Charlie - Help - Blood in Diarrhea/Lethargy. Scared.

Pancreatic Lipase Test Results

Got copies of all the blood test reports from our current vet's assistant. She even printed out the reports from the ER vet, so we have more info there as well. One statistic that I did learn about is the pancreatitis test.

The specific pancreatic lipase test that they did on July 9th came out at 9.8
According to the vet assistant, it should be below 3.5
As it was not, they diagnosed her with pancreatitis, but she has seen those figures come out higher in the past.

The vet assistant also said that she sees cats acting VERY strange when they have tramedol (anti-pain tablets). This is consistent with what we have seen, as Charlie looks like an old drunk for the past 2 days. The vet assistant said that our first priority is to get the diarrhea under control.

So we have given 1/2 tablet of anti diarrhea medicine (finidiar) and we hope it will help. There was more diarrhea in the litter box when we got back from the vet, so clearly that is not going away on its own. She told us to not give another tramedol (anti pain) tablet this evening and to observe charlie's reactions and see if things improve. I will of course get a 2nd opinion on this from the specialist vet that we will see at 4:30, but it seems like a good idea.

The thing is, we still don't know what's causing charlie to act this weird all weekend. Puking and vomiting alone would have that impact on me! At the ER vet, they made an assumption that it was the pain from the pancreatitis (or at least, she told us to give the anti-pain shot as in any case, it wouldn't hurt anything). We did that, but now the anti-pain pills seem to be causing a weird reaction, so we are going to ease off on those this evening if the specialist vet agrees.

Perhaps the specialist vet also has some more specific ideas on food that we should feed. I did read on her site that she's a fan of giving raw diets to animals. I don't know if that means uncooked meat or what. We will find out and share when we're home.

Thanks for the encouragement Melanie. We're hanging in there. ;-)

 

Re: Charlie - Help - 2 days of diarrhea & vomiting. Scared.

That's great that you got copies of Charlie's records. As to the diarrhea, it could always be something simple too (so try not to worry too much) -- like a disruption of her intestinal bacteria (imbalance in the good versus bad bacteria) caused by her diet change this month or even from stress. And goodness knows her little body has been under a lot of stress lately. I know my cats tend to get diarrhea from stress -- and also that the consistency of their stool changes with whatever they are eating too. This happens with humans too! When your intestinal bacteria gets imbalanced (like sometimes from antibiotics or eating strange foods), you will continue to have diarrhea until your "intestinal flora" gets balanced again. So, the answer may be as simple as giving Charlie pro-biotics to repopulate the good bacteria. Of course, I am just guessing, but the new vet should be able to give you an educated assessment on the conditions. I am just trying to help you not worry so much...as the cause could be something fairly simple.

Honestly, that's why I like holistic vets (the "whole cat" perspective). While some traditional vets see diarrhea and immediately think, "What kind of pill can I prescribe to stop this?" (and PS, a lot of these pills have side effects that are worse than what they are trying to treat); rather, a holistic vet will look at the whole picture and try to figure out why the system is out of balance and how to bring it back into balance, using substances that are the least toxic to the cat. I like the fact that the holistic vet is a "real vet" though... graduated from veterinary school, yet sought out the additional training to better understand the whole cat (not just how to treat parts of it by giving pills and shots...trying to get you out the door in 15 minutes and collect $200)... if that makes sense. LOL!!! So that the holistic vet can certainly prescribe strong medications if needed, but they are also knowledgeable about less toxic alternatives.

Good luck!!! Let us know how it goes!!!

 

Re: Charlie - Help - 2 days of diarrhea & vomiting. Scared.

Paws crossed that the new vet will be able to steer you in the right direction for sweet Charlie.

There are people here who feed raw diets and they do particularly think it helps with pancreatitis. A vet has info on raw diets here : www.catinfo.org

 

New Vet's Thoughts: Lantus VS Caninsulin

“Flexibility requires an open mind and a welcoming of new alternatives.” ― Deborah Day

I am very optimistic about Charlie's new vet. We have decided together that since our current approach is not working for us, that we need to change it. We are doing that starting tonight.

Earlier today when we talked to our old vet, she said that "the best university in the Netherlands does not recommend lantus insulin and that is why they only prescribe caninsulin". I told this to the new vet, and she said, "Yes, I have spoken to the head professor there and told him I disagree. The only reasons he could come up with for why they stick with the old protocol is that Lantus was designed for people and not for animals. I remind him that caninsulin was designed for dogs, and that a LOT of people kill their cats with caninsulin because it is so terribly hard to manage the extreme drops."

How the new vet sees it:
- She says that from her experience, it's not 30% of cats that are able to get off the juice (insulin). It's 50%.
- She believes this is tied to use of the right insulin for your cat, blood tests/home testing, and a very regulated diet
- In her view, even 5% carbs per meal is too high. She wants us to only feed charlie wet food that has less than 1 or 2% carbohydrates.
- She is a proponent of raw foods (uncooked chicken, beef, lamb, sardines). Just no pork. She says that cats have the ability to digest this without the risky effects that humans do.
- She recommends fish no more than 1-2 times per week and says that real fish is better than canned tuna, etc. But even canned tuna is better than tuna cat food because it's higher quality.
- Proportions of food per day (2 x 40 grams). This is how I remember it, but maybe I heard her wrong. My partner heard it differently. Need to check.
- She says the pain pill (tramedol) is too hard on cats and that it's normal that she looked drunk. It's basically an equivalent to methodone or morphine. She says to stop using it until we confirm that pancreatitis is in fact, causing pain (as it could be the diarrhea/vomiting that's causing pain).
- She is not a fan of caninsulin. She even thinks that (Melanie, here's the part where you say "SEE! I told you so") caninsulin could be the reason why Charlie is puking with extreme diarrhea. She said she had 1 patient in the past where that happened, and when they switched the cat to lantus, it stopped. In our case, she said we can't be sure that's the cause, but by switching to lantus we will see if there's an improvement, and if so, we stick with it.

So that's it. Current status:
- Pre-shot blood test came in as "HI" on our meter. We did the test twice and it still came out as "HI". I assume that means "Off the charts"! Does anyone know? I'm also guessing that is because Charlie now has an extreme fear of getting in her carrying case, driving in the car, and sitting on metal tables where strangers touch her belly.
- We gave Charlie 1 unit of lantus (this is what the new vet prescribed). She says 2 x 1 unit. Twice a day as with the former insulin. THOUGHTS, Lantus users, based on Charlie's chart (though keep in mind that all figures in the chart are from days where we used caninsulin). So I'm not sure this is a good reference.
- Charlie still has diarrhea. We gave her a 2nd half tablet of the anti-diarrhea pill from the other vet. The new vet says that stuff is harmless, but it is less effective than a new powder that she gave us for future diarrhea episodes.
- Charlie is still real mad at us. She is completely ignoring her dinner and water. She's now sitting in the other room with her butt facing us while looking onto the back porch. We need to give her some time to calm down and get out of panic attack mode.

If any of you are connected to any specialists on lantus, or have any tips or threads you can send me to for learning about it, I'd appreciate that. Knowledge is power.

My impression of Charlie right now:
:dizcat bcatrun_gif

Oh, and for a REAL good laugh, take a look at my photo link to see the new food that Charlie was prescribed. VERY ironic brand name given the kind of weekend she has had!

 

Re: Charlie - Help - 2 days of diarrhea & vomiting. Scared.

Hurray, hurray! This sounds very encouraging. There certainly are raw feeders here; they mostly follow this vet's recipe: www.catinfo.org. She does feel that just the protein is not enough and that supplements need to be added. You might check our her recipe and ask your vet.

There is a protocol for Lantus developed by the vet school in Austrailia. I would start a new thread and ask specifically for Lantus help. Meanwhile on this page (the Lantus forum) i have linked, do some reading. The starred topics at the top have great info on dosing, care of the insulin, etc.

http://www.felinediabetes.com/FDMB/viewforum.php?f=9


I think things are looking up for your sweet Charlie!

 

HI meter readings?

Thanks Sue. I really hope that's true and that things are looking up!

Should I be worried about the "HI" meter readings at last test?

 

Re: Charlie - Help - 2 days of diarrhea & vomiting. Scared.

Lantus builds up a shed, as explained in those links. It takes a few days, sometimes, to see much movement. I would test in a few hours and see if it was the stress that caused the high readings (and she has been off insulin for a while before that, right?) and if she comes down a little.

 

Re: Charlie - Help - 2 days of diarrhea & vomiting. Scared.

Yes, the shed takes a few days to fill, so don't judge Charlie's BG numbers based on the first few days of treatment. That is...you may think that her BGs are still running high..but just give it a few days and see if the numbers don't start to come down. Your vet will then (I assume) look at your spreadsheet and advise when you should make dosage changes. Dose changes are based on the nadir (the low point) in the cycle -- which is typically 6 hours after you inject.

So glad Charlie is trying something different!!! Many of us here use Lantus, so if you have general questions, you can ask them here. There is also a specific board for Lantus users too (for more detailed dosing questions).

I would agree that you probably want to start a new thread here since this one is getting so long.

