5/18 Tuscany AMPS~203,PMPS~231- VET UPDATE

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joyce-tuscany(GA)

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Yesterday: viewtopic.php?f=9&t=14796

Earned a dose crease last pm. Another late night in the 40's early for her in the cycle. Now shooting f1.5.

Off to the vets in 1/2 hour. Hopefully they will know what the leg alien is. ?Synovial cyst?? I'll see. My bet is that they will first want to try antibiotics "Just in case" it is an abscess. I have a hard time thinking there could be that type of infection with her sugars going low. Infections more often drive the sugars up. (FYI - tried at least 2 rounds of antibiotics with my first cat for his paw thing before they decided maybe it needed a bx - in fact it was about the same time of year cause we were up north on memorial day and saw a vet up there first...)
 
Re: 5/18 Tuscany AMPS~203

Saw you up with me last night!! Glad both of them went up...
Joyce, I know this happened to you before, but not every incidence is like the last one, not every bump is a terrible one.
Could you possibly ask for a biopsy right away, instead of the other steps if you re so concerned??
You know how we feel about you & Tuscany!! You are in our hearts today & we are hoping for a good vet visit--
We luv you!! HUGS~!!!
Almost forget!! Congrats on dosecrease & please update vet visit results!!
 
Re: 5/18 Tuscany AMPS~203

At vets now. Tuscany gone for xrays and they are going to try an aspiration today. She is complaining little more than usual. Weight was up few ounces since feb.
 
Re: 5/18 Tuscany AMPS~203

joyce, we are all sending positive thoughts to you guys right now ... hoping just for an abscess that a quick round of antibiotics will take care of .... and congrats on the decrease last night .. took at look at tuscany's SS .. it's looking soooo good these days! Lots of blues and greens ... nice!
 
Re: 5/18 Tuscany AMPS~203, +3~141

Good luck to day. Paws crossed for good news. Congrats on the dosecrease last night.
 
Re: 5/18 Tuscany AMPS~203, +3~141

Back from Vet:

xray - shows the swelling, no boney destruction, ? ulnar head slightly displaced. Aspiration - did have some blood - possibly just from the needle, few neutrophils (WBC). Consistantancy of the aspirant seemed thicker to vet - like synovial or bursa fluids. They did look at fluid under microscope. The aspiration did not change the size of lesion to any degree.

She feels that there is some chronic inflammation going on. Would like Tuscany to take Baytril for few days cause of needle invasion and cause of neutrophils (whether that was from the blood stick or already present can't tell). She also wants Tuscany to try antiinflammatory. Of course her first choice was the meloxicam. We had a discussion about meloxicam and the fact that Tuscany has renal insufficiency. (I'll have to look it up but think last creat was around 2.6?). The vet does realize that there are some issues with meloxicam - but feels that more issues if injectable (which we'd do oral) and that should would be getting small dose like .5 mg/day.

So - I asked about the prednisone - knowing that that is also a good antiinflammatory. She said we could do that instead. Of course we already know what that does to her sugars since she had 4 days of pred back in Feb. (and dang it - her numbers are doing so good and we just had a dose crease. )

So - she leaves the decision to me. I know that Meloxicam is bashed quite hard here. I also do know that ALL drugs do have side effects but that most of the patients don't have issues with. Does anyone with dm and mild crf have anything positive to say about the meloxicam??

Also - did discuss potential surgical bx/removal but vet is hesitant to use anesthesia again (had dental in October) if we can avoid.



I left without an RX for the meloxicam. I still have pred at home. Thought I'd see what some of the thoughts are here about my choices.
 
Re: 5/18 Tuscany AMPS~203, +3~141

joyce-tuscany said:
Does anyone with dm and mild crf have anything positive to say about the meloxicam??
Click to expand...

not me. with renal issues in play, that would be playing with fire, imo. but i'm biased against metacam. make that very biased. no exceptions unless it's a quality of life issue and all other options have been explored.

incidentally, meloxicam is approved only as an injectable for cats, for a one-time post-surgery use iirc. oral use for cats is off-label, so i'm not sure why your vet feels oral is the safer option.

is aspirate being sent out for further eval? (i don't know what standard procedure is, just asking because i'm curious).
 
Re: 5/18 Tuscany AMPS~203, +3~141 - VET UPDATE

i can't give to much info on any of this - short of siding with WCF and Meowzi and the statement regarding metacam. dead set against it here - did in one of my cats, I won't ever go there again. so - IMO: for whatever that may be worth.

I hope all works out OK for Tuscany - sending positive vines your way from Michelle and mannie
 
Re: 5/18 Tuscany AMPS~203, +3~141 - VET UPDATE

my concern with prednisone - it's a steroid and well, steroids aren't good for diabetic cats.
 
