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Cat Forum / Cat Anecdotes / March 2005Need Opinions (Long)
My 14-year-old (will be 15 on April 8), Bandit, just went in for a dental cleaning today. She had just had a geriatric exam on December 12 and her creatinine and BUN have gone up since then (the vet said she is not concentrating her urine as well as when she was younger). I'm worried that these is (to me) a big jump in creatinine and BUN and that it is too high, but the vet said these figures are normal for her age (and none of my cats have ever been ill - Bandit is the oldest, so I know *NOTHING* about these things). To give anyone who is informed enough information, I'll post all her lab results in case there are other things that need to be factored in, then ask my question at the bottom of this post. From December 12, 2004: (What | Bandit's Values | Normal Range) AST (SGOT) | 27 | 10 - 100 IU/L ALT (SGPT) | 57 | 10 - 100 IU/L Total Bilirubin | 0.1 | 0.1 - 0.4 mg/dL Alkaline Phosphatase | 39 | 6 - 102 IU/L GGT | 1 | 1 - 10 IU/L Total Protein | 8.3 | 5.2 - 8.8 g/dL Albumin | 3.7 | 2.5 - 3.9 g/dL Globulin | 4.6 | 2.3 - 53 g/dL A/G Ratio | 0.8 | 0.35 - 1.5 Cholesterol | 270 HIGH | 75 - 220 mg/dL BUN | 36 | 14 - 36 mg/dL Creatinine | 1.9 | 0.6 - 2.4 mg/dL Phosphorus | 5.1 | 2.4 - 8.2 mg/dL Calcium | 10.3 | 8.2 - 10.8 mg/dL Glucose | 10.3 | 8.2 - 10.8 mg/dL Amylase | 1206 HIGH | 100 - 1200 IU/L Lipase | 111 | 0 - 205 IU/L Sodium | 159 HIGH | 145 - 158 ,Eq/L Potassium | 4.8 | 3.4 - 5.6 mEq/L na/K Ratio | 33 | 32 - 41 Chloride | 122 | 104 - 128 mEq/L CPK | 109 | 56 - 529 IU/L Triglyceride | 93 | 25 - 160 mg/dL Osmolality, Calculated | 338 HIGH | 299 - 330 mOSm/kg Magnesium | 1.7 | 1.5 - 2.5 mEq/L WBC | 10 | 3.5 - 16.0 10^3/uL (that's not a "u", but my keyboard can't recreate that character) RBC | 9.1 | 5.92 - 9.93 ^6/uL (the "^" means to the power of) HGB | 13.3 | 9.3 - 15.9 g/dL HCT | 46 | 29 - 48% MCV | 51 | 37 - 61 fL MCH | 14.6 | 11 - 21 pg MCHC | 29 LOW | 30 - 38% Comment | RBC MORPHOLOGY NORMAL Neutrophils | 51 | 35 - 75% Absolute Neutrophils | 5100 | 2500 - 8500 /uL Lymphocytes | 44 | 20 - 45% Absolute Lymphocytes | 4400 | 1200 - 8000/uL Monocytes | 1 | 1 - 4% Absolute Monocytes | 100 | 0 - 600/uL Eosinophils | 4 | 2 - 12 % Absolute Eosinophils | 400 | 0 - 1000/uL Basophils | 0 | 0 - 1% Absolute Basophils | 0 | 0 - 150/uL Platelate Estimate | Adequate T4 (RIA) | 2.12 | 0.8 - 4.0 ug/dL FeLV (ELISA) | Negative | Negative ANTIGEN FIV (ELISA) | Negative | Negative ELISA [Urine] Color | Yellow Appearance | Clear Specific Gravity | 1.03 | 1.015 - 1.060 Ph | 6 | 5.5 - 7.0 Protein | Negative | Negative Glucose-Strip | Negative | Negative Ketones | Negative | Negative Bilirubin | Negative | Negative Occult Blood | Negative | Negative WBC/HPF | None | 0 - 3 RBC/HPF | None | 0 - 3 Casts/LPF | None Observed | Hyaline 0 - 3 Crystals/HPF | None Observed Squamous Eptihelia/HPF | None Observed | None - Few Bacteria | None Observed | None Observed Renal Epithelia/HPF | None Observed | None - Rare Transitional Epithelia/HPF | None Observed | None - Rare From today: (What | Bandit's Values | Normal Range) ALKP | 45 | 14 - 111 U/L ALT | 47 | 12 - 130 U/L BUN | 36.9 HIGH | 16.0 - 36.0 mg/dL Creatinine | 2.8 HIGH | 0.8 - 2.4 mg/dL Glucose | 109 | 76 - 145 mg/dL TP | 7.2 | 5.7 - 8.9 g/dL [Hematology] WBC | 6.76 | 5.50 - 19.50 K/uL Lymphocytes | 2.73 | 0.40 - 6.80 K/uL Monocytes | 0.54 | 0.15 - 1.70 K/uL Neutrophils | 3.08 | 2.50 - 12.50 K/uL Eosinophils | 0.37 | 0.10 - 0.79 K/uL Basophils | 0.05 | 0.00 - 0.10 K/uL % Lymphocytes | 40.3 % Monocytes | 7.9 % Neutrophils | 45.6 % Eosinophils | 5.5 % Basophils | 0.7 CHT | 32.5 | 30.0 - 45.0 % RBC | 7.00 | 5.0 - 10.0 M/uL HGB | 11.6 | 9.0 - 15.1 g/dL RETIC 23.0 K/uL % RETIC | 23.0 K/uL MCV | 46.5 | 41.0 - 58.0 fL RDW | 19.2 | 17.3 - 22.0 % MCHC | 35.5 | 29.0 - 37.5 g/dL MCH | 16.52 | 12.0 - 20.0 pg PLT | 313 | 175 - 600 K/uL MPV | 18.18 fL PCT | 0.6% PDW | 21.4% OK, I need this tranlated into vet lab results for dummies 101 (Phil, Kristi??). Seriously, I don't know from Adam, but it seems like that is a pretty big jump in creatinine and BUN values in just a little over 2 months. Am I wrong to be worried? When Bandit got her results in December the vet told me to start her on SD canned (she's had SD dry all her life and no problems before this). At the same time I got a Drinkwell fountain for her to encourage her to drink. Do you think she should be on a prescription diet? BTW, her teeth and gums were fine, just needed a good cleaning since it's been about 3 - 4 years since the last time she had it done. Any advice or opinions are gratefully welcomed. Hugs, CatNipped > My 14-year-old (will be 15 on April 8), Bandit, just went in for a dental > cleaning today. She had just had a geriatric exam on December 12 and her [quoted text clipped - 23 lines] > BUN | 36 | 14 - 36 mg/dL > Creatinine | 1.9 | 0.6 - 2.4 mg/dL <snipped for brevity> > From today: (What | Bandit's Values | Normal Range) > > ALKP | 45 | 14 - 111 U/L > ALT | 47 | 12 - 130 U/L > BUN | 36.9 HIGH | 16.0 - 36.0 mg/dL > Creatinine | 2.8 HIGH | 0.8 - 2.4 mg/dL <snipped> > OK, I need this tranlated into vet lab results for dummies 101 (Phil, > Kristi??). Seriously, I don't know from Adam, but it seems like that is a > pretty big jump in creatinine and BUN values in just a little over 2 months. > Am I wrong to be worried? Her BUN went up only .9, from 36 (*just* within normal) to 36.9; however, her creatinine jumped a bit more than that, from within the normal range to slightly above. My own take: I would start to be concerned, since her BUN is slightly elevated (36 being high end of normal), & creatinine also (2.4 being high end of normal for this lab). By the time these values for blood work come back high, something like 70 - 75% of renal function has been lost, but at this point it's still enough for her to function okay. However, you're going to want to bone up on CRF, & be pro-active in her treatment in the future, to keep her as healthy as possible for as long as possible. Here's a very useful, clearly written renal failure site, that covers all bases: http://www.felinecrf.org/ I used it a lot when my 2nd cat was in CRF. Cathy > When Bandit got her results in December the vet told me to start her on SD > canned (she's had SD dry all her life and no problems before this). At the [quoted text clipped - 10 lines] > > CatNipped > Her BUN went up only .9, from 36 (*just* within normal) to 36.9; however, > her creatinine jumped a bit more than that, from within the normal range to [quoted text clipped - 15 lines] > > Cathy Thanks, I've just bookmarked it. Hugs, CatNipped Very quick top-posted reply because it's past my bedtime. N?le is a doctor with 6 years medical training who now chooses to practice homeopathic medicine. She is not a vet, but she knows how to interpret blood tests (she did one of mine once when I couldn't get a decent reply about what this and this and this meant from my own doctor) so just in case cats levels are similar to humans - or at least what's normal or not is completely clear from what you posted anyway, I have mailed Bandit's results to her to see if she thinks there's anything to worry about. If she doesn't feel competent enough to give an opinion, she will say so. In that case you are no worse off, and if she does, you'll know one way or the other. Germany is an hour ahead of UK, so she will be fast asleep now. Which is where I should be! She usually responds to medical questions reasonably quickly, so I'll post as soon as she replies. Okay? Tweed > My 14-year-old (will be 15 on April 8), Bandit, just went in for a dental > cleaning today. She had just had a geriatric exam on December 12 and her [quoted text clipped - 135 lines] > > CatNipped > Very quick top-posted reply because it's past my bedtime. > N?le is a doctor with 6 years medical training who now chooses to practice [quoted text clipped - 13 lines] > > Tweed Thanks! Hugs, CatNipped >> Very quick top-posted reply because it's past my bedtime. >> N?le is a doctor with 6 years medical training who now chooses to >> practice >> homeopathic medicine. >> She is not a vet, but she knows how to interpret blood tests {...