3/8 Tawny Assist Feeding +12/73 NO SHOT BGs posted P'titis

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DD & Tinkerbell

DD & Tinkerbell

Member Since 2009
Tawny spent the day at the vet. This is what her discharge pprs read, in part: Dx: Cholangitis, possible; Dx: Pancreatitis, possible. The vet verbally told me she thinks it's pancreatitis.

Tawny has not been acting like herself the last couple days and last night when I got home after work she would not eat. I assist fed her a little by finger, and again this morning also when she wouldn't eat. I loaded her up into her carrier and dropped her off at the vet's on my way to work.

She is still not eating & when I asked the vet if she wanted me to syringe assist feed her if I couldn't get her to eat she said yes. So I heated some chicken broth and put some LC chicken cat food in the smoothie maker w/it and pulverized it all and have been giving her about 10 mls of that every couple of hours. I alternate that w/finger feeding her but honestly the syringe feeding is easier if it will give her the nutrition she needs.

She had a low grade fever earlier the vet said but I think it's come down some, I haven't taken her temp but she doesn't feel as hot. The vet also said to raise her dose a full unit and test her often, even w/her not eating if I watch her close it shouldn't be a problem. I compromised & bumped her up to 6u from just under 5.5u. She wants me to get her regulated but I have never been able to get Tawny regulated, she has always been all over the place no matter what I do it seems.

From the pprs the vet sent home w/me, today at the vet's she got: Cerenia, Vitamin B12, 1 famotidine injection, .5 SubQ fluids, & her temp was 103.8 which is what the vet called "a low grade fever". WT 12.25 lbs, normal teeth, pale pink gums, and the vet said she has a small bladder.

She did a urinalysis & there is no sign of bladder infection, and THANK GOD, NO KETONES. That of course was my 1st thot considering Tawny's history, so pancreatitis never even occurred to me. Tawny's BGs have been high since yesterday: 6am 330, 7am 268, 10:30 (at vet's) 329 and tonite 271. Tawny usually runs no higher than 220, and sometimes, like just the other day when she threw me an 89, dips down into the greens. Her other chemistries showed normal values.

Cbc showed elevated white blood cell count: 25,000 as opposed to normal of 5500-19,500. There is a notation here that reads "with elevated neutrophils = 21,000 (normal is 2500-12,500) neutrophila can be due to inflammation, as well as infection". I have no idea what all that means.

Rx: Cerenia 16mg once a day; Pepsid 5-10mg once a day & mirtazipine 1/4 tab of a 15mg tab every 12 to 24 hours.

& so it goes...

Input? Advice? Guidance?

Desi
 
Re: 3/7 Tawny - Pancreatitis

((( Desi)))

I'm so sorry Tawny isn't well. This Primer on Pancreatitis might help you.

Looks like your vet thought of alot of things but Tawny also needs something for pain like buprenorphine, the mirtazapine might make her agitated. It's better to address nausea with ondansetron before giving any appetite stimulant.

Sending many prayers..
 
Re: 3/7 Tawny - Pancreatitis

Marje and Gracie said:
Looks like your vet thought of alot of things but Tawny also needs something for pain like buprenorphine, the mirtazapine might make her agitated. It's better to address nausea with ondansetron before giving any appetite stimulant.
Click to expand...

The vet didn't say anything about pain & I didn't think to ask. The only thing I have around here for pain is Tramadol that was rx'd for one of the dogs. I do have some ondansatron. Tawny isn't vomiting. I guess I figured the pepcid was for nausea so didn't think about giving her ondansatron either.

The vet is open in the morning, I can call her about pain meds then & drive over to get them if she thinks it's ok. Any other advice?
 
Re: 3/7 Tawny - Pancreatitis

Sorry to read about the probable pancreatitis. Did your vet run an fPL to confirm it? You were given cerenia for nausea which works for many cats but if not ondansetron works better for some. My Max has had chronic panc for over 4 years. He doesn't need pain meds always but when he does he gets buprenex. Some cats need fluids but Max doesn't. I hope it leaves quickly. Elise
 
Re: 3/7 Tawny - Pancreatitis

Hi Desi,

What brand and flavor of food do you most often feed Tawny?

How many times a week or in a day, do you feed her a fish flavored food?

What is the size, shape, and color of Tawny's poop right now?
 
