Vet appt tomorrow, requesting change to Levemir

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Jay Dee

Jay Dee

Member Since 2021
Snuggie has an appt tomorrow morning and I’m going to request we switch to Levemir. How should the script be written out so I can get the most bang for our upcoming buck?

I’ve sent him my spreadsheet and let him know I want to discuss an insulin change.

im also printing out the dosing guides for Levemir and ProZinc (his current insulin) as well as the dosage decision tree from rhe AAHA guidelines. I’m going to ask for acro/IAA tests with a brief explanation of why that is needed info to guide treatment.

Anything else you suggest I print or have ready?

Thank you in advance!
 
Most of us get our Levemir from Marks Marine Pharmacy in Vancouver and they only sell it in 100 unit pens (packs of 5). They will want to know what his current dose is. My Howie is a high dose kittie (IAA and acro) so my original dosage that he was originally prescribed is not accurate so they recently asked what dose he’s currently on. I actually am going to have to get another script from my vet as he was limited to 60 pens for the year and he will blow through that well before his year anniversary of switching to it. I really like the Levemir (was also on ProZinc). I think you start with maybe something like a 70% dose of what you’re currently using but hopefully one of the more experienced folks can verify that for you.

good luck!
 
@Howiesmom thanks! That's super helpful. He's currently on 4u ProZinc but "My team" here on FDMB thinks he might need to go back to 6. How much does Howie get and are you doing anything else for the acro/IAA?
 
You want the script to ask for Levemir pens, not the vial. Just in case you ever need to have it filled in the US. I don't believe Marks cares what the script says, as long as it's Levemir.

As for Levemir dose, we typically switch from Prozinc dose to the same dose of Levemir. The 70% is for Lantus to Levemir only. But once you get the Levemir, post here and we can help you figure out what the dose should be. We take into account how he's doing on his current insulin dose.
 
Wendy&Neko said:
You want the script to ask for Levemir pens, not the vial. Just in case you ever need to have it filled in the US. I don't believe Marks cares what the script says, as long as it's Levemir.

As for Levemir dose, we typically switch from Prozinc dose to the same dose of Levemir. The 70% is for Lantus to Levemir only. But once you get the Levemir, post here and we can help you figure out what the dose should be. We take into account how he's doing on his current insulin dose.
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THANK you!!!
 
Jay Dee said:
@Howiesmom thanks! That's super helpful. He's currently on 4u ProZinc but "My team" here on FDMB thinks he might need to go back to 6. How much does Howie get and are you doing anything else for the acro/IAA?
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Oh good...I’m glad Wendy corrected/verified about dosage. Howie was diagnosed with IAA in Sept 2020 but had a negative IGF-1 result for acro. He was at 5.5 units of ProZinc at that time. However, I retested IGF-1 in Jan 2021 and he was VERY positive at 532. He was up to 50 units BID of Levemir at the time of that diagnosis. He is currently on cabergoline for the acro. As for insulin, he bounces between 30-55 units BID (currently at 43 units BID).
 
Update post-appt:

Levemir script - check!
Order placed at Marks Marine - check!

He suggested starting at 2u 2x daily (he said he prefers to start low on this) and see how that goes for a week and reassessing with him - or earlier if sky-high BGs after 3-4 days, then checking in with him.

He also said for making the switch, we should give an am dose of ProZinc, skip the pm dose to make sure all the ProZinc is out of his system and to avoid a potential hypo since we don’t know how he’ll handle the Levemir, then the next am dose should be Levemir - to avoid any potential overlap.

He was agreeable to the acto/IAA tests - tho he said we could hold off until we see how he does on Levemir first. I opted to hold off (just for now) just bc I was already looking at a $500 bill from today plus the $200 for the Levemir.

Dental is scheduled for July (they’re booking out way ahead) but it’s a non-anesthetic dental due to his kidney issues ... I didn’t know this was a thing for kidney cats - anyone have any info? I can’t imagine it being as thorough. I didn’t ask many questions bc I forgot about this during the exam/consult and was just getting him on the schedule to be sure we had something.

