11/13 SQUAMEE amps +273 .2U

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judy and squamee(GA)

judy and squamee(GA)

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My head is mush. I am trying to remember just what Gator said. My brain is not good with numbers anyway. So with this number being lower than last night's PMPS I am thinking I should go down, but how much? Last night I shot .6 on pmps 408. Now she is 273. And she is barely eating. .4? .2?edit--I shot .2
 
Re: 10/13 SQUAMEE amps +273

For some little added fun===I was trying to print up a portion of my spreadsheet to show the vet, and somehow screwed up the order of some of the dates. Anyone know how I can reorder them correctly?
 
Re: 10/13 SQUAMEE amps +273 .2U

Saw the vet. What a non=event. He wasn't the least concerned about the numbers from yesterday, just said next time give karo syrup and if I had not tested and seen it, nothing probably would have happened anyway. Also said I should shoot less insulin when the numbers go down (duh).

He gave her the fluids and she was a screaming banshee. She could clearly feel it going into her, she screamed more when he squeezed the bag. Finally she thrashed so hard (the tech had her wrapped in a towel and she bit through) the needle came out. (and he stopped,said she had gotten close to 1 unit anyway). He said to do it twice a week and charged me $35 for the stuff. Said I could come back and they would do it for me (I live 2 minutes away). The needle gauge is 18. Does that seem about right? It looks hugh to me, but he said if you use smaller it takes longer.

I am traumatized by all of this. Overwhelmed. And she is barely eating this morning and not taking the pill. I spoke with him about the transdermal penobarb. and he said he was willing to try. I misunderstood, it is not a patch, It is some gel that you rub on. It can be absorbed through the skin, or if she licks it off, that ok too. He is not sure how effective it is, but is willing to try. I am not sure if that will be better than trying to squirt the liquid into her mouth. Somewhat easier to administer, I imagine, but who knows how effective? And you still have to do it each time (3x/day).
 
Re: 10/13 SQUAMEE amps +273

re: the vet.............SPEECHLESS!
 
Re: 10/13 SQUAMEE amps +273 >2U

:lol: and knowing me it's probably better that way :lol:
 
Re: 10/13 SQUAMEE amps +273 .2U

Hi Judy,

I have an IBD cat who is on predisolone and he is impossible to pill. The transdermal gel works well. He doesn't like it much but since he loves his ears rubbed (and that is where you put the gel), it ends up being a positive for him.

I give phenobaritol to Cindy and luckily she eats PillPockets but if she stopped, I'd definitely go the transdermal way. It is more expensive but as far as I am concerned, well worth it.

18 gauge needles are the ones normally used for fluids. She could have been screaming because they hit a nerve, because her anxiety got the best of her, or just a quirk of fate. Giving fluids at home has saved me (and my cats) a lot of stress. The IBD cat, when he starts vomitting, often just needs a bit of fluids to help him settle. Cindy has a bout once a month where she just doesn't eat nor drink so dosing her with fluids keeps her from getting dehydrated. If the 18 gauge seems to hurt her, you can use a smaller gauge (20 or 22) but it will definitely take longer.

Good luck with your kitty.
 
Re: 10/13 SQUAMEE amps +273 .2U

+3 336. SO it looks like she will be going up today. And I am going out later this afternoon and won't be back till probably +15. I guess there is not too much I can do. Probably leaving around +8 so that is too early to shoot. I think the numbers will probably continue to rise, (unless this number reflected the vet experience--I don't know how long the rise lasts when they are upset) and am thinking about what to shoot. Suggestions for my addled brain to ponder?
 
LRS supplies info and instructions

You can make the dates auto populate. Google SS understands dates. So if you put the date in one cell - typically the very top cell [A3 in your case] - then in the next cell down [A4] put the formula without the quotes "=A3+1" . Then you can copy that formula cell to all the other date cells by copying that one cell then highlighting a bunch of other cells then pasting that copied cell. You don't have to start at the very top if you have some dates that are special or something.

It is important to WARM the fluids before administering. Vets do not do this. They should be warmed to less than 101F [their normal body temp]. In LA I have a fancy instant read thermocouple and I get it pretty close to 101. Here in Indy we only have a standard chefs style instant read cooking thermometer. So I aim for about 95. It's just important not to burn kitty. The best thermometer is an infra-red pointing style one that can be gotten from Fry's or Radio Shack or on the web.

Also vets use GIANT needles for their own convenience - usually 18 gauge.

