Bronx's hypo & arthritis thread

Discussion in 'Lantus / Basaglar (glargine) and Levemir (detemir)' started by Bronx's dad (GA), Mar 18, 2019.

  1. Tom & Thomas (GA)

    Tom & Thomas (GA) Member

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  2. Gill & George

    Gill & George Well-Known Member

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    Hey Paul I am so sorry about the hypo, how scary, and sorry that Bronx is in so much pain when moving.

    We used Meloxidyl , here in europe we have a cat version as they do in Austraila which contains 0.5mg per ml(just looked at the vial I have), as @Bron and Sheba mentioned it's a lower concentration than the dog version, regardless though, the injection is only meant to be given once as a loading dose and then follow up with an oral dose, which is calculated by weight. George at 6kg was put on 0.6ml of meloxidyl for his mouth pain, as the inflammation subsided as the AB took effect we kept him on 0.3ml as a maintenance dose until his mouth was healed up after all his extractions, was on it for about a month, we saw no problems with his kidney values worsening, but he did have a squidgy poo, combined effect of the meloxidyl and AB though. I saw an immediate and significant improvement in his mouth pain after the one injection, and was able to manage the pain thereafter with the oral dose.
    Additionally when I was researching Metacam I found that multiple injectable doses are not recommended in cats. See the US manufacturers recommendations below.
    https://www.metacam.com/docs/BIVM-15129MetacamInjectableCATPI_SignOfffnl.pdf

    Multiple injections increase the risk of kidney problems and here in Europe multiple injections of meloxidyl are not recommended by the manufacturer either. In cats a single injection followed by an oral dose for post op pain.
    And for arthritis an oral loading dose followed by a maintenace dose
    See below (taken from the EU info on the product https://ec.europa.eu/health/documents/community-register/2016/20161003136044/anx_136044_en.pdf the pdf is long as it includes all the various forms of metacam available, including that for dogs, cows etc)
    1. NAME OF THE VETERINARY MEDICINAL PRODUCT
    Meloxidyl 0.5 mg/ml oral suspension for cats
    2. QUALITATIVE AND QUANTITATIVE COMPOSITION
    One ml of Meloxidyl 0.5 mg/ml oral suspension for cats contains: Active substance: Meloxicam 0.5 mg Excipient: Sodium benzoate (E 211) 2.0 mg For a full list of excipients, see section 6.1.
    3. PHARMACEUTICAL FORM Oral suspension. Pale yellow suspension. 4. CLINICAL PARTICULARS

