6/27 Pedro AMBG 260 long update and problem

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Amy and Pedro

Amy and Pedro

Member Since 2009
We have been very busy since our OTJ in May. Dealing with his Cushing diagnosis and try to figure out what to do. BG had been staying in 70-80's
Pedro just came home from a 2 day vet stay - went in with good BG now home with BG at 260 - and having been fed Iam's low residue vet diet - which I just looked up and it is 28% carbs.
Need advice here. I am going to stop the new "diet" it will be against vet advice... Do I wait and see if BG drops on his old diet or restart insulin now?????

I apologize for the length here but need to give the history.

Pedro was diagnosed with Cushings in May. My usual Vet had a ultrasound specialist come in with her own portable equipment to check his adrenal glands and determined that he did have an adrenal tumor. After much research we decided to investigate surgery but opted to go to a specialist. Great place and wonderful vet clinic. They did their own ultrasound as a double check with much better equipment and dertermined he had tumors on both adrenals meaning it was pituitary cushings (vs. adrenal induced) and so not surgical (thank god we didn't go with have our own vet do surgery). Only option is a relatively new drug in the US - for dogs Cushings, but has been being used in cat's (only 2 studies in a total of 12 cats - so not a whole lot out there for info). It's called Trilostane and is given on a every 12 hour schedule - so we are back on a schedule just like insulin :). Have to monitor closely as it can cause an Addisonian crisis and kill the cat. It is not a cure but blocks cortisol production. If cat responds well can have good quality of life for several years.
With in days of starting the drug Pedro overall body condition began to improve and he was a much happier cat. Went back in for his 2 week ACTH push test and blood work and fPL test. Mentioned that I thought he might be developing a UTI due to lots of little peeing. Came home on Clavamox for possible UTI.

Took a few days for all work to come back and Vet very pleased with the ACTH test - no UTI but said to finish Clav as she didn't want to have other complecations in case it was just too early to read any UTI stuff. His fPL was 13.

So here is where it got messy. Signs of Addisonian issues include loss of appetite, lethargy, vomiting, tremors...
With in a few days of all this his appetite begins to suffer, a little vomiting here and there - beginning to wonder. Call vet and discuss appetite - know that Ab's will cause all the tummy issues too. So we monitor for a couple more days and decide not good as he suddenly just stopped eating, and is really unhappy, little tremor going...

Off to the specialist on Thursday- concerned is Addsisonian event. Spent the past 3 days there.And I had to be out of town for a family issue at the same time. New ACTH test, fPL, etc. IV fluids....... ($$$$$$$$$$!!!!! yikes)
Good news is that it was not Addison event and is still testing well for the new drug.

Bad news sort-of is his fPL was 20. So looks like it was the pancreatis really kicking in. And as the vet said- with all the changes in his system and add the antibiotic - just too much. I should have questioned and acted on first fPL test and antibiotics but didn't-- my bad

When i took him in I took his food in with me to the vet's- but he wasn't eating. They know he was diabetic and on only wet food and had his food there.

So the vet tech told me when i came to pick him up that he was eating his "new presciption diet really well and they wanted him to only eat that food as it was important for the Pancreatitis that he only eat "low residue' food. I did not check his BG when he came home last night from the vet or look up the food content until this AM. What a shock when I got his BG this AM and then looked at the contents of the food and then looked it up on Janet and Binkey's chart. Lot's of corn meal 28% carbs and he has been eating this since Friday AM.

He is now on (for his pancreatitis)
Bup every 8 hours(oral) and will wean slowly
Prenisolone 5mg 1/day and will wean off per instruction (I know this can up the BG too)
Maropitant - weaning off over next 3 days
Omeprazole (Prilosec) 10mg 2x/day

And still on Trilostane for Cushings 10mg 2/day

So, I had been feding him Sophiticat liver and chicken and 9 Lives. Plus some raw. Any better options for Pancreatitis? I will go do my Panceatitis homework too.

Perdro says "hey" to all his buddies.
 