Here's what I can tell you about Lantus -- it lasts about 12 hours and has a gradual onset. On average, it peaks in about 6 hours (though there is variability from cat to cat) and then fades out the same way (gently). So you can think of it like a wave...starts slowly and crests at about 6 hours and then fades out slowly. So if Charlie would happen to vomit her meal after a shot, it is not such a problem as with Caninsulin because the onset of Lantus is so gradual. If you are starting with a low dose anyway (like the 1 unit), it shouldn't be a big deal either way until her numbers start getting lower.

Typically, I check my cat's BG at around the +5 hour mark just to see how she's doing; and then if her numbers are not too low... I typically don't worry any more about her till the next morning's preshot (because her BG isn't going to go down that much more from the +5 number -- assuming +6 is the low point...the nadir). You will learn what is "normal" for Charlie by watching her BG numbers over time (doing curves and seeing how the Lantus affects her BG levels). The reason I like to check at +5 is so I can see if there is trouble brewing, and head it off at the pass. LOL!! So far, I have had no such trouble. Others may differ in their advice on when best to check.

I hope the Lantus works better for Charlie. I know, from personal use, it has a much more gentle action -- so you shouldn't have the dramatic highs and sharp lows like Caninsulin. It is so much easier to manage, in my opinion. Hopefully you can get off that roller coaster you and Charlie have been on for the last month and get back to a normal existence (away from the frequent vet visits). Keep posting and let us know how Charlie does!!!!!!

 

Re: Charlie - Help - 2 days of diarrhea & vomiting. Scared.

Forgot to ask... are you using the U100 syringes? I am not sure what type of syringe you used with Caninsulin but I know that on this board, everyone warns that you are NOT to use the U40 syringe with Lantus -- it must be U100. So just passing that along. Also, I assume the vet explained the proper way to handle Lantus. It is delicate and you don't shake it or roll it. It is already mixed. If stored in the refrigerator, it can last up to 6 months (though some users get less). Feel free to ask questions as you think of them.

PS: I would also say, related to the Barf food (how funny is that!!!) that if Charlie does not take to it, there may be other alternatives to the raw food -- or maybe you could gradually transition her to that food over time. It doesn't have to be an "all or nothing" proposition related to the food --- as most of the cats here who eventually got "off the juice" were using low carb canned (grocery store) food with the Lantus. So again, if something doesn't work for you, just ask questions here; and if something DOES work, please share that too -- so we can learn from that as well.

 

Re: Charlie - Help - 2 days of diarrhea & vomiting. Scared.

My cat gets them from time to time, especially when stressed or when the vet and I increase her dose of Lantus. I would guess that many or most of us have gotten them at one time or another, and they are probably nothing to worry too much about as long as they don't continue. Just check Charlie in a few hours to see if the number has come down some once she is more relaxed.

 

Re: Charlie - Help - 2 days of diarrhea & vomiting. Scared.

I didn't see a reference to it, and may have missed it, but has anyone mentioned sub-q fluids as a treatment option given possible pancreatitis and all the vomiting and diarrhea going on? Did any of the vets check for signs of dehydration?

Carl

 

Do you need food in stomach to shoot lantus?

Carl: ER vet said she was not technically dehydrated due to her blood test on Sunday. The new vet we went to today did not test her blood.

Anyone: is there any risk with lantus if there is not a lot of food in her system? The new vet seemed to think it was not that important as there is less of a drop. So we shot 1 unit before Charlie ate, and now she will not eat and is hiding in the other room.

 

Syringe Type for Lantus

Yes, we also bought new syringes (u100 .3 ml)

 

Re: Charlie - Help - 2 days of diarrhea & vomiting. Scared.

Probably nothing to worry about, especially since Charlie's BG number was HI (off the charts) last time you tested her. One unit of Lantus will only reduce the BG levels so much and the shed is still filling at this time too. With my cat, when her numbers are high, she is disinterested in eating... but as the Lantus starts to work -- around the 4 or 5 hour mark...she gets hungrier and will often seek out food. Don't know if this is true of Charlie or not.

How many hours since you gave her the Lantus? If 5 or 6, you could check her BG level now and that is pretty much the lowest it is going to go - whether or not she has any food.

As her numbers start to come down in the weeks to come, then the food will play a more important role -- which is why they advise to test, feed and shoot. But at this point (low Lantus dose and very high BG numbers), I doubt the food will make much difference today -- so probably no need to try to force feed. You will know for sure when you get the +5 or +6 BG number. Experts, would you agree?

 

Rest

We feel like we should not test tonight and just give her time to calm down from all the stress.
With 'hi' numbers and a 1 unit shot, plus the fact that it takes awhile to build up a shed, tests will be more reliable in the coming days. We will give it a rest for tonight so Charlie can get a little peace.

 

Re: Charlie - Help - 2 days of diarrhea & vomiting. Scared.

I understand. I think the risk is minimal for today anyway (and I believe you said the vet agreed with this). I didn't test for about 2 weeks when I first started (I tried but got no blood). That's why the vet and I agreed on the 1 unit dose as she felt, based on Ninja's numbers that the risk was minimal. Have a nice evening!! Hope Charlie is feeling lots better tomorrow!!!!!

 

When to Test Lantus + Little Victories

The new vet said we don't need to test for about a week since lantus takes time. Still, we'll do our pre-shot tests to see how she's tracking, and maybe 1 after 4-5 hours like you suggested (probably for her evening shot tonight).

Today we woke up to Charlie jumping in our bed and coming to snuggle. It has been so long since she has done that. I don't want to jump to conclusions, but it makes me very happy this morning and I really hope today is going to better. :thumbup :smile:

 

AMPS 7.4?

Charlie is at 7.4 this morning!

Really don't know what to do now.

1/2 unit? Nothing?

 

2nd AMPS 8.8 - Dosage Lantus?

Second test of the day came out at 8.8
Blood sugar is going up. Because this is not caninsulin with large drops over a short time, we will give another shot (probably at .5 just to stay on the safe side).

 

Re: Charlie - Help - 2 days of diarrhea & vomiting. Scared.

Hi! I am not the expert on dosage, particularly at the lower levels. If I am interpreting your data correctly, translated to US numbers, Charlie had a pre-shot BG value of 133.2 (7.4 x 18) which later went up to 158.4 (8.8 x 18) and then you gave her .5 of Lantus (is that correct)? I would say to keep an eye on her... test around +4 and see how she's doing. Did she eat anything? Her low point will be around +6. You probably have nothing to worry about since you gave her so little, but still, keep an eye on her.

I would advise changing the subject line of this post (or, better yet, start a new topic) asking for help on Lantus dose ("Low numbers, need help on Lantus Dose") and also post to the Lantus Tight Regulation forum. Those people are the EXPERTS ON THIS. Here is a link to that Board: viewforum.php?f=9 . They are going to be your guiding light moving forward. On your post, attach one of the icons above (like the star) to get attention. This is not an emergency so I would not use the "911" icon.

In your new topic, provide a brief history, that this is your first day switching from Caninsulin to Lantus and that you need some eyes on Charlie's numbers. You could also provide a link back to this original thread if anyone wants to read Charlie's history in depth: posting.php?mode=reply&f=28&t=74148

The GOOD NEWS is that Charlie is really responding to the Lantus and maybe, based on other cases I have seen here lately, she will be able to get off the juice soon. Hard to say, but that she has responded so quickly and so well to just a small dose is very, very positive! The bad news (and it isn't really bad) is that it will be a more delicate process of guiding Charlie since she needs so little of the Lantus -- but the folks on the Lantus Tight Regulation board will help guide through this and give you guidelines on when to shoot and not to shoot.

PS: So happy to hear about the "bed snuggling." That means Charlie is feeling better! Did she eat today? How's the diarrhea and vomiting?

 

+3.5 is BG 6.3 Bruised Ears

Tested just now at +3.5 and she was at 6.3
No more vomiting.
No more diarrhea.

Still giving her 1/2 tablet of anti-diarrhea pills twice a day. Those seem to be helping.
I will start another thread now as many of you have suggested.
Her ears are now quite bruised up so we really don't want to do too many tests. Perhaps again at +5 or +6 just to be sure she's not crashing. She seems hungry so we put out a bit more food (salmon for humans from the can).

Dinner will be the "barf" (haha) raw food rabbit, just as a test to see if she will even touch it with a ten foot pole.
:mrgreen:

 

Re: Charlie - Help - 2 days of diarrhea & vomiting. Scared.

You probably read PumaMum posts over the last few weeks (spreadsheet here: https://docs.google.com/spreadsheet/ccc ... li=1#gid=0 )

I mention them because Puma, too, responded quickly to the Lantus and was OTJ in just a few weeks. Paws crossed that this happens for Charlie too! It looks like PumaMum stopped shooting somewhere in the 150's (8.3 metric... though please let the Lantus experts guide you on this). They may want you to taper slowly.... like .25, then .1 etc. But I mention this because, when PumaMum had stopped shooting for a few days (because the numbers were under 100 US or 5.5 metric) and Puma suddenly started posting BG numbers in the 40's US, 2.2 metric (without receiving insulin), PumaMum got a little frightened and thought Puma was having a hypo - when in reality, it was just his pancreas kicking in and balancing Puma's BG on it's own. So just reiterating (which you probably already know) that if you see this in your future -- it is no cause for alarm. You can't have a hypo event more than 12 hours after you give Lantus.

