03/28/22 MICIO: AMPS 72 SKIPPED THE SHOT

Hi Simone, you've shot these numbers before at PMPS. Why are you stalling? Can you not monitor if you shoot?

ETA: Just saw your comments. Did he eat after throwing up? Is he able to stand up?
 
Micio vomited yesterday morning, it was a bit of bile. I picked him up from the floor as it appeared he couldn't get up on it's own but after that he was "ok" and ate the whole meal.
I'm setting higher numbers for shots (won't shot under 90), his bg's seems to have a hard time rising right now ...Just tested him again 20 minutes later and he's 75. Need to feed him before he gets sick ( I also gave him 1/4 tab pepcid this morning)
 
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Bandit's Mom said:
Hi Simone, you've shot these numbers before at PMPS. Why are you stalling? Can you not monitor if you shoot?

ETA: Just saw your comments. Did he eat after throwing up? Is he able to stand up?
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He started Cabergoline 2 days ago and also 5Mg Benazapril per day on the 20th March but going to start giving him 1/2 dose for 10 days (per the vet suggestion) cause it seems to make him dizzy/drowsy
 
MICIO&Simone said:
I'm setting higher numbers for shots (won't shot under 90 right now), his bg's seems to have a hard time rising right now ...Just tested him again 20 minutes later and he's 75. Need to feed him before he gets sick ( I also gave him 1/4 tab pepcid this morning)
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His BG may not rise above 90 for a while this morning and that could throw your shooting schedule. You could look at a token dose of 4U.
Even if you skip or shoot a token dose, the depot will continue to influence his numbers in the first part of this cycle.

You might want to look at a dose reduction as Wendy suggested? Even down to 8U?
 
Bandit's Mom said:
His BG may not rise above 90 for a while this morning and that could throw your shooting schedule. You could look at a token dose of 4U.
Even if you skip or shoot a token dose, the depot will continue to influence his numbers in the first part of this cycle.

You might want to look at a dose reduction as Wendy suggested? Even down to 8U?
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Yes, reduced dose for sure. As for the token dose, I'll test again right after he eats and go from there
 
Bandit's Mom said:
His BG may not rise above 90 for a while this morning and that could throw your shooting schedule. You could look at a token dose of 4U.
Even if you skip or shoot a token dose, the depot will continue to influence his numbers in the first part of this cycle.

You might want to look at a dose reduction as Wendy suggested? Even down to 8U?
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71 right now, before eating...not rising. Not sure what to do with the shot, would 2u be too little?
 
MICIO&Simone said:
I meant give him a tiny amount after eating hoping that at least it won't through off his numbers too much( he just finished his full meal)
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Was his BG of 71 after eating?

You are almost an hour past your usual shot time? If you shoot now, can you schedule accommodate the delay?
 
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MICIO&Simone said:
Shooting time is actually at 6am and yes, I can delay a bit the pm shot tonight
P.S.: is Booma your name?
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Yes, my name is Bhooma :-)

If you can monitor you can shoot. Either the full dose (with a reduction) or a token amount. Whatever you are comfortable with.
 
Bandit's Mom said:
Yes, my name is Bhooma :)

If you can monitor you can shoot. Either the full dose (with a reduction) or a token amount. Whatever you are comfortable with.
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Just got a 65, went even lower...not comfortable to shot at all...I have a weird feeling about Micio since yesterday morning after he kinda of crashed on the ground after he started vomiting some bile, his back legs are giving up despite the high amount of B12 methylcobalamin....He's been very slow and his pupils are big almost all of the times
 
MICIO&Simone said:
Just got a 65, went even lower...not comfortable to shot at all...I have a weird feeling about Micio since yesterday morning after he kinda of crashed on the ground after he started vomiting some bile, his back legs are giving up despite the high amount of B12 methylcobalamin....He's been very slow and his pupils are big almost all of the times
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Yes, normally I would encourage you to shoot, but after yesterday's episode plus cabergoline in the mix, I'm not comfortable unless you are.

Considering his BG is tightly regulated, the weakness in his hind legs should not be neuropathy.

Maybe @Wendy&Neko will have some idea on that front.
 
MICIO&Simone said:
No shot then, will wait another 20 minutes or so and test him again and if numbers are even lower then I'll start with some MC
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If you are skipping, he might be able to surf on his usual LC. I would not use higher carbs unless he dips below 50.

Feed some more of his usual food now.
 
Bandit's Mom said:
If you are skipping, he might be able to surf on his usual LC. I would not use higher carbs unless he dips below 50.

