large too or small or normal size?