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  #31  
Old November 12th, 2009, 12:55 AM
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Urea & Creatinine are both back into normal range with the urea just on the high edge which could have indicated a kidney infection or just the dehydration. The liver enzymes with the exception of Alk Phos are normal, Chloride on the high edge, the high cholesterol and the symptoms presenting I would suspect Cushing's, Liver disease, Pancreatitis or cancer. Alk phos and cholesterol can be indicators of liver or bile duct obstructions, all of the symptoms presented occur with Pancreatitis but high lipase and amylase are almost always occur, Tus' lipase is normal & the amylase is not listed.

Were there any notes at the bottom of the test from the Lab Dr?

If it was my cat I would have an abdominal ultrasound done to try to rule out some of the possibilities as this will give a clearer picture of what is happening in the abdomen and will show any inflammation, enlargement or tumors.

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  #32  
Old November 12th, 2009, 10:22 AM
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Originally Posted by growler View Post
Urea & Creatinine are both back into normal range with the urea just on the high edge which could have indicated a kidney infection or just the dehydration.
Her Urea and Creat were always in the normal high range which is why the kidney issue was always a puzzle, especially since the other problems kept coming up.

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liver enzymes with the exception of Alk Phos are normal, Chloride on the high edge, the high cholesterol and the symptoms presenting I would suspect Cushing's, Liver disease, Pancreatitis or cancer. Alk phos and cholesterol can be indicators of liver or bile duct obstructions, all of the symptoms presented occur with Pancreatitis but high lipase and amylase are almost always occur, Tus' lipase is normal & the amylase is not listed.
This is always been the puzzle. There would be 1 or 2 things that would point in a direction of some disease like the CRF but then the other pieces of a disease would not fit. or some other flag would go up that would not fit. What I find the most frustrating is that she could have X illness that could be resolved with Y medication but we can't find out what X is


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there any notes at the bottom of the test from the Lab Dr?
There was no other notes on this report. On the Aug report was her T4 in normal range so hyperthyroidism could not be diagnosed. No liver enzyme increases to flag one for hyperthyroidism. The mild increase in creatinine could be early signs of CRF. At this point I thought it might be her thyroid causing weight loss.


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it was my cat I would have an abdominal ultrasound done to try to rule out some of the possibilities as this will give a clearer picture of what is happening in the abdomen and will show any inflammation, enlargement or tumors.
This was the suggestion of my vet. They just got a new ultasound machine in, so it would be a good time to have her done.

I just have to wait a little while for the dust to settle on the last visit. Since she came home smelling like the vet, "my boy" decided he did not like the foreign smell and sprayed the bed room where she slept, and since Tus was full of fluids and doped up she pee'ed on the bed. It's taken me 2 days, 4 loads of laundry and about a litre of Nature's Miracle to get the smell out of the bed room. Not a happy mom with my boy, Tig. But hey I have a very clean bedroom

Oh one question. Any thought on the USG of 1.020? The vet seems to be very worried about this. I don't quite understand why??

and please give all the you can, it's your advice that's gotten me this far.

Thanks
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  #33  
Old November 12th, 2009, 12:32 PM
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A glucose of 6.1 is perfectly normal. I wouldn't worry unless it goes over about 8-ish, and even then it could be stress-induced hyperglycemia.

One of the key Cushing's symptoms is thin, fragile skin that tears easily, so I'm just really doubtful that is what you're dealing with here.

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On the Aug report was her T4 in normal range so hyperthyroidism could not be diagnosed.
Not necessarily. Do you know what the value was, and do you have any previous T4 values for her? The normal range for T4 also includes young cats, which naturally have higher T4 values than older cats, thus skewing what the range should be for seniors. As cats age, their T4 would typically start going down, not increasing, so anytime there is an increase, even if that number still falls within "normal", it should be investigated further. Having a Free T4 done at the same time as the T4 would give more precise results.


