2/24 Sebastian PMPS 238 +10 322 Lo Ketones.

Yesterday's Still Craziness

AMPS was 73. He's eating HC Gravy right now with a couple drops of honey mixed in. Waiting for him to eat a bit more than shooting.

 

Great that he's eating, nice and flat coming into amps too, so that is a bit of a relief.

Test him again at +1 and +2.

Expect to need to get him to eat something at +1 and +2.

to tag someone you @Justin & Sebastian

I'll see you in one hour.

 

Sounds good, thanks. I went with 3u. We they sent him home from the p'titis hospital stay they had us on 3u and that was enough to keep the ketones out, despite being on a very high carb diet (Purina CN). Between that and how difficult it was to get his numbers up last night and how shortly they stayed up, 3u is what my gut was telling me.

 

I'm very new here myself and am not about to try to give advice in such a challenging situation, but I've been following along as you've been dealing with Sebastian, and just want to let you know that I think you're doing a great job. It can be so hard knowing what is the "right" thing to do, especially in such a complex situation. Good luck, and I hope you & Sebastian both have a much calmer day today!

 

Ok well let's just see where it takes him.

Keep on top of the ketone monitoring, twice daily. Especially with reduction in insulin.
As I've already said the early part of this cycle will likely play out just as if you had shot the 7u, the depot of that larger dose is still in charge.

 

Have you got that +1 yet?

 

+1 is 160

 

OK that's quite a food bump he's had, lantus will not have onset yet, so we want to see what happens when that kicks in.

I'd just check him again at +2 and then again at +3.

If he starts to drop then we want to catch it early.

 

For sure. I'll be testing every hour at least until we have a better idea how he's going to play out today.

 

Good job on keeping your boy safe!

 

That +2 must be due, do you have a number yet? (sorry I'm such a nag)

I have to nip out an walk the dogs before BFG gets his shot, which will be your +3. Just wanted to make sure you were OK before I headed out.

 

+2 157

 

He's finishing up the rest of his breakfast now too. He ate 3/4 of a can at shot time and finishing up the remaining 1/4 now.

 

So flat, good that he's finishing of breakfast I was just going to suggest he have a little snack.

 

Looks like you can catch a nap now.

 

Way too early for that, if I get sleepy it'll wind up being around 1pmish. I want to stay and get a +3 anyways so I can make sure the onset isn't late and we're not going to see a big drop.

 

+3 156

 

How do you feel about having a little break grabbing a +5.

Give him a snack now, just to keep him ticking over.

 

Been trying to get him to eat at least a little with each test. Got off the horn with the vet and they have the ondansetron and the mirtazepine there and I'll go pick that up in an hour, I'll pick up some R while I'm out too. I don't intended to use that unless necessary and I get some guidance on it, and so far it's not looking like we'll need it. THEN I think I'm gonna catch a little nap.

 

I think that will work out perfect. I'll be heading out for those errands at about +4, and be back in time for the +5.

 

Good plan, he's been flat so far so hopefully today will be uneventful.
It's good that he's been grazing little and often might be easier on his tummy too.

So I'll look for you at +5.

Don't forget to get a ketone test at some point.

 

Yeah it's on my radar. I was just reviewing my notes, last one was this morning at the +9 with a 0.8 reading. I'll check it again when I do the +5.

 

Alright, lots 'o info.

We got the Mirtazapine & Ondansetron from the vet and I gave him his 1/4 tabs of both of those. Just want to confirm the dosage with you all, they said 1/4 tab of the Ondansetron every 12 hours and 1/4 tab of Mirtazapine every 3 days.

Just did a ketone reading: Lo. +5 BG is 89. He's got a really strong appetite right now, just had the tab 5 minutes ago so it's a natural appetite, and is devouring a whole can of FF Gravy, with some occasional bites of DM wet. No vomit since that one last night, which was totally my fault for flipping him over immediately after he ate. Weight is down a little, 10lbs 12oz, but I'm hoping with the low BG and the appetite coming back that will start to jump up.

I want to take a +6 to make sure he's coming up after his lunch.

 

Can't help with the dosing I will haven't used that before.

Good plan on the +6 and on feeding, that's quite a steep drop. Hope it slows him up.
You may need him to eat later, so keep that in mind you don't want him too full.

 

Someone's definitely feeling better this afternoon

 

+6 154

 

Gonna give him a little break now, should be good until +9, I'll check him then and see if I need to give a little food to hold him over till dinner

 

Those carbs bumped him right up.
They can wear off after a couple of hours., And when they do numbers can drop again.
As you have them at +5 I would probably grab s test at +7 just to make sure that's not happening.

 

Looks very the pic with his squirrel. Glad he's feeling better.

 

Cute photo!

When Bubba was RX ondansetron, it was 4 mg. tabs and I was told to do 1/2 tab. With the Mirtz, it can make some kitties aggressive and a bit nutsy. I did 1/8 of a tablet and that did the trick for him. We were also instructed to give Mirtz every 3 days.

Hopefully some other peeps that have had more experience with both of those drugs will weigh in. Our experience is very limited.

 

The ondansetron can be dosed maximum 0.5mg/kg every 12 hours so that would be 1/2 tab every 12 hours for his weight. You can also start with 1/4 tab every 12 hours and see if that works before you jump to the larger dose. Be sure they are 4 mg tablets. If they aren’t, the dosing is different in terms of how much of a tab you would give.

I prefer cyproheptadine appy stimulant over Mirtz because you can give it daily. If the Mirtz wears off before three days, you’re stuck although I’ve heard some rumbling about use of it on a daily basis. However....don’t dose it daily if your vet said every three days because I don’t know if it is a different strength to dose daily. I would also have started at 1/8 tab, as Bobbie said. Vets tend to overdose it and it can make kitty hyperactive. So see how he does.

