? 10/25 Methos 198@ +11, 201@PMPS; 262@ +1.8; 222@ +3; 202@ +4; 195 @+5; 209@ +6; 166@ + 9

SmallestSparrow

SmallestSparrow

Very Active Member
Last post https://felinediabetes.com/FDMB/threads/dose-advice-on-a-complicated-cat.295088/

here I am again desperate to not screw it up (again). I know @Wendy&Neko you told me 2.75 (which is 3- to me bc these syringes have thick lines). I tried that but his ketones were headed back to 1.0 and he started refusing food and I was scared so I did 3u. Because I’m still not clear on whether the 2.75 was better for him or bc people think I won’t give him 3u if PS under 250. I will, I just need to know if that’s what I’m supposed to do.

so he’s the lowest he’s been this cycle at 198@ +11.

do I feed him now, wait two hours and give 3U?
Do not feed, test at PMPS and give 3U no matter what?
Do I adjust to 2.5 or 2.75 no matter what?
Do I not feed, wait two hours and either give 3U or adjusted?

I try looking at others spread sheets and I’m so confused but I cannot screw this up tonight he’s been so sick.

could someone please help me? Thank you
 
What do you do @Heike & BInie? I don’t know what I’m supposed to do but every time I’ve made a decision these last two weeks it’s been wrong and I don’t think he will survive if I make another mistake
 
If I don’t give a full dose he will be high and ketones high. But if I give a full dose and he goes low then he goes high and his ketones are high
I cannot stop crying over this.
 
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I would take a deep, calming breath and then wait to see where his BG is at PMPS.

I would not feed now (or in the two hours prior to the PMPS test, which I’m guessing is getting pretty close now).

The 198 on an AT is a very nice number.

How has Methos’ appetite been recently? Is he eating well today?
 
He’s eating ok but not reliably OK. Otoh I know if all else fails he will eat greenies and kibble and proplan chicken and rice (from the MC wet list)

I think he will eat well if I feed him low carb tuna&chicken but he had loose poop yesterday and not sure if that’s bc I’ve been feeding that to him a lot lately to get him to eat
 
201. He’s been sleeping and isn’t asking for food. I can delay —will delaying put him behind the curve or would it be better to wait?
He normally gets one pill pocket at night but since He needs cerneia I can give 2 pill pockets so it sort of medium-ish carb meal anyway
 
Ok I hope this sounds reasonable: I’m going to get them both started on dinner, and use this as the PMPS (which it is) give two pill pockets and his full 3U dose and do a lot of praying and check starting at +2? His insulin will be slipped from 1500 to 1545 going forward until I shift back with daylight savings. If that sounds very wrong I will check here just before shot goes in
 
Looks like he’s holding steady so I would shoot on time, not delay. And yes, get a +2 and decide from there when to test again.

I don’t recall the all of the logic for the 2.75u suggestion but I think it’s important to find a dose that you can give consistently (so no reduced doses or skipped shots) and that allows Methos to run just high enough that you’re not shredding his already Cushings-fragile ears or having to push med/higher carb food regularly (which could contribute to soft stools). You have enough variables to contend with already.

I like the idea of 2.75u for the above reasons, although 3u looks like it’s been serving you well lately. If you’re going to aim for 2.75u, I’d document it as such in the spreadsheet (rather than “3-“). I also wouldn’t get too wrapped around the axle regarding ketones unless they got closer to 2. I’m not sure there’s a cause/effect correlation between his BG and ketone readings just yet, but it does seem to stress you (perhaps unnecessarily). Ketones can and do flux around a bit.

Just my two cents. :bighug:
 
I agree with the above and believe you are in good safe territory to shoot on time. The 198 and 201 are very stable numbers. That’s really good shootable number for glargine. Remember that you are kind of shooting the number where he’s going to be in two hours (at onset) rather than where he is now (or was when you tested him a bit ago.).
 
JL and Chip said:
Looks like he’s holding steady so I would shoot on time, not delay. And yes, get a +2 and decide from there when to test again.

