? 04/16 Eddie AMPS 162 +2 142 +3 88 +4 79 +5 95 + 11 108(Pancreatitis? Need advice please)

Discussion in 'Lantus / Levemir / Biosimilars' started by Jodey&Eddie, Apr 16, 2022.

  1. Jodey&Eddie

    Jodey&Eddie Well-Known Member

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    Jun 2, 2021
    Good morning, here is yesterday's story, which just keeps getting a little more interesting after Eddie's ordeal with the CT scan.

    https://felinediabetes.com/FDMB/thr...2-248-shooting-blue-am-surfing-yellow.262051/

    This morning I found Eddie had diarrhea, a loose puddle in front of the kitty box. He seemed ok although not as insistent about food this morning. I tested him and was really surprised to see a 9 after all that.

    I thought, Ok, shooting blue and I gave him his breakfast and the shot (9u). He then came around for his medication/treat and took those just fine. A few minutes later, he vomits the whole thing. I cleaned it up and a few minutes later gave him a TBSP of his usual breakfast so that he wasn't just getting insulin. I'll give him another in a short while.

    Does anyone have any thoughts/advice/recommendations? Poor Eddie. Thank you.
     
  2. tiffmaxee

    tiffmaxee Well-Known Member

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    Do you have any ondansetron for the nausea? If so I would give some. I would let him be and try a teaspoon of food in 30-60 minutes. Poor baby.
     
  3. Jodey&Eddie

    Jodey&Eddie Well-Known Member

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    I don't have that medication. Is it by prescription? I would imagine so. I gave him another TSP just now and he ate it although he did not come willingly as he usually does. He is in a very bad mood and probably doesn't feel all that well after this ordeal. Usually he will come to sit on the rug for his test and get a treat but I had to lift him off his cat tower and he was not happy about that. Not.
     
  4. tiffmaxee

    tiffmaxee Well-Known Member

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    Yes. An RX is needed. I see you are in Canada and it’s expensive there. Do you have cerenia? It sounds like he’s nauseous.
     
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  5. Jodey&Eddie

    Jodey&Eddie Well-Known Member

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    I'll have to check with the vet for Cerenia. I don't have any and it may need a prescription....
     
  6. tiffmaxee

    tiffmaxee Well-Known Member

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    Yes. Cdrenia also requires an RX.
     
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  7. Jodey&Eddie

    Jodey&Eddie Well-Known Member

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    I called them. Of course, it's Easter weekend and the vet who sees Eddie isn't in until Tuesday. But I explained what happened with Eddie over the last few days and they are going to see if they can do something for us. Will hear back from them in the next while and report what happens. Thank you!
     
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  8. tiffmaxee

    tiffmaxee Well-Known Member

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    Push them for cerenia. I hope you can get some. :bighug:
     
  9. Jodey&Eddie

    Jodey&Eddie Well-Known Member

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    @Wendy&Neko @FrostD

    Perhaps the cause of nausea is he's dropping fast. @+3 88. I gave tsp of MC and will monitor.

    @tiffmaxee am pushing for Cerenia. Have emailed the vet myself.
     
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  10. Jodey&Eddie

    Jodey&Eddie Well-Known Member

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    He licked the gravy and left the food. I'm watching him closely but something's not right.
     
  11. Rainbow Conti

    Rainbow Conti Well-Known Member

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    Wow eddie! I mean gee green is good but slow down buddy slow down!:bighug::bighug:

    Poor guy not feeling good!
     
  12. Jodey&Eddie

    Jodey&Eddie Well-Known Member

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    I tried giving him a little very soft LC (the one he loves) and he walked away. Getting a bit freaked out....
     
  13. Rainbow Conti

    Rainbow Conti Well-Known Member

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    Is he keeping down the mc you've given
     
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  14. Jodey&Eddie

    Jodey&Eddie Well-Known Member

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    Just tested again +4 79, yes, he's kept down the mc and I just gave him a tsp of the gravy from Friskie's "extra gravy".

    Vet is ordering Cerenia and I should be able to pick it up this afternoon. I'll also test again.

    He's also drinking quite a lot of water and in fact just peed on his bed!
     
    Last edited: Apr 16, 2022
  15. tiffmaxee

    tiffmaxee Well-Known Member

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    I’m glad you can get cerenia today. Fortunately the carbs are in the gravy so should keep his bg from dropping.
     
  16. tiffmaxee

    tiffmaxee Well-Known Member

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    I don’t think the dropping bg is making him nauseous. It generally makes them very hungry . Why is he on prednisolone?
     
