9/20 Billie AMPS 184 +2 255 PMPS 244 Long condo, lots going on

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Deanna & Billie

Member Since 2014
Last condo: http://www.felinediabetes.com/FDMB/threads/9-6-billie-pmps-256.164479/

Hello all! I haven't posted in a long time, so Billie and I may be new to many of you. She has been extra sweet and on Lantus since 2014, and everyone here taught me how to care for her.

I'm learning that some of the kitties we knew are GAs now, including some of the legendary kitties who taught Billie and I so much about how to do this dance. I'm so sorry to everyone who has lost a furchild. You're always in our thoughts and prayers :bighug::bighug::bighug::bighug:

For Billie, I'll start with the good news - although she has had elevated liver enzymes since April, has IBD, and has chronic pancreatitis, she just had an abdominal ultrasound that looked miraculously good. The vet said it was pretty much unchanged since the last ultrasound she had in 2015. Her liver looks good, and no signs of IBD turning to lymphoma. So we're very happy about that. And, in general, she has been doing very well clinically (until the past few days). I had switched her to a home cooked chicken diet with U-Stew or EZcomplete premix, and her appetite has been great overall. Only occasional vomiting or diarrhea.

About a month ago, she had a pancreatitis flare up, and her fPL was 21. She was still eating but seemed very lethargic and uncomfortable. Lots of meatloafing. Also, her BG got very hard to regulate. She was rarely below 250 and we're just now finally seeing some good numbers after multiple dose increases. The flare up may still be going on...she has been having appy issues and nausea for the past few days, or the appy issues could be from new meds she just started (I'll elaborate below).

Now, the scary part...

On Sunday night, Billie had a stroke. It was the most awful and terrifying moment we've experienced. I'm so grateful that DBF and I were both right there. Billie was walking in the kitchen and all of a sudden her back legs got stiff, especially her back right leg, and it seemed like she didn't know what to do. She then started circling to the right, and then collapsed in a sitting position with her back legs stretched out under her. She was open mouth breathing a little and her body felt extremely stiff. It's hard to say how long the whole episode lasted but maybe a minute or less. The stiffness lessened and she was able to walk. Her balance was still off, kind of a drunken walk, but she walked a few feet and laid down. I had never seen anything like this and thought it was a seizure at the time. I checked her BG (233, def not hypo) and we rushed her to the ER. Her vitals were normal, and she was able to walk, so they sent us home and got Billie an appointment with a board certified critical care specialist the following morning (Monday). It's an ER during off hours and a specialty practice during the day which is great.

Monday morning, we saw Billie's new vet (who I love). From my description of what happened and Billie's history, she diagnosed the event as a stroke, not a seizure, caused by a blood clot. She said that both diabetes and pancreatitis can cause hypercoagulation and make cats more prone to clots. She also heard a heart murmur and is concerned about possible heart disease. She did an abdominal ultrasound (mentioned above, everything looked great), echocardiogram, bloodwork, fPL, b12, and urine culture. fPL was 8.5 down from 21 a month ago. B12 was on the low end of normal so we're going to start b12 shots. Bloodwork was unchanged from a month ago, except that her ALT was much higher - in the 600s when it was previously in the 300s. The echocardiogram looked mostly normal but the vet said it looked like her heart was pumping rather hard, like it was working harder than it should need to.

So, the vet put Billie on the following meds and recommended a recheck with her in a month as well as a follow up with a cardiologist.

Plavix (blood thinner to reduce the risk of clots): 1/4 of a 75mg tablet once a day

Metronidazole (as a precaution in case liver enzymes are elevated due to infection): 1/4 of a 250mg tablet twice a day for one month

Denamarin (liver support): one tablet once a day, recommended on empty stomach

Vitamin e: 50IU once a day or 100IU every other day (not started yet)

Billie is also on a maintenance regimen with Cerenia for p-titis/nausea, which the vet recommended continuing at 1/2 tablet twice a week.

