12/29 Smokey AMPS 295 +2 276 +4 248 dosecrease PMPS 276

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Melanie and Smokey

Melanie and Smokey

Member Since 2010
Blues definitely make her bounce :YMSIGH:

She's seemed a bit off the last couple days. Sleepy, no energy, not eating much, looks depressed. Hoping she's just feeling off because mom and dad are both sick and will snap out of it soon. We stopped her Ursodiol last week, hoping its not that.
 
Re: 12/29 Smokey AMPS 295 +2 276 +4 248

Hi Melanie and Smokey,
Hope Smokey feels better soon! Hard when they are off without alot of energy and depressed. Hoping the evening goes better for you both! My Munchie had been a big bouncer with lower numbers as well.
 
Re: 12/29 Smokey AMPS 295 +2 276 +4 248

poor smokey. i was looking at his ss and he sure has come out of remission. i didn't look at the earlier ss numbers, but was he as high as 4units when he was previously on insulin? i'm just wondering why he's not responding better, if he has some kind of infection or ?

what was the ursodiol for?

are you looking for ideas/advice or not?
 
Re: 12/29 Smokey AMPS 295 +2 276 +4 248 dosecrease tonite

I'd love any ideas/advice/shots-in-the-dark julie&punkin (and anyone else that might want to through in their 2cents). I expected to see a gradual climb out of remission, not this bounce up high and stick.

The first time around she was pretty much in remission before we found the site and started testing. We went up to 3U at that time and rarely saw anything but green.

Between then and now...
*Caught calicivirus and got pretty sick from it in Nov 2010.
*Diagnosed with pancreatitis and liver disease, suspect maybe triaditis, but no signs of IBD. Actually no signs of the pancreatitis or liver disease at first either other than some excess weight loss. We found crazy lypase numbers in a routine bloodwork and ran the P specific and did ultrasounds. Her liver is "bright" on ultrasound and biopsy came back showing liver disease (at work so I can't look up specifics) and the P specific showed definite pancreatitis. The ultrasound also showed a small node in her pancreas, but the biospy came back as non-cancerous.
*We adopted a total of 3 other cats in the last 14 months. The last one started as a foster and was her mortal enemy for the first month. The shelter wanted him on SD light and she got into it a couple of times, but always seemed to come back down from it fairly quickly.

The ursodiol was for the liver disease. She was on flagyl (meant for the pancreatitis) and ursodiol, but she hated the flagyl so we stopped that and the ursodiol has been keeping her lypase numbers and her pancreatitis numbers within spitting distance of normal. We have stopped the ursodiol for a month because it seems like that may be what is causing the puking.
 
Re: 12/29 Smokey AMPS 295 +2 276 +4 248

i don't know much about those issues, but perhaps between us we can figure out what's going on. hang in there.
 
We were about 4 months past the diagnosis of the pancreatitis and liver disease and at a point of having it under control so it seems odd that those would be our problem. Though they are taxing the two organs we need to be functioning well for diabetes to be controlled.

Vet did talk about going back to some more in-depth testing if we just don't make any progress. I hate to ultrasound again and shave the poor girl's belly during winter though :( But approaching 5U is unsettling.
 
Hey, Melanie. I'm sorry you and DH are under the weather.

Are you testing Smokey for ketones? Any time I hear someone describe lethargy, I want a ketone test. So could you please get one if you're not already doing so. I've never heard of Flagyl being used to treat pancreatits. One of the board members just came back from a conference on pancreatitis and noted that Flagyl (metronidazole) is no longer being recommended for cats since it seems to be related to lymphoma. Rather, Tylosin is the antibiotic of choice.

Also, lipase assay is not a particularly meaningful test in cats. There are a lot of false positives. I wouldn't encourage you to over interpret those results.

The following may also be helpful if there is still a problem with pancreatitis:
~SQ fluids
~ pain meds
~ anti-nausea meds (hey look pepcid falls in this category, but ondansatron or Cerenia may be better choices for nausea/vomiting vs. acid stomach)
~ antioxidants (vitamin E ~water-dispersible form preferred and vitamin C ~non-acidic Ester-C form preferred)
~ liver support (milk thistle, denosyl, or marin)
~ vit b-12 injections(especially if bowel involved)
~ +/- pancreatic digestive enzymes (to 'predigest' food, however some controversy in vet med on whether or not to use these)
~ +/- antibiotics if indicated
~ +/- steroids if needed
~ +/- appetite stimulants if needed (and if liver not involved, some of these are contraindicated with liver issues)

The puking may be related to pain or pancreatitis. You could try Pepsid or either of the two drugs noted above. Pepsid will help to control stomach acid vs. the other two which are specifically for vomiting.

