Re: 12/15 Tawny PMPS 254;+1/245

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DD & Tinkerbell

DD & Tinkerbell

Very Active Member
Well, the 12/14 condo never got done on 12/14, so i decided to start that one that is now about 30 hrs behind by opening her a 12/15 condo at 1 a.m.! What was supposed to be an "in and out" trip to check the infection around the e-tube wound to LVRC (~1.5 hrs from home, ~2 hrs from THS) at 10 a.m. turned into an all-day'r...they found that Tawny had broken one of her sutures loose, had to sedate her and re-suture. They were swamped all morning and at noon Dr. Amanda told me she was going to try to get to her w/in the hr...i went and got me some lunch (what a rare treat that was) and came back, fell asleep curled up in a corner on a sofa in the lobby, and 2 hrs later they had to call my name 3 times when Tawny was ready to go. WoW. Lunch and sleep. WoW. :lol: Get to THS w/Tawny at closing time, closed up, 45 min's to the house, fed everybody else, medicated Tawny, tube-fed her, made 3 batches of liquidated Recovery mixed w/water (not using Clinicare, her BGs are too high & it's 25% carbs i think s/one said), strained it, and here i am.

LVRC checked her for ketones, too, NONE. I caught a pee at the house about 10 p.m. & again, NONE.

So in trying to catch up w/2days of condos, i'll start w/the truly utterly awesome Karrie, who has posted & PMd me for 2 days as we try to put the action plan together:

Karrie and Maverick said:
When you open your condo today can you call DKA dosing advisors in your subject line?

Can you also repost my questions? Some still need to be answered by you ;)
Click to expand...

Done & doing, see above subject line & below...

Karrie and Maverick said:
So we need to get an action plan together.
1. Managing her BG - you have to do this. I will leave this to the insulin experts. Can you call them in your subject line?
Click to expand...
Done. She is really high tonight, and only had 1/2 of a quarter cup of S/O dry at the clinic Wednesday 12/14 as far as dry food goes. Otherwise she has consumed between eating on her own and being finger fed & tube fed about 1/2 - 5.5oz can Wellness Ckn (finger fed & licking it up out of bowl), the S/O, 1/3 can of Recovery she will eat on her own and another 1/4 can via tube feeding. I plan to tube feed her again in 4 hrs.

Karrie and Maverick said:
2. Food. We have to get calories into her. They say to feed what ever she will eat. What will she eat consistently. Since she has a feeding tube you do not have to be scared = if she doesn't eat enough you can tube feed. We will figure out calories. So can you list what you think she eats well (and enjoys eating)? brand and flavours. If you think she is on a kibble kick maybe we can switch to high calorie Innova, Evo or Wellness Core - a lower carb kibble. List the wet foods also.
Click to expand...

She is definitely on a Kibble kick. The s/o dry is the only thing she will consistently eat on her own. LVRC prescribed the Urinary S/O, not the diabetic one. I have a bag of Royal Canin dry diabetic food here that was given to me recently.

She likes the Recovery, she likes it better mixed w/Clinicare but i think s/one posted CC was 25% carbs.

She like the Wellness Chicken, not the turkey so much.

Mostly she just licks the gooey parts off the wet, or licks the "gravy" if i add water, but today she did actually eat chunks out of a bowl of wellness ckn.

Karrie and Maverick said:
You have Recovery and Clinicare and wellness Chicken which is 200 calories for 156 grams.
Click to expand...


Her dischg pprs say on the Recovery she would need 200mls per 24 hrs. I cannot figure out if this is her normal need, or her healing need. That doesn't seem like much to me. so is the 1.5 times (or is it 2.5 times?) the normal need is 1.5 or 2.5 times 200, or is 200 it?

Karrie and Maverick said:
3. Huge question for you guys. What is your best guess for the calorie count we are aiming for?
Click to expand...
Karrie and Maverick said:
Desi may have to feed a couple times over night. The FAF group needs to know also. They are helping just with tube feeding and getting enough calories - nothing around the diabetes.
Click to expand...

Yes a calorie count would be incredibly helpful. converted to mls of any given food. (i ain't asking for much, am i?)

Karrie and Maverick said:
They have recommended an accurate scale. But I understand that with DKA its not just about maintaining weight like it is with FHL. Can you guys give me a crash course here and I will share it with FAF?
Click to expand...

