10/20 Butters AMPS 299 /+7 320/PMPS 279/ Good follow up appointment

[Butters & Lyla]

Yesterday
Butters is continuing to be high and flat, today. Still on the couch. I woke up gasping for air at one point and realized Butters had climbed onto my neck and was sitting on it. I have scratches on my neck, too. I reminded her I am her source of food and meds. Behave, Butters, behave.

She has an appointment at the hospital today, which will include getting a new fentanyl patch.
Sounds congested. Like stuffed up and sneezy.
Groomed a paw and was licking her cheeks this morning. The first grooming I've seen since she came home three days ago. This is progress.
Otherwise, same same.

have a good day.

 

[tiffmaxee]

How scary! Yikes Butters. I was thinking about the congestion. Tiffany got herpes from the stress of being treated for lymphoma. That could very well be what’s happening here. Ask tge vet about that. They used to give lysine for it but many feel it really doesn’t do anything. If that’s what it is it will go away on its own. It could also be a cold. Grooming is a very good sign.

 

[Megan and Bernie]

I woke up gasping for air at one point and u realized Butters had climbed onto my neck and was sitting on it.

Literally just snort-laughed out loud (such an attractive noise) LMAO! Butters missed her mama!

YAY preening!!

Hope you and Butters have a fantastic day, Lyla! Good luck at her follow up!

 

[carfurby (GA)]

I hope the appointment goes well today. I agree grooming is a good sign. Sorry for the scare with her on your neck.

 

[Tomlin]

Best at the vet ! That is great news that she is bathing.....and partaking in the ultimate cat behavior—-waking their “servants” LOL...whatever means is necessary! Laughing thinking about her on your neck “Hello?!”

 

[Cheryl & Jazzy]

Oh my goodness, Butters. You're not supposed to suffocate your mama. She FEEDS you . Or are you just trying to make up for all that lost cuddle time, poor girl.

Hope the follow up appointment goes well. And grooming is a wonderful sign!! Great job, Butters. Have a great day, Lyla

 

[Olive & Paula]

Hope vet visit goes well. She is grooming yeah!!!!! She is starting to feel better. Hope the congestion goes away. Sounds like meds are working and she is starting to feel better. Keep it up, your doing great.

 

[thebigfuzz]

Hope the vet goes well!!!! Butters got to look her best

 

[Adrienne & Molly (GA)]

Grooming is a very good sign! Good luck with the appointment today

 

[Butters & Lyla]

Thanks everyone. Will keep you posted.
I thought she was going to suffocate me. So much pressure on my windpipe and she acts like she is velcro, so as soon as I move upright she digs her claws into me rather than jump off. That's an awfully aggressive way to wake someone up, if that's really what she was trying to do.

How scary! Yikes Butters. I was thinking about the congestion. Tiffany got herpes from the stress of being treated for lymphoma. That could very well be what’s happening here. Ask tge vet about that. They used to give lysine for it but many feel it really doesn’t do anything. If that’s what it is it will go away on its own. It could also be a cold. Grooming is a very good sign.

I'll ask about that. Thanks Elise for thinking about it. Looks like the appointment is a follow up with the IM, so I'll be able to discuss it with her.

 

[Sue and Luci]

She just missed her mama bean....what a little lover she is...just trying to get REALLY REALLY close!

Sorry you had to wake up that way...but what's a little squeeze on the ole windpipe among besties?

I sure hope she gets a good report today at the vet! It does sound like each day is a little better than the last...preening!!! Excellent news!

 

[JOJI and Kit]

preening, yay!
good luck at the vet today.

 

[JaxBenji]

Oh Butters Be kind to your mama bean and keep off the esophagus...mmmkay? Hope everything goes smoothly at the vet Hugs Lyla and

 

[Red & Rover (GA)]

Ah yes, the old suffocating the human while loving them to bits ploy. I know it well.

Lyla, some cats BG goes low after a vet visit. Do a test when you get home. I hope her pain drugs are scaled back a bit and all else goes well.

