? Dosing HELP please: Lola 11/18 AMPS 108

Jade_Leah said:
and if it's possible that she is experiencing insulin resistance due to the CKD/pancreas issues.
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Infection definitely causes insulin resistance. So does inflammation. If they did an ultrasound wouldn’t they have seen intestinal inflammation or some indicator of IBD? The kidneys are enlarged rather than shrunken.
 
Suzanne & Darcy said:
Her white count is still way too high — and the neutrophils. The inflammatory markers your vet is referring to can also indicate infection/inflammation. I think she needs a longer course an antibiotic that is appropriate to treat a kidney infection.
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Do you know what antibiotics are usually the best for this?
 
It’s going to be much easier to use the aluminum hydroxide powder. If you add it to every food the phosphorus should come down. We need it down because high phosphorus is hurting her kidneys further.

At least the glucose was a lower 400 yesterday.
She’s anemic but above 20 so that’s not too bad.
 
Zenequin and Baytril are both good kidney penetrating antibiotics.

Her anemia may also improve with antibiotic treatment since infection can contribute to that.
 
About the bouncing. When the bounce is breaking, you want to try to catch it and be on top of her numbers— especially now when we aren’t sure of she’s being overdosed. When increasing in increments of whole units you can definitely shoot right past the best dose.
 
Suzanne & Darcy said:
Zenequin and Baytril are both good kidney penetrating antibiotics.

Her anemia may also improve with antibiotic treatment since infection can contribute to that.
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I have emailed our vet about getting her on one of the antibiotics you mentioned. I'm worried I'm coming across as a nuisance and telling him how to do his job, but I'm pushing through the anxiety as best as I can to try to help my lady. This is all just so much and so petrifying!
 
Zenequin has the advantage of being dosed only once per day. It’s appropriate for kidney infection as long as she has no history of seizures.
 
Jade_Leah said:
I have emailed our vet about getting her on one of the antibiotics you mentioned. I'm worried I'm coming across as a nuisance and telling him how to do his job, but I'm pushing through the anxiety as best as I can to try to help my lady. This is all just so much and so petrifying!
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I feel like you have nothing to lose by trying the antibiotic.
 
I will check in with you later on. :bighug:Just remember, you have your girl with you and she is still fighting. She hasn’t given up and she’s still eating and is still beating up your dog! She’s got spunk! That’s good! You still have time and the opportunity to help her.
 
Suzanne & Darcy said:
Zenequin and Baytril are both good kidney penetrating antibiotics.

Her anemia may also improve with antibiotic treatment since infection can contribute to that.
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I will let you know when I hear back from my vet about the antibiotics and fluids. In happy news she seems to love the Pure Bites. It'll try mixing some crushed up in her wet food tonight.
 
Jade_Leah said:
I will let you know when I hear back from my vet about the antibiotics and fluids. In happy news she seems to love the Pure Bites. It'll try mixing some crushed up in her wet food tonight.
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I hope she likes the Magic Chicken Dust. Sometimes they will lick the top and need another sprinkle again. They know how to work it!
 
Hey @Jade_Leah I just wanted to say good job hanging in there and advocating for Lola, especially with all of the confusion and chaos and information overload. It really can be overwhelming in the beginning.

Suzanne has tons of experience and has you covered so I’ll head back into the woodwork. I’ll just add that I think it’s reasonable to hope to get Lola back on track. Fluids and phosphorus binders and insulin and an appropriate low-carb food can make a big difference, as can addressing any infection/inflammation. I would be nowhere near giving up hope if I were you.

Low-carb food, even low carb dry, can significantly lower BG so hopefully you’ll see some improvement in BG once you switch over. You’ll want to be monitoring BG closely because we really don’t yet know if she’s on the correct insulin dose (and her insulin needs will likely lower once you eliminate the dastardly k/d and w/d carbs).

All of the feetsies and paws in our house are sending positive thoughts your way. :bighug:
 
JL and Chip said:
Hey @Jade_Leah I just wanted to say good job hanging in there and advocating for Lola, especially with all of the confusion and chaos and information overload. It really can be overwhelming in the beginning.

Suzanne has tons of experience and has you covered so I’ll head back into the woodwork. I’ll just add that I think it’s reasonable to hope to get Lola back on track. Fluids and phosphorus binders and insulin and an appropriate low-carb food can make a big difference, as can addressing any infection/inflammation. I would be nowhere near giving up hope if I were you.

