5.19.15 Zoey amps +14(120).+2(86)+4(39)+6.5(51)+9(107)+10(148)PMPS 338

Good morning!

If you look at Zoey's SS, you will see we had a time of it last night keeping her numbers from dropping. We were feeding LC early in the day, then switched it up to MC and finally, early this morning, we had to go to HC with some added HC gravy. We probably could have started with that earlier than we did, but we weren't wanting to slingshot her back to the top. She's over an hour past her shot time and I'm leery about shooting the full 3.5 with her numbers hanging so low and it being so hard to feed her. In a perfect world I could dial up the dose that would keep her right below renal threshold and allow us a little down time ... for about five days so we can catch up without worry.

What should we do? I'm leaning towards shooting a 3.0 once she gets right below 300 and adjusting our shot time yet again. I failed to give her the Trilastane last night (numb brain, I guess) so she will be receiving that as soon as we feed her this morning. (We've withheld food until I figure out what to do and make sure her numbers are based on real elevations and not food.) She's still being syringe fed. (ETA: brain wasn't numb last night -- just this morning. Trelastane is once a day so we're good.)

Thoughts please. Not sure mine are reliable.

Thanks bunches!

ETA: yesterday

 

If her last food was about 4 or 5 hours ago, it looks like she's coming up.

 

Yes, it was. I'm concerned with shooting her with how low she's wanting to go on these new meds - especially considering that she's eating higher carb foods more often. Just a week ago she was 4.25 on nothing but LC and now she's nadiring much later and there's nothing predictable. She's definitely coming up and can take a shot. How much? You think 3.0 would be enough to keep it going? I would have thought with us skipping two doses in the last two days that we would not have seen such low numbers so quickly.

 

I only see a skip on Sunday.

A lot depends on whether you will be around to monitor today, and is she eating or can you syringe feed if necessary, and do you have plenty of supplies. If yes to all those questions, is your shot time flexible? If so, then I would shoot what feels comfortable. I wouldn't skip. Remember, that the late shot this morning is also draining her depot.

I have to go to work in 10 minutes, so can not be around to help.

For lurkers, Zoey is a special case and is not following the normal rules.

 

If she hasn't had any food since +9 and has come up from 84 to 141 in the hour between the usual AMPS time and now, I'd shoot the 3.5....as long as you're able to test and have all the supplies you need. Lantus works best when you "shoot low to stay low"

I'd plan on getting a +1 and +2 to see how she's doing so if you need to intervene sooner, you can.

That being said, usually if we suggest shooting a lower number than you're used to, we try to promise that we can stay around to help watch over you. I'm sorry, but I have to leave soon so can't make that promise....however if you run into problems, please don't hesitate to use the 911 prefix on your first subject line to get eyes on your condo quickly

 

We delayed/skipped on the 15th as well. The 15th is when it all started to go awry and the SS gets harder to read. The does times changed from 5:00 a.m. to 7:00 ish to 10:00 ish, then delay/skip and 5:00 ish again. And now today we'll be back to 7:00 ish.

 

Okay. ... BOS in hand and big girl britches on.

 

Yeah, no BOS. What's going on with the 20 point drop? Now she's in numbers that make it appear as if her pancreas is working again. (oh, no!/ yay?! ) She's still got to be fed before I can shoot but her numbers are sputtering and I'm really leaning to a reduced dose and not until I see that her numbers are on the rise. She's had two stall/skips in the past 4 days with several reduced doses over the last week. I don't know what to do with that information and how to factor it into the equation.

I am working at home today and have plenty of supplies on hand. Extremely tired if this goes into another long night. We've shot low several times so we're good there. It's this unexplained up and down and staying low even with HC foods and being hard to feed, even syringe feeding.

I'll check back for thoughts. Thank you, too, Dyana and Chris!

ETA @Elizabeth and Bertie .. well-known advisor I recognize online at the moment.

 

That's one of the problems with stalling too long....since you're not feeding yet, the numbers can keep dropping....that's why IF you stall, as soon as they numbers start to climb (without food), that's when it's best to go ahead and shoot.

Remember, you're not shooting the number she's at now...you're shooting the number she'll be at in a few hours when the Lantus "kicks in" (onset)

 

(whew!) Didn't see you online. Okay. If dropping when stalling is a normal reaction I can wrap my head around that.

Thank you, Chris, for stopping back by.

 

(sigh) ... faster than expected/hoping drops. fed one full ounce of LC food this a.m. at shot time and reduced the dose to 3.0 because we have a vet appointment this afternoon and have no idea how long we'll be there and not a great place to try and feed low numbers. I feel the Trilastane is at work and now with the added pressure of trying to get her to eat, I will be sure to have honey on hand. It might be the only way to keep things safe if needed. Hopefully she'll hang out here and surf. I know that's how it's supposed to work (shoot the low) but Zoey has never been one who cared much for rules.

