Sam - Month 12

Status
Not open for further replies.
Djamila

Djamila

Very Active Member
Previous Thread

Well, my sweet little sugar cat is starting this 12th month of his second round of diabetes by hiding under the bed and refusing to eat anything but treats. That and the higher numbers make me think we are in yet another round with the pancreatitis. Since one seems to lead into another, I'm thinking at this point it may just be chronic pancreatitis. I'll have to do some :bookworm::bookworm::bookworm: to find if there are clinical definitions for chronic vs.....episodes? attacks? acute?

Anyway...he has an appointment with a new vet for the 15th. I like my vet, but want a second opinion at this point regarding his overall care since we are now dealing with a variety of issues.

Yesterday was also shopping day with new insulin, a couple of new boxes of syringes, an order for more test strips and lancets....and of course a new catnip banana and feather toy. :cat: Feeling a little poor-er now. :blackeye:

I do have one question for you all: Does anyone know how many carbs are in a vet bill? ;)
 
BWAHAHAHAHHAHAHA! That's awesome.

A second opinion never hurts right? Who knows they may be able to give you some new ideas.

I hate that Sam is having another attack...I'm so sorry Djamila. You guys have been going through it lately...these chronic illnesses are the absolute worst. :bighug::bighug:
 
:joyful::joyful:That video is priceless. Can I send Sam my mortgage bill?:p

I hope the new vet had some ideas/treatment options for you:bighug::bighug:
 
Awesome Sam! My Cory will love to meet him.

EEDA6CE4-4C06-4E96-A072-1BC604A52943.jpeg
 
Thank you so much for all of that great information! I think it will be particularly helpful getting ready for the new vet visit next week. It's really helpful having so much in one place so I can reference it and make sure I get all of my questions answered. :bookworm:
 
BTW, Djamila, one thing I didn't know in time about pancreatitis is that it can lead to secondary inflammation in other parts of the body, including the eyes (uveitis). Having learned about this in the worst way possible, I can't recommend strongly enough that any kitty with chronic pancreatitis gets their eyes examined regularly by a veterinary opthalmologist; doubly so if the kitty has any blood pressure problems.


Mogs
.
 
Critter Mom said:
BTW, Djamila, one thing I didn't know in time about pancreatitis is that it can lead to secondary inflammation in other parts of the body, including the eyes (uveitis). Having learned about this in the worst way possible, I can't recommend strongly enough that any kitty with chronic pancreatitis gets their eyes examined regularly by a veterinary opthalmologist; doubly so if the kitty has any blood pressure problems.


Mogs
.
Click to expand...
Hmmm ..... I wonder if that's why there are a few FD kitties here who have had eyes removed for non-cancer reasons.
 
@Critter Mom or @Teresa & Buddy, do either of you (or anyone else reading this) have any sense of how long it takes the anti-nausea meds to work? Sam takes cerenia, whenever he's having a flare-up, but this is the first time I've seen him so nauseated that he won't eat. He's had his pill and some bupe, but I'm wondering when it might kick in? He will nibble some freeze dried chicken, but has no interest in his regular food this morning.
 
Djamila said:
@Critter Mom or @Teresa & Buddy, do either of you (or anyone else reading this) have any sense of how long it takes the anti-nausea meds to work? Sam takes cerenia, whenever he's having a flare-up, but this is the first time I've seen him so nauseated that he won't eat. He's had his pill and some bupe, but I'm wondering when it might kick in? He will nibble some freeze dried chicken, but has no interest in his regular food this morning.
Click to expand...
Sorry I can't help with this, Djamila. I have read on FDMB, however, that a Cerenia injection can pack a bigger punch. Teasel had that only once when he went off his food after I gave him HC gravy food for low BG. Vet visit - Cerenia injection - Cerenia pills for use at home.
 
Thanks Kris. I've also been reading that ondansetron works better than cerenia, so it may be time to up our game around here. I usually only give him a half-dose of the bupe, but I think I might give the rest of the dose this morning. It looks like this round might be a whopper.
 
Djamila said:
Thanks Kris. I've also been reading that ondansetron works better than cerenia, so it may be time to up our game around here. I usually only give him a half-dose of the bupe, but I think I might give the rest of the dose this morning. It looks like this round might be a whopper.
Click to expand...
Yes, there are many fans of ondansetron on FDMB. Might be good to have in your arsenal. Have you tried cyproheptadine as an appetite stimulant after giving antinausea meds? Not supposed to cause behavioural weirdness that mirtazapine can cause.
 
Last edited:
Djamila said:
@Critter Mom or @Teresa & Buddy, do either of you (or anyone else reading this) have any sense of how long it takes the anti-nausea meds to work? Sam takes cerenia, whenever he's having a flare-up, but this is the first time I've seen him so nauseated that he won't eat. He's had his pill and some bupe, but I'm wondering when it might kick in? He will nibble some freeze dried chicken, but has no interest in his regular food this morning.
Click to expand...

