09/05 Shmee AMPS 235, +2.5 92, +3.5 67, +4 76, +5 116, Trip to the vet for upset stomach

Amanda & Shmee

Amanda & Shmee

Very Active Member
Previous condo

Hi everyone,
Very odd to see that number come up this morning (double checked to be sure - got 210). The doctor suggested he shouldn't need insulin anymore yesterday... I guess that is out the window. I was planning on trying .1 anyway before going off for good, so we did .1 this morning. He also refused to eat which is the total opposite of how he has been, so I switched flavors (wasting his liquid meds in there) and he ate the second flavor just fine.

I just picked him up to weigh him and he did not like it. Which is very much not like him. He was just meowing very sad-like. He also did not sleep with me last night, and slept in the same spot all day yesterday. I think he still has stomach pain or something. @Sienne and Gabby (GA) you suggested to look out for pancreatitis. I am confused as to why pancreatitis would have happened.... Goes in for brain surgery and gets pancreatitis? Should I take him to the vet? I am so scared for him. I was going to go back to work today and I did not... the doctor said whenever he is in a stressful situation he needs extra prednisolone for his stress levels :(, so if I am going to take him to the vet I assume I need to do that asap. Plus the Gaba takes two hours... Ugh.
 
I just texted Dr. McCue to get his opinion.

Side note - a few weeks leading up to AMC, he wasn't eating well. I kept having to switch flavors and put a spoon up to his mouth to get him to eat. He always eventually did, but it was a battle. Could that have been early signs of pancreatitis? I HATE this.
 
Ah, poor Shmee. It does sound like pancreatitis. And with that there is pain which would elevate the numbers. I agree that he still needs insulin support especially now with his numbers going up. I would have him seen by the vet.

It is my understanding that stress can bring on a pancreatitis flare up and I am sure that all he went through stressed him out.
 
Amanda & Shmee said:
Could that have been early signs of pancreatitis?
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Yes.

Bobbie And Bubba said:
It is my understanding that stress can bring on a pancreatitis flare up
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Agreed.

Can you get him in for a Cerenia shot? Cerenia not only helps with the nausea but also has anit-inflamitory properties. The shot will last 24 hours so you may see if they will give you additional shots to administer at home (so you don't have to attempt to pill). What pain meds are you giving?

ETA - of course check with the vet that did the surgery - I just assumed you would.
 
Ok thank you all. In preparation for the vet I just went ahead and gave him an extra dose of his prednisolone (doctor said if he ever is in a stressful situation he should get double the dose) and Gabapentin . He wouldn't eat the flavor he ate before.... more wasted meds, he did eat the second flavor which is good.

Side note - a little concerned with how much liquid meds he got now since I have had to waste some - for compounded medication I feel like I have heard you all talk about Diamondback? The doctor said I have a 30 day supply but the bottles are less than halfway gone... so I should order those today just to be on the safe side.

My vet opens at 8:30, I will call soon and hopefully they have an opening. Good thing I took an extra day off work...

@LizzieInTexas I don't think he is on any pain meds right now.. he did get a shot of Cerenia the morning I picked him up from the hospital, and he got the Covenia antibiotic shot of a drug that lasts two weeks. (I did tell him I was concerned about that shot, I know we have talked about it on here before, but he said it was safe and I honestly didn't want to have to give him pills every day on top of what he's been through, so I said the shot was ok). The drugs I give him every day are the pred for steroid replacement, levothyroxine for the thyroid hormone replacement, and desmopressin for something about water balance. To my understanding they gave him pain medication in the hospital like morphine, but none right now. Which leads me to believe the doctor thinks he should not be in pain this long after the surgery :(
 
I agree it does sound like pancreatitis.

I just realized something.. Shmee no longer has a thyroid, correct? Are you now checking both T4 and T3 levels? My civvie had i131 and had to go on both T4 and T3 hormone replacements. Just the T4 hormone replacement wasn't enough. He was not feeling great and I could see a change once the T3 hormone replacement was added in.
 
