18 Year old Poppy (renal/diabetes)

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Wonderful that you've gotten the cerenia! It can sting a bit; keeping it refrigerated may help, if you have to use it again.We usually give these meds 30-60 minutes before a meal to give it a chance to kick in.The licking and turning away are typical signs of nausea, so hopefully it will work. Cerenia can be given once daily.

There is also another anti nausea med available and commonly used across the board, Ondansetron; it is given twice daily (I *think* possibly up to 3 times as a maximum dose, but I'm no sure on that) It works along different neural pathways than cerenia: while cerenia is often used to treat vomiting, ondansetron is often used to treat nausea that doesn't cause vomiting. That being said, Willow has never vomited but Cerenia generally helps with her nausea.

And some people find that the two work best together for their cat. So it really is individual to the cat and whatever is going on. Hopefully the cerenia will help Poppy...Fingers crossed for you and her! If not, you can try Ondansetron (hopefully it's available near you)

Side note... Some vets may not be aware that ondansetron can be given to cats, as it's a human med; if yours isn't, ask him/her to look it up in Merck.

Lastly, not sure if anyone's mentioned cyproheptadine... It's another appetite stimulant, if your cat doesn't do well with mirtz.

Thinking of you both with love, please keep us updated! Nikki
 
I gave her the cerenia. She hasn't eaten anything yet, but has been sleeping for last hour or two.

I read that nausea can happen with both renal problems and diabetes and that other appetite problems it can also cause some restlessness, which Poppy has been showing at times.

I'll leave her to sleep and relax and see if she will eat later. If there is no change in appetite, I will speak to the vet about cyproheptadine and ondanestron.

Looking at Willow's spreadsheet, I am impressed by your dedication. 7 to 8 checks of BG a day and 14 different feeds across 24 hours. It really is round the clock care. I'm not sure if I could match that.
 
cleanprophet said:
I think her sense of smell is ok, but she does prefer strong smelling foods like tuna or sardines.



Her bloods were very high this morning and she is still quite unwell. Mainly she is weak, although she is still managing to walk around and jump a little (but she is wobbling around and stumbling a bit too).

I'm just hugely concerned that she isn't eating enough. It's a vicious circle because she is a bit too weak and poorly to eat and she's a bit too weak and poorly because she isn't eating.

I gave her a mirtz this morning, but nslade001 (nikki) made a good point about maybe trying antinausea meds because she could be a bit nauseous due to the stimulant or just generally a bit nauseous. Maybe a higher dose of 2mg mirtz would be an option.

Sorry, I've hijacked this thread haven't I. My post about Poppy is here:

http://www.felinediabetes.com/FDMB/threads/18-year-old-poppy-renal-diabetes.216003/
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This is my response from on the other post!

All I really want to say is, increasing the mirtz wouldn’t help if she is nauseous, but Cerenia or ondansetron (Zofran) would be a good help for that.

I personally as a human have taken mirtazapine for sleep actually, but the next 48 hours I am SO hungry, and I don’t even realize sometimes it is from the mirtazapine!!!

Has anyone talked to you about syringe-feeding? Forgive me, I can’t temembwr right now or re-read all the thread. It’s not something which I have a lot of experience with, but perhaps if she is having trouble eating this could be what helps turn things around? Someone else could weigh in on that.
 
AliceMeowliss&Cassandra said:
This is my response from on the other post!

All I really want to say is, increasing the mirtz wouldn’t help if she is nauseous, but Cerenia or ondansetron (Zofran) would be a good help for that.

I personally as a human have taken mirtazapine for sleep actually, but the next 48 hours I am SO hungry, and I don’t even realize sometimes it is from the mirtazapine!!!

Has anyone talked to you about syringe-feeding? Forgive me, I can’t temembwr right now or re-read all the thread. It’s not something which I have a lot of experience with, but perhaps if she is having trouble eating this could be what helps turn things around? Someone else could weigh in on that.
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I have been told that the appetite stimulant effect of mirtazapine does last for up to 48 hours, so it is possible that I will see more appetite tomorrow.

I haven't tried syringe-feeding. It is something I may look into. But I would only do it if she was reasonably tolerant of it.