Adorable pic with his squirrel!!! I’m glad he’s feeling better.

 

+7 is 200

 

Hi there

That was some night you guys had ...glad you are safely on the other side of it.

With enough calories and enough insulin to metabolize those calories his weight should gradually climb up.

Somewhere around here there’s a formula to help determine how many calories a kitty needs to maintain ideal weight. I believe it also can help one figure out how many calories are needed to gain or lose weight as well. I’ll see if I can locate it.

With a ketone prone kitty that has a recent history of DKA it’s important to get enough calories. The general rule of thumb is 1.5x the calories required to maintain ideal weight. Depending on how much weight needs to be restored even more calories may be required.

BK was down to 7.60 lbs following his 2nd DKA episode on 6/25 2008. Thankfully he started eating again (like there was no tomorrow) - massive amounts of food- anywhere from 9-20oz each 24 hours! I used to buy the tall (16oz) cans. After about one month, he started slowing down. By 10/23/2008 he was a very handsome and solid 11.2lbs.

I recommend you keep track of calories consumed right now since he needs enough to satisfy metabolic needs, keep ketones at bay and ultimately restore weight lost.

Make sense?

 

He is being a bit squirrely. He's meowing at me like he's hungry but he's got food out and just goes over and sniffs at it but doesn't actually eat it. We'll see how it goes over the next couple days, I might half the dose and give it every 1 1/2 days depending on how long it lasts.

I don't think I'll need to be on the ondansetron for long. He hasn't vomitted all day so I think we're past it. I'm going to keep him on both for at least another day just to be safe and I'll re-evaluate tomorrow if we should keep going.

 

I tried to find the link but couldn't. It was to one of Dr Lisa's pages I think and I'm almost positive the formula was 16.5kcal per lb of ideal weight.

Yup. I'll do my best, it's been a bit tough to keep track because he'll eat one thing one day and then turn his nose up at it the next so it's been tough to keep an accurate track, but if I'm able to limit it to 2 or 3 kinds of food only it shouldn't be too challenging.

 

is this it
Required calories per day = [13.6 X optimal lean body weight in pounds] + 70
Taken from Dr Lisas site

http://catinfo.org/?link=felineobesity#How_Much_Do_I_Feed

 

Ondansetron is for nausea and that may be why he’s eating a bit more. I wouldn’t rush to stop it.

 

He's already been on the Cerenia for a few days. I'm going to keep him on both until I'm sure he's past it. I'll probably save myself like 2 days worth so I have it for next time and use up the rest which should take us through the week.

 

+9 is 149

 

Yup, that's it exactly. I think that'll probably be a good place to start. It says it's a very generous estimate, and Sebastian needs to gain weight instead of lose it, so I think it'll be a good starting point. It equates to about 1 1/4 can of wet or 1/2 cup of dry, which is pretty much exactly what I was feeding before the p'titis and weight loss and what I've been trying to get him to eat since.

 

Thanks @Gill & George

Although I don’t know what his ideal weight is, to illustrate Let’s say it’s 12 lbs :

12x13.6 +70 =233.
Bringing that up to the recommended calories (1.5x) to keep ketones at bay means an additional 116 calories per day.
Grand total (rounds up to) 350 calories per day. As he picks up weight the that number will need to be revisited.

I know it’s ‘one more thing’ to be mindful of...but it’s a very important part of tipping the scales (no pun intended) in Sebastian’s favor and waving goodbye to ketone formation.

 

Cute pic! Playing is a great sign! I hope Sebastian continues to feel better.

 

+11 is 202.

I'm going to still give him the FF Gravy for dinner to keep the carbs up while the depot drains. I've got one can set to come out at dinner with another set for +6, and a side of Dr Elsey for snacking to even out the carb drops. With his BG in a safe range today and his ketones dropping off the meter I'm pretty confident he'll be fine tonight and I don't need to watch him and can get some much needed sleep.

Pretty happy with the 3u so far, I figure worst case scenario we'll need to walk it up a bit as the depot drains, but I'll make sure to keep him nice and fed and monitored to keep out of ketone range. All in all I'm really happy with his progress today, definitely seems like he's over the worst of the flare up and I'm looking forward to seeing some positive progress over the next few weeks.

Thanks again for all the help everyone, literally could not have done it without you.

 

With the PMPS being 238 I decided to split one can of FF Gravy between the two meals and then pad them with LC wet. Unfed BG seems high enough I can start dialing back the carbs.

 

What are your thoughts on dose?

 

Sticking with the 3u. Going to ween off the HC as the depot depletes and then we'll follow normal protocol.

 

As long as you are up do you think you could grab a test? Seeing as you weren't able to get one just before bed last night.
Having no data at all in the pm cycle will make it very hard to make dosing decisions, especially with Sebastian as there are a number of factors complicating these decisions.

 

Yeah, I'm going to take the +10 here in a minute and I'll do the +11 too

 

+10 is 322 and Lo ketones. Going to do only LC food for meals now

 

I would not give anything now and just wait to give him his food at AMPS

Yes I would see how he get's on with the LC food. As you are available to monitor during the day you should be able to catch any drops.

 

In an Ideal world I would think about trying to keep him below the renal threshold for the time being at any rate, I would avoid carbing him up if you see him hit blue, but you will need to assess the need for more carbs by judging,

• where you are in the cycle
• how fast he drops
• your availability to monitor
• how easy it is to get him to eat.

How's he feeling this morning?

 

Yup, definitely doesn't need anything now and food has been pulled.

Yup, I'm here all day.

He seems a bit tired but otherwise okay. No vomit and his fur looks and feels nice. The big tell will be right after he eats, he'll either get a nice little burst of energy and want to play or just go flop down somewhere.