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Pumpkin and Jack

Pumpkin and Jack

Member
My name is Rachel and I have a 9 year old sugar kitty named Pumpkin and her little tabby brother Jack. She was first diagnosed around November 2021, went into remission after a seizure around February 2023 (I wasn't home testing at the time, now using the Accu-Check Guide Me). She unfortunately went back on Vetsulin again around May 2024 and is fed primarily Tiki Cat after dark canned food but gets some sprinkles of freeze dried raw as a treat on occasion.

Pumpkin was a bit stressed out when I had to bring her with out of town two weeks ago. She started getting pickier with her food which I thought was just due to some minor nausea from hairballs being it's shedding season. Saw the vet yesterday 4/2/25, did a quick blood test for pancreatitis which came back negative and she put her on a half tablet (16mg) of Cerenia to start with for nausea along with Elura to stimulate her appetite as we both felt comfortable leaving a full blood panel for later since she seemed fairly normal.

However, within an hour of giving her Elura I believe she was experiencing bradycardia and/or hypotension as she was lethargic out of nowhere and down to 10 breaths per minute while semi concious and unwilling to move. By the time I got to the vet they said her blood pressure was normal and that she looked fine (I'm assuming it's between the stress and the time it took to get there). I didn't agree with their dismissal and in my gut knew something still wasn't right but I wasn't going to have them charge me an extra $50-100 for the doctor to come in and tell me she looked fine. At this point she had eaten a quarter of a can of her regular food for breakfast, and likewise only a quarter of a can for dinner. It breaks my heart because you can tell she wants to eat but feels too awful to. The two medications made her ravenously lick up all the broth around her chicken shreds but even after throwing it in a blender and topping it with all her favorite bits she won't eat her food anymore and I've fallen back to this cheap pate I feed my boy that I would never have otherwise fed her as it's the only thing I can entice her with. No transition unfortunately.

At around 5 am this morning I noticed her hovering at the water bowl along with an awful smell either coming from her or her litterbox. I didn't notice at the time but she was probably jaundiced at this point. Took her in as soon as I could this morning due to the behavior and after a lot of back and forth we decided to get her on antibiotics and a steroid after bloodwork showed her liver was struggling either in relationship to inflammation of the gallbladder or a long fancy name for a thing that causes a lot of general GI inflammation (I unfortunately don't have notes right now to reference and was extremely emotional as we had discussed euthanasia and the possibility she might not make it through this one). I can't afford procedures beyond bloodwork and at the end of the day discerning between the two didn't sound like I'd be able to treat her more effectively anyways so we didn't consider anything else beyond the bloodwork. She was put on a full 16 mg tablet of Cerenia going forward, along with Amoxicillin, Metronidazole, and Prednisole. I was warned that Prednisole could end in a diabetic keto acidosis scenario but I don't really have any other choices and I'm terrified of how quickly I'm losing her after having gone through something similar when she went into remission previously.

She had a week of not eating well that a different vet I was seeing at the time treated as gastroenteritis and/or pancreatitis (it was lockdown, I was jobless, and bloodwork was again all we could do). I thought was going to lose her then but she rebounded but with how she's been I'm not too sure she has the strength to do it a second time. I was devastated then as I was still recovering from having to put my dearest fur baby down just before her health scare and it's no less devastating having to face that now. The worst part is I've trained her to be a sort of therapy pet for my sister who I live with that has a lot of undiagnosed mental health problems (she refuses doctors or any help but will let this cat tell her what to do with her fluffy powers). Funny enough Pumpkin use to be a very crabby cat that wanted nothing to do with anyone. Strangely, after training her she's become very sensitive and affectionate and comes to calm my sister down whenever she has episodes and I don't know what I'm going to do if we have to put her down. It would be just as hard to not have to make the decision and her go out due to her condition but I'm.. just not okay. I don't know what to do and I can't keep it together and I have to go to work tomorrow and I don't know how to function anymore.
 
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Hi and welcome. I can’t see the spreadsheet so I’m going to ask @Bandit's Mom to look in and help you set it up.
It is really important Pumkin eats so if you are having trouble atm let her eat whatever she wants. Don’t worry if it’s not low carb for a few days. Eating anything trumps everything else. Offer small amounts often
And don’t skip any doses of insulin.
Have you taken her back to the vet to see why she is not eating? I would ask the vet for some ondansetron or cerenia. Ondansetron is better for nausea. You will need a script from the vet and get it at a human pharmacy.

