Hello from Anne and Pixie

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caringcdn

caringcdn

Member Since 2014
Hello everyone at FDMB. I thought we would introduce ourselves in our very first post. Pixie is a 14 year old, 12 lb male cat who was diagnosed with DM on February 18, 2014. Prior to this, he has been a very healthy cat with excellent blood results at his last pet visit which was a few days before Christmas. Pixie lives in a multi pet dwelling in Ontario, Canada (3 cats and 3 dogs). Interestingly enough, Pixie started to show illnesses about 1 week after a new cat was added to our household. We're babysitting this new 1 year old female until my son and his wife return from Australia. He just started studying veterinary medicine in Melbourne.

Pixie is still not regulated but we're closer as our BG curves are starting to look more like they should. My vet has recommended a slower approach to his treatment with Glargine. We try a dose and wait 7 to 10 days before we increase. We are presently at 4 units Bid, however our AMPS and PMPS are very high - 32.1 and 21.4 respectively and our nadir points much lower - 7.6 and 11.6. We are using an AlphaTrack 2 BG monitor. Pixie has been switched over from Royal Canin dental formula (kibble) to Royal Canin Hypoallergenic and Sensitvity-vr. We alternate between the two whenever Pixie is less inclined to eat.

Pixie's diabetes has been difficult to monitor because he has pancreatitis and early stage renal disease. Over the last three months his pancreatitis has been up and down with the last couple of days being down days. Pixie's regimen is quite extensive and the vet feels that Pixie is still with us because of our efforts. His protocol is as follows - 100mls of subQ fluids Bid, 0.5 ml Famotidine Bid, 0.5 ml Cerenia(5 days on, 3 days off), Vetergesic 0.15-0.3 ml Bid, 4 units Glargine Bid,
0.25 mg Metaclopramide Bid and 2mg of Mirtazapine every day.

Since getting sick, Pixie has been a challenge to feed. We have switched him from dry to canned but he never eats much at any one time. He eats a little, 1/8th of a can at a time which means that he is eating throughout the day and night. When he has good days, he eats 2 and 1/2 cans of food. On bad days I'm lucky to get 1 can into him which affects his BG results. Yesterday he didn't eat much and his AMPS this morning was 9.5 and I didn't give him his insulin because the dose is so high and his appetite low. His PMPS was 35.2 and his appetite has improved so I gave him 4 units of Glargine.

These last three months have been stressful as Pixie has been so up and down. I wonder about his quality of life and whether I'm being selfish by keeping him alive with all these injections. If I knew his Diabetes and Pancreatitis would eventually be controlled and he could live a few more years then it would be worth it but I'm not sure we can stabilize him. Thus my reason for posting. I need support and reassurance that I'm doing the right thing. Thank you very kindly for reading my very long post and I look forward to your replies. Sincerely, Anne and Pixie.
 
Hi Anne and sweet little Pixie!

I'm so sorry you and Pixie are dealing with so many issues right now. The good news is that you've come to a wonderful place with lots of knowledgeable people who can help you.

We actually have several members here who have dealt with both pancreatitis and diabetes in their kitties (and kidney disease). I'll try to get someone to come help you with the pancreatitis "piece" of the puzzle, as well as someone who is much more experienced with Lantus dosing than I am.

In terms of the diabetes, it's definitely possible to get the numbers under control. It sounds like you are testing at home. Is that right? If so, that's fantastic! That will absolutely help us figure out the right dose for Pixie. Do you have some recent numbers that you can share with us? For example, the numbers you got from today's cycle? We actually have a spreadsheet that we use to list the blood sugar readings, and we'll help you get set up so that you can use it.

In the meantime, hang in there. I know this is all overwhelming; we'll just take it one step at a time.

Shelly
 
Hi Anne!

Sounds like Pixie is very lucky to have you! Shelly asked me to come over from the Lantus/Lev Tight Reg forum and give you a hand.

Pancreatitis is really common with diabetic cats. Most of us deal with it at one time or another.

I've got a couple of resources from the TR page for you that might be helpful.

A Primer On Pancreatitis was written by Marje and has a lot of good info - sounds like you've got a pretty good protocol going already. I looked up Vetergesic because that is unfamiliar to me, and it says it's Buprenorphine, which is what most of us use for pain control in our cats. It's good you're giving him something for pain control because pancreatitis can be very painful and pain can also drive up blood sugar numbers.

We do have lots of tricks for tempting cats to eat. Everyone's got some that have worked for them.

