New to PZI Boards -- Miko is switching today

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Sarah & Miko

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Just wanted to say hello and see if anyone has any words of wisdom as we transition from Lantus to PZI :)

My sweet Miko is switching over tonight. He was diagnosed and started on Lantus 7/18, and has since then been diagnosed with pancreatitis. We haven't ruled out small cell lymphoma yet but so far no positives on any aspirates, although he does have some thickening in his small intestine along with enlarged lymph nodes (which could just be a symptom of the pancreatitis, too) -- not been able to get access to those lymph nodes yet to aspirate, but they hadn't grown from his first to his second ultrasound. He gets 1/4 ondansetran SID for nausea, very occasional bupe for pain.

Prior to diagnosis he was a super active and lean kitty on 100% raw diet. At the recommendation of his internist bc of compounded issues, and since the raw didn't seem to have prevented any of these issues to start, I've since switched to low carb canned. He's around 10 years old, neutered male, likely part siamese or burmese (so maybe all these issues are just his karmic destiny), and he's totally amazing.

Not sure what his starting dose or the concentration will be yet. He had his Lantus this morning and we won't be holding off on insulin to let his Lantus dept disappear first, just seguing right into the PZI tonight. Working my way through the stickies and links. As I understand it, I may be able to see results tonight but he should stay on that same dose for about a week to see total results?

Also, where do you all get your PZI? I'm paying $183 through my specialty vet, but it looked like some people order from pharmacies online and get much cheaper... will be good to know going forward. This journey is a lot of things but it is not cheap :)

Keeping my paws crossed that his sweet little body lets the PZI do its magic! Glad to be here.
 
Hi Sarah and Miko,

We usually suggest waiting a cycle before starting ProZinc as Lantus can continue to work longer than 12 hours and you don't want overlap. But he is at a high dose so it may not be necessary. I think I'd start at a little less, just to be cautious.

Why does your vet think he is at such a high dose? Have you considered that he might have a high dose condition like Acro? If that is a possibility, have you considered Levemir? It is used by lots of high dose kitties here because it is thought to sting less at high doses.

Your vet's price seems high. Unfortunately ProZinc is only available through the vet. I think most people here pay under $140. Lantus and Levemir are human insulins and can be gotten from a pharmacy.

Here is some imfo on high dose onditions:

http://www.felinediabetes.com/FDMB/viewforum.php?f=12
 
Carl & Bob said:
http://www.1800petmeds.com/search.jsp?trail=SRCH:prozinc&_requestid=139793

What starting dose did your vet recommend?
Click to expand...

Thank you so much for that link! Awesome -- Will definitely hang onto for next time. Every bit helps :)

Miko's starting out on 2 units of the 40 ml formula of the PZI ProZinc.

Sue and Oliver (GA) said:
Hi Sarah and Miko,

Why does your vet think he is at such a high dose? Have you considered that he might have a high dose condition like Acro? If that is a possibility, have you considered Levemir? It is used by lots of high dose kitties here because it is thought to sting less at high doses.


Here is some imfo on high dose onditions:

http://www.felinediabetes.com/FDMB/viewforum.php?f=12
Click to expand...

He does have some high dose conditions, although Acro doesn't seem likely at this time -- no enlargements of anything other than his pancreas and some intestinal lymph nodes. My vet thinks he's been unresponsive to high doses because of the pancreatitis and possible IBD and/or small cell lymphoma. He's got thickened small intestines and enlarged lymph nodes. He's had a couple aspirates and ultrasounds and there's been no definitive diagnosis yet on small cell lymphoma, but the pancreatitis is a definite. From what I understand, the pancreatitis very often drives up BG, and his has been in constant flare up for some time :( And if there were small cell lymphoma, that can very often do the same. I guess about 2/3 of cats who are unresponsive to normal doses have underlying conditions.

He does also have a pre-exisiting heart murmur but there's been no change in that and it's still low grade... I think my vet is hoping that he may still respond at a lower dose to a different insulin -- I guess pancreatitis can sometimes chill out and cause either slow or sudden need for reduction in insulin, which could be dangerous for Miko if he were on a very high dosage of insulin and it were a sudden change... So I'm really hoping PZI works. Levemir was the other consideration for him, but after reviewing his charts she decided we should try the PZI next so I'm hoping he will respond better than he did to Lantus...
 
My understanding is that pancreatitis does "come and go", but we need to try to get a hold of Kim (kse). Her Miss Kitty had repeated bouts of p-titis, and Kim was fantastic with managing the flare ups.

What meds/treatments does your vet have you doing to manage the flare ups?