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Oh one question. Any thought on the USG of 1.020? The vet seems to be very worried about this. I don't quite understand why??
It basically means her urine is very dilute. Normal is between about 1.035 to 1.060. So the question becomes, what is going on that Tus is unable to concentrate her urine? I agree that maybe an ultrasound would be a good idea, but you would want someone knowledgable interpretting the results.
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  #34  
Old November 12th, 2009, 11:58 PM
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Her Urea and Creat were always in the normal high range which is why the kidney issue was always a puzzle, especially since the other problems kept coming up.
Pretty much what is happening at this point is Tus has pre renal atozemia.

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Azotemia is the medical term for an increase in the BUN or creatinine. Uremia is defined as azotemia plus clinical signs of renal failure such as anemia, polyuria-polydipsia, vomiting, or weight loss. Azotemia is divided further into prerenal, renal, or postrenal causes. Prerenal azotemia is due to causes other than actual kidney malfunction that decrease the blood flow to the kidney. These include dehydration, Addison's disease, or heart disease, *can also be from issues with the tubes leading into the kidneys*. Renal azotemia occurs due to damage to the kidney itself, and can include chronic or acute renal disease/failure that results in more than 75% of the kidney not functioning. Postrenal azotemia occurs when there is a build-up of pressure in the urinary system. Causes may include blockage of the urethra due to feline lower urinary tract disease (FLUTD) or bladder stones, which prevent urine from being removed from the body.
It doesn't mean there isn't also something else happening at the same time.

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Originally Posted by tiggy2 View Post
There was no other notes on this report. On the Aug report was her T4 in normal range so hyperthyroidism could not be diagnosed. No liver enzyme increases to flag one for hyperthyroidism. The mild increase in creatinine could be early signs of CRF. At this point I thought it might be her thyroid causing weight loss.
Interesting, my lab reports always have some little note from the lab's Dr at the bottom.

Increased liver enzymes are not always present with HyperT, but one symptom of HyperT that 99.9% of affected cats have is obviously increased hunger.

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Any thought on the USG of 1.020? The vet seems to be very worried about this. I don't quite understand why??
Feline urine in the range of 1.013 - 1.034 is considered moderately concentrated, when in this range and combined with dehydration it may be considered inappropriately dilute, with more investigation necessary.
Inappropriately dilute urine <1.035 in combination with dehydration can indication renal insufficiency oither possible causes are liver disease, pyelonephritis (ascending urinary tract infection that has reached the kidneys) or major electrolyte imbalances - of which Tus' are fine.

http://www.iris-kidney.com/education...cation05.shtml
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  #35  
Old November 16th, 2009, 06:18 PM
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An update on Tus

We're going in tomorrow morning for an Ultra sound. I did the shaving here so she does not have to spend as much time there and of course 1 less traumatic event for the poor gal.

I'm starting to feel bad with all the bet visits, this is the most times she has ever been to the vet in 15 years, she's never been sick. Lucky I guess

Actually I noticed when I was shaving her, I had her on her back and holding her belly, so urine dribbled out. Do cats, like people, have bladder control issues, or could it be something else?

Anyway I'll keep you up to date and if there is anything else I can ask the doc. about, as always let me know.

Thanks again for the support.

Paws and claws crossed, but I got a bad feeling(
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  #36  
Old November 16th, 2009, 07:15 PM
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Good luck tomorrow, tiggy . I hope if you find anything, it is easily taken care of.
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  #37  
Old November 16th, 2009, 09:36 PM
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Thank you Love4

I'm hoping as well, that would be nice
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  #38  
Old November 17th, 2009, 12:23 AM
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Quote:
Originally Posted by tiggy2 View Post
Actually I noticed when I was shaving her, I had her on her back and holding her belly, so urine dribbled out. Do cats, like people, have bladder control issues, or could it be something else?
Yes sometimes they do have bladder control issues, possibly Tus had a full bladder & being upsidedown put enough force on the bladder to cause a small leakage, it could also have just been a reaction to the stress of being shaved

for the U.S. tomorrow
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  #39  
Old November 17th, 2009, 12:45 PM
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Hi

We're back from the vet. Tus did well with the Ultra Sound, just growled a bit.

