8/3 Minnie AMPS 239 +3 270 +6 234 +8 236

[Liz & Minnie]

https://felinediabetes.com/FDMB/thr...5ur-at-0-5-2-298-3-251-5-153-6-25-178.250772/

Ack. I've got myself into that spiral of late PM dose/late night monitoring/oversleep/late AM dose. Another day for hindsight, should have given the R immediately at PMPS and not dawdled. That extra 30min kept me up late enough to stay up to watch the gymnastics!

Feeling discouraged after vet notes suspecting pancreatitis. Not sure if Minnie is worse today, I know I am dreading fluids and more meds. Neither of them are eating normally. Sam barfed some clear foamy liquid last night so I tried pilling him with the ondansetron...oh dear. That destroyed what little confidence I had about my skills. Ondansetron failure when I got back from an appointment. How does a cat keep a soluble pill in their mouth for so long without it dissolving?? She is being picky with food and not eating as much, but definitely is eating.

Side note...sports commentators keep talking about players doing a 'pokey' in beach volleyball and I look up every time, Pavlov style, wondering where the strips and lancets are.

 

[Wendy&Neko]

Hmm, wonder what a pokey break means in beach volleyball?

I can't remember, have you ever considered getting injectable ondansetron? Dosing is a bit different but I know you are good at injections. One less thing to worry about putting into her mouth.

I saw your comments about lipemia and possible p'titis again. Reminds me of another kitty, Ming, whose caregiver doesn't post much here these days. He has chronic pancreatitis and his blood is so lipemic it's described as being pink!

 

[Liz & Minnie]

Oh... and I'm trying to picture you putting bupe into Minnie's mouth.... into the buccal pocket... and her sitting still for that... sigh...

Hm. Position might be an issue but she can sit still for a REALLY long time after I give the soluble ondansetron...and still spit it out, crumbling but not-yet-dissolved!

 

[Liz & Minnie]

Hi, Liz. I just stopped by today to check up on Minnie. The labs you posted don't look bad. The potassium looks to be in a very good range. Weren't they happy with that? No change in spiro dosing, I assume. I don't see any cell for cholesterol or triglycerides (the hyperlipedemia vet is alluding to). I guess they were high again? She wasn't fasting when they did the blood work. That can also influence those numbers. I read that DM can cause hyperlipedemia. I know I am not telling you one single thing that you don't already know because you are so on top of everything! What are they basing the panc diagnosis on? Just symptoms? Since she's had it before? Back when she first got panc I'm sure they did the Spec fPl.

How is Sam? Nobody's talked about poor Sam for a while. I hope Minnie is being nice to him!

All they said about potassium was 'Blood work supports mild dehydration and elevated glucose. Her electrolytes were normal.'! I was pleased/relieved after a week without spironolactone waiting for the sugar-free, when I just gave her double potassium. I'm still not convinced this is normally an issue for her! Doesn't seem they tested triglycerides but I'm guessing it was just observational? I don't understand the rationale for the different types of testing, which is why I added a that info to her labs tab. This time was PreOp Scrn w/Electrolytes,CBC vs previous tests Vet Screen w/ CBC superchem (twice as $) or Recheck Profile Standard (50% more $)

They've not had any DM for a long while so I don't think it's that. You definitely are telling me new things! I think the panc Dx is based on the lipids, symptoms and history. In fact I don't think she's ever had a Spec fPl, at least I couldn't find it in any of the reports (though I will search again!)

Does low appetite imply nausea? She's not doing the walk up to food, sniff and walk away thing or drooling or licking lips....she's either ignoring it completely (as if she's not hungry) or when she does eat, she doesn't clean her plate. And being picky about what she'll eat (seems to be consistent diva behavior)

 

[Liz & Minnie]

Hmm, wonder what a pokey break means in beach volleyball?

I can't remember, have you ever considered getting injectable ondansetron? Dosing is a bit different but I know you are good at injections. One less thing to worry about putting into her mouth.

I saw your comments about lipemia and possible p'titis again. Reminds me of another kitty, Ming, whose caregiver doesn't post much here these days. He has chronic pancreatitis and his blood is so lipemic it's described as being pink!

I initially asked about injectable ondansetron but the vet said it's not as good as pills. Plus my confidence with injections has diminished after the stinging antibiotic!! I will try the ondansetron pill again, I didn't throw it far enough down so she held it very still on her tongue for a LONG time so it didn't dissolve. I have to laugh.

 

[Suzanne & Darcy]

Hm. Position might be an issue but she can sit still for a REALLY long time after I give the soluble ondansetron...and still spit it out, crumbling but not-yet-dissolved!

So much for orally dissolving tablets! I’ve never tried one to see how long they would take to dissolve in my mouth… now I wonder.

