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I have a challenging case involving a male, neutered min. schnauzer 9 year old. Diagnosed with multiple xanthomas on head and one large one covering the epiglottis. The dog is loosing weight and is having trouble swollowing. Lab work is pretty vague- very mild elevation in ALT and AST (less than twice reference), cholesterol mildly low, T-4 and Free T-4 just under reference range, BUN just under normal. UA Sp Gr. 1.010 but otherwise normal. All other values normal. I know I should be looking for problems in lipid metabolism but its not in the lab work. The mass on the epiglottis is troublesome as I don't think it can be removed without messing up the epiglottis more. Any ideas? Thanks

What are the numbers for the t4 and free t4?

Are the lab results recent or are they the ones from original diagnosis of dm?

I have a challenging case involving a male, neutered min. schnauzer 9 year old. Diagnosed with multiple xanthomas on head and one large one covering the epiglottis. The dog is loosing weight and is having trouble swollowing. Lab work is pretty vague- very mild elevation in ALT and AST (less than twice reference), cholesterol mildly low, T-4 and Free T-4 just under reference range, BUN just under normal. UA Sp Gr. 1.010 but otherwise normal. All other values normal. I know I should be looking for problems in lipid metabolism but its not in the lab work. The mass on the epiglottis is troublesome as I don't think it can be removed without messing up the epiglottis more. Any ideas? Thanks

(and reference range) and what is the bun?

When was that started?

Finasteride (Proscar, Propecia in this country), is not a drug I've ever used, but should be potentially useful to reduce BPH. In Plumb's formulary it cautions about using it in sexually developing animals, to be cautious if the patient has hepatic impairment, and may cause some minor sexual side effects--decreased libido, decreased ejaculate volume and impotence has been reported in humans. Because it is expensive and can take weeks to work, it may not be as useful for animals as it is in humans, especially since neutering is acceptable in animals and not so much in humans. You might try posting on the Repro board and see if they have some experience with it... Ovaban can cause diabetes mellitus and mammary gland neoplasia, increased appetite and weight gain, lethargy, change in behavior or hair color, acromegaly, and adrenocortical suppression. It's a scary drug. ☼

(husband wants to and wife maybe not) are there any other therapeutic regimens we can consider?

Administering the insulin correctly?

Finasteride (Proscar, Propecia in this country), is not a drug I've ever used, but should be potentially useful to reduce BPH. In Plumb's formulary it cautions about using it in sexually developing animals, to be cautious if the patient has hepatic impairment, and may cause some minor sexual side effects--decreased libido, decreased ejaculate volume and impotence has been reported in humans. Because it is expensive and can take weeks to work, it may not be as useful for animals as it is in humans, especially since neutering is acceptable in animals and not so much in humans. You might try posting on the Repro board and see if they have some experience with it... Ovaban can cause diabetes mellitus and mammary gland neoplasia, increased appetite and weight gain, lethargy, change in behavior or hair color, acromegaly, and adrenocortical suppression. It's a scary drug. ☼

Thoughts?

Will the owner let you do a glucose curve?

Finasteride (Proscar, Propecia in this country), is not a drug I've ever used, but should be potentially useful to reduce BPH. In Plumb's formulary it cautions about using it in sexually developing animals, to be cautious if the patient has hepatic impairment, and may cause some minor sexual side effects--decreased libido, decreased ejaculate volume and impotence has been reported in humans. Because it is expensive and can take weeks to work, it may not be as useful for animals as it is in humans, especially since neutering is acceptable in animals and not so much in humans. You might try posting on the Repro board and see if they have some experience with it... Ovaban can cause diabetes mellitus and mammary gland neoplasia, increased appetite and weight gain, lethargy, change in behavior or hair color, acromegaly, and adrenocortical suppression. It's a scary drug. ☼

Risks?

Is it possible that this could still be hypoadrenocorticism in light of the potassium, na:k ratio, low pre-injection cortisol and clinical signs?

I have a 17 month old labrador that has been drinking between 65 and 85ml water/kg/24 hours for the last two weeks. This increased water intake is enough to make him slightly incontinent.Cx: Very active healthy dog, excercises 1-2 hours a day, eats well. Lnn's/chest/abd nad. Small amount of previous hx ( had puppy strangles before owners rescued him, skin pretty much under control, suffers from recurrent conjunctivitis, was lame about a month ago - shoulder had NSAIDS for 2 weeks - now not lame) Water intake has been confirmed by owner now for two weeks. Bloods and urine as below. WBC.................... 7.5 x10^9/l 6.0 - 15.0 RBC.................... 6.50 x10^12/l 5.00 - 8.50 Haemoglobin............ 16.5 g/dl 12.0 - 18.0 PCV.................... 49.5 % 37.0 - 55.0 MCV.................... 76.2 fl 60.0 - 80.0 MCH.................... H 25.4 pg 19.0 - 23.0 MCHC................... 33.3 g/dl 31.0 - 34.0 % Range x10^9/l Range Neutrophils L 37 60 -70 L 2.8 3.0 - 11.5 Lymphocytes H 52 12 -30 3.9 1.0 - 4.8 Monocytes 5 3 -10 0.4 0.0 - 1.3 Eosinophils 6 2 -10 0.5 0.1 - 1.25 Basophils 0 0 -1 0.0 Film: Occasional reactive lymphocyte seen Platelet count appears normal in film Total Protein.......... 63.3 g/l 54.0 - 77.0 Albumin................ 33.8 g/l 25.0 - 37.0 Total Globulin......... 29.5 g/l 23.0 - 52.0 Calcium................ 2.68 mmol/l 2.30 - 3.00 Phosphate.............. H 1.77 mmol/l 0.80 - 1.60 Sodium................. 148 mmol/l 139 - 154 Potassium.............. 4.70 mmol/l 3.60 - 5.60 Chloride............... 113 mmol/l 105 - 122 Urea................... 7.2 mmol/l 1.7 - 7.4 Creatinine............. H 119 umol/l 0 - 106 ALP.................... 44 u/l@37C 0 - 50 ALT.................... H 34 u/l@37C 0 - 25 Bile Acids............. 0.3 umol/l 0.0 - 10.0 Cholesterol............ H 7.8 mmol/l 3.8 - 7.0 Triglycerides.......... L 0.54 mmol/l 0.56 - 1.69 Glucose - Random....... 4.3 mmol/l 2.0 - 5.5 Urine: Protein 1+, SG on multiple occasions 1.020 PH 6, rest negative, sediment - no cells or casts. Toxoplasma IgG........ Positive @ 1/50 Toxoplasma IgM........ Positive @ 1/12.5 Am i missing something here where should I go from here? ☼

Have you checked urine specific gravities on several occasions to see if there is a greater ability to concentrate?

Is this kitty still eating the canned m/d?

I have a 17 month old labrador that has been drinking between 65 and 85ml water/kg/24 hours for the last two weeks. This increased water intake is enough to make him slightly incontinent.Cx: Very active healthy dog, excercises 1-2 hours a day, eats well. Lnn's/chest/abd nad. Small amount of previous hx ( had puppy strangles before owners rescued him, skin pretty much under control, suffers from recurrent conjunctivitis, was lame about a month ago - shoulder had NSAIDS for 2 weeks - now not lame) Water intake has been confirmed by owner now for two weeks. Bloods and urine as below. WBC.................... 7.5 x10^9/l 6.0 - 15.0 RBC.................... 6.50 x10^12/l 5.00 - 8.50 Haemoglobin............ 16.5 g/dl 12.0 - 18.0 PCV.................... 49.5 % 37.0 - 55.0 MCV.................... 76.2 fl 60.0 - 80.0 MCH.................... H 25.4 pg 19.0 - 23.0 MCHC................... 33.3 g/dl 31.0 - 34.0 % Range x10^9/l Range Neutrophils L 37 60 -70 L 2.8 3.0 - 11.5 Lymphocytes H 52 12 -30 3.9 1.0 - 4.8 Monocytes 5 3 -10 0.4 0.0 - 1.3 Eosinophils 6 2 -10 0.5 0.1 - 1.25 Basophils 0 0 -1 0.0 Film: Occasional reactive lymphocyte seen Platelet count appears normal in film Total Protein.......... 63.3 g/l 54.0 - 77.0 Albumin................ 33.8 g/l 25.0 - 37.0 Total Globulin......... 29.5 g/l 23.0 - 52.0 Calcium................ 2.68 mmol/l 2.30 - 3.00 Phosphate.............. H 1.77 mmol/l 0.80 - 1.60 Sodium................. 148 mmol/l 139 - 154 Potassium.............. 4.70 mmol/l 3.60 - 5.60 Chloride............... 113 mmol/l 105 - 122 Urea................... 7.2 mmol/l 1.7 - 7.4 Creatinine............. H 119 umol/l 0 - 106 ALP.................... 44 u/l@37C 0 - 50 ALT.................... H 34 u/l@37C 0 - 25 Bile Acids............. 0.3 umol/l 0.0 - 10.0 Cholesterol............ H 7.8 mmol/l 3.8 - 7.0 Triglycerides.......... L 0.54 mmol/l 0.56 - 1.69 Glucose - Random....... 4.3 mmol/l 2.0 - 5.5 Urine: Protein 1+, SG on multiple occasions 1.020 PH 6, rest negative, sediment - no cells or casts. Toxoplasma IgG........ Positive @ 1/50 Toxoplasma IgM........ Positive @ 1/12.5 Am i missing something here where should I go from here? ☼

Is there any chance of corticosteroid exposure orally or via topicals (eye, skin, ear medications?)?

How much does she weigh?

I have a 17 month old labrador that has been drinking between 65 and 85ml water/kg/24 hours for the last two weeks. This increased water intake is enough to make him slightly incontinent.Cx: Very active healthy dog, excercises 1-2 hours a day, eats well. Lnn's/chest/abd nad. Small amount of previous hx ( had puppy strangles before owners rescued him, skin pretty much under control, suffers from recurrent conjunctivitis, was lame about a month ago - shoulder had NSAIDS for 2 weeks - now not lame) Water intake has been confirmed by owner now for two weeks. Bloods and urine as below. WBC.................... 7.5 x10^9/l 6.0 - 15.0 RBC.................... 6.50 x10^12/l 5.00 - 8.50 Haemoglobin............ 16.5 g/dl 12.0 - 18.0 PCV.................... 49.5 % 37.0 - 55.0 MCV.................... 76.2 fl 60.0 - 80.0 MCH.................... H 25.4 pg 19.0 - 23.0 MCHC................... 33.3 g/dl 31.0 - 34.0 % Range x10^9/l Range Neutrophils L 37 60 -70 L 2.8 3.0 - 11.5 Lymphocytes H 52 12 -30 3.9 1.0 - 4.8 Monocytes 5 3 -10 0.4 0.0 - 1.3 Eosinophils 6 2 -10 0.5 0.1 - 1.25 Basophils 0 0 -1 0.0 Film: Occasional reactive lymphocyte seen Platelet count appears normal in film Total Protein.......... 63.3 g/l 54.0 - 77.0 Albumin................ 33.8 g/l 25.0 - 37.0 Total Globulin......... 29.5 g/l 23.0 - 52.0 Calcium................ 2.68 mmol/l 2.30 - 3.00 Phosphate.............. H 1.77 mmol/l 0.80 - 1.60 Sodium................. 148 mmol/l 139 - 154 Potassium.............. 4.70 mmol/l 3.60 - 5.60 Chloride............... 113 mmol/l 105 - 122 Urea................... 7.2 mmol/l 1.7 - 7.4 Creatinine............. H 119 umol/l 0 - 106 ALP.................... 44 u/l@37C 0 - 50 ALT.................... H 34 u/l@37C 0 - 25 Bile Acids............. 0.3 umol/l 0.0 - 10.0 Cholesterol............ H 7.8 mmol/l 3.8 - 7.0 Triglycerides.......... L 0.54 mmol/l 0.56 - 1.69 Glucose - Random....... 4.3 mmol/l 2.0 - 5.5 Urine: Protein 1+, SG on multiple occasions 1.020 PH 6, rest negative, sediment - no cells or casts. Toxoplasma IgG........ Positive @ 1/50 Toxoplasma IgM........ Positive @ 1/12.5 Am i missing something here where should I go from here? ☼

Any history of other drugs that might cause pu/pd?

