Meet Squirrel

[Carla and Squirrel]

Hello fellow FD caregivers,

Sorry in advance for the long post.

Squirrel is my 10 year old male orange tabby with a serious love of bread. He was diagnosed on December 26, 2016 and is unregulated. He was originally started on Novolin N and his dose was increased to 4 units twice a day by February. We had blood work done in December and everything looked good minus his BG and Spec fPL which was 7.4. I was not home testing at the time. I had already switched him over to low carb canned.
The weekend of March 25th he stopped eating and drinking and became very lethargic. We had more blood work and a new Spec fPL done. Slightly anemic, high BG, and a Spec fPL of 23.2. I bought the Relion Micro and began home testing. After a few rocky days of subcutaneous fluids, hand feeding chicken, and adding on buprenorphine and cerenia his appetite recovered. We switched to Vetsulin and have been struggling to find a dose that will work for him. I've been trying to find low carb, low phosphorus, low residue food that he will eat but his appetite after the first flare was ravenous. He even gained a little weight for the first time in months. He had a few off days and symptoms of a UTI so we did two rounds of antibiotics and even did a steroid shot for the pancreatic inflammation. My vet has suggested an ultrasound and listens to me and is willing to try other blood work panels to try and figure out what else he may have going on but she is leaning toward cancer. Unfortunately money is tight and I'm not sure which tests I can afford that would be the most beneficial.
Two days ago his appetite started waning again. Now we appear to be back in a pancreas flare. The comments in my SS detail my observations and his BG test results are up to date. I found the vetsulin board and read through all the stickies and studies on pancreatitis I could find. We are going back to the vet in the morning for fluids and Cerenia and Covenia shots. I'm hoping to find an injectable emetic as I am unable to pill him when he is off food. I adore my vet and know she is trying to help him but he just doesn't seem to be responding. This is my first post but I've been actively reading the boards since March and love this community.
I'd appreciate any pointers, feedback, and opinions at this point. I'm also curious as to whether there are any vets who specialize in feline diabetes in the Dallas area.

Worried mom,
Carla

 

[Olive & Paula]

Carla, there is a lot going on. First welcome. Glad you are home testing. Pancreatitis can come and go. Also common with diabetic cats as both involve the pancreas. Cerenia can be injectable. Zofran is another, not sure about injectable though. Cerenia and Zofran can be given together as they work differently. Pain med should be given as long as needed. Buprenorphine is preferred. Smokey remained on all meds for months. It can take that long. Cypro for appetite stimulant if you need it. Cypro can filled in any pharmacy.

Convenia is not the best AB to give. Once it's given it can stay in the system for many weeks. Should you kitty have side effects, it can't be stopped like most others and you have to wait it out. Steroids should only be used as last resort. They do have a direct affect with diabetes and can actually be the cause of it.

Feeding is very important and keeping them eating can be a challenge until they feel better. For diabetes Fancy Feast classic Pate is what most here use. Ideally you want a low carb wet food. There are stickies you can browse through. You might have to assist feed until the meds kick in. Also baby food meat is good and most kitties will eat that when not feeling well. Gerber and Beechnut are the 2 brands. Make sure no onions or garlic.

If your vet will take suggestions Prozinc or Lantus insulin would be better choices. Obtaining from Canada is the most economical way and most of us use Mark's Marine Pharmacy, they will require a script and the box of 5 pens is the best deal and will last close to a year if handled and stored properly.

Ask your vet to give you all the meds so you always have them on hand. Some come in suspension from a compounding pharmacy and the Buprenorphine you can get in liquid form in 30 ml quantity that you squirt in kitties check.

It's overwhelming but can be managed. Ask questions. Most of us have and do deal with both and more. Keep us posted.

 

[tiffmaxee]

Welcome but sorry you are having so many issues with Squirrel. What has your vet given for nausea? Max had chronic pancreatitis for about seven years and infave he m ondansetron, a human med most of tge time that I bought with a script from Costco. Vets often sell cerenia which is also good and works for many. Some need a combo of the two. I used the pills and put in gelcaps. Then I chased it with Gerbers 2nds baby food. Max would eat well with ondansetron on board. Finding tge correct amount for him took awhile but once I did he didn't need an appetite stimulant. While you don't want to give one to a nauseous cat because it can cause food aversions, cyproheptadine worked really well for him. I hope Squirrel feels better real soon.

 

[Phoebes (GA)]

Phoebe has chronic pancreatitis and has gabapentin for inflammation
and pain, cerenia every night for puking, zofram 2x a day nausea and bupe on her ear (gel) 3x prn. for pain. They are a delicate dance these pancrentitis and FD kitties. Pain meds and anti nausea and anti emetics most important. Good luck love his name!! lol Welcome to the best place you never want to be(thats what they say here) also its not a race its a marathon.

 

[Tracey&Jones (GA)]

Pancreatitis is a beast. You can see Jones' list of meds. He has his own pill box so I can keep them straight.