Anyway her liver is good, her kidneys are as expected for a cat her age, but her pancreas is enlarged. The vet said, if you can see the pancreas it usually means problems?? So...it leaves me to believe she has pancreatitis.

I have some antibiotics for her in case she has bladder issues from the dribbling pee. I did not want to stick another needle in her belly to make sure, so but her on the antibiotics. Vet also suggested a high fibre/low fat diet.

So that's were we stand now. Any suggestion from you guys? Gee's I can't believe how tired I am. Just wish I could know for sure what's going on and deal with it:sad:

Also tired of all the different research I've had to do, and now my boy has started to chew his belly up and Rosie is " not well" eitherOK that's my complaining for the day, thanks for listening
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  #40  
Old November 17th, 2009, 01:32 PM
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I so get it Tiggy!!! One of cats has completely different problems but I'm just so tired of worrying about him :sad: and trying to digest all the different information I'm getting. I just wanna be able to love on him and have that be enough! Hang in there.
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  #41  
Old November 17th, 2009, 02:24 PM
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Quote:
Originally Posted by tiggy2 View Post
Anyway her liver is good, her kidneys are as expected for a cat her age, but her pancreas is enlarged. The vet said, if you can see the pancreas it usually means problems?? So...it leaves me to believe she has pancreatitis.
Can you get the vet to send a sample of her blood out for a fPLI test? That tends to be a fairly accurate diagnostic for pancreatitis in cats. If she really does have it, pain killers are the most important part of treatment. There is some debate about whether or not a low fat diet helps (for some it might ease symptoms, in other cases it makes no difference). Lots of p'titis cats do well on some of the canned Merrick flavours, which have a moderate amount of fat.
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  #42  
Old November 17th, 2009, 10:02 PM
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Can you get the vet to send a sample of her blood out for a fPLI test? tends to be a fairly accurate diagnostic for pancreatitis in cats.
I will send her an email and see if the lab still has some of Tus's blood from the last test's we did and hopefully they can use that to do the test.


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she really does have it, pain killers are the most important part of treatment.
Would the stomach upset cause that much pain or is it some other type of pain? How can I tell if she's in pain aside from the acid indigestion she seems OK, maybe a little more distant lately.

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some debate about whether or not a low fat diet helps (for some it might ease symptoms, in other cases it makes no difference). Lots of p'titis cats do well on some of the canned Merrick flavours, which have a moderate amount of fat.
Ya I thought I read that somewhere about the fat diets, but if she'll eat them, what harm can it do? Might be good for my fat cats..yes??

Anyway just fed them all again, as I seem to spend a fair amount of time feeding the cats. I presume it still holds true for Tus on the frequent feedings? I try and get food in to her as late as possible to try and get her through the nite. Don't know if this helps or not.

I'll let you know on the test.

Any other med's or supplements to help her out?
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  #43  
Old November 17th, 2009, 10:08 PM
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I so get it Tiggy!!! One of cats has completely different problems but I'm just so tired of worrying about him :sad: and trying to digest all the different information I'm getting. I just wanna be able to love on him and have that be enough! Hang in there.
I try.

and thank you for the kind words. It gets hard with multi cats and they are all getting just a little older.

I have 2 that are 8 years old ( known affectionally as the "kids") 2 that are 15 (the old dolls) and 1 that is 11, her 11 year old buddy died 2 years ago of unknown illness(
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  #44  
Old November 17th, 2009, 10:31 PM
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Would the stomach upset cause that much pain or is it some other type of pain? How can I tell if she's in pain aside from the acid indigestion she seems OK, maybe a little more distant lately.
The pain of pancreatitis comes from the inflamed pancreas itself. Since cats are so good at hiding their pain, and because pancreatitis is known to be extremely painful, pain meds should be given regardless of whether a cat is actually showing any overt signs.