Here are a few:
...sprinkle on parmesan cheese, freeze dried meat, oregano, catnip, Fortiflora (a probiotic avail on Amazon)
...heat up the food slightly so it smells more
...poke some rotisserie chicken or lunchmeat (no sugar though) into the canned food
...pour on a little tuna water (no onions or garlic)
..."prime the pump" by using your finger to get some food into his mouth
...make little "meat balls" of the canned food - sometimes that seems to make it more enticing
...open a more expensive can of cat food ;-) :lol: just kidding, but a different variety can be helpful. I fed punkin Fancy Feast low carb varieties (classic chicken feast, classic turkey & giblets both around 5% carbs) and would pull out the fish flavors if his appetite was iffy.

Catinfo.org is a great site run by a vet who sometimes posts here on FDMB. Dr. Lisa updated the food lists for everyone last summer, so the carb content of all of these foods are reasonably up to date. I'm not finding your specific food in her food charts, but the Royal Canin Digest Sensitive is 20% carbs, which is definitely more than we would suggest. That's considered a high carb food. Trying to get a cat regulated using high carb food is somewhat like a diabetic person continuing to have ice cream 3 times a day! If it's possible to switch him to a low carb food, that would be ideal. If he MUST eat that for some reason, we just work with it. But most of us feed around 4-7% food that is not vet prescribed food, even though most vets start diabetic cats out with prescription food it is not necessarily and very expensive. Everything under 10% carbs is considered low carb. Be aware that if you change his food to a lower carb, his insulin needs may decrease dramatically.

This is the link to the Tight Regulation Protocol. I want to flag the PDF for you that is about 5 paragraphs down from the top of the page. You'll want to read that, and maybe print it out. There is a section on there about pancreatitis. The TR protocol is the only protocol published in a professional veterinary journal for how to treat a diabetic cat. Most (although not all) of the people on the TR page are following this protocol.

We "speak" in US glucometer numbers here - we have members all over the world, so it helps us to have a common language. The protocol addresses Alpha Trak numbers - the number that you would consider normal numbers are 60-160ish on the AT. That's roughly 3.5-9 in mmol. When you get a spreadsheet going, you'll be able to enter the numbers in mmol and it will "translate" it to US numbers for us.

Our most essential tool for giving advice is a spreadsheet. The New to the Group? sticky has a TON of good information, including directions on how to get a spreadsheet going. Start there. It helps us to see the blood sugar numbers laid out on a spreadsheet. The numbers tell us the most in the context of how many hours after the shot they are, and what other numbers are around it.

I'm confident we can help you help Pixie. I had the same hesitations as you - should i be doing this to my kitty - but we had 2.5 years more after he was diagnosed, and he had so many other health conditions going on. I wouldn't have traded that time for anything. Cats get very used to the testing and shooting routine (don't forget a treat for every pokey!) The bond you will get as you take care of him is one like you'll never have with another pet.

Glad to have you here! As soon as you get a spreadsheet up, i'd invite you to post on the TR forum. If you need help on the ss, just say so - we can give you a hand with it if needed.

keep asking questions - we'll do our best to help you.
 
Hello, Anne and Pixie! Julie asked me to stop by as we have had many issues with appetite with Zener. We know how stressful it can be for the caregiver when the kitty won't eat. We love the Cerenia, that has helped a lot. We've had good luck with cyproheptadine as an appetite stimulant. We think Zener is helped by tummy massages too, because he gets stomach cramps. He likes to have his tummy rubbed but not many cats do. :lol: Do you think Pixie could have any IBD? Let us know how we can help.
Liz
 
Hi Anne and welcome to you and Pixie. My cat Max developed pancreatitis when my other cat became very sick with CRF and lymphoma. That was over 4 years ago. He was recently diagnosed with diabetes in November. Shelly asked me to take a look at your drug regimen. Before I comment on that I would like to invite you to join the yahoo pancreatitis group. You will get lots of help there. feline pancreatitis support@yahoogroups.com.

For some cats cerenia works really well. For others, ondansetron works better for nausea and cerenia if the cat if vomiting. Sometimes both drugs are used together. Max gets ondansetron when having an episode but the last time I gave him cerenia for 5 days just to try something different. How long have you been using mirtazapine? I didn't have much success with it for Tiffany. I found cyproheptadine worked much better. Since you are giving a pretty large dose of mirt, I would ask about trying cyproheptadine. Max only needs 1/8 of a 4mg pill to start eating. Tiffany needed 1/4 a pill but mirt made her vocal and didn't help her appetite beyond the first day. Max needs 2mg of ondansetron BID.

For some pancreatitis cats a novel protein helps, one which they have never had before. Others a grain free diet works. For Max, stress was the factor and it sounds like the stress of the new cat may have brought this on.

As for getting your cat to eat, have you tried baby food that is pure meat without garlic or onion? It worked for Tiffany and works for Max when he won't eat other food. I also found a freeze dried food and I sprinkle just one tiny piece over his canned food when he doesn't eat it when I put it down.It is good that Pixie is eating small amounts often. That is exactly what my vet told me to do for Max. He explained that if they eat too much they don't feel well and then don't want to eat any more.

