5/5 Billie AMPS 348 +6 262 PMPS 202 +3 326

Last condo (The 27 Condo): http://www.felinediabetes.com/FDMB/...e-vines-home-from-the-er.195035/#post-2183753

Hello all! I figured I would make a fresh condo since the other one spanned a couple days, but I want to reply to the kind words and suggestions shared last night/this morning.

@Sienne and Gabby (GA) and @Squeaky and KT (GA) Thank you very much for helping me brainstorm. That's wild and scary that Bebo has such a severe reaction to fish!! It's highly possible that Billie's allergies are that severe. I have been making her homecooked pork with premix like @tiffmaxee said. Her appy has been a little iffy for the past week since all of this started, though, and she stopped liking the premix. She was just eating plain pork for the past few days, and then yesterday morning wouldn't eat that...so I did open a few cans of other things including Fancy Feast T&G which has meat byproducts and Hound & Gatos salmon. Those are part of my backup arsenal when she won't eat and I basically throw everything but the kitchen sink at her to get her to eat. She has been okay with them in the past, but it's still possible that something messed with her, or that the meat byproducts had something she is allergic to in them. She is eating the plain ground pork chop again today, so hopefully we can transition back to that and start incorporating the premix again gradually if she'll allow it.

Weatherwise, we're in upstate NY (near Albany) and this was the first warm week we've had this spring. So everything is finally blooming and the pollen index is sky high. We don't open windows at this time of year as lovely as it is outside because both Bill and Brooklyn have allergies that flare up in May and September. But, I think it still affects them. I've never seen respirations like that before though, even during her worst allergy flare ups when she was covered in hives.

As far as meds go, I researched drug interactions and didn't find anything significant...Except, I found one random blog post (https://www.inspire.com/groups/neph...cussion/milk-thistle-and-prednisone-danger-1/) saying that pred and milk thistle should not be taken together. I can't find anything else to support that, though. Most other sites say that taking milk thistle can help protect the liver from the stress of steroids. So I'm not sure about. The only other thing to note is that Billie gets reduced doses of Cerenia and Cypro when she gets them because both have the "use with caution in patients with compromised liver function" warning. For the Keppra, as far as I know, she is not on the extended release version, and we do cut it. She gets 1/4 tablet every 8 hours per her neurologist. Hopefully that's okay!

I have another new theory about what could have caused the episode yesterday, based on more scary events that transpired around 12:30AM. She began staggering a little when walking and seemed to be having trouble with her balance and back legs. She was up and eating and using the litter box, but definitely seemed weak. It lasted until about 3am. This is *exactly* what happened after she was on the methylpred for 4 days a few weeks ago, and it's why I stopped giving it then, because I interpreted those symptoms as a side effect. All of her vets said that it's not a common side effect and must have been unrelated, but I really wonder if it's a side effect for Billie, especially since it happened twice and otherwise has never happened before. It would be a very odd coincidence. I know muscle weakness is absolutely a side effect with longer use.

I wonder if maybe her methylpred dose is too high. It totally seems to be helping her - her jaundice looks a little better today which I'm hoping means it's working for her liver. But I wonder, since we give smaller doses of certain other meds due to her impaired liver function, if we should do the same with the methylpred. Like, 1 mg BID instead of 2. Her vet said we should keep the dose as is, since it's the right dose based on her weight. But I'm torn. She also has a history of being sensitive to medications. A standard dose of mirtazapine sent her into Serotonin Syndrome and it took about 5 or 6 days to clear her system rather than the 3 it is known to take. I did skip her morning methylpred dose today, just to see how she did. Her respirations were decent all day, and she wasn't wobbly or weak in her hind legs.

The other thing to throw out there...she was definitely constipated yesterday/overnight (probably contributed to the iffy appy). I gave her Miralax, and she passed a gorgeous BM this morning. I suppose the constipation could have been making her walk funny and causing her to kind of slouch down in the back legs, but I don't know that it would also affect her balance and make her stagger. It never has done that when she has been constipated before.

