/28April20/+8:59/Will/Can Not Eat

Your doing just fine. There are so many things to deal with and some of it you just have to fine tune until the mix is right.I

Ollie's stool doesn't get that loose, its quite soft and wet though. Smokey's I only remember the smell.

 

Karen

I’m heading out but I believe Wendy and/or Sandy will be here for your shot time.

We’ve been discussing dosing 5u if he’s still flat or hasn’t risen much. We might need to drain his depot a bit more. But they will check in to help you decide at shot time.

 

Gulp.

OK.

Thank you, Marje!

 

+11.5: 104

 

how’s he behaving?

 

I'm afraid to give him any insulin at all. What do I do?

I don't think I'll be able to get him to eat.

Should I give the cabergoline on a mostly empty stomach? Just squirt it in his mouth?

Should I give more cerenia or ondansetron? Which one? How much? When? Vet says cerenia has pain med but odansetron doesn't, while it's said that ondansetron is better for anti-nausea. Vet says I can give both, staggered. I gave 8 mg cerenia at 1:40 and 4 mg ondansetron at 5:30.

I gave buprenorphine at 1:40.

It's now 9:21 here. 9 minutes from his normal shot time. But this morning he got his shot almost 45 minutes late.

 

whew, glad you're here, Sandy.

He's quiet.

I just a second ago got his food dish out and he immediately got up at the sound of it and came over.

But he's been doing that all afternoon and evening but not really able to eat.

 

He’s feeling crumby because of the pancreatitis. If he continues to have abnormal lose stool I’d ask your vet if flagyl would be a good idea. The dose of it needs to be on the low end.

 

Ok, I will ask tomorrow.

 

Why did he feel soooo much better this morning and then go way back downhill again?

 

I just read that flagyl is for infections, but this isn't an infection, is it?

 

and I just read that flagyl can cause diarrhea and not eating and nausea. Ugh! Confusing.

 

My $0.02-
In the absence of ketones - Under the present circumstances I would skip the Lantus shot.

Easier to tap down any pinks or reds that may occur following a skip with some R than struggling to steer numbers up with a cat that wont eat.

 

Ok, I am taking your 2 cents as my guide. I can't do without your sage guidance. So, I won't give any Lantus tonight. Are you advising me to keep testing tonight and give R tonight? How often should I test? At what number should I give R? How much R? Follow the last scale you gave me?

And should I go ahead and squirt the cabergoline in his mouth?

What about my questions above about the nausea meds and buprenorphine?

Thank you! I apologize for being a pest!

 

Last R scale:
PS 350 or higher 1.75u R
PS 300-349 1.5u R
PS275-200 0.75u R
If +6 is greater than 350, 1.25u R

Because there will be no +anything tonight, because no Lantus tonight, I'm not sure how to do the R

 

Yes on cabergoline. Can you syringe feed a little into him if needed?

 

I will certainly try!

 

Also pretty please advise now on what to do in the AM.

Thank you!

 

Yes to caber and it's okay without food. Ollie gets hers + 11 and snack before that if she eats it is at +9

 

I got the caber in him

 

I opened a can of Fromm grain free turkey and duck pate for Maxi's brother, and Maxi rushed over to it, so, relieved that he could eat, I quickly mixed his binder in and let him eat, which he seems to do with relative gusto.

I think he got 2 - 2.5 ounces of it down.

Then he went right to the litter box and had very runny diarrhea. (I have a pic if helpful.)

I have this, which was recommended yesterday:

 

Link from Marje about this:

https://www.foodfurlife.com/my-cat-has-diarrhea---what-do-i-do.html#/

In addition to the bland diet of just poached meat and broth, the next, most important – in fact, critical – aspect of addressing your kitty’s diarrhea is giving your kitty one of the most studied probiotics in the world, Saccharomyces boulardii.

