11/12 WENDY = PMPS 389/ +2@391/ AMPS 364/ +2@337/ +5@302/ Dose

[Wendy and Eva]

** Update - Wendy has been on 5 units since 10/20/2022 and she's still not regulated **

10/20/2022: Wendy couldn't keep any food in her stomach and was vomiting every time she would try to eat. I took her to the vet and requested for TAMU GI Panel test. The vet gave her a B12 shot and sent me home with injectable Cerenia and Buprenorphine. I had to advocate for the vet to prescribe the Buprenorhine because he didn't see the need for it. I showed him articles from this forum which he briefly read and gave in. He only gave me 5 days/syringes worth of medicine. I also requested Ondansetron, and again, he didn't see the need for it. I showed him the article which he didn't read and said he had to order it because he doesn't like to prescribe to his patients. Wendy wasn't lethargic and was moving around without any issues. Was also tested for ketones and was negative.

10/21/2022: Administered Cerenia injectable after AM shot and Buprenorphine 0.6cc. Has been very alert and moving around faster than the usual. Has been eating and drinking water without any issues. I did question the dose that was prescribed to administer, but vet confirmed it was the correct dose. Administered SUB-Q fluids as per vets instructions.

10/25/2022: TAMU GI Panel results confirmed Wendy has pancreatitis. The vet explained there was no cure for it and only prescribed B12 shots to be administered once per week. I asked if he could prescribe Buprenorphine so that I can have in my toolbox to administer when Wendy has flareups, but unfortunately he declined my request. He said, if Wendy gets sick again, to call him and we would take it from there.

10/21/2022 to 11/01/2022: During this time, Wendy was given Buprenorphine and did well. She did vomit one other time but was not as bad as the day I took her to the vet. The Bup made her pupils enlarge and was moving around a lot faster. She also started urinating outside the litter box and in random places. Wendy has gained her full appetite and moves around without any issues.

11/07/2022: Administered injectable Ondansetron and Cerenia due to her vomiting before AM shot. Medicine kicked in and was able to keep food in her stomach for the remainder of the day.

11/08/2022: Wendy has been sitting by the water bowl for longer periods of time. She drinks some water and then lets her chin touch the water. She will stay in that position for over 5 minutes which she has not done before.

Overall Wendy has been doing well, but is still not acting like before being diagnosed. I know there are several factors that play in place, and one of the biggest one is getting her regulated.

Experts: I do apologize for not posting daily and will start doing so moving forward. I was under the impression I was to post when I had questions or concerns, but now understand the importance of providing daily updates.

Questions:

1. Is the dose of Buprenorphine that was prescribed by the vet too high? Wendy was weighing 9.4lbs during that time.
2. I am having a hard time manually updating the labs on my spreadsheet and need some help. Who could help or guide me through this process? I did copy a picture of the TAMU report.
3. On my last post, it was recommended to keep her on 5 units and have done so. However, I know I've kept her on that dose for too long because her numbers haven't changed much. Should I increase, and if so, what should I increase her to?
4. Any idea why she keeps her head in the water bowl? Some days are worse than others and that's when I administer sub-q fluids. Vet recommended I continue administering fluids on a daily basis and said it wouldn't harm her. Should I administer only when I see her "off"?
5. Would Buprenorphine cause her to urinate outside the litter box as she at times has been doing? She started doing it after taking this medication and we can't think of anything else. I took fresh urine to the vet to test for UTI & Ketones (I do test daily for ketones at home) and results were negative. She will only do this at night when we are asleep. There are no stressors for her not to use the litter box. I'm beyond frustrated because she has ruined imported chairs and rugs. I want to help her but don't know how. The litter box is always clean and we have plenty of them for her to use.
6. I was prescribed 5 days/syringes of Buprenorphine and was charged $120. Does this sound about right? It's almost as expensive as the insulin. Any recommendations?
7. When do you recommend I do a curve on Wendy?

@Wendy&Neko @Chris & China (GA) @Marje and Gracie

https://www.felinediabetes.com/FDMB...s-332-3-356-5-259-11-513.269878/#post-3010047

 

[Diane Tyler's Mom GA]

I can also try tagging
@Suzanne & Darcy

@tiffmaxee

@Sienne and Gabby (GA)

 

[Wendy and Eva]

I can also try tagging
@Suzanne & Darcy

@tiffmaxee

@Sienne and Gabby (GA)

Thank you!!!

