Bronx's hypo & arthritis thread

Christie & Maverick said:
Ain't that the truth:woot:. You must still be in a bit of shock, I can't imagine. Wish our boys could get nice consistently flat Lantus cycles, but that just doesn't seem to be their gig. How's the little man, can you get some food in his belly? Tuna juice has worked for me in the past when my CRF kitty didn't want to eat, as well as bonito flakes, and some deli meats (no sugar if possible).

Something you don't need to syringe...we need Bronx to feel comfy, and that doesn't sound like he'd be interested in ;)
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He is finally showing some interest in wet food. No idea when I will shoot him tonite and how much. I am gun shy now big time!
 
Christie & Maverick said:
Maybe time for having a look at the info on stimulating kitty's appetite http://www.felinediabetes.com/FDMB/threads/suggestions-on-how-to-stimulate-kittys-appetite.130770/


Ah..that's a story in and of itself, I was upset after I tried to help someone whose kitty had consistently low BS, I suggested they take the cat to the vet, they finally did but it ended up being too late. I was devastated. I almost deleted my account, still not sure what my presence here on the forum is, if any. But I see my old friends and can't help but post. Trying to work my way back. Thanks for thinking of me even while Bronx is feeling yucky :bighug:, it means a lot to me.
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That’s terrible, but I’m glad you are still coming around. I think of you and Mav often. It’s good to know he is doing alright. :bighug:
 
@Wendy&Neko mentioned taking a few units off previously...is that 2u at +6 on you SS? I'd be gun shy too...you must be off schedule a bit? Sure would be good to get the 5Ps on track, but not having been through what you did with Bronx, I'd be a bit cautious too.
 
(((Paul and Bronx)))

Thank god you came home when you did! I don't know what Wendy will suggest. I know if I were in your shoes I'd dose ultra conservatively if for no other reason than both of you need to catch your breath after this ordeal... physically and emotionally. Attempting to get back on track doesn't have to be done immediately.

Be kind to yourself..
 
I agree with Jill, go conservative for a bit, and wait for normalcy to return before going back up in dose. Let’s see if this is a bounce or too low a dose or both talking. You don’t want to have to fight lows right now. Have you talked to the vet about his recent symptoms?
 
Wendy&Neko said:
I agree with Jill, go conservative for a bit, and wait for normalcy to return before going back up in dose. Let’s see if this is a bounce or too low a dose or both talking. You don’t want to have to fight lows right now. Have you talked to the vet about his recent symptoms?
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I shot 3u. Was at vet a few days ago about Bronx's front limbs. She said B-12 in food is useless and thinks his issue is a joint problem from the acro and not neuropathy. We are upping the Gaba to 100mg BID from 50mg. She mentioned Metacam if his kidneys/liver #s cam back fine, but was against it after seeing the ALT up a bit. Metacam sounds dangerous, so I was fine with just trying an increase in Gaba and using more CBD oil. The walking on his front hocks is getting pretty bad. Painful to watch, can't imagine how he feels. Not sure what else to do, afraid of Bube due to his constipation issues.
 
Given Bronx’s numbers lately, I agree it probably the acroarthritis you are seeing. Have you ever tried acupuncture? It can be really helpful for pain.
 
Christie & Maverick said:
Ah..that's a story in and of itself, I was upset after I tried to help someone whose kitty had consistently low BS, I suggested they take the cat to the vet, they finally did but it ended up being too late. I was devastated. I almost deleted my account, still not sure what my presence here on the forum is, if any. But I see my old friends and can't help but post. Trying to work my way back. Thanks for thinking of me even while Bronx is feeling yucky :bighug:, it means a lot to me.
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I'm sorry you had to deal with that. I'm glad you're still here. :bighug::bighug:
 
LizzieInTexas said:
Update? How are y'all doing?
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Hi Lizzie.

He hasn't pooped since the karo poop/vomit explosion 4 days ago, but otherwise doing ok besides walking a little shaky. The acro-arthritis is the worst thing going on right now. Really hard to watch him try to walk. So sad since his BW came back pretty good and in decent health besides this joint pain. I am going to increase the Gaba up to 100mg and try more CBD oil. He sleeps a lot more since I increased the Gaba from 50mg to 75mg. 100mg just might make him even more sleepy. Wendy mentioned acupuncture, maybe I'll look into that if nothing else helps. He doesn't mind travelling.