 

[Liz & Minnie]

So much for orally dissolving tablets! I’ve never tried one to see how long they would take to dissolve in my mouth… now I wonder.

I wish I could draw for you but will have to describe. I think she lets it sit on her tongue and very carefully keeps her tongue well away from the roof of her mouth...no saliva, no dissolve! If I'd thrown it in a better location it would dissolve, or I should have another go at squirting water. I'll confess, I have tried it - can't remember what made me feel nauseous a while back, but I remembered my stash of these and that they're human meds so I took one. Sweet fake strawberry flavor overlaying a bitter taste, but dissolves just fine for me.

 

[Suzanne & Darcy]

All they said about potassium was 'Blood work supports mild dehydration and elevated glucose. Her electrolytes were normal.'! I was pleased/relieved after a week without spironolactone waiting for the sugar-free, when I just gave her double potassium. I'm still not convinced this is normally an issue for her! Doesn't seem they tested triglycerides but I'm guessing it was just observational? I don't understand the rationale for the different types of testing, which is why I added a that info to her labs tab. This time was PreOp Scrn w/Electrolytes,CBC vs previous tests Vet Screen w/ CBC superchem (twice as $) or Recheck Profile Standard (50% more $)

They've not had any DM for a long while so I don't think it's that. You definitely are telling me new things! I think the panc Dx is based on the lipids, symptoms and history. In fact I don't think she's ever had a Spec fPl, at least I couldn't find it in any of the reports (though I will search again!)

Does low appetite imply nausea? She's not doing the walk up to food, sniff and walk away thing or drooling or licking lips....she's either ignoring it completely (as if she's not hungry) or when she does eat, she doesn't clean her plate. And being picky about what she'll eat (seems to be consistent diva behavior)

I guess they just were looking at her blood on a slide and noticed it. I suspected that because she/ he said serum.

I guess they can’t know for sure it’s a pancreatitis thing, but suspect it and it’s cheaper to treat it as if it were and see if it improves. That’s practical. I’m surprised.

What I don’t understand about Minnie’s eating is that sometimes she’s very hungry and sometimes she’s not. Does it correlate with her BGs? I don’t know. I think she’s a picky eater, but does that explain it all? That behavior is not classic nausea, but it might be for Minnie. When you get the Ondansetron into her, does it help? When is the last time she had an abdominal ultrasound done? I’m not suggesting you go spend your money on one; I am just trying to recall.

 

[Suzanne & Darcy]

I wish I could draw for you but will have to describe. I think she lets it sit on her tongue and very carefully keeps her tongue well away from the roof of her mouth...no saliva, no dissolve! If I'd thrown it in a better location it would dissolve, or I should have another go at squirting water. I'll confess, I have tried it - can't remember what made me feel nauseous a while back, but I remembered my stash of these and that they're human meds so I took one. Sweet fake strawberry flavor overlaying a bitter taste, but dissolves just fine for me.

That sounds nasty. I’m glad I always just popped them into the back of Darcy’s throat with a piller instead of letting them dissolve.

 

[Liz & Minnie]

OH. I stopped dithering and called vet to report she's not really improving so subq fluids it is. Going tomorrow where they'll do the first round and (hurrah!) let me in for a lesson. Hopefully they'll let me actually do it and not just a demo after.

I also posted on another thread about pancreatitis - apparently they should have a highly digestible diet (usually labeled GI food) while they're having an episode? The prescription food is i/d but that's 23% - any recommendations on low carb options?

I guess they just were looking at her blood on a slide and noticed it. I suspected that because she/ he said serum.
I guess they can’t know for sure it’s a pancreatitis thing, but suspect it and it’s cheaper to treat it as if it were and see if it improves. That’s practical. I’m surprised.

I haven't seen it myself...I was imagining they could even see the serum floating in the tube? Maybe that's crazy thinking. I'm fascinated how they operate behind the scenes, I don't know if the IM looks at the slides herself or just sends the vial to their in-house lab. Just before she was hospitalized the last time, she had that crazy off-the-charts hyperlipidemia which disappeared the day the meds finally arrived from Wedgewood. Anyway, they said she is slightly dehydrated so I guess if her appetite is down that's only going to get worse, whatever the cause, so subq fluids makes sense. I think from her history, they all think pancreatitis is root cause of her DM.

What I don’t understand about Minnie’s eating is that sometimes she’s very hungry and sometimes she’s not. Does it correlate with her BGs? I don’t know. I think she’s a picky eater, but does that explain it all? That behavior is not classic nausea, but it might be for Minnie. When you get the Ondansetron into her, does it help? When is the last time she had an abdominal ultrasound done? I’m not suggesting you go spend your money on one; I am just trying to recall.

