When should Bandit start Lantus again? (Update)

Here is my post about Bandit in Health: http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=46075

To sum up, Bandit had a dental on Tuesday, which did not go so well. He is in a lot more pain then last time because the teeth (two extractions) did not come out as easy, and when cleaning his ears the vet tech perforated his eardrum, causing Horner's and Vestibular syndrome. My poor guy is miserable. He's currently getting .15ml of .3mg/ml of liquid buprenex every 18 hours. I have two of those syringes left and then the rest are .15ml of .6mg/ml. But I think most of his misery is due to the Horner's and Vestibular problems. Here are his numbers from the past few days:

6/22: 2pm--279, 4pm 284
6/23: 12:15am--200, 8am--279,
6/24: 1am--340, 7:30am 329

That he's going up is worrying me. My vet told me to wait two weeks before starting any insulin, regardless of how high the numbers go. I don't know if I trust them anymore after what happened. I think I could handle waiting a couple weeks if they don't go any higher, but if he goes into the 400s or 500s should I still wait? Do I have to worry about ketones this soon? What are people's opinions on restarting his Lantus injections?

I feel so guilty. I brought him in for the dental to prevent him from going out of remission, not to make things worse.

 

Re: Advice please...when should Bandit start Lantus again?

Oh Julia I'm so sorry you and Bandit are going through all of this. And I don't have any good input for you.....I would like to know from the Vet the reason for not starting the insulin...I was reading that this syndrome can cause a kitty not to eat....just wondering if that issue is one of the reasons the Vet said not to start the insulin.

I hope Bandit starts feeling better and these issues are resolved ASAP for you guys.

 

Re: Advice please...when should Bandit start Lantus again?

I don't understand the logic behind the bupe dosing. Every 12hours would like help him a great deal.

About the insulin, if the numbers are consistently above 240-250, I would give some insulin. I see no reason for him to suffer with such high BG numbers. Why a vet who as caused one problem would want to avoid treating another problem tells me to question any advice given.

I am not clear why your vet thinks it's OK to allow your Bandit to stay in such high BG numbers when it could be that Bandit's needing insulin again. There is nothing to stop you from giving insulin until he is feeling better and may well go OTJ again. If he needs it, why withhold it?

 

Re: Advice please...when should Bandit start Lantus again?

I hope the vet is not charging you for what they did to Bandit. Geez. I'm so sorry Julia. This really stinks.

If it were me, I'd start insulin. I hate seeing Bandit in these numbers. IMHO, giving some support to Bandit's pancreas and system makes more sense than waiting and seeing if numbers go higher. I'd like to know the vet's rationale for waiting. Maybe there's some logic that's not immediately evident.

If the extractions were difficult, did the vet give Bandit any antibiotics? I'd be concerned that numbers were up due not only to discomfort but due to infection/inflammation. If there's something brewing, there is a risk for ketones. I don't recall if Bandit was prone to ketones and there's no mention of it in your profile.

Have you given any thought to using the Feline Health Center at Cornell?

 

Re: Advice please...when should Bandit start Lantus again?

I don't know the logic either, but I have no experience with Bupe. Originally they wanted me to do it every 24 hours, and I said I thought that wasn't working for him, and they changed it to 18.

What they told me was that they want to wait and see if his numbers will go down on their own once the pain starts to subside. It makes sense to me, but I have no idea how long is too long to wait, or how high is too high to wait. It's only been 3 days, so should I give it now? Wait a week of numbers above 200? Start right away if he's above 400? And what would I start him on? .25u? .5u? 1u? I am just at a complete loss at what to do.

I think I will adjust his bupe this weekend for every 12 hours. He's just so miserable I have no idea how much is from pain and how much is from the dizzy problem. if he's constantly dizzy, will the bupe make that better, worse, or have no effect?

He's still eating, but I have to push the food on him more every feeding. This for a guy that would run down the stairs at breakneck speed and nip at my ankles if I wasn't getting his food to him fast enough.

 

Re: Advice please...when should Bandit start Lantus again?

