Boots - vet follow-up discussion, discouraging!

[Megan and Boots (GA)]

Last condo - results from recent vet tests

So I got a call from our vet today. First off, results from urinalysis culture showed negative for bacteria, so that's good - though it doesn't give a nice "easy" answer as to why he's had some accidents peeing outside the box lately.

I also asked her about a couple things that you all had mentioned and recommended:

1. Digestive enzymes - she wasn't even familiar with this, just with pancreatic enzymes. I explained it was more of a general, digestive health enzyme supplement, like probiotics, available OTC. She said I could give her some names and she'd look into them, but couldn't speak to any benefit/harm now.
2. B12 injections - she has experience with these, but stopped short of OKing a prescription. She recommended we bring Boots back in for bloodwork first to see if he is in fact deficient, so if/when we start B12 supplements, we'll have a baseline for comparison. I hate to think she just wants to get us to pay for bloodwork... but I'm skeptical. I did get the impression that maybe if I pushed, she'd prescribe it (she did say there's no real harm, even if they aren't deficient, since they're water soluble and will just be excreted in excess). She also mentioned that there are some newer studies on oral B12 that show promise.
3. Adequan - she has zero experience using this on cats. My vets are at an all-cat practice, so they don't even see first-hand the benefits to dogs, unfortunately. She's familiar with it, but seems to think that Cosequin we give him now is sufficient and similar in nature anyway. She seemed hesitant to prescribe Adequan. She said if we wanted, we could try maybe as-needed Onsior or Metacam. Not what I wanted to hear...

So our thoughts initially are to bring Boots back in for the TAMU pancreas screening tests - B12, B6, EPI testing. Not eager to have to fast him and lug him back to the vet, but I guess it would be good to get those things tested. We then think maybe speaking with her in person, maybe bringing some documentation on Adequan recommendations/success/studies could sway her to let us be a guinea pig patient and try it out, off-label, in Boots. She's not averse to trying new things (she sent us for I-131 treatment years ago, and recommended TR protocol for FD management), and I'm hoping that maybe an in-person discussion could sway her. If not - I guess we can try another local vet who might be willing to give a second opinion and try Adequan, but not looking forward to having to drag him all over for that, if it comes to that.

Anyone have any advice? I never know how hard to push the vets. I want to be an advocate for my cats, but I also know no one likes being told how to do their job. We love our vet, really, we do. Both vets at the practice are kind and knowledgeable. But I'm pretty frustrated and discouraged now.

Good news is: Boots' numbers have remained nice and steady and low since settling him back in at 1.0U following some upheaval post-vet visit last week. Hooray for that!

 

[Julie + Muffin]

Hi...I have another kitty Louie who has pancreatitis and he is on Vit B12 shots once a week for 4 weeks. When I talked to my vet about it because she hadn't brought it up (someone on the yahoo group did) she said not a bad idea and it wouldn't hurt anything anyway. I am not one to talk to about not pushing vets because I push all the time. We have a sanctuary and we are responsible for a lot of cats. Our vets are used to it. In fact it helps them try different things if they haven't thought of it which in turns helps them with other patients. I caught Louie's issue quickly because he is a 22 lb. cat that stopped eating his usual. Knew something was wrong asap. Took him to vet immediately. Blood tests/ultra sound revealed pancreatitis. He hated it but put him in the hospital for 3 days with supportive care (IV fluids, cerenia, mirtazapine, and awful metroniazole) but I believe that supportive care helped him tremendously. He is still on cerenia but I am lowering dose to 1/4 tablet a day rather than 1/2 hoping it will give him just enough to keep appetite in check. The vet wanted to get him off cerenia but hadn't thought about just lowering the dose for a while to ease him off. She liked the idea. We know our fur kids more than anyone. Our vet respects that. Stay away from Metacam. Not good for cats. My vet won't even prescribe it anymore for cats. I have not heard of Adequan so can't speak to that but I am curious now. Anyway sorry this is so long. I hope you find the right path for your Boots.

 

[Megan and Boots (GA)]

@Julie + Muffin , thanks for sharing your thoughts. Do you notice any improvement since starting the B12? Improvement in energy, appetite, etc? We might be starting Boots on Cerenia long-term too, but haven't yet begun (he actually seems to be feeling well and has been eating well ever since his vet visit last week - maybe we scared him straight! )

And do you give Louie anything else for the pancreatitis? Enzymes or anything?

 

[Amy&TrixieCat]

1. Adequan - she has zero experience using this on cats. My vets are at an all-cat practice, so they don't even see first-hand the benefits to dogs, unfortunately. She's familiar with it, but seems to think that Cosequin we give him now is sufficient and similar in nature anyway. She seemed hesitant to prescribe Adequan. She said if we wanted, we could try maybe as-needed Onsior or Metacam. Not what I wanted to hear...

