10/11 Butters AMBG 137 Home from ER...for now...

Butters & Lyla

Butters & Lyla

Member Since 2020
Yesterday
Good news, the overnight vet was so much more reasonable. She said if I take Butters home, she will write RXs and give a shot of Cerenia just before I take her home. I asked her to leave those instructions for the daytime vet.

Spec fPLI came back a 9. They said sometimes they will keep pancreatitis patients for days, and suggested Butters could benefit from a longer stay. But then she said that Butters was nervous all night and still hasn't eaten anything or peed. They won't let me in to see her and try to get her to eat because of COVID. I have asked every person I have spoken with. They have no exceptions for this rule. It's so sad.

So because of this, and because I will have meds should she need them, I have decided to bring her home and try to get her to eat, and let her pee. I hope I'm making the right decision. She will have had 24 hours of IV fluids at that point. They said if she doesn't eat within 12-24 hours, that I should bring her back and they will do more aggressive care, including a feeding tube.

They recommended an ultrasound for her at a later date, through my primary care vet because they are an ER vet and now that the Spec fPLI results are back they feel they know enough to treat her symptoms. But if I push for one they will do it. Do you think it is immediately necessary?
 
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Daytime vet just called. The other anti-nausea drug is called metoclopramide. She wants to send Butters home with some of that, rather than an RX for ondansetron. She says one or the other wouldn't make a difference and seemed completely confused over how to write a RX for ondansetron that will be the correct dose, even though I said I had broken up the pills in the past.

ETA: Final thing, I was on the phone with the overnight vet for a good 30 minutes. 20 minutes of that was me feeling like she was giving me the third degree about Butters' diabetes. She was quizzing me on her curves and nadirs. It was very annoying and frustrating. They thought her numbers were too good for a cat who requires insulin. I pointed out she hasn't eaten anything and the depot, and then smiled and nodded as politely as I could for the rest of that part of the conversation.
 
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I hope Butters can relax and heal at home :bighug: So glad that you are getting meds - I'm sure those versed in meds will chime in but just make sure you get a good supply :)

You are doing great, Lyla - and if you get her home and some thing is amiss, you can always take her back :bighug::bighug::bighug:
 
Oh my...what a night you've had!

First I'm glad there's a plan. At least you can bring Butters home and make her more comfortable - at least you'll have meds and hopefully she'll eat something and can go pee. Let's hope it's one thing at a time.

I'm sorry you had to spend so much time trying to defend your position on the care you've been giving Butters for her diabetes. It IS really difficult and challenging to try to inform a supposedly informed health care professional that you know more than they do about this particular disease. She's probably more curious than anything else...and this isn't the best time to have to educate her on the depths of FD! For crying out loud! The focus of this hospitalization is on her pancreatitis and the treatment thereof. I'm sure that was trying ... to say the least. I'm not sure I would have been as pleasant as you were about it...ugh...

Please keep us posted as to the progress of your day...I'm so hopeful that she'll be able to relax and pee and eat when she gets home. What time are you going to pick her up? Early, later??? Just wondering.

You've both been in my thoughts all night! Thank you for posting early!!!
 
My take
Butters & Lyla said:
Daytime vet just called. The other anti-nausea drug is called metoclopramide. She wants to send Butters home with some of that, rather than an RX for ondansetron. She says one or the other wouldn't make a difference and seemed completely confused over how to write a RX for ondansetron that will be the correct dose, even though I said I had broken up the pills in the past.

ETA: Final thing, I was on the phone with the overnight vet for a good 30 minutes. 20 minutes of that was me feeling like she was giving me the third degree about Butters' diabetes. She was quizzing me on her curves and nadirs. It was very annoying and frustrating. They thought her numbers were too good for a cat who requires insulin. I pointed out she hasn't eaten anything, and then smiled and nodded as politely as I could for the rest of that part of the conversation.
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my take on that is ur there for pancreatitis not diabetes
 
Pick up time is 1230 DST. So about four hours from now.
I figured it was best just to be polite as possible. They still have Butters and I still need things from them, so I didn't want to come across as difficult. I just let them talk....and then forget what they said. :)
She was incredibly curious. She kept asking...you do curves? What is her nadir? Do you always check before giving insulin? Yes. What number will you shoot at? What number won't you shoot at?

Should I be asking for subq fluids to take home if they don't suggest it, which they haven't? I don't even know if they'd give them to me.
 
Ok. Glad she coming home. Here is what you should ask for. Might not get it all but it doesn't hurt to ask.

