Warren - 5/29/2000 - 7/1/2016 rest in peace my furry friend

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Darn, I thought we had a smoking gun with the UTI test.

He does seem to pee mostly on rubber backed rugs. The backpack isn't rubberized as far as I can tell, but it is kind of an odd material.
He also likes to pee on shoes. He really really likes shoes.

The vet just called but then had to rush off the phone for an emergency and is going to call me back. She was all for the prozac, but started babbling something about how they only have capsules and I'd have to break them open and divide it up into multiple doses and she was mid sentence about trying to figure out another approach but then had to go.
 
Hi Rob,

Great to get an update from you, and excellent news that you've got the vet onside with the proposed treatment for Warren.

Prozac comes in different forms (including a liquid preparation). Here is a useful article with further information, precautions and side effects for treatment of pets with fluoxetine (Prozac). From the article:
How Fluoxetine is Supplied:
* Fluoxetine is available as 10 mg, 20 mg and 40 mg tablets or capsules.
* It is also available in a 20mg/5ml liquid form.
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Also ...
Dosing Information:
* Medication should never be administered without first consulting your veterinarian.
* For cats, the dose is 2 to 5 mg per cat once daily.
* The duration of administration depends on the condition being treated, response to the medication and the development of any adverse effects. Be certain to complete the prescription unless specifically directed by your veterinarian. Even if your pet feels better, the entire treatment plan should be completed to prevent relapse or prevent the development of resistance. Pets must receive fluoxetine for 6 to 8 weeks before it can be determined that the medication is ineffective.
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It's fairly straightforward to divide up capsule contents by sprinkling them onto a plate and using a razor blade or scalpel to split the powder into reasonably even doses.* (CKD cat caregivers do it with capsules of vitamin B complex, AlOH binder, and so forth.) Each time you start a new capsule you can use one dose and pop the remaining doses into little empty gel capsules, ready for later use. Presumably it could be sprinked onto a teaspoon of food for administration? (Maybe add a few teaspoons of the spring water from a tin of human tuna on top if it's necessary to disguise the taste.) As I said yesterday, I've not used Prozac in a veterinary context myself, but if I was giving it to my cat I'd want to start at the smallest dose possible as a safety precaution to see how well the cat could tolerate it, and to minimize the chance of a strong adverse reaction. (You should've seen Saoirse after her one and only dose of mirtazapine (another anti-depressant - much stronger than Prozac). Saoirse's normally an extremely pacific cat, but the mirt turned her pupils into dinner plates and her into a major Psycho Kitty (qu'est-ce que c'est? ;) ), hence my suggestion that your vet give you a token supply of cyproheptadine to have handy at home just in case the fluoxetine were to disagree with Warren.

Really rooting for you two in the Shire! :)


Mogs

* (And before any smart alecs out there ask, no I am not a coke head. :p )
 
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It sure can't hurt to try to keep those rubber backed things out of his environment! Ditch the rugs, get some shoe trees or tubs to keep shoes in (instead of on the floor) and tell your son to keep his backpack off the floor

Just trying to offer cheap suggestions that might help with Warren!

I had a "rubber back rug" pee'r......when I replaced the rugs with ones that had no rubber, problem was solved
 
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I feel like my Mushu needs prozac, he's been the most anxious cat I've ever had since we got him. Apparently he used to have an insane flee infection before he got to the shelter. He doesn't pee on the floor but he's kind of manic and sits in the box for hours scratching the walls, etc. Lots of strange stuff like that. Really interested how it'll affect Warren.
 
Just got back from the vet.
Got Warren a b-12 shot. Vet doesn't think it will do anything but agreed it can't hurt. Seems like I want to give him one weekly though for 6 weeks. She said she usually only does that for cats with IBS. I think she'd be fine with it though.

She's prescribing 2.5mg of transdermal Prozac which gets applied to his ear. I'm waiting for the mail order pharmacy she called it into to call me with pricing. She also hadn't heard of combining with cyproheptadine and said let's just see how he does. She did say I could expect it to take 2-3 weeks to work.