I have a lg postal scale and an old-fashioned non-digital baby scale, guess i'll start there.

Karrie and Maverick said:
We will work out a plan around insulin, calories, how much to supplement via the tube.
Click to expand...

I plan to raise her dose in the morning if her BGs are still really high, despite what the clinic says. i don't have any recent nadir and she is for today (12/14) pretty much off dry, but i would like to go a whole .5u but i know the protocal recommends .25u, She is too high, 490 at pmps. Could the sedation have spiked it this high?

she is going to THS w/me so i can watch her. 3u BID right now.

I am falling asleep, got to go...bbl...

This action plan Karrie recommends is just the ticket, if we can put s/thg together.

Sandy and Black Kitty said:
Hi there!

For a kitty recovering from DKA, you want to feed at least 1.5 times the calories required under normal circumstances.
The feeding tube will be a great help with getting enough calories into Tawny.

Is Tawny getting any SQs?
Click to expand...
No, no SQs, does she need to? She drinks a lot of water.

Sandy and Black Kitty said:
Keep the following in mind-
Not enough insulin + not enough calories + infection leads to ketones.
Click to expand...
i did not know this...one more reason to up her dose w/next shot.

Desi
 
Re: 12/15 Tawny 1 a.m. Update - Need DKA & Dosing Advisors P

DCIN is still asking for donations to cover Tawny's third DKA hospitalization. This is her blog page which has the link to a chip-in.

An anonymous donor is matching donations $2 for $1. Since that started, DCIN has received about $200 in donations (making it $600 with the donor's match). DCIN still hopes to collect another $210 in donations, allowing DCIN to receive another $420 from the matching pledge. If we can do that, DCIN will be able to cover all of the costs from this 3rd hospitalization without using DCIN's general fund.

Please donate if you can. If you can't, prayers for Desi and Tawny are just as precious. Because Desi and Tawny are so precious.
 
Re: 12/15 Tawny 1 a.m. Update - Need DKA & Dosing Advisors P

I'm really glad for the absence of ketones!!

As far as dose, I wouldn't raise the dose more than 0.25u given that you have minimal data. I'm actually a bit reticent to suggest that you raise the dose since there are no spot checks (unless you were able to grab a sleep test). I'm seeing if I can round up some additional folks for more input.
 
Re: 12/15 Tawny 1 a.m. Update - Need DKA & Dosing Advisors P

Sienne and Gabby said:
I'm really glad for the absence of ketones!!

As far as dose, I wouldn't raise the dose more than 0.25u given that you have minimal data. I'm actually a bit reticent to suggest that you raise the dose since there are no spot checks (unless you were able to grab a sleep test). I'm seeing if I can round up some additional folks for more input.
Click to expand...

Once again, the intuition and knowledge of this board is right. Not enough mid-cycle data to safely raise the dose, and this morning @ +9 Tawny's BG was 185, and this after she had eaten about 1/4 of an eighth of a can of Wellness Chicken on her own! Thank you Sienne! Will definitely hold off on the dose crease. The last time she got dry was at the clinic yesterday about 2 p.m., about 17 hrs b4 the 185. During that 17 hours she has eaten either Wellness Chicken or Recovery on her own, maybe 3/4s of a 5.5oz. can and been tube fed 40mls Recovery.

When I got ready to tube feed her this morning I set a bowl of Wellness Chicken in front of her and she ate about 1/4 can on her own. I am wondering if I should go ahead with the tube feed or wait & if waiting, how long? an hour? longer? (I posted this query on the FAF group too.)

I think the action plan Karrie mentions is very important, I have an outline & would like input:

Tube-feedings: every ________ (how many hrs?) Recovery and Wellness Chicken or Turkey, blended with either water or Clinicare;

If she eats an 8th of a can on her own, follow w/tube feedings: (1) right away; (2) wait ______ (how long?)

Supplement w/dry? The urinary S/O the clinic wants me to let her eat? (This is the one thing she is eating consistently on her own.)

Add'l input on what else needs to be on the action plan is greatly appreciated.

She is not getting SubQs at the moment, she is drinking well on her own.

