Started Prozinc August 1 after 6 years with Lantus

You might want to reconsider the Convenia. This is a link to information from a vet, Lisa Pierson, DVM, regarding the risks of giving a cat Convenia. Many vets will give a long acting antibiotic injection rather than bother their clients with having to give pills. The problem is that once the drug is given, there's no way to interrupt its action. Convenia is maximally active for 1 - 2 weeks but lasts for up to 2 months. Its primary action, based on the drug company's information is for skin infections. It does not have an indication for dental issues. Just a personal note, my vet will not prescribe Convenia.

GI issues are not uncommon with Clavamox and Clindamyacin. You can give probiotics to offset the issue but you need to separate the dosing by a few hours.
 
Suzanne & Darcy said:
I agree with what Marje said here. With my most recent heart kitty, I was just looking through her cardiology reports since Sienne had mentioned the ejection fraction. Ginger’s was not great at 39.8%. Anyway, I came across a list of questions that I had submitted to the cardiologist regarding comparing the first ultrasound data to the data recorded by the cardiologist at Ginger’s first visit. The bottom line was that there really was not a lot that we could compare because the vet who had done the original echocardiogram didn’t have the advanced equipment that the cardiologist had (so while the first echocardiogram was good enough to show things like thickening of the left ventricle, etc., there was a whole lot of missing information about her heart function. In addition, Ginger was being over medicated, and the cardiologist had us discontinue two different medications.

I would definitely keep the Tuesday appointment and see how it goes, but I would also try to get on the schedule with one of those cardiologists.
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My vet is telling me the US is an echo. She’s been a vet over 35 years and she trusts this old guy. He’s diagnosed a few of my pets before. He’s a grumpy old man but seems to know his stuff. I’m pissed because she didn’t prioritize me to call the cardio. The old guy was available First thing Tuesday so I took it. The cost is about the same. If he finds something I still have to go to the cardio!
I’m a mess😥😥😥
 
Sienne and Gabby (GA) said:
You might want to reconsider the Convenia. This is a link to information from a vet, Lisa Pierson, DVM, regarding the risks of giving a cat Convenia. Many vets will give a long acting antibiotic injection rather than bother their clients with having to give pills. The problem is that once the drug is given, there's no way to interrupt its action. Convenia is maximally active for 1 - 2 weeks but lasts for up to 2 months. Its primary action, based on the drug company's information is for skin infections. It does not have an indication for dental issues. Just a personal note, my vet will not prescribe Convenia.

GI issues are not uncommon with Clavamox and Clindamyacin. You can give probiotics to offset the issue but you need to separate the dosing by a few hours.
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I didn’t even want to mention Covenia because of the reaction I get.

Bella saw a highly qualified dental specialist and an IM. She’s had Covenia in the past and it really helped her mouth. All the probiotics in the world didn’t help when she had diarrhea for 28 days due to clindamyacin. I won’t do that again.
I was shocked when both specialists said you can give Covenia weekly to cats.

She’s done well with that drug but her mouth issues are progressing which is why I had planned the extractions. She’s too frail now snd until we get answers on the heart, the dentist won’t do it.
 
I don't disagree with getting feedback from the cardiologist before doing a dental or any other procedure. Not everyone is familiar with the issues around Convenia. You've clearly done your homework. I've never heard of giving Convenia weekly, either.

(Part of the reason that I post a heads up is because we never know who is reading which threads. There are lots of people who will take what a doctor says and not ask questions. I want to be sure our members are asking questions!)
 
DianefromDallaa said:
My vet is telling me the US is an echo. She’s been a vet over 35 years and she trusts this ol
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Yes. Cardiac ultrasound is same thing as an echocardiogram. I hope I didn’t imply it wasn’t the same. Two names; same thing.

