Update on Gem

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jkbank

Member Since 2012
Hi there everyone - I wanted to give a quick update on Gem for those that may be wondering.

Gem seems pretty stable - her appetite is up, and her energy seems to be slightly higher. I'm a little concerned with the appetite - since I am not doing any BG testing, I really have no idea what's doing with that. I try to test urine with the strips when I can, and it has always been negative for ketones and high for glucose. I feel bad that I am shooting so blindly but I feel I really have to focus on her skin right now. I feed her when she meows for food, she seems to like small meals throughout the day (like 1/2 can of FF at a time). I don't know what that means for her BG but I figure she should eat when she's hungry.

As for her wounds - been using the Vetericyn, as suggested by a few people here. The largest one appears to be improving….it is no longer so raw, seems to be scabbing over (sorry for TMI!). I don't know if that's good or bad, but it looks better to us! Dr Peterson had been in touch with a surgeon who recommended some type of cocktail that gets compounded into a powder, which we would apply to the wound and when sprayed with saline forms a protective shell. Sounds good, but I am really trying to avoid putting Gem in the carrier for a while so I will stick with the Vetericyn for a bit and see how it goes. Hopefully we can buy enough time to give the trilostane a chance to work, help her body heal from within. One thing I gotta say, she has been such a trooper through all this - takes her pills with no fuss, lets me spray her and shoot her etc (I have had to go back to the chicken pill pockets as she didn't seem to like the duck ones, but I think it's a fair trade-off…not great for her BG, but gets the meds in her).

Anyway, assuming things stay as they are, we go back to the vet a week from Tues for blood work to see where her cortisol levels are. I continue to hope for the best but prepare for the worst - and relay that to my kids, that even though she looks a bit better, we still don't know if we can save her.

Thanks for all your words of support!
 
Thank you for the update! All in all, it sounds encouraging. Appetite up, energy up, and dealing with all of it like a trooper! The BGs? You know already how to deal with all that stuff, so once she's healed some more, you'll be able to handle it.

Hugs and scritches for you and Gem!
Praying for the best here,
Carl
 
Hi Karen,

I have been wondering about how Gem is doing. Thanks for posting an update.

It sounds like she is doing pretty well. I am happy to hear that the wound seems to be healing a bit, and that her energy and appetite are good. I think that spreading her meals out through the day is a good idea. She sounds like such a sweet cat, tolerating all of this so well.

I am very encouraged by this report. You are doing such an amazing job with her, and I know she is soaking up all of the love she is getting from her family.
 
I've been watching for an update on Gem and so happy to see a positive one at that! Our prayers continued for all of you.

Mel, Maxwell, Musette, Autumn & The Fur Gang
 
Hi All

Oh thanks for your positive response to my update! Sorry I haven't posted in a while, life gets in the way!

Just to be clear - when I say her energy is improving, I say that in the context of her overall condition! It is not as if she's running around chasing toy mice!! She spends most of her time laying around - I bought her these 2 fleecy mats that we sewed together to make a big mat she can stretch out on. She gets up to eat and pee, and not much else. I guess the differences are slight, she just seems more....present, I guess. She picks her head up more, will get up and walk around the room and then lay down again. It's hard to explain and I guess it's only obvious to us.

I don't want to be a downer, just trying to keep things in perspective and not get my hopes up too much. That said, any improvement is good :)

A few follow-up questions:

1) Do you think it's good that the wound is scabbing? Is that what we'd be looking for? Probably a question for the vet, but in the meantime, I'll ask you guys!

2) Though her diabetes is not my primary, urgent concern right now, it's still on my mind. I don't think I can be fiddling with her dose if I am not testing her, which I am not prepared to do right now. But do you think the hunger throughout the day is a bad sign? I have stopped the Purina DM entirely and am now feeding her mainly FF classics, with some BG, Wellness and Cowboy Cookout mixed into the rotation. I don't want to be overdosing her but like I said,I'm flying blind here. No ketones in her urine but other than that, I just don't know. Perhaps I'm better just leaving things as is for now. Thoughts?

3) Do you think giving her those chicken flavor pill pockets (3 in the morning, 4 at dinnertime) is really messing with her? I don't think I have much of a choice, as she obviously must take these meds, but do you think those bursts of sugar are hurting her?

Thanks again for your support, insight and prayers!

Oh she also looks to be grooming herself a teeny bit, something we haven't seen in a while...more good stuff!
 
Thanks so much for the update. I am continuing to send Gem healing vines and thoughts. I'm glad it sounds like she is doing better. I think feeding her whenever she's hungry sounds like the right thing to do, and in the smaller meals.
You are doing such a good job taking care of her. Thank you.

