11/17 Butters AMPS 319/+2 304/+6 308/PMPS 193

Butters & Lyla

Butters & Lyla

Member Since 2020
Yesterday >300 all day.:facepalm::banghead: And it looks like Butters is starting today in the 300s as well:blackeye:. Why? Bounce/Inflammation/Not enough insulin? I don't know.

Today is day two of the bupe reduction and cycle eight of 2.125u of insulin for Butters. I went from .7mL q12 to .3mL q12. She was in the 300s before the bupe reduction so I don't think that it would be the cause.

Have a good day, all.
 
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Aww Butters, you're going the wing way. Come on back down, sweetie. Hopefully the pain meds are still effective with the reduction. It's gotta be mind boggling trying to figure out what is causing her numbers to vary so much and keep all the meds on track with what you think she needs. I don't envy you that. :( Really hope she levels out soon. Have a good day :bighug:
 
Morning Lyla, I'm praying that Butters will start giving you
better numbers, I know you must be frustrated, please hang in there.
I hope her pain is under control with the reduction of the bupe.
Sending hugs :bighug::bighug::bighug:
 
Are you lowering the bupe because you think she’s not in pain or for another reason? Still giving gabapenton?
 
Maybe not ready to have bupre reduced yet. How are you determining the pain? I know Ollie was in pain because I couldn't touch her sides or belly. Couldn't brush her. Her face had an awful look about it. When pain was less, she loved having her back brushed, but still couldn't touch her belly. When feeling really good she liked to lay belly up and roll. Didn't mind a very light belly tickle.

P'titis has its own timetable. I don't know if I got spoiled by vets keeping me supplied in meds, one even called me when he would be out of office for long weekend or at conference for a week to make sure I had enough while he would be gone, always had 30 day supply at home, I cringe when I read "vet only gave me 2 days worth of meds".
 
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Having trouble with posts, they keep timing out.

Anyway to add to above. When Ollie would have an episode or flare, the plan just changed. P'titis became the priority. Keep her eating, adjust insulin as needed (at one time she went back up to her original 9 units twice a day), get the fluids in her without aggravating the heart disease. P'titis came first, once it started to abate, everything else started to go back to normal.
 
Olive & Paula said:
Maybe not ready to have bupre reduced yet. How are you determining the pain? I know Ollie was in pain because I couldn't touch her sides or belly. Couldn't brush her. Her face had an awful look about it. When pain was less, she loved having her back brushed, but still couldn't touch her belly. When feeling really good she liked to lay belly up and roll. Didn't mind a very light belly tickle.

P'titis has its own timetable. I don't know if I got spoiled by vets keeping me supplied in meds, one even called me when he would be out of office for long weekend or at conference for a week to make sure I had enough while he would be gone, always had 30 day supply at home, I cringe when I read "vet only gave me 2 days worth of meds".
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Determining pain: She will swat me if I try to touch her sides or belly, plus I was looking at the feline pain scales that @Tomlin posted. Butters will never, ever lay belly up. But I can touch her belly without getting swatted when she isn't in pain. In fact, overnight she slept with her belly pressing right into my elbow:confused:. I can't imagine that would be comfortable if she was in pain.

Yes, I am very anxious because no one is giving me a 30 day supply...and we are past the 30 day mark. I was given 7 days' worth of Bupe last Monday and am doing my best to ration it along with what i had left over from the hospital. I am going to have a real problem getting more for her unless this vet who I am interviewing on Thursday works out.


tiffmaxee said:
Are you lowering the bupe because you think she’s not in pain or for another reason? Still giving gabapenton?
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She seemed to be doing better the past few days. I thought I was supposed to wean her off the meds at some point.:( It has been 4.5 weeks that I have had her home from the hospital and on meds. Yes she is still getting gabapentin 25mg q12 and some bupe q12. As well as Cerenia q24.

Tomlin said:
So, yesterday morning you reduced the Bupe?
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Yes.

Clearly her numbers are terrible and it aligns with the bupe reduction so I'm thinking I should just increase back up.
 
