Murphy's results

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Carol & Murphy (GA)

Carol & Murphy (GA)

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Spent the whole day at the cat hospital - was great to get speciality care
I overslept this morning and didn't test him, and didn't give him his 0.5 unit of insulin - I wish I had because his blood sugar at 4 pm is 622 (no insulin plus stress) yikes

anyway, his abdominal ultrasound was, unfortunately, what I expected
1) slightly enlarged liver
2) pancreatitis
3) inflammatory bowel disease in jejunum
4) enlarged bile duct

so he has what is called triaditis - it's not a good diagnosis - basically, inflammation of the entire upper GI tract
But got some new anti inflammatory meds, and if those don't work, there's more options but this is a chronic, difficult to manage diagnosis -
I was advised to switch to u-100 syringes to more accurately dose the insulin and avoid eyeballing the dose

So, we'll go from here - unfortunately the eating issues (or lack thereof) and frequent development of food aversions are all part of this diagnosis
At least I know for sure - it's pretty discouraging though
and insulin dosing remains a nightmare as it all depends on what (of if ) he decides to eat that day
 
Oh boy, sorry about that diagnosis. Good to know that you have a couple of options if the meds don't work.
Carol & Murphy said:
inflammatory bowel disease in jejunum
Click to expand...
What is jejunum?
Try not to be too discouraged, with the new anti-inflammatory meds he'll start feeling better and then he'll eat better. Hugs Carol :bighug::bighug::bighug::bighug:
 
The jejunum is the upper part of the intestine (the part the connects to the stomach) - after that comes the small intestine and then after that is the large intestine - thanks for the positive thoughts, but these drugs are not exactly miracle cures
 
:bighug:Well, not a big surprise for you, but not what we hoped. I hope the meds will work to get his appetite back so you can get back on track with the insulin.

I imagine there are some kitties here with the same issue. You might search and post on health. Wonder if there is a online support group? We can help as always with the insulin, but it'd be nice for you to be able to talk to others with the same digestive issues.

Hugs to you and Murphy. I guess it is a good thing that you know now what you are dealing with; just wish it was less complicated. I am glad there seem to be some options for meds.
 
Sorry about the diagnosis, but at least you know what your working with. Hope the new meds help. Did they give you any pointers as far as feeding? Like low fat or avoiding certain things?
 
Carol, check this out for some more info on Triaditis.
Hi Jim, I'm sorry that you and Noelle are having to deal with Triaditis. It can certainly be a rough road to travel. One thing that you might want to ask the vet about is pain medication. Pancreatitis especially can be very painful and one of the cornerstones of treatment is adequate pain control (with an opioid like Buprenex, not NSAIDs like Metacam). Also cobalamin (vitamin B12) injections can help tremendously with appetite and will improve the absorption of other vitamins and minerals. Here is some more info on that for you:
http://www.idexx.com/pubwebresources/pdf/en_us/smallanimal/education/dx-consult/managing-pancreatitis-and-concurrent-conditions.pdf
http://vetmed.tamu.edu/gilab/research/cobalamin-information
 
Bobbie And Bubba said:
Carol, check this out for some more info on Triaditis.
Hi Jim, I'm sorry that you and Noelle are having to deal with Triaditis. It can certainly be a rough road to travel. One thing that you might want to ask the vet about is pain medication. Pancreatitis especially can be very painful and one of the cornerstones of treatment is adequate pain control (with an opioid like Buprenex, not NSAIDs like Metacam). Also cobalamin (vitamin B12) injections can help tremendously with appetite and will improve the absorption of other vitamins and minerals. Here is some more info on that for you:
http://www.idexx.com/pubwebresources/pdf/en_us/smallanimal/education/dx-consult/managing-pancreatitis-and-concurrent-conditions.pdf
[URL='http://vetmed.tamu.edu/gilab/research/cobalamin-information[/QUOTE']http://vetmed.tamu.edu/gilab/research/cobalamin-information[/URL]
Click to expand...
I clicked on the link and it is not active. Sorry, but I thought the info about B12 injections for the appetite was interesting. Maybe something you could ask about.
 