Low-carb food, even low carb dry, can significantly lower BG so hopefully you’ll see some improvement in BG once you switch over. You’ll want to be monitoring BG closely because we really don’t yet know if she’s on the correct insulin dose (and her insulin needs will likely lower once you eliminate the dastardly k/d and w/d carbs).

All of the feetsies and paws in our house are sending positive thoughts your way. :bighug:
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Thanks, @JL and Chip. You know I totally respect your knowledge. We have worked together before! Please keep in on what we have going on here with Lola because your insights are very valuable!
 
Suzanne & Darcy said:
Thanks, @JL and Chip. You know I totally respect your knowledge. We have worked together before! Please keep in on what we have going on here with Lola because your insights are very valuable!
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So Lola's PMPS was HI yet again, but she got her insulin and with a mixture of sprinkled on Pure Bites and churu on top I got her to eat 2/3 of a little can of Weruva play pate. Now, she is notorious for liking something one day and hating it the next, but I am taking the wins where I can get them.

Hello @JL and Chip ! Thank you so much for your input and kind words. I really need them right now when everything seems so foreboding!
 
Suzanne & Darcy said:
Get a test tonight before bed if you can… just to make sure…. Even if it feels useless. Hang in there with me.
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I got a reading at a tiny bit befor the +2 mark and it was still HI but I did another when I woke up to use the restroom and got a reading at the +7 mark and it was 462! I can't believe I'm excited about a number in the 400s I will let you know what her AMPS is and I've updated her spreadsheet.
 
Hello again,

Sadly, AMPS was HI but I was expecting as much. I am outside playing tug with the foul beast (sweet and insane 8 month old puppy Dan) to give her some alone time with her wet food that I doctored up with the Magic Dust and Churu again.

I'm not sure if there is an answer for this, but any clue how much food I should be trying to get in her per day to keep both her diabetes and her CKD happy-ish? I honestly have no idea how much I should be giving her and how often. She's currently 9lbs and some change and holding (but would be healthiest at around 11.5-12lbs as she's a big kitty and 9lbs is skin and bones for her).
 
Jade_Leah said:
She did not want the wet food I offered her this morning just ate the Magic Dust and Churu off after multiple applications. I gave her dry but hated doing it because it's not yet the new food I ordered.
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My regular vet is now saying that I need pass on my question/request to put Lola on antibiotics to the specialist she is going to. The one that told me they don't recommend that I do spot checks in between dose adjustments
 
Jade_Leah said:
My regular vet is now saying that I need pass on my question/request to put Lola on antibiotics to the specialist she is going to. The one that told me they don't recommend that I do spot checks in between dose adjustments
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Oh good grief! That is so ridiculous. The general practitioner vet can’t prescribe anti to a cat with high WBC, neuts, etc. It dangerous to just sit on this and wait. I cannot understand why he’s passing the buck like that. She needs those ASAP.
 
Jade_Leah said:
Hello again,

Sadly, AMPS was HI but I was expecting as much. I am outside playing tug with the foul beast (sweet and insane 8 month old puppy Dan) to give her some alone time with her wet food that I doctored up with the Magic Dust and Churu again.

I'm not sure if there is an answer for this, but any clue how much food I should be trying to get in her per day to keep both her diabetes and her CKD happy-ish? I honestly have no idea how much I should be giving her and how often. She's currently 9lbs and some change and holding (but would be healthiest at around 11.5-12lbs as she's a big kitty and 9lbs is skin and bones for her).
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I would give her as much as she will eat. How much is she eating? Does she show signs of nausea like going up to food sniffing it and walking away? Or other signs?
 
Okay, it wasn't as bad as I feared but I still feel like the man doesn't have a clue.

"Jade,

Thank you for your update regarding Lola. I have copied Woodman Drive AH on this email as well so we can all remain on the same page regarding Lola's care. I want to make sure we have one consensus as we move forward since there are a lot of moving pieces with Lola's situation and it can get very confusing with multiple recommendations over email.

There was no overt evidence of GI disease on ultrasound when Lola was hospitalized, however, that does not rule out the possibility of underlying GI disease.

The urine culture identified no growth of bacteria when Lola was hospitalized, however, I am not opposed to another short course of antibiotics as a trial to see if it results in any improvement, as long as Lola continues to eat well and does not have side effects from the medication.

