? 5/22 Zeke AMBG 147 - RUTRO!! +5.25 / 77 OTJ Trial Day 13 ** Advice Please

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MrZ

MrZ

Member Since 2013
Good afternoon L&LL,

Yesterday: http://www.felinediabetes.com/FDMB/threads/5-21-zeke-ambg-100-pmbg-78-otj-trial-day-12.138215/

Recap of last twelve days:

Day 1: AMBG 120 / PMBG 79
Day 2: AMBG 98 / PMBG 83
Day 3: AMBG 96 / PMBG 64
Day 4: AMBG 88 / PMBG 71
Day 5: AMBG 106 / PMBG 64
Day 6: AMBG 118 / PMBG 66 (Spiked to 150 in the AM)
Day 7: AMBG 77 / PMBG 82
Day 8: AMBG 134 / PMBG 72
Day 9: AMBG 120 / PMBG 76
Day 10: AMBG 107 / PMBG 73
Day 11: AMBG 94 / PMBG 73
Day 12: AMBG 100 / PMBG 78


Well, not a great start to the day. Zeke still has diarrhea and in fact it seems worse as he had several very soft BMs overnight/this morning and one last night which was very liquidy. I weighed him this morning and he loss five ounces overnight. Yes - Five - Overnight!!! He’s now down to 12 lbs. 13 ½ ounces. I weighed Ivan and Mia to make sure it wasn’t an issue with the scale. The scale is working fine. Their weights are consistent with recent weigh-ins. We think that Zeke must be hitting the LB so soon after eating that he’s not getting enough time to absorb the food.

Although for the most part Zeke’s energy level seems normal this morning, he was being very purry (loud) early today which is not normal for him so we think he may be in discomfort, pain or just generally feeling yucky. We gave him larger meals throughout the day yesterday to try and stop the weight loss and hopefully add some back on. I’m wondering if the extra Evo may be a factor in the worsening of his tummy issues. I’m gonna just feed him Nature’s Variety today and see how he does. I am also going to give him some tesi clay powder (which our vet has okayed) along with the metronidazole for the diarrhea. So far today his appy is not that great. By now he would have had 2 or 3 meals. I’ve barely gotten him to eat 1.5 meals over a 2.5 hour span.

While his appetite was really good yesterday when we personally fed him, we’ve no way of knowing how much of his Otto fed meals he ate. There was about 0.5t of food left in one of the compartments, but Ivan may have eaten what Zeke left from his other three overnight meals. So Zeke may have eaten a lot less food for all we know. So at this point, we don’t know what to make of this weight loss though we’re understandably alarmed by it.

I called the vets office this morning to consult with Zeke’s vet but she’s off until Tuesday. The receptionist basically said to wait a day, continue with the metro and make sure that he’s not getting dehydrated. I saw Zeke drinking water last night and will be adding water to his meals today to try and keep him hydrated. They’re open 24/7 so we may be taking Zeke in tomorrow if we don’t see an improvement.

Okay, so here are my questions:

Do you think this could be pancreatitis? If so, could this be due to lack of insulin as a result of no shots these past 12 days?

What test is required to diagnosis pancreatitis?

What other condition might be the cause of this weight loss/diarrhea? Should we have them do an ultrasound?

What other tests should we consider asking be performed?

Where do you think we stand as far as his OTJ Trial? He’s now at 133 nearly three hours after his last meal though he hasn’t had all his usual morning meals. Do we call this a fail already or wait to see what his PMBG is (see the following paragraph before you answer please)? Is the fact that he’s sick, at all considered when deciding to abort or not? Just our luck that this would happen on day 13. Why not day 2? That would have been a lot less disappointing. Though, I suppose some might say Day 6 was an indication of an impending derailment.

Unfortunately, we don’t know exactly when this (off and on) diarrhea started but he’s been dealing with it throughout most of this trial. He’s had great BGs in the PM but as you can see, the AM readings have not been in normal range throughout this trial. Honestly, we’re inclined to hold off resuming insulin as (1) overall he’s been having better numbers without insulin than with (excluding the few spikes which we believe is due to the diarrhea/illness), and (2) his pancreas is definitely working. On the other hand, if you believe that we’re stressing out his pancreas and it might be best to give him a little more support and resume with (say) a drop, we would consider doing that. It's understandable to (want to) dismiss these higher numbers as attributable to an illness but would it be wise to do so?

We anxiously await your thoughts as to what may be going on and your advice as to what we should do next.

Thank you all.
 
