Wednesday, August 17, 2011

August 17, 2011 Dose #5 Tonight

Yesterday was a quiet day, nothing special happened. Shadoe's dose likely will increase as her BG is staying high. Their gabapentin dose last night was well taken by both; I believe they know the liquid makes them feel better, so I had no resistance from either of them. What a relief that was!
Shadoe's appetite stayed high, and she searched out Oliver's leftovers after she finished her own foods.
Oliver still does not seem to have that much of an appetite, and is quieter than his normal.

This morning, both were not as cheery, and Oliver refused to purr. He was licking his lips quite a bit, so to be safe, I gave him pepcid and 125ml fluids at 1130am. Most of the fluids had dissipated by approx 3pm, so he was not too dehydrated. By pm shot time, he was starting to act a bit better.

Tonight, both were fine with the oral gabapentin, followed by some syringed tuna water to rinse down the gabapentin. By 4hrs after the gabapentin, Shadoe is out in the open again, and Oliver is nicely stretched out on the floor.

Tomorrow morning is their B12 shots. I hope they are both in better spirits. in the morning.

Tuesday, August 16, 2011

August 16, 2011 Dose #3 Last Night

Yesterday continued well for Shadoe - she was out in the open, and relaxed more when near the other cats. She did alot of rolling around happy, like a Snoopy happy dance, as well.

Her appetite has remained high, but she is also drinking more water. I have always added water to her food as she is not a big water drinker, but she has started to drink water more frequently now. She is also getting bolder, after eating most of her food, she will waddle over to Oliver's bowl on the raised table to eat some of his food - they get the same food at a time, so it's not like he has something better!

Shadoe's numbers are still showing some resistance, and I increased her dose to 14.75u this morning. I have had to use some R as well but still she is ending in the 300s (17-22 range) at preshot. As well, with the high numbers come the urine in front of litter box. Hopefully her dose is just normal acro fluctuation.

Oliver is still with a reduced appetite, but he is eating, just eating less lately. He is more alert and has attempted to interact with Apple kitten. Overall, he's doing OK, eating, good litter box deposits, walking better and a bit quicker, and generally more relaxed. There's really not much to say about Oliver other than he seems better

Last night at 8pm, I had a much easier time giving both cats their gabapentin, as if they have connected feeling better with the gabapentin. Just like both cats are fine being tested and Shadoe usually just shows up when it's time to test her BG.

 For this, the 3rd dose, I gave to Shadoe first. I did prepare and have the tuna water drained and in a syringe in the frig so that it was cold along with the gabapentin. Shadoe does not like any oral liquid meds, and she did do some gurgling, but she leaned back quite still, for her, to get her gabapentin, then the tuna water chaser, and finally a little bowl of tuna. It does not take her long to catch onto the take the bad thing and get the good thing ritual.

For Oliver, he really is an angel and never fights or complains about any meds. I do not put him on his back as he hates it and I suspect it is uncomfortable for him, so he gets his meds while laying on his side and just turn his head a bit sideways to squirt the liquids into the side of his mouth but make sure it goes down the side of his throat. He also loves the following tuna water and small bowl of tuna.

Both were happier in a couple hours afterwards. I give the gabapentin at 8pm and Shadoe's usually better by 10pm. I am also testing their BG at shot time-6pm, gabapentin time-8pm, and then before bed around 10pm or 1030pm.

This morning, Shadoe was high again with 350 (19.4) so her Lev dose was increased to 14.75u. Oliver was quite good wit 173 (9.6) so we stayed with his Lev dose of 23u.

Shadoe did have a very good night, slept on the bed and was very purry, but this morning, she was not purring with the high BG until after she was fed and had her shot.

Oliver seems to have had a good nite, and did start to purr when he realized it was food time!

Will see how they do on dose #3 through today.

Monday, August 15, 2011

August 15,2011 Great start to the day

Today started at 6am and both cats were purring non-stop.

Shadoe was purring very loudly and was quite alert and up on her feet, ready to start the day.
Oliver was in his chair and was already purring before I touched him which is new for him; he usually will start to purr/grunt after he gets his good morning pats if he is feeling well, but today, he was already doing the grunty-purr. This start to the day is a terrific improvement for both.

Both had higher am BG - Shadoe was 394, gave 14.5uLev and .75uR. Oliver was 303, gave 23uLev and 1uR.
Both have possible reasons for being high - Shadoe has been rising from 12u on Aug01/11, and Oliver may be bouncing from his 100s yesterday, but I am still wondering about the xylitol sweetener in the gabapentin.
Either way, it does not matter because if a higher dose of lev is needed to have two happy cats, I am fine with it.

As far as appetite goes, Oliver is eating a bit less, but Shadoe eats eagerly now. She chomps on some of hers, then waddles over to have a bit of Oliver's. They are the same food and supplements, but she must think he has something better. It's good to finally have her eat without coaxing.