The purpose of my post was only to say that not all ultrasounds of the heart are equal. There is different equipment as well as different operator experience, knowledge, and training. For example, when the cardiologist did the ultrasound of Ginger’s heart, they didn’t even have to shave her fur. That’s a small and perhaps silly thing to note, but there were huge differences between the detailed reports I got from the cardiologist and the other vet. That’s doesn’t mean the other vet wasn’t a good vet. And I am definitely not denigrating the IM vet that is going to do the echo on Tuesday and I am really glad you will be having it done at that time— and can hopefully get some answers.
 
I’d also like to add a couple things. First, you do really need a cardiologist at some time. Not meaning to heap on you at all but I also had a very experienced IM doing an echo on my younger cat and he said she had HCM. Our closest cardiologist (Tobey’s) is two hours away and that’s why I took her locally but I immediately made an appt for the cardiologist and he said she did NOT have HCM. They had her positioned incorrectly. Her heart, for some reason, is a little bit askew from where it typically would be but the IM was not experienced enough looking at the heart to know that.

Also...you said they used Aranasp when her HCT came down. I looked at her labs and the lowest I saw it was 30%. Aranasp should not be used until the HCT or PCV is below 20. You can read more about it HERE but you’ll need to scroll way down to the section “Possible Treatment Plan for CKD Cats”. There is no harm in giving her the B vitamins I discussed and which are also discussed on the linked page.
Suzanne & Darcy said:
You fixed it. Spreadsheet in the signature works!
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I did that ;):)
 
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Suzanne & Darcy said:
Yes. Cardiac ultrasound is same thing as an echocardiogram. I hope I didn’t imply it wasn’t the same. Two names; same thing.

The purpose of my post was only to say that not all ultrasounds of the heart are equal. There is different equipment as well as different operator experience, knowledge, and training. For example, when the cardiologist did the ultrasound of Ginger’s heart, they didn’t even have to shave her fur. That’s a small and perhaps silly thing to note, but there were huge differences between the detailed reports I got from the cardiologist and the other vet. That’s doesn’t mean the other vet wasn’t a good vet. And I am definitely not denigrating the IM vet that is going to do the echo on Tuesday and I am really glad you will be having it done at that time— and can hopefully get some answers.
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I didn’t take it that way at all. I’m concerned because he’s a traveling doctor so his equipment is portable not sophisticated.
 
Marje and Gracie said:
I’d also like to add a couple things. First, you do really need a cardiologist at some time. Not meaning to heap on you at all but I also had a very experienced IM doing an echo on my younger cat and he said she had HCM. Our closest cardiologist (Tobey’s) is two hours away and that’s why I took her locally but I immediately made an appt for the cardiologist and he said she did NOT have HCM. They had her positioned incorrectly. Her heart, for some reason, is a little bit askew from where it typically would be but the IM was not experienced enough looking at the heart to know that.

Also...you said they used Aranasp when her HCT came down. I looked at her labs and the lowest I saw it was 30%. Aranasp should not be used until the HCT or PCV is below 20. You can read more about it HERE but you’ll need to scroll way down to the section “Possible Treatment Plan for CKD Cats”. There is no harm in giving her the B vitamins I discussed and which are also discussed on the linked page.

I did that ;):)
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My vet administered a tiny dose when her PCV dropped below 30, not 20. Her RBC dropped and the vet thought this was a good option. She’s too frail did feel better.
 
DianefromDallaa said:
My vet administered a tiny dose when her PCV dropped below 30, not 20. Her RBC dropped and the vet thought this was a good option. She’s too frail did feel better.
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I understand but I know my vet wouldn’t have done it. There could be other reasons why she is frail. She could have an iron deficiency that is not related to her CKD. I don’t know. But I do know you have to be careful using Aranasp and it is not recommended to give it to a cat with an HCT of 30. It’s based on the HCT and not the RBCs.
 
