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

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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:
Finidiar ® tablets Tasty tablets Composition : Each tablet contains
  • 4 mg of calcium chloride hexahydrate,
    40 mg of aluminum hydroxide gel (dried),
    kaolin 225 mg,
    2 mg of magnesium chloride,
    35 mg sodium chloride and beef flavoring.
Click to expand...

And this is what the new vet gave you:
(Puur Natuur brand "puur spijsvertering" for dog & cat).
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
      dilutionof Magnesium phosphoricum.
    Additives per 3 grams: Technological additives, binder: 104.3 mg Bentonite.

I thought earlier you had mentioned aform of probiotic in it too?
Click to expand...

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

charliesmom said:
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.
Click to expand...

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!
 
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.
Click to expand...

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

MelanieP and Ninja said:
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.
Click to expand...
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.
 
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?
 
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