8/23 Reuben PMPS 438 +2 421 +6 414

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Alexa and Reuben

Alexa and Reuben

Member Since 2012
Yesterday

Good Morning LL Friends! We woke up with a number and not a word, yeay!

We are fine, I didn`t give him bupe last night as he wasn`t in crisis and I didn`t feel confident learning a new med skill (getting the dose out of the glass vial requires creative problem solving). So I waited until this morning and gave him .02 bupe (using the start low go slow approach with this med). He is Not in meatloaf position now, and is visibly more relaxed. I am not giving metoclopramide as indicated by the vet, as I checked the drug interactions and there is one. So instead I am using the pepcid (.25mg last night and then again this morning). I have get a BG reading right now and will come back with more about the new vet. Thank you all again soooo much for helping us! dancing_cat Happy Thursday!!
 
Re: 8/23 Reuben AMPS 479 +3 333

His +3 looks good. Moving in the right direction! A +5 would probably be good to get next. Did the pepcid help him? If not, you might want to call the vet for the other nausea med.

Melanie & Racci
 
Re: 8/23 Reuben AMPS 479 +3 333

Yes, we are painting our numbers on the big picture, and +3 333 looks like such a nice auspicious number don`t you think? He was back in meatloaf position (under a chair in and unfamiliar corner) so I added .02ml bupe just now and encouraged food and water. I`ll watch and see what happens.

Here's the vet visit summary. I went with the minimum requirement being for us to walk away with a prescription for bupe, and anything beyond that was going to be a big bonus. We got the scrip and we got some bonus. First, he is very easy to communicate with; he listens well and explains things well. He totally supports the diabetes treatment we are doing, and the home testing. We talked all about the pancreatitis and Reuben's chronic intestinal infections; dehydration, pain management and long term (big picture) goals. His first and foremost perspective about the long term is that, given Reuben's history of illnesses that have stressed his liver and kidneys, he wants to use the least amount of drugs possible to achieve our goals in order to preserve the health of the organs, and give him the best chance at a long and happy life.

I like this way of thinking.

He chose metoclopramide (the vets around here really seem to still like this drug...) for the stomach issues since it also stimulates motility, but when I researched drug interactions it turned out that the meto and bupe combination can have a bad reaction. He replaced the meto with pepcid. He does not want to use ondansatron or maropitant right now; I didn`t understand why and will research them and pepcid to learn about them. He prescribed the buprenorphine. About the dehydration, he said we should start with oral hydration, that it is preferable, that we should control the pain first and see if Reuben responds with better liquid intake and hydration; and that subQ's are next if it isn`t resolved soon. He feels confident that pain reduction is going to resolve the majority of the issues, and even wants me to suspend the antibiotic for the stomach infection, as in his opinion the symptoms indicate more problem with pain than infection. An interesting perspective that I am willing to act on but not until the pain is under control.

I think a water fountain is a really good idea and will see if I can find one today. I haven`t seen a specifically pet fountain, but any fountain should have the same result - and little fountains are all the rage right now so it shouldn`t be a problem to find one.

Reuben is sleeping! Yeayyy!! It means the bupe is working. I'm so happy I think I`m going to :cry: cry!

Baby Steps... Keep watching the big picture.. My motto is Unready and Willing :razz:

I have to put my house back together now :roll: The kitchen sink faucet broke yesterday so it has to be fixed, and then all the dishes that piled up washed, fun!! And, I hit my shin on the edge of a cedar bed base last night and it produced a giant lump that hurts so badly if I try to stand up that I have just been sitting all morning. Has anyone ever had this happen? I have to research and see if it seems like something that will resolve itself or if I have to intervene...

I`m sorry it has taken so long to get this post up, it takes me forEver to write!!

Thaaaaaank youuu All - I hope all the LL kitties are happy and well and going toward green today :razz: I will go condo visiting after a while when the sink and leg are resolved :razz: :YMHUG: hugs to all the kitties and beans!!! Alexa & Reuben
 
Re: 8/23 Reuben AMPS 479 +3 333

What you have on your leg sounds like a normal reaction to a bad knock (fibroblasts, fluids, blood etc. accumulating). Do you have helichrysum oil (also called immortelle oil) in the house? Applied neat to swellings/bruises, it will help with pain and fluid build-up. If not, apply an ice pack and consider ibuprofen for pain relief. Bruising/swelling is a normal reaction to knocking a limb. :smile:

Hope this helps.
Jane
 
Re: 8/23 Reuben AMPS 479 +3 333

Loving all the lovely messages of encouragement!!! :razz: dancing_cat

Thaaaaaank youuuuu :razz: :razz:

Jane - I pm'd you back just now (just sooo sloowww with the message writing, it`s amazing!) Oh thank you for the dx on my bumpy leg, i`ll go get an ice bag and take pain meds right now. I`ll see if I can get the helichrysum / immortelle oil.

Hi Melanie :razz: thank youuu for the advice, I`ll get the +5, and... How do I know the difference between nausea and pain symptoms?

dancing_cat :razz: dancing_cat
 
Re: 8/23 Reuben AMPS 479 +3 333

Well, I think I must have gotten bupe contact high because it is Not +5, but in reality it is +6 and I seem to have lost an hour!! So we will never know what the +5 reading was... :roll: Yesterday the +4 was blue, so he could have gone there today but we don`t know. I like that the +6 today is pink as opposed to the +6 red yesterday. Tomorrow I will put an alarm on for the testing so I don`t miss any important ones.
 
