6/12 Mali AMPS 475;dose increase;+9.5 437;PMPS 530

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RG & Mali (GA)

RG & Mali (GA)

Member Since 2013
yesterday's condo

Mali starts off the day in red, but we start the new dose today at 1.00u. Let's hope that get's her surfin' :!:

Thanks to all for stopping by the condo lately and hope all is well in LL :!:
 
Re: 6/12 Mali AMPS 475;dose increase

Paws crossed...you can do it Mali!

Good luck with the testing today, Robert. I won't be able to check in until tonight...it's my work day.

Have a great one and I hope you see a nice slide.
 
Re: 6/12 Mali AMPS 475;dose increase

Hi guys ... Good luck with the new dose today! I hope it's just what mali needs to surf some pretty numbers! have a great day guys!
 
Re: 6/12 Mali AMPS 475;dose increase

Hi Robert. Hope the dosecrease gets Mali to lower numbers and, as you said, gets her surfing in calmer waters. I'm sure it will. I looked at Mali's SS and got to say good job on getting the mid cycle test. Your doing a great job.

Have a great day.
 
Re: 6/12 Mali AMPS 475;dose increase

good luck w/ the new dose, don't get frustrated if you don't see immediate results. The new shed has to fill. Some cats even go up for a few cycles before settling. We call it New Dose Wonkiness (NDW).
 
Re: 6/12 Mali AMPS 475;dose increase

Remember to be patient with the increase. The effects are not always immediate. It can take a couple of cycles for the depot to catch up with the increased dose.
 
Re: 6/12 Mali AMPS 475;dose increase;+9.5 437

Deb & Wink said:
Is Mali doing ok today?
Click to expand...


Thanks for the help, Deb...Mali is just fine. She is still "up there" at +9.5 @ 437,but as everyone says, she probably will have the NDW for a while.
I haven't tried your post solution yet, but I will get to it in a little while. Thanks again.
 
Re: 6/12 Mali AMPS 475;dose increase;+9.5 437

Thanks everyone for the words of encouragement on Mali's dosecrease. She clocked a 437 @ +9.5 today and this the only test I was able to get since AMPS because I've been out all day. I will get more tonight and I know we will see improvement. I want to post an email to the board from Mali's vet and Deb was nice enough to give me instructs on doing it. I think it will be of some interest.
Thanks again for all the support here at FDMB.
RG
 
Re: 6/12 Mali AMPS 475;dose increase;+9.5 437

I wanted to post this response from Mali's vet in regard to several questions that I had for her in reference to the continuing pain from pancreatitis even though it is undetectable in Mali, regarding the debate on whether antibiotics are the way to go for treatment of pancreatitis in reference to Marje's paper on pancreatitis and also the role of Hypocobalaminemia plays in Mali's treatment.
I am not sure this is of interest to all on FDMB, but since everyone always seems to want to know how Mali's vet visit and blood work came out, I figured this note along with her blood work in her SS would clarify some of the "mudiness" in my attempt to relay the information. I know we have people on this board that are much more adept in the science of these diseases than I am and I appreciate your indulgence.
Thanks much and I hope everyone has an excellent evening :!:


Excellent questions! I am writing so you have something to refer back to. Please call me if you want anything clarified, or just email back.

1) Could Mali still be having some pain without showing signs of pain? Yes. This is something we talked about alot when Mali was first diagnosed - cats hide their pain well! I recommend keeping all pancreatitis cats on Buprenex, but since it was no longer being given at home, and you were having trouble medicating it was stopped. We can absolutely refill this for you if you no longer have it or are out. I already had Mali down for unlimited refills for 1 year past her last exam. Her discomfort from pancreatitis would not, however, be enough to cause the dramatic spikes Mali has in her blood sugar. I wish it were so simple!

2) Antibiotic therapy- This is controversial and there are as many sources for it as against it for pancreatitis, however in Mali's case she also had evidence of a possible cholangiohepatitis based on the appearance of her tortuous bile duct and liver on ultrasound, (that's why we discussed biopsies and culture) and antibiotics are indicated for cholangiohepatitis, and also in cases when we have an unknown cause of insulin resistance as infection itself can drive blood glucose upwards by rendering the body unable to recognize insulin. A broad spectrum course of antibiotics helps rule out infection, and we are using drugs to target the liver and gallbladder. Mali's urine culture was negative, but UTI is another common infection that can cause insulin resistance. Cancer can cause resistance too, but antibiotics won't help that.

3) Hypocobalaminemia is another word for low B12, which is what Mali is already on preventatively. A biopsy would be needed to diagnose IBD vs lymphoma, but we can test B12 (cobalamin levels) with a fasted GI profile (bloodwork) which we did on Mali, and hers was normal which means the ileum itself was not affected enough to be low, but there is no way to evaluate the other two portions of the intestine (jejunum and duodenum) with the blood test. Ultrasound showed some abnormalities in the intestinal appearance which is why we went ahead and started the B12 since it has so many positive effects on appetite and energy level in cats.

I hope that helps further your understanding of Mali's case - you certainly are getting a lesson in feline internal medicine! Please let me know if I can assist you further.
 
Re: 6/12 Mali AMPS 475;dose increase;+9.5 437

Glad that cut and paste did the trick. If not, I would have come up with plan B.
 