If not, what should he weigh?

I have a 17 month old labrador that has been drinking between 65 and 85ml water/kg/24 hours for the last two weeks. This increased water intake is enough to make him slightly incontinent.Cx: Very active healthy dog, excercises 1-2 hours a day, eats well. Lnn's/chest/abd nad. Small amount of previous hx ( had puppy strangles before owners rescued him, skin pretty much under control, suffers from recurrent conjunctivitis, was lame about a month ago - shoulder had NSAIDS for 2 weeks - now not lame) Water intake has been confirmed by owner now for two weeks. Bloods and urine as below. WBC.................... 7.5 x10^9/l 6.0 - 15.0 RBC.................... 6.50 x10^12/l 5.00 - 8.50 Haemoglobin............ 16.5 g/dl 12.0 - 18.0 PCV.................... 49.5 % 37.0 - 55.0 MCV.................... 76.2 fl 60.0 - 80.0 MCH.................... H 25.4 pg 19.0 - 23.0 MCHC................... 33.3 g/dl 31.0 - 34.0 % Range x10^9/l Range Neutrophils L 37 60 -70 L 2.8 3.0 - 11.5 Lymphocytes H 52 12 -30 3.9 1.0 - 4.8 Monocytes 5 3 -10 0.4 0.0 - 1.3 Eosinophils 6 2 -10 0.5 0.1 - 1.25 Basophils 0 0 -1 0.0 Film: Occasional reactive lymphocyte seen Platelet count appears normal in film Total Protein.......... 63.3 g/l 54.0 - 77.0 Albumin................ 33.8 g/l 25.0 - 37.0 Total Globulin......... 29.5 g/l 23.0 - 52.0 Calcium................ 2.68 mmol/l 2.30 - 3.00 Phosphate.............. H 1.77 mmol/l 0.80 - 1.60 Sodium................. 148 mmol/l 139 - 154 Potassium.............. 4.70 mmol/l 3.60 - 5.60 Chloride............... 113 mmol/l 105 - 122 Urea................... 7.2 mmol/l 1.7 - 7.4 Creatinine............. H 119 umol/l 0 - 106 ALP.................... 44 u/l@37C 0 - 50 ALT.................... H 34 u/l@37C 0 - 25 Bile Acids............. 0.3 umol/l 0.0 - 10.0 Cholesterol............ H 7.8 mmol/l 3.8 - 7.0 Triglycerides.......... L 0.54 mmol/l 0.56 - 1.69 Glucose - Random....... 4.3 mmol/l 2.0 - 5.5 Urine: Protein 1+, SG on multiple occasions 1.020 PH 6, rest negative, sediment - no cells or casts. Toxoplasma IgG........ Positive @ 1/50 Toxoplasma IgM........ Positive @ 1/12.5 Am i missing something here where should I go from here? ☼

I am not sure what to make of the toxoplasma titers....are these high values for your lab?

A recent blood pressure?

I have a 17 month old labrador that has been drinking between 65 and 85ml water/kg/24 hours for the last two weeks. This increased water intake is enough to make him slightly incontinent.Cx: Very active healthy dog, excercises 1-2 hours a day, eats well. Lnn's/chest/abd nad. Small amount of previous hx ( had puppy strangles before owners rescued him, skin pretty much under control, suffers from recurrent conjunctivitis, was lame about a month ago - shoulder had NSAIDS for 2 weeks - now not lame) Water intake has been confirmed by owner now for two weeks. Bloods and urine as below. WBC.................... 7.5 x10^9/l 6.0 - 15.0 RBC.................... 6.50 x10^12/l 5.00 - 8.50 Haemoglobin............ 16.5 g/dl 12.0 - 18.0 PCV.................... 49.5 % 37.0 - 55.0 MCV.................... 76.2 fl 60.0 - 80.0 MCH.................... H 25.4 pg 19.0 - 23.0 MCHC................... 33.3 g/dl 31.0 - 34.0 % Range x10^9/l Range Neutrophils L 37 60 -70 L 2.8 3.0 - 11.5 Lymphocytes H 52 12 -30 3.9 1.0 - 4.8 Monocytes 5 3 -10 0.4 0.0 - 1.3 Eosinophils 6 2 -10 0.5 0.1 - 1.25 Basophils 0 0 -1 0.0 Film: Occasional reactive lymphocyte seen Platelet count appears normal in film Total Protein.......... 63.3 g/l 54.0 - 77.0 Albumin................ 33.8 g/l 25.0 - 37.0 Total Globulin......... 29.5 g/l 23.0 - 52.0 Calcium................ 2.68 mmol/l 2.30 - 3.00 Phosphate.............. H 1.77 mmol/l 0.80 - 1.60 Sodium................. 148 mmol/l 139 - 154 Potassium.............. 4.70 mmol/l 3.60 - 5.60 Chloride............... 113 mmol/l 105 - 122 Urea................... 7.2 mmol/l 1.7 - 7.4 Creatinine............. H 119 umol/l 0 - 106 ALP.................... 44 u/l@37C 0 - 50 ALT.................... H 34 u/l@37C 0 - 25 Bile Acids............. 0.3 umol/l 0.0 - 10.0 Cholesterol............ H 7.8 mmol/l 3.8 - 7.0 Triglycerides.......... L 0.54 mmol/l 0.56 - 1.69 Glucose - Random....... 4.3 mmol/l 2.0 - 5.5 Urine: Protein 1+, SG on multiple occasions 1.020 PH 6, rest negative, sediment - no cells or casts. Toxoplasma IgG........ Positive @ 1/50 Toxoplasma IgM........ Positive @ 1/12.5 Am i missing something here where should I go from here? ☼

Does this dog eat meat or does it have access to cat poop?

Any takers?

Report it if you wish, but it won't likely do you much good. Dr. Mernee's views are well known here, so this isn't rely much of a surprise. I consider the ad unethic, but beware, he has literly a ton of data to back his opinion on vaccination. His habit of cling the rest of us crooks is the only place you might get to him legly.P Headley I intend to live forever. So far so good. oc@aol.com

Is this something that should be reported to the state board?

Have you measured with a doppler or oscilometric?

, I have concerns about the sulfonureas in cats after reading the paper by O'Brien et al that showed how they can actually worsen diabetes in cats by increasing the deposition of islet associated amyloid/polypeptide in the pancreas. Deb Greco has written the following (Wild West meeting 1999)regarding amyrl: The sulfonylureas increase insulin secretion and help with insulin resistance but they may also cause an increase in hepatic glucose output as well as promoting progression of pancreatic amyloidosis. Cats with type II diabetes can be expected to respond better to oral hypoglycemic therapy but response to glipizide has been disappointing. However, this may be due to patient selection rather than drug failure. Glimiperide is a new sulfonylurea agent and seems to have fewer side effects than glipizide. Another advantage is that it can also be dosed once daily at a dosage of 1-2 mg SID. I am not familiar with actos. Could you please tell me what the generic name is? Like I'd rather work with a high proten, mod fat diet and insulin. I am not "onvinced" yet about the oral meds in cats. I suspect that by the time we see them, they are insulin dependent... Cheers! >M ☼

Combined thiazolidinedione-insulin therapy : should we be concerned about safety?

Have you done a ua?

Dear Doctors, Misty is a 15 year old mn dsh who has been diabetic for several years and had been well regulated on 8-9 units of humulin n. His owners went on vacation and a relative was caring for Misty.(The relative retrospectively has admitted the cat wasn't quite right while the owners were away but con't the insulin injections) The day the owners came home in the pm before bedtime, they said Misty appeared ok. By 6am the next day they found him flat out and thought he was dead. They gave him karo syrup and presented to me at 8am with their story and that he was "100% better" than he was at 630am. Well, he was laterally recumbant, hypothermic, in shock, blind, and vocallizing incoherently - in my opinion, in dire straights. His BG was 104. We began treatment with IV fluids and heat but later on that am he began to seizure. I treated him with Valium several times during the day and with IV dexamethasone - he was sent to a local emergency clinic for overnight observation for the seizures which there were none. We have been carefully monitoring his bg and lytes and adjusting his insulin/fluids/dextrose accordingly. He has regained pupillary light reflexes though he is menace neg. He has begun to sit up sternally and move his limbs though he cannot stand. He is passing bowel and urine and occasionally will eat food on his own if offered or at times needs to be syringed fed. I noticed today he has some dependent edema in his rear legs (day7). So that's the short story about Misty but the owner and I have questions as to how long it may take Misty to make a recovery. I feel he has made some improvements each day except today (edema-fussy appetite). I told the owner the nervous system is a slow healer and the vision may never come back. Sounds like to me the morning they found him he was extremely close to dead. What are your feeling, opinions, and suggestions? Thanks so much for your imput! Dr. Hoey :)

Make sure the caloric intake is sufficient, ok?

Were the cortisol sent to a commercial lab or run in-house?

How does glucose in the urine effct the specific gravity? I have a diabetic dog that has 1000+ glucose in the urine that I think may also have Cushing's however the USG is 1.034. The urine does not appear that concentrated. I was wondering if all the glucose in the urine could be making the USG deterimination falsely high?

You mean that the urine is more concentrated than you'd expect for an animal presenting with pupd or for increased urine volume?

Do you have a co2 on the panel?

A recent case involves a 9 yo mn Jack Russell Terrier presented with a history of multiple collapses with excitement or recently coughing over the past 4 months. The coughing is mild and occasionally productive with mucus and syncope occurs with just one cough rather than bouts of coughing. He has a grade 3-4 mid to late systolic murmur loudest over the left apex. Chest radiographs 2 weeks ago normal, no cardiomegaly or pulmonary changes. ECG normal sinus rhythm 140/ minute. ECHo normal apart form moderate mitral regurgitaiton with no left atrial enlargement or other abnormality noted. Blood pressure systolic 130 mm Hg, using Doppler. Yesterday a colleague administered furosemide at 3 mg/ kg im in case the cough was cardiac in origin. Within 30 minutes, the patient re presented with sustained signs of weakness and intermittent syncope. He appeared dazed, unuware fully of surroundings though still responsive to stimuli, unable to walk with ataxia and falling due to weakness. Heart rate fallen to 50-70 / minute still normal sinus rhythm. Mucosal colour varied from pink to pale to grey at different intervals. Systolic blood pressure 90-100 mm Hg, on Doppler.This weakness persisted almost 24 hours. Today heart rate averages 140/ minute again and systolic blood pressure appears over 120 mm Hg. This is the second time he has reacted badly to furosemide as his regular vet had prescribed oral furosemide 3 months previously at 2 mg/ kg bid and collapsing episodes had increased dramatically. I am assuming that this may represent vasovagal syncope precipitated by coughing, excitement and now furosemide- do you feel that this is likely to be the case? Is the furosemide effect likely to be due to its vasodilation? Would you try beta agonists/ atropine medically?

Have you checked a blood glucose during these post-furosemide periods?

What should she weigh?

diabetes and insulinoma 99-02-09 Midtownvet We have a difficult one in the hospital now. 11 yr old k-9, diabetic for 3 years now with no rechecks since diagnosis. Owner has been using iletin nph at 17 units bid( 65 lb dog). this am the dog was lethargic and had a seizure, the owner then gave the dog 20 units of insulin, and the seizures persisted. the dog with seizures and a BG of 36 at 12 noon, started 5%dextrose and gave 2500mg dextrose bolus, with valium. By 4 pm the dog had BG's of 55 with seizures still present. We have given multiple boluses of dextrose and 10% drip by 7:30 and the glucose is still in the 50's. Seems strange for the insulin to last this g or do we have a concurrent insulinoma/neuroendocrinoma? Any answers on the incidence of insulinomas in diabetics or is still the owners insulin? Thanks Bill

Any other problems on pe or bloods?

Anybody else?