Could you let me know the specifics of the liver disease. I can do some research, if you'd like.
 
I have urine strips, but haven't tested her much. I will try to catch her in the litter box a few times to get some ketone readings.

Yeah, the lypase only told us something was wrong. We went on to the ultra sound and sent out for the pancreatitis specific test (can't remember the name). We repeat that test along with the in-house lypase periodically.
The in-house lypase was over 6000 when it should have been under 1400 (?) so even though it doesn't really tell us much as to what is wrong, it definitely said something was wrong. Since the liver specific blood work has always been fine, the only sign of issues was the weird ultrasound, we watch the in-house lypase as a guide on the liver.

The flagyl was meant to go after the bacteria throughout that whole...<sick head can't think of the word>...system. The way the ultrasound doc discussed it, the live, pancreas, intestines all are a closed system and the bacteria getting into the pancreas is getting into the liver too and the flagyl is one of the antibiotics that can go after the bacteria in that system. I did read the article by the other board member. I saw a couple of problems with it. Most of the other antibiotics were contra-indicated for cats with liver disease. The other weird thing was that at the end of the study, the conclusion was contrary to the title of the article. It concluded that there was no findings against flagyl in cats. It was kind of weird. Haven't had a chance to go through it completely.

Either way, we quit the flagyl about the time we started insulin. She hid under the bed from us constantly while on it so we decided if it ruined her quality of life it wasn't worth it. The ursodiol alone has seemed to do ok. The in-house lypase and the pancreas specific numbers have been run at least once, I think twice since we stopped the flagyl and were just a touch above normal.

We tried Denamarin (?) - a blue pill with sam-e, milk thistle,... for liver support. She's not pilled easy and with the other meds and this one needing to be given without food for 1hr before or after, again we opted for quality of life.

I've discussed the anti-nausea meds with the vet. She wants to try the no food for 48hrs first. Not going there. I noticed the pattern of the puking happening in the morning around the AM Ursodiol, so we stopped that. Not seeing much for puking anymore.

Until these last 2 days she certainly didn't need an appy stimulant. She'd be at the food dishes constantly. I was wondering if it was one of the reasons we can't get her numbers under control, but with her looking so skinny I hesitate to limit food.

I will look for the biopsy results for the liver for some of the specifics. It talked a lot about possibilities and maybes. Mentioned hepatitis, but not sure were my cat all of a sudden caught hepatitis. The ultrasound doc sounded a little stumped. He couldn't word it any other way than "it looks really bright".

Other than the BGs and the slightly elevated lypase, her blood work is all good. I've asked about antibiotics since the numbers won't come down, but since nothing in the blood work indicate an infection, she doesn't want to do antibiotics since we don't know what antibiotics we'd use if we don't know what we are going after.
 
It sounds like the vet was trying to address anerobic bacteria that's in the gastrointestinal track -- that's what Flagyl is for. Just as an FYI, I don't know if you've ever taken Flagyl. It can really put you off food. It's not so much that you get nauseated from it -- it's more like it just feels so much better to not eat.

I wonder if you were to feed a small snack at around +9 if that would help with some of the stomach stuff. Or consider Pepsid -- which if Smokey is hard to pill may not be easy or consider a bit of food. If she is producing stomach acid, a little bit of food frequently may help. The fact that she's hungry or wanting to eat frequently may be a clue to what is helping her. Cats are smart. She may have figured out what makes her feel better.

Just as an FYI, you can get most meds compounded into liquids or transdermal forms. You need to be specific about not wanting meds in sugar syrup. Also, have you tried the allergy formula Pill Pockets? They don't contain corn syrup so are fine for a diabetic cat.
 
You also want to raise the insulin a little faster than we normally would with a newly diagnosed kitty.