1. Cerenia
2. Ondansteron or other drug
3. Pain med, if they won't give Buprenorphine, gabapentin is better than nothing. Ask for that. It's a painful illness. They wouldn't go without anything.
4. Appy stimulant
5. Small bag of fluids (ringers lactate), line, needles
6. Couple cans Rx food Hills critical care a/d pate not the savory cuts (sick kitties love it and it thins nicely if you have to syringe it).

Give her time to settle in and relax at home. I think by tonight she might perk up for you. Let her do it on her own, don't rush her. Try to limit your fussing over her (hardest part). Let her sleep and rest.

Give tiny bit of a/d food if she eats it then give more with med in it. Less fuss than pilling.

You have the diagnosis with blood work to back it up. Ultrasound maybe if this episode goes on to long or gets worse. Something to discuss with your vet.

While waiting to pick up, maybe get a couple of jars of baby food meat flavor with no onion or garlic. Some sick kitties will eat it.

Keep us posted.
 
Sienne and Gabby (GA) said:
Metocloprimide is also called Reglan (at least in the US). It's used to increase gastric motility. It is not an anti-nausea medication. It can help with vomiting as is has some anti-emetic properties. I have no clue why vets think it's effective for treating nausea. This is information from a reputable compounding pharmacy on the drug.
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Thank you for this.
I had read some things about it after I got off the phone with the vet, but figured I was just missing something. I have left a message at the hospital saying i want the ondansetron RX and not the metocloprimide.
 
FYI - both ondansetron and Cerenia are very bitter. If you have any bland gel caps, or can pick some up at a pharmacy once you get Butters home, your kitty will thank you. I've had drooling cats with either med and putting them in a gel cap avoids the problem. I've used a size 3 capsule.
 
Happy Butters is coming home :bighug:.

The question of to do or not to do a US right now vs later is always up for debate.

A common thing that is happening out there is for a cat to present with what can be “just” pancreatitis OR in reality, there is actually also some underlying IBD component that resulted in the pancreatitis. However, what happens is they run a snap PL or spec fPLI and call it a day vs getting the additional diagnostics like an US. The nice thing about the Spec fPLI is it gives you a level. 9 isn’t that high, so I wonder if the pancreatitis is secondary to a GI issue OR it could just be a more mild pancreatitis that will hopefully resolve.

One option is to do what they are suggesting—take the cat home and see how it goes. Honestly, I would take the cat home BUT definitely schedule the US to be done at a later point because if there is underlying IBD, that is important to know and helps with guiding treatment planning so that hopefully, you are able to prevent future pancreatitis flares.

I have only had personal experience with Reglan for nausea and it ROCKS. However, my understanding is that it most likely only has a direct anti nausea effect for dogs but, as mentioned previously, an indirect effect on nausea in cats by helping GI motility. Given that there is no known GI issue with an underlying motility component for Butters at this time it seems it would be a crap shoot as to whether it would help—-but maybe they’ve had a different experience OR they have a limited formulary of drugs? I would definitely get the ondansetron—works so well!
 
Glad Butters gets to come home today. Hopefully they give you what you need to care for her and don't hassle you about it.
Once she's home, I think she'll at least relax enough to pee. Hopefully eat some. I know you'll give her the very best home care. Praying she'll be feeling better soon. If you need to, you can always bring her back to the vet. :bighug:
 
I would not do the ultrasound. The other drug they are giving you does not work for cats. They don’t have the proper receptors. Decline it. Push for ondansetron. I was given it years ago for my lymphoma cat and it did nothing then learned the only reason to give it to cats s if they have motility issues. I will find the medication literature to back this up.
 
I'll pick up some gel caps. That will make that easier.

Thank you @Olive & Paula for the itemized list!
The vet called back & agreed to RX for ondansetron. Here is what they will give me/Butters at the moment:
1. Cerenia shot before she leaves
2. ondansetron RX
3. mirtazapine liquid (they offered pills or liquid but thought liquid would be a better choice)
4. a few cans of Hills a/d

Do I need to ask for Cerenia pills as well?

The overnight vet said she would send buprenorphine home. I haven't taken it up with the daytime vet yet. I'm assuming for the time being that it will be sent home with her.

The daytime vet said no to subq. She said if Butters isn't eating or drinking on her own that I need to bring her back, and to not worry about subq right now. I don't know if I should push harder on this? I'm asking for so much.
 
As I was reading @Tomlin 's comment...I thought you'd find it interesting that this vet told me just now on the phone that ondansetron is very hard to find and to call around to pharmacies before I go somewhere with the RX. I asked her oh is this because of covid? And she said, no, it is because she gives it to her dog and has always had trouble finding it for him. :confused:
I guess it confuses me why it is good for her dog but she'd rather give my cat the metoclopramide. Again, not wanting to rock the boat, I just said, "oh so it works well for your dog? Yeah I find it works well too". And left it at that.
 
