7/13 Kozmo, AMPS 473, +1 504, +2 459, +4 338, +5 207, +7 187, +10 486, PMPS 362, 2wks post DKA

Previous thread.

AMPS 473

Hi @Bron and Sheba (GA) just answering your questions from yesterday’s thread:

Kozmo ate 1.5 pouches of LC/?C wet overnight and small amount for AMPS just now.

Neil’s collecting more cerenia from the vet this morning. They’ve provided a script so all we have to do is call to arrange collection in future (it can’t be used anywhere else).

 

That’s good about being able to get the cerenia.
I see you have a red Preshot. I’d feed some food at +1 and +2 in case he decides to drop. If he doesn’t, the food won’t hurt but if he does, it might help slow the drop.
How is he generally? And are you and Neil feeling more rested?

 

504 at +1... about to feed him a snack.

I fell asleep after +4.5 at 1:30am and slept well until I had to pick up his overnight food bowl at 6:30am, two hours or so before AMPS. It’s still a trying period for us and I was overwhelmed with it all again yesterday. It’s like being on a rollercoaster. We think we’re getting the hang of it, only to discover we know very little.

 

That 504 could be a food bump...... hopefully.
You are actually learning a lot! It’s hard not to get overwhelmed when things go wrong or are unexpected.
Kozmo is in a much better place than he was 2 weeks ago.
I would get a +2 or a +3 to see if he’s dropping. He had a similar +1 yesterday and dropped to 50 at +5.

 

There’s no doubt about that

I’ll grab a +2 then snack and take it from there. Every day is a new experience.

 

459 at + 2 and a snack.

 

Should I test again at +4?

 

I would. Just to see if he’s dropping. His bounces are very short lived... which is very good. You can see most days he has blue or green BGs. He’s just not telling us when he’s going to get on that slippery slide.

 

You may want to consider an auto-feeder. Not sure what is available to you there...but this is the one I use.

https://www.amazon.com/PetSafe-5-Me...563&sprefix=automatic cat fee,aps,177&sr=8-16

It turns and closes off the food two hours prior to pre-shot test and Luci gets a snack in the wee hours without me having to get up to manage it.

 

338 at +4... hrs not interested in a snack at all. Coming down slower than yesterday, he was 178 at this point. Shall I check at +6?

Hi Sue, thanks for that. It’s certainly worth looking into.

 

It’s better he’s coming down more slowly today. Maybe get a +7.

 

Just saw your remarks in the SS about what the vet said. Oh dear. Can’t she see the Lantus has kicked in and is working. He’s getting some lovely numbers. It’s just his bouncing. Didn’t you say she’d never used Lantus before?
I would not put him under a GA at the moment so soon after DKA. Personally (and I’m not a vet) I can’t see what is pointing to needs an ultrasound. He’s eating quite well for a post DKA cat. Most of them need cerenia for a while. His constipation has a known cause. He’s responding to the Lantus. He has no ketones.
I would ask her what the reason is for the need for an ultrasound..... And where in the body she wants to ultrasound. She can’t demand it. Kozmo is your cat!

 

Health: We’ve just discovered the result

207 at +5... we were interested to see if excruciating constipation pain caused his BG to escalate.

We're in a terrible situation with them. She's provided a script for 16 Cerenia tablets which we can present to our local pharmacy - that's good, but she won't allow any more unless we submit Kozmo to an ultrasound of his pancreas under general anaesthetic. She doesn't believe that it's normal to feel nauseous post DKA - he stops eating when his BG is high also. She doesn't think bouncing is normal. She called Neil for a phone consultation while he was collecting the script for cerenia and hasn't seen Kozzie's updated spreadsheet (she ignored it when I provided it to her a week ago).

Since this morning, however, Neil had just arrived home when Kozmo started straining and howling in his litter box with no success with actually passing a stool - just a little urine forced out each time. He was howling relentlessly like like this day and night for 12 months before (our previous) vet finally prescribed Gabapentin for what he diagnosed as arthritis and anxiety. The result was immediate. I had taken him in quite a few times during the course of two years to address the howling and we were told that it was normal for Burmese cats to behave this way and no, they won't x-ray his pelvis because there's no point.

