Introducing Selkie and Essay

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Essay

Essay

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My cat Selkie is a little over nine years old, and was diagnosed with feline triad syndrome about eighteen months ago. Last May she also came down with ringworm (she's an indoor only cat, but I do regular volunteer work at a local cat rescue and assume I somehow brought it home to her). She's been in quarantine since June.

Because of the triaditis history Selkie been on quite a few medications, including steroids. In an attempt to clear the ringworm we backed her off virtually all the steroids this summer. We had to do blood work on Selkie on a monthly basis since the ringworm drugs can be hard on the liver, and her blood glucose was checked every time and was always normal, until a week ago. Retests today confirm that she is indeed diabetic, quite possibly due to the triaditis.

Insult to injury is that Selkie's ringworm relapsed badly about three weeks ago, which probably is due to immunosuppression related to diabetes. Tonight I started her on insulin. I have an AlphaTRAK on order and will have to work with urine strips until it comes in.

I'm lucky in that I'm already somewhat knowledgeable in maintaining a diabetic cat. I'm a veterinarian, but my specialty is food animal and much has changed since I graduated. My veterinarian is big on at-home monitoring, and I would have wanted to do that in any case. I'm hoping to find others who have triaditis cats with diabetes. Feline triad syndrome has been identified only rather recently, and there isn't a lot of literature out there on triaditis cats with diabetes. It will be helpful (and somewhat comforting) to hear how others are coping with this.
 
hi essay, i am not familiar with this condition but wanted to welcome you.
as long as you have everything you need to start testing (you'll be testing the ear right?) and if you let us know which insulin you are using we can at least help you with dosing and regulating her numbers.
btw, what is food animal veterinarian?
 
Welcome to the group.

I am not familiar with triaditis and am sorry the selkie has this and ringworm too.

Regarding meters. Many of us save money by using human meters. The meters and strips are cheaper than alphatrak and you can get strips anywhere. Many use walmarts relion meters which seem to do a good job and are inexpensive

So just a suggestion and this way you can start testing immediately.

We do have some vet techs on board as well as dr lisa who know tons about feline diabetes. You may want to contlact her about the triaditis. Her website is

www.catinfo.org.

Let us know how else we can help.
 
Hi and welcome.

Tucker has two of three issues that make up triaditis. He's got pancreatitis and IBD, both confirmed via biopsies and Tucker's Pancreatitis is also confirmed via ultrasounds and PLI tests. Add to that he too is suffering from a bad case of Ringworm brought in from kittens I was fostering and that he's on steroids due to constant circling that after much research on VIN my vet has confirmed is a brain tumor. Ringworm started around May, we can't treat orally as he has too many other issues, so we were doing weekly baths for a while until his chronic pancreatitis flared the last time.

Since starting the Prednisolone in March his circling has stopped. Tucker also suffers from Hypokalemia and takes 4 Tumil-K pills per day.

So, even though many of us may not have triaditis cats, there are many of us dealing with multiple conditions and may be able to help you.
 
You didnt mention which insulin your cat is on, but the Lantus insulin support group has alot of information at the top of the board.
Read the sticky's.
They explain about how to do your daily posting, setting up your spreadsheets, the Lantus/Levemir insulin storage shed and Lantus/Levemir protocols.

If your cat is on PZI, there is a forum for that insulin too, but there seems to be more info in the Lantus forum for getting started here.

Adding your spreadsheet and the cats profile to your signature will allow other users to view them and advise you when you ask questions.
 
Thanks all.
To answer questions:

I'm a food animal veterinarian, which means I specialize in animals destined to enter the food chain. While you have to study all species in veterinary school, I ended up working with pigs. I kept up on feline medicine because I have four cats, but that's not the same as actually doing daily practice on companion animals and keeping abreast of all the current treatments. The stuff you learn in vet school either goes stale or gets completely forgotten if you don't use it regularly.

We're starting Selkie on glargine, so the Lantus link will come in handy. I already hit it last night, and will definitely doing more research in coming days.

