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Shelley7

Shelley7

Member Since 2022
Hi there. I hope this is the right place to post. This is such a huge forum.

I filled in my intro info and put his google sheet in the signature box but I don't know if I did it correctly. Can someone let me know if my info is accessible or if I need to do something differently?

I just started Lantus today (1 unit bid), but my cat (Frankie) is on 2.5 mg of prednisolone and will remain at that level until next Wednesday. I'm wondering how often I need to test? I did a AMPS, +3, +6, +9 and will do a PMPS but they are all staying in the 400's range and it's possible that he'll have some insulin resistance b/c of the pred. Although I don't mind poking him if it's giving valuable information I didn't feel like all those pokes today were necessary.

When the readings are this high, can I just do the pre-shot checks and maybe one at +6-7?

Also I realize that Lantus is a depot thing and can build up so it is possible that he stays at 400 for days and then suddenly bottoms out? If so when would you expect that? Day 3? 4? Should I test more on a certain day if expecting that kind of build up effect?

Thank you!
 
Hello and welcome! I can view the spreadsheet. Good job on the testing.

It's hard to say with one day of data, so my advice is just be vigilant with the testing. Preshots should be fasting for 2 hours for consistency; the others do not need to be fasting. I would amget a +2 or +3 each cycle, many times when that is flat you'll have a calm/boring/flat cycle, but if it shows a drop you'll want to keep testing. Just post and ask for advice if you see more than a 75 point drop between PS and +2/3, OR if you see low yellow or blues at any point. Just so we know to keep an eye out

What's current diet? Weight ok, or under/overweight? Other supplements/meds?

Can you add the other info to your signature when you get a chance? You'll find a wealth of information and instructions here. Helps us to know when/how diagnosed, other health issues. You'll also want to read about hypos and hypo kits, as well as ketones/DKA and ketone testing (all linked in the link above).

I saw you mention in another thread your cat has SCL or IBD? Is that why he's on the pred? What is next Wednesday, a vet visit to possibly tweak dose?

Going to tag @Wendy&Neko and @Katherine&Ruby as well for IBD/SCL.
 
Shelley7 said:
I realize that Lantus is a depot thing and can build up so it is possible that he stays at 400 for days and then suddenly bottoms out? If so when would you expect that? Day 3? 4? Should I test more on a certain day if expecting that kind of build up effect?
Click to expand...
Hi and welcome.
In the beginning, Lantus takes from 5 to 7 days for the depot to fill and for you to see the full effect of the dose. So don’t change the dose for the first 5 to 7 days unless your kitty drops under 50 on a human meter or 68 on a pet meter and then you reduce the dose.
INSULIN DEPOT here is some information about the depot.
 
Hi. Thanks for responding. I added his whole story to my intro page. I tried to put the basics in the signature page but it kept saying my lines were too long and giving me error messages. His current weight is about 10 pounds (a little overweight but not bad and wasn't losing weight from the high sugars). Current diet is LC wet/homemade meat only. He was diagnosed on 1/4. He's been on pred for 2 years for IBD/?SCL (no biopsy). He also has had asymptomatic chronic pancreatitis with his recent fPL at 38. He's currently on Day 10 of a slow prednisolone taper (was at 5, now at 2.5 mg x 10 days). The initial plan was to transition him over to budesonide which arrives on Tuesday so at that point I'll be going to qod with pred and starting budesonide but I'm also seeing oncology that day to discuss chlorambucil. He seemed ok until about 2 days ago and now is very withdrawn and pooky although not in any distress and eating/peeing/pooping, etc. It might be that the high sugars are getting to him but I think it's more likely that he's feeling this reduced pred dose and his gut is flaring a little. I was hoping to not start insulin until we could get him off the pred b/c just to not have too many moving parts but since he clinically looks worse, now decided to start and see if regulation helped him feel better. No ketones in urine.

FrostD said:
Hello and welcome! I can view the spreadsheet. Good job on the testing.

It's hard to say with one day of data, so my advice is just be vigilant with the testing.

What's current diet? Weight ok, or under/overweight?