I do not suspect that the diet is the sole driver of her new insulin resistance; I suspect that she may have an underlying source of inflammation (such as pancreatitis - pancreatic inflammation). The k/d is not terribly high in carbohydrates - it is ~8 grams of carbs/100 Kcal where most "diabetic" diets are 7 g/100 Kcal or less. I am more concerned about her kidney function at this time - if she will eat the k/d consistently, we can regulate diabetes around the diet that is most appropriate for kidney disease.

We've had several different recommendations for insulin dosing because of the updates regarding her glucose level coming in at varying times from you and Dr. Middlebrooks. Because of her current situation with the glucose reading "HI," I think an insulin dose increase is reasonable.

Considerations moving forward:
If you think that Lola was improved on the antibiotic, we can try an additional 7 day course of Clavamox with monitoring of her kidney values and blood glucose to see if there is improvement.
If her BG is truly and consistently reading "HI," we can increase the insulin dose back to 5 units under the skin twice daily.
If she is doing well at home, I would recommend a recheck BG curve in ~1 week at home and a recheck CBC/chemistry with Dr. Middlebrooks or myself in ~7-10 days.
Let me know how else I can assist."

I will not be increasing her insulin
 
Clavamox os probably the #1 most likely to cause GI upset. Many cats cannot tolerate it at all. It causes diarrhea, vomiting, inappetance in many cats. I have to keep a list of which of my cats can/cannot tolerate it. Has she ever taken Clavamox before? I usually end up with lots of Clavamox on hand around here because it gets prescribed and the cat gets sick from it and then we have to stop the medication and switch to a different antibiotic.

My only thought is that you could say you would prefer Zenequin because you would only have to pill her once a day.
 
The switch to the new food should help a lot. I can’t wait. Although you should probably start by giving the new food a little slowly to help avoid GI problems like diarrhea. And if she’s starting an antibiotic you should probably also give a probiotic— separated by a few hours from the antibiotic if possible. Proviable is one that is not too expensive. I use Visbiome Vet but that is because I have 2 cats with IBD. It is great and well-studied and is supposed to be beneficial for the kidneys, but it’s somewhat expensive.
 
I have had a very busy day so wasn't able to get anything since AMPS but at +6 she is at 352! My regular vet is fine with switching to zenequin or enrofloxacin (he says its the same drug class and what he has in stock) but wants to hear from the specialist first. I'm going to call the specialist office to get an answer because email is taking forever.
 
Suzanne & Darcy said:
The switch to the new food should help a lot. I can’t wait. Although you should probably start by giving the new food a little slowly to help avoid GI problems like diarrhea. And if she’s starting an antibiotic you should probably also give a probiotic— separated by a few hours from the antibiotic if possible. Proviable is one that is not too expensive. I use Visbiome Vet but that is because I have 2 cats with IBD. It is great and well-studied and is supposed to be beneficial for the kidneys, but it’s somewhat expensive.
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Ok so both vets are on board for zenequin, but the specialist has vetoed enrofloxacin as a substitute for it if my regular vet doesn't have the right size zenequin for Lola's weight. I'm going to ask him to order it if he doesn't have it in stock. Thank you so much for your advice and giving me the courage to push back!
 
Suzanne & Darcy said:
Please keep in on what we have going on here with Lola because your insights are very valuable!
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Oh sure. Just didn’t want to have too many voices adding to the confusion. Thanks for the compliment, by the way. It does truly sometimes take a village. :)
Jade_Leah said:
but the specialist has vetoed enrofloxacin as a substitute for it if my regular vet doesn't have the right size zenequin for Lola's weight. I'm going to ask him to order it if he doesn't have it in stock.
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Enrofloxacin (Baytril) can cause problems in some cats (blindness comes to mind), so perhaps that’s the reason for the veto. Some vets are more comfortable prescribing it than others. I’ve used it frequently over the years in my crew with no problem.

Zenequin is a great choice for possible kidney infection, but the key is giving it for a long enough of treatment. My pyelonephritis kitty was on it for 4-6 weeks if I recall.

