? Ches the red - electrolytes / bowels

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Kris & Teasel said:
R insulin is a fast acting short duration insulin that can be used in very tiny doses at strategic times within a cycle to pull Bg numbers down more strongly. This is in addition to the regular, or basal, insulin.
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Worth an ask - just seem to have some VERY risk averse vets round here who like to treat all their clients like muppets - ok this one IS! :oops:
 
AJay said:
Just to note - if you want your cat to pee - try the running water trick... Might be worth a try - seemed to work for Ches. Either that or the water I've been putting thru him.

Thank you from the bottom of my coffee cup guys! xxx
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What's your "whole cat" assessment of Chester today?
 
R is a very powerful, short acting insulin that's used mostly in DKA cases that are at the vets.....it pulls down high numbers so the basal insulin can "grab on" better.

But it should only be used at home with help from others that have lots of experience with it. I know @Sandy and Black Kitty have helped others.

It's usually started at doses like .01 with lots of testing in the first few hours to see how much it drops the BG....it also has to be timed right....you don't want to have both the basal insulin and the R "nadiring" at the same time
 
Kris & Teasel said:
What's your "whole cat" assessment of Chester today?
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We've had a bloody good day!
He's been fab - I don't know the Healthy Chester - pre all this stuff, obviously. He hadn't been drinking loads, Faeces were very soft, but not explosive liquid. We went out into the orchard, he was bright and alert - not loads of energy - to be expected. Dug holes for wee and poo and covered them over. Seemed happy and contented. Eating well
 
"R" is regular very fast acting insulin. Often used by vets to get BG down fast and also used with high dose kitties in much smaller doses. We have folks here experienced with it's use but it isn't anything you'd want to try on your own. Something to keep in a back pocket should the need arise.

If AJay seems more subdued or off since the Vetsulin that is just more ammo to use to get the vet to consider putting him back on the ProZinc. Some kitties just don't feel well on Vetsulin.

I see Kris & Chris beat me to the insulin query! LOL!

I think we are agreed that Chester should get 2.75u tonight at +8 and we'll figure out next dose times and shoot based on BG readings. Monitor at +2 for starters.
 
AJay said:
We've had a bloody good day!
He's been fab - I don't know the Healthy Chester - pre all this stuff, obviously. He hadn't been drinking loads, Faeces were very soft, but not explosive liquid. We went out into the orchard, he was bright and alert - not loads of energy - to be expected. Dug holes for wee and poo and covered them over. Seemed happy and contented. Eating well
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This is great! It's easy to get fixated on numbers and forget to look at the kitty in front of us.
 
MrWorfMen's Mom said:
"R" is regular very fast acting insulin. Often used by vets to get BG down fast and also used with high dose kitties in much smaller doses. We have folks here experienced with it's use but it isn't anything you'd want to try on your own. Something to keep in a back pocket should the need arise.

If AJay seems more subdued or off since the Vetsulin that is just more ammo to use to get the vet to consider putting him back on the ProZinc. Some kitties just don't feel well on Vetsulin.

I see Kris & Chris beat me to the insulin query! LOL!

I think we are agreed that Chester should get 2.75u tonight at +8 and we'll figure out next dose times and shoot based on BG readings. Monitor at +2 for starters.
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I can be subdued - but usually at different times and when alcohol is withdrawn... LOL!!!

Ok - so 2.75 to start...
 
Something else to consider before going to an 8 hour shot.....to return to your previous shot time and go back to every 12 hours, you'll have to wait until +20 from now to shoot again, or stay on an "adjusted" schedule until you can work your way back....which could take quite a long time....his ketones are negative now and you've only got 4 more hours....might be easier to just push lots of water into him, check ketones when you can and keep an eye on him....start over at your usual shot time in the morning

Is he eating well?
 
He has been eating well. We did an 8 hour and a couple of 10 hour cycles the other day to get them back onto normal shot schedule due to a furshot and some high BG numbers right after discharge from ER. Worked a charm then!
 
@Chris & China Getting him back to schedule is the least of my worries. Him being in high numbers is - He risks dehydration and low potassium like you have NO idea - This is why he ended up being in the vets.

I don't think I could push more water into him than I am - 1 very stressed kitty....

If you can help mw with he schedule, then I can adjust / work it in with my schedule - getting him out of high numbers is vital really given his history.
@MrWorfMen's Mom ?
 
