3/2 Fortune PMPS 234 +1 307 +2 289 +4 183 + 5 118 +6 89 +6.5 86 +7 84+7.5 70+8 64+8.591+9175 +10173

Discussion in 'Lantus / Levemir / Biosimilars' started by RachelG, Mar 2, 2021.

  1. RachelG

    RachelG Member

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    Jan 8, 2021
    Last condo

    Fortune is home, happy, and much more himself! :joyful: When he got out of his carrier he went right to the water fountain and then to Marty's (our civvie) food bowl to lick up the dried food from this morning! YAY!!

    Since he was hungry I did give him a little snack. Ok, maybe two little snacks :smuggrin: I hope we didn't spoil his appetite for his dinner...but I'm just so happy to see him circling, meowing and asking for food! He also seems much stronger, and is so lovey!! UGH I'M SO HAPPY HE IS HOME!

    We hope that the subq fluids prescribed (finally) will help maintain his kidney levels.

    The IM increased his insulin to 3IU (again) this morning since he was over 600 last night. I have not been able to get the numbers, but I am having DH call again tomorrow to get them. They are not fans of me and my questions/requests. :oops:

    I do think Fortune was likely due for an increase. He touched the 200s at 2.5 so it would have likely been a .25 increase once we were consistent with the cycles. But with him so high and having "early DKA," does it make sense to try this 3IU dose? I don't want to harm him by keeping him at too low of a dose, or too high of one.

    I also pushed the IM for direction (directly) about if he drops to the 50s tonight like he last time she increased his dose to 3IU on discharge. She recommended not shooting at all if he is under 250 (!) and giving a half dose if he doesn't eat. I'm not sure I am comfortable skipping, and we are able to stay up if needed to make sure he is safe. What I'm not sure about is taking his dose down (again, like last time, but a smaller reduction because we are now at 2.5) or seeing how he does at 3IU.

    Open to thoughts...
     
  2. carfurby (GA)

    carfurby (GA) Well-Known Member

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    Feb 19, 2012
    I'm so happy to hear Fortune is home and feeling more like himself! What wonderful news! I don't have any dose advice.
     
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  3. tiffmaxee

    tiffmaxee Well-Known Member

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    Nov 15, 2013
    Welcome home Fortune! I would not skip after all he’s been through. See what the PMPS is and then decide if 3.0 seems right is what I would do. I sure hope he will eat. How much sub-q were you told to give and how often?
     
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  4. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Feb 21, 2015
    One thing that helps keep ketones at bay is food so frequent small snacks is good.
    So glad he is home!
     
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  5. JaxBenji

    JaxBenji Well-Known Member

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    This is such a wonderful update! So glad he's home :bighug::bighug::bighug:
     
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  6. RachelG

    RachelG Member

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    Thanks for all of the well wishes!! :bighug:

    Oh, I have no intention to skip! My question is, if I should stay at 2.5 (I don't think that's right though), up to 3 IU (which is what he got this am) or split the diff and do 2.75. (PS How are you feeling?!)

    I'm trying to figure out how to give him small snacks without spoiling his appetite. :arghh: How do folks who feed frequently give wet food without it going dry/stale?


    I also want to mention that he did not have ketones in his urine (YAY!), which I think helped a lot. We must have caught things super early?
     
  7. tiffmaxee

    tiffmaxee Well-Known Member

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    I think I would shoot 2.75 but see what others think. When I fed some meals ofen igavejusr a few spoonfuls at a time. It didn’t dry up. You could put a bowl of ice or an ice pack under the dish. I am glad ketones were not in his urine. He was not DKA it seems. :)
     
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  8. RachelG

    RachelG Member

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    Jan 8, 2021
    Ooo that's a relief! When the IM called for the update she kinda sped through the part where she said, "he is no longer DKA because we flushed the ketones..." and I asked her to stop and explain when and how Fortune was DKA since no one had mentioned that in either of the previous updates/calls! He had trace ketones and was decimal beyond normal, so they tagged him as DKA because he was symptomatic (not eating well, tired, etc.). Who knows? I did just buy the ketone blood meter for peace of mind!