} She usually responds to medical questions reasonably >> quickly, so I'll post as soon as she replies. Okay? >> [quoted text clipped - 5 lines] > > CatNipped Here is N?le's reply: ... I am indeed no vet and I don't even know what the English abbreviation BUN stands for, but just the fact that the cat was at the upper end of the normal range with both values when the first test was made, and is now slightly above what's considered to be normal, would not let me panick right now. There may just be differences on different days. Creatinine is a fine indicator for the kidney's work, and should be checked again in a couple of month's time. If there are any kidney problems, creatinine will rise long before any symptoms appear. It is clear that in old age the organs will not work as well as they did when the person was young. The "normal" range of blood values here is defined from blood samples of soldiers - young men, aged 20, more or less healthy... I would trust the vet if he told me these are normal values for an elderly cat. N?le .... Hope this helps. Tweed > >> Very quick top-posted reply because it's past my bedtime. > >> N?le is a doctor with 6 years medical training who now chooses to [quoted text clipped - 20 lines] > I am indeed no vet and I don't even know what the > English abbreviation BUN stands for, Blood urea nitrogen. It's more a "background" measurement, where creatinine, and espeecially the calculated or invasively measured creatinine clearance rate, gives a more current indication of actual renal function. ?but just the > fact that the cat was at the upper end of the > normal range with both values when the first test [quoted text clipped - 22 lines] > Hope this helps. > Tweed <big ole snippo> >> Here is N?le's reply: >> ... [quoted text clipped - 6 lines] > creatinine clearance rate, gives a more current indication of actual > renal function. Thanks, Howard. I'll tell her, she'll like to know. Sometimes the language difference can cause difficulties, especially with technical and specialist terms. Tweed > <big ole snippo> > [quoted text clipped - 14 lines] > specialist > terms. Just in case it would help the context, an earlier test was nonprotein nitrogen (NPR). BUN is more specific. While it's rarely needed, there's also a blood ammonia -- primcipally used when either there is suspicion of, or to track, infection by ammonia-secreting bacteria. > My 14-year-old (will be 15 on April 8), Bandit, just went in for a dental > cleaning today. She had just had a geriatric exam on December 12 and her [quoted text clipped - 5 lines] > have ever been ill - Bandit is the oldest, so I know *NOTHING* about these > things). <snipped results> > Do you think she should be on a prescription diet? I would certainly read up on chronic renal failure, but do not become panicked. My brothers cat was diagnosed with CRF a year ago when she was 14 and she is still going strong on a new diet (low protein kidney diet). Like your kitty, she's 15 this year. Her urea was 11.2 (normal high is 10.7) and her creatinine was 196 (high normal is 177). Your kitty, similar to my brothers cat is only showing slightly elevated numbers. Do not become stressed. CRF cats can live for years after diagnosis with proper management. My brothers cat had her levels re-tested in December and everything came back normal... so hopefully the diet is helping. I'm surprised your vet didn't mention a diet change to a kidney diet. Although it is true that kidney problems are common in older cats, this by no means should be an indication that nothing should be done about it. Just my opinion. Kelly > I would certainly read up on chronic renal failure, but do not become > panicked. My brothers cat was diagnosed with CRF a year ago when she was 14 [quoted text clipped - 9 lines] > should be an indication that nothing should be done about it. Just my > opinion. That's what I thought, but my vet said that most cats don't like the kidney diet food and she would rather see a cat eat regular food than not eat kidney diet food. Hugs, CatNipped > Kelly > > I would certainly read up on chronic renal failure, but do not become > > panicked. My brothers cat was diagnosed with CRF a year ago when she was [quoted text clipped - 17 lines] > diet food and she would rather see a cat eat regular food than not eat > kidney diet food. Well, that *can* be true - it was of my CRF cats. Otoh, you could *try* renal diet foods, & see if she likes any of them. Cathy > Well, that *can* be true - it was of my CRF cats. Otoh, you could *try* > renal diet foods, & see if she likes any of them. > > Cathy That's what I thought too and I'm thinking about going back to the vet to pick some up. Along those lines, what would you suggest to make sure it's only Bandit that eats it, or does it matter if the others do too? I have 3 other cats, a 6-year-old, a 5-year-old, and a 10-month-old and they all intermingle. I free feed SD (Senior Advanced Formula and Kitten formula) dry all day long and give SD (Senior Advanced Formula & Adult Formula & Kitten Formula) one can mornings and one can at night. I don't want to have to separate Bandit from her sibs if at all possible. One thing that would help, Bandit tends to stay in my bedroom, preferring to not climb the stairs, so I feed and water her (Drinkwell fountain & several water dishes) in my bedroom, but I keep food and water upstairs for the younger cats also. The only problem is, is that they *all* eat downstairs but only the 3 younger ones eat upstairs too. [BEGGING H+B GROUP (this was crossposted to both rpca and rpch+b in order to get more opinions): Before we get into the SD vs. Wellness debate again, let me say that my vet recommends SD as did the vet before her and the vet before him and the rescue group I work with. All my cats have been healthy all their lives on it, so I'm going with what my vets have recommended unless you can show me where it's not good for Bandit given her recent kidney problems. So please let's not flagellate this deceased equine again! ;>] Hugs, CatNipped > My 14-year-old (will be 15 on April 8), Bandit, just went in for a dental > cleaning today. She had just had a geriatric exam on December 12 and her [quoted text clipped - 8 lines] > these > things). > To give anyone who is informed enough information, I'll post all her lab > results in case there are other things that need to be factored in, then > ask > my question at the bottom of this post. > > From December 12, 2004: (What | Bandit's Values | Normal Range) [snip a bunch of values saying her liver is very healthy] > Cholesterol | 270 HIGH | 75 - 220 mg/dL I'm going to have to extrapolate from human medicine. The elevated cholesterol doesn't worry me in an older creature, as the normal level really tends to go up with age. Total cholesterol alone really doesn't say anything by itself about the state of the circulatory system; you have to know its three major subcomponents, HDL, LDL and triglycerides. > BUN | 36 | 14 - 36 mg/dL > Creatinine | 1.9 | 0.6 - 2.4 mg/dL BUM is less predictive of kidney disease than creatinine. These are values to watch, but not necessarily be concerned about. > Phosphorus | 5.1 | 2.4 - 8.2 mg/dL > Calcium | 10.3 | 8.2 - 10.8 mg/dL > Glucose | 10.3 | 8.2 - 10.8 mg/dL > Amylase | 1206 HIGH | 100 - 1200 IU/L > Lipase | 111 | 0 - 205 IU/L Amylase and lipase are indicators of pancreatic disease, with the amylase coming up first. This slight elevation probably isn't significant, but might be well to watch, given the glucose is at the upper end of the scale. > Sodium | 159 HIGH | 145 - 158 ,Eq/L > Potassium | 4.8 | 3.4 - 5.6 mEq/L [quoted text clipped - 3 lines] > Triglyceride | 93 | 25 - 160 mg/dL > Osmolality, Calculated | 338 HIGH | 299 - 330 mOSm/kg Looking at a number of these values, I'd suspect she was very slightly dehydrated. That could artificially raise many values. It's a tossup, because while the chemistry and hematocrit may suggest blood dehydration, the urine is less concentrated -- which might mean less kidney efficiency. > Magnesium | 1.7 | 1.5 - 2.5 mEq/L [snip essentially normal blood cells and urine] > FIV (ELISA) | Negative | Negative ELISA > [Urine] [quoted text clipped - 8 lines] > BUN | 36.9 HIGH | 16.0 - 36.0 mg/dL > Creatinine | 2.8 HIGH | 0.8 - 2.4 mg/dL Time to start watching. The definitive test would be the creatine clearance rate. In humans, this is usually done with a 24 hour urine sample, which is not very easy to collect from cats. As I understand, the creatinine clearance in cats is done by taking a blood sample, injecting a known quantity of creatinine, waiting a specified time, and measuring how much is left. > OK, I need this tranlated into vet lab results for dummies 101 (Phil, > Kristi??). Seriously, I don't know from Adam, but it seems like that is [quoted text clipped - 10 lines] > > Do you think she should be on a prescription diet? I just don't know how to interpret the trends in cats. Hydration is important. Diet certainly seems a consideration in cats. In humans, there's an increasing tendency to prescribe ACE inhibitors, which are principally drugs for high blood pressure but do protect the kidneys. It is much easier to pill humans. >> My 14-year-old (will be 15 on April 8), Bandit, just went in for a >> dental cleaning today. She had just had a geriatric exam on [quoted text clipped - 8 lines] >> these >> things). (snippage) > It is much easier to pill humans. [tongue in cheek] So say you! A lot of the time I barf my daily meds back up as soon as I swallow which is why I make sure I take them standing over the bathroom sink! Jill > > Cholesterol | 270 HIGH | 75 - 220 mg/dL > I'm going to have to extrapolate from human medicine. The elevated > cholesterol doesn't worry me in an older creature, as the normal level > really tends to go up with age. Total cholesterol alone really doesn't > say anything by itself about the state of the circulatory system; you > have to know its three major subcomponents, HDL, LDL and triglycerides. Yeah, I extropolated that just going by my mom's and grandmother's cholesterol. They are/were both very high, but my grandmother lived to 104 and my mom is 79 and still going full speed ahead. > > BUN | 36 | 14 - 36 mg/dL > > Creatinine | 1.9 | 0.6 - 2.4 mg/dL > > BUM is less predictive of kidney disease than creatinine. These are > values to watch, but not necessarily be concerned about. > Amylase and lipase are indicators of pancreatic disease, with the > amylase coming up first. This slight elevation probably isn't > significant, but might be well to watch, given the glucose is at the > upper end of the scale. Didn't even twig to that. > > Sodium | 159 HIGH | 145 - 158 ,Eq/L > > Potassium | 4.8 | 3.4 - 5.6 mEq/L [quoted text clipped - 9 lines] > dehydration, the urine is less concentrated -- which might mean less > kidney efficiency. They had me fast her from 10:00PM last night but she still had access to water. > > ALKP | 45 | 14 - 111 U/L > > ALT | 47 | 12 - 130 U/L [quoted text clipped - 7 lines] > injecting a known quantity of creatinine, waiting a specified time, and > measuring how much is left. Yep, that's what I thought (about starting to watch it and possibly do some preventative intervention. As I just posted in h+b, I don't know why somebody doesn't invent a flavored bottled water for cats with CRF. Mine lap up the water from canned tuna and beg for more. But at almost a buck a can I can't afford to throw away that much tuna to get enough water for it to make a difference. People in the US alone spend upwards of 30 billion dollars a year on their cats! DH says that it's crazy that nobody would buy bottled water for their cats, but *I* would. Twenty years ago everybody said that people wouldn't buy bottled water for themselves when it comes out of the tap for free, but today bottled water is a multi-billion dollar industry (people spend more for a gallon of bottled water than they do for a gallon of gas in the US!!). I wish I knew how to start up that business!!! I could use a couple of billion dollars!!!!! ;> Hugs, CatNipped "CatNipped" <lcrewsREMOVE@THIShouston.rr.com> had some very interesting things to say about Re: Need Opinions (Long): >As I just posted in h+b, I don't know why somebody doesn't invent a flavored >bottled water for cats with CRF. Mine lap up the water from canned tuna and >beg for more. But at almost a buck a can I can't afford to throw away that >much tuna to get enough water for it to make a difference. I've heard of beef-flavored bottled water for d-pets. Hmmmm, maybe some VERY low-sodium beef or chicken broth, diluted further if needed?  Signature"The universe is quite robust in design and appears to be doing just fine on its own, incompetent support staff notwithstanding. :-)" - the Dennis formerly known as (evil), MCFL > > > Cholesterol | 270 HIGH | 75 - 220 mg/dL > > I'm going to have to extrapolate from human medicine. The elevated [quoted text clipped - 7 lines] > 104 > and my mom is 79 and still going full speed ahead. Simplifying a bit, the total cholesterol is LDL + HDL + (triglycerides/5) Without making more than a passing observation that the terminology could be better, LDL and HDL are both proteins that (low-density) carry cholesterol _to_ the blood vessels, and (high-density) carry cholesterol _away_ from the blood vessels. In general, if you have a sufficient amount of HDL to "cover" the LDL, you are safe from atherosclerosis. A common estinate is the ratio of HDL to total cholesterol. 4-5 means you aren't at any particular risk. You could have a total cholesterol of 300, but with an HDL of 60 or better, you probably are safe. <snipped> > I just don't know how to interpret the trends in cats. Hydration is > important. Diet certainly seems a consideration in cats. In humans, > there's an increasing tendency to prescribe ACE inhibitors, which are > principally drugs for high blood pressure Which reminds me, to the OP (CatNipped) - have her blood pressure checked as the CRF progresses. Many more vets are now equipped to take a cat's bp than even a few years ago (when it was virtually impossible to find a nearyy vet w/ the equipment & training to use the equipment). High blood press. can be regulated with med & so can prevent blindness - retinas can detach with undetected high bp. Cathy but do protect the kidneys. It > is much easier to pill humans. > <snipped> > > I just don't know how to interpret the trends in cats. Hydration is [quoted text clipped - 17 lines] > but do protect the kidneys. It > > is much easier to pill humans. I've wondered about the techniques used. The one time I saw it done by a veterinary cardiologist, he put a cuff around Clifford's tail and measured the systolic. In human intensive care, however, we use Doppler ultrasound transducers, and even simpler pressure wave detectors, to give continuous measurement of systolic and diastolic pressures. > I've wondered about the techniques used. The one time I saw it done > by a veterinary cardiologist, he put a cuff around Clifford's tail and > measured the systolic. Oh no! I sure hope that's not the only way to measure a cat's BP. Vino doesn't have a tail and although he doesn't need to have it measured right now, it might come up in the future. I'd hate to think that tail-less cats are at a disadvantage here! -- Britta Sandpaper kisses, a cuddle and a purr. I have an alarm clock that's covered in fur! Check out pictures of Vino at: http://photos.yahoo.com/badwilson click on the Vino album > > I've wondered about the techniques used. The one time I saw it done > > by a veterinary cardiologist, he put a cuff around Clifford's tail [quoted text clipped - 7 lines] > -- > Britta FWIW, I have only done it on the front leg/paw. -L. > > I've wondered about the techniques used. The one time I saw it done > > by a veterinary cardiologist, he put a cuff around Clifford's tail [quoted text clipped - 6 lines] > that tail-less cats are at a disadvantage here! > -- Nah. I didn't see them do it so I don't know how, but they got a blood pressure reading from my tailless Mikey, so it can be done. ------ Krista > > I've wondered about the techniques used. The one time I saw it done > > by a veterinary cardiologist, he put a cuff around Clifford's tail [quoted text clipped - 5 lines] > measured right now, it might come up in the future. I'd hate to think > that tail-less cats are at a disadvantage here! As I mentioned, it