? 11/18 Aida AMPS 87 no food no insulin

Daphne and Aida

Daphne and Aida

Active Member
Previous thread: https://www.felinediabetes.com/FDMB/threads/11-13-2024-aida-amps-107-2-92-7-84.295684/#post-3221036

Again, thank you all for your feedback.
Aida has been poorly, some days she’s doing fine, but with very small appetite. And then she falls back to diarrhoea and vomiting. Yesterday night she had a violent diarrhoea followed by vomit…

Unfortunately, the vet isn’t on board with learning about the current things… I sent her the papers from here and from the io group. She responded with “ok, but all the boards I’ve attended to for humans prescribe us to do as I told you” - that is starve the cat, give no pain relief, give no fluids and no anti-vomiting either. I didn’t bother to tell her that Aida isn’t a human, and that what applied to one species doesn’t necessarily apply to another…

Good thing is that in Greece, almost everything can be bought from the pharmacy without prescription if you say that it’s for your cat and the vet told you so and so. I went ahead and bought ondansetron, and in my effort to build some trust, I informed the vet. She wasn’t very happy and insisted that I don’t give her more than 2mg once a day. That hasn’t help Aida so far obviously, so I upped to BID and then TID, and I upped the dose from 2mg to 3 mg and today to 4mg. I’ve read in a paper that I can go up to 5mg for a 5kg cat.

I give her 50mg Gabapentin, but only once daily, I don’t know if it’s ok to give more often, if any of you knows I’d be willing to get your feedback on that!

And I went ahead and bought a lactated ringer fluid bag. I lack the vocabulary in Greek unfortunately to explain the pharmacist that I also need the IV set, so I’ve been giving her 15ml and 15 ml via syringes, not very easy…
(yes, I AM greek! But I’ve been living abroad for such a long time that I don’t have any vocabulary for such specific things) A Greek person from another group just gave me the vocabulary, so I’m going to be able and buy the thing! The vet was horrified at the idea that I would give her fluids at home, so I didn’t bother to tell her that either… The Greek person did give me the contact info of a vet with whom she could collaborate, so I’m planning to switch to her, even if it means to travel across the city to go there.

She’s scheduled for an abdominal ultrasound today, I explain to the secretary of the clinic that if Aida’s BG falls too low I’m going to feed her and reschedule the us. The anaesthesiologist just called me, he feels unsure about doing anaesthesia to a cat that is that sick and asked me to speak first with the vet and get her take on it. I still haven’t heard back from her. And I’m not sure why a cat should get a full anaesthesia for an ultrasound, last time they just sedated her…

This morning, after her diarrhoea, she ate 5 pieces of kibble, and I gave her 4 mg ondansetron. She was at 87, I opted for not giving her any insulin, since I was preparing to bring her for the us. Better for her to be slightly hyperglycaemic, right? And we’ll build the depot back later.

So far her skin doesn’t look too dehydrated. When I notice that it doesn’t fall back normally, I give her fluids. I try to give her 25ml, but the syringe keeps sliding out of her skin, so I end up giving her 15ml. I wonder if I should up it a bit?
 
Hi Daphne,

So sorry to here Aida isn't feeling well. I'm very glad to see you are educating yourself and doing what you feel is best for Aida regardless of the vet. She definitely doesn't sound up to date on her feline diabetes education. Unfortunately, I'm not able to help you a lot but if you can put a question mark in the title of your post you might get more help sooner. Hopefully Aida starts feeling better soon! :bighug:
 
I’m sorry Aida is still not feeling well. With the correct dosing of the meds hopefully that will change. The first time Max had pancreatitis he needed medication fur a few months. He was under dosed and I had to give him an appetite stimulant. I learned how to manage his chronic pancreatitis after that and didn’t know how short duration ondansetron had so even then he was under dosed. :bighug:
 
:bighug::bighug::bighug:

I’m so sorry she’s ill. You’re correct, we don’t feed humans. We do feed cats. Speaking from having two with pancreatitis. If they don’t eat then liver damage can follow. Methos was on 50 of gabapentin twice a day (I think he got narcotics in the hospital but wasn’t sent home on them). Tammuz was prescribed a narcotic for at home but refused to take it so he also got gabapentin.
Mirataz topical ointment is an appetite stimulant if you can get it there. Other things that entice my boys: fortiflora (sprinkled on top—it’s a probiotic but not a great one, I use it because the appetite stimulant in it really works—I think it’s the liver flavoring). I also crumbled freeze dried liver on their food, or freeze dried chicken. In the beginning when they wouldn’t eat anything I let them just eat treats so at least they got some calories—either the chicken or liver (and the non diabetic also greenies)
I read that B12 was important during pancreatitis (I will try to find the article) so my vet agreed to let them do weekly B12 shots for 4-6 weeks.
I hope they’re better soon
 
I would not add B12 until you have done all the testing and have a diagnosis. I’ve never been advised to add it for pancreatitis. An ultrasound is a good idea as this could be IBD or even SCL. I know you joined the excellent pancreatitis group on groups io and they will guide you.
 
Thank you all!
I'm super late with all the messages in all the groups, sorry!!
I am super happy to say that Aida is doing much much much better, no nausea, so I've reduced the ondansetron to 2mg, not sure how long I should keep it. Formed poops. Ravenous appetite. And alert and playful!

I checked her ketones - I bought a reader since she's super discreet with peeing, easier with blood testing. It read 0.1, is that ok?

We have an appointment tomorrow with a specialist vet, recommended by a member from another group that lives in Athens. I've emailed them my wishes: explore the IBD/SCL diagnosis, rule in or out pancreatitis and hyperthyroidism, and make a treatment plan accordingly. If there is hyperthyroidism I'll bring her for I131, that's for sure. It'll be hard on my finances but there is no way I'll let her take methimazole long term.

SmallestSparrow said:
:bighug::bighug::bighug:
I’m so sorry she’s ill. You’re correct, we don’t feed humans. We do feed cats. Speaking from having two with pancreatitis. If they don’t eat then liver damage can follow.
Click to expand...
Thanks for confirming it!!

SmallestSparrow said:
Mirataz topical ointment is an appetite stimulant if you can get it there. Other things that entice my boys: fortiflora (sprinkled on top—it’s a probiotic but not a great one, I use it because the appetite stimulant in it really works—I think it’s the liver flavoring). I also crumbled freeze dried liver on their food, or freeze dried chicken. In the beginning when they wouldn’t eat anything I let them just eat treats so at least they got some calories—either the chicken or liver (and the non diabetic also greenies)
Click to expand...
Good idea! I made a note for next time - although hopefully there won't be a next time!

SmallestSparrow said:
I read that B12 was important during pancreatitis (I will try to find the article) so my vet agreed to let them do weekly B12 shots for 4-6 weeks.
I hope they’re better soon
Click to expand...
I've also read the same thing, and also about IBD kitties that have absorption issues, I give both my cats 250mcg orally per day (the other one has CKD, so it's no harm to add a water-based vitamin, from what I've read on Tanya's website). But then #tiffmaxee says it isn't necessarily so for pancreatitis.
 
If symptoms are resolved any pancreatitis blood test will almost always be negative. I’m glad she’s doing better. Saw your post on the scl/ibd list. I’m a member but do not post.
 
Forgot to add, the ultrasound planned on Monday was canceled:
the anaesthesiologist wasn't confident with inducing a diabetic cat, to which I gladly canceled it…

No way I would leave her in the hands of someone who plans not to sedate but anaesthetize a cat for an ultrasound (????) and has no clue as to which protocol to follow for an illness as common as diabetes!!

The more I get to know vets, the more I'm becoming more confident in defending my kitties' wellbeing. It's the first time in my life that I totally ignored the opinion of a person who spent years and years studying, usually, I have tremendous respect for them. But telling me that it's now that she's sick is the best opportunity to make her lose those 200 gr of her belly, that I should starve her, there goes my confidence through the window!
 
