New to board - introducing Shaikha

My 13 year old doll-faced Persian that I brought back to the US from overseas (rescue kitty) developed severe pancreatitis in mid-May. Since then it has been a difficult task to stay ahead of what isn't working on a particular day. Her latest problem is diabetes, added to her other two diagnoses of pancreatitis and IBD. Initially she was in bad shape with diarrhea and a lot of pain. We put her on prednisolone, buprenorphine, and vitamin b-12 shots. We also changed her diet to a grain-free food (Hills d/d). Her pain improved sufficiently on the prednisolone that eventually I was able to get her off the pain meds. Unfortunately, as we tried to taper her down off the pred initially she got worse, so we had to go back to a higher dose. After about another 7-10 days I was able to start tapering her off the pred, and initially she did okay. Then I noticed her drinking more water than usual and urinating frequently, so I took her in for a checkup and her BG was elevated sufficiently that my vet decided she had developed diabetes. He put her on Vetsulin at 0.2 once daily dose to start. Unfortunately, her BG was still too high so we split the dose into twice per day. That was a bit better, but readings seemed to just get higher, so we doubled the dose to 0.4 total per day, split into two doses.

On the last visit before the holiday weekend her BG was 347, so my vet wanted me to do a BG curve. He also sent me home with a borrowed AlphaTrak meter to use. I've had a hard time getting blood from her ears, but it is getting better. I've had more luck towards the base of the ear than at the tips, though. I don't have lancets yet, but have ordered some. They just told me to use clean needles (I've got another cat with renal failure, so we do a lot of subQ therapy around here). I have seen bruising though because I think the needles are too big so I've sacrificed a few insulin syringes to get blood instead but still need to perfect my technique. I hope this gets easier with time. Poor Shaikha has been really good in spite of her mom's inexpert technique.

I know that one thing I need to do is to be more regular with feedings. It still takes me a long time to get a blood droplet and get food ready for all three cats (one cat is healthy, but the CRF cat also requires a lot of care as he also has anemia, pancreatitis, IBD, and liver disease). I'm working on it, but sometimes I find I missed the target time by an hour and by then her BG is really high.

One additional wrinkle is that once we stopped the pred her pain levels increased again and she really wasn't doing well. I've managed to get pain controlled with buprenorphine again, but my vet was concerned enough about her condition that he consulted with TAMU's GI lab. They spent a long time with him reviewing test results and history, and recommended that we give her antibiotics because the pancreatitis may be the necrotic type. She is just finishing off the series of clavamox plus flagyl twice per day (tomorrow will likely finish off the clavamox, but my vet wanted her to continue flagyl twice per day until we see him after the holiday weekend). TAMU also recommended that we put her on leukeran since they did not recommend steroids (to include budesonide) since her diabetes isn't regulated. She's had two doses to far of leukeran and the only side effect has been a slight decrease in appetite. I've had to give her some snacks since she is eating less at meals (usually given when I see a lower BG reading about 3-4 hours post-shot). I also switched her to anzemet for nausea instead of ondansetron, and I think that helped as tonight a few hours after her shot she wolfed down food instead of picking at it. I know I need to ensure she is on a regular feeding and insulin schedule, and keeping her appetite up is necessary. I know how to assist feed though and if need be will do so with her too.

I don't have her readings from before July 1 as they were all done at the vet's office, but here is what I have. I need some help deciding what to do because her numbers are all over the place:

7/1: 347 at 4:30pm; AM meal was a 6:30am but I think I accidentally gave too little insulin at breakfast due to a switch from U40 to U100 syringes; insulin 0.1 at dinner
7/2: 0.1 dose insulin at 7:00 AM (no BG taken; couldn't get blood); 227 at 5:00pm, 0.1 insulin dose around 5:30pm (had to give dinner & shot early due to going out)
7/3: 481 at 7:24am, 0.1 dose, breakfast at 7:30am (I know, I overslept); 296 at 5:40pm followed by dinner, 0.2 dose (vet wanted it doubled plus BG curve done), snack at 10:30pm
7/4: 420 at 7:00am, breakfast at 7:30am, shot at 7:45am; reading at +5 = 93 (gave snack after), reading at +10 = 224; reading at 7:15pm = 366 followed by dinner; reading at +3 = 75 (gave another snack due to low reading although her behavior was fine); 0.2 insulin dose BID

I know I need to test more frequently and will try to do so tomorrow to fill in gaps so I can find out how low she is going on the new dose. I will also try to keep her on a stricter feeding and insulin schedule time-wise. Her high readings worry me though. Given how low she went about 3-5 hours into the cycle, I'm worried that doubling the dose was too much of a change at once. Then again, the high readings close to 11 and 12 hours worry me too.

Suggestions welcome. I want to ensure I fix this tomorrow but am not sure how much I need to test her and how best to adjust the schedule to make this work better. I did read all the documentation for newbies, but it is a lot to take in, especially the BG curve information and how to regulate. I'm a little overwhelmed right now. I've got two extremely sick cats at once. I think I've got my CRF cat more stabilized after his latest pancreatitis flareup (he's also on anzemet now, along with ursodiol and lots of other things to combat severe nausea), but I never dreamed that Shaikha would get sick at the same time. She's always been very well until now, though I do think she may have had IBD for a while before the pancreatitis showed up but I just didn't recognize the symptoms (in part because I thought the cat having the loose stools was my CRF cat so that delayed her getting treatment).

Sorry for the long intro! Any help much appreciated.

Wendy

 

Hi Wendy-

Just wanted to say hello and welcome. I am also new here and have been home-testing for the past 2 weeks. Wow! You've got a lot on your plate! I had a lovely little persian man many years ago. He passed in 2001 after LOTS of health issues....pure breeds....they come with their own set of troubles. I loved him lots.

I can't give you any help with the insulin because I'm still sorting that out for myself, but I will tell you that the testing does get easier...on you and your kitty. Ugh! Those first few days were BRUTAL! I had a similar post 2 weeks ago when I started, and I too found that it was easier in the beginning to poke my girl lower on her ears. Though now I'm able to do it easily closer to the top and on the edge (the 'sweet spot'). One thing that people will tell you right away is to make sure your kitty's ear is warm...cold ears just don't bleed. I learned this the hard way. My girl was super tolerant of my incompetence and all the extra pokes. I just give a little ear rub to warm it up first and she's good to go. In all the posts I've read, lots of people use a sock warmer, but I've found that the ear rub does the trick.

I'm sure you will get lots more welcomes tomorrow and lots of advice to follow. Hang in there! Best wishes for you and your kitty!

s

 

OK - deep breath! I'm going to give you lots of information, so get a cup of coffee, take a deep breath and let's tackle this:

It's great that your vet encourages home testing! Yeah vet!

How did your vet determine the diabetes? Did the vet do a fructosamine test, or just a simple blood test in the office? Vet stress can artificially raise the BG levels 100-200 points. A fructosamine test is the best way to determine diabetes, as it measures the glucose levels over a 2-4 week period.