I also disagree with the vet’s statement that k/d dry food is only a little higher carb than diabetic food. Granted some “diabetic” food sold at vet clinics isn’t particularly low carb, so that statement might be technically true(ish), but there are better choices available for both kidney and diabetes. Most of us have “been there done that” and had to navigate the mixed messages. :confused:
 
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Jade_Leah said:
I have had a very busy day so wasn't able to get anything since AMPS but at +6 she is at 352! My regular vet is fine with switching to zenequin or enrofloxacin (he says its the same drug class and what he has in stock) but wants to hear from the specialist first. I'm going to call the specialist office to get an answer because email is taking forever.
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Oh my! I am soooo excited to have anything in the 300s. I wish I had seen this earlier because it jas made my day (now night.). I am literally almost in tears with a pink number! That is so silly of me, I am sure, but I can’t help it.
 
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JL and Chip said:
Oh sure. Just didn’t want to have too many voices adding to the confusion. Thanks for the compliment, by the way. It does truly sometimes take a village. :)
Enrofloxacin (Baytril) can cause problems in some cats (blindness comes to mind), so perhaps that’s the reason for the veto. Some vets are more comfortable prescribing it than others. I’ve used it frequently over the years in my crew with no problem.

Zenequin is a great choice for possible kidney infection, but the key is giving it for a long enough of treatment. My pyelonephritis kitty was on it for 4-6 weeks if I recall.

I also disagree with the vet’s statement that k/d dry food is only a little higher carb than diabetic food. Granted some “diabetic” food sold at vet clinics isn’t particularly low carb, so that statement might be technically true(ish), but there are better choices available for both kidney and diabetes. Most of us have “been there done that” and had to navigate the mixed messages. :confused:
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Yeah. I didn’t bother to mention that about the k/d dry food because the vet, although well-meaning, clearly doesn’t have a good understanding of carb percentages. It is confusing too — dry matter basis, metabolized energy, % per kilocalories, etc. I was pretty sure that Jade wasn’t buying it either!
 
And I totally agree about the “short course of antibiotics” since we all know how long a kidney infection can take to fully clear. I just was happy that they’ve agreed to begin antibiotics. We will fight the battle to extend the antibiotics once the bloodwork improves after the “short course”. Hopefully they will at least give you ten days to start!
 
Jade_Leah said:
or enrofloxacin (he says its the same drug class and what he has in stock)
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Yes. Both Baytril (Enrofloxacin) and Zenequin (Marbofloxacin) are in the fluoroquinone class of antibiotocs. I have also never had GI problems when using these in my cats (not like Clavamox.) With regard to Baytril. The cats who went blind were given very high doses of the medication. I have used it in my cats many years and no problems at all. I hope they will prescribe Zenequin.
 
Jade_Leah said:
Ok so both vets are on board for zenequin, but the specialist has vetoed enrofloxacin as a substitute for it if my regular vet doesn't have the right size zenequin for Lola's weight. I'm going to ask him to order it if he doesn't have it in stock. Thank you so much for your advice and giving me the courage to push back!
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You Go, Girl! You are Lola’s best and only advocate!
 
JL and Chip said:
Oh sure. Just didn’t want to have too many voices adding to the confusion. Thanks for the compliment, by the way. It does truly sometimes take a village. :)
Enrofloxacin (Baytril) can cause problems in some cats (blindness comes to mind), so perhaps that’s the reason for the veto. Some vets are more comfortable prescribing it than others. I’ve used it frequently over the years in my crew with no problem.

Zenequin is a great choice for possible kidney infection, but the key is giving it for a long enough of treatment. My pyelonephritis kitty was on it for 4-6 weeks if I recall.

I also disagree with the vet’s statement that k/d dry food is only a little higher carb than diabetic food. Granted some “diabetic” food sold at vet clinics isn’t particularly low carb, so that statement might be technically true(ish), but there are better choices available for both kidney and diabetes. Most of us have “been there done that” and had to navigate the mixed messages. :confused:
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Suzanne & Darcy said:
Yeah. I didn’t bother to mention that about the k/d dry food because the vet, although well-meaning, clearly doesn’t have a good understanding of carb percentages. It is confusing too — dry matter basis, metabolized energy, % per kilocalories, etc. I was pretty sure that Jade wasn’t buying it either!
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Tagging you here too @Suzanne & Darcy to get all of my updates out in one place!

I wasn't buying what the vet said about the k/d food at all. Except for the fact that I had already bought it in a literal sense. And Hills w/d. And gut biome. And now Elsey’s (arrived today and she likes it so far!!) and Young Again. It's a veritable buffet. At least I'll have food to give to friends/people in the community who made need it and it'll actually be appropriate for their cat. That's one of the comforts I'm taking in all of this mess- that I will be gaining knowledge and experience that could help other people and their beloved kitties (and my future self and kitties as well).