I’ve never had a cat under anesthesia for an ultrasound. I think I would still want an ultrasound given the severity of symptoms. I would want to know about possible scl/ibd. One of my cats suddenly had severe diarrhea, nothing sticking. I had an endoscopy done but it was inconclusive. I was not happy as I think the sample was not good and there were lab errors. I changed to a different protein, started a good probiotic and gave her ondansetron every 6-8 hours. Chai was also put on folic acid for 6 weeks by the internist after the gi panel. When symptoms stopped I tapered and then stopped ondansetron. My vet did have me start prednisolone and kept her on it very gradually. I was so scared she would become diabetic. That took 6 months! So we are assuming IBD. At her last appointment he doesn’t think either IBD or scl because she’s not vomiting intermittently. :banghead: what? I tell you my story because it could be something or nothing.
 
Oh boy those vets… really!
Took her to the specialist today, he kept her for the day to do an us, full blood panel+chemistry and a fine needle aspiration. He wants to explore the hyperthyroidism, the IBD/SCL and pancreatitis, and he didn’t seem overwhelmed by all this, pfew!
He did say that hyperthyroidism is good for the kidneys, I looked at him I guess with my super critical expression and he was “hem yes, not good actually, it makes the numbers look better”, lol!
He reacted in a very positive manner to the spreadsheet and my filing system.
Crossing fingers…
It’s one of the new clinics that follow international standards, and big surprise: they do send to Idexx Germany!! So YES! Feloro will be able to continue being followed by his endocrinologist!

I was overly confident yesterday, she seemed to fine that I thought good, I can start reducing the ondansetron… She had diarrhoea in the evening, today in the morning she vomited and again diarrhoea, no appetite… I gave her 4mg ondansetron again, 1 hour later she ate a tiny amount.
 
tiffmaxee said:
I’ve never had a cat under anesthesia for an ultrasound. I think I would still want an ultrasound given the severity of symptoms. I would want to know about possible scl/ibd. One of my cats suddenly had severe diarrhea, nothing sticking. I had an endoscopy done but it was inconclusive. I was not happy as I think the sample was not good and there were lab errors. I changed to a different protein, started a good probiotic and gave her ondansetron every 6-8 hours. Chai was also put on folic acid for 6 weeks by the internist after the gi panel. When symptoms stopped I tapered and then stopped ondansetron. My vet did have me start prednisolone and kept her on it very gradually. I was so scared she would become diabetic. That took 6 months! So we are assuming IBD. At her last appointment he doesn’t think either IBD or scl because she’s not vomiting intermittently. :banghead: what? I tell you my story because it could be something or nothing.
Click to expand...
I think it’s still very difficult to differentiate IBD from SCL, even with biopsies. I came across this paper today…
https://pmc.ncbi.nlm.nih.gov/articles/PMC10229359/
For Aida, it could be that she has hyperthyroidism and her only symptom is the GI disturbances!
 
tiffmaxee said:
I learned the hard way to not taper or eliminate support medication until 100% back to normal for a few days and then just one change at a time.
Click to expand...
And yet the vet, the new new one, said on the phone that it would be better no to give ondansetron 3 times a day, better to switch to maropitant - I understood that maropitant is better a) for vomiting and b) because it only needs to be given once daily.
Then when I went to pick her up, he only had one pill of for me, to be split in two, which means 2 days of medical treatment. To which I kind of forcefully said that’s ridiculous, and her was ok, we can give you for more days if you want, but I don’t believe that she’ll need it for much longer than 3 days in total…
I think I scared him…

Anyway, Aida has subclinical hyperthyroidism, she presents absolutely no symptom yet her T4 and fT4 are elevated. So we’re starting methimazole treatment today. He made a prescription for 5mg spilt in two doses daily. Again I said kind of forcefully that it’s too high of a dose since she’s barely over the normal range and she presents no symptoms. He reacted by asking me if I was a medical professional - a very legitimate question, I am not. He then told me that he has treated over 100 cats with 2.5mg bid methimazole and they were doing fine. But if I prefer, we can start her with 1.25mg bid. I said I was more comfortable with that dose, and we’ll up it if needed.