seemed a rather crude technique, especially since he had an ultrasound unit there. > Which reminds me, to the OP (CatNipped) - have her blood pressure checked as > the CRF progresses. Many more vets are now equipped to take a cat's bp than [quoted text clipped - 4 lines] > > Cathy Yep, my vet does, among lots of other neat stuff, for instance, the bill for today included: - Blood pressure monitoring - Circulating hot water blanket - Hospitalization - IV catheter / fluids / surgery - IV extension set - LRS 500 FL bag - Preanesthetic examination - pulse oximeter - IV pump - Weight - Dental Pack - Isofulrane Anesthesia 1/2 hour - Technician time - 20 minutes - CBC inhouse - Ketamine 100 mg/ml - Mini profile with CBC - Biohazard disposal - Level II lab All that for just a teeth cleaning! Oh well, it was cheaper than my last vet who didn't do the preanesthesia, the IV, or a bunch of that other stuff for her last cleaning. Only $183.30 which is *WAY* low for not only a large city like Houston, but a high-scale suburb (The Woodlands). Hugs, CatNipped > > Which reminds me, to the OP (CatNipped) - have her blood pressure > > checked [quoted text clipped - 40 lines] > large > city like Houston, but a high-scale suburb (The Woodlands). Well, with any older patient, general anesthesia is always a risk. In this case, incidentally, the anesthesia was in two phases: injected ketamine to render her either asleep or just not caring, and isoflurane as the prolonged anesthesia. It's quite likely the ketamine was given through the IV. Mr. Clark does have to go in for cleaning, and probably some gum treatment, which gives me an idea. > > Which reminds me, to the OP (CatNipped) - have her blood pressure checked > as [quoted text clipped - 39 lines] > > CatNipped Good, sounds like he's thorough. Cathy > I just don't know how to interpret the trends in cats. Hydration is > important. Diet certainly seems a consideration in cats. In humans, > there's an increasing tendency to prescribe ACE inhibitors, which are > principally drugs for high blood pressure but do protect the kidneys. It > is much easier to pill humans. There's a drug called Fortekor that has been used in the UK for a number of years to protect the kidneys that is also now being prescripted by Doctors in Canada (not sure about the us) which is an ACE inhibitor. Fuga > > I just don't know how to interpret the trends in cats. Hydration is > > important. Diet certainly seems a consideration in cats. In humans, [quoted text clipped - 8 lines] > Doctors > in Canada (not sure about the us) which is an ACE inhibitor. I would think that the ideal ACE inhibitor preparation for cats would be a long-acting injection. Unfortunately, most human ACE inhibitors are twice-daily tablets. Intentionally top posting, so as to not snip all the medical information... 'Nipped, Natasha will be 18 in about 6 weeks, and was diagnosed CRF about 18 months now. While once or twice a year her TED would do all the tests, in the interim she just has tests for creatinine and BUN done. Since we've been monitoring them, Tasha's values for those have maintained slightly out-of-spec high while everything else has been within the proper range. TED says that at Tasha's age nothing works as well as it used to, and that those values are just what's now "normal" for her and (paraphrasing now) that she (TED) isn't going to get too excited about them as long as they continue about where they are. One thing to keep an eye out for - Tasha needed a Dental badly (bad teeth were the suspected source of an increase in the indicators of an infection we were also seeing at that time), but the TED that was seeing her for that didn't want to anesthisize her to do it because her BUN (or was it creatinine? I don't recall which) was higher than usual. I talked him into doing it anyway, and sure enough, after some bad teeth were removed, the infection went away, the BUN went back to "Natasha Normal", and Tasha was wondering what all the fuss was about. purrs for your babies! Jeanne Hedge, as directed by Natasha >My 14-year-old (will be 15 on April 8), Bandit, just went in for a dental >cleaning today. She had just had a geriatric exam on December 12 and her [quoted text clipped - 131 lines] > >CatNipped > My 14-year-old (will be 15 on April 8), Bandit, just went in for a dental > cleaning today. She had just had a geriatric exam on December 12 and her [quoted text clipped - 116 lines] > pretty big jump in creatinine and BUN values in just a little over 2 months. > Am I wrong to be worried? What was is his present PCV or Hct and USG????? TP and USG give a more accurate assessment of renal function than either test alone. Whenever there's such a difference in tests or questionable results - especially in tests run so closely together, I always have the most important tests run again (BUN, Cr., Hct, TP). Phil > What was is his present PCV or Hct and USG????? TP and USG give a more > accurate assessment of renal function than either test alone. > > Whenever there's such a difference in tests or questionable results - > especially in tests run so closely together, I always have the most > important tests run again (BUN, Cr., Hct, TP). Or go to a more sensitive and/or specific test. In a human, one might repeat a slightly abnormal creatinine, probably with the cheaper Basic Metabolic Profile (7 tests) than the Complete Metabolic Profile (24 tests). Still, many clinicians would move quickly to measuring the creatinine clearance rate from a 24 hour urine specimen. Since it's impractical to collect 24 hour urines from a cat, I understand the equivalent procedure: take a baseline blood creatinine level, inject a known quantity of creatinine, wait a timed period, and take another blood sample and measure change. Urine specific gravity (USG) can be a good and simple monitoring test, but remember that getting urine from a cat often is an invasive procedure. As you point out, it's hard to interpret without additional data -- is it low because the kidneys aren't concentrating excretions, or just that the excretions are low? Or could it be off due to dehydration? You may have had the latter in mind when you mentioned Hct. Incidentally, there's a general lesson here. I'd personally find the convenience of getting lab tests (for me) without a prescription, but it's a legitimate concern that, say, one test abnormal value needs to be evaluated in the context of other tests. Doing this takes a certain amount of biochemical and physiological education -- you don't need medical or veterinary school to learn that, but you will have to do some hard study. > > What was is his present PCV or Hct and USG????? TP and USG give a more > > accurate assessment of renal function than either test alone. [quoted text clipped - 8 lines] > tests). Still, many clinicians would move quickly to measuring the > creatinine clearance rate from a 24 hour urine specimen. That might be true for human pts, but most vets and owners would rather rerun the blood test than hospitalize the cat overnight in a metabolism cage. > Since it's impractical to collect 24 hour urines from a cat, I > understand the equivalent procedure: take a baseline blood creatinine > level, inject a known quantity of creatinine, wait a timed period, and > take another blood sample and measure change. For cats, its more practical and less stressful for the cat to just rerun the blood test. > Urine specific gravity (USG) can be a good and simple monitoring test, > but remember that getting urine from a cat often is an invasive > procedure. Voided urine is absolutely acceptable for urine that will not be cultured. Also, cystocentesis is a routine office technique that is not generally considered an 'invasive procedure' for cats although in the strict definition, it is - so is merely drawing blood. As you point out, it's hard to interpret without additional > data -- is it low because the kidneys aren't concentrating excretions, > or just that the excretions are low? Obviously the retest would consist of the renal panel - not creatinine alone. Or could it be off due to > dehydration? You may have had the latter in mind when you mentioned Hct. Right. . > Incidentally, there's a general