4/10-12/11 - Harley Introduction, ER Vet Visit & Home

[Laura and Harley (GA)]

Just wanted to say hi and let you all know we are so glad to be here at last, for awhile I wasn't sure we would. We switched from ProZinc tonight with Harley's PM shot and I'll try to get some spot checks in to see how he's doing. His starting dose is 0.5u.

The short story so far...Harley was Dx'd in February 2009 and we were on Vetsulin until July 2009 at 1u bid. Fortunately I'd switched him to low-cab wet Fancy Feast classics, but unfortunately I had not found this site and was not home testing so I was dependent on my vet to tell me now he was doing. When we went OTJ Harley was very well regulated according to his fructosamine tests (perhaps TOO well regulated as those don't take into consideration close hypo calls). He was Re-Dx'd in January of this year and we started ProZinc at 1u bid. I shot blindly for about a month until I found FDMB and got my Newbie kit thanks to Lori & Tom. (((God Bless you both!) My first test was a PMPS at 89. Needless to say I skipped the shot and called my vet to tell her 1u was WAY too high. From there we were happily micro-dosing for about a month, even shotting TID, trying to see if Harley could go OTJ. But Harley developed pancreatitis and for the last 4 weeks or so that has been our number one health priority. His spec-fPL at Dx on 3/16/11 was 20 and right after a real bad flare last week it was up to 40. He's showing signs of feeling better but is not out of the woods yet. He's still on prednisolone 2.5 mg bid, Anzemet 0.12 ml sid, 100cc SubQ fluids sid, and buprenex prn as needed for pain.

My vet and I consider the switch to Levemir as also part of the treatment for healing his pancreas because while on ProZinc he would drop hard and fast +2-4 and mostly be on the way back up by +6-7. As a result, he would demand food as though he were experiencing a hypo event and eat frantically in an effort to raise his BGs which we believe may possibly have put too much stress on the pancreas.

Just so everyone knows, I've changed his food from uber low-cabs to some of the higher cab, lower fat foods from Janet & Binkys charts. I view the pancreatitis as his number one health condition and the diabetes secondary. I'd love to see him as well regulated as he was on ProZinc but if that is not to be, I at least want him to be as pain-free as possible. As anyone who has ever dealt with acute or chronic pancreatitis attacks knows, it can be agonizing.

Thank you to everyone who contributed to the clear, concise, well organized stickies and newbie information. I read and re-read it and think my head understands what it is we're trying to accomplish with Lev. I may need you all to cover my itchy trigger finger with a mitten though.

Purrs and scritches!

 

[Marcy & Klinger (GA)]

Re: Hi everyone - Newbies Harley and Laura are in the house

Welcome to Lev, Laura and Harley! :smile:

 

[Vicky & Gandalf (GA) & Murrlin]

Re: Hi everyone - Newbies Harley and Laura are in the house

Hi Laura and welcome!

I do know the agony of pancreatitis, for both cat and mom. You are doing the right things. What is the Anzemet for? I am not familiar with that med.

The main thing to remember with Lev is to try not to react to higher preshots with raising the dose. Nadir is more important with Levemir.

Thank you for the wonderful notes in his spreadsheet. I hope you see some results with the .5U of Lev. That's probably the safest dose for him at this point.

Has he had an ultrasound? He's been sick for quite a while. Have you heard of triaditis? Pamela knows a lot more about that than I do, but essentially it involves the pancreas, liver & biliary duct-work and IBD of the small intestines. Here's an article: http://www.justforcatsvet.com/site/view ... theCat.pml

I would also like to take this opportunity to ask if you've considered a raw diet? While I cannot claim it cured Gandalf's pancreatitis, I definitely saw a vast improvement for him in only a few days after starting him on the Feline's Pride variety, which recently acquired a distributor in the Chicago area. Or it's available via mail order. http://www.Felinespride.com

So, we're here to help with the Levemir and give you as much information as possible to help Harley. I hope the Levemir works for him and is the start of good things!

 

[Sheila & Beau GA & Jeddie GA]

Re: Hi everyone - Newbies Harley and Laura are in the house

Welcome Laura and Harley! You are "just up the road a piece" from me (Roger's Park).

Poor Mr. Harley has sure been through a lot. I agree that the p-titis is you #1 priority. While no one "likes" to have a diabetic cat, the diabetes is sure easy to manage and work around other issues. I really hope that the lev can make a big difference for him by getting his BG down into normal ranges for a longer period of time and a more gentle ride.

Lev sure helped my Beau, who has had his share of p-titis episodes. He was started on vetsulin too and, while regulated, he still had p-titis episodes now and then, with one really bad one when we were all out of town one summer. He completely stopped eating on me so I was syringe feeding for a few days. I really think that lev made all the difference to him because he went OTJ after just 3 months (he was on vetsulin 2+ years), but he has not had a flareup since the switch either (knockwood/antijinx).

Do you ever use Pepcid AC? That seemed to help Beau a lot. I gave it to him 20-30 mins before a meal along with some Greek yogurt.I would check with your vet though since I don't know how it might interact with Harley's other meds. How is Harley's appetite when he has a flare-up?

 

[pamela and tigger]

Re: Hi everyone - Newbies Harley and Laura are in the house

Hi, from another Illinoisan! I live in north central Illinois in a small town outside of Rockford.

I love that you have a profile set up, but it was very sad reading about poor Harley's past. He is very lucky to have found you for his forever mama.

I hope you love levemir as much as we do and that Harley responds well.

 

[kse]

Re: Hi everyone - Newbies Harley and Laura are in the house

Just dropping by to check on you and Harley. Good luck on Lev!

Looks like you are getting a warm welcome!

 

[Kelly & Oscar]

Re: Hi everyone - Newbies Harley and Laura are in the house

welcome to the levemir group! Glad to see you guys over here :YMHUG:

 

[Laura and Harley (GA)]

Update 4/10/11 - Harley at ER Vet

Thank you so much to everyone for all your warm welcome, good wishes! We feel right at home already! I will try to respond to your posts and questions but I just can't do it right now. I hope you will understand.