I elected to go with the AlphaTRAK because it has a proven track record for animals. Human monitors are variably successful in getting accurate readings from whole blood because cat blood differs from human blood in several significant ways. I'm currently unemployed, so the decision was difficult, but I figured if I was going to go to all the trouble to put together glucose curves and follow up with daily monitoring then I really should make sure that I'd be getting the most accurate results possible. A plus is that I do cat rescue work and this will now give me an option to test polyuric cats in our shelter, saving the organization a few bucks.

Feline Triaditis is a recently described syndrome of three different ailments of the digestive tract (hence the "tri" in triaditis":

·Inflammatory bowel
·pancreatitis
·cholangiohepatitis

Selkie was confirmed with all three in spring of 2009 by biopsy, and has been on prednisolone and budesonide (a steroid that is supposed to act mainly in the gut and not go systemic, though I currently have my doubts about that) since that time. Sh'e's also been on flagyl, pepsid, and a taurine supplement since then. I moved her at the time to EVO kitten and cat because it had the highest protein to carb ratio of any over the counter cat food I could find. Yesterday I started Selkie on DM at my vet's suggestion, but I see from the label that DM has lower protein and higher carb content than the EVO did, so I'll have to look into that further.

Again, thanks for the welcome everyone.
 
Hi and welcome :)

Just to address food...DM ingredients really aren't great. If cost is an issue then grocery store brands are an option if you avoid fillers like wheat, cor, rice, etc.

Regarding the alphatrack there is disagreement on whether it really is necessary but if you are comfy with it then we are just happy you will be testing.

As you ha ve already learned, balancing multiple health issues can lead to conflicting treatments but the good news is that FD is totally treatable.

Looking forward to more of your posts

Jen
 
Welcome Essay and Selkie

As far as diet for your girl goes you may want to take a look at Binky's list found here http://www.felinediabetes.com/diabetic-cat-diets.htm My boy Fenix (aka Max) is being fed 9-lives canned food from this list, I keep his carbs between 4-6% and after only one week on Lantus and just a change in diet he is now off insulin and being diet controlled. I do also home test just to keep an eye on his BG but so far he is running the same as my non-diabetic cats (all 10 of them). Everyone here eats exactly the same thing and not only has Fenix become diet controlled on this diet, my other 10 are now the more lovely than they were on their original diet of dry food. Their coats have improved, their energy levels are up and they are just happier cats. Before the diet change they were surviving but now they are thriving. So really there is no need to go with the expensive prescription cat food (half of mine thought it was disgusting anyhow). There is far better out there on the commercial market than the ingredients in the prescription stuff, and won't drain your wallet either. Besides my diabetic I also have one with severe food allergies, we tried everything with him but what finally cured him was getting him off the dry food as well.

While most of us don't have the formal education that you have, we do have many many years of living with and successfully treating FD cats as well as just about everything else feline. Unfortunately what most of us have found is that very few Vet's are up on what it takes to treat a diabetic cat. The mere fact that you are going to be home testing and you have a personal vet that supports it makes you already ahead of the game. :-D Basically the motto here as far as insulin goes is "start low and go slow". You can always up the dose if it isn't working but you can't take it back once it is in the cat.

Again welcome to the FDMB family and as you have questions please ask, we have members around the world so there is usually someone hanging around that can give you answers or at least knows who to ask to get them for you. While I'm not sure we have anyone that is currently dealing with a triad cat we do have lots of members that are dealing with cats with multiple health issues so someone should be around to help.

Mel
 
I'd stick with the EVO and stay away from the DM. Are you feeding dry and not canned?

As I mentioned, Tucker has multiple ailments and one thing I can tell you is that if one acts up, the others act up. He takes injectible pepcid when his belly is feeling funny, I prefer that to the pill form because if he's vomitting it's hard to keep something down.

Weekly injections of Vitamin B12 help the GI tract.

You may also find that by sticking with the grain free EVO, some of the GI issues may resolve themselves. I adopted Tucker when he was already a senior. Through this site and a phone consult with Dr. Lisa I learned that Tucker is allergic to gluten, corn and wheat. Once I removed the gluten from his diet he went into remission for a short time. A couple of my other adopted FDs are in remission based on diet change alone.

