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Saturday, February 7, 2009

Both the vet and the client

Soon before I left NYC, my cat's diabetes became quite uncontrolled. His previously controlled blood glucose became consistently high, and could not be regulated, even with increasing doses of insulin. This is called insulin-resistance. While he didn't have "text-book" insulin resistance, I knew something was awry.
Diabetic cats' insulin requirements can dramatically increase when they have a concurrent illness. Things to rule out are: urinary tract infections (including pyelonephritis), chronic pancreatitis, hyperadrenocorticism (Cushing's), acromegaly (increased production of growth hormone), dental disease, heart disease, and different types of cancer.
So I brought him to the hospital where I was working, performed full-body radiographs: normal. Full CBC, chemistry, T4, urine cortisol-creatinine ratio, feline PLi, urinalysis, and urine culture - all perfectly normal. Hmm....
There was not a clue as to what was going on. While a little frustrated, I knew there was a strong possibility there was still something wrong with Isaac. When I returned to Toronto, I scheduled an ultrasound for him. The ultrasound showed mildly enlarged kidneys, consistent with pyelonephritis (I've already posted twice on this disease). Interestingly, and frustratingly, his previous urinalysis was completely normal - crystal clear - and his culture was negative; not a hint of an infection.
With chronic disease, though, this is still possible and therefore not a complete mystery.
I started Isaac on a 6-8 week course of antibiotics and so far, he's doing great.

Had I not performed the ultrasound, he would likely have deteriorated.

What are the lessons here? 1) To understand that tests are not always diagnostic - of course they can be - and that normal test results do not necessarily ruled out everything.
2) In many cases, further work-ups are necessary. After preliminary tests, this often (but not always) means imaging, such as x-radiography, ultrasound, MRI (magnetic resonance imaging) or CT (computed tomography).
3) Sometimes, even specialists (in medicine, too!), cannot achieve diagnoses - there are true mystery illnesses.
4) Follow your suspicions: in this case, there was some, but not overwhelming, evidence that Isaac was sick. I was most probably right.

Isaac's diagnosis of pyelonephritis is strongly suspected, but is still not confirmed. I am now both the client and the veterinarian, and will just have to be patient for now....

Will Isaac have to go back?


GoLightly said...

Good golly, best of luck with that.

Brings to mind another silly question of mine. Sorta like the hip dsyplasia musing, why are boy cat's kidneys and pee-pees so um, not right, and why is diabetes so common in cats?
I just muse aloud sometimes. Sorry.

Best of Luck with Isaac.

I've read, and heard, and kinda believe, vets make the worst clients. James Herriot made a lot of sense to me:)
My DVM loves her pets to bits. Agonizes over their troubles and treatments. In a good way, don't get me wrong.

I enjoy my ignorance, sometimes:):)
I think Isaac's pretty darned lucky, myself.
At least you care about him.

My dog is going through chronic (4 years) tummy troubles. Just found out last week that her relatives, some, have the same issues. One was giardia, one wasn't giardia, some had diarrhea (not flip) all ate poop after they were sick.

ALL nauseated to the extreme.
I think Flip is sensitive to cigarette smoke, but husband won't buy it. Yeah, I KNOW.
I should ask all these relative folks if they smoke.

All eating poop, like Flip started to do, after her last bout. Like she was addicted to it or something. Weird.
I think, I don't want to know what's wrong sometimes.

No, that sounds wrong. I wish I could spend enough to really figure it out, but I know it may never be figured out, and I go back to ignorance, bliss, again. She's such an odd duck, anyway. The dog. Well, me too.
She is just fine between bouts. Long time frame between bouts. Healthy and happy and shiny coated just thinner,but not bad thin, now.

It's the sleep deprivation she puts me through, intermittently, but anyway..

You can't stop a dog in the midst of a rewarding behaviour. They do get sick from eating stuff they shouldn't. Flip was a kennel dog, before I got her.

If I don't watch her every move, she's looking for stuff to predate, i.e. stalk and eat. Moles and snakes and turtles mostly, fearless herder dog. (beaten up by sheep, FAIL as herder)
She has bad hips. They must bother her.
I think, she needs a shrink.

Anyway, sorry for the long ramble, NOT looking for a diagnosis, at all.
Believe me, I've done mostly what all can be done.
I haven't gone looking for another opinion. My vets are like WTF?
So am I.
My animals, they always get SOMEthing.

Just a musing on why and how they manage to get sick. And how little we can actually do, sometimes, to help them.

I'm just taking your mind off Isaac, you're doing all that you can. What more can you do?

Relax, have some fun, 'k?
Isaac will be happy, that you are.

Mel said...

Eep! In geriatrics with chronic issues, I pretty much always assume subclinical infection if something starts going awry all of a sudden. Largely I base this on experience and my 89-year-old grandmother, who starts having arrhythmias and syncope whenever she gets a UTI. That and my diabetic ex, whose regulation always went to hell when he got sick.

petdoctorforum said...

i love your blog.
I a vet and blog at bit too but most of my blogging is non-vet subject,,,..anyway , love your blog.
Ive launched a forum in the last few days, its its got a public pet area and a private (vin like but free) vet area...
please come and check it out, post some comments, or review it on your blog!!