  17. Max & Lori

    Max & Lori Well-Known Member

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    When Max gets a flare up of pancreatitis, he gets nauseous and has diarrhea. His BG usually shoots up though. The trauma he went through during the CT scan could have caused pancreatitis maybe??? Max had a flare of pancreatitis just after his CT scan and ended up back in the ER the following day. They kept him a couple of days. The vet at the ER told me it could have been caused by the anesthesia. I don’t know if that’s what’s wrong with Eddie, but it’s just a thought. I hope he gets better soon. The Cerenia will help a lot.
     
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  18. Jodey&Eddie

    Jodey&Eddie Well-Known Member

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    On my way home with Cerenia. Last test was 95, so gravy worked.
    He’s on Prednisolone because he had pituitary removal for acromegaly.
     
  19. Jodey&Eddie

    Jodey&Eddie Well-Known Member

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    on my way home with Cerenia. BG going up.
     
  20. Jodey&Eddie

    Jodey&Eddie Well-Known Member

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    Cerenia down the hatch.

    Mostly concerned about insulin tonight. Hopefully he will feel better and eat something.
     
  21. Jodey&Eddie

    Jodey&Eddie Well-Known Member

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    I'll really keep an eye on him. He's never had pancreatitis but that CT event was really stressful for him. Just gave him the Cernia (and he took it in a treat, so looking up a bit, although he seems to want to just hang out quietly).
     
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  22. Jodey&Eddie

    Jodey&Eddie Well-Known Member

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    I’ve given Eddie the Cerenia and he’s in the living room and wanting to be left alone. I’m wondering if there’s a possibility of pancreatitis induced by the anesthesia and stress.

    Eddie has nausea, vomiting, lethargy, diarrhea, and decreased appetite. I don’t know if he has abdominal pain (as he growls no matter what) or if he has a fever. I don’t have an animal thermometer. I understand pancreatitis can be very serious.

    What should I do if he won’t eat and I can’t give him insulin or if he just remains as he is: not interested in food and somewhat lethargic. He is holding his ears out to the side…instead of in the upright position. I wonder if that means he is really uncomfortable and should I be getting him into a vet???
     
  23. Max & Lori

    Max & Lori Well-Known Member

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    I hope that he gets better soon! Maybe he doesn’t have pancreatitis and just an upset tummy then. Pancreatitis is painful. Sounds like Eddie is uncomfortable. Stress can cause all kinds of issues in people and animals.:bighug:
     
  24. Jodey&Eddie

    Jodey&Eddie Well-Known Member

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    I hope it's just an upset tummy, too. :):cat:
     
  25. Jodey&Eddie

    Jodey&Eddie Well-Known Member

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    The vet answered my email regarding pancreatitis. He said,

    All is possible but pancreatitis is not the only possibility. Before we go there I like you to give him rest so he can find his ‘emotional balance again’ and offer him his normal amount of food at his regular time, if he eats great, then the normal amount of insulin, all back to as it was.
    If he does not eat then you give him 1/3 of his regular insulin dose and he can be fed again the next day.
    The small amount of insulin is not as much to keep his BG down, much more to cut off the path to ketogenesis that diabetics may take when they are stressed and don’t eat.
    If he remains dumpy by tomorrow then he will need some fluid support.


    This sounds reasonable to me. Am I missing anything?
     
  26. Tiger(GA) and Ruth

    Tiger(GA) and Ruth Well-Known Member

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  27. FrostD

    FrostD Well-Known Member

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    I'm sorry I had to skim quickly but few thoughts:

    Yes, it does sound a bit like pancreatitis but really needs to be tested/seen for that. Idk about that "emotional balance" stuff, but remember I am a more clinical/hard science sort of person...and what you are describing sounds more than just he's having a bad day.

    Related - I have a theory that Mr Kitty's BG dropped significantly both times he got pancreatitis due to the IAA (March and June of last year, I did not note the June one, I need to go back and do it). The antibodies got pulled away to deal with whatever else. And I see Eddie mimicking that. Purely my own theory, couldn't point you to any resources or anything


    1. Test ketones please as soon as you can. And do it daily while he's feeling poorly

    If it is pancreatitis-
    -. @Wendy&Neko knows better about Canadian drugs, but you'll also want something like zofran/ondansetron for the nausea (Cerenia better for vomiting). As I understand zofran is expensive in Canada
    -. You will want pain meds, like bupe or gaba (most people find gaba makes them a little loopy)
    - you may need an appetite stimulant, I'd get one anyway they're nice to have in a pinch
    - fluids, see if they'll let you keep fluids at home.