 

[tiffmaxee]

I used ondansetron pills. Orally it’s given 2-3 times a day. I don’t know the dose when injecting. Standing by the water dish is a sign of nausea. Is the bupe oral? What is the dose? How much does she weigh? There were times when Max needed meds for months. If your vet gives you an RX you can get ondansetron at any pharmacy including Costco.

If not eating the normal amount daily fluids is a good idea. How much are you giving?

I have not known cats to urinate outside if tge no. Due to buprenex.

It does look like she needs an increase.

 

[Bandit's Mom]

Sorry to hear that Wendy has been so unwell. It's even harder when vets are uncooperative. I don't suppose you can go to another vet who can prescribe ondansetron and bupe? I don't have any experience with pancreatitis (@tiffmaxee has quite a bit) but I guess you've seen this
A Primer On Pancreatitis ?

From Tanya's CKD website, hovering over or being hunched over the water bowl could be a symptom of Gastric hyperacidity or Dehydration

Is she showing any signs of neuropathy? That could be a reason why she isn't going in the litter box.

I can help you with inputting her labs into her SS. Were Wendy's kidney values checked?

On the dosing front, you are holding doses too long. Even with SLGS, doses are evaluated/increased every week. With TR, you want to increase by 0.5U (dose increases between 5u and 10u are in multiples of 0.5U) every 3 days till you start seeing nadirs below 200.

 

[Sienne and Gabby (GA)]

The other explanation for hovering over the water bowl and possibly for urinating outside of the box is that Wendy's numbers are not well regulated. I'm linking the post on dosing methods for Lantus. Chris linked this information when you posted on 10/20. In addition, as others have been pointing out, you are holding doses for too long. This is not a trivial consideration. If you are holding a dose and the BG numbers are not in a good range, glucose toxicity will develop. What this means is that your cat begins to treat the higher range numbers as her new "normal." This makes it more difficult to get the numbers back into a better range. In looking at Wendy's spreadsheet, it's very unclear how you are approaching dosing for Wendy.

When Wendy/Neko suggested holding the 5.0u dose, she did not mean forever. Without posting regularly and without understanding when to raise doses, it makes it more difficult to lend a hand with getting Wendy regulated.

In addition, your vet needs to understand how to treat pancreatitis. It's an incredible painful condition. I can understand his reticence to give you a supply of bupe to have on hand if Wendy isn't symptomatic. It's a human medication and it's a narcotic. However, for humans, it's typically prescribed as a tablet. For our cats, it's most often prescribed as a liquid that is deposited in the cheek pocket or under the tongue so it's quickly absorbed.

Wendy's nadirs are under 300. As such, you increase the dose by 0.25u. I'm going to assume you're following SLGS. That being the case, you hold the dose for no more than a week unless Wendy's numbers drop below 90. If that's the case, you reduce the dose by 0.25u. With SLGS, you do a curve once a week.

Bringing a urine sample to the vet to test for a UTI really is worthless. In order to truly know if your cat has a UTI, your vet needs a sterile urine sample. This is accomplished by inserting a needle into the cat's bladder (a cystocentesis) and the urine is tested to determine if bacteria is present and if so, what bacteria it is (a culture and sensitivity). Collecting a sample at home is pretty much a guarantee that the sample is contaminated.

Costs for medications vary from state to state and pharmacy to pharmacy. Your vet doesn't need to order ondansetron. It's a human medication (Zofran) and is available at any pharmacy either as an injection or tablet. Your vet should know this. It sounds like he's wanting to charge you for his dispensing medication that is readily available at a pharmacy. All you need is a prescription.

 

[Wendy and Eva]

I used ondansetron pills. Orally it’s given 2-3 times a day. I don’t know the dose when injecting. Standing by the water dish is a sign of nausea. Is the bupe oral? What is the dose? How much does she weigh? There were times when Max needed meds for months. If your vet gives you an RX you can get ondansetron at any pharmacy including Costco.

If not eating the normal amount daily fluids is a good idea. How much are you giving?

I have not known cats to urinate outside if tge no. Due to buprenex.

It does look like she needs an increase.