Test for ketones in the urine with Ketostix from a pharmacy. Ketones in the urine or blood will appear before a DKA diagnosis

Hang in there. We can help you:bighug:
 
The spreadsheet works. The first thing you see is info about the cat. Sheet 1 is where the bgs go and that is currently empty of data.

DX Nov. 2021, went into remission and had seizure Feb 2023, back onto Vetsulin Dec. 2024, fed Tiki Cat After Dark. Some recent health concerns which is all detailed in the spreadsheet link. Saw vet yesterday, put on 16mg Cerenia and Elura, lethargic and breathing slow after given Elura, went back to vet, litter box concern this morning and looked jaundiced, went back to vet, vet thinks GI issue, cat is currently on Cerenia, amoxicillin, Flagyl, prednisolone.
 
I don't see any information about Pumpkin
You need to create your signature
Can you please fill out your signature
Here is the information we need for your signature
Just click on your name up top and then tap signature and add this information. It's at the end of everyone's post in gray letters
  • Add info we need to help you:
    • Caregiver & kitty's name
    • DX: Date
    • Name of Insulin (do not include dose or frequency)
    • Name of your meter
    • Diet: "LC wet" or "dry food" or "combo"
    • Dosing: TR or SLGS or Custom (if applicable)
    • DKA or other recent health issue (if applicable)
    • Bexacat or Senvelgo (if applicable) and dates
    • Acro, IAA, or Cushings (if applicable)
    • Spreadsheet link. Please put the signature link on the bottom line of your signature information, on its own, so it is easy to find.
    • Please do not put any information about your location in the signature for security reasons. If you wish to add your country location, please add it to your profile.
Be sure to click the 'Save Changes' button at the bottom. If you need help urgently it is important we know these things at a glance. We don’t want to waste valuable time finding out information.

The way you have created your SS where it says numbers is not the way we create our spreadsheet
Can you do it like this and link it to your signature

https://www.felinediabetes.com/FDMB/threads/how-to-create-a-spreadsheet.241706/

The link will also explain how to use it
@Pumpkin and Jack
 
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If anyone wants to see the information about Pumpkin when you tap on her spreadsheet ,then tap on her info tab up top and then swipe to the left , you will see a lot of information about Pumpkin

@Pumpkin and Jack
I tried to copy all you information so I can paste it here but it won't let me. Anyway you can do it, I think it's going to be very confusing for members to find it
 
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Bron and Sheba (GA) said:
Hi and welcome. I can’t see the spreadsheet so I’m going to ask @Bandit's Mom to look in and help you set it up.
It is really important Pumkin eats so if you are having trouble atm let her eat whatever she wants. Don’t worry if it’s not low carb for a few days. Eating anything trumps everything else. Offer small amounts often
And don’t skip any doses of insulin.
Have you taken her back to the vet to see why she is not eating? I would ask the vet for some ondansetron or cerenia. Ondansetron is better for nausea. You will need a script from the vet and get it at a human pharmacy.

Test for ketones in the urine with Ketostix from a pharmacy. Ketones in the urine or blood will appear before a DKA diagnosis

Hang in there. We can help you:bighug:
Click to expand...

She would only eat a quarter of a can in the morning and evening with a few bites inbetween yesterday but has gone up to eating a half a can after the vet visit and an additional quarter of a can and a lickable squeeze treat so I think we're maybe doing slightly better! She turned her nose up to the temptations cat treats which was the only carb-y thing I really tried but she has a whole smorgasbord of food to try out. Fortunately my tabby is a garbage disposal for whatever she absolutely won't eat (but I fear for his tummy a bit).

She became jaundiced after her liver backed up. Started as a furball making her queezy and eating less to full on lethargy in a day. Seems inflamed GI is the cause of her nausea/inappetince, not hairballs, but I don't have definitive testing to confirm what exactly it is. She is on cerenia currently.
 
Being the forum thinks I'm a spam bot, as Diane mentioned, I had to put all of Pumpkin's backstory in my spreadsheet if anyone is confused. I will continue to add to that to keep it all in one place. Side note, realized I had the date wrong. She started up the second time on Vetsulin in May not December. Corrected that on my sheet.