Today's course of action: Administered 25mg Gabapentin at +5 and he's now settled down at +6. He was able to pass stools prior to us halving the dose because of the nature of gaba. First dose of Pet Wellbeing Smooth BM Gold to help soften his stools, second in PM.

We'll continue the Pet Wellbeing Smooth BM Gold indefinitely - if it doesn't work, we'll try something else and we'll keep with 25mg Gabapentin until his stools soften enough to pass without causing too much pain, then reduce to half (hopefully).

We have no other option apart from trying to manage this ourselves. Poor Kozmo. We're shocked with the discovery that the underlying cause is his slipped plate and the inability to poo without Gabapentin. We need the super vet.

We'll test him at +7 in 45 minutes.

 

As an addendum to my previous post, Kozmo has been passing stools every day and also earlier this morning. They’re not normal - they’re hard little droppings and have been like that since he was hit by a car as a kitten.

 

Can Kozmo have lactulose? I'm asking because I just started using if for Tina. She had a manual extraction Saturday morning, and has just started going (very soft stool) on her own. Would lactulose be more helpful than the Pet Wellbeing Smooth BM??
Tina has spinal arthritis, stenosis, etc. and collapse of the joint space in one hip. She takes 50mg of gaba twice daily, but has only more recently had this constipation problem. (First had glands extracted, then on glandex for 2-3 months, then serious constipation.)
I like all the notes in your SS. Kozmo is gorgeous - give him extra kisses from us.

 

187 at +7... he chased me through the kitchen for tuna (in spring water) even though he hates fish, so I gave him a little in all the water plus his wet food snack.

Thank you so much for your suggestion, Jan and for letting me know about your Tina - one less reason not to feel so alone. Kozmo had two manual extractions prior to his pelvis plate many years ago. Lactulose is a wonderful suggestion and we’re looking into it now. No idea if Kozmo is lactose intolerant but at this stage it’s the last of our worries.

 

I would LOVE it if Lactulose could help Kosmo. It is also supposed to be undigestible, so the carbs in the syrup shouldn't be an issue. We started with 4ml every 8 hours.

 

May I ask how Tina is coping with 50mg Gabapentin? Kozmo is quite ‘zoned out’ on 25mg twice daily and we suspect it might lower his blood pressure slightly and cause a syncopal episode here and there.

 

She does well with the higher dose of Gabapentin. We started at 25mg like you did, but she needed more help, and thankfully she is NOT zonked out. I didn't even notice much of a difference. It doesn't sound like your baby needs a higher dose if he is already tired from 25mg at a time, and of course you are smart to keep his BP in mind.

However, and here is our secret that bothers me quite a bit: I also give Tina Metacam (NSAID), .25 to .3ml daily (always with food). Without it, she cannot walk normally, and with it you can hardly tell she has arthritis. The Black Box warning came about as a result of seriously overdosing animals. Very small doses are not so dangerous. It's still a tough topic, and most people I've seen around here, avoid it like the plague.

I've read a lot about the pros and cons of Metacam, and keep choosing quality of life over potential worsening of kidney disease. I get labs regularly. Her kidney disease has been stable (especially after starting subq fluid) for quite a while. Some studies even show Metacam could help with CKD at certain stages. I do still worry about stomach problems with NSAIDS. I follow the absolute lowest dose possible rule and only give after she eats. She's been on it for over two years, with a couple short breaks.

Once again, I'm going to ask the vet about a tiny dose of Buprenorphine to replace the Metacam (in the past I've always been told it would zonk her out, or it was only used in an emergency), but an opioid would not be any good for constipation, right?. The Balance of health management sure is a challenge!

I sure was wordy; just hope any of the above can help some. If anyone ever sees something better, smarter, I can do, please tell

 

Thank you for sharing your bothersome secret. I like that you’ve stepped outside the square for Tina (our teeny tiny dog is a Tina too - Kozmo’s best friend) and we’ll move heaven and earth to do the same for Koz. He’s tried Metacam with little effect, though who knows what’s on the horizon?