    Do you measure the food in tsps? I'm weighing it currently to better track how much he is eating and to try and get some weight back on him :(

    We are shooting in about 30 minutes, so hope folks chime in soon. :)
     
  9. Butters & Lyla

    Butters & Lyla Well-Known Member

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    May 30, 2020
    Happy homecoming, Fortune!:bighug:
    I weigh all of butters's food. I've estimated with hers that 1 tsp = 7 grams (1/4 oz). But it's easier for me just to record all of her feedings in grams on her spreadsheet. I think it's a great idea for you to weigh his food and weigh him, too. I put butters on a baby scale at least once a week.
     
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  10. RachelG

    RachelG Member

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    Jan 8, 2021
    We used to have a baby scale back in 2014 when Fortune had his first IBD flare up! But then he chonked up and we didn't need it anymore, lol. I think it may be time since he has lost so much. IDEK how much he weighs rn - the IM hates when I ask questions, so I prioritized other things.

    I think I'll switch to grams since it is more precise at a smaller amount. Thanks for the suggestion!
     
  11. RachelG

    RachelG Member

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    ETA - I'll switch to grams tomorrow. So tired.
     
  12. RachelG

    RachelG Member

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    Jan 8, 2021
    I missed your question! 100ml every other day starting tonight.

    Also - so far he has eaten 1.7oz (out of 2.6 offered), and eaten 4.7 since getting home. He stopped and went to nap...so I'm going to offer more when he gets up. We are shooting in about 20 minutes, so hopefully that will be enough to support the dose...:nailbiting:
     
  13. tiffmaxee

    tiffmaxee Well-Known Member

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    You should have two hours before it kicks in.
     
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  14. RachelG

    RachelG Member

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    Ok great! About to offer him some more noms. 10 min to shot...Will post PMPS in two secs.
     
  15. RachelG

    RachelG Member

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    Jan 8, 2021
    PMPS is 234. Hmm...3 IU or 2.75?
     
  16. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    You got greens on 2.5 units, then you had enough skips and partial doses that the 2.5 unit depot never got build up again to show what it can do. I'd be OK with 2.75, as long as you can monitor.
     
  17. RachelG

    RachelG Member

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    Ok, let's do the 2.75! Thank you! We will stay up and monitor.

    We had 6 uninterrupted cycles of 2.5 IU back on 2/22-2/24, and he was due for an increase on 2/25 AM but we postponed because of the onc appointment. So technically he should have been at 2.75 since Thursday AM.
     
  18. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    Feed it well watered, that prevents it from going crusty. If you use an autofeeder you put a gel pack under the feeder tray.

    With recent ketones/close to DKA, I would not skip. Period. Until ketones are a lot further back in history. And do a minimum of half dose. Regardless of his appetite. Tonight you are fine with full dose.
     
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  19. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    And he went green on the 2.5 unit depot the following cycle.
     
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  20. RachelG

    RachelG Member

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    Oooh can you share more info on the autofeed with a gel pack? I'll try the water tip, too! Thank you!

    I know he went green - just to mess with me! LOL and maybe from the vet/fluids/chemo? IDEK.

    Appreciate you @Wendy&Neko & @tiffmaxee for the advice! Shooting 2.75 now, and hoping for the best.
     
    Last edited: Mar 2, 2021
  21. RachelG

    RachelG Member

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    Jan 8, 2021
    One more thing - we are about to administer his fluids. Is there reason that should interfere with his insulin? We were just told to give them to him tonight, not "with dinner" or X hours after insulin...and now I'm nervous.
     
  22. Liz & Minnie

    Liz & Minnie Well-Known Member

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    Yay, welcome home Fortune! Hope you got plenty of sleep while he was in the hospital :)
     
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  23. Liz & Minnie

    Liz & Minnie Well-Known Member

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  24. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    For some cats, not all, fluids can reduce the numbers. He's high enough it should be too much of an issue. But you still might want to separate the two by a couple hours or wait until you see him zooming up more. Shoot insulin not in the scruff/neck area when you are going to give fluids, which go in scruff. So separate by time and distance. I usually gave fluids after nadir, when Neko would be going up anyway. The one time she got fluids at the vet after her shot, she came down before onset. But she was in low blues, so more noticeable.

