4/14 Silver AMPS 232 +2=265 +4=259 +6=252 +8=254 +10=266 PMPS 254

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carfurby said:
I hope you can make it safely to the vet today and the vet can help you figure out what is going on with Silver's numbers. Sending prayers.
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Thanks. Not sure what else he can do - we already had a full blood panel done. Pancreatic test - wouldn't that show up in the blood? Even the teeth - the emergency vet looked and said he didnt see any sign of infection. So I am baffled. It is raining hard and due to switch over to freezing rain in half an hour. Our appointment is in three and a half hours so I do not know if I will make it. But that will mean waiting two more weeks as I am out next Saturday. Oh dear.
 
If there is nothing going on (infection, etc) then after your curve why wouldn't you increase the dose? Maybe its just as simple as Silver needs more juice??
 
Stacy & Asia said:
Send your weather prediction people down here then, please. Half the time they say we will get a big snow, it ends up raining, we get a dusting, or nothing happens at all. :joyful:

I hope you did not wake up to an ice mess.
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Actually it's freezing rain now while I'm at the vet. My car is encased in ice.

Vet okay. Had to stand my ground re the dosing and ignore his request for a fructosamine test. He said the Recovery food he's been getting could be increasing his BG and to hold off on giving that for a few days. He's off now getting the dental quote and nurses will do pancreatitis test. Silver purring at the vet so he's quite happy. Vet suggested lower insulin dose at night than in the am (again I'm listening but ignoring). I told him I would not be happy with the use of Metecam or Convenia. Hope he heard me.
 
Beenie (GA) said:
If there is nothing going on (infection, etc) then after your curve why wouldn't you increase the dose? Maybe its just as simple as Silver needs more juice??
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No. That would not be the right thing to do until he has had his dental and the pancreatitis test comes back. If you look at his ss you will see that the last three increases have had no effect. Best find cause of numbers not dropping first.
 
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Does this quote look reasonable? @Stacy & Asia @Tracey&Jones
 
I think it looks very reasonable, but I’m probably not the most knowledgeable person for this, it’s canada dollars and I don’t know what is typical there, but also, when I got Asia’s dental, it was in the thousands of dollars (and she was in and out, no hospital stay in that price), so anything without 4 digits before the dot would look reasonable to me anyway! ;)
 
Love-Paula aka Woodsywife said:
You shouldn't need to skip work for a dental. Usually you drop kitty off as soon as they open and pick up late afternoon or right before they close.

In regards to increasing insulin to no effect. A couple of things; you just haven't reached the dose yet, kitty might be resistant to insulin, you don't know if Silver is hitting blue during the day, maybe the insulin itself isn't the right one this time. Might consider an abdominal ultrasound, it could pick up something that blood work doesn't.

Olive's ss looks like Silvers just with pink preshot. Olive just doesn't want to give them up or stay blue longer than a few hours. We do know she has a tumor (found on ultrasound) that is probably causing it but will never know the type as a biopsy is out of the question. So we keep increasing knowing she might always require treatment this way which is quite aggressive. She hasn't been on insulin long enough to do the resistance blood test yet. Cushings came back negative. She is better now than when she arrived, if this is the best it can be than so be it. She is happy, feeling good, not in pain and even starting to play now. Silver could be in similar situation, cause is unknown. He needs what he needs in dose. I don't think in terms of the dose # anymore. It is what it is. Resigned to the fact she is high dose and it will go higher. Her overall demeanor is what I consider now. Just food for thought here.
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Well I start work in Toronto at 8am - I have to leave at 6:15am to get there on time. So drop off st 8 means I wouldn't get to work until quite late. I've booked an appt for April 25th and we can go from there. Was told I could leave him overnight at no charge but then he would have no food from 6:30pm until after the dental. I think that's too long as I would give him a bedtime snack at 11pm before bed if he was here.
 