Totally up to you and AJay.....just throwing ideas out there!!...I know AJay is exhausted (I would be too!...of course I live in pretty much a constant state of exhausted myself....LOL)
 
Chris & China said:
Totally up to you and AJay.....just throwing ideas out there!!...I know AJay is exhausted (I would be too!)
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Im ok Chris - just on overdrive energy for Ches. I appreciate the ideas - i really do. He also has possible Triaditis / IBD type stuff going on so very sensitive absorption system as it is :( We need all the low numbers we can grab hold of. lol x
 
Yes let him eat as he chooses other than 2 hours before shot times. We can always raise the insulin later if the need arises.
 
Suggested schedule to get back on to normal 12 hour cycles and shot times.
Do two more 8 hour cycles. Shoot Wednesday @ Noon and at 8pm if BG numbers allow. Then resume 12 hour schedule.

If I've screwed up the times AJay. just holler and I'll re-calculate. I HATE time zones!
 
K - hes starving.. Good sign for him really. :) Help me with fluid and potassium levels.

So you and Kris going to work out a schedule? +8 is 12pm here (lunchtime) Check every 2?
 
MrWorfMen's Mom said:
Suggested schedule to get back on to normal 12 hour cycles and shot times.
Do two more 8 hour cycles. Shoot Wednesday @ Noon and at 8pm if BG numbers allow. Then resume 12 hour schedule.

If I've screwed up the times AJay. just holler and I'll re-calculate. I HATE time zones!
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Times work :) I came to same conclusion lol.

Could you / someone be around for then please? I'll aim to test about +7.5 to give you time? or test closer to +8? Just so I can check numbers, please.

So Im to check for any big drops - 1t spoon of carb if needed - as before? Any chance it could rise?

Terrified cos you guys are going off to bed soon
 
Not sure what you mean by "Help me with fluid and potassium levels."

I'm usually up early and tomorrow I have to put out my recycle so no sleeping in for me! I'll check in at +7.5 11:30am your time (06:30 mine.)

As for testing tonight, see if he is dropping at +2. If so give him that 1tsp of food to slow him down. If you want to give higher carb that's fine. If the drop at +2 is large >5 mmol, then test again at +4. If it's a minor drop, test again at +5.

I hope you can catch a few cat naps. I feel guilty going to bed!

I better goo get my furball their bedtime snack and test my little sweety now. I'll check in before I hit the sack just in case there are any other questions.
 
If he's eating, then it helps me out with his hydration and potassium levels. Otherwise I am into Sub q fluids and syringing more.. Just what I have noticed.

>5 mmol? So from 29 to 24? for example? I thought that would be ok? Sorry :( Just need it in idiots language right now. :(

Don't feel guilty about hitting the sack. :) Plenty of repeats and pre records I can work my way thru... xx
 
Keep putting fluids through?

Sorry - Im not panicking much... Tara will be around soon tho, bless her
 
When did you last give fluids? I wonder if instead of subQ can you add some water to his food? Some kitties won't eat it if it's soupy but others think it's great!
Check his scruff and gums. If gums are tacky or scruff doesn't snap back immediately, then he's down on fluids and might need more subq.

Drop from 29 to 24 is fine but if it's in the first two hours when he's just eaten with his shot, it could mean he's dropping fast. Rather than having to chase after numbers later, I'd intervene with a bit of food to just level him off. 5mmol in 2 hours is a significant drop and if he keeps dropping fast it could cause a bounce which is OK but not ideal because then we fret over the elevated numbers.
 
4.15 fluids. Cant give any sub q's till 12pm lunchtime. He's not snapping back - but he's not at that level of hydration, its not hanging either. Kinda midway. He's being iffy with his mouth cos of all the interference. Difficult to truly tell :(

Ive been syringing warm water to help absorption.

Understood re numbers. Thank you xx
 
If we can keep his BG down, he won't be peeing out as much either so these 8 hour cycles as hard as they are on you, might help keep his urine output under better control and improve his hydration. He's eating better now too so if he keeps that up without the backend problems, he should improve.
 
AJay, another thing that works well for diarrhea and soft/runny poos is s. boulardii. I use plain s.boulardii (no other ingredients) and mix a full capsule-full into the food, morning and night. You may want to start off at 1/2 cap 2x daily and gradually work up to 1 full cap.

Hope Mr. Chester's bg numbers stay down for you, and that he continues to have no ketones. :bighug::bighug::bighug:
 
Chris & China said:
R is a very powerful, short acting insulin that's used mostly in DKA cases that are at the vets.....it pulls down high numbers so the basal insulin can "grab on" better.

But it should only be used at home with help from others that have lots of experience with it. I know @Sandy and Black Kitty have helped others.