So.. while a 40 US BG (2.2 Metric) within a few hours after giving Lantus may be cause for concern; a 40 (2.2 metric) when you have given no Lantus in the preceding 12 hours is cause for joy.

Keep us posted on how Charlie is doing!!

 

Re: Charlie - Help - 2 days of diarrhea & vomiting. Scared.

Those numbers are sounding so good! I wish that was my cat!!!! Great that there is no vomiting or diarrhea!!!! If she won't eat the barf food (how could they NAME IT THAT???), just continue on whatever you are giving her now. She seems to be doing great on that (related to her numbers anyway) My cat Ninja gets hungry when her BG numbers drop, so she self-regulates to some degree in that way (which is good).

 

Raw Diet Link + New Vet's Thoughts on Pancreatitis

Quick update (before I post to the other lantus board):

- We did a second blood test at +5.5 and Charlie is at 7.2 (130 in US terms). Seems her Nadir on lantus may be sooner than +6? At least we know that for the time being, giving .5 units twice a day is safe.

- Charlie does not seem so energetic now. She looks down in the dumps again (tired, or majorly annoyed). She has been hiding behind the couch again most of the day after that morning snuggle (but oh how nice it was to see her cheerful for a few sweet moments)! She's nowhere near as weird as she was over the weekend (with the diarrhea & vomiting) but she isn't normal either. Guess she's adjusting to her new insulin, or still has some pain?

Forgot to mention that our new vet recommended us to check out this website (in case it is interesting for you guys too):
http://feline-nutrition.org/

For those of you on facebook, the facebook page is: RawFedKitty

The other interesting thing is, the new vet said she is not convinced that Charlie has pancreatitis. We sort of got signs of this from the 2 ER vets as well. During the 2 ER visits this past month, those vets touched Charlie's tummy to probe for swollen organs. Charlie didn't love this, but at the same time, she didn't squeal in pain either. Both DRs said that normally cats with extreme pancreatitis get much more vocal or squirm.

My new vet says that in her opinion, we have only tested 1 thing for pancreatitis so far (Charlie's lipase levels) and that test came out positive.
A true test for pancreatitis would also include an ultrasound (expensive so even though it would make it more clear, she doesn't recommend it right now).

In her view, vets telling people their cats have pancreatitis is like Dr's telling parents their child has A.D.D. In many cases it's true, but also in some cases, there are examples where kids get prescribed ridilin and they do not need it. Her quote was "Ever since there is a test for pancreatitis, many cats seem to have it." She smirked.

So it can go one of two ways:

- Either Charlie has pancreatitis. If she does, her ability to get off the juice may be hampered, or even impossible. If this is the case, we would see more episodes of vomiting & pain as well and then we need to think about how to manage that.

- Or, Charlie does not have pancreatitis and she does still have the theoretical ability to get off the juice. Let's hope for this! The vet said there is a theoretical possibility of this, especially since Charlie's insulin has been going down in general quite quickly. Lets see what happens.

Like all of you, we really don't know at this stage. We are hopeful, but of course not at all overly idealistic about this either, as if it comes, it comes.
We will feed her a more restricted diet, try out the new type of insulin, try to tightly regulate it and test, and see how it goes.

As a side note:

We went back to our old vet this morning to see if she would take back the unopened bottles of caninsulin and unopened syringes. I really REALLY expected them to say no (especially to the insulin), but as we came straight from the house and the bottles were still cold and just out of the fridge, she took them and gave us some money back. This, I think would NEVER happen in the US (as someone could someone could theoretically spoil the insulin somehow and it could hurt another cat and cause lawsuits). From our perspective, it was nice though (as we have already spent 1000 Euros in just 1 month)! Still, from a clinical point of view, I think it's a sign that although my old vet is nice, they are the WRONG vet for our needs. Again, thank you Melanie for encouraging us to "break up".

We told our old vet why we were going to go to a specialist and she said she understood. She says to give her a call in a few weeks to let her know how it's going, and if we ever need them again, we should come back. Good to know.

 

Re: Charlie - Help - 2 days of diarrhea & vomiting. Scared.

Charlie may be hiding from more blood tests. LOL!! Don't blame her. She has had a lot of poking and prodding lately. Not sure about a nadir being at +3. Have never heard of that, but you are new to Lantus (this is your first day and the shed is still filling) so hard to draw conclusions about anything in these early days. The experts will weigh in on that. Typically, I believe you are supposed to look at the numbers over days and look for patterns. (????)

Interesting about the pancreatitis. Here's hoping Charlie does not have it after all. Also great news you were able to get some of your money back on the Caninsulin. You are right, I do not think that would happen here in the US. That is also great that your old vet is still open to helping you -- should you need her in the future.

As a PS: My intent was not to get you to "break up" with your old vet, but rather to "date around" to see what else was out there. LOL!!! I sure hope the new insulin works better for Charlie. Even now, her first day, at least her numbers are showing some stability - compared to the Caninsulin -- which should provide some relief for you both.

Keep posting to let us know how things are going. BTW: Since you are in the Netherlands (6 hours ahead of us on the east coast in the US), not many of us are up when you get up in the morning -- so if you ever need a quick answer and no one is showing up on the Lantus board, re-post to the main board and you may find someone there.

 

Little Positive Developments

Charlie is still very very tired, but we've seen some positive behavior changes throughout the course of the day:
- She left her spot hiding behind the couch and laid on the floor near our balcony (where we were sitting).
- After that she slept on our bed (just inside from the balcony)
- Tail not drooping (as it was earlier today)
- She's eating (so far she avoids completely the raw diet, so we gave her other food that's still under 2% carbs)
- Number are stabilizing much more every since the move to Lantus (at least so far). We will do one final test before bed, but overall we are VERY HAPPY to have left caninsulin behind in the dust.



Any developments, however small, keep us smiling.

 

Re: Charlie - Help - 2 days of diarrhea & vomiting. Scared.

Early signs look promising! Please continue to update with her progress over the next week or so, as this info could be of help to others who may be considering a switch from Caninsulin (how Charlie tolerates the Lantus, if her numbers continue to stabilize and if her behavior returns to normal). So glad to hear things are looking up!!

 

Re: Charlie - Help - 2 days of diarrhea & vomiting. Scared.

Charlie came to snuggle in bed again.
She is out from behind the couch. Last night she even slept on her chair where she normally sleeps.
AM pre shot was 22.6
Stiil gave .5 unit at 7:30am.

Woke up to black poop & diarrhea in the litterbox. God awful smell! Gag....
Will keep going with the anti-diarrhea medicine, but will switch to the version provided by the holistic vet (a sort of powder with cyllium, bentonite & lactobacillus).

I need to go back to work today so will not be able to do the test in 4 hours with my partner. Lets see if 1 person can do the blood test on their own with this little tiger. It's going to be difficult. Does anyone have tips for how to do blood tests on your own? I guess many of you know how to get this done. Charlie will not eat the treats associated with blood test time. I still can't find any that she likes. I just hold her and snuggle her and we do the test (struggling to find a remaining, unbruised spot on her sweet little ear).

Nobody is replying to my question on the lantus board yet. Maybe today?

Oops. I spoke too fast. Charlie is back hiding behind the couch.

 

Re: Charlie - Help - 2 days of diarrhea & vomiting. Scared.

Hi Jill! I guess I am the only one up at 5 am here on the east coast of the US - as it seems I am always the one replying to your post first. LOL!! I don't think you can read much into Charlie's numbers yet. It takes a while for them to settle down. In addition to just starting Lantus, you also sometimes get really high numbers whenever you increase dosage too. Not sure why but I read that in the protocols and that has been my experience as well. When I increase dosage, I get some odd high numbers (along with normal ones) for a few days and then everything settles down. Just keep posting your readings and a picture will begin to take shape.

Sorry about the poop...LOL! The unusual smell could be from the strong medicines Charlie has been on recently (just a guess). I know that is true for humans.

It would be good to get a BG reading around the +6 to see how she's doing (start developing a pattern), but if your partner is not successful then it's not the end of the world. Charlie is on such a low amount of Lantus and her pre-shot was high today - so not much danger there of her going low. What treats did Charlie like to eat before she was diagnosed with diabetes? Does she like catnip, or a special toy, brushing or anything else that makes her purrrrrrrr? Maybe it's going out on the porch...or something else she like do do? If you can find that one thing she really likes, and withhold it except at testing time (so she associates that positive experience with testing), that is the key.

I saw some replies on the Lantus board from your question of yesterday. With the dosing adjustments, you can go at your own pace. If you and your vet want to hold Charlie at .5 for a week or so (till you get used to things) that should be fine. Others will comment on this as well. If you can't do tests every 3 or 4 hours at this time that is ok too.. maybe hang out on the Lantus relaxed board for awhile (as well as the Lantus tight regulation) to see what they are about too. I know you and your family have been through a real roller coaster ride this last month with the Caninsulin, and probably could use a break. The Lantus insulin is gentle and Charlie is on the lowest dose, so you have time to ask questions and go slow. Hope that all makes sense -- just saying not to feel pressured to move too quickly . The support groups are here, ready and waiting -- whenever YOU are ready.