Can you add the other info to your signature when you get a chance? You'll find a wealth of information and instructions here. Helps us to know when/how diagnosed, other health issues. You'll also want to read about hypos and hypo kits, as well as ketones/DKA and ketone testing (all linked in the link above).

I saw you mention in another thread your cat has SCL or IBD? Is that why he's on the pred? What is next Wednesday, a vet visit to possibly tweak dose?

Going to tag @Wendy&Neko and @Katherine&Ruby as well for IBD/SCL.
Click to expand...
 
Bron and Sheba (GA) said:
Hi and welcome.
In the beginning, Lantus takes from 5 to 7 days for the depot to fill and for you to see the full effect of the dose. So don’t change the dose for the first 5 to 7 days unless your kitty drops under 50 on a human meter or 68 on a pet meter and then you reduce the dose.
INSULIN DEPOT here is some information about the depot.
Click to expand...

I guess I'm wondering if I can back off the testing to 3 times a day until day 4 or 5 then and then be more intensive about it since that's when the dose effect is expected. This is definitely complicated by the fact that this will also be the time when the pred is dropped again, so maybe this was a bad idea to start it today.
 
Hi Shelley and Frankie! Great job on getting that spreadsheet up and running and all of the testing you've gotten done today. Agree with what @FrostD says about testing. Right now his numbers are so high that getting as many tests as you can will be helpful as he will be fairly unpredictable. An unregulated cat's glucose levels can swing widely, so being around to catch the lows will be helpful for dosing and will keep Frankie safe.

How long as Frankie been on pred? How did you come to realize he has IBD or SCL, and are there plans to get a biopsy to figure out which one it is?

Ruby has been on pred for the past 7 months for SCL diagnosed from endoscopic biopsy after trying desperately to cure her inappetence and vomiting with raw food and a barrage of supplements recommended by an IBD group. We went from being nearly in remission with a drop of insulin twice a day to now around 3 units since the pred. It took us a long time to get to the right dose to keep her below renal threshold, which is the point at which glucose starts getting dumped into urine, possibly causing kidney problems. We want to avoid that by increasing doses of the Lantus as aggressively as we can to battle the hyperglycemia caused by the steroid while being mindful of overdosing. Remission is not a possibility for us as long as she stays on twice a day doses of the steroid, but she is doing pretty well and gaining weight.

Once you get more comfy, you should take a gander at the dosing methods of the Lantus forum: https://www.felinediabetes.com/FDMB...-low-go-slow-slgs-tight-regulation-tr.210110/. If you're able to test often and your cat is only on a wet food diet, I would suggest you try Tight Regulation to get him into better numbers as quickly as possible. He will feel better as a result.
 
Yeah you have to play with the signature/keep it brief to get it all to fit.

Wendy and Katherine will be better suited to answer this, but in my opinion I wouldn't rush to get him off pred if it's working for him. Budesonide usually doesn't affect BG, but we've seen cats where it does...and pred is the first choice for IBD and SCL as it is. Budesonide also heavily metabolized in the liver, are his liver values ok? We consider the diabetes second priority, meaning treat the IBD/SCL as needed to make him feel good and adjust the insulin and timing as needed. It's not quite as daunting as it may seem at first
 
Katherine&Ruby said:
Hi Shelley and Frankie! Great job on getting that spreadsheet up and running and all of the testing you've gotten done today. Agree with what @FrostD says about testing. Right now his numbers are so high that getting as many tests as you can will be helpful as he will be fairly unpredictable. An unregulated cat's glucose levels can swing widely, so being around to catch the lows will be helpful for dosing and will keep Frankie safe.

How long as Frankie been on pred? How did you come to realize he has IBD or SCL, and are there plans to get a biopsy to figure out which one it is?

Ruby has been on pred for the past 7 months for SCL diagnosed from endoscopic biopsy after trying desperately to cure her inappetence and vomiting with raw food and a barrage of supplements recommended by an IBD group. We went from being nearly in remission with a drop of insulin twice a day to now around 3 units since the pred. It took us a long time to get to the right dose to keep her below renal threshold, which is the point at which glucose starts getting dumped into urine, possibly causing kidney problems. We want to avoid that by increasing doses of the Lantus as aggressively as we can to battle the hyperglycemia caused by the steroid while being mindful of overdosing. Remission is not a possibility for us as long as she stays on twice a day doses of the steroid, but she is doing pretty well and gaining weight.

