911 Saoirse - PRAYERS PLEASE: UPDATED MONDAY GMT 21:00 - Steady Progress

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Critter Mom

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(Previous thread starts here: http://www.felinediabetes.com/FDMB/...ea-reduced-eating-again-eyelids-puffy.152157/)

We are having another very rough day. Saoirse really isn't well.

* BP Check:

Saoirse very, very stressed and cranky so we could not get a completely reliable reading. BP 180 - 190. Last home reading a couple of months ago it was 140 at home.

* BP Measurement - Home Equipment:

I've ordered a Doppler unit to try to monitor Saoirse's blood pressure at home (due tomorrow). I am hoping I can use desensitization techniques so that she won't find it stressful and therefore we will have accurate readings upon which to base her treatment. I would welcome advice and suggestions about this from any members with experience of monitoring BP at home.

I also ordered a paediatric stethoscope. (Thank you, @Larry and Kitties, for the suggestions about monitoring equipment; much appreciated.)

* BP Lowering Medication (Amlodipine):

Strategy was discussed with vet. I told him that Saoirse was very, very cranky and that - apart from the terrifying scare in the small hours of Saturday morning with the ½ tablet dose - the medication did seem to help Saoirse because once she was stabilized she seemed a lot calmer and more comfortable.

I also told the vet about my late father. He had cardiovascular issues and used to get quite hot-tempered at time. He would go red in the face at those times. My brother (a doctor) told me that high blood pressure can affect people in that way. I am wondering whether Saoirse's crankiness may be a clinical sign of high BP. I also wonder whether she is in pain. :( We agreed to give her 1/6 tablet of amlodipine. I administered it a few hours ago. No fainting this time. Saoirse was a little groggy for a while but she did seem a lot less uncomfortable. I gave her the tropicamide an hour later and that seemed to help her as well. I think my girl is in pain and it is shrivelling me up inside. She has just gone to hide under the dining table. :( :(

* Affected Eye (Right Eye):

Still bloody. Worried about whether she may have glaucoma which worries me because tropicamide is contraindicated. It does seem to make her feel better after she gets it but I'm worried sick about whether it's the right med for her. Does anyone reading have experience of eye problems in feline diabetics, including glaucoma. I would welcome anything you can share with me. Also the vet advised that there is a possibility of problem being cancer-related (see below).

* Left Eye:

Pupil is dilated and does not react to light - not as dilated as one being treated with tropicamide. I thought the eye was also being affected by the drops. The vet says it should not affect the untreated eye this way. There are also some dark spots (?) on the retina in this eye and this could potentially cause problems.

Vet is making immediate referral to veterinary opthalmologist to measure intraocular pressure and possibly do a scan of Saoirse's eyes to better determine what is happening. I would welcome hearing of any experience members can share in this regard.

* Digestive System:

Saoirse is hungry but having some difficulty with eating again today. In the main, she needs a bit of help to start eating but once she gets going she eats well. I need to let her lick some of the juice from the food off my fingers or warm the food up for her. Could this be a sense of smell issue? She did seem a little nauseated earlier (ondansetron on board this morning OK - afraid to give famotidine or anything else right now) but that was just after she passed a few segments of tan stools with some mucus on them and then she started passing tan-coloured diarrhoea. Between the blood pressure issues and possible med side effects (e.g. tropicamide may cause nausea; amlodipine has nausea and abdominal pain as a common side effect in humans; fusidic acid can cause liver upsets and transient jaundice - and I'm too frikkin' scared to give Saoirse her SAM-e and milk thistle supplement right now - terrified of doing anything that might make the situation worse. :( ) Saoirse seemed to find it easier to eat after the amlodipine and tropicamide were administered so I wonder whether she's in enough pain to make her queasy. Also Saoirse's BG has been running around the 13.0 mark (Alphatrak) and that's not going to make her feel too clever either. Gave 0.25IU Lantus this morning. Assuming PMPS is high enough I will give 0.25IU again tonight. (I can't give more because I will not last the night before passing out; I am physically sick with exhaustion. I wish I had a family and that there was more than just me to watch over Saoirse; I don't want to fail her and if I can't get at least some rest that is what could happen. I am so scared.)

I've already taken a dose of beta blockers today to try to stop shaking and function better for my girl. I am contemplating taking another one. My stomach is a mess. My heart is in shreds.

