6/25 Cookie ProZinc AMPS 582

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pstanfield

pstanfield

Member Since 2021
@@FrostD
@@JanetNJ

Ketones - 0.5
AMPS BG 582

Gave 0.75u.

Thought she was not looking good because she wasn't responsive and was laying down on her blanket, far away from her water bowl. Turns out she was just sleeping nicely, and jumped up when I opened a can of food. :) Her weight is better, too. Not great, but trending up!!! Was at 3.09 lbs on 6/21, and is at 3.9 lbs this morning.

First two bowel movements this morning were soft but formed, and third one was actually normal. No diarrhea, no mush, hoping this means she is really starting to turn a corner.

Prior threads if needed:
Previous Threads for History-
Thread 1: 6/17 - 6/19 Thread
Thread 2: 6/19 - 6/21 Thread
Thread 3: 6/21 - 6/22 Thread
Thread 4: 6/23 Thread - Went Low
Thread 5: 6/24 Thread
 
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Mostly good news! We'll keep an eye on those ketones. I hate to increase on a nighttime cycle so hopefully those stay steady or go down
 
pstanfield said:
+5 BG 212 - A little early to be going up :confused:
Ketones 0.3
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That's usually a sign that the dose isn't high enough, it "runs out" so to speak. It could also be considered flat really, 197 and 212 are basically the same.

Some cats just don't get good duration from certain insulins, but we've seen she can have good cycles at higher doses so I don't think that's the case.

If the ketones hold where they are I'd like to keep 0.75U tonight for consistency, but it's always your call, especially if you're worried about ketones. I think 1U is a safe dose at this point and will get her in better numbers.
 
Ok seeing that 300 now and still low appetite I'd go up to 1U tonight. Current dose not holding her long enough in blue or yellow, so concern for ketones and her weight (unregulated diabetics typically need more food to even maintain weight, and she has some serious gaining to do yet no appetite).

If she were closer to ideal weight and further past the DKA we wouldn't be changing the dose so quickly, so anyone else reading this should know this is a special case.
 
We are now +9.5 and HI and ketones are at 0.7. :(. Should I give fluids? She has eaten about 92 calories worth of food today. Fluids and force feed? She has eaten, I actually have been weighing her food before and after she eats, and calculating the calories, as well as the force feeding.

@FrostD
@JanetNJ
 
pstanfield said:
We are now +9.5 and HI and ketones are at 0.7. :(. Should I give fluids? She has eaten about 92 calories worth of food today. Fluids and force feed? She has eaten, I actually have been weighing her food before and after she eats, and calculating the calories, as well as the force feeding.

@FrostD
@JanetNJ
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Yes. Fluids and assist feed.

How are you assist feeding by the way? It's best to do small amounts every so often, so every half hour or hour or so. That might help you get more in her during the day.

Thinking out loud, just so you have my thoughts, you could try 1.25. Buttt that's a big jump, we don't usually increase by that much at these low doses, and might shock her system a bit and be a little counterproductive by causing a possible bounce. She hung very very low for a long time at 1.5, so the 1.25 makes me wary, mostly for your sleep and sanity (that and it's hit or miss who is around at night, usually Bhooma and Bron though).

If it were me personally I'd be trying 1.25U, though I'm comfortable losing sleep and feeding those hanging low numbers, and I'd hazard a guess that a handful of others would disagree with me on this one (lack of dose consistency, too big a jump, and potentially leaving you to fend for yourself overnight).

All that said, I think you have enough data and understanding to do what you think makes sense. As we say, you hold the syringe!
 
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FrostD said:
Yes. Fluids and assist feed.

How are you assist feeding by the way? It's best to do small amounts every so often, so every half hour or hour or so. That might help you get more in her during the day.