THANK YOU to all who have helped get me here, and endured my many panic attacks and tech challenges LOL!! In just one week I’ve learned so much, and felt truly empowered during the appt today (I was a little - ok a lot - nervous but it all ended well I think!)

So - is this the right track to start on?
 
Jay Dee said:
Update post-appt:

Levemir script - check!
Order placed at Marks Marine - check!

He suggested starting at 2u 2x daily (he said he prefers to start low on this) and see how that goes for a week and reassessing with him - or earlier if sky-high BGs after 3-4 days, then checking in with him.

He also said for making the switch, we should give an am dose of ProZinc, skip the pm dose to make sure all the ProZinc is out of his system and to avoid a potential hypo since we don’t know how he’ll handle the Levemir, then the next am dose should be Levemir - to avoid any potential overlap.

He was agreeable to the acto/IAA tests - tho he said we could hold off until we see how he does on Levemir first. I opted to hold off (just for now) just bc I was already looking at a $500 bill from today plus the $200 for the Levemir.

Dental is scheduled for July (they’re booking out way ahead) but it’s a non-anesthetic dental due to his kidney issues ... I didn’t know this was a thing for kidney cats - anyone have any info? I can’t imagine it being as thorough. I didn’t ask many questions bc I forgot about this during the exam/consult and was just getting him on the schedule to be sure we had something.

THANK YOU to all who have helped get me here, and endured my many panic attacks and tech challenges LOL!! In just one week I’ve learned so much, and felt truly empowered during the appt today (I was a little - ok a lot - nervous but it all ended well I think!)

So - is this the right track to start on?
Click to expand...
I'm so happy you are starting the levimer
So you are continuing with the prozinc until you get the levimer
I am going to tag
@Wendy&Neko
Hi Wendy could you please read about the info her vet gave her today
And see what she thinks about skipping the PM dose of prozinc and also the starting dose.
Also want to get her take about the dental, I know they should take X-rays before and after the dental
@Wendy&Neko
Thank you Wendy
 
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Jay Dee said:
but it’s a non-anesthetic dental due to his kidney issues
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This is a useless waste of time and won't help Snuggie at all. A complete dental must include x-rays (both pre and post) which requires anesthesia. Remember, 2/3rds of the tooth is under the gumline so it doesn't do any good to polish the top third while the bottom 2/3rd may be rotting away.

Jay Dee said:
He also said for making the switch, we should give an am dose of ProZinc, skip the pm dose to make sure all the ProZinc is out of his system and to avoid a potential hypo since we don’t know how he’ll handle the Levemir, then the next am dose should be Levemir - to avoid any potential overlap.
Click to expand...

Not necessary. ProZinc is an "in and out" insulin so after the AM dose has worn off, there's nothing left. There's no reason you can't give ProZinc in the morning and start the Levemir at night (or stick with the ProZinc for both AM and PM doses and then start the Levemir the next morning so you'll be able to test all day in case he reacts strongly to the new insulin.)

Jay Dee said:
He suggested starting at 2u 2x daily (he said he prefers to start low on this) and see how that goes for a week and reassessing with him - or earlier if sky-high BGs after 3-4 days, then checking in with him.
Click to expand...

Nope again...by the time you get the Levemir, Snuggie will probably be back to (or close to) the 6U dose. Matter of fact, it's probably time to take him up to 4.5 (or more.... @Wendy&Neko is who I'd ask since she has more experience with higher dose kitties).

When you get the Levemir, we'll see how he's doing and how much ProZinc he's on and suggest a starting dose of Levemir at that time.

Also, once you start the Levemir, it may take 5-7 days to fill the depot before you see the full effect of whatever the starting dose ends up being.
 
Chris & China (GA) said:
This is a useless waste of time and won't help Snuggie at all. A complete dental must include x-rays (both pre and post) which requires anesthesia. Remember, 2/3rds of the tooth is under the gumline so it doesn't do any good to polish the top third while the bottom 2/3rd may be rotting away.