lesson here. I'd personally find the > convenience of getting lab tests (for me) without a prescription, but [quoted text clipped - 3 lines] > medical or veterinary school to learn that, but you will have to do some > hard study. LOL! I know you mean well - I just found your last statement very funny. ;-) Phil >Voided urine is absolutely acceptable for urine that will not be cultured. >Also, cystocentesis is a routine office technique that is not generally >considered an 'invasive procedure' for cats although in the strict >definition, it is - so is merely drawing blood. I've held the cat as the vet drew urine with a needle. A good operator can do it without causing the cat much apparent distress. He hardly flinched during the procedure. > > > What was is his present PCV or Hct and USG????? TP and USG give a > > > more [quoted text clipped - 13 lines] > rerun the blood test than hospitalize the cat overnight in a metabolism > cage. I specifically said 24 hour urine is not practical in cats, so an alternative is needed. Why rerunning a chem-7/basic metabolic profile shortly after the first would give significant data puzzles me. How quickly would they rerun it, and what would be the predictive power of the multiple determinations over what period of time? With typical CLIA-level controls, a split blood sample should not have clinically significant variation. I must be confused on when you expect to take this second sample. > > Since it's impractical to collect 24 hour urines from a cat, I > > understand the equivalent procedure: take a baseline blood creatinine [quoted text clipped - 3 lines] > For cats, its more practical and less stressful for the cat to just rerun > the blood test. I don't understand the value of doing a repeat serum creatinine shortly after the first. A series over time, yes. Simple repeats, with well calibrated analyzers, shouldn't give substantially different results on specimens close in time. > > Urine specific gravity (USG) can be a good and simple monitoring test, > > but remember that getting urine from a cat often is an invasive > > procedure. > > Voided urine is absolutely acceptable for urine that will not be > cultured. Agreed. I've also tried to capture it, with highly variable success. > Also, cystocentesis is a routine office technique that is not generally > considered an 'invasive procedure' for cats although in the strict [quoted text clipped - 6 lines] > Obviously the retest would consist of the renal panel - not creatinine > alone. And how much time would elapse before this retest? Any food or water? > Or could it be off due to > > dehydration? You may have had the latter in mind when you mentioned [quoted text clipped - 14 lines] > LOL! I know you mean well - I just found your last statement very funny. > ;-) I guess I don't understand your point. Understanding the interactions in renal function tests takes a fairly substantial amount of study of renal physiology, and, at a useful level, that will require a background in biochemistry. If you are going to get into the role of diuretics or ACE inhibitors, you need to have an idea about where they act at a macro level in the kidney (e.g., loop of Henle) and how some of the homeostatic systems work, such as renin-angiotensin. > > LOL! I know you mean well - I just found your last statement very funny. > > ;-) > I guess I don't understand your point. Understanding the interactions in > renal function tests takes a fairly substantial amount of study of renal > physiology, and, at a useful level, that will require a background in > biochemistry. Think so, huh? One does not require a background in biochemistry to question significant variations in results from 2 tests performed so closely together - especially when the variations are in key analytes for renal function. CRF in cats doesn't progress that fast during the early stages of the disease. It takes a substantial amount of experience in working with renal cats to recognize test results that are questionable. > > > LOL! I know you mean well - I just found your last statement very > > > funny. [quoted text clipped - 15 lines] > the disease. It takes a substantial amount of experience in working with > renal cats to recognize test results that are questionable. Again, this depends on what actual time interval you mean by "so closely together." If there was a significant variation in creatinine in two samples an hour or so apart, from the same patient, any CLIA-qualified laboratory would tear into the analyzer and run a set of controls. They would also take a patient sample and split it into two parts. You still haven't defined what you mean, quantitatively, by "close together". There is a point at which significant variations become a warning of problems in laboratory quality control, and that IS an area where training is appropriate. > Again, this depends on what actual time interval you mean by "so closely > together." Did you not see the dates of the tests? > You still haven't defined what you mean, quantitatively, by "close > together". See above. > > Again, this depends on what actual time interval you mean by "so closely > > together." [quoted text clipped - 5 lines] > > See above. I wasn't clear that you were referring to the specific tests cited, and I unfortunately didn't save the posts. It was my impression that you were speaking generally of closely spaced tests, as in an immediate repeat. IIRC, these were some months apart. Neither creatinine nor BUN is, in and of itself, a terribly good predictor of the glomerular filtration rate, which is the physiologic parameter of interest. I don't know if there is a feline version of the Cockroft-Gault equation for estimation of creatinine clearance based on a single measurement, but this is widely used in human medicine in lieu of 24-hour samples. Ideally, one looks at the urinary as well as blood creatinine and BUN, and also considers osmolality. There are judgement calls, since BUN tends to underestimate GFR while creatinine overestimates it. Both have to be considered in light of hydration, and with multiple measurements since there can be considerable short-term variation. > > > Again, this depends on what actual time interval you mean by "so closely > > > together." [quoted text clipped - 7 lines] > > I wasn't clear that you were referring to the specific tests cited, I didn't think it would be so difficult for you to figure out since I was clearly referring to the variations in the two tests run on Dec. 12 and Feb, 27.... I'm sure happy we cleared that up! Aren't you? Do you have any other questions you'd like to ask that I've already answered? Are you a hospital lab tech or a high school/college biology student? > > > > Again, this depends on what actual time interval you mean by "so > closely [quoted text clipped - 18 lines] > > Are you a hospital lab tech or a high school/college biology student? No, I am a clinical engineer, a biochemistry major who branched into computer science, with about 30 years in laboratory and intensive care clinical engineering. Current work, for example, includes real-time telemetry and sensor correlation for intensive care and stepdown at one major hospital, and developing expert systems for prescribing assistance. That specifically includes dose adjustments based on renal and hepatic function, starting with fairly basic things such as GFR estimation by Cockcroft-Gault if there is no better information, and then applying renal elimination curves in the presence of limited clearance, as well as issues such as zero-order and first-order phsrmacokinetics. The latter often involve constructing molecular pharmacological models to help recommend optimal dosing levels, avoid interaction, and obtain synergies in comorbid conditions. My most recent research interest is applying mathematical modeling of infections disease epidemiology to the diagnosis of computer network worms and other malicious software. Are you normally this arrogant, or are you making a special effort? What is your experience? > > > > > Again, this depends on what actual time interval you mean by "so > > closely [quoted text clipped - 39 lines] > Are you normally this arrogant, or are you making a