3/10 - Gen, AMBG 92

[Allie & Gen]

Yesterday

So yeah, I skipped his AM shot again. I overslept (I was up with bad insomnia last night, the anxiety coming home to roost I think), he was in the green, and rather than syringe feeding him first thing to shoot I wanted to give him a chance to eat on his own if he would.

So far he's eaten a little more boiled chicken (with great enthusiasm!), ignored the Recovery I put out for him, and eaten a little of a FF pate that I decided to try.

In another hour or so I'm going to try administering the liquid mirtazipine in a capsule, instead of directly into his mouth from the syringe. I don't think he's gotten any of it into his system the last two times when I've tried it that way, and I'm hoping this might give it an actual chance to work.

If need be, I'll syringe feed in time for a PM shot.

He's been acting very much like himself today so far, demanding cuddles and yelling at me for being in the kitchen or on a work zoom meeting. He hasn't pooped since a very small amount yesterday, which is starting to worry me because he did have a fair amount of (mostly syringe-fed) food yesterday and you would think it would need to come out. (Also I suspect he's peeing in the bathtub again.) I've been putting a little Miralax in everything I give him in hopes that it will help. I did see him drinking some water on his own after eating chicken earlier, which was good to see.

And now, another zoom meeting. Sigh!

Back to say some hellos after. I hope everyone's having a lovely Tuesday, with safe surfs for the kitties. It is absolutely gorgeous outside today and I NEED to make sure to take a walk before dark!

 

[Allie & Gen]

@tiffmaxee, to answer your quesiton -

If you look at the spreadsheets of cats in remission that do monthly checks you will see many have bg well under 100. Did you keep track of that for Gen when in remission? We should continue on your new thread instead of here if anything more added so as not to confuse things.

Unfortunately, no. In 2021, I was much less informed in general. My vet did encourage home testing, but Gen had such a dramatically adverse reaction to being poked that my vet finally told me to stop trying, because it was causing more harm than good (I rarely got enough blood to get a reading, Gen and I were both rather traumatized, and stressing out a cat who had recently been in DKA seemed unwise, I think.) We had fairly frequent vet visits, a couple for curves, but I was shooting blind the entire time, and we stopped when my vet told me to stop based on fructosamine results. (I took a quick look at my email, but I'm not sure what those results were exactly. I'm going to dig around in his records a bit.) After that, there was no more routine testing, just an occasional part of regular vet visits. I kept an eye out for the symptoms that had been present the first time around (PU/PD, weight loss, etc).

I'm aware of the data used here, both for OTJ trials and in the spreadsheets of cats in remission. Of course, those are based on the standards accepted here on the board (for what constitutes remission, I mean, and for what values are safe/ideal). I place a lot of trust in this community for the cumulative years of evidence and good outcomes, but I want to review other sources of data as well so I can do a slightly more independent analysis/review and be more confident/directly informed when discussing treatment with vets I respect (like Gen's primary). This isn't actually something I'm looking for help with, to be clear - I'm doing more of a written version of "thinking aloud." I welcome other folks' thoughts and experiences as a matter of interest, but I want to look at the data and research that are the underpinnings of what we practice (and what others may practice, for comparison).

That's a lot of words for "thanks, I know, and also I appreciate your points but what I'm looking for isn't really something you can answer for me on your own." Sorry. And thanks!

And all of the above said, I really am focused on getting Gen eating again before I get into any of it.

 

[Albert & Xander]

Yay for improvement! I hope he keeps feeling better

Definitely make sure to take a moment to get out later for the nice weather

Do you think the vet was referencing alphatrak ranges? I'm not familiar with those measurements but know it is higher than we typically see on human monitors. My vet also showed concern about hypo when I mentioned his nadirs in the 60-80 range. I'm assuming she was referencing pet monitor ranges that she may be more familiar with, but who knows.

 

[Staci & Ivy]

Yesterday

So yeah, I skipped his AM shot again. I overslept (I was up with bad insomnia last night, the anxiety coming home to roost I think), he was in the green, and rather than syringe feeding him first thing to shoot I wanted to give him a chance to eat on his own if he would.

So far he's eaten a little more boiled chicken (with great enthusiasm!), ignored the Recovery I put out for him, and eaten a little of a FF pate that I decided to try.

In another hour or so I'm going to try administering the liquid mirtazipine in a capsule, instead of directly into his mouth from the syringe. I don't think he's gotten any of it into his system the last two times when I've tried it that way, and I'm hoping this might give it an actual chance to work.

If need be, I'll syringe feed in time for a PM shot.