Not necessary. ProZinc is an "in and out" insulin so after the AM dose has worn off, there's nothing left. There's no reason you can't give ProZinc in the morning and start the Levemir at night (or stick with the ProZinc for both AM and PM doses and then start the Levemir the next morning so you'll be able to test all day in case he reacts strongly to the new insulin.)



Nope again...by the time you get the Levemir, Snuggie will probably be back to (or close to) the 6U dose. Matter of fact, it's probably time to take him up to 4.5 (or more.... @Wendy&Neko is who I'd ask since she has more experience with higher dose kitties).

When you get the Levemir, we'll see how he's doing and how much ProZinc he's on and suggest a starting dose of Levemir at that time.

Also, once you start the Levemir, it may take 5-7 days to fill the depot before you see the full effect of whatever the starting dose ends up being.
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Thank you so much
@Chris & China (GA) :cat:
 
Thank you @Diane Tyler's Mom @Chris & China (GA) @Wendy&Neko !!

Our insulin time is 7:30ish MDT so in 1.5hrs. I will wait to hear back from Wendy but if I don’t hear back I’ll go for 4u and start new dose tomorrow.

he said he did the conversion to get to 2 but I’ll call him when Levemir gets here and if we are up to 6 I’ll ask what he suggests.

no ketones today and all other labs in progress

And I suspected as much re the dental. Plus it sounds kinda barbaric!
 
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Jay Dee said:
he said he did the conversion to get to 2
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There is no "conversion" needed. The number of units you shoot in a U-40 insulin is the same number of units you shoot with a U-100 insulin.

Go ahead with that increase to 4.5 units tomorrow, if it's too late tonight.
Jay Dee said:
He was agreeable to the acto/IAA tests - tho he said we could hold off until we see how he does on Levemir first. I opted to hold off (just for now) just bc I was already looking at a $500 bill from today plus the $200 for the Levemir.
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If he needs that much insulin, switching insulin won't change any underlying conditions, should he have them. I get the wait on the cost though. But WOW on your costs today! I was late answering because I too was at vetty today. She was doing real curb side service. Out on the side walk, sitting at the edge of the curb taking blood from a dog, while I watched from the car 10 feet away. :cool: Anyway, check up and b/w costs way less than $500 for me.

On the dental thing, the vets can do tartar removal, often just with their thumbnail or a few instruments if a cat is OK with that (mine is), but that won't help any issues below the gum line. A large number of cats get resorptive lesions under the gum line, and you do need the dental xrays for that. If there is a vet dental specialist near you, they can usually do work on the more complicated cats. At a price of course. :(
 
Wendy&Neko said:
There is no "conversion" needed. The number of units you shoot in a U-40 insulin is the same number of units you shoot with a U-100 insulin.

Go ahead with that increase to 4.5 units tomorrow, if it's too late tonight.

If he needs that much insulin, switching insulin won't change any underlying conditions, should he have them. I get the wait on the cost though. But WOW on your costs today! I was late answering because I too was at vetty today. She was doing real curb side service. Out on the side walk, sitting at the edge of the curb taking blood from a dog, while I watched from the car 10 feet away. :cool: Anyway, check up and b/w costs way less than $500 for me.

On the dental thing, the vets can do tartar removal, often just with their thumbnail or a few instruments if a cat is OK with that (mine is), but that won't help any issues below the gum line. A large number of cats get resorptive lesions under the gum line, and you do need the dental xrays for that. If there is a vet dental specialist near you, they can usually do work on the more complicated cats. At a price of course. :(
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Thank you very much @Wendy&Neko
That was crazy taking blood from your dog outside.
I hope all his well with your dog :cat:
 
It wasn't my dog, but rather someone else's. Dog needed his people there to calm him down and hold him so blood could be done, and with COVID, people couldn't go inside. Dog was fine - he was getting treats.
 