I don’t recall the all of the logic for the 2.75u suggestion but I think it’s important to find a dose that you can give consistently (so no reduced doses or skipped shots) and that allows Methos to run just high enough that you’re not shredding his already Cushings-fragile ears or having to push med/higher carb food regularly (which could contribute to soft stools). You have enough variables to contend with already.

I like the idea of 2.75u for the above reasons, although 3u looks like it’s been serving you well lately. If you’re going to aim for 2.75u, I’d document it as such in the spreadsheet (rather than “3-“). I also wouldn’t get too wrapped around the axle regarding ketones unless they got closer to 2. I’m not sure there’s a cause/effect correlation between his BG and ketone readings just yet, but it does seem to stress you (perhaps unnecessarily). Ketones can and do flux around a bit.

Just my two cents. :bighug:
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Until his enema last Friday soft stools was never his problem. He had a huge amount out w enema, then two soft poops Saturday. Then either small dry poop or tiny dry poop…until huge soft poop yesterday. Not sure if left over irritation from enema, delayed problem from the amoxil he finished 2 day ago, the fish flavors (still tiki cat but fish instead of chicken)—either bc of the fish or bc it has higher fat content. And he’s been getting tiki comfort sachet (high calorie high fat) bc I’m desperate to put weight on him and he likes them. I was limiting fat bc of elevated fPL and enzymes but that’s probably a cyst or tumor in his pancreas rather than pancreatitis. So they said he could have fat but maybe that’s the issue also. So many options. I try to not think his K is high bc it was normal on Wednesday.

his shot delayed just bc it takes a while to get him to decide to eat. Then he eats slowly.

again the shoot consistently is what I don’t understand. I will shoot lower numbers if that’s what I’m supposed to do. His ears are going to be shredded and his adrenal upset anyway—now that his aldactone is reduced he’s going to be super unpredictable so I’m going to have to test more often. Maybe he will settle down or at least pick a set nadir time but I don’t see that happening for a while.

thanks for your help! I hope this was right. Now I get anxious if he gets up too soon after shot.

edit: I will shoot lower numbers *with a full dose* if that’s what I’m supposed to do
 
I would not stress too much over those ketone levels. They really do fluctuate around over the course of the day. My cat had very high ketones for a long time, but as long as he was eating well and seemed well (no vomiting or lethargy) he did just fine. When his ketones got down into anything under 1, I was elated. .4 and .8 that I saw on your SA aren’t really something to lose sleep over. Just keep testing them and watch for trends. If they keep going up and up, time for a vet visit. If he’s lethargic or won’t eat or is vomiting a lot, obviously you would take him to the vet.
What is the reason for his unreliable appetite? Is he having a pancreatitis flare? You take great care of him! And he’s such a complicated cat.
 
Him pretending to be asleep before PMPS…see his tongue sticking out?
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Suzanne & Darcy said:
I would not stress too much over those ketone levels. They really do fluctuate around over the course of the day. My cat had very high ketones for a long time, but as long as he was eating well and seemed well (no vomiting or lethargy) he did just fine. When his ketones got down into anything under 1, I was elated. .4 and .8 that I saw on your SA aren’t really something to lose sleep over. Just keep testing them and watch for trends. If they keep going up and up, time for a vet visit. If he’s lethargic or won’t eat or is vomiting a lot, obviously you would take him to the vet.
What is the reason for his unreliable appetite? Is he having a pancreatitis flare? You take great care of him! And he’s such a complicated cat.
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In the beginning (Bexacat) I was told contact vet for over 0.2. Once he got 0.3 the cut off moved to above 0.3. On insulin when he was getting 0.4 it moved to 0.6. Until he got 0.6 & 0.8 & 1.0. And when his ketones are above 0.3 he’s lethargic and doesn’t want to eat so it’s just stressful because I’m there with a hypo or hyperkalemic (depending on week) cat with glucose in 400s and ketones of 0.8 or 1.0 but I know there’s no point in going anywhere with him bc they tell me to just stop checking his BG and ketones. Then they say it’s only important if he doesn’t eat or is lethargic. And I say “but he won’t eat and he is lethargic” then I take him home and cry (not necessarily that order) (edit: this is at ER, not only is my vet only in office some half days but her office doesn’t do DKA testing or treatment…and his highest ketones have been weekends or 3 am.