Please review the handling instructions for the Glargine. You don't shake or roll the vial, don't inject air into it like other types of insulin. Refrigerated it can last longer than the 28 days suggested.
 
Something I've seen for liver support (both human and animal) is milk thistle (Silymarin). I've not used it on any of my cats (yet!), but it is something you may wish to research.

One of the internet vendors I've used for supplements is iHerb and they carry milk thistle in capsules.

CalVet Supply carries some milk thistle products too.
 
Marin for Cats, Denosyl and Denamarin (combo of both) are excellent liver support supplements. I use the marin and denosyl separately for Hope instead of the Denamarin. She is also on Ursodiol for gallbladder.
 
Ironically I've done a fair amount of research on silymarin because I was in liver failure eight years ago due to an adverse drug reaction (the drug still saved my life, so I have absolutely no complaints). While it improves the transaminase levels in the blood, there isn't actually any evidence that it improves liver function or prevents further liver damage. Most of the studies I'm familiar with were for human hepatitis patients, so I'm not sure their results are even applicable in cats. I stopped keeping up with the literature after I received my transplant, so I will do a little more research into it.

I really don't want to throw any more drugs into Selkie for her triaditis at this point if I don't have to; adding insulin into the equation will complicate things enough and I don't want to make too many changes simultaneously. If we run into immediate problems it will be easier to figure out what caused them if I keep the number of changes to her regimen to a minimum.

We have been able to improve Selkie's liver function using ursodiol, which acts to thin the bile. Bile can be caustic, and if it backs up in the liver due to inflammation and swelling of the bile ducts it can cause further damage. Interestingly enough, ursodiol is a synthetic drug that owes it's origins to a compound found in bear bile. The Chinese have long revered bear bile as a treatment for liver failure, and it turns out they had a reason to!
 
tuckers mom said:
What dose of Lantus do you plan to start with?
Click to expand...
We're going conservative: one unit BID with food. We'll adjust based on results. I'm hoping the meter comes in soon, so I can get a good set of initial readings on Selkie.

I have a OneTouch glucose meter for myself (because of the transplant I have had to take some large doses of pred, which temporarily make me diabetic). My initial plan was to monitor Selkie with that just so I'd get *some* readings on her, but I discovered to my shame this morning that I simply can't get a large enough sample from her ear to get a valid reading without Selk-selk going ballistic. It appears I shall have to wait for the vet meter.
 
The vet meter may take the same amount of blood as the One Touch. Have you seen the hometesting help links? If not, I've posted it here:

viewtopic.php?f=14&t=287

The rice sock has been a huge help for me when starting out with a new FD. Some white rice in a cotton sock, microwave for about 10 seconds. Apply to ear to warm it. The warmth helps promote blood flow. That and milking the spot once I use the lancet.

I had one FD that did not give blood easily, my sweet Misty(GA), I massaged her ear a bit before using the warm rice sock. These days the FDs I do have their ears are trained to give blood so I no longer need the sock.
 
tuckers mom said:
The vet meter may take the same amount of blood as the One Touch. Have you seen the hometesting help links? If not, I've posted it here:

viewtopic.php?f=14&t=287

The rice sock has been a huge help for me when starting out with a new FD. Some white rice in a cotton sock, microwave for about 10 seconds. Apply to ear to warm it. The warmth helps promote blood flow. That and milking the spot once I use the lancet.

I had one FD that did not give blood easily, my sweet Misty(GA), I massaged her ear a bit before using the warm rice sock. These days the FDs I do have their ears are trained to give blood so I no longer need the sock.
Click to expand...

The AlphaTRAK only takes .3 microliter of blood (blast - I took FOREVER looking for the "micro" symbol on my character map and finally gave up). My OneTouch takes three times that amount, a full microliter. That doesn't sound like much until you try to con a cat into letting you work your way through the learning curve! Selkie is stressed out enough right now - she's been in quarantine for five months now for the ringworm, and she's getting lime sulfur baths every three days. If I can make this any easier on her I will.

The rice sock looks like a sweet idea. I am definitely going to give that a try next time.
 