Sadly, I do not have god news tonight. I had to admit Harley to Vet Specialty Center in Buffalo Grove where he will be receiving a plasma transfusion tonight and an ultrasound tomorrow morning followed by an internal medicine consult. When I've been doing his ear pricks the last 2 days I've been noticing the blood was a little brighter red and especially today he's bled more than usual and the blood takes longer to clot. I was going to ask my vet about that yesterday but forgot in the excitement of changing insulins. ohmygod_smile

The nice ER vet took his full history, examined him, and said from the outside he appeared to be doing very well. He was alert, pink and not pale, not jaundiced, and appeared well hydrated. His abdomen was still a bit sensitive to the touch. But she ran the CBC and clotting tests just to make me happy and sure enough, his PT was 17 which was normal but his PTT was so high it could not be read on their machine. It was over 400 in a reference range of 7-120. Apparently PTT is produced by the liver and could be an indicator of liver damage or disease. The CBC also showed that his blood was tightly packed indicating dehydration despite my daily 100cc fluid treatments and his drinking water.

So the game plan changed immediately to admission, transfusion, IV fluids, ICU monitoring and an ultrasound tomorrow morning. Somehow deep in my heart I suspected that all was not well despite the fact that he was eating again. As a precaution, I took his Lev, 4 cans of cat food, 2 stinky tee shirts and his chicken treats with me just in case I had to leave him.

I beg you all to please keep Harley in your thoughts and prayers tonight. I only hope it is not too late.

Love and purrs to all.

 

[kse]

Re: 4/10/11 - Harley at ER Vet

Saying prayers as I type.

 

[Vicky & Gandalf (GA) & Murrlin]

Re: 4/10/11 - Harley at ER Vet

Oh honey, I am sorry Harley is ailing so badly. I have to applaud you for quick action on taking him in for emergency care!! Seriously, that is amazing how you noticed the clotting and bright redness of his blood. I can't tell you how proud I am of you as a pet parent!

I would be highly suspicious of triaditis at this point since it sounds like his liver is involved. I'm glad they are doing the ultrasound. That may show something definitive. I don't think it's "too late" by any means. Cats are amazing creatures and can bounce back from the worst illnesses much better than people.

Gosh, Harley is one lucky little man! Will be thinking of you and Harley tomorrow. I can't get online again until tomorrow night, so hopefully you will have some answers by then and can let us know.

:YMHUG:

 

[Sheila & Beau GA & Jeddie GA]

Re: 4/10/11 - Harley at ER Vet

Oh no! Sending healing prayers to Harley.

(((Laura)))

 

[Joanna & Bix (GA)]

Re: 4/10/11 - Harley at ER Vet

Oh no! Not another rough patch, you guys need a break!!! I'm really impressed you realized something was wrong and got him to the ER. Hopefully they can figure things out and get him in a good place quickly.

Sending good thoughts and prayers :YMHUG: :YMHUG: :YMHUG:

 

[pamela and tigger]

Re: 4/10/11 - Harley at ER Vet

Poor Harley, I hope they find out what is wrong. He has been through so much and seems like such a trooper for all that he has been through.

Sending prayers for your little guy.

 

[Marcy & Klinger (GA)]

Re: 4/10/11 - Harley at ER Vet

Sending purrs and prayers for Harley. I'll keep you in my thoughts. (((Laura)))) You are indeed a great momma bean!!!

 

[Laura and Harley (GA)]

4/11/11 - Update on Harley at ER Vet

Hi everyone, thank you so much for all the healing vibes and kitty prayers coming Harley's way. We so appreciate you!

Harley had his plasma transfusion overnight and that went well. The tech. taking care of him said he didn't want to eat but he was kind of feisty which is a good sign. I'm not surprised because he usually does not want to eat when I'm not with him. (When I've gone out of town on business trips, my BF tells me his appetite always plummeted.)

I got a call from the internist this AM and I was pissed to find out they hadn't given him his Lev because "you didn't leave us the needles for the FlexPen and this pen only dials in whole units anyway so how do you give his dose?" I'd told the admitting ER doctor that I use U100 syringes w/half unit marks and to draw like from a vial. She said no problem, they have those syringes in stock so I didn't need to leave any with them. Apparently the message did not get relayed. So they asked permission to give him R instead because his BG was 449 on their in house machine. I said OK, I just want him to get through this and get home where I can take care of him. Then she said "well I'm going to talk to your vet about why he's on Levemir because normally we use Lantus." I said flat out that he's on Levemir because I did the research and I don't want him on Lantus, I wanted Levemir for him.

Things get even better :roll:, the ultrasound showed - nothing! That's really good news, pancreas normal, liver normal, intestines normal, spleen a little enlarged but not sure if that's significant or if perhaps it's normal for him. But now this internist is saying we don't really know what he has and why is he inappetant. grr_red I told her the only things that have gotten him to eat for me are the Anzemet (dolasetron) and buprenex injections. Appetite stimulants made him gag, froth, foam and vomit. They also created a food aversion to chicken which in turn took him off most of the food that he usually eats and Pepcid (which I used to crush up and wrap inside a spoonful of baby food.) Pepcid didn't do much for him anyway when I did get it into him.

Regarding the high PTT clotting time, they are going to check to see if it's a Factor XII disorder which could indicate it's a hereditary condition - Hageman's disease. To determine that, they'd need to send blood off to Cornell University for a deffinitive test. And even if that's the case it's nothing they'd treat him for. She didn't seem to think the clotting problem was significant. I'm sorry but I said to her that to me it was very significant because I've been poking his ears for 3 months now and I definitely saw a change in his blood and the way it clots. I used to have to warm his ears, now I have to do is poke and he bleeds like crazy. Too much in fact. It's like water. So I think she's full of $%^&. I didn't say it, but I did think it. And she wasn't listening to me anyway. Does she not know or care that the start of clotting disorders can also be a complication of acute necrotizing pancreatitis and the start of DIC? DIC She poo-poo'd the two spec-FPL tests saying that they don't go by those, they treat more based on visual examination. Well just because it didn't show up on a u/s doesn't mean he can't still have pancreatitis as a complication of perhaps IBD/triaditis.

