10/9 JETTA PMPS 205 +1.5 216 +3 246

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Re: 10/9 JETTA Home from the vet

Perfect. Thanks for all of the clarifications.

I was just looking over Jetta's ss and a potential take away from this is that there may have been some signs as early as late September that a flare was brewing. I just went back and read your post from the night she wouldn't eat her normal food....another sign. Little clues to put in your pocket for the "next time".

For tonight, under the circumstances....here is how I would prioritize.

Flare
Food
Diabetes

I don't know how much food Jetta usually gets....so the amounts may need to be adjusted. I would try to get in at least 50% of her normal meal split apart the night. Up to 75% if possible

So far and going forward:
4PM 1tsp low residual + water bs 194
5PM 1tsp low residual + water
530PM 1tsp low residual + water
710PM test blood sugar and report (I'll watch for you)
715PM Depending on bs at 710 plan to shoot a full dose. If it looks at all low, we'll either skip or shoot a bcs. You do not want to have to fight low bs tonight and have to give carbs with this severe of a flare.
715PM 2 tsp low residual + water
800PM Bupe
815PM bs
9PM Steroid
915PM bs,1 tsp low residual + water
With all of the water and lr, you should definitely be seeing some action in the lb....

Keep going like this testing until you feel like her bs is safe and until she's had the specified amount of food. You can continue with water as much as you want.

Edit to add in RED
 
Re: 10/9 JETTA Home from the vet

Thanks Jessica. Shee's been on FF and eats usually 1 can (3 oz from AM shot to +2) then another can from +5 to sometime after PM shot and at least half a can overnight. So I guess she's been eating 6-8 oz per day. I'll test at 7:10.

And today while decompressing, I also thought there were signs brewing. Hindsight strikes again gosh darnnit. I think the dry food yesterday just helped push her over the edge.

FWIW- She's not taking the syringe feedings well. the first and second went fairly OK and I think I wore more of #3 and 4 than she ate.
 
Re: 10/9 JETTA Home from the vet

She may need a little break, just need to ensure she's getting some. Will she eat any on her own yet? The pain can make them not want to....you may have more luck after the Bupe at 8:00.

Sounds like we have a game plan for a bit....see you around 7:15 ;-)
 
Re: 10/9 JETTA Home from the vet

I don't think you need to worry about the amount of food. You need to consider the calories. Calculate the number of calories that Jetta normally eats -- her usual FF diet. Figure out the number of calories of the I/D. You'll need to try to feed the equivalent number of calories.

FYI: the Beechnut is totally devoid of carbs and is low in calories. The numbers are on the jar.
 
Re: 10/9 JETTA PMPS 205 DOSE?

OK- she's at 205. Not much change since +8.5 The i/d has 161 calories per can. I don't see the calorie content for the particular FF varieties she's been eating. I know there's a calculator somewhere. I'll hunt for it now.

She's not eating on her own. She's still out of it from the injection she got at noon at the vet. I wonder if 8 pm is too soon for another dose? She has only stood up twice, she's just been napping.
 
Re: 10/9 JETTA Home from the vet

i'm sorry jetta is having a bad time of it today. i popped onto the computer to record alex's pmps and saw what's going on, but i have dinner guests so i can't stay online. i want to remind those who are helping... jetta has experienced HL and ketones at diagnosis.

that means two things. it's important to get food and insulin into her... even if it means feeding her a little higher carb food to keep her from bottoming out from the insulin. sienne is right. you want to get at least her normal daily amount of calories into her over a 24 hour period.
 
Re: 10/9 JETTA PMPS 205 DOSE?

Jacspets said:
OK- she's at 205. Not much change since +8.5 The i/d has 161 calories per can. I don't see the calorie content for the particular FF varieties she's been eating. I know there's a calculator somewhere. I'll hunt for it now.
Click to expand...

J & B's food list shows the amount of calories in FF... if the varieties you're feeding are on the list.
 
Re: 10/9 JETTA PMPS 205 DOSE?

Thanks for popping on Jill- yes, good reminder.

Her FF looks to be 74-78 calories per can. So the i/d is more and it's also HC at 24%.
 
Re: 10/9 JETTA PMPS 205 DOSE?

I'm thinking in regards to the earlier stated priorities on this one.........but I would probably go with only a half a shot tonight. As the inflammation subsides, the pain meds kick in and the less than desirable amount of food is happening....I just don't think it's worth it to risk having to deal with low bs as well and have to give the one thing that Jetta just doesn't need....carbs.

For me, the flare and needed low residual nutrition are trumping the diabetes tonight and I believe you have enough on your hands already.

I know this just made things more difficult.
 
Re: 10/9 JETTA PMPS 205 DOSE?