I should have explained, I've used so many different meters over the years, that I got used to the droplet size and I really should try to remember it's a big difference when you have a cat with an untrained ear. Thank you for the correction.

I completely understand about making things easier. Tucker is not a fan of his ringworm baths, although we cannot do the lime sulfur dips, he's using a fungal shampoo and Miconazole.
 
I did testing with the AT the day it came out and tested it against 8 other meters. People see the statements that one meter only needs .3 and this one only needs .2, etc. and they go by that when the truth really is we all need to see a drop of blood to know it is there. I have never needed more blood for my OTU that I did on any of the other meters I tested excluding the ADAdvantage.......we all know that does need a good drop of blood. I just have to wonder if people have ever tried to test with just the teeny drop of blood that first comes up to see if their meter gets enough to do a reading or if their mind is telling them it is not enough and they need to get a bigger drop. I have the AT and will not use it.
 
Hope + (((Baby)))GA said:
I did testing with the AT the day it came out and tested it against 8 other meters. People see the statements that one meter only needs .3 and this one only needs .2, etc. and they go by that when the truth really is we all need to see a drop of blood to know it is there. I have never needed more blood for my OTU that I did on any of the other meters I tested excluding the ADAdvantage.......we all know that does need a good drop of blood. I just have to wonder if people have ever tried to test with just the teeny drop of blood that first comes up to see if their meter gets enough to do a reading or if their mind is telling them it is not enough and they need to get a bigger drop. I have the AT and will not use it.
Click to expand...

It looks like your experience has served you well. I was unable to obtain the appropriate amount of blood for my personal human glucose meter when I attempted with Selkie this morning and again this afternoon, but then both she and I are still learning the ins and outs (drat that learning curve!). I was successful in getting the appropriate amount of blood for the smaller AlphaTRAK strip when my vet let me experiment with it in her office. Since I need to start getting accurate readings as quickly as possible on my little honey bunny, I don't regret deciding to go with the AlphaTRAK. I'm pleased you've been successful with another approach though.
 
If you want to start getting readings on Selkie while you are waiting for your meter to come in Walmart has a nice Relion meter for about $20 that only takes .3ml of blood and the strips are very cheap as well, the whole set up would probably only set you back in the neighborhood of $40. It is what I use for Fenix and have gotten very good results with it. Just a thought for a cheap backup until the Alphatrak arrives.

Mel
 
I've used the one touch and bayer contour. I was amazed at how small amount of blood the contour required and the huge amount the one touch needed. Like others said, as long as you test, that's what counts.

Thanks for the explanation about triaditis. I'm familiar with all but the last "itis".

One thing to keep in mind when dealing with multiple issues including diabetes, is that sometimes you have to use meds that you may not want to because of the diabetes, but you learn to work the diabetes around the other issues and meds.

So, what part of the country are you located? I'm just being curious, I'm thinking midwest or south, since you handle pigs.......
 
tuckers mom said:
I'd stick with the EVO and stay away from the DM. Are you feeding dry and not canned?

As I mentioned, Tucker has multiple ailments and one thing I can tell you is that if one acts up, the others act up. He takes injectible pepcid when his belly is feeling funny, I prefer that to the pill form because if he's vomitting it's hard to keep something down.

Weekly injections of Vitamin B12 help the GI tract.

You may also find that by sticking with the grain free EVO, some of the GI issues may resolve themselves. I adopted Tucker when he was already a senior. Through this site and a phone consult with Dr. Lisa I learned that Tucker is allergic to gluten, corn and wheat. Once I removed the gluten from his diet he went into remission for a short time. A couple of my other adopted FDs are in remission based on diet change alone.

Please review the handling instructions for the Glargine. You don't shake or roll the vial, don't inject air into it like other types of insulin. Refrigerated it can last longer than the 28 days suggested.
Click to expand...


Definitely feeding canned food. All my cats are on canned except for my little classic tabby, Lyta Alexander, who for whatever reason refuses every canned food I have tried on her to date. (As an aside, Lyta refuses any human foods, all soft treats, and most crunchy treats. I adopted her from the rescue group I work with as an adult, so I have no idea if there was anything in her past that has made her this way. At this point it isn't worth arguing with her; she gets EVO dry which is the best compromise I could come up with.)