So I OK'd them rechecking his PTT to see if it had improved and doing the B12 cobalmin-folate tests looking for deficiency to see if he might have IBD.

She said the next steps would be to consider endoscopy or exploratory surgery. She was pushing exploratory surgery because all the organs could be seen and we'd know for sure what is wrong. I said I'd think about it but meanwhile I want to see him tonight and we'll discuss me taking him home. My head's all in a muddle and I need to sort things out. I really don't want to put him through surgery both for his sake and also for financial reasons. Endoscopy maybe, but not surgery.

Sorry if I'm venting but I'm really annoyed with this doctor and her 'tude. I don't care if she isn't nice, warm and cuddly with me so long as she is a brilliant diagnostician and great with the animals. Maybe I'm being overly judgemental and not giving her a fair shake because I'm so overwrought right now but I wonder if she knows what the heck she's doing.

 

[pamela and tigger]

Re: 4/10/11 - Harley at ER Vet

Laura, I am so sorry you and Harley are going through this.

I did a little research (which you seem to be doing a lot of too!) on the Anzemet (dolasetron) and it appears one of the side-effects is increased PTT:

Hematologic: Rarely-hematuria, epistaxis, prothrombin time prolonged, PTT increased, anemia, purpura/hematoma, thrombocytopenia.

Just thought I would throw this out there if you hadn't run across it already.

Sending many prayers your way for your Harley.

 

[Sheila & Beau GA & Jeddie GA]

Re: 4/10/11 - Harley at ER Vet

Still sending healing prayers his way.

Good that they didn't find anything on the US. Can I ask what ER you took him too? And what internist you talked to today? It isn't Animal 911 is it (on Dempster in Evanston, so a bit of a drive for you)? During the day they have a couple of specialist vets there, one of which is very good. She dx Beau's pancreatitis back in 2002 with US, the old p-titis test, and xrays and blood work (both from my reg vet). Her name is Dr. Yohn. I was very impressed with her.

You may be cranky and overwhelmed, but there is nothing more frustrating that "We don't know what's wrong" and/or "we don't do that here..." (whatever "that" is).

The info that Pamela posted is interesting. Maybe it was that med that is causing the clotting issues?

Just reading about an enlarged spleen. One of the symptoms is "easy bleeding" - wonder if that means decreased clotting? Maybe a connection there? If he has triaditis involving the liver, I think that could cause an enlarged spleen (not sure, just guessing based on anatomy).

 

[Laura and Harley (GA)]

Re: 4/10/11 - Harley at ER Vet

Wow, Pamela - THANK YOU! I didn't know that increased PTT time was a potential side effect of the Anzemet. I'd read about risks associated with heart conditions and increased Q-T or S-T time, but no clotting disorders. I may need to tuck my tail between my legs here.

Boy, that sure changes things and not for the better. Now I don't know what to do about his nausea. He could not tolerate the oral odansetron (chicken flavored compounded) because it was so bitter. He frothed, foamed and vomited it up. I can't pill him, and my vet doesn't want to use Cerenia anymore because it's not supposed to be used more than 5 days in a row (we only used it once).

Sheila, Harley's at Vet Specialty Services in Buffalo Grove. The internist is Dr. V.

 

[pamela and tigger]

Re: 4/10/11 - Harley at ER Vet

Wow, Pamela - THANK YOU! I didn't know that increased PTT time was a potential side effect of the Anzemet. I'd read about risks associated with heart conditions and increased Q-T or S-T time, but no clotting disorders. I may need to tuck my tail between my legs here.

Boy, that sure changes things and not for the better. Now I don't know what to do about his nausea. He could not tolerate the oral odansetron (chicken flavored compounded) because it was so bitter. He frothed, foamed and vomited it up. I can't pill him, and my vet doesn't want to use Cerenia anymore because it's not supposed to be used more than 5 days in a row (we only used it once).

Sheila, Harley's at Vet Specialty Services in Buffalo Grove. The internist is Dr. V.

I can understand your problem with the nausea. Have you tried Slippery Elm Bark? Tanya suggests using this on her CRF site for nausea.

Also, when Tigger had pancreatitis and later triaditis he would eat grass to settle his stomach. He still does on occasion - either oat or wheat grass which he finds outside.

Here is an interesting link:

http://www.pawsonline.info/grasseating.htm

"We have all seen cats eat grass...but why do they do it? Listed below are some suggestions that have been put forward over the years:

*Cats use grass as a laxative to enable them to pass hairballs lodged in their intestines.
*Cats eat grass to make them vomit up hairballs.
*Cats eat grass because they are feeling sick and this makes them vomit, getting rid of poisons.
*Cats eat grass to relieve inflammation of their throats.
*Cats eat grass to relieve stomach ache.
*Cats eat grass to add roughage to their diets.

In his book, "Cat World" Desmond Morris points out that it is the juices of the grass that cats are interested in. It is known that these juices contain folic acid, a vitamin that is vital to cats as it helps in the production of haemoglobin. For a cat to be deficient in folic acid would stunt its growth and may cause anaemia."

I know you have your hands full now, but it is easy to make your own:

http://www.weirdstuffwemake.com/sweetwatergems/cats/catgrass.html

One other thing, when Tigger was feeling badly still with his triaditis dx, we tried Ursodiol (Actigall). It is compounded into any flavor (I just mixed it into his food-he didn't even know). He starting feeling and eating better within a couple of days. Not sure if that would help your Harley or not.

I hope you find some answers for him soon. Poor guy.

ETA I saw on one of your earlier posts that you had ordered some Feline's Pride. How did that go over?

 

[Vicky & Gandalf (GA) & Murrlin]

Re: 4/10/11 - Harley at ER Vet

Laura,

This is why I wanted Pamela on board here. She has an amazing talent to find the best info online! Her computer must have more bookmarks than gigabytes!