    I used the Petsafe 5 feeder. Under the tray is a rectangular area that can fit a gel pack (or ice cubes for low tech). I just bought a small cheapo gel pack and folded to fit. The Catmate ice packs also fit the Petsafe spot, if you have that feeder already. You can also put an ice cube on top of the food and it'll keep things cool while it melts and adds water. Which would be good for him right now.
     
  25. RachelG

    RachelG Member

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    Thanks @Liz & Minnie this is awesome!

    I appreciate the thought, lol. Unfortunately, we didn't. Mostly because I was a nervous wreck that he would take a turn while hospitalized :nailbiting: It was a really hard decision for us to admit him overnight again, and I was very on edge. Just grateful he is home, and that there was something to make him feel a bit better.
     
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  26. RachelG

    RachelG Member

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    Crap. DH determined that because the vet didn't indicate separating them, we are good to go and not question them constantly. :rolleyes: We gave about 75 of 100 ml, in the scruff, about 15 min after insulin. No idea what this will do, but it doesn't feel like it will help things. :banghead: I just hope Fortune is suffering from our inexperience! We will try and give the rest later on tonight.

    We don't have a feeder yet, but this is very interesting. The only problem would be our civvie Marty eating Fortune's fuds. Maybe we can craft an RFID thingy on it and put the key on Fortune's collar...Hmm...
     
  27. tiffmaxee

    tiffmaxee Well-Known Member

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    Max did go lower the first time I gave fluids. After that it never happened again.
     
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  28. RachelG

    RachelG Member

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    We will find out soon! Both boys are snoozing - Marty barely ate tonight, now. I don't know what's going on :blackeye:

    Going to do a +2 and see where we go. Also going to keep offering food cuz he needs the calories, and isn't eating a ton in one sitting.
     
  29. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    It's ECID on whether a cat reacts to fluids by going lower. You will find out soon!

    You can get more expensive feeders that react to RFID chips. Of if one cat is fatter than another, put the feeder in a box with a "doorway" the fatty can't get into.
     
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  30. Katherine&Ruby

    Katherine&Ruby Well-Known Member

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    Oct 8, 2020
    LOL you are such a mom, bragging about your boy cleaning plates after getting home. :)

    I have the spendy microchip feeder. It's been a godsend as I don't have to worry about Olive eating Ruby's food and vice versa. I only wish they had a timed version, but I'm sure it's in the works.

    Enjoy kitty cuddles this evening! :bighug:
     
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  31. RachelG

    RachelG Member

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    Katherine, I am such a mom! I remind myself of my grandmothers because they were always telling me to "eat, eat, one more bite before you get up, do it for me," and I am telling Fortune the same thing :p

    I like the autofeeder ideas - when I first looked into them we had them on the same food, and fed 2x/day separately. Now one is a diabetic and both have CKD, and one is on a diet. I am wary of introducing something that may deter Fortune from eating. If he gets his full appetite back (please G-d) I think I'll spring for it!

    Appreciate the advice on the feeders overall!
     
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  32. RachelG

    RachelG Member

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    I just pictured Marty getting his hiney stuck in the doorway! I'm giggling, my plump fluffy bunny - it would be so cute!
     
  33. FrostD

    FrostD Well-Known Member

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    So glad he's home! Hopefully no more trips in the near future
     
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  34. RachelG

    RachelG Member

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    Jan 8, 2021
    Gave the remaining fluids with him snuggled in my arms. I'm worried the needle is uncomfy - it's a 20 gauge. I'm glad I can snuggle him during it, at least, and provide some comfort. I hope it will rev up his appetite, too!

    +2 is higher than PMPS, but a +4 for good measure post fluids couldn't hurt? Or can I go to bed?
     
  35. tiffmaxee

    tiffmaxee Well-Known Member

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    Nov 15, 2013
    I’d probably do a +4 because of fluids. The best needles are the terumo needles. Really sharp. I think 20g are fine. I even at one point used 19g with Tiffany because they were faster. You can buy them on line.
     
