12/18 Squamee AMPS 357

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judy and squamee(GA)

judy and squamee(GA)

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AMPS 357

Took her to the vet early this morning. She spent the night standing over or lying next to her water. She was crying a little this morning. Just before we took her, whatever it was seemed to pass a little, and she started eating. Vet is talking brain tumor, but really doesn't know what this behavior is and if she is in pain when she does it, tho he suggested it might be a headache. What he did find was ketones in her urine and said we had to up the insulin. He recommend 1.5 units. I told him about her swings, and then he said 1 unit. Now I am perplexed---should I shoot 1.2? I am going to be out most of the afternoon. Guess I can't do it---I think I need to be here to check on her. Any thoughts?
 
With ketones present it's time to get our big girl panites on.

I would go with 1.2u if you are going to be home. Are you still giving sub Q fluids?

She did ok on 1 unit with a similar PS.
 
Then go with 1 unit. She did just fine with that on a like bg a few days ago.

Isn't there a test or something they can do to find out if it is a brain tumor? At least you would know for sure.
 
Thank you SOOOO much, Robin. I shot 1U. You are invaluable to me---I am tortured by this situation and it helps immeasurably to not have to be alone with the decisions.
We could do a CAT scan and an MRI but it is very expensive, and the only treatment would be brain surgery. I don't want to put her through all that and the money is out of sight.
 
((((Judy)))) I'm thankful that we don't have to be alone in this too.

I sure understand about the expensive tests, I guess knowing wouldn't change anything anyway.

Scritches to Squamee.
 
We could do a CAT scan and an MRI but it is very expensive, and the only treatment would be brain surgery.
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For what it is worth, probably 95% of the time they don't find anything and when they do, they can't do anything about it. When Cindy starting having grand mal seizures, we were willing to do anything and everything to help her. Therefore we did do the testing (MRI, spinal tap, xRays, etc.). As we further learned as we became more knowledgeable about epilepsy, the testing almost never changes the treatment course and the it rarely finds anything of value.

The only plus out of all that expense for us (and time under anesthesia for her) is that we now believe that that may have been the start of her acromegaly. It hasn't changed anything we've done for her medically and in some ways, it is a bit more frustrating because we wish they'd found the tumor on her pituitary (assuming that is where it is) earlier.

If Squamee keeps up the behavior near the water bowl, it might be worth it to check for UTI or other issues (assuming that wasn't done this go-round).
 
Thanks, Robin. And we are giving her SubQ 2x/wk. We will be giving it today. The good news is that she has not lost weight in the last 12 days (since last at vet) and he said her urine was pretty concentrated, so it seems like the kidneys are not the issue right now.
The problem for me is that nobody really knows or can tell me that she is not suffering when she stands there , not moving, over her water bowl, or then lies down next to it. I was up with her on and off all night last night---I don't think she ever left the bowl, just alternated between lying next to it and standing over it. It was like a spell was broken this morning when she started eating. (and not a lot, but still, eating). If only she could talk!
 
Thanks, Debbie. I don't know if he checked for UTI today, although he did take her urine. I was too distraught to think straight. It is all very unsatisfactory. I see behavior which is clearly pathological, and very stereotyped---she does it over and over, for increasing lengths of time---and it really doesn't get addressed. He focused on the ketones and increasing the insulin. I know that is important, but I don't think it has anything to do with the behaviour which I am finding so stressful.

Also, she is on Flagyl BID---would that address a UTI?
 
Great news about no weight loss and no kidney issues.

I wish she could talk and tell you what is going on.

You could call the vet back and see if he checked for UTI.
 
AMPS 357 1U
+9 241
So now I am going to try to be more aggressive. Thinking about 1.2 or more for tonight.

Came home and she is still standing over the water bowl. ARGGh! When I asked the vet (who is a covering vet and the head of the place, not the one I usually work with---this one I really don't like) if she was suffering, he said no, that she would let me know when she was. I asked how, and he said you will see that she is not a happy camper. And standing all day and night over a water bowl is a happy camper?!
 