As far as his BG, no idea why he is down to about 3u of insulin all of a sudden after doing so well at around 7u for the last few months. I just bought 10 pens too :banghead:.

I really have to consider his QOL. Basically just sleeps most of the day and then walks in pain for the water bowl or food. Does purr when I pet him and is happy in his heated bed, but that's about it. So sad to watch him try to walk. How long do we let this go on? Always thought an organ will do him in, never thought I may have to make the ultimate decision based on his joint paint. Sucks getting old :(

20190323_110703.jpg

Happy in his bed though :)
 
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Christie & Maverick said:
Maybe time for having a look at the info on stimulating kitty's appetite http://www.felinediabetes.com/FDMB/threads/suggestions-on-how-to-stimulate-kittys-appetite.130770/


Ah..that's a story in and of itself, I was upset after I tried to help someone whose kitty had consistently low BS, I suggested they take the cat to the vet, they finally did but it ended up being too late. I was devastated. I almost deleted my account, still not sure what my presence here on the forum is, if any. But I see my old friends and can't help but post. Trying to work my way back. Thanks for thinking of me even while Bronx is feeling yucky :bighug:, it means a lot to me.
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:bighug::bighug::bighug::bighug::bighug:
 
Bronx's dad said:
Hi Lizzie.


I really have to consider his QOL. Basically just sleeps most of the day and then walks in pain for the water bowl or food. Does purr when I pet him and is happy in his heated bed, but that's about it. So sad to watch him try to walk. How long do we let this go on? Always thought an organ will do him in, never thought I may have to make the ultimate decision based on his joint paint.

Sucks getting old :(

View attachment 43533
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I'm so sorry this is happening. I hope things turn around for the best. :bighug::bighug::bighug:
 
Jill & Alex (GA) said:
I've been thinking about you and Bronx. You're in such a tough spot, Paul. I really feel for you. I'm always hesitant to suggest this, but if you ever think you might want to look at this, ''Making "The Decision": Help to know when and how', I found the material to be helpful. I know others have also.
Take care...
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Thanks Jill. I have read that before and will do again. Such a tough decision.
 
Bronx's dad said:
Painful to watch, can't imagine how he feels. Not sure what else to do
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I've been giving my 3 cats (all 17 yrs old) Paws CBD OIL It helps with Pain, appetite & improves their mood. My Vet recently talked with Cornell University,they are doing a study on Cats using CBD OIL (Nearly all drugs are only tested on dogs. )
My vets' little dog has really bad arthritis & nothing has helped. Cornell recommended CBD Oil Two brands that they tested,
"ElleVet for Felines"
https://ellevetsciences.com/products/feline-oil
https://ellevetsciences.com/products/feline-oil

And the one I've been using for over 4 yrs . "Paws" by Charlotte's Web https://www.charlottesweb.com/dog-cbd-oil ( it says it's for dogs but it's fine for cats also.)

My vet has been only using it for several weeks & told me he notices a definite improvement!
I gave it to my cat that had melanoma. He was eating & appeared Pain free until he died,(the cancer spread)

It might be worth trying for Bronx. (I add 7 drops to Chicken baby food,once a day.)

Best of Luck to You & Bronx!:) :bighug:
images
 
I know how hard it is to see them struggle to move. :( I threw the book at Neko’s acroarthritis. I did daily acupressure in addition to the acupuncure. Acupuncture gave the biggest improvement of all. Neko knew it too. When we got to the vet’s treatment room she wanted us to get on with it and stop chatting. :p She leaned into the vet during the treatments. Which consisted of just a couple needles and primarily the acupuncture lasers. ECID in how well a cat handles the needles. And it might take a couple sessions before they figure out the connection to feeling better. I remember Serryn’s Vyktor showing showing his disapproval at first. Serryn found a vet who came to the home to do treatments.

A couple other things I tried for arthritis you might want to consider. Duralactin is a natural anti inflammatory. I have read of some vets giving it instead of Metacam. Only give it if Bronx’s calcium numbers are OK. I noticed some improvement with a Neko on it. Another in the natural category is hyaluronic acid. I used the brand Hyaflex. It is drops which I added to food and is supposed to help the joints. My brother takes it for his knee.