If I were a camel, today just might be the straw. Just sayin'. Paws crossed, and legs and eyes ....

 

you have to do what you are comfortable with....
you've got added complications....not just fd.

hope the vet visit goes well.....with improved report...

 

.. 39, 4 hours in and two full ounces of food, half being MC. I fed her 3mls (all I could get into her) of MC food mixed with HC gravy and also a touch of honey directly to the tongue. She's showing no signs of hypo (unless her usual signs of not feeling good are masking the hypo signs). She can still fight me off quite well so I wouldn't say she's lethargic. That's about all I have to go on. I'm very concerned about the remainder of time on this insulin dose.

I would use more honey if I wasn't afraid of bringing her up so fast that she comes down super hard tonight. I missed an alarm last night and that never happens.

 

Given Zoey's special circumstances, you may want to consider taking her to the vet for a glucose drip if she's not coming up. I would worry more about her sitting in these lower numbers than having her come up too much.

 

Come on Zoey - up a little bit please! It's not very nice to worry your beans like that when they're already worrying about you all the time. It's lovely to see her doing so well on a lower dose, but numbers in the 30s are never nice to see show up on the meter.

I think I'd go with giving her more honey if she's not up a fair bit at her next test - it'll only raise her temporarily but it might give her enough of a kick start to stay above 50 the rest of the cycle. If she's still running low at your vet appointment, I'm sure they'll help you get her back up to more reasonable numbers. And you have time to adjust tonight's dose if you need to at this point.

I'm not surprised you're exhausted - your schedule with Zoey and all her different treatments at the moment would tire anyone out! I think we've all done the sleeping through the alarm thing at least once - I always thought it was something I'd never do either as I've been used to having to wake up at odd times for flights etc when we've been traveling, but I still managed to sleep straight through an alarm more than once with Rosa.

 

she's stable at 39 for the moment. I was a bit more successful this last go around with syringe feeding her. (She's a daddy's girl and he's not here to do it) I wrapped her in a towel like a burrito so I could sit her up in my lap and her claws not shred my arms. I rubbed a bit more honey on the gums and I'll check her in a half hour. Vet's not far down the road and I'll run her straight there if she continues the dip. She's alert so I'll see where we are in 30. She has a 4:30 appointment this afternoon with the vet scheduled so I'll definitely ask him to give her some extra something to carry us through the night.

That's the plan at the moment. Open for discussion though.

 

Sometimes burrito wrapping is the only way to get anything done if you value your skin! Sounds to me as though you're doing everything right and it's good that the vet isn't far away just in case she decides to drop further. It's always concerning when the HC doesn't seem to bring them up as much as usual but it sounds as though she's doing fine for now. Hopefully the honey will bring her up just a little at her next test.

 

Oh, good, April! Your thoughts are the same as mine. Makes me feel a little more sensible when someone's in agreement. LOL

I know you worked tirelessly with Rosa, too! You were up with her the first night we were here. How is she doing? I miss seeing your condos and looking in on y'all.

 

I know what you mean - even when you know how to handle the low numbers, it always helps to have other people around to keep an eye on things too!

Rosa's doing really well thank you - she's still off insulin and her numbers have all been good at her weekly tests - she seems to be a higher end of normal kitty and is often in the 80s or 90s, but I'm happy enough with that. She's back to being into everything - she was always a cat who liked to be involved in whatever I was doing and she's all the way back to that now. I can remember too clearly the days when I used to find it a little irritating that I couldn't move without one cat or another being under my feet - if there's one thing I've learned it's that it feels much worse when I'm not constantly falling over her than it does when I am!!

 

Sorry to bother you with this but I don't feel I can give any creditable advice if I don't understand.

You have two 5/18 entries on the SS and I'm assuming the second one has the numbers from this morning's stall after +12?

You did the smart thing by shooting 3u this morning. The numbers you are seeing might be because the 3.5u dose with the trilostane in the mix was too much. I'd see how she does today....how fast she comes up and if she stays up. If you are fighting her numbers all day long, we might want to drain the depot a little more.

 

Marje - yes, the second set for 5/18 is when the amshot started. We've stalled/skipped twice already in the last four or five days and the SS was getting too hard to keep up with. So the first 5/18 is the +12 through +14 of the previous day's cycle. The second 5.18.15 is the start of today's cycle which was delayed by three hours and reduced by .5.

ETA: not to actually keep up with, to make sense of with the changes going on in times and stalls. tried to make it a little easier to follow.

 

Awesome report on Rosa, April! Think about her often and glad she's back to the way things were.

 

Thank you! I will make occasional updates for her - I promise! It's so kind of you to think of her when you've got so much already going on with Zoey - she will be delighted to hear you were asking about her!