OT (sort of but it involves Tawny): She goes back to the clinic in the morning @ 10 a.m. for another check on the infection around the e-tube incision. They want to watch it closely. This creates a huge dilemma for me, as the vet will only be there in the morning, and I have a job interview in a lawyer's office at 10:30. The distance between the 2 places is 2 hrs one way and I obviously cannot be in 2 places at once. I am trying desperately to get out of That Horrible Store by the end of the year. I have to work, someplace where I will get a paycheck, I have not gotten a paycheck for over 18 months from the store and I have never taken a draw, there is nothing to draw. I have lived mostly off my credit cards for almost a year.

So I am wondering what you all think: Would it be OK to call the lawyer's office & tell them I have a "scheduling conflict" and ask to reschedule the interview?

I guess my only other choice would be to drop Tawny off at the clinic around 8 a.m., go to the interview, and then go back down and pick her up. I could do that.

I'd like your thoughts on asking to reschedule the interview, tho.

Thanks.

Desi
 
Re: 12/15 Tawny 12/14 PM+9/185; DKA/Feeding ?s/Action Plan I

It's great to see Tawny doing well and a plan coming together.

That's quite a quandary on the scheduling conflict. You need to weigh for yourself the potential for rescheduling the interview without negative repercussions. Personally, I would probably go with leaving Tawny with the vet until after the interview. You know she will be fine there and you can clear your head to focus on the interview.
 
Re: 12/15 Tawny 12/14 PM+9/185; DKA/Feeding ?s/Action Plan I

Given the economy and the number of people looking for jobs.... I'd give strong consideration to door #2.
 
Re: 12/15 Tawny 12/14 PM+9/185; DKA/Feeding ?s/Action Plan I

Hi Desi,
We are very glad to see that a plan is in place and only a few details need to be filled in. Positive thoughts, prayers, and healing vines are all on the way to Tawny today. Now that our snow is gone :sad: , Rusty will be able to pick some fresh healing vines! :smile:

I agree with Linda about the job interview. It is best not to postpone it. As long as Tawny will be at the vet's tomorrow anyway, they will certainly be able to keep her a few more hours. Good luck with the interview. I hope that everything will work out for you with regard to the store, a paying job, and a healthy Tawny (and a Tinkerbell back on track).

:YMHUG: :YMHUG: :YMHUG:

Ella & Rusty
 
Re: 12/15 Tawny 12/14 PM+9/185; DKA/Feeding ?s/Action Plan I

I would not postpone the interview Desi. It will make you plan for getting out of the store easier along with providing a regular paycheck. I'm sure the clinic will love to have Tawny a little longer. Good luck with the interview. Sending positive interview vines. Good to see Tawny is doing better.
 
12/15 Tawny AMPS 274

Obviously getting her off that S/O dry is helping her #s, DUH.

She has been nibbling at her Wellness Ckn all morning but not really eating enough for me to be comfortable w/her intake based on what I am learning here and on the FAF group, so I tube fed her 40mls Recovery blended w/a little water just now. Then she nibble at her Wellness again, a couple of bites.

She goes to THS w/me again today. Food, tube feed and meds needed during the day (Reglan every 8 hrs) in hand. And meter.

I will not postpone the interview. I will drop her off in the morning at about 8, leave her there and pick her up later then. Good advice, kind of what I thought, too. Thanks.

Desi
 
Re: 12/15 Tawny AMPS 274 / Action Plan Input Requested

(((Desi))) you have so much on your plate and you are doing so great with it all. I, also, vote for going to the interview. You need a light at the end of the tunnel regarding THS and this is your chance to get out and be happy with
what you have to do to support yourself.

Sending Tawny healing vines...I'm so glad she is eating on her own somewhat!! Good girl!!
 
Re: 12/15 Tawny AMPS 274 / Action Plan Input Requested

Best of Luck with the job interview.
 
Re: 12/15 Tawny AMPS 274 / Action Plan Input Requested

Good luck with the job interview Desi!!!!!!

I will work out the calories of the feeding plan. Have to print out this thread which will help and help give you guidelines. Glad to hear you are keeping up tube feeding. I knew you could do it!

Karrie
 
Re: 12/15 Tawny AMPS 274 / Action Plan Input Requested

How much does Tawny weigh again?