I've just given her some food now and she had a little eat. It was shredded chicken in sauce and she was interested in it but when she got to the chicken, she tried to chew it and had some difficulty and started to lose interest. I think the best option is to try the same approach that nikki does with Willow and blend the foods down to something that she can lick and forget all about chewing.
 
cleanprophet said:
Looking at Willow's spreadsheet, I am impressed by your dedication. 7 to 8 checks of BG a day and 14 different feeds across 24 hours. It really is round the clock care. I'm not sure if I could match that.
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Hi, it's a team effort between me and my husband, thanks! There's really no need to worry and about matching lol. Willow is on Lantus and we follow the Tight Regulation protocol, which runs cats at lower numbers so requires more testing, but not necessarily as much as we do. It works for us. Many follow the Start Low, Go Slow guidelines which is what I believe Prozinc users follow. It keeps cats at higher numbers generally, so there is less risk of hypoglycemia (although there is always a risk) and therefore requires less testing (preshots plus hopefully two mid-cycle tests, I believe) and home Blood Glucose curves once a week (which would be I think 6-8 tests on that day).

As for the food, we (and many!) make use of an automated pet feeder such as this one, which we set to feed at certain hours so we don't have to :) also helps with sleep lol.

Please don't feel overwhelmed! It is possible to keep Poppy safe and you sane. We've all got some tips and tricks to share, just ask!
You're doing great, Poppy is so lucky to have you :)

With love, nikki
 
nslade001 said:
Hi, it's a team effort between me and my husband, thanks! There's really no need to worry and about matching lol. Willow is on Lantus and we follow the Tight Regulation protocol, which runs cats at lower numbers so requires more testing, but not necessarily as much as we do. It works for us. Many follow the Start Low, Go Slow guidelines which is what I believe Prozinc users follow. It keeps cats at higher numbers generally, so there is less risk of hypoglycemia (although there is always a risk) and therefore requires less testing (preshots plus hopefully two mid-cycle tests, I believe) and home Blood Glucose curves once a week (which would be I think 6-8 tests on that day).

As for the food, we (and many!) make use of an automated pet feeder such as this one, which we set to feed at certain hours so we don't have to :) also helps with sleep lol.

Please don't feel overwhelmed! It is possible to keep Poppy safe and you sane. We've all got some tips and tricks to share, just ask!
You're doing great, Poppy is so lucky to have you :)

With love, nikki
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It is quite stressful at the moment, no doubt. I almost feel like taking Poppy to the vets and leaving her with them for a day so that I can get a good night's sleep and a little break from it all.

I don't mind the testing but I do feel bad disrupting Poppy if she is resting/sleeping. At the moment I am mostly just doing 3 tests a day (morning, mid-cycle and evening). I may try to move to 4 tests (morning, +3, +6 and evening).

I'm going to start blending her foods tomorrow because I suspect she will eat much more if it is more like a liquid/sauce. Just like Willow, she simply struggles with most solids now. I remember 2 or 3 years ago she would often just eat chunks whole or if I gave her some of those biscuit/pocket treats, she would eat them whole too. I knew that because on the rare occasion she vomited it back up and it was whole and unchewed. Even back then she was struggling to chew. I think that lack of teeth and increased fatigue (through age and this current illness) is possibly presenting as a lack of appetite. It could be a lack of appetite but I am more and more certain now that she has moved beyond chewing most foods.

Of course, the other issue is that because she has obviously had a a decreased appetite for some time she will have adapted to that. Her stomach will have shrunken in conjunction with that and so it is a case of trying to build her appetite up bit by bit.

How much water would you add to one pack/pate?
 
cleanprophet said:
I have been told that the appetite stimulant effect of mirtazapine does last for up to 48 hours, so it is possible that I will see more appetite tomorrow.

I haven't tried syringe-feeding. It is something I may look into. But I would only do it if she was reasonably tolerant of it.

I've just given her some food now and she had a little eat. It was shredded chicken in sauce and she was interested in it but when she got to the chicken, she tried to chew it and had some difficulty and started to lose interest. I think the best option is to try the same approach that nikki does with Willow and blend the foods down to something that she can lick and forget all about chewing.
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It's great that she's eating some :) I can't remember if I mentioned, but add water when you puree the food (many/ possibly most of us just add water to all meals anyway, as it's a great way to ensure they're getting plenty of water). Willow's ends up a slurry consistency, and works very well for her. She just can't do shreds either.

Syringe feeding does usually take some practice but is very doable, much is the cat realizing that it's not all bad, and the owner learning not be too stressed (as cats do pick up on that); both learn the routine and it just happens. There are videos, etc if it comes to that, but let's hope the anti nausea meds and Appy stimulants do the trick.

There's a labs tab on your SS if you'd like to enter Poppy's lab results...There are some people quite experienced with reading them, and they sometimes pick up on something our vets might miss, not being nearly as familiar with FD cats as are many here.

