05/25-26 Eddie (26th) AMPS 256 +7 178 PMPS 196

Discussion in 'Lantus / Levemir / Biosimilars' started by Jodey&Eddie&Blue, May 26, 2024.

  1. Jodey&Eddie&Blue

    Jodey&Eddie&Blue Well-Known Member

    Joined:
    Jun 2, 2021
    Hello,
    this was the 24th
    https://felinediabetes.com/FDMB/threads/05-23-24-eddie-not-mia.290385/#post-3181960

    It's all over the place. They also seem to be all over the place with giving him insulin. Like 4u on the 24th, 8u on the 25th and 6u today (26th)

    Now this morning, the 26th, they gave him 6 units. They are basing dose on preshot numbers it seems and because they are a 24hr clinic the vets keep changing.

    @Wendy&Neko given all that, would appreciate some guidance re: tonight's dose as I'm bringing him home.

    MAY 25TH I just spoke with a vet who was reading out the ultrasound report about various "thickenings" showing in areas of Eddie's GI. They say either IBD or lymphoma and she says surgery to determine which it is. I will not put Eddie through that.

    I was freaking out because the voice on the phone was just reading the report, which I'm including here. Clearly, there is no way to determine whether IBD of lymphoma unless there are samples taken in surgery. So, no.

    I contacted the IM vet who was great. He said we will take things one step at a time. Eddie will get the echo on Tuesday (hopefully. If you can believe it, there's only one vet who does it at the clinic, part-time). If the echo shows Eddie can have dental surgery, I will bring him to the coast on June 4th (dental June 5th).

    The IM vet has recommended--and I agree--that we will increase Eddie's Prednisolone now (currently he's been getting a low dose for his weight 1.25mg/once daily). We will increase to BiD. IM vet says if IBD, this will certainly help and even if lymphoma (hopefully, SCL), it will be included. I wrote to him yesterday regardingprednisolone dose if IBD or even if SCL. "I read this about SCL on the Cornell University College of Veterinary Medicine: “Cats with this disease can be effectively treated at home with a combination of a steroid (prednisolone) and an oral chemotherapy drug (chlorambucil, and over 90% achieve remission of their clinical signs.”

    The IM vet mentioned that Eddie is already on Prednisolone but I pointed out that he is on 1.25mg/once daily, which he has been on for nearly 4 years. He was prescribed that dose when he weighed much, much less than his current weight (about 10kg). He has lost some weight this past while and I would attribute it to his not eating well for weeks. In any case, he does still weigh slightly over 10kg. My question is this: does it make sense to increase his Prednisolone given his current weight?

    The IM vet wrote that he agrees and so that's what we'll be doing. It seems everything hinges on the echo results and if Eddie can get the dental done. I don't know what to do if he can't because he must eat.

    MAY 26th:
    I'm picking him up around noon today. I managed to get his Levothroxine compounded so the only pill-form medication he will have to take is the Prednisolone and it's tiny. The clinic has him on Gabapentin not Buprenorphine as they said the bupe affects appetite whereas Gabapentin does not. I don't know if this is accurate or it's just one of the many vet opinions that often determine protocol.

    Max is doing better. Putting a little weight on his leg. It feels like I'm running a vet clinic here at home.

    I'll post more as the day unfolds.
     
  2. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

    Joined:
    Sep 21, 2018
    Sending prayers for Eddie :bighug::bighug::bighug::bighug::bighug:♥♥
    I'm glad Max is doing better Jodey :bighug::bighug:
     
  3. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    8 units wasn't really doing it before his latest hospital visit. 12-14 got him too low - not too sure on the actual dose cause of hospitalization then too. Maybe 10? But I also would like to know what your schedule is like the next few days regarding monitoring
    Hold on, there is one more alternative. If his lymph nodes are inflamed (often the case) and he can undergo sedation, not anaesthesia, an ultrasound guided sample can be taken via fine needle aspirate (FNA). That sample can then be sent to Idexx to send out for PARR testing, which tests for clonality. That is a valid way to differentiate IBD from small cell lymphoma, without anaesthesia. For my kitty, there was some questions on the sample taken via endoscopy, so I went the PARR route too - it went to UC Davis.

