6/7 Zeke AMPS 120 - Update to "6/2 Zeke - AMPS 170. Dosing advice please" condo

[MrZ]

Hi L&LL,

Previous post: http://www.felinediabetes.com/FDMB/threads/5-23-zeke-ambg-71-otj-trial-day-14.138315/

I could use the advice of any members who have experience with how best to get a failed OTJer back on track. Personally, I do not consider this a relapse. In my opinion Zeke was never actually in remission. But the fact remains that he went without insulin for over 14 days and now he is mostly flat blue and I need to be aggressive so as to hopefully not let the situation get any worse. I have updated Zeke's ss to reflect what has occurred since Day 14 of his trial. It is not pretty.

His diarrhea has been an ongoing issue, some days it seems to be getting better only to have it worsen the following day. This pattern has occurred at least twice. This morning he did have a well formed poo. We'll see what we get tomorrow. He is still getting the metronidazole, 250mg, 1/4 tablet twice daily.

His appetite continues to be not so good. Where before he almost always finished every serving without issue, now we have to re-present his bowl with various added enticements to try to get him to finish. Even then, we're not 100% successful in getting him to finish each meal. Because of the diarrhea, we're hesitant to feed him anything other the Turkey Wellness. Zeke does not have access to any other higher carb foods or treats.

We have a vet appointment on Friday. We plan to request a referral to a specialist/oncologist and are interested in having any and all tests that they recommend to try and identify the cause of his weight loss. I would like to have an ultrasound done to rule out the presence of a mass.

Here are my questions:

How often should I adjust his dose and by how much? This morning I gave him 4 drops of insulin. He dropped to 117 but then was back up to 154 by +9. As you can see on his ss he has not dropped into green much (since we resumed insulin) and even then has not remained green for long when he has. I had wanted to start slow as I wasn't sure how drastically his numbers would fall. With him not eating "on command", I didn't want to (unnecessarily) risk putting him in a situation where I might have had to break out the syrup/gravy. I'm now more concerned that if I'm not aggressive enough, his BGs may get a lot worse.

What kind of tests would you consider requesting if your kitty had the drastic weight loss that Zeke has had? For now we've stabilized the loss but we feel he may be underweight. I would say that he has had muscle loss. He is at 12 lbs, 14 oz. He's lost 3 lbs since May of last year.

Because he's not getting enough insulin to keep his numbers down, should I stop feeding him after say +4? He currently is getting fed around +7 and +9, meals which may possibly be affecting duration and don't appear to be helping to bring down his PS numbers. Because of his appetite and our effort to halt his weight loss, we're having to spread out his meals. So if I cut out the later meals, he'll probably lose more weight. What is the lessor of two evils?

What dose should I give him tonight? I know that Lantus likes consistency but if you think I've been too conservative with his dosing, I'm willing to increase tonight.

Thank you all.

 

[Wendy&Neko]

(((Laura))) I am so sorry Zeke is back on the juice and still unwell. How does 3 or 4 drops compare to .25 or .1 units of insulin? I would go up faster than one drop at a time. You can still follow the protocol in terms of timing, so up after 6 cycles with blue nadirs. I would keep feeding him and add insulin as needed to counter the food if he is willing to eat and needs to gain weight.

b/w and and ultrasound seems like a good place to start to try to figure out what is happening. Sending tons of vines to lil Zeke.

 

[MrZ]

(((Laura))) I am so sorry Zeke is back on the juice and still unwell. How does 3 or 4 drops compare to .25 or .1 units of insulin? I would go up faster than one drop at a time. You can still follow the protocol in terms of timing, so up after 6 cycles with blue nadirs. I would keep feeding him and add insulin as needed to counter the food if he is willing to eat and needs to gain weight.

b/w and and ultrasound seems like a good place to start to try to figure out what is happening. Sending tons of vines to lil Zeke.

Thanks Wendy. The measurement markings on the UltiCare syringes are inconsistent. On the syringe I used this morning it would have been maybe a .1 unit (I would guess). Do you think I should go with a 0.25u tonight? In hindsight, I suppose I should have gone with 0.25u after that 297. I was concerned that a drastic jump might trigger a huge drop and bounce chain reaction.

 

[Laura&Chichi (GA)]

I dont have advice, but I hope you find out what the reason for the weight loss is. Did it start when you reduced to 2% from 4% carb food? Maybe he needs more food, and or higher calorie food? Do you use fortiflora? I know thats supposed to help poop issues. Sending lots of vines for Zeke...and for you!