Some updates: added some glucose curves in. I have a lot more BG records beyond this as spot checks before meals or throughout the day but I'm too exhausted to get them in. My eyes are swollen and I still have to work tomorrow so maybe this will help start things. Gave her first doses of the two antibiotics earlier today and gave the steroid at dinner with her insulin. She seems fine so far but I'm nervous for the long haul. Hoping my job will let me work remotely tomorrow despite our strict 2 days remote only. Was supposed to be recovering from being sick these last two days but have been to the vet 3 times in the span of these last 2 days and made several stops around and even made her bone broth only to find my vet thinks oxtail is too fatty and will trigger more GI issues right now. :(
 
Some more information from Rachel's profile which I copied and pasted it here
My name is Rachel and I have a 9 year old sugar kitty named Pumpkin and her little brother Jack. She was first diagnosed around November 2021, went into remission after a seizure around February 2023 (I wasn't home testing at the time, now using the Accu-Check Guide Me). She unfortunately went back on Vetsulin again around December 2024 and is fed primarily Tiki Cat after dark canned food but gets some sprinkles of freeze dried raw as a treat on occasion.

I can't seem to say anymore without triggering a spam warning. See my spreadsheet for more info.
 
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Pumpkin and Jack said:
Being the forum thinks I'm a spam bot, as Diane mentioned, I had to put all of Pumpkin's backstory in my spreadsheet if anyone is confused. I will continue to add to that to keep it all in one place
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@Bandit's Mom
Hi Bhooma would you know why the forum thinks Rachel is a spam bot ?

If anyone wants to see the information about Pumpkin when you tap on her spreadsheet ,then tap on her info tab up top and then swipe to the left , you will see a lot of information about Pumpkin
 
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Pumpkin and Jack said:
Seems this forum is very spam sensitive so I'm just going to post the link to my spreadsheet that has all that I wanted to say on it for now. Will be updating more information to it when I'm back. I have to go pick up a few things and figure out how to stop crying.

TLDR, Pumpkin has been up and down with her diabetes and recently stopped eating well due to what is believed to be GI inflammation leading to liver issues. She's on Prednisone and I'm terrified of her going into diabetic ketoacidosis. Planning to get some strips to test for that now.

Funny enough I had literally just read someone else's post on the topic of Prednisone just before things started getting serious but I thought she was just having hairballs (which again, ironically people suggested was a precursor to a more serious problem).

https://docs.google.com/spreadsheet...nCeyxus-FURMThWSVeIC8RFYixcw4gN4jF7N7/pubhtml
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@Suzanne & Darcy

If you want to see the information about Pumpkin when you tap on her spreadsheet ,then tap on her info tab up top and then swipe to the left , you will see a lot of information about Pumpkin

She said the forum thinks she's a spam bot, so she has to put all the information about Pumpkin on her spreadsheet, tap on her SS then tap on the info tab up top, then swipe to the left to see it all
More information from Rachel's Profile Page which I copied and pasted here
I asked her to change the diagnosis date on her SS to Nov 2021 like she said in her profile page. Right now it says 12/2024
She was first diagnosed around November 2021, went into remission after a seizure around February 2023 (I wasn't home testing at the time, now using the Accu-Check Guide Me). She unfortunately went back on Vetsulin again around December 2024 and is fed primarily Tiki Cat after dark canned food but gets some sprinkles of freeze dried raw as a treat on occasion.

I can't seem to say anymore without triggering a spam warning. See my spreadsheet for more info.
 
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How frequently should a sick cat be urinating? I want to watch for ketones but she might have gone last night and hasn't drank much water since then. I understand they need to work this out by filtering thru urine and I'm worried things are already tipping the wrong way. :(
 
Keep offering lots of food. Try putting a teaspoon of warm water into each snack of food.
Are you feeding 1/2 hour before giving the Vetsulin?
If you think she is still nauseated she can have ondansetron at the same time as cerenia as they work on different pathways. Cerenia is once a day and ondansetron is 3 or 4 times a day.
 
