92 PMPS - need advice

Suzanne & Darcy said:
That message from above is from last night (didn’t push send because I hadn’t actually finished the message.).

Now for this morning, for now, with those nice greens last night, I would hold the dose a few more days (which you were already going to do because of Thursday being your next day off.) We can then see if it was just a fluke of a new pattern that will hold. His AMPS this morning is great! Love the blue.
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Thank you! I was surprised (but happy) to see some lower numbers. I will continue with his current dose and get as many tests as I can.
 
Hello. I was just thinking about y’all yesterday. I am glad you posted. I think there is a bit of a difference. There are less yellows during the daytime cycles. I can see that. This dose has been held a long time. I think you should go ahead to 4.25 when you have a day where you will be home or when you can come home mid-cycle to grab a test. How did it go with the automatic feeder?
 
How is Biddy otherwise? Is he eating well? How’s hospice activity level? Is he doing the normal things that he likes to do? Litter box activity normal?
 
Suzanne & Darcy said:
Hello. I was just thinking about y’all yesterday. I am glad you posted. I think there is a bit of a difference. There are less yellows during the daytime cycles. I can see that. This dose has been held a long time. I think you should go ahead to 4.25 when you have a day where you will be home or when you can come home mid-cycle to grab a test. How did it go with the automatic feeder?
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That sounds good to me! I have tomorrow off so I will increase to 4.25 in the morning
 
@Suzanne & Darcy hello! I just wanted to check in and see how we've been looking. I am seeing some lower numbers, maybe I should give it more time? He is doing incredibly well at home. We are rechecking ALT tomorrow so fingers crossed that has continued to improve as well!
 
@Suzanne & Darcy would you mind taking a look out our spreadsheet when you have a moment? I think things are looking good but I know I tend to hold doses too long sometimes. Also we rechecked his ALT and it is exactly where it was last month. No improvement, but I'll take stable at this point!
 
How’s it going with the attempt to decrease the dry food? That’s disappointing about the ALT, but maybe it’s just too soon to see changes? I see some positive changes in the spreadsheet numbers. You are getting some green nadirs. Is there any difference in what he eats on certain days when the numbers are higher or lower? Because of the green nadirs and the food adjustments, I would not increase his dose at this time.

Also, under the SLGS dosing method, he would have already earned a reduction for dropping under 90. You and I both know that a reduction— the way things stand now — would not be in Biddy’s best interest when he’s seeing improvements and having safe green nadirs on this dose. So, could you please just add after SLGS the words “reductions at 70” or reductions at 60 — it depends on what you want your reduction point to be. You can choose. 50 and above is okay. We just don’t want to see 40s while on insulin and definitely not 30s. Non-diabetic cats do have BG in the 40s but that’s not the same because they don’t have insulin working to lower BG further and cause a symptomatic hypo.

If you want to follow MPM reductions are taken for drops below 50, but that’s too can be customized.
 
Suzanne & Darcy said:
How’s it going with the attempt to decrease the dry food? That’s disappointing about the ALT, but maybe it’s just too soon to see changes? I see some positive changes in the spreadsheet numbers. You are getting some green nadirs. Is there any difference in what he eats on certain days when the numbers are higher or lower? Because of the green nadirs and the food adjustments, I would not increase his dose at this time.

Also, under the SLGS dosing method, he would have already earned a reduction for dropping under 90. You and I both know that a reduction— the way things stand now — would not be in Biddy’s best interest when he’s seeing improvements and having safe green nadirs on this dose. So, could you please just add after SLGS the words “reductions at 70” or reductions at 60 — it depends on what you want your reduction point to be. You can choose. 50 and above is okay. We just don’t want to see 40s while on insulin and definitely not 30s. Non-diabetic cats do have BG in the 40s but that’s not the same because they don’t have insulin working to lower BG further and cause a symptomatic hypo.

If you want to follow MPM reductions are taken for drops below 50, but that’s too can be customized.
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I really haven't seen much difference depending on his food but he has a fairly strict feeding schedule. He's been getting 1/8 can z/d and 1/8 cup dry HP at 6am(AMPS), 1/4 can z/d at 1pm(+7), 1/8 can z/d and 1/8 cup dry HP at 6pm(PMPS), 1/8 cup dry HP at 8pm(+2) and another 1/8 cup dry HP at 1am(+7) to prevent vomiting. He's been doing so well that I have been reluctant to change his routine but he is up to 18 pounds and I would like him to get more wet food.