Well, they charged me for the dental. Not the ear cleaning, obviously. I never even asked for an ear cleaning. He is on antibiotics, first clindamycin that gave him bad diarrhea and then we switched to Flagyl yesterday.

If I start him on insulin, what dose should it be?

He doesn't have a history of ketones. I would love to go to Cornell but I just spent $500 that I didn't have in the first place on his extractions, and Cornell is very expensive. Do you think he should see someone there?

 

Re: Advice please...when should Bandit start Lantus again?

Awww, Julie...poor Bandit....I am so sorry to read this. I agree with Sienne about starting insulin...why wait? Start low and go slow....when Zoe started back on insulin in April we started at 0.5 units and worked our way back up the dosing scale. As for the Bupe, when Zoe is on it, it is 0.15 every 12 hours....that's all I can say.

Good luck.....and give Bandit some xtra scritches...

 

Re: Advice please...when should Bandit start Lantus again?

First, the dose of bupe effects the duration of action not the amount of analgesia. The more your give the longer it lasts. When Gabby had extractions and was given bupe it was on a BID dose. Pain can raise numbers. However, Bandit is getting something for the pain. If there's dizziness related to the vestibular problem, a pain med isn't going to fix that. What are they doing for the vestibular problem. (I think the Horners often clears on it's own but I'd have to go back and research that since I'm relying on memory.)

Clindamycin makes sense. Flagyl doesn't. Flagyl is for anerobic bacteria that can cause diarrhea. It would not, as far as I understand it, be the AB of choice for an inflammation due to gingivitis or as a prophylactic treatment post-dental.

I use what is probably the most expensive vet practice in Chicago. I didn't chose them because they were expensive. I chose them because they are invested in continuing education and have state of the art equipment and it's a feline only practice. I believe that I'm getting what I pay for. I don't know that Bandit needs a specialist at Cornell. A solid general vet should suffice. I do think I would question your vet's choices and explanations. If this were me, I would be starting to think twice about my vet and certainly about the vet techs that work there. Frankly, causing harm to Bandit is malpractice. I suspect your vet knows this especially since they did not have your consent to touch Bandit's ears.

 

Re: Advice please...when should Bandit start Lantus again?

I just did some reading on Flagyl and you're absolutely right, it's not going to handle bacteria in his mouth. I just made an appointment with my emergency vet for tomorrow at 3:30. I think I might be making them my regular vet after this. They're not that much more expensive than my current vet.

Do you think I should start him back on the Clindamycin tonight even though it gave him diarrhea? Should I give it along side the flagyl, or instead of? Or wait until tomorrow to see what the other vet says? When i get home tonight he'll have been on the flagyl for 36 hours. If I wait for the vet appt tomorrow, it will be 60 hours on it alone. I don't know how long it can take for his mouth to become infected.

 

Re: Advice please...when should Bandit start Lantus again?

Ok, I was doing some more research and anaerobic bacteria is harmful bacteria in the mouth (see paragraph 2): http://published.massivelinks.com/a...e/the-problem-with-periodontal-disease-r23154, so maybe it can be used on this type of situation? I called the emergency vet and asked them what to do.

I can't help freaking out over every little thing right now.

 

Re: Advice please...when should Bandit start Lantus again?

Julia....hugs to you and Bandit. I'm sorry he's not doing well.

No advice but just wanted to say I'm thinking about you and Bandit.

 

Re: Advice please...when should Bandit start Lantus again?

((((hugs))))

is it possible for you to get hard copies of bandit's record from your vet so you can fax/email/bring them to your new vet for tomorrow's appointment?

 

Re: Advice please...when should Bandit start Lantus again?

Already done. I had them fax them over today.

 

Re: Advice please...when should Bandit start Lantus again?

snaps to you. i hope you can relax a little (wine works) between now and then.

 

Re: Advice please...when should Bandit start Lantus again?

I'm glad you did some research. Given the appointment with a vet you seem to like/trust, I'd not do anything more at this point. If you start changing too much, it may make it harder for the vet to sort out what's going on since there will be more variables in play. You've got a little over 12 hours before you see the vet. A few deep breaths won't hurt.