Meters

I do suggest that you pick up a human meter and start testing with that. The least expensive meter and strips is sold at Walmart (Relion brand). It also requires a small amount of blood. Another great meter is Bayer Contour - again tiny amount of blood required and can find strips inexpensively on ebay.

A human meter will work just fine on your cat. Don't get sucked into the need to buy alphatrak. It's very expensive and you can only get strips from the vet. Which can be expensive and troublesome if you run low and need them while they are closed.

For more information about discussion of meters, check this out: http://www.felinediabetes.com/phorum5/r ... ?8,1840808

Food

Let's talk food, generally speaking, it's best to NOT feed dry food at all. Canned and even raw food is a much better option. Given your cats additional issues, I would recommend introducing raw food to her. If she's never eaten it, it will take time, don't give up. But it will help with the IBD and pancreatitis as well.

The goal with food is to stick with low carb. Sadly dry food and prescription foods don't work.

Nutrition and diet links

Transitioning from dry to wet food

Be sure to read the links to Dr. Lisa's website, she has a great piece talking about food and nutrition.

You also want to keep to low carb foods - that is food that is 10% or less in carb value. Again, look at the link above and check out Janet & Binky's food chart. It lists the carbs, along with other values of the different foods both dry, canned and raw.

With IBD issues, you want to keep to one food/flavor in order to stop the diarrhea. Maui has IBS(irritable bowel syndrome) (not sure it's full blown IBD), but what I did was take poultry flavors and I started her with Fancy Feast, Turkey & giblets feast. She ate that for weeks, before I slowly introduced other flavors.

I know feed all my cats, friskies SD - turkey & giblets, nature's logic canned and homemade raw food. Her IBS only happens occasionally now, not several times a day like before.

Sadly, prescription food, is very expensive and not good quality - just read the ingredients and is very high in carbs. Higher than what you want to feed. the good news, you can return the food for a refund, it's guaranteed. You can easily get what you need feeding commercially available foods.

Insulin

You said that the vet started you on vestulin. That tells me that your vet is unaware of the major recall of vestulin and that it's been taken off the market.

Vestulin recall notice

Lawsuit against vestulin manufacturer - schering plough

I highly recommend that you go back to the vet and choose another insulin. There are currently three good insulin choices on the market today: Lantus (glargine) and Levimer (determir) are human insulins and work very well in cats, Prozinc is an animal based insulin, it's a new insulin and people are having success with it.

The two L insulins work in similar fashion and there a lot of people here using them.

Insulin support group links

Check out the insulins and read the starred information at the top, then make your own decision as to what insulin you want to try. Be prepared that your vet may be unfamiliar with these three insulins and may be resistant to your request. We can help you convert your vet and get what you need to get started.

Now as for the prednisone (steroids) - sadly this is probably the reason your cat developed diabetes to begin with. Steroid use is known to cause diabetes, and combined with dry food, well it's how Maui became diabetic.

However, while many here will encourage that you discontinue steroid use, if you are unable to , due to her pain levels, then you will need to learn how to manage the diabetes around the steroid use.

It's also possible that when you change her diet and put her on more appropriate foods, even raw foods, you may find her pancreatitis and IBD diminish, and the need for steroids will diminish as well.

It's best to think of diabetes as a process and a three prong attack - food/nutrition, insulin and home testing.

With regards to home testing, again it's great your vet encourages it. In order to help, we have a google document spreadsheet that was designed to help us, help you keep track of the bg's and to put it in a universal language. As we have people around the world, we don't talk in real time (7 am, 8 am, 9 pm) - as 7 am for you may be 9 am for me. Rather we talk in
hours so for example, if you test at 7 am and gave a shot, then lets say you got a couple spot checks in at 8 am, 10 am and 5 pm, it would look like this:

AMPS (morning pre-shot) put BG# here
+1 put BG # here
+3 put BG # here
+10 put BG # here
PMPS (evening pre-shot) put BG# here

Since insulin should be given twice a day, we split the clock into 12 hour increments morning and evening.

This way, anybody can look at your spreadsheet and see what's going on without needing to know the time of day. As we are all in different time zones.

How to create a spreadsheet

Now, I've given you lots to think about and read, get another cup of coffee, start reading and please come back with your questions, as I know you will have them.

 

Thanks for all that information!

My vet diagnosed diabetes after several out of range glucose tests. Shaikha is actually pretty calm at the vet's office so I don't think that stress was a major factor. He did some of the BG tests using a machine (was also testing other things), but some of the others were done using a meter. He mentioned a fructosamine test but I think was trying to save me some money because her care and medication to date has been costly so far (added on top of major bills for my other cat). He felt that it was a combination of severe pancreatitis and associated inflammation causing the pancreas to not act properly plus the steroids tipping the balance. She did very well on them for several weeks before diabetes set in, but to be honest we really had no choice but to use them because we'd have lost her otherwise, it was that bad. If we can get her balanced and if the leukeran doesn't work, then we may consider putting her back on them but obviously would prefer not to as it would continue problems with diabetes. We are hoping that if the leukeran can get this pancreatitis flareup calmed down it will help the diabetes go away (and being off steroids can also help there; I understand that steroid-induced diabetes is not always permanent).

I've seen the relion brand mentioned here and do plan to go out and get one. I'm depleting the very-expensive strips I bought for the alpha track rapidly due to doing the BG curves, so having a cheaper alternative would make me happy. Question: The alpha-track is supposedly coded to work for cats. Do you need to make any adjustments for a cat on the human meters like the Relion?

Shaikha has eaten dry food all her life and though she is curious about the wet food, she doesn't eat much of it. Having her on Leukeran has just compounded the issue. At this point I'm wanting her to eat anything she prefers because we need to keep sufficient calories into her. I will try to transition her to a wet food alone (my vet also wants this), but he said the most important thing is that she eats right now. We don't need FHL to deal with on top of everything else. I will assist feed if needed though. So far I think the anzemet has helped. I upped the dose a little this AM and think that helped as she was a little hungrier about an hour after I gave her the initial breakfast. We may need to do small snacks for a while as she adjusts to the leukeran and I figure out what anzemet dose works best for her.

I personally wouldn't be comfortable feeding a raw diet (I'm a vegetarian and feeding wet cat food is hard enough for me, though I know that cats are carnivores and I obviously won't try to make them vegetarians too). The other issue is that we live in a VERY rural area. There are no organic meats or fancy canned cat foods around here, which is why I fed the prescription diet because I can at least get that locally. Feeding something else would mean a 1.5 - 2 hour drive one-way to get foods (if they even have a good selection) or spending $$$ to ship heavy cans to my house. I've also got a CRF cat and would never want him to get into raw food accidentally. I know that some people love raw diets, but if I can find a canned variety that works locally that would be preferable for me. My vet wants grain-free because of the IBD and TAMU agreed, so that's why we went with either Hills z/d or d/d. She started out eating z/d fine, but stopped so we tried d/d instead. My CRF cat is on z/d because that seems to keep his pancreatitis at bay. Is there any prescription diet that is good for diabetics that is also grain-free and novel protein?