The Probiotic – S boulardii

S boulardii, a yeast (in fact, a close cousin to brewer’s yeast with vastly different properties) is a time-tested and proven probiotic strain with many supporting studies including clinical trials indicating its efficacy in the treatment of intestinal infections, the maintenance of inflammatory bowel disease, and the resolution of diarrhea from just about any cause. It is indicated for use with “Travelers Diarrhea,” where e coli, shigella and salmonella account for about 80% of acute diarrhea. (Zanello 2009). It is safe for use in children – and pets. Research published in the past decade has explored and discovered its direct anti-inflammatory and immuno-modulatory activities as well. Please see Saccharomyces Boulardii: Scientific Studies in GI Disease.

The many studies of S boulardii indicate it is a very effective anti-diarrheal, and its use “decreases significantly the duration and frequency of diarrhea.” (Zanello 2009). It has been used in the treatment of antibiotic-resistant clostridium difficile infections in cats at U.C. Davis. Clearly the benefits of S boulardii in humans applies equally to cats. This should come as no surprise, as one of the lead researchers in the cat microbiome, Dr. Jan Suchodolski of Texas A&M, indicates “pet specific” probiotics are unnecessary – in fact, the use of researched strains is important as probiotics confer benefit across mammalian species.

How does it work? Very simply, S boulardii is not digested or metabolized: it is not absorbed in the gut. It does not act systemically. S boulardii acts locally in the lumen of the intestines. During its passage through the intestines, it mimics the physiological effects of the digestive flora, stimulating healthy immune response, reducing inflammation, and promoting restoration and growth of healthy normal gut flora. “During the intestinal transit, S boulardii interacts with resident microflora and intestinal mucosa. Moreover, experimental studies displayed that S boulardii induces a protection against enteric pathogens, modulates the host immune response, decreases inflammation and hydroelectrolytic secretions, inhibits bacterial toxins, and enhances trophic factors such as brush border membrane enzymes and nutrient transporters.” (Zanello 2009).

Thus S boulardii, unlike bacterial probiotics, does not colonize the gut. With dosages discussed in published studies, S boulardii takes about three days to achieve “steady-state” concentrations. When administration is stopped, the yeast is cleared from the colon in about 36 hours. Thus the use discussed here for “emergency treatment” of diarrhea is designed to literally flush the system with S boulardii, enabling it to get to work faster than with twice-a-day dosing.

“Emergency Stop Diarrhea” S boulardii Administration for Cats with Severe Diarrhea

Probiotics are typically sold in measures of “CFU.” CFU = colony forming units. S boulardii is the exception, it is often sold in mg. Note that 250mg of S boulardii is the same dose as 5 billion CFU.

Traditional dosing for therapeutic treatment of diarrheain adult cats as provided by U.C. Davis is one-half of a 250mg capsule (5 billion CFU) given twice daily. Treatment for kittens is half of the adult dose. It can be given with food; it does not have to be. This is usually sufficient for loose stools of normal frequency. For the “emergency stop diarrhea” approach, we find more frequent dosing of smaller amounts of the probiotic, providing a higher total CFU the first day or two, resolves diarrhea much more quickly.

For adult cats (defined here as 9 months of age and older):

Give one-quarter of the 250mg / 5 billion CFU capsule every two hours or so. Many cats accept it when mixed into finely ground poached chicken breast / turkey breast / pork loin or meat-only baby food. (Beech Nut, Goya, and Gerber list “meat” and broth or gravy as ingredients. These are fine, they are referring to the water used to cook the meat, and they contain no spices). If your cat does not like the taste of the probiotic, you can syringe after mixing with water. If you are not experienced syringing liquids into your cat, you can use empty #3 gel capsules. Simply fill 10 to 20 of these by transferring the S boulardii from the larger capsules into the smaller ones. These are a size easy to pill your cat. Pill your cat with one #3 capsule filled with S boulardii every two hours or so. For pilling instructions, see How to Pill (Your Cat).

This frequent dosing method usually stops diarrhea within 24 – 48 hours, other than when diarrhea is caused by another disease that requires treatment (low B12, exocrine pancreatic insufficiency, hyperthyroidism, as examples). This “loading dose” can be continued for longer if necessary, up to three to four days – but if you do not see substantial improvement in the diarrhea on day 3, it is best to follow-up with your veterinarian. It is NOT necessary to use this approach, it can be given at “therapeutic” doses as discussed above twice a day (and doubled if you see improvement in stool but diarrhea or soft cow patty stools have not resolved).