I took her advice about raw food when Gandalf was so sick in '09 and I'm very glad I did. I only mention that because the slippery elm bark and the Ursodiol are possible options because IMO if Pamela suggests them, there must be something important to them.

Also, I have had very good experiences with Gandalf at the University of IL vet school in Champaign. I know it's a 3 hour drive with an ill cat but I don't know if the U of IL at Chicago has a veterinary section up there or not. I know they would get to the bottom of his illness and not give you the brush off or question your use of Levemir. I was using it 3 years ago when I first presented him there and they gave me suggestions on using it as they have done research on Levemir's use in cats, probably the only vet school in the US to do so.

I have some suggestions about pilling. I syringe feed blended raw food. If he would eat that, you can pop the pill then chase it with the syringed food.

Has anyone shown you how to pill a difficult cat? http://video.about.com/vetmedicine/Give-a-Cat-a-Pill.htm

This next video is closer to how my vet showed me, but she said to tilt the head back so the nose is pointing at the ceiling. Their jaw should drop open or is easier to open with your middle finger like they show in this video. http://partnersah.vet.cornell.edu/node/309

This video has a good suggestion I would never have thought of - http://partnersah.vet.cornell.edu/Cat-Pilling/Help/No-Help

Sometimes we think we can't do something with our cats simply because we haven't found a method that works for us AND our cat. Hope this gives you some ideas.

Link update - geez, I don't know what's up with the board, but it's taken me 4 times to get these to work. The problem is the board puts ellipses in the address if it's a certain length and seems to forget what the ellipse replace. If you edit your message after posting the link once, it puts in the ellipses and then it doesn't work. I bracketed them with "url" so they should work.

 

[Vicky & Gandalf (GA) & Murrlin]

Re: 4/10/11 - Harley at ER Vet

Here's a video with a Gandalf half grown look-a-like and the method my vet showed me!

http://www.5min.com/Video/How-to-Give-Your-Cat-a-Pill-124694023

I have to say though, I don't pill Gandalf like this. Only Tigget, who is much more difficult. I can get Gandalf to open his mouth with just my fingers in his jaws. His head is too big for me to use that method anyway!

Link update - this one worked fine for me, updated 4/12 8:30 PM

Yeah and now it doesn't work because I edited the post!!! Fixed it.

 

[Laura and Harley (GA)]

Re: 4/10/11 - Harley at ER Vet

I just wanted to post a quick update that Harley is home and his PTT is back to normal (73 in a reference range of 70-120). I did not give the Anzemt tonight just in case that's the culprit. I'l try to find out more info. on this tomorrow.

I gave his Lev. at 8 pm - 2 hours past normal (a funny story there) and will try to back it off 15 min. at a time until I can get it back on schedule. Just like DST.

Vicky, Pamela and Sheila - thank you for all your expertise and the great information! I admit I haven't been able to read it all tonight but will try to tomorrow and of course finally answer all your questions. Promise!

Harley is beckening for us to go to bed. I think he's right. Thank you everyone again, 'night

Laura

 

[Peggy and Mickey (GA)]

Re: 4/10/11 - Harley at ER Vet

Hello and Welcome,
We are newish here just wanted to say hi.

 

[Sheila & Beau GA & Jeddie GA]

Re: 4/10/11 - Harley at ER Vet

UIUC (University of Illinois at Chicago) does have a vet school - a big one - on the west campus where the medical school is, but I would not know who to recommend to try and see there. Maybe Vicky's doc in Campaign could recommend someone if you are interested?

So glad to hear that his PTT is back to normal. Get some sleep.

(((Laura and Harley)))

 

[Vicky & Gandalf (GA) & Murrlin]

Re: 4/10/11 - Harley at ER Vet

Laura, I'm told a couple of the links I gave for videos don't work. I don't have time to fix this AM.

Sheila, thank you for letting me know there is a Chicago vet school!

If you decide to go to the U of I, you don't need to ask for anyone. Being a school they have to consult with other staff/teachers so several people are involved. The senior vets sign off on treatment plans. This is probably one of the reasons they work so well - it's not one vet alone. And some tests like Ultrasound are cheaper.

 

[kse]

Re: 4/10/11 - Harley at ER Vet

Hi Laura--Glad Harley is home. I came over to get an update on him.

Wishing you and Harley the best!

Kim and Kitty

 

[Sheila & Beau GA & Jeddie GA]

Re: 4/10/11 - Harley at ER Vet

Laura, there are a few linking issue with the links that Vicky provided. She is at work now so can't fix them, but she will tonight when she gets home.

I am interested in the cat grass possibilities (posted by Pamela). I wonder if indoor cats are missing folic acid, or some other nutrient or digestive benefit in grass. For instance, the throwing up factor may be the body's way of ridding itself of bacteria BEFORE it effects the pancreas and causes p-tits. Beau's vet suggested that Beau had "simmering" p-titis for a while and I asked how he got it. He was a feral that I trapped and brought home (long story). She said he may have eaten something with bacteria in it and it caused inflammation he just couldn't shake.

Anyway, I am going to plant some cat grass this year in a window box or some other planter. I was thinking about regular grass, but that oat grass looks like a better bet in terms of them eating it.

 

[pamela and tigger]

Re: 4/10/11 - Harley at ER Vet

Laura, there are a few linking issue with the links that Vicky provided. She is at work now so can't fix them, but she will tonight when she gets home.

I am interested in the cat grass possibilities (posted by Pamela). I wonder if indoor cats are missing folic acid, or some other nutrient or digestive benefit in grass. For instance, the throwing up factor may be the body's way of ridding itself of bacteria BEFORE it effects the pancreas and causes p-tits. Beau's vet suggested that Beau had "simmering" p-titis for a while and I asked how he got it. He was a feral that I trapped and brought home (long story). She said he may have eaten something with bacteria in it and it caused inflammation he just couldn't shake.

Anyway, I am going to plant some cat grass this year in a window box or some other planter. I was thinking about regular grass, but that oat grass looks like a better bet in terms of them eating it.

