8/26 Reuben AMPS HI +3 HI- PMPS HI +3 HI

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Re: 8/26 Reuben AMPS Pending - Questions

Hi Sienne! I think one of Alexa's main concerns is still those high high BGs. We're coming up on Day 3 on this dose. I agree with your emphasis on reviewing Reuben's dose every three days. Anything on his SS jump out at you at this point? If not, I'm guessing there the next increase coming up pending the end of Day 3 on this dose...

Jane
 
Re: 8/26 Reuben AMPS HI

Morning Alexa and Reuben, I don't think I've had a chance to come by and visit you and Reuben. I read yesterday's condo and see where he's recovering from pancreatitis. Sending Reuben some healing vines from me and Maggie? There are a few other kitties who have gone thru the same thing, no fun and painful for both kitty and Bean. How is he feeling today?
I admire you for making him Dr. Lisa's recipe raw food, but sorry it only lasted three days. Good luck on the remodeling. Sounds like you have a lot going on right now. Good luck on the dosing, too. Have a great day.
 
Re: 8/26 Reuben AMPS HI

Come out, come out...wherever you are! The other kitties are hanging out in the "numbers" and they'd like for you to join them! Come on down, silly boy!!! Hope you feel better, Reuben.

Alexa, you're still doing a great job! Hope you two have a great Sunday!

~Deborah & Shasta
 
Re: 8/26 Reuben AMPS HI

Sorry guys, we were busy with the morning shoot and then taking forever to write this post :oops: ...

Yes, my concern is exactly as Jane describes. Here we are back up over 500 after day 2 at 2.0 - that possibly didn`t even get down into the 300's. Is this a normal bounce under the circumstances, silly question I know.

Reuben is eating well, but suffering from nausea and vomiting - I am trying to get Cerenia and it should be here tomorrow. He does respond well to Metoclopramide, which I have but am hesitant to use while we wait for the Cerenia for two reasons: I found a contra indication for using metoclopramide and buprenorphina together: This is from the 'Drug Checker' site--- http://www.drugs.com/

Interactions between your selected drugs
metoclopramide ↔ buprenorphine

Applies to: metoclopramide, buprenorphine

MONITOR: Central nervous system- and/or respiratory-depressant effects may be additively or synergistically increased in patients taking multiple drugs that cause these effects, especially in elderly or debilitated patients.

MANAGEMENT: During concomitant use of these drugs, patients should be monitored for potentially excessive or prolonged CNS and respiratory depression. Ambulatory patients should be counseled to avoid hazardous activities requiring mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Also, the form of metoclopramide that Reuben responds to is the liquid, which, although the vet assures me is Not in a sugar syrup, sure tastes sweet to me.

Reuben`s energy is very low. He sits or lies down, sleeps or not, depending in part on the level of bupe in his system. He is agile and capable of completely normal cat-like behavior - which for me points to nausea rather than weakness. For example - the litter box is a very large box with tall sides, and he jumps out of it in one leap like a kitten and then runs back to his spot on the couch - as though nothing at all were wrong with him.

There is little if any neuropathy at all.

I feel that it is important to make clear that the level of veterinary skill where I am is drastically lower that what I am hearing from all your experience. Reuben is as sick as he is as a result of veterinary malpractice and ineptitude from the beginning of our troubles. And the very Best vet that I found (who diagnosed pancreatitis, diabetes and detected the massive intestinal infection last December), and saved Reuben's life, used glipizide instead of insulin and prescribed NOTHING for pancreatitis, and he was the best one in an area spanning 5 states. I live in a completely different part of the country now, and things are even less up to date here. The vet I am working with has very little knowledge of either pancreatitis or diabetes, but is willing to prescribe for me based on the research I present to him.

I feel like I am missing something I should be doing right now, and need your perspective and knowledge.

thank you!
-alexa
 
Re: 8/26 Reuben AMPS HI - Questions

I really do think you're seeing a bounce. You can adjust dose after 2 days/4 cycles when numbers are high. The pros to an earlier increase are obvious. The cons are that if a bounce is breaking at the time you are increasing the dose, Reuben's numbers could drop low. You're already seeing blues at this dose so you would need to monitor carefully if you opt to increase during a bounce.
[url=http://www.tillydiabetes.net/en_6_protocol2.htm:2vpcgopu][b:2vpcgopu]Tight Regulation Protocol for Lantus & Levemir[/b][/url] said:
However, if the cat is producing continuously high BGs (nadir always >=300 mg/dl), only hold the dose for 2-3 days before increasing it by 0.5 IU. Alternatively, if the cat is continuously producing moderately elevated BGs (nadir always >=200 mg/dl), increase the dose every 2-3 days by 0.25 IU ( if the cat is getting a low dose) or 0.5 IU (if the cat is getting a higher dose).
The TR protocol is aggressive with regard to bringing numbers down. It's also safe. I would follow the protocol in order to bring the numbers down as quickly as possible.