Animals are my passion and helping them and finding them homes and care is something I participate in as often as I can. It's my thing. So it goes without saying that my animals are no less than my greatest companions who will receive the best care I can provide them even if I have to pretend Lola refuses to wat the k/d food to a slightly cocky 20-something internal medicine vet so that I can open his mind to the food cats with this mix of comorbidities actually NEED.

I have a couple of pieces of good news. I secured 10 days of the Zenequin! Lola's PMPS is 418 on the AlphaTrak 3 is 418 aaaand it's 396 on the ReliOn meter that finally showed up today along with the ketone strips!

Do you think I should keep using both meters at least until I run out of strips for the Alphatrak? Do I need to set up a new spreadsheet for the ReliOn? Or can I just add a new sheet at the bottom of my current spreadsheet and pull the template for the human meter over onto the new tab? To neatly keep everything in one place.
 
I decided to share some pictures because I'm feeling sappy and we've been talking about her for days. We've been together since December 2012 when she was 4 months old. I saw her on PetFinder and fell in love. I've always said she's my most successful online relationship outcome

This is Lola at the height of health in all her round glory May '22:

https://photos.app.goo.gl/LsVvp2hhcvWQAYecA

Her the day of her diabetes diagnosis Nov '23:

https://photos.app.goo.gl/AJrNvXtw2wtHNJLp8

Her during her hospital stay :

https://photos.app.goo.gl/y2oXgQTd43oe4wzR8

Aaand her today:

https://photos.app.goo.gl/dLAGn74Xcmo378Ew7
 
Suzanne & Darcy said:
Oh my! I am soooo excited to have anything in the 300s. I wish I had seen this earlier because it jas made my day (now night.). I am literally almost in tears with a pink number! That is so silly of me, I am sure, but I can’t help it.
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I just saw this comment and it made me cry. Haha. You are so sweet. I really hope things are moving in the right direction and that the zenequin does something good for the gal as well.
 
Jade_Leah said:
I decided to share some pictures because I'm feeling sappy and we've been talking about her for days. We've been together since December 2012 when she was 4 months old. I saw her on PetFinder and fell in love. I've always said she's my most successful online relationship outcome

This is Lola at the height of health in all her round glory May '22:

https://photos.app.goo.gl/LsVvp2hhcvWQAYecA

Her the day of her diabetes diagnosis Nov '23:

https://photos.app.goo.gl/AJrNvXtw2wtHNJLp8

Her during her hospital stay :

https://photos.app.goo.gl/y2oXgQTd43oe4wzR8

Aaand her today:

https://photos.app.goo.gl/dLAGn74Xcmo378Ew7
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Thanks for sharing those photos! She definitely looks better today than she did while in the hospital. She is underweight, as you already mentioned. We will fatten her up and just wait until you see how much better her fur is going to look! She’s still pretty though!
 
Can you get a test any time tonight?

I am feeling really hopeful. We will probably have to ride out the ups and downs because that’s the way it usually goes, but I am feeling very optimistic tonight.
 
Suzanne & Darcy said:
Can you get a test any time tonight?

I am feeling really hopeful. We will probably have to ride out the ups and downs because that’s the way it usually goes, but I am feeling very optimistic tonight.
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I was out like a light and didn't get any tests last night but her AMPS is 447 on Alphatrak and 382 on ReliOn this morning. So slightly higher than last night but still seems better than it was!

I noticed that the difference in readings the two meters gave was bigger between last night and today. A difference 22 of vs today's 65. Is that unusual?
 
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@Suzanne & Darcy @JL and Chip @SmallestSparrow

I JUST GOT A BG READING OF 199 AT +6

Trying not to get TOO excited because I know how these things flip flop all over the place but I am thrilled.

She is back to refusing wet food mostly but likes the Dr. Elsey's and the Young Again food arrived today. She gets her 2nd dose of the Zenequin this evening. We retest her blood next Wednesday and I'm doing her next at home BG curve that day as well as long as nothing happens before then. The one thing I miss about the hospital is the ability to get her renal values at any time.

Thank you all for hanging in here with me. I know the battle has only commenced but I am letting myself feel a tiny bit of relief.
 
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