Good idea Sheila. Let us know how they like it. It doesn't take that long to grow. I love that web page of all the kitties laying on and eating the grass. It makes me smile every time I look at it. There are so many similar cat grass web pages out there too.

Laura, I hope Harley is doing much better today.

 

[Laura and Harley (GA)]

Re: Hi everyone - Newbies Harley and Laura are in the house

Hi everyone, Harley seems to be holdling his own today and is snoozing after his evening medication routine. The only meds. he got tonight were the pred. Lev. and SubQ fluids. He's eaten pretty well today so there's no need for the Anzemet or the bupe (cross paws antijinx to the max!)

He's snoozing in my laundry basket right now so finally I can properly acknowledge everyone's friendly welcomes and respond to your posts.

Hi Laura and welcome!

I do know the agony of pancreatitis, for both cat and mom. You are doing the right things. What is the Anzemet for? I am not familiar with that med.

This may already have been answered but Anzemet (dolasetron) is an anti-nausea drug in the same family as Zofram (odasetron) and we've been using it as an injectible. Harley had 5 doses before I rushed him to the ER.

The main thing to remember with Lev is to try not to react to higher preshots with raising the dose. Nadir is more important with Levemir.

Then we're definitely in the right place with the right insulin! I could never admit it before, but when shooting PZI I based all my doses on both pre-shots and nadir but given Harley's tendency to dive hard and fast, I took the nadir into account far more than the pre-shot numbers. I'm actually not a big fan of dose hopping so holding a dose might not be as big an issue for me with this switch than for others.

Thank you for the wonderful notes in his spreadsheet. I hope you see some results with the .5U of Lev. That's probably the safest dose for him at this point.

I had to do a bit of convincing with my vet for her to let us switch. We came to an agreement on 1) the starting dose would be 0.5u, 2) we'd hold the starting dose for a week with me doing spot checks to make sure he's not going too low and then I'd curve him and 3) dose changes would be made by both of us together. She's never had a cat on Lev before and she's had 3 cats on Lantus. 2 were OK but the 3rd dropped like a stone once the shed filled so she's being really cautious with us. I like that cause Harley's starting dose on both Vetsulin and ProZinc was too high but I didn't know it at the time.

Has he had an ultrasound? He's been sick for quite a while. Have you heard of triaditis? Pamela knows a lot more about that than I do, but essentially it involves the pancreas, liver & biliary duct-work and IBD of the small intestines. Here's an article: http://www.justforcatsvet.com/site/view ... theCat.pml

Guess this has already been answered by the events of the past 2 days. Thanks for the great article, I hadn't seen this one before.

I would also like to take this opportunity to ask if you've considered a raw diet? While I cannot claim it cured Gandalf's pancreatitis, I definitely saw a vast improvement for him in only a few days after starting him on the Feline's Pride variety, which recently acquired a distributor in the Chicago area. Or it's available via mail order. http://www.Felinespride.com

I actually ordered some Feline's Pride Cornish Hen earlier in the week Harley got sick. It arrived after our first vet visit for constipation and I gave him some on a spoon which he promptly ate. I then mixed about a spoonful or two in his food which he also ate. The next meal he wouldn't touch it at all. So I didn't push the issue. 3 days later we received hte pancreatitis Dx. Fast forward about a week and a half and I'm trying to get Harley to eat his food as best I can and again I offered some newly thawed FP. He ate a spoonful and also some mixed into his food but then stopped eating it. Two days after that he had the really bad flare that sent us back to the vet. I don't know if it was the food, did I get a bad batch, does he have IBD, or maybe it means sothing and the timing was just a coincidence. I haven't dared to repeat the experiment. (BTW my civvie Princess who normally eats anything and everything won't touch the raw food.) I did read a post from a member who said that raw food actually made their cat's IBD worse.

So, we're here to help with the Levemir and give you as much information as possible to help Harley. I hope the Levemir works for him and is the start of good things!

Thank you in advance for all the help! Despite the fact it's only been a couple of days, I'm already liking what I'm seeing with his reaction to Lev. Sure the numbers are higher than I'd like, but it's showing the more gentle action and duration that I'd hoped for. I don't even have to test him to know the Lev. really starts to work in him around +3 because that's when he's asking for food even if the movement is negligible. On PZI he was begging for food between +1.5-2 and the numbers were dropping faster. Yeah Lev!

 

[Laura and Harley (GA)]

Re: Hi everyone - Newbies Harley and Laura are in the house

Welcome Laura and Harley! You are "just up the road a piece" from me (Roger's Park).

Poor Mr. Harley has sure been through a lot. I agree that the p-titis is you #1 priority. While no one "likes" to have a diabetic cat, the diabetes is sure easy to manage and work around other issues. I really hope that the lev can make a big difference for him by getting his BG down into normal ranges for a longer period of time and a more gentle ride.

Howdy neighbor! Isn't it amazing how "easy" the diabetes can be when compared to more challenging diseases our kitties get? I never thought I'd think diabetes was "easy" until now.

Lev sure helped my Beau, who has had his share of p-titis episodes. He was started on vetsulin too and, while regulated, he still had p-titis episodes now and then, with one really bad one when we were all out of town one summer. He completely stopped eating on me so I was syringe feeding for a few days. I really think that lev made all the difference to him because he went OTJ after just 3 months (he was on vetsulin 2+ years), but he has not had a flareup since the switch either (knockwood/antijinx).

I'm so glad to hear that lev helped your Beau with his pancreatitis attacks! Paws and tails crossed for you that this continues.

Harley's first attack was bad enough that he only drank water and licked gravy off of food, his second one was so bad he wouldn't eat or drink anything. I can relate to the syringe feeding because I was trying that with Harley, kitty burrito and all, and I still got some big time cuts and scratches from him. The only way to get food into him safely is to try and make him want to eat on his own. Hence I got creative, I even fed him Wellness Core dry food to get him to eat something.

Do you ever use Pepcid AC? That seemed to help Beau a lot. I gave it to him 20-30 mins before a meal along with some Greek yogurt.I would check with your vet though since I don't know how it might interact with Harley's other meds. How is Harley's appetite when he has a flare-up?