@LizzieInTexas Cerenia doesn't help with pain too does it? I want to be sure I know why I am asking for this when I talk to the vet. For possible inflammation of the pancreas?

@Mandy & Rex he no longer has a pituitary gland. To my understanding he still has a thyroid? I feel like I should know this but I think the thyroid and pituitary glands work closely together, which is why he has to have the thyroid hormone replacement. I could be wrong though :(. And yes he needs to get a full blood panel and get his T4 levels checked after 7-10 days to see if the hormone replacement drugs need to be tweaked at all - was going to call the vet today to get an appointment set up.
 
The pituitary gland is often referred to as the "master gland" because its hormones signal many other glands in the body. It's one of the chief controllers of the endocrine system, a massively complex system that biochemically runs the body. There's a close relationship between the pituitary gland and the thyroid and Shmee is missing half that relationship now.

I hope you can get Shmee feeling better soon, Amanda. This has to be so hard for you ... :bighug:
 
Amanda & Shmee said:
he no longer has a pituitary gland. To my understanding he still has a thyroid? I feel like I should know this but I think the thyroid and pituitary glands work closely together, which is why he has to have the thyroid hormone replacement. I could be wrong though :(. And yes he needs to get a full blood panel and get his T4 levels checked after 7-10 days to see if the hormone replacement drugs need to be tweaked at all - was going to call the vet today to get an appointment set up.
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I am not knowledgeable on the pituitary gland. Do ask if you need to watch the T3 levels and see what the vet says. Let us (me) know what they say.. I would like to know. :)
 
Mandy & Rex said:
I am not knowledgeable on the pituitary gland. Do ask if you need to watch the T3 levels and see what the vet says. Let us (me) know what they say.. I would like to know. :)
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Ok I will. I am looking at Shmees last full blood panel and there is no t3, but there is a t4. Is the t3 a totally different test I need to request?
 
Kris & Teasel said:
Oh, Amanda, I'm not criticizing you in any way! :bighug: I just wanted to give you a capsule version of what the pituitary does ... it's all very complicated. Wait to see what your vet says today. We're all here to support you.
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I know you aren't I am sorry I did not mean it like that. It is true though, I am just saying that is literally all I can think about now a days. He is so different and so sad... I hate this.
 
Amanda & Shmee said:
@LizzieInTexas Cerenia doesn't help with pain too does it? I want to be sure I know why I am asking for this when I talk to the vet. For possible inflammation of the pancreas?
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Cerenia is an anti-nausea med. It also has anti-inflammatory properties but in reality the steroids do too. The steroids (and pain if there is pain) could be driving up the BG numbers too. Pain could cause him not to want to eat too. If pain, is it from surgery or pancreatitis or upset tummy from AB? Who knows. There are just too many variables.

I am not sure but Gabapentin may be for pain? I am not familiar with it
 
They said there is an opening at 3:45, but they had a cancellation for an early appointment so she is calling my vet to see if we can get him in sooner. Although he just had the Gabapentin at 8:30... so hopefully it is at least after 10:30. God he is going to be so terrified..

LizzieInTexas said:
Cerenia is an anti-nausea med. It also has anti-inflammatory properties but in reality the steroids do too. The steroids (and pain if there is pain) could be driving up the BG numbers too. Pain could cause him not to want to eat too. If pain, is it from surgery or pancreatitis or upset tummy from AB? Who knows. There are just too many variables.

I am not sure but Gabapentin may be for pain? I am not familiar with it
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Yes Gaba is for pain but also for make them sleepy/less anxiety at the vet which is why I give it to him before vet visits.
Sorry so why am I asking for a shot for anti-nausea if he isn't vomiting? Because I feel like my vet is going to ask me that. I should say because his pancreas might be inflamed and it has anti-inflammatory properties? I appreciate all the help!
 
Humans get depressed after major surgery. Humans get depressed from chronic pain. Shmee just had major surgery. It will take him a bit to recover. I am not discrediting your concerns at all by this statement. Just keep that in mind also.