Selkie was already on EVO for eighteen months before this happened, so I have scant hopes that a diet change will put her into remission. She did have a minor pancreatitis flare up six weeks ago, and my vet's and my working hypothosis is that this may have triggered our current hyperglycemia problem. We both have hopes that it is transient, but I'm approaching this as a long-term committment.

You guys are making me feel better about my vet. She did take the time to review how to handle the vial (as did my pharmacist). She also said that it can potentially last up to three months, though I'm to keep a close eye on the blood sugars. When the glargine seems to be less effective we'll consider it out-dated and move on to a new bottle.
 
Jen & Squeak said:
Testing can take time to get right; did you warm the ear, use vaseline and what lancet are you using?
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Ack! I'm sorry I skipped your post. I'm getting so much information it got lost in the landslide!

I did warm the ear, and held off just above the tragus. The vein pops up beautifully, but Selkie jumps when I use the lancet (Accu-Check Soft Clicks; box doesn't give size information). I have successfully gotten very small amounts of blood, but not nearly enough for my human meter.

I have not been using Vasoline because her ears are currently hairless due to a bad case of ringworm that we've been unable to get under control.
 
Essay said:
You guys are making me feel better about my vet. She did take the time to review how to handle the vial (as did my pharmacist). She also said that it can potentially last up to three months, though I'm to keep a close eye on the blood sugars. When the glargine seems to be less effective we'll consider it out-dated and move on to a new bottle.
Click to expand...

You will want to get the vet to write the RX (or write your own) for the cartridges or pens next time.

The vial contains 1000 units, and it will very likely go bad before you can use it all up and you
throw away a lot of insulin.

The cartridges come as 5 3ml cartridges (1500 units). You open one cartridge at a time and will likely be able to
use the entire amount of each cartridge before opening another cartridge. With proper handling 2-3 months, depending
upon dose.

It seems more expensive, but actually on a per-unit basis it is less expensive, especially when you do not have
to throw any away.

You still use insulin syringes to draw up the insulin...from the little rubber area on the tip of the cartridge.
 
Karen & Smokey(GA) said:
You will want to get the vet to write the RX (or write your own) for the cartridges or pens next time.

The vial contains 1000 units, and it will very likely go bad before you can use it all up and you
throw away a lot of insulin.

The cartridges come as 5 3ml cartridges (1500 units). You open one cartridge at a time and will likely be able to
use the entire amount of each cartridge before opening another cartridge. With proper handling 2-3 months, depending
upon dose.

It seems more expensive, but actually on a per-unit basis it is less expensive, especially when you do not have
to throw any away.

You still use insulin syringes to draw up the insulin...from the little rubber area on the tip of the cartridge.
Click to expand...

Good to know - I was unaware tht the glargine was available in that form. I will definitely have my vet script that for me next time. I've never written script for myself - probably a comfort zone thing. Since I don't treat my own animals, and since I admittedly am far more comfortable with swine medicine than feline, I've just avoided ever scripting for myself.
 
I always test the thicker edge of the ear, about 1/3 way up from the base and I never look for a vein. Vaseline (if you can use it) will help the blood bead up quicker, you just need a very thin sheen. A rice sock is invaluable both as a heating pad and as support against the lancet device. I love my softclix and Squeak has never had an issue with the sound. I sit him on the ground between my legs and warm his ear with one hand and use my right hand to relax him and then do the testing.
 
You may need to desensitize her to the sound of the click if you aren't going to do the ear stick manually, ie several sessions each day of click without poking and give small low carb treat, for several days, until it doesn't bother her.

It also may help to pick up some topical neosporin ointment with anesthetic in it and apply it about 10-15 minutes before you do (attempt) an ear stick. The petrolatum in it helps any blood droplet stay cohesive (surface tension, I think), and the numbing effect may reduce one of her objections to being poked. (wipe off afterwards!)
 
Jen & Squeak said:
I love my softclix and Squeak has never had an issue with the sound. I sit him on the ground between my legs and warm his ear with one hand and use my right hand to relax him and then do the testing.
Click to expand...

