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wombat88

wombat88

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I have to get Shaikha to the vet so will post more when I return, but take a look at her SS if you can. She's going through a weird stage right now and I'm considering switching her temporarily to BID and a lower dose since her duration is much longer than normal for her. She is still on AB's for treatment of her liver (and kidney) problems, so we've got another 10 days of those. I do think they have made the difference, in addition to her taking ursodiol. My guess is we had a simmering issue for a while with inflammation and infection there but didn't know it, and that likely was making her numbers much higher than normal. She's had a odd trend on numbers with more rapid zooms than usual until recently when I backed off dose, and now we are getting durations of 12 hours or more.

She has not gotten insulin since 11pm last night. My plan is to re-test her at dinnertime and if she's high to shoot a lower dose. Then try to do BID for a while to see if she can manage that. Knowing her, she'll probably need to return to TID because she'll start zooming again, but if we could get her on BID that would help me a lot schedule-wise.

I got a ton of blood test results to share, but need to get out of here. Her anemia is not good so we may need to start an ESA drug since she is definitely not regenerating. Am nervous about that but it is either that or transfusions, and she's low enough now that it is impacting her appetite. More later.
 
You are amazing! What you have learned about diabetes and all her other issues is incredible. No advice. I do know often TID cats can go back to BID - gives them a jump start, I guess. Good luck at the vet.
 
Welcome back!
Payne wants these #'s!! You are still giving 5mg. pred. daily? I am surprised, really .... that you can get #'s like this with pred. on board.

You could try and go back to b.i.d. her numbers are showing she is leveling off BUT is she doing that because she is healing? or because of the t.i.d.? She takes so little insulin, that might work. I don't think a big gulper like Payne could :) ohmygod_smile

With all her other problems, it is really good that this part of her is doing good. Does she like liver? My brother has a hard time with anemia and he finds liver helps some ....

Hope the vet goes well!

Nancy and Payne
 
Here is an update: Her PCV at the vet was actually much better than we expected. The CBC done previously showed a very low HCT, but she'd also had a number of blood tests done, so that may have been a factor. She was at 13.4% on the CBC we'd sent out, but her PCV today was 20% so that's good enough for now. She does NOT have FIV and was also negative on the blood parasite studies, so that is good news. I didn't think that either problem was present, but we were trying to be thorough given her persistent anemia. Her iron panels show her anemia to likely be related to chronic disease and inflammation. She actually has a VERY high serum ferritin level, despite having a low serum iron. Ferritin is a measure of iron stored in the body, while serum iron is what is circulating. Her iron binding capacity was slightly high, which isn't entirely consistent with anemia of chronic disease, but we feel pretty confident that is what is going on with her given how abnormal her serum ferritin is. At the minimum we know that giving her iron will not solve the anemia and will only overload her liver more, because her body is busy moving iron out of her bloodstream and into storage to avoid feeding infection. In other words, feeding foods like liver or giving iron supplements will do her no good. Though she is anemic, it isn't because she doesn't have enough iron -- she's got tons, just not in her bloodstream because of her body's protective mechanisms. The reticulocyte count shows her anemia is markedly nonregenerative, so her body isn't making enough red blood cells and isn't capable of doing so. The specialist said that if her anemia was due to chronic disease, she may continue being anemic but not seriously so. If she does drop to below 17% consistently, then we likely will need to start using ESA drugs. Given the risks of antibodies associated with them, we won't go there unless absolutely necessary.

We also reviewed her spreadsheet and my vet agreed that we should try BID for a while. It is easy enough to switch her back to TID if it doesn't work, but it is worth a try. He felt that the TID may have helped heal her sufficiently plus possibly getting better control of her infection have also helped. The plan is to try 0.5U to start twice per day, starting tonight. We'll see how she does with a much lower dose on BID, then tweak it up if her levels start rising too much. We aren't sure how much insulin she needs since she's responded differently lately, but we'll know more soon. Another possible wrinkle is that she's probably got about 10 days more antibiotics left. We are a little nervous about how she'll do without them, but if her levels start rising after we stop that will be another indicator that she may need them a little longer.

She's a perplexing case in many ways, but I do think she's feeling much better. The only concern is that her appetite is down again, but that may be due to my switching her from anzemet back to ondansetron. I'm trying her on anzemet again to see if that helps with her appetite. If so, that's the ticket. I don't think the antibiotics have caused her problems, but they could also be playing a role since some can make nausea worse.

I'm hopeful BID will work for her. We'll still probably need to tweak doses a lot, since we never know what her pancreas will do. My guess is though she's healing some or at least the inflammation is down, and if that's the case the benefit is better glucose levels. With her, things can change on a moment's notice so I'm fully prepared for a wild ride.
 
Nancy and Payne said:
Welcome back!
Payne wants these #'s!! You are still giving 5mg. pred. daily? I am surprised, really .... that you can get #'s like this with pred. on board.

You could try and go back to b.i.d. her numbers are showing she is leveling off BUT is she doing that because she is healing? or because of the t.i.d.? She takes so little insulin, that might work. I don't think a big gulper like Payne could :) ohmygod_smile

With all her other problems, it is really good that this part of her is doing good. Does she like liver? My brother has a hard time with anemia and he finds liver helps some ....

Hope the vet goes well!

Nancy and Payne
Click to expand...

Yep, still giving 5 mg. pred daily. We don't know if she'll do well enough on bid or not, but I figure it is worth a shot. Like I said in my other post, we can always go back to tid if she starts zooming again. I'm thinking she won't though unless she gets sicker again. We'll see. No liver for this girl, though. She's swimming in iron right now, and given the inflammation already in her liver that's not a good thing.
 
Thanks for the update, I have been wondering how things are faring! That it great she is getting better duration. Your plan makes sense to me. It will be interesting to see how she does on BID, and I'm sure you could use the break!
 
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