Thinking out loud, just so you have my thoughts, you could try 1.25. Buttt that's a big jump, we don't usually increase by that much at these low doses, and might shock her system a bit and be a little counterproductive by causing a possible bounce. She hung very very low for a long time at 1.5, so the 1.25 makes me wary, mostly for your sleep and sanity (that and it's hit or miss who is around at night, usually Bhooma and Bron though).

If it were me personally I'd be trying 1.25U, though I'm comfortable losing sleep and feeding those hanging low numbers, and I'd hazard a guess that a handful of others would disagree with me on this one (lack of dose consistency, too big a jump, and potentially leaving you to fend for yourself overnight).

All that said, I think you have enough data and understanding to do what you think makes sense. As we say, you hold the syringe!
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Vet said to give 5 ml to start, then 10 ml, and go up each 2 hours with another 5, maxing at 30 ml. If she eats on her own, stop assist feeding. The problem with that is, when she does eat on her own, she is not consuming enough calories, so I decided to assist feed going about 10-15 ml every 1-1.5 hours. How many mls per 30 min would you recommend?
 
pstanfield said:
Vet said to give 5 ml to start, then 10 ml, and go up each 2 hours with another 5, maxing at 30 ml. If she eats on her own, stop assist feeding. The problem with that is, when she does eat on her own, she is not consuming enough calories, so I decided to assist feed going about 10-15 ml every 1-1.5 hours. How many mls per 30 min would you recommend?
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I always did about 10-15mLs of very watered down food every 30 mins to 1 hr when I had time (so like in the few hours before bed, then give him a break, wake up middle of the night and try again). I tried not to push him past the point where he was really fed up, but sometimes they just need the darn food.

30mL seems like a lot for a cat that's nauseous and not feeling great
 
*really, I just tried to divide up the calories he needed into different sessions as best I could. I don't think I ever went past 20mL. If he took a decent amount, then I gave him a little longer break between.

Did she give you a daily calorie target for her to gain the weight back?
 
FrostD said:
*really, I just tried to divide up the calories he needed into different sessions as best I could. I don't think I ever went past 20mL. If he took a decent amount, then I gave him a little longer break between.

Did she give you a daily calorie target for her to gain the weight back?
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I agree, I have not gone past 20, and usually have been giving 10-15 ml. Target to maintain is 208, to gain is 220, which seems like a lot for her right now, since she is only 3.9 pounds. Either way, I need to be more aggressive in assist feeding, because the little that she is eating on her own is not going to do it.

Also, I see the importance of the keto blood meter, I just took a using sample and it is negative, but the meter definitely showed her going up, even if slightly. Better to monitor earlier, instead of waiting for ketones to show up in the urine.
 
pstanfield said:
I agree, I have not gone past 20, and usually have been giving 10-15 ml. Target to maintain is 208, to gain is 220, which seems like a lot for her right now, since she is only 3.9 pounds. Either way, I need to be more aggressive in assist feeding, because the little that she is eating on her own is not going to do it.

Also, I see the importance of the keto blood meter, I just took a using sample and it is negative, but the meter definitely showed her going up, even if slightly. Better to monitor earlier, instead of waiting for ketones to show up in the urine.
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Yep! It's expensive but so worth it in these situations.

I'm actually a little concerned she still doesn't have an appetite. Does she still seem nauseous or in pain? It might be worth checking with your vet if you can increase the dose of nausea and/or pain meds. I really feel like she should be eating more on her own by now if meds were fully working.

If I remember correctly, she did not give you an appetite stimulant, correct?' II'd call and see if maybe they can give you some or a prescription before they close for the weekend (if they haven't already). Appetite stimulants don't really help if they're still nauseous, so ideally can tweak nausea meds doses and combine with the stimulant to get her going.

All you can do is do your best to get as much as you can in her, you're doing a good job! And more than a lot of people would be willing to do.
 