I don’t mind wordy at all - normally, it’s me!

 

Ahhhh, my Tina's best friend is also a dog His name is Barkley, a Springer Spaniel. They hug and rub and Tina even grooms the dog.
Kosmo sure knows how to go to lower numbers after starting high. I wish you good luck in finding the "perfect" snack times!

I also have an autofeeder like Sue has. It sure comes in handy when away. You are doing better than you might think. You've come a long way

 

486 at +10 (was curious)

It appears the pain Kozmo was experiencing earlier wasn’t due to constipation, which makes sense because he’s been using his litter as usual. We’re thinking the pain made him feel and act like he was constipated - straining, jumped in the litter over 20 times, howling, agitated - and we never want to see him go through that again. He’s much relieved with the 25mg dose of gaba we gave him so we’ll keep him on that from now on. We’ll try him on Lactulose in the hope it’ll soften his little nugget poos.

We ordered an automatic feeder!

 

PMPS 362 - could the red +10 be because he had a decent snack at +9.5 (meaning I probably shouldn’t have tested)?

What a day. Should we test at +1 and +2 with snacks after?

 

378 at +1

 

270 at +2

Not sure if we should test at +4 or +5 or if at all. Will set alarm if so.

 

Hundred point drop in the last hour? Yep, gotta do at least one more test, I wouldn't do any later than +4.

Kozmo, the beans have to sleep sometime, remember?

 

Hi Annie
Just looking through your post today...
Commenting on what your vet said. We get post DKA kitties here all the time and many struggle with nausea. Hopefully with 16 tablets ( that’s 32 doses right?) you won’t need any more.

If the vet is concerned about pancreatitis, a simple blood test will tell her if he has it. The treatment for pancreatitis is pain meds, anti nausea meds and subQ fluids if needed, so Kozmo is on the correct treatment if he does have it. The tests are a Snap fPL which will tell you yes or no if he has it ( done in-house) OR the Spec fPL which will give a number as to the severity of it (send off site). I think that need to be done before putting a cat under a GA if you are concerned about pancreatitis. Sheba had an ultrasound of the pancreas and I held her and she was fine without any anaesthetic or sedation. Most cats just have the blood test and only go on and have the ultrasound if there are issues.

With the constipation I am wondering if subQ fluids on a regular basis a couple of tones a week would help with the consistency of the poop. A lot of us give them at home ourselves and they aren’t hard at all. The vet would have to approve and Kozmo’s heart would need to be checked first to get the go ahead from the vet. Just a thought. See what others think.
Are you still feeding the drop?

 

134 @ +4... he wouldn’t snack after +1 but he did after +2

Neil queried the vet today and she confirmed they were done in house and results were negative but she wants an ultrasound anyway. Neil wasn’t impressed at all.

Kozmo won’t allow anyone other than me go near his stomach and even then it’s risk of having him permanently dangling from my arm.

Maybe something to consider if the lactulose and Smooth BM Gold don’t work. We’ve been treating it until now with Laxapet and it makes a difference. The problem has been that Kozmo stopped grooming himself - normally a clean cat, he cleans the dog too - and it was impossible to administer. I’m sure we’d manage giving subQ fluids but we’d have to find a new vet first.

 

I’ll test again at +5

 

Whoa! Looks like Kozmo is in a hurry tonight! Hope he levels off soon. Will watch out for the +5.

 

90 at +5

I took him downstairs straight after and he’s had a snack. I didn’t think to do that after the 134 at +4

 

He is certainly responding well to the Lantus. Not sure what your vet expects.
I’d test again in30 mins up see if he’s dropping lower.
Sounds like the gaba makes a big difference to him and improves his appetite...... I guess gaba removes the pain and who wants to eat when in pain.

 

90 at +5.5

 

Surfing nicely.

 

Tools down?

 

Hmmm... If you're still up, I'd probably get another test. Hopefully he'll just do his usual surf 'n bounce from the drop.

Kozmo, why don't you do this during the day????

 

I just realized, it's 3 in the morning for you, isn't it? Oh my. No wonder you are eager to get some sleep (and hopefully are right now)!!!!