We visited the IM today. I actually liked him! There was some questions that I was looking answers for and I feel he did a good job of answering.
Was it wise to do an endoscopy and biopsy right now to confirm if he had lymphoma or not? ANSWER: He did not present physically or clinically to warrant that procedure at this time. If things change drastically and then yes. He didn't think his IBD was very severe at this time based upon the ultrasound, aspirates and his exam.
Was there anything in Jones' current medication regime that needed to modified? ANSWER: Yes
As I find his poop to be small and dry sometimes (except for the last few days due to the food changes I have been doing)? He felt we should drop the metronidazole. It is an antibotic and is used for diarrhea. Since he hasn't had uncontrolled (just food induced) diarrhea for at least 3 months, he thought we should drop this. Of course it is on hand in case things change. Also giving AB with the pro-biotics probably isn't the best idea.
We should increase the prednisolone to 1.25mg BID vs. SID. This will hopefully help improve appetite and relieve the IBD a little more. I know that this will continue to increase if and when his disease progresses, so I am ok with that. I know how to handle the diabetes effect of this medication. I maybe looking for advice in the future about dose. This change starts tomorrow morning.
To slowly reintroduce the pro-biotic and introduce psyllium powder over the next. week or so.
I asked about SEB - LOL - the look on his face! He had heard of it. He didn't offer an opinion on it as - "there is so much other medications used at the same time it is hard to say if it works are not. We don't receive any education in the Eastern methods of medication in school." He suggested I may want to go to a holistic vet if I was interested in pursuing that avenue.
He would eventually like to see if we can eliminate the Cerenia - because then we will know if he is truly stable - limited medical support. Outside of that, he is leaving the insulin dosage to me as "he felt I knew better than he did on what to do on that issue" and prevent any uncontrolled diabetes from returning. As Jones is technically in remission but he understood what I was trying to accomplish with my "whisper" dose.
I never heard of giving a cat psyllium to regulate the poo. Jones is allergic to pumpkin.
You might want to check out felineconstipation.org if you haven't already. The metronidazole might be the cause of the dry stool and I bet it is. I've been given it for diarrhea for cats. One thing I have learned is that it's best to only change one thing at a time if possible and since things are stable I'd do that. I'm glad no further procedures are needed at this time and I hope it continues that way.
Metronidazole is both an antibiotic, and an anti-inflammatory. That latter use is why my Theo was originally on it for his IBD. I have heard of giving psyllium as a source of fiber. It's the main ingredient in the Oet Alive Natural Moves that some people here use.
I hope splitting the pred dose helps even out Jones BG. If you ever want to do an endoscopy or a biopsy, you will have to stop the pred for a couple of weeks first. So just as well the IM vet thought it wasn't necessary at this point. I also like that the vet wanted to reduce the number of meds and move slowly with changes. Neko's IM vet had heard of SEB, but just told me he had no experience with it.
He was really good and I felt heard. We spent about 40 minutes with him. He talked with me, asked my concerns and didn't think I was crazy with trying to find a better solution if there was one there. Looked over Jones and even went back over the labs sent to him. Then he allowed me to go over point by point my questions and he answered them.
We are actually doubling the dose but it is a small dose to start with. The IM was surprised it was so small. So I will most likely need to increase his insulin dose but I don't think it will be too drastic. Fingers crossed.
Yep, have my own pill splitter. I was cutting them into quarters. So instead of 1 quarter a day - he will get 2. IM felt it may help with the appetite. I am...ok with that if he feels better and will eat and hopefully come off the stimulants. Just means I need to watch those BG numbers. I have noticed the effect of carbs though. 8% staring 5/16 at night and this morning plus some 13% that was given this afternoon. I thought that one was less carbs...but doubled checked and I was wrong. Too bad as he likes that one and will eat it.
BTW - Big hugs, can't tell you how sorry I am. They don't stay long enough, but then I think they know the true meaning of living before we do so don't need to stay as long.
I'm delighted that you found an IM that was willing to spend so much time with you and answered all your questions. Everything he said seems reasonable to me. I also love the fact that he did not want to mess with your handling of Jones' FD. He's a keeper! Can you clone him??
1.25, even twice a day, isn't really that much Pred. Hopefully it's enough to help Jones' appy without majorly affecting his BGs. In the end, Harvey was also on 2.5mg, although his was given all at once. He still got some pretty good numbers on a relatively small dose (but not as small as Jones is on!). My philosophy was that it was better to have him get the pred and eat and feel better and need more insulin than to be on a lower dose and be miserable.
I laughed when I saw it on a diabetic supply site. It seemed like a good thing with all the new members and the overwhelming beginnings to the FD journey.
Considering he started on 10mg of pred a day - I will take the 2.5mg. And I agree - as long as he feels good!