Oh Carol, I just came over to see Murphy's results and I am disappointed right along with you! It is good to be with specialist vets who really know what they are doing, and what a blessing that you can get that great diagnostic level of care for him, so you know exactly what he "has". I hope that there will be things for you to try that really help with this. I wish I had something more than a hug to offer....:bighug: Just love him up and calm him down. You will get the BG back down soon.
 
I forgot to add that he also has a heart murmur for which he needs a cardiac echo. He needs that before he has his dental- which I was told he really needs and will need to have a few extractions.
His B12 level was normal in the labs drawn 2 weeks ago, I wonder about the B12 shots in that case, but will check
Milk thistle is certainly an interesting possibility - I use it myself sometimes after I've been out (on those very rare occasions these days)
 
Carol, if he needs a cleaning badly and some bad teeth, perhaps you will see his numbers come down. :) And, maybe the bad teeth have had an impact on his eating if his teeth hurt.
 
Carol, I'm so sorry to hear that diagnosis...but as Sue said, this is what we expected. Now that you know for sure, hopefully it will help you treat him!

I know it's tough to hear, but we are all here for you! Hugs!
 
thanks everyone- I feel quite depressed this morning - no hope for remission, that's for sure - only hope is that it can be controlled (with lots of effort) most of the time. As I've said before, the ibdkitties FB page is really depressing - all descriptions of triaditis include the words "horrid diagnosis" On a brighter side, 3 units brought his blood sugar from 622 to 75!!
 
Great about the green last night! Did they give you any ideas on feeding? Did you give him the allergy test? Maybe there are some food allergies that, when you avoid them, he'll do better.
 
Hi Sharon - regarding the feeding, she said to just continue doing what I am doing -have a variety of the lowest carb dry foods I can find and feed him whichever one he will eat that day - she said to try Young Again as often as possible (I do- every day - 99% it a "no") She thought that his life long intolerance to wet food was tied into this diagnosis, and while agreeing it was strange, didn't have much to say -other than she didn't think fat content of wet food was much of a factor - she said kibble has a high fat content - I'll have to check that. So the plan is continue giving him wet food as he'll tolerate and put meds in it when possible. I have to give him cerenia every day (both anti-nausea and anti inflammatory properties) the hope is to hold off on the steroids for as long as possible He's doing okay today I haven't gotten the results of the hair and cheek swab I sent in for allergy testing -I think it takes a few weeks. I'm not that convinced, now, that his issues with food is related to allergies- probably more to the IBD. It will be interesting to see what the results are though
 
Yes I believe YA is very high fat, NV less so, but still fairly high. As far as allergies, it certainly won't hurt to avoid any he's allergic to, and may help. Read up on the Milk Thistle for cats too. Sounds like it won't hurt to try it. Even says it might help with diabetes as well.
 
So very glad that you got a solid diagnosis. At least you know what will help and what will not. It is so hard to figure out what is best for Murphy when you don't know. So now, you can move forward and make him feel more comfortable as possible. It seems like I have read recently of some others who have received similar diagnosis on the health forum. Hugs to you and Murphy.
 
Hi Carol

I’m so sorry to hear about Murphy’s diagnosis. I actually don’t have experience with triaditis; Gracie just had very mildly elevated liver values and IBD the last several months. She never had any issues with her pancreas and her liver was never enlarged. Her small intestines were slightly thickened. The specialist was not sure if the increased liver values were from the IBD or not since her liver and pancreas always looked normal on ultrasound...and she had several. She was on ursodiol and I would strongly urge you to discuss this with your vet. If Murphy’s bile duct is enlarged, this medication would help him very much. You should also give supplemental taurine (such as NOW 1000 mg) with it as ursodiol, although a natural bile acid, can deplete the body of taurine if given long-term. I gave Gracie 1/8 tsp of the 1000 mg bid but check with your vet. I think it would also be important to know what is causing the dilation of the bile duct; in other words, it can be inflammation or it can be an obstruction. They typically cannot tell just from an u/s so you might want to discuss with your vet if a bile acid assay test is indicated. It will tell you whether his bile duct is dilated due to obstruction. It’s a simple test to do; they take blood, then you feed him, and after a short amount of time (a couple hours, I believe), take him back for another blood draw. The labs on his SS don’t have a date so I’m not sure when that blood draw was done. It’s kind of unusual to see that much going on intestinally with an enlarged liver and dilated bile duct and not see some elevation of his liver values. Milk thistle is a very good supplement to help with liver issues. You can give it just as milk thistle or through something like Denamarin.

