8/19 Garland AMPS 272 +2 293 +6 325 +9 409

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Violet and Garland

Violet and Garland

Member Since 2011
Garland fighting to recover from DKA and FHL. Has a feeding tube. Spent 7 days in ER, home now for 6. Still very lethargic. Just lays there :sad: NOTE- I noticed this morning it seems she threw up a little. Not much but some. Her last feed was at midnight, I think this happened around 6am? (i didnt see her do it, I only saw it when I checked on her)

Mixing clinicare with her recovery for the tube. Does the ratio matter?

How much extra water should I give? Right now she gets the 6ml after the feeds to flush the tube and another 6ml with her meds for the day

Lantus 2u 2x a day now

I have R to use as well



Previous threads
viewtopic.php?f=9&t=50135 (Lantus dosing/Ketones)
viewtopic.php?f=28&t=49370 (First thread, DKA/FHL)
 
Re: 8/19 Garland AMPS 272

Sandy & BK said:
Hi Violet,
Since you increased the Lantus to 2u, and being that the effects of Lantus are cumulative, You may see some action from the higher Lantus dose tomorrow. Based on that I think it's wise to be conservative with the R.
If Garland is over 300 at AMPS,and you will be able to get tests at +1, +2, +3 and +4 you can try giving her a tiny bit of R, 0.1u, immediately after her 2u of Lantus. If that has no effect and she remains high, you can give additional R around +7 or at PMPS, and at that time try 0.25u R. Again I'll stress - since you do not yet know how Garland will respond to R any time you give it you must closely monitor.
Click to expand...
Sandy is one of our experienced R users. Given her comments from last night and Garland's AMPS, I would suggest that you hold off on the R. The increased Lantus dose may be doing the job all on its own of bringing Garland's numbers down.

I don't have experience with using a feeding tube. Karrie or one of the other folks here who have more expertise in this area can better answer your questions.
 
Re: 8/19 Garland AMPS 272

(((Garland))) I hope she starts to feel better soon.

P.S. Lantus Land: be sure to stop by the LLEF condo to take a look at Garland's fundraiser.
 
Re: 8/19 Garland AMPS 272

No the ratio doesnt matter the thing is its replacing the water which has zero calories. So you want to still use enough clinicare that the food/clinicare goes through the tube easily. Clinicare has less calories than the food - the food is her medicine for FHL and a cornerstone in DKA recovery.

Did she vomit food this morning? Can you describe it - clear slime, bile, froth or food?

Is she using the litterbox?
 
Re: 8/19 Garland AMPS 272

Im not sure when she threw up... It wasnt "dryed up" yet, but it wasnt brand new fresh when I saw it at 730. I thought I remember checking on her around 4 or 5 and not seeing it? But I could be wrong. It looks like food? Its not much. Yep, shes using the litter box
 
Re: 8/19 Garland AMPS 272

Hi guys .. no advice on the ratio/water questions .. just wanted to say that I think you are doing great with garland .. I know it was a lot to take on, but you did and you are doing so well! Garland is very lucky to have such a caring bean .. hugs to garland!
 
Re: 8/19 Garland AMPS 272

Karrie, I have only used Clinicare for the 3 E tube kitties I had and the 4th one I worked with along with the vet that had FL, DKA and diabetes. Using just Clinicare is everything needed to turn liver around......Autumn was on it for 9 weeks but.......because it is a liquid you end up feeding a set amount every 3 hrs. 24/7. Ratio is not needed if using Clinicare to thin down food for tube, just thin it down to get through the tube using the Clinicare instead of water. I also recommend using Clinicare instead of water to thin down food for syringe feeding.
 
Re: 8/19 Garland AMPS 272

Good morning Violet ~O)
Nice AMPS today. Looks like you are seeing some action from the increase to 2u on the Lantus. Remember, with the Lantus you want to aim for consistency - every 12 hours, 2u (for now).
Keep us posted on the BGs as the numbers become available.
 
Re: 8/19 Garland AMPS 272 +2 293

wonderful news about her urine report and sending her lots more healing vines that she continues to keep getting better cat_pet_icon
 
Re: 8/19 Garland AMPS 272 +2 293

Now that we know she is zero for ketones I'm going to push you to get the right anti nausea medication for her to get her feeling better. As I noted in your thread on health FHL is horribly nauseating. Nausea is not just vomiting. She is nauseas without vomiting.

