Re: 1/5 Rocket AM BG 167-NS-update LONG
at 2 pm (MT) he wanted to eat as he stood by his dish....so i fed him half can FF...not sure if the 1/8 cypro helped...he is now again in the bathroom
the negotiations have began with the vet...she wants me to give 300 cc daily splitting it in half....no his kidney values are not bad...when i have time and i'm more sane i will translate them....he probably shows dehydrated on the lab report from saturday as i had not given him his fluids....not sure if that's her logic
negotiations have began with her (note:she is the owner of the clinic, she is not the vet that Rocket saw when first dx with CRF...Rocket used to go for his first 14 yrs to a vet and was same as Comet's but that vet totally dismissed his early CRF until he crashed so he sent me home with fluids and told me if he continue to hide in the closet he was telling me it was time for him to go...so i sought out to find a new vet...i ended up at this clinic...with a diff vet...she was there with the CRF dx, seizures, FD dx-she is the one that put him on lantus and then the pancreatitis dx....unfortunately her contract was 1 yr...and to my surprise Jan2009 when Rocket needed help she was gone...so i was left to deal with the returning vet as she had been away 1 yr....and i've been working with her ever since...but this past november when i took him in she was not there so he ended up seeing the owner....and this past monday he saw her again....his vet's side manners are better than the owners...though the owner seems to know stuff)....i like many other people tend to question when vets Rx large doses of any med....
this is what she has to say "One plan to consider, if you rather stop the buprenex, would be to stop everything except the fluids (at 300-400ml per day - maintenance levels of fluid intake in the average cat is 60ml/kg/day - he is just over 7kg thus the recommendation for this to be an adequate amount) +/- cerenia or ondansetron (zofran) but not both, but only if you are seeing lip smacking. You could even consider stopping the phenobarb and see what effect, if any, it has on the tremoring. Then, depending on what signs he is showing, we can re-introduce things as they seem indicated. For instance, if the tremoring gets worse, we re-introduce the phenobarb (probably at a slightly higher dose); or if he still isn't eating, we give the cyproheptidine at the proper dose (if the proper dose doesn't work, then we could consider oxazepam). Or, if we are thinking the tremoring is a neurological disorder and he is not eating, perhaps it would be more prudent to try valium which stimulates appetites, helps with seizures, and would relax him. Bottomline, I think we need to see what his symptoms are and treat accordingly. Too many drugs, and possible masking/changing of signs, perhaps even under or overdosing is clouding our ability to judge what is best. "
i'm not doubting her intention....on his well being...but i had to point out to her that if his kidney values are ok and the subq are helping...wouldn't he need more fluids when his kidneys get worse and if so then upping it now when not really needed may do more harm than good....i'm awaiting on her reply
ok here it is:
His white cell count was good. A tad lower then their normal range at 4.5 (normal was 5.5) but most cats are actually more around 3 as they often get what we call a stress response in a couple of their cell types, making those cells stick and not come out in the blood to be counted by the machine. A white cell count of 4.5 is very good. I am not concerned.
Right now his kidney numbers are pretty good. Calcitriol is one of those medications where their mechanism of action sounds very plausible that it could be beneficial but it has never been proven in any study. Consequently, many experts do not recommend its routine use as they are not convinced it is helpful - at least not helpful enough to justify the expenses associated with its use. Others say they see improvement with it, but that is subjective. There is an arguement that it may be beneficial if the pth is high, but going back, I can't find a documented high pth. When exactly did you start it so I know where to look in the file. So, hard to say -but he isn't due for his next one until Friday (if I recall what you told me), so we have a couple of days to decide. Regardless, missing a few doses wouldn't make a big difference in the long run. I think for sure, for now, I want to stop the ALOH and go from there. If he has to have such high doses in order to have the calcitriol, may not be worth it. But we will see.
OK - let's stop everything but the phenobarb and 150cc bid fluids. If he is lip smacking, use either the cerenia or zofran (not both). Watch closely for tremoring, and report when seen (look carefully at head, it is very subtle). If we think it is the same reason he originally went on the phenobarb, then we will up the dose a bit - but talk to me first. A few hours of tremoring won't hurt him. Please provide me an update in the morning - I will look for email as soon as I get in, which is usually about 8:30. I can probably give you some preliminary feedback on your report before I get in to appointments. Based on what he does overnight, we will plan further. If he still won't eat well, my next recommendation will be appetite stimulant - our choices for that are a proper dose of cyproheptidine (I would try 1/2 tablet to be honest, because he is big and we want to know it is not working for him and won't, and not because he isn't getting enough), mirtazipine (which I know you don't like the effects of), or perhaps a benzodiazepine (valium, oxazepam) but I have to research that one if given in combination with phenobarb. Please give some thought as to what you are willing to try so we can move quickly on to the next recommendation when it seems indicated.
Talk to you tomorrow.
i will stop everything but the pheno
i emailed her with that...as per the fluids...i'm not on board with that much...she still on another reply doesn't want me to give insulin at this point...and i knew that....with his many issues still not resolved i don't know if giving insulin will make matters worse and if they do...then she will have a say in that...