You might want to also look at the website for IBD Kitties. If you are on Facebook, there is also an IBD Kitties FB group; both are great resources for treating IBD. It’s not just as simple as changing foods. There are a lot of supportive supplements that can be given including probiotics, digestive enzymes (which are not the same as pancreatic enzymes that are give for EPI). Quite frankly, I find that IBD is tougher, in many cases, to manage than FD. The other issue is whether it is IBD or lymphoma. Studies are now showing cats with IBD will typically progress to lymphoma so you might want to discuss with your vet whether it is worthwhile to do any other diagnostics in that regard.

If you haven’t seen the Primer on Pancreatitis that I wrote, it might give you some other info as well.

If I can be of any other assistance, please tag me. I’m happy to share with you all I’ve learned about liver and pancreatitis issues and IBD.
 
Marje and Gracie said:
I think it would also be important to know what is causing the dilation of the bile duct; in other words, it can be inflammation or it can be an obstruction.
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I agree.
Just wanted to add a note of caution when it comes to giving ursodiol aka Actigall...

"If the common bile duct is obstructed with a gallstone, it's not appropriate to increase bile flow. In such a situation, the use of ursodeoxycholic acid would be contraindicated."
http://www.veterinarypartner.com/Content.plx?A=549

Alex was on ursodiol for years. I highly credit the use of ursodiol (when appropriate) in conjunction with giving taurine and denamarin for adding years onto her life. We had it compounded into a chicken flavored liquid.
 
Jill & Alex (GA) said:
I agree.
Just wanted to add a note of caution when it comes to giving ursodiol aka Actigall...

"If the common bile duct is obstructed with a gallstone, it's not appropriate to increase bile flow. In such a situation, the use of ursodeoxycholic acid would be contraindicated."
http://www.veterinarypartner.com/Content.plx?A=549
Click to expand...

Thanks, Jill, for clarifying. This would be a benefit of the bile acid assay....determining whether there is an obstruction of the bile duct.
 
Thanks so much @Marje and Gracie and @Jill & Alex (GA) - A veterinary radiologist did the ultrasound so I feel pretty good about the quality - it took over an hour - they specifically said that he did not have gallstones, and they didn't think there was any obstruction (but rather due to inflammation). The liver was only mildly enlarged (he had hepatic lipidosis a few years ago, and since that his liver enzymes have always been normal). The lab work on his SS is from 12/10/15 (I couldn't find where to put the date)
My vet did prescribe the ursodiol - we talked about how best to give it - she said it would be 1/6 of a human pill which seemed difficult to split accurately so we went with having it compounded into a liquid. This is from a mail order pharmacy so I probably won't get it until next week - how did you two give it? I didn't know about the taurine but will definitely start that as well (where do you get it?) What about B12 - his value was normal at the Texas A&M lab two weeks ago- should I still supplement? I do belong to the IBDkitties Facebook page but I have to admit that it depresses me greatly - it's so clear that so many people so struggle with it, and so many notices of cats PTS there, I have to steel myself to look at it. But Lacey seems great, so I'll look at it more carefully. My vet did talk about denamarin - I thought I had agreed to adding that to, but it seems like it's not on the list of meds I was sent home with - perhaps she wanted to start with the daily cerenia (since nausea and inappetence is his major issue) and the ursodiol first - it is something that can be compounded into a liquid with the ursodiol?
 
I thought I would take advantage of Murphy's shaved abdomen/flank and shoot his insulin into his flank, I did that today but wonder about absorption - I gave him 2.5 units and it hardly budged his blood sugar - as opposed to 3 units last night resulting in a 547 decrease (which was shot in the shoulder area) Anyone have any information?
 
