? 30April2020/Maxi/Unwell Again/PMPS+6:258/ +9:287/+11:287

bambinaki

bambinaki

Member Since 2010
Last thread: http://www.felinediabetes.com/FDMB/threads/28april20-8-59-will-can-not-eat.228919/

After seeming to have recovered 100% last night, poor Maxi doesn't feel so good now.

I could tell he didn't feel great, then he had diarrhea again. He did eat a fair amount, but with decreased appetite, and hangs out at the water bowl more than normal.

I gave him 2mg ondansetron, 0.15ml buprenorphine, 125mg S boulardii.

Anything else I can do?

Any reason to go back to the vet?

Any ideas on why he has a LOT of gas with very strong odor? Is this common with pancreatitis?

Having gone from 9.25 to 7 units of Lantus, what should Maxi's Lantus dose increasing schedule be?

Thank you
 
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Sandy and Black Kitty said:
Did the vet check a stool sample!
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No. Should I bring one in? How long does it take for results of stool tests?

The vet and I just spoke and agreed that if he doesn't get better I should take him to a specialist clinic (Affiliated Veterinary Specialists). She is arranging for them to accept us if we go today or tomorrow.

Do you think I should take him?

He's not nearly as bad as he was Monday. He got better then worse then last night he was doing great and then worse again. Maybe it is the cabergoline?
 
bambinaki said:
No. Should I bring one in? How long does it take for results of stool tests?

The vet and I just spoke and agreed that if he doesn't get better I should take him to a specialist clinic (Affiliated Veterinary Specialists). She is arranging for them to accept us if we go today or tomorrow.

Do you think I should take him?

He's not nearly as bad as he was Monday. He got better then worse then last night he was doing great and then worse again. Maybe it is the cabergoline?
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It wouldn’t hurt to have an ultrasound. That way, they can make sure it is the pancreas. Interestingly, my Gracie always had a high specfPL but, unlike Maxi, she never had one symptom. The ultrasounds showed her pancreas to be uninflamed but inflammation of the liver/gallbladder can also cause an elevated specfPL. If the pancreas, gallbladder, and intestines are inflamed, he could have triaditis. Jill’s Alex had this several times and it made her quite sick.

If he goes outside, you might want to have a stool sample checked for parasites.

There is also a condition called exocrine pancreatic insufficiency (EPI). Maxi’s stuff came on pretty fast unless there were potential clues but you can also have a blood draw done for a GI Panel which will test Folate, Cobalamin, TLI (for EPI), and another specfPL which you don’t really need. If he has EPI or a low vit B12, the S. boulardi won’t work but we usually don’t run out and do a GI Panel right off the bat. He will need to be fasted at least six hours to do a GI Panel.

I’m not trying to suggest he has any of these....I’m just tossing out ideas for you to discuss with the vet. Your vets can decide what to check him for. I also would not stop meds if symptoms quickly resolve like yesterday. You usually want to continue them for several days after he’s better.

Sending him tons of vines to feel better.
 
Has he had any Cerenia yet today? Sometimes cats need both it and ondansetron and they target different nausea receptors. Hanging out at the water bowl is also a sign of nausea. Poor little guy.

As for the Lantus, at some point we might call this a failed reduction, but the depot is so messed up yet it's too early to say that. With a failed reduction you can go back to the last good dosek or maybe a smidge lower. In the mean time, have you though about helping him out with a little bit of R?
 
Wendy&Neko said:
Has he had any Cerenia yet today? Sometimes cats need both it and ondansetron and they target different nausea receptors. Hanging out at the water bowl is also a sign of nausea. Poor little guy.

As for the Lantus, at some point we might call this a failed reduction, but the depot is so messed up yet it's too early to say that. With a failed reduction you can go back to the last good dosek or maybe a smidge lower. In the mean time, have you though about helping him out with a little bit of R?
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I just gave him 8mg of cerenia.(Last cerenia was 24 hours ago.)
I gave him 2mg of ondansetron at 4am.
I gave him 0.15ml bupe at 5am.

When do you think I should give ondansetron again?
What about bupe? (Since odansetron can cause headache, I like to give bupe with it.) He doesn't seem bothered (whacky) from the bupe. He was either very sleepy (or felt bad) this morning, and had big pupils, but otherwise doesn't show signs of being whacked out.

If we were to call this a failed reduction, what was the last good Lantus dose? Before all this, he was up to 9.25 for 2 cycles, then when his glucose dropped to 58, he skipped Lantus for a cycle, and the next cycle he took 9.25, then 9, then 7, then he skipped a cycle, then 7 for the last 3 cycles.

Yes, I've thought about R but obviously haven't given it -- was thinking not to add more to the mix. But I will certainly give it if you think it's a good idea. His last number 45 minutes ago was 281. I'll test again in 15 minutes and then ask you what you think about giving R.

Thanks a lot
 
Wendy&Neko said:
Poor little guy.
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Oh, and I'm going to bring him to the specialist clinic tomorrow at 8am. I will ask for an ultrasound and GI panel and about triaditis (I haven't looked that up yet and have no idea what it is) and EPI.

