8/22 Garland AMPS 316 +4 356 +7 293 PMPS 359

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Violet and Garland

Violet and Garland

Member Since 2011
Garland came out of the DKA and is now recovering from FHL, E tube feedings

Good morning! Garland had a good night last night. She walked around a bit and seemed much more alert than usual. I hope the progress continues today!

Sometime early this morning, (between 4-7) Garland pooped outside her litterbox. It was sooooo weird because she has NEVER gone outside the litterbox. Even when she could barely move, she still managed to get in there. Hmmm...

I still havent given her the cerenia yet. I wanted to make sure I do it right. Its 1/2 a tablet every 24 hours, right?? Also, how long do I keep doing the potassium gel?

Yesterday
 
Re: 8/21 Garland AMPS 316

I believe it is a once a day dose. Didn't the vet give you instructions? If not, call the office -- they should be able to tell you.
 
Re: 8/21 Garland AMPS 316

Morning Violet, I'm so glad to hear Garland is starting to feel better. I've been following Garland's condo. This is my first visit to your, as I didn't want to get in the way of flowing information. You are doing such a terrific job with your baby. Good luck with the meds and have a nice day. Give Garland some scritches from us, too.
 
Re: 8/21 Garland AMPS 316

good morning, violet!

i'm happy to see you've increased the lantus dose to 2.5 units. we need to become more aggressive to try to bring garland's numbers down since ketones can and often do return. food and adequate insulin will go a long way in making sure they don't return. i read that DCIN will be sending you a meter which measures ketones in the blood. that's wonderful!

since garland has a feeding tube and we have to become more aggressive in bringing her numbers down, i'd like to pass along some suggestions from another member on how to bring up low numbers if necessary. she has quite a bit of experience with feeding tubes, ketones, and DKA.

i don't want to scare you. the idea here is to make sure you're prepared to manage a low number curve. low numbers can be managed as long as you're testing frequently and are prepared.

  • if karo is needed --- rub karo on her gums. do NOT try to push karo down the feeding tube.
  • get a few 3cc oral syringes (without needles). fill them with karo and place them around the house... maybe one in the kitchen, one in whatever room you hang out in, and another perhaps on a bedside table. having them pre-filled and accessible will enable you to grab one quickly in the event of an emergency.
  • it would also be a good idea to have a needless syringe pre-loaded with the gravy from a high carb canned food. you could keep that in the refrigerator.

3cc syringes aren't expensive. you can get them from any vet. if you have trouble getting them, i'm sure we can find someone who can send you some.


in the event of low numbers, this is what you'll want to do (besides post for help):

1. rub karo on gums

2. put hc gravy through the tube

3. if the number is rising at this point, follow-up with a partial feeding of whatever you've been giving garland. if the number has not risen... lather, rinse, and repeat.

any questions?


i'm so happy to hear garland is showing signs of recovery. :mrgreen: :mrgreen: :mrgreen:
 
Re: 8/21 Garland AMPS 316

My Internet is down at home typing frm my phone. Don't use the cerenia I received an email from an far moderator that it shouldn't be used in cats With liver insufficiency like garland please do what you can to get the ondansetron today. The vet overprescribed that you give 1/4 of a 4mg pill NOT the whole pill evey 12 hrs
 
Re: 8/21 Garland AMPS 316

So here is Garlands day so far

4am feed

pooped outside the litter box?? (strange)

7am Meds (meto, pepcid, potassium)
730 feed 30cc
8am lantus 2.5
9am --start cerenia- 1/2 tablet
throw up
1030- feed 30cc
-----
when I went to get her for her 1030 feed, i took her to the other room, fed her and then brought her back to the master area. It was then I noticed the throw up in the corner. So she must have thrown up sometime after the 9am cerenia but before the 1030am feed.?? I dont remember seeing it when I went to give her the cerenia at 9.. although it was in the corner, I almost missed it this time. But Im 99% sure it was after the cerenia
-----
I had to take my daughter to speech therapy at 11, i just got back. She didnt throw up the 1030 feed (yet)

Why would she have thrown up after taking an anti-nausua med?
 