Stacy & Asia said:
I think it looks very reasonable, but I’m probably not the most knowledgeable person for this, it’s canada dollars and I don’t know what is typical there, but also, when I got Asia’s dental, it was in the thousands of dollars (and she was in and out, no hospital stay in that price), so anything without 4 digits before the dot would look reasonable to me anyway! ;)
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Canadian would be less in US dollars. The "hospital stay" is just them keeping him for the day for the dental. No overnight.
 
Surprised his numbers didnt go sky high - that +4 was just as we got in the door from vetty visit. I would so love to see a blue today.

Question - I told the vet no Metacam or Convenia (as I read that on DCIN's list of no no's to the emergency vet) - why are they no no's? @Chris & China? I have had them put a note in his file so they had better listen.
 
Metacam is really hard on the liver or kidneys can't remember which but I think kidneys. When vets first started using it, they were using the same dosage strength used for dogs. Guess what...cats are different and it ended up killing/harming some kitties. The product is black labeled in the US. In Canada, they came up with a reduced dosage strength meant for cats. However it is a pretty hit or miss if a kitty will still react to it. Jones didn't, my civvie ended up with the runs, off her food after her dental. So, for me, all my cats are on the do not use list for metecam.

Covenia - is an inject-able anitbiotic, that if there is an allergic reaction..you can't get the AB out of the system. So it is great you don't have to pill a cat for 10 days...but if something goes wrong you are stuck. I am not sure if there is a lot of cases of allergic reactions..but there is a chance.

I am in Alberta...so everything is higher here...my civvies dental cost 1200 for 3 extractions, xrays, cleaning, in hospital care and the meds to go home with. So I think that is a reasonable quote. Maybe someone from ON can jump in and answer.

Just a note, you can have inflamed gums due to dental disease. Happens in humans as well - that old bleeding gum thing when you brush. Doesn't mean there is an infection per se but the gums are not in good health either. For my civvie...there were 2 teeth that were reabsorbing under the gum line...couldn't see a thing by visual check, but she was in pain and things were inflamed underneath.

I don't think it is pancreatitis as you haven't mentioned some of the common symptoms of it. I really wonder if there is something going on underneath the gum line.

That vet is not good with FD. Let us hope he can do the dental and then you can move on.
 
I taped a big sign to the carrier with the meds I do not allow in bold large red ink. I had 2 cats given dentals last February. February is dental month and my vet gives 20% off during it and I got multipet discount. They were routine, no extractions, they did not do xrays unless there are extractions (even though I requested). It was $545.0 for Tripper and $465 for Tux. Extraction was $150 extra per tooth. So I think your estimate is reasonable.
 
Tracey&Jones said:
Metacam is really hard on the liver or kidneys can't remember which but I think kidneys. When vets first started using it, they were using the same dosage strength used for dogs. Guess what...cats are different and it ended up killing/harming some kitties. The product is black labeled in the US. In Canada, they came up with a reduced dosage strength meant for cats. However it is a pretty hit or miss if a kitty will still react to it. Jones didn't, my civvie ended up with the runs, off her food after her dental. So, for me, all my cats are on the do not use list for metecam.

Covenia - is an inject-able anitbiotic, that if there is an allergic reaction..you can't get the AB out of the system. So it is great you don't have to pill a cat for 10 days...but if something goes wrong you are stuck. I am not sure if there is a lot of cases of allergic reactions..but there is a chance.

I am in Alberta...so everything is higher here...my civvies dental cost 1200 for 3 extractions, xrays, cleaning, in hospital care and the meds to go home with. So I think that is a reasonable quote. Maybe someone from ON can jump in and answer.

Just a note, you can have inflamed gums due to dental disease. Happens in humans as well - that old bleeding gum thing when you brush. Doesn't mean there is an infection per se but the gums are not in good health either. For my civvie...there were 2 teeth that were reabsorbing under the gum line...couldn't see a thing by visual check, but she was in pain and things were inflamed underneath.

I don't think it is pancreatitis as you haven't mentioned some of the common symptoms of it. I really wonder if there is something going on underneath the gum line.