I feel like I'm standing on quicksand and every move I try to make to get out of the predicament just sucks me down further.

Help!

:(



Mogs


EDITED TO ADD:

Saoirse was not sedated at the vets on Friday so the fatty stool and nausea on Saturday was caused by something else.

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Ditto, and more prayers coming!
:bighug::bighug::bighug::bighug:

OH and
cat.gif
for Saoirse, when she's feeling up to it:)
 
Im sorry to hear. We are still going through rough times and starting to think about difficult decisions. We will keep Saoirse in our thoughts and prayers
 
Just went to give Saoirse her next dose of antibiotic drops. Her eye was all crusted. I gently wiped away the discharge. It is bloody and her eye is a complete MESS.

Have called the OOH service. Waiting to hear from the vet.

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Im sorry to hear. We are still going through rough times and starting to think about difficult decisions. We will keep Saoirse in our thoughts and prayers
:(

Thank you so much. Keeping you, Whitey and your family in my thoughts and prayers, too.

:bighug:
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Message back from vet. Bloody discharge is from inflammation not from blood in the actual eye apparently. Keep giving Isathal eye drops. Asked what about tropicamide. Vet nurse passing on message from vet said carry on with what I was doing since vet had already seen me today. I asked about whether she could check with the vet if I could give Saoirse something for pain relief (I have some bupe). Got nowhere with that one. Apparently there is nothing more that I can do tonight. I am in despair.

Some of the discharge is bloody and some of it is yellow.

Saoirse's BG is at 12.7. I gave her 0.25IU Lantus 14 hours ago (AMPS was 13.7). I've just given her another 0.25IU dose now. (Worried to give earlier till I was sure that she was OK on the amlodipine.)

I have managed to give her a dose of ondansetron and she is eating a meal now. She got a fair bit of grub down today.

Saoirse is really growly and miserable and I can't do anything to help her. I know she's in pain. This is worse than the pancreatitis flare. At least then I could give her some pain relief.

I feel so helpless. And frustrated. And very scared. I am utterly, utterly out of my depth here.

:(
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Mogs

Sadly I have no words of wisdom for you at this time, but do know that I am sending many, many prayers and healing vines for both you and Saoirse

:bighug: :bighug:
 
This is so very sad to read and I know it is so terrible to be going through. I wish I lived near you because I'd be over in a flash.
I know this is so hard, but is it time to think about letting go? It is all about quality of life and what the future looks like for our kids when they get so sick.
I don't mean to upset you... sending hugs and prayers.
Pepper and the kitties
 
It sounds like the vet thinks everything is as expected. It seems like if she wasn't in pain you both could deal with this much better. If only you knew it was ok to give her the bupe! Are you worried about interactions with her other medications?
 
Yes, Andy. I asked the vet nurse to ring the vet back to ask if it was OK to give Saoirse some buprenorphine but she refused the request.
 
since you have the bupe and have experience with it.... I would give it myself .
I just would not go over 0.3 mL ....
at least give her 0.1mL ....

adding prayers and truckloads of vines.....
and hugs....
remember that sometimes they get sick, intensely, but with treatment, improve................
 
(((((Mogs))))) (((((Saoirse))))) I have no experience or words of wisdom but am sending continued thoughts and prayers for you both. You are a wonderful, loving mom to your furbaby!
 
What I was thinking is that in the US (most) of our pharmacists are quite educated and know more about drug interactions than (human) doctors do. I have no idea if their knowledge could extend into pet-specific medications or not, but it might be worth a shot for peace of mind.
Is there a 24 hour pharmacy you could ring and mabye they would be able to tell you if it's safe?

Edit to add: Short of that, I would continue to badger the emergency vet for an answer.

@Blamethecats and Hannah I don't see Mogs giving up anytime soon.ever.
 
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You and Saoirse have been in my thoughts. I'm sorry to hear you are both having such a rough time.

I don't have any experience with a veterinary ophthalmologist but I have been to a neuro-ophthalmologist for myself several times in past few months for increased intraocular pressure. There are a few different types of tonometers that can be used to measure intraocular pressure (the wikipedia page on tonometry is interesting but might be more information than you want right now). For people the most common test done during a typical eye exam uses a puff of air to measure the pressure. Another common test for humans uses eye drops to numb the eye so a device can be placed against the cornea to measure the pressure.