I did not know about the Vetsulin recall and doubt my vet does either. I've googled it and it appears there wasn't a "recall" per se, but that they stopped manufacturing it. I think my vet knew it wasn't being made any more because he said the bottle he gave me was his last one. He was lamenting trying to figure out other insulins that will work for his patients. I'd be up for trying a human insulin if I can get him on board to prescribe it. Question... human insulin doesn't cause antibodies, does it? My CRF cat is transfusion-dependent because he developed antibodies to epogen, and I would guess based on that alone my vet will be scared (as well as me) to try a human product again. Will read the links you provided again.

Shaikha is off steroids and has been for several weeks since her glucose readings started going high (we had to finish tapering over a few more days though). Her high BG levels continued even after that and seemed to be getting worse, which is why we put her on insulin since sugar levels we "dangerously" high according to my vet.

I did create a spreadsheet and have put it in my signature. Let me know if you can't access it. I was having trouble last night getting the link to work (getting a Google crash message which they said was due to a bug), but hopefully it is working now.

Today I'm doing much better with being on time with feeding and BG readings. In fact, it is time to do another as I'm trying to bracket what the nadir point is.

 

Thanks for the welcome, Sherry. Shaikha didn't come from a breeder that I know of. Where I lived, Persian cats were common because families brought kittens back from their relatives in Iran. They were not highly overbred according to my vet over there and didn't come with many of the issues typical purebreds did. There just were a ton of them to rescue because people got kittens and tired of them, then either turned them into a breeding factory, abused them, or dumped them on the streets. I fostered and rescued plenty of them, in addition to other strays.

Glad to know it gets easier. I'm finding I can poke her now and mostly get blood on the first or second try. I'm surprised at how little blood the meter needs. I need to get lancets and petroleum jelly. We live about 12 miles outside of town so getting any supplies involves a lot of driving. I've ordered some but plan to make a trip to Walmart tomorrow to try to get that plus look at the Relion meters. I also need to take both cats back to the vet on Wednesday so will see what my vet says about switching insulin. Even with being more careful on feeding & shot times today her BG is still all over the place, so I'm concerned that the Vetsulin has problems, so I'd like to switch her to the other brands mentioned if I can get my vet to agree.

It is lot to learn, but I did it with my other cat with CRF and will get there with diabetes too.

 

Welcome Wendy! You have gotten great information so far and I will not reiterate anything for you. I am curious about one thing though - 0.1u is a really small dose to start off on... like really really small dose. You are getting good numbers with it, so don't change anything! But - 0.1u is literally like just a drop of insulin. Is that how much you are giving - or is it to the first mark on the syringe? (1u)

 

I'm trying to report the amount based on the u40 to u100 chart on this site. In a u40 syringe (my insulin is u40) it was 0.2 daily (0.1 BID), or 1 unit in the u40 syringe (2.5 units in a U100) each time I gave insulin (twice per day). My vet then upped the dose to 0.4 per day, or 0.2 BID (2 units in the u40 syringe and 5 units in the u100 syringe).

The chart provided doesn't really say what the 0.2, etc. means but I'm assuming milligrams maybe?

Does the above seem correct?

Wendy

 

Hi Wendy, welcome to FDMB!

Hillary has given you a lot of info, I'll try not to repeat any.

You have a lot going on, and I don't know anything about the many health issues you are dealing with along with the diabetes, so I will focus on what I do know. We use ProZinc, which is protomine zinc recombinant human insulin, it is NOT animal based. As far as I know, there haven't been any issues with antibodies developing to it, but I haven't done any research in that area. There are PZI insulins that are animal based. If you go to the PZI ISG, there are links that explain the different types. At this point, I'm not sure that I would worry as much about switching insulin as getting the dose adjusted, but thats me. *shrug* It's *possible* that your cat may be a transient diabetic, and may not be on insulin for long.

I read through your posts, I didn't see anything about testing for ketones. I would recommend that you get some ketostix and test for ketones. It is important to know if ketones are an issue. Please ask if you need more info on that, I don't have any experience with ketones but others here do.

Are you going to be keeping the AlphaTrac until you get your own meter? If not, I would strongly urge you not to change to a low carb diet until you have a meter. Just changing to a low carb diet can cause BG #s to drop a lot, and you need to be able to monitor and adjust the insulin dose accordingly. I use a Relion meter, and I'm very happy with it. The human meters do seem to read lower than the AlphaTrac, so while you use 80 as a low # for the AT, you would use 40-50 as a low # with the human meter.

As far as dosing....1 unit is 1 unit, not 0.1....there is no mg in insulin dosage, it's always in units. So you were dosing 1.0 unit BID, and now you are dosing 2.0 units BID (5 units on the u100 syringe, correct?) The 0.2 on the chart is 0.2 units...yes, you can dose that small if you need to.

Increasing by a full unit at a time is not a good idea. I would go back to 1.0u, and increase by no more than 0.5u at a time, and personally, I would increase by even smaller amounts. How long was she on 1.0u before the increase? Some vets seem to think that they can regulate a FD in a few weeks, and they sometimes increase too much too fast. We believe in start low, go slow here.

 

Shaikha has been diagnosed with pancreatitis (several high spec fPL readings). We strongly suspect she also has IBD but I've opted not to put her through invasive testing for that, but diarrhea and soft stools have been commonplace in her since probably mid-April despite no change in diet. Since switching her to a novel protein and grain-free diet, her stools have firmed up but they are still a very odd texture (sort of plastic looking with a smooth, shiny surface). She has no other health issues other than severe arthritis that developed as a result of abuse before I rescued her. We treated that with dasuquin and occasionally stronger stuff if she's really bad off.

I plan to ask my vet about ProZinc on Wednesday, as well as the possibility of using a human insulin like Levamir or Lantus. We'll see what my vet thinks. I'm concerned that her levels are not very tightly controlled right now, and am worried that the Vetsulin I've gotten isn't working as it should. It may be dose, but at 12 hours after I don't want her in the high 300s or anywhere in the 400s.

I haven't tested for ketones and my vet hasn't mentioned them. After reading through this website, though, I ordered some test sticks from Hocks so hopefully I can start integrating that. I could use any advice on what to look for and how often. I also plan to ask my vet about that on Wednesday.