What kind of Fancy Feast are you feeding her at breakfast and dinner? She drops very fast in the first hour. First, is she eating a good amount at breakfast? I think you should feed her something with a few more carbs in it for the meal fed at shot times— something closer to ten percent. This could help slow her initial drop. Those steep drops can really cause bouncing. If it works, it also could cause her nadir to move a little later in the cycle.
 
Suzanne & Darcy said:
What kind of Fancy Feast are you feeding her at breakfast and dinner? She drops very fast in the first hour. First, is she eating a good amount at breakfast? I think you should feed her something with a few more carbs in it for the meal fed at shot times— something closer to ten percent. This could help slow her initial drop. Those steep drops can really cause bouncing. If it works, it also could cause her nadir to move a little later in the cycle.
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This is great advice. She eats Fancy feast chix, turkey or salmon pates. I have RC kidney pate. It’s higher than 10% but better than all the other kidney food.
 
DianefromDallaa said:
This is great advice. She eats Fancy feast chix, turkey or salmon pates. I have RC kidney pate. It’s higher than 10% but better than all the other kidney food.
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If you just mix a small amount of it with the Fancy Feast— or just give a small spoonful of it to her along with the FF, it might help slow the drop.
 
Marje and Gracie said:
I understand but I know my vet wouldn’t have done it. There could be other reasons why she is frail. She could have an iron deficiency that is not related to her CKD. I don’t know. But I do know you have to be careful using Aranasp and it is not recommended to give it to a cat with an HCT of 30. It’s based on the HCT and not the RBCs.
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Suzanne & Darcy said:
If you just mix a small amount of it with the Fancy Feast— or just give a small spoonful of it to her along with the FF, it might help slow the drop.
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I will do this tonight and tomorrow at shot time.

Have you ever used sucralate? We used in the past on Bella. My vet suggested using it because it seems that Bella is painful after eating. She gets zofran 3x/day and Cerenia. I try feeding after bupernex.

Is sucralate worth trying?
 
DianefromDallaa said:
I will do this tonight and tomorrow at shot time.

Have you ever used sucralate? We used in the past on Bella. My vet suggested using it because it seems that Bella is painful after eating. She gets zofran 3x/day and Cerenia. I try feeding after bupernex.

Is sucralate worth trying?
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I think I would try Slippery Elm Bark powder made into a syrup before I tried Sucralfate. Are you familiar with it? I say this because she is already on so many meds and it’s less likely to interact.
 
I bought the Frontier Co Op organic inner bark powder (you definitely want the inner bark). It is not cheap. Amazon sells several different kinds. Health food stores carry it as well.
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DianefromDallaa said:
Uromax Urinary,Kidney and bladder formula.
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I looked up the ingredients for this supplement. It appears it is designed to help prevent bladder stones (and kidney stones). It has a few good ones for the bladder like chondroitin but it has some ingredients to acidify the urine,that are not good for a cat with CKD. cranberries should not be given to cats with CKD and UroMaxx also contains Vitamin C to further acidify the urine.

Here’s a screenshot of what I found on the felinecrf.org website about cranberries and why they should not be given to CKD cats.

1756724808523.jpeg
 
Suzanne & Darcy said:
I looked up the ingredients for this supplement. It appears it is designed to help prevent bladder stones (and kidney stones). It has a few good ones for the bladder like chondroitin but it has some ingredients to acidify the urine,that are not good for a cat with CKD. cranberries should not be given to cats with CKD and UroMaxx also contains Vitamin C to further acidify the urine.

Here’s a screenshot of what I found on the felinecrf.org website about cranberries and why they should not be given to CKD cats.

View attachment 73936
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Hat is so crazy because a top IM specialist told me to get this.
 