Laura and Zeke - I don't have any answers for you as it pertains to what to do with his trial, other than since he's having better numbers sans insulin and his PM numbers are normal, if he were mine, I think I'd still proceed and keep a close eye to see if his numbers go up overall....just my two cents. GREEN and healing and better tummy vines headed to Zeke! Eddie's keeping a spot right next to him at the Falls reserved for Zeke.
 
It very well could be pancreatic insufficiency, not absorbing the nutrients from his food, but that would usually happen after having pancreatitis for a long time so I doubt that. Is his stool very light in color? It could very well be pancreatitis. The test for it is the Spec fPL, a blood test best done without food for 8-12 hours. With a diabetic cat, I wouldn't fast more than 6 hours. Which lab does your vet use? If IDEXX, it's an add on test that they do. My vet uses Antech so it is sent to IDEXX. The treatment for it is flagyl which you are giving already, nausea medication usually either cerenia or ondansetron, buprenex if in pain, and sub-q fluids to prevent dehydration. The fluids might make him feel better no matter what is causing the diarrhea and I would either get them to give at home or take him to the vet for them. I'm so sorry he isn't feeling well. Bad timing when you should be happy with him going OTJ. :bighug:

Don't let them test with the quick in house SNAP test. It doesn't give you a number, just pass/fail so if in the gray zone you still won't know.
 
tiffmaxee said:
It very well could be pancreatic insufficiency, not absorbing the nutrients from his food, but that would usually happen after having pancreatitis for a long time so I doubt that. Is his stool very light in color? It could very well be pancreatitis.
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Thanks Elise for your advice. I will bring it up with the vet next visit. I did notice his stool to be light in color but figured it was just due to the tesi clay/change in food/tummy issues. We discontinued the clay a few days and his stools somewhat returned to normal color (kinda tanish/orangey), though my DH just said he had a BM (two pellets) and they were light in color. From the feel of his coat he doesn't appear to be dehydrated. If we take him in tomorrow I will ask about the sub-qs.
 
Well, I just tested him and he is down to 77. He would not eat the Nature's Variety lamb so I fed him 2 teaspoons of turkey wellness, 30 minutes before the 77, and he gobbled it up no problem. I think we'll need to offer that up to him because HE CANNOT LOSE ANYMORE WEIGHT. Sorry, not screaming at you, just the situation (you know?).
 
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He certainly came down nicely since this morning - that has to be good news. :) Now come on Zeke, stay somewhere around that 77 for the rest of the day - no more scaring your beans at the last minute OK?

Happy Day 13!! :D :D :D
 
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The stool sounds normal in color to me. Max's changes depending with what he eats. How long has he been taking metronidazole ? That should help. If he skips a day as it gets back to normal don't be surprised or worried. That is to be expected. You mentioned you were giving more Evo. Is that a new food for him and have you given any new foods the last few days? That would be enough to cause diarrhea. It's good he ate the Wellness willingly. If he ate the Evo or any food while nauseous that might cause him not to want to eat it again right now. Small amounts often helps if it's pancreatitis too. You are doing all the right things.

Appy and intestinal healing vines for Zeke.
 
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Just an observation here which might just be a coincidence but the first two nights of his OTJ trial, you also fed him at +9 and +10 and he had green AMBGs. I wonder if that is worth trying before you throw in the towel. I'd try that before I restart insulin since he's green later in the cycle and at PMBG. If he starts to creep up at PMBG so you have blue at AMB and PMBG and no green in between....then I'd definitely get right back on insulin. Of course, if you see a yellow number...absolutely insulin.

Is there any reason why he can't have WN all the time? I see no difference between a 2% food and a 4% food for a cat in remission. If you don't want to feed WN, have you thought about trying a raw diet? I'm just asking because Tobey had on again/off again soft stools until I transitioned him to Primal raw and he has been doing fabulous.

Have you ever read the Primer on Pancreatitis?
 
If Zeke lost 5 ounces overnight, it is probably fluid he has lost from the diarrhoea. Have you checked to see if he is dehydrated? He may need to have some extra oral fluids.

