5/31 Ruby AMBG 180/+3 227/PMPS 259/+2 201

[Katherine&Ruby]

Yesterday on Sunday in the Park with Ruby.

It looks like I have to call off this OTJ trial. We will hopefully be able to try again, but there are too many unknowns with Ruby's condition right now. It didn't feel right to start it to begin with, I should not have been so optimistic. We have an appointment with her holistic vet tomorrow and I will get an appointment for endoscopy sometime this week. Ruby has been eating A LOT with the help of mirtazapine. Perhaps her BGs will come down. I feel such a heavy heart right now and so much concern for my Ruby.

Should I give her insulin? If so, how much?

 

[Bandit's Mom]

Do you want to see where her BG is 3 hours after food?

 

[Katherine&Ruby]

Do you want to see where her BG is 3 hours after food?

Sure, I will test her again then. But I won't be able to shoot then because then we'll be waaaay off schedule. I'd have to wait until this evening, which is ok too I guess. Maybe since her eating is so iffy I shouldn't consider the shot. She's eating now but who knows what she will do in 8 hours and I can't give her any more appy stims until tomorrow.

 

[Bandit's Mom]

Sure, I will test her again then. But I won't be able to shoot then because then we'll be waaaay off schedule. I'd have to wait until this evening, which is ok too I guess. Maybe since her eating is so iffy I shouldn't consider the shot. She's eating now but who knows what she will do in 8 hours and I can't give her any more appy stims until tomorrow.

This is her 12th day without insulin - maybe she will come down - no harm in waiting a day or two to see how this plays out?

 

[Katherine&Ruby]

This is her 12th day without insulin - maybe she will come down - no harm in waiting a day or two to see how this plays out?

I'm comfortable doing that as long as she stays below renal threshold, but if she gives me a high yellow or pink, I'm not sure what to do.

 

[Katherine&Ruby]

Thanks for being another comforting voice in my head right now, Bhooma @Bandit's Mom.

 

[Tomlin]

I’m sorry Katherine but keep your optimism even though it is hard right now .

The Mirtazapine is a double edge sword. I do not use it because, in the past when T has had issues, if he ate too much at one time (beyond a few tablespoons full) it aggravated the underlying issue. Yet, I know you didn’t have the ondansetron and clearly the Cerenia with Bupe wasn’t cutting it, so that’s why you used the Mirtazapine. Thankfully, it’s Monday, but if you could try feeding just many tiny meals—with some time in between them (easier on digestion) that may help. Otherwise, again, they eat too much and it can aggravate the underlying issue. I was hopeful that maybe this wouldn’t happen when I read that she was on your lap purring. I didn’t feel it was necessary to say anything given that she seemed to be doing well .

What I don’t know is exactly how aggravated her GI is from the food and more important, how long it will take to calm down & the effect it will have on BG. Again, another slightly tricky situation. If you feed smaller meals and things calm down, the BG may come down and if you give insulin, it can be an issue—-especially if there is an appetite issue. On the other hand, I know you don’t want her BG remaining higher. I personally think giving it a little time today, like Bhooma is recommending to see what happens, given the GI issues, makes the most sense right this moment in time. Think of it as some information gathering.

Virtual Hug!

 

[Katherine&Ruby]

I’m sorry Katherine but keep your optimism even though it is hard right now .

The Mirtazapine is a double edge sword. I do not use it because, in the past when T has had issues, if he ate too much at one time (beyond a few tablespoons full) it aggravated the underlying issue. Yet, I know you didn’t have the ondansetron and clearly the Cerenia with Bupe wasn’t cutting it, so that’s why you used the Mirtazapine. Thankfully, it’s Monday, but if you could try feeding just many tiny meals—with some time in between them (easier on digestion) that may help. Otherwise, again, they eat too much and it can aggravate the underlying issue. I was hopeful that maybe this wouldn’t happen when I read that she was on your lap purring. I didn’t feel it was necessary to say anything given that she seemed to be doing well .