If you have any questions, ask and I will do my best to answer. IDEXX has a really good round table article by Robertson on pancreatitis. One thing I don't see you are giving is buperenex for pain. That might really help.

It is a trial and error kind of disease that many vets don't know much about. Hang in there. I know how hard it is to do so much and feel like you aren't getting anywhere.

Elise
 
Hello Shelly and Jersey,

Thank-you for your reply and putting me in contact with others on the board. Pixie and I really appreciate the help, encouragement and support.

Pixie is feeling a bit better today and is eating with less coaxing. I am home testing with the alphatrack 2 meter and I will attempt to post a spreadsheet asap.

Sincerely,
Anne and Pixie
 
You're very welcome, Anne! I remember how overwhelmed I was when I first joined FDMB. Just knowing that I wasn't alone was a huge help for me. It's great to hear that Pixie's "appy" (appetite) is better this morning.

Let us know if you have any problems setting up the SS. I think I tinkered with mine for a whole afternoon before I finally figured it out! ohmygod_smile

Shelly
 
Hello Julie and Punkin,

I'm so glad to be making new friends who are sharing the same sorts of challenges with their pets. I want to thank you for all the super suggestions in your post and I have checked them all this morning. Very helpful :-D

Pixie is on a low carb diet - Royal Canin Sensitivity has 5% and Hypoallergenic has 5.5%. The vet assured me of that and I also checked the numbers with the formula you have here on the board, i.e., 100% - %crude protein - %crude fat - %crude fibre - %moisture - %ash = % carbohydrate.

And yes, Pixie's pain medication is Buprenorphine which is also known as vetergesic in Ontario. Pixie was on 0.3ml Bid since almost the beginning but 2 weeks ago the vet ran out and it was back-ordered. Fortunately, I still had some injections with 0.2ml which I started giving him Bid. Last Friday, the vet indicated it still hadn't come in and I was on my last 4 injections, so we decided to give Pixie 1 injection per day. He seemed to cope but I believe it led to his slow deterioration over this last week as he was without any pain medication for two whole days. They say that there is no withdrawal in cats as they do not process it the same way humans do but I sure noticed a difference in his behaviour. Pixie is a very easy-going, mild-mannered cat who luckily lets me do all of these things with little restraint or complaints. Those last two days without pain meds, he was vocalizing so much more than usual and displaying very aggressive behaviour toward the other animals in the house. He was biting and attacking them and even gave me a huge bite in the forearm which completely caught me off guard. Needless to say, when the pain meds came in on Wednesday, I rushed in and had them fill two weeks worth. I gave him a full dose 0.3 ml on Wednesday evening and it completely knocked him out and it seemed to really aggravate his condition. He ate even less so I decided to give him only half the dose yesterday, 0.15 ml and he looked and acted a little perkier but seemed to still have pain. Today I gave him 0.2 ml and he's eating more but I noticed that he had what seemed like a tummy ache for a few hours this morning. I don't know if anyone else has experienced similar things with this medication? I have posted Pixie's spreadsheet and I am looking forward to your comments.

Thanks again, Julie and Punkin. Sincerely, Anne and Pixie.
 
Hi Anne and Zener,

I can't believe all the great responses so far. Absolutely fabulous. After my first reply to Shelly, I have been having trouble submitting replies. The computer gets timed out and indicates I should reload the page. I have done so numerous times without success. Perhaps there are network issues, so in the meantime, I'll write my replies and hopefully submit them when I can. I've resorted to posting from my daughter's computer and my last post was submitted. Whoopee!

Yes, the vets think that Pixie also has IBD and I'm wondering if that's one of the reasons he's not eating. After your post, I started looking at him after he eats and I noticed that he did seem to have tummy ache after his first meal this am. He ate more than usual and then he was listless and laying on his side. I tried massaging his tummy because he does let me do this and he didn't mind. There was no purring so I could tell he wasn't quite himself. I also have noticed that in the last couple of days, when he's lying on his side on my bed, he seems to have trouble righting himself. He struggles a little and has to try it a few times before he's successful. After a few hours, he was better because he was up and about, eating and purring once again.

Another thing that I have noticed for many, many weeks is that Pixie has the shakes - just as if he's cold. I have checked with the vets and they don't know why. In checking online, I noticed that one symptom of Diabetes is hypothermia, however I'm not sure if he's cold. I know he isn't hypoglycemic because I've checked his BG and he's always fine, i.e., higher than he should be. In additon, one website indicated that cerenia sometimes gives cats the shakes. I wish I could remember back when we started the cerenia if that is when the shakes started but I can't be sure. Any ideas?

I'm going to look into cyproheptadine as the mirtazapine is not cutting it at this time. Thanks, Anne and Pixie.
 
