Gem - HELP insulin shot question

Tested Gem's BG (big mistake as I tore more of her skin while holding her and I feel sick to my stomach now) but it tested 178 just before her dinner. I don't know whether to shoot her, give her less or what. I called the hospital where she was on Thursday and they were no help, basically telling me that a pre-meal number is meaningless and I'm better off testing her urine. Last thing I need is a hypo incident - I don't think she'll survive that. Is there a danger in the skipping the shot altogether???

 

Okay - relax and take a deep breath.

So you're saying it's shot time and she's testing at (178)? If so, what is your do not shoot number? Until very recently, my line in the sand was (200) because I don't know how Hershey would react. To skip a shot is no worse than a fur shot. You can always monitor testing periodically until she rises enough to shoot. Or you can opt to skip her shot if changing the shot times isn't possible with your schedule.

Libby (and Hershey, too!)

 

What insulin do you use?

And, a pre-meal test is NOT useless. We feed Hershey 4 small meals - shot time and +6 and test him before each meal.

 

Gem gets lantus, 3u twice a day. I don't have a line in the sand number. Gem is a complicated case, she was just diagnosed with Cushing's (you can see a bunch of my posts on her). I am not going to test her anymore, it is too stressful for me with her fragile skin condition.

I guess I want to know if I'm better off erring on the side of skipping the shot…not sure what the danger in doing that is. She is completely unregulated.

 

I'm sure others will be along soon to give their input. I haven't read your Cushing thread (haven't been on HEALTH lately) and am unfamiliar with that condition. I don't know anything about Lantus or dosing with it; we use ProZinc. But, I know that sometimes fur shots happen and that's the same as not getting a shot.

 

Looking at Gem's SS, I see that you shot 3u once before on a 180 about a week ago? The last data on the SS is from the 23rd though. Have you been testing since then, and if so, what have her numbers been like?
I'm going to link this to the Lantus forum and get someone with lantus experience to drop in and help if possible.
Can you hold off on shooting for a few minutes?

Carl

 

Yes, I will hold off, thanks

SInce we've been dealing with so much other stuff with Gem I had to stop with the testing. The only recent numbers I have that are not on the sheet are:
Thursday at the hospital she tested in 170's twice, I gave her 2u at night.
Fri morning she was back to the 300s so I gave her 3u, both AM and PM.

Like I said, due to her skin condition, I refuse to test her anymore, I just can't.

 

Carl has posted in the Lantus forum to try and get more eyes.

I hope that someone who has more experience with dosing information will stop in. I think that since you can't test her again tonight you could skip the shot.

 

I've never been in your situation, so I'm sorry I'm not much help. If she is eating fine, I guess you could either skip the shot or give her a token dose of like 1/2 unit, just to get something in her. Is she eating fine? She does seem to be coming down from a bounce according to the numbers you gave, and if you can't test tonight, then I would want to be very conservative. She did fine with the 180 PMPS a week ago, but because you are unable to test tonight, I would either skip the dose altogether or else just give her a very reduced dose and watch her well, and I would probably set some alarms just to check her (visually) through out the night. Frankly, I'd rather you err on the side of caution and skip.

Do you have any urine glucose test strips? They would help out a little.

Best of Luck, and Hugs.

 

Thanks for doing that Carl, means a lot to me

 

I do have those test strips (I assume you mean Keto stix, right?) though I don't have much luck in testing her that way as she doesn't pee in the litter box.

I guess my question is - what is the danger in skipping a shot? I know the risks in overdosing but not under….

 

Totally out of my element here but just a thought - wouldn't her condition be stressful for her? Wouldn't that perhaps actually be rising her numbers (I know stress does this and pain does this etc. in cats and humans) - when I'm sick my BG numbers are wacky and always higher than they should be. If that IS the case or a possibility than that might be something to consider into the mix if you have not already. Perhaps a token dose is the way to go - poor Gem doesn't need to be dealing with hypo and neither do you. I hope it all works out and you get some extra eyes on this if you are still debating the point at this time.