That vet is not good with FD. Let us hope he can do the dental and then you can move on.
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Actually this vet is very experienced with FD as he has two of his own with FD. We just don't agree on all things and that is ok. I can ignore what I want to ignore. I really don't like vets talking to the wall instead of me but that's the third one I've come across that does it. He's better on the phone. I presume they are just better with animals. He clearly was great with Silvera and Silver was very relaxed around him. So that alone makes me happy. He did mention gingivitis so that's not good I am presuming.

Got dental booked for April 25th and I think I'd like to keep his dose the same until then? Guess it depends on the next few days. Off to do +6 now.
 
Love-Paula aka Woodsywife said:
I taped a big sign to the carrier with the meds I do not allow in bold large red ink. I had 2 cats given dentals last February. February is dental month and my vet gives 20% off during it and I got multipet discount. They were routine, no extractions, they did not do xrays unless there are extractions (even though I requested). It was $545.0 for Tripper and $465 for Tux. Extraction was $150 extra per tooth. So I think your estimate is reasonable.
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My vet does extractions at a rate of $140 per 15 mins. @Tracey&Jones I didn't realize yoru province has higher prices than ON?
 
Juliet said:
No. That would not be the right thing to do until he has had his dental and the pancreatitis test comes back. If you look at his ss you will see that the last three increases have had no effect. Best find cause of numbers not dropping first.
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:banghead: I guess I just don't understand. I thought with a history of DKA giving the kitty the insulin they need is priority to keep the numbers down. So lets say after the dental if dose needs adjusting down like @Judy and Boomer then you reduce as necessary. Not arguing just trying to understand for my own edification.
Hopefully all gets sorted out and you see Silver's numbers come back down.:)
 
Beenie (GA) said:
:banghead: I guess I just don't understand. I thought with a history of DKA giving the kitty the insulin they need is priority to keep the numbers down. So lets say after the dental if dose needs adjusting down like @Judy and Boomer then you reduce as necessary. Not arguing just trying to understand for my own edification.
Hopefully all gets sorted out and you see Silver's numbers come back down.:)
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Every cat is different is the important thing here. DKA has not been confirmed and Silver does not have a history of DKA. The fact he recovered so quickly and was off his food less than 24 hrs vet is not convinced it was DKA especially as there was no infection and quite a high dose of insulin. The fact Silver has had more food than usual and high calorie Recovery food could easily be reason for higher numbers. I am following SLGS and out 12 hrs a day so will only increase insulin when it is safe to do so. Now is not the time as he is still recovering from last weekend and getting used to the dose increase from a few days ago.

His dental is just ten days away and I may leave dose as is until after the dental.
 
Beenie (GA) said:
:banghead: I guess I just don't understand. I thought with a history of DKA giving the kitty the insulin they need is priority to keep the numbers down. So lets say after the dental if dose needs adjusting down like @Judy and Boomer then you reduce as necessary. Not arguing just trying to understand for my own edification.
Hopefully all gets sorted out and you see Silver's numbers come back down.:)
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I don't have any firsthand knowledge of DKA so it's difficult for me to comment. I'm not sure yet whether Boomer's dose will need adjusting down....after a dental he goes quite low that night and then tends to be in good numbers for a short period of time. He actually went into remission once after a dental but it only lasted a few weeks. He received a full dose this morning and will have some NDW until the depot fills. Then we'll see if his numbers drop.
 
Red & Rover (GA) said:
Glad you had a safe trip to and from the clinic, Juliet. The roads are absolutely atrocious.
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Thanks. They are awful. Doesn't help with a crying cat next to you. He's cozy and sleeping beside me with his sister on the other side. Nice Saturday afternoon although I'm doing a curve so I need to disturb him for his +8.

@Judy and Boomer I'm hoping he does come down after the dental. None of us are convinced he had DKA.
 
Juliet said:
Thanks. They are awful. Doesn't help with a crying cat next to you. He's cozy and sleeping beside me with his sister on the other side. Nice Saturday afternoon although I'm doing a curve so I need to disturb him for his +8.