What I don’t know is exactly how aggravated her GI is from the food and more important, how long it will take to calm down & the effect it will have on BG. Again, another slightly tricky situation. If you feed smaller meals and things calm down, the BG may come down and if you give insulin, it can be an issue—-especially if there is an appetite issue. On the other hand, I know you don’t want her BG remaining higher. I personally think giving it a little time today, like Bhooma is recommending to see what happens, given the GI issues, makes the most sense right this moment in time. Think of it as some information gathering.

Virtual Hug!

Thanks, Amy! Ruby had a lot to eat yesterday--8 ounces of food in total (she usually gets 6). Maybe that's what's driving the numbers up. She was RELENTLESS in trying to get me to feed her. She ate a combo of lamb and turkey yesterday--I alternate fatty and lean proteins every day to avoid any potential upset from fattiness. I gave her omeprazole this morning instead of famotidine, so if stomach acid is the culprit I might see the results of it in a few hours.

 

[Our Dolly Girl (GA)]

Thanks for being another comforting voice in my head right now, Bhooma @Bandit's Mom. QUOTE

Hi Katherine. Our gut instincts are usually right. She did start the trial right after having a lot of medical issues. Then again, this high number may aberration but I guess yesterday she was slightly off as well. It still has to be a big disappointment , I’m so sorry for you both. I wouldn’t tell Ruby just yet in case things turn around as Bhooma, my lifeline, suggested. You are both as always in my loving prayers. Hugs

 

[Our Dolly Girl (GA)]

Sorry I messed up and erased the bottom of Bhooma so my message is I had to give Dolly Mirtazapine quite a bit in the early days. It helped her an appetite but she devoured food rather then eating normally. It was sometimes scary to watch. Eventually it got her eating on her own. I gave her transdermal.

 

[Bandit's Mom]

erased the bottom of Bhooma

Bhooma's bottom could use some erasing. She likes chocolate too much!

 

[Tomlin]

The fact that she didn’t want to eat yesterday and needed the Mirtazapine on top of the other meds would most likely indicate that there was already an issue before the food was eaten & then eating all that food most likely did aggravate what was already happening.
.
The Mirtaz transdermal is more subtle, but still, I personally found that it was always best to manage the nausea &/or pain and then T would be willing to eat small, controlled meals on his own & if he wouldn’t, then that was helpful info vs using the Mirtaz and he eats too much only to pay for it later. That’s my issue with that drug in these situations. It is definitely worth a try & something to reach for when you are stuck like you were yesterday, but otherwise, I just personally haven’t had luck with it helping vs causing issues in these situations.

 

[Katherine&Ruby]

Hi Katherine. Our gut instincts are usually right. She did start the trial right after having a lot of medical issues. Then again, this high number may aberration but I guess yesterday she was slightly off as well. It still has to be a big disappointment , I’m so sorry for you both. I wouldn’t tell Ruby just yet in case things turn around as Bhooma, my lifeline, suggested. You are both as always in my loving prayers. Hugs

Thanks, Adrienne. (Don't worry, I fixed your message. ) Ruby will get back on track. It's good to know she has it in her to stay off insulin, and also good to know these flares are the reason. Now the task at hand is to figure out how to stop them from happening. That's for the vets to figure out.

 

[Tomlin]

Bhooma's bottom could use some erasing. She likes chocolate too much!

YOU ARE HILARIOUS !!!! I about fell off my couch laughing at that comment .
I’m keeping my bottom AND my chocolate .

 

[Our Dolly Girl (GA)]

Bhooma's bottom could use some erasing. She likes chocolate too much!

Making me laugh 1st thing in the morning Thanks Bhooma. REMEMBER it’s salad not chocolate ice cream with anchovies

 

[Katherine&Ruby]

It is definitely worth a try & something to reach for when you are stuck like you were yesterday, but otherwise, I just personally haven’t had luck with it helping vs causing issues in these situations.