Feed some more of his usual food now.
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Yes, no higher carbs untill below 50. Still trying not sure what the Carbs contents are on Wellness Pate' Chicken though...on the Catinfo food chart (Food Chart 2017 FIX NATION 12-3-18 (catinfo.org) ) it says "Wellness complete health" with only 4% Carbs on the Chicken flavor but not sure is the same kind I have (Pate' version)
 
MICIO&Simone said:
Down to 63@ "usual" +3
How do I report BGs on the spreadsheet if I don't shoot? Just fill the bg's numbers anyway? Tnx
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Yes. You original AMPS (72?) would be under AMPS. You would put "NS" (No shot) under the U column and all the readings after that would go under the respective times as if you had shot.

Btw, you can change the title to say you skipped the shot - it reads like you are still stalling :-)
 
How is Micio doing now? Other than still green.:D Eating OK? Movements OK?

I just went back in history, Neko got 2.5 mg on benazapril for most of the time, until her proteinuria got worse a year or two later. But that was short term and she went back to 2.5 mg. How much does Micio weigh? Neko usually weight 13-14 lbs, though was a bit above that when she started benazapril. It's usually dosed by weight, so I'm thinking, unless Micio is a lot larger, going back in benazapril dose is a good thing.

As for cabergoline, it's not unusual to see some GI systems (vomitting) the first week. We've had at least one person go back to every other day cabergoline to start, then increase later.

On your subject title, we usually say "AMBG" for AM blood glucose if you tested but did not shoot. AMPS indicates you did shot. Wise move not to today. This is how it can go with cabergoline, As I mentioned yesterday, skips, reduced doses, etc.
 
Wendy&Neko said:
How is Micio doing now? Other than still green.:D Eating OK? Movements OK?

I just went back in history, Neko got 2.5 mg on benazapril for most of the time, until her proteinuria got worse a year or two later. But that was short term and she went back to 2.5 mg. How much does Micio weigh? Neko usually weight 13-14 lbs, though was a bit above that when she started benazapril. It's usually dosed by weight, so I'm thinking, unless Micio is a lot larger, going back in benazapril dose is a good thing.

As for cabergoline, it's not unusual to see some GI systems (vomitting) the first week. We've had at least one person go back to every other day cabergoline to start, then increase later.

On your subject title, we usually say "AMBG" for AM blood glucose if you tested but did not shoot. AMPS indicates you did shot. Wise move not to today. This is how it can go with cabergoline, As I mentioned yesterday, skips, reduced doses, etc.
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Micio has is about lb 14.3 and Dr. wanted me to start him on 5mg Benazepril (1/2 pill every 12 hours); he still very slow and slept all day (which concern me cause he hasn't poo yet). Still waiting on the vet phone call for directions on meds. Just tested him 134, going to feed him now and then give him a shot: should I do 8u?
 
I definitely wouldn't shoot 8.5 units again. Are you planning on stopping cabergoline or just skipping a day?
 
Just noticed Micio's UPC ratio was double Neko's. Might explain the higher benazapril dose. The one time her UPC ratio got up there, was actually from a free catch - she let loose on the table when they were about to poke her bladder. :p UPC ratio from cysto was where it should have been.
 
FrostD said:
Well this looks a little familiar... (See my SS from July 2021 after starting cab)

Hind legs were noticeably worse? How long has he been on B12?
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Yes, but Micio started getting wobbly right after I started with Benazepril on 20 March; then I started with Cabergoline on 26 March and right after I noticed he got even worse. He's on B12 Methylcobalamin since last December and recently I upper the dose to at least 6,500 per day
 
Wendy&Neko said:
Just noticed Micio's UPC ratio was double Neko's. Might explain the higher benazapril dose. The one time her UPC ratio got up there, was actually from a free catch - she let loose on the table when they were about to poke her bladder. :p UPC ratio from cysto was where it should have been.
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He's @ 152 now, 1/2 hour past feeding and shooting time, I'll do 8u
 
Id
MICIO&Simone said:
Yes, but Micio started getting wobbly right after I started with Benazepril on 20 March; then I started with Cabergoline on 26 March and right after I noticed he got even worse. He's on B12 Methylcobalamin since last December and recently I upper the dose to at least 6,500 per day
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I'd suggest reading about the cabergoline and Benazepril in humans (whenever I see weird things happening not documented in cats, I look at the human studies...I know humans aren't cats but it can give clues).

In humans - cab can inhibit benazeprils anti-hypertensive effects. BUT cab can lower blood pressure on its own (or it can raise it, frustrating I know). Can also cause orthostatic hypotension, could explain the legs and him not getting up (I have orthostatic hypotension due to low BP, it unfortunately sounds familiar).

