Fred: Pulled out his e tube!

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Jamye and Fred said:
Hey guys they offered to sub a dif pain med other than the Bupe. Your thoughts?
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If they offer Tramadol that is also an opiate so the same family as bupe. I only gave tramadol to Saoirse once; it's a tablet and it made her vomit. (Never a cat prone to vomiting even with the chronic pancreatitis, she wasn't even very nauseated at the time so it was definitely the med.) Bupe is the painkiller that IDEXX recommends and it probably has the least side effects. The syringed bupe is absorbed in the mouth and one would assume is less likely to cause further GI distress. (Never nauseated Saoirse but she got smaller, more frequent doses the only time she needed a lot of it in a short period of time a few months ago.)

I know that there have been issues reported with an NSAID drug called Metacam (meloxicam) in the States - IIRC it may carry a black box warning about its harmful effects. (I think the concentration is different in the US to the UK one. NSAIDs are hard on the kidneys - the wrong formulation has been reported to cause severe, sometimes fatal, kidney damage in cats.). I would not treat my cat with meloxicam if I were in the US unless I had completely researched the risks myself and ONLY if there was no other alternative available. Whatever about kidney issues, given that Fred is already having issues with GI bleeding, NSAIDs are contraindicated in such cases so that's another thing to consider. (NB - first dose of meloxicam can be given intravenously BUT if it were my cat I would still be very reluctant to even consider this drug as it is formulated in the UK when other - better and SAFER - meds are available. The 'trippiness' with the bupe is transient and maybe with a smaller, more frequent dose it could well reduce that side effect.)

This is just my two cents based on my reading and my experience; I'm not a vet.

Ask your vet about ALL potential side effects so that you can make a fully informed decision which takes into account the potential risks and benefits of any treatment choices offered.


Mogs


EDITED TO ADD:

IMPORTANT NOTE: There is a MAJOR drug interaction between ondansetron and tramadol - the combination can induce serotonin syndrome (potentially life-threatening). Here's a link to the drugs.com interaction checker with details:

drugs.com - Major drug interaction between ondansetron and tramadol

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I agree that the first line of pain treatment for pancreatitis (as well as others) is bupe . Although the injections are much easier to give, the best absoption would be from giving it orally into the side of the mouth where it is absorbed into the system through the mouth tissue.
 
He's sitting on his chair on the balcony. Good to see him outside. It's lightly raining.
 

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@Tuxedo Mom - Terrific article, Mary Ann. I am SO pleased to see a peer-reviewed article advocating initiation of insulin therapy for diabetics with pancreatitis (the treatment that 'specialist' denied Saoirse last year ...).


Mogs
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Buprenorphine .15mL @12 hours, Cerenia 16 mg @ 24 hours, Metronidazole 0.4mL @ 12 hours, Fortiflora, Ondansetron will be added later today.
 
Did your vet give a combination of mirtazapine and buprenorphine when Fred was at the hospital?

This is very important.

EDITED TO ADD:

You mentioned that Fred was growling at the hospital when you went to pick him up:

- Did he display any other signs of unusual aggression?

- Were his pupils dilated? If yes, for how long?

- Any other unusual behaviour you noticed (e.g odd/unsual vocalisations / unusual purring).

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Buprenorphine .15mL @12 hours, Cerenia 16 mg @ 24 hours, Metronidazole 0.4mL @ 12 hours, Fortiflora, Ondansetron will be added later today.
 
Jamye and Fred said:
Attached copy of itemized vet bill showing all administered meds.
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Hi Jamye,

Just a short message that has nothing to do with your cat : when you post such a picture on Internet, try to mask your family name and address. This board is accessible to anybody surfing on the web, and you don't know how your personal data can be used. :)
 
Critter Mom said:
Did your vet give a combination of mirtazapine and buprenorphine when Fred was at the hospital?

This is very important.

EDITED TO ADD:

You mentioned that Fred was growling at the hospital when you went to pick him up:

- Did he display any other signs of unusual aggression?

- Were his pupils dilated? If yes, for how long?

- Any other unusual behaviour you noticed (e.g odd/unsual vocalisations / unusual purring).

.
Click to expand...


Jayme this is the question Mogs needs you to answer
 
Capoo said:
Hi Jamye,

Just a short message that has nothing to do with your cat : when you post such a picture on Internet, try to mask your family name and address. This board is accessible to anybody surfing on the web, and you don't know how your personal data can be used. :)
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Oh I assumed we are a trusted family here. Deleted. Thank you.
 
Fred's meds/etc. in hospital: (from pic uploaded earlier)

8 Oct

Fortiflora (feline)
IV fluids
Sedation - DKT
Miscellaneous dispensed medication (handwritten note: metronidazole; no other meds specified)
Buprenorphine injection (no dose info)
Cerenia Tablets 16mg (4 pack)

@jayme - I've transcribed the salient info from the itemised list into this post. I suggest following Sophie's advice to edit your earlier post ASAP and delete the picture attachment to protect your privacy.