Thanks for the update! You can count on the fact that there are many people reading your thread, and are ready to pop in if needed or asked :)

Also, maybe start a new thread tomorrow, as this one is getting a bit long, probably because of me lol.

With love, nikki
 
cleanprophet said:
It is quite stressful at the moment, no doubt. I almost feel like taking Poppy to the vets and leaving her with them for a day so that I can get a good night's sleep and a little break from it all....

I don't mind the testing but I do feel bad disrupting Poppy if she is resting/sleeping...

How much water would you add to one pack/pate?
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You have to do what you need to, because you have to be healthy to care for her. Be sure to take some time for yourself, and by that I don't mean time on the computer reading more on FD!

Waking Willow was hard for us as well (guilt!) I've taken to giving her test strip container a good shake and clicking the lid hard, which usually wakes her, and when she sees I have her monitor she perks up because she knows it means a treat (even when inappetent, she generally loves her treats). So it's a routine we all learn.

Willow used to hork food too. The amount of water to add can vary, since some food is far more gelatinous and needs more water than, say, a fish based saucy food. Also, how watery she'll take it. We're probably usually 50:50 food:water, and it's more runny than paste-like, we call it slop or slurry. The more you can put in, the better (if she'll eat it)

Hth, with love, nikki
 
Diana&Tom said:
Ref the reluctance to eat - your description reminds me of a situation @Elizabeth and Bertie experienced with her kitty Sophie... I think she found a particular food in the end that was quite acceptable, and also fed raw turkey mince which kitty managed. Eliz, have I remembered right and if so can you expand please??
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I was actually planning on picking up some turkey mince tomorrow. I think some people cook it slightly and some use it raw. I might just blend it in with some other food to increase the proteins in the meal.
 
nslade001 said:
You have to do what you need to, because you have to be healthy to care for her. Be sure to take some time for yourself, and by that I don't mean time on the computer reading more on FD!

Waking Willow was hard for us as well (guilt!) I've taken to giving her test strip container a good shake and clicking the lid hard, which usually wakes her, and when she sees I have her monitor she perks up because she knows it means a treat (even when inappetent, she generally loves her treats). So it's a routine we all learn.

Willow used to hork food too. The amount of water to add can vary, since some food is far more gelatinous and needs more water than, say, a fish based saucy food. Also, how watery she'll take it. We're probably usually 50:50 food:water, and it's more runny than paste-like, we call it slop or slurry. The more you can put in, the better (if she'll eat it)

Hth, with love, nikki
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Good point. It's a question of working out what she prefers. I used to giver 15g gravy tubes because I could hide her phosphate binder in there. She used to always lap them up after a meal. About a month or so ago she simply started refusing them. I noticed that she would even have trouble eating them because they are quite thick. I suspect she will prefer it quite watery.

As for syringing food. I could try that with some of the blended stuff, if she doesn't eat the blended stuff. I have syringed 20ml-30ml of fluids in the past and that's possibly a little more awkward because it is more fluid and is easy for her to choke a little. There are plenty of videos. I'll take a look at them if it comes to it.
 
Just one last little night time update. I blended some chicken in sauce (the stuff she struggled with a little earlier). She wasn't interested unfortunately. On the plus side, she had a good drink and then used her litter tray (I don't think she's used her tray for some time). Her BG test was HI again, which is possibly not surprising after her crash yesterday. She's had her 1 unit of insulin and I've settled her down for the night on her bed with her water and the blended food.

I'll see how she is tomorrow and if she has eaten anything overnight and then maybe try a different food in the blender for her to try.

I wonder whether she still has some issues with her pancreas and this is affecting her appetite? Perhaps some more time on IV would help because I suppose it's possible she still has some inflammation in her pancreas?
 
Did Poppy have pancreatitis? I totally missed that, and thought she had just been diagnosed with diabetes on top of her CRF.

Absolutely, she may still have a flare going on. Cats with pancreatitis are usually treated with a combination of antinausea meds, appy stimulants as needed, and painkiller, usually buprenorphine as pancreatitis *is* painful, even if cats don't show signs of pain. Also, they are often given SQ fluids at home along with the other 3.

Please see this primer on pancreatitis as it is quite detailed, and do post for advice or if you have any questions. It would absolutely explain her loss of appetite.

With love, Nikki

PS if you could, it would be great if you could set your alarm to do a spot check a bit later, especially if she hasn't eaten, to ensure she isn't dropping too low again.

Could you entice her to eat anything, even by licking small amounts off your finger or a spoon? Sometimes they'll eat for that when they refuse to eat by themselves, fussy things.