Here's some info from Jill when Binks came back from the Falls:

"Cats that have a tendency to get ketones and/or who are getting relatively high flat curves after the switch should have their dose raised earlier (after 24-48 hours)." http://www.tillydiabetes.net/en_6_protocol2.htm (under "Starting dose")

when kitties return from the falls, you want to be as aggressive as safely possible. you're an experienced caregiver.
don't let any pink grass grow under binks' paws:

"However, if the cat is producing continuously high BGs (nadir always >=300 mg/dl), only hold the dose for 2-3 days before increasing it by 0.5 IU. Alternatively, if the cat is continuously producing moderately elevated BGs (nadir always >=200 mg/dl), increase the dose every 2-3 days by 0.25 IU ( if the cat is getting a low dose) or 0.5 IU (if the cat is getting a higher dose)." http://www.tillydiabetes.net/en_6_protocol2.htm (under "Increasing the dose")
Click to expand...
 
hi melanie. you're already getting excellent advice. i'd just like to add a couple of other comments...

ursodiol: alex has been on ursodiol for about a year and nine months. i tried taking her off of it several times (vet's suggestion) and BG numbers would go up and she obviously didn't feel well. i'd put her back on it and numbers would come down and she'd feel better. it was strange because for all practical purposes, she shouldn't need ursodiol anymore. we then decided to try to wean her off gradually. to make a long story short, she gets ursodiol every other day and has for quite some time now. my vet thinks she may be on it the rest of her life and i tend to agree with him. it's just weird because you should be able to just stop giving ursodiol when kitty seems better.

we have it compounded into a chicken flavored suspension so there's no problem with pilling.

There is a possibility that chronic use of ursodeoxycholic acid in cats may deplete the body of the essential amino acid taurine, thus necessitating dietary supplementation with this amino acid. http://www.marvistavet.com/html/body_ursodiol.html

Because of the above, Alex gets 1/8 teaspoon taurine powder mixed in food twice a day.

denamarin: as you noted, denamarin should be given on an empty stomach at least one hour before a meal. this supplement is great and it's a shame not to be able to give it to support the liver. luckily, Alex is easy to pill, but there have been many others who are not so lucky. there's been some discussion (can't remember if it was on this board or the old one) about how much efficacy would be lost if the pill was slightly crushed and placed in a piece of pill pocket or cheese. someone called the company and was told to expect only about a 30% loss in efficacy if it was slightly crushed. prevailing wisdom at the time was a loss of 30% was nothing compared to the benefit of giving the pill.

dosing: don't be afraid to be aggressive in dosing. over the last several years i have noticed that whenever a kitty comes back from the Falls they always end up exceeding the maximum dose they were given the last time they were on insulin.

this has held true with Alex also. this is her third time on insulin and each time i've had to take her dose up higher than the previous time. one thing i've noticed with Alex... she feels lousy when her numbers are in the 100s and 200s. she's visibly better in "normal" numbers... which is why i continue to practice tight regulation even though i doubt she'll ever go OTJ again.


ECID, but i'm just throwing this out there. food for thought is all...
 
Sienne and Gabby said:
I wonder if you were to feed a small snack at around +9 if that would help with some of the stomach stuff. Or consider Pepsid -- which if Smokey is hard to pill may not be easy or consider a bit of food. If she is producing stomach acid, a little bit of food frequently may help. The fact that she's hungry or wanting to eat frequently may be a clue to what is helping her. Cats are smart. She may have figured out what makes her feel better.
Click to expand...
feeding frequently does help! i don't have to do it so much with Alex anymore, but i did at one time. i even throw out the "no feeding" 2 hours pre-insulin injection when she's not feeling well. you just have to know you *could* be shooting a food spike... and deal with it.
 
punkin gets pill pockets twice a day for the chinese herbs that i'm giving him for his acro. when he had a dental last march he ended up needing antibiotics for 40ish days. i wrapped them in the allergy-free duck and pea pill pockets, the least possible to cover them. for 18 days i pushed them down his throat, and on day 18 he woke up, decided he liked them and grabbed them out of my hand. ever since then, i throw them on the floor and he gobbles them down like they are the best thing he's ever tasted.

just a thought in case you can entice smokey with those. i threw down "decoy" pill pockets first without any pills in them so he'd get used to them. one pill pocket can divide and cover 2 pills for us. i wouldn't use more than needed, just because a whole pill pocket is pretty good sized.
 
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