Re: 8/23 Reuben AMPS 479 +3 333 +6 337 +9 372

Hi Alexa,
There are any number of pet drinking fountains on the market. We have the plastic "Petsafe Delux" (bought at PetSmart), but I think that if I were going to get a new one, I would get one that is made of stainless steel. Here's a link to one that looks interesting on Amazon.com:
http://www.amazon.com/Pioneer-Pet-S...drop/dp/B0037NKDSG/?tag=felinediabetesfdmb-20

Good luck with the fountain, and good luck with all of Reuben's issues. Sending him lots of healing vines this evening. Your new vet sounds very caring and good.

Hope you have a good evening and a restful night,

Ella & Rusty
 
Re: 8/23 Reuben AMPS 479 +3 333 +6 337 +9 372

Hi Alexa,
Nice pink day for Reuben, great to see those numbers! Glad you are pleased with your new vet, and you have gotten the meds you need for Reuben. Bummer about about banging your leg - been there, done that, ouch. In addition to ice and meds, elevating it to help reduce swelling. Hope you and Reuben have a nice relaxing evening!
 
Re: 8/23 Reuben AMPS 479 +3 333 +6 337 +9 372 PMPS 438

I have the ceramic version of the fountain that Ella linked. I'd be careful about getting a fountain at a hardware store or garden supply place. You don't know if any chemicals could leach out and contaminate the water and make Reuben sick.
 
Re: 8/23 Reuben AMPS 479 +3 333 +6 337 +9 372 PMPS 438

Hi! Thanks for the information about the fountain. I`m ordering it right now! :razz:
 
Re: 8/23 Reuben AMPS 479 +3 333 +6 337 +9 372 PMPS 438

Oh my goodness!!!! Real numbers!!!!! CONGRATS! and those 300's are really nice for a cat that has only known HI for numbers! :-D

Keep up the great work, Reuben & Alexa

Sleep well, you two deserve it!!!
 
Re: 8/23 Reuben AMPS 479 +3 333 +6 337 +9 372 PMPS 438

Although those red & purple is still hard on our eyes but it's good that Reuben is slowly improving
Better lowering his bg slowly than taking a dive down. Just remember any sudden drop can still trigger a bounce, green or not still the same.
 
Re: 8/23 Reuben AMPS 479 +3 333 +6 337 +9 372 PMPS 438

Hi Alexa!
Reuben had a great day today. His #s are much better. He has a regular curve today. I think his nadir was probably about 3.5-4.5 so we don'tknow how much lower he went, but I would guess in the low 300's.

The new vet sounds great! I'm glad you found someone good and supportive. I like that he gave you so much time also.

When they're nauseas they usually want it but when they get to the food they turn their heads and lick their lips.

talk to you in the morning.

Melanie & Racci
 
Hi Alexa

Thanks for your PM. I've looked over your SS again now, and I've asked some of the other ladies to come have a look and pitch in with thoughts.

You're coming up on the 8th cycle on this dose, and on the 14th day in mostly black, red and pink numbers. IMHO, I think it's worth considering another increase by 0.25u to help Reuben out of those unhealthy ranges. He did see that one pretty blue BG on the 22nd - I'd like to see him show more of that kind of number, to give his pancreas more time in the healing-range BGs. I would not go straight to a 0.5u increase, just to rule out going past a dose (in this case, 2.0u via the 0.25u increase) that could do some good for Reuben.

The reason I'd go for the increase now rather than on the 5th day (TR Protocol suggests 3-5 days on a new dose to see what it can do, depending on the nadir range) is that Reuben has only had that one single dip into the blue, and the rest of the time, he stayed above 200, and often even above 300, with his nadirs. Glucose toxicity remains at the forefront of my concerns for Reuben. Here's the quote from the protocol:

Quoted from TR Protocol Sticky:
Increasing the dose:
Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.

So, to sum up: I would try an increase by 0.25u, making his dose 2.0u (also nice and easy to measure :lol:) for the next shot.

Let's see what others think!
Jane
 
I agree with Jane. Time for a nice easy to measure 2.00 units, I think.

Good luck with the Pancreatitis. You can also join the Feline Pancreatitis Support group, where they can help you with your meds questions.

I've been giving J.D. Ondansetron since March.
 
Thank you sooo much,Jane and Dyana, you are awesome to be here with an answer so quickly! :razz:
I will start with 2.0 on the next dose, and join the Pancreatitis group. For the moment I`m going to try and get a couple of hours of sleep before the next shot! ( -.- ) zzzzz See you guys tomorrow!
 
The increase sounds like a good plan. You want to get into the habit of evaluating Reuben's dose every 3 days/6 cycles. Sitting overly long in high numbers makes it harder to get the numbers to come down.

"General" Guidelines:

Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 consecutive cycles).

Each subsequent dose is held for a minimum of 3 days (6 consecutive cycles) unless kitty earns a reduction (See: Reducing the dose...).

Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.


Increasing the dose:

Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.

After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.

After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.
Click to expand...
 
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