I know it's all exhausting at first and I hope I'm not pushing...

With love, nikki
 
Well, the vet did say Poppy had pancreatitis, but they never did the check (PLI check or something) to say with real certainty. But for various reasons they were confident it was pancreatitis and treated it as such. Now, I should also point out that I brought her home before the vets said that it was time for her to come. This was because she had been in 5 days and on the afternoon of day 5 was very unwell (flat out on a heat pad, not very alert, low temp etc). The vet was quite pessimistic and, although not saying it outright, was hinting towards ending her discomfort. I returned 5 hours later at 10pm and Poppy's temp had recovered and she was up and about. The fact that she had been there 5 days and was looking quite confused. I took her home and she was quite weak even then (this was 11 days ago). Since then she's been up and down a lot.

I assumed that they were giving her antibiotics, but when I took her home there were no meds at all. The vet said that fluids were the best treatment for pancreatitis. He also suggested that they could try an ultrasound to have a look at see if there was anything they were missing.

I'm not starting to come around to the idea of taking her back in to go back on fluids in case she does still have inflammation in the pancreas or something else going on.

I think like Willow, Poppy seems to go for the fish wet foods. I think I will try some of that tomorrow. I always check on her 2-3 hours after I put her to bed. I'll try and do a spot check, but I will probably be back checking on her about 6-7 hours after her insulin. She was up HI (41.7+) this morning and 6 hours after the insulin had come down to 28.1.

I did mention to the vet today about me giving her sub-q's at home and he said that would be fine but we will wait and see of the cerenia has an effect. Given that fluids are the best treatment for pancreatitis, I think this is something I should really do. Maybe 100ml's twice a day and see how she does?
 
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I agree that subQ fluids at home is the way to go if the vet is agreeable.
I also think you need to be giving regular cerenia and / or ondansetron to combat the nausea. Cats won’t eat if they are nauseated. Ondansetron needs the vet to write a script and you get it from the pharmacy as it is a human medication. It can be given every 8 hours if needed and can be given at the same time as cerenia. I found ondansetron very effective for Sheba.
If Poppy is not getting enough to eat she will be weak.
I know it is hard if renal issues, FD and pancreatitis are in the picture. You are being a great dad Scott
 
Bron and Sheba said:
I agree that subQ fluids at home is the way to go if the vet is agreeable.
I also think you need to be giving regular cerenia and / or ondansetron to combat the nausea. Cats won’t eat if they are nauseated. Ondansetron needs the vet to write a script and you get it from the pharmacy as it is a human medication. It can be given every 8 hours if needed and can be given at the same time as cerenia. I found ondansetron very effective for Sheba.
If Poppy is not getting enough to eat she will be weak.
I know it is hard if renal issues, FD and pancreatitis are in the picture. You are being a great dad Scott
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He really is :)

Scott, cats often do better at home unless the situation is dire, and if the caregiver feels they can do it; at this point it sounds like Poppy may be best treated at homes with antinausea meds and SQ fluids as suggested by @Bron and Sheba; I would strongly suggest starting painkillers as well.

Although Willow was never tested for pancreatitis, she has had a couple of suspected flares and both times seemed much more comfortable when put on bupe, although she never showed signs of pain beforehand such as meatloafing or hiding; she just became lethargic, inappetent and nauseas. We use the bupe you put in her cheek, and is absorbed.

Unfortunately, some vets still feel that if a cat isn't exhibiting obvious signs of pain, there is no need to treat for it :( your vet seems quite reasonable, with the cerenia injection and agreeing to SQ fluids, so will hopefully respond well to your request.

With love, Nikki
 
I checked on her a couple of times and there's no signs of low glucose. She's drunk some water but not touched any food.

I'm now in a position where something has to change one way or another. That means either me giving her SQ fluids at home (maybe 3 times a day) and syringe feeding her or taking her into the vets to go on IV's there. Obviously in the hospital, they can monitor her much more closely and give her the meds she needs as and when (be that pain relief, stimulant or antinausea). The problem is, I just don't like leaving her in the hospital for days at a time. I'm concerned that she will become withdrawn and depressed. If this is still an issue with pancreatitis and I am thinking that it is, then would giving her SQ fluids at home be enough to get on top of the inflammation in the pancreas? She had 5 days on IV's and it didn't quite get on top of the pancreatitis. She is an older cat and maybe she needed some more days on IV's? I don't know enough about pancreatitis. Is it possible that, in an older cat, they might not be able to bring it under control?