I plan to go to Walmart on Wednesday and look at purchasing a Relion meter. I have the AlphaTrac and will use up all the strips, then return it to my vet. I'm not planning on making changes yet to her diet because I don't want to bring on a flareup of IBD or worsen her pancreatitis. Food changes are difficult given her current condition, plus we also just started her on leukeran so I want to keep as many variables constant as I can so we can see how it is working. I've gathered info on Fancy Feast, which is a food I can get locally but will need to try only one type at a time and introduce it slowly because I don't want diarrhea to throw her system into an uproar. We finally got rid of her diarrhea on the Hills d/d so I'm being very cautious about any changes given how serious her condition has been.

Yes, I was using 1 unit BID (2.5 in my 3/10 cc U100 insulin syringe) and then switched to 2 units BID (5 units in my U100 syringe). Today I switched to 1.5 units though because of her two low readings yesterday. I think that has worked better because her BG didn't crash today. Shaikha was on 1 unit for about a week before we increased her insulin (my chart doesn't show dates prior to July 1 because I wasn't recording BG levels and hadn't set up a chart; BG was being done at my vet's office once per day).I think my vet was hoping she'd only have temporary diabetes but it seems she is staying at higher levels than she initially was showing, which isn't good. I think he also tends to think in U40 syringe terms, and those syringes are harder to measure small changes than the U100 syringes I've been using. I plan to see how she does on the 1.5 unit dose until Wednesday and will take in my charts and see what he thinks.

PS: I've adjusted my spreadsheet to show the correct units now. Sorry for my own confusion. This is all new to me.

 

Ok - I figured that was what was going on! No worries - you had it straight for how you were figuring out the dosing, it was just confusing us! :lol: I think you did the right thing by going down to 1.5u btw.

 

Here's a mish mash of info - I hope I don't repeat too much from the others.

Go with wet food, seriously. My Shadoe, if she gets ahold of just a mouthfull of dry food from my civvie Booboo, Shadoe's number goes through the roof. There have been many cats that switch to a proper diet, wet, low carb, and they don't need insulin, or on insulin for a very short time. Diet controlled is maybe a possibility, so that's why everyone says to toss the dry. Give it a try and see how it goes. If Shaikha is already eating wet, then go with all wet.
there are plenty of good foods, low carb, high protein, that you can try and they won't cost you an arm and a leg either.
Binky’s Food Lists

Vetsulin is not great, as you can see from Hilary's links. It is also a faster acting insulin I think so it may last closer to 6-8 hours, and for that reason, especially with your schedule, Lantus or Levemir may be much better options. With the shed, and a bit of an over lap, you will not have the big ups and downs as with Vetsulin. I first tried Caninsulin for Shadoe and got no results, so switched to Lantus and then Levemir.
You can give the warning info to your vet, and say that you want to use Lantus or Levemir as they are longer lasting and don't have harmful issues.

Tight Regulation Protocol
LANTUS & LEVEMIR – INSULIN DEPOT –AKA- STORAGE SHED
Lantus&Levemir – Data Ready to Shoot Low Numbers

The ears will 'learn' to bleed. It will get easier in a very short time. Meters I have are OneTouch ultra and also AccuChek - they are both good, but many use Relion as it's much cheaper for the strips.

So Welcome to the site, and please do ask any questions you may have.
If you have questions about the other insulins, you can always post to the Lantus/Levemir group and someone will ge there to answer you.

 

I think you are doing great. Shaikha has lots of issues to deal with, and your vet seems to be on top of things. (Lots of vets discourage hometesting....) Fantastic that you have a spreadsheet already.

Take your ReliOn to the vet visit so you can see how it compares to your vet's. It should reassure you.

We like wet lo carb best but understand there are many other issues in your case. You might get some insight into some of those and diet on this vet's website: http;//www.catinfo.org She has lots of good information and tips on transitioning.

If you are just dying for more homework, you might go over to the Insulin Support groups sites and read the stickies on the top of the pages. They will get you information on each insulin and how it works - the advantages and disadvantages. You could even print off some pages to show your vet. http://www.felinediabetes.com/FDMB/viewforum.php?f=5

 

I will try to switch her over to all d/d wet for now, but to be honest she isn't eating it as she needs to. Since she's on a chemo drug, her appetite is down some (though it was down a bit even before the leukeran; her pancreatitis re-flared since stopping steroids).She isnt' eating enough so I want to keep her eating whatever I can that won't throw her pancreatitis and IBD into a tizzy. My other pancreatitis cat had a flareup after I switched back from z/d to k/d, so food changes need to be done slowly and carefully (he's now back on z/d and doing great, though loose stools are still an issue). Shaikha has much worse pancreatitis than the simmering type that Tabriz has. I may try her on Fancy Feast later since I can get that locally, but need to stick to one type of protein at a time if I can. I worry about the mixtures of meat proteins they have in many of these varieties after looking at the ingredient list.

What you say about Vetsulin makes sense given the changes in Shaikha's numbers. It causes a pretty quick drop in BG then it starts rising after that to really high levels, as early as 10 hours after dosing. I will talk to my vet on Wednesday about all of this. As for posting in the other forums, I thought they were closed? From what is posted there, it appeared that starting June 1 that all posts had to be in this forum, or is that not correct?

PS: How do I create a profile for Shaikha? It appears people are using some sort of template, but I didn't see a link to one like there was for the BG chart. It would save people a lot of time I'd think since food and other info is in one place. The charts and profiles are a great idea!

 

No, the other forums are open. They combined the regular health with the diabetic health a month or so ago so general health is no longer open. We do want you to start on this forum with your general questions. Once you choose an insulin, you may want to post on the insulin support group for dosage help, as everyone there uses your insulin.

Here are the directions for setting up a profile: viewtopic.php?f=6&t=17766

 

Here's the link to create a profile. How to create profile

You will hear this a lot that wet food is better for cats than dry. However, shaikha has a lot of issues going on and it's important that she eat. If you can transition to canned food that is obviously best for her and your other cats. So, that's something you can work on.

With my three, it was a lot of working getting them to eat wet only. It took several weeks to remove the dry completely. Read Dr. Lisa's site, she provides lots of tips and tricks to transition a cat.

Just remember you don't want her to stop eating, so if you need to continue the dry, while you work on this, so be it. Just keep in mind, that with the removal of dry, the amount of insulin she may need may decrease sharply.

Regarding a curve, honestly you don't need to test every hour at this point, yes collecting data and information is good, but you can save strips and her ears by testing every 2-3 hours or so rather than every hour.

are you familiar with probiotics, it's something that I put in my girls wet food to help with the digestive issues. It's the same stuff that is found in yogurt. I use a brand called pet dolphilus and I get it online. http://www.vitacost.com/Jarrow-Formulas-Pet-Dophilus - You only put a pinch in the food daily. One bottle will last at least 6 months, possibly longer. (store in fridge)

I don't know about any antibodies or reactions using human insulin, what I'm going to do is PM Jess & Earl. She's a vet tech and may know. I'm also going to PM Monique & Spooky - she's in Germany but knows all these technical stuff and I'm sure can answer these questions for you.