 

let me grab a link really quickly for you on how to dose without testing. you clearly need a creative solution - and i was just rereading this article last night.

be right back.

 

The stix for testing urine glucose would be Diastix (or Ketodiastix which test for ketones and glucose).

If you skip the shot, her BG number will go higher. There is a possibility, especially if a cat has an infection, of developing ketoacidosis. However, Gem had bloodwork done recently, and there was no sign of infection. I believe that she also got an antibiotic shot.

I respect Dyana's advice. Since you do not want to stress Gem or yourself out, I would consider skipping the shot, or as Dyana mentioned, giving a very token low dose.

The board FAQ on handling a low pre shot number is:

Q4.4. My cat's pre-shot level was way below the usual value. Should I give the injection?

A4.4. There's no hard and fast rule, but if you don't have data on how your cat responds to insulin, here are some general guidelines. Below 150 mg/dl (8.3 mmol/L), don't give insulin. Between 150 and 200 (8.3-11.1 mmol/L), you have three options: a.) give nothing; b.) give a token dose (10-25% of the usual dose); c.) feed as usual, test in a couple of hours, and make a decision based on that value. Above 200 (11.1 mmol/L) but below the cat's normal pre-shot value, a reduced dose might be wise. In all cases, if you are reducing or eliminating insulin, it's wise to check for ketones in the urine. Above the normal pre-shot value, give the usual dose, but if the pre-shot value is consistently elevated, it's a good idea to schedule a full glucose curve to see whether a change in dose or insulin is appropriate. In most cases, the target "peak" value should not be below 100 mg/dl (5.6 mmol/L), and for some cats it might be higher.

Keep in mind that these are general guidelines, and they should be personalized to your own cat's reactions to insulin. If your experience is that your cat does not became hypoglycemic with a dose which is close to her usual, then your experience should be your guide.

Lantus and Levemir users: Because Lantus and Levemir are gentler insulins, you may find that these guidelines are stricter than you need. If you have some data on how your cat responds to insulin, please read Jojo and Jill (Team J)'s guidelines at FDMB (http://www.felinediabetes.com/phorum5/r ... 22,1017956).

 

If no one else comes along with advice, I would just go ahead and skip the shot for tonight. Better to be too high for a day than too low for a minute.

There are Keto-Diastix that have a second patch on them that will test glucose. The attached article was written in 1999, so may be somewhat out of date, but I was just thinking that it is an alternative, when too much poking or handling becomes an issue.

 

look at the end of this article, end of page 10 and onto page 11. they are talking about dosing "fractious" cats - ones who can't be blood tested. the article was written in 2005, so it's not the most recent info, but the University of Queensland in Australia has been in the forefront of diabetic cat/dosing studies. i would give it a try in your situation.

it is an overall strategy, so it may not help you tonight. you'll have to study up on this and figure out how to measure urine glucose (which, by the way, there are some crystals that can be sprinkled in the cat box to do that) and water intake.

http://www.uq.edu.au/ccah/index.html?page=43391&pid=0

 

Thanks Julie for coming along. I will be interested in reading that link, too.

 

Thanks all. I am totally stressing myself out. I think until now, even with that reading I would have given her her normal dose, as we've never had consistently low numbers, never come close to a hypo. But I feel so awful about tearing her skin trying to get that reading, and I'm so worried about every little thing.

Linda, yes you're right, she had an antibiotic shot, given this past Tuesday. I also realized that the AM shot today was later than usual (due to all of us sleeping in, my son spent the day throwing up yesterday). So perhaps the test time was closer to the nadir (which I've not been able to figure out yet because I don't have enough data). I think I will give a lower dose, and assume that she hasn't changed much - it's just me who has

What are the dangers of KDA? Yes, I have Ketodiastix, and I can try to get a reading. In all the times I've tested her she's never had any ketones - that's good, right?

Maybe this is the sign I'm looking for? Though she is acting the same, perhaps this is not a way to live a life.

