3/5 Ducia AMPR 262,1.25U,+3 233, ketones Large

Discussion in 'Lantus / Levemir / Biosimilars' started by Tanya and Ducia, Mar 5, 2017.

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  1. Tanya and Ducia

    Tanya and Ducia Well-Known Member

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    http://www.felinediabetes.com/FDMB/...0-5-increase-no-shot-105-after-1-hour.174243/

    Hello,
    I wanted to post an update on Ducia:

    On Friday 3/3 PMPR 317, Lantus dose 1.5U an increase from 1U then she was
    +3 BG 197, +6 BG 206

    Saturday 3/4 AMPR 68, skip the shot, fed, +1 105, +2 124, +4 178, +6 320, +9 382
    PMPR 370, fed low carbs, 1U, +3 330, +6 294, +9 266
    ketones positive Large on dip strips

    Sunday 3/5 AMPR 262, fed low carb, 1.25U (best eyeballing we could manage) and +3 233.
    ketones positive Large.
    The +3 is taken 2 h 15m after a meal and 2 h 35m after 75 ml SQ fluids per vet advice.

    We are very new to FD- post DKA- post Hypo that we are dealing with and we cannot understand her readings well. She dropped to 68 after 1.5U, remained high after 1U yesterday PM cycle, but relatively unchanged today AM after 1.25U which was 0.25 increase. I cannot figure out what to make out of it.

    Vet called with the urine analyzes, ketones >80mg, urine glucose >2000. He didn't email the results as was agreed so I do not have them at the moment.
     
  2. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

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    Large ketones really cannot be managed at home. This could easily be an emergency situation. I'm very surprised your vet did not tell you to come in or go to an emergency vet.
     
  3. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    I agree with Sienne's comments in her post above. If ketones are large treatment involves hospitalization.
    Ducia is bouncing from the low yesterday morning (68).
    Here's a short and simple explanation of what bouncing means:

    Bouncing - Bouncing is simply a natural reaction to what the cat's system perceives as a BG value that is "too low". "Too low" is relative. If a cat is used to BGs in the 200's, 300's, or higher for a long time, then even a BG that drops to 150 can trigger a "bounce". Bouncing can also be triggered if the blood glucose drops too low and/or too fast.The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low. The action is often referred to as "liver panic" or "panicky liver". *Usually*, a bounce will clear kitty's system within 3 days (6 cycles).
     
  4. Tanya and Ducia

    Tanya and Ducia Well-Known Member

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    He did. We cannot afford hospitalizations any more.
    Her physical condition is actually good if to judge by behavior, eating/ drinking and litter box visits.
    We going to monitor closely, give SQ fluids 75 - 100 daily and we also can control her food/water intake as she is fit with Esophagus tube.
     
  5. Tanya and Ducia

    Tanya and Ducia Well-Known Member

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    I took her ketone urine dip strip test just now still at the lower level of Large.
     
  6. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    That's still to high to expect to successfully treat at home.

    As you already know, diabetic ketoacidosis can develop quickly when kitty is throwing ketones. It's a life threatening condition. Given the circumstances, the best advice I can offer is to start applying for assistance to every organization in this post: Financial Help Links. Perhaps you can find an organization to help.
     
  7. Tanya and Ducia

    Tanya and Ducia Well-Known Member

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    Thank you.
     
  8. Tanya and Ducia

    Tanya and Ducia Well-Known Member

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    We can monitor closely at home, give food/water via Tube and adjust dosage. we have hopes because her actual behavior is better now. Much healthier than we've seen in weeks. The goal as we see it is to keep her within the range of 100 - high mid 200s for some time continuously.
     
  9. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    These are all things that will help and her behavior is a positive sign, but throwing "Large" ketones is extremely worrisome. There's more to treatment than food/water and insulin. That's why hospitalization is highly recommended. Perhaps you'll find help on the list I gave you. It's really in Ducia's best interest to look for any possible help available to you.
     
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  10. Tanya and Ducia

    Tanya and Ducia Well-Known Member

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    Thank you , I will check the list right now.
     
