? 3May2020/MAXI/Sunday Morning Hospitalization Update & Questions: Pancreatitis Test & FreestyleLibre

bambinaki

bambinaki

Member Since 2010
Last thread:http://www.felinediabetes.com/FDMB/...ization-update-questions.229085/#post-2565514

Hello-

Maxi is continuing to improve!

They did another pancreatitis test. Negative is below 3.5; Maxi's was 25.8. I *think* the pancreatitis test from the regular vet the other day was 23. If this is correct, should I be concerned about this increase?

He has eaten some canned food, but still mostly dry.

Peeing but not excessively. No bowel movement yet.

Transitioned to oral medicine: cerenia, gabapentin, Entyce, clavamox, Epakitin.

PS (7 units Lantus): 500 --- +8: 344 --- 360

Still on IV fluids; will wean off today.

Still getting cuddles. The "Crazy Cat Lady" was not working last night, but she will be tonight.

I wrote and emailed Maxi's Story and photos of Maxi feeling good to them yesterday morning to put next to him and have all his caregivers read and look at, which they kindly did.
Last night the doctor said that yesterday morning, they couldn't see the Maxi described in Maxi's Story, but yesterday afternoon that Maxi was coming out.

Questions: With the FreestyleLibre monitor, I will have to buy a new one every 2 weeks to stick on him, right? I will still have to check his numbers frequently day and night to make sure he's not hypoglycemic and/or to know if I should give R, right?

Thank you
 
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You are correct about the Libre meter. The sensor has a 2 week lifespan (if it works) and is relatively expensive compared to strips. You must test -- which involves getting a reading by putting your cell phone with the app near the sensor -- in order to know what the BG level is.

Please look at this article on appetite stimulants in cats. Entyce has not been approved for use in cats. It also has an effect on growth hormone. This may not be a good idea in an acre kitty. (And can you please update. your signature to include the aero diagnosis?) You have other choices with regard to an appetite stimulant.

You may want to discuss the use of both Cerenia and ondansetron if nausea is an issue. They work on different receptor systems and can be used together. You also need to make sure the nausea is being addressed before dosing an appetite stimulant. If Maxi is nauseated and you give an appetite stimulant, it's likely that a food aversion to whatever is in the town will develop.
 
Entyce also tastes awful. I like cyproheptadine which is a human antihistamine and just a crumb worked for Max. Once I got his nausea under control I rarely needed it. Aluminum hydroxide works better than Epatikin but once home we can discuss that.

The number on the pancreatitis test doesn’t necessarily coincide with the severity. There were times Max had a high number but not as many symptoms as when he had a much lower number. It’s not a perfect test and can be higher with other conditions such as CKD and diabetes. I learned to judge Max by how he felt and his appetite.
 
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It does sound as if it was pancreatitis. Maxi has enough tests that you know now some things are normal which is very good.

You do want pain meds in addition to the others for when you go home.

Remember the lantus depot has been interrupted. It will take time to re-establish it. Make sure they are aware of that.

From the Feline constipation link Wendy sent you. The cabergoline you used was Olive oil based. It might have contributed, something to ask them about.

'Lubricant' Laxatives

  • Olive oil – Technically a cholagogue (see Glossary), not a lubricant laxative, olive oil has mild laxative properties when a larger dose is given. A larger dose for a cat is a small amount! For a mild bout of constipation, a quarter teaspoonful of olive oil can be given for acute treatment but cats require animal fat sources, not plant oils, so olive oil is not suitable for ongoing care. Olive oil contains terpenic acids and phenolic compounds which a cat's liver is not able to properly detoxify. Some pharmacies carry small bottles of pharmaceutical-grade olive oil. Do not force any oil into the mouth of a cat
Ollie's p'titis tests go up and down and it could be just because she is chronic p'titis. Like @tiffmaxee said I see how Ollie symptoms present. If she doesn't eat well I watch her, if she wants to eat but walks away and or throws up, I immediately give cerenia and fluids. Sometimes I have to increase her bupre dose. If you catch a flare right when it starts and treat it, it's so much better for all. When you get home, ask you vet for all the meds including bupre and subq fluids so you have them at home and can give immediately should Maxi flare.
 