Glad to hear Charlie came to snuggle in bed again this morning and slept in her chair. That must mean she is feeling better. Maybe she is hiding behind the couch trying to avoid more BG testing today? I'm not sure why her ear is getting bruised, as my cat's ears do not get that way -- though my cat is black and maybe I just don't see it? Post the technique you are using for the BG tests (lancet guage and poking technique...LOL) and maybe someone will have more advice. Do you pinch the ear (gently) with your cotton square to stop the blood after testing? I read that would help minimize bruising - but hopefully others will have more tips on this.

 

Re: Charlie - Help - 2 days of diarrhea & vomiting. Scared.

i'm sorry, but this statement is misleading. those of us who have worked with lantus users for years have seen some kitties drop from very high preshot numbers within the first few days of administering even small doses of lantus. it's why spot checks are recommended whether a tight regulation protocol is followed or not.

here's one such example and i could cite many others:

• 3rd shot of insulin

• dose = 0.5u lantus

• amps 400, +6 88, +10 88, pmps 197

jill, it sounds like you're having a little trouble with testing. rather than pressuring you to test, i'd like to suggest feeding or having food available for charlie mid-cycle because *most* kitties will eat when they feel their blood sugar dropping. food will help keep her from dropping too low if she happens to be one of those kitties who wants to practice her diving skills early on. :mrgreen:

just a suggestion...

 

Re: Charlie - Help - 2 days of diarrhea & vomiting. Scared.

Re finding a treat Charlie likes - does she like tuna or chicken? Tuna without oil is a good treat. So is just plain chicken, baked with no spices and chunked. Finding a treat she anticipates will help with the testing.

Sorry about the poop. Hope the new medicine works.

 

Re: Charlie - Help - diarrhea again. Blood in urine! Scared.

Please help. Any ideas? Heading home from work in a taxi now feeling sick to my stomach. Our new vet is only there on mondays in amsterdam. Our old vet doesnt recommend lantus so i dont know what to do.

New vet says it may just be stress. She says we need to test her urine as it may also be a bladder infection. This is never ending. My partner says charlie is real sack and is not moving. I am heartbroken and scared. nailbite_smile

 

Re: Charlie - Help - 2 days of diarrhea & vomiting. Scared.

Did you get a BG reading on her? She's not hypo is she? I have never heard of blood in urine being associated with Lantus or insulin (experts...what is your opinion?). It seems that a lot of diabetic kitties get urinary tract infections or cystitis - which your original vet should be able to help you with.

I am so sorry Charlie is not doing well. Experts....do you have any advice for Jill and Charlie. Can anyone speak about the symptoms of UTI or cystitis?

 

Re: Charlie - Help - 2 days of diarrhea & vomiting. Scared.

Jill & Alex: I apologize. You are right. This was advice my vet gave me about my cat (when I was afraid to leave her to go back to work) and I was passing it on, as no one else was up this morning to advise. What is the recommended protocol on this -- when the caregiver has to leave the cat for the day to go to work and cannot spot check during the day? I would imagine this is a common problem.

 

Re: Charlie - Help - 2 days of diarrhea & vomiting. Scared.

I'm wondering if this is even diabetes related. I'm shooting from the hip here so please take it as such...

Is there any chance she got into anything toxic? (rat poison, antifreeze, poisonous plants (lillies are especially bad), etc?)

Could she have ingested string/yarn/tinsel/rubberbands, etc?

Is there any bruising elsewhere on her body (other than her ears, which is expected)?

And a few general questions...
What is her temperature?
What is the color of her gums, inside the ears, and whites of eyes?
How is her breathing?
Do her pupils react to light?
Does her skin stay tented when you pull up on it? How do her gums feel (dry/tacky vs moist/slimy)?
Did the vet do full bloodwork? X-rays? Stool sample? Urinalysis? Urine culture/sensitivity?

Yes diabetic cats are prone to UTIs. The blood in the urine could be related to everything else that's going on or not (highly doubt that it's a side effect of the Lantus). If she's truly non-responsive, it's an emergency and you need to get her to a vet. (yes, test her BG ASAP and treat immediately if she's hypo). My two cents...

 

Re: Charlie - Help - 2 days of diarrhea & vomiting. Scared.

Hi Jill,
I've been following your saga and am so sorry this has been so difficult for you! I just wanted to comment on the "black" poop. When we were trying to find the right diet to deal with my kitty, Max, and his diabetes AND confirmed pancreatitis (suspected IBD) he experienced an epsisode of black poop (like an Oreo cookie). His stool was formed, but the vet had me check to see if it was also black inside (sorry for the graphic details). It was. Shortly thereafter he stopped eating. We discovered that he was experiencing instestinal inflammation (and bleeding) due to irritation from the food he was eating, thus the black poop. We were able to adjust his diet (after a lot of experimenting with different foods) and he is doing well again. Max also hid when his tummy was hurting, but sometimes all the ear pricking and my anxiety caused him to hide too.

By the way, we were also using Lantus and have been OTJ after just a month.

Good luck! We're thinking about you and Charlie.
Heidi and Max

 

Charlie - Help - More Diarrhea with blood

I actually got it wrong in my panic in the taxi on my way home from work.

The blood was actually in Charlie's diarrhea.

We were giving her anti-diarrhea medicine Monday & Tuesday (1/2 tablet finidiar AM & PM) and that had stopped the diarrhea, but on Tuesday we didn't see any poo so our new vet said to stop the finidiar as maybe it was making her constipated. We did that. The new vet gave us a new anti-diarrhea powder (bentonite, psyllium, etc mixture) that was supposed to flush her out. We only gave her 1 spoonful of that in with her food this morning after we saw the black stool and diarrhea again when we woke up. It didn't stop the diarrhea as she pooped 5 times today (all times were diarrhea). A few of the times there was blood in the diarrhea, and even slimy stuff. Our new vet says slimy stuff is normal with the bentonite powder, but not the blood.

Called the old vet: She says it's no big deal and we should not panic. She thinks it may be broken mini-blood vessels in her intestines due to all the cramping and diarrhea over the past days. She closed at 4 so cannot see Charlie. She thinks it's not an emergency. Says we can bring urine in for a test tomorrow if we want but she says Charlie is a difficult cat so there's not much they can do. ??????

Called the new vet: She says she's less concerned about the diarrhea and more concerned about how Charlie has been acting today. She says if we can manage to get some urine collected between now (4:30pm) and 6pm, her assistant will be at the office in amsterdam, and she can do a urine test for both ketones and for a bladder infection. We still have no ketone test strips. They are not available at the pharmacy here. We tried ordering them online at amazon.com, but they will not ship them from the US to europe. ????
We still need to find a way to get them to have some on hand. For now, if Charlie will pee and we can collect urine in the next hour, we will take it to the assistant at the new vet. If not, we try again in the morning. In any case, we will go to the new vet's office before 6 to collect some sort of anti-pain stuff that is not as harsh as the methodone/morphine pills that we had her on this past week (tramedol) as our new vet says that stuff is bad.

Report from Today:
- Charlie came to us in bed this AM
- After she ate, hid behind couch with cloudy eyes (hiding behind the couch is NOT her normal behavior. It seems to be what she does when she doesn't feel good as she wants to avoid us).
- Later, Charlie got up a little bit, sat by balcony door (not hiding but not active either). Just laying there.
- She got up again at 12. walked around a bit. her eyes had cleared up
- Then she went back to hide behind couch some more
- After that she came out again. that's when the diarrhea started. since then she has been real lethargic, depressed, and weird.

My partner says ate a little bit this morning (about 20-30 grams of wet food). She has been drinking throughout the day.

AMPS (7:30am) = 22.6
Blood glucose +6 = 20.8 (partner not sure if this worked as there wasn't a lot of blood)
Blood glucose + 7 = 16.1
Blood glucose + 8.5 = 17.1

For the 2 blood glucose tests that my partner did, Charlie was squirming. For the one I just did with my partner at +8.5, Charlie growled and expressed her discontent, but to me, she acted like a wet noodle. She was tired, limp in my arms, discontent.

Our new vet said if there's blood in the urine, it could be a bladder infection, but she didn't give any feedback on blood in the stool. So far, we haven't seen any blood in the urine but I guess if we can collect some urine we will still bring it in to have them test for ketones and a bladder infection.

Thoughts? This is just never ending. PLEASE help our girl feel better. This has honestly been one of the worst months ever. :YMSIGH:

 

In general, you have to ask for / demand tests in the Netherlands to get them done.

They take a very natural and passive approach to medicine in general (with people and also with animals). My impression is that much of this is cost driven on the human side as healthcare is provided. So maybe this all around way of working trickles over the veterinary medicine as well. I'm not sure. I've been here 6 years and this is what the locals tell me. They say "demand it and be forceful if you want something". So generally, you have to be very knowledgeable and firm and you'll get what you need if you inquire about it.