I read about Pepcid after his first attack and started crushing up 2.5 mg and wrapping that in a spoonful of Gerber Baby Chicken which Harley would eat . But after his second attack, he wouldn't touch it. My vet had me try chicken flavored cyproheptadine which Harley vomited up - and that created a food aversion to anything chicken. So 90% of what I'd been able to get him to eat up until then was out of the question. The bigger problem was really the nausea. It seems to be subsiding now, but a week ago today I was at my wits end trying to get him to eat anything until we got the Anzemet.

I see your kitty Beau and I have to smile because my nickname for my guy is really Beau! He came to me as a rescue kitty already named Harley. It was a good name and he recognized it I didn't change it. But I also call him Beau because it means "handsome in French.

 

[Laura and Harley (GA)]

Re: Hi everyone - Newbies Harley and Laura are in the house

Hi, from another Illinoisan! I live in north central Illinois in a small town outside of Rockford.

I love that you have a profile set up, but it was very sad reading about poor Harley's past. He is very lucky to have found you for his forever mama.

I hope you love levemir as much as we do and that Harley responds well.

Hi Pamela and Tigger, Thanks for the warm welcome and especially for the information on the Anzemet! You are a lifesaver, literally.

I'm already loving Lev. and Harley is too :mrgreen:

 

[Laura and Harley (GA)]

Re: 4/10/11 - Harley at ER Vet

Still sending healing prayers his way.

Good that they didn't find anything on the US. Can I ask what ER you took him too? And what internist you talked to today? It isn't Animal 911 is it (on Dempster in Evanston, so a bit of a drive for you)? During the day they have a couple of specialist vets there, one of which is very good. She dx Beau's pancreatitis back in 2002 with US, the old p-titis test, and xrays and blood work (both from my reg vet). Her name is Dr. Yohn. I was very impressed with her.

SO far Harley's been to Vet Specialty in Buffalo Grove and Animal Emergency in Northbrook. We haven't been to Animal 911 yet. All of the ER vets are a hike from Des Plaines.

I might look up Dr. Yohn to see if she's still there. Perhaps I could bring Harley's records and consult with her to see what she thinks.

You may be cranky and overwhelmed, but there is nothing more frustrating that "We don't know what's wrong" and/or "we don't do that here..." (whatever "that" is).

You are so sweet, but really I think I was a bit out of line posting what I did yesterday. I still don't care for that vet but I should have calmed down first before posting. At the end of my replies, I'll tell the story of meeting her last night...

 

[Laura and Harley (GA)]

Re: 4/10/11 - Harley at ER Vet

I can understand your problem with the nausea. Have you tried Slippery Elm Bark? Tanya suggests using this on her CRF site for nausea.

Also, when Tigger had pancreatitis and later triaditis he would eat grass to settle his stomach. He still does on occasion - either oat or wheat grass which he finds outside.

Here is an interesting link:

http://www.pawsonline.info/grasseating.htm

"We have all seen cats eat grass...but why do they do it? Listed below are some suggestions that have been put forward over the years:

*Cats use grass as a laxative to enable them to pass hairballs lodged in their intestines.
*Cats eat grass to make them vomit up hairballs.
*Cats eat grass because they are feeling sick and this makes them vomit, getting rid of poisons.
*Cats eat grass to relieve inflammation of their throats.
*Cats eat grass to relieve stomach ache.
*Cats eat grass to add roughage to their diets.

In his book, "Cat World" Desmond Morris points out that it is the juices of the grass that cats are interested in. It is known that these juices contain folic acid, a vitamin that is vital to cats as it helps in the production of haemoglobin. For a cat to be deficient in folic acid would stunt its growth and may cause anaemia."

I know you have your hands full now, but it is easy to make your own:

http://www.weirdstuffwemake.com/sweetwatergems/cats/catgrass.html

One other thing, when Tigger was feeling badly still with his triaditis dx, we tried Ursodiol (Actigall). It is compounded into any flavor (I just mixed it into his food-he didn't even know). He starting feeling and eating better within a couple of days. Not sure if that would help your Harley or not.

I hope you find some answers for him soon. Poor guy.

Thanks for reminding me about Slippery Elm Bark, I'd read about it but hadn't found any yet. Most of my waking hours have been caring for Harley. I even sent the BF out to do all the shopping so I could stay with him during the hours when I wasn't at work. Can it be given daily or is it something this is only used during flareups?

Thanks for sharing the cat grass tips with us! I have an extra litter box the purrfect size to grow grass in. Those pictures of the kitties in teh boxes are so cute!

ETA I saw on one of your earlier posts that you had ordered some Feline's Pride. How did that go over?

Answered above, the experiment was kind of inconclusive. It was a bad time to try it with so much else going on at the same time. It's hard to know if I got a bad bunch of food or if he just didn't take to it right away.

 

[Laura and Harley (GA)]

Vicky, thanks for all the great cat pilling videos! Each one has great tips and tricks that I've tried to some degree, but I admit some things like rolling the pill in butter or peanut butter I hadn't heard of before.

I've had such good luck with some chicken flavored prednisolone and clavamox that I confess I stopped trying to pill Harley because it was just so much less stress for both of us. He'd fight me so hard I'd have cuts on my hands and he'd pull and twist (even when backed into a corner or between my legs) so that I was afraid he'd hurt himself more. Nothing like trying to learn how to pill a cat while he' s having an active p-flare.

I guess I could try again when he's well and things aren't so stressful for both of us. Maybe with something inert so he could get used to it.

I can give insulin, SubQ fluids and liquids but pills are my Achilles heel.

 

[Sheila & Beau GA & Jeddie GA]

Wow, you were busy answering everyone tonight - must have taken forever!

Just throwing this out there for what it is worth: Jeddie is bad about pills too, maybe not as bad as Harley. I pill him very similarly to the videos, BUT I make him sit all the way down and just tilt his head back and quickly pill him by pushing it all the way into his throat. When he sits "up", it's easier for him to paw at me and scratch me.