Hi Elise and Tiffmaxee,

I have so many questions regarding your post, so if you don't mind, I'll list them and try to be brief.

1. When I heard that Max developed pancreatitis when Tiffany became sick, this really hit home for me. When Pixie was first diagnosed, I kept asking the vet if stress could bring this on as we had this new cat, Kiri, who was not responding well to Pixie. Kiri was, however, fine with Pepe who is our 7 year old, more aggressive cat. The vet didn't seem to think so. Furthermore, over the last few months, I've noticed that I'm having trouble getting Pepe to eat. He seems fine and isn't losing weight but he seems off. So I've come to the conclusion that cats are really affected by illness in the other cats around them. I wonder if the new cat didn't respond to Pixie because she could sense or smell illness? Just musing aloud.

2. Pixie was placed on cerenia because he was vomiting but he hasn't vomited for at least three weeks. I'm going to check with the vet about ondasetron because I do believe that Pixie is now suffering more from a belly ache or nausea. I will definitely ask about cryoheptadine, as both you and Anne have mentioned and because I agree that mirtazapine is not working wonders for Pixie. Pixie is on Bupernex or Bupronorphine and I wrote a bit about my experience with this drug in my post to Julie and Punkin. Very unusual to say the least.

3. By the way, Pixie was changed to a novel protein when he was diagnosed with pancreatitis which was about two weeks after his DM dx. The novel protein made a world of difference as he was on death's door at that time and the food seemed to pull him out. Now I haven't tried the baby food but I'm curious about this and wonder if there is any particular brand that is better than another? In addition what are the freeze-dried treats that you use? When you talk about grain-free, I wonder what you mean exactly. What ingredients should I be looking to avoid if I'm shopping for a grain-free product? It seems silly to be asking but I want to be sure I know exactly what to avoid.

4. So many of you have suggested reading material and I'm very grateful. I am a reader and I have been searching since day one for answers. You're absolutely right that the round-table IDEXX report was excellent. It confirmed so much of what I have been doing. Sometimes, when you're at the vet's office, especially if your pet is very ill, you don't always grasp all that is being said. So this article and the many others on this site are superb.

5. About the pancreatic support group, do I simply send an email requesting to join?

Finally, bravo to everyone at FDMB on making this site an extremely professional, informative and most importantly, compassionate board. I read your responses to my husband and he couldn't believe that, firstly, there are so many others experiencing the same sorts of things and some far worse than others, and secondly, that people are so compassionate and agreeable to spending the time necessary to read and answer my post. From the bottom of our hearts, Pixie and I thank you.
 
Hi Anne,

I clicked on your spreadsheet but wasn't able to access it. I think we need to do just one more thing with it. When you log in to your Google account and pull up your spreadsheet, there should be a blue "share" link on the upper right-hand side of the page. Click on that and select the option to "share with anyone who has the link." That will allow us to see it.

The site has had some technical issues over the past couple of weeks, which they're currently working on fixing. It's definitely not just the computer you're using!

Shelly
 
We agree that this is an amazing place, the greatest place you never wanted to be! :lol: We had Zener on mirtazapine for a short time and he had one brief episode of the shakes (head tremors for about 5 secs) so we stopped it. None since then. He's been on Cerenia for 2 years and haven't had any problems with that. He does have cerebellar hypoplasia so sometimes it's hard to tell. :lol:
Liz
 
Hi Anne. Some cats have a bad reaction to mirtazpine. the anecdote is cyproheptadine which is what I use as a appetite stimulant. I like that it can be dosed up to twice a day. It usually works within 30-45 minutes for Max. Not all cats respond to it either but at least it clears the system faster. Once Max got the correct dose of ondansetron for him, he didn't need cypro at all. It doesn't work for all cats either but did for my two.

As for the bupe, it's another dose to effect drug. Too much can make them loopy and too little won't do anything.

I'm not the only one that has had a cat get pancreatitis from stress. Max and Tiffany were inseparable almost from the minute I brought them home the same day. At first the vets thought he was grieving which I am sure he was. It wasn't until he stopped eating right before Christmas that they took me seriously and tested him with two ultrasounds which weren't remarkable and then the fPL test.

Max likes Gerber's 2nds baby food. He like the ham, beef, and chicken. Of course if the novel protein is working you would need to pick a protein that Pixie hasn't had before. What is the protein source of the food you are now feeding? Grains include corn,corn meal, wheat gluten and the like. The fancy feast classic do not contain grains and many cats really like it. If you try baby food make sure it doesn't contain any garlic or onion as both can cause heinz body anemia in both cats and dogs.

I need to make sure I give you the right address for the FPS group as I tried to give it to someone else and the link didn't work. I will double check and get back to you with it.

Elise
 
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