4/7 Billie PMPS 279 +4 175 update, methylprednisolone pills?

http://www.felinediabetes.com/FDMB/threads/1-17-billie-amps-188-4-143-pmps-303.189781/

Hello from Billie!! Last time I posted an update, she had just overcome a terrifying episode of serotonin syndrome caused by mirtazapine. She made a full recovery!

Over the past few weeks, though, she has seemed a little more lethargic, and she has lost more weight despite eating well and stable BG. She went for a recheck with her cardiologist (heart still looks perfect! No more myocarditis) and her IM vet last week. IM vet found that her liver values, which have been elevated for about a year have mildly worsened. She's also very mildly anemic. IM vet thinks triaditis is the most likely problem, due to the liver values and her long history of chronic pancreatitis and suspected IBD. She recommended "big guns" treatment at this point. Billie has been on Denamarin for liver support and Cannapet for inflammation recently, but the worsening numbers, weight loss, and borderline anemia are concerning.

The options she suggested were Atopica or pred. Since Atopica can throw off appetite, I leaned toward pred. I was concerned about the increased risk of heart issues but Billie's cardiologist agreed that it would be the best option. I am of course increasing her insulin by TR protocol to accommodate the increased BG.

She started it on Tuesday - methylprednisolone, 2 mg pills BID. I'm not sure I fully understand the difference between methylprednisolone and prednisolone, but her IM vet felt that this would be the best choice. She will go back for bloodwork in 2-4 weeks. I also had them add the TLI to check for EPI to last week's bloodwork but haven't gotten that part back yet. I kind of had to fight for that one but I think it's worth checking considering the weight loss and good appetite.

I'm curious if anyone has had experience with methylprednisolone vs. prednisolone. So far, I haven't noticed any unexpected side effects...but definitely increased drinking/urination and increased BG as suspected.

I hope everyone else is doing okay! Lots of vines to all kitties and beans in need

PS: I'm attaching bloodwork for anyone who might be inclined to take a peek. Notable changes since her last bloodwork in January - the mild anemia, and the elevated bilirubin. All bilirubin measurements were within normal range in January. Other elevated liver enzymes have increased slightly but not too significantly. Monocytes have been elevated since September. Lymphocytes are newly elevated.

 

I'd be nervous about any form of pred with the heart issue. Did the vet consider budesonide at all? That's what Neko was on. Have you had her cobalamin and folate tested?

 

Hi Wendy! Thank you for visiting!! The vet said that budesonide would be too localized to the small intestine and would not necessarily reach her liver. Does that sound right?

I'm still worried about the pred too...her cardiologist felt that it would be safe since her heart is currently 100% normal without any heart meds (she did an echo last week) but I do worry about her previous problems coming back.

She had folate and cobalamin tested in October or November. Folate was slightly elevated but the vet didn't think much of it. B12 was low end of normal so she has been getting B12 shots every other week.

I hate to admit it, but I'm at a loss. I worry about her continuing to lose weight and wasting away. She is down to 7 lbs from 8 lbs in September. 8 was her stable weight for about 2 years. I also worry about the pred doing more harm than good. My main concern is her comfort and quality of life. She still seems content and comfortable and happy to be around us, super purry, but her energy level has been lower. Not so low that she hasn't bopped Brooklyn on the head twice in the past week...but she hasn't been doing her usual hunting routine every night.

 

Glad to hear Billie's had a very recent echo and check by the cardio vet. That would make me feel better. Just so paranoid about pred and the heart from my experience. You are right on the budesonide being more localized, but it can help the IBD issue. So can probiotics if you aren't giving them now, Has Billie had a recent ultrasound too?

Sorry I have no experience with methyl pred. When my civie first went on pred, his vet wanted to put him on an injectible version that had some special name, can't remember what it was. It had less side effects than regular pred. But the vet's supplier stopped making it available. Pred will usually help the appy and put on weight.

Good to hear she is still up to bopping her sister.

 

If you're concerned about IBD, there's an excellent website, Raw Feeding for IBD Cats. Whether you are interested in feeding a raw diet is less the issue than the section on Medications and Supplements. They have an excellent section on probiotics. The probiotics may help to calm down Billie's gut and possibly encourage absorption.

 

Thank you Wendy and hi Sienne! Thanks for visiting!

Yes, exactly. I trust Billie's cardiologist a lot - I'm a huge fan of hers. So I'm still paranoid but comfortable since she signed off on the pred.

Her most recent ultrasound was in early January, done by a radiologist. I just dug through her lab folder looking for the summary but couldn't find it... I must have stashed it somewhere else. I know her liver was the main concern. There were some small nodules, darkness, and changes in the liver. They concluded inflammation, infection, or cancer. Her IM vet feels that cancer is less likely and triaditis is much more likely. Her small intestine had some mild thickening, but no lymph node involvement. Her pancreas looked consistent with pancreatitis. Not wanting to put her through a biopsy at this point, we tried an antibiotic trial in January to rule out infection, and it didn't make a difference in her liver values. She was stable enough that we didn't move on to a steroid trial at that point. But, here we are based on her most recent bloodwork and the continued weight loss despite what seems like a good appetite.

I hope the pres does help her put on weight and makes her feel good! Another selling point of the pred over Atopica was the vet telling me that if it is cancer, Atopica could do more harm than good and could cause cause it to grow faster. That kind of scared me away from the Atopica.

Billie has been drinking raw goat's milk for probiotics but I actually just got Nexabiotic for her too because of the s. boulardii, which I read about on the Raw Feeding Facebook group I'll check out the website too!! I've tried raw for Billie, but she's just not into it, unfortunately. She's eating Koha kangaroo at the moment.

I'm feeling reassured by that +4. I think she's settling into her new dose after a couple days of yuckier numbers since starting the pred.

 

I hope the steroid helps Billie. Sending prayers.

 

I hadn't heard of it with prednisolone yet.

maybe this helps
https://www.thorne.com/take-5-daily/article/what-is-methylation-and-why-should-you-care-about-it


I am currently using a methyl folic acid .

 

Hi. I looked up methpred on a few sites and it seems to be basically the same as prednisolone.