OK- I'm good with that. She was negative for ketones earlier today and I'll check again next time she gives me an opportunity. I'll shoot .25 u now.
 
Re: 10/9 JETTA PMPS 205 DOSE?

And as Jill stated...get those calories in OK? Has she shown interest yet in eating? If yes...go back to the higher calorie FF. Your best chance may be after the Bupe. Remember, right now she's in pain and inflamed, so you may have to push it more now.
 
Re: 10/9 JETTA PMPS 205 DOSE?

Jacspets said:
She's not eating on her own. She's still out of it from the injection she got at noon at the vet. I wonder if 8 pm is too soon for another dose? She has only stood up twice, she's just been napping.
Click to expand...

Just saw this. I am going to pull out my drug book and will be back in a few.
 
Re: 10/9 JETTA PMPS 205 DOSE?

I'm so sorry to read about Jetta but I'm glad she's home with you. I'm so glad that you are getting so much good advice here. Good luck tonight- you'll be in my thoughts and prayers.

PS. Jessica- you rock!
 
Re: 10/9 JETTA PMPS 205

There seems to be kind of a mixed bag as to how often Bupe is given to cats. I found between 6-12 hours. I"m assuming they gave it either IV or as a shot at the office. I'm also assuming they gave you oral syringes to let absorb at home?
Even with the oral, the onset is 15-30 minutes, so you could definitely play it by ear as to when to give the next dose. I wouldn't give again until she's more coherent, but I wouldn't wait until she's bouncing off the walls either- cats can be very stoic, and hide pain very well. I know 6-12 hours is a big window....but it tells you a little bit about ECID on opiates!

Another juggling act for you tonight...I'm so sorry you are going through this.

Any luck with more food?
 
Re: 10/9 JETTA PMPS 205

Thanks Jessica- they did give her a shot in the office and oral for me to give at home. I just looked back at her reciept and noticed they have her as 9.6 pounds :o :shock: ohmygod_smile ohmygod_smile ohmygod_smile She's barely over 6 pounds. Does your handy book tell you dosing by weight? Now I"m wondering if they have her wieght off by 1/3 did she get 1/3 too mcuh? The syringes I have here for her are pre-loaded at 1.5 ml.
I think I'll wait a while before I give it to her.

She still hasn't moved- no interest in food. No interest in standing for that matter.
 
Re: 10/9 JETTA PMPS 205

Try syringing some more food OK...even if she isn't interested. It is very important we get some food in her. I'm going to look up the dose and will be back.
 
Re: 10/9 JETTA PMPS 205

I did sryinge her close to 2 tsp at her shot. Should I gove more now? At least the i/d is higher calorie than her normal food.
 
Re: 10/9 JETTA PMPS 205

There are a couple of issues here.

First -- and foremost -- in a cat with a history of HL and DKA, insulin and food are critical for keeping ketones at bay. I understand what Jessica is saying but, that last thing you want is a cat with pancreatitis/IBD and ketones. This may mean that you are going to need to stay up and feed Jetta in order to get the calories in. It may not be such a wise idea to reduce the dose -- certainly not by half. Also, please start testing for ketones religiously. A cat does not need to be in high numbers to develop ketones.

Second -- the FF calories are based on a 3oz can (approx. 25 cal. per oz). The I/D is based on a 5.5 oz can (approx. 29 cal. per oz). They are basically the same as far as calories.

Usually with bupe, the amount of the dose doesn't effect the pain relief properties. It effects the duration of the medication. In other words, if you reduce the dose, it won't last as long.
 
Re: 10/9 JETTA PMPS 205

I see what you're saying about the calorie content. I'm prepared to be up with her as long as I have to be, so no problem there. She is my number 1 priority.

I already shot the reduced dose, so I think that menas I'm stuck with that decision now.

Despite the fluids she got at noon, she has not urinated at all. She did just visit the LB and passed more blood/foul smelling mucousy stuff. I'll sit here until she does decide to urinate. And I'll also get more food into her now.

And Sienne if I read you right- you're saying go ahead with teh Bupe oral now?
 
Re: 10/9 JETTA PMPS 205

For sure keep going with the food. Many small meals over a longer period and I'm 100% with Sienne - she needs the calories. I'm saying that a cat having to fight carbs when they're in a severe flare, is going to cause more pain, more inflammation, and ultimately accepting no food. I'm trying to find the balance between calories and calming that inflammation.

Sienne....you seem to know more about the dosing with Bupe for cats...In humans, the amount of opiate definitely affects the pain control, but it also affects the CNS.....This minute, I am a little more concerned with the dose in general. I can only find the dose to be 0.01 - 0.02 mg/kg and the only ampule supplied volume as being 0.3mg/ml. If this is in fact how it's supplied and how it's dosed.....why would her vet give her a 1.5ml syringe? The dose would be something between 0.1ml -0.2ml q 8-12 hrs.
 