The receptionist at that clinic told me to ask the regular vet about fasting him for a GI panel. She didn't want to say because he's diabetic. The regular vet said it would be ok to fast him starting at midnight tonight. He's used to eating a small meal at 3:30am.

Do you think fasting like this will be ok?

I'm planning not to give him cabergoline tonight. Do you think that's ok?

I hope I can collect some stool. He is indoor only but I guess that doesn't rule out a parasite. ?

Thanks again for your sympathy for the poor little guy. He is super good natured, very loving and sweet and gentle and accepting and forgiving. A friend who knows cats and knows Maxi always says "There's no one like Maxi."
 
bambinaki said:
When do you think I should give ondansetron again
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Remember Wendy suggested you can give 2 mg every 6-8 hours.

Typically for a GI Panel, it’s a 12 hour fast but my vet called Texas A&M where we had the GI Panel run on blood my vet drew and they said a diabetic cat should not be fasted more than six hours for the test.

If he’s indoor only, has no contact with another cat, and you don’t have and haven’t ever had a flea issue (remember humans can bring fleas in in their clothes, etc), and has never had any issues with his stool, it’s unlikely he has a parasite or worms. But, if you’ve ever seen any sporadic issues with his stool, he could have a parasite, potentially although unlikely. Giardia and coccidia can have active and inactive cycles but you would have seen previous episodes of smelly diarrhea.
 
Marje and Gracie said:
Remember Wendy suggested you can give 2 mg every 6-8 hours.
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It has been more than 10 hours since he last had ondansetron, but the vet said to stagger it with the cerenia, and he just got cerenia 1 hour ago. So, I'm not sure how much time in between counts as staggering. And maybe you think it doesn't even need to be staggered?
 
Marje and Gracie said:
Typically for a GI Panel, it’s a 12 hour fast but my vet called Texas A&M where we had the GI Panel run on blood my vet drew and they said a diabetic cat should not be fasted more than six hours for the test.
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More confusion! I will go with Texas A&M vets and fast him only 6 hours.

So, according to what you said about parasites, it seems unlikely to be that. He hasn't had stool issues before. However, he has had fleas, but not majorly, and not for 5+ years. Before he moved from Indiana to Florida with my mom, he would go outdoors, but since then he's been only indoors. After that, an occasional flea was found on him, but that was over 5 years ago.
 
bambinaki said:
It has been more than 10 hours since he last had ondansetron, but the vet said to stagger it with the cerenia, and he just got cerenia 1 hour ago. So, I'm not sure how much time in between counts as staggering. And maybe you think it doesn't even need to be staggered?
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It does not need to be staggered.

bambinaki said:
So, according to what you said about parasites, it seems unlikely to be that. He hasn't had stool issues before. However, he has had fleas, but not majorly, and not for 5+ years. Before he moved from Indiana to Florida with my mom, he would go outdoors, but since then he's been only indoors. After that, an occasional flea was found on him, but that was over 5 years ago.
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I never say never but it’s unlikely. If he had tapeworms, you’d probably have seen them by now in his stool or coming out of his bottom.

bambinaki said:
I will go with Texas A&M vets and fast him only 6 hours.
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That’s what the TAMU lab said. You can probably find it on their website as well.
bambinaki said:
283

Do you think I should give R now?
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He’s pretty flat so it’s ok to give it according to your scale but be sure you can test by at least R+2 and be cognizant that flat numbers like this “might” signal a bounce clearing cycle tonight.
 
Marje and Gracie said:
He’s pretty flat so it’s ok to give it according to your scale but be sure you can test by at least R+2 and be cognizant that flat numbers like this “might” signal a bounce clearing cycle tonight.
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His number went down to 275.

I gave 0.5-0.75 unit of R.
 
Marje and Gracie said:
I never say never but it’s unlikely. If he had tapeworms, you’d probably have seen them by now in his stool or coming out of his bottom.
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I just brought some poo to the vet to test. I hope they are able to because it's mixed with litter. If they can run the test with just a small amount, they will be able to pull some that is not mixed with litter.
 
From the Royal Veterinary College, University of London, Diabetic Remission Clinic

"Thank you for providing some additional information about Maxi. I suspect his cabergoline is not the cause of his recent GI upset. Side-effects of cabergoline are most often seen close to the start of treatment and Maxi's dose does not seem excessive (assuming he is receiving 30 mcg once daily). I would however avoid giving him the cabergoline while he is experiencing these signs just in case they might be making them worse. It can then be re-introduced once he is better. Was cabergoline significantly improving Maxi's blood glucose control? The only risk of an abrupt stop is that his diabetic control will worsen. Although this is always disappointing to see, it at least should not pose a great risk to Maxi."

The answer to their question is "no," right?

@Pamela & Amethyst
@Olive & Paula
@Marje and Gracie
@Sandy and Black Kitty
@Wendy&Neko
 
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bambinaki said:
The answer to their question is "no," right?
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Hard to say, he was starting to see greens. Was that the Lantus dose, or the cabergoline? With the depot only partially established, he's looking better on 7 units now than he did when he was on that dose before.

Bummer on the partial fur shot. :(
 
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