He’s never been a big eater —I’ve always had to encourage him except when his Cushing’s first started and before the vetoryl. He’s been on four meals a day forever until he started insulin —now he’s on four meals and four snacks. I’m either sticking his ear or spoon feeding him pretty much all day and night.

We thought he had pancreatitis (elevated amylase, lipase, fPL) but they think the US looks more like a cyst or tumor—at some point I need to schedule a Doppler flow but need to discuss first w vet if it matters in how we treat him (although they can do the Doppler with just gabapentin…but he always ends up going low (for him) while getting these tests so I’d like his BG more stable first

I asked if he should be on pain meds but she thinks it will cloud evaluating him for hypoglycemia. Which is reasonable. I try to not go more than two days in a row of cerenia but today is day 3 and many times he goes to 5 days…he was on it almost half of the days last month. Sometimes it helps. Often it doesn’t. He hates Zofran and vimits if I force the issue. Mirataz doesn’t seem to make him hungry but I try it a way—on the days he’s not on Cerenia and sometimes even if on cerenia.
 
For appetite stimulant, you can ask about cyproheptadine. It’s what we used back in the day (before mirtazapine became popular) and was very effective. It doesn’t work in all cats but I found it had fewer side effects in general than mirtazapine.

Another option for anti-nausea is plain old famotidine (Pepcid AC), 1/4 of a 10 mg tablet BID. Just make sure it’s Pepcid AC and NOT Pepcid Complete. Famotidine has fallen a bit out of favor but I used it for years (with my IM’s approval) and it’s still my go-to, even though I use ondansetron as well. I actually seem to see better results with famotidine. Anyway, just something to keep in mind. Sometimes with these complicated cases, we just have to throw things at the wall to see what sticks. “Every cat is different” isn’t just a saying. :confused:
 
JL and Chip said:
For appetite stimulant, you can ask about cyproheptadine. It’s what we used back in the day (before mirtazapine became popular) and was very effective. It doesn’t work in all cats but I found it had fewer side effects in general than mirtazapine.

Another option for anti-nausea is plain old famotidine (Pepcid AC), 1/4 of a 10 mg tablet BID. Just make sure it’s Pepcid AC and NOT Pepcid Complete. Famotidine has fallen a bit out of favor but I used it for years (with my IM’s approval) and it’s still my go-to, even though I use ondansetron as well. I actually seem to see better results with famotidine. Anyway, just something to keep in mind. Sometimes with these complicated cases, we just have to throw things at the wall to see what sticks. “Every cat is different” isn’t just a saying. :confused:
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I cannot thank you enough! I will ask my vet when she’s in the office Tuesday. Those sound like great options. It makes me nervous using cerenia and miratz so often, esp when I rely on weakness to gauge his K level (I wish they made a meter for K!)
I wonder if he always needed frequent small meals either bc his pancreas was unhappy all of his life, or maybe the adenomas in his liver put pressure on his gastric outlet or his gall bladder. It was easier to get him to eat when I could feed him with Tammuz because Tammuz would eat his food fast and try to eat Methos’ so Methos felt like he couldn’t dawdle too long—but I’d need to start feeding him an hour before I left for work which was a killer when I had a two hour commute.
Also wow you’ve had so many complex kitties!
 