Bron and Sheba (GA) said:
Keep offering lots of food. Try putting a teaspoon of warm water into each snack of food.
Are you feeding 1/2 hour before giving the Vetsulin?
If you think she is still nauseated she can have ondansetron at the same time as cerenia as they work on different pathways. Cerenia is once a day and ondansetron is 3 or 4 times a day.
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She takes a long time to eat normally so usually it takes half an hour for her to finish from the first bite. Right now I'm sitting with her for a couple hours at a time trying to coax her to eat and eventually getting something but haven't watched timing on injection after food but keeping close to regular injection time.

Do you think a whole Cerenia tablet is too much? Was reading into it and seems like it might be excessive for her being only 9.75 pounds now but I know she needs the support. I don't know if my vet would carry ondansetron if she didn't already offer it. Is this something she could write a prescription for that I could get at a human pharmacy? Otherwise I'm worried it won't come soon enough.
 
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Does Cerenia need to be a whole 24 hours apart or how early can I give it? She got her first half pill on 3/2 at 10 am and gave her a quarter yesterday 3/3 at 9 am but they bumped her up to a full tablet and she seems like she's getting nauseous already this early AM. Vet isn't open for another 2 hours 20 mins.

*corrected dates
 
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Bron and Sheba (GA) said:
Keep offering lots of food. Try putting a teaspoon of warm water into each snack of food.
Are you feeding 1/2 hour before giving the Vetsulin?
If you think she is still nauseated she can have ondansetron at the same time as cerenia as they work on different pathways. Cerenia is once a day and ondansetron is 3 or 4 times a day.
Click to expand...


Update, she started eating some food just now and added a spoon full of water to it. Normally I give her a quarter if a cans worth of water mixed in with her food but I never do that when she is sick because she tends to not eat when I water it down but I think just a spoonful may work out well. She is lip smacking quite a bit which is concerning me a lot right now so I still need to figure out how soon I can give her Cerenia.

Currently she's still slowly working away at her pate but hovering near water as she seems to want to drink but again is nauseous. Apparently hungry enough to get past the nausea though.
 
Are you sure
Pumpkin and Jack said:
Does Cerenia need to be a whole 24 hours apart or how early can I give it? She got her first half pill on 2/2/25 at 10 am and gave her a quarter yesterday 2/3 at 9 am but they bumped her up to a full tablet and she seems like she's getting nauseous already this early AM. Vet isn't open for another 2 hours 20 mins.
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Do You have the dates correct here , are you taking about Feb?
As far as I know Cerenia is once a day
She probably needs the ondansetron
 
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If she’s lip smacking that’s a sure sign of nausea, poor love. I would ask the vet to give you some ondansetron. It’s much better for nausea and it is important to get the nausea under control. Remember you can give both the cerenia and ondansetron together.
 
Diane Tyler's Mom GA said:
Are you sure

You have the dates correct here , are you taking about Feb?
As far as I know Cerenia is once a day
She probably needs the ondansetron
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I am exhausted sorry. Should have been 3/2 and 3/3. I'm just trying to determine if there can be any overlap or if it has to be precisely spaced out 24 hours. Vet has their techs go over medication and they don't like to give me those sorts of specifics just giving me a vague and unassuring, "yeah thats probably fine".
 
Pumpkin started drinking some water and I was able to snag a test as she visited the litterbox right after. Vet warned me she'll have dark urine so I'm assuming the test means she has low or no ketones. Strip looked tan rather than yellow, peach, or purple.

Can't post pic and remembering reading something about attachment issues and needing to do something to upload files but forgot where I saw it. I desperately need sleep and trying to see if I can get a doctors note for today.

Will ask vet about ondansetron and how early I can give cerenia. I was just worried she might vomit before they open with how nauseated she was looking but it seems like she might be okay ish for now.
 
Waited all day for the vet to call me back to ask about Ondansetron just for the front desk to call and say she's busy in surgery until 10 PM tonight. They are never this bad normally but I'm floored. Finally got discharge notes which more clearly stated the vet is leaning on the side of presuming she has Cholangiohepatitis. Will update some things on sheet but I still haven't been able to talk to the vet directly and will be missing a lot yet.

Pumpkin will only eat Churu sticks which she's managed to eat maybe two of in total today and a small handful of Temptations treats (I was advised against giving anything higher in fat and this is 20 something % compared to everything else being closer to 5%). I can't get her to eat a real meal and getting really nervous again. Only gave her half her dosage this morning and no idea if eating treats is enough to dose her again tonight. Waiting to hear back from front desk to see if she was able to catch her or if they are able to get advice from one of the other on staff emergency vets for the Ondansetron. Not sure what I should do for now since the latest open pharmacy will be closing in less than two hours.