Re: 5/18 Tuscany AMPS~203, +3~141 - VET UPDATE

How about Adequan and/or Dasuquin? I think they are both anti-inflammatories, although not really pain meds. My vet refused to give Metacam after Blackie was dx with renal insufficiency and I completely agreed. If pred was my only other choice, I would go with that.
 
Re: 5/18 Tuscany AMPS~203, +3~141 - VET UPDATE

Hillary & Maui said:
my concern with prednisone - it's a steroid and well, steroids aren't good for diabetic cats.
Click to expand...

there is a time and place for steroids. sometimes other issues trump diabetes. not saying this is one of those times, i don't know - but just wanted to put it out there that sometimes 'roids shouldn't be ruled out just because of FD. FD can be managed around other issues/meds.
 
Re: 5/18 Tuscany AMPS~203, +3~141 - VET UPDATE

Gosh Joyce, thats tough. :(
I understand because that is wher I have been w/ Latte recently. Only I KNOW metacam would kill her, due to her experience with it in the past.

I dont know if Latte would feel worse w/o the pred. I dont think it really does a whole lot for her arthritis issues to be honest. We have been using the bupe for pain management, because thats pretty much all we can do at this point.

Dr. Lisa posted something about a recent study done on cats w/crf and taking metacam. The results were good. Quite frankly, Im not convinced of the study after the years of time, energy, research I have done on it since Latte's arf.

I think if you are considering it for qol issues, then You have to ask yourself if you are prepared to lose Tuscany because of the choice you make. I know that sounds harsh, but I dont mean it that way. It's a strong possibility and if she lost her battle from it, could you rest easy? The answer might be yes, in her circumstance. You may be at the point where you HAVE to take that risk, and you would be ok no matter the outcome. Only you know the answer.

At the very least I would not rush into a decision. Give it a few days or more..

If you go to the link in my signature you will not only find stories about owners/cats harmed by metacam BUT ]ou will find links with info on things like side effects, manufacturer inserts, some research = think, etc).

I hope this all turns out ok.
I'm really sorry you have to make a hard choice like this.
I know whatever you decide will be in Tuscany's best interest! No judgement here. :)
 
Re: 5/18 Tuscany AMPS~203, +3~141 - VET UPDATE

Joyce--I just know you will make the right decision--Why not pm Jojo & Jess & Earl Too--Couldnt hurt!!!
I'm sure they would both be there for you--As We are--We love dear Tuscany & sending strongest healing vines to her-
Hope she gets much much better!! And real real quickly!!
 
Re: 5/18 Tuscany AMPS~203, +3~141 - VET UPDATE

Hi Joyce, I know you will do all the necessary research and not rush into a decision about which drug to use. I am ignorant of these medications, but I am a good cheerleader, and I and Stu are cheering for Tuscany to feel lots better real soon.

Ella & Stu
 
Re: 5/18 Tuscany AMPS~203, +3~141

WCF and Meowzi said:
incidentally, meloxicam is approved only as an injectable for cats, for a one-time post-surgery use iirc. oral use for cats is off-label, so i'm not sure why your vet feels oral is the safer option.
Click to expand...

Choy Foong, I assume this is because there are more reports of renal issues after the injectable than with the oral, and there are published studies showing oral meloxicam being of benefit to cats and generally well tolerated. I think the issues with the injectable are complicated, as in most cases it is given to cats coming out of surgery so you have the added complications of "what-if"s -- hypotension, blood perfusion issues, etc. after surgery.
 
Re: 5/18 Tuscany AMPS~203, +3~141

Hi Joyce
joyce-tuscany said:
They did look at fluid under microscope.
Click to expand...

Hopefully this went out to the pathologist? No chance it was sent out for bacterial culture, right? When will you have results?

About the anti-inflammatory ... remember that pred also has immunosuppressive properties, so if she is worried about infection (sounds like not too worried?), the pred can inhibit the immune response. I assume she wouldn't have gone along with your suggestion if she really thought it was infection....?

And the metacam ... there are studies showing its safety in cats at low doses. I'm trying to think of it as "what would I do" if it were Dillon ... The answer depends. Depends how very essential an anti-inflammatory is in this case. If your kitty is painful, it's another story, because pain due to inflammation should involve an anti-inflammatory. Did you talk to the vet about just not doing either one, if she's not painful? At least until the aspirate results come back?
 
Re: 5/18 Tuscany AMPS~203, +3~141

Jess & Earl said:
WCF and Meowzi said:
incidentally, meloxicam is approved only as an injectable for cats, for a one-time post-surgery use iirc. oral use for cats is off-label, so i'm not sure why your vet feels oral is the safer option.
Click to expand...

