Dosing assistance

Lane&Biddy

Lane&Biddy

Member
Good morning! Biddy's vet recently (just 2 days ago) had us increase his Prozinc to 3.5u BID. I have noticed his PMPS has been much higher than it has been since diagnosis. Should I continue this dose for the full 7 days and do a glucose curve or make adjustments now? He is acting completely normal.
 
I agree with the increase to 3.5. He will need another increase after this one.

He eats dry food?

Please try to always get a test at +2 at night and please try to get mid cycle tests during the day. Some days it seems you are able to. It’s really helpful information. We can get him into better numbers. I would love to help. I do not think those couple of higher PMPS numbers are significant. We are looking for trends and not necessarily every little bit higher or lower. We also have to consider that there is an allowable meter variance that sometimes gives us readings that can be as high as 20 percent variable (even with the same drop of blood.). What we want to look for are the nadirs and we will adjust the dose based on the nadirs for the most part. You are really doing a wonderful job of taking care of your sweet Biddy!
 
Suzanne & Darcy said:
I agree with the increase to 3.5. He will need another increase after this one.

He eats dry food?

Please try to always get a test at +2 at night and please try to get mid cycle tests during the day. Some days it seems you are able to. It’s really helpful information. We can get him into better numbers. I would love to help. I do not think those couple of higher PMPS numbers are significant. We are looking for trends and not necessarily every little bit higher or lower. We also have to consider that there is an allowable meter variance that sometimes gives us readings that can be as high as 20 percent variable (even with the same drop of blood.). What we want to look for are the nadirs and we will adjust the dose based on the nadirs for the most part. You are really doing a wonderful job of taking care of your sweet Biddy!
Click to expand...
Thank you so much for your response. With 6 other senior pets it’s been hard to do more testing but I’m sure I’ll get into a better routine now that holidays are over with. I just want the best for him. He is currently still getting about 2 tablespoons of dry food and working on slowing cutting back.
 
I certainly understand what it’s like taking care of cats with multiple health conditions. It can be really hard and very time consuming. Just a few more days and it looks like (if things stay as they have been) will be ready to increase to 3.75. I am sure the pred doesn’t help, especially at such a dose twice a day. I hope that eventually you will be able to reduce it. My cat with IBD has finally (after months) been able to go to 10 mg. Once a day instead of twice a day. Keep up the good work. If you can just get a +6 it would be helpful. Then maybe a +4 on a different day. He is making some progress— and with the pred, that’s tough.
 
We had to go back to 10mg twice a day and still struggling to get back on track. So I should obviously test AMPS and PMPS but also at +4 or +6 in the morning and +2 at night? Should +2 be checked every day going forward or just until he is more regulated?
 
Lane&Biddy said:
We had to go back to 10mg twice a day and still struggling to get back on track. So I should obviously test AMPS and PMPS but also at +4 or +6 in the morning and +2 at night? Should +2 be checked every day going forward or just until he is more regulated?
Click to expand...
I’m just suggesting that you can vary the times of day that you test in order to fill in spreadsheet data … like a checkerboard. Just try to get at least one mid-cycle test and you can vary the time a bit. Once we have a better idea of when his nadir is, you can try to test then. The +2 test, either morning or evening, is really a helpful test. ProZinc onsets (starts to kick in) at about +2 in most cats, so by checking around two hours after the shot you can tell if the cycle is going to be what we call an “active cycle” or not. If the +2 is a lot lower than the AMOS or PMPS, then that indicates that you will need to monitor the cycle more carefully.
 
Suzanne & Darcy said:
https://docs.google.com/document/u/0/d/11cXW_FOZo4PFWxU2SHKbwsFuybhhltVZX4ZB0bRCRJ8/mobilebasic

the above link to a sticky note explains more about why the +2 is important.
Click to expand...
Thank you SO much. I was never told any of this. My vet told me I just need to test shot time which I have obviously disregarded. I think vets are worried pet parents aren’t willing to put in this much effort so they don’t bother explaining further unfortunately but I am determined to get my little guy feeling better no matter the cost. You’ve already been a tremendous help to us!
 
Thanks for writing and asking me to take a look at his spreadsheet. I was just thinking yesterday that I needed to touch base with you and see how everything is going. You are doing such a great job of getting those tests on many days. Thank you so much for that. I do see what you mean about Boddy dropping more quickly at night. Many cats do drop lower at night and Biddy must just be one of them; it’s not unusual. It really looks like you should increase to 3.75 units. You have held this 3.5 unit dose a bit too long, which can make ot harder to get them regulated as their bodies get so accustomed to the higher numbers. I am encouraged to see some lower preshots— some yellow preshot numbers instead of all pinks. That is some positive progress. You still have plenty of room for the increase with those nadirs. Even in the evening, there’s still room for an increase. The last couple of days Biddy has been higher in the evening? Any idea why? How’s it going with the Prednisolone and the Triaditis? I see you have started Denamarin. That really helped my cat’s elevated liver enzymes. It’s all around a very good supplement.
 