Carol & Murphy said:
A veterinary radiologist did the ultrasound so I feel pretty good about the quality - it took over an hour - they specifically said that he did not have gallstones, and they didn't think there was any obstruction (but rather due to inflammation).
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Our radiologist came to the same conclusion with Alex. They didn't feel a bile acid assay was necessary prior to prescribing ursodiol.
Carol & Murphy said:
My vet did prescribe the ursodiol - we talked about how best to give it - she said it would be 1/6 of a human pill which seemed difficult to split accurately so we went with having it compounded into a liquid. This is from a mail order pharmacy so I probably won't get it until next week - how did you two give it?
Click to expand...
I usually gave ursodiol to Alex right before her last feeding of the night (with an oral syringe)... only because I tried to spread out her meds/supplements whenever possible. I'm not sure "when" matters... other than having food on board.

Follow directions from your vet. Depending on the strength of the compounded ursodiol, you may be administering this med once or twice a day.
Carol & Murphy said:
I didn't know about the taurine but will definitely start that as well (where do you get it?)
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You could probably pick it up at any reputable health food or vitamin shop. Make sure it's "pure"... without other ingredients. I usually purchase Taurine and other supplements from iherb.com: Now Foods, Taurine, Pure Powder, 8 oz (227 g). I gave Alex 1/8 teaspoon mixed in food twice daily (breakfast and dinner). All my cats receive the same dose, but it's always a good idea to double check doses with your vet.
Carol & Murphy said:
What about B12 - his value was normal at the Texas A&M lab two weeks ago- should I still supplement?
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The only B vitamins I gave Alex on a regular basis was B-Right by Jarrow (B complex vitamins). However, many kitties do benefit from B12 injections. Check with your vet.
Carol & Murphy said:
My vet did talk about denamarin - I thought I had agreed to adding that to, but it seems like it's not on the list of meds I was sent home with - perhaps she wanted to start with the daily cerenia (since nausea and inappetence is his major issue) and the ursodiol first - it is something that can be compounded into a liquid with the ursodiol?
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I don't think denamarin should be compounded into a liquid with the ursodiol. It'd be another question for your vet.

We gave Alex Denamarin For Cats and Small Dogs (Contains 90 mg of S-Adenosylmethionine and 9 mg of silybin A+B):
"For optimal absorption, tablets should be given on an empty stomach, at least one hour before feeding, as the presence of food decreases the absorption of S-Adenosylmethionine." Denamarin is one of those pills that you don't want to cut or crush because it loses it's effectiveness. Many bury the pill in a bit of a treat or pill pocket for easy pilling. It's a tiny pill, so pilling shouldn't be a problem. I found Denamarin to be a whole lot less expensive on Amazon than purchasing from my vet. :)


Marje may have other suggestions or ideas...
 
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Carol & Murphy said:
I thought I would take advantage of Murphy's shaved abdomen/flank and shoot his insulin into his flank, I did that today but wonder about absorption - I gave him 2.5 units and it hardly budged his blood sugar - as opposed to 3 units last night resulting in a 547 decrease (which was shot in the shoulder area) Anyone have any information?
Click to expand...

I never shot in the flank area, but I've seen others that have. It *shouldn't* make a big difference in absorption, but see what others think.

I think today you're up against the bounce from that 500+ point drop last night.
 
Carl & Polly & Bob (GA) said:
I never shot in the flank area, but I've seen others that have. It *shouldn't* make a big difference in absorption, but see what others think.

I think today you're up against the bounce from that 500+ point drop last night.
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Thanks Carl - I never considered it was a bounce - I think you are correct! I'm going to try the flank again today - it's so tempting to have another alternate site with no fur!
 
What an awesome resource, Jill. Thanks! Definitely food for thought.
 
Carol, I agree, I don't think it had to do with placement of the shot. Black number, dropped to green, back to red? I agree, it's a bounce. Might take a few days for him to clear and settle down after it.
 
Sorry I didn’t get back here yesterday. Work....

If you look at Gracie’s SS, I alternated shooting chest, side, flank and occasionally shot scruff. I never could tell any difference but I’m a firm believer in ECID. I mainly did it so she would not develop any fatty tissue from shooting the same spot all the time (which she began to do when I was just shooting scruff early on....it went away when I started moving the shots around).