Once you get more comfy, you should take a gander at the dosing methods of the Lantus forum: https://www.felinediabetes.com/FDMB...-low-go-slow-slgs-tight-regulation-tr.210110/. If you're able to test often and your cat is only on a wet food diet, I would suggest you try Tight Regulation to get him into better numbers as quickly as possible. He will feel better as a result.
Click to expand...


Thank you. So sorry to hear that Ruby is dealing with this too. Frankie was diagnosed with IBD 2 years ago. He was immediately put on prednisolone and I wasn't offered a biopsy option. Later I realized that this could change the course of treatment decisions but it was too late and now he's too fragile. His only symptom was severe weight loss and then very low B12 and folate numbers. He did pretty well on 5 mg of pred except over the last year, his fPL has been climbing and his pancreas looks pretty bad on ultrasound (fluid, fibrosis) and he still has intestinal thickening etc, so based on that I don't think the pred really had the IBD in remission although he was never symptomatic from the pancreas. I feel like given his age and the pancreatic destruction, there is a chance that it has progressed to SCL and so I'm trying to decide whether to try budesonide which may be better for BS but may not control the gut disease well enough or chlorambucil which could control the gut disease but without a biopsy might be aggressive for ibd/chr pancreatitis. I'm leaning towards chlorambucil because I'd like to give him a chance at diabetic remission if it's possible and we won't really know that unless off the steroids. He also has stage 2 CKD (stable, not his main problem) but after a month of glycosuria I'm worried about his kidneys as well. Such a complicated picture with new diagnoses just piling on top of each other.
 
FrostD said:
Yeah you have to play with the signature/keep it brief to get it all to fit.

Wendy and Katherine will be better suited to answer this, but in my opinion I wouldn't rush to get him off pred if it's working for him. Budesonide usually doesn't affect BG, but we've seen cats where it does...and pred is the first choice for IBD and SCL as it is. Budesonide also heavily metabolized in the liver, are his liver values ok? We consider the diabetes second priority, meaning treat the IBD/SCL as needed to make him feel good and adjust the insulin and timing as needed. It's not quite as daunting as it may seem at first
Click to expand...

After wringing my hands over the question for a long time, I have no misgivings about putting Ruby on prednisolone versus budesonide. The pred reduced the inflammation in her intestines to zero, and I don't think I would have had the same result with budesonide. Would I have been able to keep her glucose levels lower on budesonide? Would she be in remission? Maybe. But she's been doing so well and I would much rather have her be on insulin than having the terrible symptoms she had before we started steroid treatment.
 
FrostD said:
Yeah you have to play with the signature/keep it brief to get it all to fit.

Wendy and Katherine will be better suited to answer this, but in my opinion I wouldn't rush to get him off pred if it's working for him. Budesonide usually doesn't affect BG, but we've seen cats where it does...and pred is the first choice for IBD and SCL as it is. Budesonide also heavily metabolized in the liver, are his liver values ok? We consider the diabetes second priority, meaning treat the IBD/SCL as needed to make him feel good and adjust the insulin and timing as needed. It's not quite as daunting as it may seem at first
Click to expand...

His liver is ok values wise but is inflamed on ultrasound. Pred sort of was working for him in that he didn't have active symptoms, but it's tricky b/c he never had symptoms, even at initial diagnosis and during the time on pred, his pancreas has been chronically inflamed and the gut disease has progressed. So I feel like if I can find another drug that doesn't cause diabetes and can get better control of the gut process, that would be ideal. But if not, then it may be the best of some bad choices. Also my internal medicine vet was adamant that he had to come off all steroids. Like yesterday/urgently. My primary agreed that a wean is prudent but was willing to do it more slowly and try budesonide.
 