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  36. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    Jun 4, 2020
    This is so great! Fortune is home!! And eating!! I always separated Darcy's fluids by about two hours from his insulin. It didn't seem to affect his BG much... but it did help his ketones to go down.

    I will go to sleep with a smile on my face thinking of Fortune at home again tonight! Hugs, Rachel! Kiss that boy!
     
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  37. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    Oh, yes. Definitely buy Terumo needles. I just ordered more from Thriving Pets a bout two weeks ago. 20 g is good (I prefer it to the larger needles.) I have 19s and 20s. 19s are for a cat that won't hold still long enough. I won't use the bigger gauge needles that the vet tries to give me. They are harpoons.
     
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  38. RachelG

    RachelG Member

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    Jan 8, 2021
    Thank you Suzanne!! We have been lovin on him all night, and he has barely left my side all night :woot: I'm in heaven. I cried the whole way home because I was so happy to see him, and see how energetic and happy to see me he was - pushing against the carrier when he saw me, circling, etc. It was a complete 180! @Bronx's dad (GA) I thought of how you described your trip home with Bronx after SRT :bighug:

    I'm not sure if I'm reading into him snuggling/burrowing into my arm too much - he used to do it all the time. I'll check the terumo out!

    He just had some more food before we turn in for the night. We resorted to food with questionable measures of carbs and phos in an effort to get him to eat. I need to order a phos binder - the IM wants to "wait and see," re: phos binder yet feed him "whatever will get him to eat." Every time I ask for things (like subq, or potassium supplement, etc.) she shuts me down until a different doctor intervenes, so I'm going to get DH to ask instead. :smuggrin:
     
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  39. RachelG

    RachelG Member

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    Jan 8, 2021
    DH will be doing +4 and adding to spreadsheet.
     
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  40. RachelG

    RachelG Member

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    Jan 8, 2021
    Just kidding - I'm here cuz it's 183. DH will check +5, and if it's the same or lower Ill check +6.

    It's all worth it to have him snuggled in bed with me rn.
     
  41. tiffmaxee

    tiffmaxee Well-Known Member

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    Nov 15, 2013
    You can get aluminum hydroxide powder from Amazon.
     
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  42. tiffmaxee

    tiffmaxee Well-Known Member

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    You can also get it at thrivingpets.com and they have terumo needles. If you search on line you might find cheaper prices though.

    Terumo needles
    https://www.shopmedvet.com
     
    Last edited: Mar 2, 2021
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  43. RachelG

    RachelG Member

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    Jan 8, 2021
    Well, we are at 118 @ +5. Fortune was not interested in a snack, so waiting an hour and testing again.
     
    Last edited: Mar 3, 2021
  44. RachelG

    RachelG Member

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    Unless we should test sooner?
     
  45. RachelG

    RachelG Member

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    Welp, the 3 IU this morning made him drop pretty fast...but what goes down must go up, right?
     
  46. RachelG

    RachelG Member

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    Should we feed high carb, medium carb or low carb? Fortune at a little bit (1.1oz ) @ +6 but it was LC
     
    Last edited: Mar 3, 2021
  47. Wendy&Neko

    Wendy&Neko Senior Member Moderator

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    86 and 89 are the same number within meter variance. LC should be OK.
     
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  48. RachelG

    RachelG Member

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    Jan 8, 2021
    Thank you, Wendy! :bighug:

    84 @ +7. Not sure if he is flattening out because he an ounce of low carb @+6. We got 10oz into him this afternoon / evening since he got home and now he isn’t that hungry. :banghead:

    He had a few small nibbles of MC/LC mixed - the only thing that would entice him. Hopefully it will keep him flat or raise things...

    Should we test in 30 or at +8?
     
  49. RachelG

    RachelG Member

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    70 @ +7.5

    He is eating some more of the mix now.
     