 

I think skipping the shot is much less dangerous than shooting too much without knowing her BG. High numbers cause damage, but nowhere near as much damage as "too low" numbers can. I think the way it is usually stated is "better too high for a day than too low for a few minutes".

That said, a tiny token dose probably would be okay, like half a unit or so. Like Dyanna said, just so she gets something in her.

Is the cushing's and what you experienced tonight, is that something that will improve? I don't know anything about cushing's. Will her skin always be an issue, and will it mean you can't test her at all? When you said "I can't test her anymore", is that tonight or will you be able to eventually? When Gem was diagnosed, were you able to discuss any alternative methods of testing glucose with the vet?

Carl

 

the problem with those intermittent test results you have are that they really don't say anything except that she's diabetic. without being able to see them in context you don't know if they are "real" numbers, or if Gem has hit some low numbers and is bouncing temporarily into higher numbers.

i think if i were you, i would skip tonight, read that info i gave you, get the supplies to do urine glucose testing and measuring her water intake, and try to go that route. then regroup in the morning. if she's on all canned food, she *should* need less insulin than 3 units, but i don't want to just say that or recommend you change the dose without knowing more. i am not especially familiar with cushings either, but it is considered a high dose condition, so maybe she needs that much.

have you read any of the information on the high dose forum on cushings?

i can't tell how much you know about lantus, but dosing is based upon how low the cat gets in between the shots. the preshot number is not meaningless in context. it does tell us if it's safe to shoot or not. but it doesn't tell you how effective that particular dose is in the cat's body.

 

Carl - without getting into too much detail here, the Cushing's Dx was just confirmed Thursday, though I've suspected this for a while. The specialist at the hospital who ran the test and examined her feels that there are no treatment options for Gem and it is time to let her go. Therefore we did not discuss other testing options. In fact, I don't think they really recommend any of the home testing stuff. When I said "I can't test her anymore" I guess I meant for tonight and in the immediate future. I am taking Gem to an endocrine specialist on Monday and after that will make a determination for Gem's future. My brain tells me that we cannot help her anymore but my heart is not there. I guess that's why I'm freaking so much about this shot - I just don't want to do any more damage.

 

Well, if there's one thing I've learned in the time I've been around FDMB, it's that your heart is usually right. So I guess I'm saying, don't give up on her. I've seen some pretty miraculous stuff happen in this place.

Hugs,
Carl

 

Thank you so much Julie. I have tried to read as much as I can about lantus. Thanks to this board I have gotten lots of great info, and that's when I started testing at home. But before I could get too far, the skin problems escalated, which led us to the Cushing's Dx. That has really derailed me.

Based on what everyone here is saying, there is less danger in going too high than too low, so I think I will give a low dose shot tonight. I don't know what to do in the morning, because I don't think I can test her blood, and I haven't had a lot of success with urine testing. Gem doesn't pee in the litter box at all so it's hard to get a sample.

 

(((Hugs))) I think you'll just need to be a little more creative. Like more urine testing and less blood testing, maybe. More measuring of water intake, if possible. And being more aware of how she is acting.
I would post a copy of the hypo printout (taped inside the pantry door, or somewhere it's always there and always handy), make sure all the family members are aware of the signs of hypo and know to contact you immediately if any are present. She could still have a few good years in her. I don't think you should give up on her, just yet.

Carl and I posted at the same time. I have also seen a lot of miraculous stuff happen, here.

 

Thanks Carl - that is pretty much why I am taking her to this specialist. His sole focus is on endocrine diseases so if there is anything to be done, he will be the one to know it. And if he says her condition has deteriorated to the point where there are no treatment options, then with a heavy heart I will accept that and know in my heart that I did all I could.

