8/11 - Frosty - bouncing, or needs more insulin? Brain surgery likely not an option. Needs GI workup

Discussion in 'Lantus / Basaglar (glargine) and Levemir (detemir)' started by Ana & Frosty (GA), Aug 11, 2018.

  1. Ana & Frosty (GA)

    Ana & Frosty (GA) Well-Known Member

    Joined:
    Jan 19, 2018
    Good evening, all

    I had a tough week and basically spent all day today in bed. It was raining so the perfect day to do so. So I am posting late, but non-the-less, HAPPY CATURDAY, everyone!

    So I had cut back Frosty's dose significantly because he was starting to go hypo. And he is now trending higher, although he did have some low 100s occasionally at night on this dose.

    I am thinking I will continue the q3 hours curve tonight (since I'll be up after sleeping all day), and then tomorrow I'll do a q2 hour curve, and if he's still running above 150, go up to 2 units.

    I had decreased his food to 1.5 cans FF BID instead of 2 due to his vomiting. He seemed OK for a few days, but then he did threw up overnight last week. It was about 8 hours after he ate, and it was still food.

    I finally got a call back from our IM vet, and I talked about the vomiting. She also reminded me that when he had his abdominal US as a workup for Cushing's, his stomach was very distended and full of food. That day, his US was probably 5-6 hours after he ate. So putting it all together.... his stomach does not seem to be emptying properly, which is causing the vomiting.

    The question is - why? Unfortunately, since Frosty is very anxious (steroid psychosis?) he was not cooperating with the ultrasound. They also didn't shave his belly due to his skin tears, so the test was limited. What it did show, apart from the stomach, was a pancreas full of cysts.

    She also told me she has no experience what so ever with hypophysectomies, but she is concerned that Frosty has a serious GI issue, such as small cell lymphoma, or IBD, that is causing the vomiting. She said (and I completely agree) that if he is to undergo brain surgery, he needs to be absolutely healthy.

    She recommended getting another abdominal ultrasound to try to figure out what is going on, to look for any bowel thickening, and look at the pancreas again. If we can rule out something serious, then it could just be delayed gastric emptying, and he could get some meds to help him move food along.

    But basically, brain surgery right now is out of the question. :( He has been OK over the last couple of days, so I am stalling making an appointment. But I think I should, especially since we are going away on 2 weeks and with my luck, he's gonna start throwing up the day before we leave. I wanna get on top of this earlier rather than later, so that if it is something serious, there is more to be done. But it's been intermittently happening, so I think that there probably IS something wrong with his GI tract.
     
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  2. Chubba (GA)

    Chubba (GA) Well-Known Member

    Joined:
    Apr 30, 2017
    Sending vines and :bighug:.
     
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  3. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Hi Ana, our experience.

    May/June 2017
    Documented in Leo's thread at this point <<--- link
    Leo stopped eating. We syringe fed for a bit. We had a feeding tube surgically installed. He wasn't getting over the eating issue.
    We had an open-gut biopsy done. Result was small cell lymphoma (SCL).

    We started treatment of prednisolone and Leukeran (Chlorambucil). That resolved the issue. He is permanently on those. If I did it again, I would see if they could do an open gut surgery with the small holes. Leo healed fine, but it was hard on him for 4-5 days. Let me know if you have questions.

    I'm sorry that Frosty is not doing so well right now.
     
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  4. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    Sorry about the possible GI issues. :bighug: Having had multiple cats with the IBD/SCL issue, I know hard that is. Have you tried novel proteins with Frosty? Neko was on budesonide instead of pred, and it didn't impact her BG like pred does. Hopefully an ultrasound will tell you an endoscopy would be Ok instead of surgery for diagnosis.

    As for dose, you did skip by 2.0 units, though he is seeing nadirs under 150 on this dose.
     
    Last edited: Aug 14, 2018
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  5. Ana & Frosty (GA)

    Ana & Frosty (GA) Well-Known Member

    Joined:
    Jan 19, 2018
    I haven’t really tried anything other than Pepcid for Frosty’s GI issues. He was briefly on flagyl and probiotic when he had diarrhea after being on clavamox for his skin tear back in May, but once they resolved I stopped it because I wanted to limit the amount of medication he was taking. I don’t think probiotic will help with GI transit time anyway.

    I give him 1 hairball pill at night either daily or every other day, since I know fiber also slows down GI transit time. But don’t want him to get a hairball that can make the vomiting worse, esp now that he’s starting to shed a LITTLE bit. He grooms quite a bit, as allowed by the clothes he wears. Right now he’s in his shirt so he has more area open for grooming.

    Tonight we are still in the 200s at +3 and +5.5

    @Wendy&Neko , do you think I should just go up to 2 units tomorrow and do a curve off of that, or should I do a q2 hour curve on the current dose to make sure we definitely aren’t seeing anything under 150 before I increase?

    I’m not too upset with his numbers since the highest he goes is 400s (so no black) and comes down below the renal threshold. But I think he can do better.

    Also, I read about the Tresiba insulin in the forum, and i might ask my IM vet if she’s familiar with it. I would be willing to try it since it got the other 2 cats so well controlled. I would probably follow the SLGS protocol with it if she would agree to prescribe it, and compare the numbers. I have had a few human patients on it lately and they seem to like it. (Sadly, most of my human patients don’t check their sugars as often as they should). But their a1cs aren’t bad.

