3/8 Tess Amps~Hi +3~506 "R" +10~346 "R" PMPS~331 +1.75~349 +3~383 +5~389 +11~508 "R" DKA on Th

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Ann & Tess GA

Ann & Tess GA

Member Since 2010
Sorry the last few days have had me in a stupor! I just couldn't focus to post. Tess was not eating again on Thur. I picked her up and got a faint whiff of acetone on her breath so off to the ER.

They said it was DKA but we caught it early. Two days in the ER and she came home last night.

The furshot on Monday tipped her over the edge I think, that and we were toward the end of the last pen in the pack. We had increased her dose on Thur AM but it wasn't enough. My fault for not getting in more ketone checks.

They had her on an IV w/ R for a day. We got a new Rx on Friday. Yesterday morning they stopped the R and we went in to give her the Lev shot (they were pretty nervous about the tiny dose).

Right now my concern is NDW since she was off Lev for a full day and that is what got us into this on Monday w/ the furshot. That and they were feeding her Hills M/D which is 14% carbs. I asked about giving an R bolus and they finally said yes, unfortunately it wasn't until after 6:00pm and the pharmacies were closed.

She is "Hi" this morning and we are waiting for the pharmacy to open and we've ditched the M/D for 4% Nulo. The ER vet gave me a dosing schedule that seems ridiculously high to me. If her BG is over 400 give 1 unit of R!

I know most of you that use R give only a drop or two. I also remember that there is concern about using R for Tess since her numbers tend to be so all over the place, but we can deal w/ low numbers better than another DKA. Any advice on how much R and when to give. Tess's nadir is very late w/ Lev so I am thinking early in the cycle if preshot is way up there.

OT Emma did very well w/ her dental. 9 teeth removed, all her molars and most of the pre-molars, canine and front teeth intact. She was not pleased to be kept inside for another day on Friday, on Saturday morning whe we did let her out she had caught and eaten half of a lizard within the first two hours! So she is doing well w/ the loss of so many teeth.
 
(((Ann and John))) What a scary couple of days.:bighug: I'm so glad you caught things early. Does Tess have another infection?

Emma is one amazing cat!
 
Thanks Wendy. They aren't sure yet, urine test is out for C&S and we won't have results until Monday. They are thinking that the bacteria may have become resistant to the Orbax and the last round didn't totally wipe it out.
 
Morning Ann and John :coffee::coffee::coffee:

OMG! :arghh: I have been so worried about you guys...

I am glad though that you caught the DKA early, and all is well, or at least getting better. Kudos to you too in dealing with the ER. All too often they are not prepared or equipped to deal with beans in the know. In a way it had to be a relief for them,. I cannot help with the R, but am glad that in the situation it worked for her. We never went that route with Mannie, due to his tendency to drop so quickly whenever he felt like it. Even when he was running in such high numbers we never had a problem with ketones, famous last words I guess. I heard that from Barbara and Tuffy too, until one day... there they were for Tuffy. it can happen at any time to any of our kitties. Anyways.... I am glad she is on the road to recovery.

I would contact Libby in regards to the R dose. She always seemed to have a very leveled headed approach to its use, without putting the kitty in danger. My instinct tells me your initial thoughts are on target. very small dose and only when preshots are high.

I would ditch the MD too, it was my back up to the back up when Mannie wouldn't eat, and only then. Carbs are so high.

interesting thoughts on the resistance to Orbax...

Well, my thoughts are with you. Hang in there. I know how difficult all this is. Very nice to read however that Emma survived her dental so well. awesome!
 
As far as I know, even with high dose kitties you start R with a trial beginning with the smallest dose - typically 0.1u. I'm going to defer to folks with more experience with tiny L dose cats on helping you with the R, but the basics are the same. You shoot the R when you are confident that it will not cause nadirs to coincide with the Lev nadir. In other words, you don't want the strongest action of the two of them to occur at the same time.

Marje and Dyana both have plenty of experience with tiny dose Lev + tiny dose R. They would be good to help too. @Dyana and @Marje and Gracie

sending my best to you guys - i'm sure this has been scary!
 
Hi Ann, saw that my name came up.

Is Tess still throwing ketones? And am I correct that she has had two doses of Lev (last night and this morning) and no R since yesterday morning?

With her numbers the way they are, I would say that adding R is probably safer than increasing her L dose. It will help pound through the resistance without affecting the depot, then when the numbers come back down (as whatever is causing that resistance clears), you can just stop the R.

Since Tess is post-DKA, I would suggest using R and feeding whatever you have to feed to keep the numbers up. At ER they usually use lots of R, then counter that with glucose drip. Sending her home with 14% food might have been intentional so you can continue using R.