Diabetic feline w/ GI lympho 99-02-19 Eaction":true,"hash":"cf8af76d-322f-4990-af4d-2617fb4fc070","type":"last_name_match"} My own 14 year old kitty (adopt in 1985 while in vet school) has been diabetic for about two years...well controll on BID Humulin U...began vomiting more (always been a 'puker') and weight loss about three months ago...endoscopic samples suggest lyphoma of stomach and duodenum but full thickness samples to be taken next week to confirm. Assuming the worst (since this cat is mine)---I have three questions---First--is there any great advantage to using the multidrug therapy from the Oct 1998 JAVMA article as oppos to the COP induction/Dox maintenance protocol publish in JVIM in 1996? I realize the COP/dox study did not address alimentary lymphoma specifically so I'm looking for personal experience or unpublish results here. Second---any suggestions or advice on handling the diabetes when I add prnisolone? Should I automatically increase the dose (currently 2 units BID) or hang back and see what happens? Finally---suggestions on nutrition---currently on W/D cann and dry...eating and feeling pretty well and weight is about 9.5 lbs (originally a 12 to 13 pound model--not fat--just a very large cat)...what would you recommend I fe (vomitting is controlling pretty well on Reglan/Flagyl)? Thanks in advance---'Tupper' has always been a little devil and my wife claims 'he's YOUR cat' but I have a soft spot for him.... ED. PS Bob---I'll call when I'm back in Rochester and have results---I'm in PA right now...

You'll be there, won't you?

I'm not very attached to the glycobalance....does she like it?

Diabetic pom collapses 97-01-21 HICKDOC I have a 10 year old pomeranian that was diagnosed as diabetic in 1995 and cushingoid in june of 1996. A spayed female, she presented 1-18-97 near comatose, vomiting, shaking and so weak she could hardly hold her head up of the table. Her temp was 98.5. abn labs included a potssium of 6.35, plasma protein of 11.0 ( hemolyzed by difficult venipuncture but not lipemic), glucose 4-5 hour post insulin was 433, ssgpt 1138 (10-100), sap 696 (1-70), cholesterol 709, calcium 12.3, phosp 7.6 triglycerides 601 ggtp was normal serum osmolality was 324. Her color was 'muddy' almost cyanotic.She was dehydrated but no other abnormal physical signs. She responded to solu medrol and normal saline. Once we got urine flow (she was empty at admission) 2 hours after starting treatment we found no ketones in her urine. Her post acth stim 1 month ago was 4.7 so we tentatively ruled out hypoadrenalism, the glucose wasnt high enough to supsect non-ketotic diabetes and quite frankly I dont know whats going on. She went home pretty near normal less than 24 hours after being admitted and I really thought she was gonna die before I could get the iv catheter in because she was so weak and lifeless. I am glad she is doing well and we are fine tuning her diabetic control a little as we did hourlies today and she is still a little high (glucose that is not her insulin dose). The owner is on a tight budget and we have both done the best we could for the dog with the given circumstances...dont want her to crash again so I feel we need to check her out more but dont know how best to spend this lady's money....Help will be appreciated. thanks Jim

Is this dog on tx for hyperadrenocorticism?

Is it still significantly pu/pd?

Another Ketotic Kitty 96-02-09 ASPENWING I have been working on a 13yr NM DLH since last April who presented as a ketoacidotic diabetic. We were able to eliminate the ketones almost immediately and have been on only 1/2 U ultralente insulin once daily since 10-95. Any attempt to eliminate the insulin drives the blood glucose up quickly. He has had several hypoglycemic episodes over this time but not since 9-95. I have asked about doing oral insulin products but was told this is not successful with previously ketotic cats. Recently, 9-95 and again 12-4-95 he presented with UTI's and was treated with clavamox. The owner is running out of funds so can do little in lab work. (in fact today I was afraid she was going to opt for euth.) Today he presented severely depressed, dehydrated and with 3+ ketones in urine. His blood glucose was only 225. I'm trying to understand how to regulate this guy. Should I try a different insulin, if I increase to BID he crashes,( of course late at night too.) Are the recurring UTI's from the constant urine glucose?-though every time they have checked it in the last 2-3 months it has only been between 1/4-1/2. Any advice would be greatly appreciated. Thankyou, ☼

I dont have any great ideas on a cheap way to deal with this however.what clinical signs does the cat show prior to getting ketotic?

Will the owner allow a cysto urine sample for culture?

Hyperglycemia post depo 96-02-16 KCCatDr I'd really like some help with this one...I think I'm too close to it to be objective (it is my tech's baby). The cat is a 14 year old MN Siamese X that was agnosed with IBD (by endoscopic biopsy) about 8 months ago. This cat has also had several very small cutaneous mast cell tumors removed over the years and is atopic (agnosed by a veterinary dematologist by intradermal skin testing). He has had intermittent vomiting and colitis for many years. He absolutely does not tolerate oral prednisone -- within a few s he is vomiting, has increased liver enzymes, has lipemic serum (I am suspicious that it induces pancreatitis but haven't been able to prove it). He has done this repeatedly when I try him on pred. He has tolerated injectable steroids better but becomes profoundly polyuric. He also doesn't tolerate oral antibiotics (major vomiting) so I haven't been able to try him on metronidazole. He won't eat any of the specialized protein ets (I think we've tried them all) -- he only eats dry food. A few weeks ago he began having soft stools (small bowel) and losing a little weight (1/2 lb over 2 weeks) which I suspected was a flareup of his IBD. He d well with one dose of injectable dexamethasone (regained the weight, stools firmed up) so rather than re-biopsy (to R/O lymphoma), I elected to give him depomedrol. Within a few s he was severly polyuric, glucosuric, and hyperglycemic (consistently about 350). His attitude is sluggish and he isn't eating as well (his stools have continued to be normal). Other than the hyperglycemia his labwork is normal (I have a TLI penng). My lemma -- should I start insulin? Considering that this cat doesn't seem to tolerate anything I do mecally, and considering that my tech is a basket case (she's convinced he's going to e), I'm a little reluctant to jump in. Still, I have to believe that a glucose of 350 has to make him feel bad. So, what would you all do? Should I wait it out? How likely is he to become ketoacidotic? This next month is going to be a long one. Thanks for your thoughts.

Have you ever ultrasounded his abdomen?

Hi, :any chance of taking care of the teeth/dental issues and seeing if things improve with that?

Re: weird cat 96-05-13 K9DOC

*have you seen this cat drink or are we going on the client's observation?

Rest of results of ua?

Re: weird cat 96-05-13 K9DOC

*could kitty be getting into a high salt source?

How many calories/meal does she currently get?

Re: weird cat 96-05-13 K9DOC

* do you have any ideas why kitty's alt and sap are elevated?

Do you have a current cbc/chem/ua?

Re: weird cat 96-05-13 K9DOC

*is the wbc total wnl?

Could you post some photos?

Re: weird cat 96-05-13 K9DOC

And how high is her hct?

Do you have a urinalysis?

DM And Older Thin Cat 96-05-16 POVARAH Problem with DM and older thin cat that had a severe hypoglycemic reaction after giving NPH insulin and the cat vomiting. Owner is very concerned about a recurrence of the hypoglycemia and had 'heard' about the use of regular insulin for the control and treatment. I can't seem to make them understand that regular insulin will not keep the cat under adequate control and that hypoglycemic episodes can happen with that if there is no food for it to act upon ( such as cat vomiting). What in your experience would be a good starting point, agood diet and what type of insulin to be used with this very thin cat? I know that some what of a glucose curve should be done in the beginning. Should the use of BID NPH be considered? As stated earlie my biggest problem is to get the idea of the reular insulin use as a 'cure all' out of their head. Any help and suggestions would be appreciated.

What do your glucose curves look like?

What should she weigh?

Feline Asthmatic/Diab. 96-06-27 PBGDVM I have an 8 year old spayed female DLH who presented in 1994 with signs suggestive of feline asthma. Survey thoracic films revealed a bronchial pattern. CBC was totally normal. At that point the owner had no more money for evaluation so I put the cat on prednisolone at 1mg/lb BID and tapered from there. Unless the cat was on the mega dose route - she was not controlled. Then I utilized triamcinolone at 4mg EOD and she has maintained on this for approx. 2 years with very little coughing. Recently she had a bout of vomiting/diarrhea/dehydration. She presented to an emerg. facility that worked her up quite well. She displayed lipemic serum after not eating for 3 days, blood glucose of 219, urine glucose in the big time amount range - and a cholesterol of 438 (normal high for lab used was 270). Other abnormalities were very mild. Her WBC count was 21,600 with 1,700 bands. She was hospitalized on IV fluid support and IV cafalexin. The owner removed her from their care after 3 days and took her home. She has done fairly well at home. I rechecked her blood and urine glucose 2 weeks later and found that her serum continued to be lipemic following a 12 hour fast, and the urine had a lot of glucose. The blood glucose value was 230. I concluded that she was indeed a diabetic. Possibly she had a pancreatic episode which landed her in the emerg. clinic. I took her off of the triamcinolone and we have been trying to maintain her asthmatic signs on cyproheptadine at 2 mg BID and terbutaline at 1.25mg BID. This has not worked to eliminate the coughing entirely but has helped. In two weeks off of the triamcinolone and on WD she now shows no urine glucose and a blood glucose of 153. My questions - for anyone who is still with me - are the following: 1. Are there any other drugs I can try to attempt to control her asthma that might work better than cyprohep. and terbutaline? 2. If not - how much coughing in an asthmatic is too much? 3. Is it better for the cat to be back on steroids and I can just start dealing with the diabetic condition with glipizide or insulin? ANY thoughts would be greatly appreciated. Thanks

Have you done radiographs recently to be sure there isn't right middle lung lobe collapse?

In my new grad days, i would have obtained permission to take the cat home with me and finish the curve over night at home… the bloom wore off that long ago! do you have an after hours clinic that could finish the curve for you and the owner, if the owners discover that they are truly unable to perform their own curves at home?

