Re: 1/12 Zener PMPS 247 vet report
Gosh, we are overflowing with gratitude for all the healing vines and eating wishes sent to Zener. Human vetty report was good for me so trip to Germany for work is a go for Sunday. Here is the latest:
Today
1/12/2012 Zener
AMPS 142, 1st cycle @0.25u, 1.1oz Wellness chicken 4%, 1 mg ondansetron
+1.5 204, 1.1 oz 4% syringe
~2 1.1oz 4% syringe
~4 1.1oz 4% syringe, 2.5 mg pepcid
+5 162
+10 injection of Cerenia at vet, urine negative for ketones and glucose
PMPS 247, 2nd cycle @0.25u, ate 1PP with 3mg zobaline on his own, 1.1oz 4% syringe fed
Acted a little interested in pureed food, his regular, not the syringe food, but still no go.
We were pleased with the vet visit. We saw the owner of the clinic and she seemed the most knowledgable about Lantus of anyone we have seen so far and was up to date on the anti-nausea meds. She was pretty certain, which we liked, that there is a reason for the inappetance and though the syringe feeding is okay for now, the goal is to solve the problem and get him eating on his own. She wants to see the ultrasound to rule out anything like a blockage or tumor, and discussed with us possible problems such as poor motility, ulcer, IBD, lymphoma and gastroparesis. Because he does not have diarrhea or bloody stool or vomiting, she doubts it is IBD. The ultrasound will rule out the biggies - like obstructions, large lymph nodes or tumor. She is coordinating with the doc that does the ultrasounds to get us in on Saturday rather than Sunday, so I will still be in town. Once she has this information, we will make a plan on where to go with treatment or further diagnostics. To rule out ulcer would require endoscopy and to confirm lymphoma would require tissue biopsy, so those are down on the list for now as they are more invasive. These tests will depend on how the ultrasound looks. In addition to the ultrasound, they will do a type of blood panel, something about Texas A & M I think, that will look at additional tests such as enzymes and some other values GI related. Does anyone know about this type of blood panel? He has to fast for 12 hours for this one, so on Saturday, we are to give a token dose of insulin or none, depending on the numbers, and in the afternoon, we will take him for the ultrasound, they will also do the blood draw, and we will take our testing supplies and Lantus to give him his shot at 6pm if he is not ready to come home before then.
The diagnosis of gastroparesis is a harder one to make in cats (than people) and is more a diagnosis of exclusion, and is sometimes seen in cats who are not well regulated for a long period of time, similar to a peripheral neuropathy in the legs, though affects the nerve that innervates the stomach. The treatment is reglan and something else that I'm forgetting at the moment, acupuncture, plus achieving better insulin regulation. She is not keen on appy stimulants right now because if the food is not moving through him, that can make him uncomfortable as well as nauseous. We asked about using the reglan, which we used for a day and then stopped after the vomit episode. She also wanted to reduce the meds and see if we could sort out what might be the problem. He has not been on bupe for a couple of days and she wanted us to not use that for now. The good news is he is peeing and pooping regularly and it looks pretty normal. Liz is doing such a great job with the syringe feeding! He also had not lost any weight since Tues.
She gave him an injection of Cerenia as the new research shows in addition to anti-nausea properties it has some pain relieving effect and can be a bit of a "miracle" drug for some kitties. These additional effects make it useful in kitties who are nauseated and having pain, as well as for vomiting. He has not vomited since the big puke on Monday night. She also discussed the use of a feeding tube for a short time, if we are striking out with other interventions, as it can be a bit better tolerated by some cats than syringe feeding.
By the time we got home, he seemed to be feeling a bit better. And, of course, if he feels better so do the beans. He ate a pill pocket on his own, but was not interested in any freeze dried chicken or pureed regular food. He acted like he wanted to eat a little, even sitting at his picnic table, but not yet. I think that's everything. I'm sure Liz will chime in if I missed something.
ETA: zobaline is the other treatment for gastroperesis.
Liz