Ballonee 12/25/17 AMPS 466 PMPS 109

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SpencerLindley

SpencerLindley

Member Since 2017
Update: Last night Ballonee's PMPS was 333 and she decreased to 63 at +4 after eating really well (3/4 can of food (1/2 recovery, 1/2 diabetic formula)

This morning she was 466. Acting so much like herself though.

Replying to Nan & Amber from a convo this morning on yesterdays thread:

"She's actually earned another reduction to 0.1U with the low numbers yesterday"

Yes I'm going to watch her today and and probably decrease is she's still going low on me. Yesterday she got symptomatic which scared me.

"On the spreadsheet it looks like her regular food is still 1/2 diabetic, 1/2 recovery food, which would be low carb. Can you start feeding her some of the gravy-containing food in her regular meals, and see if that allows her body to handle the 0.25U dose?"

Yes she is still on low carb. She is highly reactive to the gravy food. It works like a charm for her when she get's into the low numbers. If I were feeding her that I think I'd definitely need an increase in the insulin. She has an appointment with the vet on the 28th so maybe he'll have some input as well... he did mention that he's never had a cat on 0.25units before though so I'm not sure how much he can figure this out with me..

I was wondering what the rationale for feeding the high protein low carb food to diabetic cats is? Am I going to hurt her by adding in some gravy food to her meals? or a higher carb food? This was suggested to me before too in a chat about brittle diabetes.
 
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SpencerLindley said:
I was wondering what the rationale for feeding the high protein low carb food to diabetic cats is? Am I going to hurt her by adding in some gravy food to her meals? or a higher carb food? This was suggested to me before too in a chat about brittle diabetes.
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This is a really good question. Note to any casual readers of this thread: the advice given is Ballonee-specific!!!! Do not copy or apply to your own cat.

In general, diabetic cats should be fed low-carb food. In Ballonee's case, a very recent DKA means that there are other needs that trump this recommendation. Specifically, she needs sufficient insulin to prevent recurrence of ketones (lowering BG is not the only function of insulin), and that may mean having to give her more carbs so that the insulin doesn't cause her to go hypo. In most diabetic cats, we concentrate on the insulin-BG relationship, and dose insulin in response to BG numbers only (mostly). In Ballonee's case, we kind of want to reverse the relationship, and manipulate the BG numbers (through carbs) to match the amount of insulin we are giving.

To answer your question: no, it won't hurt her to give her more carbs. Later on, when there's more distance from the DKA (and when she's gained some weight back and is less fragile), you'll probably want to decrease carbs again, but she's not there yet.

I'm going to tag a member with a lot of DKA experience, @Meya14 , who may be able to offer more specific suggestions for Ballonee's care. It's a bit slow here on the boards over the holiday, unfortunately, but hopefully at some point more people will get a chance to weigh in on this as well.
 
Thank you so much for the information and your support especially over the holiday!! <3 Now that we are taking about this she's been a bit different today! I just checked and shes 10.9 at +3.5 so maybe following a different trend today :/ Imagine my surprise when I checked her and it was over 4.0 haha. But yesterday she had more carb rich food because of those two pretty low numbers and maybe she's still bouncing from yesterday. So unpredictable this little one. I think that's what I'm going to have to do though with adding some carbs. She seems to stabilize better as well as feel better.... Also on a side note when I pet her I'm noticing a bit of weight gain.. her spine doesn't feel quite so harsh on the hand. Vet's weighing her on the 28th should be interesting. I hope she gained.
 
I don’t believe it is a situation of needing to feed her gravy or HC food to hold her at 0.25u longer. And I, personally, would have decreased her dose with that 50 on an AT and then a 63 last night because she was three cycles past her reduction and one cycle included a skipped shot. The 0.5u is not affecting her depot at this point.

Part of DKA is ensuring she has enough insulin but you are dealing with a safety issue here and HC will wear off quickly. The focus needs to be in getting more calories into her.

I understand she has recently had DKA but you also need to keep her safe. I’d rather not see you skip doses; if you get a number you are not comfortable shooting, stall without feeding and post here for help and we can teach you to shoot lower so you don’t have to skip shots.

What I would suggest to you is that you learn to manage the curve with food to get those big drops under control. If you can learn to flatten the curve more, she will do better. However, that means you also have to test sooner. Cats on lantus typically onset about +2; so she’s probably taking a steep dive then. What you don’t want is a dive bounce cycle which is where she is now.