Hey Amy. So sorry to hear about everything you and Pedro have been going through. I wish I had some words of wisdom for you, but I'll leave that for the experts! Just wanted to drop off some hugs, prayers and positive thoughts for you guys. We'll be thinking of you.
 
Hi Pedro and Amy. I'm so sorry to see that Pedro wasn't/isn't feeling well. Poor baby and poor Amy...I know when our kids don't feel well, we don't feel well. I never had to deal with p-titis but know that it isn't a very fun thing for anyone. That and everything else that is going on with Pedro can't make him feel good. I hope that things start to look up for you and the little guy soon.

Looks like Spot and Pedro are kinda in the same boat. It's not the food he was eating, it's his teeth and shots. His bg this morning was 302! He's now down to 210, thank goodness. Of course that was w/insulin :cry:
 
I wish I had some knowledge for you. But I do have lots of hugs and warm thoughts for you both. I hope Pedro feels better very soon as you and your vets work out the treatment plans. He is such a cutie and I want him to be running and jumping around like a happy silly kitty very soon. (((Amy)))
 
((((((Amy)))))) Can't give advice just good wishes and thoughts for you and Pedro. Don't beat yourself up, the vets should have known better than to feed HC food to a diabetic!
 
(((((Amy))))) Wow...what a time you guys have been having.....
Can you cross-post on Health re food for pancreatitis as well as waiting for folks here to add their thoughts.
Can't believe the ingredients of that prescription food! Yipes! No wonder his BGs are elevated.
Along with the pred...wow for the BGs....he had such pretty numbers before.

Well, it is good that the Cushing's medication is working....or at least, seems to be okay! :razz:
Poor Pedro.
Poor YOU.
:cry:
I am sure that others will have suggestions for foods for Pedro. Please give him hugs and kisses from Raja and Shadow and me...we miss you a lot. Seeing your condo again is great but not under these circumstances. As always, it's the best place to have questions answered though, right? :YMHUG:
 
I'm so sorry to read this. Perhaps if you post on Health or PM Jess & Earl they will respond. Good luck. Keep us posted. Healing vines, snowflakes Pedro's way.
 
wow, the vet changed his diet without your permission? wow...

I'm not sure on pancreatitis diet. I think some people here keep feeding fancy feast. Maybe raw, or I've seen some of the Merrick flavors mentioned because some are lower fat and maybe only slightly higher carb.

Sending vines that the Cushings medicine keeps working and doesn't cause too many side effects...
 
I'm hoping CF stops in today -- she might be able to help.
Sending you guys hugs and snowflakes for feeling better.
 
Hi Amy, Wow you guys sure have been having a time of it. Your poor baby and the stress that you have been under too. I really empathize with you.

You may know that my Tori is a CP kitty. She has had two serious episodes that required hospitalization. The first time she wound up with a feeding tube. Anyway we started following the at home treatment plan that Jojo recommends. That includes most of the things that you are doing with Pedro. When Tori has a flare she now receives the Buprenex as well as Pepcid and Metocopramide. We also give fluids twice a day. To be honest I would check with your internal medicine vet before giving fluids. I'm really not sure if that would be contraindicated with the Cushings. I know that the kitties skin can be very fragile. As for the diet I have Tori on a raw diet and that seems to be what she tolerates best no matter what is happening. When she is off her food usually the first thing she will go for is the raw with a dusting of Bonito flakes on it.

So I would check about the fluids and also start an anti-emetic if you haven't already. Hope that helps. I sure hope Pedro feels better for you soon. Hopefully getting him eating his regular food will help bring his sugars down for you.

We'll be thinking of you.
 
I am so sorry to hear that you and Pedro are going through this.

As far as Pancreatitis, you are doing a lot of the right things. Bupe for pain, Prednisolone may help reduce the inflammation, Maropitant for Nausea, Omeprazole for stomach acid. I believe that you can also layer Ondensetron with Maropitant for nausea. You can also layer Pepcid with Omperazole if needed. I have no idea if any of this would interact with his Trilostane. You could possibly add in Mirtazipine as an appetite stimulant, and some Fortiflora on his food. Anecdotally, many owners report that foods lower in fat are better tolerated in their CP cats. If he can't have sub Q fluids, you could make sure you are adding some water to his food, and maybe if you warm it a bit he will find it more appetizing. My kitties also take Actigall for their CP.