She's a complicated girl...I will keep hypothesizing and doing what I think will help the most with the least harm. I'm very seriously considering going to 1 mg BID with the methylpred starting tonight but have to ruminate a little longer. I'm just so glad she's home and relatively stable. I really truly thought this was the end on Wednesday and again yesterday. She still has more miracles in her after all Her jaundice is still there but I do think it looks a little better than yesterday. Her appy came back in the middle of the night post-ondansetron/cypro and has been good all day. (That med combo seems to work the best for her...better than Cerenia). She seems more like herself and less lethargic than she did a few days ago. She was also purrier today.

We'll see what the evening brings! Thank goodness it's Saturday. Sending vines to all the kitties and beans needing vines

@Tricia Cinco(GA) & Harvey Thank you!!! I think you're right - she is not at all interested in leaving yet I can tell, and the vet could see it too. He said she's happy. He also said she was "all up on" him and meowing every time he went over to the oxygen cage to check on her. She's a charmer She still has a lot of life in her.

@PussCatPrince Thank you! She is a trooper for sure! She amazes me.

@Susan&Felix Omg 27 is 9 lives cubed! I love it

@Wendy&Neko I counted her respirations right after I read your message thinking "wouldn't that be funny..." not 27, but under 40, so I'll take it

@Nicole Z So glad the z pack helped Mulan and cleared up the asthma!! Also, I have to say, Aurora is absolutely stunning

 

I'm glad Billie is doing better today. It does make you wonder if it is a side effect of the steroid. I hope you can figure things out and keep Billie feeling good. Sending prayers.

 

I'm glad Billie is eating and seems to be feeling better. I agree that the problem may be the methylpred. Question: is it methylprednisone or methylprednisolone? I only ask because I know prednisolone is preferred for cats. I believe it is actually easier on the liver.

I don't know that I would cut the dose in half, especially since it seems to be helping. Maybe give 1.5 mg bid?

Sending continuous vines.

 

Hi Deanna,
So happy to hear that Billie is doing better. Interesting about the methylprednisolone. Rusty was prescribed just plain prednisolone this winter. We had to have it compounded into a transdermal because he won't take meds orally. The first time I tried (1 application) it he got very weak (the reason for taking it was his really bad congestion). I discontinued it. But I tried it again about 2 weeks later because his congestion was incredibly bad. Again, one application. This time he got so weak that he could hardly stand, and even fell down the stairs. The vet had never seen this type of reaction to pred. But since that was all he was taking at the time, it had to be the pred. He was back to normal balance and strength immediately.

More vines for Billie.

 

@Ella & Rusty & Stu(GA) Wow, no way!! Poor Rusty! That's awful and I'm so glad he got back to normal. Interesting. It sounds like the very same kind of reaction. Now I feel less crazy. I know what I'm seeing, despite two vets telling me it's not a side effect. These kitties do like to break the rules.

Tonight, Billie got 1 mg of the methylpred instead of 2, and she's having a great night. She ate very well and has been resting comfortably. Her gait and balance are normal. Her BG is going in the wrong direction, but she did get a reduced dose last night since she wasn't eating well at PMPS. I'm just marveling at the fact that she's even here. I'm hoping this pred dose will work out to keep her inflammation down without causing the side effects.

@Tricia Cinco(GA) & Harvey Thanks for the vines and the visit! It's methylprednisolone, so her liver doesn't have to convert it from prednisone to prednisolone. But I think it can still stress the liver. I don't know why the IM vet prescribed methylpred instead of pred but she said it's basically the same drug. We'll see how it goes!! Hopefully this dose helps without the scary stuff.

@carfurby Thanks for stopping by and sending prayers!!

 

It looks like you made the right call, reducing the Pred. You know Billie much better than any vet. Sometimes they don't realize that. If you have to adjust the insulin dose, it's a small price to pay for her feeling better.

From what I could find, the only difference between them is the dosing strengths and methods they come in.

 

If she starts to get more jaundice I’d go back to the regular dose of methyl prednisolone as it does seem to be helping. It might just be keeping whatever is gi8ng on with her away. Great to see she’s improving.

 

I would be very careful about making a change of 50% in the amount of a steroid dose. Steroids need to be tapered and, frankly, I don't have a clue whether dropping the dose that much would be a problem.

Another thought... Are you anywhere near a vet school? Some of your questions might be good to direct to a veterinary pharmacist. I know Cornell's feline center has a phone consultation program but it seems like your vets are on top of things. I don't know if the Cornell folks would be a resource regarding meds.