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  11. Squalliesmom

    Squalliesmom Well-Known Member

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    Please, please try to find a way to get Ducia back to the vet and hospitalized. I am afraid this is more than can be managed without veterinary intervention. You and Ducia have been through so much, and fought so hard for her to get well, I would hate to see anything happen to her now! Please do look over the list of financial help, and try contacting some of them. Ducia needs help and she depends on you to get it for her.:bighug::bighug::bighug:
     
  12. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

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    I will add my voice to say please do everything you can to get Ducia back to the vet. A ketone situation can turn very bad, very fast.

    I took a look at Ducia's spreadsheet and see that she is back in blues this afternoon. I hope you have found a way to take her to the vet so that she is undergoing professional care, but either way I want to emphasize: she cannot afford any skipped insulin shots at this point, no matter what her BG numbers are. Give her the highest-carb food you have if you have to, to increase the BG numbers and keep her safe, but she must have insulin to help deal with ketones. It's not all about the BG numbers at this point-- others can explain why better than I can.

    Keeping you guys in my thoughts, hoping you are able to find a way to get her to a vet ASAP.
     
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  13. Tanya and Ducia

    Tanya and Ducia Well-Known Member

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    She will have her shot at the reg time, at 6:30pm pacific. The dosage will depend on how she reads thru the day.
     
  14. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

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    Any luck on getting her to a vet? We're all very worried!
     
  15. Tanya and Ducia

    Tanya and Ducia Well-Known Member

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    Should our fin circumstances were better off I would agree without a moment of hesitation. But they are not. The critical care hospital she's been the last time did excellent job getting her out of critical condition after hypo and she left with urine glucose significantly lower. But she had high 300s BGs.
    We thought that if we follow the food protocol (1 can given in 4 portions over 24 hours), monitor frequently her BGs and adjust the Lantus dosage accordingly we would be successful in stabilizing her in the wide range of 100 - 230-ish as highest. If such range can be achieved, the urine glucose would lower, too. We monitor her now with ketone dip strips. The last one was in the lower large, which is still dangerous, I understand that. There are many complications to her FD, in addition to lurking ketons. The ER approach was to have some more very expensive procedures done to figure out what is actually going on with her p-tities, her liver, etc. That would be right on my own expense as it is more of a maintenance, a long term treatment than an emergency for which we already received more than generous help. Secondly, I couldn't shake off a feling that although the procedures were highly desirable we've been "milked" in a way. The resolution of all -DKA, p-titie, fatty liver is dependent on stable BG. We do our best at home. We monitor, we can get her SQ fluids as needed. The food/water intake is easier with the etube which as our vet verified placed well and has no issue with it. Her condition - behavior, sleeping, litter box visits are improved tremendously. I haven't seen her like tat in weeks.

    Just in +9 BG 91, 1/4 can food eaten; ketone test result in color at the trace level but I want it to be verified @ litter box visit. She also passed a poo which is much closer to a normal color, not the jaundice like variety she has yesterday. I guess I am trying to say that although professional care would be incomparable better we see here at home improvements.
     
    Last edited: Mar 5, 2017
    Reason for edit: ETA
  16. rhiannon and shadow (GA)

    rhiannon and shadow (GA) Well-Known Member

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    is that a 5 oz can or a bigger can?

    one 5 oz can isn't enough for daily calories.... unless its special.
     
  17. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

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    I am going to tag @Meya14, @Marje and Gracie , and @Jill & Alex (GA) , who might be able to explain things better than I can (looks like @rhiannon and shadow (GA) are already here, which is great). In the meantime, I'm just going to repeat what I said earlier about the BG numbers not being the whole story here. The insulin itself acts to help keep ketones down. It is better to run higher numbers and shoot the full dose than to give a reduced dose because numbers are low. You can always feed high-carb food to get numbers high enough to be able to shoot the full dose.

    I'm not experienced enough to give any more specific advice than that, but those are the general guidelines. Additionally, even in a non-DKA case, we don't recommend changing Lantus doses in response to pre-shot numbers-- it is a "depot" insulin, and works better with a consistent dose.
     