He's been acting very much like himself today so far, demanding cuddles and yelling at me for being in the kitchen or on a work zoom meeting. He hasn't pooped since a very small amount yesterday, which is starting to worry me because he did have a fair amount of (mostly syringe-fed) food yesterday and you would think it would need to come out. (Also I suspect he's peeing in the bathtub again.) I've been putting a little Miralax in everything I give him in hopes that it will help. I did see him drinking some water on his own after eating chicken earlier, which was good to see.

And now, another zoom meeting. Sigh!

Back to say some hellos after. I hope everyone's having a lovely Tuesday, with safe surfs for the kitties. It is absolutely gorgeous outside today and I NEED to make sure to take a walk before dark!

Hi Allie, very happy Gen is eating some on his own, that's great.
I would think since he's not eaten very much of late he may be behind in pooping so try not to get totally freaked, just yet.
It sounds like he's feeling more like himself and that's wonderful to read.
We are sending you both lots of good wishes and support, lots of kisses for Gen!

 

[Jessica & Indy]

So happy that Gen is doing some eating on his own! That is wonderful news! Hope you get a chance to get out in the sunshine it does a body good.

Feel you on the anxiety causing insomnia, feel like daylight savings isn't helping either. Glad your boss let you take meetings from home today. <3 <3

Make sure to take care of yourself too! <3 <3

 

[Allie & Gen]

In other news, I'm having a lot of trouble with the budesonide that I was supposedly going to receive in the mail on Sunday. I called yesterday to follow up and was told that the order was never put through and they would contact the prescribing doctor (someone I've never spoken to, on the Internal Medicine team, who consulted on Gen's case). Supposedly, Wedgewood would then contact me directly. Well, it's been crickets, so I just called again and the person at the hospital pharmacy this time says Gen's file shows that they reached out to the prescribing doctor and never heard back. So now it's Tuesday, and not only do I not have the med, but it hasn't even been ordered. I'm getting really irritated.

(Gen's primary vet confirmed that she would like him to start taking it right away.)

 

[Allie & Gen]

But hey, I was able to pill Gen with the mirtazipine (liquid, which I placed into a capsule)! So here's hoping that helps with his appetite.

 

[Wendy&Neko]

Good job getting the liquid in a pill into Gen! I never tried that one. Glad to hear he is eating some, though on his own terms.

I got budesonide compounded at a local compounding pharmacy that also makes meds for pets. That way I could pick it up when it was ready instead of waiting for shipping. That was a liquid, probably more than fits in a single gel cap.

My thought was the same as Albert's, that the vet was thinking AT ranges. Though I still think that's being too conservative.

As a FYI on non diabetic cat, besides Neko, I've tested 3 other cats. Two were in the 50's, though one hit the 70's when on prednisolone, and the third cat tested at 49! Human meter of course.

 

[Allie & Gen]

Do you think the vet was referencing alphatrak ranges? I'm not familiar with those measurements but know it is higher than we typically see on human monitors. My vet also showed concern about hypo when I mentioned his nadirs in the 60-80 range. I'm assuming she was referencing pet monitor ranges that she may be more familiar with, but who knows.

It's possible? I wish I had a better sense of the difference between AlphaTrak and human meters, but I keep hearing that conversion is impossible, which is so frustrating! I think I talked about human meters wrt the Libre during Gen's intake, but it didn't occur to me to point it out on the phone with the vet.

Good job getting the liquid in a pill into Gen! I never tried that one. Glad to hear he is eating some, though on his own terms.

I was relieved it fit - but it's such a small dose, and the oral syringe they gave me was the perfect size to use to fill the capsule. I can't make them up in advance, of course, because the capsule will start to break down, but it worked well for immediate administration.

I got budesonide compounded at a local compounding pharmacy that also makes meds for pets. That way I could pick it up when it was ready instead of waiting for shipping. That was a liquid, probably more than fits in a single gel cap.

God, I hope Gen will take the budesonide better than he did the mirtazapine. I wasn't even thinking about that, but it's definitely a liquid, and the dosage he wants me to use is 4mg, which definitely won't fit in a gel cap.

As a FYI on non diabetic cat, besides Neko, I've tested 3 other cats. Two were in the 50's, though one hit the 70's when on prednisolone, and the third cat tested at 49! Human meter of course.

Thanks, that's a helpful datapoint.

 

[Allie & Gen]

So I think the mirtazapine has kicked in, BUT Gen must still be feeling super nauseous. :/ He was crying to be let out of my room (the door was closed because I had a telehealth therapy appointment), ran right over to his food dishes, and sniffed each one multiple times before turning away. (I set three different types of food out a little earlier in hopes that one would be acceptable.) It seemed like he really wanted to eat.

I've given him his evening ondansetron/gabapentin/cerenia dose, which I hope will help, and I guess I'll be syringe feeding him in twenty minutes or so, so I can shoot. Damn.