She didn't want me to spend the $ on a 4th UTI test at this time.
 
robr said:
She also hadn't heard of combining with cyproheptadine
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They aren't combined and taken together....the prozac can sometimes cause another problem called serotonin syndrome (fairly rare, but something you should know just in case).....the cypro is the "treatment" for serotonin syndrome
 
Larry and Kitties said:
Fluoxetine is not expensive since you can get it at a human pharmacy . It is on Target's list of $4 prescriptions. I ony see the capsuls listed
http://www.target.com/pharmacy/generics-condition
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Larry, do you know whether in animals there's any variation in response between branded Prozac and generic fluoxetine? (I ask because I can attest personally that there is a difference in response between the two for some humans.)
 
Critter Mom said:
Larry, do you know whether in animals there's any variation in response between branded Prozac and generic fluoxetine? (I ask because I can attest personally that there is a difference in response between the two for some humans.)
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Prozac made me sweat like a pig and unable to walk (horribleness). That was a short 2 day trial :confused: - decided medication wasn't for me after that.
 
Hi Rob,

Sounds like a really productive visit with the vet! :)

It's great about the B12 and the Prozac Rx. It's a two-pronged attack. I am wishing so very hard for these to help you both.

:bighug::cat:


Mogs
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pevsfreedom said:
Prozac made me sweat like a pig and unable to walk (horribleness). That was a short 2 day trial :confused: - decided medication wasn't for me after that.
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I was able to tolerate branded Prozac OK. Prozamel, one of the fluoxetine generics, made my nightmares more frequent and much worse. (*shudder*)

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Critter Mom said:
I was able to tolerate branded Prozac OK. Prozamel, one of the fluoxetine generics, made my nightmares more frequent and much worse. (*shudder*)
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Sorry about that, the mind is a weird thing and these medications are even weirder. I think I tried Prozac, lexapro, and paxil, all of which were absolutely horrible (and were generic versions) [I have kind of bad OCD/anxiety hence why I tried them].
 
The transdermal pen (30 day supply) was about $25 including shipping from Wedgewood Pharmacy in case anybody else might find this info useful in the future.
 
Rob, give the new script a few weeks to see if it works. I had to go through 3 different medication before I found one that stop Pedro's inappropriate urinations. Valium is the drug of choice for my buddy and all spraying has stopped. I also give 0.20 ml of Rescue Remedy for pets once daily. I feel your pain as we have worked down the same path and had many of the same conversations with my husband regarding Pedro's fate. I went to Sam's and purchased their large incontinence pads and simply covered everything in my office. If Pedro sprayed urine on one I simply tossed it in the trash and replaced it with a new one. Keep us posted.
 
Critter Mom said:
I've not come across those, Rob. How do they work?
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I'll let you know when I get it in about 5 days. The woman described it as setting it to a dose, twisting something and the medicine in gel form comes out of the tip and that gets applied to the ear. She told me to read the very thorough instructions for more info when it arrives.

Warren is sitting in my lap at my desk as I type this and says hello and thank you to everyone because he's still alive and breathing. At least that's what he'd be saying if he could talk.
 
Critter Mom said:
Larry, do you know whether in animals there's any variation in response between branded Prozac and generic fluoxetine? (I ask because I can attest personally that there is a difference in response between the two for some humans.)
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I know I reacted very badly to Prozac, rash all over my upper body and unable to sleep.
 
robr said:
Warren is sitting in my lap at my desk as I type this and says hello and thank you to everyone because he's still alive and breathing. At least that's what he'd be saying if he could talk.
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Hi Warren! :D I'm sending a special Good Luck kitty just for you along with lots of wishes for your new medicine to make you feel better.