I wrote extensively about Managing the Curve with Food for Girlie (see post #13). After Christmas, you might want to read it and let me know if you have questions. IMHO, that is the remedy for holding her at a better dose longer where she can get into green and stay there. Once you get her flattened, then you might very well need to take the dose up.

Merry Christmas!
 
I read "Managing the curve with Food" and it stressed me out so much I almost chewed my fingers off.

From 0.25 units how much would you decrease. To 0.1? Should I discuss with my vet before I decrease?

About shooting low:
I get nervous with Ballonee to shoot low because she is an incredibly unpredictable eater.. I would hate to be in a situation where shes dropping and I can't get food into her. Id rather not syringe feed if possible since she doesn't take well to that and avoids food after.

My other concern is I also work shift work and can't always be there in which case it's safer to miss a dose when they are reading low, no? I have a couple of night shifts coming up and I don't want her to bottom out on me when I'm not there to check on her.

This is what I took from your above post about flattening the curve: Test earlier than +3 +4 to see when she initially drops and feed again before this drop so the steep drop doesn't occur. Is that correct? The rest I'm going to have to process later.

Marje and Gracie said:
I understand she has recently had DKA but you also need to keep her safe
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I'm honestly working every second of the day to do that. I'm new to this and really doing the best I can with the knowledge that I have of feline diabetes. Thank you for the information. Merry Christmas to you as well!
 
Tonight her number was 109.. She ate really well. I gave her 0.1 units. A little uncomfortable doing so because of how she drops. Just keep monitoring closely?
 
SpencerLindley said:
I read "Managing the curve with Food" and it stressed me out so much I almost chewed my fingers off.

From 0.25 units how much would you decrease. To 0.1? Should I discuss with my vet before I decrease?

About shooting low:
I get nervous with Ballonee to shoot low because she is an incredibly unpredictable eater.. I would hate to be in a situation where shes dropping and I can't get food into her. Id rather not syringe feed if possible since she doesn't take well to that and avoids food after.

My other concern is I also work shift work and can't always be there in which case it's safer to miss a dose when they are reading low, no? I have a couple of night shifts coming up and I don't want her to bottom out on me when I'm not there to check on her.

This is what I took from your above post about flattening the curve: Test earlier than +3 +4 to see when she initially drops and feed again before this drop so the steep drop doesn't occur. Is that correct? The rest I'm going to have to process later.

I'm honestly working every second of the day to do that. I'm new to this and really doing the best I can with the knowledge that I have of feline diabetes. Thank you for the information. Merry Christmas to you as well!
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I understand that it’s very hard when you are working so much and you also have this DKA issue in the past.

I didn’t mean to stress you out with the info or for you to try and process it all at once. You can bookmark it by clicking on “watch thread” in the upper right corner and it will save it in your “watched threads” file.

But yes, the bottom line is to initially test at PS, +1, +2, +3 etc and feed a higher low carb food to try and prop the lowest numbers of the cycle up so you don’t have to worry about her going low. Sometimes that flattens them out at a higher number, which is the goal, and then you can tweak the dose.

With all you’ve said about work, about worrying about her dropping low, with the numbers you got yesterday on an AT, if she were mine, I’d drop the dose to 0.1u. However, if she does not come back down to green once any bounces have cleared, go back up. Don’t sit on a dose that’s not working. Reductions don’t need time to “settle” like increases do. We don’t ask people to just start shooting 68 (AT) or 50 (human meter). We teach them to do it gradually so they can see how the cat drops and how it responds to food. It’s important that you write things down so that if she drops 30 mg/dL and you feed her a MC food, you know how she responds to it. The time in the cycle is equally important. She will likely respond faster to a MC food fed in response to a lower number late in the cycle than she will early in the cycle when she’s just onsetting.

The lower the PS, the less they will drop afterwards. There’s much more room for them to drop when they start at 300 than when they start at 100. Still, it’s important to test and not be complacent until you understand her patterns.

If she’s an unpredictable eater, all the more reason to be sure she gets as many calories out of what you feed her. You are testing for ketones daily, yes? Even in normal numbers, they can throw ketones. And remember, if she’s eating and drinking normally, she is not likely to develop DKA. It’s the not eating, not drinking, infection, and not enough insulin that is the recipe for DKA.