Litter boxes showing no change for Oliver, but Shadoe's stool seems better, well formed and not hard, so that's an improvement for her. Oliver's urine volume is a bit less, and Shadoe's has increased plus she is having more out of box urine incidents, but I suspect they are connected to her higher BG and increasing dose needs. She has always had these issues, so it's nothing new for Shadoe. When she stabilizes in dose, she'll have less issues.

Oliver is not more active; he still spends most time in his chair, or mine, but when on the floor, he does alot more stretches and he stays stretched out, so that's new for him.
Shadoe seems a bit restless, but in a good way. She may go under the sofa like in the past, but she does not stay long. She'll come out and look around, then cross the room and lie on a rug. After a short while, she may get up again and go to lie on the hall rug. She has also started to just walk around and look at things, drink a bit of water, stare at Oliver, try his food, stroll into the bedroom, come back out, have some of her own food, then lie down for a nap. She also searches out her honeysuckle wood toys and catnip toys. This morning, she actually showed an interest in the construction of the hirise right outside the window, so I put her up on Oliver's shelf where he lies to watch the workers. Shadoe did not stay long but she seemed intense on watching the workers and the crane lifting materials.

Oliver seems lighter on his paws now, and walks up his stairs gingerly.
Shadoe comes close to bouncing on her paws; she seems to have a spring to her walk now.

What a fine start to the day.


Sunday, August 14, 2011

August 14, 2011 Dose

All day and evening, Shadoe has been a completely different cat - I think she is even walking higher on her back paws, so I wonder if she's had some mild neuropathic issues and by starting the B12 shots and now adding the gabapentin, the combination has greatly improved her overall and in several ways.

Shadoe has always been the head of the roost, terrorizing the newest addition, Apple Blossom. Shadoe has also let Oliver know from Day 1 on his arrival when adopted that she hates him. All of that has done a complete face; Shadoe now actually touched noses with Apple Blossom and now just ignores the kitten. Shadoe also walks right by Oliver, and even stepped over his back legs to pass by him without rushing.
Shadoe definitely feels better. She also eats with appetite and is eager for meals. She also follows me around sometimes and also lies out in the open with no regard for the other cats. I couldn't be more pleased with Shadoe's improvements.

Oliver is another story. What can I say about his changes - they are much more subtle, and maybe his doses are too low or maybe he just does not have the same degree of problems as Shadoe.

I believe that Oliver is calmer, more relaxed, and he does much more stretching out long, so his midsection must have less or no pains, discomforts. He also purrs (grunts) much more readily and more frequently. I suppose it's harder for a 31lb cat to light on his feet, but he does seem less 'burdened' when he walks.

Tonite at 8pm was dose #2 for Gabapentin, and the next B12 will be on Thursday.
I do wonder if the Gabapentin would be better if it was twice the strength so that the dose amount could be half as much because giving .75ml orally of a bitter med makes the administration a bit of a challenge.
Oliver is a pushover and does sputter and gag a bit, but does love the tuna water afterwards and a small bowl of tuna. Shadoe, on the other hand, is a struggle with her .5ml dose as she squirms around and fights to close her mouth. She also likes the tuna water after but she will eventually hide on the future doses. I need to remember to give hers first because she saw Oliver getting his gabapentin and she took off under the sofa!

After just one dose, I am content with Oliver's changes and ecstatic with Shadoe's.

Recording Oliver and Shadoe -their reactions to meds

August 14, 2011 - I started both on gabapentin 25mg strength last night. Oliver's dose is .75ml and Shadoe's is .5ml. Dr. Mitelman said we can start low and see how it goes, and we can make adjustments as needed.

A bit of history needs to be recorded to understand how we arrived where we are now. I'll start with Oliver as he has less history, cover to the present, then cover Shadoe's history.

In October 2010, Oliver was sick, so the vet put him on Tylosin 100mg from Oct30/10 to Nov08/10. I had some Tramadol for him for pain so vet said to give him 25mg on the first 2 days, and he seemed to act relieved.
He became quite dehydrated, so I started 100ml fluids with small amounts of buprenex, and he perked right up. That bout was his first since being adopted Mar17/10.

In February 2011, he seemed a bit sluggish, and 1/4tab pepcid along with .1ml bupe am and pm on Feb04/11 seemed to fix whatever was bothering him until Feb17/11, so we tried the pepcid am and pm for a few days and bupe a couple times if the pepcid did not do the job. At this time, he had very good BG and there were several skipped shots here and there through the month. Because pepcid seemed to help in most cases, whenever he seemed a bit off, 1/4tab pepcid was given.

On April 04/11, I decided to try giving Oliver 1/4tab Tramadol to see if it would perk him up. He has never been very active, did not play, and moved slowly. Sleeping and eating were his main activities, yet if you looked at him, you would see his hooded eyes, as if he was drowsy.