With Charlie, I don't always know what we need, and I"ve also spent so much money on this that I don't want to be foolish and stupid. In a way, I also hope the vets will guide me and I use this board to help guide me in a focused direction on what to do next / what to push for.

Thus far, I've pushed for the blood work. At the ER the 2nd time (Sunday), they said she was not dehydrated, did not have ketoacidosis shown by her blood test, and the blood test showed no emergency reason why she should get an IV or stay overnight.

We have not had Xrays. We have not had stool samples tested. We had a urinalysis once at the beginning (showed she tested positive for diabetes). We have not had a urine culture/sensitivity test (whatever that is).

Our new vet is VERY sweet and will help us with what's needed. I guess the challenge is that she's only there on Mondays so if things are urgent, I need to know that and take charlie either to our old vet (who doesn't really move mountains to get her in, and who has an attitude that my kitty is difficult so I should just kick back and wait). Or I need to take her to the ER vet (300 euros each time, so I need to be sure).

It's tricky. For now, I will drive to the new vet's office. Charlie has not peed but they will give a pain killer and will give me a ketone strip to bring home so I can at least get that reading on my own tonight. Then I will be back on the board here looking for help. Hope you guys will be around. If not, more CRASH reading on the internet. What did people do before technology was there? This board just crashed for a moment and I almost had a heart attack. More later.... got to get in the car now to get to the new vet before they close

 

What food are you giving Charlie? You said she was feeling fine, no diarrhea this morning - then she ate (and that you included the new anti-diarrhea powder in her food); and after that, Charlie's eyes got cloudy and she went to hide behind the couch again; and the diarrhea started again. So, I am guessing (this is only my non-expert guess) that is could be connected to either the food or the new anti-diarrhea powder -- that one or both did not sit well with Charlie. Of course it could be anything...but those are the two things I would start with -- and as you said, you are working with your vet to make sure it is not something more serious.

Is the food she is eating now new to her (new this month, since she was diagnosed with diabetes)? If so, do you think it could be a contributing factor to her vomiting and diarrhea of the last few weeks? Is there a reason you gave Charlie the anti-diarrhea powder this morning if she did not have diarrhea? Just wondering as anything new could be the culprit.

Does Charlie seem to be feeling better as the day progresses -- that is, as more hours pass from the time she ingested the food and the anti-diarrhea medicine? If so, maybe that is telling as well.

Does the new vet understand it is blood in her feces and not urine? I am wondering why they are recommending urine tests rather than a test of her stool? I did read in a number of posts that occasional blood in the stool is somewhat common; not that I am recommending that you take it lightly by any means - just that many cats seem to have this from time to time. My cat Ninja has had light bloody mucus in her stool on occasion; though she was otherwise acting normal. The vet said if it persisted to bring her in; but it didn't.

Sorry for all the questions. Please keep us posted on her progress.

 

Hello.
I am interested in the diarrhea medicine. It has psyllium in it? ? That's a strange combination because psyllium is basically fiber
which is counterproductive to loose bowels. You take psyllium to make yourself go.
I would think the previous diarrhea medicine that had her not pooping afterwards was the better one. After several bouts in the box,
you would want the medicine that slows it down.

All the different combos are probably wrecking havoc and she needs some time to stabilize.
red blood indicates the bleeding is external or close to the exit, dark red/black indicates something more internal.

She could also be sensitive to an ingredient in the food.

If you would private message me your address, I would mail you ketostix, gratis.

 

PS: I just looked up bentonite & psyllium and this appears to be a "colon cleanse" which is supposed to help detoxify the body -- but basically a strong laxative (at least for humans); so I agree with Rhiannon about this. The notes for human consumption say to "stay close to the toilet" if you use this.. LOL!! So not sure why that was recommended -- though maybe to get all the harsh medicines out of the system from the last few weeks. But personally...I would try eliminating that powder (no pun intended); and also run this by your vet as well (why prescribe this if your cat already has diarrhea?). You can also google "bentonite & psyllium" and will find the references I did.

PS: Are you sure Charlie needs a pain killer? Maybe she just needs to rest from the bentonite and psyllium? I ask because the more meds you introduce into her system, the more complicated it becomes. But you have to decide whether she needs it or not (not me). Just throwing that out. Also, if Charlie continues to have diarrhea maybe she could go back on the Finidair. It was the last "good" thing that worked for her, and even your new vet said she did not think it was harmful -- so you might want to run that by the vet as well (ok to go back to the Finidair if needed?).

PSS: I am going to send you a private message (PM) with my email address, in case the site goes down again and you need some emotional support getting through the next few days (until Charlie is feeling better). I am hoping that some of the Lantus dosing experts might do the same -- as I am not experienced in that area and can't help much there. I know how scary it is being new and for the FDMB board to go down. Not sure why that has been happening lately, but I will PM you my email, just in case.

 

Hello again,

I would have to agree with Melanie. I'm suspicious that something is bothering Charlie's intestines. It's hard to know if it's the meds or her diet. Sometimes it took a few days to a week before we knew whether Max reacted well to a diet change. It not we got vomitting, black stools, or no appetite.
It's also my understanding that red blood in the stools occurs at the end of the intestinal tract or in the rectum from straining or irritation and black stools is a result of inflammation and bleeding further up the intestinal tract. We dealt mostly with vomitting and not diarrhea so never had to use anti-diarrheal meds, but I can see how they could cause issues too. I remember it being a vicious cycle until we got the vomitting and appetitie figured out.
Just my two cents....

Heidi

 

Hi guys,

This whole last month has been a series of changes for Charlie, so yes. The food has changed and this is one factor. She ate dry food her entire life (for the most part, high end "theoretically healthy" weight loss food prescribed from vets). We've tried all sorts of wet foods this past month as we switched her over to only wet food. Now we're moving to a diet of wet food that is less than 1-2% carbs.

What she ate last night:
- We put out raw food (40 grams of the frozen rabbit bought from our new vet). She may have tasted a tiny bit, but I think more than likely she didn't touch anything.
- As we saw that she wasn't eating it, we put out 1/2 can of a new brand of wet food "Natural Health" (ostrich). (10.8% protein/5.7% fat/2.2% minerals/.4% fiber/79.5% moisture). She ate some of this but didn't really seem so interested.
- So we put out 1/2 can of human salmon from the can (0 carbs/8 grams fat/ 19 grams protein per 100grams). She ate most of that.

We left the food there when we went to bed. When we woke up, all the food was gone except the raw rabbit. So she ate something last night, but yes, it was all new to her. And all recommended by the new vet (except for the salmon, which our vet said "should be fine if it's for humans").

We just wanted to make sure she ate since she was getting new insulin and had a rough weekend of vomiting and diarrhea for 3 days.

This morning, she ate 1/2 can of a new brand of wet food "Renske" (chicken and rabbit). In it, we mixed 1 spoon (or less) of the new, powder anti-diarrhea stuff from our new vet.

It's true that the "finidiar" from the old vet stopped her diarrhea on Monday night and Tuesday morning. The only thing is, on Tuesday, it seemed that it stopped it so much that she wasn't pooping at all. So our new vet said to give her some of the powder (Puur Natuur brand "puur spijsvertering" for dog & cat). Spijsvertering is Dutch for "digestion".

This is the exact list of ingredients (sorry for the poor translation - google translate does a lot but it doesn't work miracles):
Suitable for: Cat, Dog
Composition: Composition per 3 grams: Natural products, botanically defined: Psyllium Husk. Other Ingredients: Methylsulfonylmethane 625.5 mg, 8.0 mg Magnesium (as citrate), Fructo Oligo Saccharides and a dilution of Magnesium phosphoricum.

Additives per 3 grams: Technological additives, binder: 104.3 mg Bentonite.

Indication (s):
• By eating the wrong thing
• a disturbed bowel function
• for constipation
• preventive for the purpose of an optimum gut function

I asked the new vet's assistant today if she was sure this wasn't for constipation and not diarrhea. She said it's actually for both.
Still, by phone, I decided with my new vet to put Charlie back on the old "finidiar" for this evening and tomorrow, until the diarrhea is gone. The old vet told me previously that normally cats need to be on "finidiar" for 3 days before things normalize. We only have enough for 2 more days, so by the time it's gone, I'm hoping the diarrhea will be completely gone.

The new vet didn't necessarily suggest the urinalysis. I mean, she did, when I originally called to tell her I thought Charlie had blood in her urine because she thought it could be a bladder infection. Then, later when I called back to say I was mistaken and that the blood was actually in her diarrhea, she said we didn't need it. Still, I saw a note from the lantus board suggesting that we should test Charlie's ketones this evening, so our new vet said we could just test for both in a urine test. The new vet's assistant gave us the strip to do so at home, and we will do so this evening when Charlie pees.

You also asked if Charlie has been feeling better as the day progresses today. That's hard to say. From morning to afternoon, it got worse. She still seems down in the dumps, but maybe a little bit better since her evening shot. At that time, we also gave Charlie 1/2 tablet of finidiar again, and force fed her a few syringes of a fluid from a brand called VIYO for "recuperation". This fluid is supposed to just restore key vitamins and minerals to get her feeling better after all the weekend she has had. It says it's for "effective, rapid and smooth support recovery from illness or surgery". (www.viyorecuperation.com)

We chose not to give her the pain pill. Goal is to avoid as many new variables as possible to start slow and see what works first.