Choy Foong, I assume this is because there are more reports of renal issues after the injectable than with the oral, and there are published studies showing oral meloxicam being of benefit to cats and generally well tolerated. I think the issues with the injectable are complicated, as in most cases it is given to cats coming out of surgery so you have the added complications of "what-if"s -- hypotension, blood perfusion issues, etc. after surgery.
Click to expand...

That's a good point. I've often wondered what if even short periods of anesthesia (even gas) led to hypotension etc and what the impact is on the kidneys, even of a short period of that. I suppose it is possible that the impairment of renal function may actually be attributable to these other complications and not metacam? The published studies on oral meloxicam - I kind of hate to ask this, as the very thought of it just seems so wrong - were there any CKD kitties that participated, and if there were, did their renal function remain stable or deteriorate?
 
Re: 5/18 Tuscany AMPS~203, +3~141 - VET UPDATE

(((Joyce))) (((Tuscany))))
So much information in this condo! I'm sorry that I don't have nothing much to add - other than I wonder how much anti-inflammatory there is in the Dasuquin. Because I understood that there is a AI-component in it.
Metacam... Although I don't have any direct experience with it, it is on my absolute "last choice" ever list.... Jess and WCF and others have much better information than I could ever have.
 
Re: 5/18 Tuscany AMPS~203, +3~141 - VET UPDATE

I don't really understand much of what you wrote, but it sounds like you have a good vet that will work with you to make Tuscany comfortable. I hope everything turns out ok. ((((Joyce))))
 
Re: 5/18 Tuscany AMPS~203, +3~141 - VET UPDATE

Dasuquin is the step above cosequin--I just started Moonie & civvie on it--It acts like glucosamine & condroitin, and contains ASU, which is avocada/soybean unsaponifiables, and claims to improve joint function & comfort levels--also claims to improve bladder function--as per the product explaination. I dont think it is a technical anti-inflammatory, but may have qualities of anti inflammatory--I'm trying it for Moonie, before I go to something stronger like Adequan..
 
Re: 5/18 Tuscany AMPS~203, +3~141

WCF and Meowzi said:
That's a good point. I've often wondered what if even short periods of anesthesia (even gas) led to hypotension etc and what the impact is on the kidneys, even of a short period of that.
Click to expand...

Oh hypotension is common with anesthesia, that's why it is important for BP to be monitored.

Meloxicam in healthy hypotensive-from-anesthesia dogs did not seem to impair function http://www.ncbi.nlm.nih.gov/pubmed/16412133 http://www.ncbi.nlm.nih.gov/pubmed/15524325 but cats are always a different kettle of fish. A CKD + meloxicam study would be hard to do in cats as you'd need older cats with established CKD, which probably means owned cats, and who would enroll their cat in that study?
 
Re: 5/18 Tuscany AMPS~203, +3~141 - VET UPDATE

(((Joyce))) just sending support to you and sweet Tuscany.
Glad you're getting so much info here!
 
Thanks everyone for their input today. Regarding a few comments: we already use adequan and dasuquin. I do not think there was any further testing /cytology being done with the aspirate. I can check but it wasn't mentioned. The goo from inside was thick and she did not get alot out from her needle aspiration. I was under the impression that anything further would need surgery to drain/remove/sample/etc.

I've started her Baytril tonight - it is just for a few days to make sure no infection sets in from the sampling.

DH and I were discussing the meloxicam/steroid meds tonight. Haven't started either. I am under the impression from the vet that the working diagnosis that she was leaning to was either synovial or bursa irritation in the joint causing the swelling. They did not see any suspicious cells from the aspirate - but that was not a pathologist looking - just the 2 vets. So while there is some reassurance there still remains many questions (and ultimately this could be something much more serious).

If nothing got any worse than it is now I think Tuscany could function fine. She is walking with only slight limp -but please no fast movement cause she still tends to loose her balance sometimes. If you manipulate the joint she will complain. I don't think she is in pain with her low activity life at this time - only if you mess with her leg. At the same time though I think that any further growth of this will start to cause her more discomfort and more trouble with walking. If one of the meds could help decrease the size of this (like a large marble) it would be good.

I am mostly whining about the fact that her sugars have done so well since the 4 days of steroids in Feb. I hate losing the momentum....... I hate seeing red on the SS and having Tuscany not looking perky and alert.
 
Hi Joyce

If you have the resources, you could take her to an orthopedic surgeon. He/she could best evaluate the mass and the course of treatment. If you PM me the names of those close to you, I can see if anyone I work with has heard of them.

I'm disappointed they didn't send the aspirate out to the pathologist -- dunno why not. Frustrating.
 
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