SpencerLindley said:
Tonight her number was 109.. She ate really well. I gave her 0.1 units. A little uncomfortable doing so because of how she drops. Just keep monitoring closely?
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Excellent! I would start with a +1 since you shot a lower number (not low, just lower).
 
Thank you so much for all the information. I'm going to go over it more in the next few days to make sure I understand everything.


Marje and Gracie said:
Excellent! I would start with a +1 since you shot a lower number (not low, just lower).
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She was 115 at +1.5.. I'm glad to see it went up a bit.. I've never actually gotten a +1 since shes been back with me so it's interesting to see it increase a bit.
 
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Sorry to just see this....I hope you fed that.

You can see the importance of early tests. She was flat from PMPS to +1 so a test at +2 would let you catch and feed the drop before it got lower.

When they are green like this and above 67, the goal is to feed a few tsp of LC and try to get her to flatten out and surf the greens.
 
I did feed about 1/8 can of LC

An hour later she was 4.6 so a little bit up from the food. Planning to check again soon. So now I'm hoping that she sticks around this level for a bit before the lantus wears off by itself is that correct?
 
At 100 now.. so in the blue.. Didn't feed anymore though. I think she's probably starting to increase on her own now.. Did miss the really low area this time though so I think that's a success.
 
@SpencerLindley Yes, that’s good that she didn’t drop lower.

Since she is on such a small amount of insulin but her SS does not indicate she’s ready to go into remission, it’s going to be very important that you test and feed earlier in the cycle so you can keep her from earning a reduction.
 
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Well.... below 68 on the AT2 which, assuming that's what you were using today, she has already hit.

I confess that I'm not sure what to counsel you to do at this point. What was her eating schedule like today when she went from 315 to 61 between AMPS and +3? Marje's advice on feeding carbs during the cycle in response to BG numbers (to try to prevent these kinds of drops) is sound, but it seems that Ballonee can drop hard early enough that you'll definitely have to get tests before +3 to be able to do it effectively.
 
She's 414 now.. I have no idea what to do anymore. I might call her vet.. There hasn't been a dose that hasn't made her go under 72 at least.
 
Yeah mostly.. I mean I did want to get the lactulose into her the vet told me to hold off until he spoke with me but hasnt called yet. She poops but its quite hard. She's eating great. Acting okay mostly but with the huge ups and downs gets kind of exhausted I'm guessing.
 
How much food do most cats have before their insulin shot? She's eating a normal amount correct? like 1/2 can of food then shot? I dont think I can get her to eat more than that
 
In 3 hours.. Yes she's eating the 1/4 can recovery 1/4 can diabetic .. Yeah I think its just pretty much a drop of insulin after right? That sticky is how I learned to draw up the 0.1.. I think a decrease wouldn't be great though cause she's going up to numbers like 23.. hours before the end of the cycle
 
SpencerLindley said:
I realize the high numbers are better than the hypoglycemia but at this point I just feel so lost on what I'm doing
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:bighug:

SpencerLindley said:
How much food do most cats have before their insulin shot? She's eating a normal amount correct? like 1/2 can of food then shot? I dont think I can get her to eat more than that
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She doesn't have to eat the full meal before the shot. It might actually be better to spread the food out over a period of time if you can, possibly adding a few drops of syrup if she seems to be going low. This could be a good way to implement Marje's advice about managing the curve and trying to flatten Ballonee out a little.

Mog's questions about Ballonee's weight will help determine the proper amount of food for her.
 
Yeah this next shot my decision making is kind if important she'll be at a friends house tonight as I have a night shift 11 to 7. Super nervous. I showed them how to check her glucose.
 
She has a vet appointment on the 28th as well so I'm looking forward to that. I'm going to feed her at 7 tonight with her shot and then again at 930 before I leave (before her numbers to low).. Do you think the 0.1 is a good dose to stick with?
 
How comfortable is your friend with the testing? I don't think she'll go low again tonight, but you never know. Given that she's eating well and is currently ketone-negative (plus you aren't going to be able to keep a close eye on her all night) it might be better to take this reduction, and re-group tomorrow morning, or after you've had a chance to talk to the vet.
 
