3/11 Update on Ducia

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Tanya and Ducia

Member Since 2017
previous post:

http://www.felinediabetes.com/FDMB/...to-monitor-her-jumpy-bgs.174568/#post-1916492

Hello,

I want to let you know right away that Ducia is all right. In fact, she must be better as we’ve been treated this morning to activities that we haven’t seen for a long time. Just like the old times before Dx.

We had to deal with the infection of the Etube insertion site that we discovered late night on Thu 3/9 and have spent some nightly time at the ER. The site was cleaned; we were given a demo as to how to do redressing at home and discharged with Clavamox, an antibiotic. The human medic whom I have at home does the bandages change/Neosporin application daily. The tube placement confirmed and we use it for meds and water. She eats on her own now.

The reason for infection is unknown. She wasn’t distressed, nor did she pawn it, and we’ve seen our vet to inspect it last Friday. I noticed that there was a sweet, not foul, but sweet smell around her face and was alarmed.

There are some advantages in the late night ER visits. After some earlier patients were let go we got full attention of extremely nice doctor who took interest in our home caring for Ducia. She said that Ducia was far better that she would have expect of a post DKA cat who is being cared for in non-clinical settings. Later on when in her kennel Ducia peed and this doctor took a sample and it was NEGATIVE for ketones.

Thank you DCIN for paying for this visit and giving us very rare opportunity to talk face to face to a doctor who is encouraging and caring. Our vet completely disapproves our home care.

Per this ER doctor Ducia’s blood work is improved. I will update LAB in SS later on but briefly some of her liver enzymes are improved, no ketones, phosphorus is in norm, her bilirubin is ok although was so bad the last time checked that the other doctor strongly suspected jaundice. The xray shown no lung problem her heart is all right. There are things to worry about such as anemia but her RBC count is not getting worse, it is stable and slightly elevated since the last time checked.

The Dr was very encouraging in what we do at home. In her opinion the 0.75U dose seemed appropriate for Ducia at least for now. It was Ducia’s nadir (+6 +7) and her BG was 189. I check her urine for ketones and keep posting in SS as Neg or Trace because it is the best I can do.

The testing pad after test, +15 sec, looks very pale beige like a pale human skin. I use Walgreens strips. Their lowest Negative mark is pastel yellow, very light but obviously yellow. The Trace level is like very pale human skin, as a Northerner’s skin. I prefer to check under the day light but in any case cannot clearly say which one is it. Is that how everyone does it?

The doctor in the ER said that Ducia water should be 170 ml water daily. She does not count canned food as water even though some cans are over 80 % water. It seems a lot to me for Ducia. Per Dr I should give her 35 ml water by syringe x 4 times in 24 hours judging by her current weight (which BTW she gains). Have you seen a 35 ml syringe? It’s a very large syringe and pouring that much water down the cat’s etube four times a day made me think of flower bed watering. I have never met a cat who drank that much. I appreciate your thoughts on that very much. Another thing about water is that Ducia is not a drinker. I water her canned food but she’s been ignoring her water bowl almost completely. I wonder how to make her drink when the tube is taken out. She doesn’t like water I guess.

And the last thing is the Clavamox (amoxicillin trihydrate/clavulanate potassium). It seems to be very powerful AB. Common side effects are GI upset. Ducia has vomited and that what caused it I thought. We give her Cerenia and Famotidine so it was odd that she did vomit. She also licks her lips a lot since we started Clavamox. I know it is sign can doesn’t feel good. Does anyone know this med?

Ducia BG this AM cycle are in Yellow with some Blues. Her latest Reds might be explained by the infection, and once AB clears that out her numbers, I hope improve.

We feel very good here today and send you all :bighug::bighug::bighug:
 
clavamox does upset many kitty tummies...... that is normal. And often they don't want to eat because of it....
You will have to work hard to get her to eat....
it would be good to have ondansetron , call the vet and ask him to call it in to a human pharmacy. 4 mg pill , 1/4 of a pill morning and night.

the infection was probably brewing and contributed to the ketone traces....

I'm glad she is doing better....
 
She has been eating all right so far. But I can tell it's the strong one on her. She was licking lips often ever since we started this Ab as if nauseated or unwell.
 
You can also give Ondansetron, Cerenia and Famotidine at the same time, as they work differently. Do you make sure she has food in her tummy before you give the Clavamox? I always gave it after food and never had a problem with it, but some cats don't tolerate it well.
 
It's a very strong anti-nausea drug used for humans that are having chemotherapy....it's actually better for nausea than Cerenia (which is better for actual vomiting)
Yes, I know Cerenia is anti-vomit. I'll cal vet about Ondansetron. What are the other signs of nausea? Licking lips, not much interest in her food?
What else and does giving more water a good idea for?
 
Licking lips and sniffing then turning away from food is a sign of nausea. If kitty is nauseated, she is not eating , so water is helpful, but if she's nauseate even that might make her feel worse.
 