262@ +2. In theory good news but he did have 2 pill pockets contributing to that. Do you think I can go two hours before rechecking? Maybe I shouldn’t risk it…
 
JL and Chip said:
If you’re going to aim for 2.75u, I’d document it as such in the spreadsheet (rather than “3-“).
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Unfortunately the current syringes have thick lines so estimating difficult —but I’m afraid to change to the BD ones bc I don’t want to start anything new while so many other things (meds etc) changing. @Wendy&Neko gave me instructions on how to calculate 2.75 but I’ve been too exhausted and sad to muster the energy. If things go ok tonight I will try tomorrow to do calculations but then if this goes ok i may be staying at 3.
 
SmallestSparrow said:
Unfortunately the current syringes have thick lines so estimating difficult —but I’m afraid to change to the BD ones bc I don’t want to start anything new while so many other things (meds etc) changing. @Wendy&Neko gave me instructions on how to calculate 2.75 but I’ve been too exhausted and sad to muster the energy. If things go ok tonight I will try tomorrow to do calculations but then if this goes ok i may be staying at 3.
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So keeping with the same syringes (completely understandable), maybe eyeball half way between top of the 2.5 line and top of the 3 line (when holding the syringe upright as if preparing to draw insulin) and call that 2.75u. Basically you just want to be consistent, regardless of where you’re drawing to on the syringe.
 
SmallestSparrow said:
In the beginning (Bexacat) I was told contact vet for over 0.2. Once he got 0.3 the cut off moved to above 0.3. On insulin when he was getting 0.4 it moved to 0.6. Until he got 0.6 & 0.8 & 1.0. And when his ketones are above 0.3 he’s lethargic and doesn’t want to eat so it’s just stressful because I’m there with a hypo or hyperkalemic (depending on week) cat with glucose in 400s and ketones of 0.8 or 1.0 but I know there’s no point in going anywhere with him bc they tell me to just stop checking his BG and ketones. Then they say it’s only important if he doesn’t eat or is lethargic. And I say “but he won’t eat and he is lethargic” then I take him home and cry (not necessarily that order) (edit: this is at ER, not only is my vet only in office some half days but her office doesn’t do DKA testing or treatment…and his highest ketones have been weekends or 3 am.

He’s never been a big eater —I’ve always had to encourage him except when his Cushing’s first started and before the vetoryl. He’s been on four meals a day forever until he started insulin —now he’s on four meals and four snacks. I’m either sticking his ear or spoon feeding him pretty much all day and night.

We thought he had pancreatitis (elevated amylase, lipase, fPL) but they think the US looks more like a cyst or tumor—at some point I need to schedule a Doppler flow but need to discuss first w vet if it matters in how we treat him (although they can do the Doppler with just gabapentin…but he always ends up going low (for him) while getting these tests so I’d like his BG more stable first

I asked if he should be on pain meds but she thinks it will cloud evaluating him for hypoglycemia. Which is reasonable. I try to not go more than two days in a row of cerenia but today is day 3 and many times he goes to 5 days…he was on it almost half of the days last month. Sometimes it helps. Often it doesn’t. He hates Zofran and vimits if I force the issue. Mirataz doesn’t seem to make him hungry but I try it a way—on the days he’s not on Cerenia and sometimes even if on cerenia.
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I put my Zofran into gelatin capsules so kitty never tastes it. It still works.
 
SmallestSparrow said:
Unfortunately the current syringes have thick lines so estimating difficult —but I’m afraid to change to the BD ones bc I don’t want to start anything new while so many other things (meds etc) changing. @Wendy&Neko gave me instructions on how to calculate 2.75 but I’ve been too exhausted and sad to muster the energy. If things go ok tonight I will try tomorrow to do calculations but then if this goes ok i may be staying at 3.
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I used these. It wasn’t hard to get doses in between the half and the whole (.75 unit doses). Good syringes overall.
 
