2/21 Fortune AMPS 566 +2 HI +4 489 +6 431 PMPS 326

Yesterday

We saw HI last night and 566 this morning.

Fortune seems very nauseous despite the ondansetron (2mg) and Cerenia (8mg). He had trouble finishing his first can, so we had to stall to shoot by 15 min. He will eat more when I hand feed him, but that is not his normal by any means. He only had one bite of his second can.

Also noticed he is drinking and peeing more this morning. Worried he is going to have another anemic episode and we won’t make it to the recheck appointment on Friday.

So frustrated that they didn’t give him darbepoetin or SubQ fluids to help prevent the anemia! The doctor wanted to wait and see his levels next week but we haven’t been able to make it one week. And I do not want to hospitalize Fortune again.

We are caught between a rock and a hard place because we no longer have a GP that I can take Fortune to in the meantime.

We gave him some mirataz - hopefully that will help him be more like himself - the cat who has the insanely good appetite despite his circumstances.

 

Do you have any ondansetron? It works better for nausea for many cats. Did the vets get the final reports? Fortune wasn’t low enough to start darbopoetin. You don’t want to start that if the HCT is above 18%.
I hope he eats with the mirt. Perhaps the high BG is making him feel bad.

 

Yes, finally! He is getting 2mg twice a day, with cerenia once a day. Poor bunny is still nauseous. For him that means barely finishing one can instead of his usual two (trying to get some weight back on him).

His HCT has stayed above 23% so that’s good I guess? I just don’t know how we prevent an anemic episode of it is his kidney.

I forgot to write what I put in the title - I think we are due for a dose increase, but not sure the bouncing affects that?

 

Ondansetron can be given every 8 hours. How much does he weigh?

 

His HCT has stayed above 23% so that’s good I guess? I just don’t know how we prevent an anemic episode of it is his kidney.

Yes, 23% is good. Anemic bit if he stays there you would not start darbopoetin. Does he get B12 and B Complex? That can help and the extra will come out in the litterbox.

He’s bouncing so too soon to increase I think but see what others say.

 

We were giving him b12 but since his hospitalization they wanted us to stop for a few weeks, and give it once a month.

He was 11.6 lbs, but I think he is down to 11 after the last hospital visit. I tried to find dosing info for ondansetron, but it seems like we are giving him a high dose already? Couldn’t find a good source.

 

Now his BG is HI. His BG has correlated to his anemic episodes so we aren’t sure if we should take him to the ER again.

Poor kitty. I feel so helpless.

I’m hoping we get direction on the increase.

 

Hi Rachel,

Look at page 232 of the pdf in this thread for dosing anti-emetics: https://www.felinediabetes.com/FDMB...ment-of-feline-chronic-kidney-disease.156005/. Wendy shared this with me a few days ago when Ruby wasn't eating well. Hope your boy starts to feel better and doesn't need to go back to the hospital. Big hugs to you!

 

Dosing is.5-1.0 per kg.

 

Ask about B Complex. You will need to find a new general vet and if possible it would be good for that vet t be a diplomat of internal medicine. No easy task I know.

 

[

Thank you, Katherine! Will check it out. Appreciate you sharing.

.5-1.0 mg per kg?

He is about 5 kg so at 2mg we are at the lower end of the dose.

I know, it’s just scary to see a new vet with everything going on. TBH I’m not sure they would take his case on because of the complexity. We have the internist at the new hospital, and the oncologist and surgeon there too. But I would prefer establishing care with someone more local. Sigh.

 

I know. It’s so hard with Covid. It’s nice to have someone close in the loop that can handle the less complicated part and get you meds when needed. Sigh.

 

Yes, I would increase. Normally we hold doses that see greens for longer, but that green you saw on 2/19 was suspect. Not only did he just up really quickly, then stay flat which seems odd, but there was some odd dosing at the vet clinic that could be influencing that number, if it was really green.

The only caveat to increasing, is not if it looks like he's breaking the bounce today. So if you were to see a blue PMPS, I'd hold off the increase until tomorrow.

Even after Neko's general practice clinic vet has "fired us" up to the internal medicine vet, she still was willing to give prescriptions/meds as needed as per the IM vet. She was getting copies of all the clinical summaries and meds from the IM too.