Also, with cats that aren't eating how often should you see a stool? I know she's likely constipated with her condition right now and she's not getting much in her but I'm very worried as I don't think I've seen a stool from her since the 1st. Jack is a nuisance and likes to run into her litterbox to use it so sometimes there's a mixup but I'm convinced the last time she went was 3 days ago at this point.
 
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Cat's don't do well without food. It gets dangerous pretty quickly. I have found that I am harder for the vet to ignore when I show up in person and politely refuse to be dismissed without talking to a vet. I haven't been arrested yet. They get busy and out of sight is out of mind. I don't think its malicious, but that doesn't make this situtation any less dangerous for your cat. Someone else might have better advice, so keep checking your thread, but go get that Ondansetron. You waited on them all day. Pharmacies are closing.
 
Got in touch with front desk again, vet will be in between surgeries shortly here but was able to get info on my other questions. Given that she's not eating they aren't worried about the lack of stool, was informed if she eats a small meal worth of treats that I can still do a half dose of insulin, and found out there is a 24 hour pharmacy a little further away that I can pick up the Ondansetron assuming I have the green light on that one. Won't be able to talk to the vet directly for another hour and half ish for anything else though.

Really mad at myself as I'm realizing the stress of the last couple of days left me mixing up information. I know she ate a quarter of a can for breakfast on the 2nd with a half dose insulin at the vet and she ate a half a can on the 3rd for a full dose in the afternoon, but I'm confusing what she ate beyond that and what I promptly dosed her with beyond that. I know I skipped a dose but I can't remember if it was before on the 1st or between the 2nd and the 3rd. I'm never this disorganized but I can't even seem to remember questions I've been ruminating on all day long when I get on the phone. Was able to rest some today but I guess not enough.
 
I don't know about how it is where you are, but it's even worse on the weekends, so I would go. "I need a prescription for Ondansetron for my cat. the Cerenia has helped with the vomiting, but she is still showing signs of nausea, especially as her Cerenia begins to wear off. She is not eating enough, and tomorrow is the weekend."
 
I'm so sorry Pumpkin is not feeling well, I hope you hear from the vet soon. You're doing a great job helping Pumpkin, it's exhausting in all the ways, I feel for you :bighug::bighug:

There's a lot of experienced people on here that will offer all the help they can. Sending you healing vibes. :bighug:
 
Pumpkin and Jack said:
Got in touch with front desk again, vet will be in between surgeries shortly here but was able to get info on my other questions. Given that she's not eating they aren't worried about the lack of stool, was informed if she eats a small meal worth of treats that I can still do a half dose of insulin, and found out there is a 24 hour pharmacy a little further away that I can pick up the Ondansetron assuming I have the green light on that one. Won't be able to talk to the vet directly for another hour and half ish for anything else though.
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That's a relief about the 24-hour pharmacy. Whew. I thought you and I were going to have to storm your vet's office!
*blows out torch and puts pitchfork back in the shed.

I know what it's like when you cat serves up an emergency on a Friday night. Their timing is impeccable! Let us know what the vet says.
 
Kobe (Dean and Lesley) MO said:
I don't know about how it is where you are, but it's even worse on the weekends, so I would go. "I need a prescription for Ondansetron for my cat. the Cerenia has helped with the vomiting, but she is still showing signs of nausea, especially as her Cerenia begins to wear off. She is not eating enough, and tomorrow is the weekend."
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The one big reason I've stuck with this particular vet is they have regular office hours but double as an urgent care with floating vets on staff and go through the weekend. They're open until 11 PM weekdays but have limited hours on the weekends. I'm sure they just had a rough day in the office but it sucks being on the receiving end of someone else's bad day when it's an emergency.

Laurie&Petey said:
I'm so sorry Pumpkin is not feeling well, I hope you hear from the vet soon. You're doing a great job helping Pumpkin, it's exhausting in all the ways, I feel for you :bighug::bighug:

There's a lot of experienced people on here that will offer all the help they can. Sending you healing vibes. :bighug:
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Definitely feeling the support! :bighug: Been through a lot and good to know others have been there too.