Also, I use pill pockets. For Beau, who is a very easy to pill cat, I do it because he likes it and it is better to have him eat it than to have me force it into his mouth. He also gets a heart med that is too big for a pill pocket, so he has to get pilled for that - I just like giving him a break for his other med. I use half a pill pocket for his methimazole. Charlotte, my oldest, will also take methimazole that way and she is one of the worse cats I have ever had to pill. I also use half a pocket for her. Jeddie needs his prozac "coated" with the pocket so I only use a quarter of one for him. If he tastes the prozac he starts foaming at the mouth.

Yes, they have "sugars" in them, but I use such small amounts and have not noticed a BG difference. They also make an allergy-free version that does not have sugars in it that is a little more expensive and don't hold together quite as well. Plus, I think they are really stinky. They might be worth trying.

 

[Laura and Harley (GA)]

Wow, you were busy answering everyone tonight - must have taken forever!

Just throwing this out there for what it is worth: Jeddie is bad about pills too, maybe not as bad as Harley. I pill him very similarly to the videos, BUT I make him sit all the way down and just tilt his head back and quickly pill him by pushing it all the way into his throat. When he sits "up", it's easier for him to paw at me and scratch me.

I try to make Harley sit all the way down too so he can't paw me but usually he gets up. Tonight I tried sitting him down and leaning him back to tilt his head back and it worked. It still took 6 tries to get him to open his mouth and to get the pill (Pepcid) into him. I think I got it in.

Also, I use pill pockets. For Beau, who is a very easy to pill cat, I do it because he likes it and it is better to have him eat it than to have me force it into his mouth. He also gets a heart med that is too big for a pill pocket, so he has to get pilled for that - I just like giving him a break for his other med. I use half a pill pocket for his methimazole. Charlotte, my oldest, will also take methimazole that way and she is one of the worse cats I have ever had to pill. I also use half a pocket for her. Jeddie needs his prozac "coated" with the pocket so I only use a quarter of one for him. If he tastes the prozac he starts foaming at the mouth.

Yes, they have "sugars" in them, but I use such small amounts and have not noticed a BG difference. They also make an allergy-free version that does not have sugars in it that is a little more expensive and don't hold together quite as well. Plus, I think they are really stinky. They might be worth trying.

I need to get regular pill pockets. I tried the allergy duck and pea ones with the cyproheptadine tablet the first time I pilled Harley and he tasted the pill despite the pocket. He frothed and foamed so bad. Plus it created a food aversion to those pockets. If I even come near him with one of them, he'd start to froth and foam - even when there was no pill in them.

Why am I pilling tonight? Not for fun - Harley threw up almost a whole meal again and is licking his lips at the water bowl. I gave a shot of bupe and was able to get the 2.5 mg of Pepcid into him. I called Vet Specialty and talked to an ER doctor who looked up Anzemet in their books and said that there's no record of any side effect to do with prolonged PTT times. But I don't have another $2000 to spend if they're wrong.

The only thing Harley will eat right now is the baked organic chicken breast treat chunks I made for him. So he won't starve tonight. God help us, when is this going to end?

 

[pamela and tigger]

Dang Laura, you didn't have to answer all of us individually like that! But it was so sweet of you to do so! You have enough on your mind. I am glad to hear that Harley is holding his own today and doing better. That is good news indeed.

I am not sure how easy the Slippery Elm Bark would be to give to Harley but Tanya has a number of suggestions and sources. Ideally if he would accept it in his food that would be the easiest. Here is theSlippery Elm Bark link on her website.

I can understand your reluctance on the Feline's Pride after what you just said. Just know that I have been feeding it to Tigger for over three years now. They have always had a good product, but now they have moved into a new warehouse with even more quality control than before, if that is possible. Anyway, when you get time check out their new website in my signature and all the testimonies of people who have had IBD kitties who have improved after switching to a raw diet. I know a lot of those people in the testimonies so I can say they are real. Mine and Tigger's is at the bottom.

ETA - I am sorry Laura, we were posting at the same time. Crap. I am so sorry Harley is not doing well again tonight.

"I called Vet Specialty and talked to an ER doctor who looked up Anzemet in their books and said that there's no record of any side effect to do with prolonged PTT times."

Weird he would say that since it lists that as one of the side effects....?? But maybe in cats it is different? I don't know if I would want to take a chance either. Is there perhaps a holistic vet in your area that can help with some natural remedies? Surely in Des Plaines there must be?

At least he is eating the baked chicken breasts. Tigger loves that too. It is his lunch and before bedtime snack.

Sending hugs and prayers to you and your dear boy.

 

[pamela and tigger]

Laura, just wanting you to know we are thinking of you and Harley and hoping things are okay.

 

[Laura and Harley (GA)]

Laura, just wanting you to know we are thinking of you and Harley and hoping things are okay.

Hi everyone, I'm sorry I didn't post an update yesterday, it was pretty hectic. The good thing is Harley's attack on Tuesday night was not quite as severe as the two previous ones. He was off food all night long but ate with 1/2 an appetite yesterday. I called up my secondary vet (I have 2 for this disease, another very long story which is in my diagnosis post in PZI) and he too had never heard of Anzemet causing clotting issues but he agreed to give me injectible Pepcid (famotidine) instead. I picked the syringes up last night and Harley is perking up again. The acid test is if he can drink water on his own. If he can, the nausea is being controlled.

I talked directly with the radiologist who performed Harley's ultrasound yesterday. She sent me all 14 of his images in case I want to seek another internal medicine consult. She said his pancreas was 7mm which is considered normal, and the spleen was a little enlarged but still within the normal range so she didn't even note it on the report. So nothing obvious on the u/s. We need any good news we can get!

Today I have to call several vets including the holistic vet in Des Plaines. They were closed yesterday.

I tried some ready-to-eat wheat grass with my two kitties that I picked up from my local pet store. My civvie, Princess, went crazy for it. Harley just looked at it and walked away. I pulled out one shoot and gave it to him but no action. Bummer. Maybe he needs a different kind. He's never really been a chew on plant kind of guy. I have to keep most foliage away from my Princess because she'll eat anything.