 

This makes sense! They were holding the 2IU dose until he was transferred to the internist, who over two cycles took him from 2 to 2.5 to 3 IU! I think that's why we saw those two PMPS greens.

When we asked her straight up about changing the dose that high and that fast and the concern that it may drop his BG too fast, she told us she has no concern. She also discharged him the same cycle she changed it, with no direction for follow up (she does know that we test his BG at home, but she doesn't know the frequency). I also called Friday regarding his symptoms/next steps and never heard back. I just worry about a different kitty who's pet parents don't test. She could kill!

Our GP hasn't returned any of our calls since Fortune's first hospitalization. We did hear from him over email on 2/3 (the night of Fortune's collapse) which was a great comfort, and I know he was in touch with the BP internist on Thursday 2/4. Both BP and the current hospital sent/send him daily updates, yet he hasn't returned their calls, or mine since 2/5. That first Saturday home on 2/5 we were able to get metronidazole from the practice (I asked for ondansetron and they gave us more Cerenia. ). If he wants to fire us, tell us, but this is so unprofessional and heart breaking - he has known Fortune for over five years.

I got both of our boys' records sent over so we can find a new GP. The local vets tend to treat animals without chronic issues, so I have been considering establishing care with a closer specialty hospital with a GP practice (not BP!).

/endrant

 

Just an update - since Fortune didn’t eat his breakfast well (95% of one can vs two) we postponed his mid-day snack with the probiotic.

He made it very clear that he was hungry, so we indulged him with 3/4 of a can (1/4 went to Marty, poor neglected kitty) and the Fortiflora.

I’m thrilled to report that he polished it off, and was meowing for more!!

Regarding the dose increase - considering doing it in the am tomorrow so we can better monitor the impact. Thoughts?

 

A one cycle delay is fine. That'll be the sixth cycle since the green so may or may not be bounce breaking.

 

How can I tell if we "break the bounce?"

 

♥

 

Numbers drift down during the cycle towards AMPS. Something like a blue AMPS might indicate that.

 

Ah got it. The last time he had a blue AMPS was in the hospital, over 4 days ago. If we somehow get a blue one tomorrow morning, would I hold the dose?

SN: I feel like I am neglecting my other cat. The spreadsheet has been super helpful to track symptoms and patterns - how have folks done that for non-diabetic/chronically ill kitties? Figured I'd ask other folks before trying to create my own system.

 

If you got a blue preshot, I'd delay the increase a cycle. A bounce breaking cycle has a lot of downward momentum, add that to an increase and you could be busy!

I use the labs tab for my non diabetics. Love being able to see the trends.

 

Thank you - on both accounts! My Marty hasn't had blood work in almost 7 months, we're taking him this week finally, but I hope for boring results.

If we see a blue tomorrow I will do a happy jig and stall the increase. TBQH I'm really nervous about insulin resistance. The criticalist at the hospital mentioned it in passing, and with Fortune's high numbers make me pretty concerned. When would you consider kitty resistant to insulin? His diabetes was brought on after 2.5 years on prednisolone from the SCL, if that is at all relevant...

 

Yes. Maybe you didn't see when I posted it yesterday, but ondansetron can be given more frequently... three times a day every 8 hours, if you can manage it.

I'm confused because I looked at your spreadsheet and it says he ate a lot. I guess his appetite picked up toward the end of the day? Do you think it was the gabapentin?

I'm going to be praying for your dear, dear Fortune.

 

I did see, thank you! I also responded. I'm not sure of dosing, so my question was geared to dose with frequency.

Yes, thankfully - he ate most of his dinner (90% of 6 oz) and a snack this afternoon with his probiotic! It was very worrying when he barely ate a whole can at breakfast (3 oz) normally he eats 6 oz twice a day. We are trying to help him gain weight after he has lost so much.

We aren't sure if it was the mirataz (we gave him some on his ear after breakfast) or the gabapentin (which we also gave last night, so it should have still been effective this morning), but grateful he is with a strong appetite!

I hope your Mr. Darcy is feeling well tonight!

 

Yes. With everything he’s been through and still was eating, I was worried when you said he wasn’t eating much. That’s not Fortune. So when I looked at your notes from later on, I felt better.

Were all good here, thanks.

 

Oh, and for future reference, the felinecrf.org site is the go to place for dosing on tons of stuff, especially anything for a CKD kitty (like nausea meds).