6/22 Guinness PM 252|+3 187|+5.5 105 50ml fluids given at +3

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linda and guinness

linda and guinness

Member Since 2009
Happy Wednesday Lantus Land. It's my day off, so I have time to put up Guinness's condo today. His current Lantus dose is 10.75u and he has been surfing the blue and yellows recently with a few long stretches of either bounces or "flare-ups".

I've gotten one of three test results back from the vet, his fPLI (Pancreatitis) test showed a REALLY elevated number 30.5. I wasn't able to get the range from the vet (she had to put her own cat to sleep yesterday so she was having trouble talking with patients), but I did look it up on line and found that over 3.5 is indicative of pancreatitis. That coupled with the Ultra Sound he had a few months ago that showed a "slightly" enlarged pancrease makes my vet feel this is our problem. I'm moving forward with some treatment options as of today. 250mg of Cobalamin/B12 injection given once a week, 5 mg of Pepcid AC given 1/2 hour prior to meals and 200cc of subqutaneous fluids given twice a day. I started the Pepcid last night, gave his B12 injection today and plan to start the fluids once I feel confident doing it later today.

His IAA and Acro test results have not come back yet.

NEW DEVELOPMENT: As I was typing this, Guinness threw up his entire 10:30am meal, plus some. Is it the B12 injection? Pill pocket? or 5mg of Pepcid. These are the new additions and he very rarely throws up his meals. ugh.
 
Re: 6/22 Guinness AM 181|+2.5 238|+6 274 One Test Result

Oh Linda, I am sorry to hear about the pancreatitis. I don't know much about it, but I know you love your kitty and you'll do your best for him.

Is your vet ok? That must be really really hard on her. :sad:

I am not sure what would've caused him to throw up his meal. Hopefully its just the stress of all the changes and he will adjust soon.

Take care,
Stephanie
 
Re: 6/22 Guinness AM 181|+2.5 238|+6 274 One Test Result

What pain meds did you get? Bupe is the normal .... pancreatitis is very painful, so don't scrimp on the pain meds.

The fluids of 200cc? (ml?), seems like an awful lot, I hope you are splitting the fluids - giving in maybe two sittings.
My Shadoe starts squirming around 75ml and Oliver does not get more than 100ml at a time as you don't want to give too much fluids at a time as it's hard on the heart, and Oliver's heart is enlarged. Do you know of Guinness' heart state?

For Pepcid, you don't want to give more than 5mg per day, so cut the 10mg reg strength pills into 4, and give BID. I give the pepcid piece at shot times in a little bit of laughing cow cheese.

For the fluids, be sure you are at a high enough BG as fluids can bring down the BG. I give fluids when their numbers are on the rise or say at shot time if the numbers are high.

That's a mighty high test result; be sure to get some bupe as he must be in a fair bit of pain.
If he's having trouble keeping food down, maybe your vet can give you something like cerenia to handle the nausea. The pepcid won't work well if he can't keep it down.

I hope he is feeling better soon.
 
Re: 6/22 Guinness AM 181|+2.5 238|+6 274 One Test Result

Thanks for the tips Gayle.

I also think the 200cc of fluids is too much based on what I've been reading. After he vomited his meal I was able to get a little under 50cc in him before he squirmed away (after I'm sure I poked some shoulder bone or something). My goal is going to be about 100 once a day, not twice a day like my vet said. I may even go to every other day. I'm not really convinced that he is that dehydrated. And yes, he does have an enlarged heart, but it's been ultrasounded and no fluid was found around it, just a big-hearted kitty.

I will give him 25mg Pecid 2x/day instead of 5. I gave him 25mg last night and he seemed to do well with it. Today I switched to the 5mg and that's when he vomited (plus he got the b12 injection). I also decided to try the pill pockets today and I've read that some cats vomit them up.

No pain meds were given at this point. I have some old (2 years old) buprenex lying around that I could give him until I can get some from my vet, but I'm afraid to give him old meds. Any thoughts on the expired meds?

Thanks again for the tips!
 