Within 2 doses, he was a different cat. On April 20/11, I gave him the first 1/4tab at 2pm, and started am and pm dosing with his shots. Here are my notes from his spreadsheet:
Tram is definitely helping him. After just 2 doses, he is brighter eyed, moving around more, and more relaxed and purring. Will watch for lower BG and adjust dose if needed.

Needless to say, I continued to give him Tram, same dose until my supply from Lorna was depleted. I had already decided to request more from Dr. Mitelman for Oliver, but first I wanted to try him on a maintenance dose of Buprenex, just to be sure the Tram was what he liked. In the past, when I ever gave him any bupe, he would comically zonk right out to the point of just laying around with his tongue out, and I bet if he would talk, he'd slur his words - bupe for pain in Oliver was just too much for him. Ironically, if Shadoe gets the same dose or even more, she is  perfectly fine and bounces around like a kitten.

Anyway, I had 3 strengths on hand: .3, .4, and .6. I tried the different strengths and even doses as small as .03 of the .3 strength, but still, Oliver found the bupe to be too much for him. I had also started giving Shadoe a low dose to see if maybe she had some pain or discomforts, and it could be possible that she may perk up like Oliver did on the Tram. I was shocked to find that Shadoe was much more out in the open, purring, and even bouncy and eating more when the bupe was given BID to her. Trial ended - no good for Oliver, but good for Shadoe, indicating that she could use something.

I had to stop by the vet office to pick up copies of the testing for PLI of both and also Shadoe's b/w, so I decided to see if I could give Dr. Mitelman some info on on various pain meds and maybe get fitted in to ask for an rx for more Tramadol or maybe, ask what he thought about trying Gabapentin for Oliver. Other acros were doing quite well on it, so I thought let's give it a try if he thought it might be good for Oliver. I told him how Shadoe improved as well with the bupe, but I was hesitant to give any opioid long term.

We decided to go with the gabapentin at 25mg strength, giving a .75ml dose to Oliver and also try it on Shadoe with a dose of .5ml.

I should mention here that on our last visit with both Oliver and Shadoe, we got B12 to give Shadoe shots and I again decided that if it's good for her for her pancreas, then it should be good for Oliver as well!

The results so far is that Oliver is good, better, on 12.5mg Tramadol, loopy on any strength/dose of Buprenex, and the jury is still out, but leaning towards the B12 and gabapentin are doing some good because he is more alert since stopping the bupe. Hopefully, in time and a few more doses of each, he'll continue to improve.

Here is Shadoe's history of medications - it's a bit longer as she was diagnosed with diabetes October 04, 2009.

On August 26, 2010, Shadoe was not well, so vet sent us home with bupe and Flagyl (Metronidazole). She was still not good on .1ml bupe and 50mg Flagyl by August29, 2010, and tests showed pancreatitis, so we started 100ml fluids  for4 days. Treatment with bupe, Flagyl, and also 1/4tab pepcid continued each morning until September 09, 2010, with 100ml fluids given if her BG was high enough - Shadoe's BG drops low from fluids, so they were given if her BG was higher or on the rise.

In January 2011, Shadoe was given pepcid and the odd time some fluids if it seemed she was not feeling well
- Shadoe has a tendency to be 'gassy' and the pepcid seems to settle her well enough to eat better. In mid-February, I tried giving Shadoe pepcid at each shot time, and her numbers did get better. When I stopped giving pepcid, she seemed worse and had higher numbers, so I started giving her pepcid on a regular basis with each shot. Sure enugh, her numbers seemed to improve.

Shadoe was good with the odd need for pepcid, bupe or fluids until June 2011 when she seemed to have a good CP flare, I suspect,. but since I had kept a stock handy of pepcid, bupe, and fluids, I just started the 3 up from June 22 to July 01, 2011. Her pains seemed passed but I continued with the pepcid for awhile.

Again, on July 11/11, she had more problems, the same growling when her belly was touched and also needed to be put into the litter box as maybe it bothered her stomach to climb into the boxes. At certain times, I could tell she was ready to use the box, so I just picked her up and put her in the box and she was OK. If I was not around, she would be in front of the box. Bowel movements were fine, always in the box but urine was right in front of the box.

Again on July 01/11, Shadoe started her lip licking, so she got pepcid BID for a week and was better again.

In August, I got the B12 for her, and decided to also start her on a low dose of bupe BID to see if it helped her feel better, like the tram had helped Oliver months ago. I don't know what it was but I have to say that I think the bupe really did help her feel better as she changed dramatically.

Shadoe was always shunning light. She slept in dark places, under the sofa or bed, in dark corners, or she would just face the wall or corner, or cover her eyes with her paw. After starting the bupe BID, she now sits out in the open, does not  face the walls or corners, and is much more relaxed and purring all the time.

Now we are current, up-to-date here.
I am giving both their B12 injections each Thursday night for a month then bi-weekly, and finally, monthly, .25ml for Shadoe and .5ml for Olier, and the gabapentin daily, .5ml for Shadoe and .75ml for Oliver.

As of today, August 14, 2011, they are both much happier campers, so something is working well!