2/10 Poncho updates

As requested, a new thread for our convenience. New update tomorrow.....

 

Christoph,
I'm copying your last update here in your new thread and linking the old one here too.

Poncho's Previous Condo

Christoph's first update:

Christoph's latest update from previous thread:

 

Ok....thank you!

 

for review: Sliding scale for when feeding A/D or medium carb food
pre-shot numbers - possible dose
350 to 400 - 1.25 units
300 to 350 - 1.00 unit
250 to 300 - 0.75 units
200 to 250 - 0.50 units
< 200 - 0.25 units.
When you are ready to start reducing the carb content of food, you may need to drop the doses further

 

And your meter isn't defective.
It reads +/- 20 % of what a lab would get and reads about 30-40% lower than a pet meter.
See my signature link Glucometer Notes for feline reference numbers using human meters.

 

I've been wondering if their meter was either defective or the clinic vet had a tech do the test and didn't do it right. They screwed up a few other times.

 

Hi Chris,

I'm so pleased that you've got better veterinary support now, but I'm sorry to hear that Poncho has pancreatitis. I'm not sure whether I posted this link for you before, so to be on the safe side here are the IDEXX guidelines for pancreatitis treatment. It's a very comprehensive document and details all of the medications and supportive measures that can help Poncho get better. From my own experience of nursing Saoirse through a bad pancreatitis flare last year, I found that the anti-nausea med (ondansetron) in the early stages wasn't enough to help her keep eating under her own steam on its own. The addition of cyproheptadine (appy stimulant) helped her a great deal. After a while she didn't need the appy stimulant but I still need to give her anti-nausea meds at times. I always make sure I have a supply of ondansetron at home. It has been invaluable in managing Saoirse's pancreatitis symptoms since the flare-up last year and has thankfully stopped potential inappetence in its tracks for her on several occasions.

Sending more prayers for you both, scritches for Poncho, and for you.

 

Thanks Critter Mom, I'll ask the new vet about both meds. He started drinking a little water tonight. His body sure soaks up the fluids. I'm going to test his BG tomorrow since the next vet appt is Fri. God Bless.

 

Great news that he's drinking a little on his own! God bless you too, Chris. Wishing you both a restful night.

 

Thanks and good night to you also.

 

Just realised I never linked the URL for the IDEXX pancreatitis treatment guidelines. (Doh! ) I shall remedy that now.

Link

If I had brains I'd be dangerous...

Oiche mhaith!

 

As I was going to bed I noticed after Poncho used the litter box his back legs were weak so I tested his BG and it read -Hi-. I gave him 1 unit insulin and will be up again to test him again in 2 hrs. Maybe the new vet gave me a bum steer. I'm wondering if I should've given him 1.25 or 1.5 but he dropped fast into hypo at +4 at the clinic. I've been force feeding the Hills ad still and he had about 3/4 can today. This is frustrating as heck! Please advise?!

 

Hi I just replied in your other thread and so only just saw BJM new sliding scale. I think now you have given the 1 unit I wouldn't add more but for the next dose I would follow the new scale.

I mentioned in your other thread that I believe poncho should continue with the insulin. having only just got over ketones by with holding insulin poncho will be at risk of them reappearing.

 

I think you were right. What's with these vets?!!! So I guess next dose is @ +8 per the last schedule, retest @ +4? Should I delete this thread since I started the new 911 thread?

 

Keep this thread and delete the other one. This one has done good info in it. The other one just has my reply.

Yes to the +4 and yes to the next shot @+8 unless someone tells you otherwise.

Post up your results.

 

Just read your reply in the other thread. So your +2 is still high

Hopefully he will begin to drop in abit. I do think now he is getting more food he will need more insulin as BJM mentioned in her post with the new scale.

Clearly no matter what is the underlying cause your cat needs insulin to knock back the numbers. If you go back to the vet I think you need to discuss this further and I don't let her say your human meter is off and you need a cat one, you don't.

I think in the long term prozinc may not be the best I insulin for your cat and I wonder if lantus wouldn't give you better numbers for longer. It is dosed every twelve hours and builds up a depot in the cat so the effects last longer. You could discuss this with your vet perhaps.