Re: 8/21 Garland AMPS 316

Karrie and Maverick said:
My Internet is down at home typing frm my phone. Don't use the cerenia I received an email from an far moderator that it shouldn't be used in cats With liver insufficiency like garland please do what you can to get the ondansetron today. The vet overprescribed that you give 1/4 of a 4mg pill NOT the whole pill evey 12 hrs
Click to expand...
What???? Oh no!! To late!! I already gave the cerenia this morning! What does that mean? Is it going to hurt her? I gave her half a pill like they said
 
Re: 8/21 Garland AMPS 316 +4 356

Hi Violet,

I don't k now about FHL so I don't know why the cerenia would not be appropriate.
Since your vet prescribed it, please put a call in to him and let him know you have read that it should not be given to cats with liver insufficiency. Let him know you are very concerned about that and since you have given Garland the dose they recommended you need to know the possible side effects.
 
Re: 8/21 Garland AMPS 316 +4 356

Sandy and Black Kitty said:
Hi Violet,

I don't k now about FHL so I don't know why the cerenia would not be appropriate.
Since your vet prescribed it, please put a call in to him and let him know you have read that it should not be given to cats with liver insufficiency. Let him know you are very concerned about that and since you have given Garland the dose they recommended you need to know the possible side effects.
Click to expand...
i agree with sandy. don't panic. talk to your vet.

my alex had liver problems amongst other things awhile back. we were having a heck of a time getting her to eat so we talked about giving her an appetite stimulant. appetite stimulants can be hard on the liver, but we had to weigh our options at the moment. we chose to give her the stimulant despite it being hard on the liver because we figured she had to eat. it turned out to be a good decision. the point i'm trying to make is sometimes you have to weigh your options. the benefits *may* outweigh the risks.

i don't know why cerenia is not appropriate in this case, but your vet should. talk to him...
 
Re: 8/21 Garland AMPS 316 +4 356

Jetta's been on Cerenia 1/2 tab, once per day, for 5 days. Yesterday was her last dose. Garland shouldn't vomit while taking it. Maybe the pill didn't quite make it all the way down and came back up with a bit of extra? We had that issue one evening last week. While cleaning up the vomitus I found the remnants of the little pink pill. Not sure about the Liver issue. Jetta's got a liver issue too, and she was prescribed it. Hmm?
 
Re: 8/21 Garland AMPS 316 +4 356

Oh Violet I think you are fine with just the one dose. Sorry if I made you panick. Just that if you have both choices and because she is an FHL kitty it is recommended to go with ondansetron. So I wanted you to call around and get that filled. A lot of cats on the FAF board are on both cerenia and ondansetron. Someone pointed out that the article I linked you to, "Dr. Tams cautions about the use of cerenia in liver patients in that vomiting article".

Just to clarify too - do not use an appetite stimulant for Garland. She has her tube - focus on tube feeding and getting her back to feeling well. Once nausea is addressed and her liver starts healing, she will start drinking on her own and showing interest in food.
 
Re: 8/21 Garland AMPS 316 +4 356

Jacspets said:
Jetta's been on Cerenia 1/2 tab, once per day, for 5 days. Yesterday was her last dose. Garland shouldn't vomit while taking it. Maybe the pill didn't quite make it all the way down and came back up with a bit of extra? We had that issue one evening last week. While cleaning up the vomitus I found the remnants of the little pink pill. Not sure about the Liver issue. Jetta's got a liver issue too, and she was prescribed it. Hmm?
Click to expand...
Hmm.. It just looked like food. There is a chance she threw up after she ate at 7... It was in the back corner so I may have missed seeing it. Although im almost positive it wasnt there...
 
Re: 8/21 Garland AMPS 316 +4 356

Karrie and Maverick said:
Oh Violet I think you are fine with just the one dose. Sorry if I made you panick. Just that if you have both choices and because she is an FHL kitty it is recommended to go with ondansetron. So I wanted you to call around and get that filled. A lot of cats on the FAF board are on both cerenia and ondansetron. Someone pointed out that the article I linked you to, "Dr. Tams cautions about the use of cerenia in liver patients in that vomiting article".

Just to clarify too - do not use an appetite stimulant for Garland. She has her tube - focus on tube feeding and getting her back to feeling well. Once nausea is addressed and her liver starts healing, she will start drinking on her own and showing interest in food.
Click to expand...
whew. thanks :)

I dont use an appetite stimulant. Cernia is anti nausea right? Do you know how long I should be doing the potassium supplement?
 