What a good and sweet girl, you are, Gem
cat_pet_icon
 
I think if the chicken pill pockets work, and the duck ones don't and you have to get the pills in her, then use what works. And continue to get those dip stick ketone and glucose tests whenever you can. Keeping a close eye on her additude and how she seems to feel is a good thing, as you know her best, and would know if she seemed more off, and needed a vet visit.
I know nothing about the scabbing or wound treatment, sorry.

I think feeding whenever she wants it, is the right thing to do, because of the dosing blindly. If she's low, and she's asking for food, she needs it. If she's high, and she's asking for food, likewise she needs it.

Hopefully others will give you some more advice regarding her wound healing.
 
I don't know anything about wound healing, but it sounds like the scabbing is a sign of healing. At least it is closing the wound. Continue to look for any signs of infection, such as redness or discharge. If the scabbing starts to make the wound itch, keep a close eye that she doesn't try to lick it. She can't be allowed to do that. It is great that she is grooming, but make sure the wounds are covered or she has a collar on to prevent licking the wounds (if they are in an area she can reach).

I think that voracious appetite is also a symptom of Cushings. One thing you want to watch for is when the Trilostane starts to kick in, it is possible that her BG levels could also start to come down. I know you can't test her right now, and you are doing a good job with the urine testing. If you start to see urine tests without any glucose in them, you will know that her BG levels are coming down. If she is generally hungry throughout the day, I think that is not as worrisome as if, for instance, she became uncharacteristically hungry a few hours after her shot, signalling possible low blood glucose. I think that feeding her regularly, and whenever she asks for food, is good.

I don't think the Pill Pockets are really messing with her. You need to get the pills in. I believe that the Duck and Pea Pill Pockets are being discontinued in the feline formulation, but that they will still sell them in the dog formula. I don't know if the dog formula tastes different or if the taste would appeal to her.
 
I have no advice as far as insulin, and my experience with Cushings is limited to horses (different medication, obligated herbivores). I think others here are better to help you with Cushings, diabetes, and insulin than I could be. I understand the fears of shooting blindly, I hope you can get to a point of testing her regularly soon.

As far as treats, you HAVE to get medications into her, so I say do what you have to. I've heard some say cream cheese has helped, and it's low carb. Any low carb moldable food might be a thought! I don't know what dietary restrictions you're under other than low carb, but what about real meat added to food? I don't think I'd try lunch/deli meats with all the sodium/preservatives, but what about chicken breast or thighs, maybe even chopped in a food processor and top her canned foods? Would that get more nutrition into her?

I've had special needs pets before, and I think you're doing great. It soulds like the wound is healing, which is great. All her conditions aside, it sounds like you're getting the important stuff done: she's perked up a bit, she's eating, drinking, and urinating. Good on you and you'll be in my thoughts!

Suzanne
 
Linda and Bear Man said:
I don't know anything about wound healing, but it sounds like the scabbing is a sign of healing. At least it is closing the wound. Continue to look for any signs of infection, such as redness or discharge. If the scabbing starts to make the wound itch, keep a close eye that she doesn't try to lick it. She can't be allowed to do that. It is great that she is grooming, but make sure the wounds are covered or she has a collar on to prevent licking the wounds (if they are in an area she can reach).

I think that voracious appetite is also a symptom of Cushings. One thing you want to watch for is when the Trilostane starts to kick in, it is possible that her BG levels could also start to come down. I know you can't test her right now, and you are doing a good job with the urine testing. If you start to see urine tests without any glucose in them, you will know that her BG levels are coming down. If she is generally hungry throughout the day, I think that is not as worrisome as if, for instance, she became uncharacteristically hungry a few hours after her shot, signalling possible low blood glucose. I think that feeding her regularly, and whenever she asks for food, is good.

I don't think the Pill Pockets are really messing with her. You need to get the pills in. I believe that the Duck and Pea Pill Pockets are being discontinued in the feline formulation, but that they will still sell them in the dog formula. I don't know if the dog formula tastes different or if the taste would appeal to her.
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Thanks Linda
Luckily Gem is not even trying to lick the wounds, and I don't think she can reach them. When I say grooming, she is really only licking her neck and front paws, which is still better than nothing :)

As for appetite, I don't know if it's voracious, but just steady…so we put her breakfast out, she eats a bit and then an hour or so later will cry for more. Part of it is that she wants the food super super fresh. Sometimes we stir it up to fake her out :)

Funny, my vet still had the duck pill pockets (both cat and dog) so I picked some up but she doesn't seem to eat them. I guess I could try the dog ones, but for now I think getting the meds supersedes the slight spike she may be getting.