Of course I'd like her to make it to Monday without my killing her by screwing up her insulin

 

hon, don't give up hope yet. i've sent a message on facebook to the woman who was the moderator of that high dose group that included kitters with Cushing's, Patti. she's fabulous and i know she'll try to track down the people who have experience in this and can help you with it.

hang in there. we've seen miracles here - it's all about learning what works for each kitty and getting someone with experience.

we just have to connect you with the right people to get you help. it's coming - so keep checking back.

 

Thanks Dyana - from your mouth to god's ears I wish you were right. But sadly, I don't think that's the case. Again, without getting into too much detail here, her skin is literally peeling away. She has a large open wound on her back, and when holding her to test her this evening, I tore it some more. So realistically I think she is past the point of treatment. From what I've read, the meds available for Cushing's take some time to kick in, and in that waiting period, she is at risk for more tears, infection and of course pain.

 

OK, thank you so much. Like I posted before, at this point, I just want to help her hold on til Monday when we go to the specialist. So I'm trying to do the least risky thing in terms of the insulin dose.

 

somehow this didn't post earlier - this is what i referred to in my last post. we can track down some of these people for you.

This is all there is on the high dose forum (inactive) on cushings:

http://www.cat-health-guide.org/felinecushingsdisease.html

http://www.cat-lovers-only.com/cushings-disease-in-cats.html

we may be able to find some of those people to come and help you. i think some are still around here and there. would that be helpful to you?

 

i don't know if this relates or not, but punkin has acromegaly, which is a tumor in the pituitary gland that causes the diabetes. it is also a high dose condition. we took him to Colorado State University last September to get the treatment called Steriotactic Radiotherapy (SRT) - which is radiation therapy that zaps the tumor. cushings is also a tumor in either the pituitary gland or the adrenal glands - i don't know if they do SRT on these cats or not, but i can put you in touch with the people we worked with. they are fantastic.

how old is gem?

 

(((((JK and Gem)))))


I know you feel overwhelmed right now. My first advise is to get a new vet, anyone who tells you to give up without trying seems really insensitive. I've been thinking about you and Gem since our post a couple days ago and am sorry you have gotten the diagnosis of cushings for Gem. However what you need to do is see a specialist, which you have already scheduled for Monday!! Don't give up now you are headed in the right direction. Having a diagnosis means you can begin to seek treatment.
Have you looked into getting the shirts that Lisa n Cole recommended. They will help keep the tears clean while they heal. Lisa is one of the most informed persons I know and had a lot of success in treating Coles cushings. I will copy her in right now. Try to get some rest this weekend and continue to keep Gem comfortable. You are doing a great Job and are a great mom to Gem. I know she loves you for all you do. Please keep me informed of your progress and PM me if you have any questions I may be able to help with.

 

patti answered my message and has gone to find some help for you. :YMHUG:

 

(((((JK and Gem)))))


I know you feel overwhelmed right now. My first advise is to get a new vet, anyone who tells you to give up without trying seems really insensitive. I've been thinking about you and Gem since our post a couple days ago and am sorry you have gotten the diagnosis of cushings for Gem. However what you need to do is see a specialist, which you have already scheduled for Monday!! Don't give up now you are headed in the right direction. Having a diagnosis means you can begin to seek treatment.
Have you looked into getting the shirts that Lisa n Cole recommended. They will help keep the tears clean while they heal. Lisa is one of the most informed persons I know and had a lot of success in treating Coles cushings. As Well as Linda and Bear Man and Amy and Pedro and others I have not had the pleasure of meetting. I will copy them in right now. Try to get some rest this weekend and continue to keep Gem comfortable. You are doing a great Job and are a great mom to Gem. I know she loves you for all you do. Please keep me informed of your progress and PM me if you have any questions I may be able to help with.

 

oh yay! i didn't see Cheryl was here. wonderful - experienced people coming out of the woodwork.

thanks cheryl!

 

Thanks Julie. When I first posted that we got the diagnosis, I did hear from a few of those people (Amy & Cheryl for sure) and they were very helpful. I think right now I'm in a holding pattern til Monday. I just panicked with the relatively low BG number and how to handle that.