SpencerLindley said:
Crittermom, I actually don't have a scale at home for her and to be honest I don't know the answer to her ideal.weight. She was 1.98 when I brought her in I think she's most definitely gained. Side note no ketones in the urine though so that's good just checked.
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Good news on the ketone front! :)

It's good to hear that you think Ballonee may be regaining some weight; 1.98kg is so tiny! (All of mine have been in the 4kg+ range.) Here's a body condition chart to help you gauge where Ballonee is 'shape-wise':

Feline Body Condition Chart

For future reference, a great aid to monitoring weight at home is a digital baby scale (available at Amazon, for example). Certainly more affordable than a veterinary scale! I'll be very keen to hear what she weighs at her check-up on Thursday.

I'm so pleased to hear that your friend can step in to help you and your girl. It's such a blessing to have someone there for you both who can offer a bit of 'real world' support. (((Your friend))) Be sure to have all the hypo toolbox foods/supplies in Ballonee's overnight bag.

Keeping fingers and paws crossed for a smooth, safe and uneventful sleepover for your little dote. (((Ballonee)))

:bighug:


Mogs
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She did get below 68 but you just reduced her so you don’t want to do it again.

If you want to be able to control the drops, you have to feed her mini meals, as discussed in what I linked for you, early in the cycle. I would suggest that until you get it under control, you test at PS, +1, +2, +3 every cycle you can. You might also need to test at +4 depending on how she’s dropping and whether you can flatten her early in the cycle.

Once you get her flatter, you can try and back off the testing and just feed the cycle as you know she likely needs.

I’ll be back to read more in a while. It’s our Christmas today and we are about to have dinner.
 
@Marje and Gracie -

Here are a couple of bullet points to save you a little time getting up to date with status:

- Spencer is working a night shift tonight.

- Ballonee is being cared for by Spencer's friend overnight so testing might be an issue. (They've been shown how to test but, if I understand Spencer correctly, they've not had any practical experience yet.)


Mogs
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The reason why she is so erratic is because she’s taking those steep dives.

Three things cause a bounce:
  • Dropping too far too fast
  • Lower numbers than kitty’s liver is used to (they migh5 be blue numbers)
  • Low numbers
By spreading the food out, you are giving the insulin something to work on.

This will continue until you get the curve flatter or her liver gets used to lower numbers.

It’s usually better to feed a food in the 6-10% range than it is in a 0-3% range.
 
@Marje and Gracie -

With Ballonee being such a very tiny kitty (1.98kg at last vet check) and being currently underweight (info posted earlier in Feline Health) how should this influence treatment decisions, bearing in mind that Ballonee's little body currently seems not to have much in the way of stored energy reserves to counter a potential hypo when the insulin's at peak effect in the cycle? It's a worry that Ballonee is experiencing episodes where she's symptomatic as well as biochemically hypoglycaemic ...

ETA:

... and, due to life circumstances, there will be times when it will not be logistically possible for Spencer to monitor/steer Ballonee throughout any given cycle. What are the safety contingencies for situations like that, especially for an underweight kitty recovering from a very recent episode of DKA receiving only a miniscule dose of insulin?


Mogs
.
 
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Critter Mom said:
@Marje and Gracie -

With Ballonee being such a very tiny kitty (1.98kg at last vet check) and being currently underweight (info posted earlier in Feline Health) how should this influence treatment decisions, bearing in mind that Ballonee's little body currently seems not to have much in the way of stored energy reserves to counter a potential hypo when the insulin's at peak effect in the cycle? It's a worry that Ballonee is experiencing episodes where she's symptomatic as well as biochemically hypoglycaemic ...

ETA:

... and, due to life circumstances, there will be times when it will not be logistically possible for Spencer to monitor/steer Ballonee throughout any given cycle. What are the safety contingencies for situations like that, especially for an underweight kitty recovering from a very recent episode of DKA receiving only a miniscule dose of insulin?

Mogs
.
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Hey Mogs!

Yesterday, I suggested that Ballonee be fed as high a calorie food as possible. It’s important that she be able to get as many calories in the food she does eat. I hope that would help her gradually gain weight.

I also posted that feeding a higher low carb food, even in the range of 10%, should help her BG flatten as long as she isn’t fed all her food at once. Spencer might need to get an auto feeder so Ballonee gets food at least through +3 to +4 or, if we can see when she nadirs for certain, perhaps even later.

She’s already on about as low a dose as we should take a recent DKA kitty for the BGs she has. The other goal besides getting her flatter is to raise the overall curve to just get a bit more insulin in her, if necessary and possible.