Search this page for Benazepril as an example - https://www.wellrx.com/cabergoline/monographs/

Id almost be willing to bet the combo of Benazepril and cab is lowering his BP too much. Talk to your vet, but if it were me I'd try discontinuing the Benazepril and have his BP monitored on cab alone...it may replace the need for Benazepril or he needs a much lower dose. I am no cardiologist though so talk to vet!
 
FrostD said:
Id

I'd suggest reading about the cabergoline and Benazepril in humans (whenever I see weird things happening not documented in cats, I look at the human studies...I know humans aren't cats but it can give clues).

In humans - cab can inhibit benazeprils anti-hypertensive effects. BUT cab can lower blood pressure on its own (or it can raise it, frustrating I know). Can also cause orthostatic hypotension, could explain the legs and him not getting up (I have orthostatic hypotension due to low BP, it unfortunately sounds familiar).

Search this page for Benazepril as an example - https://www.wellrx.com/cabergoline/monographs/

Id almost be willing to bet the combo of Benazepril and cab is lowering his BP too much. Talk to your vet, but if it were me I'd try discontinuing the Benazepril and have his BP monitored on cab alone...it may replace the need for Benazepril or he needs a much lower dose. I am no cardiologist though so talk to vet!
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Vet prescribed Benazepril manly cause Micio's proteinuria (and high bp), not sure how cab alone would take care of that but I can bring that up after I read the link/article you sent...Thank you!
 
MICIO&Simone said:
Vet prescribed Benazepril manly cause Micio's proteinuria (and high bp), not sure how cab alone would take care of that but I can bring that up after I read the link/article you sent...Thank you!
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I'm not sure cab alone would take care of it, but I do suspect he needs a smaller dose of Benazepril with the two meds combined. Curious what vet says
 
I agree he needs to stay on benazapril. High proteinuria is damaging to kidneys. Might be worth getting his blood pressure checked.
 
Wendy&Neko said:
I agree he needs to stay on benazapril. High proteinuria is damaging to kidneys. Might be worth getting his blood pressure checked.
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Well, not sure about Benazapril neither...looks like Micio had a mini seizure 1/2 hour ago. Right after he used the litter box he vomited a whole bunch of bile followed by a what I believe a little seizure, and that's what probably happened the other morning too. Will try to take him to the vet tomorrow, won't give him any of those meds anymore...
That was horrible seeing him like that
 
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Simone, how is Micio today? I was not on this Board almost at all all yesterday due to construction at my house... and I just read through all of this. I am very concerned about Micio! I know you were trying to get to the vet today. Let us know, if you can, how he is doing. :bighug::bighug::bighug:
 
Suzanne & Darcy said:
Simone, how is Micio today? I was not on this Board almost at all all yesterday due to construction at my house... and I just read through all of this. I am very concerned about Micio! I know you were trying to get to the vet today. Let us know, if you can, how he is doing. :bighug::bighug::bighug:
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Thanks for asking...Micio's not doing well: he's stable but lethargic. Unfurtunately the new vet I just started seeing kinda let me down already: Dr. is out all week and nobody can pass a message to him?! And other doctors at the clinic refuse to dial with Micio or give any suggestions on meds cause Micio's health multiple issues are too complex for them, first appointment anyway would be on April 14th...sounds just like a bunch of bs to me so, I have to look for another vet.
So, it all started when I first start giving him Benazepril on the 20th and he got already slower and maybe drowsy but other then on the 26th I started him on Cabergoline and the morning after he vomit some bile and felt on the ground (while vomiting) and I found him struggling to get up but couldn't till I helped him; I skip Cabergoline yesterday.
Then, again, late last night, I was watching him while at the litter box and saw him struggling a bit to poo but he made it "ok" (sometimes in the past,but not lately, he would vomit after pushing for poo), then he went back to pee a bit and as soon as he got out he started vomiting a whole bunch of bile while having a seizure for a few seconds...I thought he was chocking, he couldn't stand up and I helped him to stand up, then he calmed down but looked scared and confused for a few minutes. Later on he ate his regular meal. I stopped the Benazepril too while awaiting for the vet to call me back but instead they refused to give me any suggestions other then go to the ER.
I wanted to wait a day to see if, without those meds he'll get better but not sure he is: he eats his meals but sleep all day and barely walks around; will give him some Cerenia cause I think is nauseous and bad smell coming from his mouth/stomach (teeth are ok, no sign of infection back). He hasn't poo today and I'm afraid same thing will happen...will probably take him to ER anyway cause he needs to be seen by a doctor.
I think Micio had a bad reaction to those meds and I don't know if he'll recover and the vets behavior doesn't help at all...I'm speechless and don't know what to do, feel like my Micio is dying
 
Is there an ER with an internal medicine vet part of that clinic? Maybe a cardiologist? Sounds like Micio needs to be seen by someone used to complicated cases. Will the current clinic refer you to an IM vet?