Feel better (((Pedro))).
 
I was surprised at the Prilosec vs. Pepsid.

I've read some of the discussions about food with a CP kitty. If I'm remembering correctly, I think people were suggesting a diet lower in fat. If you look at p. 4 in this roundtable discussion on pancreatitis, they note there isn't a lot of research on diet and p'titis but the thinking is that the diet should be low in fat.
 
Thanks for the support and suggestions - I just talked with the emergency vet at the clinic about the diet. She didn't want to mess with the Internal Med vet's diet but when I said how about a raw diet or boiled chicken - she went for that. It is all about the fat with the pancreatitis diet as many here mentioned.
I really checked out foods on the on the J & B's chart for fat, vet's diet is 36% and what I have been feeding is 56%. That seems to be about avg. for most foods. I'm going to whip up some raw diet and cross my fingers for now. Willing to deal with the vet's irritation that I changed diet.

I don't think too much interfers with the trilostane in terms of diet. Thanks for the link for the roundtable on pancreatitis.
I'll let you know how things go.
 
How amazing that you have a meds that is showing such positive affects for Pedro's cushings! The results must be very comforting to you, to be sure!

About the foods, well have to say Fool me once, shame on you. Fool me twice, shame on me. Sometimes, even with the best of vets, you have to be firmer than firm when it comes to the foods and any other details that you feel are important. There was one time that our vet gave their crappy M/D foods, and I flipped. The next time, I took in our foods and said Don't you DARE feed your office crap to my cat, you hear me??? You are going to cause an upset to her BG.
They listen now.

Pancreatitis, is still a mystery to me because I seriously don't understand how is the full and proper way to treat it. I gave SQuids, and bupe for pain for the first few days, then codeine ear gel fr pains. For foods, I did not give her anything special but I did water it down quite a bit. I have a feeling the SQuids helped so much.

I hope others can give you better advice on the foods, but maybe you can look at the list and find a food that is lower carb but more in the line of the low phos that the vet wants you to feed. You could get some of that and explain to your vet about how it fits both needs. It may work.
 
Cosmo struggled with Hepatic Lipidosis, and of course, the diabetes and pancreatitis. The HL resolved, but we maintain a low carb diet as part of his treatment to stay a diet controlled kitteh. He also has CRF.

The research on diet for CP is... mixed. Cosmo has been on Wellness Chicken and Turkey flavors for almost 2 years now. It is NOT low fat. It doesn't seem related to flares. it has high quality protein (good for any kitty, but esp those with kidney issues), low carb, and no grain/no gluten (I think).

When Cosmo has a CP flare, I know b/c his belly gets distended (this is a new symtpom), he barfuses, lays about the house, and is less snuggly. He also licks lips and vomits a lot (the first couple times are food barfs. then it is clear slimy stomach juice).

How we treat
1) SQ fluids (extra). He gets them anyway for CRF. Every day.

2) pepcid: I have two forms- 1/4 of a 10mg pepcid pill (in a pill pocket) or .25mg injectable. If he's barfing already, I give the injection. if he's still eating and interested in treats, I give the pill form. (I give every 18 hrs. Usually one injection or pill. Sometimes 2 (for 36 hrs of coverage). pepcid is cleared through the kidneys, so I try to limit how often and how much.

3) if barf more than 2 times in a 2 hr period of time, he gets an injection of either cerenia or anzamet (prefer anzamet...smaller dose). Either anti-nauseant is good for 24 hrs. He usually only needs one injection per flare.

4) bup. If he's meatloafing.

5) if he doesn't eat for more than 24-30 hours, I give some mirtazpaine (Remeron). 1/4 pill every 72 hrs. he usually just needs one dose, but we only give when he's having a HORRID CP attack. I usually know his attack is over when he's interested in eating again.

Of course, ECID, and I know that Cosmo's main goal in life is to eat everything yummy that he can get his little paws on. So, I use that criteria as a HUGE indicator of how he feels.

Best of luck!!
 
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