Two things in this particular bullet point raise red flags for me: a cat-only vet who doesn't have any Adequan experience (and doesn't seem to want to learn about it), and a cat-only vet who would even consider prescribing metecam, which has an FDA black box warning on it for causing kidney failure in cats.

I have used Adequan with two cats now, and it is far superior to cosequin if a cat has significant arthritis. My GA civvie, Mario, was on Cosequin first, but once his arthritis progressed, the Cosequin was no longer any help and we switched him to Adequan. It was a miracle for him, and he was on it for at least 2.5 years. We started Trixie on it this past April, too, and even though she was only on it for a few months (she passed away June 8th), it also helped her tremendously. My one regret with both Mario and Trixie was not starting them on Adequan sooner.

 

[Julie + Muffin]

@Julie + Muffin , thanks for sharing your thoughts. Do you notice any improvement since starting the B12? Improvement in energy, appetite, etc? We might be starting Boots on Cerenia long-term too, but haven't yet begun (he actually seems to be feeling well and has been eating well ever since his vet visit last week - maybe we scared him straight! )

And do you give Louie anything else for the pancreatitis? Enzymes or anything?

I don't know if the improvement in Louie is from the B12..hard to tell. I think the Cerenia is helping with the appetite for sure. My vet feels that long term Cerenia is not a problem. They don't prescribe more than 1/2 tablet once a day. I'm hoping 1/4 tablet will keep him interested. He needs to lose weight but right now I just want him stable in eating. I also need to find a low fat cat food that he likes, both canned and dry. I don't give anything else right now. You may want to go to yahoo groups and sign up for the pancreatitis group. Some good info there. Also I don't know if you have heard of Wedgewood Pharmacy on line...they are known for "tiny tabs". We have a kitty on gabapentin for pain which is a horrible liquid and our vet is calling Wedgewood to get tiny tabs for him. Regarding enzymes...Cosequin has never worked in our cats or my dog. Are you giving Boot's fluids? Dehydration is sometimes an issue in these kitties.

 

[Wendy&Neko]

I would recommend getting the TAMU tests done and getting that baseline. If there is something else going on in his bowels, you want the "before" results, instead of after starting B12. Maybe a trade off with the vet. Agree to the TAMU tests (which you might have wanted to do anyway), in trade for her prescribing the Adequan. I would definitely push for it. Like Amy, I am surprised they haven't heard of using Adequan for cats. Even in Canada where we use Cartrophen instead (similar product), vets have heard of using Adequan. I was a great one for gently pushing or suggesting a trial to my vets. More of a "what do you think about trying...". They would research and get back to me. That's the kind of vets I like.

You last condo also had discussion of acupuncture and cold lasers for arthritis pain. Neko got a lot of relief from acupuncture. I would be careful on the cold lasers - it is contraindicated if there is any cancer.

 

[Megan and Boots (GA)]

I think I just need to get past my Cerenia fear. It seems like plenty of people have given it long-term to kitties with no issues, but I guess it's just the fact that when we were introduced to it, the dosage was really as-needed, and couple days on then taper it down over a couple days... I think that if from the start we had been told that it's OK long-term, but just use it as-needed for starters, I wouldn't be at all hesitant now. I guess I also just don't want to medicate when not needed, and it's just hard to know when/if it's really needed, especially when he has a streak of a couple days with solidly good appetite. We were thinking of starting him on it the next time he shows lack of appetite, and just leaving him on it daily (1/4 tab) for maybe 2-3 weeks to see if any more days of inapptence occur - because that would be a really long streak for him, and therefore a clear sign it's doing some good.

@Amy&TrixieCat I really was disappointed about the Adequan, but she didn't say no outright, so I think if we go again for an appointment soon for bloodwork, I'll bring some paperwork of evidence (even just anecdotal if there are no actual studies) and see if she'd be open to reading it and prescribing it. I'm sure not going to give up, when I hear such good things about it! If we have to go elsewhere for a second opinion, we will, but I am hopeful we can convince her to let us be a guinea pig and try it. She's giving us paperwork and studies to read from time to time, so it's time I return the favor! And she did mention the kidney issues with Metacam. I think she only mentioned them because I was clearly pushing her for a solution more than just Cosequin. But she's warned us in the past about the dangers of drugs like NSAIDs and how you have to weigh risks/benefits. I don't think we'll go down that road, anyway.

@Wendy&Neko Yeah, we talked about it a little while ago, and we think we will get him another appointment for the TAMU tests in maybe 2-3 weeks (give him a little break now). Then we'll know his baseline numbers and can start B12 and be able to get observable AND quantitative/clinical indications of whether it's helping or not. Thanks for the cold laser warning. I found a cold laser facility nearby, but will look for acupuncture now instead.

 

[Wendy&Neko]

After a point, Neko was on Cerenia daily. But she was also taking chemo drugs then and cerenia as well as ondansetron seemed to really help her appetite, and make her feel better.

Some people have had a lot of success with cold laser. I was just suggesting caution until you know exactly what Boots has.