@Judy and Boomer I'm hoping he does come down after the dental. None of us are convinced he had DKA.
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Trial by fire for you as a driver. I'm glad you got there and back safely. Here's to the dental - I hope it helps Silver a lot! :)
 
Question re dose - given his curve - should I increase again? I was going to hold off the next ten days til his dental but I am worried due to last week's suspected DKA incident. Following SLGS would say wait a week but I am also told that rules go out the window when DKA and ketones are in the picture. Tagging some old timers and hoping someone can advise on this.

Thanks

@Jill & Alex (GA)
@Sienne and Gabby (GA)
@Sandy and Black Kitty
@Tracey&Jones
@Stacy & Asia
 
Have you thought about TR? I will probably get flack for this, but what about not waiting the 7 days and increasing after 5 days? I know it's not written anywhere but it's between the TR and the SLGS methods.
 
Love-Paula aka Woodsywife said:
Have you thought about TR? I will probably get flack for this, but what about not waiting the 7 days and increasing after 5 days? I know it's not written anywhere but it's between the TR and the SLGS methods.
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I'm just not sure what to do the increase. TR isn't possible for me unfortunately. I'm out 12 hours a day for work and can't leave food out very easily so I don't meet the requisites for doing TR. I am considering dose increase but I'm on the fence hoping others will jump in.
 
Ok so I increased. My rationale - his numbers are consistently high yellows with not a blue in sight and I am nervous of DKA given that he has ketones. If I was close to seeing any blues I would have held dose for the full seven days.
 
Love-Paula aka Woodsywife said:
Your curve today does indicate an increase is needed. I see you did. Just have too how Silver does with it.
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Yes but as I said before you cannot just look at the curve today - there are several mitigating circumstances - not sure if you are aware he was hospitalized over the weekend and was taken off Lantus for that duration; he has been eating Recovery food which raised his BG that I have now stopped giving; the depot was completely depleted and needed refilled not to mention he was at the vet today which wouldnt have helped his numbers. My ONLY rationale for increasing is the presence of ketones - NOT this curve as it is unrealistic to say the least. Also he just did have an increase three days ago - I am beginning to feel the increase was not wise. Time will tell.
 
Juliet, I'm sorry if this has been answered elsewhere but how old is your Lantus vial? Is it still crystal clear, no snowflake like floaties in it? I ask because way back when I was using it (the 3 mL cartridges) one of the cartridges suddenly "turned" on me for no reason I could determine. One day I took a good look in a bright light and I could see these miniscule floating flattish crystals in it that I hadn't noticed before. At that time Teasel was sky high all the time so it wasn't his BG numbers that alerted me.
 
Kris & Teasel said:
Juliet, I'm sorry if this has been answered elsewhere but how old is your Lantus vial? Is it still crystal clear, no snowflake like floaties in it? I ask because way back when I was using it (the 3 mL cartridges) one of the cartridges suddenly "turned" on me for no reason I could determine. One day I took a good look in a bright light and I could see these miniscule floating flattish crystals in it that I hadn't noticed before. At that time Teasel was sky high all the time so it wasn't his BG numbers that alerted me.
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Actually I was thinking that. It looks ok but I'm in a basement so hard to see closely. I'm more concerned because I got it from the Supply Closet and it took a week to arrive so I'm not sure how it was handled. I will get a new vial on Monday (can't go out tomorrow as my car is encased in four inches of ice and the storm isn't letting up until Sunday night). Good idea. Thanks.

Oh and if it's the insulin - what would I do about dose - if current insulin is bad then new insulin effectiveness could mean way too high a dose?
 
Juliet said:
Actually I was thinking that. It looks ok but I'm in a basement so hard to see closely. I'm more concerned because I got it from the Supply Closet and it took a week to arrive so I'm not sure how it was handled. I will get a new vial on Monday (can't go out tomorrow as my car is encased in four inches of ice and the storm isn't letting up until Sunday night). Good idea. Thanks.

Oh and if it's the insulin - what would I do about dose - if current insulin is bad then new insulin effectiveness could mean way too high a dose?
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If you have a bright desk lamp try putting the vial close to that light. That was how I saw the crystals in mine.
 