I had Gracie’s ursodiol compounded into a chicken flavored liquid but you have to be sure and tell them no sweeteners including artificial (like maltodextrin) or else they often add artificial sweeteners. I gave it to Gracie right before her PMPS meal and it was a treat...she loved it!!! The Denamarin can’t be compounded and I spoke at length with the manufacturer. The issue with Denamarin is it must be given on an empty stomach and they recommend after fasting overnight. I did this for a very long time....getting up at 5 every morning to give her Denamarin two hours before AMPS. I never noticed it did any good for her. One thing that helped her immensely was water soluble liquid vitamin E but you absolutely must discuss this with your vet first. I also used the NOW taurine powder and I’d just order it online at the cheapest place I could find (usually vitacost or iherb). Same dose as Jill gave Alex...1000 mg powder and I gave her 1/8 tsp bid mixed in her food. She never minded it.

I’d discuss the Vitamin B injections with your vet. From the way you have his SS set up for labs, I can’t tell what his number was as opposed to the reference ranges. If his cobalamin is greater than 1000, then he’s not likely to need bit B12 shots but, again, I’d talk to the vet. For his labs, if you go to the top of the lab tab on his SS, you can put the date of his labs in the top space to the right of the “range” column. You can look at Gracie’s lab tab to see how I did it. To take the green out of the columns you don’t want it in, click on the square where you don’t want the color, then go to to the top, click on the “pitcher” in the tool bar and select white.

I know the FB IBD group is tough. I had a hard time there, too. Not only is the disease so horrific but the loss there is profound. Lacey is redoing the ibdkitties.net site and should have it up and running soon. But....there are still some pretty smart people on the FB page that could better direct you as to conversations with your vet on Vit B12 injections. On one hand, if you know his intestines are thickened and he might have IBD, it could be helpful so he doesn’t drop on cobalamin. OTOH, I don’t know if vets prescribe VitB12 unless the numbers indicate the cat needs it.
 
Marje and Gracie said:
Sorry I didn’t get back here yesterday. Work....

If you look at Gracie’s SS, I alternated shooting chest, side, flank and occasionally shot scruff. I never could tell any difference but I’m a firm believer in ECID. I mainly did it so she would not develop any fatty tissue from shooting the same spot all the time (which she began to do when I was just shooting scruff early on....it went away when I started moving the shots around).

I had Gracie’s ursodiol compounded into a chicken flavored liquid but you have to be sure and tell them no sweeteners including artificial (like maltodextrin) or else they often add artificial sweeteners. I gave it to Gracie right before her PMPS meal and it was a treat...she loved it!!! The Denamarin can’t be compounded and I spoke at length with the manufacturer. The issue with Denamarin is it must be given on an empty stomach and they recommend after fasting overnight. I did this for a very long time....getting up at 5 every morning to give her Denamarin two hours before AMPS. I never noticed it did any good for her. One thing that helped her immensely was water soluble liquid vitamin E but you absolutely must discuss this with your vet first. I also used the NOW taurine powder and I’d just order it online at the cheapest place I could find (usually vitacost or iherb). Same dose as Jill gave Alex...1000 mg powder and I gave her 1/8 tsp bid mixed in her food. She never minded it.

I’d discuss the Vitamin B injections with your vet. From the way you have his SS set up for labs, I can’t tell what his number was as opposed to the reference ranges. If his cobalamin is greater than 1000, then he’s not likely to need bit B12 shots but, again, I’d talk to the vet. For his labs, if you go to the top of the lab tab on his SS, you can put the date of his labs in the top space to the right of the “range” column. You can look at Gracie’s lab tab to see how I did it. To take the green out of the columns you don’t want it in, click on the square where you don’t want the color, then go to to the top, click on the “pitcher” in the tool bar and select white.

I know the FB IBD group is tough. I had a hard time there, too. Not only is the disease so horrific but the loss there is profound. Lacey is redoing the ibdkitties.net site and should have it up and running soon. But....there are still some pretty smart people on the FB page that could better direct you as to conversations with your vet on Vit B12 injections. On one hand, if you know his intestines are thickened and he might have IBD, it could be helpful so he doesn’t drop on cobalamin. OTOH, I don’t know if vets prescribe VitB12 unless the numbers indicate the cat needs it.
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thank you so much - this is really helpful - really helpful Murphy having another night of not eating much - he turns on a dime - he was begging for food so I gave him dinner early - he ate a little bit then turned away and hid under the couch -:(
 