Definitely increase it given the BG with the behavioral changes. Given that you know this was the issue and you have some nice room with the BG, I would also feel comfortable increasing the insulin at the same time. If there was a question & I was uncertain, I would do one change. However, given this is pretty obvious cause and effect & you see what the pain does with the BG, there won’t be confusion with the BGs by increasing the dose back to where it was and increasing the insulin.

It may take some time to get the pain back under control (sometimes you can catch up quickly) so you may only see the effects after a couple of the higher doses have been given. Hopefully, she will be back “involved” with meal time and you see the BGs come down as well. If the pain is controlled & you have the higher dose of insulin, you will likely see some lower #s than what you saw right before you decreased the Bupe :).

I would probably contact the IM if you are going to cut it close with running out of medication just to be safe. Better to try to have the safety net. Hopefully, all will work out Thursday and the new vet will be a good match & partner with you to make this whole process easier. Hang in there :bighug:!!
 
Ideally you want them off the meds, however, some just take longer and some can never be taken off but can do very well on lower maintenance dose. It took awhile for vets to know me and trust me to not abuse medication. They found out (I email them) I will try regularly to reduce and let them know if it works or not. It also took a few reassessment from them and me asking "can you give me more quantity since I work and can't get here every couple of days to pick up more"

Just thought of something, make sure the bupre doesn't have sugar or sweetener in it. I didn't know it did. Now the vet uses unsweetened chicken flavor in the practice. They didn't know it contained it either. Same with gabapentin. I always called the pharmacy to make sure and make them aware she was diabetic.
 
The first time Max was officially diagnosed with pancreatitis he was on his beds for months. When I started eliminating them I reduced the number of doses and not the amounts at first. I think you should increase her instas well.
 
Prayers that the vet interview goes well and that you have found the right one. It’s crazy given all the literature from veterinary journals on how buprenorphine works so well to not give it to you. :banghead::bighug:
 
Tomlin said:
Definitely increase it given the BG with the behavioral changes. Given that you know this was the issue and you have some nice room with the BG, I would also feel comfortable increasing the insulin at the same time. If there was a question & I was uncertain, I would do one change. However, given this is pretty obvious cause and effect & you see what the pain does with the BG, there won’t be confusion with the BGs by increasing the dose back to where it was and increasing the insulin.

It may take some time to get the pain back under control (sometimes you can catch up quickly) so you may only see the effects after a couple of the higher doses have been given. Hopefully, she will be back “involved” with meal time and you see the BGs come down as well. If the pain is controlled & you have the higher dose of insulin, you will likely see some lower #s than what you saw right before you decreased the Bupe :).

I would probably contact the IM if you are going to cut it close with running out of medication just to be safe. Better to try to have the safety net. Hopefully, all will work out Thursday and the new vet will be a good match & partner with you to make this whole process easier. Hang in there :bighug:!!
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Some days are easier to hang in there than others:bighug:. But I have now seen the cause and effect in regards to lowering her bupe dose and have noted it in my spreadsheet for future reference. :facepalm: Lower numbers would be nice, but not too low please Butters.:nailbiting:
I hate to be negative, but I don't think going back to that IM is even an option. It would be difficult to do unless I lie about how much insulin I am giving her. Lying is not one of my strengths. I'm just trying to think positive thoughts that this new vet will work out. I think I can make it to the end of next week with the bupe I have, so I will need more from this vet when Butters sees him on 11/25 (video interview is 11/19).

Olive & Paula said:
Ideally you want them off the meds, however, some just take longer and some can never be taken off but can do very well on lower maintenance dose. It took awhile for vets to know me and trust me to not abuse medication. They found out (I email them) I will try regularly to reduce and let them know if it works or not. It also took a few reassessment from them and me asking "can you give me more quantity since I work and can't get here every couple of days to pick up more"

Just thought of something, make sure the bupre doesn't have sugar or sweetener in it. I didn't know it did. Now the vet uses unsweetened chicken flavor in the practice. They didn't know it contained it either. Same with gabapentin. I always called the pharmacy to make sure and make them aware she was diabetic.
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I think the vet would need to investigate why Butters couldn't be taken off meds if I can't get her off of them. I have to be careful how I come across to this new vet, lest he decide I could be a drug abuser. I won't have the benefit of having an established relationship with him for quite a while.