It's usually started at doses like .01 with lots of testing in the first few hours to see how much it drops the BG....it also has to be timed right....you don't want to have both the basal insulin and the R "nadiring" at the same time
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My R experience is using it with a depot type insulin. Im not at all familiar with Caninsulin.
Glad Chester is being monitored for the development of ketones. His recent history of 2 episodes of DKA is troubling.
The recipe for the development of ketones -
Not enough insulin+Not enough calories+Infection/Inflammation.
Also note that BGs do not need to be crazy high for ketones to develop.


The way DKA works is that when there is not enough energy from food making it into the cells, the body will breakdown fat and protein to try and fulfill the need for more metabolic energy. The excessive breakdown of these stored reserves creates a toxic by-product - ketones. As ketones build up in the blood stream, the resulting pH and electrolyte imbalances can very quickly develop to life threatening levels , a state of DKA.
So, get more insulin into him, consistently, even if it means feeding higher carb.

Hydration is also very important - when a kitty is dehydrated insulin given by subcutaneous shot does not get properly absorbed. Make sure to fully address any infection and or inflammation.

 
Oh no! :( I saw some higher readings on the SS over night into the morning and wondered what was up. Did something other than the high BG happen? Crossing everything I can here!
 
MrWorfMen's Mom said:
Oh no! :( I saw some higher readings on the SS over night into the morning and wondered what was up. Did something other than the high BG happen? Crossing everything I can here!
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She was most concerned about his bg levels and hydration, thinks perhaps a UTI and needs to stop that in its tracks if that's what it is.
 
I really hope this is only a blip that will resolve. Let us know if the other vet has any insights into how to treat all his other issues going forward.
 
I've spoken to AJay on he phone but parts of the conversation were hard for me to make out so until I get a chance to check with her for the correct info I'm holding off on details other than to say he's having an overnight stay at a lovely hospital with monitoring. And finally a glass of wine! Food and sleep for AJay! :)
 
TempestsMum said:
I've spoken to AJay on he phone but parts of the conversation were hard for me to make out so until I get a chance to check with her for the correct info I'm holding off on details other than to say he's having an overnight stay at a lovely hospital with monitoring. And finally a glass of wine! Food and sleep for AJay! :)
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What a wonderful friend you are, Tara :)
 
wine.jpg Ches.jpg

Laydeez and Gentlemen, I declare it Wine o'Clock in honour of a truly humbling awesome group of people. It really has restored my faith in human nature! To that end I declare that tonight is a night off for all of those who have offered help and the most incredible support in some of the toughest days with Mr Golden Paws.

Ches is now in a different vets. Its quite a distance from me, but he is getting awesome care and support. <3 I first took him to my local branch of the Practice. Jon agreed to see him as a last minute on the end of his clinic. @TempestsMum (aka unbelievably amazing, awesome, wonderful person!) helped me to concoct a version of events and facts that was not going to drop anyone in the smelly stuff. Some facts were omitted, others were moulded to suit ;)

Jon was understandably reticent to get dropped into the middle of a complex case that had been handled by another vet and an opinion from a specialist. But after being presented with a full set of facts and figures from "our" end, he was persuaded to give it a go and see what could be done. In true vet fashion he was cagey about the prognosis but agreed to work with me, to find a way forward for Ches that suited him including the possibility of Sub q fluids at home! :D :D if needs be.

I haven't asked yet, but I feel they may be open to him being referred to a homeopathic vet too :)

As there was limited care that could be given to Ches at the local clinic - no point starting treatment to then have to unsettle him and move him to the main clinic 40 mins away with the other blood testing equipment. We made a paw pact that I would come back for him later on and have a chat to the Clinical Lead who was over there.

I nipped home to check the animals, post, see if the fortiflora had been delivered... Mom offered to feed me and I had a half hour kat nap :)
At 5pm I went back to see Ches - what a transformation!!! He had really picked up and meeped, head rubbed and purred his way round the table!

In the space of the 4 hrs I was away, they ran some more blood tests and put him on a Hartmanns IV. Caths (Clinical Lead) assessment of him was that generally the bloods were very good - considering what she had read in his previous history from the other vets, she expected a lot worse. Hydration and electrolytes were generally good - Potassium at the low end of normal, but holding.