When the diarrhea has substantially resolved with use of the emergency stop treatment protocol, begin use of S. boulardii at the therapeutic dose level (2.5 billion CFU twice daily) and continue for at least one week. If stools soften, resume use of S. boulardii at the therapeutic dose as needed. Given its role in improving performance of bacterial probiotics and its anti-inflammatory properties, the use of S boulardii at maintenance levels (anywhere from 500 million CFU to a total of 2.5 billion CFU daily) can be continued indefinitely along with a bacterial probiotic. It confers many health and GI protective benefits, and we use it along with bacterial strains in all of our cats, all the time.

For kittens under nine months old, follow the same instructions as for adults, just use half the amount.

Please Note: If diarrhea becomes worse with S boulardii administration, stop use immediately. There can be several reasons for this reaction, however. We have seen cats do poorly with a brand of S boulardii that contains lactose, and switching to a brand like Jarrow without it, the product works quite well. This is most common. We have also seen what is most likely bacterial die-off with the S boulardii. Again, stop administration for 24 hours, and reintroduce it (while continuing to feed the bland diet) slowly. Do not follow the "emergency stop diarrhea" instructions. Use it just twice a day, but at 1/4 of the recommended amount the first day, and 1/2 the recommended amount the second day if kitty did not react to the lower dose. If you do not begin to see improvement even with this slower method of introduction, stop the S boulardii, best to see the vet.

 

Figuring out how to give it now.

Any input welcome

 

That’s exactly what I use. Just follow the instructions I linked for emergency stop. I would try this before flagyl. While ECID, I’ve never had a cat that flagyl didn’t make sick. But again, ECID.

 

I just put the recommended amount in a small dish, add water and stir fast because it gloms up. If you have a little bit of food that is easily stirred into a smooth slurry, you can put it in with that and the water and syringe. It doesn’t taste bad.

 

I was given it for Max when he had a pancreatitis episode similar to what you are experiencing.

just saw what Marje wrote. Try that.

 

You need some rest after the day you two had today. Test at +14 to see where hes at. The next 12 hours could get ugly because the effects of the BCS will likely show up in this cycle - or not. I would follow the AM/PM part of your present scale expanding the low end to 250 for these circumstances. So-

250-299 ~ 0.75u
300-349 ~ 1.5u
350 and up ~ 1.75u

There is always a +something
Get a +14 and if its 250 or above you can shoot the R. Regardless of the number or whether or not you shoot R at that time get some rest.
If you happen to be up at+19 test and if warranted you can shoot R at that time provided its been at least 5 hours since the previous R shot. I would not shoot R past +19 in this case.

Do yourself and the rest of us a favor and document which numbers you fed what and how much during todays cycle, including honey or syrups - anything that can affect BG. I liked to see it in the corresponding cell, others prefer the notes column. Its very important information - information you can build on as you continue this journey.
Know thy cat.

 

I have done that as well as I could. The one cell turned black and refuses to be changed back to blue.

 

Ok. I will test at +14 and +19. But in between I won't rest because I'm giving the S boulardii every 2 hours per instructions at the site I linked above.

What do I do in the morning??

THANK YOU

 

Man, that is another tricky pain. The S boulardii I got is 500 mg capsules, and it's 6 billion live cultures. The instructions are about 250 mg capsules and 5 billion cultures. So I dumped a capsule onto a plate and eyeball divided 1/4 out of it, mixed it in water and syringed it into his mouth.

How do I store the rest of the inside of the capsule? Is it ok to be exposed to air?

And you recommend keeping Maxi on S boulardii always? The website says: "the use of S boulardii at maintenance levels (anywhere from 500 million CFU to a total of 2.5 billion CFU daily) can be continued indefinitely along with a bacterial probiotic." Should I get a bacterial probiotic too? And what particular maintenance dose would you recommend?

Syringing the cabergoline and S boulardii is very very hard. I hope I don't have to do that with food. Hard for me and more importantly hard for Maxi.

