6/25 Zeke AMBG 147; PMPS 293. Concerns with meds prescribed.

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MrZ

MrZ

Member Since 2013
Good morning LL,

Thanks Elise, Catherine, Julie, Dyana, Chris and Kathy for stopping by Zeke’s condo yesterday afternoon.

Here’s Zeke’s yesterday. We are so thrilled to report that he is doing great. His appy is good and he’s not having any difficulty eating (thankfully no nausea). Turns out he had 5 good teeth that the vet felt are not at any risk of going bad, so he’s not completely toothless. Although his upper canines had to go he still has the lower ones, along with three molars.

He came home with a morphine patch for pain, and this morning we started him on Flagyl and Onsior. It appears Zeke was given 1 tablet of Onsior on the day of surgery. As per our vet’s instructions, we are to give Zeke 1 tablet daily today and tomorrow and then 1 tablet daily (every other day) on 6/28, 6/30 & 7/2, for a total of 6 tablets. As per the FDA information I found on the internet on Onsior, this drug is only supposed to be given for a maximum of 3 days. As per the Prescribing info on the Onsior website, a cat > 13.3 lbs (Zeke’s 16.09 lbs) may be given 2 tablets per day, for a maximum of 3 days.

QUESTION: Does anyone have experience with this drug and have administered as prescribed by our vet (i.e., for more than 3 days)? I wonder if the fact that the teeth extractions included two canines (which are very long teeth and therefore, I would imagine, might require a longer recovery period) had any impact on our vet deciding to prescribe this anti-inflammatory/pain med as she did. Unfortunately, our vet would not be very receptive to our inquiries on this (see below) so I’m hoping LL might provide some reassurance that as long as we watch for any adverse reactions, dosing as she’s prescribed should be ok.

DH was responsible for Zeke’s shot this morning and decided to skip as Zeke was at 147. DH thought, “well, if Zeke’s doing this well after 24 hours of no insulin, then maybe we should hold off and see how he continues to do”. Well, three hours later, after his usual fuds, Zeke was up to 208. I did notice that Zeke was given Humulin R at some point yesterday during or after his procedure. Perhaps that’s why he wasn’t so high this morning when DH tested him. We are planning on giving Zeke his shot this PM.

DH picked Zeke up yesterday after surgery and had a post-op meeting with our vet. She was going over the post-op instructions with DH and had advised us to give Zeke his PM shot. DH and I had already decided we were gonna skip the shot. Well, when DH started to tell her that we were thinking of skipping the shot, she flew off the handle, to the point of shaking with anger at our insolence. She proceeded to state that we needed to stop looking to the internet for medical advice and instead just follow her instructions. She made it clear that if we weren’t willing to do that, “this isn’t going to work”. Wow!?! We’re gonna give her some time to cool down and just continue to do what we feel is best for Zeke as far as his FD. If she’s open to it, we’ll have her see Zeke for everything else but FD. However, we’re gonna wait to have that conversation after we get Zeke through this recovery.

Well, that’s all for now. Wishing you all a great day. Hugs to you all for the gracious support you all are always willing to provide.
 
Re: 6/25 Zeke AMBG 147; +15 / 208. Update and Question

yep. those fangs have longer roots so they can take a little longer to recover fully. We had dissolvable stitches and my vet was more worried
about the wet food getting in. That's partly why I made little tiny balls of the pate.... plus Shadow wasn't used to using her tongue yet.


I am praying hard that this will bring Zeke into remission shortly down the road..... and you can say "in Your Face!" to your vet. :-D
After all, you pay her for advice and assistance.... that doesn't mean you have to follow it .... or that she's right....
especially when it comes to diabetes. ..... so few of them know what they are doing in that regard.
 
Re: 6/25 Zeke AMBG 147; +15 / 208. Update and Question

Good news that Zeke is recovering so well from his surgery. It was a good idea to skip last night - I've seen way too many kitties go low the night after anesthesia. The BG lowering effects of anesthesia last a while, so that could have contributed to this mornings lower number.

Any chance you can get to the point with your vet where you don't discuss dosing and shots? My vet trusts me to do the right thing and when we visit she just asks what the current dose is for her records. Your vet has to remember who is the client and who is the service provider. I think I'd be considering finding a new vet. As my DH said when I read some of your condo to him - not every vet can graduate top of their class. :roll: Onsior is supposed to be short term only. Even the manufacturers web site says it is to be used for just 3 days. If you peruse the website you'll see lots of uses of the phrase "use for a maximum of 3 days". An alternative is buprenorphine, which is commonly used for pain in cats, including from extractions.