Has Miko ever had any issues with ketones? Have you tested for them with the sticks? Reason I mention it is because of the large decrease in dosage. Ketones are just something that you might want to keep an eye out for short-term until you see how he responds to the PZI.
 
You may already have this link, but just in case: A Primer on Pancreatitis

You may wish to discuss if a blood thinner (anticoagulant) would be indicated due to your cat's murmur and the pancreatitis (inflammation).

Why I suggest asking the vet:
Spitzer threw a blood clot to his hind legs (saddle thrombus) after a GI biopsy to see if he had IBD or lymphoma. The chances of another one were 50% within 10 months and good recovery was unlikely. He was in such pain, I let him go. I was told he had a mild heart murmur at the Emergency vet. Apparently, a heart murmur indicates disturbed blood flow, which may allow the blood to pool and clot.
 
Carl & Bob said:
My understanding is that pancreatitis does "come and go", but we need to try to get a hold of Kim (kse). Her Miss Kitty had repeated bouts of p-titis, and Kim was fantastic with managing the flare ups.

What meds/treatments does your vet have you doing to manage the flare ups?

Has Miko ever had any issues with ketones? Have you tested for them with the sticks? Reason I mention it is because of the large decrease in dosage. Ketones are just something that you might want to keep an eye out for short-term until you see how he responds to the PZI.
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I would LOVE a way to manage the flare-ups. Right now he's on ondansetran regularly for nausea, since that's an issue, and occasional bupe for the pain. He seems to experience pain only very rarely which is good since he hates the oral medication and then runs from me anytime I need to test his BG or give him insulin. Nothing else. The internist says it's just a waiting game, although if he has small cell lymphoma it could be another reason why his pancreatitis is lingering... she did say it's rare, but she has seen cats who have it for months on end and then at long last the flare up finally ends. I've been researching supplements and anything that would help, and would be so grateful for any other suggestions. I started him on probiotics for a couple days and they firmed up his poop which can sometimes be very soft, but then I read about the mortality rates in human pancreatic patients on probiotics and stopped in abject terror.

He did have ketones in his blood (not urine yet) when his pancreatitis first made itself be known. I stopped harassing him so much about ketone tests once he got so high on Lantus, but that's a great point and I'll definitely get my aluminum boats and litter box stalking started again. He will be so excited :D

BJM said:
You may wish to discuss if a blood thinner (anticoagulant) would be indicated due to your cat's murmur and the pancreatitis (inflammation).

Why I suggest asking the vet:
Spitzer threw a blood clot to his hind legs (saddle thrombus) after a GI biopsy to see if he had IBD or lymphoma. The chances of another one were 50% within 10 months and good recovery was unlikely. He was in such pain, I let him go. I was told he had a mild heart murmur at the Emergency vet. Apparently, a heart murmur indicates disturbed blood flow, which may allow the blood to pool and clot.
Click to expand...

Oh, BJM, I am so sorry. This made me cry for your beloved Spitzer -- I am so sorry. And I will DEFINITELY ask about this. I've been so worried about the stress on his little ticker with his high BG and everything else going on in his body, but I did not have a clue about the inflammation and murmur tie in. Thank you so much.
 
I'm going to PM Kim. She's not on the board much, but she was on last week.

I know that one thing she did for Kitty was bupe like you are using. And she also administered sub-Q fluids regularly when Kitty would have a flare up. You will need to definitely ask the vet about that though. The heart murmur might be an issue when it comes to sub-q fluids.
 
I just wanted to give you a heads up, because Miko seems to have some similar issues as Spitzer, and if preventing a blood clot is possible, it may save you a lot of grief.
 
Carl & Bob said:
I'm going to PM Kim. She's not on the board much, but she was on last week.

I know that one thing she did for Kitty was bupe like you are using. And she also administered sub-Q fluids regularly when Kitty would have a flare up. You will need to definitely ask the vet about that though. The heart murmur might be an issue when it comes to sub-q fluids.
Click to expand...

Thank you so much, Carl -- the sub-q fluids definitely help him, but you are right on the heart murmur. They don't particularly want the sub-q fluids to be a part of his treatment plan bc of the murmur, although when his system was crashing when pancreatitis was first dx he was given limited fluids and they really seem to have made a difference.

terriy said:
Just wanted to say Hi and welcome to PZI! Lot of great folks here!
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Thank you Terriy! :)

BJM said:
I just wanted to give you a heads up, because Miko seems to have some similar issues as Spitzer, and if preventing a blood clot is possible, it may save you a lot of grief.
Click to expand...
I so appreciate the heads up. <3
 
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