It took about 5 months for us to get it under control and his blood work to come back to normal. Of course the IBD does not help. And as noted above, Jones developed FD from the prednisolone steroid he was on.

As Phoebes says - it is a marathon but I think you will find that the people here will provide information and suggestions that can help you decide what is best for Squirrel.

 

[Phoebes (GA)]

Pancreatitis is a beast. You can see Jones' list of meds. He has his own pill box so I can keep them straight.

It took about 5 months for us to get it under control and his blood work to come back to normal. Of course the IBD does not help. And as noted above, Jones developed FD from the prednisolone steroid he was on.

As Phoebes says - it is a marathon but I think you will find that the people here will provide information and suggestions that can help you decide what is best for Squirrel.

What made you decide to add the steroid. I am so afraid to do that since they are to blame to begin with. Wondering if I should give in and maybe they would help. Which steroid do you give? And just bite the bullet, she already is on high dose of insulin would it go higher?

 

[Tracey&Jones (GA)]

What made you decide to add the steroid

I didn't decide the vet did. Based on initial test results she figured he had IBD with lymphoma. Lymphoma is not a rare development with long-term IBD from what I read. I never had the lymphoma confirmed as it required a surgical biopsy and he was not healthy enough at the time for that. And with the big C - prednisone is the go to medication as part of the chemotherapy regime. It is called prednisolone for cats. It wasn't till later when we saw his BG increase that she mentioned that it could cause diabetes in cats and we would have to watch. By that point we were so far out into the lake that I figured we just has to swim to the other side. He did get FD in the end. As we were able to get his pancreatitis and IBD under control, we dropped the prednisolone dose from 5mg twice a day to 1.25mg once a day. And he was pretty stable if you see from his spreadsheet.

Then his silly bean thought that we should try budesonide instead of prednisolone. Both are a steroid. They are both used to treat IBD. There is pluses and minuses to both. I was hoping the budesonide would help us get over the hump and become OTJ as it is less likely to influence BG's. As you can see from the last two weeks - for me, the jury is still out. I will give it another couple of weeks before deciding if I need to go back to the pred. It really all depends on the whole cancer question and I don't have that answered. Decided I never would, just work with what I have and fix what I can.

Jones is not on a pain meds however. She never gave him one, which from what I read here is kind of a staple with pancreatitis.

His last check up in January she did say I could start weaning him off his meds and I was to decide which ones and when. That I why I thought I would try the budesonide over the pred. Then change diet to homemade cooked/raw then move to take out the metronidazole as it is a AB and he has already been on it for 5 months and would like to see if we can drop that. He is also on a probiotic and SEB (just started 1/8tsp at night), which should help when coming off the AB.

 

[Olive & Paula]

Some kitties do very well on budesonide some don't. If the prednisone is needed for IBD, then he needs it and you just need to make the insulin adjustments which home testing will let you know which direction to go. Right now the pancreatitis needs to be addressed. That's fluids, pain meds, anti nausea and anti emetics. Smokey was on the metronidazole for quite some time. Eventually we were able to decrease all meds to smaller maintenance doses for life. Which in a way was good, it left room to increase during a flare.

It sounds as if you are doing all the right stuff. Just have to get through the current flare. It can take a little time.

Here's a question, has the vet mentioned Leukran? Chemo drug. I to refused the biopsy for Smokey because of his age and the anesthesia. However, my vet was considering the drug anyway. But IBD was ruled out once we received the pancreatitis results from Texas U.

 

[Phoebes (GA)]

Based on initial test results she figured he had IB D with lymphoma.

That sounds exactly like Phoebes story. I would not put her thru the biopsy. And vet did recommend the chemo drug, but I had the chemo pill when I had cancer and felt like crap. So decided against it. But will have to think about the steroid. Maybe the steroid will help regulate her due to less inflammation. Thank you for telling your story.

 

[Tracey&Jones (GA)]

chemo drug

Was that Luekeran? That was suggested as well and we tried it for 2 weeks. He was miserable and when we did the follow up paperwork - his RBC and WBC's were in the tank. So vet suggested to do it once a week but there was no protocol for it. I just stopped it. I figured I will keep it in my back pocket for later. There is the new protocol for pulse dosing. You give it for 3 days and then stop for 21. That is a little closer to what they do with humans. You have to keep in mind that chemotherapy in humans is very toxic and is used for the purpose of killing all cancer cells. The doses and intent is different for dogs & cats. It isn't as toxic. They still feel like crap though. Those first three days after injection were pure killer for me.

Some days I lose sight...but you need to treat the cat not the numbers and stats.

 

[Phoebes (GA)]

Was that Luekeran? That was suggested as well and we tried it for 2 weeks. He was miserable and when we did the follow up paperwork - his RBC and WBC's were in the tank. So vet suggested to do it once a week but there was no protocol for it. I just stopped it. I figured I will keep it in my back pocket for later. There is the new protocol for pulse dosing. You give it for 3 days and then stop for 21. That is a little closer to what they do with humans. You have to keep in mind that chemotherapy in humans is very toxic and is used for the purpose of killing all cancer cells. The doses and intent is different for dogs & cats. It isn't as toxic. They still feel like crap though. Those first three days after injection were pure killer for me.