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I agree in the Entyce and also Elise’s comment about the specfPL. The number gives you no idea on the severity. In other words, 10 as a reading is no better than 25. Abnormal is abnormal.

Also...why is he getting epakitin? Is it due to his P level now being over 6? Epakitin is an old-school P binder. The Bret P binder is aluminum hydroxide powder. It is tasteless and works really well. The concern with Epakitin is it contains calcium carbonate and can potentially raise the calcium level. Not good for a CKD cat as you want to be sure Ca x P stays below 70. He’s ok right now but I’d definitely get him on aluminum hydroxide. You mix it into his food so it binds the P in the food. This page on Tanya’s discusses aluminum hydroxide dosing.

I will say it’s odd for a cat so early in CKD to have such a high P level. Were you giving him bone broth or anything like that because that will definitely drive up the P. I’m trying to determine if this is, perhaps, temporary because of something he was being given other than his regular food? He was pretty stable on his P prior to this although his P really needs to be less than 4.5. However, less than 6, you should do it by feeding lower P foods.
 
Sienne and Gabby (GA) said:
Please look at this article on appetite stimulants in cats. Entyce has not been approved for use in cats. It also has an effect on growth hormone. This may not be a good idea in an acre kitty. (And can you please update. your signature to include the aero diagnosis?) You have other choices with regard to an appetite stimulant.

You may want to discuss the use of both Cerenia and ondansetron if nausea is an issue. They work on different receptor systems and can be used together. You also need to make sure the nausea is being addressed before dosing an appetite stimulant. If Maxi is nauseated and you give an appetite stimulant, it's likely that a food aversion to whatever is in the town will develop.
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Thank you, Sienne.

I will ask about eliminating Entyce and adding ondansetron back in.

What about CBD?
 
tiffmaxee said:
I like cyproheptadine which is a human antihistamine and just a crumb worked for Max. Once I got his nausea under control I rarely needed it. Aluminum hydroxide works better than Epatikin but once home we can discuss that.
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Thank you, Elise.

I will ask about cyproheptadine. Do you use that instead of cerenia and ondansetron?

I had read before about aluminum hydroxide as a binder, but I remember reading that was for later stages. As, Marje said, I don't want him to be overloaded with calcium.
 
Marje and Gracie said:
Also...why is he getting epakitin? Is it due to his P level now being over 6? Epakitin is an old-school P binder. The Bret P binder is aluminum hydroxide powder. It is tasteless and works really well. The concern with Epakitin is it contains calcium carbonate and can potentially raise the calcium level. Not good for a CKD cat as you want to be sure Ca x P stays below 70. He’s ok right now but I’d definitely get him on aluminum hydroxide. You mix it into his food so it binds the P in the food. This page on Tanya’s discusses aluminum hydroxide dosing.

I will say it’s odd for a cat so early in CKD to have such a high P level. Were you giving him bone broth or anything like that because that will definitely drive up the P. I’m trying to determine if this is, perhaps, temporary because of something he was being given other than his regular food? He was pretty stable on his P prior to this although his P really needs to be less than 4.5. However, less than 6, you should do it by feeding lower P foods.
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Thank you, Marje.

He has been on Epakitin for months for kidney disease / phosporus. I was going to five him bone broth when he wasn't eating until somebody here told me it's high in phosphorus. I was mixing food other than his low carb + low phosphorus food in to try to get him to eat. It usually worked to some small extent. That was only the last 10 days or so before he went into the hospital.

I will ask about getting him off Epakitin and on aluminum hydroxide.
 
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bambinaki said:
Thank you, Elise.

I will ask about cyproheptadine. Do you use that instead of cerenia and ondansetron?