I'm waiting for a callback on extending her antibiotic, last dose is today. They said she would be in meetings all day, but would get back to me before the end of the business day. Also, they are open tomorrow so I have that as a back-up. Her appetite honestly comes and goes, I've seen it pick up at different times, but after she eats something, she seems satisfied and walks away, but she has yet to finish a 3 oz can of food in one sitting. It's usually about 1/2 oz to 1 oz, and it's picking between different foods.

I've asked about the appetite stimulant, and they want me to keep trying everything I can with Fortiflora, toppings or offering a variety, and the Vit B-12. Well I think we have run that gamut and it is still not working consistently enough to get her eating more. The caution with the cyproheptadine is with her elevated liver enzymes, I believe, so they were waiting to see how she does without it.
 
pstanfield said:
I'm waiting for a callback on extending her antibiotic, last dose is today. They said she would be in meetings all day, but would get back to me before the end of the business day. Also, they are open tomorrow so I have that as a back-up. Her appetite honestly comes and goes, I've seen it pick up at different times, but after she eats something, she seems satisfied and walks away, but she has yet to finish a 3 oz can of food in one sitting. It's usually about 1/2 oz to 1 oz, and it's picking between different foods.

I've asked about the appetite stimulant, and they want me to keep trying everything I can with Fortiflora, toppings or offering a variety, and the Vit B-12. Well I think we have run that gamut and it is still not working consistently enough to get her eating more. The caution with the cyproheptadine is with her elevated liver enzymes, I believe, so they were waiting to see how she does without it.
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Why do you think she needs more antibiotics? That could be what's killing her appetite.
 
JanetNJ said:
Why do you think she needs more antibiotics? That could be what's killing her appetite.
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She was off for two days after a 10 day dose, and started to do poorly, that's where her BG was higher, and it started coming down when we restarted the antibiotics on Monday (6/21). Vet said she wanted her on for 7 days from Monday, but I didn't have enough Clavamox that I had gotten from the ER to last past today, which is also it's expiration date. Edit - When I took her in on Monday 6/21, Cookie also had a fever.

We are not doing well, we found some greenish/yellowish discharge near her vaginal area, now suspecting a UTI. Taking her in tomorrow, but I am at a loss. BG is still HI, she is weak, and I don't know what else to do. And her ketones are creeping up, and I only have one ketone strip left because it came with 10, and the other strips won't get here until Sunday.

Edit: I have an appointment with vet first thing in the morning. I just cannot afford the ER. I've spent $10,000 at the ER alone this month, and it's $1500 a day. I am feeling like it might be time to let her go.
 
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pstanfield said:
She was off for two days after a 10 day dose, and started to do poorly, that's where her BG was higher, and it started coming down when we restarted the antibiotics on Monday (6/21). Vet said she wanted her on for 7 days from Monday, but I didn't have enough Clavamox that I had gotten from the ER to last past today, which is also it's expiration date. Edit - When I took her in on Monday 6/21, Cookie also had a fever.

We are not doing well, we found some greenish/yellowish discharge near her vaginal area, now suspecting a UTI. Taking her in tomorrow, but I am at a loss. BG is still HI, she is weak, and I don't know what else to do. And her ketones are creeping up, and I only have one ketone strip left because it came with 10, and the other strips won't get here until Sunday.

Edit: I have an appointment with vet first thing in the morning. I just cannot afford the ER. I've spent $10,000 at the ER alone this month, and it's $1500 a day. I am feeling like it might be time to let her go.
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Hang in there :bighug: you've had a rough week with little sleep. As much as we never want to see a cat put down, we're not there with her, it's your decision what is best for you guys.

WalMart usually carries the strips but not sure if in store. amazon might be able to get them to you by tomorrow. For now the urine ones will do.

I'm actually thinking yeast infection, if it's anything like humans, antibiotics cause yeast infections. I'd have thought the boulardii would help but maybe she's just got too much going on.

Given the ketones, I really think 1.25U is your best shot at keeping everything in check. So if it comes down to it, know that you've done everything you can within your means.
 