I know you have reservations about buprenorphine, but it really was a game changer for Neko. It got her almost a couple years of good quality. Before bupe she was sleepy and not interacting much, after she was up and about and actually played! Maybe there is some balance of quantity that doesn’t bother his motility as much but still provides pain relief. I never tried CBD. From a human with arthritis I have heard it’s good for nausea, not so much for pain. And since it’s an unregulated industry, you do have to pick a reputable manufacturer, which can be said of any supplement.

I hope you can find some combo of solutuons that can help Bronx.:bighug:

ETA: I got a memory foam bed for Neko. She loved it, really easy on her joints.
 
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Hi Paul,
I'm so sorry that Bronx is in pain and hope that you can find something that will help him feel better. Metacam used to be a no-no for cats and was black-boxed by the FDA, but that was years ago and medicine has moved on. However, I just looked it up and it is apparently for dogs only. I would be scared to try it.
Sending lots of vines and gentle scritches for your boy. I know how hard it is to make the decision. With Rusty we were on the verge of making it several times, but he rallied and our vet agreed that he wasn't ready. When his time came he let us know. Bronx will let you know.

:bighug::bighug::bighug:
 
Wendy&Neko said:
A couple other things I tried for arthritis you might want to consider. Duralactin is a natural anti inflammatory. I have read of some vets giving it instead of Metacam. Only give it if Bronx’s calcium numbers are OK. I noticed some improvement with a Neko on it. Another in the natural category is hyaluronic acid. I used the brand Hyaflex. It is drops which I added to food and is supposed to help the joints. My brother takes it for his knee.

I know you have reservations about buprenorphine, but it really was a game changer for Neko.

ETA: I got a memory foam bed for Neko. She loved it, really easy on her joints.
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Thanks Wendy, I will look into Durlactin & Hyaluronoc acid. I still have bupe but do worry about added constipation problems. He hasn't pooped in 4 days now... One of his heated beds is memory foam but that is in my bedroom and he never makes it there anymore :(. I should move it to the LR where he spends most of his time.

Any theory as to why he is still hitting greens at 2.5u? No idea what's going on in that dept.
 
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I’m so sorry Bronx is having trouble with his arthritis.
I know a lot of people do not like metacam but I used it for Sheba when she was in a lot of pain from arthritis and I really thought I was going to lose her. I started her on metacam and the difference was nothing short of amazing. She went from hardly moving to getting up and moving around as she used to and without pain, all in a short period of time.
You just have to make sure the dose is the correct dose for a cat, only give it with food and not give it if food is not eaten. I was able to reduce the dose to half eventually and her qualify of life was maintained.
Kidney values need to be monitored. Sheba had the beginnings of CRD and the metacam did not effect them over the following 2 years.
 
Bron and Sheba said:
I’m so sorry Bronx is having trouble with his arthritis.
I know a lot of people do not like metacam but I used it for Sheba when she was in a lot of pain from arthritis and I really thought I was going to lose her. I started her on metacam and the difference was nothing short of amazing. She went from hardly moving to getting up and moving around as she used to and without pain, all in a short period of time.
You just have to make sure the dose is the correct dose for a cat, only give it with food and not give it if food is not eaten. I was able to reduce the dose to half eventually and her qualify of life was maintained.
Kidney values need to be monitored. Sheba had the beginnings of CRD and the metacam did not effect them over the following 2 years.
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Thanks Bron. Vet ran BW to see if we could try Metacam and she was concerned with his ALT liver number. But it really isn't too high at all and Bronx's kidney values look fine. Vet is being too conservative, but if I insist she will probably allow us to move forward. But it will require a lot of vet visits to administer the Metacam and monitor the kidney values. At this point, keeping him pain free is the way to go. I will seriously consider it. What's the point to put him down before trying everything possible, including Metacam, first?
 
Sorry to hear about Bronx’s arthritis. It is very hard to watch them struggle. My last kitty was very old and she had similar issues.

I know there have been a lot of suggestions and not sure if this was mentioned, but thought I would throw it out there so at least you could look into it.

This supplement product, which has been recommended for gum health, has anti-inflammatory properties and has also been used for arthritis pain and inflammation.