(((((Judy))))) Sorry I haven't checked in a while, I am sorry Squamee is having a tough time! Do you have another vet you could talk to? With Bix I have found it SO helpful to have both his specialist & my regular vet to ask questions of. I know I can't always evaluate very well on my own, and really need that reality check factor periodically from someone I trust, and who has a more objective vantage point. Even a family member or friend might be able to observe her and give you a reality check on what her level of suffering (or not) seems to be.

Another thought is to ask the vet for some pain meds like Buprenex (gets drizzled in their mouth, so easier than other meds to administer) that you could try if she has another episode that worries you, and see if that makes a difference. ? If she acts a lot better on that, maybe it would be an indicator that she had been in pain. (? Though who among us *wouldn't* feel better doped up?)

Just brainstorming... hope she feels better soon!
 
AMPS 357 1U
+9 241
PMPS 283 So I am thinking 1.2 because the vet had said 1.5.

Yes,Gator, we are giving fluids 2x/wk. Will be doing it in a few minutes.
 
I looked at your ss and a month ago she was doing pretty well on the 1.1 unit at these numbers so you should be fine with 1.2u.

Gator?
 
I encourage you to increase the times a week - especially when keytones are going on. I think you are doing 100 per session. You could likely do that up to once a day if needed but ramping that up to once every two days might be more realistic.

Also I'm having a hard time with your SS Judy. It's time we work on splitting it up between multiple work sheets. You can either give me access to edit your SS [in which case you will need my google email] and I'll do that or I can show you how to do it if you contact me.

It looks like she was down from PS to PS and even below the 300 mark on 12/18 - so I do not thing increase is necessary.
 
Well---that was interesting! I have been unable to get on this site for about an hour. Reminds me of the old board.
Robin, thanks for the call. I shot 1.2.
Squamee remains bad. In addition to standing over her water bowl, she has been crying some, and after finally being able to drink a little, she vomited---mostly fluid and some foamy stuff.
I tried to give her a little pepcid (the vet said 1/8 of a tablet---not easy!-I used a pill cutter but the pill was crumbling) but she did not eat the food I put it with.
Vet also prescribed an appetite enhancer--cyproheptadine. I pilled her and followed Gator's recommendation of syringing water afterwards. Very messy. Don't know how much she kept down. And she has not eaten.
So I am worried about a hypo -because she has always regulated herself with food and she is not eating.
And I am worried about ketoacidosis --so I can't not give insulin. What an impossible situation.
I have been checking the internet for any info about cats standing over their water bowls without drinking. There are a few references to enteritis. FOr some reason the inflammation of the stomach lining causes them to want water while being unable to drink.
I didn't sleep much last night--I kept checking on her and finding her over the water bowl. I can't imagine I will sleep much tonight, either. And it's rather pointless, because when I find her that way, I can't do anything about it anyway.
 
Gator, I had already shot when I saw your advise to hold the dose.
What does multiple work sheets mean? How do you get from one to the other if you want to look at the whole thing?
 
Gator, when you said not to increase the dose were you taking into account that the vet said she had ketones in her urine and needed more insulin? And thank you for the offer to edit my SS. I can't think of doing anything more myself. How do I do what you said?
 
I need to split my ss too, it's getting too long. I'll split mine and post how to do it for any one else who wants to. You create another tab and you can click back and forth.

Test her before bed, but I think you're probably fine. I would rather deal with low numbers than Ketones. We know how to handle a hypo.
 
You've been all over the map with your dose [for good reason]. 1u for her is actually near the top of her "ceiling" dose. When we talk about putting our big girl panties on I think we're just talking about getting serious about keeping her below 300 - not pushing her into the blues all the time. Also an increase of the SubQ should help too with the keytones. And when she's above 300 then I would think about testing keytones.
 
Rob & Harley said:
I need to split my ss too, it's getting too long. I'll split mine and post how to do it for any one else who wants to. You create another tab and you can click back and forth.
Click to expand...

The best thing to do is to put in one date at the top. Then below that cell write an equation. So if the date were in cell A4 then the formula would be without the quotes "=A4+1" then copy that formula down to the rest of the date cells for 3 months. About three months is the best period to put on one sheet. Thus the dates will auto populate AND you can change the date for different sheets and they auto correct. Not sure why the template does not do this.
 
My vote is to try mirtazapine first. 1/8th tab ever 36 hours instead of 1/4 tab every 3 days. It is such a small amount, there would hardly be chance she would spit it out.