When you go to Walmart - put this on your shopping list:

- ketostix - found with diabetes supplies
- relion meter and strips to go with meter
- lancets
- petroleum jelly
- neosporin with pain relief is fine - found with first aid supplies
- canned cat food - see what they have - even their brand is fine - special kitty - just make sure it's 10% or less on the carb chart
- treat for yourself

The ketostix tests for ketones in the urine. This will tell you whether you have a possible DKA situation or could become one.

Now, you ask, how the heck do I test the urine. Well if you are able to catch her when she uses the LB, great put the stick in the stream. If not, you could put plastic wrap on top of the litter and dip the stick into the urine pool.

While every cat is different and your cat may never throw ketones, I recommend testing at least once a week, more if you are able, but don't make yourself nuts over it.

I understand your aversion to raw food being a vegetarian - are you a vegan or just a vegetarian? I have friends that are both and understand the ick factor. The thing to remember is that your cat is a carnivore and needs meat in her diet. Raw food, is a great way to feed her. I also understand it helps with the IBD, pancreatitis and other issues she has. While you don't have to make your own raw food (like I am now doing), you can buy commercial raw food - typically found in the freezer section of specialty pet stores, or through online purchasing.

I'm not going to push raw food on you. But would like you to consider it as an option for your cats along with the wet food.

Lecture over.....

If you are able to go to the other forums and see the posts there, then you are signed up as a member and are allowed to post. The posts that you saw that are locked, are done so, because they were set up for informational purposes and not for comments. You can start a new post if you like, or continue to use this one for now.

I'm going to PM Jess and Monique and ask them to stop by.

 

Thanks for the link on profiles. I will work on that next.

I think that getting my cats to eat wet food will be a challenge. Tabriz (my CRF cat) does eat wet-only now but he's gotten used to that after having a feeding tube for a while, plus I need to assist feed him on occasion so having liquid food is sort of essential. He will only eat food he can lap up. Chunks or bits he has to chew he'll refuse. I basically take his canned food, whatever it is, and add some water and make it like a thick pudding. I've found that Shaikha is more interested in wet food that way too, though she won't eat very much (maybe a tablespoon at a time). I've read the other tips at Dr. Lisa's site and probably will try sprinkling her dry food on the wet, though not sure it will work. I think it is a texture thing with her.

I've not wanted to test her hourly and really haven't done so. At best it works out to every 2-3 hours over the past two days, but today is the last day for this as I'll be out of town for a good chunk of the day tomorrow (a friend will come in and give her the PM meal and insulin plus tend to my other cats). She's been pretty good with me poking her so far.

I'm familiar with probiotics and do give them on occasion to both Tabriz and Shaikha, but have been scared to give them too often to her. There was a medical study done that showed high mortality rates on human pancreatitis patients went up when probiotics were administered. They are not sure of the reason but on a pancreatitis list I'm a member of they are suggesting strong caution be used for pancreatitis kitties. I've given them on occasion when I've changed foods, but try to limit how much given the huge difference in mortality between the group administered probiotics and those who were not. When I give them, I use Benebac, which is a powder or gel specially designed for animals. I do like Jarrows vitamins and will look at the Vitacost site (where I also buy a lot of supplements for both myself and Tabriz in particular).

Thanks for checking on the antibodies for me. After what happened to Tabriz I'm running scared on "human" anything.

I'll look at the foods at Walmart, but will probably not try to make any changes until I see how the leukeran is working first. We are trying to keep her on an even keel for the next few weeks. If the leukeran works, we'll know after a few weeks. She does seem to be more comfortable to me, enough so that I may try reducing her buprenorphine to see how she does without it. Will the neosporin gel be a problem if the cat cleans their ears and eats it? Shaikha is a meticulous groomer and I'm sure she'll ingest it. I like the "treat" idea.

Another reason I'm not wanting to make too many changes is that I'm facing some major surgery myself in the next few weeks. My husband and a good friend will help with the cats care, but they need a LOT of care between the two of them and I don't want to lay too much on anyone, plus my husband I know won't do all I do. He likes the cats, but feels we've spent too much and done too much as it is. You would not believe our vet bills (well, maybe some of you will).

I've got three Smart Cat Boxes so getting urine shouldn't be a problem. I had to switch to them because of Tabriz's anemia (he was munching clay litter for the minerals).

I try to eat vegan mostly, but do eat some cheese on occasion, especially when traveling. I'm allergic to dairy so I have to be careful how much I ingest of that. Getting any type of specialty food (pet or human) will be difficult given where I live. The closest PetSmarts are 1.5-2 hours one way from me. This area doesn't have things like Whole Foods or specialty groceries of any kind. Walmart is as upscale as it gets. Buying frozen or canned foods online I'd think would be cost prohibitive due to high shipping costs, so if I can find something locally that would work. Anything I find locally won't be raw for sure because there's nothing I'd trust meat-wise in these stores.

I didn't realize the insulin forums were open for posting. I guess I misunderstood the message at the top. Will talk to my vet about switching insulin types and then post some more there.

 

Hi and welcome,

You've already been given so much great advice, not much I can add. I wanted to say my little man Tucker has IBD and Pancreatitis so I know how hard it is. You're doing such a fantastic job.

Do you give subq fluids to Shaikha or just your CRF kitty? Subqs do wonders for Tucker when he's in a flare. Glad you started the Flagyl, that always helps Tucker when his belly hurts. We are now giving the B12 injections once a week for a short time to help with his blood sugar. Tucker has a brain tumor and was circling so much he couldn't walk well, he has since had to start pred so getting him regulated is challenging.

I hope things with your little furry get better very quickly.

 

I've also given her subQ fluids when the flareup was at its worst, but don't give them daily. She's getting poked so much I didn't want to make her scared of seeing me come by. In the worst of her attack, Tabriz and Shaikha actually lined up for their subQ treatments. It was funny to see. Both of them purr when they get them, though Shaikha recently trying to bolt while the needle was in so I decided to try to give them to her much less often. I do think they help, but don't want to add to her stress levels. She also has PU and PD since her diabetes isn't controlled so she is drinking oceans of water as it is.

Sorry to hear about Tucker's brain tumor. I highly recommend buprenorphine if you need a pain killer. I think I read somewhere else you were asking about it. I use it on both Tabriz and Shaikha when they are hurting and it works wonders. Tramadol has a lot of side effects. It can work, but needs to be used with caution. After reading more about it on other email lists, I decided to stick it in a drawer and only break it out if there is an emergency. I think that buprenorphine has been more effective anyway.

 

Thank you very much for your kind thoughts and advice for Tucker. He's my special little man. He does have a small supply of Buprenex for pain, but with the shortage of Buprenex going on I am slightly worried that when we need to refill, I may not get that.

I think someone else here had tried Tramadol and didn't care for how her cat reacted to it, but my memory is not what it used to be.