Spencer is in the same boat as many who work long hours and can’t monitor as much as others do. Each CG has the responsibility to learn their cat’s onset, nadir, duration, and patterns so they know when it’s safe to shoot a full dose and go to work with HC food out, if necessary.

We can give info and answer questions but we can only do so much with the data that is provided on the SS. There might be more flexibility if Ballonee hadn’t had DKA but we want to avoid skipped shots unless it is clearly unsafe.

Is it possible for friends to stay with her like tonight or for her to go to work with Spencer?
 
She's been known to go low 2x in one day
Nan & Amber said:
I don't think she'll go low again tonight, but you never know. Given that she's eating well and is currently ketone-negative (plus you aren't going to be able to keep a close eye on her all night) it might be better to take this reduction, and re-group tomorrow morning, or after you've had a chance to talk to the vet.
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You're right :) she didnt go low.. She had a nice Nadir of 5.2.. now if only she could always stop around that point lol. I did do the reduction because that's what I felt safe doing tonight <3 thank you

Critter Mom said:
I'll be very keen to hear what she weighs at her check-up on Thursday.

I'm so pleased to hear that your friend can step in to help you and your girl. It's such a blessing to have someone there for you both who can offer a bit of 'real world' support. (((Your friend))) Be sure to have all the hypo toolbox foods/supplies in Ballonee's overnight bag.
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I will definitely keep you updated. I'm really curious to hear what she weighs now too. I was soo thankful to my friend. It was brave of her.. I think I'd be terrified watching someones "just recovered from DKA kitten" haha.

Marje and Gracie said:
I’ll be back to read more in a while. It’s our Christmas today and we are about to have dinner.
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I hope you had a great time with your family <3
Marje and Gracie said:
Three things cause a bounce:
  • Dropping too far too fast
  • Lower numbers than kitty’s liver is used to (they migh5 be blue numbers)
  • Low numbers
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I honestly think her body is soo used to the higher numbers.. when she gets even into the blue numbers she starts acting so "off" :( and then when she starts acting "like herself" that's when she reads high :( She's going to have a lot to get used to.

Marje and Gracie said:
Spencer might need to get an auto feeder so Ballonee gets food at least through +3 to +4 or, if we can see when she nadirs for certain, perhaps even later.
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I would absolutely love to do that but Ballonee is a tricky kitty... I'm not sure if she would eat on schedule. I'm just so happy that she's now eating when I tell her to in the mornings and evenings.. I wouldn't be able to bring her to work with me as much as I'd love to <3

Looking forward to the vet visit tomorrow... Thank you so much for all of your great advice everyone. Sorry I didn't check back I finished our PM routine and then took off to work :(
 
Critter Mom said:
... and, due to life circumstances, there will be times when it will not be logistically possible for Spencer to monitor/steer Ballonee throughout any given cycle. What are the safety contingencies for situations like that, especially for an underweight kitty recovering from a very recent episode of DKA receiving only a miniscule dose of insulin?
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This is kind of what I'm worried about :( Like I say I want to do everything I can for her but it's unlikely that I can continue to stay at home everyday and help her through low number episodes. So far she's at least had one a day? Like if her shot is given in the morning I can't necessarily stay at home for three more hours making sure she eats if I have a day shift :( Even though Id like to. I wouldn't trust Ballonee with a food dispenser.. if she goes low she gets really tired and just kind of sleeps.. I don't know if I could trust that she'd get up and feed herself.
 
I
SpencerLindley said:
I honestly think her body is soo used to the higher numbers.. when she gets even into the blue numbers she starts acting so "off" :( and then when she starts acting "like herself" that's when she reads high :( She's going to have a lot to get used to.
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This is totally normal and all FD cats do it until they get used to lower numbers again so I wouldn’t worry about that.

Many cats will eat as the numbers start to drop so observe her and see if she asks for food at any time. If she does ask for food, other than her normal feeding times, test her and see where she is.

There are two goals for you to focus on to help her right now:
  • Get enough calories in her to help her gain weight; I would aim for extra calories at this point. If you know what her ideal weight is, feed the calories for that.
  • Get the right amount of carbs in her to bring her BG up and level so we can increase the dose safely.
I keep reading from others that you need to feed her HC food so you can get more insulin in her. What they are missing is that some cats don’t need HC food to flatten the curve at a higher level so you can safely increase the dose.