Re: 8/21 Garland AMPS 316 +4 356

Sandy and Black Kitty said:
Hi again Violet,

How is Miss Garland feeling this afternoon? Has she been keeping her meals down?
Click to expand...
Shes okay. She only threw up the once this morning. So far keeping the rest down. WHile I fed her last meal she actually licked her paw and cleaned her face a little :)
 
Re: 8/21 Garland AMPS 316 +4 356

Hi guys .. so glad to stop by and see that garland is improving! I will keep sending positive thoughts her way that it continues .. You are doing such an amazing job with her!
 
Re: 8/22 Garland AMPS 316 +4 356 +7 293

Oh, and one more quick question.. could her high BS numbers be because the recovery Im feeding her isnt low carb? Is it low carb?
 
Re: 8/22 Garland AMPS 316 +4 356 +7 293

What brand of Recovery are you feeding. The Royal Canin Recovery RS is fairly low carb at 6%. But the clinicare is high carb at 25%.

The dosing experts should recommend whether to continue with the clinicare. How many mls of this are you using each day? How much of the recovery food are you able to feed and estimate as best you can how much she is holding down in a 24 hour period?
 
Re: 8/22 Garland AMPS 316 +4 356 +7 293

i don't know - sienne will no doubt have that answer, but the high numbers likely just means she needs a little more insulin. the numbers will also be higher than they were before every time you raise the dose, so this morning's increase might be the cause. you just stay the course while that settles down and follow the directions jill/sienne etc are giving you on dosing and she'll come down.

for your link - click on the URL button at the top of the reply box and then copy your address from yesterday's post. then click between the brackets url]right here [url and paste in the address. that should create a "live" link that can be clicked on.

the "fancier" option is:
click on the URL button at the top of the reply box and then copy your address from yesterday's post.

then add an = sigh after the first url letters, paste the address to the right of the equal sign like this:
url=paste yesterday's condo address right here] and in this spot name it yesterday, or whatever you want [url

that should create a "live" link that can be clicked on.
 
Re: 8/22 Garland AMPS 316 +4 356 +7 293

Violet and Garland said:
Shes okay. She only threw up the once this morning. So far keeping the rest down. WHile I fed her last meal she actually licked her paw and cleaned her face a little :)
Click to expand...
That's wonderful. Hve you filled the prescription for the Ondansetron?
Violet and Garland said:
Oh, and one more quick question.. could her high BS numbers be because the recovery Im feeding her isnt low carb? Is it low carb?
Click to expand...
She needs her nourishment right now, that's the most important thing. Youo need to put some focus on being a bit more aggressive with the insulin. As Jill suggested-
Jill & Alex said:
since garland has a feeding tube and we have to become more aggressive in bringing her numbers down, i'd like to pass along some suggestions from another member on how to bring up low numbers if necessary. she has quite a bit of experience with feeding tubes, ketones, and DKA.

i don't want to scare you. the idea here is to make sure you're prepared to manage a low number curve. low numbers can be managed as long as you're testing frequently and are prepared.

if karo is needed --- rub karo on her gums. do NOT try to push karo down the feeding tube.
get a few 3cc oral syringes (without needles). fill them with karo and place them around the house... maybe one in the kitchen, one in whatever room you hang out in, and another perhaps on a bedside table. having them pre-filled and accessible will enable you to grab one quickly in the event of an emergency.
it would also be a good idea to have a needless syringe pre-loaded with the gravy from a high carb canned food. you could keep that in the refrigerator.

3cc syringes aren't expensive. you can get them from any vet. if you have trouble getting them, i'm sure we can find someone who can send you some.


in the event of low numbers, this is what you'll want to do (besides post for help):

1. rub karo on gums

2. put hc gravy through the tube

3. if the number is rising at this point, follow-up with a partial feeding of whatever you've been giving garland. if the number has not risen... lather, rinse, and repeat.
Click to expand...

Do you have any questions on any of the information Jill provided you with this morning? Do you have the supplies: karo, HC food, 3cc oral (needleless)syringes? And plenty of test strips?
 