THANK YOU

 

Thanks

 

@Sandy and Black Kitty @Marje and Gracie

I would be grateful for advice on cerenia and ondansetron through tonight and tomorrow, and especially for advice on what to do about insulin at AMPS and through the day tomorrow.

 

Cerenia is given once a day.
Ondansetron can be given 8 hourly if needed.
I think I would give him the doses routinely at the moment as cats with pancreatitis will be nauseated and won’t want to eat.

 

If you are giving it every 2 hours, it's probably ok to leave it out, on the plate.

I just wanted to let you know that you are doing great! You are fighting hard for Maxi. You have a lot of different medicines and problems to juggle - and you are doing it! It's hard, and it has been a bad day for him, but you are taking care of him and making it better. I am in awe.

 

Thank you, Bron.

I gave another 2mg ondansetron. I just read on the bottle that it can cause headache. Just what Maxi needs. Especially since the acromegaly can cause headache. So I also gave another 0.2ml Bupernex.

Is it ok to give cerenia, ondansetron, and buprenorphine/Bupernex several times a day on an ongoing basis?

Is it ok to use Feline Greenies pill pockets?

I hope someone can tell me what to do about insulin in the morning - in 7 hours.

 

Thank you very much. It's very nice of you to say that. It really helps because I feel incompetent to do this well. Thanks again.

 

I don't have experience giving cerenia and ondasetron to any of my kitties. Plenty of folks here do. modify your condo header to include those questions and folks with experience will chime in.

I see Maxi is still blue at +14 but closing in on yellow.

Regarding a Lantus dose tomorrow morning, where he ends up at AMPS (+24) will be a factor, along with his appetite.
Beyond that I cant say.
Think about it - would you have imagined one short week ago that all this greenage would appear and you would be struggling to keep numbers up?

You are presently in a flying-by-the-seat-of-my-pants-one-shot-at-a-time place right now. This is where you learn to recognize and go with the flow. julie & punkin (also an acrocat) used to call it "dialing for doses".

We will all do our best to guide you safely along and one day the waters will no longer be uncharted and your knowledge and instincts will have developed to a point where you will know how to proceed when things suddenly shift. You will get there.

Lets see what thoughts @Wendy&Neko and @Marje and Gracie have about Lantus dose going forward.

I'll be keeping an eye on the ss and look for your 29April condo before 9:30am eastern and we'll sort it out then.

Hang in there!

 

Thank you very much, Sandy.

I’m counting on someone being there for me in the morning.

Yesterday and today I have thought many times how a few days ago I thought I was in hell with Maxi but now I look back on those days as easy compared to this.
Sure I like lower numbers but not scary low and definitely not Maxi suffering.

I keep wondering if Maxi will come out of this and live happily for any length of time. If some hope for that can be realistically offered, it’d be nice.

Since Maxi hasn’t had a 3rd diarrhea tonight, I’m going to forego the next dose of S boulardii in less than an hour and sleep for 2 hours until his +19.

Thanks again

 

Cerenia: once daily, no more. I’m not sure what your vet prescribed but it’s typically 4 mg (1/4 of 16 mg tab) given once a day. However, if Maxi is big, the vet might have prescribed a higher mg dose.

Ondansetron: usually 1 mg bid but can be dosed higher (e.g. 2 mg bid) or more often such as 1 mg every six hours

Bupe: dose per vet instructions although it has a wide range and, for my cats, I start at half the dose the vet prescribed to keep them from seeming drugged. It’s easier to give a small dose and increase than to give the higher end and have them whacked out for a day.

As far as I know, the only pill pockets that are sugar free are the duck and pea grain free for dogs.

I won’t be up in time in the morning but if he’s still blue, I’d think about 5u.

 

See above post on cerenia, etc.

I have these tiny spoons and I use the smidgen as that gives me about 1/4 cap. I pour out enough of the grains to fill the smidgen spoon and then put the capsule top back on and put it in a little dish for the next dose. Once his stools are better, you can do therapeutic for a few days and then maintenance for however long you think he needs it. I’d use the maintenance dose on the website I linked. It won’t hurt him but if you feel it’s making things go the other way, which I’ve never seen it do, stop it. I also give my cats the Renew Life Ultimate Flora 15b...one cap per day.