 

[Tomlin]

Ah yes, the old suffocating the human while loving them to bits ploy. I know it well.

Lyla, some cats BG goes low after a vet visit. Do a test when you get home. I hope her pain drugs are scaled back a bit and all else goes well.

Good catch! I think this was a question when Butters was hospitalized. My Ts BG plummets at vet visits to the point that not only do I not give insulin in the morning but I also reduce the evening dose the night before the Appt.

 

[Diane Tyler's Mom GA]

Such good news, except almost suffocating you.
She wanted you to have a fur collar to wear with your PJ's lol
I'm so happy to hear she coming around and that the office visit goes well.
I hope the the congestion turns out to be nothing
Have a good day Lyla

 

[Pamela & Amethyst]

Please update

 

[Megan and Bernie]

Please update

I second this LOL

 

[Butters & Lyla]

Update is mostly good:
-Fentanyl patch is not getting replaced. IM says to just watch for any signs that pain is reappearing but she thinks she will be fine.
-Keep going with other meds: gabapentin 25mg TID, cerenia 8mg SID, cyproheptadine...she says to start weaning her off this first. Currently doing 1mg BID. Second drug to wean her off of according to IM would be cerenia, and gabapentin last. I'm not sure this makes sense to me. I'd think cerenia should be the last to go.
-Still hearing the gallop. Have a cardiologist appt for an echo in January.
-She said just give Butters time to get back to her shiny self. As long as she appears to continue to be on the up and up, no need for another follow up appointment.
-upper respiratory issues are likely stress related and she said keep an eye to make sure it doesn't worsen, but should go away on their own.

Yay Butters.

 

[Butters & Lyla]

Ah yes, the old suffocating the human while loving them to bits ploy. I know it well.

Lyla, some cats BG goes low after a vet visit. Do a test when you get home. I hope her pain drugs are scaled back a bit and all else goes well.

Good catch! I think this was a question when Butters was hospitalized. My Ts BG plummets at vet visits to the point that not only do I not give insulin in the morning but I also reduce the evening dose the night before the Appt.

Thanks for the reminder. I saw it in my email and I got a BG test when we got home: 320. Sigh. Well, at least that is one additional data point to know how Butters' BG responds to vet visits.

Her numbers are right back to where they were two months ago, or even higher. It's hard to stop myself from jacking up her insulin dose a little more.

 

[Red & Rover (GA)]

Hopefully, Butters will stop seeing pink elephants now.

Her appetite may decrease a bit. No munchies due to the fentanyl.

 

[Butters & Lyla]

Hopefully, Butters will stop seeing pink elephants now.

Her appetite may decrease a bit. No munchies due to the fentanyl.

There must be some still in her system. The munchies persist. Every time she sees me she is demanding more food.
I bet she enjoyed the pink elephants, though.

 

[Tomlin]

Lyla-as long as Butters is eating well, you can increase the dose. I do increase Ts dosing to manage the increase in BG due to the flare, but I don’t get overly aggressive with it so that in the following scenarios 1) he has any issues and doesn’t eat while I am attempting to decrease or discontinue medications 2) inflammation decreases and BG decreases with it. Just keep what I like to call a “buffer zone” so that you remain nice and safe

 

[Cheryl & Jazzy]

Happy the follow up went well. Hopefully not having the patch won't cause any pain to reoccur. Glad she's still eating well. Did they say how long of a process it would be to wean her off of everything? Hopefully not too quickly. Are you supposed to just watch for symptoms and decide when she's good?

 

[Pamela & Amethyst]

YEAH!!!

 

[Lisa & Oberon]

So glad she's doing well!!!

 

[Sam&Milo(GA)&Singha]

Yay! I'm so glad to hear that Butters is doing better!! Definite improvement from when I was last online. I'm glad he heading in the right direction. I'm sure her BG will come down as she keeps improving. Take care!!

 

[Olive & Paula]

Good report for Butters. Since she had a bad episode I wouldn't hurry to wean her off. Give her a week without patch and see how she does. Cerenia helps with inflammation.