Re: 8/22 Garland AMPS 316 +4 356 +7 293

thanks for the reminder, sandy! it's important for anyone who is trying to help with dosing to know that violet is prepared to manage a curve with low numbers.

food and sufficient insulin play such an important role in recovery. violet, please take a look at lynee & max's spreadsheet:

https://spreadsheets.google.com/pub?key=pJQhoF5eu2c0z6GypqD-uRQ.

max had a feeding tube, too.

scroll down to 3/15/09 - 3/19/09. you'll notice how lynee added additional lines on her spreadsheet to record how many calories and cc's max was getting throughout the day. she also added a column towards the right to record the total calories and cc's max consumed each day. these notations helped her know if max was receiving as much as he should be. these notes also helped those who were helping her as far as dosing went.

i think it would be helpful for all concerned to incorporate a system like or similar to what you see on max's spreadsheet.
what do you think? do-able?
 
Thanks for the URL stuff. I will see if I can get it to work LOL (im not really techy savvy)

I read all the stuff about hypo. The symptoms and how to treat it in an emergency. I have dry food, high carb gravy wet food, honey, and karo on hand at the house. I also have several syringes. I really hope I dont have to experience that though YIKES...scary

I have not filled the Rx yet. Im figuring out the financial part and then hopefully will be able to get it in the morning.

I havent had a chance to look at the spreadsheet with the food rows in it yet, but i will in the next few minutes. Its hard to know exactly what I am feeding her. I found it easier to mix a big batch in the morning and then get her feedings from that, instead of mixing a new one every time.
------------------

Garland hasnt thrown up anymore today. YAY! Shes even started to clean herself up a bit. I have her out in the living room now. I feel so bad for her being shut off in the master all by herself. But when the kids are awake, I have no other choice. :(
 
Violet you are doing so well! take a deep breath .... it will not always be this hard! And she's cleaning herself! that is great! dancing_cat dancing_cat dancing_cat Keep up the good work!
 
Here are a couple of thoughts...

If you aren't tech savvy and don't think you can set up the SS with the additional columns, there are people here who are good at this sort of thing. We can get someone to help. Just let us know.

If filling an entire prescription is too expensive, talk to the pharmacist. S/he may be able to split a prescription in half so it's more affordable right now.

Are there times when you can reliably be on line? Information, like what Karrie posted, is getting lost. We need to know what you are doing and when you will be around so we can get information to you. This is going to be of critical importance if you are going to use R. Likewise, if Garland's numbers tank, we don't want you to deal with this solo the first time. Garland is not out of the woods by a long stretch. Ketones can develop in the space of a few hours and go from trace to critical in a short time. It's great that Garland is showing signs of recovery but do not become complacent -- you need to stay vigilant.
 
Hey Violet,

How long ago did you do Garlands PM shot? It sounds like a good time to try some R again, but we have to know you are ready to be attentive for the next 4 hours.

She has kept her food down (since the early morning incident) How many feedings has she had and how much each feeding - approx.?
You have Karo and oral syringes.
you have HC canned food with gravy
Do you have plenty of test strips?
You have R
Can you commit to testing at +1, +2, +3 and +4 (after the R)?

It's time to try and beat those BGs down. Baby steps ( with the R) though, so we need to get crackin' !
 
Well, we lost the window of opportunity for R tonight Violet.

Is it possible for you to get into a routine of checking in each day 1/2hour before shot times?

Sienne and Gabby said:
We need to know what you are doing and when you will be around so we can get information to you. This is going to be of critical importance if you are going to use R. Likewise, if Garland's numbers tank, we don't want you to deal with this solo the first time. Garland is not out of the woods by a long stretch. Ketones can develop in the space of a few hours and go from trace to critical in a short time. It's great that Garland is showing signs of recovery but do not become complacent -- you need to stay vigilant.
Click to expand...
Sienne is right. . .
 
I am doing all that I can. I promise. Im not slacking off or anything. I do have 2 small kids who need a lot of attention, as well as appointments and things that cause my day to get hectic. I cannot stay up tonight until 3 in the morning testing every hour and then feed her. I cant stay up until 4am. I just cant. I am already a walking zombie from feeding Garland around the clock for the last week. I can give her some R in the morning and test her every hour then though. I was so tired this morning I didnt notice my 2 year old had found some thumbtacks in a drawer (that I had left unlatched accidentally) until she had taken them to the playroom and given one to my 1 year old. I need sleep to function and to take care of my kids, and get my errands ran. I am feeding Garland every 3 hours through the night. Im soooo tired...