My cat Sheba developed chronic diarrhoea 18 months ago which threw her out of remission. All the tests showed nothing. It took ages to find the cause but when I changed her canned food it stopped, so I am sure she had developed an allergy to the food she had been eating for the last couple of years. I now feed her a home prepared diet of raw kangaroo meat and cooked chicken (raw chicken makes her sick) and supplements etc..She is so much better in lots of ways. Her bowels are good, her coat is lovely and her weight has gone back to normal.
When Sheba had diarrhoea badly I gave her cooked, mashed plain pumpkin which helped a lot. Maybe you could try that until you find out the cause. I think you can get canned pumpkin in the US, I make my own. If you buy it, make sure it is plain pumpkin and not the pie pumpkin as that has sugar added.
Sheba gets bouts of pancreatitis every so often but her bowels are not effected by it as far as I can remember. She goes off her food, curls up as if in pain, and gets a bit dehydrated and sometimes a temp.
Good luck. Hope you get it sorted soon
ETA: have you tried feeding Zeke plain lightly boiled chicken. He might drink the juice too.
 
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rjwesq823 said:
Stupid question and sorry if this isn't the place. I've looked at the terminology y'all use and have gotten most of it. But what are vines?
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Legend has it that some time ago (before our time here), a member sent another one "healing vibes" but there was a typo and it said "healing vines" and it stuck. So healing vines are get well wishes.
 
I wouldn't throw in the towel. His numbers came back down. It may be that the diarrhea made him feel lousy so his BG went up. One thing to remember is that if a cat's not feeling well, an elevation in BG can be an early warning sign of an infection, inflammation, pain, etc.

I would also not jump to conclusions about pancreatic insufficiency or anything else. This may be a GI bug. I went through a period of having Gabby on and off metronidazole for weeks. She had every test in the book It finally took having her on a steady dose of metronidazole for a month to clear up the diarrhea.

 
Are you still giving the +9/10 snack in the pm cycle as Marje mentioned? I see it marked in the pm+8 cell like you're doing that every night, so maybe you are. I think i'd try that first.

I'd guess that whatever is going on with his gut is causing these higher numbers and if his gut settles down, the BGs will likely settle down too. I agree that the weight loss is likely fluid loss from the diarrhea. Even if he doesn't seem dehydrated, lots of diarrhea is bound to cause some and it also may leave him feeling wiped out. I'd add as much water to his food as he'll tolerate.

That 147 is a red flag, but i'm reminding myself that we look at overall trends, not just a single test or two. I think i'd carry on and try to address his diarrhea issue, giving whatever food seems to soothe him and avoiding whatever food seems to aggravate his system.

Hang in there, Laura! We're all on Team Zeke right now and hoping he pulls things together.
 
Marje and Gracie said:
Just an observation here which might just be a coincidence but the first two nights of his OTJ trial, you also fed him at +9 and +10 and he had green AMBGs. I wonder if that is worth trying before you throw in the towel. I'd try that before I restart insulin since he's green later in the cycle and at PMBG. If he starts to creep up at PMBG so you have blue at AMB and PMBG and no green in between....then I'd definitely get right back on insulin. Of course, if you see a yellow number...absolutely insulin.

Is there any reason why he can't have WN all the time? I see no difference between a 2% food and a 4% food for a cat in remission. If you don't want to feed WN, have you thought about trying a raw diet? I'm just asking because Tobey had on again/off again soft stools until I transitioned him to Primal raw and he has been doing fabulous.

Have you ever read the Primer on Pancreatitis?
Click to expand...

Thanks Marje so much for your response. We are spreading out his meals so much that I didn't reflect on his ss because it would be too busy and I wasn't expecting that to be valuable information. He gets his meals pretty much from much +1,+2 and from+6 to +9 each cycle. I only switched him to wellness because I thought that might help to get him diet controlled. I started transitioning him from 4% to 2% on May 3 and started him on 2% exclusively on May 11. This morning I started up with the wellness as he was turning up his nose to the lamb/evo. I have not read the primer on pancreatitis because our vet has never brought it up as an issue. I only mentioned it today as I was wondering if that what was possibly going on. Okay thanks, for now we will stay the course with the trial. Thank you again for your advice. It is so greatly appreciated.
 
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manxcat419 said:
He certainly came down nicely since this morning - that has to be good news. :) Now come on Zeke, stay somewhere around that 77 for the rest of the day - no more scaring your beans at the last minute OK?

Happy Day 13!! :D :D :D
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Thanks April. He listened! Some six hours later he was at 73.
 
tiffmaxee said:
The stool sounds normal in color to me. Max's changes depending with what he eats. How long has he been taking metronidazole ? That should help. If he skips a day as it gets back to normal don't be surprised or worried. That is to be expected. You mentioned you were giving more Evo. Is that a new food for him and have you given any new foods the last few days? That would be enough to cause diarrhea. It's good he ate the Wellness willingly. If he ate the Evo or any food while nauseous that might cause him not to want to eat it again right now. Small amounts often helps if it's pancreatitis too. You are doing all the right things.