EDIT - and Linda too! My apologies if I'm leaving someone out, everyone's been so helpful

 

Of Course. I'm sorry this is such an active condo my message accidentaly posted twice. I will go over to the facebook group and post a message as well.

Hang in there ((((JK and Gem)))) help is on the way.

 

Gem is 13. I'm in NYC and wil be going to see Dr Mark Peterson Monday. From what I read, he is tops in these types of disease. If there is something to be done, I suspect he will be the one to know what to do.

 

Thanks Cheryl

In some defense of the vet, who is not my regular vet but an internist who administered the test, I know she did not say that lightly. Gem has Cushing's, diabetes, restrictive cardiomyopathy and some kidney failure. Her skin is really really bad. She said they could try the trilostane but are concerned that in the time it takes for that to kick in, her skin will continue to deteriorate, as evidenced by the fact that I tore it more holding her to test her BG. That said, we will see what Peterson has to say.

As for the shirt, I spoke to my regular vet and her concern with the shirt is that the rubbing against it will tear the skin more. I am applying an antiseptic solution to help keep it clean.

 

I am truly overwhelmed by all the support I've received here. It's something I've never experienced before, and I am truly grateful.

So, I had Gem eat a little more food, and gave her about 2 units (a little under actually). I have the hypo stuff at the ready. I managed to test her urine, negative for ketones and high for glucose. I need to go to sleep, my 9yo son has a hockey game at 6AM, but dh will be up with her for a bit, and he is aware of what he should be looking for.

Is there some time frame in which it is likely we would see a hypo episode? A general time after which the danger passes?

 

I'm glad the internist did not say it lightly. I'm sure she is doing the best for the two of you. There are lots of caring vets out there and it certainly doesn't hurt to get another opinion. I know you are doing the very best for Gem and I'm sure she feels it too! Witty had multiple conditions as well and it is a lot to juggle (many cushings cats do). Keep working closely with your vets as you have been doing as in the end they are the professionals and we will continue to offer our support. I'm sending healing vines, white lights and prayers your way.

 

Hello,
I'm Patti - one of the "old" acromoms - (Merlin was my acrocat). I try to stay in touch with all the acro moms/dads and Cushing's moms/dads. Please forgive me for just now only reading thru all your posts. However I am so happy that ALL the great Cushing's moms have come to your aid. They are your BEST assets. Everything that I thought or knew to tell you they have beaten me to those answers. I can only imagine what a horrible time this is for you. The only thing I didn't see mentioned is a drug called trilostane that is sometimes used in the treatment of Cushing's. And sometimes there is surgery on the adrenal glands. As always there are pro's/con's.

Dr Mark Peterson makes regular posts on an endocrinology blog that we in the acro group read about regularly. I'm so glad to hear you will be seeing him. He will certainly guide you to helping your precious Gem.

I so wish I knew more to offer you. But please please keep us updated.

Oh i did want to say that the idea of doing urine testing for glucose monitoring may be your best bet. There are many people who have to do that to monitor their kitties. I know it's not the "norm" for what is often wanted here but considering how fragile poor Gem's skin is I think this is a great idea. And it would decrease the chance of infection for her.

one more thing - if you need any help with her heart stuff - I can give some input on that as I work with cardiac kids - so often very like our cats!

Sending you both the very warmest of thoughts! cat_pet_icon
These special kitties have such a way of taking our hearts!!!!

Patti and always in my heart Merlin (acromegaly) ...and Boris (diabetic)

 

Thank you so much for chiming in here. Again, I am overwhelmed.

The vet and I did discuss trilostane - that would be her only medical option at this point. Gem is definitely not a candidate for surgery. I think I mentioned somewhere, the vets feeling re: trilostane is that it takes a while to start working, and the skin is the last thing to come around, and she doesn't think it is in Gem's best interest to wait that long, what with these open wounds.

If Dr Peterson feels there is a treatment option available to her, I will certainly switch to urine testing. But one step at a time.