Also you can mortar and pestle ANY pill onto a powder then add a little tad of water. That was the point of my M&P post last weekend. Then such up into a syringe and squirt it in there fast - not all drippy like.

Try 1/4 tab of cypro first before going full blown 1/2 tab. Cypro is nice because it is pretty much gone in 12 hours [and absolutely by 24 hours]. so you can give it more on an as needed than mirt.

But these pills are so small you just have to get it really far back in there then slowly add water into the side of the mouth.

IMHO it is important to start at a LOW dose with these appetite stimulants and work up if you have to.

If you can work this appetite stimulant thing then we can round off these crazy spells of innapetanence.
 
Gator, you said "My vote is to try mirtazapine first." I assume this is prescription? I am not sure how cooperative this vet will be. Why do you prefer this? I will certainly need a reason to tell him
 
Appetite stimulant discussion

Mirtazapine is happy pill, cypro can be tired/grumpy pill. Mirt is Rx. They act different and I actually recommend having BOTH on hand. Some respond to one and not their other. See your PM. One is a human anti-depressant the other is a human antihistamine. Mirt is also thought to have anti-neasuea properties. It's also a bit longer lasting. BUT you have to be careful with Mirt and serotonin syndrome - especially in light of pain or other meds. Appetite stimulants are GREAT but they require a lot of thinking and observation. I absolutely encourage their use but they require a lot of experimentation. And the way to do that is to start at a low dose. No vet will tell you to give 1/8th mirtazipine every 36 hours because it is not in their book. And there are perhaps dosing for mirt that can maybe allow you to give 1/4 to start with then 1/8th every 36 hours after but then wait 3 days for it to totally wear off. In my experience, vets do not think like this. The normal is 1/4 pill every 3 days which is not good in my experience: sends then way too high to start with then way too low at the end. A compounded mirt would allow it to be diluted and allow a more continuous/even dose - I've never had a vet suggest this. Why? Have most ever tried mirt on their cat? Do most vets even know what serotonin syndrome is?

Maybe an appetite site/forum is needed :lol: - so much info to share alone just on that topic that vets do not share or IMHO believe in. I wish I had experience with diazepam in cats. But I will say that diazepam makes me purr that day but be grumpy the next [but it doesn't make me hungry either]. I get worked up obviously about this appetite/weight topic. It's natures way to do away with cats by suffocating their appetite - that's just the way cats act to various problems. Maybe if one can overcome the appetite issue then one can treat the underlying problem.

An awesome scale to weigh most cats at home is like $50 [and one can use it for so many other things like mail, cooking and more]. As you know I'm really big on this too. Not sure why more don't weigh their cat at home. If folks test BG at home and put into SS then why not weigh at home and put into SS? Why do many depend on a rare visit to the vet to determine their cat's weight on a likely abused scale? We talk about using control solution here for glucometers but not calibration weights for scales? Some human diabetics weigh their food and/or calculate how many calories they are in-taking to offset with insulin. Why don't we advocate this with cat owners too?

I don't know... just a little venting maybe. :smile: Part too is my inability to articulate what I believe the importance better.

For cats, appetite and thus weight is such a central issue. And for diabetic cats it's an even more important issue. I wish we had a better understanding/agreement on what to advocate for that. It's obviously a topic I feel close to and thus really sympathize with the swings you are dealing with Judy. In some ways I know how difficult it is to deal with. I just want my magic wand and make Squamee feel better.

Also, on the pill topic, it's possible to grind up many pills, add a tad [drops - or some from a syringe] of water [or other compounded medicine] then suck up and squirt into the mouth - basically doing your own 'ghetto' compounding :mrgreen: . The back of a spoon can work well to grind if you do not have mortar and pestle. Or I used to take the powder of miralax and put into the bottom of a syringe, put in a little water then shake very vigorously to mix then syringe in. Not sure if this is the best method though as it's hard to get the mix going in the syringe that way.

You will need your 3+ readers, a razor and cutting board to cut up the 1/8th mirtazapine and even then it will not be perfect. Just do the best you can. Be very delicate with them once cut up. It's such a small amount. Put into a case that that they will not get knocked around by larger pills or they will lose their dust. What you get is so small that I would be very hopefully you could pill it successfully the old fashioned way + some water in the side of the mouth from a small 1ml or 3ml syringe after. There tends to be a break in the teeth that's perfect for getting the nipple of the syringe in.
 