I gave her her dose at 8pm. its 1030 now. I have lots and lots of strips

I never know when I can be online. Everyday for me is different as far as my appointments and such. My daughter has a severe speech delay, so she has a bunch of therapy appointments throughout the week. I can usually get online once they are in bed for a bit around 8pm for sure. But my days are sporadic.

If someone wants to help me with the spreadsheet that would be awesome. I looked at the one provided, and it seemed really really complicated...

I am feeding her Canine Recovery. I am using clincare to make it thinner. I just add it and stir until I get the consistency I want


I really do appreciate all the help and advice. Thank you all from the bottom of my heart :)
 
Sandy and Black Kitty said:
Well, we lost the window of opportunity for R tonight Violet.

Is it possible for you to get into a routine of checking in each day 1/2hour before shot times?

Sienne and Gabby said:
We need to know what you are doing and when you will be around so we can get information to you. This is going to be of critical importance if you are going to use R. Likewise, if Garland's numbers tank, we don't want you to deal with this solo the first time. Garland is not out of the woods by a long stretch. Ketones can develop in the space of a few hours and go from trace to critical in a short time. It's great that Garland is showing signs of recovery but do not become complacent -- you need to stay vigilant.
Click to expand...
Sienne is right. . .
Click to expand...
I wouldnt have been able to do the R tonight anyways. Sorry I wasnt able to get online until just now. My 1 year old has been teething for the last 2 weeks, hes been super fussy. I just spent the last hour and half trying to get him to sleep. Poor little guy. I wish I could make him feel better

Yes. I can check in before shot times.
 
Sienne and Gabby said:
Here are a couple of thoughts...

If you aren't tech savvy and don't think you can set up the SS with the additional columns, there are people here who are good at this sort of thing. We can get someone to help. Just let us know.

If filling an entire prescription is too expensive, talk to the pharmacist. S/he may be able to split a prescription in half so it's more affordable right now.

Are there times when you can reliably be on line? Information, like what Karrie posted, is getting lost. We need to know what you are doing and when you will be around so we can get information to you. This is going to be of critical importance if you are going to use R. Likewise, if Garland's numbers tank, we don't want you to deal with this solo the first time. Garland is not out of the woods by a long stretch. Ketones can develop in the space of a few hours and go from trace to critical in a short time. It's great that Garland is showing signs of recovery but do not become complacent -- you need to stay vigilant.
Click to expand...
Im going to call the pharmacist in the morning. I really dont want to be alone when I give her the R.. YIKES I need you guys here with me for that :)

Venita is sending me a ketone monitor so I can start monitoring her ketones. The strips arent working for her. I promise i am staying as vigilant as I can. Im going to stick this through until shes all the way better. :)

Im feeding her 30cc every 3-4 hours... I can start writing it down if that helps
 
Great on getting a blood ketone monitor. You won't have to worry about getting a false positive with a urine test. Just a word of warning... The strips are expensive.

I'm glad you're calling the pharmacy. Most pharmacists will work with you on this issue.

Here's what I think Jill is suggesting. If you want to prep a batch of food, that's fine. However, measure out everything. If you mix up a 5 oz can of food, put some of the Clinicare in a measuring cup so you can figure out how many ounces you're using to thin the mixture. Then, based on the # of calories per ounce of Clinicare + calories per ounce of food, you'll know that if you're giving 2 ounces of the mixture, you're feeding a specific # of calories. That's the best way to know if Garland is getting a reasonable number of calories.

Do not worry about feeding the Clinicare. It's higher in carbs BUT it also has a higher caloric content. Food is important for Garland's recovery. We can always adjust the dose of Lantus to compensate for the food.

As far as schedule, would it be possible to let us know the night before, when you'll be on-line the next day? If 1/2 hour before shot time works, that's great.

In the morning, if you could put a note in your subject line asking for help with setting up the SS, I'm sure someone will volunteer. You'll need to give that person permission to edit your SS.
 