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FrostD said:
Hang in there :bighug: you've had a rough week with little sleep. As much as we never want to see a cat put down, we're not there with her, it's your decision what is best for you guys.

WalMart usually carries the strips but not sure if in store. amazon might be able to get them to you by tomorrow. For now the urine ones will do.

I'm actually thinking yeast infection, if it's anything like humans, antibiotics cause yeast infections. I'd have thought the boulardii would help but maybe she's just got too much going on.
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I just feel so bad for her. Do I keep assist-feeding her? She's got to feel awful. I was hoping her numbers would start coming down by now. I am torn between wanting to just let her be, and wanting to keep her calories up.
 
She's week because of the infections. Once they clear she should start feeling better. I'm so sorry you guys are struggling.


 
pstanfield said:
I just feel so bad for her. Do I keep assist-feeding her? She's got to feel awful. I was hoping her numbers would start coming down by now. I am torn between wanting to just let her be, and wanting to keep her calories up.
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The numbers are the least of her issues. The priority is solving this infection and getting enough calories in. Does she like tuna? It's more important right now that she eats.... More than what she eats. Even if all you can get her to eat is higher carb or even dry. The priority is getting her to eat. If she won't than assist as needed.
 
pstanfield said:
I just feel so bad for her. Do I keep assist-feeding her? She's got to feel awful. I was hoping her numbers would start coming down by now. I am torn between wanting to just let her be, and wanting to keep her calories up.
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Like Janet said, the numbers are a small part of the picture.

The whole thing is sort of a wicked cocktail. The infections are keeping BG sky high, there's nothing more you can do with insulin to help that (because of how low it drops her, the insulin is doing it's job). The infections, BG swings, and probably antibiotics are contributing to overall poor feeling and inappetence. All of which in turn contributing to ketones (I don't think you're in the danger zone yet, so please keep assist-feeding, that's the most important thing you can do to keep DKA away right now). I'm sure she feels like absolute crap. BUT, and this is what I've always looked to with all my animals, if she's got fight left, that's what matters. Eating on her own is a good sign. If you find something she'll eat on her own, go for it, no matter the carbs. Just let us know so we can think about the insulin requirements.

I had a sneaking suspicion something wasn't resolved yet based on numbers and behavior. While the clostridium might be gone, I wonder if triaditis is still lingering. Plus possible yeast infection or UTI.

I would get a urine sample if you can, that way they don't have to catheter her or use the needle thing. And the discharge if you see it again.

I'm really hoping tomorrow is a straightforward appointment with some answers...and probably more antibiotics.

I would make yourself a list of things for the appointment so as not to forget. Things like:
-Med adjustments
-Med refills if you need them (nausea, pain, probiotics, fluids, supplies)
-UTI/yeast infection discussion
-Appetite stimulant
 
FrostD said:
Like Janet said, the numbers are a small part of the picture.

The whole thing is sort of a wicked cocktail. The infections are keeping BG sky high, there's nothing more you can do with insulin to help that (because of how low it drops her, the insulin is doing it's job). The infections, BG swings, and probably antibiotics are contributing to overall poor feeling and inappetence. All of which in turn contributing to ketones (I don't think you're in the danger zone yet, so please keep assist-feeding, that's the most important thing you can do to keep DKA away right now). I'm sure she feels like absolute crap. BUT, and this is what I've always looked to with all my animals, if she's got fight left, that's what matters. Eating on her own is a good sign. If you find something she'll eat on her own, go for it, no matter the carbs. Just let us know so we can think about the insulin requirements.

I had a sneaking suspicion something wasn't resolved yet based on numbers and behavior. While the clostridium might be gone, I wonder if triaditis is still lingering. Plus possible yeast infection or UTI.

I would get a urine sample if you can, that way they don't have to catheter her or use the needle thing. And the discharge if you see it again.

I'm really hoping tomorrow is a straightforward appointment with some answers...and probably more antibiotics.