Sending many healing vines for recovery for sweet Micio. :bighug::bighug::bighug: I hope the stopping of the benazapril makes a difference. There is an alternative drug that can be used for proteinuria.
 
Oh Simone. I am so sorry. This is just terrible and you don't know where to turn. It does seem like this all started with the Benazepril, but I can see how he should need that. Maybe something else is going on.
 
It could be a coincidence that it started the same day as the Benazepril. I would not give the Cabergoline right now as he doesn't need any added stomach upset, if it is causing any. I believe you have already stopped this.

Has his blood pressure been checked lately? Make sure they do check it. High BP can cause seizures (happened to us.)
 
I hope you have a good emergency hospital. Wendy had good suggestions there. I am so upset for you and poor Micio. I will pray for him!
 
Wendy&Neko said:
Is there an ER with an internal medicine vet part of that clinic? Maybe a cardiologist? Sounds like Micio needs to be seen by someone used to complicated cases. Will the current clinic refer you to an IM vet?

Sending many healing vines for recovery for sweet Micio. :bighug::bighug::bighug: I hope the stopping of the benazapril makes a difference. There is an alternative drug that can be used for proteinuria.
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I have an ER with IM specialist I've seen before for Micio but don't think I'll be able to obtain a referral from this new vet cause he's out till next week and they told me the other doctors in the same clinic refuse to take Micio's case cause is not their patient?! so wrong
I can try to call tomorrow and see if I can get an app with the IM...do you think IM also takes care of seizures too?
 
Suzanne & Darcy said:
It could be a coincidence that it started the same day as the Benazepril. I would not give the Cabergoline right now as he doesn't need any added stomach upset, if it is causing any. I believe you have already stopped this.

Has his blood pressure been checked lately? Make sure they do check it. High BP can cause seizures (happened to us.)
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yes, Micio's bp was checked last on the 16th March and it was 172/107.
Micio still very tired, only wake up for food or to go pee or drink. Worried about next time he'll go poo and will end up with another seizure then we'll go straight to er
 
Wendy&Neko said:
Is there an ER with an internal medicine vet part of that clinic? Maybe a cardiologist? Sounds like Micio needs to be seen by someone used to complicated cases. Will the current clinic refer you to an IM vet?

Sending many healing vines for recovery for sweet Micio. :bighug::bighug::bighug: I hope the stopping of the benazapril makes a difference. There is an alternative drug that can be used for proteinuria.
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What alternative drug is there for proteinuria?
Also, forgot to ask: talked to the vet about adding a phosphorus binder and he said that Niacinamide interferes with insulin and an over the counter one would be better ( I think he said Mylenta, but can't find that name..)...what do you guys recommend as a phosphorus binder for cats with diabetes?
 
MICIO&Simone said:
What alternative drug is there for proteinuria?
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Tanya's treatment page here: https://felinecrf.org/proteinuria.htm#treatments
Scroll down to the medications section. Semintra (telmisartan) is the alternative one.

Not sure phosphorus at 5.5 is a rush to treat with binder, though getting close. Over 6 is for sure, but it depends what stage CKD he has. I used aluminum hydroxide powder with Neko. Mylanta is one brand of aluminum magnesium binder and Tanya's page said they aren't suitable for CKD cats. The page on phosphorus binders: https://www.felinecrf.org/phosphorus_binders.htm You have to add some with each meal.
 
Wendy&Neko said:
Tanya's treatment page here: https://felinecrf.org/proteinuria.htm#treatments
Scroll down to the medications section. Semintra (telmisartan) is the alternative one.

Not sure phosphorus at 5.5 is a rush to treat with binder, though getting close. Over 6 is for sure, but it depends what stage CKD he has. I used aluminum hydroxide powder with Neko. Mylanta is one brand of aluminum magnesium binder and Tanya's page said they aren't suitable for CKD cats. The page on phosphorus binders: https://www.felinecrf.org/phosphorus_binders.htm You have to add some with each meal.
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Yes, Semintra...I remember now and I remember asking the vet about it but he recommended Benazepril to begin with instead.
I think I read that aluminum hydroxide cause constipation and that's something Micio doesn't need...will take a look at link you sent me, thank you!
 
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