Gastritis and Diabetes Part1 96-07-10 CHAIMLIT Dear Abby oops,(wrong board) I meant Honorable consultants, I am Max, an 13 year 16 lb (Been off the Nordik trak lately) Male neutered (I don't recall ME signing the permission slip) , who has my poor caring veterinarian totally confused so he asked me to purr you folks a line or two, I was drinking and peeing up a storm especially in 'all the wrong places' about 3 months ago and my wonderful owners had that blood hungry vet draw up some of my precious red vital fluid and these were the pertinent #s. (Yes I was quite stressed). Glucose 446 BUn 24 Creatinine 1.9 Alk phos 51 cholesterol 259. UA sg 1.040 glucose 4+ sediment inactive and Protein/creatinine ratio .2. You'd think that that would've been enough but NO, he drew some more a few days later and got a glucose of 402 and a fructosamine of 488 (175-400) So being the pain inducing happy masochist that he must be , he had the temerity of teaching my owners how to stick me twice a day with NPH Humulin N starting off at one unit bid and then gradually worked their needle jabbing way to 4 units bid all the while sticking little bits of funny paper in my litter and telling the vet that 'it's still quite positive'. Well I started vomiting about 1 month later and being the type A owners that I have , what did they do but rush me in again to you know who and Dr Exanguination did his dirty deeds again and this is what he got. Glucose 54 and basically everything else wnl. Howvever the urine was still ++ on glucose stix.He did have the lab verify this glucose value. So he stopped giving me insulin and I still kept on vomiting,no diarrhea and I definitely was feeling like the 2week old leftover tuna cassarole. He found that I had a mild UTI and sent me home with instructions for my needle happy owner not to give me any more insulin and some awful tasting antibiotic called cefadrops.... Well I kept on vomiting even though I wanted to eat and he told my owners to drop the antibiotics and try lamb and rice baby yum yum food. Boy that was good but something was in the cards cause I kept on yakking 2-4 times a day. Well you guessed it , back I went to my designated hospital suite and I might as well just stuck out my shaved neck and said 'Go for it big boy'. Glucoses ranged between 150-170 but my urine was still +++. At this point he was muttering something like 'Fanconi syndrome', My owners told him that I was not excessively drinking or peeing at home. He did some plain xrays which didn't show much and then he had me drink this god awful white chalky stuff and then then we did aerobics for the next three hours. At the end of this all he said something like,' it took 2 hours for the barium to finally leave the stomach'. Then the last straw. He brings me to a room the next day where he has this long snake like thing that was supposed to be inserted all the way up into little ol me and I said at that point 'Give me the general' and for once he listened. He told my owners that he had found a sizable polyp just in front of the pyorus and did detach its stalk but couldn't totally remove it because he just had biopsy instruments and no grasping forceps. He did however break it up into smaller pieces and get lots of biopsies of it and the stomach and some of the intestine. He said the pathologist reported ' Slide contains several sections of gastric mucosa with marked glandular hyperplasia which some regions appears to be polyploid with a fibrous stroma. Moderate numbers of lymphocytes and plasma cells are seen within the fibrous stroma. No evidence of stromal invasion seen in the evaluated sections. Other sections of gastric mucosa contain moderate numbers of lymphocytes and occasional plasma cells and histiocytes are seen within the mucosa. No evidence of neoplasia seen. 2 small fragments of intestinal villi ( technical problem with biopsy forceps at this point) are evaluated. No significant lesions seen. Gastric mass: Gastric polyp with moderate chronci inflammation Stomach: Diffuse moderate lymphocytic gastritis Small intestine. Villus tips only, no lesions seen. Comment: Gastric mass is a hyperplastic polyp most likely secondary to the chronic gastritis. No evidence of stromal invasion to suggest a malignancy seen in the sections evaluated' I was finally sent back home with a diet called D/D but it I still threw up on it. but not as often as I did before.. He's thinking of other diets but he's not sure which ones. He also says that he would normally like to put a cat like me on prednisone but because I was an off or on diabetic he's not sure that's such a bright idea. He also mentioned drugs like carafate and tagamet and propulcid none of which he has stared yet.. Do me a favour will ya and help this poor confused soul who keeps muttering something like' I just wanna pound out hamburger or tofu patties somewhere far away from here like Kansas , Texas or Vancouver'. Looking forward to growing back some neck hairs....Max

The histology sure sounds like an inflammatory response (to what you ask?

Really?

Hyperglycemia 96-07-17 Wet Vet 41 I just performed a fasting AM blood glucose on a cat I'm suspecting to be diabetic. It was 362. This cat really gets stressed - he poops in the cage and on the table EVERY time he comes into the clinic - even for minor stuff. He growls but absolutely never tries to bite or hurt us. So how much can I expect the BG to rise from this stressed out cat?

Did you happen to be able to collect a urine at the same time?

Maybe you're referring to the suggestion of starting the acth-stim 4-6 hours after the dog gets the pill?

Insulin Type 96-07-26 LodiVet I have a nine year old diabetic male neutered cat that has been on insulin since 93. It was only recently that I have been able to get the cat in for glucose curves. He is on iletin NPH BID, most recently 6 U in the am and 5 U in the pm (we have been increasing his dose incrementally since starting the glucose curves). At one hour post injection his glucose was 464; at 3 hours, 225; at at 5.5 hours, 87; at 7.5 hours, 157; and at 8.5 hours, 189. I would like to switch the cat to lente, probably BID. Would this be correct? Should I stick with iletin, or should I, at the same time, switch to humulin. Is it true that the beef/pork preparations are going off the market. Excuse me for rehashing an old topic. Thanks!!

Is that the reason you want to switch?

Or he doesn't feel like eating period?

Re: Diabetic/acromeglic(?) cat 96-08-01 Hypurr I agree totally with Dr Dave. (Not surprising, but there it is.) Look for another problem in this kitty. Look for infection (oral? urinary tract?) and/or concurrent causes to be PU/PD, despite low serial blood glucoses. Also, as I have yet to find the crystal ball store, I still plod along (well, my techs, bless their souls, do) with BG's q 1- 1 1/2 hours until I have seen two consecutive increased values. Just cause I have missed a few in-ter-est-ing things by trying to go by the expected onset of insulin action 'data'. Please let us know what you find on U/A, CBC, chem screen, etc. We'll be waiting.... Good luck! :-) >M (aka="" )="">

I would spend the money on a cbc, chem screen with amylase and lipase as well as a urinalysis, before checking acth stim and a cortisol, personally....dr dave?

I know this goes against much of the common dogma and my new friend's retort was "don't you think we use the best people and information to be sure that feeding our food alone is 'enough'?" to which i called him a fool to be less afraid of what we don't know than what we do know (can hear how loud things were getting?

Re: Diabetic/acromeglic(?) cat 96-08-01 Hypurr I agree totally with Dr Dave. (Not surprising, but there it is.) Look for another problem in this kitty. Look for infection (oral? urinary tract?) and/or concurrent causes to be PU/PD, despite low serial blood glucoses. Also, as I have yet to find the crystal ball store, I still plod along (well, my techs, bless their souls, do) with BG's q 1- 1 1/2 hours until I have seen two consecutive increased values. Just cause I have missed a few in-ter-est-ing things by trying to go by the expected onset of insulin action 'data'. Please let us know what you find on U/A, CBC, chem screen, etc. We'll be waiting.... Good luck! :-) >M (aka="" )="">

Everyone?

Has this dog failed several exclusion and/or hypoallergenic diets?

Cisapride 96-08-08 WoodburyAH I just picked up a case on a second opinion. Female spayed Maine Coon 10 years of age. The medical history is diabetes mellitus and frequent episodes of constipation/obstipation that usually resolve with enemas. The cat has only needed to be deobstipated on one occasion. The cat eats wd dry and some canned food with fiber added. I would like to consider cisapride for this cat. Are there any contraindications in a diabetic animal?

Again, are there any contraindications for the use of cisapride in an asthmatic (as well as diabetic) cat?

What do previous curves look like?

Re: Tracheal stricture/collap 96-08-21 K9DOC John: Interesting. No, we don't see tracheal collapse often. US of the heart might be helpful to help ascertain the etiology of the increased vascular pattern if possible. I think bronchoscopy would be the most helpful in evaluating the severity of the collapse and to get a BAL and culture from the lower airways while there.

Can you get your ultrasonographer to fine needle the mediastinal mass if he/she feels that it is a mass rather than fluid?

Does he have ketones right now?

Re: Tracheal stricture/collap 96-08-21 K9DOC John: Interesting. No, we don't see tracheal collapse often. US of the heart might be helpful to help ascertain the etiology of the increased vascular pattern if possible. I think bronchoscopy would be the most helpful in evaluating the severity of the collapse and to get a BAL and culture from the lower airways while there.

(or collect fluid if it is that?

Any films were we could look at renal size?

Re: Tracheal stricture/collap 96-08-21 K9DOC John: Interesting. No, we don't see tracheal collapse often. US of the heart might be helpful to help ascertain the etiology of the increased vascular pattern if possible. I think bronchoscopy would be the most helpful in evaluating the severity of the collapse and to get a BAL and culture from the lower airways while there.

:)) also, if this is a mediastinal mass, do you know what kitty's retrovirus status is?

It sounds like she's on less than 4 units bid if you're describing increasing the dose to that much....if she currently is on 3 units bid, then 1.7 units/kg bid would mean she's around 1.7 kg?

Pica? 96-05-09 PJFDVM Have a family that has raised three consecutive min schnauzers. Each one has become a vaccum cleaner that will eat anything left out. I always considered this behavorial. However the first two dogs both became diabetic in time. After reading interesting things about the value of using chromium and vanadium in diabetics and suggestions that some cases of diabetes may indeed represent a trace mineral defeciency, I am wondering if the behavior in all three of their dogs could be a form of pica. Perhaps that's too far of a stretch, but wanted to post it here to see if any ideas or responses from the holistic world for an open-minded traditional practitioner. Comments?

Got any fur?

So are the electrolytes normal during these mid-month dips and still normal prior to the next injection?

Re: Repost:Diabetic anesthesi 96-09-11 OC I am far from an expert, but when anethetizing a diabetic, I allow normal feeding up to the morning of surgery, and try to do that patient first. I reduce insulin by 50%, use my normal anes protocol, and use LRS as my fluid. In a diabetic, I always have a catheter in place and fluid running. At any rate, I monitor BG every 30 minutes to be sure I am not getting huge alterations in glucose levels, with my main concern being hypoglycemia. I would rather the patient be marginally hyperglycemic than have to deal with a hypoglycemia that I wasn't aware of. Basic anesthesia cautions are unchanged, and to date I have had good results. Headley

In that case, monitor the bg intra-op and calculate a glucose infusion to maintain normoglycemia (anyone really want the formula?

How is the appetite of this dog?

Re: Repost:Diabetic anesthesi 96-09-11 OC I am far from an expert, but when anethetizing a diabetic, I allow normal feeding up to the morning of surgery, and try to do that patient first. I reduce insulin by 50%, use my normal anes protocol, and use LRS as my fluid. In a diabetic, I always have a catheter in place and fluid running. At any rate, I monitor BG every 30 minutes to be sure I am not getting huge alterations in glucose levels, with my main concern being hypoglycemia. I would rather the patient be marginally hyperglycemic than have to deal with a hypoglycemia that I wasn't aware of. Basic anesthesia cautions are unchanged, and to date I have had good results. Headley

Sorry the response is so late but i have been gone and haven't seen my other half much to talk chit-chat with! any body know were our fearless leaders are?

Are the owners using the 10 ml bottle and a syringe or the pens?

Triglycerides 96-09-16 Nogutz Is there a point when triglycerides are so high that you don't think it's post prandial anymore? I have a 3 y/o f/s dsh that I saw last week for a miliary derm that had responded previosly to depo (I don't remember when). I gave her depo (20 mg) and then saw her back on Saturday for vomiting and anorexia. The owner then reported that she had had some PU/PD a month previously that had gone away. Needless to say, on X-ray, the stomach was full of food, so she wasn't eating because she was probably so full! The bloodwork came back with a glucose: 180 (hopefully just stress), triglycerides: 931 and ALT :131. My plan is to recheck a fasted sample to rule out post prandial, and I'm hoping the increased triglycerides are not due to diabetes given the fact that I gave the depo shot, but is there anything else I should be thinking of?

Is the cat obese?

This is a tough situation.....is the ear chronic end stage?

Pruritic diabetic 96-09-11 Myxomatoes I have a controlled diabetic feline with atopy ). He becomes very drowsy on anti histamines. Any other non steroidal ideas? I read in Danny Scott's book about a mast cell stabiliser called oxatomide. Has anyone had any experience with this? thanks,

Do you have the animal on efas too?

How many calories/day does he currently get?

D. Insipidus Husky 96-09-04 FourDocs Hello there; a 100# 10yr FS husky seems to have a partial diabetes insipidus that responds well to intranasal DDAVP, when the owner can get it in. Sometimes jabba the dog will not allow small owner to place said prescription in pooch's nose, eyes or anywhere else for that matter. He's done some research, and wonders if he could use the pill instead. Pill? Pill?! What's the dosage orally of this mythical pill? Have you guys used it, and if so how much? How often? Thanks for your input, and have a nice one,

Has the dog been tested for cushings?

How much should he weigh?

Darned Hyperglycemia 96-09-14 RATHOLE333 Gotta 10 yr old FS Dalmation with D. Mellitus. Have juggled her Lente insulin around and still PU/PD and losing wt. Did ACTH stim - WNL. On 24 IU SID 8 a.m. 507, 10 a.m. 470, 2 p.m. 219, 4 p.m. 137, 5:30 p.m. 108. Decreased to 16 IU then split 8 IU BID. 1st blood taken 6 hrs post 8 IU Lente 9 a.m. 402, 11 a.m. 338, 1 p.m. 319, 3 p.m. 347, 5p.m. over 600. Urine dipstick no ketones but tons of glucose. Sent off CBC/chemistry panel waiting results. Considering hospitalizing and trying to regulate with NPH BID (or SID at 1st?). Start low and increase how often? Every 2-3 days? Repeat ACTH stim? Any ideas? Thanks - AEG

How much does the dog weigh?