Healing vines for Zeke and getting used to his new mouth.
 
Re: 6/25 Zeke AMBG 147; +15 / 208. Update and Question

i'm curious about the Flagyl - isn't that for yeast infections/antifungal? is that instead of an antibiotic?

a lot of people just nod their heads about dose, don't respond back, and then do what they think is best. that's my recommendation, unless you want to find a different vet.

You probably know you can shoot early if he's rising. I might, just to get some insulin into him.

The thing to watch for after dental extractions is infection. If you see any pawing at his face, or his BGs go up, i'd be checking back with the vet to look for infections. Punkin had problems with that - so be watchful.

i'm so glad he came through as well as he did. i don't know anything about Onsior, other than i've heard people mention using it. No personal experience with it though. i did like Bupe.
 
Re: 6/25 Zeke AMBG 147; +15 / 208. Update and Question

Laura --

I don't usually say this but I'd encourage you to interview a few possible new vets. Your vet needs to be your partner in Zeke's health. The vet may have expertise in medicine but you know your cat. This is a collaboration. Neither you nor your DH should be berated.

Julie is correct. Flagyl is an antibiotic that's used to deal with anerobic bacterial infections -- usually something like a yeast infection or GI problems. I've never come across its use after a dental procedure. I'm also quite suspicious of how the Onsior was prescribed. I honestly don't understand why Zeke needs both Onsior and a pain patch (I'm assuming this is a fentanyl patch.) Your vet seems to be shooting from the hip and IMHO, Zeke deserves better.

Did the vet give you instructions on how to get the pain patch off? (Avon Skin So Soft or mineral oil will help.)
 
Re: 6/25 Zeke AMBG 147; +15 / 208. Update and Question

I've been given flagyl when diarrhea was present from pancreatitis. Since the need for it is being questioned I feel I must post that there are two types, one which is not so good for cats. It also has a wide range of dosing and you are better on the low end. If there aren't any symptoms I would question using it. JMHO.
 
Re: 6/25 Zeke AMBG 147; +15 / 208. Update and Question

I think I'd find a new vet.

I also think I would not give my cat a medication for 5 days when the manufacturer says to use it for no more than 3 days.

I go to a cat only practice and there are several vets there. One is young and open to new ideas. Another is older and clearly resents my questions. The older one told me a couple of weeks ago that I clearly didn't trust her and that I should stop testing Oliver's BG and just give him his insulin as instructed. I ignored that advice, of course. And I told the other vet that I have a policy of "trust but verify." Or rather, trust but educate myself. I am ultimately responsible for my cats' health and I have had enough experience with vets over the years to know that none of them are infallible.

Follow your instincts with your cat.
 
6/25 Zeke AMBG 147; PMPS 293. Issues with meds prescribed.

Thank you all for your comments. I am so upset over what I should do with Zeke’s meds. If I don’t go with our vets instructions, I don’t know what kind of harm I might do to Zeke. I don’t think I can get a second opinion soon enough. I suppose I will call our vet tomorrow and at a minimum get an explanation as to why the Flagyl and Onsior were prescribed and what possible alternatives she could recommend. On top of the meds issue, I am also upset that Zeke was at 293 at PMPS. He hasn’t been this high (barring the AM cycle on 2/21, after a failed reduction) since January this year. I had hoped removing those bad teeth would improve his numbers. :sad: :?

Rhiannon – I’m with you girl! For now though, an immdiate and significant improvement from tonight’s PS will do.

Wendy – Not discussing Zeke’s dosing with our vet is what we’d preferred. Unfortunately, ever since she proclaimed him “converted”, she keeps bringing it up, checking to see that we’re dosing as she has instructed (we’re not). We’ll have THAT discussion with her later. Yes, I saw the “no more than 3 days” warning for the Onsior and that’s why I turned to the board. THAT’s a discussion we’ll have to have with our vet tomorrow. I was hoping someone on the board had heard that this med was commonly used beyond the 3 days, but as that does not appear to be the case, I’ll prepare to get Zeke’s vet's feathers ruffled. If she doesn’t suggest an alternative option though, I don’t know what we’re gonna do.

