1/22 Asia AMPS 287, +2 250, +4 203, +7.75 68

http://www.felinediabetes.com/FDMB/threads/1-21-asia-pmps-356-shot-half-dose.189945/

Shot 1.25 this morning, boy her depot must be a mess at the moment! She’s eating well since last night and her cerenia is supposed to wear off later in the cycle when she wouldn’t be eating anyway. This is such a crazy balancing act, I feel like I’d rather give her insulin and keep her numbers down, even if it means loading her up with Karo all day. I don’t know if that’s a wise approach, but given the severity of her kidney distress at the moment, I can’t handle seeing these pinks and worse because all I do is visualize internal damage. Tricky stuff, this.

Waiting for vet to open and trying to get her in today.

She’s purring and alert but I can also tell something isn’t quite right. Thanks for all the vines, this old girl has fight and at least, so far, I can tell she still wants to be here.

 

Sending lots of vetty vines!
I know those yellows/pinks are hard to see and not worry about but she's only had a few high numbers and most days she sees green or blue.

 

I'm glad she is eating for you. I hope you can get her into the vet today. Sending prayers.

 

Sending tons of vetty vines and feel good vines for Asia. You are such a good mama-bean!

 

Vetty vines for Asia

 

Got an appointment for later today with the other vet in the practice, whom I’ve never seen before, hope I like her and hope Asia does too, although that’s a big ask for a cat to like a vet, isn’t it?

They got the report from blue pearl over the weekend.

 

did you ever have a car that, due to some yet to be diagnosed engine trouble, required you to drive with one foot on the gas and the other on the brakes? I did and that’s what a phase like this, full of change and uncertainty, feels like. Tricky business... and emotionally exhausting.

Renal threshold, risk of hypo, absence of reliable appetite...
all important consideration shot by shot right now.

Better a day too high than an hour too low.

 

It sure is! I hope I have some more information after the vet visit and maybe we can lessen some of the complications.

 

Vetty vines fur that!

 

203, much better, less offended kidneys today!

 

Sending lots of vetty vines your way!!!

 

Vetty vines!!!

 

Vines and purrs from us!

 

Back from the vet, went very well! Asia is 68 @ 7.75

Will update more once I get Asia settled and finished doing cat things.

 

So glad it went very well- looking forward to the update!!! Keep it safe, Asia!

 

Saw the other vet, Dr L at the practice that we had never seen before. I really liked her, she’s quite clever. Briefly discussed the bad ER incident, and that they did nothing, but I wanted some diagnostic tests to see what’s really going on. She recommended a blood test, I wish I wrote it down, but didn’t, that can test for a protein in the heart muscle? Something like that, she said it’s a newer test and it could indicate if an echo is needed. Thinking over that one.

She was impressed with Asia’s SS (Dr S sent her the link in advance) and said not many of the diabetic patients look that...regulated?! And their numbers are all over the place. She also really liked my notebook.

She ordered the injectable bottle of cerenia and gave 3 prefilled syringes until it comes. Dr. S (other vet) wasn’t sure if the plastic would mess with/absorb with prefilled, so I hope it comes sooner than later.

She’s thinking kidney stuff or pancreatitis flare, she thinks the phos isn’t high enough to cause nausea.

Got X-rays! Didn’t see anything alarming, some tiny calcifications in the lungs that she said are very consistent with her age. A badly degenerated disc in her spine, which probably explains a good bit of her hind end weakness/issues. Osteoarthritis in hips and spine. A good bit of poo in the X-ray, she said the disc issue could also relate to some motility/poo stuff because of where the nerves go and have to go back through that area to the brain. She has been laying in her LB which is a new behavior, she has regular BMs, until this weekend, and hasn’t been straining that I could tell, but it looks uncomfortable regardless. Now to decide pumpkin or miralax. I’m a little afraid of miralax!

Basically said the gentlest place to get the u/s is with them, but the guy they bring in absolutely won’t let me be in the room. Sigh! And so they would sedate her, not a fan of that, if I were there I know she wouldn’t need to be sedated, she probably wouldn’t need sedation even without me there, but that’s just how they roll. But it’s this or lots of random phone calls to find a place that would let me be there, and then I just have to hope their doctor is very skilled with what he/she is doing as a bonus.