As for her heart, she is taking meds for that, though I know they will only keep it from getting worse, not make it better. If that were the only thing we were dealing with, we would manage it with the meds. But all these conditions exacerbate each other and make it harder to treat.

Hopefully the low dose of insulin was the right way to go and she will hold on til Monday. I will definitely post back with updates.
Thanks again

 

I would make sure that you and DH both feed some food before you go to bed and also make sure that she has food available during the night.

 

Thanks, that makes sense, I will leave some food out and tell dh to try and make sure she eats something before he goes to sleep.

I know the rule is no dry food for diabetics, but do you think I should leave some out just to be safe, or just leave canned?

And do you know the answer to my above question re: time frame we would be out of the woods? Is there some danger zone, or is the risk for hypo always there?

 

on a well-regulated cat, the low point of the blood sugar on lantus is usually between 3 & 8 hrs after the shot. but there's not really any way to know on your cat . . .

personally, i'd leave out plenty of low-carb canned food, not dry.

would you mind editing the first post of this thread and taking off the 911? it's just a heart-stopper!

 

OK, thanks! Yes, I'll take out the 911 now, it definitely helped get me responses when I needed it!!

 

If she is likely to eat the canned food on her own, that should be fine. You want to make sure that she has food available that she will eat if you are asleep.

 

Thanks Linda, I will leave her canned food. I honestly have no idea if she'll go to it, as we really haven't been in this situation before, but in general she will go back to her bowl numerous times so I think she will.

Thanks to all who posted with their advice and support. I must go to sleep or I will be catatonic tomorrow!

I will post tomorrow to let everyone know how we made out. I think I will keep her at 2u til we go to the dr on Monday just to be safe. She's been living with high numbers for so long that I think that's less of a risk than going too low. I will test for ketones when possible.

Love to all,
Karen

 

Good night, Karen. I hope that Gem has a good night.

 

Just wanted to send you good wishes as well. As much as it might not feel like it, you've made many positive steps. You are so fortunate to be within reach of Dr. Mark Peterson -- he has a stellar repuation.

Chip had skin tears as well, and I can completely relate to the stress and panic one feels when it occurs. I'm pretty good at handling medical stuff yet I found myself on edge many times when dealing with Chip and his skin. We initially suspected that he might have Cushings but it was never officially diagnosed. He had skin tears, a pot belly, and a voracious appetite (eating close to 30 oz of canned food a day but losing weight). I took him to specialists and we tested for a lot of things, but we never felt like we completely figured out the puzzle.

Chip's skin was fragile but not the typical paper-thin that is commonly seen with Cushings. I was able to test his ears with minimal impact because he would lay quietly and I didn't have to restrain him. I'm sorry if you've already stated it -- but how is Gem during testing? Is it a battle? If so, then I definitely understand why you opt not to do it. The only other thing I can suggest (other than urine testing which you've already expressed difficulty with) is to try testing on a paw pad. Does Gem allow you to mess with her feet at all?

It's hard to shoot blind but, given the circumstances, do what you have to do. You're in a less-than-perfect world right now that not a lot of people have navigated, so you'll have to feel your way through it. Pick a dose that you feel reasonably safe with, get a spot check if you have the courage (it's hard, I know), otherwise watch like a hawk and leave food out for Gem to nibble on. That's the best I can offer. I think you have pretty good instincts, so try to trust them.

Again, I'm sorry with what you're going through. I fought the battle to try to save Chip and it was exhausting. Many of the treatments were contraindicated and it was a constant balancing act. I had to be creative in how to deal with him. On the other hand, it seemed like HE wasn't ready to give up and wasn't in excessive pain or uncomfortable, and so it was hard to quit trying. In the end, it was clear when it was time. We suspect that the underlying problem was probably cancer but never knew for sure.

I also lost a dog to Cushings (inoperable adrenal tumor) and my current dog has an early "atypical" form of it. That's another whole story. Bottom line is that Cushings sucks.