Re. the drug interaction: This sounds like a fairly common description of this type of interaction. You can always decrease the dose of bupe. Bupe acts in a peculiar way. Regardless of dose, the pain effects are the same. Increasing or decreasing the dose doesn't change the pain management effects. The dose does change the duration of the analgesic effects. In addition, metoclopramide doesn't help a great deal with nausea. It's a drug that slows gastric motility. You might be better off using famotidine (Pepsid) until the Cerenia arrives. I don't think there's an interaction between famotidine and bupe. FWIW, drugs.com does state that the liquid form of metoclopramide is sugar-free.

Bupe is a narcotic. It does have a sedating effect. If Reuben is too sedated, I'd lower the dose.

You should also be aware that glipezide can have some less than desirable longer term effects.
[url=http://www.marvistavet.com/html/body_glipizide.html:2vpcgopu][b:2vpcgopu]MarvistaVet[/b][/url] said:
One of the most important cautions with the use of this medication is that by increasing the release of insulin, glipizide also increases the secretion of other proteins in the pancreas. It is generally abnormal protein deposition in the pancreas that caused the diabetes mellitus in the first place, thus the use glipizide may lead to progression of pancreatic destruction. For this reason, we recommend glipizide as a last resort when insulin administration cannot be given or for a select few cats who are sensitive to insulin secretion.
 
Re: 8/26 Reuben AMPS HI - Questions

Sending healing vines to Reuben and a big thumbs up to you, Alexa, for being so proactive and determined to help your kitty! I'm very happy to hear that your vet is working with you, and will help you get what you need based on your own research. That is wonderful. Hang in there! cat_pet_icon
 
Re: 8/26 Reuben AMPS HI +3 HI- Questions

¿¿¿??????¿¿¿¿???? +3 HI ¿¿¿¿¿????????????¿¿¿¿¿¿¿¿¿¿¿



I THINK I`M GOING TO CRY :cry: :cry: :cry: :cry: :cry: :cry: :cry: :cry: :cry: :cry: :cry: :cry: :cry:
 
Re: 8/26 Reuben AMPS HI +3 HI- Questions

sienne -

What is this +3 HI??????? HELP!

yes, 6 months of glipizide was less than helpful to us. we are battling the effects of the poor/negligent/downright pathetic (and i am being kind here) veterinary 'care' we invested in so far, on a number of levels. (and starting to get mad about it)

i`ll try the pepcid again. i had suspended it because on the 3rd dose it stopped working.

thanks for the info on meto no sugar, i will learn how to use the site to look these kinds of things up!

and thank you for explaining how the bupe works, i didn`t know that dose amt affects time in the system, not degree of pain relief.

thankyouthankyou
alexa
(zar)
 
Re: 8/26 Reuben AMPS HI +3 HI- Questions

Sienne - shooting through the bounce may be worth a try with an acceerated increase? Thoughts?

Alexa - BREATHE. Hang in there. We're here to help you. Try to be patient and hopeful, ok?
Hugs
Jane
 
Re: 8/26 Reuben AMPS HI +3 HI- Questions

Oh you're there jane, whew!!! okay, i`m breathing, i just put dr weill's breathing tape on...arrrrggghhhhhh angry(2)_cat !!!!!!!!!!
 
Re: 8/26 Reuben AMPS HI +3 HI- Questions

Hugs.jpg


Keep breathing!!!! ((HUGS)) to you and Reuben!

~Deborah & Shasta
 
Re: 8/26 Reuben AMPS HI +3 HI- Questions

Repeat after me: The bounce will clear.

How is Reuben acting? I do think it's worth testing regularly for ketones until you start seeing Reuben spending more time in lower numbers. I don't suspect anything. It's a preventative measure.
 
Re: 8/26 Reuben AMPS HI +3 HI- Questions

Yup, here, just on and off, stoopid internet!!

I was PM'ing with Sienne about this too. I'd lean towards just gritting your teeth through this bounce (I expressed myself badly earlier) and considering an increase after 3 days on the current dose (protocol suggests 3-5 days, so 3 days is technically fairly "early", but CAN be warranted with very HI numbers). I'm sure Sienne will pipe in on this again too.