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Any other med's or supplements to help her out?
There's a great link here with a brief overview of pancreatitis and some treatment options (although it's slanted towards diabetics, the info is still worthwhile).

Here's a link discussing the diagnostics used to recognize pancreatitis:
http://www.cvm.tamu.edu/gilab/resear...reatitis.shtml
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  #45  
Old November 18th, 2009, 02:58 AM
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Anyway her liver is good, her kidneys are as expected for a cat her age, but her pancreas is enlarged. The vet said, if you can see the pancreas it usually means problems?? So...it leaves me to believe she has pancreatitis.
A vet internist (one who speciailizes in the inside stuff) or a vet with a lot of experience with ultrasounds can see the pancreas even when there are no issues, but that generally holds true.

I second the suggestion to have the fTLI or the fPLI test run to give better diagnostics.

Some info here on Pancreatitis and fairly technical here pancreatitis in pdf

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Originally Posted by tiggy2 View Post
Would the stomach upset cause that much pain or is it some other type of pain? How can I tell if she's in pain aside from the acid indigestion she seems OK, maybe a little more distant lately.
I would suggest if you can write down what brand/flavour Tus eats each day & what her symptoms are that day - is she vomiting more or less, does she act more sick, feeling better, running around, sleeping more etc See if you can spot a trigger that makes her feel worse, that way you can eliminate some of the foods that cause worse symptoms.

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  #46  
Old November 19th, 2009, 09:49 AM
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update on Tus

I managed to obtain some pain med's., Ketoprofen 5mg (expensive drug, gee's almost $5.00 a pill), anyway I gave her 5mg suppertime yesterday and she seemed better last nite, but this morning she's in pain again. I'm supposed to give her 1 a day, but I gave her 1/2 a pill this morning cause she looks so miserable.

I'm also wondering if the increase in Amitriptyline is making her more dopy? She walks like she either in pain or really "stoned" or maybe a bit of both. I've increased the Amitriptyline from 5 mg a day to 5 mg twice a day in order to get her eating more. She's just skin and bones.

Also the vet is finding out if the lab has some of Tus's blood left from her last blood work. To get the fPLI test done it has to be sent to Ontario, I'm in NB and her blood is in PEI..some fun hey, so god only knows how long that's going to take:sad:

I do have one question? What is the prognoses with pancreatitis in a 15 year old cat? She seems to be going down hill quickly and if this is the case what can I do to make it at least better for her etc etc?

I have another cat with issues but I'll start another threat as it's my "boy" and he's now licking his belly bald So have a look for "Licking his belly bald..now what?" and any advice for him would be appreciated

Thanks
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  #47  
Old November 19th, 2009, 10:19 AM
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I noticed you are using Amytriptylne on your cat. What is the purpose of the vet giving that to your cat?

I had Sweet Pea on it and was told by my vet that this should only be used on healthy cats as it can have some pretty severe side effects, especially on the liver. I ended up taking her off of it because it made her aggressive.

Here is a link:

http://www.vetinfo.com/side-effects-...line-cats.html
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  #48  
Old November 19th, 2009, 10:52 AM
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I noticed you are using Amytriptylne on your cat. What is the purpose of the vet giving that to your cat?

I had Sweet Pea on it and was told by my vet that this should only be used on healthy cats as it can have some pretty severe side effects, especially on the liver. I ended up taking her off of it because it made her aggressive.

Here is a link:

http://www.vetinfo.com/side-effects-...line-cats.html
Thanks for the info on the side effects, makes sense why she's so dopy and drinking more.

The reason we put her on this is to get her to eat more and to lick at herself less. She has her back legs licked and gnawed bare.

If you know of any other appetite stimulants, let me know as the poor think is nothing but skin and bones.
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  #49  
Old November 19th, 2009, 12:09 PM
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If you know of any other appetite stimulants, let me know as the poor think is nothing but skin and bones.
Mirtazapine. Works great, you only need to give it once every 3 days, and it suppresses nausea as well.
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  #50  
Old November 19th, 2009, 01:18 PM
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Mirtazapine. Works great, you only need to give it once every 3 days, and it suppresses nausea as well.
Thanks for the tip, I've printed out the info on it and I'll pass it on to my vet and switch her over. The amytriptylne is really making her dopy, especially with the pain med's.