Mirtazapine and cypro are definitely my "last resort" options. It's disturbing to see her behavior on the mirtazapine, but cypro doesn't seem to work on Ruby. I gave the mirtaz because I need to get her through the next day until I can bring her to the vet tomorrow and perhaps she will have some alternative treatment that could calm Ruby's system until her endoscopy. And if the endoscopy shows she will have to take a steroid, I'll have to contend with that as well vis a vis her BGs.

 

[Katherine&Ruby]

Bhooma's bottom could use some erasing. She likes chocolate too much!

Thanks you, dear Bhooma, for adding some levity to my morning! LOLZ!

 

[Tomlin]

It's disturbing to see her behavior on the mirtazapine

Is it the pill or the transdermal (you run on the inside of the ear?)

 

[Katherine&Ruby]

Is it the pill or the transdermal (you run on the inside of the ear?)

1.88 mg tablet.

 

[Tomlin]

1.88 mg tablet.

You may want to get some Mirtaz to keep in your supplies instead. The tablet, even low dose, can be an issue for some cats (T is one of them). The Mirtaz is a gel which makes it easy to control the dose. Also, due to it being transdermal delivery, it’s effect isn’t as dramatic which can be a good thing with a cat like Ruby who became ravenous. More subtle response. With that being said, some don’t like it because you are not going to see the cat suddenly become ravenous & it can be so subtle that it doesn’t do much at all. Again, with these GI situations, subtle vs ravenous, if someone is going to reach for the appy stim, is often better and safer.

https://mirataz.com/mirataz/

 

[Katherine&Ruby]

You may want to get some Mirtaz to keep in your supplies instead. The tablet, even low dose, can be an issue for some cats (T is one of them). The Mirtaz is a gel which makes it easy to control the dose. Also, due to it being transdermal delivery, it’s effect isn’t as dramatic which can be a good thing with a cat like Ruby who became ravenous. More subtle response. With that being said, some don’t like it because you are not going to see the cat suddenly become ravenous & it can be so subtle that it doesn’t do much at all. Again, with these GI situations, subtle vs ravenous, if someone is going to reach for the appy stim, is often better and safer.

https://mirataz.com/mirataz/

Thanks, Amy. I will ask for it at the vet tomorrow.

 

[tiffmaxee]

The pill made Tiffany hyper and VERY vocal. Th was a long time ago when it could only be given every 3 days and she would only eat day one. Cyproheptadine worked and I liked that it could be given twice a day if needed. With Max ondansetron in the right dose worked best with an occasional dose of cyproheptadine or zyrtec. I always was told to feed mini meals as feeding too much at one time would make them feel yucky, even if really hungry due to the appy stim.

If she starts to feel better the bg will hopefully come down.

 

[Katherine&Ruby]

The pill made Tiffany hyper and VERY vocal. Th was a long time ago when it could only be given every 3 days and she would only eat day one. Cyproheptadine worked and I liked that it could be given twice a day if needed. With Max ondansetron in the right dose worked best with an occasional dose of cyproheptadine or zyrtec. I always was told to feed mini meals as feeding too much at one time would make them feel yucky, even if really hungry due to the appy stim.

If she starts to feel better the bg will hopefully come down.

I wish the cypro worked on Ruby but maybe I needed to be more patient with it. I fed Ruby 7 times yesterday, so all of her meals were small (1-1.5 oz each meal) and given about an hour or two after the last one. I could have fed her smaller portions I guess but I didn’t want to feed her all night long.

 

[carfurby (GA)]

 

[tiffmaxee]

I wish the cypro worked on Ruby but maybe I needed to be more patient with it. I fed Ruby 7 times yesterday, so all of her meals were small (1-1.5 oz each meal) and given about an hour or two after the last one. I could have fed her smaller portions I guess but I didn’t want to feed her all night long.

Those are small enough meals. I’ve read the transdermal mirtazapine is much gentler and works. Worth a try.

 

[Marina & Chico]

Ohhh so sorry Katherine for the higher values, she was doing sooo well the most important though is to figure out the cause of her appetite loss. I am very sensitive about Ruby’s GI issues because i relate it to Chico’s GI issues as well.