Re: 10/9 JETTA PMPS 205

OMG I'm SO sorry. I'm stressed and clearly lositng my mind. The syring holds 1 ml. There's only .16 in it. Geez you all must think I'm an idiot. ohmygod_smile
 
Re: 10/9 JETTA PMPS 205

do you know what dose of bupe they gave her at the vet? The same 0.16 mL? Some cats seem to be sensitive to bupe and need lower doses than the norm. If it has been 8 hours and she has been out of it, then she might need a lower dose. I'm no expert on bupe, I have never used it, but I know I've seen some people post about that.

Be very diligent about ketone testing, ok? Normally we don't suggest reducing the dose on a cat that is flaring and having appetite issues, especially when they have a history of ketones. Better to keep giving insulin and feed more carbs if necessary to keep the numbers up. Just stay on top of it. You're doing great!
 
Re: 10/9 JETTA PMPS 205

Jacspets said:
OMG I'm SO sorry. I'm stressed and clearly lositng my mind. The syring holds 1 ml. There's only .16 in it. Geez you all must think I'm an idiot. ohmygod_smile
Click to expand...

Not a bit....that makes me feel a ton better. She may be more sensitive to bupe and not need as much. If she's out of it right now, I definitely wouldn't give yet. Keep feeding alright... and get a bg when you can.
 
Re: 10/9 JETTA PMPS 205

Sorry I've been away but I want to jump in as I have alot of experience with bupe.

Please call the vet and double check on how much they gave her. 1.5ml is a huge amount. For example, my Gussie weighs 9.6 lbs. The maximum bupe he should have every six hours is 0.25ml. Teddi weighed 5.6 lbs...so close to what Jetta weighs and her maximum dose was 0.15 ml every six hours. Soooo....perhaps they gave her 0.15 ml instead of 1.5 ml??? Even with the allowable dosage every six hours, I typically only give the max dosage every 8 hours. And I am talking about a 3ml/mg volume.
 
Re: 10/9 JETTA PMPS 205 +1.5 216

I'm giving her the Bupe now. NOW that I've figured out my goof. She's getting .16 and I'll feed her again. Poor baby, I hate seeing her like this. It breeaks my heart.
 
Re: 10/9 JETTA PMPS 205 +1.5 216

Sounds good Jaclyn.

My hunch is that the recent increase in her numbers is related to all of this...the pain, inflammation, etc. Yesterday's over-carb was probably the straw that broke the camels back and sent everything into overload. From a whole system standpoint...this makes sense.

You saw your first blue today in a few weeks. A combo of no food and some pain control probably helped. Watch her numbers closely over the next few days because as the inflammation subsides and as the pain is controlled, you could potentially see her get back to where she was before this began a few weeks ago.

Remember...your big goal tonight is nutrition and getting the calories in her, small, but frequent meals. The low residue, will help to not add to the inflammation and the pains meds will help to keep her comfortable. Helping these two key things will naturally help to keep the bg lower......so fingers crossed we've covered all of the bases to best handle all of the concurrent issues without causing any more.

I'm going to say it one more time to reiterate the importance of food....we're doing the work on the IBD and Pancreatitis with pain meds and low residual food, which will positively affect blood glucose....you have to work on the food to keep the HL at bay.

Jetta's lucky to have you Jaclyn ;-)
 
Re: 10/9 JETTA PMPS 205 +1.5 216

Great job, Jaclyn and I know you must be exhausted after your trip and now taking such wonderful care of Jetta.

Sending you hugs and many, many healing vines to Jetta.
 
Hi Jaclyn, I hope you're doing OK. Wow, what a day. Jetta, so nice to see you on the yellow floor. I hope you're feeling lots better real soon. Sending tons of healing energy your way.
Liz
 
Thanks Marje. The terrible thing is I'm leaving again Thursday morning. I need to see DRASTIC improvement by Tuesday to leave her with DH while I'm gone. So far I think my chances are slim.

Anyhow, she got her steroid and her bupe. She sounds like an entire orchestra is playing in her intestines. She just started making all sorts of awful noises. I swear I can even feel her insides shifting against my hand. I feel bad force feeding her when I know if feels 100 times worse than it sounds. But, I know she needs to eat. I"m feeding her now and will set an alarm for an hour and a half. I'll be sleeping on the floor with her, so if she gets up, I'll know it.

Thanks to Jessica and Sienne and Jill for the advice- and Marje the bupe advice. And for everyone else stopping by with vines. We will get through this- we have to.
 
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