Re: 3/7 Tawny - Pancreatitis

Rx: Cerenia 16mg once a day; Pepsid 5-10mg once a day & mirtazipine 1/4 tab of a 15mg tab every 12 to 24 hours.
Click to expand...
I'm just comparing the doses I give, and yours sound a lot higher.
Cerenia 16mg/4 "Give a 1/4 Tablet by mouth once a day (every 24 hours)"
Pepsid 10mg - I give 1/4 tablet once or twice a day as needed for stomach acid
Mirtazapine 15mg "Give 1/4 Tablet every three days"
Ondansetron 4mg "1/4 TABLET TWICE DAILY"
I just typed exactly what my bottles of pills say.

The Pepsid is for stomach acid, and the Ondansetron is for nausea. Nausea doesn't necessarily lead to vomiting. One sign of nausea is acting hungry and taking a bite or two and then walking away, or sniffing or approaching the food and then licking their lips, or walking away.

When I think J.D. has a flare up, I always give him Ondansetron with Cyproheptadine (cypro is another appetite stimulant that you can try). He also gets buprenex through the worst of it. I haven't had to give J.D. fluids for pancreatitis but some cats need it.

I would check her temperature from time to time at home. I mean you wouldn't want to find out that it has gone a lot higher.

Sending feeling better soon vines to Tawny.
 
Re: 3/7 Tawny - Pancreatitis

I didn't realize the cerenia was for nausea, she didn't need any more meds yesterday after she came home except for her insulin b/c she'd had everything else at the vet's, so I hadn't checked on that one yet other than coming here, now I know. The other stuff I was already familiar with from when she was so sick a couple years back. I have some ondansetron here too I could be giving her but I guess I'll keep on with the cerenia b/c that's what the vet started her on yesterday, unless someone here knows of a reason I shouldn't.

Dyana, on the mirtazapine I was kind of surprised that she wrote "Mirtazapine 15mg 1/4 tablet every 12 to 24 hours" since my previous experience w/this one is as it's been Rx'd for J.D. which was how it was Rx'd for Tawny b4. I will give her another today, she hasn't had one since Thursday and she still hasn't eaten, and see how she does, but I am hesitant to give her one every 12-24 hrs as Rx'd, I won't go every 12 hrs for sure, I might go every 24 for 2-3 days until I can get her to eat on her own. Now that I look at her dosages again compared to what J.D. gets it does seem quite high, doesn't it?

Tina, Tawny typically eats a store brand LC mixed grill pate or Friskies any of the LC pates. She does not like any of the fish flavored so that's not an issue. She hasn't pooped for a couple days now b/c she hasn't eaten but her last one was solid and normal brown.

Elise, I don't think the vet ran an fPL, everything she did I posted according to Tawny's discharge pprs. I can't even remember what an fPL is.

This morning she still won't eat, I am off to check her BG and assist feed her.


Desi
 
Re: 3/7 Tawny - Pancreatitis

Hi Desi,
I am sorry to hear that Tawny is not feeling well. Rusty has had 2 mild flare-ups of pancreatitis over the past 3 years and we mainly made sure that he ate (and fed him foods that we knew he liked, even though they were a little higher in carbs; we raised his insulin dose accordingly). Marje's primer on pancreatitis (she posted the link above) is excellent. I found the IDEXX Pancreatitis Round Table discussion (one of the links for further reading in Marje's primer) to be particularly informative. Would it be possible for your vet to run the Spec fPl test? Tawny would need to fast for 6 to 8 hours before having blood drawn for this test, and the blood sample has to be sent to the IDEXX labs. In several days your vet will get the results and they will tell you Tawny's exact score. That way you will know where she is on the scale of mild to severe and will be able to take appropriate steps. There is also a "snap fPl" test that your vet can run in house if she has the IDEXX equipment. This will tell you whether or not Tawny has pancreatitis, but will not tell you what her score is. I think it is good to have the regular Spec fPl so that you will have a baseline score to compare with future flare-ups.

Sending lots of healing vines to your girl,

Hugs, scritches,

Ella & Rusty
 
Re: 3/7 Tawny - Pancreatitis

When I got the cerenia out to give Tawny just now it reads "FOR DOGS ONLY". This concerns me as I have no experience w/this med. I called the vet's office & was told that if that is what the vet rx'd & if she put her label on the box (she did) it was safe to give Tawny. I am still concerned & would appreciate any input before giving Tawny this.

I also asked about any pain meds & they are supposed to call me back. ~ Desi

Updated to add: I googled this and it appears to be safe, any thoughts?
 
Re: 3/7 Tawny - Pancreatitis

Cerenia was first approved for dogs. It has been used for cats for well over 5 years and is safe. So far the injectable is approved for cat use. Those of us in the lymphoma list and pancreatitis yahoo lists use it all the time. It is mentioned in the IDEXX Round Table discussion that Ella suggested you read as well as the use of ondansetron which is the drug I use more often for Max. I have also used cerenia fir him and Tiffany when she was vomiting.