I would weight Tawny often to make sure she isn't losing weight. A good way to know that we aren't feeding the bare minimum will be shown in the scale. Maverick was 13.5lbs when he got his feeding tube and in the beginning he needed 330 calories to maintain his weight. Sick cats often need more calories than a healthy cat just to maintain weight. The problem is every cat is different. Once he started recovering he didn't need this many calories to maintain his weight. I would weigh her daily if thats possible. I'd be aiming for more than 200 calories for now. I'd say 200 would be the minimum.

So I've been racking my brain trying to figure out how to give you a guideline. I've created a spreadsheet to help: https://docs.google.com/spreadsheet/ccc?key=0AtsM5Bt7yJ1tdDlGalFXZTNhVDRvNDRLX080ZlQxeFE

The green boxes is where you enter the info. Left side is per individual session - adding up what she ate on her own and how much you can syringe feed. I am going on the assumption that she can eat 40 grams of food in one sitting. You can probably work up to 50 grams. But some cats may throw up on this amount.

I have to still add calories/gram information for the kibble. There is different calorie levels for the S/O it seems. Can you read the calorie information and post it on your condo?

Here are my recommended guidelines.
1. Feeding every three hours. Maverick had a PEG tube and I could check and see if his stomach was empty. It always was empty at the 2 hour mark. You can do every four but if you need to do every three thats fine too. Present food for her to eat on her own and make up the difference with a tube feeding.

2. Wellness is a lot higher in calories per gram than Recovery RS. I recommend you tube feed the wellness also. It needs to be blended longer but per ml you will be getting in a lot of calories. If I compare ounce per ounce if Wellness came in the same sized can as Recovery. Wellness would be 217 calories to Recoveries 172. See the difference? With Wellness a can is 200 calories but its a smaller can. But I've given you the option of both in the spreadsheet - accounting for volume. So if she eats 1/4 can/39 grams of wellness on her own, you don't need to assist feed anything. If she eats 1/8 can of wellness on her own you can tube feed the difference in Wellness or Recovery and it sums up the calories.

3. If she starts no liking wellness we can figure this out for any food or kibble. The problem is the kibble - she probably grazes on this? So how do we know how much she's just eaten before a feeding? So I didn't take the kibble into account for the assist feeding. Can the kibble be an overnight thing maybe? What are your thoughts here.

I'll PM you my number so we can talk through the spreadsheet. I'm trying to make things simple and I don't want to overwhelm you. Maybe others can email their spreadsheet suggestions.

Karrie
 
Re: 12/15 Tawny Dropping Too Fast?

I think she is dropping too fast now and I am going to kibble her up unless s/one says otherwise in the next couple minutes:

AMPS 185 - grazed on Wellness & tubed 40mls Recovery, grazed some more
+3.5 / 143 - grazed on Wellness & tubed 40 mls Recovery, grazed and finger fed some more
+4.75 / 114

I forgot the S/O but I have some Alley Cat kibble here.









I can watch the drop to a certain extent but if we get busy I have to stay on the cash register and can't get back there to her.
 
Re: 12/15 Tawny +3.5/143; +4.75/114 Dropping Too Fast? HELP!

Kibble takes a long time to impact BG.

Do you have any gravy food and get her to lick the gravy. Just like you would if she was dropping. And then test 15 minutes later to see if she goes up. Then 15 minutes after that to make sure she isn't dropping. You can strain the gravy and feed it and some of the food via the feeding tube also. Just get rid of the chunks that could block the tube. The little fine mesh/metal strainers would only cost a few bucks. I think they are used for tea.
 
Re: 12/15 Tawny +3.5/143; +4.75/114 Dropping Too Fast? HELP!

Also - that's not a big drop for an hour. I'd just test. If she goes into the green consider high carb.
 
Re: 12/15 Tawny +3.5/143; +4.75/114 Dropping Too Fast? HELP!

Karrie and Maverick said:
Kibble takes a long time to impact BG.

Do you have any gravy food and get her to lick the gravy. Just like you would if she was dropping. And then test 15 minutes later to see if she goes up. Then 15 minutes after that to make sure she isn't dropping. You can strain the gravy and feed it and some of the food via the feeding tube also. Just get rid of the chunks that could block the tube. The little fine mesh/metal strainers would only cost a few bucks. I think they are used for tea.
Click to expand...