    Food you can syringe feed (and the syringes with which to do it). I believe a lot of cats like the AD recovery food, but I usually use the Gerber Meats baby foods (it's just plain turkey/chicken in baby food jars).

    Pancreatitis is usually manageable at home, I prefer it anyway due to Mr Kitty's complexity.

    I don't think I would do a 1/3 dose honestly. See what Wendy thinks. I shot full dose nearly each shot with one or two BCS.
     
  28. FrostD

    FrostD Well-Known Member

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    You can use a human thermometer by the way just be sure to...lube it up and not go too far. And probably mark it as "cat thermometer" from here on out. Speaking from experience :confused:

    alternatively if his ears feel very warm/hot that's a pretty good sign.

    As far as eating...I do not take a "sit back and wait approach" due to risks of ketones, DKA, hepatic lipidosis. If he's not eating, he gets small amounts syringe fed every two hours or so along with water.

    Sometimes plain tuna water (no broth or onions, etc) in water or food is enough to entice them
     
  29. JL and Chip

    JL and Chip Well-Known Member

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    Dec 28, 2009
    Ditto the suggestions for a ketone test as well as getting a temperature. Normal temp for a cat is up to 102.5. Given Eddie’s history, anything much higher than that might warrant a trip to the vet.

    What is his current BG? Even if he’s grumpy, I believe it’s important to get those data points. Illness can add some unpredictability so I wouldn’t make assumptions.

    I also agree about being prepared to syringe feed. I keep a/d on hand because it liquifies easy and works well in a feeding syringe. Baby food is fine as long as it doesn’t exacerbate the diarrhea — just make sure there are no onions in it.

    More suggestions but want to keep it brief for now. How is Eddie at the moment? Any changes?
     
  30. Jodey&Eddie

    Jodey&Eddie Well-Known Member

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    At the moment he is not interested in food. He just had a diarrhea event, which was basically brown water and he is drinking water and hovering over the water bowl. I just did a +11 6.0. He is normal. Normal.

    I called the emergency clinic. They think he should come in and get fluids and get checked out. He is not interested in food, only water.

    @FrostD @Wendy&Neko @Bandit's Mom

    My friend who is a nurse is here and she says he needs to get his CBC/WBC done to determine pancreatic enzymes.
     
    Last edited: Apr 16, 2022
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  31. FrostD

    FrostD Well-Known Member

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    Go with your gut. If it were me I'd take him in

    I am not sure if Canadian test are the same, but I assume so - you need a SNAPfPl and specfPl. A snapfPl will give you normal vs abnormal, an abnormal result is not a definitive diagnosis but they will usually process with treatment as if it's pancreatitis. The specfPl is a better diagnostic but has to be sent out. I'm sure they'll do CBC, etc as standard practice. You may also consider cobalamin and folate checks, as they can be low in cats with pancreatitis and supplementing can help them recover more quickly. I can't remember if he had a GI panel recently.
     
    Last edited: Apr 16, 2022
  32. FrostD

    FrostD Well-Known Member

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    Unfortunately I do have to get to bed but will check in on you when I inevitably wake up, please let us know what you do and how he does

    In my experience they will probably want to hospitalize him if it is pancreatitis; unless it is so severe you absolutely cannot get him to eat/drink, even with syringe feeding, I would opt to treat at home if they'll send you with all the meds. Only reason I would hospitalize is if he needs a feeding tube (probably too soon for that still) or is presenting with ketones. Unless emergency stays in Canada are significantly cheaper than in the US :/

    If it is pancreatitis be sure to read Pancreatitis Primer Ruth posted, it has all the info you need and meds you should request
     
    Last edited: Apr 16, 2022
  33. Jodey&Eddie

    Jodey&Eddie Well-Known Member

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    @Bandit's Mom
    Could you please take a look at what's going on here with Eddie.

    I'm getting confused. Because I have to deal with the vet in case I followed instructions:
    All is possible but pancreatitis is not the only possibility. Before we go there I like you to give him rest so he can find his ‘emotional balance again’ and offer him his normal amount of food at his regular time, if he eats great, then the normal amount of insulin, all back to as it was.
    If he does not eat then you give him 1/3 of his regular insulin dose and he can be fed again the next day.
    The small amount of insulin is not as much to keep his BG down, much more to cut off the path to ketogenesis that diabetics may take when they are stressed and don’t eat.
    If he remains dumpy by tomorrow then he will need some fluid support.