Elise
 
Re: 3/7 Tawny - Pancreatitis

My box says for dogs only, too.
If I remember right the Cerenia has some anti inflamatory properties in the gut area and also helps a little with pain. Originally I believe it was supposed to be given for 5 days on and 2 days off. I think care givers would give Ondansetron on the days that the Cerenia wasn't given. I don't know the medical reasons why the instructions to take 2 days per week off the Cerenia.

I think the Snap test sometimes gives false test results and only returns a result of yes or no like a pregnancy test. I took J.D. to the vet techs once after fasting all night for a blood test to do the Spec fPL and came home and read on my receipt that said they did the Snap test and was furious (and stressed out because of J.D.) with the vet techs. I called and they had enough blood left to send out for the Spec fPL which gives a number result like the regular blood tests from IDEXX give. Besides they tried to charge me $120 for the Snap test they did in house (which I refused to pay) and the sent out Spec fPL test was only $82. You do have to wait about 4 days for the results with the Spec fPL.

Sending eating vines to Tawny.
 
Re: 3/7 Tawny - Pancreatitis

I would not give the mirtazapine more often then every three days regardless of how the vet prescribed it. You can give cyproheptadine daily.

I think it is more common to use the ondansetron for nausea and the cerenia for vomiting.

You can use tramadol for pain if she tolerates it. My cats hate it and it makes Gracie hyper.
 
Re: 3/7 Tawny - Pancreatitis

I prefer cypro too. Cerenia is supposed to help with inflammation and pain too but I find it better for vomiting than nausea. Some people use both cerenia and ondansetron when having a really bad attack.
 
Re: 3/7 Tawny - Pancreatitis

Tawny is not vomiting. I told the vet this yesterday. She never even mentioned ondansetron, just the cerenia.

I called the vet's this a.m. & asked about s/thg for pain, "like bupe?" Just about noon (closing time) she called me back. Here's what I have to say about that: "If I wanted to be treated like crap I would have stayed married the first time." (That's the same thing I say about where I work incidentally & this is why I rarely take any of my furbabies to the vet btw.) After she tells me she researched it and it would be OK to give Tawny tramadol (1/4 of a 50 mg tab every 12 hrs or so) & told me it will either make her hyper or "spaced out" she proceeded to give me an unsolicited lecture that went s/thg like this "well, just how much are you going to put her thru? we are dealing with a diabetic cat here. she has pancreatitis. she's diabetic. diabetes is an uncurable disease..." and on and on it went about the diabetes, and how much cats with diabetes suffer. Well I didn't pay her a ton of money yesterday for a lecture, I paid her to help my cat. I am so mad I could spit nails. I am so sick of this backwoods lack-of-mentality around here I could scream. I am so sick of flooding and loss and death and disintegrating sheetrock and sinking kitchen cabinets (Hurricane Isaac) and law suits (Hurricane Isaac) and being scared every time it rains that it will all flood yet again that I could scream even louder. I am so ready to bail out of here I can't see straight. The closest decent vet is about 50 miles away down in Mandeville where Tawny was b4. & when I called them yesterday to get her in there, they said I had to take her to "her regular vet" 1st for a referral (she doesn't really have a "regular vet" b/c the only 2 vets close by are the one described above & the other one we stopped going to many yrs ago for the same reason). So there we go.

All this ranting just b/c of a vet's attitude. I'm done now. Thanks for putting up w/it. (& now you know why I rarely post any more, I'd probably always be ranting.)

Time to assist feed Tawny some more and ck her #s.

Desi
 
Re: 3/7 Tawny - Pancreatitis

{{hugs}}

... because it looked like you could use a few.
 
Re: 3/7 Tawny - Pancreatitis

Hi Desi - hugs to you. I can so relate.... so could Barb. heard the same rant from her many a time on veterinary service there. I am sorry. I have read all written here, agree with it all. Mannie had a few bouts of p'titis too. For us, it was bupe for pain, B12 injections, fuds (whatever he would eat), and cerenia, we did mirtz (every three days) until he felt better . we did not need fluids. They wanted him on an AB too, we started that, but that made him nauseous, so we stopped, as there really was no indication that a bacterial infection was the cause for his P'itis. I think you are doing great - In a few days Tawny should feel better. Paws crossed.
 
