30/8 Jai Jai – AMPS: 434, +2: 326, +4: 268, +6: 281, +9: 394 | PMPS: 428, +2: 400, +4: 340

Yesterday’s Condo: http://www.felinediabetes.com/FDMB/...454-pmps-464-2-407-4-454.143473/#post-1486509


My Active Thread on the Main Forum:http://www.felinediabetes.com/FDMB/threads/jai-jai-update-and-discussion.143333/#post-1485314

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There are some discussion going on in the previous thread, and I appreciate everyone's input. Thank you for dropping by. I hope the rest day help you recover some energy and strength.

There are a lot things going on during the weekend. The irritation found yesterday gets more serious, and we made an enquiry to the clinic if they drew blood from his rind leg. They said no, and I’m concerned if it is an infection. The clinic offered an ointment to us and we will pick it up after tomorrow’s work. Jai Jai will wear a collar until the rash is cured.



In the previous post, @Vyktors Mum suggested that there might be possibility that Jai Jai had some low mid-cycles and he bounced back at the following PMPS and the PM cycle. That might explain why I got the same level of AMPS and PMPS that I thought Jai Jai had high BGs throughout the day. Obviously, Jai Jai seconded Vyktor Mum’s theory. Today’s BG curve matches exactly what have just said.

Given that Jai Jai hit some lower figures in today's AM cycle than he usually does, I will hold the dose of 0.5 for at least 10 cycles as planned previously.

Today also marked a change of routine. @julie & punkin (ga) and @Sienne and Gabby kindly told me to follow test/feed/shoot approach, and I started this in the morning. I was very nervous because all the three things have to be done in a short period of time. Before adding some pumpkin puree to Jai Jai’s meal, he had some occasions that he vomited right after eating. It happened almost once a week! He coughed this evening and made me think that he might vomit after the small meal. I was nervous again. If this happens after the shot, I do not know how to deal with it. Should I give another meal?

Speaking of the pumpkin puree, it helped fix Jai Jai’s diarrhea three weeks ago. But his poo was wet and a bit loose this evening. I need to keep monitor his poo to see if this will be fixed tomorrow. Fingers crossed.

I know it is a lengthy and wordy daily condo. Thank you for your time. And all comments are welcome.

 

The soft stool could mean a intestinal problem, IBD, food allergy, or pancreatitis. I know. It's a big list. I'm sorry I can't remember if the Spec fPL was run and the results. That is the test for pancreatitis. You switched his food with the diagnosis which makes me think it might be the food. He might need a different protein or grain free. It is very often that fish or meat cause it. Please discuss this with the vet. Loose stool can sometimes come with pancreatitis as well metronadozole can help if that is the case. It also acts as an anti inflammatory.

 

Hi, Elsie. I did not run the spec fPL test last time because the vet said that Jai Jai did not need it on the grounds that Jai Jai did not have the symptoms. We did some encounters in the previous time, so I did not insist. Jai Jai was hypo on 25/8, and I brought him to the clinic as it is a 24-hour one. The vet assistant immediately contacted my vet about Jai Jai's situation, and treated his hypo with glucose drip.

On the next day, the vet politely referred me to other vets. However, what she so called "referred" was actually printing some of the website of others and asked me to knock on the doors by myself. Vets normally requested for the medical reports before taking the case, I was turned down several times before. I need some time to find a vet so I am extremely cautious about the dose and any medical concern of Jai Jai.

Regarding the soft poo, I am concerned, too. I am hoping that is just incidental.

 

Is your cat licking the area where the hair fell out or scratching at it, or did the hair fall out on it's own and it doesn't seem itchy? It's hard to tell from the picture, but round, flat lesions with hair loss cause me to always think of ringworm. Generally ringworm will have reddened ring around the area and the center is more pale. It can, but usually doesn't itch. If it's near her low back/tail check for dandruff or greasy yellowed skin and fur. Problems with these (cat acne) can increase likelihood of fungal infections like ringworm.

It can spread to humans/other animals if conditions are right, but it's usually a sign of too much moisture, trouble cleaning, or decreased immunity (diabetes can decrease immunity).

 

If ringworm you can treat with athletes foot cream. Max had it as a kitten. He was a rescue. You need a diagnosis though.

I'm so sorry you are having such difficulties finding a vet. Yes you will need to tread lightly. I suggest that if you disagree with anything they suggest that you listen and pretend to agree. Then you need to do what you feel is right. Sorry I couldn't remember the details. My mom is very sick and I'm kind of a mess. Dealing with the list takes my mind off it and if I can help with my experiences I will.

 

Yes, you will definitely need to find another vet. Diabetic cats often have other issues, and at the minimum, you need to be able to get insulin prescription refills and have a vet to go to for emergencies.

I think you have room to increase his dose by 0.25u. Today's curve shows that he's getting into the 200's on this dose. With Tight Regulation, the goal is to get the cat into normal numbers (50-120). I know you are holding the dose longer than the typical 3 days, but since you've done the curve today, it is clear to see how low the dose is getting Jai Jai. That's the important bit of information to know before increasing a dose, and since you can see it clearly, i don't think there is any reason to wait longer to increase. There is no point to holding the dose for the sake of waiting longer - the only point to waiting is to make certain you know how low the cat is getting on the current dose.