I-TDC

I hope you can find a solution so he is more comfortable. The heated pet bed is great for arthritis pain, so at least when he is lying down he is more comfortable.
 
Bronx's dad said:
Any theory as to why he is still hitting greens at 2.5u? No idea what's going on in that dept.
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First off, your dosing is all over the place, not sure you are seeing the results of 2.5 units. The larger depot impacts 4-6 cycles after a reduction, and with that large a reduction, possibly the high end of that. You are still seeing action from the recent higher doses. I have no idea how large the depot thinks it is. If possible, I would pick a dose and stick with it, let the depot stabilize first. Otherwise it makes it too hard to figure out how to use our dosing methods, OK, off the soap box.:bighug:

Second, Bronx is still within the two year time frame after SRT. It’s possible you are seeing some tumour cell die off. SRT is said to impact up to two years after, and I have seen a bit longer (Polly). However, changes from SRT are usually more gradual that what you have seen this last week. Maybe the combo with increased sensitivity to insulin from the hypo.
 
Bronx's dad said:
Thanks Bron. Vet ran BW to see if we could try Metacam and she was concerned with his ALT liver number. But it really isn't too high at all and Bronx's kidney values look fine. Vet is being too conservative, but if I insist she will probably allow us to move forward. But it will require a lot of vet visits to administer the Metacam and monitor the kidney values. At this point, keeping him pain free is the way to go. I will seriously consider it. What's the point to put him down before trying everything possible, including Metacam, first?
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You don’t need any extra vet visits to administer the metacam. It is an oral medication. I would not give the injection. It is often started off with an injection the first day and then starting the oral dose a couple of days later but the injection is not essential and that is where the problems can stem from..It is a once a day medication and I gave it with the evening meal. It has no taste. You just need a blood test to check the kidney values after a few weeks then every three months, although I have to say I didn’t get them checked every three months. Shebas results were always the same. And making sure they have a full tummy is essential. I used to give her most of her meal and hold back a bit to put the medication in. That way I knew she had eaten. If she didn't eat, which was rare, she didn't get the medication.
The metacam we have here in Australia is specifically for cats and it is used extensively with few problems. If you can get the dose right you should be ok. Here is a link to our metacam. You can see the strength and dose and make sure it is the same or make the adjustment so that the dose is the same as the Australian strength/dose ratio.. It is based on weight and is drawn up in a specific syringe. It gives you the list of precautions etc. main thing is getting the strength and dose right.......in the US the problem, as I saw it, was that the metacam was for dogs and the strength was not taken into consideration when the dose was given to cats. I think our strength is half the strength of the US dog metacam.
I was preparing myself to losing Sheba when she was put on metacam..... this was before I joined FDMB ...
Anyway, have a look at it. It has to be your decision and you have to be comfortable with it all. But I agree I would try everything before deciding it's the end.
https://www.petceutics.com.au/prescriptions/metacam-oral-suspension-for-cats-30ml.html
 
Bronx's dad said:
Hi all,

Flew home today on a redeye from the west coast and gave Bronx his "normal" shot of 7.5u after testing him this morn with a 142 BG. Good thing I was home today and saw him staggering and almost falling down at about +8. Tested twice and he was 22/20. Gave a can of high carb 24% and at least a teaspoon of Karo which he gobbled down. Tested again about 10min later and he was 32, and a few more minutes after that he was 43. Just now 57 about a half hour after the hypo. This was scary. He is still a little shaky on his feet now. Will test frequently.
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Thank God !!! So so happy he's ok!!!
 
Hi Paul - sorry I missed this thread during this week. This subforum is so busy.

Leo has the exact same front leg issues, and as you observed it is not neuropathy. Leo likes the heat lamp if it is chilly, and he also likes the sun. I think warmer legs must feel better for him. Bupe is a good assistant for pain as well. I pick Leo up and move him a lot of times to help him.

I'm sorry to hear that Bronx hypo'ed so low. That is damage territory. Leo's severe hypo (BG=22) was on 1/20/2019. It took him at least a week to recover. We now see obvious after-effects:
- his cognition is a little less, and he has trouble recognizing us unless we are close
> this could be partial blindness or eye-related brain issues
- he has hypo'ed a lot more since the deep hypo
- in medium light, one pupil is now always slightly larger than the other pupil

Now, I test a lot more often. Further, he gets a teaspoon of gravy in the Fancy Feast food, if he is not eating. Some food is better than none. We limit the gravy - just a tad to get him eating.