 
Hi Rob,

How are you and Warren doing today? Well, I hope. :)

Here is a thread that I think you should read:

Diabetic Neuropathy and B12 Methylcobalamin thread

From reading the above, it might be an idea to consider methylcobalamin B12 supplementation on a regular basis as the consensus seems to be that it is a better form of B12 than cyanocobalamin. I don't know whether your vet can give methylcobalamin injections instead of cyanocobalamin? Bearing in mind that time is of the essence it might be worth enquiring because B12 injections are a more efficient way of boosting levels because they circumvent any GI B12 absorption difficulties Warren might have.



Mogs
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robr said:
Don't want to jinx anything, but today is day 5 with great numbers. Pmps last night was 66, amps was 67. Unheard of. No litter box accidents in 48 hours. Fingers are crossed.
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Hurrah!! Prayers are being answered!! All your POSITIVE efforts are paying off!!!
OMG. This is making my day Rob.
Go Warren. You can do it.You can do it.You can do it.:)
 
robr said:
Don't want to jinx anything, but today is day 5 with great numbers. Pmps last night was 66, amps was 67. Unheard of. No litter box accidents in 48 hours. Fingers are crossed.
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That's really promising, Rob!

I saw the PMPS last night and saw you'd administered the insulin. You've definitely qualified for the Cojones of Steel award. :eek: :nailbiting: ;)

Now that you're down to "shoot low to stay low" territory, I think you really need to post daily in the LL support forum simply because there will be more traffic there to help you with monitoring and to give you support should Warren dip too low.

FOR WARREN'S SAFETY: It is VITAL that you get at least a +2 BG test to see where the cycle is possibly taking Warren, especially at night.

Also, I'm sure you've already got this forum sticky but just to be on the safe side heres the TR group's guide to Shooting and Handling Low Numbers (helps to really familiarise yourself with it in a quiet time, not in the middle of a low; much calmer! ;) ).

Another thought. From your other thread I see your little girl is quite the fishing expert! :) I'm glad that Warren enjoyed his treat but ... don't vary his diet at the moment.

Different foodstuffs can spike a cat's blood glucose levels. For example, that unexpected 'bounce' after Warren's yummy fishy supper may possibly have also been influenced by the fish. (You can determine which foods spike a cat's blood glucose levels by testing before and after a meal of the food being studied, but that's for the future. In the normal run of things such wobbles are chalked down to experience and the caregiver works to get past the hiccup - no pressure. However in your critical situation you don't have that luxury at the moment. I strongly recommend that you keep everything as static as possible: food, feeding schedule, other routines. Particularly I can't recommend strongly enough that you feed Warren exclusively on the food variety that he has been eating while he has been getting these really good numbers. You need to minimize the risk of anything upsetting this good - and oh so critical - period of tight regulation.

Stay on that lawn and picnic like a mad thing, Warren! :)


Mogs
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EDITED TO ADD:

A caveat. My earlier comments about sticking to the one food for Warren at the moment only applies when Warren is in safe numbers on a normal cycle with no risk of hypo. Obviously if Warren were to go a bit low, you will need to feed what he needs to steer his numbers properly (his regular low carb, medium carb gravy, honey/karo - whichever is needed to get his numbers back into a safe range - as indicated in the 'Shooting and Handling Low Numbers guide.)
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Rob,

When you set up new threads on the LL support group, I'd appreciate it if you could tag me somewhere in a post so I can follow how Warren's doing. I can't cope with searching the board for threads; it's too busy and it overwhelms me.
 
robr said:
I desperately need help. I will refer you to a couple of threads and then summarize where am at:

Intro forum:
http://www.felinediabetes.com/FDMB/threads/meet-warren-again.136271/#post-1424641

Lantus forum:
http://www.felinediabetes.com/FDMB/threads/5-4-warren-amps-518.137335/

Warren was diagnosed with diabetes a bit over a year ago. He was on Vetsulin for a couple of months and went into remission for almost a year. When he started having problems again, I had a full lab workup done, urinalysis, blood, physical, etc and my vet said the only health issue Warren has is his diabetes. In Warren's 15 years, he has NEVER had issues with behavior... problems using the litter box, etc.