 

[Marje and Gracie]

You're experienced and if you can get Zeke to eat even via syringe, I'd consider raising to 0.25u if you are comfortable with it.

Is there any chance he has come in contact with any other cats that he could have gotten Coccidia or Giardia? It's hard to find them on a stool sample but they really only respond panacur or Albon.

 

[Tricia Cinco(GA) & Harvey]

{{{Laura}}}

I'm so sorry to hear that Zeke is still having tummy issues and has had to go back on the juice. I have no advice for you. Just sending appy vines for Zeke and comfort vines for you.

 

[MrZ]

Thank you all for your comments and advice on Zeke's condo. I'm happy to report that Zeke is doing better. We think that the diarrhea issue has been resolved. His poos have been well formed last two days. This morning's was well formed but a little wet so we're still closely monitoring. His appetite is better but nowhere as robust as is typical. While we've been able to somewhat halt the weight loss, we've been unable to get him back up above 13 lbs. Despite our vet assuring us that his weight is fine, we think he's frail and would prefer if we could get him back up to 13.5 lbs. This is challenging as we're already feeding him more than we normally do and we're needing to not interfere with the effectiveness of the insulin we're giving him. We're still tweaking the breakdown of his meals but probably pretty close to what may work, at least as it relates to the duration of the insulin. I'm counting drops so the dosing is not exactly consistent but we're probably dosing between 5 and 8 drops or approximately 0.25u. Needless to say we're extremely disappointed that he's back on insulin. However, we're choosing to not dwell on that and instead are trying to be as emotionally neutral as we can when testing. At least for a while, Zeke seemed to do much better (in my opinion) on little or no insulin. But his BGs now indicate that he needs insulin, so back on the dance floor we go.

Zeke had a vet appointment on Friday. The vet didn't think an ultra sound right now was worth the effort. He wants to see the results of the BW and urine sample first to rule out other issues - it's gonna be a process of elimination. He thinks those results may be helpful when the U/S is done later, providing perhaps the areas that the specialist might want to concentrate on. We're good holding off for now.

Thanks Laura&Chichi for the reminder on the fortiflora. I had planned on ordering some but as I was digging in the pantry I found a box that is still within it's expiration date. Sprinkling it on Zeke's food has helped immensely. He goes bonkers for it. I don't recall if that's been his reaction in the past. We're gonna keep giving him some to also help abate/improve any tummy issues.

Zeke had a very stressful day yesterday. We're having major plumbing repairs done that required loud sawing and jackhammering through concrete all day. Additionally, the cable guy was here working on some connection issues. I thought Zeke would be well shielded from the trauma of a strange man in the house and all the noise from the plumbers outside by moving his kitty hideaway (two big nested boxes that he likes to hide in) to the back bedroom. Unfortunately the cable guy had to go in that back room and was there a while running some very loud diagnostic tests and was even standing right next to the hideaway and placing equipment on top of it. I thought it would be best to just let Zeke stay in the hideaway as opposed to pulling him out and placing him in a different room. Well as soon as the cable guy left and I went to pull out Zeke to see how he was doing and comfort him if need be, Zeke came barreling out from the hideaway, somehow positioning himself to be as low as he could possibly be to be slinking while at the same time racing like 100 miles per hour. He then jumped behind the tv. Poor kitty. It took a while to get him to calm down. He was so full of adrenaline that he did something we never that he would be able to do. HE JUMPED THE BABY GATE that (normally) blocks him off from the study - the private dinning room where Mia and Ivan have their all day endless buffets. Oh, no!!! Hopefully this was just a one time feat. If he attempts and succeeds jumping over it again, it will certainly complicate the feeding arrangements we've so come to rely on to help regulate Zeke's food consumption. That Zekey - he never ceases to amaze and amuse us.

Well, wising everyone a very wonderful Sunday.

- Laura and Zeke

 

[julie & punkin (ga)]

fear can make you do amazing things! I guess that he was full of adrenaline from the cable guy. My guess is he wouldn't be able to jump the gate again until the next time he's that scared!

I'm glad he's overall doing better. If he were mine, I'd let the other issues take precedence and adjust the insulin as needed. So if he needs to gain weight, I'd either feed him more volume or higher calories and work the insulin dose around that.

Hope you get some answers from the testing. I know it's disappointing to have to go back on insulin again - he seems to just need a tiny bit - but if that's what he needs, then that's what he needs. Big hugs for you - he's so lucky to have you in the dance with him, Laura.

