06/09 Eddie AMPS 337 +6 320 PMPS 362 +8 292

AM +6 320. Am noting where we'll need to go with insulin in the next while.

I'm also wondering about the Ondansetron: will Eddie have to remain on it as preventative or is it for acute conditions?
 
Jodey&Eddie&Blue said:
the Ondansetron: will Eddie have to remain on it as preventative or is it for acute conditions?
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It depends. Once he starts chlorambucil, he'll need to have it about 1/2 hour before the chemo, and likely 3-4 times a day for a few days, possibly up to 5. Then he'l have a break. If he has any more pancreatitis episodes, then he'd need it for that. So possibly only as needed. But I've seen some cats need it all the time. With Neko's CKD + heart condition + SCL, she needed it all the time. Should Eddie go into remission from SCL, the chlorambucil may eventually discontinued, and along with it the ondansetron.

Make sure you separate the ondansetron and the mirtazapine. Give the ondansetron time to work (30-45 minutes) before giving mirtazapine. Otherwise you'll be in the appy stimulant while nauseated and could put you into the food aversion situation.
 
Wendy&Neko said:
It depends. Once he starts chlorambucil, he'll need to have it about 1/2 hour before the chemo, and likely 3-4 times a day for a few days, possibly up to 5. Then he'l have a break. If he has any more pancreatitis episodes, then he'd need it for that. So possibly only as needed. But I've seen some cats need it all the time. With Neko's CKD + heart condition + SCL, she needed it all the time. Should Eddie go into remission from SCL, the chlorambucil may eventually discontinued, and along with it the ondansetron.

Make sure you separate the ondansetron and the mirtazapine. Give the ondansetron time to work (30-45 minutes) before giving mirtazapine. Otherwise you'll be in the appy stimulant while nauseated and could put you into the food aversion situation.
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The thing about the chlorambucil and SCL is that the latter is not confirmed and that Eddie's issue might be IBD although the medication protocol is the same for either condition. I guess the point, too, is that while ECID, this is good to know!

And separate the ondansetron and mirtazapine. Right! I'm also advised not to give mirtazapine at the same time as buprenorphine.
 
Jodey&Eddie&Blue said:
although the medication protocol is the same for either condition.
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Actually, no it's not. IBD can be treated with probiotics (and prebiotic like psyllium husk fiber) and a novel protein diet. Some IBD cats (like mine, need ongoing steroid but lower dose). Chlorambucil only if intractable IBD and nothing else working. SCL means steroids until remission, the chlorambucil for a maybe a year, then stopping medication. The medication protocol is different. You could on your own try a novel protein diet to see if that helps. That means food with completely different proteins than he's used to - pick one to start. For example, lamb, venison, rabbit, pork, kangaroo. Read the ingredients closely, many have multiple proteins in the ingredients. Try to avoid fish and chicken which are in a lot of commercial products.

Jodey&Eddie&Blue said:
I'm also advised not to give mirtazapine at the same time as buprenorphine.
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i hadn't heart that one. But once I tackled Neko's nausea, I typically didn't have to give an appetite stimulant.
 
Wendy&Neko said:
Actually, no it's not. IBD can be treated with probiotics (and prebiotic like psyllium husk fiber) and a novel protein diet. Some IBD cats (like mine, need ongoing steroid but lower dose). Chlorambucil only if intractable IBD and nothing else working. SCL means steroids until remission, the chlorambucil for a maybe a year, then stopping medication. The medication protocol is different. You could on your own try a novel protein diet to see if that helps. That means food with completely different proteins than he's used to - pick one to start. For example, lamb, venison, rabbit, pork, kangaroo. Read the ingredients closely, many have multiple proteins in the ingredients. Try to avoid fish and chicken which are in a lot of commercial products.


i hadn't heart that one. But once I tackled Neko's nausea, I typically didn't have to give an appetite stimulant.
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This is an increasing complication of a complicated situation. Here the point will be that Eddie will not undergo exploratory diagnostic surgery to determine if IBD or SCL or LCL for that matter. Even the IM vet says in regards Eddie this is unnecessary as the testing will not be able to accurately determine what's happening with Eddie.

So, I'm left with the IM's suggestion that either way (IBD or SCL) one treats with cholorambucil to begin

I'd be happy to try the novel protein rouTe but I have to get Eddie to eat on this own consistently, and that is the major challenge as far as I'm concerned. It is not constent. I feel most anxious and helpless when I have to impose feeing on him, like I did tonight, even though he seems to have had a pretty good day incluiding eating on his own earlier. I cannot predict. I do know if it's possible to maintain or for how long. I'll try another protein. I will.

I guess right now I'm wondering does he need ondansetron? How do I know if he feels nausea or not. Or dental healing? Does the need Mirtazapine? Or now? Or if so for either when? Does he still need buprenorphine? Yes? No? How long? I do not know enough to answer those questions.

All of this.
 
I would say bupe for at least a week. Call the dental clinic and get them to confirm the bupe timing. Ondansetron yes, especially if he's only sometimes eating.

Jodey&Eddie&Blue said:
Even the IM vet says in regards Eddie this is unnecessary as the testing will not be able to accurately determine what's happening with Eddie.
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Did he say why? If a tissue sample is obtained, it's sent to pathology. Of still a question, the sample is sent off for PARR testing. The SCL group I'm on only has a problem determining what is happening if the sample is not actually taken. I'm not saying do the surgery, but I don't understand why they couldn't figure out what he's got.
 
Wendy&Neko said:
I would say bupe for at least a week. Call the dental clinic and get them to confirm the bupe timing. Ondansetron yes, especially if he's only sometimes eating.


Did he say why? If a tissue sample is obtained, it's sent to pathology. Of still a question, the sample is sent off for PARR testing. The SCL group I'm on only has a problem determining what is happening if the sample is not actually taken. I'm not saying do the surgery, but I don't understand why they couldn't figure out what he's got.
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You might recall the ultrasound results (attached) that identified thickenings and the interpretation was inconclusive for either IBD or SCL. That's why they can't figure it out. Both the IM vet and I agree that doing the diagnostic surgery is not an option for Eddie. Furthermore, the IM vet said that the images show inconsistencies and are in different areas (see attached for refresher).
I may be mistaken about the treatment but I seem to recall the IM vet said whether IBD or SCL, he would with cholorambucil. Maybe in the swirl of all that's been happening in the last six weeks, I've misheard or misunderstood something.
 

Attachments

That's my confusion with the following statement.
Jodey&Eddie&Blue said:
Even the IM vet says in regards Eddie this is unnecessary as the testing will not be able to accurately determine what's happening with Eddie.
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The IM vet is correct in that surgery is necessary to accurately determine what's happening with Eddie. Whether IBD or SCL, some vets will go with chlorambucil. The down side to chlorambucil is increased nausea and that it's a carcinogen. Meaning it's best only given when it's needs to be (SCL).
 
Wendy&Neko said:
That's my confusion with the following statement.

The IM vet is correct in that surgery is necessary to accurately determine what's happening with Eddie. Whether IBD or SCL, some vets will go with chlorambucil. The down side to chlorambucil is increased nausea and that it's a carcinogen. Meaning it's best only given when it's needs to be (SCL).
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Hmmmm, well, this is concerning. I did some reading up and it appears that of all the medications chlorambucil is the least toxic to cats, in particular. Anyway, we'll see how things play out in the next while as he's nearing the one week mark away from the dental surgery.
 
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