Kobe (Dean and Lesley) MO said:
That's a relief about the 24-hour pharmacy. Whew. I thought you and I were going to have to storm your vet's office!
*blows out torch and puts pitchfork back in the shed.

I know what it's like when you cat serves up an emergency on a Friday night. Their timing is impeccable! Let us know what the vet says.
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I needed that touch of humor. :joyful: And definitely will do!
 
Kobe (Dean and Lesley) MO said:
Let us know what the vet says.
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Just got a call from the front desk, vet is going to put her on Ondansetron twice daily but wants her to come in if she's not eating a proper meal by the same time tomorrow.

Was trying to look up things online for Cholangiohepatitis but not getting much in the way of diet specific choices other than a novel/limited ingredient diet to rule out sensitivities but we have to pull through this first to get to that point. Saw some folks mentioning it in their posts from years ago but didn't see any updates which isn't all that reassuring. :(
 
Pumpkin and Jack said:
The one big reason I've stuck with this particular vet is they have regular office hours but double as an urgent care with floating vets on staff and go through the weekend. They're open until 11 PM weekdays but have limited hours on the weekends. I'm sure they just had a rough day in the office but it sucks being on the receiving end of someone else's bad day when it's an emergency.

Definitely feeling the support! :bighug: Been through a lot and good to know others have been there too.

I needed that touch of humor. :joyful: And definitely will do!
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Sometimes I need to laugh or I'd cry. Crying still happens.
I totally get it. You need a working relationship with a vet. I am so glad you got the prescription!
 
Gave her the half tablet of Ondansetron last night and immediately she was ready to eat some food. Dont know if it was almost a placebo because I don't think it could kick in that fast. She only ate a quarter of a can but I was happy she got something in. BG was high when I checked a half an hour later so she got a full dose of insulin. This morning she ate a little more than an eighth of a can without any meds. Timing has been awful since it takes hours of coaxing and her doses get later and later. Trying to so thrm an hour earlier to get her back on a schedule I can do with having to leave the house for work at 7 every day but she's currently still dosing at 10.
 
Diane Tyler's Mom GA said:
@Pumpkin and Jack
Can you update your spreadsheet for 4-2. 4-3 and 4-4 you need to start to get some tests in during the night cycle after the PMPS .
I'll tag a member that's experienced with Vetsulin
@Suzanne & Darcy
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I'll try to add records. I ended up adding a new tab on my spreadsheet to keep my mind straight. I have a hard time with the original template as I don't usually do a full curve at home and will check her BG at sporadic times when shes acting different so its hard to map. I will input what I have on my glucometer but I'm all mixed up from emotions so I don't remember what dosages I gave on some. I know I wouldn't have gone overboard but I know I skipped at least one of them.

I am struggling to get her medication timing right. I am praying they'll let me work remote Monday at least as I have to leave the house at 7 am for work and I don't get back until 6 pm and right now she's stuck on a cycle of 9 or 10 am/pm. Can't get her to eat enough to give insulin sooner. :(
 
Pumpkin and Jack said:
I am struggling to get her medication timing right. I am praying they'll let me work remote Monday at least as I have to leave the house at 7 am for work and I don't get back until 6 pm and right now she's stuck on a cycle of 9 or 10 am/pm. Can't get her to eat enough to give insulin sooner. :(
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Hopefully, with the anti-nausea meds on board, she will be eating enough for you to be able to shift her schedule back a little each cycle. I had a similar problem when Kobe came back from the vet with his insulin schedule 3 or 4 hours behind. :bighug:
 
Is there anyone else experienced with jaundice/backed up liver combined with inflamed GI problems? Doesn't have to be Cholangiohepatiti necessarily. She has a strong odor (not garlic/nail polish remove/fruity breath or anything like that) but I can't really place a name to it. I'm sure its part of what she's going through trying to dump out of her liver but I don't know when to expect the jaundice to go away and presumably that smell as well. Vet said she might look worse before she looks better in the next couple of days but if she suddenly turned highlighter yellow after these initials days that it's getting worse. They didn't mention anything about the odor when I was at the vet and she's always near her litterbox so it might be stinky urine I'm smelling but I'm just nervous.