 

[Wendy&Neko]

I agree with Amy on the dose. Normally if people go away, or for another reason have to temporarily lower the dose, we suggest they go back to the last good dose when they are back and ready to monitor again. 1.0 was her last good dose.

 

[Butters & Lyla]

Happy the follow up went well. Hopefully not having the patch won't cause any pain to reoccur. Glad she's still eating well. Did they say how long of a process it would be to wean her off of everything? Hopefully not too quickly. Are you supposed to just watch for symptoms and decide when she's good?

She didn't give me an exact timeline, but kind of said consider weaning the cyproheptadine this week, cerenia next week, and gabapentin the week after that. Yes she also said to watch Butters for symptoms and make sure she was ready to have the meds cut back. It was all a little grey.
I have been staring at her all night just waiting for the slightest grimace to cross her face. If that happens, it's pink elephant time again.

Good report for Butters. Since she had a bad episode I wouldn't hurry to wean her off. Give her a week without patch and see how she does. Cerenia helps with inflammation.

I agree. I'm going to hold the other things steady for now unless she gives me a sign otherwise.

 

[Butters & Lyla]

Lyla-as long as Butters is eating well, you can increase the dose. I do increase Ts dosing to manage the increase in BG due to the flare, but I don’t get overly aggressive with it so that in the following scenarios 1) he has any issues and doesn’t eat while I am attempting to decrease or discontinue medications 2) inflammation decreases and BG decreases with it. Just keep what I like to call a “buffer zone” so that you remain nice and safe

I think a buffer zone is a good call for the moment. I want to be sure she is going to consistently eat for me before I attempt to bring her back to where she was before all of this started. It's so funny how focused I was on those flat, green cycles. Right now I'm just jumping for joy when she cleans her plate and attempts to groom herself a little bit. Priorities have changed slightly.

 

[Red & Rover (GA)]

Priorities have changed slightly.

One of those priorities should be you looking after yourself more too. Catch up on sleep when you can, eat properly, breathe, have some pink elephants yourself.

Of this variety:

Not this variety:

 

[Diane Tyler's Mom GA]

Lyla I'm happy to hear the visit went well. Praying that taking the patch away
will have no impact on controlling her pain and that the baba will be enough.
Glad hear she's still eating well.. You and Butters are always in my thoughts and prayers

 

[Tomlin]

Since you are questioning the order of discontinuation of meds I wanted to share our experience and how we were advised regarding adjusting & discontinuing meds:

1) Start with the pain medication first but don’t just stop it. If you are 3x/day dosing try to move to 2x/day dosing. However, it will not always be a perfect process. You may find that when you move to 2x/day dosing, Butters starts to have some pain at the 10 hour point vs 12 hour point so you would give the medication vs allowing the pain to get ahead of you and wait until the 12 hour point. Eventually the time between doses will get closer to the 12 hour point. Do the same as you go from 2x/day to 1x/day. Keep in mind, you may experience some back and forth for awhile before being able to completely go from 2 to 1 to 0 and that is perfectly ok and not unusual. This is a recovery where once it’s reduced or discontinued you may find yourself having to pull it back out of the toolbox briefly at some point. Hopefully not, but it can happen and I don’t want you to get startled by it. There’s a tendency (and its normal) to be excited about being able to stop a med but then worry if you need it again, albeit maybe for a dose or 2, and that is ok. No worries and it is still progress if it is only needed occasionally vs consistently as Butters comes out of the flare.

2) We used Zofran so that was the next med to be adjusted & discontinued

3) Cerenia was the final med to be adjusted and discontinued

Again, it is so important to keep in mind that during the process, there may be some stops and starts, just like the recovery itself. You may have peeled off the anti nausea but see some pain return, you just pull out the pain med and use it. It is not typically a perfect linear recovery where every single day is improvement. It could be more realistically described as a roller coaster but with less and less dramatic turns and hills as you go .

Similar to DM, don’t become overly focused on one day, but instead, the trend of the recovery. As long as you continue to see more improvements vs issues over days/week you are headed in the right direction .