I would make yourself a list of things for the appointment so as not to forget. Things like:
-Med adjustments
-Med refills if you need them (nausea, pain, probiotics, fluids, supplies)
-UTI/yeast infection discussion
-Appetite stimulant
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Does the urine sample have to be fresh, and does it need to be in a sterile container? Store in refrigerator or room temp?

I used a medical Q-tip (what I use to clean my dog’s ears) to clean some of the discharge off her fur, and put that in a baggie. I’ll bring that. So with her numbers being high, I am assuming there is no point in testing tonight, but test AMPS?

Thank you to everyone for the guidance and support. It is so hard to know just how much our fur-babies can take. If she is willing to fight, so am I , and I just need some hope that she can fight this.

Thanks, @Janet, for the relaxing music, I needed that for sure!!

Cookie has about 20 ml of the Purina CN left so I am going to make sure she gets that tonight, I'll break it up into to parts so it isn't so much for her.
 
pstanfield said:
Thanks, @Janet, for the relaxing music, I needed that for sure!!
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I often play healing music for cats videos when a cat is sick or on the way to the vet. It helps. Play one for your kitty toomorrow. It's funny one of the vets at the office I go to mentioned once she does that for her own cat and I was like ME TOO! LOL

I HOPE ALL GOES WELL tomorrow.
 
pstanfield said:
Does the urine sample have to be fresh, and does it need to be in a sterile container? Store in refrigerator or room temp?

I used a medical Q-tip (what I use to clean my dog’s ears) to clean some of the discharge off her fur, and put that in a baggie. I’ll bring that. So with her numbers being high, I am assuming there is no point in testing tonight, but test AMPS?

Thank you to everyone for the guidance and support. It is so hard to know just how much our fur-babies can take. If she is willing to fight, so am I , and I just need some hope that she can fight this.

Thanks, @Janet, for the relaxing music, I needed that for sure!!

Cookie has about 20 ml of the Purina CN left so I am going to make sure she gets that tonight, I'll break it up into to parts so it isn't so much for her.
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Relatively fresh yes. My vet always said collect them store in fridge, good for 24 hours. Ok if there some litter or stuff in it, just not a lot.

I would test 3 hrs from your last one just to be safe, we've seen her come down from blacks before. If shes still HI then maybe again 3 hrs after that, then AMPS.

She's got a lot going against her right now, but shes still in it!

You might want to ask the vet about short acting insulin...but I have no experience with it. It might help snag those high numbers and bring them down enough for the ProZinc to hold it down.

What time is AMPS for you? You're central time, right?
 
FrostD said:
Relatively fresh yes. My vet always said collect them store in fridge, good for 24 hours. Ok if there some litter or stuff in it, just not a lot.

I would test 3 hrs from your last one just to be safe, we've seen her come down from blacks before. If shes still HI then maybe again 3 hrs after that, then AMPS.

She's got a lot going against her right now, but shes still in it!

You might want to ask the vet about short acting insulin...but I have no experience with it. It might help snag those high numbers and bring them down enough for the ProZinc to hold it down.

What time is AMPS for you? You're central time, right?
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Yes, central time for me. AMPS is 5:00.
 
Poor girl, still HI and not standing on her own. It may be diabetic neuropathy from unregulated diabetes, that is almost always reversible given time. Id go ahead and give 1.25U in the morning unless she magically comes down. Good luck at the vet :bighug:
 
FrostD said:
Poor girl, still HI and not standing on her own. It may be diabetic neuropathy from unregulated diabetes, that is almost always reversible given time. Id go ahead and give 1.25U in the morning unless she magically comes down. Good luck at the vet :bighug:
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Melissa, you don't think this could be the high before the bounce clears? She had a similar black cycle 3 nights back and a black AMPS and then she was in limes through that cycle.
 
