Traci, I appreciate all the effort and patience you're putting into this!
Looking at the feline normal ranges you have on this site, they look so similar to the values I have for Tommy - Tommy's must be in Traditional units, not SI, despite what they told me. It doesn't surprise me, I get misinformation here all the time.
I will print out the charts you have on here and give them to her for reference. Tommy's values are mostly in the normal feline range but differ for BUN, WBC, albumin and bilirubin, where they are slightly higher or lower. If I give her your feline normal ranges we could hopefully come to a correct diagnosis for Tommy.
I apologize if this is all very difficult to explain, and me being not too bright myself with these things!
One thing I'm sure about: there are no feline normal reference values available here. If there were, the vets would use them. They are just not organised here (yet), and this is is all too new still, only 10 years ago there was hardly anybody having cats as pets, and they are still the minority of animals that are brought to the vet. And cat owners that want bloodwork done .... oh, once in a blue moon, I guess.
But what now really puzzles me is that Tommy shows no sign of apparent diabetes anymore. He doesn't drink a lot, nor pees a lot, and has loads of energy. Could this already be due to the new diet (low fat food and no bread anymore)? Also, we got the glucose testing strips this afternoon and I managed to test his urine once (cause he peed only once the whole day!), and it was negative, no change of colour whatsoever! But admittedly that was 7 hours after he had last eaten, so maybe itwas to be expected anyway.
I just hope this high glucose value was a false alarm!
Tommy has diabetes
Re: Tommy has diabetes
Well the problem with that approach is with the glucose.
If Tommy's glucose, even in Traditional Units is 324, this is way out of normal range for a cat, meaning it is too high. The unit of measurement is important when getting correct values for cats. If your vet is using human reference ranges and odd units, and she portrays that onto Tommy, and then she treats diabetes based on humanvalues or units, then this would be a dangerous thing to do.
She needs to use either correct SI units or correct Traditional units, (important to use the correct units of measurement) either way. I have no idea what she is referring to when she uses "mgm". She needs to start with either SI units of mmol/L or Traditional units of mg/dL:
mg/dL = milligrams per deciliter (Traditional units for measuring Glucose, BUN, Creatinine)
mmol/L = millimoles per liter (SI units for measuring Glucose and BUN)
umol/L = micromoles per liter (SI units for measuring Creatinine)
So, your vet should call the human lab and ask if any vet has submitted normal reference ranges for cats or dogs, and if not, ask them where to get them (the human lab may even have a number to call or a laboratory to call to get them)
If Tommy's glucose, even in Traditional Units is 324, this is way out of normal range for a cat, meaning it is too high. The unit of measurement is important when getting correct values for cats. If your vet is using human reference ranges and odd units, and she portrays that onto Tommy, and then she treats diabetes based on humanvalues or units, then this would be a dangerous thing to do.
She needs to use either correct SI units or correct Traditional units, (important to use the correct units of measurement) either way. I have no idea what she is referring to when she uses "mgm". She needs to start with either SI units of mmol/L or Traditional units of mg/dL:
mg/dL = milligrams per deciliter (Traditional units for measuring Glucose, BUN, Creatinine)
mmol/L = millimoles per liter (SI units for measuring Glucose and BUN)
umol/L = micromoles per liter (SI units for measuring Creatinine)
So, your vet should call the human lab and ask if any vet has submitted normal reference ranges for cats or dogs, and if not, ask them where to get them (the human lab may even have a number to call or a laboratory to call to get them)
..........Traci
No, my vet did not choose the humane reference ranges, the lab has them pre-printed on the sheet of paper, and the actual values from the test performed are printed next to those figures. The report sheets have two columns, one for Tommy's values, and one for 'Normal range' (which we found out are human values).
My vet also didn't choose the weird mgm units. That too is printed on the sheet. In fact there it says "mgm %". Other values have "gms", "gm%", "mm/hr", "IU/L", etc. I really believe these to be your Traditional units, because I know how thinks work here. Indians don't bother much with details, they butcher the English language all the time, even in official government papers, and people who have studied and should no better. You come across all kinds of oddities, weird ways of spelling, wrong abbrevations ... I think the 'mgm %' is just one of those and is in fact your mg/dl. I'm pretty sure that if I ask my vet about it she will just shrug and say "mgm, mg/dl, yes, yes, same!" Living here I've learned not to be too fussy about many of these inconsistencies. I know this sounds weird, and my German brain doesn't like it either, but India really works like that.
What bothers me more is that she didn't even seem to know that there are feline reference values. This is the kind of carelessness you come across here all the time. Things are done "approximately", not exactly.
I will definitely talk to her about that - my guess is that when she studied, there were no feline reference values available at all, no Internet yet, and they were told to use human values for reference and that normal feline values are slightly lower, or something like that. I don't think my vet is stupid - she seems to be a bright enough woman and I respect her. You have to keep in mind with how little they have to manage here - no special animal facilities, not much equipment for diagnosis, and no money to set all this up. Like your suggestion that vets should test 100-200 cats to acquire a normal feline reference chart - there's is simply no money to do such things. Even the RSPCA doesn't have that money, if you see in what kind of premises they are operating and trying to treat hundreds of street dogs, you'd just shake you head in disbelieve. They haven't even covered the basics in animal care, let alone advanced techniques.