I had read before about aluminum hydroxide as a binder, but I remember reading that was for later stages. As, Marje said, I don't want him to be overloaded with calcium.
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No. Cyproheptadine works as an appetite stimulant as does Entcye supposedly. For nausea I mostly used ondansetron and sometimes cerenia. I found once the nausea was controlled I didn’t need an appetite stimulant. I also found when Max was really sick nothing worked. It’s important to get the nausea controlled.Then he will eat the food you want him to eat. That’s why I tried not to use any appetite stimulants because if a nauseous cat eats they might develop food aversions to the food they eat while nauseous. That’s why I never minded him eating a different food while getting the nausea under control. I always gave ondansetron about a half hour before trying to feed. That’s also why when Max felt better the last medication I slowly removed was ondansetron. I started by removing the appy stimulant first and then slowly decreasing the ondansetron to fewer times a day.
 
tiffmaxee said:
No. Cyproheptadine works as an appetite stimulant as does Entcye supposedly. For nausea I mostly used ondansetron and sometimes cerenia. I found once the nausea was controlled I didn’t need an appetite stimulant. I also found when Max was really sick nothing worked. It’s important to get the nausea controlled.Then he will eat the food you want him to eat. That’s why I tried not to use any appetite stimulants because if a nauseous cat eats they might develop food aversions to the food they eat while nauseous. That’s why I never minded him eating a different food while getting the nausea under control. I always gave ondansetron about a half hour before trying to feed. That’s also why when Max felt better the last medication I slowly removed was ondansetron. I started by removing the appy stimulant first and then slowly decreasing the ondansetron to fewer times a day.
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OK thanks Elise.
 
When you have time read on Tanya’s about AH binder. It’s rare but possible to have aluminum toxicity. I d been in CKD groups tor well over 20 years and don’t recall it happening.

Are you giving bone broth?Another thing you might consider switching to making your own food and using EZ Complete as egg shell is used instead of bone. I wish I could feed it to my youngsters but one has allergies to chicken I think so I can’t.
 
bambinaki said:
What about aluminum toxicity?

And if I get him on aluminum hydroxide, should I start giving him something to keep him from getting constipated?
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As Elise said, it’s rare. It’s one of the reasons why you don’t start it until the P level gets 6 or over but my CKD cat was on it for over four years and never had an issue with it. But he also was not on a high dose because I started him as soon as he got to 6 and his creatinine was not over 3.5. The binder kept his P level at about 4.5 and we also fed lower P foods. The constipation is ECID. My kitty never had an issue with constipation; actually, none of my cats that I used aluminum hydroxide powder with did but Gus was on it the longest.
 
Great to hear that Maxi is improving, I hope that means he's be home soon.
bambinaki said:
Questions: With the FreestyleLibre monitor, I will have to buy a new one every 2 weeks to stick on him, right? I will still have to check his numbers frequently day and night to make sure he's not hypoglycemic and/or to know if I should give R, right?
Click to expand...
Just wondering why you'd want to continue using the Freestyle Libre when he gets home? He'd have to go to the vet clinic every couple weeks to get shaved and have a new monitor stuck on. It's not something people usually do themselves. As for checking while it's on, yes, you still have to check the results. As for R, if you need sleep at night, just don't give R. It's fine if he rides a little higher for a cycle.

I echo Sienne's comments on Entyce. That was a actually a rather worrying article about it. I have seen people here try it on their cats, and besides the fact that it didn't seem to work that well, it did raise blood sugar numbers - probably due to the growth hormone stimulating properties. And on an acro, I'd be really concerned about anything that could cause bradycardia or hypotension. Neko already had some bradycardia, didn't need anything else making that worse.

I echo the other comments on adding back in ondansetron. Hopefully with it and Cerenia you won't need an appetite stimulant at all. Also agree with the others on Epatakin - Neko was on aluminum hydroxide too when it was time to add a binder. Easy peasy to give, just mix a little into the food.
 
tiffmaxee said:
Are you giving bone broth?Another thing you might consider switching to making your own food and using EZ Complete as egg shell is used instead of bone. I wish I could feed it to my youngsters but one has allergies to chicken I think so I can’t.
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No, I'm not giving bone broth.

Making my own food sounds like a good idea, but I don't feel I can take that on now.

Thanks, Elise.
 