Did your soon to be former vet do any blood work prior to the dental? If so, make sure you have those results. Were there post-extraction x-rays? Again, make sure this info is being sent.

This is just me but whatever charges you incur for treatment of the vestibular problems and the Horners, I would ask the former vet to pay for. (If you have an attorney in the family or who's a friend, have them write a formal letter asking for the vet to do the right thing.)

 

Re: Advice please...when should Bandit start Lantus again?

julia, i'm so sorry to hear what has happened. i agree with the others. i'd start insulin to prevent further damage being done to bandit's pancreas while he's healing. in 2009 a simple case of gingivitis knocked alex out of an almost 3 year remission. jojo advised me to schedule a dental and get her on insulin asap. i dosed her aggressively to bring her down into normal numbers quickly. within 8 weeks she was OTJ again. all she needed was a dental and a little extra support. i know this isn't exactly the same as what's going on with bandit, but there are similarities in that he has a pancreas which was working just fine until a problem arose.

once on insulin, keep a look out for dropping numbers at those +1s and +2s. they'll be a signal his pancreas is beginning to take it's job back and a reduction will be coming. if he should bottom out on you as alex did at +1 on 08/31/09, don't be afraid to pull out the karo. since the pancreas is doing it's job, feeding may only drop bandit's numbers further. karo is a wise choice in a situation like this.

wishing bandit a speedy recovery...

 

Re: Advice please...when should Bandit start Lantus again?

I'm really glad that Jill stopped by.

Are you OK with starting Bandit at 0.5u? You may need to be aggressive with dosing to get Bandit back to the Falls. On the other hand, there are any number of variables in play -- pain, possible inflammation or infection, etc. that can effect BG numbers. As they clear, Bandit's numbers may drop. So, getting some support for Bandit's pancreas and keeping a close eye on numbers will be key.

 

Re: Advice please...when should Bandit start Lantus again?

I'm ok with starting him at .5u. I'm going to wait until after the appt. tomorrow though, and see what the vet at Colonial says. Then maybe Sunday or Monday start him out. He did have pre-dental bloodwork, and all that's getting faxed over today. He didn't have xrays after the dental.

I can get a +1 and +2 in the evenings, but not during the day except on weekends because of work. I'm also going to be gone July 11-17 for a grad class, so there will be limited testing that week, too, and I'll have to find someone to administer his shots that week. I can usually convince my brother to test about 3 or 4 times a day if I'm not there, but he won't do it more than that.

Letting him stay high for an extended period and damaging his pancreas doesn't make sense to me. It may be he only needs insulin for a few weeks or even days if it is pain and stress that's making him so high, but if I'm monitoring him I don't see how it could hurt. I do see how not giving him insulin could hurt, though.

Ugh, I posted on facebook today for recommendations for good vets in town for cats--and the first one suggested by a bunch of people was my current vet that caused all this mess in the first place. ohmygod_smile

I'm hesitant to go to Cornell because unless your cat has a very specific problem, you can end up paying more for sub-par care. The people who do the regular check-ups and consults are all students. I feel more comfortable finding a reliable vet practice. Colonial (where I'm taking him tomorrow) seems to be very highly regarded, as does Briar Patch. Both seem to have highly educated vets.

 

Re: Advice please...when should Bandit start Lantus again?

By the way, I forgot to mention this whole time that his BG before the dental was normal--never above 120--so he was not having increased BG due to inflammation. But the teeth were looking inflamed so that's why the vet recommended they come out. I know inflammation can cause high BG, so I decided to have it done asap so he would not go out of remission.

The high numbers only started after the dental.

Obviously my plan was not so successful.

 

Re: Advice please...when should Bandit start Lantus again?

Julia,

I am so sorry for all the angst you have with Bandit. You did what the vet recommended. Too bad veterinary science, like medicine, is sometimes more art than science.