  18. rhiannon and shadow (GA)

    rhiannon and shadow (GA) Well-Known Member

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    yes.... you need to give insulin.... it can be a reduced amount....but you need some. Don't worry about the numbers right now except being too low.....

    not enough insulin + not enough water + infection is the recipe for dka.
    Is there an antibiotic being given?


    editing: I said that wrong.....

    The typical cause for ketones developing is not enough insulin + infection/inflammation + not enough calories
     
    Last edited: Mar 5, 2017
    Reason for edit: added correction
  19. Tanya and Ducia

    Tanya and Ducia Well-Known Member

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    We do hope that a week within stable BG range can give us an opportunity to access her condition better and to work on further plan of action.
     
  20. Tanya and Ducia

    Tanya and Ducia Well-Known Member

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    It is 5.5 can however yesterday she had more than that -about 1 and 1/4 can, and it looks she is going to have more than 1 and 1/4 today.
     
  21. rhiannon and shadow (GA)

    rhiannon and shadow (GA) Well-Known Member

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    her bg numbers aren't causing the ketone issue......
    The typical cause for ketones developing is not enough insulin + infection/inflammation + not enough calories

    I don't see any mention of an antibiotic.

     
  22. Tanya and Ducia

    Tanya and Ducia Well-Known Member

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    I have high carb Soulistic canned food with gravy.
     
  23. rhiannon and shadow (GA)

    rhiannon and shadow (GA) Well-Known Member

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    you can give her a little more food than that .....
    How is her appetite?
     
  24. Tanya and Ducia

    Tanya and Ducia Well-Known Member

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    she is currently is on antibiotics
     
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  25. Tanya and Ducia

    Tanya and Ducia Well-Known Member

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    Great after 6 hours fasting
     
  26. Tanya and Ducia

    Tanya and Ducia Well-Known Member

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    It is low carb Friskie classic pate, but she is getting more for the 2nd day, about 1 and 1/4.
     
  27. rhiannon and shadow (GA)

    rhiannon and shadow (GA) Well-Known Member

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    why is she fasting..... do you just mean the time in between meals?

    Will she take little bits in between? I would be offering kitty milk .... for the calories....
     
  28. Tanya and Ducia

    Tanya and Ducia Well-Known Member

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    Thank you!
     
  29. Tanya and Ducia

    Tanya and Ducia Well-Known Member

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    yes, the time between the meals. She supposed to get her 24h ratio in 4 portions. It works good because by her preshot test she gulps it in 3 min and receives her insulin. Otherwise it is etubing which we for now reserve for med, or an emergencies.She eats more thou for thhe 2nd day now.
     
  30. Tanya and Ducia

    Tanya and Ducia Well-Known Member

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    we are going to test in 10 min, high carb food ready as well as the regular. I will ask your advice as soon as tested. All depends on BG.
     
  31. Tanya and Ducia

    Tanya and Ducia Well-Known Member

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    She getting Metranidazol 0.5x2 for 7 days. Vet took urine test yesterday no mentioning of infection. Visible no fever, improved physical condition, CBS on 02/23/17 hasn't shown any infection/inflammation.
     
  32. Tanya and Ducia

    Tanya and Ducia Well-Known Member

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    I'll take a break for +10 test. Be back shortly
     
  33. PumpkinsMom

    PumpkinsMom Member

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    Tanya,

    As I said via text, she can and should eat as much as she wants right now.

    Do not give high-carb food unless she is legitimately having low numbers.

    You are doing great with subq fluids and free water via e-tube.
     
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  34. Tanya and Ducia

    Tanya and Ducia Well-Known Member

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    +10 BG 77. eats another 1/4 of can regular , not high calorie food.
    I me4ant not high carb food
     
  35. Tanya and Ducia

    Tanya and Ducia Well-Known Member

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    What are the constipation signs in cats? Ducia just went to the litter box, pushing pushing and nothing happens. She left the box. It has happened twice already today however earlier she left 1 small fecal ball in there. Is she constipated? If yes, what can we do?
     
  36. Tanya and Ducia

    Tanya and Ducia Well-Known Member

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    She ate about half of the 1/4 can and walked off. She maybe constipated. Should I finish the rest of whatever she left thru etube?