Our vet recommended to keep him on low fat diet and it started working pretty well, then i made the huge mistake to give him duck (i learned how to tell if meat is fat thanks to that experiment) and it derailed him for over a month now we have tried only rabbit for a while without success and now are back to turkey which is what worked best for him. We have some signs of improvement again (gigantic antijinx). My point is maybe it is worth trying low fat meats only with Ruby as well

It was very interesting to see your position towards steroids for GI issues, i have mixed feelings on this topic when i think we might have to go the same way with Chico but it makes sense to treat the health threatening issue first and then go back to getting BG under control…

i wish we could go back a few years and change their diet to avoid all of this

 

[Tomlin]

Is the food ground? I’m just thinking about trying to make it easier to digest?

 

[Tomlin]

i wish we could go back a few years and change their diet to avoid all of this

Take that burden off your shoulders.....there are genetics at play vs only a cats diet causing these issues. I have a friend who got her cat from a breeder who only uses certain alkalinity water, raw food, glass litter boxes (that was new to me!). The cat developed GI issues at a year old. He is now controlled on novel proteins, but they continue to have to watch him because there are still issues with his appetite at times. Unfortunately, this is not just a diet issue for many cats.

 

[Katherine&Ruby]

Hi Marina, and thank you for the supportive words. I know you struggle with this with Chico.

Our vet recommended to keep him on low fat diet and it started working pretty well, then i made the huge mistake to give him duck (i learned how to tell if meat is fat thanks to that experiment) and it derailed him for over a month now

I have read somewhere that although it was thought that fattier diets aggravated pancreatitis, that’s not a commonly practiced strategy anymore, but it’s always in the back of my mind. I am also trying to balance Ruby’s dietary issues against her CKD, which requires lower phosphorus meats. Because lean meats like turkey have high phosphorus, I try to balance it out with lower phosphorus meats that generally, unfortunately, are higher in fat. I research the fat and phos levels of every meat I give to Ruby. Juggling all of these elements is a challenge and I feel like I am doing my best in that regard.

 

[Katherine&Ruby]

Is the food ground? I’m just thinking about trying to make it easier to digest?

Yep! Everything is ground. The turkey she ate yesterday is chunkier and requires a little chewing but the lamb is ground to a nearly smooth paste that Ruby laps up.

 

[Marina & Chico]

Take that burden off your shoulders.....there are genetics at play vs only a cats diet causing these issues. I have a friend who got her cat from a breeder who only uses certain alkalinity water, raw food, glass litter boxes (that was new to me!). The cat developed GI issues at a year old. He is now controlled on novel proteins, but they continue to have to watch him because there are still issues with his appetite at times. Unfortunately, this is not just a diet issue for many cats.

That is what DB tells me all the time and i know it might as well not have been enough… i just wish i would have taken this factor out of the equation. I am working on trying not to blame myself since it wont help in any way, i appreciate your support

 

[Tomlin]

That is what DB tells me all the time and i know it might as well not have been enough… i just wish i would have taken this factor out of the equation. I am working on trying not to blame myself since it wont help in any way, i appreciate your support

I am thinking it was not having the large glass litter box that caused our issues......!!!! Maybe if we had had a glass box and a large disco ball over it? Clicked my heels twice.....LOL.

Big hug.....put that monkey on your back away !!

 

[Marina & Chico]

Hi Marina, and thank you for the supportive words. I know you struggle with this with Chico.


I have read somewhere that although it was thought that fattier diets aggravated pancreatitis, that’s not a commonly practiced strategy anymore, but it’s always in the back of my mind. I am also trying to balance Ruby’s dietary issues against her CKD, which requires lower phosphorus meats. Because lean meats like turkey have high phosphorus, I try to balance it out with lower phosphorus meats that generally, unfortunately, are higher in fat. I research the fat and phos levels of every meat I give to Ruby. Juggling all of these elements is a challenge and I feel like I am doing my best in that regard.