 

Wendy - honestly, it sounds like you are on top of this and have a good idea of what you can and can't do. You are way out of my league with the issues that you have with your family. Please take my suggestions as just that suggestions and nothing more.

You've got a lot to handle and adding FD to the lot, well this is a process (a marathon and not a sprint). So, take what you can from this board and our suggestions and incorporate it accordingly with your situation.

It sounds like you've got a lot figured out already.

To answer a couple of your questions - I don't know what will happen if Shaikha ingests neosporin. Maui and Blue (that I cared for) never groomed their ears so it was never an issue. If Shaikha grooms her ears, then you may not want to use neosporin - I'm thinking Jess, Monique or someone may know if it's ok or not. But to err on the side of caution, you may not want to use it. I only suggested the neosporin, if you notice bruising on the ears where you test, using this will help them heal.

Tucker's mom mentioned tramadol and I know that Donna & Flame use it on Flame when he needs it. She says it works for him.

Let us know how else we can help or what other questions we can answer.

And yes, a treat for the bean is always in order!

 

My vet was also worried about it but has been able to find it. I think the shortage was worst earlier this spring but has eased since then. Just have your vet order a stash for you. The generic buprenorphine was what caused the shortage, by the way. You can find buprenex easier than the generic, so I've just paid more for the brand name as both cats need it.

I just decided to look at Plumbs before pressing submit and I'm glad I did! I remember what the biggest problem was now with it after reading the book --it can cause seizures in animals who have that problem or who are taking drugs that reduce the seizure threshold. Given Tucker's brain tumor, I'd not take the chance if it were my cat. It also is a problem for any cat with hepatic or renal impairment as they don't clear it like those with normal function (one reason why I decided not to chance it in Tabriz). It should be withdrawn gradually if it is used over a long period of time. Plumbs also mentions that "very limited information is available on adverse effects on cats". Too much can cause respiratory depression, lethargy, coma, seizures, cardiac arrest, and death.

 

Is this information that you got from Plumbs regarding the tramadol? We are in some new territory with Tucker lately as he crashed in late March, his potassium went too low so he is now on Tumil-K twice a day. My little man likes to keep me on my toes ;-)

 

Yes, I have a copy of Plumbs 6th edition so the information I was paraphrasing came from there. I'm really glad I have it because my cats are on so many different medications. Vets don't always get dosages correct or may miss interactions with other drugs, so my copy has paid off a bunch for me already. We are using drugs on both cats that my vet hasn't used previously. He'll often consult on VIN when he hasn't used something before, but between my own research, Plumbs, and info I've gleaned from other lists I've been able to avoid doses that were too high or too low or drugs that might conflict with others they are taking. Even human doctors don't always realize the interactions drugs can have, so that's where pharmacists come in.

Tabriz (my CRF kitty) also takes potassium each day. Does Tucker have renal failure as well? Low potassium can cause a lot of problems, so having that regulated is really important. You don't want it too high or too low.

 

Hillary, please don't take my comments as I'm not willing to make any changes diet-wise or that your comments have offended me in any way. You've been very helpful and have given me a lot to think about! I might even consider raw food at some point (but not for my CRF cat) if I could figure out a way of getting things already in a can and it was easily (and cheaply) obtainable. Grinding meat would gross me out too much though, so I know myself well enough to realize that's never going to happen. I just don't want to make changes right now with her diet because we need to figure out what treatments are working and get her balanced a bit more. We nearly lost Shaikha in May so I'm treading very carefully as far as her treatment goes. She was in absolute agony from the pancreatitis when it first started, so it has been a crash course in how to treat one malady after another since then.

What is a "bean" other than something I love to eat, vegetarian that I am? :mrgreen: I'm assuming it is a play on human being? My cats do own me, that's for sure.

 

:lol: Tucker's bloodwork is good, no renal failure, just low potassium, high cholesterol. He's at about 3.9 now, taking 1.5 Tumil-K pills twice per day. No idea what led to his potassium problems.

The research I did I believe showed that 40% of senior cats can end up with low potassium. I don't know Tucker's actual age, adopted five years ago, he was already sick and somewhere between 11-13 yrs of age, so he could be 16-19 yrs old now.

Thank you for the information, and bean means human, vetty bean would be the vet, you are bean to your kitty, but my cat Bean is not bean to me, although she thinks she is :lol:

 

Hi Wendy

Let's see if I can answer any of your questions; forgive the multiple replies and the cuts-and-pastes:

I use petfooddirect.com . They often have specials where everything is 18-22% off, and in many cases that covers the cost of the shipping. It's worth looking at. If you go to the 'supply closet' forum on this board, people post coupon codes there that you can use.

I also wonder if your vet would order teh food for you? Vet offices often work with wholesalers for food and litter, and I wonder if you could get something that way.

Not that I know of. Remember, too, that grain-free doesn't mean it's carb-free. Instead of "grain", a lot of foods use potato or some other starch which has a high glycemic index anyway.

Vetsulin is not feline insulin either, so Vetsulin/Levemir/Lantus/ProZinc should all have the same chance of causing it. In theory. Practically speaking, cats don't seem to form antibodies to exogenous insulin for whatever reason. We do have some cats on the board who have formed antibodies to their own insulin but this also seems to be a rare condition.

 

Thanks so much, Jess. This helps to ease my mind about trying a human insulin. I'll look into petfooddirect.com because that sounds like my best alternative. I really live in the boondocks so not having to travel hours to get cat food is definitely appealing. I'm not sure my vet would order anything through a wholesaler. His is a simple country practice, though he's been absolutely wonderful working with my two kitties who seem to develop weird diseases that he rarely if ever sees -- and survive them too because mom won't give up. We've both learned a lot together, and I know that my cats have helped to save others who were scared to try subQ fluids or feeding tubes or whatever.

I've printed out a bunch of info on levimir, which sounds like one I'd definitely like to try, but if he doesn't want to try something that different then I'll go with PZI instead. Given my upcoming surgery it may be safer to stick with something similar to Vetsulin as I probably will be unable to monitor BG that frequently depending on how much I'm laid up myself. Then again, it sounds like levimir would control BG better for her and might also help me get her off insulin eventually if we can get the right mix of diet, etc. going. We'll see what he thinks.

 

Jennifer, be careful when you give Tumil-K tablets. They should be given with a meal. Potassium on an empty stomach can make the cat very nauseated. Just in case your vet didn't tell you that! Glad to hear that renal function tests are normal for Tucker. He sounds like he's got enough on his plate as it is.

Now I know what a bean is, at least on FDMB! There are a lot of acronyms to take in here. @-)

 

Hi,
I'm just popping in to say welcome. I have a few cats with a lot of the same issues as yours, who are taking (or have taken) most of the same meds. My diabetic, Bear Man, has severe IBD, CRF, anemia, and hyperthyroidism, to name a few of his issues. My civie (non-diabetic) takes Leukeran for intestinal lymphoma. I know it is a challenge to juggle food, meds, and the needs of multiple sick kitties, but it sounds like you are handling it extremely well! I look forward to reading your future posts.

