8/30 Ozy AMPS-301,+4-280,PMPS-161 Q's on treatment

[donaleen and Ozy]

Yesterday http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=103282

I got advice/suggestions from Marje, Gayle and Nepenthe that giving Ozy subcutaneous fluids would be a good idea. I think it is to flush out his system. I have done that with previous cats when they were really sick but not with Ozy. I need to learn more about when to do it with him and how much to give. Please advise.

My vet suggested I get a special diet tailored for him by UC Davis veterinary nutrition. Has anyone done that? I don't know what it costs or much about it. Here is a link but it doesn't give much information on the diet. I do want to give him the best diet I can.

http://nutrition.vetmed.ucdavis.edu/index.cfm

The vet is also suggesting that we get an ultrasound to see if anything else is going on with him like cancer. My point of view on treating Ozy is to give him the highest quality life I can. I am not sure the ultrasound will help with that. Any thoughts?

And his BG is still high... I am hesitant to increase his dose. I think his pancreatitis complicates finding the right dose since pancreatitis attacks raise his glucose (his pancreatitis was bad yesterday). He did have a low of 31 when his dose was 4.00 (now he is on 3.75).

Lots of questions....

thanks
donaleen

 

[Marje and Gracie]

Re: 8/30 Ozy AMPS-301 Q's on treatment

donaleen:

on the subq fluids.....yes, it's subcutaneous. It's a standard treatment for pancreatitis to give subq fluids. From the Primer on Pancreatitis that I linked yesterday in your condo:

Fluid Therapy: It’s important to ask your vet about administering subcutaneous (subq) fluids especially if the kitty has been vomiting and is dehydrated. Fluid therapy can also help restore any electrolyte imbalances. In some cases, your vet may want to administer IV fluid therapy at the clinic. This video on How to Give Subcutaneous Fluids to your Cat at Home will assist you if the vet believes subq fluids are warranted.

Subq fluids aren't solely given for dehydration. They are also given for electrolyte imbalances. I would discuss with your vet as they will have to prescribe fluids and tell you how much. You can't buy Lactated Ringers Soln without a prescription. If you do give them, you want to give them later in his cycle after a nadir as fluids can drop the BG in some cats. You also want to give them in a different location than the insulin.

I've not had the need for the UCDavis Nutritionists. I would have to wonder if they would advise you to feed him a prescription diet; my vet, (who is a nutritionist) does not ever recommend feeding the prescription diets. But since I don't know their approach, it might be worthwhile checking into.

Because the specfPL is not fool proof (and it depends on whether he was fasted or not), I think the u/s (if you can swing it) is not a bad idea. Gracie's specfPL was a little elevated and she had absolutely no symptoms of pancreatitis. I had her u/s done and the culprit was actually her bile duct. Because the liver, pancreas, gall bladder are all proximal to each other, an infection in one might affect the others. If we had treated her for pancreatitis, we would have missed the boat. Her pancreas on the u/s was perfect....the anomaly was only to the bile duct.

If he doesn't look better today/tonight BG wise, I would consider increasing his dose.

 

[donaleen and Ozy]

Re: 8/30 Ozy AMPS-301,+4-280 Q's on treatment

Thanks, Marje. The diet would be based on real meat, not on anything canned. Her recommendation was because I mentioned wanting to feed him a fresh meat diet. She said that they can design a balanced fresh meat diet based on his needs. She did warn us away from raw meat because she believes his digestive system is weak and would not do well with bacteria/pathogens. I am so confused about that part, raw versus cooked. Portland has a number of raw meat pet food offerings.

His spec fPL in early July was 19.5 and it was a fasted reading; I think 19.5 is pretty high, isn't it. He was first diagnosed with pancreatitis three years ago; we were told that the steroid treatment (long term prednisalone for another condition) had likely caused the pancreatitis. The diabetes diagnosis is very recent, in early July, when we were told the pancreatitis probably caused the diabetes. So I don't think there is much doubt that he has pancreatitis.

Money is somewhat of an issue for us. We don't have a high income. Not sure what the ultrasound would cost.

I really like the vet. I think she is quite good and has been supportive and generous with her time as well as open minded about treatment.

donaleen

Raise the dose, huh? Let's see how today goes. Come on, Ozy, come down.

