5/16 Ruby AMBG +8 299/PMPS 287/+2 313

Katherine&Ruby

Katherine&Ruby

Very Active Member
Yesterday.

We’re going to bring Ruby home soon. Spoke with her IM who said she ate really well and is being very affectionate. Unfortunately her BG was at 325 this morning. :arghh: Vet asked if I’d like to give her insulin and I said no to keep her on her schedule. Question is if she’s still high at her PMPS, what dose would I give her? Should I stick with what I had her on before the hospital, at .1?

Really upset about this and hope I can get her tightly regulated again quickly. :(
 
Do you know if she is still eating the DM crunchies for food? I think what she is eating/will eat will determine how much insulin to give.
 
I’m glad she’s coming home. :) I have to say I agree with Tomlinson that it would be good to speak to the vets that do the endoscopy directly. Know you deal with theresidents at the ER but I have learned to talk with the head person before discharge. Just my two cents.

I would go back to .10 when you restart insulin.
 
You have some time to see if she'll eat her raw once home. If not, I'd be tempted by 0.25 units, depending on what she does during the day numbers wise. Maybe some vetty stress in there now?
 
Wendy&Neko said:
You have some time to see if she'll eat her raw once home. If not, I'd be tempted by 0.25 units, depending on what she does during the day numbers wise. Maybe some vetty stress in there now?
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Thanks Wendy. We have about 7.5 hours until her PM shot. Hard to say what her BGs will be later given the crunchies, the one hour commute back home, and reacclimating to being at home with Olive (it took them weeks to become comfortable with each other again last time Rubes was in the hospital). Sigh. Hope she will be willing to eat her raw food. Vet offered to give me DM kibble to bring home and I said no, I don’t even want it in the house for her to smell. Starting her back on .25 seems like a good call (ETA: if she is still unusually high) and I will monitor her vigilantly.
 
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PerfumedCatMom said:
Yesterday.

We’re going to bring Ruby home soon. Spoke with her IM who said she ate really well and is being very affectionate. Unfortunately her BG was at 325 this morning. :arghh: Vet asked if I’d like to give her insulin and I said no to keep her on her schedule. Question is if she’s still high at her PMPS, what dose would I give her? Should I stick with what I had her on before the hospital, at .1?

Really upset about this and hope I can get her tightly regulated again quickly. :(
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Katherine, so excited Ruby is coming home. Good luck with getting back to raw, returning to good numbers and good vibes between Ruby and Olive. :bighug::bighug::bighug::bighug:
 
PerfumedCatMom said:
reacclimating to being at home with Olive (it took them weeks to become comfortable with each other again last time Rubes was in the hospital).
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Have you ever tried wiping Ruby down with a very, very slightly damp warm cloth and then, rubbing her back down with a shirt of yours (dirty of course so it has your scent!) as well as with an item that has her non hospital scent as well as something with Olive’s scent on it? Otherwise, it takes awhile for the vet/hospital scents to be cleaned off and for the “normal” scents to be Re established on her little body.

I have a multi cat household and do this every time we return from the vet or a couple of mine will literally lose it & go after the one returning from the appointment. I have to remove what I like to refer to as Cat Perceived Stranger Danger :nailbiting::eek::rolleyes:!

Welcome Home Ruby:bighug:!
 
Tomlin said:
Have you ever tried wiping Ruby down with a very, very slightly damp warm cloth and then, rubbing her back down with a shirt of yours (dirty of course so it has your scent!) as well as with an item that has her non hospital scent as well as something with Olive’s scent on it? Otherwise, it takes awhile for the vet/hospital scents to be cleaned off and for the “normal” scents to be Re established on her little body.

I have a multi cat household and do this every time we return from the vet or a couple of mine will literally lose it & go after the one returning from the appointment. I have to remove what I like to refer to as Cat Perceived Stranger Danger :nailbiting::eek::rolleyes:!

Welcome Home Ruby:bighug:!
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Never thought of doing this but it makes so much sense! Thank you!
 
Ruby-doo is home. :)

I wiped her down as soon as we got home as Amy suggested. Olive sniffed at her butt suspiciously and walked away. She's walking with a little limp, maybe from the catheter and IV they had in her at the hospital. She ate a spoonful of raw food. I tested her a few minutes after and she's still high but that's to be expected. At least it's come down a bit since this morning. She's now napping contentedly (heartwarming pic below).

The discharge instructions are to give her 12 mg of Cerenia tonight before dinner, 1.875 mg mirtazapine as needed every 24 hours and ¼ tab of omeprazole (Prilosec) twice a day for 2 weeks then every 24 hours for one more week. I asked if I could give famotadine (Pepcid) instead and the IM said that omeprazole works better. Giving antacids for such a long period of time worries me, but I'll see how she does on it for the next few days. I saw from the invoice that they gave her a B12 injection yesterday, so will follow up next week to see if additional oral supplementation or injections are recommended for her appetite.

Overall I'm glad I brought her to AMC and that I have access to their specialists now whenever we need. That access cost me a pretty penny but I feel much better having a plan to manage her appetite and knowing that we can do scoping anytime we need.