    • 4.1 Target species Cats.
    • 4.2 Indications for use, specifying the target species Alleviation of mild to moderate post-operative pain and inflammation following surgical procedures in cats, e.g. orthopaedic and soft tissue surgery. Alleviation of pain and inflammation in chronic musculo-skeletal disorders in cats.
    • 4.3 Contraindications - Do not use in pregnant or lactating animals. - Do not use in cats suffering from gastrointestinal disorders such as irritation and haemorrhage, impaired hepatic, cardiac or renal function and haemorrhagic disorders. - Do not use in case of hypersensitivity to the active substance or to any of the excipients. - Do not use in cats less than 6 weeks of age.
    • 4.4 Special warnings None.
    • 4.5 Special precautions for use Special precautions for use in animals If adverse reactions occur, treatment should be discontinued and the advice of a veterinarian should be sought. 18 Avoid use in any dehydrated, hypovolaemic or hypotensive animal, as there is a potential risk of renal toxicity. Post-operative pain and inflammation following surgical procedures: In case additional pain relief is required, multimodal pain therapy should be considered. Chronic musculoskeletal disorders: Response to long-term therapy should be monitored at regular intervals by a veterinary surgeon. Special precautions to be taken by the person administering the veterinary medicinal product to animals People with known hypersensitivity to Non Steroidal Anti-Inflammatory Drugs (NSAIDs) should avoid contact with the veterinary medicinal product. In case of accidental ingestion, seek medical advice immediately and show the package leaflet or the label to the physician.
    • 4.6 Adverse reactions (frequency and seriousness) Typical adverse reactions of NSAIDs such as loss of appetite, vomiting, diarrhoea, faecal occult blood, apathy and renal failure have occasionally been reported. These side effects are in most cases transient and disappear following termination of the treatment but in very rare cases may be serious or fatal.
    • 4.7 Use during pregnancy, lactation or lay The safety of the veterinary medicinal product has not been established during pregnancy and lactation (See section 4.3).
    • 4.8 Interaction with other medicinal products and other forms of interaction Other NSAIDs, diuretics, anticoagulants, aminoglycoside antibiotics and substances with high protein binding may compete for binding and thus lead to toxic effects. Meloxidyl must not be administered in conjunction with other NSAIDs or glucocorticosteroids. Concurrent administration of potential nephrotoxic drugs should be avoided. Pre-treatment with anti-inflammatory substances may result in additional or increased adverse effects and accordingly a treatment-free period with such drugs should be observed for at least 24 hours before commencement of treatment. The treatment-free period, however, should take into account the pharmacological properties of the products used previously.
    • 4.9 Amounts to be administered and administration route Dosage Post-operative pain and inflammation following surgical procedures: After initial treatment with meloxicam 2 mg/ml solution for injection for cats, continue treatment 24 hours later with Meloxidyl 0.5 mg/ml oral suspension for cats at a dosage of 0.05 mg meloxicam/kg bodyweight. The oral follow-up dose may be administered once daily (at 24 hour intervals) for up to four days.
    • Chronic musculo-skeletal disorders: Initial treatment is a single oral dose of 0.1 mg meloxicam/kg body weight on the first day. Treatment is to be continued once daily by oral administration (at 24-hour intervals) at a maintenance dose of 0.05 mg meloxicam/kg body weight.
    • 19 Particular care should be taken with regard to the accuracy of dosing. The recommended dose should not be exceeded. A clinical response is normally seen within 7 days. Treatment should be discontinued after 14 days at the latest if no clinical improvement is apparent. Route and method of administration Shake well before use. To be administered orally either mixed with food or directly into the mouth. The suspension can be given using the measuring syringe provided in the package. The syringe fits onto the bottle and has a kg-body weight scale (from 1 kg to 10 kg) which corresponds to the maintenance dose. Thus for initiation of the therapy on the first day, twice the maintenance volume will be required. Avoid introduction of contamination during use.
    • 4.10 Overdose (symptoms, emergency procedures, antidotes), if necessary Meloxicam has a narrow therapeutic safety margin in cats and clinical signs of overdose may be seen at relatively small overdose levels. In case of overdose, adverse reactions, as listed in Section 4.6, are expected to be more severe and more frequent. In the case of overdose symptomatic treatment should be initiated.
    NB the european dosing is per kg (1kg=2.204 pounds)




    My vet has said to me that he manages numerous cat's with arthritis on small maintenance doses of meloxidyl. We have talked about it as a possibility for George but I'm exploring other avenues at the moment as it gave him very squidgy poo.

    As far as I understand in us the oral product is more concentrated (twice as much metacam per ml) and as such you would need to calculate the appropriate dose for a cat. If you use the syringes available with the product which have a weight scale on them you would effectively end up giving Bronx twice the recommended dose. Hope that makes sense.
     
  3. Tom & Thomas (GA)

    Tom & Thomas (GA) Member

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    In the US, you won't find meloxicam packaged for feline use, and whatever you get will have the warnings about use in cats.

    The concentration of the drug will vary between different packagings/brands of the oral suspension, e.g. 0.5mg/ml vs 1.5mg/ml. You want to be administering 0.05mg/kg. I did the arithmetic to be sure, and for the product I use this does work out to half the canine dose.
     