If Bandit is eating reasonably well, like several people, I would start insulin .5. As a diabetic myself, I know that pain or infection raises the need for insulin. Expect this to be true in cats since we are all mammals.

If he is in pain, then he needs more pain medicine. I have no suggestion for the ears - never dealt with that.

Hopefully, he is out of the woods before you have to travel.

Best to both of you,

Claudia

 

Re: Advice please...when should Bandit start Lantus again?

Hi Julia
just read your ordeal - I'm so sorry!
Poor little Bandit, will be thinking of you and hoping for a quick recovery too.
(((((hugs))))

 

Re: Advice please...when should Bandit start Lantus again?

Poor Bandit! Hope that l'il kitty will feel better soon!

 

Re: Advice please...when should Bandit start Lantus again?

He started eating picky at dinner tonight, and then continued to be picky with his 1am snack. I'm hoping the vet tomorrow (I guess today now) can shed some light on whether it's nausea or pain that's making worse. :-(

He did seem to be a little perkier tonight, but his eyes from the Horner's have gotten worse. His left eye is now completely rolled up with the third lid covering it. And he had another bout of diarrhea tonight despite the flagyl, fortifloria, and not pooping since Wednesday morning. I just want things to get better somewhere.

 

Re: Advice please...when should Bandit start Lantus again?

(((Julie)))

Depending on what the vet suggests, there are some 'heavier' duty probiotics out there. Another member here who has since gone but who had a wealth of medical information suggested ReNew Ultimate for Gabby. I found it at Whole Foods in the refrigerated supplement section.

 

Re: Advice please...when should Bandit start Lantus again?

{{{{{{{{{{EXTREMEHUGS}}}}}}}}}} Julia & Bandit {{{{{{{{{{EXTREMEHUGS}}}}}}}}}}

How is he now? Is he improving? I'm crossing my fingers and sending tons of healing vines for little Bandit and you. He doesn't deserve that kind of treatment from the vet tech, much less the vet's office. Nobody deserves that. I wish for him to make a full and speedy recovery. He's such a sweet little guy.

Hey, Bandit... Iz Blackie here. Hang in there buddy. Me and all the rest on here are sending tonz of prayerz and healing vinez for you, and we all wish you make a full and zpeedy recovery, lil bud. {{{{{{{{{{EXTREMEHUGZ}}}}}}}}}} You needz to ztart eatin' zome more fudz, zweetie. You can do it! I KNOW you can. You know your MommaBean iz looking after you very well, an' zhe lovez you vewy much, too. You're in da bezt pozzible care ever imaginable. :YMHUG: ~ Blackie

 

Re: Advice please...when should Bandit start Lantus again?

i have no advice but am sending you bucketfuls of sympathy. you're probably at bandit's appt now - i hope some helpful advice is coming!

 

Re: Advice please...when should Bandit start Lantus again?

Just sending lots of white light and healing vines, for Bandit and for you.

 

Re: Advice please...when should Bandit start Lantus again?

How did the vet appt go?

 

Re: Advice please...when should Bandit start Lantus again?

Julia: just catching up today as I have been dealing with my own civvie, almost 16, with three extractions, not eating, etc.

You have gotten great advice about the insulin, etc. On the bupe...are you absolutely sure you are getting it up into his gum and it is not dribbling back down and out? I was having this problem with my girl because
her tongue is swollen so her mouth hurts. Today my vet gave me injectable bupe for her.....since you are adept at giving subq shots, you might want to consider it. I'm giving Teddi .15 mls every 8 hours. It isn't compounded..
it's just the injectable. It's too bad about the clindamycin because that is a very good AB for anaerobic bacteria esp where there is bone involvement. I hope you can find the probiotic Sienne recommended at Whole Foods to help
with the liquipoo.

I do believe I would have a heart to heart with that vet about the charges considering the eardrum damage and the Horner's. That is totally unacceptable. Perhaps a reference to the veterinary licensing board in your state would
convince him/her that it is the appropriate thing to reverse your charges.

Sending you great big hugs.