Ohhh, i had no idea turkey is high in prosphorus… i know you are doing a great job at managing her diet, you are a role mode to me, i still have a lot of things to learn

 

[Summer and Susie (GA)]

I'm so sorry to hear that Ruby's glucose went up. I agree with others to wait it out and see what happens. I believe they are also right about finding out what the other issue is and then dealing with the glucose. I can hear in your words how disappointed you are but I also hear that your main concern is your girl's health. I'll be praying that answers are found quickly, safe solutions will present themselves and your Ruby's glucose will come down. You are a wonderful and caring cat Mom. Do not lose confidence in yourself. You have a whole village behind you.

 

[Marina & Chico]

I am thinking it was not having the large glass litter box that caused our issues......!!!! Maybe if we had had a glass box and a large disco ball over it? Clicked my heels twice.....LOL.

Big hug.....put that monkey on your back away !!

Hahaha i see what you did there

 

[Katherine&Ruby]

+3 = 227.

 

[Wendy&Neko]

I'd be tempted to start a bit of insulin tonight if she keeps going up. My trigger finger gets itchy that way. Though waiting one day should be fine.

I hope you get the ondansetron soon. I have seen a study that shows it is more effective at controlling nausea than Cerenia. The small lymphoma group I belong to is a big fan of it vs. Cerenia - though that does work in some cats. Yes, I belong to the SCL group, for the third cat in a row now. If you need to start steroids, ask for budesonide which doesn't impact the BG as much in most cats, but it's an ECID sort of thing.

Because lean meats like turkey have high phosphorus,

Not necessarily. Have you seen the analysis on the FoodFurLife website for turkey breast? It has low P, 0.8%. Often you will see raw poultry products from manufacturers with ground bones in them which makes them higher P. I fed Neko venison and kangaroo as well, two low fat and low P meats.

 

[Katherine&Ruby]

Ohhh, i had no idea turkey is high in prosphorus… i know you are doing a great job at managing her diet, you are a role mode to me, i still have a lot of things to learn

You are so sweet, Marina, and thank you so much for all of your kindness. You are doing a fantastic job with Chico, keep doing what you're doing.

Sadly chicken and turkey are high in phosphorus but duck is not, but I think again it's because duck is higher in fat content. Even venison or deer meat, which is very low in fat, is high in phosphorus. I feed Ruby and Olive turkey thighs, because at least there the fat content is higher (and therefore lower phos) than leaner breast meat.

 

[Katherine&Ruby]

I'd be tempted to start a bit of insulin tonight if she keeps going up.

What dose should I start her on again? .1? drop?

I hope you get the ondansetron soon.

It's arriving from it's journey from Iowa to New Jersey to Alaska back to NJ tomorrow. Thanks USPS!

Not necessarily. Have you seen the analysis on the FoodFurLife website for turkey breast? It has low P, 0.8%. Often you will see raw poultry products from manufacturers with ground bones in them which makes them higher P. I fed Neko venison and kangaroo as well, too low fat and low P meats.

I'm going by the nutritional analysis file from Hare Today, the food purveyor from whom I sourced the turkey thighs I'm feeding. It says they are 1.84% phos DMB. It is boneless and skinless. So I'm not sure what the difference is in the analysis done by FFL aside from the fact that it's breast vs thigh? It can't be such a huge difference between the two parts of the turkey? I will ask Laurie at FFL about this.

ETA: The venison from Hare Today is also high in phos, 2%. Maybe it’s how they source the meats?

 

[Katherine&Ruby]

I'm so sorry to hear that Ruby's glucose went up. I agree with others to wait it out and see what happens. I believe they are also right about finding out what the other issue is and then dealing with the glucose. I can hear in your words how disappointed you are but I also hear that your main concern is your girl's health. I'll be praying that answers are found quickly, safe solutions will present themselves and your Ruby's glucose will come down. You are a wonderful and caring cat Mom. Do not lose confidence in yourself. You have a whole village behind you.