    Last edited: Mar 24, 2019
    Reason for edit: Edited to correct size of maintenance dose.
  4. Krystina & Nelli

    Krystina & Nelli Well-Known Member

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    Paul, I have thought (too) about his QOL. Most recently today. I was going to ask you if you think Bronx is happy
    .
    If I were you (I'm not)... IMHO I would try acupuncture. I’m sure in your area you might be able to find a good acupuncturist :bighug:.
    If so, GABA could be potentially reduced?
     
    Last edited: Mar 24, 2019
  5. Krystina & Nelli

    Krystina & Nelli Well-Known Member

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    He looks happy and comfortable :bighug:
    :bighug: :cat: :bighug:
     
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  6. Krystina & Nelli

    Krystina & Nelli Well-Known Member

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    Did nothing for Nelli. I tried, rearched hopingto find a good source. Three different brands sit, now unused, in her cabinet. Ended up being a waste of money... that’s ok though, Nelli is worth it :cat: :bighug:
     
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  7. Krystina & Nelli

    Krystina & Nelli Well-Known Member

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    :)... :bighug:
     
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  8. Krystina & Nelli

    Krystina & Nelli Well-Known Member

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    Constipation
    I have read, re-read- (so much info to consume) felineconstipation.org. I’m sure you have too :facepalm:.
    I bought a 40lb bag! of the (real, pure) beet pulp fiber (omg, soooo much- I’ll send you a bag of :)) Found it at our Feed store- horse owner peeps mix it in with the hay, always for older horses.
    upload_2019-3-24_13-47-42.jpeg upload_2019-3-24_13-50-18.jpeg upload_2019-3-24_13-51-16.jpeg
    ALSO, I bought his... started out with tiny 1/8 tsp in Nelli Darwin. She never turned her nose up- walked away. Days later now we are up to 1/4 tsp in two meals a day.
    Last but (unfortunately) not least, Nelli was given a motility script. As you know I try if at all possible to avoid chemical rx. This is a temporary drug for Nelli. Goal is to wean offthis as pumpkin and BPF (Fiber is termed a prebiotic because it feeds the probiotics) gets back healthy... gut bacteria :)
    She hadn’t pooped in (- outside most often, hard to monitor)... FOUR days- at least :(
    After 3rd dose, next morning pooped and pooped a good one :bighug:
     

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    Last edited: Mar 24, 2019
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  9. Krystina & Nelli

    Krystina & Nelli Well-Known Member

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    BUPE
    @Bronx's dad ... Paul, I had NO IDEA how much arthritic pain Nelli was in until given an rx for Bupe after her recent (remove the maggots surgery :woot: :eek:). A game changer? Wendy’s statement cannot be more exact.
    Although Nelli and Bronx have different arthritic issues and potential degrees of... Nelli is 20ish years old.
    Her little joints are tired. She has degenerative joint disease in spine, back legs and in front. If you try this route again, consider yourself lucky (?) to get a script. It has been almost impossible for me in county (extreme opioid abuse problem :() I live-
     
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  10. Krystina & Nelli

    Krystina & Nelli Well-Known Member

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    @Gill & George ... you are awesome :bighug:
     
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  11. Krystina & Nelli

    Krystina & Nelli Well-Known Member

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    oooops! @Bronx's dad forgot to attach Motility drug...
    upload_2019-3-24_14-48-45.jpeg
     
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  12. Bronx's dad (GA)

    Bronx's dad (GA) Well-Known Member

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    Thanks! I will ask my vet about this. She said injections only done by her starting with once a week and then stretching it out. I may have to go to an IM to get a script for this oral Metacam. My IM is good and will probably allow me to use it as long as I keep getting BW to see how the kidneys react.
     
  13. Bronx's dad (GA)

    Bronx's dad (GA) Well-Known Member

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    Thanks for this great info!
     