She's also very constipated. Thinking about adding pumpkin back into her food and maybe force feeding with a syringe but don't know if it's a bad idea right now or if I need to let things work out naturally. Will the fiber help or make it worse..? Vet advised against using Miralax and I don't think coconut oil is a good idea right now. I have a non-petroleum based hairball gel but it's loaded with sugary crap and found out it has silica in it which I'm less than thrilled to find out about. She strained and produced no stool a couple hours ago and possibly passed stools for the first time since the vet yesterday night but it might have been my naughty tabby boy sneaking into her room to use her litterbox instead. Being they looked like stools you'd see from a constipated cat I'm inclined to think it might be hers but he has had constipation off and on as well so I'm not confident.

Also, her glucose is running a bit high so I'm debating whether its a good idea to give her extra mini meals or carb heavy treats being my vet didn't want to adjust her insulin for at least a week or more yet. I need to get data on the spreadsheet but I'm a disorganized mess right now.
 
Pumpkin and Jack said:
She would only eat a quarter of a can in the morning and evening with a few bites inbetween yesterday but has gone up to eating a half a can after the vet visit and an additional quarter of a can and a lickable squeeze treat so I think we're maybe doing slightly better! She turned her nose up to the temptations cat treats which was the only carb-y thing I really tried but she has a whole smorgasbord of food to try out. Fortunately my tabby is a garbage disposal for whatever she absolutely won't eat (but I fear for his tummy a bit).

She became jaundiced after her liver backed up. Started as a furball making her queezy and eating less to full on lethargy in a day. Seems inflamed GI is the cause of her nausea/inappetince, not hairballs, but I don't have definitive testing to confirm what exactly it is. She is on cerenia currently.
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Didn’t I see that she is on Ondansetron 4 mg? This should be given every 8 hours. Minimum of twice a day. Perhaps you are already doing this? I am trying to get caught up. I did read the info tab of your spreadsheet but I was not able to discern the dates of when each incident happened.
 
If your Pumpkin had a negative reaction to Elura, I would not give it again (even if you think it was a coincidence.) I would get a tube of trans-dermal Mirataz that is applied to the inner ear. I would start with half of the recommended dose and proceed carefully because some cats will become very vocal and restless on Mirataz (or the oral form Mirtazapine.) Many of my cats have not needed the full dose and have only needed it every other day instead of daily. Every cat will respond differently; Mirataz has been around a lot longer than Elura and I trust it more.
 
Suzanne & Darcy said:
Didn’t I see that she is on Ondansetron 4 mg? This should be given every 8 hours. Minimum of twice a day. Perhaps you are already doing this? I am trying to get caught up. I did read the info tab of your spreadsheet but I was not able to discern the dates of when each incident happened.
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Yes she is on half tab of Ondansetron twice daily. It seems to have an immediate affect and helps her eat. I was honestly horrified when I read the possible side effects and severe reactions because they mirrored her experience with Elura. Knock on wood nothing bad has happened since though.

Suzanne & Darcy said:
If I had a cat with a liver problem (and I have had) I would start it on Denamarin right away. It’s marvelous for the liver and I have seen liver enzymes go down a great deal with Denamarin.
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I'll check with my vet on Denamarin. I know she may want to retest again before starting something like that. Pumpkin is already feeling like she's at her limit with being on 5 meds: Ondansetron, Metronidazole, Amoxi/Clav, Cerenia, and Prednisone. I am not big on pharmaceuticals myself except in emergent situations like this of course. More prescriptions the more chances of interactions or complications and they can overload the kidney and liver in my opinion. I opt for nutrition wherever possible but I'm not well versed on cats to know what's appropriate for a regular every day use verses when you're in a critical situation already on several medications. Can't just take a supplement without consulting my vet, and I know my vet will think everything is snake oil.

Suzanne & Darcy said:
If your Pumpkin had a negative reaction to Elura, I would not give it again (even if you think it was a coincidence.) I would get a tube of trans-dermal Mirataz that is applied to the inner ear. I would start with half of the recommended dose and proceed carefully because some cats will become very vocal and restless on Mirataz (or the oral form Mirtazapine.) Many of my cats have not needed the full dose and have only needed it every other day instead of daily. Every cat will respond differently; Mirataz has been around a lot longer than Elura and I trust it more.
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I believe she had that the last time she had a flare up when she wasn't diabetic but it expired and vet didn't seem to consider it at the time even when I brought it up. Really wish she would have actually considered that it worked last time but I think she saw they had diagnosed possible pancreatitis and wanted to draw up her own plans.
 