I am VERY impressed with your vet!!!!

If Mali were my cat, I'd start her on a low maintenance dose of buprenex. I"m not sure what form your vet gave you.....injectible or compounded in a flavored liquid to squirt in her cheek pouch or the injectible form you can squirt in her cheek pouch (which tastes icky). If you are having it compounded into a flavored liquid, be sure that it has NO sweetener including maltodextrin. It is a myth that diabetics can have maltodextrin without it affecting BG. Check with your vet on what she considers to be a maintenance dose or she might have already told you. Buprenex has a pretty wide dosing threshold so I'd aim for the lower end and increase if necessary but again.....your vet can guide you on the maintenance dose. One thing I disagree on is the BG. I have seen cats go up into red and black numbers ...take a look at Checker's SS. He has a disc problem in his back; he was throwing alot of red and black and we suggested to Barb that she start him daily on bupe. He was doing so much better but he's been in pain the last day or two and his numbers have gone back up again. Do you give her fluids? I would talk to the vet about occasional fluids if she thinks she might have a mild, chronic case of pancreatitis.

I also agree that the antibiotic is definitely appropriate if she has cholangiohepatitis. Gracie has been on a very long course of clavamox for a bile duct infection. I know Mali is also on ursodiol. Again....if you are having it compounded like I do Gracie's, double check and make sure it has no sweetener or maltodextrin. For some reason, I was thinking she gets a pill? Metronidazole (Reglan) might also be a possibility (is she already on it?) but it made Gracie sicker than a dog. She's had no issues with the clavamox. So talk to the vet also about clavamox....some cats tolerate it....some get really sick. ECID.

How are you giving the methylB12? Are you giving it by injection or a capsule? Most capsules have sugar or another additive that will raise the BG so you want something like Zobaline. If you are giving injections, I would check with the vet because often the injections are cyanocobalamin and you really want methylcobalamin.

I hope that helps. She's a pretty sharp vet you have there. Now between her and us...maybe we can get this girl in better numbers.
 
Marje and Gracie said:
I am VERY impressed with your vet!!!!

If Mali were my cat, I'd start her on a low maintenance dose of buprenex. I"m not sure what form your vet gave you.....injectible or compounded in a flavored liquid to squirt in her cheek pouch or the injectible form you can squirt in her cheek pouch (which tastes icky). If you are having it compounded into a flavored liquid, be sure that it has NO sweetener including maltodextrin. It is a myth that diabetics can have maltodextrin without it affecting BG. Check with your vet on what she considers to be a maintenance dose or she might have already told you. Buprenex has a pretty wide dosing threshold so I'd aim for the lower end and increase if necessary but again.....your vet can guide you on the maintenance dose. One thing I disagree on is the BG. I have seen cats go up into red and black numbers ...take a look at Checker's SS. He has a disc problem in his back; he was throwing alot of red and black and we suggested to Barb that she start him daily on bupe. He was doing so much better but he's been in pain the last day or two and his numbers have gone back up again. Do you give her fluids? I would talk to the vet about occasional fluids if she thinks she might have a mild, chronic case of pancreatitis.

I also agree that the antibiotic is definitely appropriate if she has cholangiohepatitis. Gracie has been on a very long course of clavamox for a bile duct infection. I know Mali is also on ursodiol. Again....if you are having it compounded like I do Gracie's, double check and make sure it has no sweetener or maltodextrin. For some reason, I was thinking she gets a pill? Metronidazole (Reglan) might also be a possibility (is she already on it?) but it made Gracie sicker than a dog. She's had no issues with the clavamox. So talk to the vet also about clavamox....some cats tolerate it....some get really sick. ECID.

How are you giving the methylB12? Are you giving it by injection or a capsule? Most capsules have sugar or another additive that will raise the BG so you want something like Zobaline. If you are giving injections, I would check with the vet because often the injections are cyanocobalamin and you really want methylcobalamin.

I hope that helps. She's a pretty sharp vet you have there. Now between her and us...maybe we can get this girl in better numbers.
Click to expand...

I thought you may like what she said...in addition to being young, very well educated and dedicated (also the vet clinic is a CATS ONLY clinic so no barking droolers around :lol: ) she is very approachable and not a "I'm the vet and know all and you don't know anything" type at all.

I have put Mali back on the bupe (liquid form squirted in cheek pouch, .25 ml) since I am having better luck with giving liquid meds. It has no sweetner to my knowledge, but I will make sure.

We have given her subq fluids twice (full bag), right after her pancreatitis dx and once a month or so ago, but not presently.

Yes, she is taking ursodiol (.25ml/24hr) and Metronidazole (.5ml/12hr). She is also on Orbax (1ml/24hr) and Atopica (.25ml/48hr)
The ursodiol and Metronidazole are compounded.
She gets the B12 subcutaneously every 7 days and once again, I am not aware of any sweetners added, but I will check on that for sure.

Mali tolerates these liquids pretty well although when she has a course of 4 or 5 back to back, she does drool and foam sometime. It's the pills that are killer for her. The otherwise very mild mannered miss Mali turns into Linda Blair(The Exorcist) and really throws a tizzy when you come at her with the pill gun. :twisted:
 
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