50 cents vs 1.00?

Diabetic Eye Problems 96-09-27 Rightcourt I have been treating r 7y sp 86lb F diabetic samoyed for the last 6 months. At present she is taking 29 u of NPH insulin and her last BG curve was 302 (59-121) at 9:00 am and at 4hr intervals was 101.7 and 115. She is now starting to loose her eye sight (cataracts). Is there any current treatments for this? Should I continue the BG curve longer? Check fructosamine? Posted in optho also Thanks

Is she on once or twice a day insulin?

Where is she pruritic?

Re: Allergic rhinitis & diabe 96-10-14 Toxoplasma Patsy- When was the last time the dog was worked up with rads of the nose, bloodwork, etc? If it has been a while, it may be worth repeating that examination in case something else has shown up. It is possible that the dog has developed some pulmonary disease if the dog is having some significant coughing which could be allergic, or a new problem, so chest rads may be helpful. Sometimes, I have had success with hydroxyzine or chlorphenarimine. Good luck,

What dose has been necessary in the past?

Is her thyroid controlled, though she's been offered other foods?

Deprenyl Again 96-10-14 AltheaVet Ok, just so that I get how this stuff is used. 1) Start at 1mg/kg q 24 hours 2) No lab test type monitoring. Just watch for resolution of clinical signs. 3) If no improvement in clinical signs, go to 2mg/kg q 24 hours. Here are my questions: 1) You mentioned that the veterinary product has been approved which will make the cost of treatment much more reasonable. Realizing the difference between 'FDA approved' & 'available to order', can I actually order the veterinary product yet? Do I get it from Dep. Animal Health or a distributor? 2) When you say look for improvement in clinical signs within the first 4 weeks, can I assume you are largely referring to the PU/PD & appetite change? 3) If the owner feels there is only partial improvement, how can I tell what my next step is if ACTH stimming isn't going to be helpful? Thanks, AltheaVet

Ohbeeone, what sayeth you?

Can we measure c02 levels?

Humulin- Ultralente 96-10-22

Dave or duncan, do you know if pzi is ever going to placed back on the market?

Is this for both the pre and post cortisol values?

Hypoglycemia 96-10-30 Oncocoot Well, here's one for which I would really appreciate some opinions....9 yo mc 10 kg Pug, presented to l dvm for pu/pd, led to dx of diabetes mellitus, mild asympatic ketosis. Started on Humulin Ultralente q24h at home. Oops!! somehow the owners first gave 24 units for the first dose and then 54 for each of the next three. What a surprise that the dog was represented not doing too well!! To make a long story short, but perhaps a bit less complicated, these things also happened: PCV fell from 45 to 18, now stable, with bloody vomiuts noted once; seizures, none in past 24 hours. The dog was supported with dextrose, now just on LRS, and seems a bit better though still quiet. Neurologically better, can now walk. ALT mildly elevated. BA pre 58 (N10) post="" 202="">/10)>25). a="" neurologist="" was="" consulted="" and="" felt="" the="" seizures="" were="" not="" related="" to="" the="" insulin="" overdosage="" -="" but="" with="" that="" much,="" i="" guess="" i="" am="" not="" sure.="" your="" comments="" are="" most="" appreciated.....="">/25).>p Rosenthal

To confirm, this is a 9 yr old pug?

Who is starting the fights now?

Hypoglycemia 96-10-30 Oncocoot Well, here's one for which I would really appreciate some opinions....9 yo mc 10 kg Pug, presented to l dvm for pu/pd, led to dx of diabetes mellitus, mild asympatic ketosis. Started on Humulin Ultralente q24h at home. Oops!! somehow the owners first gave 24 units for the first dose and then 54 for each of the next three. What a surprise that the dog was represented not doing too well!! To make a long story short, but perhaps a bit less complicated, these things also happened: PCV fell from 45 to 18, now stable, with bloody vomiuts noted once; seizures, none in past 24 hours. The dog was supported with dextrose, now just on LRS, and seems a bit better though still quiet. Neurologically better, can now walk. ALT mildly elevated. BA pre 58 (N10) post="" 202="">/10)>25). a="" neurologist="" was="" consulted="" and="" felt="" the="" seizures="" were="" not="" related="" to="" the="" insulin="" overdosage="" -="" but="" with="" that="" much,="" i="" guess="" i="" am="" not="" sure.="" your="" comments="" are="" most="" appreciated.....="">/25).>p Rosenthal

Were the blood sugars low when the dog was seizuring?

U of montreal does subs pretty cheap, i think like $3500 canadian?

Hypoglycemia 96-10-30 Oncocoot Well, here's one for which I would really appreciate some opinions....9 yo mc 10 kg Pug, presented to l dvm for pu/pd, led to dx of diabetes mellitus, mild asympatic ketosis. Started on Humulin Ultralente q24h at home. Oops!! somehow the owners first gave 24 units for the first dose and then 54 for each of the next three. What a surprise that the dog was represented not doing too well!! To make a long story short, but perhaps a bit less complicated, these things also happened: PCV fell from 45 to 18, now stable, with bloody vomiuts noted once; seizures, none in past 24 hours. The dog was supported with dextrose, now just on LRS, and seems a bit better though still quiet. Neurologically better, can now walk. ALT mildly elevated. BA pre 58 (N10) post="" 202="">/10)>25). a="" neurologist="" was="" consulted="" and="" felt="" the="" seizures="" were="" not="" related="" to="" the="" insulin="" overdosage="" -="" but="" with="" that="" much,="" i="" guess="" i="" am="" not="" sure.="" your="" comments="" are="" most="" appreciated.....="">/25).>p Rosenthal

Did the dog remain seizure free while having a normal glucose?

Absolutely sure that the dose was truly the 'low' dose for the test?

Hypoglycemia 96-10-30 Oncocoot Well, here's one for which I would really appreciate some opinions....9 yo mc 10 kg Pug, presented to l dvm for pu/pd, led to dx of diabetes mellitus, mild asympatic ketosis. Started on Humulin Ultralente q24h at home. Oops!! somehow the owners first gave 24 units for the first dose and then 54 for each of the next three. What a surprise that the dog was represented not doing too well!! To make a long story short, but perhaps a bit less complicated, these things also happened: PCV fell from 45 to 18, now stable, with bloody vomiuts noted once; seizures, none in past 24 hours. The dog was supported with dextrose, now just on LRS, and seems a bit better though still quiet. Neurologically better, can now walk. ALT mildly elevated. BA pre 58 (N10) post="" 202="">/10)>25). a="" neurologist="" was="" consulted="" and="" felt="" the="" seizures="" were="" not="" related="" to="" the="" insulin="" overdosage="" -="" but="" with="" that="" much,="" i="" guess="" i="" am="" not="" sure.="" your="" comments="" are="" most="" appreciated.....="">/25).>p Rosenthal

Is the dog a diabetic again on lrs?

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

Hypoglycemia 96-10-30 Oncocoot Well, here's one for which I would really appreciate some opinions....9 yo mc 10 kg Pug, presented to l dvm for pu/pd, led to dx of diabetes mellitus, mild asympatic ketosis. Started on Humulin Ultralente q24h at home. Oops!! somehow the owners first gave 24 units for the first dose and then 54 for each of the next three. What a surprise that the dog was represented not doing too well!! To make a long story short, but perhaps a bit less complicated, these things also happened: PCV fell from 45 to 18, now stable, with bloody vomiuts noted once; seizures, none in past 24 hours. The dog was supported with dextrose, now just on LRS, and seems a bit better though still quiet. Neurologically better, can now walk. ALT mildly elevated. BA pre 58 (N10) post="" 202="">/10)>25). a="" neurologist="" was="" consulted="" and="" felt="" the="" seizures="" were="" not="" related="" to="" the="" insulin="" overdosage="" -="" but="" with="" that="" much,="" i="" guess="" i="" am="" not="" sure.="" your="" comments="" are="" most="" appreciated.....="">/25).>p Rosenthal

Is the anemia compatible with a gi bleed?

Vomiting or diarrhea?

Hypoglycemia 96-10-30 Oncocoot Well, here's one for which I would really appreciate some opinions....9 yo mc 10 kg Pug, presented to l dvm for pu/pd, led to dx of diabetes mellitus, mild asympatic ketosis. Started on Humulin Ultralente q24h at home. Oops!! somehow the owners first gave 24 units for the first dose and then 54 for each of the next three. What a surprise that the dog was represented not doing too well!! To make a long story short, but perhaps a bit less complicated, these things also happened: PCV fell from 45 to 18, now stable, with bloody vomiuts noted once; seizures, none in past 24 hours. The dog was supported with dextrose, now just on LRS, and seems a bit better though still quiet. Neurologically better, can now walk. ALT mildly elevated. BA pre 58 (N10) post="" 202="">/10)>25). a="" neurologist="" was="" consulted="" and="" felt="" the="" seizures="" were="" not="" related="" to="" the="" insulin="" overdosage="" -="" but="" with="" that="" much,="" i="" guess="" i="" am="" not="" sure.="" your="" comments="" are="" most="" appreciated.....="">/25).>p Rosenthal

Do you have an ultrasound and radiographs of the dog's abdomen?

Is he on purina dm that's the original canned version?

Diabetic Picky Eater 96-10-28 COUNTRYVET Pepper is a M/C DLH 1986 with a hx of chronic miliary dermatitis around neck and dorsum, with virtually a year round presentation. First saw 12-94, client wanted ovaban because 2 previous CSS injections that year hadn't helped. Cat under alot of stress, occasional diarrhea, treated for colitis and tapeworms 1-95. More dermatitis by 7-95, requested ovaban. By 10-95, PU/PD with diabetes presumed secondary to ovaban, and patches of alopecia where the hair epilates with light pulling, facial pruritis, only one flea, and weight loss. Recommeded IVD Venison food trial and start insulin, client just wanted CSS shot. Cat wouldn't eat venison or d/d, started insulin 1195, and now finally down to 3 U NPH SID to keep diabetes under control, but still has miliary dermatitis barely controllable by CSS shots. So in a bind: cat very picky, won't eat the diet that will control (I'm sure it's food related by now) pruritis and dermatitis, and don't want anorexic diabetic cat on insulin. The alternative, giving CSS to diabetic, is also unappealing! So any recommendations as to which way to go--continue CSS (BOOOOO) or force on a diet that he may be anorexic on for several days or more? Client has never let me run anything more than UA and inhouse blood glucose, am I missing something? It would be really nice to get him off insulin, suspicious of the SID dosing (is she really checking his urine appropriately? is diabetes really the problem?). After all, sent home Advantage 2 months ago for ++fleas, and she still hasn't done it! Open to suggestion! Sue

Have you tried the cat on antihistamines?

It appeared classic for laryngeal paralysis.....is the reduction in cortisol going to exacerbate the larpar signs?

Help! I'm confused! 96-10-21 DancinDVM I'm slightly baffled by this case. 5 yo female spayed himalayan cat with 3-4 day history of anorexia, but drinking water OK. Initially owners declined bloodwork, cat was supposed to go home on Clavamox, went home on Amoxi, no improvement. Panel today - T. bilirubin .9(n .1-.6), BUN 42 (n-10-30), Ca. 7.6 (n-8.2-11.0), glucose 274 (n-75-160), Potassium 6.2 (n-3.7-5.2), Sodium 120 (n-146-155), Cl. 91 (n-115-125), CO2 27 (hemolysis tho), rest of panel no siginificant abnormalities, urinalysis Glucose 1000 on strip, and cat is hypothermic (presented at 99, went to 102 while in heat, now down to 100 ) - My question is is this diabetes, Addison's, both? Money may be a concern here, so right now, of course I can't reach the owner until orrow, I'm giving SQ fluids and 1 unit of Ultralente insulin. Any help is appreciated!!!

Is kitty dehydrated?

Are they on a low carb, high protein, canned diet?