We are fairly consistent on dosing, but Leo is still bouncing all over. Our objective is to keep him away from hypo's when possible.

If I was not working at home these days, it is clear that Leo would no longer be around. Our later-stage Acro kittehs take a lot of care and lovin'.
 
I think there's a long thread in Think Tank about meloxicam.

The FDA warning came about because cats were being dosed as if they were miniature dogs. Cats need to be given half the by-weight dose as dogs. The product my vet prescribes, Henry Schein EloxiOral, comes with an oral syringe for dosing dogs by weight. I give the seven-pound dose to my 14-pound cat.

You might want to find the 2010 "ISFM and AAFF Consensus Guidelines for Long-Term Use of NSAIDs in Cats." Includes information about how to determine whether a cat is a suitable candidate and recommendations about how to monitor use.

Dr Robin Downing, a pain specialist, wrote a couple nice pieces about how to integrate the various modalities for treating chronic pain in cats. 2016 CVC in San Diego proceedings. She views an NSAID as a good way to break the pain; if other treatments prove effective, it can later be phased out.
 
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Tom & Thomas said:
The FDA warning came about because cats were being dosed as if they were miniature dogs. Cats need to be given half the by-weight dose as dogs. The product my vet prescribes, Henry Schein EloxiOral, comes with an oral syringe for dosing dogs by weight. I give the seven-pound dose to my 14-pound cat.
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My vet said it would have be done by injection in her office each time. She did say it is for dogs so no way I could get a script.
 
JeffJ said:
Leo has the exact same front leg issues, and as you observed it is not neuropathy. Leo likes the heat lamp if it is chilly, and he also likes the sun. I think warmer legs must feel better for him. Bupe is a good assistant for pain as well. I pick Leo up and move him a lot of times to help him.

I'm sorry to hear that Bronx hypo'ed so low. That is damage territory. Leo's severe hypo (BG=22) was on 1/20/2019.
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On the 2nd hypo that day, the meter read "Lo" both tests which I think is below 20. Was a scary day for sure. He is still a little shaky on his feet but don't see any other signs that Leo has. I am so sorry he hasn't fully recovered from his hypo.

I do have Bupe buy am leery of using it because of Bronx's constipation issues.
 
Bronx's dad said:
My vet said it would have be done by injection in her office each time. She did say it is for dogs so no way I could get a script.
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It sounds like your vet is only accustomed to using meloxicam to treat acute pain, like from an injury or after surgery, rather than chronic pain. For extended use to treat chronic pain, you don't inject it but just squirt the dose into the cat's food.

My vet dispenses it directly, I don't need to go to a pharmacy. Metacam is the brand name for the product commonly used to treat dogs here in the US. The use in cats is off-label but well-documented.

It should start helping immediately. You are certainly at a point where relief from suffering would outweigh the small and largely avoidable risk of renal damage. And, as you note, the effectiveness of gabapentin is being undercut by the sedation caused by your current dosage level (though I have no experience here).
 
Tom & Thomas said:
It sounds like your vet is only accustomed to using meloxicam to treat acute pain, like from an injury or after surgery, rather than chronic pain. For extended use to treat chronic pain, you don't inject it but just squirt the dose into the cat's food.

My vet dispenses it directly, I don't need to go to a pharmacy. Metacam is the brand name for the product commonly used to treat dogs here in the US. The use in cats is off-label but well-documented.

It should start helping immediately. You are certainly at a point where relief from suffering would outweigh the small and largely avoidable risk of renal damage. And, as you note, the effectiveness of gabapentin is being undercut by the sedation caused by your current dosage level (though I have no experience here).
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Sounds like a good idea if it would help. Maybe you can find a vet in your area that is more familiar with alternate uses like Tom suggests. Or possibly a phone consult with Toms vet, maybe that vets has colleagues closer to you that are like minded in their clinical use of this drug? Maybe if your vet is open to suggestions he/she could look at the data on use in cats for chronic pain? I know my vet will listen if there is something documented that she is not familiar with, she is happy to learn something that may help her other patients. Not all are like that though..
 
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