I was curious about what kind of test a veterinary ophthalmologist would use and after some searching I found a third type of test I had never encountered before. Here is one of the few videos I found of a cat being tested with a Tonovet tonometer:
I also found a video of an owl which I thought was fascinating and much better than the cat video. This video shows a close up of the meter in action:
Sorry about the huge videos in the middle of the thread! Just pasting the link caused the videos to embed and I have no idea how to disable it.

Hugs, love, thoughts, vines, scritches, and snuggles to you and Saoirse!
 
Oh, Mogs. I'm so sorry you're having another bad night with Saoirse. I would keep calling the OOH and try to find out about the bupe - there has to be something you can do for the pain she's in and bupe is often the safest option, but I just don't know enough about the interactions with other meds to be certain. You are doing everything you possibly can for your baby - none of this is anything you've done or not done, but for the vet to refuse to help you get Saoirse out of pain overnight is just unforgivable. It should be an easy enough question for any qualified vet to answer for you! I'm here if you need help staying awake again - just let me know. I'm sorry I wasn't here earlier when all this happened - other things to do for a few hours unfortunately, but if I'd known earlier I'd have been right here.

Hugs and healing vines headed your way. And no, never ever give up! You and Saoirse will get through this - I know you will. :bighug: :bighug: :bighug: :bighug:
 
This is all I could find searching quickly http://www.drugs.com/answers/what-are-the-problems-when-taking-amlodipine-and-395650.html From reading it through, it sounds as though you'd need to monitor for signs of low blood pressure. If it was me, I would be inclined to giving the smallest dose of bupe you can that works for her - just enough to get her out of pain - but it would mean checking to see how she's doing. I also know you must still be beyond exhausted after the last few days, but at least it does look as though it might be an option if you think you can do it. :bighug: :bighug: :bighug:
 
(((Mogs)))

All I can tell you is that our CKD kitty was on a low dose of amlodipine once daily and also took a low maintenance dose of bupe bid. He was a large cat and only had CKD and arthritis. The high BP from the CKD and which was never more than 180, responded very well to his amlodipine dose. He never had any interactions.

As much as I wish I could help, I'm not a vet, Saoirse has much more going on than he did, and ECID. I could never forgive myself if something happened to her just because I said my cat took it with no problems. When you are dealing with these many issues and an opioid, I just think a vet has to be helping you to coordinate these drugs and treatments.

You know I would do anything for you and Saoirse but I can't put her at danger with my limited knowledge.

Many prayers and hugs.
 
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in the US (most) of our pharmacists are quite educated and know more about drug interactions than (human) doctors do.
This is a superb idea. As luck would have it, I was thinking along similar lines yesterday. In our home town in Ireland there was an absolutely brilliant pharmacist. He would come out personally to brief customers in all key aspects of the current Rx and how it would interact with their other meds. Also, he was always delighted to answer any questions you had about drugs and he was a walking pharmaceutical encyclopaedia. I wonder whether our local pharmacy might be able to help me? Or possibly the online pharmacy I get Saoirse's ondasetron from ... (They're the ones that advised me about the best generic for cats.)

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Sending more prayers, hugs, and healing vines for you and Saoirse.
Mogs,
Saoirse knows how much you lover her and that you are doing everything possible for her.
 
It would definitely be worth trying any possible avenue for information you can get quickly Mogs. If there is someone there who can give you a definite answer, that would make it all so much easier for you to know what to do to help her the best. :bighug:
 
Yes, it is entirely possible that Saoirse has lost her sense of smell. Try smearing a bit of food on Saoirse's lips..just a dab, enough she can drag her tongue across her vaso-motor organ at the roof of her mouth.

Can you combine several of her meds in a bit of catsoup and syringe it into her mouth? To get it all in at one try, instead of having to administer each med separately? And try pureeing her food, in case you haven't already. Dip your finger in, and coax her to lick.

From the description of the stools I would say she's got colitis right now..probably a reaction to the meds. She's really getting pasted what with all that she's going through...and the colitis is likely a stress reaction . But just in case she's picked up some kind of bug, be careful to wash your hands thoroughly after you even come near her feces...some of those bugs can jump species from cat to human.