 

[Wendy&Neko]

Re: 8/30 Ozy AMPS-301,+4-280 Q's on treatment

If you are interested in a real meat diet, but don't want to feed raw, one option is to cook the commercial raw foods. Most reputable raw food manufacturers have spend the time and money on nutritional analysis to have everything you need in the product. Maybe they think Ozy needs something special added? Although cooking raw food isn't as beneficial as eating it raw, it should still be good food. You could just pan fry with water added. Cat's are designed to eat raw meat, but sometimes can have compromised digestive systems. For example, animals undergoing chemotherapy should have their raw food cooked. My Neko eats commercial raw food. However, it's flash frozen, not fresh.

 

[donaleen and Ozy]

Re: 8/30 Ozy AMPS-301,+4-280 Q's on treatment

What will happen if we do NOT raise his dose for another day or two? I want to give his pancreas a little time to get over this bout. He is better but not all the way better, I think. I think his pancreas doesn't produce as much insulin (if any) when his pancratitis kicks up.

And, thanks, Wendy. I think the cooking destroys some things like taurine and so you have to supplement those things that get destroyed. I do lightly saute the ground turkey I give him for a treat most days.

donaleen

 

[Sienne and Gabby (GA)]

Re: 8/30 Ozy AMPS-301,+4-280,+8.5-192 Q's on treatment

If you look at the raw food diet on Dr. Lisa's site, she does include information about par-cooking the chicken. The meat is par-boiled to remove any potential bacteria, ground, then mixed with the necessary supplements. As a result, any of the supplements do not lose their benefit since they remain uncooked.

You don't have to increase but, based on your logic, if Ozy's pancreas is less than happy and not producing insulin, then giving more insulin will put less stress on his pancreas.

 

[donaleen and Ozy]

Re: 8/30 Ozy AMPS-301,+4-280,+8.5-192 Q's on treatment

Yes, I have read that several times. I am a bit non plused by grinding the meat and I don't have a freezer. But I bet I could work that out one way or another. What scares me is destabilizing him by changing his diet. Also, Sienne, didn't you advise me not to change his diet when his glucose is so out control?

As for increasing the dose, yes, you are right, that is one side of the coin. I agree it would take pressure off his pancreas now. That makes sense. But when he dips low, is that because his pancreas is producing insulin? Does his pancreas sporadically work? Does the bounce then trigger the pancreatitis attack?

Or is it me varying his diet too much, giving him too much fresh cooked turkey and salmon on the same day. I don't have that much data and it may be too complicated for me to get right. I want to do the best I can for him and I believe that means a good diet.

One thing I am sure of. He got better after starting insulin but now he has plateaued. He doesn't want to move around much or even to sit up that much so something must hurt, though some days are much better than others. And his glucose is still way out of control.

 

[Marje and Gracie]

When he dips low then he could either be producing endogenous insulin OR his depot could just be full (due to the cumulative nature of lantus) and he needs less insulin. Bounces should not trigger pancreatitis.

Also, once a cat is over the limit for what is considered to be pancreatitis on the bloodwork, it doesn't mean that a cat with a specfPL result of 50 is worse than a cat whose number is 19. It doesn't have that kind of relationship.

If he were my kitty, I would want to give his pancreas more support by giving him more insulin when the numbers are high.

 

[donaleen and Ozy]

Thanks, Marje. I appreciate you taking the time to tell me what you think. I know your experience is much broader than mine.

If he doesn't go under a hundred tonight, does that mean a dose increase in the morning?

Here he is, with a low for the cycle at PMPS. I wonder what tonight has in store?

 

[Marje and Gracie]

Lets see how far down he goes. When he clears his bounces, it's best to see him in green. If he isn't getting into green, he likely needs an increase.

 

[nepenthe]

One thing I notice about this pancreatitis in my boy is that there are some things that make his BG go high, for no apparent reason. Even low levels of carbs cause higher #'s.

The other day I tried a 3 day experiment. I gave him 2ox of raw, boneless skinless chicken breast. Within 2 days his BG started to get higher.

What I am suspecting now is that the higher BGs are a result of irritation/inflammation of the pancreas, due to it overworking itself in the digestive process. We know that amyloid deposits degrade the islet cells of the organ, and I think its reasonable to suggest that a damaged pancreas would lead to impaired digestion.