Violet: just sending you hugs and caring thoughts. I wish we could be there to help you....watch the kids, anything that would help relieve your exhaustion. But you are doing fantastic. We all know you are doing a great job for your sweet baby and your kids.

Wishing you some rest and comfort.
 
I wouldn't try the liver shake. Garland has a feeding tube so getting her eating on her own isn't the priority. Its tube feeding, medication, monitoring for DKA. The thing is with unadressed nausea what you do not want to happen for Violet and Garland is food aversion. So instead of her having her feeding tube for three or four weeks you may be looking at ten weeks or longer. When nausea is addressed and her liver starts healing, she will go back to eating and drinking on her own.
 
Karrie and Maverick said:
I wouldn't try the liver shake. Garland has a feeding tube so getting her eating on her own isn't the priority. Its tube feeding, medication, monitoring for DKA. The thing is with unadressed nausea what you do not want to happen for Violet and Garland is food aversion. So instead of her having her feeding tube for three or four weeks you may be looking at ten weeks or longer. When nausea is addressed and her liver starts healing, she will go back to eating and drinking on her own.
Click to expand...
so letting a kitty eat on their own if they show an interest is to be discouraged for three or four weeks?
iirc, the other kitties we've seen on feeding tubes were allowed to eat if they wanted to... in addition to being fed through the feeding tube.
just trying to understand...
 
No when a kitty starts showing interest in food thats great. But Garland isn't even drinking on her own yet. You don't push food on an inappetant cat. When you know nausea has been addressed and the cat is healing - grooming, drinking, walking around, then you start introducing old foods in small amounts not to overwhelm them before each feeding. Then you monitor how much they eat on their own to figure out how much to tube feed to make up the difference.

I caused some food aversion with Maverick trying to push him into eating on his own. I had spent $6000 on his emergency surgeries and two peg tubes and if he pulled it out again I would have had to euthanize him. But he had his tube for ten weeks which is longer than most just recovering from FHL. Once he showed interest in eating on his own, it was within a week that he was eating enough to sustain his weight without tube feeding.
 
thanks for the explanation, karrie. i think my confusion centers around seeing kitties come through here who have had a feeding tube for only a few weeks. food was usually left out and available if they wanted it. it sounds like there might be a little ECID thing attached to FHL, too.
 
Sienne and Gabby said:
Great on getting a blood ketone monitor. You won't have to worry about getting a false positive with a urine test. Just a word of warning... The strips are expensive.

I'm glad you're calling the pharmacy. Most pharmacists will work with you on this issue.

Here's what I think Jill is suggesting. If you want to prep a batch of food, that's fine. However, measure out everything. If you mix up a 5 oz can of food, put some of the Clinicare in a measuring cup so you can figure out how many ounces you're using to thin the mixture. Then, based on the # of calories per ounce of Clinicare + calories per ounce of food, you'll know that if you're giving 2 ounces of the mixture, you're feeding a specific # of calories. That's the best way to know if Garland is getting a reasonable number of calories.

Do not worry about feeding the Clinicare. It's higher in carbs BUT it also has a higher caloric content. Food is important for Garland's recovery. We can always adjust the dose of Lantus to compensate for the food.

As far as schedule, would it be possible to let us know the night before, when you'll be on-line the next day? If 1/2 hour before shot time works, that's great.

In the morning, if you could put a note in your subject line asking for help with setting up the SS, I'm sure someone will volunteer. You'll need to give that person permission to edit your SS.
Click to expand...
the batch im on is already mixed. So im not sure the ratio. The next one i will measure out everything to get a better idea...
 
True - every cat is different. Some FHL cats only have their tube for a week or two. Some just need a few days of assist feeding and even though they still have FHL eat on their own. I don't think Garland is up to being presented with food. She is still unwell - she's not even drinking water on her own, and is just seeing sparks of improving (grooming, and walking a bit). It's not about eating on their own which a lot of people equate to being better. For Garland the focus is on getting her feeling better and then eating on their own usually happens quite quickly. I'd say play it by ear with Garland and go from Garlands cue's. The good thing is she has the tube and although inconvenient - she isn't ready to eat on her own. But maybe quite soon she will be.
 
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