State of the (Boy) Cat Address, 2011

So about that darn cat. He's diabetic again. We've known that for about six weeks now but it took a month to establish that he was just not going to respond to glipizide this time. At least now I've learned that "Hey I'm going to start peeing in weird places" means "I've got diabetes, check my glucose levels", plus I had the glucose meter on hand. All that means I'm about a week into giving him insulin injections. Hard to say what's that's doing for certain. I haven't done a full glucose curve for him (we're supposed to wait two weeks for his blood chemistry to stabilize), but I have been peeking roughly daily. Truth is halfway between his breakfast and his dinner the numbers still seem bad, which probably means I'll need to up his dosage. But then there's the anecdotal side of it - the pee volume is down (locations are still wrong, damnit cat!), and he's definitely more active since the injections started. I hate to read too much into his behavior when it might be just that I'm watching him more carefully, but this really was a matter of the day I gave him the first injection he was considerably more underfoot and playful that day. So maybe the insulin is giving him good numbers for a big chunk of the day, and just at the nadir between injections the numbers are bad again. I'm no expert …

For reasons I don't quite understand, the doctors insist that there's no interaction between any of these diabetes treatments and the Metacam (for his walking). Which I would believe – it's not that I don't trust them – but the thing is that the reason I thought there was an interaction was that they told me there was back in 2009 when all of this diabetes & walking stuff started. As far as I can tell they didn't want to start him on Metacam while he was having diabetes because kidney function is weird in diabetics. But now that we know Metacam is OK with his chemistry it's OK to add the glipizide or the insulin on top of the Metacam - even though they weren't willing to add Metacam on top of glipizide before. Either that or something new is known in 2011 that we didn't know in 2009. I'm not sure which.

At any rate, that's the deal now. He still gets his Metacam syrup every three days and he gets a shot of insulin with every meal. I was dreading that but the truth is that he doesn't notice the needle. He appears to think it's normal for me to pet him after each meal and so he's more than happy to come over and sit with me and get the shot.

Of course, the first time I won't be around at the feeding I'll have to convince Karin that the needle isn't "gross". We'll see how that goes …

About that Cat Blogging

Has it been two months since my last blog about Heisenberg's health? It has! (And there were only eight posts in the last two months. Meh. I've been busy.) But I've been delinquent in posting about the goober and that's especially a shame because we had good news. The funny thing is I posted that last post on August 17th. Well, that 21st was his monthly "glucose curve" where I checked his glucose level every two hours for twelve hours. Now remember, I said something from 80 - 170 mg/dL was "normal" for cats and he was considered "managed" at numbers around 250. Well that Friday his numbers were between 67 and 88. Yes that's right his numbers are now low. See cats can go into spontaneous remission from diabetes and just start producing insulin again. Nobody really knows why. So yeah, he hasn't taken glipizide for about two months now. I still spot check him occasionally and I haven't seen anything higher than 87 mg/dL in that time. He still had the neuropathy walk and I eventually asked the vet about it (and about the possible vertebrae fusion). What they originally said is that any treatment for that would interfere with the glipizide and we couldn't do that. So now he's on a non-steroidal anti-inflammatory called Metacam. Metacam is a scary thing to Google for felines: it's not approved for cat usage in the US, and it can cause renal failure. So I watched him really carefully as we started him on it. It definitely makes a big difference in his gait. He's not walking like he did last year but he's faster and more agile on the Metacam than not. Just to keep the roller coaster going last week he started peeing inappropriately again, and I immediately thought "Well crap, that could be renal issues with the Metacam" so we took him into the vet Saturday so they could get a urine sample and do some tests. Word is that he's doing just fine, all of his levels are what we want to see and he can stay on the Metacam. So he's just peeing on the floor to spite me. (sigh) I did rearrange his access to the litter box to see if that made him happier, we'll see over time. Anyway, the main takeaway is that he no longer has diabetes which is good. He's on a medicine which has been bad for some cats and you can find plenty of anecdotal evidence about cats who couldn't take Metacam on the internet. But that's not science, and my anecdote is that he seems to love taking the Metacam - he'll even come over and sit in my lap while I'm obviously holding the syringe (it's a syrup that you squirt into his mouth). He's got stable levels in his blood and he's been taking it long enough that it was going to cause problem it would have by now. We still have to keep a close eye - if he got sick from something else that could break the equilibrium and then we could have trouble. But for now he's a solid little guy and he may not have to go back to the vet for another four months. Which is a good thing.
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Followup on His Royal Highness