Help! I'm confused! 96-10-21 DancinDVM I'm slightly baffled by this case. 5 yo female spayed himalayan cat with 3-4 day history of anorexia, but drinking water OK. Initially owners declined bloodwork, cat was supposed to go home on Clavamox, went home on Amoxi, no improvement. Panel today - T. bilirubin .9(n .1-.6), BUN 42 (n-10-30), Ca. 7.6 (n-8.2-11.0), glucose 274 (n-75-160), Potassium 6.2 (n-3.7-5.2), Sodium 120 (n-146-155), Cl. 91 (n-115-125), CO2 27 (hemolysis tho), rest of panel no siginificant abnormalities, urinalysis Glucose 1000 on strip, and cat is hypothermic (presented at 99, went to 102 while in heat, now down to 100 ) - My question is is this diabetes, Addison's, both? Money may be a concern here, so right now, of course I can't reach the owner until orrow, I'm giving SQ fluids and 1 unit of Ultralente insulin. Any help is appreciated!!!

(re bun....) what was usg?

Also what liver enzymes are up?

Help! I'm confused! 96-10-21 DancinDVM I'm slightly baffled by this case. 5 yo female spayed himalayan cat with 3-4 day history of anorexia, but drinking water OK. Initially owners declined bloodwork, cat was supposed to go home on Clavamox, went home on Amoxi, no improvement. Panel today - T. bilirubin .9(n .1-.6), BUN 42 (n-10-30), Ca. 7.6 (n-8.2-11.0), glucose 274 (n-75-160), Potassium 6.2 (n-3.7-5.2), Sodium 120 (n-146-155), Cl. 91 (n-115-125), CO2 27 (hemolysis tho), rest of panel no siginificant abnormalities, urinalysis Glucose 1000 on strip, and cat is hypothermic (presented at 99, went to 102 while in heat, now down to 100 ) - My question is is this diabetes, Addison's, both? Money may be a concern here, so right now, of course I can't reach the owner until orrow, I'm giving SQ fluids and 1 unit of Ultralente insulin. Any help is appreciated!!!

Has cat been vomiting?

Can you post the full u/a?

Help! I'm confused! 96-10-21 DancinDVM I'm slightly baffled by this case. 5 yo female spayed himalayan cat with 3-4 day history of anorexia, but drinking water OK. Initially owners declined bloodwork, cat was supposed to go home on Clavamox, went home on Amoxi, no improvement. Panel today - T. bilirubin .9(n .1-.6), BUN 42 (n-10-30), Ca. 7.6 (n-8.2-11.0), glucose 274 (n-75-160), Potassium 6.2 (n-3.7-5.2), Sodium 120 (n-146-155), Cl. 91 (n-115-125), CO2 27 (hemolysis tho), rest of panel no siginificant abnormalities, urinalysis Glucose 1000 on strip, and cat is hypothermic (presented at 99, went to 102 while in heat, now down to 100 ) - My question is is this diabetes, Addison's, both? Money may be a concern here, so right now, of course I can't reach the owner until orrow, I'm giving SQ fluids and 1 unit of Ultralente insulin. Any help is appreciated!!!

Is kitty collapsed?

The curve on 10/9 was not too bad - how was she acting at that time?

Help! I'm confused! 96-10-21 DancinDVM I'm slightly baffled by this case. 5 yo female spayed himalayan cat with 3-4 day history of anorexia, but drinking water OK. Initially owners declined bloodwork, cat was supposed to go home on Clavamox, went home on Amoxi, no improvement. Panel today - T. bilirubin .9(n .1-.6), BUN 42 (n-10-30), Ca. 7.6 (n-8.2-11.0), glucose 274 (n-75-160), Potassium 6.2 (n-3.7-5.2), Sodium 120 (n-146-155), Cl. 91 (n-115-125), CO2 27 (hemolysis tho), rest of panel no siginificant abnormalities, urinalysis Glucose 1000 on strip, and cat is hypothermic (presented at 99, went to 102 while in heat, now down to 100 ) - My question is is this diabetes, Addison's, both? Money may be a concern here, so right now, of course I can't reach the owner until orrow, I'm giving SQ fluids and 1 unit of Ultralente insulin. Any help is appreciated!!!

Were bloods run in house or at a reference lab?

Are other areas hyperkeratotic?

Help! I'm confused! 96-10-21 DancinDVM I'm slightly baffled by this case. 5 yo female spayed himalayan cat with 3-4 day history of anorexia, but drinking water OK. Initially owners declined bloodwork, cat was supposed to go home on Clavamox, went home on Amoxi, no improvement. Panel today - T. bilirubin .9(n .1-.6), BUN 42 (n-10-30), Ca. 7.6 (n-8.2-11.0), glucose 274 (n-75-160), Potassium 6.2 (n-3.7-5.2), Sodium 120 (n-146-155), Cl. 91 (n-115-125), CO2 27 (hemolysis tho), rest of panel no siginificant abnormalities, urinalysis Glucose 1000 on strip, and cat is hypothermic (presented at 99, went to 102 while in heat, now down to 100 ) - My question is is this diabetes, Addison's, both? Money may be a concern here, so right now, of course I can't reach the owner until orrow, I'm giving SQ fluids and 1 unit of Ultralente insulin. Any help is appreciated!!!

Alkalosis with a low cl could be from an upper gi obstruction ....does she have abdominal discomfort or have you taken rads?

And, you said the initial ua was normal- what was the usg and was there glucosuria?

Re: Senile cat? 96-10-20 K9DOC Renee': I presume you have done lab testing including T4 and all is normal? Hyperthyroid cats sometimes act weird like that. Really a bit young for 'senility'. I've not seen this type of change with hyperadrenal cats and most of these are resistant diabetics in addition to HAC.

Dave, has any work been done with l-deprenyl in cats with 'cognitive dysfunction'?

Any chance for a fpli, folate/cobalamin?

Difficult Diabetic 96-10-26 MVYVET M/N DLH recently adopted, unknown age presented 10/3/96 for PD, PP, wt loss. PCV=25% TS=7.2, WBC=14,190, Gluc=352,BUN=43, T.bil=1.03, T4=5.3 , glucosuria and hematuria, all else WNL. Started cat on 1/2 tapazole BID, Confirmed fasting blood glucose and began insulin regulation. Got moderately good regulation on ultralente 3 units BID . Sent home on amoxi 100 BID ( nasty teeth and hematuria), tapazole, insulin, WD. Cat returned 10/18 for obstipation. Owner had given NO insulin for > 24 hrs due to anorexia. Blood glucose on admission was 145 and remained WNL for 3 days with no insulin while obstipation was corrected. Even after cat started eating well, blood glucose remained normal. Sent home 10/21 on Tapazole, amoxi (persistent mild hematuria and I'm too chicken not to treat w/atbx), propulsid 2.5 mg BID, Lactulose in WD to effect +/- canned pumpkin, with advice to moniter urine and BMs. On 10/23 owners reported return of PP, PD, and cat 'sat in shower' all night. On 10/24 2+ glucosuria. I advised to start low dose insulin again but owners didn't do it. 10/24 2+ glucosuria and anorexic. Normal BM in PM. Owner again did not start insulin as advised. 10/25 ate a little. Owner would not come in for exam or blood glucose but we agreed to start on 2 units insulin am , 1 unit PM and watch urine. 10/26 urine is negative! for glucose. Questions: I see Tufts has just upped their normal feline T4 to 5.2. Should I stop the tapazole? Our plan was to recheck in a few more weeks. Could this be affecting the blood glucose? Any tips on how to handle such a widely erratic diabetic or is there something else I should be doing/looking for? Every time cat is here he comes around, eats like a horse, feels great and regulates well. . . then goes home and falls apart. It can't be insulin-handling problems either since we documented 4 days of insulin-free normal glucose levels here. Owners are about at their emotional and financial limits of course. Sorry this is so long... thanks, MGJ

Was this cat showing signs that could be attributed to hypert4 at the time that value was taken?

If it's looking out of control (very high), then what do we do?

Re: insulin resistance 96-10-24 K9DOC Lou: Unless you are doing glucose curves, you don't really know what's going on during the day and it's possible that this dose is either too high or still too low. Peak time may be 4-6 hours after injection. Frankly, I suggest going to Humulin NPH BID. I've found Ultralente insulin very erratic and unreliable in most cats. You will need to reduce your dose as you start with this different insulin type.

Just different clinic populations?

Any other curves to look at?

Feline Diabetic 96-11-03 Usertlb Have recent diabetic-have always used NPH (Ilentin) bid--are they supposedly taking this off the market leaving only NPH (humulin)?--if so are you recommending starting off with NPH(humulin) so we won't have to 're-regulate' if we have to switch? This cat is asthmatic-responds well to depomedrol--other than periodic 'swings' (probably upwards) in glucose-any special concerns I need to be aware of?--This cat received a Depomedrol injection approx. 3 weeks prior to the dx of Diabetes (blood glucose at time of dx=500 and 387 (fasting) w/ UA glucose=4+)--Ever seen a cat have long term increase in glucose due to Depo inj.?(eg 3 weeks)--(does that make sense?) Cat is eating/drinking more and wt. loss. Thanks in advance

Is the cat on a fiber diet?

How much of the diet has been the dry dm?

PU/PD 96-11-19 AVMDVM 11 yr old male(C) presented PU/PD Blood sugar 480 with slight elveations of liver enzymes. ALT 180, albumin 3.8 cholesterol 286 serum lipemic. O will not consider insulin so Rx glucotrol 5mg bid. Solved PU/PD but cat ADR (ain't doing right) Greasy hair coat, constipated for awhile.Repeat blood work & liver functions way out of sight. Chol 365, AST 590, ALT 1200, Alk Phos 246, Albumin 3.4 Glucose 159. Obviously glucotrol reaction? Suggestions other than stopping Glucotrol. Cat still eating! Thanks

Is the cat ketotic?

I appreciate that it's time consuming, but can you post a few curves?

Leukopenia and Phenobarbital 96-11-14 ENDONUT Has anyone seen leukopenia as a result of phenobarbital?. I have a 6 year old F/S mix breed dog with a history of adult onset seizures of a few months duration that is currently controlled.on 15 mg phenobarbital (15 pound BW) BID. A trough phenobarbital level a few weeks ago was within normal limits. Recently the dog has had falling episodes induced by excitement. The dog has been normal on physical examination and neuro exam. A chem, 6 lead ECG and rhythm strip, OHW, and chest xray has shown no significant findings. The CBC has shown a nonregenerative anemia of 30% (normocytic, normochromic) normal platelet count, and leukopenia (690) with 80 cells counted. The episodes have subsided with limiting excitement. Antibiotic coverage and a bone marrow aspirate is in the works. Certainly, systemic neoplasia might explain all of the dogs signs. Thanks. p DACVIM, Melbourne, Fl

Is that what you're thinking?

If the owner has financial constraints she needs to get on board with learniing how to do bg curves at home--any chance of that?

Insulin Resistnace? 96-11-17

How much water is the cat drinking?

Have you cultured the urine?

Insulin Resistnace? 96-11-17

Do you have any recent bloodwork on the cat?

No chance we can get the blood pressure measured with a doppler?

Insulin Resistnace? 96-11-17

Is the cat persistently glucosuric?

Can you post the lab results you have thus far?

Cushing's Once More 96-11-29 Wet Vet 41 I just tested a 8 yr old poodle for cushing's using LDDS. BTW, i am using 0.015 mg/kg dex by deep im injection. Baseline was 6.4 (norm 2-4). 4 hrs post was .2 (norm 1).="" but="" 8="" hrs="" post="" was="" 2.2.="" bullet="" has="" a="" hx="" of="" recurrent="" pyodermatitis="" that="" returns="" as="" soon="" as="" off="" antibiotics.="" he="" drinks="" alot="" but="" owner="" claims="" not="" a="" ravenous="" appitite="" (but="" he="" is="" gaining="" weight).="" profile="" showed="" elevated="" sap="" and="" decreased="" lymphs="" -="" otherwise="" ok.="" bullet="" is="" also="" blind.="" would="" you="" call="" this="" guy="" cushinioid="" and="" treat="" with="" lysodren,="" retest="" later,="" or="" just="" keep="" him="" on="" antibiotics="" and="" if="" worsens="" retest.="" these="" borderline="" ones="" are="" tough.="" thank="" you="">

Do you have a urinalysis, what is the elevation of alp, and is the dog's pododermatitis under control?

