01/23/2021 Casper AMPS HI, 0.75U, +3 HI

Discussion in 'Lantus / Basaglar (glargine) and Levemir (detemir)' started by Yuling & Casper, Jan 23, 2021.

  1. Yuling & Casper

    Yuling & Casper Member

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    Dec 25, 2020
    Good morning,

    A new day for Casper. His AMPS reading is HI again (above 700), 0.75U is given as scheduled.
    Previous thread
    Thanks!
     
    thebigfuzz likes this.
  2. tiffmaxee

    tiffmaxee Well-Known Member

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    Nov 15, 2013
    He sure is a bouncy boy! I hope the new vet figures out what his other issues are as perhaps that’s part of the problem. I hope this new vet is a good one. :bighug:
     
  3. Yuling & Casper

    Yuling & Casper Member

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    Morning! His +3 again reads HI. This is start being more consistent rather than occasional cases. I am not sure if his condition actually worsen that may require 1U? But why such a big change in less than a week?
    I also asked the welcome section group last night and see if there is any cases like his condition or is this normal. So far no reply. We hope we can get a better understanding this morning with the new vet.
     
  4. tiffmaxee

    tiffmaxee Well-Known Member

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    Sometimes they get a big reaction to insulin and then that ends and we need to keep increasing. The skips and all the dose changes when low are causing wonky numbers. We can’t increase sooner than 6 cycles but the next one will likely be a .50 increase if you will follow TR. You need to decide on a dosing method because with SLGS you hold 7 days. I would strongly advise TR.

    Look at Henry. He had to be fast tracked.

    https://felinediabetes.com/FDMB/thr...ps-96-2-97-3-5-80-5-5-85.241825/#post-2724460

    Look at his 2020 ss first.
     
  5. tiffmaxee

    tiffmaxee Well-Known Member

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    I think you need to get a complete picture of the cause of the anemia and what’s up with the kidneys first. Then we can deal better with fd.
     
  6. Yuling & Casper

    Yuling & Casper Member

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    Agree.
    You also mentioned the infection or other conditions may cause the high BG as well. That's why we wanted the new vet. Does he has DKA or not (ketones test still showing negative), what type of anemia he has and whether or not he is suffering from renal disease or kidney disease. These are all the question marks we have so far, different vets gave us different answers, or the same vet gave us different stories every time we questioned.

    Do you mean 0.25U increase or 0.5U? And I would like to stick to TR, I believe this is what we've been doing.
     
  7. tiffmaxee

    tiffmaxee Well-Known Member

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    Great. Add TR to your signature and your ss. Once you find out if there’s an infection or something needing treatment we can better understand Casper. With TR if nadirs are 300 we increase by .50. Let’s see what 6 cycles does on .75 and what the vet has to say. I would bring hard copies of all your labs. Maybe print out the spreadsheet too. Good luck. You have been through so much and deserve the best.
     
  8. Yuling & Casper

    Yuling & Casper Member

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    I printed out all the lab works, but not our ss though. I can always email them a copy or run back if they needed.
    We are waiting in the parking lot.
     
  9. tiffmaxee

    tiffmaxee Well-Known Member

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  10. Yuling & Casper

    Yuling & Casper Member

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    Update:

    The vet did the blood test, urine test, and other parameter tests to find out his current status, the results are not looking good at all. His condition is worsen than 2 days ago. We are dealing with stage 4 kidney failure, non-regenerative anemia, high blood sugar diabetes.
    The vet was quite honest with us, Casper's situation does not look well at all. Especially he could see we did try so many times and previous treatments don't seem to help him to recover. They tried to put an IV caster in, but not successful. They could see all his four legs are pocked and bruised from the previous hospitalization and his vein condition is quite poor. He said he doesn't want to paint a dark picture, but we may just wasting our time.

    We asked him to give Casper a chance to treat him the best as he can, so his plan is to put him on the short-acting insulin to bring his BG down under control, along with the medications and fluid. The hard part is, once the fluid is in, Casper will need another blood transfusion which their facility cannot handle...
     