Wendy&Neko said:
Just wondering why you'd want to continue using the Freestyle Libre when he gets home? He'd have to go to the vet clinic every couple weeks to get shaved and have a new monitor stuck on. It's not something people usually do themselves. As for checking while it's on, yes, you still have to check the results. As for R, if you need sleep at night, just don't give R. It's fine if he rides a little higher for a cycle.
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Based on what you have said, I don't want to continue using it.
 
I asked about Entyce and Epakitin today. Reply: We prefer them; they work well in our experience.

I asked if she had anything against cyproheptadine and aluminum hydroxide, and she said no. So, I definitely want to get rid of Entyce and Epakitin.

I asked about keeping Maxi on ondansatron. Reply: He's on cerenia and doing well. I definitely want to get him back on ondansetron combined with cerenia when he gets home, which should be tomorrow. How long should I keep him on them?

She said their test of his phosphorus was normal per the range they use. It was 5.5. What do you think of that?

Thank you!
 
Since they have nothing against cyproheptadine, ask for an RX for it when you take him home. They will likely advise too high a dose. I’d start with 1/8 of a pill. They are 4 mg. You will need to get it at a pharmacy. The aluminum hydroxide powder does not require an RX. I’ve bought it from thrivingpets.com. How long has he been on epatakin?

If cerenia alone or ondansetron alone eliminates the nausea great. If not you can go back to both. Do you have enough ondansetron at home?

I think there’s a chance this was an acute episode and you might be lucky and he won’t have another. You will want to continue with the meds until he’s back to normal and then slowly decrease one by one. The last thing to decrease should be the nausea meds. I usually waited for a week of normal. If he’s back on ondansetron I’d start by skipping one dose and see if he eats like he normally does. I’d do that a few days and if all goes well then try just once a day. If there’s any sign of nausea such as just licking the liquid or eating a few bites add it back. There were times Max was in it for a month or two and other times a few weeks. With cerenia you would go from every day to every other and gradually eliminate. I hope this makes sense.

I hope Maxi comes home tomorrow.
 
tiffmaxee said:
How long has he been on epatakin?
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I think since October.

tiffmaxee said:
The aluminum hydroxide powder does not require an RX. I’ve bought it from thrivingpets.com.
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https://www.thrivingpets.com/catalo...ngpets-aluminum-hydroxide-powder-usp-50g-jar/
Is this what you buy?

tiffmaxee said:
Do you have enough ondansetron at home?
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I have some and will get some more. I still have a refill on the current prescription.

Do you think they will have me continue with the clavamox? Do you agree with doing that?

Same questions about the gabapentin. He's off buprenorphine and they said gabapentin was doing the trick. Should I get him back on buprenorphine? Both gabapentin and buprenorphine?

tiffmaxee said:
I think there’s a chance this was an acute episode and you might be lucky and he won’t have another.
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That would be a much needed gift!

tiffmaxee said:
I hope Maxi comes home tomorrow.
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Thank you, Elise, and thank you for the helpful medicine instructions.


@Sienne and Gabby (GA) @Wendy&Neko @Marje and Gracie @Sandy and Black Kitty
 
That’s the correct aluminum hydroxide. I would use either bupe or gabapentin. I’ve only used bupe.

Refresh my memory as to why the clavamox. Was there an infection? I’ve never been given an antibiotic for pancreatitis. My vet only gives antibiotics when he feels really necessary.
 
tiffmaxee said:
Refresh my memory as to why the clavamox. Was there an infection? I’ve never been given an antibiotic for pancreatitis. My vet only gives antibiotics when he feels really necessary.
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I'm not sure. I think I remember the first doctor saying that it was in case he had a urinary tract infection.

I agree with your vet.

I will certainly ask why if they want Maxi to continue taking it. And I'll ask why he was put on it at all.

I just ordered the aluminum hydroxide.

Thank you!
 
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That's the same aluminum hydroxide I used. A little goes a long way. I actually got it from someone here and passed it onto to someone else here - so it was enough for 3 cats!

The decision on bupenorphine vs. gabapentin you will have to make on your own. Some cats do better on one vs the other for pain. Some need both.
 
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