 

There is a lively debate in the human literature, with some studies showing benefit and some showing an increased risk of sepsis. In cases of fulminant, acute pancreatitis I'd avoid them, but in cases of chronic pancreatitis I dont' think there's evidence of harm. Just the same, I don't think there's good evidence of benefit either, so putting them aside for now is reasonable IMO.

If she's eating the d/d happily, I'd leave her on it for now since you mentioned there may be some appetite issues with her new medication. The Fancy Feast, Special Kitty, etc. are all low-quality foods so besides carb content (which is important, of course) there is not much difference. Sounds like you're juggling a lot right now so I'd agree with you to make 'keeping kitty eating and digesting her food' a priority.

As a side note, regarding the raw food, IMO it should be used cautiously in cats with immune system compromise (such as those on chemo or steroids).

The pain reliever component would be toxic in large amounts, and similarly the cat might get the runs if s/he ate a large amount of plain neosporin as it is in an oil base. (Also, I guess the antibiotic component could disrupt intestinal flora.) Personally I have never used neosporin on any ears; I'd avoid the one with pain reliever even though the cat would probably never eat the proper amount to have ill effects.

Also as a side note, if your cat did well on steroids and does not do well without them, I'd use them and work the diabetes around it. My late, wonderful cat's digestive system limped along with the help of pred and I dealt with his diabetes when he eventually developed it. I tried *twice* to wean him off steroids with disastrous results each time because a vet I worked with was always crowing that he was going to get diabetes. When I sought out an internist she said "so if he does, we'll deal with it" and we did.

Ok, to avoid making yet another post I'll make another side note on tramadol:

Some people on the board have felt that it made their cats too wonky. Generally, it seems to make some cats briefly goofy and then give good pain control, in others (like my cat Dillon) it just gives good pain control, and in a minority of cats it makes them truly dysphoric (too 'high'). It is metabolized mainly by the liver and is ok in CKD/CRF cats, and in animals with liver or kidney disease the general rule is to start at the low end of the dose and titrate up. My dog was prescribed tramadol by a board-certified anesthesiologist (specializing in pain mgmt) despite his chronic hepatitis and he tolerates this drug extremely well.

Like many drugs in the pain mgmt/tranquilzer family, it can lower the seizure threshold and in animals at risk for seizure it should be used just when truly needed (i.e. when there is a quality of life issue and other easier means of management have failed) and started at a low dose.

Keep in mind that the info in Plumb's is akin to the four pages of printout you get at the pharmacy when you get any drug (including rx ibuprofen, etc.) and it lists everything possible. It can't take the place of a discussion of your cat/dog's specific case with an experienced practitioner. For your CKD kitty, Wendy, I'd certainly not rule it out as an option for pain, I'd talk to your vet and have him research it on VIN.

 

Wendy - I'm not offended or upset or anything, I only stated that you are out of my league, because I don't know anything about all the issues you are dealing with and my recommendations are more general than specific and may not be relevant or viable for your particular situation.

I'm glad Jess came on and gave you more insight and her thoughts on raw food, especially with the other conditions you are treating.

If you go to petfoodddirect's website and sign up for their mailing list, you will get the coupons Jess mentioned directly. I've ordered from them, they are quick and if you can get the 18-22% coupons it covers the shipping costs.

 

Hillary,

What Jess said has also been my concern about that type of diet. Shaikha is immune-compromised as is Tabriz, and I know that raw food always has the risk of bacteria in it. A healthy cat with an intact immune system can fight off problems, but I don't think my two could. If we do switch to canned food alone then it will likely be cooked food. One good thing is that Shaikha seems to be taking more to the canned d/d food. I've added even more water than usual so it is much more runny. She ate quite a bit last night and this AM, though still wanted dry food of course. At this point I'm just happy she eats given her chemo drug. I do think that is working for her but we are still giving buprenorphine. If the leukeran doesn't work we may need to return to the steroids, but I'd prefer not to do so if I can. I cut back her insulin and she had much better numbers yesterday, so I'd hate to throw her off kilter all over again (not that she's regulated just yet though, but at least I didn't see numbers less than 100 or more than 400).

 

If you are dealing with a compromised immune system, I would stand by your decision to stay away from raw. My vet is very against raw for the reasons of salmonella, and has sent me some literature that really made me reconsider using it. My cats made the choice for me as they won't eat it but.....

There do seem to be some great benefits from feeding a properly balanced raw diet, but right now, as Jess says, eating SOMETHING (and eating safe food) seems the most important thing.

 

i had to stop in to say hello i lurk on the crf support group, and i remember tabriz's AoCRF saga. welcome to fdmb

 

And I remember Meowzi's name! I always liked it. Thankfully diabetes is one disease (knock on wood) that he hasn't picked up. He's running out of systems that work properly, but he's still hanging in there, despite anemia, CRF, pancreatitis, IBD, and liver disease. I think he's on life #7 of his 9 lives.

How is Meowzi doing? I didn't realize your cat had diabetes too. That's a tough combination. Which condition came first?

 

Hi I have been here 6 weeks so wanted to say Welcome aboard and the people here are awesome .YOu baby has a lot of problems but hopefully they will all settle down Prayers and Angels coming to your place to help with the healing LOL Kath :mrgreen:

 

Thanks for the welcome! I think she's doing a little better since we started the leukeran. We'll see how it goes with her first CBC tomorrow. Leukeran can cause anemia, so I'm hoping her tests are normal. Thanks for the prayers; I've got two sick cats right now who can use them.

And yes, I'm finding out quickly just how awesome the people on this board are! There is a veritable treasure trove of collective wisdom and great information here, which is much appreciated!

 

Bear Man looks like such a sweetie pie! Thanks for the welcome, Linda. How does your civvie do with the leukeran? So far, Shaikha seems to be tolerating it better than I expected. We are doing her first CBC tomorrow so hopefully there will be no anemia or other signs of complications. It sounds like you do have a lot of issues to juggle as well! How do you handle the IBD and anemia in Bear Man? Is he on steroids for the IBD or taking EPO drugs for the anemia? We may need to put Tabriz (my civvie) back on pred despite his CRF because he's got a terrible case of intractable diarrhea. His appetite is really off and we are having to switch foods occasionally to get him to eat, which plays havoc with his IBD. I had to switch him back from z/d to k/d tonight, but he hadn't eaten anything and what I was able to syringe this AM he threw up. Her ate the canned k/d tonight without complaint so I'm hoping he'll do so tomorrow too. He's already got liver problems so I can't risk him not eating and making things worse. It is exhausting, but he's so worth the effort, sweet boy.

 

My civie, Teddy, does quite well with Leukeran. he has been on it for over five years. He gets some inappetance and vomiting, and takes Ondansetron. He also gets a lot of itchiness. He gets his CBC checked regularly. His RBC tends to run at the low end of normal, but he has never had to stop tx.