Re: 3/7 Tawny - Pancreatitis

Here are Tawny's BGs:

yesterday:
1 hr b4 amps: 330
amps 268 - ~5.25-5.5u
+3 (at vet's) 329
pmps 271 - 6u per vet (who told me to go up a full unit even tho Tawny wasn't eating)
+3 281
she had not eaten other than maybe 1/4 can LC Friskies via finger feeding & syringe feeding (mixed w/chicken broth)

Today:
amps 278 - 6u
+2.5 - 191 cerenia given 16mg
+7.25 - got home from errands (Tawny supplies) BG 93 gave 5 mg Pepcid
+7.5 - began finger & syringe assist feeding
+8 - 85 continued assist feeding
+9 - 75 continued assist feeding, gave 10ml HC gravy

I know 75 is usually a "safe" # and does not warrant HC, however if I have to put her in the car & drive her the 50 miles to the ER I need a head start on the #s coming up. She is sleeping near me now, I think that hour & a half of feeding wore her out. It's not that she ate that much, only that it took that long. I fed her slowly, mostly off my finger, she kept everything down, but she has not vomited at all regardless. I probably got between 1/2 & 3/4's of a 5oz can of Friskies into her during that time. I have not given her the Tramadol b/c again, if we have to go to the ER...

Time to check her #s again.

Edited to Add:
+9.5 - 79
 
Re: 3/8 Tawny Assist Feeding +9 - 75 BGs posted P'titis

(((((((Desi))))))))) I wish I could come over and sit with you on your back porch and talk cats with you.

I took J.D. to a very expensive IM vet to talk about BP and got a 1 and 3/4 hours lecture on diabetes while I just nodded my head. I feel the same way about doctors.

You can rant all you want here. Eventually, you'll feel better ;-) We are your family and we are here to listen, girl.
 
Re: 3/8 Tawny Assist Feeding +9 - 75 BGs posted P'titis

Dyana said:
(((((((Desi))))))))) I wish I could come over and sit with you on your back porch and talk cats with you.
Click to expand...
Me, too, Dyana.

Dyana said:
...I feel the same way about doctors.
Click to expand...
Me, too, Dyana.

Dyana said:
You can rant all you want here. Eventually, you'll feel better ;-)
Click to expand...
That rant plus all the hugs from here have helped already. Spending the afternoon sitting on the bed surfing the internet from my laptop for properties for sale on the FL Gulf Coast while alternating between finger/syringe feeding Tawny & checking her #s hasn't hurt either. You know what they say about fight or flight after all. There's not much fight left, that's for sure.
 
Re: 3/8 Tawny Assist Feeding +9 - 75 BGs posted P'titis

(((Desi)))

The really good news is that there are no ketones. I remember what that was like for you and Tawny and let's not go there again. Please!

I wish I was with you at the vet's office. I'm not a whole lot of fun for medical personnel when I'm pissed off because I can speak their language. Personally, I'm more than ready to pull the, "So, if this diabetic were your child, would this be your attitude?" card. I'd be gleefully asking if your vet ever had pancreatitis or knew of anyone who did. I but that person would describe the pain associated with pancreatitis as "unbearable." So if your vet is suggesting the unthinkable, would she make the same suggestion for a diabetic child with pancreatitis? Likewise, if she was in pain from pancreatitis, should she not get an appropriate pain med? The last time an MD pulled an attitude with me, my sister described him as turning from bright red to sheet white by the time I was done reaming him out. (I train residents so I don't take a lot of crap from physicians.)

What can we do to help?

FWIW, while some of the approach to treating pancreatitis has changed, Jojo's standby was Pepsid. (It's no longer accessible, but she had a post on the old board about cat's with pancreatitis having a "Pepsid deficiency.") The biggest issue may be trying to determine if it's nausea or abdominal discomfort/pain or both that's causing Tawny to not want to eat.
 
Re: 3/8 Tawny Assist Feeding +9 - 75 BGs posted P'titis

Sienne and Gabby said:
(((Desi)))

The really good news is that there are no ketones. I remember what that was like for you and Tawny and let's not go there again. Please!
Click to expand...
You got that right! Not going there again. Not. Got Ketostix today in town, not that she's peed any. I've been syringing water into her too. The very 1st thing I said to the tech when I dropped Tawny at the vet's was "she's probably got ketones, make sure you check her for ketones." When the vet called me yesterday at work I said "has she got ketones?" and she said "no." The paperwork also indicates no ketones, tho I can't tell if it was from her blood or her urine, I think urine b/c it's under the urinalysis section & the Cbc info is under that. that is so stupid, the vet took blood, why she didn't check her blood for ketones is beyond me. I'll go back to town tomorrow and get those strips for the blood ketone meter I still have. But you see what I mean about this backward mentality around here? Geeeezzzzz... & of course I'm so trusting I just assumed she checked her blood ketone level and since I can't get a word in edgewise when she's lecturing me I didn't get a chance to ask specifically...DUH!