Suzanne & Darcy said:
Here is the link to the whole page on kidney stones, bladder stones, crystals in cat urine, etc.
Kidney Stones – Tanya's Comprehensive Guide to Feline Chronic Kidney Disease
I know your baby has had some problems with UTIs, has she also had stones or excessive crystals? That link explains that calcium oxalate crystals are the most common type found in CKD cats and explains how to combat that tendency.
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No stones recently although one was on last years US.
She had a crazy E. coli infection in May thst was resistant to everything except meropenem - a drug few people know about. It was awful. 3 injections daily. It was suppose to last 6 weeks but she was getting so sick we stopped at 3. Her kidneys took a hit so we did 2 days of IV and she was looking better. Thst was early June but I think she had pancreatitis brewing the entire time which didn’t help her feel better.

Since then we’ve done so many urinalysis and cultures to make sure that this thing hasn’t come back. They even checked at the hospital when she was in ICU
 
Today Bella is not feeling well. Last night she wasn’t feeling well either.

She did eat, but I could tell she was nauseous because she was slightly drooling.

When she doesn’t feel well, she twitches and that’s what she’s doing now. Her blood pressure is elevated so I’ve given her medication. I just texted with my vet because I remembered seeing high liver values on her last blood work up and wondered if the amlodipine is making her liver feel worse.

According to my Vet pancreatitis, elevates the liver values and not be amlodipine. Either way she’s not feeling well and I don’t know what to do for her. She had her pain meds three hours ago.
 
DianefromDallaa said:
Today Bella is not feeling well. Last night she wasn’t feeling well either.

She did eat, but I could tell she was nauseous because she was slightly drooling.

When she doesn’t feel well, she twitches and that’s what she’s doing now. Her blood pressure is elevated so I’ve given her medication. I just texted with my vet because I remembered seeing high liver values on her last blood work up and wondered if the amlodipine is making her liver feel worse.

According to my Vet pancreatitis, elevates the liver values and not be amlodipine. Either way she’s not feeling well and I don’t know what to do for her. She had her pain meds three hours ago.
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Oh no. I am just seeing this now. I am so sorry. How heart wrenching to see her in pain. Is it the pancreatitis? What are you giving her for pain? Do you give Cerenia as well. That is helpful for pancreatitis as it is anti inflammatory and has analgesic and can work together with other medications. Of course if you are dealing with severe nausea, Zofran is best, but can be used alongside Cerenia.
 
Suzanne & Darcy said:
Oh no. I am just seeing this now. I am so sorry. How heart wrenching to see her in pain. Is it the pancreatitis? What are you giving her for pain? Do you give Cerenia as well. That is helpful for pancreatitis as it is anti inflammatory and has analgesic and can work together with other medications. Of course if you are dealing with severe nausea, Zofran is best, but can be used alongside Cerenia.
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I give .2ml of bupernex every 8 hours and 1/2 tab of zofran.

I gave Cerenia earlier than usual and she did perk up. I’m doing it around 6pm now.

She seems to get painful after she eats. When she’s in pain her face twitches and the dentist said it’s her teeth bothering her.

I was hoping she would be strong enough to go thru a few hours of surgery but now I’m not so sure. I know clindamyacin would be the best but her stomach doesn’t tolerate it.

Right now I just need to get answers on her heart tomorrow morning.
I think her pancreas is flaring because suddenly her glucose isn’t great and prozinc is only lasting 5/6 hours.
She’s outside on did go on the patio with me and was active so I was encouraged.

I don’t want to see her in pain but it’s hard to think of euthanizing when she seems normal at times.

Praying for good results tomorrow.
 
Bella dropped far and fast. Handheld is reading 80 which is low for her. Gave dry food trying- nothing. Gave 2 cc of honey. Nothing.
We are 5 hours into her cycle so I am hoping she will be increasing but then I’ll be dealing with a bounce.

She was at the vet this am for ultrasound so Prozinc was given late.

When I gave her zofran dose earlier, she was drooling like crazy.
Alarms going off. I need to call vet and give more honey.
 

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Suzanne & Darcy said:
What has her number come up to since the 80? What did the Libre say when your pettest meter said 80?
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Libre was 53 and Pettest was 75. It was probably lower but that was after honey and dry food.