Don't let the vets rush you or dismiss you. Address all your concerns. Don't leave until you and the vet have a plan you both agree on. See if vet will give you their personal cell # so you can text or call with any questions or concerns once you are back home (mine did :)).

Ask about fluids (sub-q). Dehydration will make them feel icky too. :bighug::bighug:
 
Amanda & Shmee said:
Ok I will. I am looking at Shmees last full blood panel and there is no t3, but there is a t4. Is the t3 a totally different test I need to request?
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Yes, it's a different test. Let's wait and see what the vet says about it. It's too early to check that anyway. It takes about 2-3 weeks for the thyroid meds to get "full" - ie the Lantus depot that takes 5-7 days, but with thyroid, it is 2-3 weeks. I'm sorry if I caused you more stress by throwing this one in the mix.

You still did a great thing for Shmee. I suspect it's just the pancreatitis you are dealing with.. it's a tough thing to deal with.
 
Just because there isn't vomiting doesn't mean there isn't nausea.

http://www.felinediabetes.com/FDMB/threads/a-primer-on-pancreatitis.79693/
Symptoms
Cats with pancreatitis, even when severe, often present with non-specific clinical signs. In one study of 40 cats with severe pancreatitis the following clinical signs were reported:
• lethargy (100%)
• anorexia (97%)
• dehydration (92%)
• hypothermia (68%)
• vomiting (35%)
• abdominal pain (25%)
• a palpable abdominal mass (23%)
• shortness of breath (dyspnea) (20%)
• loss of muscle coordination (ataxia) (15%)
• diarrhea (15%)

In diabetic cats, BG levels often increase possibly in response to pain but also inflammation.
 
Vet appointment set for 10:30. Leaving shortly.
Ok thank you this information has been very helpful. I will talk to my vet about all of that.
The thing with not eating though.. he has been eating VERY well, better than he ever has really. The only time he refused his food was this morning with the high BG, but then after I switched flavors he ate it all. Just an odd side note.

So for today at the vet, I will talk to the vet about getting the Cerenia shot for nausea, the fpl test, bupe shot for pain, and sub q fluids. I just watched the video on the thread on how to do it yourself. I feel like I could probably handle it... but I don't know if I should try to do it myself just in case I fail if he really needs it / or it the vet should just do it.
 
BG one hour after the HC / 92 = 67 (+3.5). Ugh this is so scary of course when we are going to the vet... I wonder if I should reschedule until 3:45 until his BGs get higher? The vet should make his BG go up though which is good.. I wish I would not have given him insulin this morning.
 
Hang there. See what the vet says. Maybe the vet will give you bupr to take home so you have some if needed.

Yes order the meds as it will take a few days to arrive. You don't want to miss any.
 
Amanda & Shmee said:
BG one hour after the HC / 92 = 67 (+3.5). Ugh this is so scary of course when we are going to the vet... I wonder if I should reschedule until 3:45 until his BGs get higher? The vet should make his BG go up though which is good.. I wish I would not have given him insulin this morning.
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I agree with everyone else who said he might just be be recovering with the ups and downs in sugar as well as eating habit and behavior, but I think it’s reasonable to take him to the vet if you’re concerned.

Also, take everyone’s advice / opinion (including mine) with a grain of salt. A lot of it is based on our experience with our cat or maybe a handful of cats, but we aren’t vets and we havent done randomized studies. Yes, it could be pancreatitis and I know many kitties on here had it, but it could also be many other things. Leave the guess work to the vet. He COULD just be feeling crappy.

How is his nose doing, any discharge or sniffling? It would be good to just start with vital signs, such as checking his temperature and blood pressure. If we are concerned about infection they may check his blood work. I don’t think a change in thyroid levels would lead to a sudden change in appetite or glucose levels, so I wouldn’t really worry about that right now. That’s something to monitor long term.

Keep us posted!!
 