Some cats are very carb sensitive and 10% carbs would act like 20% in others. We’ve even seen some cats get a huge food spike from freeze dried treats! Ballonee needs to be fed the % carbs that work to bring her BG up and flat....not a “generic” number of carbs. I suggested starting with 10% but you might find that is too much or too little.

Your “job” is to find out how carb sensitive she is. I would suggest you write in the Remarks of her SS what you feed, how much you feed, when you feed it, and what carbs you used. When she drops lower, what did you feed to bring her up and how did she respond? These are things you need to know to treat her diabetes.

I know this is a stretch but is it possible for you to take a couple weeks off work to focus on getting weight on her, figuring out her food, getting her curve flattened? I understand that most people don’t have that flexibility but it bears asking.

I will say that cats can be taught to eat on a schedule. I did it with my Gracie after she was dx with FD and that’s how I’ve raised my kitten. It takes consistency but it really helps when they know they are to eat at a specific times. But...the caveat is that you need the time to teach it to her.

She’s actually only had four cycles of numbers where she’s dipped down lower than we like. It occurred because no she wasn’t tested enough early on and the drop of the numbers fed. That’s not a critique....it’s just what I see on the SS and I’ve seen enough that look like this to know that is what happens.

We understand it’s tough to juggle work with a kitty recovering from DKA. We’ve had many members who have had to do it. :bighug:
 
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SpencerLindley said:
Even though Id like to. I wouldn't trust Ballonee with a food dispenser.. if she goes low she gets really tired and just kind of sleeps.. I don't know if I could trust that she'd get up and feed herself.
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This is a very valid concern. Not all cats will seek food when they're low. I'm speaking from personal experience here and I've also read reports of similar posted by other members on this board.

Saoirse got very lethargic when she was being treated with Caninsulin. One night, when I went to do her regular 'before bed' test it showed her BG level had tanked from a fairly high level at PMPS right down to the bottom of the normal BG range. She had been lying flat out behind a curtain and was really out of it; didn't respond at all when I called her name (unprecedented behaviour) and did not look for food. When I roused her and put food in front of her she absolutely mullered her way through the meal, and I was able to feed her and monitor the rest of the cycle. If I hadn't been home testing - or if I had not been with her - I shudder to think what could have happened ...


Mogs
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^^ My Ballonee is like that too. That's why if at all possible, and honestly at this point I dont know if it will be, I'd like to find her a dose that doesn't always guarantee a number under 70. I don't really even know what I'm doing with her dosing anymore to be honest. I've gotten mixed advice.. all of which I agree with if looking at it from different angles.. and I've tried to get a hold of her vet for the last 3 days and literally no one has called me back. I even said it was about her glucs :(
 
I'm sorry about the conflicting advice-- there are some special circumstances in Ballonee's case that make it hard, so there just isn't a single obvious solution. We're all trying to give advice that will keep her safe above all, but also advice that you can actually follow as you are balancing all the other demands in your life.

I think this will get easier once Ballonee puts some weight back on and is able to process insulin without either crashing down, zooming up, or both (the zooming up is a fact of life with a lot of cats in the beginning, it's the crashing down on tiny doses that is making Ballonee unusual and hard to advise). In the meantime, you're gathering data on what the different doses can do and how she responds to various levels of carbs alongside those doses. I think the only thing you can do is to give the dose that you feel most confident you can handle, and keep doing what you are doing in terms of observing her progress (testing for ketones daily, noting her behavior/mood, etc.).

I hope that the vet is helpful (not calling back is not a great sign, but the holidays always play havoc with response times so that might be the problem there).
 
Nan & Amber said:
I'm sorry about the conflicting advice-- there are some special circumstances in Ballonee's case that make it hard, so there just isn't a single obvious solution. We're all trying to give advice that will keep her safe above all, but also advice that you can actually follow as you are balancing all the other demands in your life.
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Yes, and I'm so thankful for all of the advice given to me. I honestly don't know where I'd be right now without all of the support here <3 closer to a mental breakdown hahaha :P I did an update post for today's date. I got her an appointment with a different vet who's supposed to be really great. So crossing my fingers. And she has an appointment tomorrow with her regular vet so maybe he can give me some dosing advice in the mean time.
 
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