Charlie is now out from behind the couch. She's sleeping in her chair in the living room. Looks very wiped out and tired but that's all I can say at the moment. Later when she's up for her +3, I'll check the other things you inquired about (color of gums/inside ears/whites of eyes/etc).

Check her sheet for the latest stats. Her numbers seem to have gone up today in general.

 

I like the idea of avoiding as many variables as possible (less medication). I understand how Charlie would have gotten worse from morning to afternoon -- assuming the anti-diarrhea powder was working like a colon cleanse for her (it takes a few hours to kick in -- so to speak -- so she'd be fine in the morning but as the day progressed, less comfortable ). But I think its good that Charlie is now out from behind the couch and sleeping in her chair. I hope she is feeling back to normal by morning.

Not sure about the food as I have never heard of any of those brands - but certainly new food can have an effect on bowel movements. That is pretty common. Any experts out there that can speak to this? That is, if you change to a new food brand and the cat has a reaction (diarrhea), how long before that typically works itself out (and again, I mean no puns here)? Do you stay with the new food and ultimately the diarrhea stops or do you have to ditch that particular brand that caused the reaction and try something else? I have not had experience with this so don't really know.

On the numbers going up, again it is very early with the Lantus so try not to read too much into this. They may start to drop later in the week. Experts, is this right?

Post again with updates to let us know how Charlie is getting along.

PS: Is that a new Charlie pic? If so, she is looking pretty good. LOL!!

 

Hi,
sounds like things are improving slghtly.

I'm glad you went back to the Fenidiar since it had an effect to stop the diarrhea.
Psyllium is not going to help with diarrhea and it's the first ingredient.
( I know psyllium very well.... My husband takes it because he is on lipitor (cholesterol) and lipitor can be constipating over time)

If the fenidiar just stops everything up again, I would reduce the dose. You may just have too high a dose as your cat is very sensitive right now. We and they are all individuals and what's a good dose for one of us might not be the right dose for another.

Since you are having to experiment with finding acceptable foods.
I would say go look back over www.catinfo.org
She talks about the "best " food is of bird variety, chicken and turkey. Duck is always going to be higher in fat, and I think ostrich may be in that category.
Fish is good in moderation but you do want human quality.... Often the seafood selection in pet food is the leftovers that sat on the dock
too long and it still gets used, just sent over for pet food instead of people.
Plus if your cat loves it best, they can decide that's all they want which isn't good for them either.

You said the salmon was a hit so I suspect your cat will love the seafood best so your best bet may be the blends like the chicken and fish blend
you mentioned.
You could also find a product called bonito flakes to sprinkle on top of a can of chicken cat food to make him think he's getting fish in his food.
Bonito is some kind of fish in japan and they sprinkle these flakes on their food as a flavor enhancer.

Have you tried dragging a string nearby to see if he'll play a little. That would make you feel better about how he is feeling, especially
if he'll play even for a short time.

We're hoping and praying for you.

 

This is incorrect. Fiber (e.g., pumpkin) can be used to help with both diarrhea and constipation. This is essentially the same information that the vet tech provided.

I would not be overly concerned that Charlie didn't poop after having been given the anti-diarrhea medication prescribed by your old vet. Given the amount he was running to the litter box, there's a good chance he didn't have that much waste in his system to excrete. Not all cat's move their bowels every day. You need to give him a chance to get his GI track back working again.

Has anyone suggested a probiotic? I don't know what's available in Amsterdam but we use a product manufactured by Purina here. It's called FortiFlora. Many people use other, human probiotics but the trick is finding the right dose for your cat. Will Charlie eat yogurt? Yogurt (just plain, unsweetened yogurt) that has live cultures can help with diarrhea. Some cats do not tolerate milk products well, though.

With regard to Ketostix, they are manufactured by Bayer. The company has offices in Switzerland and Germany. You can probably find a phone number and explain your dilemma with regard to getting their product in Amsterdam.

Feeding Charlie exclusively human food is a problem. Human food is not nutritionally complete for a cat. You would need to add a variety of supplements in order to have a nutritionally complete an balanced diet. The link that Rhiannon provided to Lisa Pierson, DVM's site on feline nutrition is an excellent source of information.

I noted in your thread on the Lantus board that none of your links are working. I get a server error with your spread sheet and you are not linking your posts together in a format that works. I'd love to help you with dosing but I need to be able to see your spreadsheet. You need to enclose your links in so it looks like with the http:// info between these brackets.

Do you know if a Snap fPL test is available? This is a test for pancreatitis and is available through IDEXX labs. I don't know if it's available in Europe. Elevated amylase and lipase levels are are not reliable diagnostic tools for feline pancreatitis. Ultrasound is helpful but, as you noted, expensive. The Snap fPL is kind of like an at home pregnancy test -- it's a yes or no, you don't get a number.

 

FYI: I am having trouble looking at your spreadsheet too. The link was working fine earlier today but now is not.

 

Does the link work now?

 

Yes, working fine now.

 

The link is now working!!

For now, hold Charlie's dose of Lantus. Lantus is a depot-type of medication. This means it takes a while for what amounts to a storage "depot" to be established. One of the contributors to the Lantus board wrote this excellent explanation of the insulin depot. It helps to explain why Lantus (and Levemir) are long-acting types of insulin. It also means it takes several days to evaluate the effectiveness of the initial dose of Lantus.

I also want to make an observation. Some cats have difficulty with a food transition. The result is typically diarrhea. It may be that what you're seeing is the result of the quick shift in diet. I would discuss with your vet whether it is advisable to wait this out (and if so, for how long) or to make a slower transition. If you look at Dr. Pierson's website on feline nutrition, she provides information on how to transition a cat from a dry to canned food diet.

Another couple of quick questions... Are you adding water to Charlie's food? I really do suspect that he's dehydrated. He may not be severely dehydrated but any of us who's had a GI flu know to increase our fluids. With the vomiting and diarrhea, he's no doubt lost fluid and adding water to his food will help. (It's also a generally good idea since water is good for a cat's kidneys. They tend to not drink a great deal on their own, with the exception of when their diabetes is unregulated.)

Was Charlie tested for hyperthyroid? This would typically be a test called a T4 on a lab sheet. Some cats who are hyperthyroid will go through bouts of vomiting.

 

Hi, I'm sorry that Charlie is having such a hard time (and you, too!) But I'm glad you got the SS back. ;-) Sienne and others are great at looking at them and working out dosing advice. Lantus can take 5 to 7 days to build the shed and be fully effective. We usually hold the initial dose that long, unless there is a marked drop in BG.

I've never heard of a vomiting or diarrhea reaction to Lantus. It is most likely food related since Charlie has had so much change lately. It is always a good idea to go slow w/ food changes. Or it could be the pain meds he was on or simply stress. The bloody stools do indicate a bowel problem.

The first thing many of us turn to for diarrhea is a probiotic as Sienne suggested. I get a live culture probiotic formulated for pets, but very similar to the human ones. If there is a health food store they may have it. Live culture is best if you can find it, it would be refrigerated at the store.

Psyllium is a fiber source and fiber is actually a pre-biotic, it feeds the probiotics, the good bacteria in the gut. Psyllium can also absorb water (useful for constipation) and add bulk to the stool (for diarrhea). For cats it is not the best choice, but a little doesn't hurt. There are just things that work better. As if you didn't have enough to read and learn about, this site http://www.felineconstipation.org/prevention.html#FiberorPrebiotics explains more than you would want to know about feline digestion.

I looked up the Finidiar to see what was in it:

And this is what the new vet gave you:

Others may have more insight as to what most of these ingredients are doing. I do know that the kaolin and bentonite are both clays and will absorb many times their weight in water, especially the bentonite!

As for treats chicken is usually a hit. Many of us get freeze dried chicken breast treats. If pet stores don't have them, check backpacking websites or emergency supply sites. Raw chicken hearts are great too, they have lots of taurine and are good for cats teeth as they need to chew on them. The bonito flakes are dried, shave tuna. You can find them in Asian groceries for making fish broth. They have lots of other dried fish there too, just make sure there is no salt or other additives. My Cleo used to love the unsalted anchovies. Too much fish is to be avoided though.

I hope things settle down for Charlie and you soon.

 

Help with Test Method

I will start adding water to Charlie's food. She does drink water though, and we have been watching her with an eagle eye on that point. We've even force fed her this emergency fluid a couple of times tonight, and have bowls of water out all over the apartment to make it easier for her. Still, I will add it to the food as this will ensure she gets a bit more.

We transitioned from dry food to wet food this past month. My new vet is of the opinion that Charlie should never EVER touch another kernel of dry food again. I'm leaning in the same direction, as it has taken us a long time to get on the path, and now that we're on it, I want to get even better (improving and increasing our testing too, which I'm not particularly succeeding at yet).