Hello, the vet prescribed 0.6cc once daily by mouth for 5 days. Wendy was weighing 9.6 lbs. during that time. Her weight fluctuates from 11.5 - 9.4 lbs. I attached pictures of the syringes with the amount prescribed as well for you to see. I live in Texas and I know prices vary from state to state, but do you mind me asking how much you paid for the Buprenorphine? I will buy Wendy whatever medicines she needs to make her feel better, but I know that with most vets the prices will vary. I just want to make sure I'm not getting overcharged. :/

She has gained her full appetite and I give her 100ml.

 

[Wendy and Eva]

Sorry to hear that Wendy has been so unwell. It's even harder when vets are uncooperative. I don't suppose you can go to another vet who can prescribe ondansetron and bupe? I don't have any experience with pancreatitis (@tiffmaxee has quite a bit) but I guess you've seen this
A Primer On Pancreatitis ?

From Tanya's CKD website, hovering over or being hunched over the water bowl could be a symptom of Gastric hyperacidity or Dehydration

Is she showing any signs of neuropathy? That could be a reason why she isn't going in the litter box.

I can help you with inputting her labs into her SS. Were Wendy's kidney values checked?

On the dosing front, you are holding doses too long. Even with SLGS, doses are evaluated/increased every week. With TR, you want to increase by 0.5U (dose increases between 5u and 10u are in multiples of 0.5U) every 3 days till you start seeing nadirs below 200.

Hi Bhooma, it's good to hear from you! Wendy is not showing any signs of neuropathy but was clearly showing signs of pancreatitis. I had to ask the vet to please test her for it because she had all they symptoms. I am currently researching for a new vet because this one is good but not with feline diabetes. Her kidney values were checked and all looks well. I appreciate you offering to help inputting the labs into her SS. I'll take up your offer and send you a PM.

 

[Wendy and Eva]

The other explanation for hovering over the water bowl and possibly for urinating outside of the box is that Wendy's numbers are not well regulated. I'm linking the post on dosing methods for Lantus. Chris linked this information when you posted on 10/20. In addition, as others have been pointing out, you are holding doses for too long. This is not a trivial consideration. If you are holding a dose and the BG numbers are not in a good range, glucose toxicity will develop. What this means is that your cat begins to treat the higher range numbers as her new "normal." This makes it more difficult to get the numbers back into a better range. In looking at Wendy's spreadsheet, it's very unclear how you are approaching dosing for Wendy.

When Wendy/Neko suggested holding the 5.0u dose, she did not mean forever. Without posting regularly and without understanding when to raise doses, it makes it more difficult to lend a hand with getting Wendy regulated.

In addition, your vet needs to understand how to treat pancreatitis. It's an incredible painful condition. I can understand his reticence to give you a supply of bupe to have on hand if Wendy isn't symptomatic. It's a human medication and it's a narcotic. However, for humans, it's typically prescribed as a tablet. For our cats, it's most often prescribed as a liquid that is deposited in the cheek pocket or under the tongue so it's quickly absorbed.

Wendy's nadirs are under 300. As such, you increase the dose by 0.25u. I'm going to assume you're following SLGS. That being the case, you hold the dose for no more than a week unless Wendy's numbers drop below 90. If that's the case, you reduce the dose by 0.25u. With SLGS, you do a curve once a week.

Bringing a urine sample to the vet to test for a UTI really is worthless. In order to truly know if your cat has a UTI, your vet needs a sterile urine sample. This is accomplished by inserting a needle into the cat's bladder (a cystocentesis) and the urine is tested to determine if bacteria is present and if so, what bacteria it is (a culture and sensitivity). Collecting a sample at home is pretty much a guarantee that the sample is contaminated.

Costs for medications vary from state to state and pharmacy to pharmacy. Your vet doesn't need to order ondansetron. It's a human medication (Zofran) and is available at any pharmacy either as an injection or tablet. Your vet should know this. It sounds like he's wanting to charge you for his dispensing medication that is readily available at a pharmacy. All you need is a prescription.

Hello, thank you for taking the time to read my post and for your input. You are absolutely right, I should be posting every day with updates and, moving forward, I will be doing so. I value all the experts advise and don't take it lightly. However, now that I'll be more consistent with posting on here, I will make the recommended changes for Wendy to include the dose. I'm also researching to find a better vet to switch to. I will be posting a new thread here shortly with an update on Wendy. Again, thank you for your time and recommendations.