Shelley7 said:
Such a complicated picture with new diagnoses just piling on top of each other.
Click to expand...
Trust me, I know this feeling of juggling! Ruby was diagnosed first with diabetes, then CKD, then SCL, all within less than a year. As Melissa said, diabetes is a walk in the park in comparison to GI disorders. You just need to get used to the routine of testing and shots and figuring out dosing. It becomes second nature after a while. We can help! :)
 
Shelley7 said:
I guess I'm wondering if I can back off the testing to 3 times a day until day 4 or 5 then and then be more intensive about it since that's when the dose effect is expected. This is definitely complicated by the fact that this will also be the time when the pred is dropped again, so maybe this was a bad idea to start it today.
Click to expand...
I would test before every preshot and then again at least once during the cycle, maybe around +4 to +6. If the BG has dropped a lot, then I would test again….otherwise leave it to the next cycle. Then do the same with the PM cycle. You may need to test earlier in the cycle if you find a big drop at +4 or +5 but we can help you with that.
 
FrostD said:
Hello and welcome! I can view the spreadsheet. Good job on the testing.

It's hard to say with one day of data, so my advice is just be vigilant with the testing. Preshots should be fasting for 2 hours for consistency; the others do not need to be fasting. I would amget a +2 or +3 each cycle, many times when that is flat you'll have a calm/boring/flat cycle, but if it shows a drop you'll want to keep testing. Just post and ask for advice if you see more than a 75 point drop between PS and +2/3, OR if you see low yellow or blues at any point. Just so we know to keep an eye out

What's current diet? Weight ok, or under/overweight? Other supplements/meds?

Can you add the other info to your signature when you get a chance? You'll find a wealth of information and instructions here. Helps us to know when/how diagnosed, other health issues. You'll also want to read about hypos and hypo kits, as well as ketones/DKA and ketone testing (all linked in the link above).

I saw you mention in another thread your cat has SCL or IBD? Is that why he's on the pred? What is next Wednesday, a vet visit to possibly tweak dose?

Going to tag @Wendy&Neko and @Katherine&Ruby as well for IBD/SCL.
Click to expand...
Thank you. That's very helpful. He's not on any supplements but he is on a lot of medications. (Gabapentin, Kristalose, Levothyroxine, Pred, Cerenia and Adequan)
 
Bron and Sheba (GA) said:
I would test before every preshot and then again at least once during the cycle, maybe around +4 to +6. If the BG has dropped a lot, then I would test again….otherwise leave it to the next cycle. Then do the same with the PM cycle. You may need to test earlier in the cycle if you find a big drop at +4 or +5 but we can help you with that.
Click to expand...
So for the PM cycle do I need to wake up at 2-4 am to test? His pm shot is to be done around 10 pm my time.
 
Katherine&Ruby said:
Trust me, I know this feeling of juggling! Ruby was diagnosed first with diabetes, then CKD, then SCL, all within less than a year. As Melissa said, diabetes is a walk in the park in comparison to GI disorders. You just need to get used to the routine of testing and shots and figuring out dosing. It becomes second nature after a while. We can help! :)
Click to expand...
Thank you. You guys have already helped so much.
 
Shelley7 said:
So for the PM cycle do I need to wake up at 2-4 am to test? His pm shot is to be done around 10 pm my time.
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Does the 10pm schedule suit you? Would it be easier to move it to 7:7 or 8:8.?
If not I would get a before bed test in ….what time do you go to bed? if the before bed test is lower than the preshot BG I would personally set the alarm and get up later and test. At the moment we don’t have any data to go on as to how he is going to react to the insulin.
 
I just looked at your spread sheets and realized that you do the Pm shot at 8 pm-ish so you can do a 3+ at 11 pm. That makes sense to me but I didn't think ahead. I gave him his shot at 9:45 am this morning which means the PM dose is coming up at 9:45 pm and I usually go to bed soon after. I will do a pre-shot check but I'm assuming it will still be in the 400's. Do you think it's safe to assume it will stay high since this is the first night? I can do the 8 am and 8 pm so I'm wondering if I should not give any tonight and just start again tomorrow with better times?
 