Since Monday evening, Billie's appy has been way off with lots of lip licking/nausea, and she has seemed pretty sleepy. I'm not sure if it's the Plavix, some of these other new meds/supplements, pancreatitis flaring up from the stress of Sunday night and Monday, or residual effects from the stroke. I'm currently pulling out all the stops to get her to eat something (rotisserie, deli turkey, ham). She did eat a few bites of deli turkey a little while ago.

Question: As far as the meds go, I have a question for anyone whose kitties are on a lot of meds - do you give some of them at the same time or do you space them all out? Is there an optimal way to avoid stressing her system and upsetting her stomach? The vet recommended giving Denamarin on its own but didn't specify for the others. I do have a call out to her but I'm curious what other people do, as Billie has never been on so many meds at one time. I've been putting the pills in gel caps and that is working well, thank goodness.

We also welcome any thoughts or advice about anything else!! Thank you all for reading :bighug:
 
Hi Deanna. :bighug::bighug::bighug: That stroke must have been so scary. I am so glad Billie can walk again. I had it happen to a civie and he could not afterwards. :(

Neko also had many meds, and like you, I used gel caps. Both Plavix and metronidazole are icky tasting so gel capping hides that, plus you can cram multiple meds in one gelcap for less pilling sessions which I found easier. Another option is that a compounding agency may be able to compound a mix of drugs. I tried to give meds with a little food on board, except the anti nausea which needed to be given before she would eat. Have you tried assist feeding her? I found that getting a little food in Neko would prime the pump, so to speak.

I do have some questions. Why Cerenia twice a week? It can be given daily. The other option for nausea is ondansetron. You need a prescription from the vet and can fill it at a anhuman pharmacy. The two drugs target different nausea receptors. Sometimes one or the other is better, or at the end Neko needed both. Sounds like Billie needs anti nausea drugs now.

Plavix had no side effects with Neko. But heart issues can also lead to nausea.

I wonder about metronidazole, liver damage is listed as a side effect in cats.

One other question, did the vet ever talk about biopsy or endoscopy of the bowels to see if it is IBD or small cell? How had Billie's weight been?
 
Hi Wendy! It's so nice to hear from you :bighug: I'm so sorry...I know that I'm incredibly lucky to have Billie still here and able to walk. I'm still trying to wrap my head around it.

She did eat a little rotisserie chicken just now, and some deli turkey twice earlier. She has only been eating a few bites of food at a time and only when I set it in front of her, but it's better than nothing I suppose. I have never assist fed her but I do have syringes in case I need to!

Good question on the Cerenia...the vet told us to give it for five days and then to go down to twice a week. But maybe it's not enough? Billie and I are new to Cerenia. I do actually have some ondansetron on hand from another pancreatitis flare, so I could give that a try for her tonight. She hasn't taken it in a while, but it worked for her in the past.

I'm hoping the nausea isn't related to Plavix, because it's so important and I want her to be able to take it without side effects. What was Neko's dose? Does 1/4 of a 75 msg tablet sound right? Billie only weighs 8 lbs, but she has been holding steady at 8lbs for at least a year.

The vet felt confident that it's IBD and not small cell right now so didn't recommend a biopsy. She said it's probably triaditis considering the liver involvement and the pancreatitis, and mentioned immunosuppressants in the future...but I don't think we're there yet.

The vet just called back to talk about the nausea/lack of appetite. She said to stop all the new meds except the nausea meds for 24 hours and see if that helps, and then we can re-introduce them one at a time starting with the Plavix. I think that makes sense. I wish we had started that way to begin with, but I didn't think about it.

I wonder about the metronidazole with her liver too...I didn't know that was a side effect and I'm glad you mentioned it!!

Once again, I'm so glad I'm here :cat:
 
Glad your furbaby is ok considering. I took Plavix personally and had zero side effects from it. It didn't work for me and now am on Xeralto (a different, stonger blood thinner). No side effects on it either, but then they are cats so who knows. :cat: :rolleyes:

Have you considered an appy stimulants? Sometimes it just takes them a while to figure out eating again :confused::banghead:. It has only taken Gixmo one dose per episode to get him started eating again. Another thing that has worked with Gizmo is Canna (cannabis). I use the capsules and just mix it in some yummy food (fish) and I can usually get it into him that way. I have also emptied out a bit of the powder and added the Cerenia into the empty space and given both in the capsule.