Thank you for all your help and suggestions, keep them coming because for every 4 things I try, 1 may work! The crock pot and boiled chicken are next on the cat_pet_icon list...

 

[Vicky & Gandalf (GA) & Murrlin]

Glad Harley's doing OK. I don't have anything to add at this point. Seems to be a wait and see period. I love your onward & upward attitude though! We all know the struggle and how easy it is to get pessimistic, so I really admire your attitude.

 

[Pam & Alley]

Hi Laura and Harley and welcome. I have been reading your posts and you're doing a great job handling the situations as they come up and Harley is lucky to have you.
I switched from N (UGH!) to Lev in December and it has done Alley a world of good.
I wish you good luck and positive thoughts.

 

[Laura and Harley (GA)]

Hi Laura and Harley and welcome. I have been reading your posts and you're doing a great job handling the situations as they come up and Harley is lucky to have you.
I switched from N (UGH!) to Lev in December and it has done Alley a world of good.

Hi Pam, Thanks for the warm welcome! OMG the N roller coaster. Harley was reacting to ProZinc as if it were N so I can sympathize/empathize with you. I see by your posts that you guys are drop dosing - way to go!

I wish you good luck and positive thoughts.

Thanks and big brother Harley sends purrs and scritches Alley's way. She's such a pretty kitty!

 

[Laura and Harley (GA)]

I just realized I forgot to tell the funny story of when I went to pick up Harley from the ER vet. I met Dr. V. and let's just we were both exhausted and stressed. They brought Harley out to me, poor baby was still wearing an e-collar, his IV port still in and looking so scared and frightened. He didn't recognize me at first but then huddled up against me.

So after the doctor and I debriefed on Harley's condition she asked me if I wanted to take him home and I said absolutely and I'd like to give him his insulin shot now before we leave because it was 6 p.m. - normal shot time. She said, before he leaves we'll have to test his blood sugar and if it's 200 or less I either 1) can't give the shot or if 2) I do they'll have to keep him and monitor him to make sure he doesn't go too low. I asked why and she said that Levemir was such a strong insulin it'd bottom him out. I said, uh, no that's Regular insulin you are talking about (Harley had gone from a 400+ preshot to 160 in about 5-6 hours after being given a unit of R that morning), Levemir was long lasting, gentle, and does not have that fast of an action especially since we'd just switched and his shed most likely wasn't even full yet and he'd missed that morning's dose. She ignored what I had to say and just repeated what she said about not letting me take him if I gave him a shot at or below 200. The kicker is that she said we could give him a unit of Regular insulin instead! ohmygod_smile 1u of R on a 200 preshot? What is she crazy? cat(2)_steam That'd drop him like a stone. What's so funny is that she'd admitted earlier in the day that she wasn't familiar with Levemir, how to give it and how it worked. ohmygod_smile

Realizing I was getting nowhere fast with logic and reason I just said to bring on the glucometer and I'd do the test myself. They offered and I accepted the use of their AlphaTrak (even though I'd brought my ReliOn Micro with me) counting on the fact that the reading would be higher and there was an excellent chance I'd be taking him home. Sure enough, he tested at 299 and devoured the baked chicken breast treats that I'd brought him as bribery. They still insisted that I not give him his shot until after I'd gotten him home and he'd eaten - even though he tried to eat through the plastic bag the treats were in. When we got home he tested at 220 on my ReliOn and I gave his shot 2 hours late.

God, you have no idea how glad I was to get him home. They were awesome with the ER care and I'm grateful for the plasma transfusion and the ultrasound. But the diabetes management is best left to me. Thought you all might get a laugh out of this tail. :mrgreen:

 

[Vicky & Gandalf (GA) & Murrlin]

Laura, that's a great story! Thanks for sharing.

I hope Levemir gets more veterinary "press" eventually so stories like these don't continue. Surely it's just because the vet had had a long day.

To be fair, vets are conditioned after seeing so many hypo cases in their career to warn about shooting below 200. But one of the reasons they've seen so many hypo cases is because the old school insulins were fast acting and without home testing owners gave shots when they should not have.

The incidents of symptomatic hypos on the board using Lantus or Levemir are very few. Mostly that's because we home test and owners here already know enough to be cautious about giving shots with lower numbers than usual. But I feel it is also because they are gentler insulins and less likely to cause hypo unless they are seriously overdosed. They are better than most insulins vets have experience with, but they take home management and that's what worries me about their continued growth in use for cats. Many owners won't want to take the time, learn the skills and even spend the money needed to adequately use these insulins.

The sad fact remains that many owners are not as proactive as the folks who come to and are on the board. Vets don't see many owners like us. My acupuncture vet and I were just speaking about this today after she told me about the DKA case she had at the ER clinic she subs at on weekends. The cat was "thin", but it was only because it had not eaten in "a few" days that the owners brought it in. She said it couldn't even hold its head up, so after the diagnosis and expensive treatment options, the owners PTS. That's the reality of diabetes for most vets. Very very sad. Also, cats are very good at hiding illness and only very attuned owners get their cats to vets in time where treatment is possible because by the time the cat is in distress it's often too late.

So your vet was only looking out for Harley. In time maybe you can share the info she needs to get on board with Lev. You handled it very very well at the time.

 

[Fozzy bear]

Hello all,

i hope your kitties are doing well this evening. wondering if any of you could help me out. i am also a chicagoan, and i am getting beyond frustrated with the vets Fozzy Bear has seen. He has been diagnosed with diabetes and pancreatitis...and his ALK phosphates were slightly elevated, so a possible triaditis. I get the current lab results tomorrow, so i am hoping for an improvement. For those of you in the chicago area and who have a cat that also has pancreatitis, can you recommend a veterinarian who you found helpful and up to date on treatment for this disease? im having the worst luck, and its so upsetting. any advice would be wonderful.


Thanks!
Kim and Fozzy Bear