We tried to test at +3 and Charlie was having NONE of it. Squirming, growling, etc. My partner got so nervous that we had to stop. Charlie has such bruised ears that they are not even bleeding at the moment. There is hardly a free spot to poke where we can get a drop of blood at the moment.

Our testing method currently:
- I lie down and put charlie on my belly. Pet her, talk to her, try to make her relax (now difficult.. before it was working)
- My partner warms the rice sock. We put the sock on Charlie's ear for awhile.
- I hold Charlie with 1 arm and hold the flashlight towards the ear with the other (so my partner can see the veins more clearly)
- My partner pokes and tests with the glucometer (freestyle precision).

At the moment it's hard for me to find something positive to associate with this ritual. The treats I have bought Charlie doesn't seem to like or ever eat. Tuna is her favorite thing, but at the moment, if we fail at getting her to eat the other food, tuna is our backup plan. So it's hard to reserve tuna only for the testing (possible in the future, maybe though). We do not use lancets. We use little needles that we got from the vet for this purpose. Those work better for us. Still, we need help with improving the technique.

Charlotte & Prop: I've seen the video on your website and I cannot believe how still you can keep the little guy (without even holding him down). What's the secret guys?

Charlile is back behind the TV again. I'm tempted to try to test on my own right now (just because I take that as an indicator that she's a little weird at the moment and I'm curious about her BG levels). Don't know if I can achieve it though. Tips?

 

Probiotic Ingredients in Puur Nature Spijsvertering

The Puur Natuur brand "puur spijsvertering" actually has a few more ingredients listed in it on the back that are not listed on the website.
I think some of these may have probiotic effects:
- bifidobacterium lactis
- Enterococcus faecium
- Lactobacillus acidopilus
- Lactococcus lactis
- Lactobacillus paracasei
- Lactobacilus plantarum
- Lactobacilus salivarius

We have temporarily stopped using this product though. Back to the finidiar for a few days until things stabilize. Not sure it's good to give both at the same time. Charlie does like yogurt (in small quantities): licking the bowl, for example. I could try that in the meantime to get some probiotic effects?

Again, THANK YOU everyone 100 times over for all of these great ideas, contributions, thoughts, tips, etc. We will not yet do a battery of tests on everything. I am seriously on information overload at the moment so I need to work in baby steps and prioritize what's most important to do first. However, I will prepare my list and discuss with my vet which of those tests are most relevant to do ASAP.

Next step is the urine test with the test strip (Charlie hasn't peed all evening, so perhaps you're right about needing more water!)
This may not happen until morning. Currently hiding behind TV pretending I don't exist. :cry:

 

Urine Test Results - What does this mean?

Urine Test Results (not sure what this all means so those with a clue, please chime in). Otherwise I will call the vet in the morning.

LEUKOCYTES:
3+
ca. 500 Leuco/uL)
In the spectrum of colors, this appears VERY far away from negative (other side of the spectrum)!

NITRITES:
Negative

PH:
(5)

PROTEINS:
1+
30 (0,3)

GLUCOSE:
4+
1000 mg/dl
(55 mmol/L)

KETONES:
Negative

BILIRUBIN:
Not sure (between 1+ and 2+)

BLOOD:
Not sure
3+
ca. 50

 

How long would you say the BG ritual takes, from start to finish? With Ninja it takes about 1 to 3 minutes tops. She won't stand still any long than that and I do the testing by myself.

If I have already told you this in an earlier post, just ignore. But when I first tried to do the BG tests, it was horrible. I had to chase Ninja all over the house and still got nothing. Then I started wrapping a blanket around her to hold her in place while I tested. I think that may have helped somewhat, because after a couple of those sessions, she seemed to get the idea that if she sat still on her own -- that I would not wrap her in a blanket anymore.

After I abandoned the blanket technique, I started the "desensitizing" process from scratch (because I figured Ninja was pretty freaked out at that point whenever she saw the lancet pen coming her way). I do the testing on my bed, where Ninja feels comfortable -- and it also it puts her at my eye level so easier to do the testing for me. I started by calling her to the bed, petting her briefly, clicking the empty lancet pen to her ear, firing the pen, and saying "good girl" (in an excited voice) and then gave her a treat and pet her while she was eating the treat. Soon, I was up to actually sticking her ear with the lancet pen (ONCE, whether I got blood or not), saying good girl, and treating. And I was able to build up from there.

The keys for Ninja were that a) she got a treat at the end; and 2) it didn't take too long and 3) I didn't try to restrain her any more than absolutely necessary. The longer I took, the more nervous she became. I used the rice sock only once. It didn't really help me get blood so I abandoned it. I know it works wonderfully for some; but not me. Now I am able to get blood on the first try (almost always). Sometimes I do rub Ninja's ear with my fingers to get the blood flowing for a few seconds.

It did take a few weeks though for Ninja's ears to "learn how to bleed" ... so that is something you can look forward to -- that the longer you do this, the easier the ears will bleed. I know, it doesn't seem fair.

I am thinking that you may have to reserve the tuna for testing if that is the only thing Charlie really, truly loves. The key is for the cat to associate the ear stick with their favorite thing -- and if you can keep the procedure relatively short, they are likely to (eventually) come around. Maybe you can entice her with tuna throughout (call her over to the bed...give tuna chunk...rub ears...give tuna chunk...stick ear...give tuna chunk..."milk the blood drop"...give tuna chunk...let go...give tuna chunk). The milking the ear thing really helped me a lot too. Most times you stick the ear but don't see any blood. So the newbies continue to stick and stick until they see the blood drop form (me included). But if you stick just once or twice, then massage both sides of where you pricked (toward each other), often the blood drop will ooze to the top.

I understand your dilemma about using tuna as backup food; but I think you may, inadvertently, be teaching Charlie that if she rejects her cat food and waits a little while, you will cave in and give her tuna. Cats are smart... LOL!!! Lantus onset is typically so gradual...that worst case scenario... if Charlie still hasn't eaten her cat food at +4 or so and is running low numbers... you could always cave in then and give her a little tuna then. Experts, do you think that is a reasonable plan?

I know that mastering this BG thing seems impossible to you now, and is very demoralizing. I was in your shoes only a few short weeks ago. I too was crying over this and saying it would NEVER, NEVER happen for me; I would never be able to do this on an ongoing basis. But you know what, I did. Tuna is a powerful motivator.

 

Possible meanings of urine test results.

I just read this link:

Explanations Urine Test

Fear my worst nightmares may be coming true and something else really is wrong with my charlie girl. Too, TOO depressed right now. I'm going to bed. :roll:

 

Found a vet to evaluate the urinalysis. He is saying not to worry, it looks like a probable urinary tract infection. I will email you his report. He said to check with your vet tomorrow for follow up and possible round of antibiotics.

 

Jill sending lots of hugs, if it a urinary infection it is very treatable. What we were wanting to get checked mainly was the ketones and they are negative. When a cat isn't eating and has high blood sugar there is a danger of diabetic ketoacidosis. Negative ketones are a very good sign. I haven't heard of a urine stick that tests for all of those things. Sienne is an encyclopedia on theses things and I hope she can give some good advice.

On testing, for Tess I sit on the couch w/ her between my legs. Usually cats will try to back away and this stops that. We no longer use a rice sock either, but we started in the winter and it helped a lot then. Any time she sits w/ you pet her and play w/ her ears to get her used to it. We use lancets, but no spring loaded device. Aim for between the vein and the edge of the ear. Since Charlie is very dark you can test on the inside of the ear which is usually lighter. Try to go for the sweet spot as shown in the photos at first, but any where along the edge will work and then you aren't always poking the same spot. A nice thing about the lancet and doing it freehand is that the lancet is flat, if you twist sightly before pulling back it will open the pricked spot a little more. Always put pressure on the ear for about 20 seconds afterwards and you should get no bruising.

There is a trick that sounds weird, but works on most cats. Cats reflexively go still when held by the scruff. That is how mother cats move their young and and squirming would be a big problem. Since BG testing needs 2 hands someone came up w/ the bight idea of using clip clothespins on the scruff. They aren't strong enough to hurt but can really calm a fractious cat. here is a link w/ pictures.

 

We cross posted, I'm glad your mind was set as ease so you can get some sleep tonight. Tess has had several UTIs, it isn't uncommon for FD cats/. Unfortunately, the antibiotics tend to cause even more diarrhea. I'd definitely get probiotics if Charlie goes on ABS, it always helps Tess.

 

Update: Seems bit better this morning + Input from New Vet

The test strip that we got from the new vet last night was called the "Combur 9 test"
It seems to be more than just a ketone strip that people use at home.
This is an on-the-spot, visual urine test that the new vet uses to get information without sending urine for full tests in a lab.
My new vet only gave me the strip (with color coding chart) to take home as I pushed really hard for it. She wasn't there last night when we went there and her assistant was only there until 6pm. We couldn't get pee from Charlie before then so when I got to the vet's office, I asked the assistant if we could take the strip home with us and do it ourself. This allowed us to speed up the process so we didn't have to wait until 10am to go there again, test, etc.

The urine test results were came out as noted in the previous message above. I emailed a copy of this to the new vet this morning but she hasn't seen it yet. We just discussed it verbally by phone this morning. I will also bring the information to the vet assistant when we go there in 1/2 hour so she can make sure the vet gets it and can look at it in more detail.