The reason I did the 9 am thing was because I woke up at 7 and tried to give 2 hours without food and then it took me longer to do the whole routine for the first time.
 
If you think it's more important that he gets the shot tonight, then I could maybe give it now and test again at +2 and go to bed around midnight. But then he's still on the 10 am and 10 pm schedule (technically 9:45)
 
Shelley7 said:
I just looked at your spread sheets and realized that you do the Pm shot at 8 pm-ish so you can do a 3+ at 11 pm. That makes sense to me but I didn't think ahead. I gave him his shot at 9:45 am this morning which means the PM dose is coming up at 9:45 pm and I usually go to bed soon after. I will do a pre-shot check but I'm assuming it will still be in the 400's. Do you think it's safe to assume it will stay high since this is the first night? I can do the 8 am and 8 pm so I'm wondering if I should not give any tonight and just start again tomorrow with better times?
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It’s early days so don’t worry…it takes a few days to get into a routine.
It would be better if you could do an earlier time as then you can do some testing before you go to bed.
I don’t think I would skip tonight’s dose with higher BGs.
What you can do is go back in time 1/2 hour a day or 1/4 hour each cycle. So tonight give the dose at 9.30 pm, and tomorrow you could do 9.15 am and 9pm. Then the next day 8.45 am and 8.30 pm etc. until you get to the time you want. It will only take a few days. Does that make sense?
 
Shelley7 said:
The reason I did the 9 am thing was because I woke up at 7 and tried to give 2 hours without food and then it took me longer to do the whole routine for the first time.
Click to expand...
Give yourself time in the beginning as it will take longer to do the test feed shot routine. Once you have it down pat it will only take 5 minutes. So start 1/2 hour earlier if you think it will take that long so you actually give the dose on time.

Do you only have the one kitty? You might like to think about an automatic timed feeder that you can use overnight so he gets some food and then close it for the two hours peshot so he can’t get the food.
 
Paws crossed you'll start to see better numbers as the Lantus depot builds.

My Neko was first diagnosed with diabetes, though that turned out to be caused by acromegaly, which also caused severe arthritis, then CKD, and then both heart disease and GI disease on the same day. We couldn't biopsy because her heart issues meant she likely wouldn't survive anaesthesia, though the internal medicine vet said it looked more like SCL. By the way, weight loss without changing amount of food eaten is a symptom of GI disease. Neko was a vomiter. :rolleyes: Though mostly foamy vomit which looked like a CKD symptom. Her spreadsheet was mostly red to start too.

Neko was on budesonide, also because of her heart, which could not survive prednisolone. Budesonide did reduce her bowel inflammation quite a bit, making her feel better and reducing the GI symptoms, and did not impact her blood sugars. Neko also went on chlorambucil. Actually now on my third SCL kitty on chlorambucil now (in remission), but that's another story. I would strongly recommend if you go that way that you get a prescription for ondansetron. Studies have show it to be much better for nausea due to chemo than is Cerenia.
 
Bron and Sheba (GA) said:
Give yourself time in the beginning as it will take longer to do the test feed shot routine. Once you have it down pat it will only take 5 minutes. So start 1/2 hour earlier if you think it will take that long so you actually give the dose on time.

Do you only have the one kitty? You might like to think about an automatic timed feeder that you can use overnight so he gets some food and then close it for the two hours peshot so he can’t get the food.
Click to expand...
Yes, only one. He is a grazer and eats most of his food through the night but is usually finished by early morning. I think I could pull his bowl at 6 (or make sure it's empty) so we have a good number at 8 but I'll keep the timed bowl in mind if his appetite changes or if it's too hard for me to wake that early. Do you have a link of those that you like?
 
Wendy&Neko said:
Paws crossed you'll start to see better numbers as the Lantus depot builds.

My Neko was first diagnosed with diabetes, though that turned out to be caused by acromegaly, which also caused severe arthritis, then CKD, and then both heart disease and GI disease on the same day. We couldn't biopsy because her heart issues meant she likely wouldn't survive anaesthesia, though the internal medicine vet said it looked more like SCL. By the way, weight loss without changing amount of food eaten is a symptom of GI disease. Neko was a vomiter. :rolleyes: Though mostly foamy vomit which looked like a CKD symptom. Her spreadsheet was mostly red to start too.