    Her shot is at 6:30pm pacific,
     
  37. PumpkinsMom

    PumpkinsMom Member

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    Yes, finish the 1/4 can in the tube and give 10mL of water after.

    She could be constipated but that would be odd considering how much fluid she is getting. Is she walking around and having some activity?
     
  38. rhiannon and shadow (GA)

    rhiannon and shadow (GA) Well-Known Member

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    she may be willing to eat more in a bit....

    for constipation, many add pumpkin to the food....
    but you can also let her lick some butter or even put vaseline on your finger and put it on her palate. She will have to swallow it.
     
  39. Tanya and Ducia

    Tanya and Ducia Well-Known Member

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    Yes, she walks around and gave more headbumps this afternoon that we have seen in the weeks.
     
  40. Tanya and Ducia

    Tanya and Ducia Well-Known Member

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    I'll take a break to finish her extra 1/4 can meal via etube. Be back soon
    Decided to postpone until reg feeding at preshot.
    Ducia lost interest in food for now
     
    Last edited: Mar 5, 2017
  41. Dyana

    Dyana Well-Known Member

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    Tanya, I have been at work all day and worrying and hoping for the best for you and Ducia. I am SO GLAD that her BGs are down, and that her ketone test result was trace. That is such good news! Please keep testing her for ketones at least twice a day, for the next few days. I always tested twice a day whenever I could when my cat was high or not feeling well. With the recent problems with ketones Ducia has had it is extremely important for you to monitor them, and I'm so glad you got the urine test strips. You have so much going for you, the good insulin, knowing how to test her BGs, the E Tube already placed, and Thanks to DCIN's generous help in doing that, and this forum, to help you. So many other people with diabetic cats in this situation have none of that. :bighug:
    I have heard it said before on many occasions that when fighting ketones, "I don't care if you have to feed her an ice cream sundae to keep her BGs up, she needs the insulin". That's why I was trying so hard last night to encourage your to give it. If she was at the vet hospital, they would be giving her a fast acting and strong insulin to get her numbers down and also at the same time be giving her a dextrose drip to keep her BGs up enough to take the insulin. That's how ketones are fought at the vet.
    I hope to God, that her next ketone test is trace again ! :cat: You are fighting the good fight. Don't give up. Hang in there. :bighug: This may take a while.
     
  42. Tanya and Ducia

    Tanya and Ducia Well-Known Member

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    let's hold on it until +11. She ate as much as she wanted, groomed, sleeping. It is her natural sleeping time.
     
  43. Tanya and Ducia

    Tanya and Ducia Well-Known Member

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    It is my 1st day of using. I'd like to verify @next potty session.
     
  44. Tanya and Ducia

    Tanya and Ducia Well-Known Member

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    I don't have Vaseline but Mineral oil. The ER doctor who gave an enema on her discharge time advised against Mineral oil but forgot why exactly.
     
  45. Tanya and Ducia

    Tanya and Ducia Well-Known Member

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    I have high carb Soulistic pouches which are Tuna in pumpkin soup. I can scoop out the liquid only and add to her next meal. Will that work? She used to enjoy that food but that's exactly what gave her FD. Hate to tough it. Don't even know why I kept it.

    I meant "hate to touch it"
     
    Last edited: Mar 5, 2017
    Reason for edit: correc misspelling
  46. Tanya and Ducia

    Tanya and Ducia Well-Known Member

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    Our vet called with urine test earlier. Her ketones are at the pre-hospitalization level of >80mg. But as I said, the strip test color was seemed to be lightening. We will keep monitoring.
     
  47. PumpkinsMom

    PumpkinsMom Member

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    I am going to strongly disagree with the advice being given to shoot a low number.

    This cat was diagnosed with diabetes and DKA 9 days ago. 5 days ago she suffered a symptomatic hypo with recurrent seizures on 1u of Lantus.

    Giving honey or ice cream or Karo is not even remotely the same as having IV access for D50 or possessing Glucagon in the event of low numbers.

    This cat is waaaaay too sensitive to even suggest the use of R at home. In a vet's office, this cat would be titrated with a constant rate infusion using a syringe pump.