It might work with my "boy", Tig who has licked all his fur off his belly. Waste not)

Any suggestions on pain med's as the ketoprofen is for short term only.
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  #51  
Old November 19th, 2009, 02:14 PM
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Any suggestions on pain med's as the ketoprofen is for short term only.
Buprenex or a Fentanyl pain patch are safer for feline use than the NSAIDS are, so I would see if your vet has either of those available. Buprenex is either used as an injectable or sublingually but needs more frequent dosing (potentially every 8 hrs, depending on the level of pain). The pain patch is good for about 5 days once it's put on.

Here's some more info on pain management in cats: http://www.vin.com/proceedings/Proce...6621&O=Generic
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Old November 21st, 2009, 11:13 AM
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I have a question?

I'm presume this pancreatitis is fatal? Tus is not eating at all now and is sleeping a lot more. I can't believe how quickly she is going down hill. Is this normal?

I'm going to the store now and get some baby food to see if I can get her to eat that because I can't give her the pain med's unless she has food in her stomache

Any other suggestions on how to make her more comfortable as I can't stand to see her suffer, especially if there is no hope of recovery.

She maybe sleeping but I'm not(
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Old November 21st, 2009, 01:43 PM
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Pancreatitis can sometimes be fatal, but not always. Supportive care is really the only treatment. I urge you to get a different pain med from your vet, I don't think the Ketoprofen is strong enough, and it has too many risky side effects. With something like Buprenex or Fentanyl, you don't need to wait for her to eat to administer it.

What about subQ fluids? That might also help her feel better. Vitamin B12 injections are worth considering and have no adverse effects.

Hang in there!! Cats can have an amazing ability to rebound from some pretty serious illnesses.
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  #54  
Old November 21st, 2009, 02:25 PM
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Pancreatitis can sometimes be fatal, but not always. Supportive care is really the only treatment. I urge you to get a different pain med from your vet, I don't think the Ketoprofen is strong enough, and it has too many risky side effects. With something like Buprenex or Fentanyl, you don't need to wait for her to eat to administer it.

What about subQ fluids? That might also help her feel better. Vitamin B12 injections are worth considering and have no adverse effects.

Hang in there!! Cats can have an amazing ability to rebound from some pretty serious illnesses.
I'll have to wait until Monday as my vet is closed on Sunday's. I managed to get some baby food in to her, so now I'll pill her with the last pill I have. Tomorrow will not be fun either.

I'll ask about the shots and the subQ fluids, although she's drinking more now then ever, she sits by the water fountain or sleeps on her box by the window.

I don't know who will break first her or I. I'll let you know what happens
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Old November 21st, 2009, 11:49 PM
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Hi again guys

Just wondering if I could give Tus prednisone tomorrow since I don't have any pain med's to give her and the one's I gave today will wear off by tomorrow am.

Would it help with her pain at all? Or is there any human pain med's I can give her to get her by until Monday.

I managed to get her to eat and I think it was helpful especially with the pain med's in her.
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  #56  
Old November 22nd, 2009, 02:49 AM
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Prednisone is not going to be enough to manage pain, and you should never give human meds to cats some can be very very dangerous to them.

Does your vet have an answering service or is there an emergency vet in your area that would be open tomorrow that you can speak to regarding a refill on the meds?
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  #57  
Old November 23rd, 2009, 10:42 AM
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Hi again

I have a request into the vet for Tus to obtain some pain med's. She has not eaten since last nite, and that was only a small amount.

I've been reading about pancreatitis and some are saying to keep food away or to put a feeding tube in to give the pancreas a break. Obviously I can't not feed her as she is loosing weight as it is, but back to the feeding tube, especially since she won't eat again and now I have to find low fat foods.

So I ask again "to put a feeding tube in or not"?

