12/13 River (AMPS 69, +2 182, +6 264, pMPS 231, +4.5 53) Truly what is a curve even

Tuesday's thread

I feel like I'm getting a little lax. The new vet said it was pretty unlikely that River will ever remit, which…is fine, I guess. (Though I got a little wistful looking at Joanne's post about Tiny's OTJ trial — so happy for them!) If she's not going into remission, that takes some of the stress of TR off me. I'll still keep trying, of course, but I'm more feeling like this is going to be a "rest of River's life" deal.

Sigh, little girl; you exhaust me.

I hope I made the right decision giving her the shot this morning despite a relatively low BG. She's eating like a champ today.

 

Did the vet give a reason for this? River was recently diagnosed.
I hope the vet is wrong on this one!

Nice start to the day. Hope River surfs safely for you.

 

I certainly hope she is wrong as well. She said the cats she usually sees go into remission are the textbook cases who can be "cured" by lifestyle changes. Because of the suspected liver, pancreas, and gut issues she thinks we're going to be dealing with this forever.

 

I disagree! @Chris & China saw China go into remission after 7 years, albeit a short one. I have seen others who had cats go into remission after years.

 

Don't give up hope. You never know. Furball went into remission after 3 1/2 years. She's back on insulin now, but she was in remission for 1 1/2 years. Vets don't know everything. A lot of vets don't know about following TR and the success we've seen here.

 

Never give up hope!!!! Eliz's Bertie went into remission after 11 years and my girl took 3yrs, 7mos and 12 days and had a high dose condition. Remission should never be considered impossible.

 

I think the odds of a remission are higher in the first 6 months, but just because the odds are better earlier, definitely doesn't mean that later remissions are impossible. One of the things I love about this forum is you get to share in other people's joy, and you learn to truly never give up hope. Now with that being said, I think a bean's quality of life could definitely improve if they're not obsessed with the idea of remission. I know we were when Lou was first diagnosed. He teased us with an OTJ trial after a month or so on insulin, but it failed on the last day. I was so stressed out trying to get him regulated because I wanted and "needed" that remission.... It was a waste of my time and energy and it only served to stress me out almost to the point of sickness. Come to find out, my buddy Lou had a high dose condition (even though his dose never actually got as high as expected) and unknown teeth issues. My point is once I finally gave up on the remission dream, this whole process has become much more fulfilling and easier overall. My only goal now is that my sweet buddy Lou is happy, healthy, and spends most of his time below renal threshold. Would I love it if he went into remission? Absolutely, who wouldn't?? (We could finally go on a honeymoon!) But I don't think about it much and I find I can more completely enjoy this experience (including celebrating with other lucky kitties and beans) than I ever could before.

Hugs to you Paige, and good luck today! I hope River rocks a green cycle and surfs like a pro!

 

@MrWorfMen's Mom @Amanda and a Loudogg @carfurby @Mandy & Rex Thank you all for your sweet support. You are all fantastic!

Heard from the new vet tonight with blood test results. Pasting below in case you're interested in reading. (Also @Carol & Murphy!)

I have River's labs back and they do show ongoing liver level changes.

Of the 5 major liver levels, only 3 were tested at Medvet (nature of in-house chemistry analyzers vs reference laboratory analyzers) but essentially we are seeing no improvement or further elevation in her levels. The concerning ones are as follows:

1. ALT (liver cell damage) - should be under 100, was 314, is now 619
2. ALP (bile duct marker) - should be under 100, was 166, now 190
3. AST (liver cell damage) - should be under 100, is 184

Her bilirubin/jaundice marker and GGT are normal.

Her total proteins remain normal. Her white cell count is stable. Most of her electrolytes are normal. She does have a mild increase in her BUN - a kidney marker also associated with dehydration. And, her blood phosphorus level is elevated. The latter two could be because she is a touch dehydrated, or from her high protein diet (though I don't usually see increases in phosphorus), or from low grade intestinal bleeding, or possibly early kidney changes.

Minimally-- if she will accept it, I would feed her wet food in the form of soup by adding warm water to it to help combat dehydration. Ideally, I'd also add in a powdered phosphorus binder called aluminum hydroxide to help lower the phosphorus to more normal levels. You could make a fair argument for a stomach acid blocker in case there is some low grade GI bleeding, though a phosphorus binder can have some beneficial effect here, too.