Wendy&Neko said:
It wasn't my dog, but rather someone else's. Dog needed his people there to calm him down and hold him so blood could be done, and with COVID, people couldn't go inside. Dog was fine - he was getting treats.
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Sorry after re reading what you wrote, I can see it was someone else's dog :cat:
 
Jay Dee said:
Yes he and I discussed U100 syringes and I’ve learned here that the half unit markings are needed - THANK YOU for the coupons!!
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Hey Jill!....ADW requires spending $89 before you get free shipping, so if you're just buying a box of syringes, once you add the shipping cost, your coupon savings isn't going to be as much.

You can get U100, 3/10ml, 30 or 31 gauge syringes with half unit marks from WalMart too. (don't ask....most of them don't know that ALL their 3/10ml syringes come with half unit marks). They are $12.58 for a box of 100
It can help to have a picture to make sure you get the right ones.
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@Wendy&Neko thank you so much! I just got home from store and did the 4u but I’d rather stick with that overnight, we had a human medical emergency last night/early this morn and Btwn that and the vet excitement, I’m exhausted - better to start 4.5 tomorrow when I can monitor him all day.

thx for all the other info too - super helpful!

the $500 included checkup, senior blood panel sent to outside lab (rather than limited in-house), sterile drawn urinalysis & culture/sensitivity, ProZinc to tide me over til Levemir gets here, plus fluids. Let’s hope his UTI is cleared up!

I’ll reread the replies again and I’ll be reading up on Levemir dosing etc

thank you all!
 
Chris & China (GA) said:
Hey Jill!....ADW requires spending $89 before you get free shipping, so if you're just buying a box of syringes, once you add the shipping cost, your coupon savings isn't going to be as much.

You can get U100, 3/10ml, 30 or 31 gauge syringes with half unit marks from WalMart too. (don't ask....most of them don't know that ALL their 3/10ml syringes come with half unit marks). They are $12.58 for a box of 100
It can help to have a picture to make sure you get the right ones.
View attachment 60722
View attachment 60723
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Thanks @Chris & China (GA) I totally forgot about Walmart :banghead:
 
@Wendy&Neko should I bump up to 5?

(Last night I goofed and forgot his sister’s food on the floor so that explains his HI reading but he’s still almost 500 this am.

Levemir should be here later this week. How much flexibility in timing the shots is there? My schedule is changing a bit so want to be sure I don’t screw it up!

@Diane Tyler's Mom @Chris & China (GA)
 
Jay Dee said:
@Wendy&Neko should I bump up to 5?

(Last night I goofed and forgot his sister’s food on the floor so that explains his HI reading but he’s still almost 500 this am.

Levemir should be here later this week. How much flexibility in timing the shots is there? My schedule is changing a bit so want to be sure I don’t screw it up!

@Diane Tyler's Mom @Chris & China (GA)
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Hi ,I'm sorry but is you name Jay?
It happens leaving out food they shouldn't get to
I can't give dosing advice but I'm sure
@Wendy&Neko
Will tell you whether to increase to 5 units until you get the Levemir
Will see the tag to tell you how much flexibility you have with Levemir
 
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Diane Tyler's Mom said:
Hi ,I'm sorry but is you name Jay?
It happens leaving out food they shouldn't get to
I can't give dosing advice but I'm sure
@Wendy&Neko
Will see the tag
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Hi! Thanks! No it’s Jill. Jay was just a cute way to spell the initial J. :-) I’m not too creative with screen names lol!

I just realized we won’t be home tomorrow so if I increase I won’t be around to keep an eye on him. So maybe best to wait til tomorrow eve to increase?

I printed out the dosing info for Levemir and am reading it - I’ll want @Wendy&Neko ’s advice to go with SLGS or TR, and what a good starting dose will be. I know I need more data on my spreadsheet but we all needed a break from data collection this weekend so as long as he was safe I was happy - and I think he was too.
 
Jay Dee said:
Hi! Thanks! No it’s Jill. Jay was just a cute way to spell the initial J. :) I’m not too creative with screen names lol!