special effort? > What is your experience? He just gets this way sometimes. "It's his way". > > Are you normally this arrogant, or are you making a special effort? > > What is your experience? > > He just gets this way sometimes. "It's his way". Understood. Of course, some ways are pathological, some are pitiful, and some are both. I hope I never lose the humility to recognize that someone may have some information that I don't, the consideration if that should be integrated with other information I do have, and the professional ethics to share, gracefully, what I do know. My mentors impressed on me the idea that professional knowledge is something to "pay forward." > > > Are you normally this arrogant, or are you making a special effort? > > > What is your experience? [quoted text clipped - 3 lines] > Understood. Of course, some ways are pathological, some are pitiful, and > some are both. ...and yours are egomanical. > I hope I never lose the humility to recognize that someone may have some > information that I don't, the consideration if that should be integrated > with other information I do have, and the professional ethics to share, > gracefully, what I do know. My mentors impressed on me the idea that > professional knowledge is something to "pay forward." Too bad they didn't you common sense. > > > > Are you normally this arrogant, or are you making a special effort? > > > > What is your experience? [quoted text clipped - 5 lines] > > ...and yours are egomanical. Grinning....who was the first to make personal comments in this discussion? It's been my experience that when two parties start in a technical discussion, and one starts namecalling and handwaving about "common sense", that person is floundering due to lack of knowledge. > > I hope I never lose the humility to recognize that someone may have some > > information that I don't, the consideration if that should be integrated [quoted text clipped - 3 lines] > > Too bad they didn't you common sense. Indeed. Too bad any mentors you may have had didn't you grammar. > > > > > Are you normally this arrogant, or are you making a special effort? > > > > > What is your experience? [quoted text clipped - 10 lines] > technical discussion, and one starts namecalling and handwaving about > "common sense", that person is floundering due to lack of knowledge. That's only because you don't have any common sense! LOL! My mentors impressed on me the idea that > > > professional knowledge is something to "pay forward." > > > > Too bad they didn't you common sense. > > Indeed. Too bad any mentors you may have had didn't you grammar. Too bad any mentors I may have had didn't me grammar? ROTFLMAO! >> > > > > Are you normally this arrogant, or are you making a special > effort? [quoted text clipped - 25 lines] > > ROTFLMAO Pack it in now, you chaps. You both have knowledge we'd all like to share. It's not a competition after all. Tweed [snipped a bunch of stuff about two people not getting along] Fascinating conversation, really, but I thought I'd share the recipe I'm going to try tonight: http://www.deliciousdecisions.org/cb/show_search.cfm?RecipeID1=166 Easy and hopefully yummy! Signaturemonique, who spoils Oscar unmercifully pictures: http://www.bounceswoosh.org/rpca > [snipped a bunch of stuff about two people not getting along] > [quoted text clipped - 4 lines] > > Easy and hopefully yummy! Use Grey Poupon Country Style!! It's GREAT! >> http://www.deliciousdecisions.org/cb/show_search.cfm?RecipeID1=166 >> >> Easy and hopefully yummy! > > Use Grey Poupon Country Style!! It's GREAT! Hrmm ... I already have some store-brand dijon at home that I'll use. I don't quite get the grey poupon thing. Is it just that it is chunkier? What's so great about it? I'm not sure if I've ever had it. I just remember those silly "Do you have any grey poupon?" commercials. Signaturemonique, who spoils Oscar unmercifully pictures: http://www.bounceswoosh.org/rpca > >> http://www.deliciousdecisions.org/cb/show_search.cfm?RecipeID1=166 > >> [quoted text clipped - 6 lines] > great about it? I'm not sure if I've ever had it. I just remember those > silly "Do you have any grey poupon?" commercials. Chunky! I hope not. It is a milder mustard made with white wine and has a completely different flavor than regular mustard. > > >> http://www.deliciousdecisions.org/cb/show_search.cfm?RecipeID1=166 > > >> [quoted text clipped - 11 lines] > Chunky! I hope not. It is a milder mustard made with white wine and has a > completely different flavor than regular mustard. It is the best. I am a big fan of generics that cost less, but I have tried every single brand of Dijon I could find and Grey Poupon Country Style is the best best best, worth every bit of the $3 per jar it costs. It has moved me to stop putting mayo on my hamburger, now I use just mustard, it is so delicious. Now if I could just give up the burger altogether. :) Baby steps. > It is the best. I am a big fan of generics that cost less, but I have tried > every single brand of Dijon I could find and Grey Poupon Country Style is > the best best best, worth every bit of the $3 per jar it costs. It has moved > me to stop putting mayo on my hamburger, now I use just mustard, it is so > delicious. Now if I could just give up the burger altogether. :) Baby > steps. Well, maybe it's worth trying at some point. Burgers aren't necessarily bad; depends on what they are and what you put on them. We've found some 9% fat burgers presliced and packaged at the store that are absolutely delicious. Then again, we live in cow country and anything made with beef is good. I have a recipe for burgers that are half-mushroom ... even messier than normal burgers to make, but they were low-fat and very flavorful. DH calls them "meatloaf burgers" because I guess that's what he thinks they taste like. Signaturemonique, who spoils Oscar unmercifully pictures: http://www.bounceswoosh.org/rpca > > It is the best. I am a big fan of generics that cost less, but I have tried > > every single brand of Dijon I could find and Grey Poupon Country Style is [quoted text clipped - 4 lines] > > Well, maybe it's worth trying at some point. It is wonderful in deviled eggs, too. > I have a recipe for burgers that are half-mushroom ... even messier than > normal burgers to make, but they were low-fat and very flavorful. DH calls > them "meatloaf burgers" because I guess that's what he thinks they taste like. We love mushrooms. Care to share your recipe? >> I have a recipe for burgers that are half-mushroom ... even messier than >> normal burgers to make, but they were low-fat and very flavorful. DH [quoted text clipped - 3 lines] > > We love mushrooms. Care to share your recipe? It's actually from a book, so I'll be happy to email it to you but I don't think it would be appropriate to post it on a newsgroup. Signaturemonique, who spoils Oscar unmercifully pictures: http://www.bounceswoosh.org/rpca "Monique Y. Mudama" <spam@bounceswoosh.org> wrote:. > > We love mushrooms. Care to share your recipe? > > It's actually from a book, so I'll be happy to email it to you but I don't > think it would be appropriate to post it on a newsgroup. Got it, thanks! It sounds like a great way to make a healthier burger. I appreciate your taking the time to type it in. 8) > > > It is the best. I am a big fan of generics that cost less, but I have > tried [quoted text clipped - 18 lines] > > We love mushrooms. Care to share your recipe? There is a classic French mushroom preparation, that I think of as a "pantry" ingredient such as stocks. In my experience, both the recipe and application of duxelles is wider than the cookbooks suggest. The nice thing is that it works very well with mushrooms that are getting a little old and soggy. Essentially, you heat minced mushrooms with some other minced aromatics -- onion, green onion, or, traditionally, shallot -- with a bit of butter or olive oil. Celery will also add to it, and perhaps black pepper. Don't let the temperature get high enough to consider it sauteeing. You are trying to do two things: caramelize the onion-family items, and take most of the moisture out of the mushrooms. Start with the onions, and as they turn transparent and a