Thank you everyone. :bighug:

Back from the vet. As of right now, she said she doesn't think it could be pancreatitis since he is not vomiting and has a great appetite. She also said he does not look dehydrated so she did not think the fluids were necessary. She thinks his stomach could be upset for a number of reasons, possibly the medications / hormones / steroids. I asked about the fpl test and she said he has to be fasted for at least eight hours to do that test so we could not do it. He needs to go in for bloodwork soon anyway (I was thinking 7-10 days after we left the vet, but it makes more sense that it would be 7-10 days after the surgery.... I should have been more on top of that). If its after surgery, today is day 8... so my vet said she is going to call Dr. McCue today and ask of we can do the bloodwork tomorrow night (he said he wants it in the morning with no hormones, but my vet is going to see if we can do at night with no hormones so I don't have to call off work). Hopefully she will get back to me asap - because if we are doing it tomorrow night I will fast him those eight hours so we can do the fpl test too. Might as well... right? So for right now, she did give him the Cerenia shot and gave me the pills; I told her I preferred the injection but she said the pills should be easily crushed up in his food without him tasting it, and the shot stings... so I just took the pills. She also said he can take Gaba for pain, I wrote down to ask about the bupe but I felt so rushed... hopefully the Gaba will help him pain-wise. His sugar came back up with the honey, up to 116 now. Odd side note.... when she examined him she thought she felt a heart murmur. She said she wasn't 100% sure, but she did check twice. She did admit that was very strange especially since he just had the echo and it was fine.

So I guess right now I wait.... which is horrible but I will wait. Until my vet calls me back after talking to Dr. McCue and we get those blood tests done. A possibility is he doesn't need as much or needs more of the hormones and steroids we are giving him, so the bloodwork should show us that and I can adjust them.
 
That’s great! Hopefully he’s just having an off day which is all part of recovery. It’s not always a linear process, it’s an up and down process. I have to explain that to my patients often as well bc they get frustrated or worried if they feel well for 3 days and then suddenly they don’t . But I don’t blame u for being very vigilant for any little change, I would be the EXACT same way

I think the blood work IS 8 days after leaving the hospital bc they probably checked his levels while he was there at least once, so you’re not behind.

Also, a cat can have a murmur from stress of being at the vet. All my cats intermittently have murmurs and then they don’t. I wouldn’t worry about it at all If the echo was normal - that’s a way better test.
 
I'm starting the probiotic today. My vet suggested it in passing too so I know it is ok with her, and was ok with Dr. McCue. From Marjies suggestion I bought the 5 billion strain, so according to the probiotics thread since he has been having some diarrhea I am going to give him one pill a day, split into two meals.
 
Ana & Frosty said:
That’s great! Hopefully he’s just having an off day which is all part of recovery. It’s not always a linear process, it’s an up and down process. I have to explain that to my patients often as well bc they get frustrated or worried if they feel well for 3 days and then suddenly they don’t . But I don’t blame u for being very vigilant for any little change, I would be the EXACT same way

I think the blood work IS 8 days after leaving the hospital bc they probably checked his levels while he was there at least once, so you’re not behind.

Also, a cat can have a murmur from stress of being at the vet. All my cats intermittently have murmurs and then they don’t. I wouldn’t worry about it at all If the echo was normal - that’s a way better test.
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That is all good to hear, I hope so too :bighug: I am still not fully convinced he does not have pancreatitis since his stomach hurts so much, but we will see. And yes my vet even thought the heart murmur was odd. Hopefully it was a stress thing.
 
Phoebes said:
I don't mean to be the bad guy here, but cerenia is very bitter and when Phoebe accidentally got it in her mouth she foamed at the mouth for about 15 mins. We break it into 1/4th and put it in a gel cap to pill, not any treats , it lessens the ability to work to full potential. Just fyi
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Phoebes said:
http://cerenia.com/using-cerenia.html
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Good catch. Since I use gel caps I assume everyone does :banghead:. That is why I recommended the shots so she wouldn't have to pill.
 