 

I agree with Marje. If Zoey starts to come up soon you could go with your new dose tonight. If she keeps scraping the bottom of the lagoon much longer, I'd go with a much reduced dose like 1.5/2.0 tonight to drain the depot. How far off your ideal shot schedule are you now? Skipping is another option if you want to get back on schedule after all those delays. You are doing an amazing job Rose (and DH).

Zoey sweetie - the 80's are a much cooler place to hang out. And your bean needs some sleep tonight.

 

(((((Rose))))) No dosing advice from me- just wanted to offer a ton more vines and prayers big time! Oh and Zoey- C'mon, up just a little, be nice for your mamabean okay?

OT- and don't answer it now in the middle of this current crisis situation; maybe sometime when the action dies down...Did you vet have any thoughts as to why the clay colored stools? I saw she's had an ultrasound, did they see anything with her gallbladder or liver? Very curious!

 

Glad she is starting up a bit. You're doing good with staying with the HC/honey until she is up well over 50. I know you know to stay on top of the testing until she's been without the HC/honey for a couple hours. If her depot is as full as we think, she could come right back down once all the good stuff wears off.

I can't imagine how exhausted you are and I know FD exhaustion

 

Okay. She's coming up. She's at 49 now and I fed her some more MC food with HC gravy (5 ml). I held off on the honey this time, not knowing if she's going to continue to rise from that. Last time she was dosed with honey she climbed for hours. Granted, these were just touches, but I feel safer now that she's on the rise and the cavalry is nearby. My thought is that I should try and keep her from rising too fast because a bounce back to the lows is just as challenging as a dose that's too high. That'll put us on replay tonight and some things I'd prefer not to revisit during the night.

Wendy ... yes, a new dose, please. Perhaps we can revisit closer to shot time and see how she did today and make an educated guess. I know this is a new frontier with the Trilastane so collective minds are better than mine. The research I've read says that within just a couple of weeks the insulin requirements were cut in half and remission was not far behind. It's why I've been so reluctant and testing so much ... it was expected on my part and I probably should have waited this morning for the BG to rise and be sure that it wasn't going to stay flat. Of course, had I done that and she went high, I would've kicked myself for that decision, too. So onward and upward. 5:30 is my ideal time. We're shooting 8:30 as of today. At the end of the day, perhaps all of those ingredients can be thrown into the mix of collective thoughts.

Ruth ... Cushings. The answer to everything is Cushings and her liver isn't functioning or pancreas. She's on milk thistle for her liver, pancrea powder enzymes for her pancreas and what ended up changing the poo and making it wonderfully close to being normal is freely adding coconut oil to her diet. For the past two days she's been eating and licking as much as she likes and her poos are almost normal.

 

Marje, I'll add more honey after this next test if it's not still on the rise.

 

That 49 is a lot more comfortable than 39! If she can just come up a little bit more on the MC/HC food mixture that would be good, but great job on getting her started back up.

 

51 yay! .. and DH is home, yay!! He'll be able to get more food in her without all of her drama so this high carb gravy stuff should bring her up. Honey is within reach though.

Vet appointment is in a little over an hour. Will pack extra food in case we're there a while. PM shot is set for 8:30 (five and half hours from now) so I'll be sending a shout out before making any decisions.

A million thank yous for everything!!

 

Good luck. Hope it goes well.

 

@Tiger and Ruth ... upon reflection I should probably acknowledge that it could be the Trilastane helping, as well. She's had two enemas in the past week and the Aspiring Great Vet told us instead of using lactulose we could use coconut oil. Her poos were getting all stuck together and clogging her up with their clay-like consistency and since being told to start giving her coconut oil again, they're almost picture perfect (Dr. Lisa's pictures, of course.) The ultra sound did not show anything wrong with her organs. They were very hesitant to diagnose her with Cushing's until she was on death's door, but so far so good. (For being on death's door, that is.)

 

No advice from me, just tons of good vetty visit vines for Zoey hope all goes well.

 

Vet visit went okay. Overall she's good but spot on her nose may be squamous cell carcinoma .. but wait and see. I seem to remember reading something in a condo about Vitamin B and cancer. I'll have to go searching for that. Of course, Zoey acted like she was not sick. Even the nasal congestion she was able to cloak somehow beneath her purrs. We came home with new meds (Cypro for appy and also an anti-histamine. ) I'll have to update all of that stuff a little later.

I've made sure Zoe's SS is up to date and her numbers are coming up but are still considerably low considering that she's been eating nothing but gravy and honey all day. Perhaps if I put her back to low carb she could get by with a very safe 1 or even no dose? I don't want to send her high though ... it's not worth the cost of trying to bring her back down and looking into those eyes that look so miserable when she's high. 5:30 is the schedule that is the best fit, but whatever we need to do we can make happen. One of the few perks of being your own boss .. you can take your sick critters to the office with you if you feel like it.

