06/01 - Shen - AMPS 124, +2 75, +4 74, +6 81, PMPS 75, +6.5 111

Link to previous condo: https://www.felinediabetes.com/FDMB...-65-6-80-pmps-77-2-25-80.278071/#post-3075783

So, I don't know if Shen has done this before but today about 15-20 mins after his AM shot, I caught him walking in circles, turning to the right. I managed to grab a video of it. I'll link it in a while.
I hope I'm not overthinking it as I tend to do.

After seeing him do a few turns, I put him on the couch. Even after sitting, he was turning his neck to the right. He settled down about a couple of minutes later.
He's sleeping normally as I type this.

I've also noticed him licking his lips a little too often since about 2 days now.

I've done a few searches on the FMDB and they threw up content about neurological issues when I typed walking in circles. One post I read referred to out of balance electrolyte count (low potassium specifically). Also disorientation/walking in circles is a symptom listed in the Hypo sticky.

We're heading out to the vet in about 45mins for a cystocentesis to update his UTI status, so I'll also ask about this.
Are there any blood tests I could get done that would help figure out the walking in circles thing?

Right now the only medicines he's getting are probiotic capsules (2.5Bn CFU twice daily) for his stools and a 1000mcg B12 capsule once daily (I don't think Shen has hind leg neuropathy, but he did seem more alert and brighter after starting B12 - could also be the lower BGs though).

Any tips? Just keep an eye out?
@Bandit's Mom @Bron and Sheba (GA)

 

Link to the video - https://photos.app.goo.gl/bt7zmKUfT3THzvww5

Checked his BG at +1 just now - 126 (just to rule out hypo-related walking in circles).

 

Good timing that you are going to the vet. The video may also help with diagnosis. The circling is something I haven't seen very often here, just twice, and with cats with acromegaly. Not something I'd think Shen has.

 

Forgot to mention that Shen has ear mites which haven’t reduced a lot despite monthly applications of spot-on. I tried Selamectin twice first, which didn’t seem to make a lot of difference. Advocate worked better.
Will ask the vet to check his ears too, in case they show signs of infection.

 

It will be interesting to hear what the vet thinks about the circling. At one point he did look as if his ears were bothering him and I thought he might scratch his ear but he didn’t. He was a bit unsteady on one of his back legs at one point as he was circling.

 

Good luck with the vet visit. I too read that ear infections can affect balance. Might also want to get his teeth checked and schedule a dental - now that he is tightly regulated. @Gill & George told me that her kitty George developed balance issues from a dental infection that affected his ears!

 

Came back in time for his +2 snack.
Can't say I came back with more information.

TLDR: Keep a watch on Shen for the circling.

Cystocentesis - the vet said his bladder wasn't full enough for a cysto. She tried palpating his bladder to get a free catch but Shen wasn't in the mood to go. She asked me to come back in the evening or to give a free catch sample to another lab. 2 minutes after reaching home, Shen peed a whole lot (he hadn't gone in at least 4 hours) but I couldn't react quickly enough to get a free catch.

I wanted to do a cysto because the free-catch results (image attached) threw up a really high bacteria count
Parameter 30-May 25-Apr

• Bacteria 18-20/ hpf 2-3/ hpf
• Pus cells 1-2/ hpf 10-12/ hpf
• Epithelial cells 1-2/ hpf 8-10/ hpf

I guess it is possible for bacteria to be present in the urine without a significant increase in pus cells or epithelial cells.

Circling - She saw the video and said it looked like he was trying to reach his tail to scratch. She asked to keep observing him. If it continues, we may have to do something. Did not give any further indication as to what the possible causes might be. Even at the vet clinic, while he was sitting on the table/counter, he kept turning to the right. I did point it out to her but she made no comment of it, just nodded. Could not have been any more vague.

Ears - She asked if he was tested for ear-mites to which I responded that another vet had suggested he might have ear-mites based on the description. I showed her a photo too, to which she agreed then. She suggested applying another brand (Broadline) of spot-on after 2 weeks. I had last applied Advocate spot-on on 15th May.

Insulin - I did not ask for any advice. Just told her that he's been doing really well since my last visit a month ago. She asked to look at his SS and what his fasting sugar was (she meant AMPS/PMPS). She was happy to hear his AMPS is in 120-150s, but when I told her that the PMPS is usually near 80-90, she said I shouldn't give him any insulin if he's under 150. I responded that I was reducing the dosage appropriately if the BG dropped too low. But she insisted, so I said OK

The vet did have a cursory look at his teeth but made no comment. I also mentioned to her that the drooling had stopped for about 2 weeks now. When I go in the evening, I'll ask her again if she thinks we can start working on his teeth now. Thanks for the reminder!

As of now, he's back to sleeping after his +2 snack. Will keep an eye out.

 

Cats!

Didn't she check his ears for mites or an infection? What drug does Broadline contain? I would wait at least 3 weeks from the last application of a spot-on before applying another one.

 

She checked his ears but I guess they were relatively cleaner since I'd cleaned them 2 days back with a wipe. She agreed they were ear-mites when I showed an older photo of his ears with the mite poop in its full glory.