Some days I lose sight...but you need to treat the cat not the numbers and stats.

Amen.

 

[Tracey&Jones (GA)]

Some kitties do very well on budesonide some don't. If the prednisone is needed for IBD, then he needs it and you just need to make the insulin adjustments which home testing will let you know which direction to go.

I think we high-jacked Carla's post. So sorry for that, but sometimes that is when you learn a lot!

Based upon this discussion, I am thinking if things are not good by the end of the day Saturday I am going back to pred. Was planning on doing a curve tomorrow. He did better on the pred overall, ate more, less mopey, BG's were better - just an overall picture. Need a 40,00 ft look at it.

 

[Tracey&Jones (GA)]

I am sorry Carla, I was just reading your post and it said slightly anemic - Tanya's site for CKD kitties has a whole section on it...but I think they start with B-vit supplements. Here is the link. It also suggests addition blood work information if you are interested.

Not sure if you thought of doing your own subq fluids at home. I am still learning on that one but it is a thought.

Jones had an ultrasound done. Outside of confirming the IBD - it will not rule out lymphoma of the stomach or intestine. I even had it done with aspirates and those came back as having no obvious cancerous cells.

Don't be surprised if Squirrel jumps around on food. Once they don't feel good they tend to not want to have that food again for at least awhile. Which jumping food can cause tummy upset. Which is why the Cerenia and Metronidazole really helped with nausea and diarrhea. The metro also has some anti inflammatory properties that can help settle the tummy.

Are you using any probiotics or slippery elm?

 

[Yong & Maury GA]

Welcome Carla and Squirrel! Sorry you are dealing with multiple issues but this is definitely a great place to get help! Lots of information, knowledgeable and supportive members too!

 

[Carla and Squirrel]

Carla, there is a lot going on. First welcome. Glad you are home testing. Pancreatitis can come and go. Also common with diabetic cats as both involve the pancreas. Cerenia can be injectable. Zofran is another, not sure about injectable though. Cerenia and Zofran can be given together as they work differently. Pain med should be given as long as needed. Buprenorphine is preferred. Smokey remained on all meds for months. It can take that long. Cypro for appetite stimulant if you need it. Cypro can filled in any pharmacy.

Convenia is not the best AB to give. Once it's given it can stay in the system for many weeks. Should you kitty have side effects, it can't be stopped like most others and you have to wait it out. Steroids should only be used as last resort. They do have a direct affect with diabetes and can actually be the cause of it.

Feeding is very important and keeping them eating can be a challenge until they feel better. For diabetes Fancy Feast classic Pate is what most here use. Ideally you want a low carb wet food. There are stickies you can browse through. You might have to assist feed until the meds kick in. Also baby food meat is good and most kitties will eat that when not feeling well. Gerber and Beechnut are the 2 brands. Make sure no onions or garlic.

If your vet will take suggestions Prozinc or Lantus insulin would be better choices. Obtaining from Canada is the most economical way and most of us use Mark's Marine Pharmacy, they will require a script and the box of 5 pens is the best deal and will last close to a year if handled and stored properly.

Ask your vet to give you all the meds so you always have them on hand. Some come in suspension from a compounding pharmacy and the Buprenorphine you can get in liquid form in 30 ml quantity that you squirt in kitties check.

It's overwhelming but can be managed. Ask questions. Most of us have and do deal with both and more. Keep us posted.

Thank you! I asked about injectable emetics but my vet doesn't have any she can supply me with so I am going to try Ondansetron. He has been on Buprenorphine since the initial pancreatitis diagnosis. He's had Convenia many times in the past for a variety of issues and never had a problem so I am pretty comfortable with it. So far the injections from Friday appear to be helping, fingers crossed. My vet has always been open to suggestions and I have a great relationship with her but the clinic she works in doesn't allow them to dispense scripts for anything other than human drugs they don't carry. With that said, I am open to considering another insulin and if he doesn't respond to the Vetsulin then I will definitely ask.

 

[Carla and Squirrel]

But IBD was ruled out once we received the pancreatitis results from Texas U.

How was IBD ruled out with pancreatitis results?

 

[Carla and Squirrel]

I think we high-jacked Carla's post. So sorry for that, but sometimes that is when you learn a lot!

Based upon this discussion, I am thinking if things are not good by the end of the day Saturday I am going back to pred. Was planning on doing a curve tomorrow. He did better on the pred overall, ate more, less mopey, BG's were better - just an overall picture. Need a 40,00 ft look at it.

I actually really appreciate the hijack. I have been wondering about adding prednisolone on board based on some other research and reading I have done. Even one of the vets in the IDEXX roundtable discussion indicated that steroids were part of their protocol for pancreatitis. I'll be keeping up with you and Jones!