5/21 Ruby AMBG 66/+6 67/PMBG 76

Katherine&Ruby

Katherine&Ruby

Very Active Member
Yesterday on Being Ruby-doo.

We had a good eating day yesterday and she did a thorough job at cleaning her bowl at breakfast, but she's acting a little listless and is meatloafing with squinty eyes and out-turned ears again. :( I started her on ondansetron instead of cerenia yesterday to positive effect, but perhaps today I will give her both if she's still acting poorly and replace the mirtazapine with cyproheptadine if her appetite wanes.

Her BGs are holding low and steady so no shot for the second morning in a row. Pleased I don't have to worry about that. Could lower BGs be caused by her not feeling well? The IM could not rule out pancreatitis since she hasn't been tested since February by TAMU, but her Spec fPL test last week was normal. Or is her little pancreas finally pulling its own weight in producing the insulin she needs? Hesitant to call this a "trial" :nailbiting:because I don't know what her tummy issues will do and whether a spike in her BGs will emerge again like they did a week ago. Time will tell.

Healing thoughts to all of the sick kitties and hugs to you beans. Happy Friday! :woot:
 
It is good to see her appy has picked up, that can always be worrisome. Let's hope the good BGs without juice continue (anti-jinx ;)). You're doing an amazing job - I'd just take your cue from Ruby and see how things go. I'd wondered perhaps about some electrolyte imbalance which may be making her feel off, but the last labs look good. While it is more likely at higher BG levels, and not often found in lower BG levels, I'd still try and check occasionally for ketones, particularly since she's had some history in the past.
 
Ruby is being enigmatic again! I do feel sorry for her as those physical signs sound like she's in pain. My vet says that you cannot always tell from the Spec fPL test if they have pancreatitis or not... she says that cat's "didn't read the manual" on pancreatitis. Darcy once (last fall) had an abnormal fPL test and the ER vet said he had pancreatitis, but she ultrasounded him and found his pancreas to look very normal and not at all inflamed. Have you tried giving her anything for pain? Do you have any Bupe on hand to give small dose? If you think that she does have pancreatitis then you should be giving fluids and Cerenia. I have been having better luck with the cyproheptadine (over Mirt) with Darcy... thank you for your suggestion to use it. The Mirataz didn't make him weird, but it didn't really seem to make him hungry either. I went into my vet "stores" and found some old Periactin and have been using it on him. It was 10 years old, but it still seems to work. I'm at the point of having to go to the vet and get some more. Man, I hope Ruby is going to feel better soon. It seems like she has a good day... followed by a bad day... etc.
 
I hope Ruby continues to eat for you and feels better as the day goes on. It seems like you're on an unofficial OTJ trial. If I remember correctly one of our former cats on this board (Trixie) had a bad pancreatitis episode and Amy had to stop giving her insulin and she never went back on insulin. You never know what will happen. :bighug::bighug::bighug:
 
Christie & Maverick said:
It is good to see her appy has picked up, that can always be worrisome. Let's hope the good BGs without juice continue (anti-jinx ;)). You're doing an amazing job - I'd just take your cue from Ruby and see how things go. I'd wondered perhaps about some electrolyte imbalance which may be making her feel off, but the last labs look good. While it is more likely at higher BG levels, and not often found in lower BG levels, I'd still try and check occasionally for ketones, particularly since she's had some history in the past.
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I haven't updated Ruby's labs SS with her results from last week (will update now), but they look even better than the results from March which are the latest ones in the spreadsheet. This is one perplexing part of the puzzle.

Thank you for the reminder, Christie, about the ketones. I will watch her litter box visits and see if I can get a good specimen today to dip in the Ketodiastix. :bighug:
 
Suzanne & Darcy said:
Have you tried giving her anything for pain? Do you have any Bupe on hand to give small dose? If you think that she does have pancreatitis then you should be giving fluids and Cerenia. I have been having better luck with the cyproheptadine (over Mirt) with Darcy... thank you for your suggestion to use it. The Mirataz didn't make him weird, but it didn't really seem to make him hungry either. I went into my vet "stores" and found some old Periactin and have been using it on him. It was 10 years old, but it still seems to work. I'm at the point of having to go to the vet and get some more. Man, I hope Ruby is going to feel better soon. It seems like she has a good day... followed by a bad day... etc.
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The rollercoaster continues. :( I asked her IM for bupe twice and got a no the first time and no answer the second. :banghead: Re: fluids, I'd have to get the vet tech here to do it because she absolutely refuses to let me administer them to her, and her gums seem very tacky (I pill her and stick my finger in her mouth all the time) and she gets a lot of water from her food when she's eating well so I'm not sure she needs that. Maybe I can try her primary vet for bupe. It's the one thing missing from my cat appy arsenal.
 
carfurby said:
I hope Ruby continues to eat for you and feels better as the day goes on. It seems like you're on an unofficial OTJ trial. If I remember correctly one of our former cats on this board (Trixie) had a bad pancreatitis episode and Amy had to stop giving her insulin and she never went back on insulin. You never know what will happen. :bighug::bighug::bighug:
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Oh Carla, you do not know how happy that makes me to know this. Thank you. ❤️❤️I have a little glimmer of hope now. :bighug::bighug::bighug:
 
Sorry to hear about the continuing issues and hope the new med approach works :bighug:! I am happy you at least get a break with the glucose :). Keep the faith....with all aspects. The GI issues & management may take a little more time to sort out, but you will get there!