Sienne and Gabby said:
I wish I was with you at the vet's office. I'm not a whole lot of fun for medical personnel when I'm pissed off because I can speak their language. Personally, I'm more than ready to pull the, "So, if this diabetic were your child, would this be your attitude?" card...
Click to expand...

You don't know how much I wish you had been too! That is always exactly what I want to ask them, "If it was your child, your grandmother, your loved one..." but I can never stand up to them--I don't have the courage--b/c I don't have any credentials they would respect, so I am therefore a moron, one of the "sheep" to be blindly led by their superior knowledge. Just a lowly country girl who works an 8-5 job and doesn't deserve any respect, just another "dumb sheep" to be assigned a # in their accounting book.

Sienne and Gabby said:
What can we do to help?
Click to expand...
Letting me rant helps, helping me help Tawny helps. It goes w/out saying that all this support helps. Thanks.

Here's Tawny's latest #s & obviously she will get no shot tonight, not the best decision I know but what choice do I have? (That's a plea for input & advice, please.) She still won't eat, I've been assist feeding her since 3pm, I can't stay up w/her all night, much as I'd like to I know my limitations & at some point I know I will fall asleep no matter how hard I try not to.

yesterday:
1 hr b4 amps: 330
amps 268 - ~5.25-5.5u
+3 (at vet's) 329
pmps 271 - 6u per vet (who told me to go up a full unit even tho Tawny wasn't eating)
+3 281
she had not eaten other than maybe 1/4 can LC Friskies via finger feeding & syringe feeding (mixed w/chicken broth)

Today:
amps 278 - 6u
+2.5 - 191 cerenia given 16mg
+7.25 - got home from errands (Tawny supplies) BG 93 gave 5 mg Pepcid
+7.5 - began finger & syringe assist feeding
+8 - 85 continued assist feeding
+9 - 75 continued assist feeding, gave 10ml HC gravy
+9.5 - 79
+10.25 - 66 more HC, about 15ml syringed
+10.75 68
+11.25 67

Desi

PS I tried to make a new SS for 2014 to start w/these #s but I can't remember how to do it! Good God, maybe I really am a moron. But I'll keep working on it. The weird thing is I have Tinkerbell's. I vaguely remember having a lot of trouble w/them & them crashing all the time, which is why I finally just gave up on them, maybe Tawny's is just gone. I'll see if I can build her a new one off Tink's old one.

an hour or so later, EDITED TO ADD: SS up to date, that means the last 3 days, in part.
 
Re: 3/8 Tawny Assist Feeding +12/73 NO SHOT BGs posted P'tit

hi Desi - i'm so sorry tawny isn't feeling well and you're having to deal with "that" vet. it'd make anybody crazy. i think we should rent Sienne out to advocate for our sugar cats! :lol:

i think you're doing an awesome job of taking care of your little girl. the only things i can add is i also wouldn't give mirtz more than every 3 days. we gave punkin cerenia several times and the dose was always 1/4 of the 16mg tablet. so if you gave the whole 16mg today, i think i'd skip giving it tomorrow. i'm not sure what the side effects could be of too much.

rant away! we're with ya! :YMHUG:
 
CHOLANGITIS: Bile Duct Infection and Inflammation

Hi Desi,

CHOLANGITIS: Cbc showed elevated white blood cell count: 25,000 as opposed to normal of 5500-19,500. There is a notation here that reads "with elevated neutrophils = 21,000 (normal is 2500-12,500) neutrophila can be due to inflammation, as well as infection". I have no idea what all that means.
Click to expand...

This sounds like a possible bile duct infection with bile duct inflammation, to me, with Tawny's elevated white blood cell count.

I would ask the vet if you could give Tawny a broad spectrum antibiotic that targets this specific type infection.

The two diseases, bile duct infection and pancreatitis, can be concurrent.
 
Re: 3/8 Tawny Assist Feeding +12/73 NO SHOT BGs posted P'tit

Ummmm......

Desi -- don't you work for an attorney? Not that I'm saying you should threaten legal action, but dropping that you're in the legal field may get the vet's attention. Vets have to deal with malpractice issues along with negligence, etc. If you've ever had to read the licensing laws for any profession, it can be a real eye opener as to what the expectations are for a professional to be licensed in any given state. And then, of course, there are professional ethics which can be a little different but can get someone censured by their professional group. All of these things can make attorneys very happy -- especially if you have a friend or employer who would like nothing more than to go after someone that's treated you badly.
 
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