I should follow up on my first post about Heisenberg. And I should post more than once a month, but that's a different topic. The good news is the little bugger is doing fine. The glipizide has made his condition "managed", which is excellent news. Depending on what source you use you hear that "normal" cat glucose levels range from 80 - 170 mg/dL. Our veterinarian told us we wanted to see numbers between 100 - 300 mg/dL for Heisenberg. When he was in for his checkup back in June he had a reading of 411. Now, that may not be accurate because he gets really riled up about going to the vet (they have to sedate him because he gets all hissy and bitey) and stress can elevate the glucose levels but it's obviously above normal. After a few weeks on the glipizide I started taking readings and I haven't seen anything above 267 and he's pretty much dialed in around 250 as an average. He's stopped drinking quarts of water and he's pretty much stopped peeing everywhere (there's an occasional backslide, but it's less than once a week now as opposed to five-six times a DAY this spring), and he seems more alert. The bad news is that he's also developed a symptom known as neuropathy where he has weakness in his back legs and has some trouble walking. It is possible this will heal over time now that we have the diabetes controlled so we're just waiting to see. While we were diagnosing that we established that he also has a couple of discs in his vertebrae that are starting to fuse together - which would cause much the same problems as neuropathy and the normal treatment is steroid and those would conflict with the glipizide. (sigh) So the upshot of all that is that he's probably never really going to walk (or jump) as well as he did as a li'l guy. But still, it doesn't really seem to bother him and we're assured that he's not in any pain because of it so we just keep on trucking. We got a ramp for the laundry room step so he no longer has to jump up and through the cat door. (It needed to be a sturdy ramp because Karin and I use that door all the time, so we got a wheelchair ramp.) I still need to build him a ramp to his cat tray but he can still jump up on a bed from the floor, so for right now he can make it into the tray easily. He needed the ramp for the cat door because of the combination of jumping up the step and through the cat door is a little tricky. I've always assumed we'd need a ramp there eventually for Schrödinger, so it wasn't that big of a deal to put one there and for now he seems OK with all of the other steps and jumps he has to do. So once I get this other ramp built we'll just step back and see how he does.
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No More Glazed Tuna Treats I Guess

(Note: The "glazed tuna treats" in the title is a joke. No such treats ever existed.) Well. It's been a hell of a week here. The big news this week should have been going on the "Muir Woods by Moonlight" hike (which was fantastic - I need to process some photos) but unfortunately that has been trumped by the fact that Heisenberg has diabetes. I should hasten to say that … well I can't say it's not a big deal because it is a big deal. But it's a manageable, chronic condition and one that won't really affect his quality of life. Actually to a degree he may come out ahead since he gets to switch to wet food instead of dry and he gets fed more often. But the main point is knowing about it means we can manage it. It was still a hell of a shock though and lead to quite a bit of running about, multiple trips to the vet, new food, new pills, and so forth. We're not injecting him with insulin yet, we may have to in the future. Right now we're starting by giving him glipizide which stimulates insulin production. That's just a pill so it's a bit easier to administer and since it doesn't produce insulin directly it's not quite as risky to his blood chemistry. If he doesn't respond (or respond enough) to the glipizide then we'll have to start in with insulin. And we do need to get a glucometer to measure his blood sugar, although we don't have to do that for a couple of weeks. If he stays on the glipizide then we'd only have to check his sugars occasionally. If he goes to insulin then we'd need to do daily monitoring. According to the internet both the insulin poking and the glucometer sample poking are things the cat doesn't even notice really - we'll see about that I suppose. This also goes a long way to explain why he's been peeing EVERYWHERE and also why the pee is sometimes sticky - he's dumping glucose out that way so he drinks a ton. Hopefully getting the sugar levels under control will mean he stops drinking so damn much and maybe even he'll start peeing in a tray again. (sigh) All in all, not good news, but at least in some ways the other shoe has dropped and we know why he's been acting weird. And in terms of bad health news this isn't too bad. It's a hassle but it's not a threat. Especially since I work at home I can do things like feed him four times a day.
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