Appy and intestinal healing vines for Zeke.
Click to expand...

Thanks Elise. We started Zeke on the metro on 5/20. He's been eating some Evo for a while but we recently started feeding him the Evo and Nature's Variety lamb exclusively. Were not giving him more wellness and less of the Evo/NV.
 
Bron and Sheba said:
If Zeke lost 5 ounces overnight, it is probably fluid he has lost from the diarrhoea. Have you checked to see if he is dehydrated? He may need to have some extra oral fluids.

My cat Sheba developed chronic diarrhoea 18 months ago which threw her out of remission. All the tests showed nothing. It took ages to find the cause but when I changed her canned food it stopped, so I am sure she had developed an allergy to the food she had been eating for the last couple of years. I now feed her a home prepared diet of raw kangaroo meat and cooked chicken (raw chicken makes her sick) and supplements etc..She is so much better in lots of ways. Her bowels are good, her coat is lovely and her weight has gone back to normal.
When Sheba had diarrhoea badly I gave her cooked, mashed plain pumpkin which helped a lot. Maybe you could try that until you find out the cause. I think you can get canned pumpkin in the US, I make my own. If you buy it, make sure it is plain pumpkin and not the pie pumpkin as that has sugar added.
Sheba gets bouts of pancreatitis every so often but her bowels are not effected by it as far as I can remember. She goes off her food, curls up as if in pain, and gets a bit dehydrated and sometimes a temp.
Good luck. Hope you get it sorted soon
ETA: have you tried feeding Zeke plain lightly boiled chicken. He might drink the juice too.
Click to expand...

Thanks Bron. Yeah, we're wondering if the lamb is just not sitting well with him. We're gonna switch him back to the wellness which he's been eating for years. We were giving him pumpkin on a regular basis but he started turning up his nose to it. The chicken is something we've not tried before. Excellent idea. We'll give it a try. It will be a good way to get some fluids back in him. Thanks for the well wishes. We can use all we get.
 
Sienne and Gabby said:
I wouldn't throw in the towel. His numbers came back down. It may be that the diarrhea made him feel lousy so his BG went up. One thing to remember is that if a cat's not feeling well, an elevation in BG can be an early warning sign of an infection, inflammation, pain, etc.

I would also not jump to conclusions about pancreatic insufficiency or anything else. This may be a GI bug. I went through a period of having Gabby on and off metronidazole for weeks. She had every test in the book It finally took having her on a steady dose of metronidazole for a month to clear up the diarrhea.
Click to expand...


Thanks Sienne. It makes me feel so much better knowing that some of the more experienced members like yourself are not recommending we abort. He definitely was not feeling well this morning. He seems much more comfortable tonight and he's not purring a lot like he was this morning when we touched him (which is not his usual MO). I'll talk to his vet about possibly keeping him on the metro a while. I hope your day is a lot better than your day from hell. :bighug:
 
julie & punkin (ga) said:
Are you still giving the +9/10 snack in the pm cycle as Marje mentioned? I see it marked in the pm+8 cell like you're doing that every night, so maybe you are. I think i'd try that first.

I'd guess that whatever is going on with his gut is causing these higher numbers and if his gut settles down, the BGs will likely settle down too. I agree that the weight loss is likely fluid loss from the diarrhea. Even if he doesn't seem dehydrated, lots of diarrhea is bound to cause some and it also may leave him feeling wiped out. I'd add as much water to his food as he'll tolerate.

That 147 is a red flag, but i'm reminding myself that we look at overall trends, not just a single test or two. I think i'd carry on and try to address his diarrhea issue, giving whatever food seems to soothe him and avoiding whatever food seems to aggravate his system.

Hang in there, Laura! We're all on Team Zeke right now and hoping he pulls things together.
Click to expand...


Thank you, thank you, thank you Julie! We are spreading out his meals so much that I didn't reflect on his ss because it would be too busy and I wasn't expecting that to be valuable information. He gets his meals pretty much +1,+2 and from +6 to +9 each cycle.

We're definitely focused on getting his diarrhea fully resolved. We're giving him more food (with a little added water) and giving him more wellness vs Evo/Nature's Variety. Hopefully, he can handle the extra food/carbs. We'll just stay the course with his trial. Paws and fingers crossed, he'll be at a much better number tomorrow morning. :nailbiting::nailbiting::nailbiting::nailbiting:
 
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