7May2020/MAXI/AMPS314/Update

[bambinaki]

Last thread: http://www.felinediabetes.com/FDMB/...iflora-questions-amps408.229265/#post-2567396

Hello-

I am very happy to report that Maxi's appetite has seemed back to normal that last 2 times he ate.

However, he did have diarrhea again last night just after midnight.

You can see the details in the remarks of his SS.

Maxi is an amazing little patient - so tolerant and forgiving.

Please keep crossing your fingers for him.

Thanks

 

[Wendy&Neko]

Poor little trooper. I hope his GI system settles down soon. Good news he's eating better now.

Looks like you could increase the dose tomorrow. You could even do a little R mid cycle to help bring those numbers down.

 

[bambinaki]

Poor little trooper. I hope his GI system settles down soon. Good news he's eating better now.

Looks like you could increase the dose tomorrow. You could even do a little R mid cycle to help bring those numbers down.

Thank you, Wendy.

This vet is of a very different school from you about diabetes treatment. She wants him to stay at 7 units for now. I will comply for now. Maxi has an appointment next week and at that time I will put my foot down about resuming T.R. protocol.

 

[Wendy&Neko]

That's too bad, all that time above renal threshold in a kitty already with CKD. Could you at least sneak in some R?

 

[carfurby (GA)]

Great news on his eating. I hope the diarrhea clears up soon. Sending prayers.

 

[tiffmaxee]

Small good steps. Pancreatitis can take a long time to get back to normal. I hope you keep up the nausea medication.

 

[bambinaki]

That's too bad, all that time above renal threshold in a kitty already with CKD. Could you at least sneak in some R?

Can I sneak it in? I mean, do you think it's ok? If R brings his numbers down, the vet will think it's because of the 7 units of Lantus. She also told me she doesn't want me giving him R. But I will with your guidance. I don't want to lose this vet because it's the only clinic that has 24 hour intensive care. So please help me figure out how to balance.

Could you please give me a R scale that you think is right for Maxi at this point?

I'm sorry I didn't reply sooner. I would have been hanging on the board, but my work (quantity, meetings, deadlines) has gotten out of control.

Thank you!

 

[Wendy&Neko]

Are you sharing the spreadsheet with the vet? When is the appointment next week? I think I would show the vet the TR protocol as what you are showing, and tell her you really want to get his numbers under renal threshold and you are comfortable following the protocol as the way to do it. Even at 9.25 units he hadn't earned a reduction. Holding onto the 7.0 dose just adds to the glucose toxicity.

 

[bambinaki]

I hope you keep up the nausea medication.

Yes, I have been. Both cerenia and ondansetron. Advice on how/when to wean off?

 

[tiffmaxee]

I would give it a few days of being normal and then take one away and see if normal. Then wait again and go to every other day and gradually taper. Whatever you do just make one change at a time.

 

[bambinaki]

I would give it a few days of being normal and then take one away and see if normal. Then wait again and go to every other day and gradually taper. Whatever you do just make one change at a time.

Thanks!

What about his pain medicine? Last night I gave the last 100 mg Gabapentin capsule, and this morning I gave 0.1ml of Buprenorphine. (I do have a bunch more Gabapentin.) Do you think that was right?

He has eaten well twice today. EDIT: He has eaten 3 times today. He took a couple licks of what I gave him the 2nd time and then didn't want the rest. Then I added a few pieces of Purina DM dry, and he liked it. The other 2 times he ate great. The best food I found that's low in carbs and low in phosphorus is the kind he seems to like the least...

I do worry about pain. He doesn't seem to be in pain, but how can I really know...

 

[bambinaki]

Are you sharing the spreadsheet with the vet? When is the appointment next week? I think I would show the vet the TR protocol as what you are showing, and tell her you really want to get his numbers under renal threshold and you are comfortable following the protocol as the way to do it. Even at 9.25 units he hadn't earned a reduction. Holding onto the 7.0 dose just adds to the glucose toxicity.

She does have the link. She said she looked at it. I don't know if she continuously looks at it. When she called yesterday and I offered to share his BG numbers, she didn't say she had seen the SS.
The appointment is next Wednesday, May 13. I will do that, Wendy. Thank you! I have already e-mailed her info about TR, but i will print it and bring it to the appointment.
If she's curious, she could even look at these messages, right?
Do you think it's best that I start dosing Maxi with R in between Lantus. May I have your recommended scale?

 

[Olive & Paula]

I'd give it a few more days of being normal before taking pain meds away.

Ollie's last serious bout took 6 weeks to get over.

This past month vet thinks is p'titis flare. Even though she's eating less, she has been intermittently vomiting, hiding, and glucoses soared. Ollie is getting checked on monday.

 

[bambinaki]

I'd give it a few more days of being normal before taking pain meds away.

Do you think I should not have stopped Gabapentin and replaced it with Bupe yet?

Ollie's last serious bout took 6 weeks to get over.

Oh gosh

This past month vet thinks is p'titis flare. Even though she's eating less, she has been intermittently vomiting, hiding, and glucoses soared. Ollie is getting checked on monday.

Poor girl. I hope she gets better very soon.

 

[Olive & Paula]

Not necessarily. As long as she is getting something for pain. I think bupre is better.

 

[tiffmaxee]

I would give it a few days of being normal and then take one away and see if normal. Then wait again and go to every other day and gradually taper. Whatever you do just make one change at a time.

In humans pancreatitis is very painful. I was given bupe for pain for Max and used it a little. ECID applies with pancreatitis as much as with diabetes. For Max ondansetron was always needed. Some of his bouts took months and he was in it that long. I learned not to stop whatever supportive meds that seemed to be working too quickly. Max had chronic pancreatitis for several years before he became diabetic. It started when he was 12 and lost his sister. He only had diarrhea a few times. It’s possible that this was an acute episode and Maxi won’t have another. I hope so.

 

[bambinaki]

For Max ondansetron was always needed. Some of his bouts took months and he was in it that long.

So, it's ok to keep a cat on ondansetron for months and months? How can I know when I can stop giving it to Maxi?

Max had chronic pancreatitis for several years before he became diabetic. It started when he was 12 and lost his sister.

Poor Max. And poor sister. And poor you.

He only had diarrhea a few times.

So he had mostly no appetite and vomiting?

It’s possible that this was an acute episode and Maxi won’t have another. I hope so.

Thanks. Me too - hoping hard. For his sake, mostly, but also I worry that I won't be able to keep this up and work. Taking care of Maxi is very time consuming and tiring.

I was hoping that the diarrhea was gone. He didn't have any since late last night, but tonight immediately after he ate, he had diarrhea.

 

[Wendy&Neko]

It’s up to you if you use R. If you do, start with the last scale.

 

[Judy and Freckles]

Glad to hear Maxi is feeling better. We are rooting for him. How are you liking the Libre?

 

[bambinaki]

Glad to hear Maxi is feeling better. We are rooting for him. How are you liking the Libre?

Thank you, Judy. Maxi is clearly feeling better, but he still has diarrhea.

The Libre was a fail! The monitor came off. I didn't use it at all.