Please try to take it one day at a time, at least until Monday. To the best of your ability, you've stacked the deck in Gem's favor. I'll be thinking about you...

 

I wish I could offer more advanced advice on your type of Cushing's. Murphy had iatrogenic Cushing's which was caused from her dosage of inhaled steroid for her asthma. She then went on to full blown diabetes and pancreatitis, and once the inhaler was reduced to a dosage she could manage, the Cushing's went away, but the same symptoms arise with either case. She had a huge skin tear (about 2x2) on her side. It just happened one day, and while I was checking her BG that night, low and behold, I felt this wet spot, and there it was. I caught it early, and off we were to the vet's the next day, and she had to have it stapled shut on each side so that the fur would grow back and you couldn't see the skin. She only had one real major tear and that was it. What I did find was that by using the Vetri-Science DMG liquid with her food, I was better able to maintain a good BG level after a while. It is something I wholeheartedly believe in and she has a testimonial on their website. She had demodex so bad, that her nose was constantly overrun by the mites. It was black most of the time, and the DMG helped boost her immune system to fight off those little systemic nasties. Given consistently, it also helps with the systemic immune response of so many diseases. I cannot say enough about it. I, too, had to resort to her little clothing situations. I went to Target and picked up "onsies," but the next day, I'd find them in the litter box with #2 on them. She must have stripped in the litter box -- but MADE HER POINT! Guess she told me -- if you are having trouble with the BG, I'd consider the DMG liquid to help int he meantime until you get the other stuff stabilized. It truly does work. Hope this helps, and I suppose you 200% on your endeavor. I know it's very difficult and I will help in any way possible.

Lisa and Murphy

 

Hi,

I am a little late to this thread but I wanted to give you the benefit of my experience with Cole. I was also unable to test him on a daily basis but had to biweekly to get an idea of where he was. I worked this out with the vet and we were able to keep him regulated. dr. Stewart gave me ranges and how much insulin to give and it worked out for us. I also keep a close eye on his input and output. If cole had no appetite or couldnt keep food down ( he also had cancer which caused him to vomit frequently), my vet advised me to err or the side of less insulin, we also were on Lantus, than too much. If Gems appetite is good then maybe her normal dose is ok, if she is not eating then less is better and it seemed to me that other people have already gave you that advice.

Cole would also get antibiotic shots to keep the risk of infection low and that did seem to help and it also seemed to speed the healing of his skin tears as well but it does take time. One thing about the shirts, cole always had an open wound or two or three. He would continually clean himself and cause more, once he had a huge one on his side that he caused but simply cleaning himself like all cats do. Without the shirts I was unable to prevent him from cleaning himself and causing more damage. I don't know if this is what Gem is doing and I saw your vet had advised against it, but just wanted to give you a little more perspective on why I decided to put clothes on him rather than the cone of shame to keep him from causing more damage to himself.
Hang in there until Monday. I know this is stressful on you and Gem and the rest of your family but you are very conscientious and are doing everything you can to help her. This disease is tough especially on top of the other issues she has. Believe me, I was frustrated by it too and it was scary at times. But you aren't alone, as witnessed by all the outpouring from this thread there is a lot of help. I wish you the best of luck and please let me know if I can help or answer any questions about Cushings.

Lisa

 

Thank you for your reply

Up until now I've been able to test Gem's ear with minimal trouble - meaning she didn't really give me a hard time and the skin stuff didn't impact her ears. But I do need to hold on to her, and where the open wound is makes that pretty impossible right now. I think I am more traumatized by the further tear than she is, I just can't do it again. As for the paws, even when she was healthy she didn't like anyone touching them so I'm not sure that's an option.

I hope Dr Peterson is able to give us some clear advice one way or the other. So many people say we will know when it's time but I don't see that now. I honestly don't know what she wants. But at least I will know that I did what I could after she sees the doctor.
Sorry you've had to deal with Cushing's multiple times. My father in law had a Cushing's dog that he was able to keep going for a good 2 years with medication. We never know what they're going to throw our way.