I reminded the IM vet not to give meds with sugars. All meds were dispensed by the hospital. Gabapentin is in pill form as is cerenia. Bupe didn't have an ingredients list on it, so who knows.

tiffmaxee said:
The first time Max was officially diagnosed with pancreatitis he was on his beds for months. When I started eliminating them I reduced the number of doses and not the amounts at first. I think you should increase her instas well.
Click to expand...

tiffmaxee said:
Prayers that the vet interview goes well and that you have found the right one. It’s crazy given all the literature from veterinary journals on how buprenorphine works so well to not give it to you. :banghead::bighug:
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Thank you:bighug: I hope he is the one.

Butters obviously wasn't ready to start coming off the pain meds, but I don't think I could have known that without trying to reduce. With the cypro, I reduced from 2 mg q12 to a sliver q12 before I went to q24 and it seemed to work well. Maybe I just got lucky. Next time I try to reduce anything I might try reducing the number of doses. But I'm not going to try again anytime soon.

Increasing insulin tonight!
 
Cyproheptadine is different. I reduced to every other day and then a silver too. With pain meds if they don’t get a therapeutic dose, it won’t work. That was actually part of Max’s problem with ondansetron. He wasn’t getting a high enough dose. If it wasn’t increased, I would have assumed it didn’t work. We now know it can also be given every 8 hours which I didn’t know at first. People still think cerenia can’t be used continuously until not needed, including my friend’s vet for her dog. With Butters it’s a bit different as your pain drug combo was working until you reduced the bupe so decreasing did give you info.
 
I'm sorry to hear she's continuing to have some pain and higher BG's. I hope she'll improve soon...as said above, pancreatitis has it's own timetable...hang on Lyla.

Sending you our best wishes and prayers! :bighug::bighug:
 
tiffmaxee said:
Cyproheptadine is different. I reduced to every other day and then a silver too. With pain meds if they don’t get a therapeutic dose, it won’t work. That was actually part of Max’s problem with ondansetron. He wasn’t getting a high enough dose. If it wasn’t increased, I would have assumed it didn’t work. We now know it can also be given every 8 hours which I didn’t know at first. People still think cerenia can’t be used continuously until not needed, including my friend’s vet for her dog. With Butters it’s a bit different as your pain drug combo was working until you reduced the bupe so decreasing did give you info.
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There is a lot to learn and it is even more challenging when the vet isn't supportive and/or doesn't know how the meds can be used. :(
I gave Butters a bupe top up this this afternoon, four hours after the morning dose. I think it helped her as she seems happier. I only have three weeks left of cerenia but I also have a bit of ondansetron.
 
I did not increase her insulin this evening. She went just <200 at PMPS; an over 100 pt drop in six hours. I don't know if this is becoming a bounce breaking cycle and/or if she will go lower tonight. I know I have previously shot insulin when she has been <100 and in a bounce breaking cycle. I can deal with low numbers. This is a challenging week for me and I'm not up to facing low numbers tonight (unless of course I had to), unlikely though it may be. If she stays in the 100s or higher overnight then I will increase in the morning.
 
You need to take care of yourself too so taking a slower approach sounds like a good idea tonight. Be kind to yourself - you’re dealing with a lot.:bighug:
 
Ice cream, wine, Butters spoon session :bighug:.....get some rest! Maybe with the pain back under control you hold based on your comfort and what you see later. Have a good night
 
Get some rest. I've said it before, p'titis can be gruelling and Butters has had a severe episode in my opinion. Don't be to quick to lessen her meds. I learned It the hard way, and it created backslides.

Here is a tip, write the bupre, gabapentin doses right in the ss in the corresponding cell. This way vet will see the relation to any increase or decrease of glucose. Look at Ollie's ss you will see where I entered her meds.
 
Please make sure to get some rest! You've been working so hard and both you and Butters deserve some down time. You're doing great, and we're all here for you!

Have a good night Lyla :bighug:
 
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