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  14. Bronx's dad (GA)

    Bronx's dad (GA) Well-Known Member

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    I do have Bupe but worry about it adding to his constipation issues. He hasn't had a real poop now in like 5 days o_O
     
  15. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    @Gill & George
    Sheba had no issues with her bowels with the metacam
     
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  16. Krystina & Nelli

    Krystina & Nelli Well-Known Member

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    :confused: :(
     
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  17. Bronx's dad (GA)

    Bronx's dad (GA) Well-Known Member

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  18. Bronx's dad (GA)

    Bronx's dad (GA) Well-Known Member

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    :woot:
     
  19. Bobbie And Bubba

    Bobbie And Bubba Well-Known Member

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    Hey Paul. I have used acupuncture on both my boy, Bubba and Forrest. When Bubba had his yeast infection/ allergic food reaction and he was violently shaking his head, his thoracic was out as per my AC. It seemed to help him.

    Also, Forrest with his hind leg issue after he birthed a huge poop and his legs were splaying, I had the same vet acupuncturist do her magic on him. Prior to the visit, he could not do the basement stairs. I bought him home and within 10 minutes he was doing the stairs and was like a new cat!. He has had several sessions since. We need another one but she has been in Florida for a few months.
     
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  20. Bobbie And Bubba

    Bobbie And Bubba Well-Known Member

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    PS as long as Bronx doesn't have any kidney issues, why not try egg yolk powder, I get it from Foodfurlife.com. It helps with motility. Are you giving a regular constipation remedy?

    I agree with the bup and adding to constipation. Bubba suffers with it and the bup made it worse. But, ECID

    ETA : Also, are you giving him an Omega 3 oil? I give to my guys every day and I feel it helps big time with arthritis. If I remember correctly, I think you all ready are.
     
    Last edited: Mar 24, 2019
    Reason for edit: ETA
  21. Krystina & Nelli

    Krystina & Nelli Well-Known Member

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    Yehl, right!?!!
     
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  22. Krystina & Nelli

    Krystina & Nelli Well-Known Member

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    Amen, so very true- Bobbie :)
     
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  23. Krystina & Nelli

    Krystina & Nelli Well-Known Member

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    @Bronx's dad ... I think Bronx gets this? (Nelli too)- it’s good stuff!
     
  24. Krystina & Nelli

    Krystina & Nelli Well-Known Member

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    GREAT :bighug: :) :cat:!
     
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  25. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    The link @LizzieInTexas posted on the bottom of page 1 of this thread has the strength of Metacam we use in Australia in the 15 ml bottle from thriving pets. The dog strength of Metacam looks like it is 3 times stronger.....no wonder there has been problems with it in cats.
     
  26. Bellasmom

    Bellasmom Well-Known Member

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    I took meloxicam and it worked really well for me, not sure about animals, made pain a lot better
    Sending prayers and :bighug::bighug::bighug:
     
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  27. Krystina & Nelli

    Krystina & Nelli Well-Known Member

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    ”BP in am cycle finally!”
    Yeah! :cat: :) :bighug:
     
  28. Tom & Thomas (GA)

    Tom & Thomas (GA) Member

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    Oral suspensions of meloxicam can be found in 0.5 mg/ml and 1.5 mg/ml formulations. I see that in Europe and Australia the packaging is 1.5 mg/ml for dogs and 0.5 mg/ml for cats. But what's important is that the dose for a cat needs to be calculated on the basis of 0.05 mg/kg, possibly with an initial dose at 0.1 mg/kg.

    The higher concentration is actually more convenient because it's that much less liquid you have to get into the cat. Using the 1.5 mg/ml version, I only have to give Thos 0.2ml instead of the 0.6ml I would need with the less concentrated form.
     
    Last edited: Mar 24, 2019
    Reason for edit: Edits for clarity.
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  29. Bronx's dad (GA)

    Bronx's dad (GA) Well-Known Member

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    yes, he does
     
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  30. Bronx's dad (GA)

    Bronx's dad (GA) Well-Known Member

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    Hi Bobbie. Yep, he is on fish oil and egg yolk powder. Actually D-Mannose seems to help his poop issues so back to increasing that.
     