Re: 6/22 Guinness AM 181|+2.5 238|+6 274 One Test Result

linda, i'm sorry to hear about this diagnosis. pancreatitis is so common with our diabetic kitties. :sad:
gayle has already given you some excellent advice. one thing i wanted to add is it's possible the pain meds could lower guiness' numbers so you might want to keep an eye out for that.

not sure if you've seen this:
jojo's CP post: http://www.felinediabetes.com/phorum5/read.php?8,1092948,1092948#msg-1092948



edited to add: i have no idea if the bupe you have on hand is good any more. you might want to ask your vet.
since pancreatitis is painful, you'll want to have a supply on hand for flare-ups.
 
Re: 6/22 Guinness AM 181|+2.5 238|+6 274 One Test Result

Thank you Jill. I'm pretty sure I've read that post from Jo Jo, but I will click on it just to be sure. I've been researching this all week. One thing that's driving me a little crazy is the "flare-up" issue. Guinness shows no sign of "flare-ups" or being in pain. He mostly lays around the house comatose because his BG's are high, and because he's awake all day trying to get me to feed him more. He doesn't avoid his food, loves his belly rubbed and doesn't sit in that classic "turkey" position. There are the reasons why I had such a hard time accepting this diagnosis after the ultra-sound. He has absolutely NO classic symptoms. Usually when Guinness is in pain he will hide. Under tables, under the bed. He'll avoid my 6 year old like the plague, but he just doesn't do that and hasn't done that this whole time. I'm moving forward believing the diagnosis now because of the test result, but don't know when to give him the bupe (when I get it from the vet), don't know if I should just give him pepcid everyday like clockwork and don't know how long I should administer the fluids (also, as I mentioned, he doesn't seem dehydrated), because I have no "flare-up" gauge. I'm going to email my vet regarding getting some bup, although I probably can't pick it up until Saturday.

Thanks again for the advice.
 
Re: 6/22 Guinness AM 181|+2.5 238|+6 274 One Test Result

oh boy, do i ever understand what you're saying. alex doesn't really show any classic signs of flare-ups either. or maybe i should say the signs are unbelievably subtle. she's normally a fantastic eater. she came by her nickname (miss piggy) honestly. :lol: if her appetite seems off in any way and i see her numbers rising i'm to the point now where i recognize those as signs of a flare. jojo one told me her cat was the same way. the signs of a CP flare were so subtle that most wouldn't recognize them in her cat.

as soon as alex exhibits these subtle signs i simply treat her on the assumption she's having a flare.

some kitties don't make this easy on us...
 
Re: 6/22 Guinness AM 181|+2.5 238|+6 274 One Test Result

If only they could let us know what's going on.....

Oliver gives me zero signs for pancreatitis, and on some regular b/w, it showed he had pancreatitis which surprised us. so I also watch for high numbers, a drop in appetite, and also some use snap of the scruff as a sign of dehydration. Just pull up the scruff and if it seems to slide slowly back, he may need some fluids.

I give Oliver tramadol BID so I rule out pain, but I also add a great deal of water to his foods to be sure he gets his liquids. If he seems off foods, I give him 1/4 tab of a 10mg pepcid .... be sure that his daily pepcid intake is kept to 5mg a day. You mentioned 25mg and that's too much I think.

Shadoe is classic, and conveniently stops eating, hides and sits like a meatloaf, plus her scruff snaps as fast as molasses. I give her pepcid first, then see if she will eat, then if not, give bupe for pain and then can give fluids as soon as her BG numbers are rising. Her BG can drop an easy 100+ from fluids, so I have to wait till she is rising.

I always keep on hand a good supply of fluids at least one full bag, 22ga needles UTW, and buprenex and pepcid regular strength 10mg. The vet office tries to give me 18ga needles but they are huge and Shadoe hates them, won't sit still for fluids. The 22ga may be slower to get in the fluids, but they slip into the skin nicely and do not seem to upset Shadoe or Oliver.