Butters & Lyla said:
Pick up time is 1230 DST. So about four hours from now.
I figured it was best just to be polite as possible. They still have Butters and I still need things from them, so I didn't want to come across as difficult. I just let them talk....and then forget what they said. :)
She was incredibly curious. She kept asking...you do curves? What is her nadir? Do you always check before giving insulin? Yes. What number will you shoot at? What number won't you shoot at?

Should I be asking for subq fluids to take home if they don't suggest it, which they haven't? I don't even know if they'd give them to me.
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Just unbelievable that they didn't know squat, I so happy Butters is coming home.
I'm sure she will be more relaxed and will eat for you and pee.
I will be praying for Butters and you today and hoping for a good report today ♥♥:bighug::bighug:
 
Thanks for the link!
Just spoke with the office. They 100% refuse to give me cerenia for her. What should I do? Try to get her cerenia from the primary care vet...who won't be open until Tuesday? And I don't know if he will give it to me. I imagine he will at least let me bring her in for a shot.

Yes they will give me bupre.

Is it ok to bring her home and just give her ondansetron once the cerenia shot wears off?

Apparently they are sending her home with an antacid...something no vet discussed with me. Omeprazole. Do I need this? Why?

Going to hold off on the ultrasound. They aren't keen to do it anyways, but will definitely schedule one.
 
I would not rush to do an ultrasound. Here’s why. Some cats have one pancreatitis episode and never have another. I’d see if it returns. I’d also want it done by a boarded radiologist diplomat and not an ER vet.
 
Butters & Lyla said:
Thanks for the link!
Just spoke with the office. They 100% refuse to give me cerenia for her. What should I do? Try to get her cerenia from the primary care vet...who won't be open until Tuesday? And I don't know if he will give it to me. I imagine he will at least let me bring her in for a shot.

Yes they will give me bupre.

Is it ok to bring her home and just give her ondansetron once the cerenia shot wears off?

Apparently they are sending her home with an antacid...something no vet discussed with me. Omeprazole. Do I need this? Why?

Going to hold off on the ultrasound. They aren't keen to do it anyways, but will definitely schedule one.
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Ondansetron alone worked for Max. I never had to give both.
 
WT????? They will give bupre (controlled substance) but not the med she really needs. Unbelievable. Wonder what their reasoning is.

Get cerenia from primary if you can.

Omeprazole is prilosec, it helps with indigestion, stomach acid. Most people use pepcid which you can get otc.I

Ondansteron could be all you need. Just arming you with all you might need. You are in a long weekend, there is nothing worse than needing something and you can't get it because everything is closed and no one thought about it.
 
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SOOO glad she is coming home Do not be surprised if she goes NON stop peep for a while today and hopefully will be starving when you get her home That was how Amethyst was once she knew she was home and safe!:bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug:
 
I have pee pads so will bring those...good idea, thanks!
That last call annoyed me. Three vets in 24 hours all with different opinions on what they will and will not give me.
I had no idea I needed an antacid for her. I'm unclear as to the reasoning for giving this to her, so will likely skip it.
 
You want ondansetron 4 mg pills. Call around to see who has it in stock. Many pharmacies only carry it sublingual for humans. My grocery store pharmacy is hit and miss but can get it within a day. I have a compounding pharmacy near me that will always have at least one package around of pills. The pills are small, you are probably just giving 2 mg so half at once. If you haven't got a pill cutter, pick that up at the pharmacy too. I just give it inside a pill pocket, not had a problem with bitterness. It'll take longer to get, but you can get ondansetron as injectible. I haven't gotten it, but another Canadian member here has.

Mirtazapine is better as the transdermal (called Miritaz) if they have it, you just rub on ears. Slower absorption, less side effect many report on it.

A Primer On Pancreatitis Check out section on treatment - maybe even print off some of the articles. It'll tell you what you need, what you don't.

Good luck!
 
Butters & Lyla said:
I have pee pads so will bring those...good idea, thanks!
That last call annoyed me. Three vets in 24 hours all with different opinions on what they will and will not give me.
I had no idea I needed an antacid for her. I'm unclear as to the reasoning for giving this to her, so will likely skip it.
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It seems as if they use that instead of cerenia. Not ideal but okay in a pinch.
 
Ask for a couple of large syringes in case you need to syringe feed.
Your old vet should have subq fluids. You don't need a prescription for them in Canada but you can't get them at a drug store either. Most medical supply (not home supply) businesses do not have a storefront.
 
You need to start breathing and relax. Butters will pick up on your stress.