But I don't want to go on another rant.
I will definitely talk to her about all this. As for Tommy's high glucose, I tend to think there was a mistake. He shows no signs of diabetes now. The weather has changed and it is cooler, and he drinks completely normal amounts, and pees twice a day at most. We will certainly continue testing his glucose - with the strips, then another blood AND urine testing.
I understand why you are doubtful about the units of the glucose value. But the values on the two tests for the dogs are completely normal, 62 and 65, and the same units have been used there. So, using only common sense now, I would say either there has been a mistake while testing Tommy's glucose level, or it was really his value at that time. I tend to think the units are correct Traditional units.
My vet also didn't choose the weird mgm units. That too is printed on the sheet. In fact there it says "mgm %". Other values have "gms", "gm%", "mm/hr", "IU/L", etc. I really believe these to be your Traditional units, because I know how thinks work here. Indians don't bother much with details, they butcher the English language all the time, even in official government papers, and people who have studied and should no better. You come across all kinds of oddities, weird ways of spelling, wrong abbrevations ... I think the 'mgm %' is just one of those and is in fact your mg/dl. I'm pretty sure that if I ask my vet about it she will just shrug and say "mgm, mg/dl, yes, yes, same!" Living here I've learned not to be too fussy about many of these inconsistencies. I know this sounds weird, and my German brain doesn't like it either, but India really works like that.
What bothers me more is that she didn't even seem to know that there are feline reference values. This is the kind of carelessness you come across here all the time. Things are done "approximately", not exactly.
I will definitely talk to her about that - my guess is that when she studied, there were no feline reference values available at all, no Internet yet, and they were told to use human values for reference and that normal feline values are slightly lower, or something like that. I don't think my vet is stupid - she seems to be a bright enough woman and I respect her. You have to keep in mind with how little they have to manage here - no special animal facilities, not much equipment for diagnosis, and no money to set all this up. Like your suggestion that vets should test 100-200 cats to acquire a normal feline reference chart - there's is simply no money to do such things. Even the RSPCA doesn't have that money, if you see in what kind of premises they are operating and trying to treat hundreds of street dogs, you'd just shake you head in disbelieve. They haven't even covered the basics in animal care, let alone advanced techniques.
But I don't want to go on another rant.
I will definitely talk to her about all this. As for Tommy's high glucose, I tend to think there was a mistake. He shows no signs of diabetes now. The weather has changed and it is cooler, and he drinks completely normal amounts, and pees twice a day at most. We will certainly continue testing his glucose - with the strips, then another blood AND urine testing.
I understand why you are doubtful about the units of the glucose value. But the values on the two tests for the dogs are completely normal, 62 and 65, and the same units have been used there. So, using only common sense now, I would say either there has been a mistake while testing Tommy's glucose level, or it was really his value at that time. I tend to think the units are correct Traditional units.
Re: Tommy has diabetes
Sorry, but I disagree, even if they were either traditional or SI, they are off, and if they aren't feline values, none of them are doing you any good.
Don't dismiss requesting your vet to call the human lab and discuss with them what units were used....it doesn't matter if it's traditional or SI, it's the units of measurement that are the most important...from there, one could actually convert them. But, you still need feline reference values to refer to.
This is just one example of how technology advances. If the vets in India aren't experienced, it's time for them to learn. If they're going into the profession, they will learn sooner or later that catching up with the rest of the world will put a demand on them, both from the industry and the clients who pay them to care for their pets.
Don't dismiss requesting your vet to call the human lab and discuss with them what units were used....it doesn't matter if it's traditional or SI, it's the units of measurement that are the most important...from there, one could actually convert them. But, you still need feline reference values to refer to.
This is just one example of how technology advances. If the vets in India aren't experienced, it's time for them to learn. If they're going into the profession, they will learn sooner or later that catching up with the rest of the world will put a demand on them, both from the industry and the clients who pay them to care for their pets.
..........Traci
Re: Tommy has diabetes
You're absolutely right. They should learn and I hope my vet is willing to do so.
I will make another appointment with her. Thanks for all this so far!
I will make another appointment with her. Thanks for all this so far!
I called her and it turns out you were right and I was wrong in assuming that those units are Traditional units! They are not SI units either (she must have just guessed that the other day), but are "mgm percentage units, that's we use here all the time, for humans as well" (her words), obviously the Indian system. She doesn't know how they are converted into mg/dl units, I could call the lab she said, they might know.
It gets better. I also was very wrong indeed assuming that there are no feline reference charts available here!
But she has not looked at them yet She thinks the second column in the test are canine normal ranges, which "only marginally differ from those for cats". I pointed out that as far as I know they DO differ and to please use the ones specifically for cats. She said she will do that and invited me to come to her clinic and check them out for myself. I might do that to see if they use the same mgm percentage units.
So, I think now I feel a little bit better.