So sorry to hear about the DX Carol, I haven't been on much, so missed your post. So much great help and advice given, wish I had some to add, but all I can do is give you a hug. :bighug: Hang in there and give Murphy a hug for me too.
 
thanks for asking, everyone He's been doing pretty well - although it is gut wrenching as he is so hungry about an hour before meal time - just starving - then I feed him and he can only eat a little before he goes to lay down - seems like his tummy hurts. So I am trying to give him the most calorie laden food first (Young Again, Evo, Purina DM) - anything to get calories into him before he gets sick. giving him small amounts of canned food - tiki cat chicken which I puree (he won't eat this plain) so I've been putting some Nature's Variety canned duck, rabbit, or lamb on top -don't know how much to push the canned though - I've been burned with the canned so often (pancreatitis) I could really use some help with the insulin dose - its very difficult as I never know how much he will eat, or what he will eat - his blood sugars are either black, red, pink or blue and green and I have no idea of when either will happen
 
Re the dosing. It looks like you've gone up to 2.5, which I think is a good idea.

I know you want him in safe ranges and that it is a balancing act between too low and too high. We always say better too high than too low, but I wonder if, in his case (and knowing you know what to do) if pushing it is a good idea.
 
sue do you mean increase the dose? I think I was freaked out by the 525+ drop from 3 units last week I feel clueless as to the dose makes it hard to steer when he wont eat
 
Carol, reading about Murphy's tummy bothering him makes me think about something I read in the Feline CKD group that many people use (and I have tried this too with my CKD girl, Andrea). It's Pepcid AC (generic famotidine). Many people on that board give 1/4 of a 10 mg tab to combat acid-tummy. I researched it myself and was giving some to Andrea (it works differently than Cerenia or ondansetron) and it may be helpful for Murphy and settle his tummy. You may want to ask your vet - there seem to be MANY people giving it to kidney-kitties with a lot of success. Not the Pepcid plus/20 mg. just plain famotidine 10 mg (aka Pepcid AC).
:bighug:
 
Cara and Wynken said:
Carol, reading about Murphy's tummy bothering him makes me think about something I read in the Feline CKD group that many people use (and I have tried this too with my CKD girl, Andrea). It's Pepcid AC (generic famotidine). Many people on that board give 1/4 of a 10 mg tab to combat acid-tummy. I researched it myself and was giving some to Andrea (it works differently than Cerenia or ondansetron) and it may be helpful for Murphy and settle his tummy. You may want to ask your vet - there seem to be MANY people giving it to kidney-kitties with a lot of success. Not the Pepcid plus/20 mg. just plain famotidine 10 mg (aka Pepcid AC).
:bighug:
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Hi Cara - thanks for the post - Murphy had been on pepcid for a few months but during my visit to Cat Hospital last week, they recommended using Prilosec instead (1/4 of a 20 mg tab daily) - My friend who is a feline vet also recommended that - not sure why - I'll try to get more information His 2.5 unit dose really caused me some excitement last night - he went down to 67 (Alphatrak) AFTER a little karo syrup- I guess it was the combination of his eating Young Again Zero Carb and a pink pmps. Young Again has such a good result from him - I wish he hadn't developed an aversion to it during his last bout of pancreatitis. It makes such a difference on the rare occasion he will eat it now
 
Let's celebrate the small successes, Carol. Nice nadir, nice recovery! The longer he stays in good ranges, the better. Yes, you may get the bounces and the days when only high carb food will work, but overall, I am feeling more positive for you two. And hugs for you because I know it is hard! :bighug:
 
Carol & Murphy said:
Hi Cara - thanks for the post - Murphy had been on pepcid for a few months but during my visit to Cat Hospital last week, they recommended using Prilosec instead (1/4 of a 20 mg tab daily) - My friend who is a feline vet also recommended that - not sure why - I'll try to get more information
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I can't give you any advice on the insulin dosages…sorry! But I will say that while I have read that both Pepcid and Prilosec can be used in cats, there can be more side effects with the Prilosec, I think. I am sure that your vet had a very good reason for switching.

I just wanted to make sure that you knew there were things available for his tummy… And you do! :D
 
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