Blue AMPS 437 10/16

https://www.felinediabetes.com/FDMB/threads/blue-amps-402-10-12.236820/

Morning, Blue is doing okay. Happy to be home!
I'm going to call the vet for the BG readings since I haven't received them.

Also, Blue struggled to get his bandage off last night so I helped him. His paw was quite large and is still swollen this morning. I'm going to ask about that as well. Maybe normal from fluids?

I checked him this morning and he's 437 and that's 9 hours after the 66 reading last night. The 66 reading was 17 hours after the 1 unit dose. I'm trying to make sense of all this but in the meantime, I dosed him .5
(you knew I wouldn't listen to the vet)

 

I hope you and Blue have a better day

 

Patty, they should have told you to take it off when you got home. Another mistake on their part. I am glad you gave .5. I would also think about starting a second ss for your vets. I thought about that for myself when I started dosing myself for Max but didn’t have to because my vet is one of the rare great ones.

 

I thought I'd just list it on my SS?

 

Oh, I thought about something else. Would there be a huge difference in monitors? I can't understand why they thought Blue had good BG numbers on 1 unit yet when I tested him it was very low 66.
When they ran the average over the last 2 to 3 weeks he was very high.
Could my monitor be off? How would I know?

 

Hi Patty,

Been thinking about the two of you all day.

This is the reason why fructosamine tests are inferior as a monitoring tool compared to home testing. The fructosamine test result will have been influenced by Blue's bounces, but they give no visibility of how his numbers had started to improve in recent days as you got him to a more effective dose.

As I said last night, they haven't told you what they consider to be 'good' numbers. I worry about this, because you do know that they think it's no biggie for a cat to be in the 600s (pet meter) at the end of their preferred 24-hour cycle.

In truth, I'm worried about all of what they're asking you to do.


Mogs
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PS: If the problem lies anywhere, I don't think it's with your glucometer, Patty. That said, I believe that if you contact customer services for the Relion meter they will send you out a free bottle of control solution with which to check it. (I've often seen the tip not to tell them that you're using the meter to test a cat!)


Mogs
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That is correct, Mogs. I got one once. Don’t specify that you are testing a cat though.

 

I didn’t realize I could do that. Great news. I’ll call and ask today.

 

I'm also worried that your vets don't seem to have possible remission as a treatment goal.


Mogs
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Patty, I meant to ask you last night about how Blue's doing on the URI front. Is he better, and did the vets say anything about it?


Mogs
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Is that why he’s on amoxicillin?

 

I’m worried about that as well.
I hate saying this because it has upset me. He hasn’t said this in so many words... but, I feel that he thinks Blue is too old. Maybe he’s treating him differently because of his age...he keeps asking “how old is Blue”? He’s asked every time I’ve talked to him. Also, yesterday when I was checking in at eye dr and didn’t have time to talk he said “well, maybe we can keep him going a little longer”. What? I don’t know but I am disturbed and disappointed in him. He has treated Blue all his life and now I feel he’s just giving up on him. I think Dr Bruno has gotten callous in his old age. It’s upsetting and I didn’t need that on top of everything else.

 

I thought he was on it for pancreatitis.

paperwork says give for 2 weeks for pancreatitis

 

He seems okay for now but it shows up every few days. It’s not consistent but occasionally he blows snot (sorry that sounds gross) out of one nostril. Always the left side.

 

Another thing...the curve testing and the statement he made about 1 unit lasting Blue 18 hours, how would he know that if they didn’t test overnight? I tested on a whim last night and it was 66. Scared me that he was that low.

 

Max was never given an antibiotic for pancreatitis. It’s not the standard approach. Have you had a chance to read the IDEXX article on pancreatitis? It might help you understand it a little better. I say maybe because so many vets don’t.

 

Makes me wonder how low he went on 1 unit and thinking that’s why they said to give it once a day. Lots of questions for them. Did they give any at night?

 

None at night. Only 1 unit at 7 a.m.

I guess it seems to work for 18 + hours if he tested that low but do I want him that low. That's another reason I questioned the meter because they use a different one. I don't know if I'm comparing apples to apples.

 

IDEXX are a world authority on feline pancreatitis. From their treatment guidelines:

Antibiotic therapy

Pancreatitis is usually a sterile process in cats and antibiotics are rarely indicated. Indications for their use include sepsis (may result from bacterial translocation from the gastrointestinal tract), bacterial peritonitis, other infections (e.g., urinary tract infection), and possibly in cases with a suppurative cholangiohepatitis where a suppurative pancreatitis is suspected. Although, there may not be grounds for using antibiotics, there may be a rationale for not using them since some antibiotics can cause nausea and vomiting in cats.​

That's a very good point, Patty. Also, it's one thing for a kitty to be running at 66 when closely monitored and with tracking of dose response, another thing altogether to have it that low unsupervised and with little or no history of how it responds to a different dose.