With Selamectin, I followed the vet's advice to re-apply after 2 weeks (15 Feb and 01 Mar). Another vet suggested to try Advocate (22 Mar and 15 May). Yet another has suggested Broadline now. I guess I'll try it 2-3 weeks into June.

Broadline spot-on:

• Active ingredients: Fipronil, (S)-methoprene, eprinomectin, and praziquantel
• Fipronil is an insecticide that kills fleas and ticks on contact.
• (S)-methoprene is an insect growth regulator that inhibits the development of flea eggs and larvae, helping to break the flea life cycle.
• Eprinomectin is an antiparasitic drug effective against various internal and external parasites, including ear mites, some intestinal worms, and certain ectoparasites.
• Praziquantel is an anthelmintic drug that is effective against tapeworms.

Advocate has Imidacloprid and Moxidectin.

• Imidacloprid is an insecticide belonging to the neonicotinoid class.
• It acts as an agonist at nicotinic acetylcholine receptors in the nervous system of insects.
• It disrupts the normal function of the receptors, leading to paralysis and death of fleas and lice.
• It has a rapid and potent insecticidal effect on adult fleas.
• Moxidectin is an anthelmintic compound from the macrocyclic lactone family.
• It acts as an agonist at glutamate-gated chloride ion channels in nematodes and arthropods.
• Moxidectin causes an increase in chloride ion conductance, leading to paralysis and death of parasites.
• It is effective against various internal parasites, including heartworms (Dirofilaria immitis), hookworms (Ancylostoma tubaeforme), and roundworms (Toxocara cati).

 

I have a small update and a big question.

Update: I submitted 2 urine samples, one for routine urinalysis and another for C&S (in a sterile container containing boric acid powder) directly to the diagnostic lab recommended by the vet.
I didn’t see the point of taking Shen to the vet in the evening, if it was going to be a repeat of today morning. I should get the urinalysis result by tomorrow and C&S will take a while.
Shen did the circling thing a few more times today.
He’s starting drooling a tiny bit and licks his lips and sort of gulps every now and then. I don't know what to make of it, but it could be the UTI again.


Question: How much of a set back would it be if I had to skip one or two doses? Tonight I have to be with a friend whose cat will be undergoing surgery, which might have a grim outcome. We used to co-parent a paraplegic cat who we lost to the same surgery in March this year, so to go through the same thing again so soon is a bit triggering for both of us.

I’d like to spend some time tonight with her cat and if possible also be there with my friend during the surgery tomorrow.

Unfortunately all this happens to coincide with Shen’s shot timings, especially the hours from pre-shot to +6. (9:30 pm/am to 4:00 am/ pm tentatively)
I could get my mother to feed Shen tonight but I can’t expect too much from her as she sleeps early and could feed him till +2 at best (pm cycle). She could give him the HC kibble to keep his BG up but I don’t know if that’s worse than giving no shot at all.

Shen drops more during the AM cycle, so if I had to step out at AMPS time (for the surgery), I’d rather not shoot at all.

I might have been willing to take a chance with shooting and leaving Shen with my mom, but with this circling development, I’m afraid to. I am also aware that Shen's potentially dealing with a UTI flare-up and/or something else right now and skipping dose(s) might throw a spanner in the works

His PMPS (9:30pm) is in another hour and I need to leave by +0.5.

One option is to delay his PM (and AM) shot by about 6-8 hours and bring it back up over a week or so.

@Bandit's Mom suggestions?

 

So you won't be around to monitor tonight and won't be home for the shot tomorrow morning? Do you have any HC wet food?

 

You could either skip tonight's shot or give it and feed him HC with the shot and have your mom feed him HC at +2. Tomorrow morning you could give the shot and have your mom feed him since she will be around to watch him. I doubt the circling has to do with low BG.

Sorry about your friend's cat. Good luck and I hope he/she sails through the surgery!

 

Yes, if I were to shoot tonight, I would have to step out within 30 mins of shooting.
I will be coming home early morning (between 4-6 am) but would again need to leave by around 9 am.

I have a few packets of Sheba chicken loaf for kittens (which comes up to 28% carbs on the online calculator, but the ash% is missing, so it must be much lower). I also have some packets of Meo Tuna wet. And Temptations creamy treats.

Ok. I'll try doing the first part at least for his PM shot. Will shoot and ask mom to feed at +2 and again before she sleeps, if she happens to stay up beyond +2.
Will evaluate tomorrow's AM shot when/if I'm back in the morning.

I feel so too. I just didn't want to be dealing with a hypo-situation while I'm away, especially when a new unrelated symptom has arisen

Thank you

 

I’ve shot the PM dose about 20 mins back. Will be heading out in another 20.
My mom’s making me nervous since she’s already nodding off. I’ve put an alarm on her phone for +2.
I’ll also feed Shen some food before stepping out.

 

Feed some HC before you leave. And leave enough out for him.

 

I’ll feed the HC before I go but unfortunately I can’t leave anything out. 3 other cats at home, of which 2 are big fans of wet food.
I might disturb my mom with a phone call or request her to feed Shen if she gets up later.