LRS info:
This site is an excellent resource for LRS equip:
http://members.verizon.net/~vze2r6qt/supplies/local.htm
http://members.verizon.net/~vze2r6qt/su ... ompare.htm

It is best to buy LRS local because shipping is $$. You need to buy a case of the 1000ml bags. The prescription should be for 12,000ml. I get ours from Costco. I've heard Sam's is another good place. The link above has other places and instructions. Again, one does not need to be a Costco member to use Costco pharmacy.

Needles:
I use the Terumo 21g x 1" needles. You can get them without prescription from http://www.shopmedvet.com . http://www.shopmedvet.com/product/terum ... nd-needles They can only be found on their web page by searching. I usually just search "terumo" . You can call them and place an order too. These are special needles - the 20g and below have a special thin wall construction.

IV Sets:
I get the cheapo 20 drop/ml 72" sets from http://www.shopmedvet.com/product/5526/ ... ation-sets . This is the only place I know where one does not need a prescription AND they are cheap.

I change the IV set every 2 bags or every 4-6 weeks - which ever is sooner. Keep the bag and Set out of the light when storing.

That should get you going.

There is all sorts of good reading on the Internets about CRF and administering fluids. Just google "feline crf"

I also highly recommend stopping past your hardware store or Wal-Mart and picking up some "S" hooks to hang the bag from. Here in Indy I've put into the cieling a few plant hanging hooks then from them hang some rather long "S" hooks - about 18" long then I hang the bag from that. I just pick up F in/with his bed and place the bed below one of the hooks on a stool. You want the maximum distance/height from the bag to the cat - this will help things go MUCH faster. With the 20 drop/ml you know you have done it right when it is nearly a stream dropping in the little chamber.

I also believe it is important to do the procedure where the kitty is comfortable. Hopefully over where they have a bed and spend most of their time. If you grab them and put them somewhere else - they will always be trying to leave then do not take so nice to being confined.

Shopmedvet also has good prices on Sharps containers. I like the 1 gallon ones http://www.shopmedvet.com/product/sharp ... containers
 
Re: 10/13 SQUAMEE amps +273 .2U

good morning!

re: vet. ugh! i'll do as lori is doing, keep my mouth shut :-) ok, i just can't. i'd be willing to bet a bottle of insulin on you intervening yesterday saved her from a symptomatic hypo. so UGH! again :-D

as far as fluids go, is she a handfull at home? the 18 gauge seems to be standard issue for vets and when i first had to do them, everyone called them harpoons and told me to get 21 gauge. my Kitty was having noooooo part of the 18 gauge. she was a tiny kitty anyway, about 6-7lbs or so anyway and she must have thought i was poking her with one of her own legs when i stuck her with the 18 gauge ones. unfortunately my fiance and my living room floor got more of the fluids then she did at first.

later when we had to do them we used the 21 gauge and while still cursing me out some for doing it, she handled it much better. then when my Spazzie had to have them, she couldn't care less as long as i sat a plate of tuna in front of her to eat while i was juicing her up.

soooooooooooo, try the 18 gauge yourself at home and see how she reacts. if she's psychotic, try the smaller gauge and see if that's better. if she's the same with both, maybe go 18 just because it's faster. 100mls with the 21 gauge for us only took about 5 minutes or so if i remember correctly.

fwiw, this is where we got ours from http://www.thrivingpets.com/index.php/t ... edles.html

of course, there's all kinds of tips to fluid administration too that will help so don't worry if the first few times don't go well. (warm the fluids, bevel up on the needle, etc....)

one thing i would suggest, if you have the vet do it, don't let them sell you a new bag every time. they can sell you a bag, use it, and store it from one visit to the next. or let you take it home and back each time. the mark-up on those bags of fluids are nutso. if you could sweet talk a prescription from the vet you can get the fluids online for about $3 or so a bag if i remember correctly and some people even get them at costco i think. you have to buy a case at a time but someone on here can always use some it seems so sometimes people buy a case and then sell off a few of them to others that need them. actually, now that i think about it, you could post in supply closet and see if anyone has any to spare

whew, lots of typing :-)
 
Re: 10/13 SQUAMEE amps +273 .2U

BTW On your numbers I think she came down this morning because she was getting over the high carb hang over. I would probably go back up to .6 tonight.
 
Re: 10/13 SQUAMEE amps +273 .2U

(((((Judy))))) you are really doing great tackling all these problems. Just take it one step at a time and remember you are already doing great by Squamee to be taking such good care of her. If everything isn't picture-perfect, don't be hard on yourself, there are just too many things going on to make everything perfect. I wouldn't stress yourself too much about each dose, just try to keep her from the extremes if you can. Not sure if that helps much ohmygod_smile but I know for me at least, I can agonize over one shot and what to do and wanting it to be perfect, and lose the bigger picture that I want both Bixie & me to be happy, and sometimes accepting "good enough" numbers for me is a necessary compromise.