They are giving injection before she leaves. So that's good. You will have Omeprazole and if not can get it or pepcid over the counter.

Don't miss giving the pain med.

I think your biggest concern will be the eating. Keep offering small amounts often. Try food other than her regular at first.

You got this and FDMB has you.
 
I have given Mirtazapine in the past. I think it is technically an antidepressant, but also useful to stimulate appetite. It works fairly fast. With Marlin, he also got the antacid from time to time too.

Hope Butters feels better soon!!! :bighug:
 
You can give ondansetron and Cerenia in combination for nausea. They work on different systems so can be taken together. Personally, I would like to know the rationale for not giving you Cerenia. This is not a medication you can get at a pharmacy since it's a veterinary drug. My vet gives me enough to keep on hand. As others noted, ondansetron (Zofran) may work just fine. One place that is likely to have it is a medical center pharmacy. It's commonly used for the nausea that results from chemotherapy.
 
Butters is home with five days' worth of meds. Ondansetron prescription is for 1 mg BID.
I opened a can of shredded chicken and fed her two tsps. She ate willingly and seems to want more. I don't want her to eat too much at once.

She peed twice at the ER. Yay Butters.
They fed Butters a bit of m/d kibble, which she ate. They gave me a baggie of kibble and two tins of a/d food. They do not believe in syringe feeding; they don't do it. So they didn't have syringes to give me.
The printed instructions they gave me states to discontinue insulin and to make her chicken and white rice.

Instructions for meds:
Ondansetron pills: 1mg BID starting anytime tonight.
Mirtazipine liquid (15mg/ml): 0.12ml every 24 hours starting 8pm tonight (they don't have the transdermal Miritaz)
Buprenorphine liquid (0.4mg/ml): 0.2ml every eight hours: 6am, 2pm & 10pm. Reduce to every 12 hours if she seems very sleepy...?
Omeprazole liquid (20mg/ml): 0.25ml every 24 hours starting 2pm tomorrow.

It also states to discontinue insulin immediately.:confused: I will be ignoring that one.
 
Sienne and Gabby (GA) said:
You can give ondansetron and Cerenia in combination for nausea. They work on different systems so can be taken together. Personally, I would like to know the rationale for not giving you Cerenia. This is not a medication you can get at a pharmacy since it's a veterinary drug. My vet gives me enough to keep on hand. As others noted, ondansetron (Zofran) may work just fine. One place that is likely to have it is a medical center pharmacy. It's commonly used for the nausea that results from chemotherapy.
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The vet wouldn't get back on the phone with me to explain the rationale, in spite of me asking repeatedly. What I gathered from the front desk who was going between me and the vet, the vet doesn't understand that they target different systems. The person at the front desk just kept saying I could have "either/or" but not both.

And yet, they told me to start the ondansetron tonight in spite of them giving Butters a shot of Cerenia at noon. I'm pretty sure I can get Cerenia for her from the vet who I swore I'd never go back to when he reopens on Tuesday.
 
Glad you will ignore the no insulin. You could be at risk for dka if that happens. However, the depot is drained now, depending on test, can't advise on dose. The chicken and rice sounds like old school thought of giving bland diet. The rice is carbs, don't want that especially with no insulin.
 
I'm going to start her back on her regular dose tonight, assuming she continues to eat and keep down food. I don't think I'd need to change it.
 
So she ate the 2 tsps of chicken right when she got home around an hour and a half ago.
Since then, she has sniffed the various foods but not eaten. She doesn't lick her lips...just sniffs and walks away.
She is also very twitchy. I am watching her: her whole body is ever so subtly twitching. It seemed to get worse after she smells the food.
 
I'm so glad Butters is home under your loving care again!

I agree with Paula...no rice please...just get her numbers and hopefully she will continue to eat well...it sounds like she is feeling a bit better!

The whole thing sounds exhausting with the vets and their contradictions!
 
It doesn't seem to me like she is feeling better. She seems to be acting just like she was acting on Friday. If nothing has in fact changed, she will vomit in a couple hours or so.

She has been getting pain meds since yesterday and plenty of them as stated on my receipt from the ER. They would definitely have kicked in by now. Unless they aren't working.
 
So glad Butters is home!! Glad you were mostly able to navigate the different vets and their advice. (Chicken and rice for a diabetic?? :banghead:) Hang in there, you've got this, and you've got support here.
 
Just took this pic. This looks to me like pain face.

She has been in this position since she came home. Not sleeping at all. Just staring. She was in the same position pretty much day/night friday and saturday morning. I wish there was more I could do for her. Various foods are out, including some gravy MC foods. I just want her to eat anything at this point. And I am just letting her be.
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