Here is the article on the FAF site which covers signs/causes and treatment of nausea in cats as you are a member it should load up for you: http://tinyurl.com/43xrgkn I can't seem to load it up though. On the FAF site - go to files - then the nausea/vomiting folder - the first article: *Nausea & Vomiting - Signs, Causes & Treatment Options
how to recognize nausea and what to do about it. Please read this today.

Here is an article linked within this that you should share with your vet. It tells why metoclopromide is not effective to treat nausea in cats. It is great for dogs. It may stop vomiting due to stomach motility but will not help a cat feel well as the nausea remains untreated. http://veterinarycalendar.dvm360.com/avhc/content/printContentPopup.jsp?id=676860

Go for Ondansetron or Dolasetron. It will make a difference. If you get a prescription for ondansetron, call around to local pharmacies if you are in the USA. You can get it for as low as 1$ for a 4mg pill (four doses - 1mg). Up in Canada the cheapest I found when Maverick had his tube was $9/pill at Walmart and it was worth its weight in gold.
 
Re: 8/19 Garland AMPS 272 +2 293

Great news on the ketones! :-D

Please remain vigilant and check Garlands urine as often as possible and make note of the tests/results on Garlands ss. Ketones can sneak back into the picture, particularly under these conditions.

How is Garland today?
 
Re: 8/19 Garland AMPS 272 +2 293

Great NEWS!!!!!! dancing_cat dancing_cat flip_cat flip_cat :RAHCAT flip_cat flip_cat dancing_cat dancing_cat
 
Re: 8/19 Garland AMPS 272 +2 293 +6 325

No ketones!!! now it's a whole new ballgame!! Way to go Garland! you too Violet! Now we can make some progress ..... :thumbup :thumbup :thumbup
 
Re: 8/19 Garland AMPS 272 +2 293

Karrie and Maverick said:
Now that we know she is zero for ketones I'm going to push you to get the right anti nausea medication for her to get her feeling better. As I noted in your thread on health FHL is horribly nauseating. Nausea is not just vomiting. She is nauseas without vomiting.

Here is the article on the FAF site which covers signs/causes and treatment of nausea in cats as you are a member it should load up for you: http://tinyurl.com/43xrgkn I can't seem to load it up though. On the FAF site - go to files - then the nausea/vomiting folder - the first article: *Nausea & Vomiting - Signs, Causes & Treatment Options
how to recognize nausea and what to do about it. Please read this today.

Here is an article linked within this that you should share with your vet. It tells why metoclopromide is not effective to treat nausea in cats. It is great for dogs. It may stop vomiting due to stomach motility but will not help a cat feel well as the nausea remains untreated. http://veterinarycalendar.dvm360.com/avhc/content/printContentPopup.jsp?id=676860

Go for Ondansetron or Dolasetron. It will make a difference. If you get a prescription for ondansetron, call around to local pharmacies if you are in the USA. You can get it for as low as 1$ for a 4mg pill (four doses - 1mg). Up in Canada the cheapest I found when Maverick had his tube was $9/pill at Walmart and it was worth its weight in gold.
Click to expand...

I cant seem to get that page to load either...

So I call the vet, and ask for a new prescription? Do they do that?
 
Re: 8/19 Garland AMPS 272 +2 293

Sandy and Black Kitty said:
Great news on the ketones! :-D

Please remain vigilant and check Garlands urine as often as possible and make note of the tests/results on Garlands ss. Ketones can sneak back into the picture, particularly under these conditions.

How is Garland today?
Click to expand...
She seems the same. Only getting up to use her litter box. I havent seen any improvement in the last week.. how long does it usually take to see her get a little better?
 
Re: 8/19 Garland AMPS 272 +2 293 +6 325

Violet: yes....because you are her advocate. Just tell them the metaclopromide is not working and what you would like to have and be firm (but not aggressive :lol: :lol: :lol: ). Whenever my vet might question something, I tell her I am their advocate and ask them to explain why something I would like them to have would not be appropriate. Usually they can't because they might just have a favorite drug. Quite often in the past, the metaclopromide is what my vets have always reached for first. So just have your facts together, explain it isn't working, and what you would like to try and why.