I hope that makes sense, but if not, please ask more. I'm highlighting the part below from the TR guidelines that I think applies to Jai Jai right now.

Increasing the dose:

• Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
  • if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
  • when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.

• After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.

• After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.

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@Meya14 - Can you tell from the picture whether the site of the inflammation might be near the leg vein that blood samples may be drawn from? I know that the emergency vets told Hollis that they hadn't drawn blood there, but I wonder whether her old vet might have, or that maybe something might have got missed out on the ER visit. The reason I'm asking is that I thought Saoirse might have contracted ringworm during her stay at a veterinary hospital because she had a ring-shaped red mark that very closely resembled the one on Jai Jai's skin. The skin got a bit scaly, too. Sarah (phlika29) suggested then that it might be inflammation due to a reaction to an injection. I took Saoirse to our vet to get it checked and it turned out Sarah was right (thankfully). Saoirse now has injection site alopecia at the place of the inflammation. The affected area was above Saoirse's shoulder so she couldn't worry at it the way Jai Jai is doing his leg. The inflammation died down after a couple of days.

 

The whole round shape is red, but I see some improvement today (the ointment has not be in use yet).

I also hope that it is just an inflammation and it will disappear a few days later.

 

Glad to hear that the inflammation is decreasing, Hollis. Hope it clears up quickly.

 

It's hard to tell from the picture where exactly it is (inner leg)? It doesn't look particularly concerning to me. Ringworm is mostly cosmetic, doesn't cause any real health issues. Inflammation post iv or injection should improve on it's own. If it's something she's scratching at, I'd be more concerned, because it might not heal well.

 

Hi, Julie. I am still so unsure when to increase the dose, considering that I am unable to monitor him in day-time, the just changed daily feeding and shooting routine.

I am also quite scared of increasing the dose right now. I need some time to get out from the fear of hypo.

So, my plan is to increase the dose on Friday night, so that I have Saturday and Sunday to monitor. If I will have some day-offs on weekdays, I will manage to do the dose adjustment as well.

In the place where I live, insulin and syringes are bought from pharmacies. No prescription is needed so I am not very concerned about this.

Regarding emergency, the vet clinic I am visiting is a 24-hour one. There are only three clinics that provide 24-hour service here. I will take Jai Jai there if I need to (((my inner self is screaming NO to ungrateful events))). But I definitely am trying to find a vet shortly.

 

The risk of not increasing his dose is that if he sits in high numbers for a long period of time, Glucose Toxicity can develop. What that means is that the cat's body gets accustomed to high numbers and begins to think that's normal. Then it takes increasing the dose even more to move the blood sugar down.

I understand your concerns - they are valid. Everyone is nervous after a hypo. I would point out that you cut his dose by 2/3 when you decreased the dose, so he's at 1/3 the amount he was at before he got into the 20's. This whole thing with feline diabetes is a situation where you are constantly weighing out the risks of a hypo or low numbers, the risk of damage from high numbers, whether or not you'll be home to monitor, etc. There are so many variables. I just want to make sure you understand in this balancing act there is also a risk of not increasing the dose once your testing has established that it's not enough to get him into normal numbers.

Then as long as you understand the risk of NOT increasing, if that's what you choose, that's fine. Does that make sense? It's always your choice - you hold the syringe. The goal of people posting here is to help you understand as much as you can so you are making informed choices.

 

Hi Hollis,

I just went over to your thread on Main Health, and saw that Jai Jai vomited this morning. That is a very important piece of information, but it's not here on the post above. I am very concerned that having some information on him on Main Health, and some information on him here in Lantus/Lev Land, with advice from some people there and some people here, is going to result in a disaster for Jai Jai.

Just now looking at Main Health, there are 56 posts on that thread that was started last Wednesday. As I mentioned a couple of days ago, the custom here is to have a new thread every day so that the threads are manageable and no one has to read through days old information to figure out what the current situation is.

I just want to express my concerns about this. You can do whatever you want to, but I think this system you've got going has the potential to be a serious problem.

 

I do understand the risk of having high numbers, but it neither worked when I increased the dose "every 3 days" as said in the TR. So, I tend to modify a bit and let the same dose works slightly longer than suggested.

In view of a change of the feeding/shooting routine that happened yesterday, and he vomited this morning and had a black number at +2, I seriously want to hold the dose a little longer till 2/9 PM. I can monitor him closely from 3 to 6 September 2015, which brings me some reassurance and comfort.

It is unfortunate that he vomited this morning. I did not have much time to setup a new link, so I can only post there and put up a "911" signal.

Although I am on a half-day leave to make sure Jai Jai is OK, I am dealing with some office work right now.

I indeed respect all the opinions and comments. I will take time to digest and consolidate, so don't worry all these will result in a disaster.