11/05 Butters AMPS 409/+3 317/+6.5 243/+9 207/pmps 207/+3 166/+6 139/+9 288

[Butters & Lyla]

Yesterday overnight and this morning I don't think Butters was as comfortable. She normally sleeps through the night (except for snacks of course), but didn't last night. I don't know if it is pain or the high BGs.

I have been back and forth with the hospital three times this morning about the bupe. The IM vet either cannot or will not call me to discuss, so communication has been through the front desk. The end result is they will give me prefilled syringes of bupe to get us to Monday, and then I am to bring Butters in for a recheck with the IM vet if I want to switch her off the gabapentin. It was a no to compounded bupe, and a no to enough bupe to get me to her possible vet appointment at the end of November. I am annoyed about all of this for many reasons. But upon reflection I'm more tired than anything.

Have a good day, all.

 

[tiffmaxee]

 

[Butters & Lyla]

When you get it another problem will be that the darned refilled syringes they give might not contain enough in each dose. One vet gave me 0.2 which did nothing for Max. I suspect that’s why it didn’t work at first for Butters. My regular vet knew better.

I also think that's why it didn't work for Butters the first time. It wasn't enough. Now I'm not sure how to tell what's enough of a dose for her or not. I think I have to play around but working with prefilled syringes is difficult. I ended up wrapping my finger in a "biodegradable" plastic bag, squirting some onto my finger and applying it to her cheek pouch.

 

[Adrienne & Molly (GA)]

 

[Butters & Lyla]

So, people often wonder why is the Bupe such an issue? It is a narcotic and unfortunately, there have been and are actually still cases of pet parents abusing the drug . As a means of “diversion” many, and actually most, clinics control how much they will give a client at one time. This is why you hear of many people getting prefilled syringes to use for oral application and only receiving limited quantities. In cases where people may have long term, strong relationships with their vets, the vet may be more likely to be more liberal with providing a prescription for it. It is frustrating but it is their way of trying to avoid problems.
(*Gabapentin is not a narcotic)

They must think I could be a drug addict, I've called so many times.
I guess no wonder I'm having such a difficult time. Maybe the hospital gave me gabapentin for Butters in the first place because it is not a narcotic. I don't think that would be a good way to decide what drugs to prescribe. I had even asked about bupe back then and the IM had dismissed it and said gabapentin was the better choice. I told her about my concerns about the side effects I was seeing from the gabapentin even at Butters' follow up, and she dismissed that, too.

 

[carfurby (GA)]

I'm sorry they are being difficult.

 

[Colio]

Sorry it's so hard.

We had a cat many years ago who had seizures and was put on clonazepam - I lost the prescription, and when I asked for another one, had to meet with the vet to talk about if I was taking the cat's drugs. And this was my vet for years.... I think they are tightly monitored on certain types of prescriptions. This one makes no sense though when they know Butters is in pain and that's the med that is helping her.

 

[JaxBenji]

Hang in there, Lyla! You'll figure out getting the bupe

Hoping Butters breaks that bounce today

 

[JOJI and Kit]

butters is lucky to have you, lyla

 

[Tomlin]

They must think I could be a drug addict, I've called so many times. How can cat sized amounts do anything for humans. Seems to me like you'd need an awful lot of it. And cannabis is legal here, so why would I even bother with my cat's bupe.
I guess no wonder I'm having such a difficult time. Maybe the hospital only gave me gabapentin for Butters because it is not a narcotic. I really don't think this is a good way to decide what drugs to prescribe. I had even asked about bupe back then and the IM had dismissed it and said gabapentin was the better choice. I told her about my concerns about the side effects I was seeing from the gabapentin even at Butters' follow up, and she dismissed that, too.

I hear what you are saying and understand the frustration for sure, but it is pretty standard protocol. Even with humans, at some point, if narcotics are still necessary past a certain point in recovery, there needs to be a Re check. I actually agree with the standard. While pain is expected with pancreatitis recovery, there does need to be close follow up due to the waxing and waning of the illness to make absolutely sure all is trending in the right direction.