SmallestSparrow said:
How do you get them to swallow the capsule?
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Oh. Is he really bad about taking pills? I was thinking you could pill him using a pill shooter. You said he takes pill pockets, right? With one of my cats who is difficult to pill, I can get away with stuffing meds into a number 5 or a 4 size gelcap. 5 is smaller. Then I put it into a pill pocket (sometimes I need to roll the pill pocket in Forti Flora or ground up Pure Bites chicken freeze dried treats or sometimes stick a couple pieces of Dr. Elsey’s Clean Protein kibble onto the outside of the pill pocket. She usually eats it. Even if she gums it and chews a couple of times the medication is still okay and isn’t disintegrating because it’s inside the gelcap. So if I have a failure I can just try again because she’s not even tasted the medication yet (and not foaming at the mouth). I would particularly put Zofran and Cerenia in gelcaps as they’re so nasty. Right now I have a cat on Metronidazole and that one definitely goes into a gelcap, although he’s easy to pill. I have used cream cheese to mask the meds as well. It’s very messy on my hands, but some cats love it. Liverwurst too.
 
Suzanne & Darcy said:
Photo. I forgot. View attachment 71286
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Yes I like these and have been waiting for him to be a bit less ketotic to switch. These I can estimate quarter units. The syringes I’m using currently have very thick lines and a thick plunger so 3- (less than three and more than 2.5) is the best I can do. I’m not marking 2.75 bc I will forget in the future that I really wasn’t estimating a quarter unit (if I mark 0.25 amounts I had a syringe that allowed me to estimate)
 
Suzanne & Darcy said:
Oh. Is he really bad about taking pills? I was thinking you could pill him using a pill shooter. You said he takes pill pockets, right? With one of my cats who is difficult to pill, I can get away with stuffing meds into a number 5 or a 4 size gelcap. 5 is smaller. Then I put it into a pill pocket (sometimes I need to roll the pill pocket in Forti Flora or ground up Pure Bites chicken freeze dried treats or sometimes stick a couple pieces of Dr. Elsey’s Clean Protein kibble onto the outside of the pill pocket. She usually eats it. Even if she gums it and chews a couple of times the medication is still okay and isn’t disintegrating because it’s inside the gelcap. So if I have a failure I can just try again because she’s not even tasted the medication yet (and not foaming at the mouth). I would particularly put Zofran and Cerenia in gelcaps as they’re so nasty. Right now I have a cat on Metronidazole and that one definitely goes into a gelcap, although he’s easy to pill. I have used cream cheese to mask the meds as well. It’s very messy on my hands, but some cats love it. Liverwurst too.
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Flagyl is the worst. My non diabetic cat Tammuz made three urgent drop off appointments in less than two weeks and was eventually put on flagyl. I asked my vet if it was punishment for me disrupting their day so many times.
Methos likes pill pockets but they’re so high in carbs and he’s been so unregulated that it kills me to give him extra. In fact I usually pinch off some of the pocket and throw away, and generally can get two sometimes three meds into one. I got him to eat his vetoryl capsule once just hidden in some tiki mousse (a thicker flavor ) but he ate around gabapentin tablets when I tried it.
 
Also with the flagyl when Muz got suspicious of pill pockets I made Oreos (flagyl in pill pocket between two greenies) and truffles (flagyl in pill pocket rolled in freeze dried salmon crushed and dusted with fortiflora. But by the end it was a knock down dragged out wrestling match that ended with the room looking like a Jerry Spinger set.
 
Also re syringes. The half unit ones I initially found were made in China. So I tried finding some made innUS or at least not China. The ones I’m using now made in Korea and are ok but lines are thick. The BD ones I like and the box says made in US but when I called the company to confirm the person was a bit evasive in answering me. I mentioned this to my vet and she quipped “maybe it’s just the box that’s made in the US.”
That night I pulled out a BD syringe to take a picture to show her the difference and the lines were crooked. Can’t win. But overall I like them, I get less bubbles but when his numbers went crazy I reverted to the Korean ones just to limit changing things.
I’d hoped after last pm that I could change today but with 400 at +5.5 gave up that idea
 
Yeah. I got less bubbles with the BDs so that’s why I stuck with them. I have many boxes of them if you want me to mail you a box or two. Of course they may be “expired”. I haven’t checked the boxes recently. They’re all sealed up in their boxes and have been always in a temperature controlled environment.
 