I put him back on Vetsulin but it did not last more than 8 or 9 hours. After perhaps a month of Vetsulin, I switched him to Lantus (a month ago). In that month I have not been able to regulate him. 1 unit pushes his blood sugar too low (40s) and the Lantus can last as long as 16 hours. 0.75 (approx, no way to measure exactly) doesn't seem to be enough. You can examine the spreadsheet, I have probably 150 data points over the month and a couple of curves.

He has been peeing on the kitchen rug, so I placed a litter box about 5' away in the bathroom. When he is locked in the bathroom, he uses it 100% of the time. When I let him out, he uses the rug too often. My wife has sentenced him to living in the bathroom and wants me to have him put to sleep. She will not tolerate any more peeing outside the litter box. The ultimatum is coming and I feel like I'm just about out of things to try.

I believe the peeing problem is related to his diabetes being unregulated. His levels looked reasonably stable the past 48 hours (200s-300s - not great numbers but first time I've seen him out of 400s and 500s for this long of a stretch), I was hoping we were finally starting to stabilize, then he peed on the floor and I checked and he had bounced (556. First time he'd been over 400 in 48 hours).

My wife feels his peeing is behavioral since he has an option of a litter box 5' away from where he is going.

Warren does not seem stressed in any way. He's happy, purring, playful, sitting in laps, he's his normal self.

I need a plan I can communicate to my wife and be able to tell her 'if x,y,z doesn't work, I will have him put to sleep'. I don't know if he'd do better with Lenevir, that's one option, but from what I've read it seems when Lantus doesn't work, it's because it's not bringing down the glucose levels, which is not what I'm experiencing. I'm not in a position to throw a lot more $$ at shots in the dark, again my wife feels I have spent enough $$ already on an "old cat" (an awesome old cat) but I can probably get away with a few hundred. I just lost my Mom in March and really hate the idea of saying goodbye to another close friend when there may be a straightforward solution. Any help is greatly appreciated.

Thanks everybody.
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Please read my post on Pretty Foots he is 15 years old. If you love your cat then do speak up for him. How we treat our animals is an indication of how compassionate we will be with our human relatives. Your wife should love that you are compassionate and will be there for her in the same loving way.
 
Hi all, somehow I missed all the posts over the weekend, I usually get an email when somebody replies but must have missed them. Thank you again for all the additional info, there's a few new things here to digest. I will also add a +2 each night to Warren's PMPs. Once I do start a new thread in the Lantus forum I will update here. I'm not entirely sure I have anything to ask there right now though. Thanks for all who are following Warren's journey through these tough times and sticking around to help. Can't tell you how much it's appreciated to get some support here. It's mentally exhausting sometimes and before this forum, I felt like I was going it alone.
 
Very happy to see some positive news about Warren!!!

I agree with @Critter Mom that it is super critical to monitor Warren when you're shooting on such a low number like 66 or 67 to make sure he stays out of hypo territory. Folks on the Lantus page can definitely help you there too. You are definitely not in this alone :).
 
robr said:
Hi all, somehow I missed all the posts over the weekend, I usually get an email when somebody replies but must have missed them. Thank you again for all the additional info, there's a few new things here to digest. I will also add a +2 each night to Warren's PMPs. Once I do start a new thread in the Lantus forum I will update here. I'm not entirely sure I have anything to ask there right now though. Thanks for all who are following Warren's journey through these tough times and sticking around to help. Can't tell you how much it's appreciated to get some support here. It's mentally exhausting sometimes and before this forum, I felt like I was going it alone.
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This is great to hear he's doing better for now. I hope it continues. Is this with the Prozac?
 
No, I haven't received the Prozac yet. I had a discussion last night with my wife about whether or not we should use it given that he hasn't had any accidents in several days now. I want her to help make decisions so I'm not the only one invested in this. She is of the opinion that his litterbox habits have been unpredictable and it's likely stress related in one way or another and given the 2-3 weeks prozac will take, she thinks I should start him on it anyway.
 