    One gotcha about this - if you go that route, it's best if done before steroid is introduced or increased, as it can mask things. Since he's symptomatic on the tiny bit of steroid, you could go the PARR route now.

    Yet another route, but it takes time, is to put him on a novel protein diet and see if that helps him. If so, there is IBD.
    I can believe it - this person may not have the right skills. I know you don't have the time, but in an ideal world, the cardiologist should do the echo too.
    He's on a teeny tiny dose. Vets vary on how much pred to give, but my 4 kg kitty is on 3-4 mg. 1 mg/kg of cat is not uncommon, or even more. But see the proviso above about doing a FNA without steroids first. I would also check with the dental vet if there are any concerns about him being on steroids. If SCL and if a kitty goes into remission, steroids can then be tapered down. Unless, they also have IBD - sigh! on the personal experience.

    Make sure you take some Jodey time today. :bighug::bighug: You will need refueling and de-stressing before Eddie gets home.
     
  4. Jodey&Eddie&Blue

    Jodey&Eddie&Blue Well-Known Member

    Joined:
    Jun 2, 2021
    @Wendy&Neko I''ll respond to the above later but for now let me report that as I'm typing Eddie is getting the echocardiogram!! I don't know how that happened but I'm so grateful to whoever pulled those strings:
     

    Attached Files:

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  5. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    So happy the echo is sooner!

    This reminded me, you don't want to up steroids until you get results of the echo from the cardiologist either. Neko's heart condition (identified because she went off her food), meant she could not have prednisolone, and had to have budesonide for her GI condition.
     
  6. carfurby (GA)

    carfurby (GA) Well-Known Member

    Joined:
    Feb 19, 2012
    I'm glad Eddie got the echo today and that Max is doing good. Sending prayers. :bighug::bighug::bighug::bighug::bighug::bighug::bighug:
     
  7. Jodey&Eddie&Blue

    Jodey&Eddie&Blue Well-Known Member

    Joined:
    Jun 2, 2021
    Ok, we are home! I will report more once I get a sense of how he's doing.
     
  8. Jodey&Eddie&Blue

    Jodey&Eddie&Blue Well-Known Member

    Joined:
    Jun 2, 2021
    Jodey time. I would love that! I'm thinking that if the dental can go ahead, I'll drive down to the coast around 5:00am (appointment is at 9:30) and then when Eddie gets checked in for the dental, I'll go for breakfast with an old friend. One of my grad students will take over the class discussion for that day and since I don't teach on the Thursday, the 6th, I'll stay overnight on the 5th and just chill. I have a vet tech coming to pet sit and she can take good care of Max. She came today to help me with doing passive range of motion (PROM). All the videos show someone doing it on a large dog who has not had surgery. No one shows a video of a Chihuahua-Corgi who is adverse to having his feet touched never mind moving his back leg around after surgery. It went well anyway and Max is putting pressure on his back leg.

    Now if only the echo allows for going forward.
     
  9. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    The FNA would be on the lymph node (if larger), not the bowels. FNA's are only done of bowel walls if there is a mass and they suspect large cell lymphoma. LCL typically involves a mass. The recorded thicknesses are typically of the bowel walls. Looking forward to seeing the ultrasound report.
     
  10. Jodey&Eddie&Blue

    Jodey&Eddie&Blue Well-Known Member

    Joined:
    Jun 2, 2021
    Ok, PMPS 196. I stuck with the 6u. Attached is the ultrasound report. @Wendy&Neko
     

    Attached Files:

  11. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    Unfortunately, no increased lymph nodes, so no FNA and PARR possible.:( Like with Neko, with have to go with best guess. First wait for the cardio vet's take on the echo to see if he can increase pred or has to go the budesonide route.

    Hoping for a restful night for the two of you. :bighug:
     
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