She’s finally 130 on HH. Libre shows 90.

So I took your advice and fed carb food at +2 and + 4. There’s not a blip on that chart. She was nose diving no matter what.
I actually only gave 1.25 units of Prozinc. We were at 1.5.
For some reason she usually drops after the vet. I think it was delayed and that just gave fuel to the prozinc.

Her drooling was on another level thst I haven’t seen before. It soaked a washcloth. Poor girl. She ate 2 big bowls of food after the vet visit and I think it was too much. Many smaller meals works better for her.

I had been giving 2 mg of zofran every 8 hours. My vet said I could do 4 mg every 6 hours. Thst seems like a lot for an 9 pound cat.

Re the heart ultrasound- according to the IM doc who did it, he thought her heart was fine. No explanation for the sudden change in rate.
I’m waiting on the report and will include as soon as I get it.

I don’t like not knowing about the sudden rate change but he thought it was pain related to pancreas. She’s on bupernex.

They talked about putting her on Cyclo?? (Cyclosporine??). Because it wasn’t an immuno suppressed and they are concerned about WBC and anemia.
I probably have some of this wrong.

I know the IM didn’t want to document this because he was just brainstorming with my vet.

We are going to get an official suggestion from her real IM.
 
Suzanne & Darcy said:
I would not do more than 4 mg.
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I had only been doing 2mg every 8 hours. It didn’t seem like it was enough.

I’m upset now because I did insulin about an hour ago and when I went to pet Bella, it was all over her back.
I don’t know how much actually got in her.
If I dose more, she could hypo. If I leave, she could go really high.
In all these years this only happened one other time.

I may have to wait until 2am (+4) and do a dose of R to get us to mornjng or do a small dose of Prozinc.

Which is better? How do you handle these situations ?

She’s on the patio with me and not looking great. Very slow. Very skittish.
 
Suzanne & Darcy said:
I don’t understand the purpose of the cyclosporine? Do they think she has immune mediated hemolytic anemia?
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It was recommended by the lab as a treatment for the pancreatic inflammation. First I ever saw this mentioned.
They said it wouldn’t be as impactful as pred or Chlorambucil.

I want the IM specialist to weigh in.

Poor Bella just isn’t feeling good. She seems to get very lethargic and sluggish after eating. She seems painful.
 
DianefromDallaa said:
It was recommended by the lab as a treatment for the pancreatic inflammation. First I ever saw this mentioned.
They said it wouldn’t be as impactful as pred or Chlorambucil.

I want the IM specialist to weigh in.

Poor Bella just isn’t feeling good. She seems to get very lethargic and sluggish after eating. She seems painful.
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Can you increase her Bupe? Bupe has quite a wide margin of safety in cats with differing doses and frequencies being used for different conditions and situations.

Regarding cyclosporine, I personally would not use it in a cat with preexisting kidney disease. Also, I do not believe it is necessarily appropriate for pancreatic inflammation. I am not a vet, but if you do a search of the veterinary literature, you don’t find data to support its use in treating pancreatic inflammation. I would ask the vets about the potential for nephrotoxicity in a 17.5 year old cat with preexisting kidney disease. Yes, in otherwise healthy cats and when given at typical doses (2.5 to 7.5 mg/kg) the risk of harm to the kidneys is not high (although “mild, transient increases in BUN and creatinine are occasionally reported.”

Here’s just a little of what I found when looking into it (I currently have two cats on Atopica/cyclosporine so I read a lot of the literature on it a while back.)

“Risk factors that increase likelihood of kidney harm

  • Preexisting chronic kidney disease (CKD)
  • Dehydration, hypotension, or poor perfusion
  • Concurrent nephrotoxic drugs (NSAIDs, aminoglycosides, aminoglycosides, contrast agents)
  • High doses or prolonged unmonitored therapy
  • Drug interactions that increase cyclosporine levels (some azoles, macrolide antibiotics)”
 
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