bit yellow, add the mushrooms, stirring VERY frequently. Eventually, you will see less steam coming off, and it's time to take it off the flame. Ideally, you've used just enough cooking fat to be a binder -- a very small amount of butter could be added at the end. The final product is a coarse paste, and should keep fairly indefinitely in the refrigerator. It's something with which you want to experiment. Folding some into some scrambled eggs is one flavor enhancer, but you'll find many other uses. A little bit deepens a brown sauce. Toss some in with green beans or dried beans. "Howard Berkowitz" <hcb@gettcomm.com> wrote > > > > We love mushrooms. Care to share your recipe? > [quoted text clipped - 25 lines] > uses. A little bit deepens a brown sauce. Toss some in with green beans > or dried beans. Ooo, this sounds fabulous. I regularly make omelets. We love asparagus and cheddar omelets with just the firm part of the tomato added inside and on top. Thanks. I've added this to the recipe file. > You are trying to do two things: caramelize the onion-family items, and > take most of the moisture out of the mushrooms. I take the moisture out of mushrooms by putting them in a dry, non-stick pan (o oil or butter) and heating them. Just when you think they will burn, whoosh out comes the moisture. Then I cook them in their own moisture until it has mostly evaporated. Then I add oil and onions. Works well with chanterelles and porcinos, too. My Mum is a nutter for mushrooms. I used to hate them as a kid, and every autumn she would go out in the woods and pick mushrooms and hide them in all the foods she made. I hated finding little bits of mushrooms in my meatloaf. I'm glad I learned to love them in time, since I'm now a vegetarian and mushrooms bring a lot of variation to food. Just yesterday I made a pasta sauce with shiitakes. Mmmm. Ate too much. :o/ SignatureMarina, Frank and Nikki marina (dot) kurten (at) pp (dot) inet (dot) fi Pics at http://uk.pg.photos.yahoo.com/ph/frankiennikki/ and http://community.webshots.com/user/frankiennikki > > You are trying to do two things: caramelize the onion-family items, and > > take most of the moisture out of the mushrooms. [quoted text clipped - 11 lines] > vegetarian and mushrooms bring a lot of variation to food. Just > yesterday I made a pasta sauce with shiitakes. Mmmm. Ate too much. :o/ sort of a reverse of the procedure I use. Will try it soon. >> Hrmm ... I already have some store-brand dijon at home that I'll use. >> I don't quite get the grey poupon thing. Is it just that it is [quoted text clipped - 4 lines] > Chunky! I hope not. It is a milder mustard made with white wine and > has a completely different flavor than regular mustard. Sure, different than yellow mustard, but is it that much different from other dijon mustards? Signaturemonique, who spoils Oscar unmercifully pictures: http://www.bounceswoosh.org/rpca > >> Hrmm ... I already have some store-brand dijon at home that I'll use. > >> I don't quite get the grey poupon thing. Is it just that it is [quoted text clipped - 7 lines] > Sure, different than yellow mustard, but is it that much different from > other dijon mustards? Ah. WEll, I only get the original so that I do not know. > > >> Hrmm ... I already have some store-brand dijon at home that I'll use. > > >> I don't quite get the grey poupon thing. Is it just that it is [quoted text clipped - 9 lines] > > Ah. WEll, I only get the original so that I do not know. When I was an all-too frequent road warrior, I made the pleasant discovery that limo or car services, in many cities, cost perhaps $10 more than a cab downtown, but actually offer more services. Before 9/11, it was especially nice to be met as I came out of the gate. My most memorable limo service, however, was in Milwaukee. The driver opened the door for me, paused, and said "I'd like you to be prepared, just in case." He reached in his pocket and gave me a handful of miniature Grey Poupon jars. We must have gone at least five miles, airport gates and all, before I stopped laughing. "Howard Berkowitz" <hcb@gettcomm.com> wrote > > When I was an all-too frequent road warrior, I made the pleasant > discovery that limo or car services, in many cities, cost perhaps $10 [quoted text clipped - 8 lines] > We must have gone at least five miles, airport gates and all, before I > stopped laughing. What a character he was. You sound like you love to travel as much as I do. > "Howard Berkowitz" <hcb@gettcomm.com> wrote > > > When I was an all-too frequent road warrior, I made the pleasant [quoted text clipped - 12 lines] > What a character he was. You sound like you love to travel as much as > I do. It was an early sign of travel burnout when I'd doze on a flight, wake up on landing, and look out and wonder "Did they really take me to Charlotte/Huntsville/Salt Lake City, etc.? It looks like just another airport." The clear message came one morning as I awakened, opening bleary eyes to scan the room. It was apparent that it was a Marriott. WHERE the Marriott was located, however, was a mystery. I looked at the phone and saw an unfamiliar area code. Inspired, I dialed the operator, who cheerfully anwered, "Marriott Milwaukee Downtown (or something like that). May I help you?" Politely, I said, "Thank you; you just have," and hung up. I wonder what she thought that was about -- or, horrible thought, she was used to it. Not to dwell on Marriott, but they did give me a calming mantra I shall share. On entering a new hotel room, I do make a point of noting the exits and reading the emergency instructions. In this case, I was at a Marriott Conference Center (which is now something else) right on the border between Naperville and Lisle, Illinois. The first instruction, in case of fire or other calamity, was: "1. Remain clam." There have been many situations since where I realized the best course of action was to emulate a live clam, silently giggling to myself. LOL! remain Clam in a Calamity? =o) Melissa > >> Hrmm ... I already have some store-brand dijon at home that I'll use. > >> I don't quite get the grey poupon thing. Is it just that it is [quoted text clipped - 7 lines] > Sure, different than yellow mustard, but is it that much different from > other dijon mustards? It has to be Grey Poupon Country Style Dijon. Grey Poupon also makes regular Dijon that is not really too different from others. Next time you are in the grocery, take a look at the Country Style. You can see the difference. It is all a matter of personal taste, but if you have not tried this, you might want to. I guess the best way to describe it is less bite, more flavor. Less vinegar, more spices, maybe? > [snipped a bunch of stuff about two people not getting along] > [quoted text clipped - 4 lines] > > Easy and hopefully yummy! ...and makes more sense than Howie'! LOL! > > [snipped a bunch of stuff about two people not getting along] > > [quoted text clipped - 7 lines] > > ...and makes more sense than Howie'! LOL! I am indeed laughing over your antics. Normally, I wouldn't bother with someone so wrapped in his own ego and desire to be one-up. Unfortunately, you are putting out inaccurate information, which you apparently can't back up with any science. That is not useful to the group. > > > [snipped a bunch of stuff about two people not getting along] > > > [quoted text clipped - 12 lines] > Normally, I wouldn't bother with someone so wrapped in his own ego and > desire to be one-up. It only seems that to you because your ego is bigger than mine! LOL! Unfortunately, you are putting out inaccurate > information, Confirming a questionable test result is inaccurate infrormation? Who was your mentor, Moe, Larry or Curly? That > is not useful to the group. Confirming a questionable test result is not useful information? I think you have a much more serious problem than just being impressed with your education. >> > > Are you normally this arrogant, or are you making a special effort? >> > > What is your experience? [quoted text clipped - 13 lines] > > Too bad they didn't you common sense. Philp, it's too bad no one ever taught you either grammar or courtesy. flluuusshhh... "Duke of URL" <MacBenah@kdsi.net> wrote in message > Philp, it's too bad no one ever taught you either grammar or courtesy. Isn't it? I grieve over it on long winter nights.... >"Duke of URL" <MacBenah@kdsi.net> wrote in message > >> Philp, it's too bad no one ever taught you either grammar or courtesy. > >Isn't it? I grieve over it on long winter nights.... Turkey Wraps with Chipotle Mayonnaise 1/2 cup mayonnaise 3 tablespoons chopped fresh cilantro 1 green onion, minced 1 tablespoon minced canned chipotle chilies in adobo 1 teaspoon fresh lime juice 2 10-inch-diameter flour tortillas (plain or flavored) 8 ounces thinly sliced smoked turkey 2 romaine lettuce leaves, center rib cut away Combine mayonnaise, cilantro, green onion, chipotle chilies and lime juice in small bowl; stir to blend. Season chipotle mayonnaise with salt. Arrange tortillas on work surface. Spread each with half of mayonnaise; top with turkey and lettuce. Roll up tortillas tightly, enclosing filling. Cut each wrap in half. Makes 2 servings; can be doubled. Theresa Stinky Pictures: http://community.webshots.com/album/125591586JWEFwh My Blog: http://www.humanitas.blogspot.com That's a lot of mayo, but I'm saving this one off anyway. I love those wraps! > Turkey Wraps with Chipotle Mayonnaise > [quoted text clipped - 17 lines] > Stinky Pictures: http://community.webshots.com/album/125591586JWEFwh > My Blog: http://www.humanitas.blogspot.com Signaturemonique, who spoils Oscar unmercifully pictures: http://www.bounceswoosh.org/rpca >That's a lot of mayo, but I'm saving this one off anyway. I love those wraps! You can certainly fool around with the proportion. Theresa Stinky Pictures: http://community.webshots.com/album/125591586JWEFwh My Blog: http://www.humanitas.blogspot.com >>That's a lot of mayo, but I'm saving this one off anyway. I love those >>wraps! > > You can certainly fool around with the proportion. Yeah, I thought about that just as I hit "send." Sorry, I'm a bit off today; I'm at home sick, slept till 12:30 (so about 5 hours more than usual) even after a nap last night. It's just a cold, but colds seem to be really good at dulling my thought process. Signaturemonique, who spoils Oscar unmercifully pictures: http://www.bounceswoosh.org/rpca > > > > > Again, this depends on what actual time interval you mean by "so > > closely [quoted text clipped - 36 lines] > applying mathematical modeling of infections disease epidemiology to the > diagnosis of computer network worms and other malicious software. Are you applying for job here?! I didn't ask you for your curriculum vitae. LOL! I'm almost as impressed with your education as you are with it! LOL! Too bad credentials aren't an assurance of credibility - one can exist without the other. Btw, your list of accolades didn't include anything about cats. That explains why you don't know abnormal test results should be confirmed. I'm thankful you're not in the veterinary profession! You'd probably kill cats that tested FeLV+ on one ELISA Snap! > Are you normally this arrogant, or are you making a special effort? Its no effort at all. LOL! In fact, I often find academic a.sholes impressed with their education amusing. > What is your experience? With cats, obviously much more than you. > > > > > > Again, this depends on what actual time interval you mean by > > > > > > "so [quoted text clipped - 45 lines] > vitae. > LOL! No, but since you've decided to act superior and all-knowing, it might be worthwhile to give some baseline to see how you have gotten your information. That, incidentally, includes whether you have a bunch of tidbits memorized, or if you actually understand clinical biochemistry and physiology. Hint: there are differences among mammals. There are also more similiarities than differences. > I'm almost as impressed with your education as you are with it! LOL! Too > bad credentials aren't an assurance of credibility - one can exist > without > the other. Then why is it that the anonymous Phil P. condescendingly asked if I was a high school student or a lab technician -- suggesting minimal credentials -- yet now, apparently, credentials are unimportant? Do note that I use my real name. > Btw, your list of accolades didn't include anything about cats. That > explains why you don't know abnormal test results should be confirmed. WHAT? You mean that we should CONFIRM abnormal test results in humans? Why, I don't think there's a pathologist that EVER thought of that. And would a nephrologist even conceive of the idea of planned sequential determination of renal chemistries? The goal is not to wave one's hands about a specific creatinine, BUN, or other measures, but to use them together to determine the actual renal damage. That is best defined in changes in the glomerular filtration rate, which is not directly measurable by any single chemical measurement. Creatinine clearance, as opposed to serum creatinine, urinary creatinine, or BUN, is the closest test we have that doesn't get into nuclear medicine or PET scans. Feline kidneys are not radically different in their physiology, although the specific levels will differ from humans. Of course, you haven't even touched on the role of the renin-angiotensin system, therapeutic interventions with that system, or quite a few other relevant matters of biochemistry. Instead, you seem to want to present yourself as the Son of Bast, who must not be challenged, and apparently will kick used kitty litter and anyone that dares disagree with his fiats. Hint: competent clinicians and scientists constantly question and discuss; it's the way knowledge disseminates and care improves. While I don't propose to bother spending time educating you on CLIA-level quality control, there are a wide range of protocols -- used in any competent lab, human or veterinary, in which the lab automatically goes into reconfirmation, or requests an additional sample. This is fairly basic quality control biostatistics. > I'm > thankful you're not in the veterinary profession! You'd probably kill [quoted text clipped - 5 lines] > Its no effort at all. LOL! In fact, I often find academic a.sholes > impressed with their education amusing. Don't worry, I don't consider you an a.shole. I am precise with my language, and recognize that an anus has at least one useful functfion. > > What is your experience? > > With cats, obviously much more than you. > > Are you applying for job here?! I didn't ask you for your curriculum > > vitae. > > LOL! > > No, but since you've decided to act superior and all-knowing, You see, that's the point you can't see through your academic credentials, I'm not all-knowing that's why I rerun the tests when I get back questionable or unusual test results that I don't understand before I put a cat through a battery of stressful tests. That doesn't take a degree in biology, just common sense, experience and compassion for the cat -- none of which you seem to have. You questioned my suggestion to retest the cat - I gave my reasons - that's it. Now stop whining like a spoiled little brat because I don't agree you. > > > Are you applying for job here?! I didn't ask you for your curriculum > > > vitae. [quoted text clipped - 7 lines] > questionable or unusual test results that I don't understand before I put > a cat through a battery of stressful tests. Let me get this straight. You get back results you don't understand. You rerun them to see if there is anything different. Why should your understanding of the repeated test be any different than the first? If you are questioning possible lab error, standard practice for many out-of-range conditions is for the lab to rerun it, as well as controls. The blood sample volumes requested are intended to be enough that the lab can rerun the test if necessary. Now, as to "stressful tests". To repeat the test, you will have to draw blood at least once from the cat. To do, say, a dynamic creatinine clearance rate test, you need to make one puncture, draw blood, and then inject creatinine through the same needle. At a timed interval afterwards, you take a second blood sample. Personally, I don't like having blood drawn. I'm sure a cat likes it even less. Nevertheless, the only difference I see i |
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