The us showed nothing new, same diffuse thickening of the intestinal wall of the jejunum, he didn’t do an FNA since he didn’t see any mass or lump on a lymph node.

The biochemistry was all fine, the blood counts showed elevated easophils, could be attributed to IBD.

One odd thing: he listened to her heart with a stethoscope and a stopwatch and said that her BP is very high, probably due to hyperT. I didn’t question him on that, but does any of you have an idea how the heart rate can translate to blood pressure?

The plan is:
1- get her hyperT under control and check her renal status as well as the existence of hypertension.
2- do a surgical biopsy. He assured me that they have a very experienced anaesthesiologist who follows the latest guidelines for senior cats and CKD and diabetic etc. I plan of course to interview him, they’ll learn to hate me there :D
3- once we have a clear picture on the IBD/SCL question, I’ll bring her for I131. No need to be managing 3 illnesses since one of them has a cure! + better for my finances on the long run.

So far regarding her diabetes, she didn’t get any insulin yesterday. I guess her depot must be depleted, her BG is still good however. Maintained her reduced dose this morning.
She is absolutely content today, when I was bringing her home yesterday she was literally clinging onto my arm and purring…

Thank you all so so much!!
 
Hahaha! I absolutely loved reading this last post! You go girl! Big hugs and high 5's! You rock!

As far as the stethoscope and stopwatch, I have no idea how he would be able to know blood pressure. I thought for sure you were going to say she had a slight murmur but NOT BP. My vet uses a pet/baby blood pressure cuff. I'm actually surprised you didn't question him about that (unless you were afraid you had scared him enough already). lol
 
Totally agree with Heather. Max had high blood pressure and was not hyper-t. It started at around 12 and cause unknown so he was on blood pressure medication. He regularly had his blood pressure checked with a Doppler. I actually bought one later in his life but just got trained in how to use it shortly before heart failure took him quickly. My cat with skin allergies has had high eosinophils and allergies definitely cause it. It is possible to have both IBD and scl but hopefully Aida has just one of those.
 
tiffmaxee said:
Totally agree with Heather. Max had high blood pressure and was not hyper-t. It started at around 12 and cause unknown so he was on blood pressure medication. He regularly had his blood pressure checked with a Doppler. I actually bought one later in his life but just got trained in how to use it shortly before heart failure took him quickly. My cat with skin allergies has had high eosinophils and allergies definitely cause it. It is possible to have both IBD and scl but hopefully Aida has just one of those.
Click to expand...
Oh I’m planning on buying one, it’s crazy how vets simply won’t do this simple exam! Could you tell me which one you bought? I’ve been looking into them, I think it’s very tricky to get one here in Europe if you’re not a professional… I’ve actually bought a Contec, and it’s really 100% inaccurate, which is a pity.
Heather, you’re right, I should have asked him… Next time I guess! I’m scared at how scared educated men get faced with an opinionated woman!
 
I did a lot of research to piece together a Doppler, probe, cuff etc. The good ones are quite expensive. Even that way it was quite expensive. Some people buy a very cheap version from Amazon and say they work. Mine is a Parks machine. Tanyascrf has a section on this since high blood pressure is often due to CKD. Vets here do not test this enough and charge an extra fee even when spending money for labs and exams. Max was tested because I wanted a baseline after my other cat had it. We both were surprised his BP was high as he did not have CKD at the time nor was he hyper/t. Makes me wonder how many have idiopathic high bp. No cause explained it for Max. It’s complicated as just like people their bp can be artificially high when at the vet. I always wondered if Max really had it and it never was low enough even on meds. I bought my machine too late.
 
You must log in or register to reply here.
Back
Top