My normal drill was:

1. Check that constipation wasn't the cause of the nausea (based on regular monitoring of bowel movement frequency and vet examination). If yes, start with metoclopramide to help normalise GI motility (2-3 doses maximum was enough). In Saoirse's case, constipation-related nausea was the exception, not the rule.

2. Cerenia injection from vet because in Saoirse's case it would get to work faster than pilling ondansetron (but for Saoirse ondansetron worked better than Cerenia). Also a B12 injection and, if the vet considered it appropriate, a 3-day amoxicyllin injection (with additional injections later till the course was completed). Often needed to assist feed by hand to keep food going in during this period. If mild pain suspected (based on crouching/hiding behaviours) would start on small dose of oral bupe at home (1-2x per day). If vet exam and/or clinical signs pointed to more marked discomfort would ask vet to give bupe injection followed by larger doses of oral bupe administered at home (2x per day for several days; 3x per day for first day or two if pain more severe).

3. Start ondansetron 2mg q12h (10lb/4.5kg cat) following day, first dose c. 16-20 hours after Cerenia jab. (Can be administered 1-2mg q8-12h to a maximum 4mg/day for 10lb/4.5kg cat.)

It can take 24-36 hours for ondansetron to build to full therapeutic effect, so some assist feeding may be needed.

Note: I'm not sure whether ondasetron is available as an injectable for cats but maybe that might help it to start working faster than the tablet version (a possible alternative to starting with Cerenia?).

4. Canned plain pumpkin added to meals to help prevent constipation (bupe and ondasetron can be constipating, not sure about Cerenia given longer term). Small amount of Miralax added to regimen if pumpkin not quite sufficient to make sure bowel movements were of right consistency and frequency.

5. Fed every 3 hours normally, with 1-2 tsps water added to each mini meal. If hand feeding needed then smaller, more frequent 'coax' feeding was done, plus occasionally syringed a little water to help with hydration (using a plastic pipette as it's much easier to control the flow of water slowly cf. giving water using a feeding syringe).


Mogs
.
 
Last edited:
Kris & Teasel said:
Yes, there are many fans of ondansetron on FDMB. Might be good to have in your arsenal. Have you tried cyproheptadine as an appetite stimulant after giving antinausea meds? Not supposed to cause behavioural weirdness that mirtazapine can cause.
Click to expand...
With the exception of the first flare when I hadn't a clue what to do to help Saoirse (nor what meds to request for her until Elise helped us) and she needed appy stimulants for a couple of weeks (and vet support was lacking in many respects), thereafter I only occasionally needed to give Saoirse a sliver of cyproheptadine to get her appetite going again after a stall but only if there was no response at all to the initial anti-nausea medication. The cypro seemed to have a synergistic effect with the ondasetron. (Had to discontinue using cypro when she started getting issues with high blood pressure. Note: cypro is contraindicated in cats with liver issues, hypertension, and glaucoma.)

The advantage I found with the cypro is that its appetite stimulant effect isn't as strong as the mirtz and you can dose it more frequently (e.g. 1/8 4mg tablet q8h for 10lb cat). It gives much finer control over appetite stimulation in that you can give it exactly when and for just as long as it's needed. With mirtazapine one can end up with a food-crazed cat just after the dose was administered but then hit a period where the stimulant effect has worn off but it's too early to give the next dose.

Mirtazapine is a horrible drug if it disagrees with you. It was prescribed for me and I had a really bad reaction to it. So did Saoirse.


Mogs
.
 
Last edited:
Djamila said:
@Critter Mom or @Teresa & Buddy, do either of you (or anyone else reading this) have any sense of how long it takes the anti-nausea meds to work? Sam takes cerenia, whenever he's having a flare-up, but this is the first time I've seen him so nauseated that he won't eat. He's had his pill and some bupe, but I'm wondering when it might kick in? He will nibble some freeze dried chicken, but has no interest in his regular food this morning.
Click to expand...
Djamila,
I agree with Critter Mom, on everything she has said. You really need to get a script for Ondasetron, I give Ondasetron & Cerenia at the same time. Buddy has not been feeling well for a few days, he was not eating his wet food only kibbles. I noticed that whenever I would touch his back he winced or would hit at me. I started giving him Cerenia with his Hemp, because I was not for sure whether he needed Tramadol or Bupe, I never give Ondasetron with Tramadol. Well he needed the Bupe, Cerenia & Ondansetron. If I give these medicine it seems to help within 1 to 2 hrs., but I will need to give them again in 12hrs. Today, he is back to eating wet food, hopefully it will stay that way. If I were you I would be prepared to give Cerenia & Ondansetron along with pain meds. I try to nip Buddy's right away if possible. any sigh he may be not doing things as usual, I start giving meds to be on the offensive. Ondansetron is needed for nausea and Cerenia for inflammation, Cerenia is not an anti-inflammatory, but it has anti-inflammatory properties. Critter Mom has really good info.
 