She said to stop all the new meds except the nausea meds for 24 hours and see if that helps, and then we can re-introduce them one at a time starting with the Plavix. I think that makes sense. I wish we had started that way to begin with, but I didn't think about it.
I did the same thing. :mad: Someone here pointed out that I had changed too many things all at the same time and I was like duh :banghead:. We get so focused on trying to get them better and we get too much going on. Sounds like a good plan.
 
Hi Deanna :bighug:
oh that's sounds so scary. I'm glad the vet is on top of it. The capsules are a big help as Wendy said, I just always put butter on mine and chased with a syringe of water .

Scritches to Billie.
 
Deanna, I'm so sorry to hear Billie had a stroke. That must have been so scary. I'm glad she is walking again. I hope you can find a balance with all the meds and get her eating again. Sending prayers. :bighug::bighug::bighug::bighug::bighug::bighug::bighug:
 
@LizzieInTexas Nice to meet you, and thanks for visiting! I've actually been really curious about a CBD product for Billie. I've been reading a lot about Charlotte's Web hemp oil on the Facebook IBD forum. Maybe that would be helpful. So glad it works for Gizmo!

@rhiannon and shadow (GA) and @carfurby, it's so nice to see you! Thank you for the hugs and prayers. And thank you Rhiannon for the butter suggestion. Billie loves butter so that's brilliant :)

Billie has been sleeping and seems pretty out of it, maybe from all the meds. I'm going to bug her for PMPS in a bit and maybe we will try the ondansetron. Hopefully she will eat something.
 
I'm hoping the nausea isn't related to Plavix, because it's so important and I want her to be able to take it without side effects. What was Neko's dose? Does 1/4 of a 75 msg tablet sound right?
That's the same dose Neko got. From what I read, best given with food.

I would try nausea meds before trying appy stims. Nothing worse than being hungry while nauseous - that can turn you off food. With Neko, it was her underlying conditions (CKD, lymphoma, heart condition) as well as her chemo for lymphoma that caused nausea.
 
Hi Deanna, I'm so sorry to hear that Billie had a stroke, but glad that she recovered from it's effects quickly. I hope you and your vet can determine how and when to give all those medications. I'm of no help whatsoever with meds. Rusty refuses to take anything by mouth!

Anyway, we are sending Billie a beautiful bouquet of healing vines and hoping that all her health issues will be under control very soon.

Hugs and scritches,

:bighug::bighug::bighug:
 
Hi there! How frightening that stroke must have been - but how fortunate that you were there.

I'm awful at giving pills, so all of Girlie's meds get compounded into liquid form, which is much easier for us. Vitamin E, however, is a wonderful treat in her mind, and she'll lick it right off my finger.

I wish you all good luck! Sending many healing vines and lots of hugs... :bighug::bighug::bighug::bighug:
 
Hi Deanna!

So nice to see you and Billie, but I'm sorry it's because Billie is having a tough time. That stroke must have been just terrifying.:eek::( I'm so glad she seems to be recovering from it.

I totally agree with the idea of giving the Cerenia more often, and also trying a combo of Cerenia and Ondansetron. I found that to be very helpful with both Minka and Harvey when they weren't feeling well. It's so important to get enough calories into Billie. Not only do you need to watch for ketones when kitty isn't eating enough, but you need to be careful to prevent hepatic lipidosis, which can be fatal (that's how I lost my civvie Kisa). I'm glad Billie is eating, even if it's only a little, but you can't let her go on more than a day or two like that.

I also had to give multiple meds. Gelcaps were a godsend, for sure! Unless I was specifically told to give without food, I made sure the kitty ate something first - obviously that excludes the nausea meds!

Please keep us posted on how Billie is doing. You know we care! :bighug:
 
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