I'm sorry I was assuming too much and created unneccessary problems! In my defence, that both the vet and the lab said they were SI units didn't help much!
It gets better. I also was very wrong indeed assuming that there are no feline reference charts available here!
But she has not looked at them yet She thinks the second column in the test are canine normal ranges, which "only marginally differ from those for cats". I pointed out that as far as I know they DO differ and to please use the ones specifically for cats. She said she will do that and invited me to come to her clinic and check them out for myself. I might do that to see if they use the same mgm percentage units.So, I think now I feel a little bit better.
I'm sorry I was assuming too much and created unneccessary problems! In my defence, that both the vet and the lab said they were SI units didn't help much!
Re: Tommy has diabetes
Well, she just called me and said she had looked at the normal values for cats, she read some to me and we discussed this, until she mentioned that they are from an American book, and the units are in mg/dl! So I pointed out that the lab obviously used different units, and how does she know that they are the same or at least similar. There was stunned silence. Obviously she never thought to question this discrepancy, just assumed they are the same? I asked her to please talk to the lab and find out how these two units relate ... She became a bit short and impatient with me then but said she will call them tomorrow. She actually said "The VALUES are the same (ranges), only the UNITS are different, and that doesn't matter."
Tommy has not gone for a pee the whole day! He must have gone before we woke up. Now it's evening. Can they hold it in so long? I soaked his dry food in water now. Is he intimidated by me watching him all the time?
Tommy has not gone for a pee the whole day! He must have gone before we woke up. Now it's evening. Can they hold it in so long? I soaked his dry food in water now. Is he intimidated by me watching him all the time?
Re: Tommy has diabetes
Ash, it is up to her to check with the human lab and to ensure that the lab is using correct units of measurement for animals, not humans. If the human lab isn't doing that, then it is up to the vet (or group of vets) to ensure that the human lab has a guideline in which to determine appropriate units of measurements and then to compare results with cat or dog reference ranges.
I would think there is a professional micobiologist in your area that your vet (or any other vet there) could consult in which to get this process corrected. If she claims she's using an American reference, she still needs to use correct units of measurement to even come close to getting a normal reference range for cats and dogs. (and she is wrong, they do differ). I'm wondering if she even knows SI units at all, let alone, how to convert them. If she's using an American reference, then it would clearly provide that information for her (unless it is very old text and outdated)
Can you call other vets in the area and ask them questions about this? Try to find out what references they use, if they have dog and cat reference ranges, if they use Traditional or SI units, and most important, if they consult a pro microbiologist to determine these things.
I would think there is a professional micobiologist in your area that your vet (or any other vet there) could consult in which to get this process corrected. If she claims she's using an American reference, she still needs to use correct units of measurement to even come close to getting a normal reference range for cats and dogs. (and she is wrong, they do differ). I'm wondering if she even knows SI units at all, let alone, how to convert them. If she's using an American reference, then it would clearly provide that information for her (unless it is very old text and outdated)
Can you call other vets in the area and ask them questions about this? Try to find out what references they use, if they have dog and cat reference ranges, if they use Traditional or SI units, and most important, if they consult a pro microbiologist to determine these things.
..........Traci
Re: Tommy has diabetes
I'm not sure I will have any luck there. There are not many small animal vets here. This is all getting a bit too much for me at the moment. My head is just spinning ...
She said she will call the lab to find out how the units they use correspond with the American units in her book. (They were Traditional units btw.)
She said she will call the lab to find out how the units they use correspond with the American units in her book. (They were Traditional units btw.)
I have spent the last days researching the "mgm %" units mystery. I didn't get anywhere (weekend!), until I remembered a Sri Lankan friend of mine who's a pediatrician. He sent me this:
"It is simple.
1st: 'm' stands for milli
then: 'gm' stands for grammes (making mgm = milligrammes)
then: % = decilitre, that is 100 ml, or one tenth of a litre (1000ml)
So you can now hopefully work the reason for using 'mgm %'.
So what you need to know is that your cats blood sugar is 324 mg/dl, his creatinine is 2.0 mg/dl, and his BUN is 56mg/dl."
In the meantime, my vet has spoken to the lab technician and he said the same thing.
So, I think we can now safely use the American feline reference charts which are in this unit.
Since the urine tests we did with the sticks indicated no presence of sugar whatsoever (we tested him 5 times), we will now do a full urine test at the lab, and then another blood test.
"It is simple.
1st: 'm' stands for milli
then: 'gm' stands for grammes (making mgm = milligrammes)
then: % = decilitre, that is 100 ml, or one tenth of a litre (1000ml)
So you can now hopefully work the reason for using 'mgm %'.
So what you need to know is that your cats blood sugar is 324 mg/dl, his creatinine is 2.0 mg/dl, and his BUN is 56mg/dl."
In the meantime, my vet has spoken to the lab technician and he said the same thing.
So, I think we can now safely use the American feline reference charts which are in this unit.
Since the urine tests we did with the sticks indicated no presence of sugar whatsoever (we tested him 5 times), we will now do a full urine test at the lab, and then another blood test.