Extremely grateful for each and every one of you who has helped me through the past few days. Thank you so much for being here for me and Ruby. :bighug:

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She looks happy to be home. So glad to come home and read a more promising state of affairs, and you sound more relaxed. Completely understand, that period of waiting and decision making is hellish - do I take her / do I admit her / what's wrong...and you successfully navigated that, hopefully got a couple of good night's sleep (which always helps. It should not be surprising but I find it always does surprise me)

So glad she is back home, and better.

:bighug::bighug::bighug:
 
Be careful about the mirtazapine if you're using oral. Not trying to scare. It is an every-third-day drug. The ear gel version is the every 24-hour. Too much mirtazapine results in serotonin syndrome. So I would recommend some reading on symptoms of that, and call the ER to ask them why it is prescribed daily when it's an every-3-day-drug. Also it is a substantial dose, not a small one (it's probably a 1/4 pill yes? Probably assigned that dose b/c cutting it smaller is impossible). And to my memory, Ruby is not an exceptionally large cat. They may have made a mistake. Same thing happened with Chessie back in October. Hugs to you and Ruby-doo.
 
PerfumedCatMom said:
Ruby-doo is home. :)

I wiped her down as soon as we got home as Amy suggested. Olive sniffed at her butt suspiciously and walked away. She's walking with a little limp, maybe from the catheter and IV they had in her at the hospital. She ate a spoonful of raw food. I tested her a few minutes after and she's still high but that's to be expected. At least it's come down a bit since this morning. She's now napping contentedly (heartwarming pic below).

The discharge instructions are to give her 12 mg of Cerenia tonight before dinner, 1.875 mg mirtazapine as needed every 24 hours and ¼ tab of omeprazole (Prilosec) twice a day for 2 weeks then every 24 hours for one more week. I asked if I could give famotadine (Pepcid) instead and the IM said that omeprazole works better. Giving antacids for such a long period of time worries me, but I'll see how she does on it for the next few days. I saw from the invoice that they gave her a B12 injection yesterday, so will follow up next week to see if additional oral supplementation or injections are recommended for her appetite.

Overall I'm glad I brought her to AMC and that I have access to their specialists now whenever we need. That access cost me a pretty penny but I feel much better having a plan to manage her appetite and knowing that we can do scoping anytime we need.

Extremely grateful for each and every one of you who has helped me through the past few days. Thank you so much for being here for me and Ruby. :bighug:

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Hi Also not to scare you BUT Mirtazapine is to be given every THIRD Day and is suppose to be only 1/4 tablet each time I agree with Margaret. Amethyst had a negative experience with it because she was given too much I would question those instructions for Rubys' safety:cat::bighug::bighug::bighug::bighug::bighug:
 
@Margaret (and Pearl) @Pamela & Amethyst Yes, it's 1/4 tablet. I'm so glad I'm so open about sharing every detail with you all. :eek: I looked back at the discharge papers from when Ruby had DKA and they said then to give every 48 hours. I checked the AMC invoice and it looks like they did not give any mirtazapine to her so it would be safe for me to give her some tonight but I will check with the IM tomorrow about when to give it next. THANK YOU BOTH!!!
 
PerfumedCatMom said:
@Margaret (and Pearl) @Pamela & Amethyst Yes, it's 1/4 tablet. I'm so glad I'm so open about sharing every detail with you all. :eek: I looked back at the discharge papers from when Ruby had DKA and they said then to give every 48 hours. I checked the AMC invoice and it looks like they did not give any mirtazapine to her so it would be safe for me to give her some tonight but I will check with the IM tomorrow about when to give it next. THANK YOU BOTH!!!
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Welcome!:bighug::bighug::bighug::bighug:
 
Just to put some facts behind what people have said on mirtazapine, from a researcher who has studied it extensively: https://todaysveterinarypractice.com/mirtazapine-addressing-appetite-in-cats/
This article describes who long mirtazapine lasts in young cats, older cats, older cats with CKD, cats with liver disease. How long it lasts and timing of dosing differs for each. Given Ruby is stage 2 CKD, this paper says every other day is fine, exactly what the clinic suggested.
 
Wendy&Neko said:
Given Ruby is stage 2 CKD, this paper says every other day is fine, exactly what the clinic suggested.
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The discharge instructions say every 24 hours, which sounds like once a day to me. Every 48 hours would be every other day, which is what I've always been told by other vets.
 
+2 = 313. Not eating, but drinking lots of water, which I have not seen Ruby do since she started eating wet food 7 months ago.
 
She's not used to these high numbers, poor thing. Have you given the Cerenia and the mirtz? I found the Cerenia took about 30-40 minutes to kick in, and you want to give that well in advance of the mirtz. You don't want to give an appy stim to a cat with nausea. Hanging by the water bowl can also be a sign of nausea.
 
Wendy&Neko said:
She's not used to these high numbers, poor thing. Have you given the Cerenia and the mirtz? I found the Cerenia took about 30-40 minutes to kick in, and you want to give that well in advance of the mirtz. You don't want to give an appy stim to a cat with nausea. Hanging by the water bowl can also be a sign of nausea.
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I gave her cerenia, ondansetron and omeprazole about 3 hours before the mirtazapine. Still no interest in food. Tried raw, tried LC, tried MC, tried two different kinds of kibble. Not having any of it. I will wake up tomorrow morning to buy baby food and try to syringe if she refuses food in the morning. She is lethargic, lying around in an odd way and she gagged up some water a little while ago. I'm not sure why she was "doing well" at the hospital but seems so sick at home. :(
 
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