Moving the injections around on his body every day?

Cushing's Once More 96-11-29 Wet Vet 41 I just tested a 8 yr old poodle for cushing's using LDDS. BTW, i am using 0.015 mg/kg dex by deep im injection. Baseline was 6.4 (norm 2-4). 4 hrs post was .2 (norm 1).="" but="" 8="" hrs="" post="" was="" 2.2.="" bullet="" has="" a="" hx="" of="" recurrent="" pyodermatitis="" that="" returns="" as="" soon="" as="" off="" antibiotics.="" he="" drinks="" alot="" but="" owner="" claims="" not="" a="" ravenous="" appitite="" (but="" he="" is="" gaining="" weight).="" profile="" showed="" elevated="" sap="" and="" decreased="" lymphs="" -="" otherwise="" ok.="" bullet="" is="" also="" blind.="" would="" you="" call="" this="" guy="" cushinioid="" and="" treat="" with="" lysodren,="" retest="" later,="" or="" just="" keep="" him="" on="" antibiotics="" and="" if="" worsens="" retest.="" these="" borderline="" ones="" are="" tough.="" thank="" you="">

Also, what is the cause of blindness?

When does he normally get the food/insulin on the days he's not having a curve?

DOCP Question 96-11-17 M Have you seen decreased duration of DOCP activity after using it for 1 year? I am treating an iatrogenic addisonian (post Lysodren) with electrolyte abnormalities and a flat ACTH stim. She has been stable with DOCP for 6 + months. Mid injection and day of injection Na and K have been normal. She also is a diabetic. She presented 21 days after DOCP injection with severe shaking- she was unable to stand. I was certain that she was hypoglycemic. I was wrong. Na was 129 and K was 6.3. I gave her dose of DOCP and placed her on NaCL fluids. She recovered quickly. Seventeen days later, she has become weak again. This happened in the middle of the night. I told the owner to give florinef. By the morning she was stronger. Na was 134 (lipemic serum) and K was 4.6. What do you think I should do here? Thanks, Mitch

What dose of docp are you currently using and are you using steroids also?

How much does dog weigh?

DOCP Question 96-11-17 M Have you seen decreased duration of DOCP activity after using it for 1 year? I am treating an iatrogenic addisonian (post Lysodren) with electrolyte abnormalities and a flat ACTH stim. She has been stable with DOCP for 6 + months. Mid injection and day of injection Na and K have been normal. She also is a diabetic. She presented 21 days after DOCP injection with severe shaking- she was unable to stand. I was certain that she was hypoglycemic. I was wrong. Na was 129 and K was 6.3. I gave her dose of DOCP and placed her on NaCL fluids. She recovered quickly. Seventeen days later, she has become weak again. This happened in the middle of the night. I told the owner to give florinef. By the morning she was stronger. Na was 134 (lipemic serum) and K was 4.6. What do you think I should do here? Thanks, Mitch

Is the dog's diabetes controlled?

I am pretty conservative on daily fluids (debatable cardiac concerns-depends who you ask) and i use 50-100 ml daily only-how much are the owners giving?

Diabetes Insipidus? 96-11-03 Felinefine I'm hoping for some help with a strange case. Two year old neutered Great Dane with 6 month hx of PU/PD. Owners have only had pet 9 months, always seemed to drink alot to them, no prior health hx available. Pet is absolutely normal on PE, CBC, Chem Profile and plain films. Originally presented for urinary incontinence, UA normal except for S.G.=1.004. At that time was drinking freely, owner estimates 10-12 liters per day (weighs 120lbs). Did gradual water deprivation prior to complete withdrawl. With water deprivation, lost 5% body weight in about 30 hours, S.G. peaked at 1.019. Did ADH test later (didn't have vasopressin initially) after 24 hour water deprivation, starting S.G. was 1.015, peaked at 1.017 at 90 minutes after 10 units vasopressin IM. Have not tested for Cushing's as nothing on exam or profile is compatible. Not sure where to go next....is this nephrogenic DI? Congenital DI? Patient currently on phenylpropranolamine for incontinence and some water restriction. Any suggestions? Thanks in advance for your help!

To clarify, this is a neutered (as in m/c) animal?

Do you have a ua?

Diabetes Insipidus? 96-11-03 Felinefine I'm hoping for some help with a strange case. Two year old neutered Great Dane with 6 month hx of PU/PD. Owners have only had pet 9 months, always seemed to drink alot to them, no prior health hx available. Pet is absolutely normal on PE, CBC, Chem Profile and plain films. Originally presented for urinary incontinence, UA normal except for S.G.=1.004. At that time was drinking freely, owner estimates 10-12 liters per day (weighs 120lbs). Did gradual water deprivation prior to complete withdrawl. With water deprivation, lost 5% body weight in about 30 hours, S.G. peaked at 1.019. Did ADH test later (didn't have vasopressin initially) after 24 hour water deprivation, starting S.G. was 1.015, peaked at 1.017 at 90 minutes after 10 units vasopressin IM. Have not tested for Cushing's as nothing on exam or profile is compatible. Not sure where to go next....is this nephrogenic DI? Congenital DI? Patient currently on phenylpropranolamine for incontinence and some water restriction. Any suggestions? Thanks in advance for your help!

Is the calcium normal?

Was it by ria or ed?

Diabetes Insipidus? 96-11-03 Felinefine I'm hoping for some help with a strange case. Two year old neutered Great Dane with 6 month hx of PU/PD. Owners have only had pet 9 months, always seemed to drink alot to them, no prior health hx available. Pet is absolutely normal on PE, CBC, Chem Profile and plain films. Originally presented for urinary incontinence, UA normal except for S.G.=1.004. At that time was drinking freely, owner estimates 10-12 liters per day (weighs 120lbs). Did gradual water deprivation prior to complete withdrawl. With water deprivation, lost 5% body weight in about 30 hours, S.G. peaked at 1.019. Did ADH test later (didn't have vasopressin initially) after 24 hour water deprivation, starting S.G. was 1.015, peaked at 1.017 at 90 minutes after 10 units vasopressin IM. Have not tested for Cushing's as nothing on exam or profile is compatible. Not sure where to go next....is this nephrogenic DI? Congenital DI? Patient currently on phenylpropranolamine for incontinence and some water restriction. Any suggestions? Thanks in advance for your help!

Was there any protein in the urinalysis?

What should she weigh?

Hyperlipidemia and seizures 96-11-06 JFWDVM I apologize in advance for this post's length. I have a 5 yo, M/N Sheltie that presented 5 days ago for seizures. O described the dog as having 2 GM seizures within the prev. 48 hours. At exam, the dog is overweight at 32#, hair coat rough and 'fuzzy'. No other abnormalities on physical. A chem panel and CBC showed elevated cholesterol (386, N=140-210) and amylase (1255 N=300-1200). No anticonvulsant therapy was initiated. Yesterday, we had Buddy in for a thyroid panel, O said he had had 2 additional seizures in the meantime. The sample we took after an 18 hour fast was grossly lipemic, so we included a TG level. Results= TSH=0.24 (N=0.12 to 0.46), fT4=0.8 (N=0.7 to 3.50), and T4=1.5. Triglycerides were 1175 (N=10-82). I scratched diabetes and hypothyroidism off the ruleout list as causes of the fasting hypertriglyceridemia, and am now looking at Cushing's. Today we are doing an LDDS. He now seems to have some abdominal pain, but no GI signs. I'm wondering now about pancreatitis. Buddy has been eating and drinking normally, no vomiting has been observed. I've reviewed the material in the database and the article in Kirk, but am still confused about this one. Are the seizures related to the hyperlipidemia? Should we initiate phenobarb while trying to get to the cause of the elevated lipids? Is this dog suffering from chronic mild pancreatitis secondary to the lipidemia, or is the reverse true? Any thoughts and advice on this case are greatly appreciated. Thanks all. Also posting this to endocrine and neuro board.

Is the dog eating and drinking?

Recent serum chemistry panel (i.e. hyperglobulinemia, etc.)?

Hyperlipidemia and seizures 96-11-06 JFWDVM I apologize in advance for this post's length. I have a 5 yo, M/N Sheltie that presented 5 days ago for seizures. O described the dog as having 2 GM seizures within the prev. 48 hours. At exam, the dog is overweight at 32#, hair coat rough and 'fuzzy'. No other abnormalities on physical. A chem panel and CBC showed elevated cholesterol (386, N=140-210) and amylase (1255 N=300-1200). No anticonvulsant therapy was initiated. Yesterday, we had Buddy in for a thyroid panel, O said he had had 2 additional seizures in the meantime. The sample we took after an 18 hour fast was grossly lipemic, so we included a TG level. Results= TSH=0.24 (N=0.12 to 0.46), fT4=0.8 (N=0.7 to 3.50), and T4=1.5. Triglycerides were 1175 (N=10-82). I scratched diabetes and hypothyroidism off the ruleout list as causes of the fasting hypertriglyceridemia, and am now looking at Cushing's. Today we are doing an LDDS. He now seems to have some abdominal pain, but no GI signs. I'm wondering now about pancreatitis. Buddy has been eating and drinking normally, no vomiting has been observed. I've reviewed the material in the database and the article in Kirk, but am still confused about this one. Are the seizures related to the hyperlipidemia? Should we initiate phenobarb while trying to get to the cause of the elevated lipids? Is this dog suffering from chronic mild pancreatitis secondary to the lipidemia, or is the reverse true? Any thoughts and advice on this case are greatly appreciated. Thanks all. Also posting this to endocrine and neuro board.

Any vomiting?

Make sense?

Hyperlipidemia and seizures 96-11-06 JFWDVM I apologize in advance for this post's length. I have a 5 yo, M/N Sheltie that presented 5 days ago for seizures. O described the dog as having 2 GM seizures within the prev. 48 hours. At exam, the dog is overweight at 32#, hair coat rough and 'fuzzy'. No other abnormalities on physical. A chem panel and CBC showed elevated cholesterol (386, N=140-210) and amylase (1255 N=300-1200). No anticonvulsant therapy was initiated. Yesterday, we had Buddy in for a thyroid panel, O said he had had 2 additional seizures in the meantime. The sample we took after an 18 hour fast was grossly lipemic, so we included a TG level. Results= TSH=0.24 (N=0.12 to 0.46), fT4=0.8 (N=0.7 to 3.50), and T4=1.5. Triglycerides were 1175 (N=10-82). I scratched diabetes and hypothyroidism off the ruleout list as causes of the fasting hypertriglyceridemia, and am now looking at Cushing's. Today we are doing an LDDS. He now seems to have some abdominal pain, but no GI signs. I'm wondering now about pancreatitis. Buddy has been eating and drinking normally, no vomiting has been observed. I've reviewed the material in the database and the article in Kirk, but am still confused about this one. Are the seizures related to the hyperlipidemia? Should we initiate phenobarb while trying to get to the cause of the elevated lipids? Is this dog suffering from chronic mild pancreatitis secondary to the lipidemia, or is the reverse true? Any thoughts and advice on this case are greatly appreciated. Thanks all. Also posting this to endocrine and neuro board.

Was the bloodwork done after a 12 hour fast?

How many calories/day does she currently get?