If you need to give 200ml per day, it will be better for Guinness to give BID - if your dr told you to drink 100oz of water a day, would you prefer to drink it all in one shot or spread it out? Even the 100ml sloshes to some big saddlebags; I'd hate to see what 200 looks like.

I hope he feels better soon.
 
Re: 6/22 Guinness AM 181|+2.5 238|+6 274 One Test Result

Gayle's and Jill's info is on target. The max amount of Pepsid is 10 mg/day (1/2 a tablet x2/day).

I hope this helps to sort out what's been going on with Guinness. I know how frustrated you've been.
 
Re: 6/22 Guinness AM 181|+2.5 238|+6 274 One Test Result

Gayle. I think I meant to post 2.5mg pepcid not 25mg...oops. The vet instructed me to give Guinness 200cc of fluid 2 times day. it just seems too much. I was lucky I was able to get 50cc in him this afternoon. I understand what you are saying about watching for them to be off their food. But, I am not exaggerating when I say Guinness ALWAYS RAVENOUSLY eats his, and his brother's if we are not guarding it, meals. I can't remember a time when he's ever turned away from food or not eaten every last drop, including old pieces stuck on their serving tray. Maybe I will have to use his numbers as a guage to start with.

You mentioned that BGs drop when fluids are given. Is this usually a sudden drop right as fluids are given or dose it happen slowly throughout the cycle. Since I'm not home most of the time during the days, I will have to plan his fluids for when I am here to test.

Thanks again for the advice. I've got a lot of reading the figuring out to do!
 
Re: 6/22 Guinness AM 181|+2.5 238|+6 274 One Test Result

For BG drops from fluids, ECID and you may or may not see big drops. For me, Shadoe drops but Oliver does not.
What you could do is test a couple times when you give fluids in the evening and see for yourself. You could also split the fluids to give him maybe 50ml in the morn before you go out, then you can give more in the evening while you are around. I am pretty sure your vet did not mean to give 200ml twice a day, but maybe 200ml divided into 100ml two sessions. It's just too hard on the heart to give so much fluids all at once. When Oliver was ill, my vet said to give 150ml BID but I said nope, that's too much for the heart. I try for 75-100ml per session.

His nadir is mid cycle, yes? So you could give fluids at ps and then again in the evening again after his shot. You also don't want to fluids close to shot times as the psBG will be thrown off... sort of like feeding 2hrs prior to shots. The numbers won't drop suddenly but you will likely see a nice lower numbers.

I had figured you may have meant 2.5mg but just wanted to be sure .... better safe than sorry.
 
Re: 6/22 Guinness AM 181|+2.5 238|+6 274 One Test Result

Linda!!!! I've been thinking about you lately!! I'm sorry to hear about Guinness. Geez, if it's not one thing, it's another!! I hope everything settles down for you. Keep us posted about the other test results. I'm especially curious to find out about the acro test!

Take care!! :-D
 
Re: 6/22 Guinness AM 181|+2.5 238|+6 274 One Test Result

((((Linda)))) it's good to see you, though I'm sorry about the pancreatitis diagnosis. It's a manageable condition for most, though, so it's not all bad news. You've gotten great advice so I won't try to add to it. ;-)

I know some people have said their cats' signs of a flare are very subtle. Someone (it might have been Jojo) said the only real sign in her cat was that he drank water when he was flaring, and never drank water at other times. I think you might just want to watch for subtle changes combined with maybe an increase in his numbers. Meanwhile, I hope the treatment you have started will help bring his numbers down. Stay alert in case his numbers and dose start to drop. You'll do fine, and so will Guinness!
 
Re: 6/22 Guinness AM 181|+2.5 238|+6 274|PM 252|+3 187 Fluid

I was considering giving him a second 50cc/ml of fluids this evening, but since his BG dropped from 252 to 187 at +3 and will probably still keep dropping until +7 or +8, I think I am going to hold off until tomorrow morning. Which, unfortunately means I will be doing it without my SO's help. Giving fluids is hard with a cat who doesn't like to be held down for any period of time.
 