 

Reiterating what I said yesterday on ondansetron dose:

That same ISFM Guildelines has Cerenia dosing at 1 mg per lb of weight once per day, if it's the oral version. 1/4 of a 16 mg pill will be too little for Maxi, he could easily go half a tablet. If you find it works, next time get 24 mg tablets and give half of that. I too had an around 14lb cat cat. At that time the smaller dosing was more common, and unfortunately not as effective on bigger cats. The ondansetron could easily be given 2 mg every six to 8 hours.

Yes, at one point Neko was getting Cerenia once a day, ondansetron 2-3 times a day and bupe twice a day. What I learned later was her ondansetron dose was too low - I was giving just 1 mg. Wish I knew then what I know now. Neko's bupe dose was 0.22 ml. As Marje said, not on the Greenies unless is the Duck and Pea - which only come in a dog version.

Could you put either "skip" or "NS" for no shot, in the Units column for tonight, so we know you didn't dose, instead of just forgetting to enter the dose.

 

Ollie gets 0.2 ml bupre every 8 hrs as maintenance dose. She can and has had 0.3 ml every 6 hrs when p'titis was at its worst.

The first time getting cerenia she was on 15 mg daily by ER doctors. Then as she got better dose was reduced accordingly. If she needs it now it's 4 mg of a pill (just looked at box and it says to give 8 mg) geez I've given 4 mg all this time but it works for her. If it's injectable is 5 mg (probably because the math is easier). And only injectable if I can give in subq fluid.

 

Cerenia: vet prescribed 1/2 of a 16mg tablet once daily 1 hour prior to feeding
Ondansetron: vet prescribed 1/4 of a 4mg tablet every 6 to 12 hours
Bupe: vet prescribed 0.1-0.2ml every 12 to 24 hours

I'm all for pain medicine if it relieves pain and as long as he's not scared I don't care if he's whacked out. If being whacked out scares him, I’m not for it.

 

Sold out of the duck and pea grain free for dogs.

I got apple and bacon flavor for dogs. I think the rep said they were grain free. Rep advised against giving pill pockets for dogs to a cat. From Chewy - don't know when will arrive.

 

I got this, Marje. Do you recommend I give Maxi 1 full capsule per day? All at once? Same time as S boulardii?

 

Elise, when I go to that link, I am prompted to enter my e-mail address to receive a link to log in, but I never got the e-mail with the log in link. Is there anther way I can get in? Thanks.

 

I give this to my cats every day and it’s the same I take. I give them 1/2 cap twice a day as they get some other supplements with it. And yes, when I was giving the boulardi as a maintenance dose, I mixed it all together.

 

I have the same brand probiotic as Marj except it's 30 billion, I give 1/2 cap. It's been awhile since I used it cuz I couldn't find it in stores. I should get it started again.

 

The problem is I sent it to you from my log in. Try
https://groups.io/login

 

Got it. Thanks a lot!

 

How’s he doing today?

 

Terrible this morning

Markedly better this afternoon

WAY better tonight! I am so relieved and hope hard he won't relapse again.

Thanks for asking

 

That’s great. Keep all the supportive meds going until normal for a few days. Then eliminate one st a time. I learned that after stopping too soon.

 

I didn't give him nausea meds tonight because he didn't seem nauseous -- he ate great. Do you think I should go ahead and give him cerenia and/or ondansetron?

Thank you

 

When did he last have cerenia? It’s given every 24 hours. If he’s done eating for tonight I’d give him some tomorrow or else give ondansetron in the morning. Pancreatitis doesn’t go away so fast.

 

He had cerenia yesterday afternon and ondansetron yesterday morning. I'll see how he eats now. Thanks!

 

I can see that he doesn't feel great. He had diarrhea again just now. He ate ok, but with less appetite again. I gave him ondansetron and buprenorphine and S boulardii.