Bandit's Mom said:
Melissa, you don't think this could be the high before the bounce clears? She had a similar black cycle 3 nights back and a black AMPS and then she was in limes through that cycle.
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It could be, it's hard to tell if it's bounce, infection, or combination. Something isn't "adding up" on the SS as a cat on ProZinc, which is why I suspect infection is contributing.

I think 1.25U will be ok even if it's a bounce breaking cycle, it should be easier to handle than those lows the other day. Or if worried about time at the vet/more lime greens can do 1U, but I'm hesitant to recommend that because of the ketones.

Patty, same as last time I'd bring your kit and meter with you just to be safe.
 
@FrostD
@Bandit's Mom

She is not even able to move at all now. I don't think I can even feed her or if she'll be able to swallow. I am going to give the 1.25, but she is really not doing well.

Ketones are still at 0.8. I just used the last strip.

Edit - if I can't feed her, should I still give the 1.25u? I am lost on this. Also, her vet appointment is at 8 this morning, so about +2.5 from when I give her the shot.
 
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pstanfield said:
@FrostD
@Bandit's Mom

She is not even able to move at all now. I don't think I can even feed her or if she'll be able to swallow. I am going to give the 1.25, but she is really not doing well.

Ketones are still at 0.8. I just used the last strip.

Edit - if I can't feed her, should I still give the 1.25u? I am lost on this. Also, her vet appointment is at 8 this morning, so about +2.5 from when I give her the shot.
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I'm so sorry you're facing this. :( I don't know what has gotten ahold of her but I'm so terribly sad for you and her. :(. I would give the 1.25.
 
My poor sweet girl didn't make it. I could tell from the way she couldn't move this morning that it might be the end. She was getting progressively weaker through the night. By this morning, she could barely open her mouth and couldn't eat or drink, let alone move. I gave her a final dose, but suspected that she was going to be gone soon. I spent the last hour of this morning just talking to her and petting her. I am glad I was at least able to love on her at the end, but you will always wonder what more you could have done.

Thank you to everyone for all the support and guidance, at least it gave me some extra time with Cookie, otherwise I don't think she would have lasted this long. A few extra purrs and love from her was a blessing, and I am grateful for that. Much love to you all.

cat_wings>o
 
pstanfield said:
My poor sweet girl didn't make it. I could tell from the way she couldn't move this morning that it might be the end. She was getting progressively weaker through the night. By this morning, she could barely open her mouth and couldn't eat or drink, let alone move. I gave her a final dose, but suspected that she was going to be gone soon. I spent the last hour of this morning just talking to her and petting her. I am glad I was at least able to love on her at the end, but you will always wonder what more you could have done.

Thank you to everyone for all the support and guidance, at least it gave me some extra time with Cookie, otherwise I don't think she would have lasted this long. A few extra purrs and love from her was a blessing, and I am grateful for that. Much love to you all.

cat_wings>o
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Oh my goodness I am heartbroken. I had a sinking feeling her time was coming. I'll pray for peace for you. I hope you are comforted by knowing you really did EVERYTHING you could and she knew she was loved. ❤️
 
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Patty, I am really really sorry for your loss. Both of you fought hard till the very end. You did everything you could for her.
Fly free, Cookie! cat_wings>o
 
Oh I am so sorry :bighug::bighug: when I read your update in the middle of the night, I had a feeling I'd wake up to bad news. Like Janet said, please please know you did absolutely everything you could. It's clear how much you loved her, hugs to you all
 
Oh Patty, I am so very sorry for your terrible loss. No one could have done more for her or loved her more than you did.

Fly free, little one, and watch over your sweet mom. cat_wings>o
 
I’m so, so sorry for your loss. I’ve been following Cookie’s updates and you did such an amazing job doing everything you possibly could for her. Thinking of both of you.
:rb_icon:
 
Oh Patty, I have been following you and Cookie, my heart is broken, tears are flowing.
You did everything you could for her, she is no longer suffering
My deepest sympathies.
Fly High precious girl ♥♥:bighug::bighug::bighug::bighug:cat_wings>o
 
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