I'm going to catch a quick nap before I get up for her 8:30 feeding/dosing. I'll check back here before I do anything. I know once I get a nap that I will feel more alert and verbose. Chat in about an hour.

 

Thanks for that info Rose- I'm reading up about coconut oil and Trilastane, I'm so glad it's helping Zoey! LOL on the perfect poop and the Dr. Lisa pictures LOL! and -I do hope you are sleeping/napping!! You've had so much going on!

I'm glad your vet gave you Cypro, I didn't want to say anything but my vet was very against Mirtz honestly; Cypro is an anti-histamine, rather than an anti-depressant, so it may actually help with her sinus as well as her appetite. Also glad they saw nothing on her ultrasound! I just knew that clay colored poop could be gallbladder or liver, but I'm glad that isn't it!

Continuing prayers, vines and wishes for you, Zoey and DH! (he is still DH right! ;-) )

 

Okay. So, I should've known she'd shoot back up. 338.

1.5? 2 units? 2.5? I shot 3.0 this morning.

@Wendy&Neko @Marje and Gracie

 

Do you need sleep tonight? I suspect you might need to refresh your batteries?

 

Ruth, I asked the Great Vet about the clay-colored poop and he said that it was probably the bilirubin and her liver not functioning correctly. There was nothing on the ultrasound and her blood work was never really indicative of any particular direction in which to look. Since we've added the coconut oil her poo is much better but he thinks the milk thistle was probably helping her along the way, coupled with the Trilastane and overall improvement of Zoe. I also asked him about the Cypro. He told me that the "new and improved" drug is the Mirtz and that's why they switched but that he had no problem going back to the Cypro because for him it worked just fine. Didn't know why the Aspiring Great Vet was so against it. I'll have to revisit a condo from earlier today and fix that cliff hanger I left out there.

Thank you for the prayers! ((hugs))

 

If my poor typing skills and misspellings are any indication, then yes, please.

 

I would lean to a larger amount of insulin, but still reduced dose, mostly because there's a good chance she's going to bounce. How's her appy today?

The lows today were probably due to the 3.5 unit dose depot not from the 3.0 unit dose. I think a 2.5 should be fine to drain the depot. And I'd probably go back to 3.0 tomorrow morning.

BTW: It's been one week since she started her Cushings meds. You said down to half her dose in two weeks. She's gone from 4 to 3 units in one week, so right on track.

 

Her appy is awful. I do have some new meds we will use in the a.m. We also have a larger feeding syringe to use so maybe tonight won't be as tedious. DH leaves early in the a.m. to pull the trailer home from the fishcamp so I'll be on my own with the syringe feeding until he gets back. Hopefully that will be before I leave for the office, if not, Zoe's on a road trip again. Okay. 2.5. Going to shoot it at 9:00 so it will be 1/2 hour late.

Thank you for answering the call!

 

Rose, you and DH are doing an amazing job looking after Zoey. Sending apply vines. Things are looking so much better than a week ago!

 

What is going to do about the spot on her nose....just watch it?

I like Cypro much better than mirtz because you can give it daily. They might be changing it up on Mirtz but it used to be once every three days. I also didn't like the way my cats acted on it. Sometimes you only need a sliver of the dose they prescribe, too.

I hope you all get some rest tonight and she doesn't go so high that she feels bad. Poor sweetie.

 

I second Marje's comments about Mirtz vs Cypro. Minka on Mirtz was like she behaved when she was first diagnosed with Hyper-T, times ten! On Cypro, just a quarter of a tablet does the trick for her (although the recommended dose was 1/2), and you can give it twice a day. Mirtz, as Marje pointed out, is once every three, and the appetite benefits only lasted about 48 hours for us.

Sending lots of appy and healing vines, and prayers, too. I hope you get a nice, smooth surf tonight and can get some more sleep. I totally understand the special exhaustion of dealing with FD when there are additional issues in the mix!

Have I mentioned lately how awesome you and your DH are??

 

Vines. So many.

Admiration. So much.

You are all an inspiration.

Marilyn and Polly

 

yikes what a time you've had! You're doing a great job handling it all, Rose. Nice to see Zoey coming down in dose, although she doesn't need to be so dramatic.

The only thing I've been thinking as I'm reading your condo, is that some cats will start vomiting if they get too much gravy or sugar syrup stuff. So if you can keep her blood sugar up with regular food that might be a good idea. I'm not saying not to use the sugar if you need it, just want you to be aware of that potential issue so you can avoid it if possible.

I sure hope she bounces all night tonight and you get some sleep.

 

I really hope Zoey lets you get some sleep tonight Rose. And that the spot on her nose turns out to be nothing too worrying. You've done a great job with her again today - I know you've been through a rough time with her, but I really hope she's turning the corner now and will start improving more each day.