I wouldn't be surprised that its impaired digestion which keeps triggering an ongoing pancreatic inflammation. Since we can't fast these animals like we would a human or dog, the pancreas never gets a rest. (true, the insulin will give the pancreas a break, but the other side of what the organ does - the exocrine aspect responsible for production of amylase, lipase, protease - never gets a rest).

Even though he doesn't test positive for EPI, I am experimenting with pancreatic enzymes (like Viokase-V) for the next little while to see if things get better.

Today I added vitamin E and Selenium as suggested by this vet (a good read): Pancreatitis Handout - Wendy Blount, DVM (opens .pdf)

One more thing - personally, I would put him on 100ml sub-qs at least 3 times a week. Maybe even 2 days on, one day off. No more than 100ml per 24 hrs. You could even do this everyday for a week - reasoning here is that its likely that p-titis cats have low potassium, which the fluid - "Lactated Ringers Solution" will top up. Essentially, besides protecting him against dehydration, it flushes out the toxins from the organ and keeps electrolyte balanced. To me, fluids is the most important treatment for p-titis.

Here is a good how to: Giving subcutaneous fluids to cats - an owner's guide

I will let you know how the enzymes and antioxidants are working out with him.

 

[nepenthe]

Lets see how far down he goes. When he clears his bounces, it's best to see him in green. If he isn't getting into green, he likely needs an increase.

One thing I noticed in Chingis when he had his last flare late July/early August, is that he never got down to green, regardless of the dose increases. My thinking here is that the disease process of the p-titis creates so much inflammation and pain, that he never gets low enough, skewing the typical feedback we would expect from blood glucose testing (pain, nausea, inflammation, among other things can all raise BG, and p-titis definitely involves all three of those things).

This is why I think it is especially hard to regulate a diabetic cat with chronic pancreatitis. Regulating a cat can be difficult enough with their insulin demands constantly changing. Reading into that - dose increases/decreases - is difficult enough. The p-titis messes with our ability to measure typical feedback from testing.

People can get hung up on spec fPl readings. I think that once a cat has it chronically, its best to assume its another flare-up when we see high numbers and jump on it aggressively, as even if we had a positive test, the course of action would be the same.

 

[donaleen and Ozy]

I certainly think Ozy's digestion is impaired. Otherwise he would be much heavier with how much he eats. I am grateful for his appetite. I think Ozy has a delicate digestive system and it is easily upset by change. He loves fresh meat/fish and I give him small amounts (everyone should have their pleasures in life). I have to be careful because I think his digestion is upset if I give him too much and he wants so much more than he gets.

I am going to call the vet today and see about subcutaneous fluids. I really appreciate any help on treatment and that sound quite promising to me.

Nepenthe, it looks like his BG is pretty stable. Ozy is not. It makes it hard to leave the house...

 

[nepenthe]

I certainly think Ozy's digestion is impaired. Otherwise he would be much heavier with how much he eats. I am grateful for his appetite. I think Ozy has a delicate digestive system and it is easily upset by change. He loves fresh meat/fish and I give him small amounts (everyone should have their pleasures in life). I have to be careful because I think his digestion is upset if I give him too much and he wants so much more than he gets.

I am going to call the vet today and see about subcutaneous fluids. I really appreciate any help on treatment and that sound quite promising to me.

Nepenthe, it looks like his BG is pretty stable. Ozy is not. It makes it hard to leave the house...

I am really interested to see how he will respond to sub-qs. In the beginning doing it every day at least for a couple of weeks. It only really takes a couple of minutes to do this. A lot depends on the cat, but the vet can demonstrate for you how to do this and the fine points to keep in mind. (I really loathe doing it, but am convinced that he wouldn't be alive today without sub-qs)

 

[donaleen and Ozy]

We will see how well Ozy accepts it. He has been pretty good about testing and injections. But, part of the long term issue with him is how difficult he can be to treat. It got so the vet wouldn't even try to examine him without sedation.

I have done subcutaneous fluids before with other cats. One who had kidney failure and one who had small intestine cancer.

His vet is out of town until Wednesday and I opted to wait to talk to her because I really like and respect her. Better to have some continuity, I think.