I never succeeded with fluids at home, but I think it was because I didn't know to warm them. Gator will fill you in on how to do that I'm sure, and also if you remember Ele & Blackie - she's over on Lantus now but I think maybe was around here when you were here last year? - has since tackled fluids for Blackie, so she might have tips if you PM her. There are also plenty of others around of course who know what to do too. The needle size freaked me out too but I never got a big reaction from the kitties on that front, it was once the fluids started going in that they hated it, so that's why I think the warming is key.

I hope you are able to get some "Judy" time too. It's important to take care of yourself!!!! :YMHUG:
 
Re: 10/13 SQUAMEE amps +273 .2U

as far as warming the fluids go, i did it a couple different ways. at first i would run the sink full of hot water and let the fluids sit in there. i found that took too long to be very effective though as the water would cool off.

so then what i would do is heat some water up on the stove as i could get it hotter that way. then i'd pour it into a bowl, add some cool water if i thought it was so hot it might melt the bag :-D and then let the bag sit in that for awhile. that worked both faster and got the fluids warmer than the first way.

then, i ran it like i would a bottle for a human baby, on my wrist and judged it that way as to whether it was warm enough. know though that the first few seconds will be cold as that's the fluids in the line. so you have to run it on your wrist for a few until you feel the warm fluids come out. yes, you waste some but if you get the fluids online for less, then it's not so shocking as seeing your $25-$30 vet bought fluids going down the sink :lol:
 
Re: 10/13 SQUAMEE amps +273 .2U

I prefer the dry method: heating pads.

I have an old-school heating pad out in LA that worked great. Here in Indy we only have a new school heating pad and it takes forever. The new school one is all fancy [and probably safer] but does not get as hot and has some sort of baloney electronics in it that turn it off after x minutes and then you have to unplug then replug the blasted thing.

I heat the bag and not the tubing as the liquid in the tubing could get WAY too hot before the main bag is done. This is why I prefer the shortest length IV set that is practical - which is probably the 72" ones.

If you want it to go faster you can taco the bag in the pad then put under your covers on your bed.

Moral to the story: try to find an old school heating pad.

Shopmedvet.com sells an inline fluids warmer for $500 which is the REAL way about it.
http://www.shopmedvet.com/product/iv-fl ... mps-warmer
You just place the IV line in an electronically warmed "U" shape device and go. It is a shame that vets cannot manage to purchase these and use them - I think that's really beyond unacceptable in a commercial setting for as much as it would get used and help.

EDIT: BTW I saw she went back down today. Who knows what is going on confused_cat if she stayed under 300 then I would be tempted to shoot less than .6 - maybe .4 or .3?? And interesting aside I took H up to a certain institution and spoke with their endocrinologist expert there. At the time I was giving about .4u to H. One of his remarks to me was that he'd never seen a cat hypo on .4u. Anyway, not sure how much to trust that, but thought I would mention it.
 
Re: 10/13 SQUAMEE amps +273 .2U

PMPS (at +13.75) 298 .4U
Thanks for the suggestion on what to shoot, Gator. Right now it helps a lot not to have to think too much! Today was not a good day. The vet stuff was awful, she has been refusing to eat much of the day, I can't get a pill into her, and so tonight, when she did try to eat, she had great difficulty with her mouth/jaw. The vet ordered the transdermal phenobarb, but the pharmacist who makes it up will probably not be in till Monday. It feels like all I do is torture her--to take the medicine, to eat, to test her, and soon, to hydrate her. And from the very very slow way she moves, I am wondering how much pain she is in. She spends most of her time sleeping, and prefers being under a blanket on the couch.
I keep thinking about giving her fluids. I guess I will eventually master it, just as I did the testiing (tho that took me several weeks!), but I have a horror of needles (I NEVER look when I have to get a shot or have my blood taken, and the first time I had an IV I felt like my arm was going to fall off) and so I am approaching it with considerable dread. I would like to get the smaller ones, but I don't know if I can do that before Tuesday, when I am supposed to do the next fluids. I know I can eventually get them on line, but if I want to get some immediately, anyone know where I should look?
 
Re: 10/13 SQUAMEE amps +273 .2U

OK, I'm starting to believe strongly that appetite has a lot to do with the numbers situation. So if she is still not eating then I would expect her to go lower tonight. I don't think it is anything to not sleep over [.4u is very little insulin], just that tomorrow morning if she is still not eating then the numbers will be lower.

