04/24 Willow AMPS 124/+3 104/+5.75 97/+9 115/PMPS 119 - Dosing Advice/Protocol Question Please

nslade001

nslade001

Member Since 2018
yesterday

Hello everyone, Willow is doing great today because we gave her mirtazapine last night...it really is night and day, the difference in both her appetite and attitude. I really don't like giving it to her (just because...more meds) but her appetite just pretty much sucks, and as of yesterday she was even refusing her meatballs, which means dry-pilling and chasing 3 pills a day. Mirtz beats that, hands down.

I'd love some experienced eyes on her SS and dosing advice please...I feel like we're just chasing greens at this point. @Sandy and Black Kitty and @Wendy&Neko , I know you're both somewhat familiar with us, hope you don't mind the tag. I know my micro increases, which worked before, obviously aren't cutting it now, and I need to start full 0.25U increases. I'm not quite sure if I have to wait more than 3 days before increasing, her nadirs aren't what they used to be but they're still under 99. I *thought* I had to hold an increase a minimum of 3-5 days, but I'm thinking a minimum of 5 now and I don't know if I read that or dreamed it lol, so would love some advice on what the next step should be. Also, it's morning and I'm not thinking straight, though DH did the middle-night-food-check and turned off my alarm so I could sleep!

As a note, she's still on Abx for UTI, generally inappetent, on cerenia and gaba daily, on lactulose though her poops seem to be slowing down again. May need dentistry, may have mouth pain, sometimes (often) hides after eating but not consisently, sometimes (but not always) hides after peeing or pooping. Picture of health :-/ If there was *any* vomiting I'd think gastritis, stomach acid, maybe her IBD coming back, but nothing except the very occasional hairball hack. Just don't know what to do vet-wise, so just maintaining pain and appetite as best as we can (which isn't very well, it seems sometimes).

Thanks to any and all for any thoughts and advice. Holding Jeff and Lyresa in my heart, sending vines to all who may need them. With love, Nikki

ETA added a comment that shows the place where I'm confused on protocol.
 
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I looked up the part of the TR protocol I'm confused on, here's a copy of the bit with the bold emphasis being mine:

Increasing the dose:
  • Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
    • when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.
So, is the "starts to see"

(a) meant to be "in the beginning", as in this is a precaution for you to see how the cat responds once it's in these low numbers to get data at those numbers; or is this (b) a new guideline as a safety measure, as in once the cat is running nadirs that low you hold the dose for longer (at least 5 days) *indefinitely*.

Thanks so much for clarification! With love, Nikki
 
Are you giving Willow any probiotics? Antibiotics can ruin tummy flora and make them feel icky and inappetant. Plus probiotics are good for an IBD kitty anyway. Visbiome is a brand made specifically for IBD.

In the above “starts to see” means the very first time seeing green, Willow is long past that. Feel free to wait six cycles then increase again by 0.25 units if the nadirs are no better than highish green. I would definitely hold longer if mid 70’s or below nadirs for Willow.
 
Wendy&Neko said:
Are you giving Willow any probiotics? Antibiotics can ruin tummy flora and make them feel icky and inappetant. Plus probiotics are good for an IBD kitty anyway. Visbiome is a brand made specifically for IBD.

In the above “starts to see” means the very first time seeing green, Willow is long past that. Feel free to wait six cycles then increase again by 0.25 units if the nadirs are no better than highish green. I would definitely hold longer if mid 70’s or below nadirs for Willow.
Click to expand...

Thanks so much, Wendy, I gave probiotic during her last round of Abx but saved some for the next round, and then I forgot to restart them! Will give at next feeding. I have renewlife ulimate flora probiotic, extra care go-pack, 30 billion, and give 1/2 capsule twice daily. Is there a "best time" to give when giving antibiotics? I'll also look into visbiome, thanks.

And thanks so much for responding to the increase question, I really feel like we're losing ground fast with the blues coming in and greens rising, but also didn't want to be "impatient" if it wasn't safe.

With love, Nikki
 
Great.jpg
 
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