Suzanne & Darcy said:
Thanks for writing and asking me to take a look at his spreadsheet. I was just thinking yesterday that I needed to touch base with you and see how everything is going. You are doing such a great job of getting those tests on many days. Thank you so much for that. I do see what you mean about Boddy dropping more quickly at night. Many cats do drop lower at night and Biddy must just be one of them; it’s not unusual. It really looks like you should increase to 3.75 units. You have held this 3.5 unit dose a bit too long, which can make ot harder to get them regulated as their bodies get so accustomed to the higher numbers. I am encouraged to see some lower preshots— some yellow preshot numbers instead of all pinks. That is some positive progress. You still have plenty of room for the increase with those nadirs. Even in the evening, there’s still room for an increase. The last couple of days Biddy has been higher in the evening? Any idea why? How’s it going with the Prednisolone and the Triaditis? I see you have started Denamarin. That really helped my cat’s elevated liver enzymes. It’s all around a very good supplement.
Click to expand...
Thank you I’ve been too scared to increase with how fast he drops at night. I should have just asked sooner. He’s been doing absolutely fantastic except more diarrhea so we went back to 10mg twice a day for pred. Checking ALT tomorrow but I just started Denamrin today.
 
Lane&Biddy said:
Thank you I’ve been too scared to increase with how fast he drops at night. I should have just asked sooner. He’s been doing absolutely fantastic except more diarrhea so we went back to 10mg twice a day for pred. Checking ALT tomorrow but I just started Denamrin today.
Click to expand...
It will take a few weeks of Denamarin before it shows up in bloodwork. I would wait a month before rechecking. What was the AMPS this morning? For the evening be sure to give a snack at +2. You may actually need to give a few more carbs at mealtime and +2 just to slow things down a bit but without hijacking the whole cycle. I don’t know what you are feeding, but if you have food that has a few more carbs (closer to 8-9 percent) it could help that quick evening drop.
 
Funny thing is though… the last five nights seem to have been different…. there wasn’t an early drop. What did you do differently?
 
Suzanne & Darcy said:
It will take a few weeks of Denamarin before it shows up in bloodwork. I would wait a month before rechecking. What was the AMPS this morning? For the evening be sure to give a snack at +2. You may actually need to give a few more carbs at mealtime and +2 just to slow things down a bit but without hijacking the whole cycle. I don’t know what you are feeding, but if you have food that has a few more carbs (closer to 8-9 percent) it could help that quick evening drop.
Click to expand...
We’re rechecking ALT after being on Veraflox for a bit. I do usually give him a snack (z/d) and meds at +2 in the evening.
 
Lane&Biddy said:
Most of his diet is z/d wet but he gets a couple tablespoons of dry Royal Canin gastrointestinal HP
Click to expand...
How do you like that food and how does he like it? My vet wanted me to order that for my cat Marcus, who had a surgical biopsy last September and was diagnosed with IBD. I looked at it and just hated the fact that chicken liver is the only protein source in there. I know he probably needs the hydrolozed protein, but so far I haven’t given it to him. I’m trying to remember now, but I think the phosphorus level in the z/d wet was okay. I don’t give my cats high phosphorus foods because I want to protect their kidneys.
 
Suzanne & Darcy said:
How do you like that food and how does he like it? My vet wanted me to order that for my cat Marcus, who had a surgical biopsy last September and was diagnosed with IBD. I looked at it and just hated the fact that chicken liver is the only protein source in there. I know he probably needs the hydrolozed protein, but so far I haven’t given it to him. I’m trying to remember now, but I think the phosphorus level in the z/d wet was okay. I don’t give my cats high phosphorus foods because I want to protect their kidneys.
Click to expand...
Both of my cats go absolutely bananas for it. We’ve been through just about every other food out there and this is the only way we get halfway normal stools and energy.
 
Suzanne & Darcy said:
Whoa! That ALT is super super high. I hope when it’s tested tomorrow that the result is much less!
Click to expand...
ALT went up to 1636! Vet said Denamarin could help keep things from progressing so fast but sounds like there’s nothing else I can do for his liver. I’m absolutely devastated.
 
Oh no. That is just horrible news. I am so sorry. What does the vet believe is the cause of the liver problems? Is there anything else that can be done? Denamarin is a powerful supplement, and I believe in it, but what is causing the elevated liver enzymes? Just the triaditis?
 
Infection from the triaditis. I wasn't super optimistic that the antibiotics would cause a significant decrease but I certainly wasn't expecting this outcome... I wish I would have started Denamarin sooner but there's no going back now I suppose.
 
Well, the liver is a remarkable organ in its ability to heal. Livers can regenerate damaged tissue and can even re-grow after partial removal of the liver. Don’t give up!
 