Neko was on budesonide, also because of her heart, which could not survive prednisolone. Budesonide did reduce her bowel inflammation quite a bit, making her feel better and reducing the GI symptoms, and did not impact her blood sugars. Neko also went on chlorambucil. Actually now on my third SCL kitty on chlorambucil now (in remission), but that's another story. I would strongly recommend if you go that way that you get a prescription for ondansetron. Studies have show it to be much better for nausea due to chemo than is Cerenia.
Click to expand...

Thank you for that advice. Sorry that Neko had to deal with so much too. It's so hard to know how far to push things and how aggressive to be vs quality and comfort kind of care. I'm wondering if the oncologist will want to do budesonide and chlorambucil or just one, but that's what I'm worried about re: chlorambucil is the side effects. Nausea and poor appetite is a problem in a kitty not on insulin but now that he's on Lantus, that becomes much more of a concern. I'll definitely ask for ondansetron. How did you dose the chlorambucil? I've heard different dosing regimens and didn't know if one gives less nausea/inappetance or would be better for sugar cats.
 
Shelley7 said:
Yes, only one. He is a grazer and eats most of his food through the night but is usually finished by early morning. I think I could pull his bowl at 6 (or make sure it's empty) so we have a good number at 8 but I'll keep the timed bowl in mind if his appetite changes or if it's too hard for me to wake that early. Do you have a link of those that you like?
Click to expand...
I don’t live in the US but I know a lot of people there use the Petsafe 5 so you could google that.
 
Ok, so I tested +2 at 11:45 pm and it had gone from 405 to 372. I know it’s late but thought maybe someone in a different time zone might still be here. Not sure if I should wake up in the night to check again, since it went lower, or if he’ll be ok until morning since it wasn’t a big drop and is still high. I’m exhausted so going to bed but will try to wake up and check the thread in a few hours if I don’t hear something now. Thanks!
 
Hi Shelley
Just seeing this. I am in Australia so will be around for several hours yet. well done getting the +2!
Yes I would set the alarm and test around +5
If you are still awake I would give a small snack low carb food now. if he hasn’t got access to food and again when you test +5
 
Wendy&Neko said:
Paws crossed you'll start to see better numbers as the Lantus depot builds.

My Neko was first diagnosed with diabetes, though that turned out to be caused by acromegaly, which also caused severe arthritis, then CKD, and then both heart disease and GI disease on the same day. We couldn't biopsy because her heart issues meant she likely wouldn't survive anaesthesia, though the internal medicine vet said it looked more like SCL. By the way, weight loss without changing amount of food eaten is a symptom of GI disease. Neko was a vomiter. :rolleyes: Though mostly foamy vomit which looked like a CKD symptom. Her spreadsheet was mostly red to start too.

Neko was on budesonide, also because of her heart, which could not survive prednisolone. Budesonide did reduce her bowel inflammation quite a bit, making her feel better and reducing the GI symptoms, and did not impact her blood sugars. Neko also went on chlorambucil. Actually now on my third SCL kitty on chlorambucil now (in remission), but that's another story. I would strongly recommend if you go that way that you get a prescription for ondansetron. Studies have show it to be much better for nausea due to chemo than is Cerenia.
Click to expand...
The only thing I'd add, is I think ondansetron and gaba have to be spaced out apart from each other?
 
Bron and Sheba (GA) said:
Hi Shelley
Just seeing this. I am in Australia so will be around for several hours yet. well done getting the +2!
Yes I would set the alarm and test around +5
If you are still awake I would give a small snack low carb food now. if he hasn’t got access to food and again when you test +5
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Thanks for responding. I saw your message and did another check at +6 (3:30 am) and it was still in 300’s. He free feeds through the night but was hungry and had actually finished all his food by 3. Made it easy to get a fasting test this morning!
 