Juliet said:
Question - I told the vet no Metacam or Convenia (as I read that on DCIN's list of no no's to the emergency vet) - why are they no no's?
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In Europe people would think it very unreasonable to insist on refusing those medications. I posted a write-up I thought summarized things quite clearly regarding Metacam in the long thread that's in the Think Tank: http://www.felinediabetes.com/FDMB/threads/metacam-is-it-safe.190795/#post-2149473

As for Convenia, I've used it repeatedly with all my cats and am admittedly a fan, I know vets who use it every day at their clinic and have never seen an adverse effect.

Any medication can have adverse effects. Hey, even insulin can be bad when not dosed correctly. IMHO the crispation around convenia and metacam is unjustified and it's unfair to single out those two drugs as "worse than the rest".
 
Juliet said:
Actually I was thinking that. It looks ok but I'm in a basement so hard to see closely. I'm more concerned because I got it from the Supply Closet and it took a week to arrive so I'm not sure how it was handled. I will get a new vial on Monday (can't go out tomorrow as my car is encased in four inches of ice and the storm isn't letting up until Sunday night). Good idea. Thanks.

Oh and if it's the insulin - what would I do about dose - if current insulin is bad then new insulin effectiveness could mean way too high a dose?
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That would be a dilemma. You could ask here for advice but I'm guessing it would be wise to reduce just a little in advance of a day you can do a curve so the depot has resettled before curving. The pros here might have better ideas about that.
 
Stephanie & Quintus said:
In Europe people would think it very unreasonable to insist on refusing those medications. I posted a write-up I thought summarized things quite clearly regarding Metacam in the long thread that's in the Think Tank: http://www.felinediabetes.com/FDMB/threads/metacam-is-it-safe.190795/#post-2149473

As for Convenia, I've used it repeatedly with all my cats and am admittedly a fan, I know vets who use it every day at their clinic and have never seen an adverse effect.

Any medication can have adverse effects. Hey, even insulin can be bad when not dosed correctly. IMHO the crispation around convenia and metacam is unjustified and it's unfair to single out those two drugs as "worse than the rest".
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I won't be using either. Thanks tho. Glad I'm not in Europe.
 
Kris & Teasel said:
That would be a dilemma. You could ask here for advice but I'm guessing it would be wise to reduce just a little in advance of a day you can do a curve so the depot has resettled before curving. The pros here might have better ideas about that.
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Hmm well I just did a curve and I can't do another one until two weeks time.
 
Juliet said:
I am out all day next Saturday.
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I see..
Juliet said:
IMy rationale - his numbers are consistently high yellows with not a blue in sight and I am nervous of DKA given that he has ketones. If I was close to seeing any blues I would have held dose for the full seven days.
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FWIW I agree with your rationale however the last ketone reading I see is several days ago.
Being that the one piece of your decision making is based on ketones, consider how quickly the levels can change - 2 days without a reading is an eternity
 
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To continue (sorry-I accidentally hit “post” previously, before completing my thoughts)...
We know right now that although ketones are above ‘small ‘ he’s OK and we know that is uncommon. What we don’t know is where Silvers tipping point is or what might tip the balance and give ketones the upper hand ...and frankly it’s best we don’t find out.
If it were my cat I would want the ketones as far back in history as possible before the dental.

Since you decided to increase, If you have concerns about how low he may go when you are away tomorrow you can leave HC out for him.

Regarding the cost of a dental, below is the estimate I received (in US dollars) for one of our civvies upcoming (on Tuesday!) dental.


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Sandy and Black Kitty said:
I see..FWIW I agree with your rationale however the last ketone reading I see is several days ago.
Being that the one piece of your decision making is based on ketones, consider how quickly the levels can change - 2 days without a reading is an eternity
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His ketones are the same. I don't post the reading every day but I am testing every day. The dental is already booked. Vet seems to think that is okay.m
I think I've already stated on many occasions I can't leave food out.

You're letting your vet give Convenia and Metacam?? DCIN stated those as huge no no's so I thought bad idea. I've put in Silver's file that he's not to be given either.
 
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