Thank you, Summer. Things are well beyond my control at this point. At least with insulin, I can guide Ruby’s sugar levels; with this GI issue, I am in the dark and lacking a steering wheel. This makes me very stressed. This will hopefully be rectified soon with more diagnostics.

 

[Summer and Susie (GA)]

Thank you, Summer. Things are well beyond my control at this point. At least with insulin, I can guide Ruby’s sugar levels; with this GI issue, I am in the dark and lacking a steering wheel. This makes me very stressed. This will hopefully be rectified soon with more diagnostics.

Praying for you and your girl. When is the endoscopy scheduled?

 

[Katherine&Ruby]

Praying for you and your girl. When is the endoscopy scheduled?

Don’t know yet. Will hear from the vet by tomorrow.

 

[Diane Tyler's Mom GA]

Hi Katherine, I know you are upset, big hugs, You are doing the best you can, hopefully they can set up the endoscopy soon and they can get to the bottom of this
Good luck with the holistic vet tomorrow.
Please try and stay calm, the doctors will figure this out
Sending you big hugs
and kisses for Ruby ♥

 

[Wendy&Neko]

What dose should I start her on again? .1? drop?

Yes, that's what I would have suggested. When you did 0.25 last time it was too much. But unless she really sky rockets, it's OK to sit on your hands for a day.

ETA: The venison from Hare Today is also high in phos, 2%. Maybe it’s how they source the meats?

The local premade raw meals I can get are 1.24%DMB P for venison (from New Zealand), but they add buffalo bone powder. So I sourced plain venison and added FFL with egg shell calcium to make it lower P. Kangaroo from the same manufacturer with buffalo bone powder was half the venison numbers, so I could continue to feed it as is.

 

[Our Dolly Girl (GA)]

Thanks, Adrienne. (Don't worry, I fixed your message. ) Ruby will get back on track. It's good to know she has it in her to stay off insulin, and also good to know these flares are the reason. Now the task at hand is to figure out how to stop them from happening. That's for the vets to figure out.

Katherine, soon the doctors will figure out what’s going on with Ruby, give you a treatment plan to address these flare ups and before you know it she will settle back into her healthy numbers. Just another curve ball called life with cats. Sending healing prayers and big hugs

 

[Suzanne & Darcy]

Dark meat chicken, dark meat turkey are both lower in phosphorus than the white meat.

 

[Suzanne & Darcy]

The transdermal mirt can also make them crazy so start low and go slow! It made my cat Tabitha crazy and aggressive at the full dose. I used half the strip length (that you squeeze out of the tube onto a glove ... NOT your finger.) every other day instead of every day. On the full dose she started beating up on all the other cats in the house ... and that was not her usual M.O. ECID, so be careful with it. I thought you didn't like using "Meowtazipine" with Ruby... but I guess it's been getting her to eat. I'm so sorry. The last condo I read she was doing fabulous. See what happens when I miss a day.

But, don't blame yourself... you really are doing everything right. You know what you are doing. You just need to get that endoscopy so you can have the information that you need to move forward. I think you are so awesome, Katherine. I so admire everything that you do for Ruby.

 

[Suzanne & Darcy]

Oh, and I totally get what you mean about not letting her get above the renal threshold!

 

[Katherine&Ruby]

PMPS = 259. Ruby has been rising since yesterday so I gave her .1 units of insulin because I do not want to see pinks tomorrow.

It is amazing how dosing insulin became about muscle memory, and after 12 days of not doing it, I almost forgot!

 

[Katherine&Ruby]

I thought you didn't like using "Meowtazipine" with Ruby... but I guess it's been getting her to eat. I'm so sorry.

Ruby hasn't been well since Friday. I really hate using mirtazapine, you're right! She was super twitchy and restless, not to mention aggressive with Olive to the point where I had to break up a few fights between them that made me feel really bad. Olive has been giving Ruby wide berth since. I needed her to be eating and nothing else was working, but she seems to have calmed down today even though her BGs are going up and up.