Djamila said:
@Critter Mom or @Teresa & Buddy, do either of you (or anyone else reading this) have any sense of how long it takes the anti-nausea meds to work? Sam takes cerenia, whenever he's having a flare-up, but this is the first time I've seen him so nauseated that he won't eat. He's had his pill and some bupe, but I'm wondering when it might kick in? He will nibble some freeze dried chicken, but has no interest in his regular food this morning.
Click to expand...
I am really sorry Sam is feeling bad again. I know how hard this is on you. Last night @ PMPS, Buddy was @ 313, I did not get up during the middle of the night to test him, this morning he was @ 54. I think he was running high yesterday because of the pancreatitis.
 
Teresa & Buddy said:
I try to nip Buddy's right away if possible. any sigh he may be not doing things as usual, I start giving meds to be on the offensive.
Click to expand...
Very same here. It makes a huge difference to keep ahead of the curve. It's so much harder to get an inappetent cat to start eating again than to help a nauseated cat to keep eating (with extra assistance from pain meds if appropriate).

@djamilla - Teresa's point about the importance of anti-inflammatories is an important one. We can't get Cerenia tablets here so I always made sure Saoirse got a course of B12 at the first sign of any trouble because it has some anti-inflammatory benefit. I've since learned that some pancreatitis kitty caregivers include a regular weekly B12 injection as part of their maintenance regimen. (Wish I'd thought to do so. :( )


Mogs
.
 
Last edited:
Critter Mom said:
(((Buddy)))

Fingers and paws crossed that Buddy'll be feeling much better very soon.


Mogs
.
Click to expand...
Buddy, is eating his wet food today and his BG # came way down today, so I am hoping things are clearing up. Buddy has B12, that he is to take 2 times a week, I have not been giving it to him lately, but I am going to start. I am sure at one time Sam was taking B12, because Djamlla was asking me what kind of syringe I was using, because the vets always give those honking big syringes with B12. Buddy has had chronic pancreatitis for years, last year the tail of his pancreas was removed and it did not help one bit.
 
@Teresa & Buddy -

Re your question on another thread about feeding issues/pancreatitis, I did a brain dump on another thread about all the things I found helpful with Saoirse. I'm sure it's all old news to you but I'm posting the link here for you just in case there might be something helpful to you and Buddy:

http://www.felinediabetes.com/FDMB/...-at-wits-and-budgets-end.188810/#post-2100608

Again, probably very old news but the following sites/links were helpful to me:

Persuading your cat to eat

Nausea symptoms and treatments

Tips for stimulating appetite

IBDkitties.net

IDEXX Feline Pancreatitis Treatment Guidelines

One of the most helpful tips I was given was the very basic one of raising food and water bowls to a comfortable height. That, and sprinkling some freeze-dried protein treats over warmed food. SEB helped at times, too.

More on Meds & Supplements:

Saoirse had some liver issues (no formal Dx but some abnormalities in scan). Saoirse had chronic renal insufficiency (IRIS stage II, quite stable). However she did have some problems with high blood pressure. The following meds caused Saoirse discomfort because of the pancreatitis and I was unable to give them to her:

* Amlodipine (hid in a corner after every single dose. :( Discontinued very quickly. Found out from Tanya's Site support group that it is known to cause GI issues in some cats.)

* Benazepril (trialled for BP because amlodipine wasn't a valid option).

* Ipakitine phosphorus binder (contains soy, and she was allergic to same. Saoirse got on OK with powdered AlOH mixed into her meals.)

* Hepatocare (milk thistle and SAM-e supplement for liver support).

(Saoirse got on much better with Hepatosyl, another milk thistle/SAM-e supplement).

* Oral antibiotics also caused GI upsets.

Other Supplements with Issues:

* Salmon oil omega 3 supplements (caused major nausea/food aversion).

* Other fish oil omega 3 supplements (very reluctant to eat food containing these).

(Moxxor omega 3 (green-lipped mussel source) agreed better with her; small capsules so easier to administer as well.)

* Nutramed herbal anti-inflammatory - milk thistle, boswellia, maritime pine bark. (Tolerated well most of the time but occasionally a particular batch would make Saoirse uncomfortable.)

* Fortiflora (triggered nausea and vomiting, and Saoirse wasn't prone to vomiting).

(I became wary of using probiotics for Saoirse based on research in humans which point to them possibly making things worse for pancreatitis sufferers.)


Mogs
.
 