Re: 6/22 Guinness AM 181|+2.5 238|+6 274|PM 252|+3 187 Fluid

I'm glad to hear from you too. I'm so sorry that you have to endure more difficulty with Guinness but confident that he'll do well under your care. I'll keep you in my prayers so that you can remain strong. Advice will come from the folks-in-the-know. Hugs.
 
Re: 6/22 Guinness AM 181|+2.5 238|+6 274|PM 252|+3 187 Fluid

What gauge needles did you get with the fluids? Can you check? A size 18ga is pretty big, so see if you can get 20ga or best is 22ga U.T.W. It will make a big difference in comfort for Guinness.

Now, I don't think alot of cats enjoy getting fluids, but you can make it comfortable.

I get everything all set up, bag hanging, needle attached, and I also have a special blanket for Shadoe and have her treats handy as well. Then I find her.... she knows by now what I am doing so she always tries to make herself scarce.
When I find her, I spend some time to calm her and get her settled on the blanket, then insert the needle and start the flow. I stay with her and pat her, giving a few treats for praise, and she usually settles down for the duration. She is good with the smaller gauge needle but hated the bigger ones. I aim for 100ml but if she starts to squirm or get restless between 50-75ml, I let her go and take out the needle. I think we both compromise and she knows she needs them, but likes that I let her decide when it's enough.

You can tell how dehydrated he is by how quickly the fluids bulge take dissipate - even though they may not like, I know that Shadoe feels better later because she perks up like a wilted plant that has been watered and purrs up a storm.

ETA:
If you are not sure if he will drop from the fluids, I would not give them to a 187. It's best to give the fluids right at shot time and then if there is a drop from the fluids before bed, you can give some mc or hc.
 
Re: 6/22 Guinness AM 181|+2.5 238|+6 274|PM 252|+3 187 Fluid

I LOVE Terumo 20g x 1" *UTW-Ultra Thin Wall Needles and the Terumo 21g x 1" Needles for administering fluids. Not sure if you can get them in Canada. Gayle might know. They don't seem to bother Alex at all.
 
Re: 6/22 Guinness AM 181|+2.5 238|+6 274|PM 252|+3 187 Fluid

I'm not sure of the needle size, but it seems pretty big. I'll ask for smaller ones. I did give fluids tonight at +3 (50ml), his BG is 105 at +5.5. He gets fed LC at +6 and I will test again if I can at +7 or +8. I will have to set my alarm to wake up and sometimes I can't.

Jill, I'm in Calfornia, so I will look for those gauge needles and ask my vet about them. He did pretty well with our second attempt tonight. Carrier, husband helping, lots of comforting words and pets, chicken breast treats after. He's very meowy and perky now, especially with the 105 BG!
 
Re: 6/22 Guinness PM 252|+3 187|+5.5 105 50ml fluids given a

i don't know why i was thinking you were in canada. ohmygod_smile
here's the link to the Brico (from Tanya's CRF site) west coast ordering page, but you have to fax the script in with your order: https://host.securelook.com/bricomed/seccrfwest.html. i'll tell ya, i heard others talk about these needles. i never would have believed the difference if i hadn't tried them myself. they're wonderful!

i bet he feels better after fluids and being in lower numbers! :mrgreen:
 
Re: 6/22 Guinness PM 252|+3 187|+5.5 105 50ml fluids given a

Yes, I use Terumo 22g x 3/4" *UTW-Ultra Thin Wall Needles.
They slide in like butter, but do take longer to give fluids.
I figure hey, we are not in any rush, so I go with comfort.

Shadoe has quite thin skin and get restless faster; Oliver's skin is thick like a car tire, and will not squirm at all. I am sure the 18s or even 20s are fine, but I cringe at how hard it is to puncture his skin, so mostly we use the 22s or 20s for him.

eta:
You now have seen how he reacts to fluids - he drops a bit, but best of all, he feels better for them. Keep track how long the fluids bulge takes to disappear and it will tell you how much he needed the fluids... I think he will now associate feeling better with fluids, and each session will add to the comfort level and routine of it all.
 
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