You and me both! She is not usually ravenous these days unless she's gone into limes. Most of the time she has a healthy appetite and never walks away from a meal, though she does cycle through pickiness of what she will/won't eat. I have cases of pawlickin chicken and ducken and DM, waiting until she decides to like them again! In June she had the classic symptoms (drooling, sniff & walk away) but this current behavior is infrequent and, now I think about it, matches the run-up to her other hospitalizations. Don't think yesterday's ondansetron helped but hard to tell since I messed with her insulin and BG so much yesterday - I was assuming the big drop was putting her off her feed.

They did an u/s in March when she had the hyperlipidemia...just pasting the report below. Highlight - no sonographic evidence of pancreatitis.

Findings: No free fluid is seen within the peritoneal space. No enlarged lymph nodes are seen. The urinary bladder is moderately distended. No calculi are seen. The spleen is mildly enlarged and slightly hypoechoic but no focal masses are seen. The liver, gallbladder, and extrahepatic bile duct are normal. No stomach or intestinal wall thickening is seen. Intestinal layering is normal. The ileocecocolic junction is normal. Both kidneys measure within normal limits and have good corticomedullary distinction, the right kidney is 4.8 cm in length, the left kidney is 4.3 cm in length. No renal pelvis dilation is seen. The adrenals are larger end of normal, the right adrenal is 5.5 mm in width, the left adrenal is 4.4 mm in width. The pancreatic duct is mildly dilated. The pancreatic tissue is normal. No peripancreatic inflammation is seen.
Conclusion: The appearance of the spleen may indicate inflammation, hyperplasia or extra medullary hematopoiesis. Diffuse neoplastic process such as mast cell tumor is considered unlikely but aspirates are possible. The dilation of the pancreatic duct is of unknown and questionable clinical significance. There is no sonographic evidence of pancreatitis at this time.​

 

[Liz & Minnie]

Pretty flat today. Not sure if I'm remembering correctly, a cycle of flat yellows indicates recovery from a bounce and possibly an active PM cycle approaching?

 

[Katherine&Ruby]

Hi Liz, neither of my cats have had pancreatitis diagnosed but I've never ruled it out as a possibility because I've read somewhere (can't remember where now, too tired) that an ultrasound isn't a good indication and even the Spec fPLI can be off. Great that she has no intestinal thickening, but it doesn't really answer why Minnie doesn't really want to eat. When I had my kitties on Weruva foods they were super picky and would get tired of flavors quickly, but once I got them on raw they were a lot less finicky, maybe because it irritated their tummies less. I think you've tried raw already though?

 

[carfurby (GA)]

Sending prayers.

 

[Liz & Minnie]

Hi Liz, neither of my cats have had pancreatitis diagnosed but I've never ruled it out as a possibility because I've read somewhere (can't remember where now, too tired) that an ultrasound isn't a good indication and even the Spec fPLI can be off. Great that she has no intestinal thickening, but it doesn't really answer why Minnie doesn't really want to eat. When I had my kitties on Weruva foods they were super picky and would get tired of flavors quickly, but once I got them on raw they were a lot less finicky, maybe because it irritated their tummies less. I think you've tried raw already though?

I tried the frozen raw 'sliders' a couple of years ago. They ate it, I can't remember why I didn't stick with it. But I think you're talking about 'making' it yourself? Not sure I have it in me to do that yet. I had the same with the Weruva and Tiki - for months they loved it until they don't now. My wallet isn't complaining at least. After a quick online search for highly digestible foods, I went and got a selection from Mud Bay and she SCARFED some Instinct Limited Ingredient Turkey pate - cleaned her plate, cleaned Sam's plate then had some more with the meds in, though left some. She's now in a food coma.

 

[Suzanne & Darcy]

OH. I stopped dithering and called vet to report she's not really improving so subq fluids it is. Going tomorrow where they'll do the first round and (hurrah!) let me in for a lesson. Hopefully they'll let me actually do it and not just a demo after.

I also posted on another thread about pancreatitis - apparently they should have a highly digestible diet (usually labeled GI food) while they're having an episode? The prescription food is i/d but that's 23% - any recommendations on low carb options?

I haven't seen it myself...I was imagining they could even see the serum floating in the tube? Maybe that's crazy thinking. I'm fascinated how they operate behind the scenes, I don't know if the IM looks at the slides herself or just sends the vial to their in-house lab. Just before she was hospitalized the last time, she had that crazy off-the-charts hyperlipidemia which disappeared the day the meds finally arrived from Wedgewood. Anyway, they said she is slightly dehydrated so I guess if her appetite is down that's only going to get worse, whatever the cause, so subq fluids makes sense. I think from her history, they all think pancreatitis is root cause of her DM.