Suzanne & Darcy said:
If your Pumpkin had a negative reaction to Elura, I would not give it again (even if you think it was a coincidence.) I would get a tube of trans-dermal Mirataz that is applied to the inner ear. I would start with half of the recommended dose and proceed carefully because some cats will become very vocal and restless on Mirataz (or the oral form Mirtazapine.) Many of my cats have not needed the full dose and have only needed it every other day instead of daily. Every cat will respond differently; Mirataz has been around a lot longer than Elura and I trust it more.
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Also, I was told the Prednisone stimulates the appetite. I know it also messes up the BG pretty bad though and I think between that and having to resort to cheap carb heavy junk she's already getting to bad numbers again. I am tying to add more info to the chart but my computer is a distance a ways from where she is resting right now and I want to be sure she's okay periodically. I'm also about ready to pass out. Not getting enough rest in all this still. :S
 
Lethargy is a known side effect of Elura. Other side effects that were seen were vomiting, drooling, headshaking and lipsmacking. For some reason, vomiting and drooling were more common in male cats.

Evaluation of the safety of daily administration of capromorelin in cats (2018) Wofford JA, Zollers B, Rhodes L, Bell M & Heinen E Journal of Veterinary Pharmacology and Therapeutics 41(2) pp324-333 reports on the results of safety studies and states that side effects seen included lethargy. Other side effects that were seen were vomiting, drooling, headshaking and lipsmacking. For some reason, vomiting and drooling were more common in male cats.

Most importantly, please see the cautions below about Elura’s use in cats who are diabetic, have liver disease or heart disease. I would discontinue its use immediately and I wonder why your vet prescribed it to begin with since it’s contraindicated in Pumpkin’s case.

The U.S. Food and Drug Administration (2021) states that capromorelin should not be used in cats who are dehydrated or who have heart disease, and that it may not be appropriate for cats with diabetes because it raises blood sugar. From the report:

“Elura may increase blood sugar levels for several hours after a dose, so it may not be appropriate to use in cats that currently have diabetes mellitus or have had diabetes in the past. The drug should not be used in cats with a condition called acromegaly, in which the pituitary gland in the brain produces too much growth hormone.

Veterinarians should use caution when prescribing Elura for cats that have heart disease or are severely dehydrated. The drug causes a cat’s heart rate and blood pressure to go down for several hours after a dose. Veterinarians should also use caution when prescribing Elura for cats with liver disease because the drug is metabolized in the liver.
 
What is she on Metronidazole for? Does she have diarrhea? It’s an antibiotic and antiprotazoal medication. I would not use it for more than 5 days unless your vet can give you a compelling reason for it. It does have some anti-inflammatory effects and I am thinking this is what your vet was hoping for? Cerenia also has some anti-inflammatory effects and is frequently used in pancreatitis as well as in CKD cats and for vomiting. Metronidazole can have toxic effects so it’s best used short term.
 
Pumpkin and Jack said:
Also, I was told the Prednisone stimulates the appetite. I know it also messes up the BG pretty bad though and I think between that and having to resort to cheap carb heavy junk she's already getting to bad numbers again. I am tying to add more info to the chart but my computer is a distance a ways from where she is resting right now and I want to be sure she's okay periodically. I'm also about ready to pass out. Not getting enough rest in all this still. :S
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Pred (which should be Prednisolone and not Prednisone for a cat) can help appetite in some cats. And yes it will raise BG. If she needs it right now, we can work around that with the insulin. It sounds like she really needs the pred for GI inflammation.
 
Her labs look like she was dehydrated and has an infection. Did they give her any fluids? Are you giving her sub-q fluids at home? Adding water to her food? I am glad she’s on the antibiotics. I would recheck bloodwork in ten days. If the liver enzymes are not going down, I would start Denamarin. Denamarin is a supplement and not a prescription medication. I would definitely talk to my vet about it, most vets are very familiar with it (and sell it, although it’s usually cheaper from other sources.)
 
Is there a reason you know of why your vet has prescribed Vetsulin for Pumpkin instead of an insulin that is recommended for cats? Vetsulin is not recommended for use in cats by the American Animal Hospital Association. AAHA recommends ProZinc or Lantus (glargine) for use in cats.
 
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