And yes, I'm sorry, Mogs..but Saoirse is probably hurting, psychologically if not physically. She's really done with feeling lousy and that will work against her, it's a vicious circle. If she DOES have glaucoma, glaucoma is painful..like a headache. Pain is caused by the pressure. Would Saoirse allow you to hold a cool compress over her eyes? Cut a washcloth up so it isn't HUGE..and wring it out well. Scritch her under her chin, and apply the compress. She's getting antihistimine drops, right? I didn't look those up.

Here's another link to feline hypertension. The symptoms appear to be spot on for Saoirse..please give it a looksee. And of course blood pressure is affected by stress.

Here's something you can try. Place your hand over your cat, but don't touch her. You want your hand to be about an inch above her fur. Concentrate on warming your hand, with the heat radiating from your palm, to her body. Saoirse's attention will go to your hand, along with curiosity that you aren't touching or doing anything to her. This can have a calming effect because it will break her concentration about feeling lousy. If she focuses on you, she won't be dwelling on herself.

Another possibility: Here's a link to a virtual metronome. Sound can do many things for the body..including helping it to keep in step. If you set the metronome to move at a pace slightly lower than Saoirse's current heartbeat, and her heart may actually slow down to 'keep in step' with the metronome. This may in turn reduce her BP. Turn your volume until you can just hear the beat, you don't want it real loud.

Now, on to you. It's imperative you keep calm because Saoirse can smell that you're upset. Can you take a quick shower to get the scent of past hours' tension off your skin? Ok, do you have any vanilla in the house? Dab a bit of it on your temples and wrists. It may help both you and Saoirse to relax. Wash fingers afterwards so you don't get any into Saoirse.

Any hot chocolate? Drink it. Dim the lights, sit down and put your feet up. Try to snooze in 20 minute intervals, and set an alarm that will GENTLY wake you up...you must sleep even if you don't want to. You'll be no good to Saoirse if you're passed out.

If you can't sleep, close your eyes and imagine you are lying in the sun, with a gentle breeze going. FEEL that sun. HEAR the breeze. Veg out. It's the next best thing to sleep.


Wish I could help you more. Please try the mentronome..and keep the sound LOW..just barely audible. If you have a smartphone you can place it about two feet away, let it tick, and it won't drive you crazy while soothing her.

Big hugs to you, Moglet. :bighug::bighug::bighug::bighug:We all wish we could be there to support you. We're with you, and Saoirse in spirit.
 
I know you mean well, but I did find your post very upsetting.

EDITED TO ADD:

Actually, I am furious!

I meant no harm and I apologize profusely for causing you more pain when you are already having such a difficult time. Sending you strength.
 
From reading it through, it sounds as though you'd need to monitor for signs of low blood pressure.
It's both high and low blood pressure I'm worried about, April. That's what is making this so frelling difficult. Some of the meds she normally takes may raise BP and that would be completely counterproductive. I need to find a way through the next couple of days till I can measure her BP at home and get as much of her supportive regimen back in place as possible. Doppler unit is due tomorrow but I need to desensitize her to the cuff and coupler. I wish they would have measured her BP on Saturday at home. She was in much better shape then and they'd probably have got a valid reading and spared both of us the awfulness that was Saturday night. If she didn't get so stressy at the vets I'd actually consider asking them to hospitalize her to try to get a picture of what's going on so that we can work out a dose of the amlodipine that will help her without harming her. I think perhaps the 1/6 tablet dose wore off too soon but she had quite a significant response to even the small dose. I wonder whether smaller doses twice a day would be safer (bit like insulin)?

I'm going to ask my friend to pick up some Feliway tomorrow to see if that might help a bit.

Thanks for the link, too, April. I'll read it through in the morning.

:bighug:

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Mogs, I just did a quick check on drug interactions for amlodipine and Bupenorphine and you are spot on in regards to BP. Bupe can lower BP too so until you find a suitable dose of amlodipine for Saoirse where she is not showing any signs low BP such as being lightheaded, dizzy or fainting, Bupe just wouldn't be safe. Unfortunately, Saoirse may have a headache which can make one feel miserable, and grumpy but as you say, you don't want to complicate the current situation. Maybe cold compresses or some very light top of head and temple rubs would help her a bit. It stinks that these little critters have so few options for pain relief! :banghead::banghead::( Continuing to send soothing and healing thoughts and prayers! :bighug::bighug::bighug::bighug::bighug: for you both!
 