Mogs
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He
Tuxedo Mom said:
Jayme this is the question Mogs needs you to answer
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He did growl at me and the vet techs and had dilated pupils until this morning. During the time when his eyes were dilated was when he seemed to be hallucinating... looking at the wall as if he could maybe walk through it, same thing with my couch. I figured it was the Bupe because it's an opiate.
 
Jamye and Fred said:
I figured it was the Bupe because it's an opiate.
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Thanks for this additional info about Fred's clinical signs, Jayme; it's very helpful.

You said in one of your earlier posts on this thread that the vet prescribed an appetite stimulant to take home with you. Can you check the dispensed meds you have to see if there is anything called mirtazapine (or possibly Remeron or Zispin). Also can you check if Fred was prescribed cyproheptadine (aka Periactin) in the meds you brought home yesterday.

I'm doing a bit of digging in the meantime. Back shortly ...


Mogs
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Thank you for being concerned but this is stressful. Like I mentioned before... He has no other meds than what I mentioned. And I just dropped the metronidazole and busted the bottle so I gotta get a refill.
 
OK.

I asked about whether Fred might have received both buprenorphine and mirtazapine (appetite stimulant) because there is a moderate drug interaction between the two. We had a cat here earlier in the year who experienced an adverse reaction when simultaneously treated with both of the aforementioned drugs.

While it is not common to see pupil dilation as a side effect of buprenorphine treatment but if my experience with Saoirse is anything to go by it shouldn't have lasted as long as you observed in Fred. That Fred's pupils remained dilated for so long and also that he seemed so 'trippy' yesterday it made me wonder about whether any other medication might be exerting an influence to cause such marked, unusual clinical signs. Bearing in mind that Fred received a sedative I had a quick look online and found the following:

https://www.cuteness.com/article/medication-sedate-cat

From the above article:

Common Side Effects
No medications are free from side effects. Common consequences of sedatives in cats include vomiting, hypotension, increased appetite, anxiety, hallucinations, disorientation, diarrhea and restlessness.​

Also, I found another article written by a vet about one particular sedative called acepromazine and in that article the author mentions that this particular drug can interact to potentiate the effect of pain meds. (Not saying that this drug is what Fred may have received, just giving you the link to an article which shows that sedative/pain med interaction is not unheard of.) Here's the link:

http://www.petmd.com/blogs/fullyvet...m-not-big-fan-when-it-comes-sedation-ace-6937

I wonder whether the bupe and the remnants of the sedative in Fred's system might have interacted? Also if the sedative Fred received yesterday does have appetite stimulation as part of its side effect profile that might explain his slightly greater interest in food last night. Speculating here, but I hope it will give you some ideas of what to ask your vet about.



Mogs
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He's not eating voluntarily but I gave him 2.5 ml of FF/ Pedialyte via syringe twice this pm. He didn't vomit. He had a loose BM just now in the litter box but no blood! This is good news. I mean not the diarrhea but no blood, first time in 3 days. He's still lounging on the balcony.
 
Critter Mom said:
OK.

I asked about whether Fred might have received both buprenorphine and mirtazapine (appetite stimulant) because there is a moderate drug interaction between the two. We had a cat here earlier in the year who experienced an adverse reaction when simultaneously treated with both of the aforementioned drugs.

While it is not common to see pupil dilation as a side effect of buprenorphine treatment but if my experience with Saoirse is anything to go by it shouldn't have lasted as long as you observed in Fred. That Fred's pupils remained dilated for so long and also that he seemed so 'trippy' yesterday it made me wonder about whether any other medication might be exerting an influence to cause such marked, unusual clinical signs. Bearing in mind that Fred received a sedative I had a quick look online and found the following:

https://www.cuteness.com/article/medication-sedate-cat

From the above article:

Common Side Effects
No medications are free from side effects. Common consequences of sedatives in cats include vomiting, hypotension, increased appetite, anxiety, hallucinations, disorientation, diarrhea and restlessness.​

Also, I found another article written by a vet about one particular sedative called acepromazine and in that article the author mentions that this particular drug can interact to potentiate the effect of pain meds. (Not saying that this drug is what Fred may have received, just giving you the link to an article which shows that sedative/pain med interaction is not unheard of.) Here's the link:

http://www.petmd.com/blogs/fullyvet...m-not-big-fan-when-it-comes-sedation-ace-6937

I wonder whether the bupe and the remnants of the sedative in Fred's system might have interacted? Also if the sedative Fred received yesterday does have appetite stimulation as part of its side effect profile that might explain his slightly greater interest in food last night. Speculating here, but I hope it will give you some ideas of what to ask your vet about.



Mogs
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Click to expand...
How did it affect that cat, earlier this year?
 
Critter Mom said:
Check his hydration levels ASAP.

How long has he been drooling? Was it after you gave the metronidazole? (It is foul-tasting.)

Don't be shy about taking him back to the vet today if required.

What did your vet advise about dosing for the bupe?

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Click to expand...
I forgot to reply here I think. Re dosing for Bupe. Vet said .15 ml @ 12 hours.
 
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