    I followed this because I may have to take Eddie into the clinic even tonight and can't be all over the place. I just want to record here that I did this.
     
  34. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    When Neko wasn't well or eating much or as much as I wanted, I generally shot the full dose and syringe fed. Cats undergoing anaesthesia who cannot eat due to that get at least a half dose, so I don't understand why 1/3 of a dose was suggested. Looks like his numbers are now going up, and will be worse due to the reduced dose. Do test ketones. Too little insulin, inappetance and systemic inflammation/infection are a bad combination.

    I hope you can treat at home. If the ugly vet visit triggered pancreatitis, going there again isn't going to help. Get fluids, pain relief (buprenorphine first choice), anti nausea med. You can get a script for ondansetron and fill it at the human pharmacy. Get the generic, much cheaper. Always good to have around in your kitty tool cupboard. In addition to AD, Royal Canin Recovery is great for syringe feeding, and actually LC instead of MC like AD is.
     
  35. Jodey&Eddie

    Jodey&Eddie Well-Known Member

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    It is midnight. I don’t have any of these things. He is not interested in food. Maybe I messed up with the vet dose but I’m flying blind here with this new twist. I feel I should take him to clinic as I don’t know if he should go like this overnight.
     
  36. Jodey&Eddie

    Jodey&Eddie Well-Known Member

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    What is AD? What will happen to him overnight if I don’t take him to clinic snd I have none of those things?
     
  37. FrostD

    FrostD Well-Known Member

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    It is AD recovery food, it's a good texture for syringe feeding. Eating is most important, don't worry much about carb content

    We can't really answer that question. The main concern is ketones and DKA if he goes untreated for too long with whatever this may be. Secondary concern is hepatic lipidosis if he's not eating. And if it is pancreatitis guarantee he feels terrible. I'm not sure how it works by you, but nights and weekends here are emergency vet only. So waiting wouldn't change cost, just delay treatment unnecessarily.

    As for the vet ...it doesn't matter. He is YOUR cat, what you do with him is your choice. If she/he asks, you just say you really weren't comfortable letting him go like that all weekend and felt he needed to be seen. You were just saying earlier this week you should have trusted your gut, I would do the same now.
     
  38. Jodey&Eddie

    Jodey&Eddie Well-Known Member

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    I am currently sitting with Eddie outside emergency clinic waiting to be seen.
    It’s the only all-nighter in town. Tried feeding him again, not interested. No vomiting or diarrhea but I just feel he needs be seen.
    At midnight with Wendy’s post I was just overwhelmed. Yes Eddie is my cat but I was exhausted snd had none of the medications or items she was listing and was caught between what to do and what not to do and because I was tired—and still am—was unable to think clearly.
    Now we’re here and I’m told we have to wait in the car until seen. I’m close to losing it.
     
  39. Max & Lori

    Max & Lori Well-Known Member

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    Jodey, you are doing the right thing. From what you were describing, it sounded like pancreatitis to me. The part about him not eating is the main thing to deal with now. When Max had pancreatitis the first time, he went into DKA really fast. He was sicker than I’d ever seen him. They kept him in the hospital to get him stabilized, then I continued treatment at home with sub Q fluids, pain medication, and anti nausea meds. It was triggered again when he had his CT scan prior to SRT. I took him back to the ER because I recognized the symptoms, in hopes to prevent DKA again, which was a good thing. Hopefully they will assess Eddie, and do labs to see what’s going on, and start treatment. If he is well enough to take home, they can get you the things he needs so you can treat him at home where he is more comfortable. You did the right thing for Eddie, and yourself. :bighug::bighug::bighug:
     
  40. Jodey&Eddie

    Jodey&Eddie Well-Known Member

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    Jun 2, 2021
    Thank you for that vote of confidence, Lori. I’m so tired. We’ve been in the car for over an hour snd Eddie just had another bout of diarrhea in the carrier. We still hadn’t been seen. I called them and basically pleaded for them to take him in snd they just did. I almost laughed when the tech said the vet wanted to ask if they could test his BG.
    They have now taken him in and cleaned him up. I’m waiting in my car to talk to the vet.
     