Not sure if I can make it back online tonight due to internet issues. If not, hang in there, and see you tomorrow. (Come to Karre's Caturday condo if you want to vent :mrgreen:)
Hugs
Jane
 
Re: 8/26 Reuben AMPS HI +3 HI- Questions

OKAY - the moment requires rock and roll---never heard of these guys, but they`re from my home town, they have a hilarious name, and the song is called 'PATIENCE' - YEAH, dancing around with my kittyboy!!

http://www.youtube.com/watch?v=LlZoDwa2z-M

Dale - THANK YOU for understanding what i'm doing :razz: :razz: even if i drive everyone here crazy i`m going to make this happen for my best buddy, who has been here for me through thick and thin for almost 15 years - you guys have a great sunday!

Deborah - you sweetie, you don`t miss a thing over here in our war camp! - ((HUGS)) :razz:

Ann - thank you so much for your visit, empathy and encouragement! we are fighting the good fight, and loving the the supportive community! looking forward to getting to know you and Maggie :razz:
 
Re: 8/26 Reuben AMPS HI +3 HI- Questions

Sienne and Gabby said:
Repeat after me: The bounce will clear.

How is Reuben acting? I do think it's worth testing regularly for ketones until you start seeing Reuben spending more time in lower numbers. I don't suspect anything. It's a preventative measure.

I tested ketones this morning - 0.1mmol/L --- we're good

he is acting the same - eating , drinking, cuddling, sleleping...zoning out, going up on the terrace and zoning out, lots of zoning out ...like that.

okay, we'll gut this out. 'the bounce will clear, the bounce will clear, the bounce will clear' :razz: :razz: :razz:

hmmm -- he`s in meatloaf position right now, even on the bupe ???
 
Re: 8/26 Reuben AMPS HI +3 HI- Questions

Hi Alexa , Yes BREATHE! I can't advise on dosing of course, but you have the experts here to guide you. You ARE fighting the good fight, you have not given up, and in case you can't see it from the midst of the battle when Reuben is getting HI, you ARE making progress. I know its hard and frustrating. Now just look back at some of your earliest posts and see how much knowledge you have gained which is your best weapon in the fight for Reuben's health. And dont forget you need to take care of yourself too. I hope Reuben feels better and you both have a great day!
 
Re: 8/26 Reuben AMPS HI +3 HI- Questions

Try the cerenia once you get it, do you know if you are getting a pill or the injectable form? Give it at least 3 days, give Reuben some relief from nausea, vomiting and pain even if you think he's feeling better don't stop it! During Leo's last attack our vet had me give it for 5 days, but she did say normally kitties go on a 3 day course of cerenia. During that time i also gave bupe as well, and fluids too.

I started giving pepcid twice a day as well whether i think he needs it or not, i think its something Leo will be on forever. We also started giving B12 injections weekly as well, i'm part of the feline acromegaly group on facebook and the members over there swear B12 helps for pancreatitis, so we are giving it a go, its only been 2 weeks he's been on it.

I hope poor Reuben starts feeling better soon, its so hard to watch them when they suffer from pancreatitis and you feel so helpless......i know how you feel Alexa. Hugs to you both. :YMHUG: :YMHUG:
 
Re: 8/26 Reuben AMPS HI +3 HI- Questions

Alexa,

I know exactly what you are going through! If you look at my spreadsheet you will see a lot of black for four months. (I'll point out, before you get discouraged, that it took 4 months for me, but I started at 2u as the vet said to do. Then I tried going down instead of up, and then had to go back up. It took longer for me to get him regulated. You started out with a low dose and are working your way up.) My meter said "HI" if the number was over 599. Yours appears to do that when it is over 499. It was heart-wrenching to get a blue or yellow number and then see red and black again. I think it's a lot harder on you than it is on him.

People on the board who had seen this time and time again would say, This is a bounce; it's okay, but for me, it wasn't ok at all. I wanted him to stop bouncing; I wanted him to get regulated, and I hated testing him and seeing his numbers. It was an emotional roller coaster. Now, I understand that it was ok; his liver was doing the right thing and was healthy, and that means that his liver, at least, wasn't terribly damaged yet. That gives you hope that his other organs are doing ok, too, and your efforts will pay off before there is any severe damage from which Reuben can't recover. Try to think of it that way.

Chances are that Reuben doesn't even notice when his blood sugar goes up. It is supposed to take a long time for a cat to be damaged by high BG. He may not feel great; he'll get dehydrated, etc., but if you help him with the dehydration as best you can, he'll feel better, and bupe must give him a nice vacation from the pancreatitis pain. Max never had a painkiller for his, but he never seemed to need one.

All my best hopes that you can ride this roller coaster with a minimal amount of stress,
 
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