  11. Yuling & Casper

    Yuling & Casper Member

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    @tiffmaxee Do you think I should order the Aranesp for Casper? This may help with his anemia situation.
     
  12. tiffmaxee

    tiffmaxee Well-Known Member

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    I’m so sorry. Hoping for the best. Keep us posted. :bighug:
     
  13. tiffmaxee

    tiffmaxee Well-Known Member

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    What is his HTC? It dies help with nonregenerative anemia. It takes a little longer to kick in than epogen but if he’s around 20% you could start it. If lower he would need another transfusion while waiting for it to take effect. Epogen works faster so you could start with it and then switch. I suggest you join the feline CRF group at groupsio. Nit Tanyas but the other one. It’s smaller and I know tge moderators. Mention I referred you from here.
     
  14. Yuling & Casper

    Yuling & Casper Member

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    Applied the CRF group, pending approval.
    We just dropped of Casper's food at the vet and the receptionist told us the doctor will call us later. We just learned that the vet hospital is closed down tomorrow, but they have a dedicated staff to monitor Casper 24/7. We asked them to treat the cat, not the numbers, although it's like a big slap into my face as I am a firm believer in data. Casper is in better shape than he was at the beginning of the month when we rushed him to ACCESS, so we are praying he can pull the miracle again.
    I was in CRF group, started reading on CKD, especially on the stage 4 kidney failure, I couldn't stop crying from that point. I felt so bad that I entrusted my precious baby with those unworthy vets, the ACCESS had brought us time and chances to help him recover, but I just put him right back to the stupid professionals who have no idea what they are dealing with. Now his condition is getting worse and I can't do anything to help him.
     
  15. tiffmaxee

    tiffmaxee Well-Known Member

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    You are doing all you can. I’ve been in your shoes with a cancer kitty. The oncologist missed a UTI. She destroyed her kidneys. She came home from a week in the ER with lots of meds and fluids and despite the oncologist she had 9 months more with mostly quality time and I lost her to worsening lymphoma and not CKD. She was on epogen and never developed antibodies to it. I hope Casper pulls through.
     
  16. Yuling & Casper

    Yuling & Casper Member

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    I am so sorry for your loss. I am pretty sure she was quite a fortunate baby to have such an amazing and caring parent like you.

    We keep praying for Casper, we know his physical condition is much better than he was 20 days ago, despite the data looks crapy. We believe it's the toxins released by the high BG that impaired kidney functions. Once his BG is under control and the toxins are flushed out of his bloodstream, his kidney function should be improving. We just need a plan for his anemia. I talked to the vet about giving Casper epogen or aranesp, he said he never heard of them, never used them on his patients. He took down the names and he wanted to do some research on them. If he doesn't feel safe to use on Casper, he wouldn't approve it but he will leave that to my decision.
    Other than that, they gave him short-acting insulin (vetsulin I believe), brought his BG down to 400s, Casper is resting in his condo, just had some water and they are going to syringe feed him shortly.

    Now after going through FCKD forum, it surprised me all the vets here never sent Casper home with any fluid or medicine, except ACCESS in Woodland Hills. I was questioning that every time when he was discharged, but never thought it could play such a critical factor in the recovery and maintaining processes. The 24/7 ER here even took our medicine that ACCESS prescribed and kept them all, told us that Casper used them, there is nothing left for him to go home.
    So, this time we are going to ask the vet to send him home with fluid and medicines to help him. I don't believe to put a family member to sleep just because their data are bad.

    and most importantly I wanted to say: THANK YOU!!!!!!!!!!!!!!:bighug::bighug::bighug:
     
  17. tiffmaxee

    tiffmaxee Well-Known Member

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    I used epogen for the first time probably 19 years ago. That a vet has never used it blows my mind. If, scratch that, when you get it you will not be able to rely on their dosing. Erika on tge iOS forum cane plain all of that. The HCT needs to come up slowly and not go too high. I remember asking you about fluids and you were told they were not necessary. That’s ridiculous. I’m not a vet but I know it’s not true. I’ve learned from the school of hard knocks.
     