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  41. Max & Lori

    Max & Lori Well-Known Member

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    Bless your heart! I know exactly how you feel. This sounds like some of the same experiences I’ve had. I will be praying everything goes okay and they can find some answers and get him started on the correct treatment. I too, become very anxious when it comes to Max (or any family member) It doesn’t matter how much training you’ve had, it’s hard to think clearly when you’ve become anxious. So just know that you did all that you can do right now and you have him at least where he can get assessment, labs and treatment. You can do this Jodey. You are a wonderful caregiver for Eddie.
     
  42. Jodey&Eddie

    Jodey&Eddie Well-Known Member

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    It's now 2.5 hours since I arrived at the emergency clinic. It's a long weekend and they have one vet on staff. I've been waiting in my car and someone comes out to say to me "Do you want the good news or the bad news?" I said, Look, just give it to me, I've been sitting here since 4:00 am. She says the "good news" is that Eddie's BG is "normal" I said what is it, exactly. She says, "I'm not allowed to give that information". Again, so tired, I almost laughed again. I said What's the "bad news"? and she says, we have an emergency come in and we won't get to Eddie for awhile, this is after he's been in there for 2.5 hours. I said, Look, has anyone checked for pancreatitis? She says, "No, and I'm not a vet tech so that's all I can tell you" and I say, Well, has anyone checked for ketones? She doesn't know. She says because of the emergency, I might as well "go home and get some rest and the doctor will call you." She says, "Don't turn off your phone" and that did it.

    I'm home now, still waiting for the vet to call.

    What really strikes me as curious is that Eddie's BG is "normal".
     
  43. Rainbow Conti

    Rainbow Conti Well-Known Member

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    Ph sweetie I know you must be so exhausted and so frustrated and well at the end of your rope! I probably would have come unglued at the little receptionist...his bg is normal yeah that's an open ended answer. The fact that they couldnt tell you??! That's where I may have lost it. But you are being so strong and you did and are doing the right thing. Dont second guess yourself at all! Taking him in was absolutely the right thing to do! Prayers for you and for Eddie have already been sent up!:bighug::bighug::bighug:
     
  44. FrostD

    FrostD Well-Known Member

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    I understand, I could sense it in your post. I was simply giving you a vote of confidence to get him seen and not worry about what the vet may think, etc.

    I swear I've never had a good experience at an emergency vet which is a shame. Hopefully you got some sleep (doubtful, I know) and get an update on Eddie soon
     
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  45. Max & Lori

    Max & Lori Well-Known Member

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    Oh no I hate that happened. It seems like emergency rooms for animals and people too are not what they used to be. You can check for ketones at home too with some urine keto sticks if you want to. I periodically check Max. I have one of the blood monitors. Urine keto sticks should be at any pharmacy. I hope you hear from your vet soon.
     
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  46. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Sorry my post overwhelmed you. :bighug::bighug::bighug: That wasn't what I intended. The vet was the place to get what you needed, and that's what you did. Good call. You know Eddie best.

    Why do cat's always pick the long weekends or Sundays to get sick? I did have a good late night experience with the ER with Neko, but COVID has made things so much harder.
     
  47. Jodey&Eddie

    Jodey&Eddie Well-Known Member

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    Jun 2, 2021
    Oh, Wendy, I didn't mean to single out your post at all: by the time I got your post I was already on the Road to Overwhelm as yesterday and last night ramped up my exhaustion last night following the CT scan incident. Seriously, by the time of your post, I just couldn't keep in mind any of the medications or what to do or what not to do.

    I've just called the hospital. The vet called earlier to ask if he could have Gabapentin because I guess Eddie won't let any of them near him. He has finally taken the step of fighting back and not just growling. So, they tested him between 4:00 am -6:00am and I learned he tested at 8.9, which is not exactly "normal" in my books.

    Currently, they are running tests on him (bloodwork) and getting him attached to fluids. They have not given him either insulin or his medications. I asked about pancreatitits/DKA and they say "the vet will call you", which I expect in the next while because they will want to have a treatment plan.

    They have given him Gabapentin and apparently he's ok with that. He has had it before and it was alright.

    I'm so tired. I have to say that I did lose it a little when I had the moment with the receptionist who blithely asked me after I was sitting for 2.5 hours in my car, which one I wanted first "the good news or the bad news". What is wrong with these people? Even when I spoke with the vet on the phone earlier she said she had talked to the internist, who hasn't seen Eddie in person for months that she wanted to get the "full picture" since, obviously, in spite of the fact I prepared a detailed document for them about Eddie, I cannot be seen to know anything.

    Thanks for the support, again, everyone. I'll create a new post when I heard from the vet about the results and treatment plan.
     
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