    The pic below is Frosty cuddling RIGHT NEXT TO ME for the first time. He started sleeping at the foot of the bed about a month ago instead of the kitchen floor or near his bowl in his room. And today he decided to cuddle up with his mom :arghh: I cried. Even older, neglected kitties can learn to feel love with proper care. :kiss::cat::bighug:

    97736580-738E-4219-86D1-ADDA68E6044C.jpeg D3EA3DF3-193B-49D0-B616-97475B424203.jpeg
     
    Last edited: Aug 11, 2018
  6. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    I would curve the current dose first. If you increased, the depot wouldn't be full and you won't get a good picture of 2.0 anyway.

    Have you seen the ibdkitties website? They have some comments that Pepcid is not a good longer term choice.

    Love hearing that Frosty feels like cuddling now. :kiss: Makes it all worth while.
     
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  7. Ana & Frosty (GA)

    Ana & Frosty (GA) Well-Known Member

    Joined:
    Jan 19, 2018
    Not yet. I probably should read more about IBD. I’m not really sure that he has it because it doesn’t fit the symptoms that humans have with IBD. But I do know by now that humans and cats are not the same the way they present with things, so I probably should look into the symptoms more.

    I was giving him Pepcid empirically because I thought maybe he had gastritis initially when this started. I am gonna try to make the appt for the vet for next Saturday if I can, so for now I’ll continue because he only vomited twice since starting it, and only small amounts. But once we have a workup and hopefully a better diagnosis, I’ll stop and see what other meds he can have to help him.

    I just gave him 1.75 but his pre shot was 450 so I kind of wish I gave him 2. I’ll start tonight though. I’ll do the curve every 2 hours today though to hopefully get a better picture of what this dose is doing.
     
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  8. Pamela & Amethyst

    Pamela & Amethyst Well-Known Member

    Joined:
    Dec 11, 2016
    love light and healing:bighug::bighug::bighug::bighug::bighug:
     
  9. Sonia & Leo

    Sonia & Leo Member

    Joined:
    May 24, 2018
  10. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    You are the best thing that ever happened to Frosty. He is so lucky to have you. I hope you can work out all of his health issues. Frosty is a good boy.:bighug::bighug::bighug:
     
  11. LizzieInTexas

    LizzieInTexas Well-Known Member

    Joined:
    Jul 25, 2016
    Are you considering the GI assay through IDEXX? I want to get that done for Gizmo. The issue is my regular vet doesn't have an account with IDEXX and the hospital where the IM is uses Antech (but haven't asked specifically if they could submit the bloodwork).
     
  12. Tracey&Jones

    Tracey&Jones Well-Known Member

    Joined:
    Dec 12, 2016
    Hugs and prayers.
     
  13. Wendy&Neko

    Wendy&Neko Well-Known Member

    Joined:
    Feb 28, 2012
    @LizzieInTexas the Texas AMU GI panel is a good one to get. Might be easier for your vet.
     
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  14. LizzieInTexas

    LizzieInTexas Well-Known Member

    Joined:
    Jul 25, 2016
    Any idea on the $$?

    Looked it up.. does it include all listed or pick/choose? I may give vet a call tomorrow. I have to get him in to recheck the anemia soon.

    http://vetmed.tamu.edu/gilab/service/assays

    @Ana & Frosty sorry to hijack :bighug:
     
  15. Ana & Frosty (GA)

    Ana & Frosty (GA) Well-Known Member

    Joined:
    Jan 19, 2018
    It's OK. I am not really familiar with that panel, and again, I am not sure exactly what we are looking for a this point. I guess we are trying to figure out why his stomach isn't emptying properly.

    In humans, there is something called diabetic gastroparesis, which can happen if a person is diabetic for a long time, and basically the nerves of the stomach are being affected, so it doesn't empty properly. I do not know if that is something that can happen to cats as well?

    Also, he hasn't really had any diarrhea, he has a great appetite, his belly isn't tender to touch, so again, I do not know if he has IBD or lymphoma or this is something different. I am going to start with the IM vet visit and ultrasound for now, and then we will see where that takes us.
     
  16. Ana & Frosty (GA)

    Ana & Frosty (GA) Well-Known Member

    Joined:
    Jan 19, 2018
    I think the crappy numbers I am seeing with this dose over the last 3 days has to do with the new box of syringes I opened. It’s the same brand, but the plastic feels thicker and plunger more difficult to move. As a result, I noticed there’s often a bubble that forms right at the base of the needle with no way to get it out. I wonder if that’s why he hasn’t seen blues lately.

    I’ll go up to 2 units tonight and see if that will help.
     
  17. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Leo's dose always has a bubble. I stopped wasting insulin to get rid of it. Now I figure it is part of the dose every time. With smaller doses (0.25 - 0.5) that might be a different story.
     
  18. Ana & Frosty (GA)

    Ana & Frosty (GA) Well-Known Member

    Joined:
    Jan 19, 2018
    I know what you mean, there is always a small one, but with these syringes being thicker, it seems the contents are more difficult to move so the bubble is larger.
     
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