She said it was a light sedation and mentioned a mix of bupe, ketamine and more things, I stopped her at ketamine. I don’t even remember why I’m anti ketamine it has been so very long since I researched it, but it’s on my no-no list and that’s the part I remember. She said they could sub it out and use bupe, dexdomitor (and antisedan to reverse it). Anyone know about these sedatives and their effects on BGs? I saw a couple SSs where whatever drug was used caused a way low BG after and I think they either half dosed or skipped the dose that day! Granted, that SS was a full sedation and this isn’t. This may happen on Wednesday.

She’s going to order the injectable methyl b for me from diamondback. So that’s great news, all I have to worry about getting her to eat is the b multi. I looked in to injectable for that too, but ruled it out because the vet preparation was very high in one thing in particular (I forget) but it didn’t sound like a good idea.
Also got an rx for cypro, she suggested mirtz first but I’m glad I read stuff here recently describing the two so I asked for cypro instead. I don’t plan on using it, necessarily, but I would like to have it on hand.

I’ve attached X-rays for any of you curious nerds.

 

I'm a nosy nerd. How did they/you get Asia to keep still?
I'm also in awe at what the vets your way can & will do and have access to.

Hopefully you are both on the right track now . Comfy is everything .

 

Sounds like you got a winner in that vet. What a nice change after the ER nightmare.

I'm tagging @Marje and Gracie for your question about the sedative. She knows all that stuff.

Cinco had motility issues and did not like pumpkin at all, so I used baby food squash for daily maintenance and Miralax when he needed a nudge. Canola or coconut oil sometime worked, too - 1/2 to 1 teaspoon.

Sending more vines for appy and for general feeling better.

 

It's a crazy new world, huh? They did not do all these fancy things for pets when I was growing up.

I could not be in there, as it's radiation. But they have a foam hot dog bun looking thing to cradle them on their back. She stayed still because that's what she would do. As long as you're not going in her mouth, she's very laid back about everything. Vet said they have to sedate some cats just to do nail trims!

 

Was the blood test proBNP? I'm glad you had a good vet visit, and met a vet who did what you wanted.

With my civie's vet, I can be there for both x-ray and U/S. Of course I have to stand well back of the x-ray and they give me an apron to wear, but my voice helped. At the IM and cardio vetty place, they occasionally had to sedate Neko (I couldn't go back there). Let me look at my records and see if I can find what they used, but it was gentle and didn't impact her BG.

 

Yes, really liked her!

She will eat pumpkin mixed in her food and always has, I don't think it has much of a taste, but she likes the consistency of it. That's good to know about coconut oil, that's sounds worth a try! I just feel like miralax is a...slippery slope? I feel like once you go miralax you never go back, and I also worry about kidney stuff with it as well.

 

Yes! That's the one. Had you had it done on Neko? Or know anything further about it?

I wish they would let me be back there. My voice wouldn't help, she can't hear, but if she sees me, she knows it's going to be okay.

ETA: I read the link, says Bengals are increased risk for HCM

 

I didn't have the proBNP done. Neko's first echo was before it was generally available for cats. But it's a good first step (and cheaper than an echo).

I can't find what sedative Neko had, but I know it wasn't ketamine. That's on my list too.

 

Yay for the vet after the awful ER visit!

I recently had to give pumpkin to Rex when I noticed he had constipation. After I started 1 tsp (0.2 oz) in each meal (3x/day), I never saw him straining. I gave it for about 1 week to 10 days.

 

Gordy had a minor sedation when he went back for blood tests with the anti-sedative. I dont know if it was a combo of vet visit and sedative or what, but his BG plummeted when we got back. That was the day i had to bring him BACK just so they could keep an eye on him so I could go to work. Obviously, ECID. But if it were me, if the sedative is used, I'd skip the shot.

 

I bet the blood test she is referring to is IDEXX’s Cardiopet proBNP. It indicates whether the cardiac muscle cells are under stress or stretch. If the result is below 100 pmol/L, the myocytes are not under abnormal stress or stretch. Over 100, further diagnostics (e.g. echocardiogram) are warranted as the test does not tell you the specific issue.

The catch is that cats with hypertension, hyperthyroidism, or more advanced azotemia might see an elevated test result even if the heart itself is normal. However, it could be a good preliminary screening tool.