I 100% agree with you about the dosing and that it will most likely now work well for Butters .Standard effective doses for Bupe for outpatient pancreatitis management (with 0.3mg/ml suspension) are 0.2mL or below. Every so often there will be the same dosage written but with a higher concentration of 0.5mg/mLbut that is not very common. Felines who need pain management for cancer & other disease states are very commonly prescribed higher concentrations and doses of Bupe, but with outpatient continuation of care from an acute pancreatitis episode or for flares from chronic pancreatitis, that is not the case. Your clinic did the more effective protocol with the transdermal, long acting Fentanyl. I am sure the hope was the gabapentin would then be enough to manage the pain and that it could be dosed to be effective, however that just wasn’t the case for Butters.

As far as abuse is concerned, someone with addiction will take anything in any concentration including drinking mouthwash for the small % of alcohol in it , so yes, even a tiny amount of Bupe is appealing for someone struggling with addiction—especially if they can call and keep getting refills.

 

[Butters & Lyla]

I completely understand fentanyl as a controlled substance and people potentially taking their pets drugs. I didn't think it through...that it isn't just fentanyl people are after. I had imagined a future where, if she did flare again, I might be able to give her some meds right away to try to keep her pain in check. It doesn't look like it will be possible to keep bupe on hand for Butters.

They sold me 14 pre-filled syringes of bupe (0.5mg/mL concentration), dosing 0.14mL q8. I received the less common one. That's the only one they have. I'll start it tonight and paws crossed it is both strong enough a dose and does not cause side effects.

 

[Butters & Lyla]

Sorry it's so hard.

We had a cat many years ago who had seizures and was put on clonazepam - I lost the prescription, and when I asked for another one, had to meet with the vet to talk about if I was taking the cat's drugs. And this was my vet for years.... I think they are tightly monitored on certain types of prescriptions. This one makes no sense though when they know Butters is in pain and that's the med that is helping her.

Wow. I hope the vet believed you.
With my last cats, I had the same vet for decades. She was the vet of my childhood cats and retired just before Butters ended up with me. She never questioned me on meds. I didn't stay on with the clinic after she left. She sold it to a big national brand and I didn't like how they conducted their business. And that kicked off my long string of abysmal vet care for butters. Statistically, the next vet I meet should be a great one.

 

[Colio]

Wow. I hope the vet believed you.
With my last cats, I had the same vet for decades. She was the vet of my childhood cats and retired just before Butters ended up with me. She never questioned me on any meds, ever. I didn't stay on with the clinic after she left. She sold it to a big national brand and I didn't like how they conducted their business. And that kicked off my long string of abysmal vet care for butters. Statistically, the next vet I meet should be a great one.

She did believe me - I think it was just something they had to do given how addictive that drug can be. I was mortified - that’s what happens when you lose the prescription before you even fill it! I sure hope you find a good vet soon. Mine is probably too far for you - at Dixie and the QEW, but I am happy with them. Let me know if you want the name.

 

[Tomlin]

I had imagined a future where, if she did flare again, I might be able to give her some meds right away to try to keep her pain in check. It doesn't look like it will be possible to keep bupe on hand for Butters.

If it makes you feel any better, the issue with Bupe on hand (unless you can get a vet to write you a prescription for the actual Bupe (tiny 1ml vials)) is that if it’s compounded, drawn into syringes or simply put into a container to draw up for buccal administration (gums) 1) sterility is lost so having it sit around is not good and 2) the actual efficacy of the drug is effected. The last thing you want if pain appears is a drug with questionable efficacy.

The other important thing to remember is even if your cat has chronic pancreatitis, it doesn’t mean that something else isn’t causing an issue so, if/when pain occurs one day (after the cat is doing well), especially and most definitely if it’s bad enough to warrant Bupe, it is best to take the cat back to the vet to figure out what is going on. Pain is bad but it is also a really helpful indicator that something is wrong and needs to be checked out. I actually hesitate to use Bupe until I know why there is pain. I make sure it it’s a flare vs something else going on.