I know that during our visit, we discussed that her medical picture was complex and that her therapy might be more involved than the typical diabetic. I mentioned a number of medications that I thought might be worth consideration. These included:

1. Continuing the B-12 every other week long term to promote optimal intestinal and pancreatic health
2. Considering the addition of RxZyme, a mild pancreatic and nutritional supplement that can be mixed into food
3. Cerenia tablets to help control inflammation and guard against nausea/vomiting
4. Mirataz ointment or miratazipine tablets for appetite support as needed
5. Possible Denamarin tablets (vs the bitter elixirs) for liver support as a potent anti-oxidant

Given the ongoing and changing state of her liver levels, I definitely think she should start/trial the Denamarin tablets. And, since the ALP remains elevated, I am generally a proponent of using ursodiol to help protect the liver and pancreas by flushing out the bile ducts- it is a medication that can be given in food or reformulated into a flavored liquid. Ideally, we'd suggest rechecking her liver in a month or so to see if there's been a positive response. Many of these triaditis cats do require lifelong therapy with these meds. If we do not see a positive change with more these conservative therapies, we may need to consider adding in steroids (or other immune-regulating medications). And, yes, steroids may affect her diabetes and insulin dosing- though usually not too dramatically in most triaditis cats.

Ultimately, I know there are quite a few factors to weigh here, including but not limited to what is practical for her (what she will tolerate) and what is practical for you (time-wise, financially, emotionally). At this point, we are looking at a cocktail of meds and ongoing insulin therapy to address the global digestive disorder.
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I can't say anything about the medical aspect, but can I just say how impressed I am with that response?! It's thorough, informative, caring, and wonderfully detailed. I love how she explained things and reiterated your past discussion. I can barely get a decent phone conversation out of my vet, let alone an email written by her. Color me impressed!

 

I was BLOWN. AWAY.

 

I can't help with the medical side of things either but I too am impressed with the thorough and clear communication. That vet is definitely a keeper. Carol will probably be your best resource for the triaditis from a cat parent perspective. Can't recall anyone else who is or has dealt with it. River and you are obviously in good hands with that vet!

 

This cat is making me scratch my head. Her numbers are all over the place today! But she's my sprightly girl. Love her.

 

Did you test a half hour after that 53? I have a suspicion she’s angling for a reduction.

As for remission, that’s a guessing game, though getting a cat regulated first is a prerequisite. Getting them tightly regulated as soon as possible after diagnosis greatly increases the odds for that other R word.

Good luck with the new meds plan. My only comment is that transdermal mirtazapine instead of tablets has less odds of side effects, you might want to inquire about it. I have seen a number of triaditis kitties here, though can’t remember who right now. Maybe do a search on this forum.

 

No I didn't, and now I'm PANICKING because I think she probably had a bit of a crash overnight. She is at 43 this morning and I'm starting a new thread with 911 to figure out WTF to do. Besides reduce her dose like…now.

 

What a fantastic vet report!! River is complex (like Teasel!) but you certainly have a vet who's on the ball with everything. Worth every penny you paid for the at home visit.

 

Yes, this is all par for the course for the great vets at Cat Hopsital of Chicago. I can't even imagine going anywhere else.
Paige, these are the same issues Murphy has, although his liver numbers have been normal for a few years now. As I've said before, start the cerenia immediately and give it daily. I would also give her the denamarin - I have some I can give you, they also have it on amazon. Murphy also gets ursodiol - I have it in a liquid. I also have some in tablet form I can give you to try. Giving B12 every 2 weeks is no big deal. And for 3 years now, I've been adding digestive enzymes to Murphy's food. So I'm doing for Murphy what she has suggested for River, and it's definitely not so bad.
Regarding remission - I think from all of the pancreatic damage he has due to triaditis and all of his past episodes of pancreatitis, Murphy will not go into remission. Once I accepted that, I have to say, I relaxed ALOT. So I agree with others, remission is definitely still possible, especially since she is so newly diagnosed. I have to say I was puzzled when I first met her, that a 6 year of skinny little girl would get diabetes, without any clear predisposing factors. Now it makes more sense.
Let me know if you want the denamarin and ursodiol tabs. maybe we can meet for a drink


eeek - I just saw the spreadsheet. I was wondering when you would start reaching those lime greens and all of the attendant fun associated with that.