  50. Jaime & Mowgli

    Jaime & Mowgli Member

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    Jan 5, 2021
    Hi Rachel,

    I'm too new around here to give much advice, but I just want you to know that I'm following your journey all the way from across the country and cheering you and your husband on every step of the way! I am very happy to hear that Fortune is feeling much better today :)
     
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  51. RachelG

    RachelG Member

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    Jan 8, 2021
    Testing again at +8 (30 min from last)

    DH is prepping syringes in case the next test is still low/lower and Fortune turns away food.

    This is new for us - usually, when he drops, he is low pre-shot :nailbiting:

    Maybe it’s that 3 IU from this morning that the IM gave him. :arghh: I wish we were more comfortable with green numbers!!!
     
  52. RachelG

    RachelG Member

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    Jan 8, 2021
    +8 64! We have been feeding him, but it’s not going up! Do we give karo?
     
  53. RachelG

    RachelG Member

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    We added some karo (dollop, not precise) to his food and smeared a little bit on his gums
     
  54. RachelG

    RachelG Member

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    Jan 8, 2021
    Up to 91 @+8.5. Going to set an alarm for 30 min to make sure he is flat/up and it’s not just the karo.
     
  55. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Watching
     
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  56. RachelG

    RachelG Member

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    Is it ok that Fortune went back to sleep?
     
  57. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Yes it’s fine if he sleeps. I would keep testing the BGs for a while longer to see it doesn’t drop again. The Karo will wear off in an hour or an hour and a half so some low carb food should keep it from dropping again if he will eat it.
     
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  58. RachelG

    RachelG Member

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    Jan 8, 2021
    Thanks for replying! :bighug: Just tested again, we are at 175! :facepalm: Can we go to sleep? Lol

    We fed him 4.4 oz overall (maybe a little more) from +6-+8.5. I’m not sure he will eat much more now - I have pretty much been trying to get him to eat as much as he wants/can to gain some weight back after the hospital stay.

    Do you think we should try and keep feeding now, or try on an hour? Setting an alarm to retest in an hour, too.
     
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  59. RachelG

    RachelG Member

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    Jan 8, 2021
    I saw that your doggie Jess had hemangiosarcoma on her heart :bighug::bighug: I’m so so sorry.


    Fortune has renal hemangiosarcoma. He had an acute anemic collapse and it was discovered on his kidney. The first hospital didn’t even want to biopsy. We were able to go to an oncologist and he had a nephrectomy where they removed the tumor and his kidney, and we hope to have some more QT together, but it’s a bad dx :(:bighug:
     
  60. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    If you are setting the alarm for an hour, I wouldn’t try and feed now. All try and get some sleep.
    If you get another BG in an hour that hasnt dropped I think you can all sleep for the rest of the night....which is almost over!
     
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  61. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Feb 21, 2015
    Yes we lost Jess to an haemangiosarcoma on her heart. Nothing could be done really as it was attached to the heart and that couldn’t be removed. We had the blood that was leaking, drained, and had another 6 weeks with her. Hopefully with the kidney removed you will get a better outcome. Don’t spend your time worrying about what might happen......it may never happen. Try and live each day as it comes and enjoy it.:bighug:

    I think you can take down the 911 now
     
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  62. RachelG

    RachelG Member

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    Jan 8, 2021
    173 @ +10

    I think that is static?
     
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  63. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    Very flat. No difference between a 173 and 175
     
  64. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    If you test the same exact blood drop more than one time with the same meter, you will get a different reading every time... sometimes a close number and sometimes a number that is quite a bit different, but within that doggone 20% meter variance.
     
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  65. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    Sweet baby sleeping?
     
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  66. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Yes I hope you have gone back to sleep:)
     
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  67. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

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    Yes, that must’ve been a horribly painful time for you. I saw that you lost both your dog, Jess, and Sheba within a short period of time. Sadness upon sadness.
     
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  68. Bronx's dad (GA)

    Bronx's dad (GA) Well-Known Member

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    Nov 30, 2016
    Hi Rachel, so happy to hear Fortune is home and doing well! You must be so exhausted, hopefully you got some sleep by the time you read this. Fortune is one lucky kitty to have you!
     
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