 

Re: Advice please...when should Bandit start Lantus again?

hope everything went well today. thinking about y'all.

 

Re: Advice please...when should Bandit start Lantus again?

Hi Everyone, thank you so much for the healing wishes for Bandit. Yesterday was a bit crazy so I left the computer off all day (first day I've done that in a while).

So the vet appointment went well. Turns out his eardrum isn't perforated, so that's not causing the Horner's. The vet at Colonial believes that he has an inflamed nerve from the nerve block that they did with his extractions. She said that the only thing she could do to help would be to give him an injection for an anti-inflammatory (i.e. metacam), but she didn't recommend it. She said because of the kidney risks with the medicine she wouldn't want to do it while there are other things going on with him (high BG, diarrhea). I agreed. She also said there's a small chance that he might have permanent nerve damage, but only time would tell how it heals. She said that cats generally recover better from this sort of thing than dogs, so there's a good chance he'll eventually be ok.

She said that she wanted to keep him on the flagyl because of the poo problems, and because he had two full days of the clinda before the switch, it would be fine to prevent infection in his mouth.

As for insulin, she said the same thing my vet said, that they don't like to recommend insulin therapy until there have been two weeks of high numbers. When I asked why, she said that they didn't want to put the cat at risk for a hypoglycemic incident by having the numbers suddenly drop if the high BG is because of pain. When I explained that I had a good knowledge of how the insulin worked, and how many times I would test per day, she said that she was confident I could make the decision about insulin on my own, since I was testing more than they generally do for a diabetic pet daily.

Bandit's still running in the mid-300s, so I think I'm going to start him tonight. My lantus pens have been in the fridge for a while, and I'm bit worried they might not work because when I pulled out some pasta salad in front of them today I noticed frost on it. I hope my fridge isn't so cold it froze my pens, because they've been sitting back there for over a year.

So the good news--last night Bandit finally started perking up and acting more like himself. We solved the picky eating--I wondered if maybe he was associating the EVO with being sick (Gabby did that during the progression of her cancer), and that's why he didn't want to eat it. I pulled out a can of leftover Fancy Feast from the cupboard and he licked his bowl clean. So off I went to to get a supply of Fancy Feast until he feels better. If he wants to eat Fancy Feast, he can eat Fancy Feast, I'm not going to argue with him. I also am wondering if the high fat content of the EVO might be not helping the poo problem, so I'm hoping for luck with the Fancy Feast in that regard as well.

I got him a toy squirrel at PetSmart, and he was wrasslin' and batting it around a bit last night. It was so good to see that, I almost cried. He's also coming to the kitchen and begging for food like he always does, and he just seems like himself again.

He still has diarrhea, so I think I might hunt for a stronger probiotic. Sienne, we have Wegmans in Ithaca instead of Whole Foods, so I'm not sure if they carry the Ultimate Flora, but I'll look. I'm sure they might have something similar, though .

I really appreciate everyone's support through this whole ordeal. I'll probably start posting once or twice a week in LL Land again now that he's on insulin (I would love to post daily but I have time issues updating my spreadsheet every day.) I'm hoping he only needs a short course to get him over this hump and then he'll go back to being OTJ.

 

Sienne, what about this probiotic? We have a vitamin shoppe down the road. http://www.vitaminshoppe.com/store/en/browse/sku_detail.jsp?id=VS-2261

 

(((((Julia & Bandit)))))

Glad to hear that Bandit is perking up again. Not glad that he is back on the juice, hopefully it won't last long and his pancreas just needs that little boost. Have you started insulin yet?

Lots of hugs to you both!

 

I'm going to start him on .5u at dinner tonight.

 

Good Luck!!!

I'll be thinking about you guys, and i'll check in later.

 

Wow...just searched my cupboards for hypo supplies and I have none! Guess I need to run to the store for some HC food and karo.

 

Julia, I am so very glad to hear that Bandit's starting to become his sweet little self. That's just awesome news!!! Still sending tons of healing vines for him and for you, and am looking forward to more updates from you. Hang in there. {{{{{HUGS}}}}}