 

I would make sure he is hydrated and you are testing for ketones too

 

Remember that at the failed curve, he was on Low carb food; the A/D is Medium carb food. When you are able to get back to the low carb, the doses will be dropped. Until then, we need to keep the glucose being matched by the insulin, so he doesn't start throwing ketones again.

 

one final thing-if you feel you need to you can edit the title of your first post to highlight your concerns about the high blood glucose reading.

 

The vet wont be there until 10am so I was told to leave Poncho as a drop off and she'll call me. In the meantime I asked them to keep an eye on him until the vet gets there since I gave him 1 u at 4am and he was still high @ +2 and next testing was +4 @ 8am after I dropped him off. I'm sure he's in pain and I'll ask for a 3day pain injection plus a script for cerenia or ondansetron, an appetite stimulant and maybe a change in insulin. I guess his pancreatitis is painful and the added stress of me force feeding him all day, the amount of the medium carb food and that he might be clogged up again spiked his BG. I'll post when she calls me.

Update: The vet's office called. Poncho was weak from lack of potassium, was clogged up again because he was too weak to go. His BG went down to the 300's and they'll check it again and dose if needed. I mentioned the ondansetron, cerenia changing insulin and pain issue so those will be addressed when I pick him up. He's already on an appetite stimulant they said. I'm relieved so far....I thought he was running out of time.

 

Sending prayers for little Poncho.

(((Chris and Poncho)))

 

Are you still adding some Miralax to his food?

 

Not since Sunday night. I was planning to ask the vet today if it was ok with the new meds. He's going to need that daily or something similar it seems.

 

A pinch of plain psyllium fiber helps hold moisture in the stool and keeps if soft enogh to pass. Can be done with the Miralax, if needed.

 

He'll need it. Thanks BJM.

 

Miralax should be fine with the other meds but run it past the vets.

So at the vets you want to discuss getting poncho :

Ongoing Potassium supplement
Ongoing pain relief- when remi had pancreatitis I was given buprenex to give at home and I did so for a few weeks. In my experience pain relief helps them to recover quicker
An appetite stimulant should be given if nausea is suspected and so you really want ongoing anti nausea medication too.
Fluids
Another vitamin B12 injection

Discuss whether beneficial switching to lantus or levemir as it might give you better control over blood glucose

 

Seconded.

 

You need both anti-nausea and appetite stimulant meds.
Otherwise, you'll get a hungry cat who walks up to and then away from the food due to the nausea.

 

I picked up Poncho and discussed his situation with the vet. She gave him an injection of buprenorphine for pain and sent him home with the same but for oral use. He was given electrolytes and new bag of fluids infused with potassium. Poncho was plugged up due to weakness from low potassium and they fixed that and she said Miralax is ok to give. She gave him some insulin and instructed me to give him 1 unit Prozinc at 6 pm when I got home and begin 2 feedings for the night plus the fluids. At 6am I'm to check BG and give 1 1/2 unit if over 400 and if under 400 1 unit and check BG 8 hrs later and record it then give 2nd shot same dose @12 hrs after 1st shot, continue feeding, meds, fluids. Friday- repeat and come in 1:40 for check up and more electrolytes, etc. I asked about Cerenia or ordansetron and she said one of the 2 meds (Mirtazapine, Metronidazole) prescribed acts as an appetite booster.....I forgot which one.....I need to look those up. No B12 today but will ask about that tomorrow. I didn't read the new posts until I got back. Poor Poncho is a sick cat and it's going to be full time job for me. Need to feed now. Thanks to all. Chris

 

The mirtazapine is for appetite.
Metronidazole is an antimicrobial in case there is some sort of infection in the GI tract.

If you can, take in your spreadsheet to the vet and the sliding scale we were testing out so he can see how it was working.

 

Ok I'll write it all down for Fri.

 

Chris, here is a hug break:

((((((((BIG HUG, CHRIS)))))))

Plus cuddles/chin scritches (whichever is preferred) to Poncho.
.