She went up a little in 20 minutes from 114 to 128 w/out dry. She has been grazing on the Wellness & getting tube fed Recovery all day. I can gravy up the Wellness, or I can gravy up some 9Lives canned I have on the shelf here at THS too.

No kibble yet, watching tho.

Thanks for coming back at us so fast w/response Karrie.

Desi

PS I know better to "transition" a cat from dry to wet too fast, but w/all her other issues this of course went completely out of my feeble little brain til I saw her dropping. It's only been about 2 hrs since her last tube feeding, has not been grazing too much, I think she's full, but her BGs will be thrown off some by the food. I know better. I know better. I know better. DUH.

Gonnas get get another BG - BRB.
 
Re: 12/15 Tawny +3.5/143; +4.75/114; +5/128; +5.5/109 EYES P

Desi you are doing great with Tawny! And isn't Karrie the BEST!!!
You guys make an awesome team, that's for sure! :RAHCAT
 
Re: 12/15 Tawny +4.75/114; +5/128; +5.5/109; +6/106 EYES PLS

Back down, +5.5 / 109, she is licking gooey stuff and gravy off Wellness at the moment. I am going to add water to it to make some gravy ---

1/2 hr later: got hung up talking to probation officer of 1 of 3 offenders who broke into and robbed THS last March -- offender is req'd to make restitution -- probation officer came by & wanted info ---

so at +6 she is at 106 - i was finger feeding her - she is eating on her own too ...

keep eyes on us pls!
 
Re: 12/15 Tawny +3.5/143; +4.75/114; +5/128; +5.5/109 EYES P

So far this looks like a really good surf. You (and Tawny :-D ) seem to be managing her numbers with the food.

You are mid-way through the cycle and looking pretty good.
Steady as she goes, Tawny!
 
Re: 12/15 Tawny +5/128; +5.5/109; +6/106; +6.75/103 EYES PLS

Looks like she's surfing fine.
 
Re: 12/15 Tawny +6/106; +6.75/103 EYES PLS / Need Input 4 La

She has been grazing on Wellness thru out all this, or licking Wellness off my fingers.

Since 7am, 10 hrs ago, so far today she has had 80mls Recovery via 2 tube feedings and eaten one whole 5.5oz can of Wellness and we are now working on the 2nd.

It may be a little early to think about this, as we are just over halfway thru the cycle, but I am already thinking about pmps & overnight. I have to get up at 5:30 a.m. to get her to the clinic by 8 so that i can come back to Bogalusa for my job interview, and then I have to make the 2 hr drive back to get her b4 i get to THS tomorrow. I don't mind doing any of this but the point is tonight i have to sleep some tonight. So I am not going to be able to get these every 15-30 minute spot checks. And the clinic is probably going to give her S/O dry tomorrow anyway, so depending on what happens with the rest of the cycle I am considering giving her some S/O tonight. I don't want to mess w/her dose, 3u, if I don't have to.

Any thoughts?
 
Re: 12/15 Tawny +5/128; +5.5/109; +6/106; +6.75/103 EYES PLS

Desi:

FWIW, this kind of drop in numbers looks to me like Tawny has some infection going on that the ABs finally beat back. I didn't see what meds she's on -- although I was assuming an AB given the infection around the tube site. I'm glad you didn't raise her dose this morning.

Fundamentally, you know that Tawny's numbers are good. She may bounce in which case you won't need to worry overnight. If she doen't bounce, it sounds like she'll eat some of the S/O on her own. That may help to keep her numbers up so you can sleep.
 
Re: 12/15 Tawny +5/128; +5.5/109; +6/106; +6.75/103 EYES PLS

Sienne and Gabby said:
Desi:

FWIW, this kind of drop in numbers looks to me like Tawny has some infection going on that the ABs finally beat back. I didn't see what meds she's on -- although I was assuming an AB given the infection around the tube site. I'm glad you didn't raise her dose this morning.
Click to expand...

Good point on the infection issue Sienne. Yes, she is getting Clavamox. I'm glad I didn't raise her dose now, too. I started to last night w/that 490, even tho i know better w/so little mid-cycle data, then I remembered I'd already hooted.