On the neg ketones:
 
Re: 8/19 Garland AMPS 272 +2 293 +6 325

Violet: yes....because you are her advocate. Just tell them the metaclopromide is not working and what you would like to have and be firm (but not aggressive :lol: :lol: :lol: ). Whenever my vet might question something, I tell her I am their advocate and ask them to explain why something I would like them to have would not be appropriate. Usually they can't because they might just have a favorite drug. Quite often in the past, the metaclopromide is what my vets have always reached for first. So just have your facts together, explain it isn't working, and what you would like to try and why.
Click to expand...

I love Marjorie's approach. I wish I had her by my side with my vet. Tell them you've read alot about FHL being very nauseating for cats and that the metoclopromide isn't ideal for cats. You don't have to stop the metoclopromide. Maverick was given both ondansetron and metoclopromide. Tell them you'd like to try ondansetron or dolasetron to see if it helps her improve as all she's doing right now is sitting in one spot. So you'd like to rule out nausea and try either one of those. If they mention Pepcid - again that is only if stomach acid is the cause. Here FHL is the cause so that won't work. The second article I link to was written by a vet. Did it load?

For improvement you need to make sure she is eating AT LEAST enough food to maintain her weight. The only way to know if she's eating enough to maintain or gain is by weighing her. If she is still losing then her liver isn't getting an opportunity to heal and is still being damaged. Do you have a baby scale or a shipping or pet scale that you can weigh her on? A human scale isn't accurate enough. Do you know anyone that has had babies or might have a baby scale? Check freecycle also. Often a sick cat needs much more calories to maintain their weight than they would when they are healthy. Maverick needed 2.5 cans of recovery RS in the beginning to maintain 13.5lbs (he was down from 17.5) but eventually he started gaining on this amount which was okay because he needed to gain.

On the FAF site its about the one week mark where things start to improve. And just keep in the back of your mind that the tube is a good thing. She will eat on her own again when she's feeling better. There isn't a rush to get that tube out because its helping make sure you are getting enough food in that her liver can heal. A lot of people think the most important thing is getting the cat eating again and getting the tube out as fast as they can.
 
Re: 8/19 Garland AMPS 272 +2 293 +6 325

Hi Violet,

Is Garland keeping her food down? If so and she is still in the 300s at PMPS, and you will be able to get tests at +1, +2, +3 and +4, you can try giving her a tiny bit of R, 0.1u, immediately after her 2u of Lantus.

I noticed on her ss that you shot her Lantus 1/2 hour early this morning and 15 min. early last night. Shooting lantus early is like increasing the dose. If you have scheduling problems, you can safely shoot 15 min early each cycle, or 1/2 hour early once every 24 hours. Any more than that and it can sneak up on you. Try and maintain the 12/12 schedule with lantus - the fewer surprises right now the better!
 
Re: 8/19 Garland AMPS 272 +2 293 +6 325

Negative ketones!! Yay!!!

Now, we've got to let Garland know that she has to keep it that way.

I'm attaching a schedule with feeding times (every 3 hours) along with medication and shot times. I hope this is feasible for you. I know for me, having something laid out in black and white, especially if I'm really stressed, is helpful. Karrie and I worked on this since she knows more about the sequencing of some of the meds in relation to food than I do. It's an Excel document so I hope you can open it. Let me know if you can't -- we'll find a compatible format.
 

Attachments

Re: 8/19 Garland AMPS 272 +2 293 +6 325

Thanks Sienne. I found a written schedule was really helpful with Maverick.

Do you guys know about Petinic? It was mentioned on another board today that it has iron in it and shouldn't be given unless iron was low. I've never used it so I don't know much about it.
 
Re: 8/19 Garland AMPS 272 +2 293 +6 325

The ingredients are as follows: Corn syrup, water, sucrose, glycerin, beef liver paste, iron proteinate, sodium citrate, caramel color, citric acid, niacinamide, potassium sorbate, cyanocobalamin, thiamine hydrochloride, pyridoxine hydrochloride, riboflavin, cupric sulfate, natural anise flavor, sodium hydroxide.
Minerals:
Iron - 12.5mg
Copper - .2mg
Vitamins:
Thiamine - 2.0 mg
Riboflavin - 1.0 mg
Niacin - 10.0 mg
Vitamin B6 - 1.0 mg
Vitamin B12 - 2.1 mcg
 
Re: 8/19 Garland AMPS 272 +2 293 +6 325

HI! Sorry I went MIA. The last couple hours have been crazy chaos around here. I had to suddenly take my 2 yr old daughter to the pedi for a UTI test, then get dinner on the table for them. whew. They are eating now, so I have a couple minutes...