So just keep in mind that food in = more insulin need. Less food in = less insulin need.

You can get all the supplies from your vet - if they do not have Terumo needles than ask for the 20g ones. It will just probably cost more.
 
Re: 10/13 SQUAMEE amps +273 .2U

judy i'm afraid i can't help you with getting the fluids, but i so sympathize with you in how you feel treating squamee. it is so very hard to see our babies uncomfortable, in pain, or sick. we do everything we can to help them. it can seem relentless.
i just want to share with you that above all else squamee is loved, secure, and with her mommie. i truly believe from the bottom of my heart nothing eles is as important. your tenderness, your love and caring is better than all the medicine and treatment for her emotional well being. you will do all you can i know to care for her pain and ailments...i know that. but what squamee knows is that she is at home with love, security, mommie and all she can possibly have in the way of caring comforts. most animals in the world and many humans would want no more than this.
hope this helps.
lori
 
Re: 10/13 SQUAMEE amps +273 .2U

Wow! I got her to take the pill and about 30 minutes later she ate about a 1/2 can FF. If she is able to eat more tonight (and I gave her a whole pill, not the 1/2 dose, so hopefully, that will help her through the night) I guess she will have higher numbers tomorrow morning. So I can think about increasing her dose--.6, .8, or even 1U if she is a lot higher? I am trying not to be too intimidated by my mistake from yesterday, but since her eating (and pill taking) seems to be increasingly more problematic, it adds to my uneasiness. I just never know if I am going to be able to get her to take the pill, and the liquid phenobarb seems ineffective. And when she doesn't take the pill she has great difficulty eating, even if she tries to eat.
 
Re: 10/13 SQUAMEE amps +273 .2U

judy and squamee said:
I am trying not to be too intimidated by my mistake from yesterday, but since her eating (and pill taking) seems to be increasingly more problematic, it adds to my uneasiness.
Click to expand...
As it [sudden food strike] should make you uneasy. It always made me uneasy. .2u increases at under 1u is actually what I would consider a fairly large increase. If you want to do more than that then have your reason for it - like you are sure she is eating more and this spell of inappetence is over for now and you see the numbers racing off.

I'll just say that if inappetence and food strikes is what you are dealing with it is something very difficult to deal with. It's kind of like trying to balance an elephant on a pinhead with a mouse running around that shows up and goes away seemingly randomly. I don't know how I dealt with it - I know I was beyond stressed and anxious. I know I had to divorce myself a lot from the emotional aspects of the care and day to day. I eventually developed a sixth sense that helped a lot which was basically just an affect of experience. I know this is not too much help but I just wanted to say that I know what you are dealing with is difficult.
 
Re: 10/13 SQUAMEE amps +273 .2U

Thanks, Gator. Are you comfortable suggesting guidelines for dosage tomorrow morning? I will be sure to factor in if she has eaten during the night (going lower if she has not). I will test her in 15 minutes and post that---if that helps.
 
Re: 10/13 SQUAMEE amps +273 .2U

I'm watching the Kings game which I bet will be over at about 1a eastern. So I'll keep looking.
 
Re: 10/13 SQUAMEE amps +273 .2U

Well, it is actually the LA Kings vs The NY Islanders [your local team]. The Kings just buried the Islanders 5 to 1. 5 minutes left and the cruddy less than legit Internets feed I was watching died cat(2)_steam . The Kings are playing very well this season and the Islanders are last in the league currently so....

Anyway, here is my input:
Barring any other input that you may have there that I don't, just go off the rise or fall from this the PMPS. If you get a fall of about 30 points or less from tonight's PS to the AM PS then you are headed in the right direction at the right pace. If things go roughly even or so then up by .1u. If they go up by more than maybe 30 or 50 then up by .2u. If things get really crazy [up] and you are convinced she is eating well/more then you might want to up by a little more than .2u. I would not more than double your dose in one cycle. If you get a larger drop than 30 points from PS to PS then I would back off on the dose - how much depend on the drop. Confusing I know. And as always you hold the syringe and I am just one opinion. Do as you see fit as the conditions you observe call for. I'm just giving an example of what I *might* do so you can make you own good decisions.

I personally like to see drops of about 20-30 points in PSs between 200-300 and 10-20 points between 150 and 200 and below 150 the PSes should be even. But that is also an experienced point of view. And things rarely work out that perfect. For you, if you can keep things under 300 then that's just fine for right now.
 
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