Another idea. Cheese Whiz. It’s not something I eat, but I know people who have used it for pills for their cheese head cats! Actually you can warm some cheddars in your hands and make a little ball. I know, what about Brie! My cat Jane loves Brie (not the rind, of course.)
 
Suzanne & Darcy said:
Yeah. I got less bubbles with the BDs so that’s why I stuck with them. I have many boxes of them if you want me to mail you a box or two. Of course they may be “expired”. I haven’t checked the boxes recently. They’re all sealed up in their boxes and have been always in a temperature controlled environment.
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Thank you you are so kind! I actually have four boxes in my supply cabinet, I’ve just been waiting for him to have less ketones. Maybe later this week (he was nml this am but I’m sure not any more. Sigh).
Thanks also for the cheese tips. I’ve wondered about cheese. I was worried about the fat in cheese but they make light laughing cow cheese (soft cheese) and I will definitely need to look for low carb pill pockets. I’ve also thought about baking some chicken livers and using pieces of those
 
Suzanne & Darcy said:
Another idea. Cheese Whiz. It’s not something I eat, but I know people who have used it for pills for their cheese head cats! Actually you can warm some cheddars in your hands and make a little ball. I know, what about Brie! My cat Jane loves Brie (not the rind, of course.)
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Jane and Mr Darcy? Are you a Pride and Prejudice fan?
 
SmallestSparrow said:
Thank you you are so kind! I actually have four boxes in my supply cabinet, I’ve just been waiting for him to have less ketones. Maybe later this week (he was nml this am but I’m sure not any more. Sigh).
Thanks also for the cheese tips. I’ve wondered about cheese. I was worried about the fat in cheese but they make light laughing cow cheese (soft cheese) and I will definitely need to look for low carb pill pockets. I’ve also thought about baking some chicken livers and using pieces of those
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I feel your pain on the ketones. I had a Nova Max Plus blood ketone meter and, at first (post-DKA) I kept taking Darcy to the vet when his ketones were high and they just didn’t take it seriously. My vet even doubted the accuracy pf the blood ketone meter. I had to show her some papers on it.
SmallestSparrow said:
Jane and Mr Darcy? Are you a Pride and Prejudice fan?
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ha ha. You picked up on that! I have a Bingley too! Lol!
 
When I am talking about ketones on which the vet would not take me seriously…. I am talking about anything from 2.0 to 6. They just doubted everything. Fortunately he never went into DKA again, but I took him in frequently and made them do a CBC on him and whenever his white count was elevated we started antibiotics. We never knew what the source of infection was (and he never got cancer so that wasn’t it) but the ketones usually went down. I also gave sub-q fluids but I never noticed a drop in ketones as a result— but at least he was hydrated. In theory, that’s a good thing for ketones.
 
Suzanne & Darcy said:
When I am talking about ketones on which the vet would not take me seriously…. I am talking about anything from 2.0 to 6. They just doubted everything. Fortunately he never went into DKA again, but I took him in frequently and made them do a CBC on him and whenever his white count was elevated we started antibiotics. We never knew what the source of infection was (and he never got cancer so that wasn’t it) but the ketones usually went down. I also gave sub-q fluids but I never noticed a drop in ketones as a result— but at least he was hydrated. In theory, that’s a good thing for ketones.
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I took him to the ER on a weekend very early (he’s a 3 am/3pm cycle normally). He wasn’t eating, was lethargic and ketones were 1.0 and glucose 455 (both the highest he’s been). His spiranolactone had been stopped the week before (one of many reasons his numbers are a mess now) and his potassium was 2.5 when last checked.
She vet practically rolled her eyes when I said I used an alpha trak for his BG and Precision Xtra for ketones (I chose those by asking my vet what vets used). She clearly felt I was incompetent with the meters. When the techs drew his blood one used the blood left after filling the tubes to check on an alpha trak and precision xtra (I can recognize them from across a room). I asked “what are his ketones” and the tech said 1.0 before scurrying out. When the vet returned his BG was 460 and ketones 1.0 and she again told me I was wasting her time. I told her I was sorry I woke her up and didn’t want to be there but I’d been told a lethargic not eating diabetic cat with high BG and positive ketones could be DKA so how did she know he wasn’t —just tell me and I’ll look for that before coming back. She replied “his blood pH would be low”—I asked what his was. She hadn’t tested him. I started to cry and asked if she could please test him …I wanted to scream. Needless to say, if I’m worried in the future I’ll drive the extra hour to the next closest ER. Luckily before Methos needed Sub q fluids Tammuz needed them so I practiced on him once before sticking an 18g into the tissue paper skin of my Cushing cat. One of the techs told me how to do it and gave me the supplies but as I did Tammuz I thought “in human medicine we usually see one before we do one (the saying goes “see one, do one, teach one”). White count isn’t useful in Methos, between the general effect of tumors, and the steroids of Cushing’s, his wbc is permanently elevated
 