Today was the first day since tuesday Ive given the petinic. It made her throw up on tuesday so ive been nervous to give it to her since. Should I stop it all together?

I gave the lantus early bc im trying to get her back from that 9am time to her original 730am shot. Im not usually home at 9 so I need to move it up. Whats the best way to do that?

I cant get that spreadsheet to open. Thank you all so much for putting it together for me ((hugs)) I cant wait to see it. I will have to see about the every 3 hours... right now its taking me close to an hour total each time, from getting it ready, feed and clean up. I have 2 kids under 3 so its difficult to leave them running free in the house for that long.. but when I see the spreadsheet I will see what I can do

When the doctor calls tomorrow I will ask him about a new nausea medicine.
 
Re: 8/19 Garland AMPS 272 +2 293 +6 325

I'll share some ideas about speeding things up a bit. Save you a few minutes maybe. Plus once you get in a rhythm with Garland and feedings things will go quicker. Good that you are going slow - I'm sure its helping the food stay down. I'd say it should take about 20 minutes for the actual feeding 40cc food plus a flush.
 
Re: 8/19 Garland AMPS 272 +2 293 +6 325

The reason its taking so long w the feed is bc the times ive tried to speed it up she starts acting like its bothering her (licking lips, moving head) Im really really scared of her throwing up.. nailbite_smile
 
Re: 8/19 Garland AMPS 272 +2 293 +6 325

To those suggesting dosing. Should there have been a touch of R when the +6 was over 300?
 
Re: 8/19 Garland AMPS 272 +2 293 +6 325

I see. Then you are doing what you should - keeping the food down is really important. Antinausea medication will address that so your feedings will go a bit quicker. Make sure you are using warmed up (not hot) food and water. Cold food/water is likelier to upset her stomach. There are other things you can do to save time like pre-preparing the syringes for the day and store them in the fridge. It needs a lot of syringes though. You set them in hotter water 10-15 minutes before feeding so you can multitask while they warm up and test on your wrist before feeding to make sure it isn't too hot. You want them warm like luke warm not hot. The throat tissue is delicate.
 
Re: 8/19 Garland AMPS 272 +2 293 +6 325

violet826 said:
I gave the lantus early bc im trying to get her back from that 9am time to her original 730am shot. Im not usually home at 9 so I need to move it up. Whats the best way to do that?
Click to expand...
The safest way to do that is 15 minutes each cycle until you get back to your ideal shot time.
So, if you shot at 8:15am today, you can shoot at 8:00pm tonight, 7:45am and then 7:30pm tomorrow an you'll be back on schedule.
 
Venita said:
To those suggesting dosing. Should there have been a touch of R when the +6 was over 300?
Click to expand...

I'm re-posting so this doesn't get buried. I believe both Libby and Sandy are keeping an eye on the R dosing. My hunch, though, is that this is the first 24 hours since the increase in the Lantus dose. Since there's not a clear point with where Lantus nadir is (and both Sandy and Libby were at work), they may have wanted to hold off just so there was no risk of both meds hitting nadir at the same time (even though that was unlikely). Since Violet is so new to using R, I would hope that having experienced R users who are available to watch in the beginning would be a reasonable strategy.
 
Re: 8/19 Garland AMPS 272 +2 293 +6 325

Do you guys know about Petinic? It was mentioned on another board today that it has iron in it and shouldn't be given unless iron was low. I've never used it so I don't know much about it.
Click to expand...
Just a comment about Petinic - if considering this maybe ask about Liquitinic instead, not corn-syrup based. Active Ingredients Vitamin B12, niacinamide, riboflavin, thiamine HC1, pyridoxine HC1, d-calcium pantothenate, liver, amino acids (from protein hydrolysate), iron (from ferrous sulfate).
 