  31. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    @Tom & Thomas
    IMHO the problem with giving the higher concentration of the metacam (the dogs metacam) is that it leaves itself open to error in dosing I think, and also when you lower the dose, which I did by half, it becomes more difficult with using a small amount to start with.
    It has no taste and I mixed it (the cats metacam) with food and never had any issues getting the correct amount to be eaten.
     
  32. Tom & Thomas (GA)

    Tom & Thomas (GA) Member

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    Fair enough, @Bron and Sheba! What matters is getting the right amount of medication into the cat. And that we both found our way there and saw that it could help.

    My Thos had no spring left in his hind legs. I had to bodge together some steps so he could climb up to the kitchen counter where the drinking fountain is. Even with a footstool to help he had to pull himself up on my bed. Now he can again jump onto furniture, including a favorite perch on a post from his childhood. Gallop around in the yard. Scramble up trees. And today he took down a squirrel, which demands quite a sprint.
     
  33. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    I believe you! I am so glad Thos is so much better. I found the difference in Sheba nothing short of miraculous.
     
  34. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Don’t let your vet give weekly injections of metacam. That would be dangerous. The injection is only meant to be given once as a loading dose. Then a couple of days later you start the oral metacam. You can also just start with the oral. It just takes a few days longer for it to take effect.
    An ordinary vet should be able to give you a script for the oral. I’m not sure your vet knows much about metacam and cats.
     
  35. Tom & Thomas (GA)

    Tom & Thomas (GA) Member

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    I'll second Bron here. There is no call for regular injections, and you don't even need an initial injection. In fact, I believe I just started out with the maintenance dose, with no larger initial dose. Thos was doing better within the next day or two.

    I'll attach the 2010 ISFM and AAFF Consensus Guidelines for Long-Term Use of NSAIDs in Cats, developed by a panel of vets from around the world, including in the US. There is a table about half-way in that gives the dosing information, in medical speak, for long-term use of meloxicam to treat chronic pain. Note that there is no mention of giving the initial dose by injection.

    If this doesn't persuade your vet, nothing will and I wouldn't trust them to give you any guidance about meloxicam. Let alone administer the drug. Sad to say but some practices look for opportunities to rack up charges, like by giving injections.
     

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    Last edited: Mar 26, 2019
    Reason for edit: Added sentence about initial dose not needing to be injected.
  36. Bronx's dad (GA)

    Bronx's dad (GA) Well-Known Member

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    Thank you so much for this info. I will not use my reg vet (who would only do injections) and go directly to Bronx's IM and hopefully get a script for oral metacam. Made an appt for Thurs. What would be the dose for a 22lb cat?
     
    Last edited: Mar 26, 2019
  37. Tom & Thomas (GA)

    Tom & Thomas (GA) Member

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    Hopefully you'll get direct guidance for use and I'd want someone to check my arithmetic (especially since I need to walk away now and get ready to leave the house)...

    Your 22lb cat converts, conveniently, to 10kg. With dosage of 0.05 mg/kg, that works out to giving 0.5mg each day. How much liquid you draw from the vial depends on which concentration is dispensed, 0.5 mg/ml or 1.5 mg/ml. For the less concentrated version, it would be 1ml; for the 1.5 mg/ml version, one-third of a ml. The product should come with an oral syringe, possibly with markings for canine use by weight. If so, you would be giving about half the by-weight dose suggested by the syringe.
     
