? 06/08 Eddie AMPS 340 PMPS 322 +8 364

Jodey&Eddie&Blue

Jodey&Eddie&Blue

Very Active Member
Good morning,

Here is yesterday:

https://felinediabetes.com/FDMB/threads/06-07-eddie-amps-331-pmps-367.290898/#post-3185413

Unfortunately this morning Eddie was reticent to eat on his own. We went through our routine. You know the drill. In any case, from yesterday's PM+8 he had Ondansetron and Mirtazapine which amounts to 4 hours before today's AMPS. He's supposed to be on Mirtazapine for 5 days (so 2 more days). Right now, it's AM+2 and he's licking at the food that is left on his plate. Go figure. I did give him Buprenorphine at shot time.

I guess it's all part of the process. But it often feels like one step forward, two steps back. If he didn't need insulin this would be so much easier because I could just let him eat in grazing mode. Oh, well.
 
If you are pretty sure he'll eventually eat it, nothing wrong with being a grazer. We have lots of people here with cats that are grazers.
 
Wendy&Neko said:
If you are pretty sure he'll eventually eat it, nothing wrong with being a grazer. We have lots of people here with cats that are grazers.
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Well, I left it there for awhile and he left it as well. I took it away but at AM +4, I made him a snack (with only a little Churu) and he ate that without any further ado.
 
Wendy&Neko said:
I mentioned an increase yesterday. Can you start getting mid cycle tests again?
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Yes, I can do that now. Shall I increase tonight to 5u? I'm confident he's staying high because he's purring while alone on his pillow and that has always meant he's in higher range and is comforting himself. Does this make sense?
 
When following TR, we go back to the last good dose. I'd be tempted to go higher than 5 units.
 
Wendy&Neko said:
When following TR, we go back to the last good dose. I'd be tempted to go higher than 5 units.
Click to expand...
I have to admit that given the last 6 weeks and everything that Eddie has gone through, including the dental (!)I’m anxious to go that much higher (2u? 3u?) all of a sudden, given his current irregular eating pattern? Eeek.
 
Even scarier is not knowing how he's doing on the current dose because there's been no mid cycle testing. Data gives you confidence.
 
Wendy&Neko said:
Even scarier is not knowing how he's doing on the current dose because there's been no mid cycle testing. Data gives you confidence.
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Well, I'll get the data and then I'll have the confidence to take it further. For now, because we just had the disinterest in eating and our little routine, I increased to 5u.

I don't know what to do about his not eating. I realize it can be a function of the results of the ultrasound: IBD or SCL and I'll work with the IM vet re: the combination of prednisolone and chlorambucil.

He's also curiously had a couple episodes of gagging and I'm guessing that has something to do with the sutures in his mouth?
 
When you talk to the IM vet about chlorambucil and prednisolone, you have to keep a couple things in mind. First, it's not more prednisolone, it's budesonide because of his heart. More pred could kill him as per the echo report. (same thing as Neko) Second, chlorambucil dosing method is extremely important in terms of nausea. Many vets still push the every other day chlorambucil. You do NOT want to do that older protocol. You want the every other week dosing, protocol of 20 mg/m2 every two weeks as documented in this paper. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3092124/

The every other week protocol is the version now preferred in the latest versions of vet oncology books. The every other week protocol gives overall less chlorambucil, whose effects on nausea are cumulative. In spite of having switched my first SCL cat from EOD to every other week, I had to battle Neko's IM cause he wanted her to start on EOD. It was a disaster in terms of nausea. EOD meant nausea every day. The every other week meant she had about 5 days of nausea when I had to give ondansetron, then we got a break for the remaining 9 days.

On the up side, in only took a few days of taking budesonide to make a huge difference for Neko.

Once you have seen what 5 units is doing (with mid cycle data), it may give you confidence to raise his dose closer to where it was.
 
Wendy&Neko said:
When you talk to the IM vet about chlorambucil and prednisolone, you have to keep a couple things in mind. First, it's not more prednisolone, it's budesonide because of his heart. More pred could kill him as per the echo report. (same thing as Neko) Second, chlorambucil dosing method is extremely important in terms of nausea. Many vets still push the every other day chlorambucil. You do NOT want to do that older protocol. You want the every other week dosing, protocol of 20 mg/m2 every two weeks as documented in this paper. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3092124/

The every other week protocol is the version now preferred in the latest versions of vet oncology books. The every other week protocol gives overall less chlorambucil, whose effects on nausea are cumulative. In spite of having switched my first SCL cat from EOD to every other week, I had to battle Neko's IM cause he wanted her to start on EOD. It was a disaster in terms of nausea. EOD meant nausea every day. The every other week meant she had about 5 days of nausea when I had to give ondansetron, then we got a break for the remaining 9 days.

On the up side, in only took a few days of taking budesonide to make a huge difference for Neko.

Once you have seen what 5 units is doing (with mid cycle data), it may give you confidence to raise his dose closer to where it was.
Click to expand...

Oh, my gosh, Wendy, thank you for this information! Especially about the chlorambucil! I'm pretty sure the IM vet did not want to increase Prednisolone at all and said it would stay the same with the addition of chlorambucil. Eddie has to be on Prednisolone FL because of the transphenoidal hypophysectomy. The IM vet is receptive to my input so I will definitely bring this forward.
 
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