  18. Yuling & Casper

    Yuling & Casper Member

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    Yup! I took pictures of everything we dropped off with Casper at the local ER. A bag of IV fluid, IV supplies, Renal plus, Cerenia, aluminum hydroxide binder, and mirtazapine appetite stimulation. He was in that ER for only 3 nights, there is no way for him to consume all the meds. But we did not want to argue with them, we thought Casper was doing great and stable and we took their words for it, "he doesn't need those, all he needs is rest". And I *f believed it! Shame on me!

    The new vet agreed to use egpogen on him, we just got off the phone with him. He said Casper's BG dropped down to 73 now, but conditions are still not showing any improvement. He is willing to work with us, however, if Casper is still not improving his condition by Monday, he needs us to make a decision:
    Option 1: keep him there to keep receive treatments what they are doing, there is nothing more they can do
    Option 2: take him home
    Option 3: which is not really an option-put him to sleep.

    I just sent in Casper's latest lab reports to the CKD group, I guess I will have to learn how to treat Casper at home myself with the help of the groups and the medicines I could get from the vets.
     
  19. Butters & Lyla

    Butters & Lyla Well-Known Member

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    I just read your condo and I’m so sorry Casper isn’t doing well. Sending so many vines and prayers that the treatments help him improve.:bighug::bighug:
     
  20. Yuling & Casper

    Yuling & Casper Member

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    Thank you Lyla! We are not giving up on him, despite the vet doesn't have so much confidence in his patient. I hope we can get him better at the hospital, if not, we just need to learn how to treat him at home with the vet's medicine support.
     
  21. Butters & Lyla

    Butters & Lyla Well-Known Member

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    I'm so so happy you are not giving up on him. The vet doesn't know his patient nearly as well as you do. :bighug:

    I wouldn't give up on him either and I'm also hoping you can get him better at the hospital or at home otherwise. I empathize very much with what you're going through. A hospital sent Butters home in the midst of an acute pancreatitis attack and I had to treat her at home without having any knowledge or experience. Elise also helped me figure that out. If the CKD group is anything like the pancreatitis group Elise recommended I join, it will be a wealth of knowledgeable and supportive people who will help you with Casper.
     
  22. Yuling & Casper

    Yuling & Casper Member

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    Good Lord! How could these professionals ever do *s like that?!!!!! I am really angry and sad at the same time, it's really hard to find professionals nowadays that are willing to run their business with dignity, honesty, and old-fashion hard-working American values.
    On the other side, I don't think I could ever express my gratitude in plain words. Whenever I was pounded down by the vets, Elise @tiffmaxee and the groups empower me with knowledge, techniques to treat him, and the most importantly, hope. The CKD group approved my application in less than 30 mins, two members from the group have already given me great advice. At least now I know what to do and what to ask for.
     
  23. tiffmaxee

    tiffmaxee Well-Known Member

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    Great. I’m going to look now and see who responded. Maureen abs Erika are wonderful,super smart, and taught me much of what I know.
     
  24. Butters & Lyla

    Butters & Lyla Well-Known Member

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    Being armed with knowledge is so important. We should be able to rely on the professionals for such knowledge but it seems that isn't always the case.

    So glad you are getting great advice now!
     
  25. tiffmaxee

    tiffmaxee Well-Known Member

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    I think you might have joined the other kidney group as I don’t see your intro. Did you join Tanyas? It’s fine too but very busy. The ones I trust are on the other group.

    You did. Ro has been around a long time and is knowledgeable. You are getting good advice. :bighug:
     
    Last edited: Jan 23, 2021
  26. Yuling & Casper

    Yuling & Casper Member

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    Dec 25, 2020
    Yes, I thought that is the group. Please let me know which one I should join.
    Meanwhile, I ordered Epogen, talked to Petco Pharmacy, and confirmed the information. Going to get a phosphorus binder and other stuff, still learning going through the articles trying to understand what type i should get and what I should be aware of.
     
  27. thebigfuzz

    thebigfuzz Well-Known Member

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    I’m so sorry that you and Casper are going through this :bighug::bighug::bighug: Lots of hugs for you both!
     