 

Thanks Elizabeth. Poncho started eating a little bit on his own today. I have to get his numbers from the vet from yesterday but last shot @ 1u yesterday @7pm then this am 7am BG 318, +8 BG 143 next shot @ 6 and she wants the same 1u dose @12 hrs till tomorrow's 2 pm appt. Along with force feeding he's eating around a 5.5 can daily. He's getting more sociable also. Vet didn't say to check BG before 6pm shot but I will and call her if it's normal range. I don't want to give a dose unless I check BG. Meter is alpha check she loaned my.....insisted in it rather than my human specific meter.

 

This sounds very positive Chris. I agree I would not give the insulin unless you have a reading first. Well done, keep up the good work. I really think those painkillers are helping him to recover. V

 

Is he eating low carb food yet or just the A/D?
The more low carb food he eats, the lower the dose of insulin that will be required.
I'm glad she loaned your the AlphaTrak. Do, however, share my signature link Glucometer Notes with her (if she has e-mail, just send he the link) so she can see the feline reference levels when using a human glucometer.

 

I'll relay the glucometer info and show her the website. I've been force feeding A/D (last was 7 am) and he's been grazing on Fancy Feast. I tried the A/D but he's got an aversion to it given the force feeding. I'm going to force feed him the A/D again soon but less since he's eaten 30 ml or more on his own. As long as he's eating around a 5.5 can by the end of the day I'm good.

 

Thanks. I agree on the pain meds. I'm crossing my fingers. Next vet visit is tomorrow.

 

Be sure to indicate which readings are the Alpha Trak vs the human meter on your spreadsheet. If there is a clear separatuin, a blank line with a note in bold red font will let folks know how to interpret the numbers.

 

I would keep up with all the supportive meds for now as it is so easy for them to slip back. I certainly would be hesitant to just stop the insulin without ongoing data to indicate it is not needed anymore.

So you want to discuss getting another vit b injection, more pain meds, anti nausea injection, sub q's with the vet. I still feel that if you can get hold of anti nausea medication it will really help poncho.

 

Ok....didn't think of that. Thanks. I noted the Alphatrak2

 

Ok.....if she still doesn't want to give the anti nausea med I'll see if the mobile vet will. Thanks.

 

I'm so glad to hear Poncho is eating a bit on his own and that you have a clear dx. Please be sure to stay on the ketone testing....I know you will

Sending many more prayers. And if you want to PM me a picture of Poncho, I'll post it for you since you are busy. We'd all love to see what he looks like. All you have to do in the PM is click on "upload file" and then browse your computer to the picture you want, click on it and it will upload.

I'm going to make a couple edits to his SS to keep it color coded correctly.

eta: don't forget you can go back to his BID dosing sheet if the vet is having you shoot every 12 hours instead of 8. It's easy to move the BID sheet into first position. Just click on the "BID" tab and move it to the left.

 

I'm so glad that you have a diagnosis. Not glad it's pancreatitis but I thought that was it. As I mentioned before Max has lived with it for over 5 years. The number on the fPL does not always reflect how bad (or not) they feel. Max is currently dealing with it now after his dental two weeks ago. I saw my vet yesterday and he didn't test for it since the medication is working. I hope you get cerenia or ondansetron to take home. Today was the 7th day I have been giving Max ondansetron. When it kicks in well I don't need an appetite stimulant. Please let us know how Poncho is when you get home and what you were given for nausea. The IDEXX ROUND TABLE discusses the importance of it. Poncho needs to eat and as I mentioned before you don't want to add food aversion to your worry list.

 

To discuss with vet: Sliding scale adjusted for AlphaTrak meter (folks, chime in if it should be tweaked further)

glucose reading - dose
538.5 to 615 - 1.25
461.5 to 539 - 1.00
384.6 to 462 - 0.75
307.7 to 385 - 0.50
230.8 to 308 - 0.25

 

I'm a bit confused about this scale. Is this the dose difference when comparing Alphatrak and a human meter given the reading? I did a pre shot BG, got a 139 and they said go ahead with a 1unit dose on a 12 hr schedule. Poncho is eating well today/tonight but I'm going to monitor him thru the night and catch up on sleep tomorrow after his vet appt.