PerfumedCatMom said:
The IM could not rule out pancreatitis since she hasn't been tested since February by TAMU, but her Spec fPL test last week was normal
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Even if the Spec fPLI is negative, there can be a more mild form &/or secondary pancreatitis . The test is less sensitive with with mild pancreatitis (54%) vs moderate to severe pancreatitis (100%). In addition, if the test is positive, it should be taken into consideration with additional diagnostics (which many times aren’t done) because there may be another cause for the elevated levels & it’s important that they aren’t missed.

I think it says it all when Dr Steiner, who helped develop the Spec fPLI, writes an article with the title “Diagnosis of canine and feline pancreatitis-Enough with lipases already” (link to article:
http://blog.vetbloom.com/internal-medicine/pancreatitis/):rolleyes:.
 
Tomlin said:
Sorry to hear about the continuing issues and hope the new med approach works :bighug:! I am happy you at least get a break with the glucose :). Keep the faith....with all aspects. The GI issues & management may take a little more time to sort out, but you will get there!



Even if the Spec fPLI is negative, there can be a more mild form &/or secondary pancreatitis . The test is less sensitive with with mild pancreatitis (54%) vs moderate to severe pancreatitis (100%). In addition, if the test is positive, it should be taken into consideration with additional diagnostics (which many times aren’t done) because there may be another cause for the elevated levels & it’s important that they aren’t missed.

I think it says it all when Dr Steiner, who helped develop the Spec fPLI, writes an article with the title “Diagnosis of canine and feline pancreatitis-Enough with lipases already” (link to article:
http://blog.vetbloom.com/internal-medicine/pancreatitis/):rolleyes:.
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Would pancreatitis show up in an ultrasound? Last week the exam showed the pancreas looked normal...
 
PerfumedCatMom said:
Would pancreatitis show up in an ultrasound? Last week the exam showed the pancreas looked normal...
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It can be of some help but unfortunately it does not rule it out or provide a definitive diagnosis. As per Dr Steiner:

“......abdominal ultrasound can be associated with both an under-diagnosis and an over-diagnosis of pancreatitis in dogs and cats, depending on the severity of the disease (i.e., mild cases of pancreatitis may not be associated with ultrasonographic changes), operator skills (i.e., an inexperienced operator may either miss subtle changes or may over-interpret changes that are not related to pancreatitis), the quality of the equipment (i.e., resolution is generally better with more expensive equipment).”

This is very similar to human medicine and such a frustrating aspect. The expertise of the person doing the ultrasound makes a big difference in making the correct calls regarding possible diagnosis.

With that being said, best case scenario, it was done well and the spec fPLI lines up with the ultrasound result and there is no pancreas involvement or there may be some mild issue that is flying under the radar of the spec fPLI and ultrasound which wouldn’t be unusual.
 
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Tomlin said:
It can be of some help but unfortunately it does not rule it out or provide a definitive diagnosis. As per Dr Steiner:

“......abdominal ultrasound can be associated with both an under-diagnosis and an over-diagnosis of pancreatitis in dogs and cats, depending on the severity of the disease (i.e., mild cases of pancreatitis may not be associated with ultrasonographic changes), operator skills (i.e., an inexperienced operator may either miss subtle changes or may over-interpret changes that are not related to pancreatitis), the quality of the equipment (i.e., resolution is generally better with more expensive equipment).”

This is very similar to human medicine and such a frustrating aspect. The expertise of the person doing the ultrasound makes a big difference in making the correct calls regarding possible diagnosis.

With that being said, best case scenario, it was done well and the spec fPLI lines up with the ultrasound result and there is no pancreas involvement or there may be some mild issue that is flying under the radar of the spec fPLI and ultrasound which wouldn’t be unusual.
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Thank you, Amy! Now if only I could get a vet to give us a bupe prescription...
 
Tomlin said:
Your vet won’t give it to you?
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Not the IM at AMC the first time I asked. She hasn’t responded to my second request sending her the photo of Ruby looking miserable, but I called the IM dept today and she’s out sick. Called and left a message for my primary vet, who is a softie, so he might give it to me.
 
Got the script for gabapentin! Talked to the IM, and she said that if Ruby is not feeling well in a few days after trying the gaba then we should go forward with an upper GI endoscopy.
 
Summer and Susie said:
Ruby's numbers are great, Katherine. I just wish she felt better. I know this is so hard on you. Keeping my fingers crossed that it is nothing serious.
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Thank you so much, Summer. I feel like I am trying to steer a runaway train. It's hard for me to watch her suffer and I'm doing everything I can to make sure I can minimize that with the tools at my disposal. That's all I can do.
 
PerfumedCatMom said:
Thank you so much, Summer. I feel like I am trying to steer a runaway train. It's hard for me to watch her suffer and I'm doing everything I can to make sure I can minimize that with the tools at my disposal. That's all I can do.
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I know you are doing everything you can. I am always at a loss for words in these situations. Just know that Ruby and you are in my prayers and I hope you get some answers soon.
 
I'm glad you got your hands on some pain relief meds, even if it's not bupe. I hope it helps Miss Ruby.

Paws crossed for continued greens. The case Carla mentioned was quite unusual. Trixie was on something over 2 units when Amy stopped insulin "temporarily". Ruby's pancreas looks like it's already been sputtering for a while. :D
 
Hi Kathetine, checking in on Ruby girl. I feel just terrible that she's in pain, I pray the gaba helps and the doctors can figure out what's wrong.
Beautiful greens though, I just want her to feel better.♥:bighug::bighug::bighug:
 
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