Bear takes Prednisolone 15 mg daily. He has been on various steroids on and off for most of his life, and continuously for the last 5+ years. I think we will need to start Darbepoeitin soon - we are waiting for his hematocrit to drop below .20, and he is pretty close to that now. He isn't doing very well these days. His appetite has always been poor. Despite his diabetes, he has always eaten some dry, just to allow him to maintain his weight. It has been a huge challenge to find foods appropriate for his CRF, and he has recently started refusing the one or two lower phos foods I can get in Canada. Everything is a juggling act with him, but things may be starting to fall apart :cry:

 

Glad to hear that Teddy is doing well on the leukeran. Shaikha has only had three doses so far, so it hasn't been long enough to know if it is working yet. She's got some inappetance but I've been able to coax her into eating more than she'd usually do. I'm still having to give her buprenorphine because of her pain. I started her on anzemet after I noticed her appetite drop off some after the leukeran was started. We'll see how it goes.

I am sorry to hear that Bear is not doing well. I'm having similar issues with Tabriz, and my mood seems to go up or down with how he's doing on a particular day. Yesterday he wouldn't eat anything and vomited up what I'd syringed in the AM, but by evening he was raring to eat but still only ate about half his normal ration. This AM he showed interest in food but again wouldn't eat a lot of it. I've been giving him anzemet in twice daily doses and am wondering whether I should just try a large dose once per day instead. I tried that this AM so we'll see how that goes. I still am not giving him the max dose so if he's still not eating well I may add a bit more tonight and see how that works. Tabriz also has CRF, by the way. Being fussy about food comes with the territory there. Are you a member of the Feline Chronic Renal Failure email group at Yahoogroups? They are a wonderful resource for people with cats with CRF. You can check them out at http://groups.yahoo.com/group/Feline-CRF-Support/. Another helpful website for renal failure can be found here: http://www.felinecrf.org/index.htm. Tanya's website is a treasure trove of helpful information on renal failure.

If Bear won't eat renal food, you can feed him non-renal but you will likely need to increase the amount of phosphorus binder he gets. Checking his current values will help you to decide on the dose of binder to use. You are giving him something like aluminum hydroxide, I presume? If not, you can read a lot about phosphorus levels and how to control them at Tanya's website.

Hope that Bear has a much better day today.

 

I just signed up for that group the other day, but have not had time to read much or post yet.

Bear is taking some aluminum hydroxide, but there are some constraints with his dosing. He won't eat it in food, so he takes it in cap$ules. He has to have it separated from his other oral meds by two hours, tid dosing seems to upset his stomach, and I can't really do that on work days anyway, so there are limits on how much I can get into him.

Thanks for the info.

 

Aluminum hydroxide binds to the phosphorus in food, which is what prevents blood phosphorus levels from rising. Have you had Bear's phosphorus levels tested recently? if they are high, then that will make him very nauseated. I'm not sure how effective AlOH would be given in capsules. Usually what we do with dry food is to sprinkle it on in a measured portion in a ziploc baggie, then shake to coat, and let it soak in overnight. It is actually tasteless if you are using the gel powder. If you have been using liquid types then those do have a minty flavor that most cats hate. Similarly, the AlOH should be mixed into any wet food where it should be undetectable. If you just sprinkle it on top that might turn the cat off, but again it should have no flavor. There's a lot to giving binders, and making sure it is mixed into the food you are trying to bind is really crucial, as well as dosing. It is not effective if given separate from food.

I'm assuming the medication you are having trouble with is the pepcid, since you can't give that at the same time as aluminum hydroxide. You can give the pepcid before or after a meal, but I know if you work that can be a real pain. In Tabriz's case he actually got sicker on pepcid no matter how much we changed the dose. It just didn't agree with him. We switched to Zantac and we no longer have that problem, plus you can give zantac as the same time binders are used. Much more convenient! Pepcid can build up in some cat's systems so you do need to be careful how much you use and how often you dose. Tabriz just was sensitive to it in any amount, but doesn't notice the zantac at all (other than me noticing he very rarely vomits while on it).

You can read much more about binders at Tanya's website. There is also another great website here that explains more about where you can get supplies and also gives Dr. Nagode's protocols, which many Feline CRF members have used successfully for years: http://members.bellatlantic.net/~vze2r6 ... inders.htm. If you click on the cat in the upper right corner you'll go to the main page and will find a TON of great information.

 

In order fore the binders to work they have to be given within an 1/2 to one hour of eating. The binders react with the food in the stomach to tie up (bind) the phosphorous so t does not get absorbed by the body. Putting it in a regular gelcap is fine.

 

Thanks for all the input. Bear's phosphorus two weeks ago was 1.9 mmol/L (6.19 mg/dL). His T4 has increased quite a bit just lately, and all of his renal values look a bit better than they "really" are. His methimazole was increased, and we are rechecking b/w and heart rate tomorrow (he was tachycardic at 240 bpm). We will also recheck his CBC.

I give the capsule containing the binder and then offer food. He eats very little, and just nibbles on food. He would not ingest the entire dose mixed into even a small amount of food. He would eat a portion, and I was left wondering how much of it he got. With the capsule, I know it's in him, and then I can beg him to eat morsels of various foods. He free feeds the rest of the day, so unfortunately, his other meals are not getting bound. I don't want to mix a ton of binder in everything I leave out because he may eat too much binder, and my civie would be eating it all day.

The oral meds are: losec (omeprazole), denosyl, cosequin, amlodipine, ondansetron, tumil K, metronidazole (flagyl), prednisolone, baytril, ursodiol (actigall), and lotensin (benazepril). Some need to be spaced apart from the binder, but all his oral meds are given together (some once daily, some twice daily). Insulin and transdermal methimazole are given with the binder and food.

My civie takes Pepcid, and has for quite a long time. I haven't noticed any issues, but that's good to be aware of.

 

Bless Bear's heart! That's a lot of medications. Tabriz has been on most of these (the exceptions being cosequin and omperazole, plus he is not hyperthyroid or diabetic so he doesn't get drugs for those conditions). When your cat isn't eating as it should, I understand the problems with adding binder. A bit of binder won't hurt other cats, but you wouldn't want it to be a regular occurrence or to be given to kittens. Pepcid shouldn't be a problem unless the cat has CRF. When the kidneys don't work as they should, it isn't cleared like it would for healthy cats, so it can build up. For that reason they suggest you give the smallest amount possible to start. There is a lot of good information here: http://www.felinecrf.org/treatments.htm ... omach_acid. Some people have had good luck with slippery elm bark, but I can't use it on Tabriz because it contains calcium and he's got high levels of that (probably high enough that we may need to consider switching fluid type or being more aggressive with phosphorus control or testing for metabolic acidosis).

it is a difficult dance with lots of conditions to balance, isn't it?