 

[Pamela & Amethyst]

Sorry for all of this awful stress Praying you find a great Vet to support you and Butters

 

[LindyNova]

I don't know how you do it. Just reading and following this episode with poor little Butters gives me major headaches and knots in my stomach. Thank goodness for the guidance you're receiving in lieu of or in addition to the Vet/Internist. Praying that this will all subside, and a healed Butters will be back in the unpainful, happy beach and lagoon land soon.

 

[Sue and Luci]

I'm sorry you're having such a difficult time getting medication for Miss Butters....

Maybe there's a guy on the corner you could ask...not funny, I'm sure...but you can see how people who need those kinds of meds end up there.

It's a sad situation when even vets have to question our intentions.

Sending prayers she feels better soon and won't need so much pain med.

 

[katy and mo (GA)]

I'm so sorry you're having to fight so hard to get something so basic for Butters. I'm off to the vet now with him but I'm wishing Butters all the best. As well as you Lyla

 

[Butters & Lyla]

Yes, I’m glad I did not increase today. 166 @+3. She could be up to something.

 

[Diane Tyler's Mom GA]

Hi Lyla , I'm sorry you are having a tough time.
Let's see what the doc has to say on Monday ♥

 

[katy and mo (GA)]

Yes, I’m glad I did not increase today. 166 @+3. She could be up to something.

WOOHOO that's great news!

 

[Wendy&Neko]

Yeah for blue!

In order to get compounded bupe, my vet had to use a special prescription pad. They had to file a copy of the prescription with somebody (province?/health authority?), and I had 3 days from date of prescription written to drop it off at the pharmacy. I messed up one time over a long weekend and had to get a second written prescription cause the initial one expired. And they charged me for each prescription. Not all vets are willing to go through the paperwork and have the controlled substance prescription pad. The compounded bupe was only good for 3 months. No refills allowed, I had to get a new prescription each time. We had to carefully calculate how much I went through in the 3 months and just get that amount made, with a bit extra for slop. But Neko was an acrocat with severe arthritis, it was something she needed the rest of her life.

Once you find that next general practice vet, who will be perfect, things will be easier.

 

[Butters & Lyla]

Yeah for blue!

In order to get compounded bupe, my vet had to use a special prescription pad. They had to file a copy of the prescription with somebody (province?/health authority?), and I had 3 days from date of prescription written to drop it off at the pharmacy. I messed up one time over a long weekend and had to get a second written prescription cause the initial one expired. And they charged me for each prescription. Not all vets are willing to go through the paperwork and have the controlled substance prescription pad. The compounded bupe was only good for 3 months. No refills allowed, I had to get a new prescription each time. We had to carefully calculate how much I went through in the 3 months and just get that amount made, with a bit extra for slop. But Neko was an acrocat with severe arthritis, it was something she needed the rest of her life.

Once you find that next general practice vet, who will be perfect, things will be easier.

That's a complicated process for sure. It sounds like your vet was great. They understood the importance of pain management and quality of life for your girl, and were willing to make sure you had enough bupe for her, which is amazing. I hope to find a vet half as good.

She did believe me - I think it was just something they had to do given how addictive that drug can be. I was mortified - that’s what happens when you lose the prescription before you even fill it! I sure hope you find a good vet soon. Mine is probably too far for you - at Dixie and the QEW, but I am happy with them. Let me know if you want the name.

I might! I'll see how the interview goes.

I don't know how you do it. Just reading and following this episode with poor little Butters gives me major headaches and knots in my stomach. Thank goodness for the guidance you're receiving in lieu of or in addition to the Vet/Internist. Praying that this will all subside, and a healed Butters will be back in the unpainful, happy beach and lagoon land soon.

Thanks A lot of headaches and stomach knots here, too. I am lucky to have so much help, though.