Mogs
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Apparently they tried to give 0.5IU BID first, weren't happy with that (can't remember the specifics of why not - Patty, can you remember what they said?). They then came up with the cunning plan to give 1.0IU q24h.


Mogs
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You are not alone Patty that is upsetting ME! WTH is he thinking. He sounds jaded like its a pain to treat these animals. sigh I hate to say it but maybe you should shop around. Just to see wh'os out there.

 

I’m not sure why they treated him with antibiotics and I didn’t question it at the time.
I did read through it earlier today and have questions. I remember him saying he suspects pancreatitis. I don’t believe he sent anything out to confirm this. I’ve never questioned his treatment plan before but now I am. $1,000 for a suspect diagnosis?

 

On the Next Door app there was a recent request for a good vet in the area so I’ll look back at that for a list.

 

He did do the in house Snap test for pancreatitis. It’s gives a positive or negative. The SpecfPL which is sent out gives a number. It only matters if in the gray area where the Snap would come out negative. He got a positive it looks like. The number does not necessarily correlate with how bad a case. His has to have been mild to recover so quickly.

 

Mogs, I think they were following what I was giving and he didn’t like it. I actually think that’s what he wanted to do all along so he did it. I told him specifically what I was doing and sent the SS. Just like the other dr., he completely ignored my treatment plan. Dr. Johnson gave 2 units if you remember and I had to miss a dose that evening. That was early on after diagnosis.

 

I noticed it also said “entered manually” which I wondered about.

 

I remember the initial dose too well. The fact that Blue is doing well after treatment makes your vet writing him off as too old even stranger. Jayla’s diabetic lived to be 21 or22 and he was a bouncer the whole time. He also had many other issues.

 

Good point that I missed. What does that mean? Now I wonder if it was negative and he thought possibly gray area. And why amoxicillin? Is the uri gone? He doesn’t mention the antibiotic for that though. It’s very confusing to figure out his thinking.

 

I think I need to probably look around for someone to help manage Blue. I hate questioning the treatment plan but I have so many issues with how the entire last couple of months have gone. I guess what I really am looking for is supportive care and guidance...but not telling me what to do without a good reason for it. I disagree with not testing. I would worry constantly.

 

Blue hasn’t been sneezing but I hesitate to say the URI is gone.

 

Or he caught a cold at the vet

 

Anti-jinx.

 

ugh I read that wrong... my apologies! I read he HAS been sneezing.

 

yes but he’s had it off and on for a while now. He's been on an antibiotic and antiviral. A few days ago he started sneezing stuff again. I'm hoping the current antibiotic will help.

 

I hope so too!

 

I haven't tested again until now. He's at 130 +5 and I gave him .5 this morning. I think 1 unit is too much.

 

I agree. I think amoxicillin makes sense for the uri possibly but it was given for pancreatitis which doesn’t. I hope it clears up the uri once and for all. The blood tests did show a virus possibly I think.

 

I think he was a little dehydrated as well, but did he need to be hospitalized for that?

 

This is awful!!!

When Saoirse started displaying FD symptoms (shortly after she turned fourteen) I knew there was something wrong so I took her to the vets we were registered with at the time. Saoirse was constantly hungry, quite lethargic, her coat was a mess, plus she was drinking like a fish and peeing for Ireland. I told the vet that Saoirse had started drinking over half a litre of water a day and I asked her how much water a cat Saoirse's size on a dry diet should be drinking. She mumbled something vacuous in response. (I now realise that she didn't actually know.)

The vet in question could not offer any suggestions as to what might be wrong with Saoirse. I asked for a diagnostic work-up and she POINT BLANK REFUSED to perform any tests. She then said that Saoirse's clinical signs were "perfectly normal" for a cat her age, she issued a Dx of "old lady" who had "had a good innings", gave Saoirse a steroid jab (for her overgroomed tummy - see below) and packed us out the door. (Direct quotes, no word of a lie here, no exaggeration for effect.)

I started accurately measuring how much Saoirse was drinking. I found FDMB. I learned. I booked another appointment (different vet, same practice). By the time we attended the second consult 2 weeks later Saoirse was drinking over 1½ litres of water a day, was so hungry that she would paw at my eyelids to wake me to feed her, and - by the time it was finally tested - her blood glucose levels were too high to register on the meter. Thankfully I'd brought a urine sample with me to the consult. It proved to be rotten with glucose so they had enough to give a preliminary Dx of diabetes and she got her first dose of insulin that evening. Two days later an ultrasound revealed inflammation of the pancreas.

I am so grateful that Saoirse didn't start throwing ketones during that fortnight. I am so grateful I found FDMB.