Seems like FDMB, Fairy Godmothers & Angels are always looking after us!

Gotta close up THS so I can get to the house...

back in a little bit. Keep eyes on us please...
 
Re: 12/15 Tawny +9/141

She surfed that out nicely, didn't she? Course she ate Wellness off and on all the way thru it. Good girl!

I am outta THS, be back online in a couple hrs, gotta get to the house (40 min drive) then feed horses, dogs, cats, test, feed, hoot Tinkerbell, then it will be Tawny's turn again!

Then I gotta get some sleep tonite!

bbl...thanks guys!

Desi
 
Re: 12/15 Tawny +5/128; +5.5/109; +6/106; +6.75/103 EYES PLS

Desi, you are amazing. You are doing so well. I know that all will be fine tonight and that you will get a good night's sleep.

Sending very positive thoughts for tomorrow--for Tawny and for your job interview.

Hugs and lots of love,

Ella & Rusty

p.s. Isn't Karrie fantastic?
 
Re: 12/15 Tawny +5/128; +5.5/109; +6/106; +6.75/103 EYES PLS

Hi Desi - I think you have the hang of things. I may not be around much. I was at emergency with my dog tonight and she has vestibular disease. I have to read up on what I can do and get help. You are in good hands with the gang here and on FAF. Sending hugs.
 
Re: 12/15 Tawny +5/128; +5.5/109; +6/106; +6.75/103 EYES PLS

Karrie, so sorry to hear about Nike. In humans, vestibular disturbances are treated with Antivert. Maybe there is a canine version of it. Sending lots of healing vines. I still get vertigo from an old head injury and it isn't much fun!

Hugs to you and your family. You have been a wonderful help to Desi and Tawny,

Ella & Rusty
 
Ella & Rusty & Stu(GA) said:
p.s. Isn't Karrie fantastic?
Click to expand...
Phenomenal. Karrie is phenomenal. I PM'd her this afternoon right after I started watching Tawny's drop and she came right back! She created that awesome SS. She has been by our side from the very very beginning of Tawny's ordeal.

All of you have, really.

Karrie has so much insight, so much experience, to share, and does. Her love of Maverick is tangible, and she honors his memory so much by being there to such an incredible degree, as I know she has been, and will be, for others, too.

Karrie, thank you. With your sharing and your guidance, you have played a key role in saving Tawny's life. And my sanity. Which is borderline, at best. :smile:

Karrie, that spreadsheet is awesome! It is a tool that will be key in getting, and keeping, Tawny healthy. I'm sure others (not that I want others to ever have to go thru this) will want to use in the future. I am so grateful.

Tawny weighs about 9 lbs right now, she should weigh about 12-13. She is starting to act like Tawny again. She is curled up right next to me right now, sleeping. Tinkerbell is next to her, and "Bob-cat", Angus and Shadow are all spread out across the bed.

Karrie, as I got ready to submit this post I saw that you had posted the news about your dog. I am so sorry to hear this. Now it is our turn--we are sending healing vines to you.

Everyone, thanks for keeping eyes on us today.

Desi

P.S. We are ready to rock n roll in the morning! One thing I forgot was that in between dropping Tawny at LVRC and getting to my job interview I have to swing by the house and test, feed and hoot my poor forgotten Tinkerbell...
 
Hi Desi,

You are getting such great advice and support. My thanks to all!!

The only thing I want to add is that the spreadsheet does not appear to consider the calories from the Clinicare that (I believe) Desi is adding to blenderize the food. I assume that Clinicare has calories, but I may be wrong. I also assume that Desi is using the Clinicare to blenderize the food for tube feeding, but again I may be wrong. Desi hasn't specifically said she is doing that, but I know she has the Clincare on hand.

Hugs to you Desi and good luck with this morning's interview. I, along with the the other here, am rooting for you!!

Scritches to dear Tawny.
 
Desi, you are such an amazing person to take care of Tawny and Tinkerbell the way you do. They are so lucky to have such a loving momma bean

Such great news to hear Tawny is getting back to herself. I'm always thinking of you guys. And thank you to Karrie, for using her kind heart and expertise to help another FHL kitty. Maverick is always here , helping us with his story :)

(((((hugs))))) to all of you :-D
 
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