4/15 Jenks AMPS 79 +3 62 +7 92 PMPS 106 +7 70 +10 55

4/14

Things were going pretty well yesterday until it was time for the overnight feeding. Jenks got racked by another flare up of vomiting and loose stools. Once he purges his system, which takes about an hour or two, it seems to quiet down and he settles in for some rest. About +10 he was alert and looking around. He ate some dry treats from my hand. So I went ahead with the appetite stimulant to see if he might eat some breakfast so we could safely shoot. He ended up doing just that. Between unenhanced breakfast food, plus a little more with FortiFlora, plus some dry treats, he ate pretty decently, so we moved ahead with the usual dose and he'll be monitored by OH through the morning. Though I hope we don't have to gravy him if he has an early morning drop, I wouldn't be surprised if it happened with this AMPS number.

The return of the vomiting/spurts complicates things because now we have to change focus to whatever is causing it, which is likely leading to his lack of appetite. Excellent BGs aside, pancreatitis seems to be emerging as the likeliest candidate, so it may be time to run him to the vet for fluids and pain management to see if that brings him around. If that's the case, I suspect we'll have to substitute our current course of appetite stimulation for other meds in the meantime, whether it's metronizadole again, or an anti-nausea, or some other combo thereof.

Answering questions from yesterdays condo:

@Beenie (GA) - He's a great snuggler. But it's a blessing and a curse. He comes in really handy in the winter because he's nice and warm. On the flipside, he has a knack for positioning himself on your leg so that the bulk of his weight pushes down on just the right spot to make it feel like your hip or knee is eventually going to pop out of its joint, but despite the discomfort, you still don't move because you don't want to disturb him because he's so cute sleeping there haha

@Bobbie And Bubba - Yeah, he's a big boy, and 26 lbs is down 3 pounds from the annual checkup last year!

@Dyana @carfurby - Thanks for the vines! He can use all he can get to stimulate that appy right now.

@Marje and Gracie - Unfortunately, Jenks and his siblings came to us as abandoned kittens, so we don't know anything about their parentage. But I clearly recall taking Jenks in for his first vet evaluation, and the doctor on duty took a good look at him as a kitten and proclaimed, "This is going to be one big cat."

I don't want to underreact either. I'm not looking for material to support any sort of inaction because it feeds a narrative that there's nothing to be worried about. I merely included that last source because it was the only one I've run across so far that actually made a reference to the potential range for CK values, even though it's unsourced.

So far, all other sources, including the personal experiences here, say that elevated CK values may point to cardiac involvement. My plan, even if everyone else disagrees with me, is to try to move ahead with investigating that. So thank you for posting what you remember about Dr. Church's costs. That helps put things into perspective. On the agenda this week is calling their office to see if they can give me an idea of what to expect if we booked a visit.

 

I’m sorry he’s had a tough go. It sounds like fluids and pain meds would help. I can’t remember if you are also giving cerenia and ondansetron but if you aren’t, I’d ask for them. They will help with the vomiting and any nausea he might have which, in turn, might help him eat better.

Well, my memory didn’t serve me quite right. The consultation with Dr. Church was $160 and echo was $400. Travel was $50. I don’t know if he charges the same thing in his offices because he wouldn’t have to transport his equipment.

I talked to Karen this morning and she said some similarities were that Doodles had inappetance and his BG was really great until it suddenly wasn’t. But we attribute the change in BG to his IAA and not necesssriky his heart.

You are a great caregiver and will make the right decisions. We are here to support you and OH...and Jenks.

 

I hope you can figure out what is going on with Jenks soon and get the appropriate treatment for him. Sending prayers.

 

It all sounds a bit complicated to me.

I do hope that whatever , you get it sorted ad the wonderful MrJenks is right as rain again very soon.

 

Sounds complicated to me, too, but we wanted to send some support for you and lots of vines for Jenks.

 

Thanks again everyone! Yeah, it's confusing not really knowing what's going on, and even moreso that pancreatitis is difficult to diagnose on its own. My plan is to get the vet on the phone and come to an agreement on some kind of diagnostic plan before going into the office, so I am not put in the position of having to make decisions on the fly. If it's possible, I'd prefer something like, "Ok, we'll do this. If it says X, we'll do this, but if it says Y, we'll go this way" and so on.

@Marje and Gracie - We though we were past the vomiting/diarrhea, so when his appetite remained diminished, I asked for an appetite stimulant. We currently have mirtazapine. But with the resurgence of the vomiting/diarrhea last night, we may need to table that in favor of an alternative better suited to dealing with pancreatitis symptoms.

We do not have, and are not giving, cerenia or ondansetron. I'll ask and see if the vet is amenable should we head down that road. Admittedly, I've glossed over the specifics of each medication when reading about them in other condos, but I was under the impression that they both did the same thing. Is that not the case? If they do different things, can you tell me more about why they work well in tandem?