  38. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    IMG_1245.JPG @Tom & Thomas that is an excellent article you just posted. I have not seen that one before. Reading through it I was reminded how important it was for the cat to be hydrated when taking Metacam. I used to check Shebas hydration every morning as she was prone to dehydration, and I used to give her extra fluids in her food and as chicken stock treats which pretty much solved the hydration problem.
    Hopefully Paul the IM vet will know more about Metacam and will be able to access the cat version for you which has the little syringe in it with marking from 0.1 to 1.0 ml Maybe you could ring thriving pets before your IM visit and ask about how to obtain the cat version of the Metacam.
    As Paul said the 22 lb converts to just under 10kg. Is the 22 lb an ideal weight? as I think they like to use the ideal weight to gauge the dose. When Harry had the eye injury last July he had to have Metacam for a week for pain and reduction of inflammation. He is a 5 kg cat and his dose was 0.5 ml once a day. The instructions were "MUST be given with food. Stop if vomiting/diarrhoea occurs and contact vet." So if Bronx is 10 kg then 1ml is correct. The IM vet may decide to give slightly less. After a few months, with Sheba, I was able to get down to the 0.2 mark as a maintainance dose without comprising Shebas QOL which had returned to excellent. She was a 6 kg cat so she went down to a 1/3 of the dose for maintainance.
    We are given a specific syringe in with the Metacam which has markings from 0.1 to 1ml. I am attaching a photo for you
    Good luck with the IM visit.
     
  39. Gill & George

    Gill & George Well-Known Member

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    You can get oral syringes calibrated in ml. I had one of those with the metacam first time round, like the pic Bron posted.
    Second time I had a syringe that was calibrated for the weight of a cat (I don't think you would get those in US)

    I agree with Bron and Tom multiple weekly injections would not only be I'll advised for his kidneys but he would also be left with considerable pain when it wore off.
    Fwiw
    George was given a loading dose injection for his severe mouth pain, then I gave him his oral med 24hrs later, unfortunately the syringe stuck and I ended up squirting most of his first oral dose into the wall, the effect of the injection did not last much beyond the 24 hr mark.
     
  40. LizzieInTexas

    LizzieInTexas Well-Known Member

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    Wow! Excellent info. Thank you for posting.
     
  41. Tom & Thomas (GA)

    Tom & Thomas (GA) Member

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    The product I use, Henry Schein EloxiOral at 1.5 mg/ml, comes with two syringes, one for smaller "dogs" and one for larger. The smaller only goes up to 0.9ml. For people with smaller animals, my very helpful vet pulls out the big syringe and adds a second smaller one; plus, she labels the carton as "Hi Dose." Actually, she'll start you off with a few pre-filled syringes so you can see if meloxicam works before investing in a vial.

    I don't know what the setup is with the Metacam product. As Gill notes, one way or the other you'll want to have an oral syringe in ml, and at a scale that works for the dosage size you're using. I don't think anything here in the US will specifically say that it is for administering meloxicam to cats.

    I add the meloxicam to a half-sized portion of Thos's breakfast, stand over him to make sure he eats it (and not Becca who likes to swoop and scarf for the sport of it), and then give him the rest of his meal.

    Dr Robin Browning, my go-to source for pain management, talks about the desirability of tapering down, and even stopping, the NSAID once the pain has been broken and other treatments are taking effect. Which sounds like what Bron was able to do. And I need to start working on.

    So what the dickens is an "IM vet"?
     

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  42. Bronx's dad (GA)

    Bronx's dad (GA) Well-Known Member

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    "Internal Medicine" Vet. Was sent to him (at Blue Pearl) after my 1st vet gave up on trying to figure out why Bronx's BG was still super high, even after we went up to 4u. IM knew about acromegaly and IAA and sent the bloodwork to MSU which confirmed acromegaly.
     
  43. Ella & Rusty & Stu(GA)

    Ella & Rusty & Stu(GA) Well-Known Member

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    So much good information here. I hope I never have reason to use it, but I've bookmarked this condo just in case. Thanks, guys!
     
  44. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    I agree. I'll add a link to this discussion in the 'New to the group?' sticky as well as link it in the Health FAQs forum. Will get to it later tonight.
     
  45. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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  46. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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