Last edited:
All info is appreciated, sometimes when your kitty is going through a bad flare things just don't register. When things are not that bad (hopefully will not get worse) is the time to go over information that might help later. I did not know that pancreatitis would affect the eyes, Buddy squints all the time. I asked his vet about the squinting and she said it was because he was in pain.
 
Saoirse used to squint, too (and it was the eye that eventually had the problem). I asked our general practice vet about it a couple of times but he didn't suggest anything. Sadly it was only when things had gone horribly wrong that Saoirse was referred to an (absolutely brilliant) opthalmology specialist.


Mogs
.
 
Teresa & Buddy said:
sometimes when your kitty is going through a bad flare things just don't register. When things are not that bad (hopefully will not get worse) is the time to go over information that might help later.
Click to expand...
Indeed. I have working memory problems at the best of times (PTSD-related) so I have to scribble things down or they're gone. I carried this over into Saoirse's spreadsheet. All the secondary monitoring, record keeping and journalling proved to be an invaluable guide to what did and didn't help her because it helped in spotting trends that I would otherwise have missed (and it was a godsend if one needed to backtrack to a regimen that had been working better for her).

Of course all this went to pot a few times when things were rough. :banghead: (Got scribbled onto paper but didn't make it into the spreadsheet, but I did hang on to the paper journals.)


Mogs
.
 
Just had a thought about another thing to watch out for. Flea spot-on treatments can cause GI upset and inappetence. It was a dose of Advocate that started Saoirse down the slippery slope to that first (absolutely awful) flare.


Mogs
.
 
Teresa & Buddy said:
All info is appreciated, sometimes when your kitty is going through a bad flare things just don't register. When things are not that bad (hopefully will not get worse) is the time to go over information that might help later.
Click to expand...

Thank you so much for this comment. I was trying to read through all of this and honestly just felt like it was going in one ear and out the other. This makes me feel like it's okay to just wait until he's more stable and then come back and read when I'm more stable too. :rolleyes:

Thank you both so much for taking all of this time to help. I know it will all make more sense once he's a little better. This is the worst attack he's had so far. :(
 
Djamila said:
Thank you so much for this comment. I was trying to read through all of this and honestly just felt like it was going in one ear and out the other. This makes me feel like it's okay to just wait until he's more stable and then come back and read when I'm more stable too. :rolleyes:

Thank you both so much for taking all of this time to help. I know it will all make more sense once he's a little better. This is the worst attack he's had so far. :(
Click to expand...
For you and Sam: :bighug::bighug::bighug:
 
Djamila said:
This is the worst attack he's had so far. :(
Click to expand...
I'm really sorry to hear this. :( From someone else who's been there ...

:bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug:

I really hope that Sam starts to improve as soon as possible. I really feel for both of you. Sending lots of positive healing vibes.

(((Sam and Djamila)))


Mogs
.
 
Critter Mom said:
Just had a thought about another thing to watch out for. Flea spot-on treatments can cause GI upset and inappetence. It was a dose of Advocate that started Saoirse down the slippery slope to that first (absolutely awful) flare.


Mogs
.
Click to expand...
This spring I was talking to the vet and I mentioned flea treatment, she said "NO" he is sick, never put flea treatment on a sick cat. I have not put flea treatment on Buddy this year and I did not put any on Red this year before she passed away.
 
Finally a little good news. A box from Chewy's arrived last night and Sam got a new catnip fish (he loveloveloveloves catnip!):

https://photos.app.goo.gl/SztOzpxjD6n1anZx2
SztOzpxjD6n1anZx2


He snuggled and played (yeah!) with it all night, and then part way through the night he woke me up and wanted to eat. Hooray! It was good to see him eating all on his own without needing me to bribe and coax him. This morning he ate a little breakfast too and just went back for a few more bites as I started writing this. Since pancreatitis seems to go back and forth between good moments and bad ones, I'm learning to celebrate every little good moment!

I increased his cerenia and bupe doses yesterday and am planning to continue those today in the hopes that I can keep ahead of this for a bit.
 
Djamila said:
Finally a little good news. A box from Chewy's arrived last night and Sam got a new catnip fish (he loveloveloveloves catnip!):

https://photos.app.goo.gl/SztOzpxjD6n1anZx2
SztOzpxjD6n1anZx2


He snuggled and played (yeah!) with it all night, and then part way through the night he woke me up and wanted to eat. Hooray! It was good to see him eating all on his own without needing me to bribe and coax him. This morning he ate a little breakfast too and just went back for a few more bites as I started writing this. Since pancreatitis seems to go back and forth between good moments and bad ones, I'm learning to celebrate every little good moment!

I increased his cerenia and bupe doses yesterday and am planning to continue those today in the hopes that I can keep ahead of this for a bit.
Click to expand...

@Teresa & Buddy knows exactly how this feels, Djamila.
 
Status
Not open for further replies.
Back
Top