Dose - it's hard to say, when they have such high numbers due to something like this going on. I would probably start with 0.1u. It should onset within an hour or two, so if there is no action then I would consider adding more. You don't want her to stay HI. For the moment the Lev nadir isn't a big deal since Lev isn't touching her (there's no nadir to worry about). That might change very quickly when her depot fills and when she starts feeling better, so obviously you'll want to stay on top of things. When you give R, don't give another dose until you are sure her numbers are rising.
 
(((Ann))) I'm so sorry that you guys have been going through all of this. Sending mega healing vines for Tess and mega comfort vines to you. Glad Emma is doing so well after her dental. :bighug::bighug::bighug:
 
((((Ann and John))))

I was looking for a condo last night and thought it was odd to not see one. I'm so thankful Tess is ok and you have her home. I'm sure you were scared to death.

Tess and Gracie have been on about the same dose of lev...give or take a bit. And, as you know, I use R. I have to play it by ear because sometimes I know her cycles are telling me to not use it; sometimes I've used it when I shouldn't have but I think every single R user will tell you that has happened to them. I've never had it cause Gracie to go really low because I'm monitoring but I have had it drop her quickly. Sometimes that has set off a bounce but overall, she tends to not bounce from fast R drops like she does lev. I have no idea why. Just some things for you to think about that might or might not be in play for Tess.

First, you don't need to wait for a pharmacy. Just go to Walmart and buy Novolin R. It's much cheaper than getting Humulin R at a pharmacy or Costco. It's the same stuff.

I dose R with my calipers because then I can be very consistent. With Tess, in normal circumstances, you would want to give her R as soon as she starts up but temper it with what you know about her onset and nadir. For example, this morning, Gracie started a slow climb and was 169 at AMPS. I thought about giving her a drop of R at that point but I have had her rise up into blue, level off, and come down at onset so I decided to wait a bit. By +3, she was 297 so I gave 0.1u to keep her from going any higher.

I would start with 0.1u. I realize that today you are giving it to bring her down until her lev depot builds. Until you get an idea of how she responds, I'd check her hourly. Keep in mind, they do not always respond to R the same way even giving the same dose of R and shooting it into the same number. So one day you might shoot 0.1u into 320 and she does nothing and the next time, she comes down. But by testing hourly, you will figure out when she onsets from R and the kind of duration she gets. I do find this has been very consistent in Gracie.

You probably have read that you only want to give it in the scruff. You also want to be sure you do not overlap nadirs so once you know her onset, nadir, and duration from R, you can overlay it to her lev cycles to determine the best time to give it.

I'll check back around and see how she's doing with it today. Also, how she reacts today might be very different than when her lev depot builds back up.

Sending tons of healing vines and hugs.
 
{{{Ann}}} and {{{John}}}

I'm so sorry to read about the trauma you have endured the past few days. Thank goodness you have so much knowledge and experience. It's twice as hard, though, dealing with what's happening to your kitty when you have to fight with the "professionals" about what to do. I'm glad Tess is showing some improvement.

Emma is a tough little kitty. I'm glad she bounced back so well from her dental. Cinco has very few teeth, but it doesn't stop him from eating like a champ. The vet once told me that cats don't need teeth to eat cat food - they rarely chew it, anyway (except my Minka, who chews pate! :rolleyes:). Emma certainly proved she can handle fewer teeth - already caught a lizard?! :joyful:

I know nothing about R, so no advice from me, but lots of vines and prayers and :bighug::bighug::bighug:
 
Thanks Elise, Michelle, Marilyn, Julie, Libby, Deb, Marje and Tricia! all the hugs and vines are very needed and appreciated.

WE gave Tess .1U of R at +3. At +4 she was already down to 317, but the Lev may be onsetting too. We fed her another .25oz of food and will continue testing hourly or more often. I'm so glad that I have all of you to fall back on! If I had listened to that vet!!!:mad: I knew I had read .1u for most who used R!

Not giving it until +3 makes me a little nervous considering the Lev onset, but even Walmart pharmacy doesn't open until 10:00 on Sunday morning. We'll keep a tight watch. Even if we don't need it often I am glad to have the R now for "just in case" scenarios like furshots and if we have to skip for some reason.

I talked to Marje on the phone. :bighug:, you are such a comfort. She mentioned that Gus would get kidney infections that wouldn't show up on a C&S, they needed to do an Ultra Sound. When the infection was taken care of his Creatinine would come down and that is just what happened w/ Tess. 3 weeks ago when we took her in for a "UTI" her Creat was up to 4.1, on the test when we took her in to the ER it was down to 2.7! Maybe they've been treating her for the wrong kind of infection all along, or maybe it was both. We'll check w/ the regular vet this week and see about getting a US done.