 

I took the numbers for use with a human glucometer and adjusted them for use with the Alpha Trak. Human meters read about 30-40% lower than a pet meter.
As he is starting to eat some lower carb food, you'll want to be careful. Be sure to let this vet know about the aborted curve with 1.5 units previously

.

 

For those following Poncho, Christoph started a new thread here. 911 hypo
That 139 on an AlphaTrak is just over 100 on a human meter.

 

I'm not good with computer stuff, but did post a pic and it stayed up briefly. I don't know how to PM you a pic....assuming that is the right way to get it on the forum.

 

You click Upload a File in the lower left of the post box.
Navigate to the location where the picture is stored.
Click on the picture.
Select Thumbnail or Full Image
Then Click Post Reply or Create Thread, depending on if it is a new topic or adding to an existing topic.

 

Poncho and his big/little brother Remington

 

Adorable!

 

Thank you.....he's having a bad weekend and I'm worried. Hypo event might have stopped progress.

 

I'm sorry he's not doing well. Do you think you should take him back to the vet?

I posted his avatar. If you want me to edit it so I zoom in on him, I can. It would crop Remington out, though. Up to you.

Many vines for Poncho. Just remember it can take months for them to turn the corner from pancreatitis.

 

Thanks. Poncho would want Remington in the pic (and me too) so it's good. Right now I'm trying to make sure he has enough food in him as we approach +6-8hrs. He hasn't ever resisted this much with force feeding. Very stressful! He has a vet appt. in the morning. I need to get the anti nausea meds!

 

Maybe its the food aversion from force feeding and you need to use a different high cal food. Maybe Max Cat?

 

I'll pick some of that up. I think we're safe now re hypo or is it 8 hrs. I can't leave until I know for sure. 191BG @ +7 , down from 194 @+5 Relion

 

Those are within 20% of each other, so essentially the same. He's probably ready to start coming up again. Wait until you're convinced, though. I'm not sure if the Max Cat is a prescription food or not.

It isn't. I thought there was a specific formula that was high cal.

I'm wondering if shifting to something slightly lower might improve his appetite; could others chime in?

 

YES! Beg for both cerenia which the vet should have and a script for ondansetron which you can get at a human pharmacy. I get it from Costco. Is there one near you? If not look on Good RX for the best prices near you. It can also be purchased on line from thrivingpets.com, healthwarehouse.com and other places. I buy at least 30 at a time because the price goes down the more you get and you can use it yourself if you ever get nauseous.

 

I've asked the new vet twice and she said he's fine with what she's giving him....mirtazapine.....her way or the highway. I'm going to try another vet I know if I can reach him or the one across the state I used for 20 yrs

 

I second what Elise said above. The anti-nausea meds make such a difference with pancreatitis. The appy stimulant on its own just isn't enough.

FWIW, Saoirse was frighteningly lethargic at times when her pancreatitis flare was at its worst last year.

Praying for you and your adorable little Poncho. (He has the loveliest little face. )

(((Chris and Poncho)))

 

Thank you Critter Mom. Poncho is a gentle, super sweet cat.....always let the other cats steal his food..

 

Could he be fighting you because he is feeling stronger. Remi tolerated me feeding him when he was sick but as he felt stronger he fought me much more.

If I had a choice I would swap the appetite stimulant for the anti nausea. Could you ask to do that perhaps. Say that he is still struggling to eat and want to try another medication?

 

Since I'll be at the vet in the morning I'll ask her again, that I need to try another angle and this is the desired one and if she says no there are 2 other vets to ask. I should make the 250 mile trip to my old vet if I can't get it from the mobile vet. He was making progress until the hypo.

 

Maybe your old vet would fax a script to one of the pharmacies for you. Max is in his second week of ondansetron since this current bout of pancreatitis. I thought he was ready to stop it but his appy tanked.

 

I'll call him if i can't get the other two to prescribe it. I'm considering taking Poncho to my old vet....250 miles. I know I can trust him....

 

Fingers and paws crossed that you'll get the right Rx today, Chris.