It sounds like things have calmed down a bit for you all, Rob. I'm really glad. It will help Warren, too.

I had another thought. If you do see Warren using his litter box, once he has finished give him lots of gentle, warm, praise and one of his favourite diabetic-friendly treats. It may help to make toileting in the right place a very positive experience indeed. It may also help reassure him in general and reduce any anxiety he may have about using the litter box.

Now that you're working with much lower numbers make sure you've always got lots of test strips at home. :)


Mogs
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Has anybody heard of probiotics causing bathroom accidents?

Shortly after I started Warren on probiotics, his peeing outside the box started happening more frequently than ever. But it was also a period where he was struggling with his glucose numbers. Still, I took him off the probiotics at just about the time his numbers were getting good. After 9 days of good numbers and no accidents, I tried the probiotic again tonight and I caught him in the act of peeing on our shoes only 2 hours later. It could be coincidence of course. His brother Brak (whom my friend adopted from us about 6 years back) loves the probiotics and does well on them (Brak also has diabetes and pancreatitis in addition). Also I started Warren on prozac 3 days ago. No noticeable changes in his behavior yet that I can tell ... but his behavior has been perfect the past 9 days. He has definitely seemed like a younger cat. I saw him jumping in the air to catch a moth yesterday and he's more 'lappy' than he has been.
 
That's a new one for me Rob, but I guess anything is possible with these sugarcats of ours!

It's great that he went 9 days without any accidents too!! I bet your wife is happy with that! (at least I'd hope she was!)

Did you pick up all the rubber backed rugs? Just wondering if you had done that and maybe it helped with his peeing problem...may just need to buy a shoe tree or a big plastic tub or something and keep those shoes off the floor where he can get to them
 
Hi Rob,

Big improvement in Warren's regulation, I see! It's great to read about how much better he's feeling and that he has more energy and joie de vivre; after all, that's what this sugar dance is all about. :)

I'm sorry to hear he had a mishap, but 9 days without one is great news. Did the shoes have any rubber components, perchance?

If discontinuing the probiotic coincided with improved toileting and its reintroduction correlated with another 'accident', I'd be inclined to stop giving that probiotic to see if his toileting habits improve again. If the unwanted behaviour stops, I'd be very inclined not to give it again and maybe try another type of probiotic in the future.


Mogs
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No more incidents since the 1 attempt at the probiotic again. He got his second B-12 shot today. My wife didn't agree that the rubber backed rugs were any sort of culprit, to me he seemed to favor them more, but my wife didn't think so. We did remove the large room sized kitchen rug so now it's just hardwood floor and one small (rubber backed) rug in the kitchen which is his favorite accident area. We just all try to remember to put our shoes in the shoe thingy that hangs on the back of the bathroom door that nobody ever uses :).

All in all it's been pretty quiet around here of late which is a good thing. I just ordered some no carb treats for Warren. The litterbox is in my home office so when I see him use it, I'll give him a treat.
 
Don't forget the praise! Lots 'n' lots of fusses 'n' praise! :)

Glad to hear that there haven't been any mishaps since withholding the probiotic. It will be interesting to see if the better toileting continues. If after a while you then try the probiotic again and Warren has a mishap again, then you'd get some bit of confirmation that something in the probiotic is a trigger. Interesting.

Please give Warren some scritches from me. I have a real soft spot for him. He could be Saoirse's fraternal twin. :)

I'm really glad for all of you that things are calmer now. Long may they stay that way. :) (Anti-jinx, anti-jinx!)



Mogs
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Warren's peeing in your shoes makes me grin....KT always peed in shoes regardless of whether he felt good, felt bad or just felt onery. All shoes in our house were always standing on their toes against something. Altho he's been gone a year today, our shoes still stand in the 'KT salute'.

KTSalute.jpg

Sure hope Warren keeps doing better!

HUGS!
 
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