I would like to learn more about MPM but I was under the impression I would need to be available to test more often than I can. There are 3 days a week I can only get one midcycle test during the day.
 
I wish he didn’t have to eat that high carb dry food. But, it is what it is if that’s what he has to have. What is HP? Regarding MPM, I forgot….. Biddy can’t really follow MPM because of the dry food. It’s probably not a good fit for your schedule anyway. We can customize the reduction point for SLGS for him though. We will just hold the doses for 7 days (or longer like we are doing now because he’s seeing green.) Having said all that…. I am actually pleased with his progress and numbers considering all the obstacles to regulation like ultra high carb food and Prednisolone. I think he must be in a much healthier place than he was not so long ago.

Other than symptoms like vomiting or diarrhea, how are you going to assess how he’s doing with the triaditis? Will he have an ultrasound after a certain period of time? I’ve got an upcoming appointment for a re-check ultrasound for one of my IBD boys soon…. next week, I think.
 
Suzanne & Darcy said:
I wish he didn’t have to eat that high carb dry food. But, it is what it is if that’s what he has to have. What is HP? Regarding MPM, I forgot….. Biddy can’t really follow MPM because of the dry food. It’s probably not a good fit for your schedule anyway. We can customize the reduction point for SLGS for him though. We will just hold the doses for 7 days (or longer like we are doing now because he’s seeing green.) Having said all that…. I am actually pleased with his progress and numbers considering all the obstacles to regulation like ultra high carb food and Prednisolone. I think he must be in a much healthier place than he was not so long ago.

Other than symptoms like vomiting or diarrhea, how are you going to assess how he’s doing with the triaditis? Will he have an ultrasound after a certain period of time? I’ve got an upcoming appointment for a re-check ultrasound for one of my IBD boys soon…. next week, I think.
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The plan is to recheck an ultrasound in the fall but I’ll have to double check with the doc since it isn’t in his record. I think she also wants to recheck a Texas A&M GI panel. I hope your boy’s ultrasound goes well!
 
Lane&Biddy said:
The plan is to recheck an ultrasound in the fall but I’ll have to double check with the doc since it isn’t in his record. I think she also wants to recheck a Texas A&M GI panel. I hope your boy’s ultrasound goes well!
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Thanks. I always get a little bit nervous about it— about the inflammation being under control. Last ultrasound was good and we have been able to reduce his pred dose to 1/2 tablet (2.5 mg) EOD for a year or so now. He’s a funny cat. He doesn’t vomit, but he frequently regurgitates a small amount of food shortly after eating. Of course, it’s in the morning when he has a small amount of food with his Visbiome. He seems to be doing okay overall though.

Now my other IBD boy is another story. I have finally gotten him to a pred schedule of 5 mg. one day and 2.5 mg. the next. He has vomited a couple of times though. :( since I started doing that… but not every day. He’s definitely like Biddy in that he must eat several times per day or he will vomit if he gets too hungry.
 
I retested 30 minutes later and got 98. I gave him 4 units, I hope I did the right thing. I’ll be watching like a hawk tonight.
 
Lane&Biddy said:
I retested 30 minutes later and got 98. I gave him 4 units, I hope I did the right thing. I’ll be watching like a hawk tonight.
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Oh boy. He is doing sooo well on this dose. But please let me know how it goes because I am also a little nervous. It’s been two hours since you posted this, and I am wondering how he is doing.
 
Lane&Biddy said:
Did I give him too much? What should I do for tomorrow? I’ll be home all day with him
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Not necessarily. It’s only that we don’t have data on this. Tonight is a very good opportunity to see how he does on 4 units with the green preshot. It’s all good as long as you are with him to monitor the cycle. I didn’t mean to spook you… only just to convey that I was kind of excited and waiting to see how Biddy does tonight. So far everything looks good and I know how vigilant you are, so I am not worried.
 
Suzanne & Darcy said:
Not necessarily. It’s only that we don’t have data on this. Tonight is a very good opportunity to see how he does on 4 units with the green preshot. It’s all good as long as you are with him to monitor the cycle. I didn’t mean to spook you… only just to convey that I was kind of excited and waiting to see how Biddy does tonight. So far everything looks good and I know how vigilant you are, so I am not worried.
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He did good last night. Should I have given the full dose? I gave him 4.25 this morning. What PS number would I reduce his shot and by how much?
 