We are also going to see about acupuncture for kidney and appy stimulation. I couldn't believe it when they said that Tess was eating like a little piglet in the ER. They didn't exactly "send us home" w/ the Hills M/D we asked for whatever it was that she was eating so well. I didn't really check out the numbers until we got home w/ it. And the ingredients!
ohmygod.gif
I remember why I never liked Hills. I'm also trying to find some Iams Maximum calorie for emergency situations. The numbers aren't too bad and she can certainly use the extra calories. I weighd her this morning and she is up 3.5 oz. after eating so well in the ER.

Poor little Emma, well not so little any more.
icon_rolleyes.gif
They said she must have been in a lot of pain from the teeth, but she never showed it and it never effected her eating. That's why the vet putt off doing the dental. When we first fed her when she came home she couldn't quite figure out what to do w/ her tongue!:p She seems fine this morning, but I just found some barf from last night, probably the ABs upsetting her tummy. We are half way through them however.
 
Ann, sorry to see this. You've been given some good advice. Between the advice and the care you've always given Tess, I'm sure she'll come through this with flying colors!

There are all too many of us who have successfully dealt with DKA and all that comes after hospitalization. Just holler if you need more help.
Sending healing vines and hugs...

:bighug::bighug::bighug:
 
It will be interesting to see how far down 0.1u brings her today. That's a big drop but the higher they are, the more they can drop especially if her lev depot was not entirely drained and, as said, the lev onsets about the same time.

I still think it was ok today, under the circumstances, to give it to her at +3. If you continue to use it, you'll know that you could get a big drop when the lev onsets at the same time as the R.
 
I'm so glad to hear both of your kitties are doing well. What a week for you guys! I was off line between Thurs. and last night -- no internet.

Unless Marje or Libby suggest differently, you want to be careful with diving R so the nadir from the R and the Lev don't overlap. It may not be a huge issue if numbers are high but if they are starting to come down, it could become an issue.
 
that's ok for now, it's a big drop but 317 is a much better place for the Lev to start than 506. If she keeps responding that well to the R, then you'll know that she is a cat that can only handle it at the very beginning of a bounce. That has always been my favorite way to use R anyway, when we're not trying to battle ketones. Use it to try to *prevent* high numbers rather than to bring them down. But when there are ketones, you have to do whatever is needed.

The nice thing about R is that you can give it more than once per cycle, if you need to and you know what you're doing. If she starts to bounce big from this drop and you think the Lev is done, you can give a little more R toward the end of the cycle. If you can prevent her from going to HI in the first place, then the Lev will have a better chance at doing its job and you probably won't need as much R.

You want to just tap her down, not slam her down, but repeated little taps can be quite effective in experienced hands.
 
Yikes! I'm sorry about the DKA and the ER and the stay at the vetty. Hugs to you and John and skritches to Tess. Sending tons of healing vines.
Liz
 
That's a good number at +7. Ideally, when you are giving R for bounces, you just want to see numbers stop going up and if they come down, just come down about 50-100 mg/dL but as Libby said, you want her out of the 500s in this instance so the lev can grab on, hopefully, from a lower starting place.
 
Hi guys,
We're in the city and just getting caught up here. Wow, Tess, you certainly have had some events!! We are so glad to hear that she is bringing down her bgs with the help of R and all the fabulous beans who know what to do with it. So we are sending a bouquet of beautiful vines. Rusty hopes Tess can join him and all the L& L kitties this week for fun. But he'll save some hotdogs for her if she can't come.

Brava Emma, you don't let the loss of 9 teeth get in your way. I'll bet that lizzard tasted good!

Hugs and scritches,

Ella & Rusty
 
(((Ann and John))) I was worried about you as well, I am sending tons of prayers and healing vines for both your girls. Thank God you caught it early, I can't imagine anything scarier than DKA and especially what Marje says, how a kidney infection might not show on the BW. Many vines!!
 
Sending more hugs to you both and scritches for both kitties. I know how scary DKA is and my heart just dropped when I saw Tess was in trouble. Thankfully you were onto it so quickly and yay for the R! I'm also thankful that Emma has bounced back from her dental so well. What a rough time for you guys :bighug::bighug::bighug::bighug:
 
I used to do a TOR by holding the plunger tightly closed with my thumb and then inserting the needle into the R vial while holding the plunger, and then releasing the plunger once it was inside. That would give me about 1 drop of R.
 
As much as you test and as experienced as you are, i think you are ok giving another dose of R now. At your last test she was still over 300 - at least what i can see on the spreadsheet, and she's risen from the nadir from this cycle.
 
I had a feeling something was wrong...I noticed there weren't any Tess condos for a few days. She is so lucky to have you as her beans.! Sending tons of prayers for both her and Emma!!!
 
Just checking in this morning. I see you gave R again at +11 and it didn't touch her....she went up. This morning was her fifth lev dose. I wonder if you should increase her dose tonight if you don't see some better numbers today.

Sending more vines
 
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