Julie – Thanks for the heads up on watching for signs of an infection. I will ask her about the Flagyl and see if we can’t switch to Bupe. I had high hopes for our vet as she is a board certified feline specialist and the practice exclusively cats only. Liked the idea of taking our kitties where there would be no droolers and figured the expertise would be a huge plus, but based on her unreasonableness with Zeke’s dosing and now these other concerns, it’s not looking promising.

Sienne – Agreed! She did provide instructions on the patch removal along with some packages of “something” (sorry haven’t looked closely yet) to aid in the removal. Yes, the Flagyl and Onsior are concerns.

Elise – Thnaks for the info on Flagyl. I’ll check the bottle when I get home to see what type we were given for Zeke.

Oliver’s mom – We’ve only seen this vet a hand full of times. She’s always been very pleasant and seemed very knowledgeable, but I am seriously questioning whether this should be an ongoing relationship. We’ll see based on her responses and reaction tomorrow. I wouldn't be surprised though if "she fires us".

Thanks again all.
 
Re: 6/25 Zeke AMBG 147; PMPS 293. Concerns with meds prescri

Hi Laura,

Isn't it frustrating when you feel like the person who is supposed to be working with you is fighting you every step of the way?

Your interaction with your vet reminded me of one I had with our now previous vet. We were discussing boarding Cobb, and she was telling me how they would have to sedate him for every shot because he is "difficult" at the vet. I told her that I would not allow her to sedate him twice a day and if they couldn't manage a shot and testing, it was safer to skip it. Goodness...you would have thought I had suggested to cut off th cat's tail or something. She lit into me about how irresponsible that was, and she would be the one to decide how much insulin to give him when he was being boarded, yada yada yada. I can't tell you the rest because I tuned her out. Needless to say, Cobb has not, and never willbe, boarded at her facility.

Our now current vet (and Cobb's original vet) is a feline-only practice. She is worth us driving 4 hours for because she listens and does not berate. She has never had to sedate Cobb for an exam, including the one we had just before his dental work, and she doesn't ask me about dosing. She initially expressed concern at his dose - until I showed her my spreadsheet. Her concern was for hypo with as much insulin as Cobb gets. But on e she saw how he is closely monitored, she admitted I probably know more about the disease than she does.

The dental work may still bring Zeke's numbers down. I'm not sure if a dental has an immediate effect. You're doing a great job!

~Suzanne
 
Re: 6/25 Zeke AMBG 147; PMPS 293. Concerns with meds prescri

just sending you a little encouragement laura. it's stressful to have this going on. :YMHUG:

how is zeke doing tonight? as you said, he hasn't seen this high of blood sugar for a while. i'm wondering if he's feeling yucky from it.
 
Re: 6/25 Zeke AMBG 147; PMPS 293. Concerns with meds prescri

How many times have I heard "stop looking at the internet!" Guess that's why I'm on my 5th vet who is open to listening to me. He should listen to me because I have enough cats to keep him in business. He says we need our own ward! Ha
He may think I'm absolutely crazy but I don't care. He listens to me and even reads and keeps all of the information I print out for him. I think Peyton's file is more full of the information I have given him than his medical records :) It is very nice to have a good working relationship with your vet. If you are not happy with something I would definitely discuss it with him/her and find out their reasoning for it. If you cannot see eye to eye then it may be time to find another vet. As someone else mentioned you may want to interview other vets. I didn't do that until I found my current vet. He took the time to talk with me an answer all the questions I had for him. He's not perfect but very willing to learn. Wishing you lots of luck and many hugs to Zeke :YMHUG:
 
Re: 6/25 Zeke AMBG 147; PMPS 293. Concerns with meds prescri

Good evening all.

Suzanne - Gosh, I am sorry you too have had such an unpleasant vet experience. DH and I have definitely decided we're gonna look for a new vet. This walking on eggshells with our vet is BS. It's great that you've found someone who has faith in you and is not interfering with how you're handling Cobb''s FD.

Julie - Thanks for checking in on Zeke. He's doing well but is a little sleepier today, very understandable considering the road trip this past weekend, in which he kept us up most nights, and of course his major surgery yesterday. Course, it's possible he's not feeling well due to the high BG. He's come down a bit (181) but obviously a far cry from where he's been on average the last 5 months. We'll continue keeping a close eye on him.

Julie - It's great that you've found someone who's so receptive to you sharing your knowledge with them. Maybe we'll find someone like that too. Thanks for the encouragement.

Have a pleasant evening (oops, didn't hit send last night). Have a great Fursday.
 
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