You can also give Ondansetron, Cerenia and Famotidine at the same time, as they work differently. Do you make sure she has food in her tummy before you give the Clavamox? I always gave it after food and never had a problem with it, but some cats don't tolerate it well.
Yes, I give food first, than water, other meds, shot and only after the Clavamox. It must be very potent.
 
Licking lips and sniffing then turning away from food is a sign of nausea. If kitty is nauseated, she is not eating , so water is helpful, but if she's nauseate even that might make her feel worse.
She just ate 2/3 can with 10 ml water. But not as enthusiastically as by the same time in the morning when she was in her Blue number. Here is another I don't understand - same food, water and meds but Ducia's reaction in morning is always better than in the PM.In the morning around +4 she was actually perky. Right now she is sleepy.
 
Tanya, I am so pleased to hear Ducia is doing so well. You are a terrific kitty Mom! Keep up the good work! :bighug::bighug::bighug:

ETA: I have used Ondansetron myself, and I can tell you it works very well to stop nausea!
 
I agree with above - I have also raided Murphy's supply of ondansteron and indeed, it does work well for nausea. Lip licking definite sign of nausea. I hope it helps Ducia, who is quite the trooper. You are doing a great job, Tanya.
 
Good morning, Tanya! Was so happy when I saw this update. The infection is unfortunate, but I'm so glad you caught it and got Ducia some antibiotics to clear it up. Sounds like you guys are doing great!

Just checked the spreadsheet and see that the AMPS is lower than you've been seeing-- hopefully that is a sign that the infection is getting under control.
 
I hope you gave her her insulin this morning. The U column on your spreadsheet is empty.
You know the recipe for ketones = not enough calories + not enough insulin + infection or other inflammation/stress.
 
I agree with above - I have also raided Murphy's supply of ondansteron and indeed, it does work well for nausea. Lip licking definite sign of nausea. I hope it helps Ducia, who is quite the trooper. You are doing a great job, Tanya.
I see a lot lip licking since we've started on Clavamox. And I am run out of Cerenia. So a call to Vet on Monday for Rx. Thank you!
 
Good morning, Tanya! Was so happy when I saw this update. The infection is unfortunate, but I'm so glad you caught it and got Ducia some antibiotics to clear it up. Sounds like you guys are doing great!

Just checked the spreadsheet and see that the AMPS is lower than you've been seeing-- hopefully that is a sign that the infection is getting under control.
Hello Nan!
AMPS was very low and it kept lowering for a while.
I had to delay the shot and reduce to 0.5U.
ut afterward we had beautiful almost entirely Blue day.
 
This morning's numbers were not low. You could have shot when she was yellow. By stalling without food, her numbers came down. Delaying a shot acts like a reduction, so adding a dose reduction on top means probably not enough insulin. I think I would go back up in dose tomorrow morning.

Some kitties have a hard time with Clavamox. If you add some probiotics to her food, it may help replenish the tummy flora that the antibiotic is killing and make her feel better. Feed the antibiotic and the probiotic a couple hours apart.
 
She was falling rapidly +10 363 and then +11 293. I thought it was wrong to shoot the falling numbers.She had a good day on 0.5U. I hoped that's how it was going to be in the PM cycle but now I can see it was a mistake.:blackeye:
Would you recommend any particular probiotic to go with Clavamox? I noticed that if we give it an hours+ after the meal she does not have much trouble with it.
Ducia recently was on Metranidazol for 10 days, I thing it has something to do with micro flora after aggressive AB.
 
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Good morning Tanya (goodness, what time is it where you are????).

I think what Wendy is saying is that, even with the falling numbers, it would be a better strategy to go ahead and shoot while she was still quite high, and use food to keep her safe and slow down the fall in numbers (assuming the nausea isn't preventing her from eating enough-- that definitely needs taking care of, if so). It takes a while to figure out each cat's patterns-- Ducia definitely seems to like to drop before and just after AMPS, while she stays relatively high in the PM cycle. You've been doing a great job keeping her safe from hypo through all these cycles, and now we have a lot of data to see how she responds to food and insulin, which will help a lot in keeping her safe going forward.

I saw you shot another 0.5 last night-- I do think that the 0.75 dose is better for her with the DKA still in the backgroun. If you are unsure about the BG numbers in the AM, please do post for help and advice! Some of the others with a lot of experience should be able to give you some more specific guidance after looking at the spreadsheet patterns. They'll also be able to help with the probiotics recommendation (I know there are some that are popular here, but I haven't used them so I can't remember the names :( ).

And, try to get some sleep! With her so high right now, it's a good time for a break.
 
Good morning Nan!
I can see NOW what a mistake giving 0.5U was.:banghead:
I just have so little experience and watching the numbers falling and adding insulin knowing in advance that she prone to those dives of hers is a tough call. Another thing is that she had great day and I wanted it to just go on and on and on. :(
Its 4am here and I am going to close my eyes for an hour or so and post the +8 reading after.
I will open new thread, post links and I'd really like to talk about shooting strategies. So far the "Shooting Low Numbers" Sticky is the one I am more or less familiar.
Shooting rapidly falling highs in the cat whose patterns I only now begin to understand .
Talk to you soon
 
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