Any suggestions on the low fat foods?

I just want the poor thing to get a little better, she's so miserable
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  #58  
Old November 23rd, 2009, 05:35 PM
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sugarcatmom sugarcatmom is online now
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Quote:
Originally Posted by tiggy2 View Post
I've been reading about pancreatitis and some are saying to keep food away or to put a feeding tube in to give the pancreas a break.
Withholding food is one of the treatment plans when dealing with acute pancreatitis in dogs, but it's not an option for cats. They must eat. Putting in a feeding tube does ensure that the cat is getting nutrients (doesn't give the pancreas a break though, there is still food that needs to be digested), but before going that route I'd make sure other options have been exhausted. Were you ever able to get any mirtazapine from the vet? This along with appropriate pain meds might help significantly.


Quote:
Originally Posted by tiggy2 View Post
now I have to find low fat foods.

Any suggestions on the low fat foods?
You don't have to feed her only low-fat foods, especially at this point where it's more important that she eat SOMETHING. Anything. What else have you tried? Will she eat plain yogurt, boiled chicken breast, cheese, low-sodium canned salmon? What about cat treats like Temptations or Greenies? Different flavours of baby food like beef or lamb? Whatever it takes to get her eating.

There is no scientific proof that a low-fat diet prevents pancreatitis in cats. This concept was transferred over from dogs and humans, but the thing is, cats aren't dogs or humans. They are designed to digest meat that is moderately high in fat (40-50%) and protein. Feeding something too low in fat will have other health consequences. Having said that, there are a couple foods that some p'titis cats anecdotally seem to do better on. Merrick Cowboy Cookout and Grammy's Pot Pie both have 42% of calories from fat. Pro Plan Turkey & Giblets is 39% and Fancy Feast Elegant Medleys Shredded Lean Turkey or White Meat Chicken are 34 and 35% respectively.

So basically, before considering a feeding tube, the things that need to be addressed are pain, hydration and nausea, and it's possible that Tus' appetite will come back in line. Mirtazapine will help with nausea and appetite. Subq fluids will ensure she's not suffering from dehydration, which can cause nausea. 1/4 10mg tablet of Pepcid AC (not Complete) can help deal with excess stomach acid if given 20-30 min before a meal. And then the all-important suitable (ie not NSAIDs) pain medication.

Let us know what the vet says.
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  #59  
Old November 23rd, 2009, 10:02 PM
tiggy2 tiggy2 is offline
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Hi guys

Well I finally got in to see the vet 9 hours later, I made an appointment and brought Tus in. So she's in the vet's over nite for IV fluids again, and the possibility of the fTLI or the fPLI test done. She is going to talk to the lab and see what exactly these test will indicate as I don't want to fork out another $200.00 to find out that she has an enlarged pancreas. The vet thinks it might be cancer and if this is so than I need to take a different approach all together, but I need to know if it is cancer or is it pancreatitis.

She is also going to post her information on a Vet forum to see if anyone else can see something that she might have missed and post the ultrasound as well.

Basically we are trying to find a confirmed diagnoses so I can at least either treat her or just give her some comfort and dignity. Remember a week and 1/2 ago it was kidney failure( Now her pancreas.

So that's where I stand now. I hate to leave her there but if I can't get her to eat she needs some nutrients to keep her going and pain med's to make her comfortable.

With regards to the food, the baby food, (chicken/chicken both type) with low sodium tuna on top worked for a few bites, but when she refused the tuna and any treats I knew I was in trouble.

As for the pepid AC, I never thought to just give it to her 1/2 hour before her meal, I more or less gave it to her after the meals. I'll remember that one. Her breath smells acidic, especially if she has not eaten for awhile.

I'll let you know what's up with her tomorrow.

and of course my boy is still licking his belly raw(( I've now started him on Tus's Amitriptyline to see if that helps as it did not work for Tus.
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Old November 23rd, 2009, 10:54 PM
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Glad she's at the vets for tonight. I hope the fluids help and she starts to feel better.
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