 

Thanks for the advice. From what I understand from the dermatologist, they can't really staple or suture Gem because whatever they do will just tear through that skin. It's so sad. And like I said, with the shirt there's concern that the rubbing will just make it worse. Honestly, I don't know how I'm going to bring her in the carrier tomorrow without getting it all dirty. Ugh, dreading that. But hopefully the doctor can help clean it and maybe have some creative ideas to protect it further.

I don't know what DMG is but I will investigate.

 

Thank you Lisa…for better or worse, Gem does not groom herself at all. So at least I don't have to worry about that, and she doesn't need a cone. I guess the shirt is almost more for our benefit as it's so upsetting to look at. And I worry about keeping it clean. Did you use any type of solution and/or cream on Cole?

 

That's good for her skin. Other than getting an anti biotic shot when the tears were large, I would clean with something called Boo Boo gel. It's a natural product I got at a pet store to help heal hot spots on dogs. What's liked about it was the that it was a gel and the packaging was a pump so I could easily pump the gel onto the wound without touching his skin and let it absorb naturally. Usually the tears would heal on their own in about 1-2 weeks. The shirts never seemed to cause more damage, I had super soft tee shirt fabric that stayed on around the neck and thought front paws. The best one was a soft fleece that covered him.

I was lucky that the vet I saw never recommended stitches or staples and the hospital Cole went to repeatedly was able to handle him ok. It sounds to me that Gem's skin may be more delicate than Cole' s. This is the hardest part about this disease and the hardest to get a handle on.

Even on the Trilostane Cole still got the skin tears and for us the shirts were an easy fix. Cole never gave up and despite the difficulties he went through he had one of the strongest fighting spirits I have ever known. You may know when it's time because there is nothing more that can be done. Cole's body told me it was time, but his attitude told me he wanted to stay. I made the difficult decision because he could no longer hold any food down due to the cancer but he still wanted to be here. I understood that I could help him go peaceful or go naturally and I choose to help him rather than see him suffer.

I am not advising that you do anything. Plus you guys may not be there yet. I am offering my experience that it may help you when weighing all the aspects to one of the most difficult decisions we face.

I hope your appointment tomorrow is helpful and the specialist gives you some workable solutions.

 

Thank you for your kind words Lisa. Gem is such a positive kitty. All the doctors that have examined her have remarked on how strong she's been, never complaining through all the pokes and prods, and as soon as it's over, purring and looking for love. You hit it right on the head, her body says she's done, but her attitude is not. But I guess part of having pets is having to make these hard decisions for the,. I would rather let her go peacefully than in an emergency situation.

I will certainly post tomorrow and let everyone know what Dr Peterson has to say, for better or worse.

 

Please see the link in my signature for secondary monitoring tools. These incorporate the one's from U of Queensland, Dr Rand.

I think if you make yourself a table of the things you want to monitor and check them daily, or twice daily, that will help with non-invasive monitoring. While not perfect, it is something.

 

Thanks, I have looked those over. The heavy drinking and urinating remain pretty constant, leading me to believe that her BG is still high, or at least unergulated, which is to be expected with everything else she's dealing with. I try and test her urine whenever I find a sample (on the floor somewhere ) and it is always negative for ketones and high for glucose. I spoke to the regular vet this morning who feels she should continue on her dose of 3u, twice daily. At this point, I will shoot her tonight and tomorrow morning, while monitoring the other signs, and then see what the doctor says. Honestly, I am mentally preparing myself and my kids for the worst, but we'll see.

 

Good luck today with Dr. Peterson. It's wonderful that you will have his tremendous experience on your side.
Fingers crossed for Gem's visit.

 

Karen and Gem,

I am wishing you all the best at your appointment with Dr. Peterson today.

Linda

 

Thanks to both of you for your good wishes. If it's OK, I will start a new thread with an update after I get back from the doctor.

 

That would be perfect! Hope all is well,
Carl