 

Ok....I pressed the issue and the vet gave me the Ondansetron....1/2 of a 4 mg tab every 12hrs.....enough for 5 days so I guess this is a trial. Poncho got his 1st dose @noon. She said he should stay on the Hills AD rather than something like Friskies (for eating on his own) because it's has superior nutrition and digestability...I read most of the prescription can food was really no better than OTC. She also is doubtful if there is a need for the pain meds, but left that up to me. She also upped his fluids to 75ml from 50ml. We'll see how he eats tonight. Keep fingers and paws crossed.....thanks Critter Mom

 

If he'll eat the A/D on his own, that'd be fine for now. It is high calorie and moderate carb.

 

AD is what I have been force feeding him....developed an aversion to it I think so I don't see him voluntarily eating it. I got some Friskies Mixed Grill he seems to like to eat on his own, but I think I need a blender to make it more liquid-like since he licks wet food instead of biting it.

 

I've found with Rosa that she likes any of the pate type foods to have quite a lot of water mixed in (I just mix it with a spoon, I don't blend it) so it's more like a soup or gravy consistency. She's seems to prefer to just be able to lick the food up too. I also find if she doesn't seem sure about a new flavor, that offering a bit on a spoon will often get her to taste it and decide it's OK where if it's just put in the bowl, she might not bother with it too much. Either of both of those might be worth a try to get him more interested in eating on his own.

 

Thanks. Poncho has been mostly a dry food eater and I usually gave him a little wet food in a separate dish. He'd always just lick the food's juices and leave dehydrated remains.....funny cat.

 

Rosa was always a dry food eater too - it hasn't been all that easy to switch her over. The only wet food she ever ate was the 'in gravy' type which of course is too high in carbs now. And then, like Poncho she'd mostly eat the gravy and leave the meat to dry up. It does sound as though they have similar food preferences! I think that's why she'll eat the pate mixed with water - I don't think she can tell the difference between that and gravy. Though she does still leave the last bit of the food at the bottom of the bowl because that's always a bit more solid after she's licked up all the wettest parts of the food with the most water in them.

 

Whatever works, go for it! Porridge consistency, maybe.

 

You might be able to get away with 1/4 of a 4 mg ondansetron tablet twice a day. Try the 1/2 for now but amd perhaps tomorrow but after that may go for the quarter and see if it is enough. That way the tablets will last longer..

Hope it does the job.

 

Hi Chris,

I'm so pleased to hear you got the ondansetron Rx! Keeping fingers and paws crossed that it will help Poncho. BTW, it took a few days for it to really start helping Saoirse so if it doesn't make much of a difference at first, please don't lose heart.

Sending more scritches for Poncho and another for you.

 

I'll try that. Thanks!

 

That's good to know. Thank you for the scritches and hugs.....Poncho is getting spoiled on the scritches!

 

Poncho needs a bit of spoiling!

 

I'm so glad you got the ondansetron!!! I agree with Remi that I'd try 1/4 to start and see if that helps.....thst way it will last longer. ECID but 1/4 works for Gracie although now I buy the injectable from thriving pets. It's cheaper and you can give it with an insulin syringe if the vet calculates the correct conversion from mls to units. Perhaps if it works for him, she will write you another script.

Keeping Poncho in our prayers.

 

That comes easy.....made a big baby out of him.

 

I didn't know it came in injectable form. I need to get this sinus infection knocked out. TheDoxicycline isn't cutting it. I'm going to ask for something else.

 

Here is the Injectable form.

Scroll down to the 20ml vial of 2mg/ml. Sienne and I both use this but you need your vet to be on board and to give you a prescription. My vet also figured out how many units instead of mls so I can use the tiny 31g U100 insulin syringes. I actually haven't had to use mine yet but it's handy in case they are also vomiting and can't keep a pill down.

 

Thanks!

 

Hi Chris,

How are Poncho and yourself doing today?