Hyperlipidemia and seizures 96-11-06 JFWDVM I apologize in advance for this post's length. I have a 5 yo, M/N Sheltie that presented 5 days ago for seizures. O described the dog as having 2 GM seizures within the prev. 48 hours. At exam, the dog is overweight at 32#, hair coat rough and 'fuzzy'. No other abnormalities on physical. A chem panel and CBC showed elevated cholesterol (386, N=140-210) and amylase (1255 N=300-1200). No anticonvulsant therapy was initiated. Yesterday, we had Buddy in for a thyroid panel, O said he had had 2 additional seizures in the meantime. The sample we took after an 18 hour fast was grossly lipemic, so we included a TG level. Results= TSH=0.24 (N=0.12 to 0.46), fT4=0.8 (N=0.7 to 3.50), and T4=1.5. Triglycerides were 1175 (N=10-82). I scratched diabetes and hypothyroidism off the ruleout list as causes of the fasting hypertriglyceridemia, and am now looking at Cushing's. Today we are doing an LDDS. He now seems to have some abdominal pain, but no GI signs. I'm wondering now about pancreatitis. Buddy has been eating and drinking normally, no vomiting has been observed. I've reviewed the material in the database and the article in Kirk, but am still confused about this one. Are the seizures related to the hyperlipidemia? Should we initiate phenobarb while trying to get to the cause of the elevated lipids? Is this dog suffering from chronic mild pancreatitis secondary to the lipidemia, or is the reverse true? Any thoughts and advice on this case are greatly appreciated. Thanks all. Also posting this to endocrine and neuro board.

What was the lipase?

Anyone have some good lit references on this?

Pancreatitis/Diabetes 96-11-25 Fixapet i was presented with a male castrated corgi, 11 years old, previously uneventful health history, current on vaccines, heartworm prevention, on 11/13 with a complaint of not being 'right' for about one month, mild weight loss, and vomiting of 2 days duration. PE: dehydrated, depressed, possible anterior abdominal mass - radiographs suspicious of same. Pending lab work he was started on IV fluids with dextrose. He had lost 9 lbs (31 to 22), some of which was due to dehydration. next Am received lab work: CBC - PCV 51, TP 7, WBC 20,100. mature neutrophilia, left shift (3015) SMAC: glucose 399, bili 2.2 alk phos 3720, alt 1163, ast 637, chol. 487, K 3.1, sodium 135, chloride 93. AM glucose was 551. U/A - 4+ glucose, 2+ ketones, abdominal ultrasound: peritonitis, pancreatitis (with possible granuloma formation) and enteritis. Clotting factors were normal. He weighs about 25 lbs. and has received Ampicillin 250mg IM BID, Baytril 34 mg IM BID, Pepcid 12 mg BID, Chlorpromazine 2.5mg BID, regular insulin hourly until his blood glucose dropped to below 200, then 5 units regular insulin IM.BID. His blood sugar regulated easily and he was switched to NPH insulin 10 units subq BID. After 48 hours his blood sugar reamined WNL with no insulin. He began eating, and gradaully his glucose began to rise, (reached 386) yesterday, so we re-instituted NPH at 6 units BID. His WBC has remained around 40,000. with a left shift (1200-1800) consistently despite antibiotic therapy. Her serum proteins declined and were treated with hetastarch initially and then a plasma transfusion. Clincially he appears improved, he is eating, brighter, no longer vomiting and tolerating his medications orally. However his blood work remains dismal: Latest results are bili 11.2, alk phos. 3290, alt 734, ast 424, albumin 1.6 (prior to plasma), I added Flagyl 125mg BID yesterday. His PCV has been slowly declining (PCV 28/TP4.2 on 11/21) but took a dramatic drop over the weekend (PCV 18, TP 3.8) I am going to transfuse him today, but where should I go from here? Thanks in advance for your help. Janet McKim DVM

Has the ketoacidosis resolved?

Can you post the actual ultrasound report?

Re: Depo-provera and spraying 96-12-29 DRDOG Diana, yes,Depo-provera has been used for this and also many other problems in the cat and dog,but YES,it does have many potential side-effects. I would not recommend it's use unless everything else failed. You might also w to post this on the pharmacology board for more info from them,and also look up the drug in Plumb's Drug Handbook in the extended Database. Steve

Is it actually spraying?

Have you performed a fructosamine?

Re: Depo-provera and spraying 96-12-29 DRDOG Diana, yes,Depo-provera has been used for this and also many other problems in the cat and dog,but YES,it does have many potential side-effects. I would not recommend it's use unless everything else failed. You might also w to post this on the pharmacology board for more info from them,and also look up the drug in Plumb's Drug Handbook in the extended Database. Steve

Against a wall or particuar object?

What are the pupillary light refexes like?

Re: Depo-provera and spraying 96-12-29 DRDOG Diana, yes,Depo-provera has been used for this and also many other problems in the cat and dog,but YES,it does have many potential side-effects. I would not recommend it's use unless everything else failed. You might also w to post this on the pharmacology board for more info from them,and also look up the drug in Plumb's Drug Handbook in the extended Database. Steve

Is it horizontal or vertical?

And still wonder, at what point do i switch him back to nph?

Re: Depo-provera and spraying 96-12-29 DRDOG Diana, yes,Depo-provera has been used for this and also many other problems in the cat and dog,but YES,it does have many potential side-effects. I would not recommend it's use unless everything else failed. You might also w to post this on the pharmacology board for more info from them,and also look up the drug in Plumb's Drug Handbook in the extended Database. Steve

When did it start?

The owners move the insulin around on his body every day?

Re: Depo-provera and spraying 96-12-29 DRDOG Diana, yes,Depo-provera has been used for this and also many other problems in the cat and dog,but YES,it does have many potential side-effects. I would not recommend it's use unless everything else failed. You might also w to post this on the pharmacology board for more info from them,and also look up the drug in Plumb's Drug Handbook in the extended Database. Steve

When was it castrated or is it castrated?

Is the food at the same time as the insulin is given?

Re: pu/pd Rottweiler 96-12-12 Ozvet Shred, Are you continuing with the water deprivation test (don't forget to check her BUN frequently). If so, once 5% of body weight has been lost without adequate urine concentration, administration of aqueous vasopressin would be the next step. I would also do bile acids to investigate hepatic failure.

Did you withdraw water slowly over several s before taking away completely?

Sometimes these inguinal areas do regrow after a while, but it takes time; when was the change to z/d made?

Anxious Cat 96-12-17 LSidney I have a client with a feral cat that she has had for three years and still cot get near because he is so scared. She wondered if giving him anti-anxiety drugs for a month may help him to become more used to them. She can give him pills in food. Would you go with Buspirone, amitrip., or something else? Also could you tell me where I could find these dosages? Finally, I have another client with a cat on Buspar for spraying. It has worked although he could not come off of it without sprayiong again, so he has been on almost a year. He has now developed diabetes mellitus. Any connection? Thanks for your help.

Buspirone is used at 2.5-7.5 mg per cat bid - amitriptyline is used at approximately 5 mg per cat per day and fluoxetine at .5 -1 mg/cat per day - use each drug for a week or two at least to determine its effect - there appears to be no relationship between diabetes and buspirone in the human or veterinary literature - check with pharmacology - its more likely that the diabetes would contribute to inappropriate elimination - was it emerging when the spraying started?

Where is the potassium being measured?

PU/PD? 96-12-10 Jebbie1 I have a patient that is a 10 yr, SF, schnauzer. The owner has observed excessive water consumption for over 6 months now. I have screened this dog for cushings with the ACTH stim and received normal results. UA is WNL, spec grav 1.020 or greater, (at least 6 UA's, weeks apart), no glycosuria, no ketouria. Blood glucose has been below 160 mg/dl on three separate occasions and were compared with UA simultaneously. But today, bg of 300 and ug off the chart. Waiting to discuss meal coincidence with owner. In the meantime, I plan to take serial bg's at four hour intervals, and pending the findings, hospitalize patient overnight and possibly do a glucose curve arrow after am insulin administration. what do you think? I've never had DM be so hard to catch before. I appreciate any comments you may have. Thanks,

When was the first acth stim performed and what were the results?

Do you have prior results?

PU/PD? 96-12-10 Jebbie1 I have a patient that is a 10 yr, SF, schnauzer. The owner has observed excessive water consumption for over 6 months now. I have screened this dog for cushings with the ACTH stim and received normal results. UA is WNL, spec grav 1.020 or greater, (at least 6 UA's, weeks apart), no glycosuria, no ketouria. Blood glucose has been below 160 mg/dl on three separate occasions and were compared with UA simultaneously. But today, bg of 300 and ug off the chart. Waiting to discuss meal coincidence with owner. In the meantime, I plan to take serial bg's at four hour intervals, and pending the findings, hospitalize patient overnight and possibly do a glucose curve arrow after am insulin administration. what do you think? I've never had DM be so hard to catch before. I appreciate any comments you may have. Thanks,

Any other signs compatible with cushing's?

How many calories/day does she currently get?

Re: DI? 96-12-09 ENDONUT Gary, Before doing a modified water deprivation test, I would test the dog for Cushing's despite the ALP being normal, since this would be the more common cause at this age of PU/PD. Abdominal radiographs/ultrasound and urine culture would help to exclude kidney disease although it is very uncommon to find a CRF patient with dilute urine and not be azotemic. I would at least culture the urine as pyelonephritis animals may not be azotemic. Keep us posted...Tom

What were the results of your serum chemistry?

How is the addison's being treated?

Re: DI? 96-12-09 ENDONUT Gary, Before doing a modified water deprivation test, I would test the dog for Cushing's despite the ALP being normal, since this would be the more common cause at this age of PU/PD. Abdominal radiographs/ultrasound and urine culture would help to exclude kidney disease although it is very uncommon to find a CRF patient with dilute urine and not be azotemic. I would at least culture the urine as pyelonephritis animals may not be azotemic. Keep us posted...Tom

What were your acth stim results?

Is there significant discomfort?

Re: DI? 96-12-09 ENDONUT Gary, Before doing a modified water deprivation test, I would test the dog for Cushing's despite the ALP being normal, since this would be the more common cause at this age of PU/PD. Abdominal radiographs/ultrasound and urine culture would help to exclude kidney disease although it is very uncommon to find a CRF patient with dilute urine and not be azotemic. I would at least culture the urine as pyelonephritis animals may not be azotemic. Keep us posted...Tom

How is the dog feeling now?

Any way to just get that one?

Re: Flax Seed Oil, Revisited 97-01-27 DermaPet I use 1 teaspoon for every 10 kg in my PetS'l'ami. This dose was given to me by Karen Campbell of the University Of Illinois who did work on flax seed oil. It is an excellent source of omega 3 and 6 Fatty acids.

However, i wonder what you mean by flax seed interfering with the aa cascade and not providing any anti-inflamaotry substitutes?

Is there any chance  you can post the full blood work from may?

CHF/Isosthenuria 93-04-30 21:36:19 Gator

What is the age and breed of the dog?

Make sense?

CHF/Isosthenuria 93-04-30 21:36:19 Gator

What is the nature of the chf?

How long has she been on the 3 units bid now?

CHF/Isosthenuria 93-04-30 21:36:19 Gator

On any medications?

Is this cat pu/pd, losing weight or is he obese?

Re: CHF of 8yr, MN, DLH 94-07-25 L Bill, Here's the short version, the cardio folks will add more though: stop the digoxin if the rhythm is normal and consider more Lasix if the cat isn't dehydrated. Probably want to add diltiazem or beta blocker before considering Enacard. Have you checked the T4?

Sick cats can have what looks to be thickened ventricular walls when dehydrated -- was the left atrium enlarged?

Does her perineal conformation appear normal to you?

Re: CHF of 8yr, MN, DLH 94-07-25 L Bill, Here's the short version, the cardio folks will add more though: stop the digoxin if the rhythm is normal and consider more Lasix if the cat isn't dehydrated. Probably want to add diltiazem or beta blocker before considering Enacard. Have you checked the T4?

Much of what you say suggests you have the correct diagnosis -- can you assess blood pressure?

Has the owner's glucometer been checked for accuracy?

Re: CHF of 8yr, MN, DLH 94-07-25 L Bill, Here's the short version, the cardio folks will add more though: stop the digoxin if the rhythm is normal and consider more Lasix if the cat isn't dehydrated. Probably want to add diltiazem or beta blocker before considering Enacard. Have you checked the T4?

Was there any evidence of chf on radiographs?

If this whole thing began when the owner changed from the food with the potato in it, can w just go back to that food?