I just realized we won’t be home tomorrow so if I increase I won’t be around to keep an eye on him. So maybe best to wait til tomorrow eve to increase?

I printed out the dosing info for Levemir and am reading it - I’ll want @Wendy&Neko ’s advice to go with SLGS or TR, and what a good starting dose will be. I know I need more data on my spreadsheet but we all needed a break from data collection this weekend so as long as he was safe I was happy - and I think he was too.
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Hi Jill, we'll wait for Wendy to come on
What will your new schedule be
 
Yes, I'd bump up to 5 units. Please try to get a before bed test each night, so we know you aren't missing low numbers followed by testing when he's bouncing. Since all you are seeing is a sea of red, I think you'd be fine increasing tonight, if you can get a before bed test in.

The starting dose of Levemir will depend on where you are with Prozinc and the numbers you are seeing at the time you get the Levemir.

The dosing method you select has to fit your life style. With TR, you must be feeding low carb wet food or raw. Any higher carb or dry food means following SLGS. TR is a more aggressive method (faster increases, low blood sugar point at which you reduce), and with that means the need to test at least twice per cycle, the preshot and one other. For cats who might have some sort of insulin resistance, Tight Regulation is the better option, if it can be done. It's doesn't work for everyone, so that's your decision.
 
Wendy&Neko said:
Yes, I'd bump up to 5 units. Please try to get a before bed test each night, so we know you aren't missing low numbers followed by testing when he's bouncing. Since all you are seeing is a sea of red, I think you'd be fine increasing tonight, if you can get a before bed test in.

The starting dose of Levemir will depend on where you are with Prozinc and the numbers you are seeing at the time you get the Levemir.

The dosing method you select has to fit your life style. With TR, you must be feeding low carb wet food or raw. Any higher carb or dry food means following SLGS. TR is a more aggressive method (faster increases, low blood sugar point at which you reduce), and with that means the need to test at least twice per cycle, the preshot and one other. For cats who might have some sort of insulin resistance, Tight Regulation is the better option, if it can be done. It's doesn't work for everyone, so that's your decision.
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Thanks Wendy, how much flexibility do you have with Levemir
 
@Diane Tyler's Mom @Wendy&Neko

thank you! Ok I’ll jump to 5 tonight and be sure we get a before bed test.

my schedule isn’t changing much but we have been shooting at 7:45 +/- 15 min. I’m heading back to the gym and will be gone 7am-8:20am for the class, so we are looking at 45 min to an hour earlier or later than usual. I’d like to see if it’s possible to do 8:30 am shot and still do maybe 7:45/8:00 pm?

Looks like we will need to be SLGS- we feed dry overnight, he only eats about 1/4 c most of the time.

thank you!!
 
You can move your shot time by 1/2 hour once per day, or 15 minutes per shot. I had a monthly meeting that started 1/2 hour before shot time (and I had to travel), so I'd slowly move shot time up a few days before hand, then back afterwards. Did the same thing when we travelled with her. 8:30/8:00 daily would work. Or do you have anyone else who can shoot in the house?
 
@Wendy&Neko oh geez I didn’t even think about meetings and traveling and returning to normal life!!

my hubs works at home now but often has calls - scheduled and unscheduled - so I don’t want to put that on him then have him accidentally forget or get sidetracked. 8:30/8 sounds like the best option - plus then they can eat when I get up and I won’t have to set an alarm to pull food at 4:45am -ack!!

i don’t think I’ll need to travel anytime soon and am working on interviewing pet sitters but I’ll for sure ask for help to figure out adjustments in timing before I do!

I also see an automated feeder of some sort in my future :-)
 
Diane Tyler's Mom said:
Why don't you just shoot at 8:30 AM and 8:30 PM?
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Most days I can, actually. I was thinking of pre-bed test times and if they’ll even be helpful if only a +2, and If I need to do PM+6. I’ve been having a really hard time falling and staying asleep and getting a full 7-8 hrs.
 