I wonder what the time frame is for the trilostane kicking in….
 
Suzanne&Grey said:
I have no advice as far as insulin, and my experience with Cushings is limited to horses (different medication, obligated herbivores). I think others here are better to help you with Cushings, diabetes, and insulin than I could be. I understand the fears of shooting blindly, I hope you can get to a point of testing her regularly soon.

As far as treats, you HAVE to get medications into her, so I say do what you have to. I've heard some say cream cheese has helped, and it's low carb. Any low carb moldable food might be a thought! I don't know what dietary restrictions you're under other than low carb, but what about real meat added to food? I don't think I'd try lunch/deli meats with all the sodium/preservatives, but what about chicken breast or thighs, maybe even chopped in a food processor and top her canned foods? Would that get more nutrition into her?

I've had special needs pets before, and I think you're doing great. It soulds like the wound is healing, which is great. All her conditions aside, it sounds like you're getting the important stuff done: she's perked up a bit, she's eating, drinking, and urinating. Good on you and you'll be in my thoughts!

Suzanne
Click to expand...

Thanks Suzanne

I can try some other foods to use to give the meds. Gem has never been one for people food so I'm not sure what she'll eat. I've bought lots of different stuff to give her as treats when she seems hungry (freeze dried shrimp, chicken etc) and she has no interest! She's always been an interesting kitty!
 
If you are consistently getting glucose in the urine, the water drinking is high, the litterbox is filled with lakes of litter, etc., you should be safe with a small increase of 0.25 to 0.5 units.

Changes when using the indirect methods may need to be done slower than if you are blood testing, so give it a good 10-14 days with continued indirect observation, before another dose adjustment.

See page 5 of the linked article, which discussses how you'd adjust the dose with a "fractious cat" that couldn't be home tested.
http://www.uq.edu.au/ccah/docs/diabetesinfo/link5.pdf
 
BJM said:
If you are consistently getting glucose in the urine, the water drinking is high, the litterbox is filled with lakes of litter, etc., you should be safe with a small increase of 0.25 to 0.5 units.

Changes when using the indirect methods may need to be done slower than if you are blood testing, so give it a good 10-14 days with continued indirect observation, before another dose adjustment.

See page 5 of the attached article, which discussses how you'd adjust the dose with a "fractious cat" that couldn't be home tested.
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Thanks BJM - as Gem doesn't ever pee in the box, it's hard to tell how much she is peeing. Same with water, as I have 2 cats. But she does seem to drink fairly often. What is the downside to increasing the dose? It would be causing her BG to go too low, right? Which I would see with the urine testing? No matter how much I read and read, it's so hard to keep up with everything. I feel like I've made so many mistakes with her, don't want to mess with her anymore! So on the flip side, what is the down side of NOT increasing the dose at this time?
 
Pros: slightly better glucose control, with slower damage from the high glucose

Cons: too much insulin could cause a hypo

If you are getting glucose in the urine, it has exceeded the renal threshold which is "usually somewhere between 180 and 270 mg/dL (10 to 15 mmol/L)" (pet diabetes wikia) by at least that much if not more. An increase of 0.25 units is likely to be a safe increment that will help, without risking a hypo.

If you are measuring the water consumption - measure what is left after 12 hours, and refill at shot time - the article gives guidelines based on water consumption and weight. It may be safe to assume the healthy cat is drinking roughly the same amount daily as will Gem unless something changes (ie insulin dose), which means any decrease in water consumption (more remaining at shot time) = better control.
 
Hi Karen,

I am not a dosing expert, nor am I an expert in alternative monitoring methods. In your position, I would be very cautious about increasing the dose. In my opinion, 3 units is already a fairly high dose to be shooting without the ability to test BG, so I would be hesitant to increase. This is my personal opinion. I think it would be one thing to gradually raise the dose based on urine glucose testing in a healthy cat as a long term strategy, but in the short term, I think that Gem is in the midst of a potentially rapidly changing situation. You don't know when/if the medication may potentially affect her appetite due to side effect or her blood glucose levels by reducing her cortisol levels. I believe that Dr. Peterson also suggested holding the dose, and that you are scheduled for a vet recheck in the near future.

You are seeing some gradual improvement in terms of wound healing and demeanour. I think the worst thing that could happen to Gem right now would be a hypoglycaemic issue. I am not saying that that is what would happen if you did gradually raise the dose, but I think it is a potential concern.