 

[Laura&Chichi (GA)]

Hi Laura! Glad to hear the fortiflora is working. I can relate to the cable guy issue. Yesterday when I came home, Chi Chi was hiding under the bed and would not come out. Turns out the family had been celebrating the Triple crown winner minutes before(yea, I missed it), and there was a whole lot of whoopin and hollerin goin on Poor thing was scared to death.
Sending lots of vines Zekes way for his appy, BW results, and future test. Don't give up! I have a feeling it wont be long before he is back OTJ.

 

[MrZ]

I know it's disappointing to have to go back on insulin again - he seems to just need a tiny bit - but if that's what he needs, then that's what he needs.

Yes, agreed. Thanks for the hugs Julie. We so appreciate the encouragement you've so often provided.

 

[MrZ]

Turns out the family had been celebrating the Triple crown winner minutes before(yea, I missed it), and there was a whole lot of whoopin and hollerin goin on Poor thing was scared to death.

And to think there are some kitties that are not at all bothered by any ruckus. Guess we have the sensitive ones. We've been working with Zeke on that. He is actually getting a little better about it. But really, noisy plumbers and a cable guy all in the same day is JUST TOO MUCH!!! As about a year ago we kinda accepted that Zeke would probably always need insulin, we've been trying to get him more comfortable with traveling, strangers and strange surroundings. He's gotten better in some regards but there's definitely still work to be done.

Thanks for visiting Laura. Wishing you and Chichi best of luck with the reducie.

 

[Sienne and Gabby (GA)]

FWIW, back in June of 2010, I went through a similar period with Gabby. She was having diarrhea. We'd put her on metronidazole for 7 - 10 days, it would clear up, and then come back. If you look on the "labs" tab of her SS, you'll see we ran blood work and a fecal culture. Everything was negative. A month on metronidazole seemed to have finally taken care of whatever the problem was.

I'm glad the ForiFlora is helping. There are some stronger probiotics out there but if the FortiFlora is helping and encouraging Zeke to eat, I'd stick with it. You can use up to 2 packets a day.

 

[Tricia Cinco(GA) & Harvey]

I'm so glad to see an update on Zeke and to read that he is doing better. I understand your disappointment on the relapse, but you never know what the future might bring, so don't lose hope of another trial. Meanwhile, I hope you get some info from the tests that will help. Sending appy and healing vines.

 

[MrZ]

You're experienced and if you can get Zeke to eat even via syringe, I'd consider raising to 0.25u if you are comfortable with it.

Is there any chance he has come in contact with any other cats that he could have gotten Coccidia or Giardia? It's hard to find them on a stool sample but they really only respond panacur or Albon.

Thanks Marje for this very timely advice. I raised his dose to 0.25u and his BGs are much improved.

Zekey is a 100% indoor kitty. The only feline contact he has is with Ivan & Mia so I don't believe Coccidia or Giardia is of concern.

Thanks again

 

[MrZ]

FWIW, back in June of 2010, I went through a similar period with Gabby. She was having diarrhea. We'd put her on metronidazole for 7 - 10 days, it would clear up, and then come back. If you look on the "labs" tab of her SS, you'll see we ran blood work and a fecal culture. Everything was negative. A month on metronidazole seemed to have finally taken care of whatever the problem was.

I'm glad the ForiFlora is helping. There are some stronger probiotics out there but if the FortiFlora is helping and encouraging Zeke to eat, I'd stick with it. You can use up to 2 packets a day.

Thanks Sienne. We mentioned to our vet the idea of getting a refill on metronidazole so we'd have it on hand if the diarrhea starts up again but he wasn't keen on that. I will mention again though if there's a reoccurrence.

We're keeping our fingers crossed that he'll continue going bonkers for the fortiflora. At least now that the diarrhea has cleared up we can offer him a different cat food if he gets too much more finicky.

 

[MrZ]

I'm so glad to see an update on Zeke and to read that he is doing better. I understand your disappointment on the relapse, but you never know what the future might bring, so don't lose hope of another trial. Meanwhile, I hope you get some info from the tests that will help. Sending appy and healing vines.

We should receive results over the next couple of days. We'll just take it one day at a time. Thanks Tricia for visiting and the vines. Nice to see that Cinco's kept the yellows away last four days. I hope that trend continues.

 

[Marje and Gracie]

I'm so glad to see an update and hear he is doing better. I hope he starts to gain some weight.m his Bgs are looking more like Zeke BGs!! Paws crossed all labs are normal.

Poor Zeke!!! That must have been so adrenaline if jumped the baby gate!!!