[QUOTE="Diane Tyler's Mom, post: 2785215, member: 24974"
Is Snuggie your only kitty?[/QUOTE]

He’s not - we have a healthy dry food addict / wet food hater that will wake us up if she can’t graze on kibble overnight.
 
Jay Dee said:
Most days I can, actually. I was thinking of pre-bed test times and if they’ll even be helpful if only a +2, and If I need to do PM+6. I’ve been having a really hard time falling and staying asleep and getting a full 7-8 hrs.
Click to expand...
I hear ya I know that if you might have to monitor longer people set alarms
to test , you probably didn't want to hear that lol
 
Jay Dee said:
[QUOTE="Diane Tyler's Mom, post: 2785215, member: 24974"
Is Snuggie your only kitty?
Click to expand...

He’s not - we have a healthy dry food addict / wet food hater that will wake us up if she can’t graze on kibble overnight.[/QUOTE]
So if you get an auto feeder she won't go over and eat the wrt food
 
Diane Tyler's Mom said:
I hear ya I know that if you might have to monitor longer people set alarms
to test , you probably didn't want to hear that lol
Click to expand...

i totally get setting an alarm if something is looking dangerous before bed but it’s going to be too difficult to do it nightly. The 8:30/8 at least allows me to get a +3 or +3.5 before bed, which I feel is going to be better than a +2/2.5...
 
Jay Dee said:
i totally get setting an alarm if something is looking dangerous before bed but it’s going to be too difficult to do it nightly. The 8:30/8 at least allows me to get a +3 or +3.5 before bed, which I feel is going to be better than a +2/2.5...
Click to expand...
Sounds good

About the auto feeders
I see a lot of members use this auto feeder comes with 2 ice packs for wet food
They also add some water to the food so it won't dry out

https://www.chewy.com/cat-mate-c500-digital-5-meal/dp/154556?utm_source=google-product&utm_medium=cpc&utm_campaign=hg&utm_content=Cat Mate&utm_term=&gclid=Cj0KCQjwmIuDBhDXARIsAFITC_63x-luggpCkFZRkS8gkKWhzRbyN2QiluSdQbUAVg-nyE2iitAjCY4aAjTmEALw_wcB


Extra ice packs
https://www.amazon.com/Mate-Replace...8EYNZ1RBTQP&psc=1&refRID=AQNY433XJ8EYNZ1RBTQP
of 5 stars Identical to original ice packs that came with my Cat Mate C500
 
@Diane Tyler's Mom thank you!

@Wendy&Neko i will do the acro / IAA tests the next time we need bloodwork done , if we find he is either/both, and if we figure out a way to keep him out of dry food, is it possible to switch from SLGS to TR?

this is a HUGE lifestyle change with the feeding and testing and all (plus his daily CKD fluids) - plus all the other stuff I have going on in my life besides a sick cat - so I’m trying to do one step at a time and not overwhelm myself too many times or all at once! LOL!
 
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Jay Dee said:
@Diane Tyler's Mom thank you!

@Wendy&Neko i will do the acro / IAA tests the next time we need bloodwork done , if we find he is either/both, and if we figure out a way to keep him out of dry food, is it possible to switch from SLGS to TR?

this is a HUGE lifestyle change with the feeding and testing and all (plus his daily CKD fluids) so I’m trying to do one step at a time and not overwhelm myself too many times or all at once! LOL!
Click to expand...
Yes you can switch over from SLGS to TR any time you like
I didn't know you give fluids, his kidneys?
 
Diane Tyler's Mom said:
Yes you can switch over from SLGS to TR any time you like
I didn't know you give fluids, his kidneys?
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Oh good!

yes - his values were sky high on feb 27 when we took him in for an urgent appt. daily fluids since then (plus a near-fatal potassium crash) and they improved in a week then in a month. We are waiting for the bloodwork from last week to see if we need to continue fluids and if so how frequently.
 
Tyler's brother had kidney disease , I gave the fluids, binders, and epogen
He was my love! He was 12 when I had to put him to sleep
But he stayed in stage 2 for about 4 years.
 
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