Amanda & Shmee said:
That is all good to hear, I hope so too :bighug: I am still not fully convinced he does not have pancreatitis since his stomach hurts so much, but we will see. And yes my vet even thought the heart murmur was odd. Hopefully it was a stress thing.
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It could be his stomach, but it could also be his head or mouth? (Which could be normal to an extent). We don’t know for sure which it is since he can’t tell us. Frosty had diarrhea for a week and didn’t have any signs of pain. We just have to wait and see what he does. He might just feel beat up and out of it - human patients often feel fatigued and nap during the day for about a week or two after surgery. In this situation the only thing we can do is monitor him and relay our observations to the vet which is what you have been doing, and you’re doing a good job! :bighug:
 
Ana & Frosty said:
It could be his stomach, but it could also be his head or mouth? (Which could be normal to an extent). We don’t know for sure which it is since he can’t tell us. Frosty had diarrhea for a week and didn’t have any signs of pain. We just have to wait and see what he does. He might just feel beat up and out of it - human patients often feel fatigued and nap during the day for about a week or two after surgery. In this situation the only thing we can do is monitor him and relay our observations to the vet which is what you have been doing, and you’re doing a good job! :bighug:
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The reason I think its his stomach is because it hurts him when I touch it. Its not just fatigue. When I pick him up, it seems like it hurts him so he meows very sad. :(

@LizzieInTexas @Phoebes Ugh my vet said the shot stings so the pills are much better since they're tasteless. :facepalm: The link you gave didn't work but I went to http://cerenia.com/how-to-use-cerenia.aspx and it does say the tablets are for dogs. This is so frustrating. I have the pills so I guess I should just try tomorrow? He is due for another tomorrow afternoon.
 
Oh yes and Dr. McCue did talk to my vet and he said 7-10 days after coming home for the bloodwork was good. So Monday I have it scheduled for 6pm. She basically said to wait until then for the bloodwork.... didn't say we should do the fpl test but I will if he is still in pain. She did say (slightly reluctantly) that if he still seems to have stomach pain tomorrow or Friday she will be in the office and I should call. Dr. McCue agreed with me earlier that it sounds like pancreatitis..... I am so frustrated. I want to be sure its not so it doesn't just keep getting worse. But I guess all I can do is wait.
 
:bighug::bighug:Amanda. Yes they were for dogs furst, but they found they work for kitties too. Yes the shots do sting I've been told. I was just saying, I wouldn't give it in food because of the whole drool foaming at the mouth. I put it in gel cap so to avoid all that. ECID so it might not bother Shmee. He probably definitely needs it. Poor guy. You both have had a few rough weeks. You're doing great. We are all here for you. :bighug::bighug:
 
Amanda & Shmee said:
The reason I think its his stomach is because it hurts him when I touch it. Its not just fatigue. When I pick him up, it seems like it hurts him so he meows very sad. :(
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Does he meow when you press on his abdomen? Or just when you pick him up?

When Frosty had his vomiting episodes I would press on his bellyto see if there’s any tenderness, distention, or guarding to try to figure out what it could be. It’s definitely hard when they can’t tell you. I hope both him and you feel better soon!! :bighug:
 
Hi Amanda...I'm busy at work these days. You absolutely made the right decision. There are just some adjustments to be made, and some waiting.

Since Shmee had his pituitary removed, there is no Acro. Longterm, the Acro would have caused a lot more issues. Theresa has bugged me a bunch lately "Why didn't we get pituitary removal for Leo?" So she is big time jealous that Shmee was able to get this important surgery done.

Realize that Shmee may also have pancreatic diabetes. He may or may not have it. As he adjusts over time you will find out if his BG stabilizes. We believe that Leo has pancreatic diabetes in addition to his former Acro. Or Leo may have residual Acro since the SRT (radiation) may not have full effect 2 years later.

I hope Shmee is feeling better in a week or so. Hugs to you and Shmee.:bighug::bighug::bighug:
 
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