JL and Chip said:
Are you still using 18ga needles? I use at least 19 or 20ga for subQ fluids. They really do seem less like harpoons. Terumo makes a thin-walled needle that is great.
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Thanks, I’ll have to check those out. I asked about a smaller gauge for Methos but my vet said the speed of delivery trumped size of hole. Probably not a significant hole size savings—neither cat seemed to mind insertion but Methos does get antsy sitting still if he decides he’d like to get up. Muz slept through his. So far he’s done ok but it would be good to have alternatives.
 
Been out of town so delayed reply. But as others guessed my reason for the 2.75 was so that you could test less (easier on Methos) and hopefully stress less (for you :bighug:) and still keep the same dose.

As Suzanne said, ketones up to 1.0 is not a "take to the vet" level.

Cerenia can be given every day if needed. No need to pause it.
 
Wendy&Neko said:
Been out of town so delayed reply. But as others guessed my reason for the 2.75 was so that you could test less (easier on Methos) and hopefully stress less (for you :bighug:) and still keep the same dose.

As Suzanne said, ketones up to 1.0 is not a "take to the vet" level.

Cerenia can be given every day if needed. No need to pause it.
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Thanks! He will probably get bumped up to 3.5 tomorrow. :( nothing seems to be working right
 
Wendy&Neko said:
Our dosing methods would say a 3.25 unit dose next.
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Thanks. When I last discussed with my vet my syringes really wouldn’t support 0.25 U measurements (and I’m not sure he needs fine tuning right now, with the decrease in spiranolactone I anticipate the already winning tumor is going to go wild). So her last guidance was give it two more days and then try 3.5.

I decided since everything was going to hell anyway to change to BD syringes and tried 3.25 this am and will see what she wants me to do once it’s not the middle of the night. She’s not a huge believer in quarter units, and since he’s unlikely to need quarter unit increments I’m ok either way. Just last month (feels like a lifetime ago) she’d commented how happy she was that he wasn’t the dosing nightmare Erik had been, and I’d replied “Erik didn’t have you…or Vetoryl and aldactone”.
 
SmallestSparrow said:
Thanks, I’ll have to check those out. I asked about a smaller gauge for Methos but my vet said the speed of delivery trumped size of hole. Probably not a significant hole size savings—neither cat seemed to mind insertion but Methos does get antsy sitting still if he decides he’d like to get up. Muz slept through his. So far he’s done ok but it would be good to have alternatives.
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Do you warm the fluids before giving them? I always place the bag in warm/hot water to bring the temperature up. I know people who use a Sous Vide machine to circulate the water. I also use Terumo thin wall needles for sub-q fluids. There is a noticeable difference in sharpness. I only use 19 or 20 gauge. Thriving Pets sells the Terumo needles. They have a chart showing the flow rate.
That sounds like such a nightmare at the vet. I’m sorry that happened. That vet sounds like kind of a jerk.
 
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