The only thing that stood out was that he was anaemic. His blood was not regenerating and she does not know why - yet. She ran a FIP test - negative :) So ideas on a postcard please :)

Cath has agreed to work with me to medically support Ches and try to get to the bottom of his various conditions. She has upped his Insulin to 3u. Wasn't worried by any of the actions we took last night - in fact quite the opposite... In time I will come clean as I think it is a benefit she would appreciate. :) She is absolutely of the opinion that Ches is not a candidate for PTS AT ALL! Not denying that he is still very sick and accepts that this could take a very long time to sort out and get him to a point he can pretty much support himself. She has upped his insulin to 3u.BG currently sitting at 20. No keytones, urinalysis generally very good. Signs of a UTI for which he'll get antic's and she'll sort me out some antic's to take home :)

An interesting comment she made was that she had swapped the saline IV for Hartmanns... I hadn't spotted in the notes from the previous Vet that he had been on a saline drip!!! High carb food and too low an insulin dose!!!! OMG!

She made a point of asking me about diet for him :D :D :D She was really happy that I had brought some of the diet he is currently tolerating - Applaws. It not ideal or complete, but it will do for now. Bozita is ordered and she will be very happy when it arrives :) She's very open to discussing what may or may not work for him in terms of settling the obvious inflammation in his system - doing invasive tests is not an option. We'll just have to work with the clinical signs and take it very slow with him. Day by day.

Finally a vet that is prepared to listen and work with us! What a breath of fresh air! It is actually the vet I did Work Experience with when I was training :D

I had about an hour with him in a separate room, cuddling, him having a wander and then doing a very passable Simons Cat impression! 3 pouches later he was heaving and looking very full :D :D

When it was time for him to go back, I picked him up like a baby cradled - the first time he has never squirmed... He lifted his head and hooked his chin over my shoulder and refused to budge :cat::cat: He really got upset when I put him on the table for the nurse to pick him up :( :( But I'll be back to see him tomorrow and give him big hugs and cuddles - and more food! :D :D

I told him that he had a lot of new family rooting for him and that he just had to rest up and let us get to the bottom of this little blip.

Tonight, I am going to have a well earned rest, ready for round 3 when Mr Golden Paws comes home :D :D

Thank you all again for giving us rock solid support when I was really losing the ability to reason at all. :kiss::kiss::kiss:
 
I am so relieved to hear that Golden Paws is now getting the attention and care he needs. AJay, your resourcefulness is amazing and Chester is so lucky to have you as his hooman! Rest well! :bighug::bighug::bighug::bighug:
 
I am SO happy to hear the good news!!! I have been so worried about both Chester, and you, too, AJay. Thank heavens for this new vet! :bighug::bighug::bighug:

You deserve that glass of vino, AJay, enjoy!:):bighug::bighug:
 
Ches is back from his holibobs!:rolleyes::rolleyes::rolleyes:

A surprise quick discharge. I only went in to visit him last night and ended up coming back home with him :D He did exceptionally well. They were impressed with his glucose curve. Eating well, bowel and bladder working properly again...

I had a hideous "consult" with yet another vet :rolleyes::rolleyes: Suffice to say I won't be having anything to do with him again and have made this quite clear to Jon this morning. As far as I was concerned I was not going to go thru all the history etc and justify testing / dosing / my actions for Ches over the last week - just to keep him alive! Long story and the Earth Angel Tara @TempestsMum has already had the rant from me.

Ches is back on 2.5u as he dropped to 5mmol at one point. Ive updated his spreadsheet this morning. :)

Thanks again to Tara, Ches is on Bozita and I have lost count of the 190g paks he has made his way through so far since we got home. lol Best bit is his tummy is tolerating it very well. :D :D :D

We've been out into the orchard, made our mark ;) snoozed under a bush that I then had to climb in and tempt him out (with food) :rolleyes::rolleyes:

Balls to the "other vet" - If I want to take home my unstable diabetic and monitor him i darn well will, because whilst you've had "training" on FD Im pretty sure you've never had to deal with it... And one day, if you're lucky, you'll learn that the care providers DO have valid info AND can be very capable and effective at monitoring their fur family if needed because they have SUPERB back up. ;) :) (And if he's even luckier, he might make a good vet...)

Thank you for all your good wishes. I really couldn't have got through this without falling apart. Lets hope we have a bit of a longer break between visits this time :) :)
 
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YEAH! Chester is home! Thank you for the update and so happy to hear he's doing well on his new food and enjoying the orchard. Sorry you had to endure yet another run in with a dimwitted vet. Unfortunately, this seems to be a pretty common experience with our extra sweet fur kids. All fingers and paws crossed there are no more bumps in the road for you and Chester! :bighug::bighug::bighug::bighug:
 
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