When she was in hospital on IV's, she was eating (not huge amounts, but the day I brought her home she had eaten the 30g-40g that was given to her a few hours earlier). This is why I am now fairly convinced that this is still an issue with the pancreas and maybe she needs good quality fluids and possibly pain relief.

The vet I spoke to yesterday said I could try to SQ fluids if there was no change in her appetite after the cerenia. I'm just concerned whether SQ fluids at home would be enough. She is weak and can sometimes struggle to move around (especially if she has been lying down for some time before). Once she is up and about, she can move around better. My concern is that if I take her into the hospital they will start suggesting that maybe she is too old and weak for treatment and the best thing for her may be euthanasia. I'm well aware of her age and doing what is best for her. I'm just not sure whether it is possible to get on top of the pancreatitis given her age and current condition. One of the vets I saw last week kept talking about "all her other medical problems". But she has this condition and the renal condition and that's it. The renal condition has been managed well and the proteins in her urine have been steady for over 2 years. Although she is possibly just into stage 3 of the kidney disease, it is progressing slowly because her age (low activity, small meals etc) and therefore if we can get this pancreas issue under control, then she could well have another year of good quality life, if not more. There is also the chance that the BG issue could improve.

As I say, I just don't know whether home treatment could be sufficient and I'm sure she probably does need pain relief. Bupe sounds good and can be used in renal cats. The vet I saw last week said they usually give metacam (which is great for inflammation and pain relief) but it isn't great for renal patients. The other pain relief he mentioned was an opiate and that would cause drowsiness.

I wonder whether giving her SQ fluids at home, syringe feeding and using metacam could be an option? The effect of metacam on the kidneys is uncertain. About 10 years ago a warning label had to be added to metacam (meloxicam) about the effects on the kidneys. I've just read an interesting article on PetMD that suggested low doses of metacam actually slow down the CKD (although some dispute the studies that showed metacam to be safe because those behind the studies had a conflict of interest).
 
I had Sheba on metacam for a few years (she was early stage CRD) and it had no effect on her renal numbers. But you can only give it if the cat is eating. It can certainly make a difference. But you need to make sure the dose is suitable for a cat.
I would ask the vet to do a fPL test to see if in fact she has pancreatitis or not.
I would also get some ondansetron tablets to see if they help with the nausea. They can make a difference
Also ask the vet if Poppy is a good candidate for some hills a/d urgent care canned food... it is higher calorie and can be fed in a bowl , spoon or syringe fed.
If possible I would keep her at home if you can manage.
Pancreatitis usually comes in flares then settles if in fact that is what she has. You need to get that fPLtest done to make sure.
Yes the BG should be able to be managed. I think your main issue is getting her to eat and maybe her hydration. I would try and address those issues.
Hugs
 
Hi,

*Many* of the cats here have acute or chronic pancreatitis. One of our members wrote the pancreatitis link I mentioned earlier. It can be managed at home with giving antinausea meds 30-45 min before breakfast, see if the cat will eat, try appy stimulant, see if cat will eat. (There are many tricks.... Willow*can* eat a slurry but usually needs encouragement to start, with finger or spoon feeding, and often adding toppers such as those in the other link I mentioned. Sometimes she'll eat off a saucer but not out of a bowl. Often she wants us to hold the bowl. We play with it. Other meals (sometimes the next) she'll eat by herself. The important thing is for her to eat.)

If cat won't eat on own, syringe feed some food. It's never come to that with Willow.

Other than that, it's just give the painkiller as prescribed (for bupe transmucosal it's usually 3 times daily). The vet can give an injection of bupe that lasts I think 3 days, I don't have experience with that. Or there's metacam; many, many here use bupe, it has less risks than metacam, and it works. The link I sent for the CRF site discusses pain control in CRF cats, including use of metacam.

And SQ fluids. The vet can tell you amounts and frequency.

I would recommend starting another thread with a new topic title, possibly something like need help...Newly diagnosed cat, possible pancreatitis. Many, many experienced board members have dealt with this. You can link back to this thread for continuity.

I hope Poppy feels better today, with love, Nikki
 
I've started a new thread here:

http://www.felinediabetes.com/FDMB/threads/pancreatitis-with-diabetes-and-renal-issues.216209/

She's gone back into the hospital for a minimum of 48 hours on fluids and a few tests. Hopefully that can get her eating again and get on top of the inflammation in the pancreas. Her BG test this morning was 30.3 after being HI last night. The vet said her BG levels and lingering pancreatitis will likely be the reason for her lack of appetite.
 
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