    She has a very late nadir and needs to be shot to her cycle as her body dictates.

    Sidenote: DCIN has spent $2700 helping Ducia and we would be sincerely appreciative of any support from our loyal FDMB supporters.
     
  48. Tanya and Ducia

    Tanya and Ducia Well-Known Member

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    Thank you Dyana,
    we are going to test in 15min and then advice as to dose will be much needed.
     
  49. Kris & Teasel

    Kris & Teasel Well-Known Member

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    I made a donation a couple of days ago. ;)
     
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  50. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

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    I will definitely defer to the opinions of the experts here.
     
  51. PumpkinsMom

    PumpkinsMom Member

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    Thank you!! :bighug:
     
  52. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    I agree. These are precisely the reasons why Ducia should be hospitalized as the vet recommended. Given the circumstances, continued ketones, and combined with the reasons you stated... it's not safe to treat at her home. Ducia should be on a glucose drip in order to receive the insulin she sorely needs. At this point, it's the safest way to give her the insulin she needs... not skipped shots or reduced doses because preshot numbers are too low. Hospitalization is the only way to safely give her the insulin she needs.

    It's not about the numbers... not about achieving low BG numbers. It's about getting enough insulin into the cat as safely as is possible.


    Just my thoughts...
     
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  53. Tanya and Ducia

    Tanya and Ducia Well-Known Member

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    I wish we could afford. The reality that we are not. We have to do our best here.
    So the situation is like that:
    Her +11 is 96, slightly up from +10 77.
    She ate. She will receive food one way or another after PMPR in 40 min.
    She will get her insulin. The question is how much.
    Her AMPR was 262. She got 1.25.
    Right now, an hour before shot and 70 min after some food she is 96.
    I'll tell you her preshot and I pray it's above 150 then we can give 1U.It is only a hope.
     
  54. Tanya and Ducia

    Tanya and Ducia Well-Known Member

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    Thank you soo much for this!
     
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  55. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    Given PumpkinsMom advice:
    Given the above, I feel like my hands are tied. I must defer dosing to PumpkinsMom.

    Since kitty cannot be on a glucose drip to keep her from bottoming out when given a full dose and you're being told not to give high carb food... I'm at a total loss as to how you can possibly get as much insulin into Ducia as she needs to thwart off ketones.

    Not trying to be coy or obstinate. I honestly don't know how you can shoot safely without bumping up Ducia's numbers and keeping them up with high carb food... and still give her the insulin she needs.

     
  56. Dyana

    Dyana Well-Known Member

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    I'm praying it's a number you feel okay shooting, too. Like I tried to say yesterday, think about what would be the limit you would shoot without skipping. She needs the insulin right now to fight those ketones. She also needs food, like 1.5 times what she normally would eat. I'm glad she's feeling good. Keep up the fight.
    I am an early to bed and early riser and on the east coast, so I can't always be there to help you. I hope you will get lots of help tonight.
    I wish you and her The Best.
     
    Jill & Alex (GA) likes this.
  57. Tanya and Ducia

    Tanya and Ducia Well-Known Member

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    Like I said, I defer to PumpkinsMom. If she doesn't come back on the board before shot time, I would text her if I were in your shoes. Under these circumstances, perhaps DCIN follows methods I know nothing about.
     
  58. Tanya and Ducia

    Tanya and Ducia Well-Known Member

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    Thank you so much.
     
  59. Squalliesmom

    Squalliesmom Well-Known Member

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    Don't use mineral oil because it coats the lining of the stomach and prevents nutrients from being absorbed.
     
  60. Squalliesmom

    Squalliesmom Well-Known Member

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    Have you tried applying for Care Credit? You can do it online, takes just a couple of minutes!
     
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  61. Glennie

    Glennie Member

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    I'm sending a check tomorrow. Don't usually broadcast our giving, but hoping if a lot of us can give some, it will help.
     
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  62. Tanya and Ducia

    Tanya and Ducia Well-Known Member

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    PMPR BG 99, ate about 2/3 can food which is slightly higher in carbs that the current. Retest @+1.
    We decided to go with 0.75U. Thanks god you guys told me to get half unit marked syringes!
     