Thanks for continuing to update me on what you remember about Dr. Church's services. My plan is to still call their office and ask what to expect if we made an in-office appointment for an echo.

Other than that, Jenks' numbers were excellent again today. He didn't want to eat much at the early morning feeding. But I did get him to eat pretty well at PMPS, which was a relief. He spends most of the day out. He was lovey with OH today. He's been out drinking water. He's resting a lot, but I would be too if I was feeling crappy. So even though he's not feeling his best right now, I take those as good signs.

 

Both Cerenia and ondansetron tackle nausea, but Cerenia is better for vomiting. Both drugs target different nausea receptors, so one drug may work better in a particular situation than the other, or you may need both. It's best to treat nausea before giving an appetite stimulant. Who wants to eat if nauseous? Plus it can cause food adversions.

Sending appy vines for Jenks.

 

They can both be given, they just address nausea differently. One may work better for Jenks than the other, or both may help him get over the hump. I had both for Asia, the onda did nothing for her the one time I gave it, and that was the last time I gave it. The Cerenia worked very, very well for her. Are you still giving the SEB twice a day?

 

No vomiting tonight, thank goodness. But Jenks did have another spat of poop urgency, while only managing to produce the occasional squirt of foul-smelling liquidy stool. Assuming it's pancreatitis, or heck anything else for that matter, why does it only strike at 3am, last an hour or so, and then disappear for the remainder of the day? Isn't that weird?

Anyway, once Jenks was pooped from trying to poop, I got him to eat some food. His BG was excellent again. He's still hanging out in the kitchen resting. Earlier he was alert, mobile, and vocal, so all good signs, right?

We're coming up on the +10ish spot check to make sure he's going to head safely into AMPS.

@Wendy&Neko - "Who wants to eat if nauseous?" is profound and something that I never thought about. Under those circumstances, I can absolutely see how an appetite stimulant could be counter-productive. How do you know if you need one or both? Just trial and error, I assume?

@Stacy & Asia - Thanks for sharing your experiences. Yes, Jenks still gets the SEB, although I think he wishes that wasn't the case. I'm making sure to give it at a time when it won't conflict with the meds. I can't tell if it's doing anything yet though.

 

For the appetite stimulant vs antiemetic, usually you try something like Cerenia first, give it some time to work and then add the appetite stimulant. If he’s eating fine with just the Cerenia or onda, nausea is the real problem by itself, if not, you add the appetite stimulant after an hour or so when the antiemetic has had a chance to start working.

SEB has different directions when to give for diarrhea, I have not needed for this issue so I can’t speak of it working from personal experience. It doesn’t seem like it’s enough if he is feeling nauseous however.

If it is pancreatitis, pain meds and Cerenia/onda should make a world of difference. It did for Asia.

It is interesting about the 3am bit. What happens around that time? Has he not eaten for many hours? What is the food situation there?

I’m sorry Jenks is going through all this, many of us have been there and it’s a pretty helpless feeling, especially if you have to convince your vet something is awry.

Tons of vines for sweet Mr. Jenks, I hope he’s feeling better soon and his GI distress calms.

 

@Stacy & Asia - Thanks for the continuing info. I can't say thanks enough.

Jenks eats at PMPS, and then a midcycle meal usually 6 1/2 to 7 hours later at +7. It's around that time that he has the puking/diarrhea spells. The urgency to go poop started pretty much at +7 on the dot tonight. An hour or so later it subsided. Not sure how or if any of it is connected, but even though I lack experience in the matter, I have my suspicions that pancreatitis keeps a schedule.

Anyway, Jenks was 55 at +10ish, so it was time to get some gravy and a little karo on board. Sometimes I get a bigger glob of karo than others, so who knows what his BG will be as we approach AMPS.

 

That’s what we do here is help each other, even if it’s just support, it all counts for a lot.

So does it happen before feeding or right after? If it is before he eats, maybe move his +7 food time up a little, by an hour and see if it makes any difference. If it’s possible to try smaller more frequent meals until this spell is over, it’s another thing to try. Vomiting after eating is very different from vomiting on an empty stomach. Often with nausea, tapping in to human experience here (mine), having an empty stomach increases the nausea and then vomiting makes you not want to eat and then dehydration sets in and dehydration makes the nausea worse and then you really don’t want to eat, etc. It’s a vicious cycle you have to try to break it up if that’s happening (which may not be the case at all, but it can’t hurt to try something and see if it helps).

I had that problem with Karo too, I think you can get more predictable results if you use an oral syringe, I find it less messy this way too.

 

I too tried the antinausea meds first. Most times that's all Neko needed to get her eating.

 

Even though Gracie wasn’t vomiting, I gave both cerenia and ondansetron because, as Wendy said, they both will address nausea but from different modalities. Many other members have found they make a nice “cocktail”. I do agree that it’s really important to give anti nausea meds before an appetite stimulant.