The first vet completely failed to recognise the diabetes symptoms. She also made a unilateral decision that Saoirse was not worth treating because of her age.

For a couple of years prior to receiving her FD Dx, Saoirse had been overgrooming her tummy. Needless to say, I took her to the vets several times to see what was wrong. Again, she was given a steroid jab (something which seems to be a default treatment by that practice).

The vets who saw Saoirse attributed the overgrooming to stress because she was an indoor cat and most likely doing it because she was bored.

Shortly after Saoirse started treatment with insulin and switched to a wet, low carb diet the overgrooming stopped and all the fur on her tummy grew back. Abdominal discomfort had been the cause, not "boredom". They failed her. They failed her for years.

They prescribed an ultra-high carb diet for her, told me not to "waste my money" on buying a glucometer, that home BG testing was "unnecessary" and "would stress her out and destroy [our] relationship", told me sod all about DKA and told me not to bother with urine ketone testing, just watch her water consumption.

They told me to only feed Saoirse twice a day before giving insulin. Within 72 hours Saoirse was having bouts of vomiting and yowling with pain from the vet-dictated protracted fasting. I called the practice to tell them that I needed to change Saoirse's feeding schedule. The response I got from the person I spoke to was: "She's just going to have to get used to it. She's had it her own way for too long." Seriously. They said that to me.

I changed Saoirse's feeding to mini meals as best I could. I told the vets that I was not going to stick to a feeding schedule that hurt my cat.

I found another vet.

At our current practice, our vets routinely consult with external specialists if a case requires additional support. Just after we moved to the practice, and while Saoirse was still on Caninsulin and w/d uber-HC dry food, our main vet asked an FD specialist to look at Saoirse's BG data. The external specialist pronounced Saoirse "a true diabetic" with "no hope of achieving remission."

I started home testing. I started feeding Saoirse a low carb food. I gathered BG data to prove that Caninsulin wasn't working well and pushed for her to be treated with Lantus. Saoirse became tightly regulated within a couple of months of treatment with Lantus.

Saoirse became a diet-controlled diabetic after three months of treatment with Lantus, six months' insulin treatment in total. So much for the "old lady" who'd "had a good innings" and who had "no hope of achieving remission."

I've shared Saoirse's story because I wanted to give a real-world example of what's possible, not what one may be told. FD is eminently treatable. I wish Lúnasa's labs were as good as Blue's.

I could crown your vet for what he's been saying to you. (I didn't take kindly to someone trying to write my girl off. And you've seen a picture of what she looked like just 4 short months after that first vet essentially refused to treat her.)

(((Patty)))


Mogs
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Depends how dehydrated. If sub-q would have been enough then no. I think he wanted a crack at the diabetes. Max had chronic pancreatitis for years and was only hospitalized a couple times only over night. The last time it wasn’t his problem. Turned out it was CHF.

 

Getting better at that!




Mogs
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General fluid therapy is a very helpful treatment for pancreatitis. (See the link to the IDEXX guidelines above for more info - it's a really, really valuable resource.)


Mogs
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I'm sorry. I love you told me this story. Sounds very familiar. She was beautiful and didn't look very old.

I think sub Q would have sufficed as well and I can do that.
I don't no what to think about all this but I'm in agreement he wanted him for the diabetes and to do it his way.

I have company and preparing dinner so will check back off and on.

I knew I was in the right place with people that have been through this process.

 

Enjoy your company and that Blue is feeling good.

 

Ooh, I hope you have a lovely evening, Patty!

for you, and lots of scritches for the Bluebird.


Mogs
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I'm back. I'm curious about Blue’s BG but waiting til PMPS and he seems to feel pretty good. He's tired but that's normal after being away from home. I think the swelling in his paw is down but still larger than his other. I'll post his BG later.
Mogs I'm hoping you're getting some rest.
Elise , you know what I'll be doing
Hey Jeanne...

 

hey there Patty I have to start dinner so wont be around much (not that I'm any real help lol)

 

You are a help! You calm me down. Sometimes that’s extremely important.

 

Yep.The Dodgers have imploded yet again.

 

Elise, the other night when they were killing us I saw how good they are. We are underestimated though. Our offense is strong but we lost one of our starting pitchers at the beginning of the season. We are starting a guy tonight that is a reliever!
Good luck! Enjoy the game. I'll test Blue in a bit and post.

 

It will be interesting to see his results.

 

He's at 388 PMPS and I gave .5
I didn't think 388 was that bad. What are your thoughts?

 

It’s not bad at all. I’d get a +2 or around then to see if he comes down much to start. Enjoy the game. I’ll check back when you post.

 

Oh well, 489 +2

 

It’s ok. To be expected. Hoping for a game tomorrow.

 

Looks like that is going to happen