  63. Kris & Teasel

    Kris & Teasel Well-Known Member

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    I don't usually say anything either. I should have sent a PM to @PumpkinsMom.
     
  64. rhiannon and shadow (GA)

    rhiannon and shadow (GA) Well-Known Member

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    just a question....
    IF Dcin is helping, won't her vet see her and work with dcin?
     
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  65. Tanya and Ducia

    Tanya and Ducia Well-Known Member

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    ok, good to know, thank you
     
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  66. Glennie

    Glennie Member

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    No, I'm glad you did. A good reminder to me. So thanks! I meant to do it last week, but it slipped my mind. I'll remember now.
     
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  67. PumpkinsMom

    PumpkinsMom Member

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    Honestly, neither the ER vet nor Ducia's regular vet is diabetes knowledgeable. They won't cut us a break at all. The ER vets, with the exception of one doctor, have been incredibly hard to work with. None of the vets are on the same page. One called Tanya about how Ducia was worse than ever. Tanya texted me. As soon as my class ended, I called the vet. That vet was gone and the new vet was like "I don't know why the other vet said that, Ducia is doing better."

    I would really like Ducia to be able to see a vet recommended by a DCIN adopter.

    If we can get Ducia's fundraiser a little more funded and find a better vet that will also offer us a discount, we'll be able to help Ducia some more.

    Just for transparency, it really is rare that a vet does not offer a discount to us. I always ask because all of our money comes from donations and our donors deserve to have their money go as far as possible.
     
  68. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

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    Since talk of fundraisers by groups or individuals must be approved by our board Administrator prior to posting on the FDMB, Chris & China messaged Robert about Tanya and Ducia for approval. In response to Chris' request, Robert agreed those following may contact Chris privately for information.
     
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  69. PumpkinsMom

    PumpkinsMom Member

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    Chris just told me that I can't make my own thread about the fundraiser but I can post it on any of Tanya and Ducia's threads. [Link removed by moderator.]

    Thank you for making an exception and allowing DCIN to continue to help diabetic cats everywhere!

    Sorry, there's obviously been some miscommunication.
    Those wishing to help out Tanya and Ducia, please contact Chris & China directly.
    Thank you!
     
    Last edited by a moderator: Mar 5, 2017
    Reason for edit: removed link to fundraiser
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  70. Chris & China (GA)

    Chris & China (GA) Well-Known Member

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    We'd better stick to the exact wording Robert agreed to

    Please contact me or @PumpkinsMom and we'll be happy to give you the information to help DCIN out!!

    Just click on one of our names and choose "start conversation" and we'll be happy to give you all the information!!

    DCIN really appreciates any help they can get!
     
    Last edited: Mar 5, 2017
  71. Squalliesmom

    Squalliesmom Well-Known Member

    Joined:
    Jun 26, 2015
    Tanya, how is Ducia today?
     
  72. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

    Joined:
    Mar 19, 2016
    I am also eager for the Ducia update! My heart sinks every time I see this post title with the "ketones large" note-- last I heard you had gotten a "trace" reading yesterday afternoon. I am hoping that that result has held up, but please do let us know!
     
  73. Dyana

    Dyana Well-Known Member

    Joined:
    Dec 28, 2009
    Tanya, how is Ducia doing today? Prayer for her ketones to be trace and for her to be eating well, playing, and pooping.
     
  74. rhiannon and shadow (GA)

    rhiannon and shadow (GA) Well-Known Member

    Joined:
    Jul 9, 2012
    look at her ss....
    she's got numbers and comments....
     
    Squalliesmom likes this.
  75. Squalliesmom

    Squalliesmom Well-Known Member

    Joined:
    Jun 26, 2015
    I saw that, too. Hope she's doing well.
     
  76. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    Hi Tanya,

    I see on your SS that you've been working very hard to care for Ducia. I'me very glad to see that the ketone tests are showing trace only. You still need to watch her carefully. Please let us know how you're doing when you have a bit of free time.
     
    Squalliesmom and Judy and Boomer like this.
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