Yes, Andy. I asked the vet nurse to ring the vet back to ask if it was OK to give Saoirse some buprenorphine but she refused the request.
I would not think she would have the right to do that, call the Vet and ask again, and tell them you are the one in charge of your bably, not the nurse? You want to hear the Dr's opinion, not hers. Ask for something different than the bupe that does not cause interactions
 
Bupe can lower BP too
Now that could be a possible way forward - and a possible reason why this occurred. Saoirse's pancreatitis symptoms had eased greatly in the past few weeks and I had tapered her off the bupe because she didn't need the pain relief for the GI issues. I think you may very well have found the culprit. Perhaps the bupe was having an occult benefit in terms of blood pressure. Also, in my reading yesterday IIRC I saw a warming about stopping blood pressure lowering medications in that doing so might cause a surge in blood pressure levels. Never for a minute would I have made that connection without tonight's input from both yourself and April (@manxcat419). Add to that the fact that Saoirse was receiving Piriton which, as I discovered over the weekend, carries a caution about its use in patients with hypertension that tends to lend support to the hypothesis that the bupe withdrawal may have triggered this whole sorry mess.

It's definitely something to go back to the vet with in the morning.

Linda and April, thank you both for giving me a lead - and a possible way forward; and one which may see Saoirse more comfortable tomorrow.

:bighug::bighug:


Mogs

EDITED TO ADD:

@MrWorfMen's Mom, @manxcat419 -

Another thing: buprenorphine dilates the pupils. Maybe that could have been protecting Saoirse's eyes. I wonder whether Saoirse has glaucoma. IIRC I think I saw mention somewhere this evening online that pancreatitis may be a factor in its development, but I can't remember where I saw the reference. If glaucoma is the issue, then tropicamide may be contraindicated.

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@rhiannon and shadow (GA) - Thank you for contacting Marje. Much appreciated. :bighug:

@Marje and Gracie -

All I can tell you is that our CKD kitty was on a low dose of amlodipine once daily and also took a low maintenance dose of bupe bid ... He never had any interactions.
Thanks for this very helpful information. It is good to know that it is possible to co-administer amlodipine and bupe safely. It's a piece of the puzzle and historically I have found that learning about treatment regimens that other caregivers are treating their pets with successfully has given me avenues of exploration which yielded results for Saoirse that have by and large been more successful and safer than some of the treatments she has been prescribed as standard. For example, Saoirse was prescribed mirtazapine and I was given no warning whatsoever that it can induce serotonin syndrome. (She had an adverse reaction.) Also, she was prescribed metoclopramide for nausea when I wanted ondansetron for her. Eventually the vet agreed to issue the Rx for the latter but it meant that Saoirse's recovery from the severe pancreatitis flare was delayed for weeks. It was only when she got the ondansetron that she made real progress. I got the ondansetron recommendation here. (Thank you, FDMB.)

When you are dealing with these many issues and an opoid, I just think a vet has to be helping you to coordinate these drugs and treatments.
That is what I would expect, too, Marje. Unfortunately I don't have that support available to me at present. (Example: Saoirse was prescribed Tramadol when she was already taking ondansetron: there is a major interaction between them. Even a feline medicine specialist insisted I give her a dose of bupe nearly 3 times what she could tolerate, insisting she knew best. The second dose at this level made Saoirse really ill. There is such an absence of joined-up thinking and very little listening to the caregiver among many vets this side of the pond.

You know I would do anything for you and Saoirse but I can't put her at danger with my limited knowledge.
I do know you'd do anything to help us, Marje (and you do!). I also know that you would never do anything to risk even the tip of one of her smallest whiskers. :) But through sharing your experience you're helping her mama bean to learn about possibilities to research and her mama bean is very grateful. Very grateful for the prayers and hugs, too. :bighug::bighug:


Mogs
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Message back from vet. Bloody discharge is from inflammation not from blood in the actual eye apparently. Keep giving Isathal eye drops. Asked what about tropicamide. Vet nurse passing on message from vet said carry on with what I was doing since vet had already seen me today. I asked about whether she could check with the vet if I could give Saoirse something for pain relief (I have some bupe). Got nowhere with that one. Apparently there is nothing more that I can do tonight. I am in despair.

Some of the discharge is bloody and some of it is yellow.

Sometimes, these things look the worst right before they start to get better....I will continue praying and hoping that this is happening for your dear Saoirse
 
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