The vet may have suggested the Pet-tinic because of the ketones. The extra calories from the corn syrup and sucrose may not have been a bad thing. If all of the food is getting it, it may be reasonable to back off of the Pet-tinic, especially since it sounds like it wasn't agreeing with Garland.

Violet -- do you have Excel on your computer? That may be why the schedule didn't load. I may also be using a different/newer version than you have.
Try this:
 

Attachments

Re: 8/19 Garland AMPS 272 +2 293 +6 325

Karrie and Maverick said:
I see. Then you are doing what you should - keeping the food down is really important. Antinausea medication will address that so your feedings will go a bit quicker. Make sure you are using warmed up (not hot) food and water. Cold food/water is likelier to upset her stomach. There are other things you can do to save time like pre-preparing the syringes for the day and store them in the fridge. It needs a lot of syringes though. You set them in hotter water 10-15 minutes before feeding so you can multitask while they warm up and test on your wrist before feeding to make sure it isn't too hot. You want them warm like luke warm not hot. The throat tissue is delicate.
Click to expand...
OMG! Thanks for the tip! The Dr told me I could do it straight out of the fridge. Ive been slightly warming it, but this time (per your advice) I warmed it warmer, more like to the temp I used to do my sons baby food. She didnt even budge once and I got done in half the time! I hope it wasnt a fluke and it continues this way :)
 
Sienne and Gabby said:
The vet may have suggested the Pet-tinic because of the ketones. The extra calories from the corn syrup and sucrose may not have been a bad thing. If all of the food is getting it, it may be reasonable to back off of the Pet-tinic, especially since it sounds like it wasn't agreeing with Garland.

Violet -- do you have Excel on your computer? That may be why the schedule didn't load. I may also be using a different/newer version than you have.
Try this:
Click to expand...

Today was the first day since Tuesday I have given her the Petinic. I would love to stop using it. Ive been nervous of it since the big throw up episode.

I have a Mac, its got Excel on it. When I clicked on the link it asked if I wanted to Save it, I clicked "okay" and then nothing after that?
 
Okay, I got it to work

How many days of this schedule do you think? I want to do everything I can for Garland of course. But Im not sure how many nights I can do getting up every 2 hours. I just want to make sure I dont fall asleep on my small kids during the day, or get so tired I cant take care of them properly. They are 15 months and 2yrs. They get into everything and require a lot of hands on attention. Ive already had some issues with me paying attention this week since Ive been staying up with Garland until after midnight.
 
Sienne and Gabby said:
Venita wrote:To those suggesting dosing. Should there have been a touch of R when the +6 was over 300?

I'm re-posting so this doesn't get buried. I believe both Libby and Sandy are keeping an eye on the R dosing. My hunch, though, is that this is the first 24 hours since the increase in the Lantus dose. Since there's not a clear point with where Lantus nadir is (and both Sandy and Libby were at work), they may have wanted to hold off just so there was no risk of both meds hitting nadir at the same time (even though that was unlikely). Since Violet is so new to using R, I would hope that having experienced R users who are available to watch in the beginning would be a reasonable strategy.
Click to expand...

Sandy and Black Kitty said:
Hi Violet,

Is Garland keeping her food down? If so and she is still in the 300s at PMPS, and you will be able to get tests at +1, +2, +3 and +4, you can try giving her a tiny bit of R, 0.1u, immediately after her 2u of Lantus.
Click to expand...

The above is my opinion. All things considered I feel it's best to proceed with caution when dealing with R particularly with a cat that has been vomiting.
 
I would feed as often as you can to help her liver recover and give her some strength. So at least a week keep up with extra feedings. Then you can see how she is doing and drop a feeding or two and fit everything in in the main awake hours. It will get easier. Once you know the routine and the rhythm and she starts feeling better, you'll get in a groove - your nerves will settle and seeing her improve will give your heart and energy a boost.
 
Nina and KB said:
Just a comment about Petinic - if considering this maybe ask about Liquitinic instead, not corn-syrup based. Active Ingredients Vitamin B12, niacinamide, riboflavin, thiamine HC1, pyridoxine HC1, d-calcium pantothenate, liver, amino acids (from protein hydrolysate), iron (from ferrous sulfate).
Click to expand...
So this has contributed to the high BGs today. . .
 
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