(((Judy))) (((Squamee))) I'm so sorry you had such a rough day. It breaks my heart to hear what you and Squamee are going through. Give her some love from us cat_pet_icon I sure hope today is a better day.
 
The appetite thing for H was more chronic I think from the cancer [if not in the beginning the certainly as time went on] and then also had acute swings with the pancreatitis. I'm hoping that maybe Squamee's appetite issues are more acute and perhaps related to the CRF issues.

So with the appy stims I would target the downswings first. If she is eating well then no need for the appy stims. Again think about rounding the edges of these swings is what I would try to target. If you can round the corner of these swings then you can also hopefully round the corner of the insulin needs and BG swings too. Make sure to be weighing kitty in some manner - even though vet. Then if cat is still losing weight with just attacking the downswings, then it might need to be increased to more of the time or full time. If you are overdoing the appy stims then it will also kind of become evident in the insulin need too. You'll start having to give more and more insulin to keep up with an appetite that's maybe too much. But "too much" is only really known by watching the weight. And it sounds like maybe at this point she might be able to use some weight she's lost in the past. I'm hoping you'll be good in the beginning by just attacking the downswings.

In the beginning I was able to get away with just 1/4 cypro per day. But that increased. The utility of these things seems to kind of wane over time. So yet another reason to kind of start slow and use only as little as necessary.

Again the cypro is nice because it is kind of more short acting. But the mirt is nice because it's a happy pill and maybe less on-off is some ways. F responds well to mirt, H did not but F does not respond well to cypro.

Don't give cypro and mirt together. As I understand cypro is maybe supposed to the the antidote to mirt serotonin syndrome if it happens. Let the mirt fully wear off [appropriate time - 36 hours if on 1/8th pill or 3 days if on 1/4 pill] before giving cypro. Also I think Colorado State I think had done some recent research on the dosing of mirt if you want to really find out the most about it. I have not read the research other than just glancing at the abstract. But this research might allow better utility from mirt. I also find mirt it takes cats a little getting used to so again important to start low and see how it goes. First time I gave H 1/4 mirt [because I did not know any better he was a purry drooly space cadet. I think maybe into serotonin syndrome territory? Wish I would have avoided that - but it was just part of getting the system to work for him ultimately I guess.

Again this just goes back to my point that it takes a bit of experimenting, close observation and a bit of patience.
 
Gator, thanks for all your efforts and so much typing.
She is not eating at all. Not even approaching food. If I bring it over to her, she won't even smell it. She is in meatloaf position on the couch or by her water bowl. Occasionally she seems able to drink a little water, but mostly she holds her head just above the water line and stays there. Once I saw her drop her face down into the water. I also saw her really pawing at the water --not playful, more like with the kitty litter.(but slowly, as she does everything now)
Vet opens at 10. I will call to ask if I can give insulin when she is not eating at all.I have not yet tested her BG as I want to bother her as little as possible. I will also ask about pain meds.
I have thought about syringe feeding her, but I don't think I can do it. My feeling is that she is shutting down and I should not be trying to drag her back. This is a very painful process and demanding that she do the things that would keep her alive a little longer, when they are talking brain tumor and no real hope of getting better, just seems wrong. Maybe I am being selfish and should try to do more for her, but I don't think I can.
 
When Joanna posted about Bix being very sick I linked an article from Special Needs Pets called How do you know when it's time. It was written about a dog but can apply to any pet. It is very hard to read. At the beginning of the article it made me mad, I cried through the middle of it but at the end it made a lot of sense and made me feel better.

If you can't find that link let me know and I will link it again.
 
Thanks Robin. I read it when you posted to Joanna. I think I will go back and look at it again. It was very helpful---especially the idea that cats are not afraid to die.
 
Oh man Judy. I'm sorry.

The swings are so hard. Not knowing if it's 'just another' that you can pull them through or really something different.

How were the keytones found at the vet [there was a discussion in health about perhaps how the human blood keytone testing might not be the best for cats]? Is she peeing? Have you checked those lately?
 
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