You and me both! She is not usually ravenous these days unless she's gone into limes. Most of the time she has a healthy appetite and never walks away from a meal, though she does cycle through pickiness of what she will/won't eat. I have cases of pawlickin chicken and ducken and DM, waiting until she decides to like them again! In June she had the classic symptoms (drooling, sniff & walk away) but this current behavior is infrequent and, now I think about it, matches the run-up to her other hospitalizations. Don't think yesterday's ondansetron helped but hard to tell since I messed with her insulin and BG so much yesterday - I was assuming the big drop was putting her off her feed.

They did an u/s in March when she had the hyperlipidemia...just pasting the report below. Highlight - no sonographic evidence of pancreatitis.

Findings: No free fluid is seen within the peritoneal space. No enlarged lymph nodes are seen. The urinary bladder is moderately distended. No calculi are seen. The spleen is mildly enlarged and slightly hypoechoic but no focal masses are seen. The liver, gallbladder, and extrahepatic bile duct are normal. No stomach or intestinal wall thickening is seen. Intestinal layering is normal. The ileocecocolic junction is normal. Both kidneys measure within normal limits and have good corticomedullary distinction, the right kidney is 4.8 cm in length, the left kidney is 4.3 cm in length. No renal pelvis dilation is seen. The adrenals are larger end of normal, the right adrenal is 5.5 mm in width, the left adrenal is 4.4 mm in width. The pancreatic duct is mildly dilated. The pancreatic tissue is normal. No peripancreatic inflammation is seen.
Conclusion: The appearance of the spleen may indicate inflammation, hyperplasia or extra medullary hematopoiesis. Diffuse neoplastic process such as mast cell tumor is considered unlikely but aspirates are possible. The dilation of the pancreatic duct is of unknown and questionable clinical significance. There is no sonographic evidence of pancreatitis at this time.​

Okay, yes... I remember this now. A pretty good report and no evidence of pancreatitis at that time it seems.

 

[Suzanne & Darcy]

I tried the frozen raw 'sliders' a couple of years ago. They ate it, I can't remember why I didn't stick with it. But I think you're talking about 'making' it yourself? Not sure I have it in me to do that yet. I had the same with the Weruva and Tiki - for months they loved it until they don't now. My wallet isn't complaining at least. After a quick online search for highly digestible foods, I went and got a selection from Mud Bay and she SCARFED some Instinct Limited Ingredient Turkey pate - cleaned her plate, cleaned Sam's plate then had some more with the meds in, though left some. She's now in a food coma.

Yes. My vet would agree with @PerfumedCatMom about the pancreatitis. You can't always tell from an ultrasound and she definitely says that the panc tests can not always be relied upon... she says that cats, "didn't read the manual on pancreatitis" and don't go by the book!

 

[Liz & Minnie]

"didn't read the manual on pancreatitis" and don't go by the book!

That cheeky minx of mine would probably read the manual and then deliberately not follow it! I will ask the IM about fPL tests tomorrow when I'm there, but I predict her response will be that she wouldn't do anything different anyway. I remember early on she said she won't do tests unless the results would make her follow a different path, which makes perfect sense. Though I am curious why it's never been done on Minnie when multiple vets have diagnosed it.

Followed up on the WSU test. Vet received the kit but has questions for the study coordinator so we wait.

 

[Suzanne & Darcy]

That cheeky minx of mine would probably read the manual and then deliberately not follow it! I will ask the IM about fPL tests tomorrow when I'm there, but I predict her response will be that she wouldn't do anything different anyway. I remember early on she said she won't do tests unless the results would make her follow a different path, which makes perfect sense. Though I am curious why it's never been done on Minnie when multiple vets have diagnosed it.

Followed up on the WSU test. Vet received the kit but has questions for the study coordinator so we wait.

I think I like that vet. Don’t do the test unless it would alter the treatment plan. Like I said… practical.

 

[Suzanne & Darcy]

That cheeky minx of mine would probably read the manual and then deliberately not follow it! I will ask the IM about fPL tests tomorrow when I'm there, but I predict her response will be that she wouldn't do anything different anyway. I remember early on she said she won't do tests unless the results would make her follow a different path, which makes perfect sense. Though I am curious why it's never been done on Minnie when multiple vets have diagnosed it.

Followed up on the WSU test. Vet received the kit but has questions for the study coordinator so we wait.

Minnie would read the manual and laugh!

 

[Katherine&Ruby]

But I think you're talking about 'making' it yourself? Not sure I have it in me to do that yet.

I swear feeding raw is nearly as easy as opening a can, plus there aren’t all of the fillers in raw that might irritate a diva’s tummy.