Shelley7 said:
Really? I wasn’t aware of that. I’ll make sure to ask. Thanks!
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Yes please check, that same vet also gave me incorrect dosing for ondansetron. Quick Google says no antacids with gabapentin because reduces efficacy, so spread them out. But I don't think ondansetron is technically an antacid...
 
Ondansetron is NOT an antacid, it is an anti-nausea medication, it binds to nausea receptors so a different action from an antacid. I only tried gabapentin for a while and it didn't do much for Neko so have no experience with giving the two the same day. I haven't heard of an issue with ondansetron and timing with other meds.
 
Shelley7 said:
I'm wondering if the oncologist will want to do budesonide and chlorambucil or just one, but that's what I'm worried about re: chlorambucil is the side effects. Nausea and poor appetite is a problem in a kitty not on insulin but now that he's on Lantus, that becomes much more of a concern. I'll definitely ask for ondansetron. How did you dose the chlorambucil? I've heard different dosing regimens and didn't know if one gives less nausea/inappetance or would be better for sugar cats.
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Hopefully you will get both. Chlorambucil is what would get you longer term relief, you don't get long term remission without it. I tried both the every other day (EOD) dosing of chlorambucil and the slightly larger dose once every two weeks. I would never go back to the every other day dosing again. In addition to be a lot less pilling for me, the every two week dosing is way easier on the cat. A possible couple days of nausea followed by the rest of the two weeks fine. Each cat is different that way, but if you predose with ondansetron 1/2 hour or so before the chlorambucil and keep up the ondansetron 2-3 times a day for another couple days, you might not see any nausea at all. Neko's internist started her on the EOD dosing, and she never got a break from the nausea. Once she went on the every two weeks dosing, she had over a week of nausea free every couple weeks. The every two weeks dosing is also less chlorambucil so overall better for the cat too.
 
Wendy&Neko said:
Hopefully you will get both. Chlorambucil is what would get you longer term relief, you don't get long term remission without it. I tried both the every other day (EOD) dosing of chlorambucil and the slightly larger dose once every two weeks. I would never go back to the every other day dosing again. In addition to be a lot less pilling for me, the every two week dosing is way easier on the cat. A possible couple days of nausea followed by the rest of the two weeks fine. Each cat is different that way, but if you predose with ondansetron 1/2 hour or so before the chlorambucil and keep up the ondansetron 2-3 times a day for another couple days, you might not see any nausea at all. Neko's internist started her on the EOD dosing, and she never got a break from the nausea. Once she went on the every two weeks dosing, she had over a week of nausea free every couple weeks. The every two weeks dosing is also less chlorambucil so overall better for the cat too.
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Shoot! The vet gave me the option and I had forgotten this post and chose the qod. I was worried that if it’s one big dose and it’s terrible then I’d have to deal with it for 2 weeks where if he’s not tolerating the smaller dose then I could back off or skip days if needed. She said the studies showed that there wasn’t much difference between the two in regards to side effects.
 
I belong to a small cell lymphoma group. A lot of people join with nauseous cats on the every two day dosing. The every two day dosing is actually a lot more chlorambucil over the two weeks than the two week dosing. A current example is my not quite 8 lb kitty who gets 4 mg every two weeks, instead of dosing 2 mg every 2 days which would be a total of 14 mg over 2 weeks. Thus, a lot more nausea. Going to the every two weeks is easier on the cat. You can always change from one method to the other, like I did with Neko.
 
Wendy&Neko said:
I belong to a small cell lymphoma group. A lot of people join with nauseous cats on the every two day dosing. The every two day dosing is actually a lot more chlorambucil over the two weeks than the two week dosing. A current example is my not quite 8 lb kitty who gets 4 mg every two weeks, instead of dosing 2 mg every 2 days which would be a total of 14 mg over 2 weeks. Thus, a lot more nausea. Going to the every two weeks is easier on the cat. You can always change from one method to the other, like I did with Neko.
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Curious why the big difference in amount? Seems odd to me. Is the 4mg less effective then? Or the 14mg just overkill?
 
The one article I've seen on the every other week dosing shows remission rates as good or better than the EOD one. I think it's an older vs. newer dosing method thing. The every other week is mentioned in the latest vet oncology books.
 
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