Well… it looks like you could have given the full dose, bit that is with hindsight we can see that. With a green preshot like that it’s important to note if he has been stable during the cycle (which he was) before shooting the full dose. If his numbers had been trending downward all day toward PMPS (as sometimes happens when a bounce is clearing) I would consider a reduced shot. If the numbers appear to be stable or rising then I would feel more confident giving the full dose.
 
You even verified that his numbers were stable and possibly on the rise last night by stalling and retesting in 30 minutes, which was the right thing to do. You will be able to use the information to help with future dosing decisions. :)
 
@Suzanne & Darcy it has been about a week since changing Biddy's food. We've been seeing slightly higher numbers this week. A few stressful things have gone on (scary maintenance workers, missing a meal and such) along with the diet change so I'm not sure if those could be factors. Overall he is doing great at home and I can tell he is feeling good!
 
It’s great to hear he’s feeling so well! That’s what we want most of all. His numbers don’t look too bad. Maybe they will smooth out a bit? Are you happy with them? So the food switch means no more dry food? Or did you try a completely new
wet food?

I wish I could find a new food for my IBD boy. He’s started vomiting some again (a week or so after I reduced his Pred. dose down just a small amount.) I am looking at a few Instinct foods, but they all contain peas and my vet cardiologist warned me against peas (not that Marcus has heart disease because he does not.) I have come to the conclusion that there is no perfect food so I am going to have to try something.
 
Suzanne & Darcy said:
It’s great to hear he’s feeling so well! That’s what we want most of all. His numbers don’t look too bad. Maybe they will smooth out a bit? Are you happy with them? So the food switch means no more dry food? Or did you try a completely new
wet food?

I wish I could find a new food for my IBD boy. He’s started vomiting some again (a week or so after I reduced his Pred. dose down just a small amount.) I am looking at a few Instinct foods, but they all contain peas and my vet cardiologist warned me against peas (not that Marcus has heart disease because he does not.) I have come to the conclusion that there is no perfect food so I am going to have to try something.
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I know, I'm not crazy about feeding z/d but he's actually doing really well so I'm not going to be making any other changes. You'd think there would be more options for hydrolyzed protein by now... He still gets a spoonful or so of dry food while I do his shot. It's the only thing that distracts him long enough for me to poke him. That being said, I think I am happy with how things are going for him.

Did your boy get his ultrasound done this week?
 
Suzanne & Darcy said:
I agree. They seem to be trending up.
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Does it seem like the trend started when I changed is food routine? I had a funeral out of town on Saturday so he got Royal Canin Gastrointestinal Hydrolyzed Protein dry food for lunch in his automatic feeder and he had the lowest number since feeding less dry. Do cats ever actually do better on a slightly higher carb or dry food? I was expecting his numbers to go down not up! But if you think it is unrelated, I will increase to 4.5 tomorrow morning.
 
@Suzanne & Darcy Biddy's vet liked his numbers better at 4.25u so I have decreased per her recommendation but I am still hoping to hear what you think about his current dose/diet. Hope all is well with you.
 
Well, I think you will be able to see for yourself if it works or not. So far, I am not seeing a return of the greens (although I would be happy to see them.). Many cats have insulin requirements that change over time. Some bounce back and forth between doses as well.

we had a few greens early on with the 4.25 dose and then they went away.
 
Suzanne & Darcy said:
Well, I think you will be able to see for yourself if it works or not. So far, I am not seeing a return of the greens (although I would be happy to see them.). Many cats have insulin requirements that change over time. Some bounce back and forth between doses as well.

we had a few greens early on with the 4.25 dose and then they went away.
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I guess I'm just feeling frustrated (for multiple reasons). I was hopeful that we would be able to get him off the dry food altogether and getting blood from him has been tricky the past couple days. I just so badly want him to be doing well, and he is but I don't want to overlook anything. I was anticipating his number to continue to improve with increasing his wet food and raising his dose to 4.5u. I know I need to be patient but some days I have more patience than others lol.
 
Lane&Biddy said:
Currently, canned z/d is his main diet with just a bit of the dry Royal Canin Gastrointestinal Hydrolyzed Protein at shot time so he will sit still.
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Maybe I should feed that to my cat. He still eats like a horse…. But is down to 9 pounds now. He keeps losing weight :(
 
Lane&Biddy said:
Oh no! Did you get the ultrasound done? Hope it went well if so!
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No. I had an ultrasound done on a different cat last week. Fortunately, that one didn’t show any abnormalities.
I do think my IBD cat needs another ultrasound. I know he had one last September, but things have changed since then.
 
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