You don't know if the PD (thirst) is a symptom of her diabetes, her Cushing's disease, or her renal issues. I would not rely on that as an indicator for raising the dose, especially as you have another cat confusing the issue. When you get a positive result for urine glucose, that means that at some point since she last voided, she has exceeded the renal threshold for spilling glucose in the urine. The renal threshold varies among cats. Glucose in the urine is not normal, of course, but it is also possible that in a sick cat the renal threshold is lower than what it would otherwise be for that cat. If you are not able to monitor the urine around the clock, then you won't know if she has gone below her renal threshold (i.e. into lower BG levels) at some time during the day. If you get a negative urine glucose test, it will not tell you if she has had a "normal" number or if she has had a very low number. The downside of relying on urine testing is that it gives you an idea of what has happened over a period of hours in the past, but it does not tell you what is happening now. I would continue testing the urine glucose, as you are gathering information. You could even add the test results to your spreadsheet. I would also suggest that you test for ketones daily.

The downside of running with high blood glucose can include a chance of developing DKA (especially if there is an infection present and the cat is not eating), an increased possibility of urinary tract infections (as glucose in the urine provides a better culture medium for bacteria), or development of diabetic neuropathy. Over the long term, the pancreatic cells may be damaged. Again, I think that as there is no current indication that these are happening, and because her condition is subject to unpredictable change, and because a hypoglycaemic episode is very dangerous for her, I would be hesitant to increase dose at this time. Once she stabilizes on Trilostane and her skin improves, then I think you could reconsider.

This is just my own opinion, and what I would probably do if it were my cat.
 
Thanks Linda and BJM for your thoughtful replies. I don't think the water consumption is a particular red flag right now. It's just in my head that the longer her diabetes is unregulated, the more damage it is doing. But again, given everything that's going on, it's probably the least of my concerns. You're right Linda, the last thing I (and she!) needs is a hypo. I think it's unlikely, but probably not worth the risk. I think I'm better off erring on the cautious side and holding off on any doing changes, at least for another week til we get back to the vet. I'm hoping that I can start testing her again soon, and see where that leads me.

Thanks again!
 
Hi Karen,

Happy to see your update on Gem.
Good she wants to eat even in small doses. My vet has told me that Trilostane is best given with food.

Wanted to offer my thoughts on changeing her insulin levels-simply based on my expereince with Cushing's and initiating treatment with Trilostane. I know that high BG's aren't what you want but you also don't want to be wondering if you are looking at a hypo situation or a Trilostane reaction.
When Pedro started on Trilostane we were also dealing with Pancreatitis. We ended up doing a couple of emergency runs to the vet because his behavior was off, appetite was bad, and then there was the vomiting. So we could just not tell what was what and were afraid we were dealing with a Trilostane OD.

Since you can't test her BG right now and you have added a new and powerful drug to her system, it would probably be safer (and less stressful on you) to wait on a dose crease. You need to be monitoring her now for any symptoms that might indicate a negative response to the Trilostane. It would be helpful to have the fewest variables in the mix right now. The fewer uncertainties you can introduce in the short term may be better in the long haul.

We're pulling for you!
 
Amy and Pedro said:
Hi Karen,

Happy to see your update on Gem.
Good she wants to eat even in small doses. My vet has told me that Trilostane is best given with food.

Wanted to offer my thoughts on changeing her insulin levels-simply based on my expereince with Cushing's and initiating treatment with Trilostane. I know that high BG's aren't what you want but you also don't want to be wondering if you are looking at a hypo situation or a Trilostane reaction.
When Pedro started on Trilostane we were also dealing with Pancreatitis. We ended up doing a couple of emergency runs to the vet because his behavior was off, appetite was bad, and then there was the vomiting. So we could just not tell what was what and were afraid we were dealing with a Trilostane OD.

Since you can't test her BG right now and you have added a new and powerful drug to her system, it would probably be safer (and less stressful on you) to wait on a dose crease. You need to be monitoring her now for any symptoms that might indicate a negative response to the Trilostane. It would be helpful to have the fewest variables in the mix right now. The fewer uncertainties you can introduce in the short term may be better in the long haul.

We're pulling for you!
Click to expand...

Thanks Amy, this really makes a lot of sense to me. The less variables, the more we can attribute any changes to the trilostane. So far, Gem's behavior is good, even perking up a bit, and her appetite is good, though like I said she seems to prefer lots of small meals throughout the day.

On a positive note, her urine glucose numbers seem to be coming down. For the longest time, it was turning those strips the darkest color brown, and now it's more in the middle. Can this be the good sign we've been waiting for?!?!
 
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