Sending scritches and

 

Poncho had a rough day....very weak and lethargic this morning, and I thought he was on his way out. We had a vet appt this afternoon and she gave him some kind of immune support meds and new antibiotic. I think his resp. illness peaked yesterday/last night because it's less severe today and his eye cleared up. His system might have beat it back and left him a bit wasted. Until his sense of smell is normal I'll have to keep force feeding, which he hates. I can't cut him any slack on that. Thanks for more scritches and hugs....they're always welcomed!

 

Chris,
I'm so sorry to hear that Poncho had a rough night; but it's encouraging that he seemed a bit better in the morning.
It's so hard caring for a kitty when the state of their health seems to fluctuate. The uncertainty of 'what's going to happen next' can really exacerbate the stress and anxiety we understandably feel.

It must be difficult for you to force feed him when he hates it. But please do remind yourself that you're doing the very best you can to help him to recover and feel better. (And I hope you're looking after yourself too..?)

Sending you continuing hugs, and well-wishes for Poncho,
(((((Chris & Poncho)))))

Eliz

 

Hi Chris,

Sorry to hear that Poncho had a rough time of it yesterday morning. Saoirse was very lethargic when her flare was at its worst. It's quite scary. I'm glad the respiratory problem seems to be clearing up. Hopefully Poncho will feel more comfortable for it. The assist feeding must be tough going for you both, but it's what Poncho needs at the moment to help him get better. The nearest I got to that was getting Saoirse to lick food off my fingers, and I found that very difficult emotionally. Fingers and paws crossed that Poncho will get his sense of smell back soon. Sending more and special olfactory scritches.

 

All is well. Gaining weight, normal BG numbers in am, getting stronger. Thanks.

 

That's good news, Chris.
And how are you doing?
.

 

That's fantastic news, Chris! I'm so glad. How's Poncho's appetite coming along?

 

Glad Poncho is doing a bit better.

 

That's good to hear Chris. Keep up the good work

 

I'm getting more sleep for a change but not normal amount yet.....but lots of cat naps for "balance".

 

Still the same as long as his sinus issue is there. He'll eat a little and then I have to fill in the void. Since all this started I've had a suspicion there was something wrong in his mouth causing his lack of appetite and always wanting to lick his food, plus when he chewed it seemed to be a struggle. The old vet insisted his mouth was normal save for the normal wear and gingivitis and his appetite issue was only pain related. Well we now know that all along he had this sinus infection brewing and this morning he has started pawing at the left side of his mouth as he chews. The vet will look at this Monday....and I'll bet all the while a problem in his mouth was a barrier to his eating issue as well as the URI. Tooth absess maybe?

 

My vet told me Max's teeth "looked ok" when I first brought him in, but she didn't get a great look at the very back teeth cause he never let anyone open his mouth. It wasn't until I noticed his mouth bleeding and smelling terrible that we figured out the teeth were the source of his problems, and probably triggered his DKA. They should be able to see an abscess on an xray if that is the source of the URI. It's probably worth considering a dental if he's got tartar even if he doesn't have an infection, as this can make it hard to regulate his diabetes.

 

That's most likely the problem. We'll find out Monday. Thanks for the good info.
I just read the initial diagnosis notes and the vet did note mild gingivitis. Maybe she missed something.

 

Some things are only visible on x-ray.

 

The only time I ever saw one of my cats paw at their mouth like that was when something was stuck to her teeth. I'd say a dental check is a very good idea.

I don't know whether it's any help to you but Saoirse's gums were mildy inflamed only a couple of months ago, but when the vet examined them recently they had become much more inflamed. I don't know whether or not diabetes might make gum inflammation worse???

 

It looked like he was trying to wipe something off the side of his mouth.....1st time I've seen him do that. I might try to give it a look when he has awakened. I hope Saoise's gums are better. Wondering if Turmeric (Curcumin) is tolerated by cats. It's supposed to be a great anti inflammatory for humans.

 

Thanks for the good wishes for Saoirse, Chris. She went for a dental on Thursday morning but she freaked out at the vets so it had to be postponed.

I've read that turmeric is safe for cats, but I've never tried it. Perhaps it might be an idea to ask members here if they have any experience of using it? It definitely is a very good anti-inflammatory for humans (I've used it myself).