What depth setting are you using? Mine is on 3, and I've been reluctant to set it any deeper since Selkie is already jumping at it. I thought my angle was good, and I am getting a small amount of blood. The flow stops almost immediately though.
 
I always used deep. The thing you need to do if the blood flow stops is 'milk' the ear so that more blood flows out. Plus the ear gets used to bleeding...or so it seems.
 
BJM said:
You may need to desensitize her to the sound of the click if you aren't going to do the ear stick manually, ie several sessions each day of click without poking and give small low carb treat, for several days, until it doesn't bother her.

It also may help to pick up some topical neosporin ointment with anesthetic in it and apply it about 10-15 minutes before you do (attempt) an ear stick. The petrolatum in it helps any blood droplet stay cohesive (surface tension, I think), and the numbing effect may reduce one of her objections to being poked. (wipe off afterwards!)
Click to expand...

Heading out for neosporin pain relief formula now. I'd considered putting a drop of orajel on the skin and letting it sit first, but the stuff would sting the sites I already tried, and the whole effort would be counterproductive. Pramoxine is a far better choice for this. Thanks for the tip.
 
Jen & Squeak said:
I always used deep. The thing you need to do if the blood flow stops is 'milk' the ear so that more blood flows out. Plus the ear gets used to bleeding...or so it seems.
Click to expand...

I've been giving Selkie several hours between attempts to rest up, so we're almost ready to try again. Thankfully this is a very forgiving cat (at least, she's always been up till now). I have to keep reminding myself this is day one.
 
A couple of tricks that helped me with the ear pokes was I take the cap off the lancet pen and use it kind of semi free hand, with positioning and then use it to make the poke quick. The other thing was at first Fenix was very squirmy, afterall he had only known me a few days before we started so we didn't have a long history of trust, so the first few days I wrapped him up as a kitty burrito. Now I don't bother I just tell him it is "ears time" and he jumps up to be tested. If Selkie is squirming you might want to try a kitty burrito or the famous clothes pin trick to scruff her.

Also I never occlude the vein, since I'm not aiming for the vein just the little blood vessels that run off it. I usually aim for just above the little flap on the ear in the thicker part of the ear. I have tried other spots but that one seems to work the best for us. It really is just trial and error until you find a spot that works well for you and Selkie.

Mel
 
I always thought I couldn't test Squeak, because he is an absolute bear about other things...but yet he surprised me and quickly got used to me testing. It also helps to mentally picture what you are do and talk it through to your cat. Sounds 'weird' but can help. And do not apologize...or they will think that there is some sort of option :)
 
Essay said:
What depth setting are you using? Mine is on 3, and I've been reluctant to set it any deeper since Selkie is already jumping at it. I thought my angle was good, and I am getting a small amount of blood. The flow stops almost immediately though.
Click to expand...

Don't be afraid to use the deepest setting.

Hold the lancet device directly perpendicular to the ear surface. Place your padded finger behind the area (one square of
folded TP works well). Press the lancet device firmly to the ear and 'click' it.

After blood is on the test strip, unfold the TP and wrap it around the edge of the ear with light pressure for
a few seconds...helps prevent bruising.

Selkie may be jumping to the sound of the clicker. So might as well use a deep setting.
I had to use the deepest setting on Smokey. Every cat is different (ECID).
 
sueandsamwise said:
What is the clothes pin trick?? I've never heard of it.
Click to expand...

If it's the one I'm familiar with, you take a clothes pin (or I've used a bag clip) and attach it to the scruff of the neck. Some people say it works on acupuncture principals to relax a cat, and indeed it does seem to relax some kitties. My own personal theory is that it hearkens back to kittenhood; kittens have a reflex to relax when mom picks them up by the nape of their neck. While adult cats are far too large to pick up by their napes, my guess is the mere feel of pressure tugging at the back of the neck still triggers the relax reflex.

Don't bother trying the trick on ferals.
 
I had to laugh at the don't bother trying this on a feral. I could just see a feral cat running around with clothes pins on his neck.

Off the subject I have a cyber throughbred horse named Essay.
 
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