Did you see what I wrote above about the liver? Don’t give up. Vets don’t know everything. They gave my cat with heart disease six months to live and she lived over three years more. I know you are very sad and overwhelmed right now and must feel like you had the rug pulled out from under you, so I will leave you alone. But don’t give up hope.
 
You know how, when a cat has a kidney infection it can take 4-6 weeks of antibiotics to treat. This could be a similar situation.
 
Suzanne & Darcy said:
Did you see what I wrote above about the liver? Don’t give up. Vets don’t know everything. They gave my cat with heart disease six months to live and she lived over three years more. I know you are very sad and overwhelmed right now and must feel like you had the rug pulled out from under you, so I will leave you alone. But don’t give up hope.
Click to expand...
Yes I did. Thank you so much I really appreciate that.
 
Lane&Biddy said:
Thank you for asking Suzanne! He is doing great. If we weren't doing blood work, I'd have no idea he's so sick!
Click to expand...
Well, that’s really important. Biddy is happy and that is so important. If he felt ill, you would know it. Thanks for telling me he’s feeling good. I need to hear good news.
 
Suzanne & Darcy said:
Well, that’s really important. Biddy is happy and that is so important. If he felt ill, you would know it. Thanks for telling me he’s feeling good. I need to hear good news.
Click to expand...
Oh I’m sure you probably don’t get enough good news to balance all of the questions and concerns you get! Thank you for checking in on him and I hope you have a great day!
 
Hello. I hope you and Biddy are having a good day. Since you are currently following SLGS, you hold the dose for 7 days (14 cycles) and then make decisions about increasing. Of course, if you saw a number below 90, you would reduce, but we are not there yet. How we know if the dose is correct is that you need to try to catch the nadir as often as you can. You can do this by either running a curve where you test every 2 hours for one cycle or you can vary those times that you test a bit — to fill in some missing time slots on the spreadsheet. We can’t automatically assume that he nadirs at +6, although he may. If he is getting yellow nadirs (as I suspect he is) then we can increase the dose to 4 units after 7 days on 3.75.
 
Suzanne & Darcy said:
Hello. I hope you and Biddy are having a good day. Since you are currently following SLGS, you hold the dose for 7 days (14 cycles) and then make decisions about increasing. Of course, if you saw a number below 90, you would reduce, but we are not there yet. How we know if the dose is correct is that you need to try to catch the nadir as often as you can. You can do this by either running a curve where you test every 2 hours for one cycle or you can vary those times that you test a bit — to fill in some missing time slots on the spreadsheet. We can’t automatically assume that he nadirs at +6, although he may. If he is getting yellow nadirs (as I suspect he is) then we can increase the dose to 4 units after 7 days on 3.75.
Click to expand...
That makes sense thank you! He’s still acting 100% and his vet is ok refilling his antibiotics for a couple more weeks. I plan to do a curve on Tuesday.
 
Biddy's vet looked over the curve I did yesterday and would like to keep him at his current dose. Do you agree? My gut is telling me to go to 4 units but he dropped pretty fast again last night so I don't know if that is the reason she doesn't want to increase? She told me to do another curve in 1-2 months.
 
Your instincts are correct. You got some good blues last night and that is so wonderful to see! They are higher end blues so you still have plenty of room for an increase. But first, before we discuss it more, did you get any tests today or were you gone all day? Even tests later in the cycle can help us to figure things out.
 
Suzanne & Darcy said:
Your instincts are correct. You got some good blues last night and that is so wonderful to see! They are higher end blues so you still have plenty of room for an increase. But first, before we discuss it more, did you get any tests today or were you gone all day? Even tests later in the cycle can help us to figure things out.
Click to expand...
I have been at work today and wasn't able to get more tests in. I usually take lunch at +7, which is why I have more from that time, but I wasn't able to make it home today.
 
Okay. I see you increased tonight. When is your next day off? Is it this weekend? He looks okay tonight. I would try to get a +4 to make sure.
 
Suzanne & Darcy said:
Okay. I see you increased tonight. When is your next day off? Is it this weekend? He looks okay tonight. I would try to get a +4 to make sure.
Click to expand...
I will get a +4 thank you. My next day off is this weekend but my girlfriend is off tomorrow to watch him. She isn’t comfortable testing but she is very in tune with his behavior and I work a block away at a vet clinic if they need me.
 
That’s good! What do you do at vet clinic? I feel pretty confident that Biddy will be safe on this dose, but I always like to make sure.
 
That must be very busy and it’s actually quite a challenging role in a veterinary practice, I know. It’s great that you’re close to home. Is Biddy’s vet the same one as the vets where you work?
 
Suzanne & Darcy said:
That must be very busy and it’s actually quite a challenging role in a veterinary practice, I know. It’s great that you’re close to home. Is Biddy’s vet the same one as the vets where you work?
Click to expand...
Yes we actually started taking all our pets there years ago and fell in love with the clinic so I applied to work there. I’ll be celebrating my 2 year anniversary there next week!
 
You must log in or register to reply here.
Back
Top