In the meantime, I called the new vet at 8:30am. At first, when I told her about the high leukocytes, she didn't say anything. After I told her about the high blood sugar and small amount of red blood cells in the urine, I mentioned "couldn't this be a bladder infection?" (thanks Melanie).

She agreed that Charlie probably has a urinary tract infection. She will not give an antibiotic yet though. She says that in her experience, only 1-2% of cystitis is bacterial. She thinks it's stress related. So at 9:30, we will pick up some drops of another kind of medicine (?) against this. If this doesn't work, later we can can move to antibiotics, she says. Again, an example of the "no anti-biotic" Dutch approach to medicine. I don't know how I feel about this right now but I will follow her lead for the moment.

Update our #'s in the spreadsheet. Charlie was at 7.4 at AMPS. We gave .5 still. Vet says it's ok.

 

Hey Jill

I think the trick in bloodtesting for me is not holding Prop. She will fight me if i hold her. Thatswhy she is on a able with walls on two sides, and me covering the last two. Charlies ears will learn to bleed fast, so it will be easier. It concerns me a bit that her ears are bruised. Props ears never got bruised. When you look at my video http://www.sukkerkatten.dk/45919012
you can see i freehand and use a pretty big needle. If you use one thats to small it will be very difficult. But even though the needle is big, and it looks kind of scary, it is only the tip of it i use.
Maybe you can drop theflashlight, just aim for the sweetspots after you have been heating up her ears a bit.

 

Re: Update: Seems bit better this morning + Input from New V

Boy, you weren't kidding about the Dutch approach to antibiotics. The US vet and most references I found to UTI said to do a round of antibiotics. Others, what has been your experience in the treatment protocol for urinary tract infection (antibiotics or other treatment)? Jill, when your vet says "If this (the alternative treatment) does not work, later we can move to antibiotics"...what time frame is referring to? That is, how long before you know if the "alternative treatment" is working for Charlie? And how will you know? Those are just some questions I would ask the vet.

Also, I would ask, is there a way to test the urine (some kind of bacterial culture) to determine if the infection is bacterial or not? She says that "only 1-2% of cystitis is bacterial" so wondering if there is a way to test for that up front. In the descriptions for UTI that I find online, it is described this way, "Urinary tract infections occur when bacteria occupy (infect) the bladder." So I don't really understand what the doctor means by this probably not being bacterial??? But again, I have never dealt with this myself so really don't know. Experts???

Since your doctor didn't comment specifically on the leucocytes, you could also tell her that a US vet indicated that "leucocytes and the blood in the urine most likely mean a urinary tract infection of some kind" and that he mentioned antibiotic treatment; and I would ask why her opinion differs from this. You could explain that this report was sent to you (unsolicited) by a FDMB board member -- if you are concerned about offending her; though I can't imagine why it would. You are simply seeking information from various sources to make the best decisions for Charlie. Your vet may be 100% correct, but if I were you, I would want her to explain to me WHY her advice differs.

PS: Did you get the report I sent you by email?

On a positive note....it is REALLY good you are talking about a UTI which is very treatable and not something more serious.

 

I don't have much to offer in the way of advice, but just wanted to tell you I've been following this and I'm keeping you guys in my thoughts .. ((hugs)) hang in there!

 

there's a lot of good info on Dr. Lisa Pierson's web page: Feline Urinary Tract Health: Cystitis, Urethral Obstruction, Urinary Tract Infection.
check it out!

Dr. Lisa says, "We also know that 99% of cystitis cases in otherwise-healthy patients are *not* due to a bladder infection - contrary to popular belief. The erroneous belief that cystitis is always secondary to an infection leads to the rampant abuse of antibiotics.".

an excerpt from the section on Cystitis:

"Before considering the use of antibiotics in cystitis patients, a culture and sensitivity (C & S), in addition to a standard urinalysis, should be run on urine obtained via cystocentesis. This involves a needing going through the abdominal wall, directly into the bladder. This sounds much worse than it really is. The patient does not feel the needle going in but, instead, may simply object to being held on his or her back.

'Free-catch' urine samples (urine voided onto an exam table or into a litter box) should not be used for a C & S due to the issue of contamination which will often give a false positive result. In other words, bacteria will grow on the culture that may not even be in the patient's bladder or kidney.

The 'culture' part of this test shows if an infection exists or not. The 'sensitivity' part of the test is run only if a bacterial colony grows. This half of the tests tells us which antibiotic is the best one to choose for the type of bacteria that was grown."



hope this helps...



PS --- you might want to start a new thread. this one is getting rather lengthy.

 

That is a fantastic article!!! Dr. Lisa rocks!!!!

 

Re: Charlie - Help - 2 days of diarrhea & vomiting. Scared.

we generally recommend making the switch from another insulin to lantus when the caregiver has a couple of days off from work. for example, if it's a weekend, we'd suggest starting on friday night. if necessary, this would allow the caregiver to spot check over the first five cycles.

 

Great info! Thanks for sharing this!

 

Plan - Urinary Tract Infection

Charlie seems to be doing a tiny bit better today (just really tired all the time). She has spent most of the day sitting on her chair rather than hiding though, so that's a step. She has eaten chicken a few times a day. She has not had diarrhea (nor pooped and hardly has peed either).

Our current plan is to finish out the finidiar until it's gone. We will continue force-feeding a few vials of that emergency vitamin/mineral fluid with water 3 times a day to make sure she stays hydrated, and give her the drops of fluid against bladder infections.The stuff that the vet gave us is called "phytonics bladder comp". You give a few drops of it in water in a syringe 2 times per day.

Ingredients:

Extract of Arnica montana, Asparagus officinale, Berberis vulgaris, Betula alba, Carbo vegetarian awareness, Dulcamara, Echinacea purpurea, Galium aparine, Hydrastis canadensis, Hypericum perforatum, Lycopodium clavatum, Orthosiphon stamineus, Solidago virga aurea, Uncaria tomentosa, Uva ursi and Saffron blossom. Bentonite Montmorillonite. Alcohol 37%.

We are considering sticking with the new stuff for the next few days. We can then see if Charlie's energy and overall state improves. We will continue blood testing as much as possible to get stats that can help the lantus specialists on this board (and our new vet) find the right dosage.

Monday at 12:30 we already have an appointment booked with the vet. My intent is to have her do a 2nd spot test in Charlie's urine. If it comes out with leukocytes again, we will push strongly for the full urine culture and sensitivity test to decide the right antibiotic (if that's done here).

We learned today that our new vet's assistant is also not really a vet assistant. This place is a sort of natural pet remedy retail shop. They have healthier foods and supplements, natural products, etc. The assistant owns that shop. In the back of the shop is a room where the vet works out of on Mondays. It happens that since she is the type of vet that believes in holistic treatments, she seems to mostly recommend products in that shop. The only worry I have is that I don't know if there's a sort of vested interest to have to recommend that stuff first.

We had such a bad experience with our last vet that we are really trying to trust this one. Contrary to the last vet, she has been available for phone calls (early mornings, evenings after dinner) and she has helped get us what we need or at least advise us when she's not in Amsterdam. She helps calm us down and Charlie seemed a "LITTLE" bit less afraid of her. She was still a tiger in there but just the way she handled Charlie was already more serene, and that helped.

My vet says this new medicine needs time to work. I'd like to give it a try, but I'd also like to have an idea of how much time is too much time to wait (in case it IS a bacterial infection of some sort)? I will work from home again tomorrow but then it's the weekend and everything is closed (vets, etc) on Sat & Sun in this country except the emergency vet. So I hope Monday is not too long to wait.

 

I'm glad Charlie seems to be feeling a little better. The "I" in UTI can be either inflammation or infection. I'm glad Jill quoted Dr. Lisa for the explanation, less typing for me as I was gong to say the same thing. When we need to take Tess in for a UTI (usually we see frequent trips to the LB and blood in her urine) they take a sample by cyctocentesis. Then they check in house (I think w/ a microscope) to see if there are bacteria present. At this point, they know if it is infection or inflammation. If it is infection, then the sample is sent out for C&S to find out what type of bacteria it is, so that the appropriate antibiotic can be prescribed. If inflamation, then the treatment for that is started. The C&S test is expensive and if they find no bacteria in the initial test it saves us quite a bit of money. While inflammation is more common in most cats, diabetic cats have a higher chance of infection because sugars in the urine make a great home for bacteria.

One other thing that was suggested for Tess was to give her glucosamine/chondroitin regularly. Normally people use it for arthritis, but the bladder lining is avery similar composition to the cartilage and G/C can soothe and strengthen the bladder too. She has had a lot fewer problems since we started with G/C and a daily probiotic supplement as well.

 

About a month ago, our first vet said she saw signs of inflammation. She thought we needed to do a de-worming treatment. We have the kit but we didn't do it yet because Charlie is an entirely indoor cat, she has no worms, and this month has been so hard on her that I'm not sure we should add this extra variable to the mix. Nor do I think that's the cause of the inflammation. Maybe this new liquid medicine (drops) will help in some way?