Our board certified anesthesiologist used butorphanol and midazolam (Versed) for Gracie’s pre dental sedatives and Alfxalone for induction and Gracie had a textbook perfect procedure with no dropping BG from the anesthesia. Dexdomitor is a lighter sedative but it’s also important to keep in mind that you can’t necessarily compare what is good for one cat and extrapolate it to another when you have differences like Gracie and Asia. Gracie was young, Asia is an elder kitty; Gracie had normal kidneys and heart; Asia has CKD and we don’t know about her heart. Ketamine is also a no-no on my list.

I also don’t like when I can’t be in an echo or u/s because my cats rely heavily on me being there to let them know it’s ok. I’ve never had them sedated and I’ve never had a specialist tell me I can’t be with them but EVID.

I’m glad you liked this vet. I’ll leave the X-rays to someone better versed in reading them.

 

Glad you had a positive experience and got some good information!

 

That's such an encouraging report! We will continue to pray that all things/ treatments fall into place to get our lovely Asia back to feeling good! She's a grand ole dam and we love her (and you too!!!! Oh so much Stacy!)!!!

 

No need for X-ray reading, I just thought they were cool to share. She went over them with me quite throughly.

Sounds like a useful test, I think I will hold off until the next set of labs for the p binders and kidney values and all that. Asia seems to have a delayed vet reaction and it sucks to keep doing this to her, but I'd like to lump as much into one visit as possible instead of go in for one thing and then go right back for another.

Yes, I don't like the sound of sedation, even light sedation when it actually isn't necessary!

 

Yikes! That's just the sort of thing that concerns me, nevermind just having a sedative in the first place!

 

I'm glad the vetty visit went well.

 

Hi Stacy,
Sounds like you have a vet you can trust. What a difference from the ER vet! I hope that the tests and procedures will yield the desired information and lead to successful treatment. Asia is a very brave kitty.
s and more vines on the way.

 

It sure would be nice if the vet could at least try and explain to the u/s guy your particular circumstances...he may have a policy, but given Asia's needs, he might reconsider and make an exception? I'm sure there are good reasons why he doesn't allow owners in the room, but sometimes people need to evaluate case by case, one size doesn't always fit all. Hope Asia's appy continues to improve

 

Also forgot to mention that I do think that P level could make her somewhat nauseous. It might not be the cause of her nausea.....perhaps it is pancreatitis....but I had a cat with PKD who was nauseous with a P level right about there. The ulcers don’t form, generally, until the P level is higher.

 

I don't know what the physical effects of ketamine are, but it's on my no-no list, too. I used to work a cat-only veterinary clinic (almost 30 years ago ), and they used it because it worked well for quick procedures like neutering males. The problem I remember was that the poor little guys would have the heebie-jeebies from it when they woke up.

So glad you and your girl had a better vet visit. What a good girl Asia is.

 

Both vets were pretty quick to say "there's no way" or "he won't allow that"

He visits their practice a few times a month to do these and I think they are at his mercy and not the other way around.

Medical stuff is tricky in this city because a lot of people will fleece you, unfortunately, so the more people you know, the easier it is to weed out the shysters.

 

Trying to figure out how to get her levels down, from what I'm reading it's much easier to keep them down than to get them down once they are high at this stage in the game. Asked vet about an increase in p binders, she said I could do a little more than 1/3 tsp a day, like perhaps a shaved down 1/2 tsp. I'm not sure when I should concern myself with aluminum toxicity. I'm still wading through that tome of a site...and I thought this FD stuff was overwhelming.

 

It was really so many years ago that I looked into it, I'm just not bothered to again, but it must have been something pretty nasty that I put it on that no no list and still remember years later, good enough for me.

I'm glad too, she certainly doesn't understand why all these vet visits are happening, I can only hope she feels a little better each time and makes that association, but having cats all my life, they never seem to link a vet to being a good thing! We had an unfinished basement in our house when I was growing up and our cat knew, somehow, the day the vet was coming and would jump up in the rafters and stay there, where we couldn't get him, the night before the visit. It became such a habit/problem, my parents had to confine him in a bathroom the night before the vet came. Vet came twice a year at best, but my cat knew he was coming, every time!