  28. Yuling & Casper

    Yuling & Casper Member

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    Thank you!! I am sure Casper is fighting hard for himself and all of us who care about him.
     
    thebigfuzz likes this.
  29. tiffmaxee

    tiffmaxee Well-Known Member

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    For help with epogen dosing join feline-CRF-support. You will get help on both groups though.
     
  30. Yuling & Casper

    Yuling & Casper Member

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    Dec 25, 2020
    I think I got it right now.... sorry,I am just so exhausted, couldn't even focus on what I am doing. I joint the CRF group, but went ahead post in the CKD group :facepalm:
     
  31. tiffmaxee

    tiffmaxee Well-Known Member

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    It’s good to have both groups. I just want you to get help with epogen from this one.
     
  32. Yuling & Casper

    Yuling & Casper Member

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    Thanks Elise! We can streamline one process and stick to it, like how we handle his BG, that's all I am after. I really thought I posted in the group you referred to...This is how I am when lacking sleep, coffee, tea, and Casper's companionship.
     
  33. tiffmaxee

    tiffmaxee Well-Known Member

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    What was his HCT yesterday? The fluids aren’t causing the anemia. Once properly hydrated it can come down to the real level and the transfusions only last so long. I’ve never had a cat that had one but Tiffany was on epogen.
     
  34. Yuling & Casper

    Yuling & Casper Member

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    Morning Elise, his HCT was 25.3, the results timed at 1:43PM. I have his reports all linked and shared in the SS.
     
  35. tiffmaxee

    tiffmaxee Well-Known Member

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    That is not high enough to start epogen. It needs to be under 20%.
     
  36. Yuling & Casper

    Yuling & Casper Member

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    I placed the order anyway, we can have it approved, shipped, and put in the fridge whenever he needs it. This is the hardest part, get the prescription items approved by the vet.
     
  37. tiffmaxee

    tiffmaxee Well-Known Member

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    I would have done the same. You just don’t want to start too soon because like anything else it comes with some risks.
     
  38. Yuling & Casper

    Yuling & Casper Member

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    Yup, I do remember you told me before we don't use this type of med unless his HTC is below 20.
    The reason why I wanted is to be prepared when his HTC goes low at the vet, as they don't have the ability to do a blood transfusion, they will just transfer him. I truly think Casper has gone through a lot in the past 30-day. He deserves a break to be treated with real care and correct medicines as he needed.
    So far, this is the list Tanya's group has helped me with, I started working on the list and get to understand what we need since last night until I passed out... :facepalm:
     
  39. tiffmaxee

    tiffmaxee Well-Known Member

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    So I disagree with some of your list. Any potassium gluconate will do. I use powdered NOW brand. So no to Renaplus. Epakitin is not the best phosphorus binder The better one is Aluminum Hydroxide powder. I hate mirtazapine. They do make a transdermal gel that is okay. I prefer the human RX cyproheptadine. You also need B Complex. As to which antibiotic it depends on the culture and sensitivity which is best for your cat.
     
  40. Yuling & Casper

    Yuling & Casper Member

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    I can order the potassium gluconate from NOW. The Access gave us RenaPlus when they transferred Casper out, that's why I ordered that one. I know Epakitin is not a good binder, I also ordered phos-binder and aluminum hydroxide from Amazon, they just wouldn't be here that fast so I would like at least to have Epakitin as an alternative for the time being. I ordered both pill mirtazapine and transdermal gel for him. We have B complex, I ordered that for him after his dental procedure, but I don't think that one has the B9...I still researching the items in between, ordered all the items through Chewy, they are pending on vet's approval.
    The other thing I haven't placed the order yet is the fluid supplies, just stepped out for a couple of hours for grocery shopping, so I am back now to see which one is better for him. I believe the Terumo UTW is the best one? going to do some searching on that.
    And we still haven't heard from the vet, the tech today suppose to give us a call and update on Casper's status.
     
    Last edited: Jan 24, 2021
  41. tiffmaxee

    tiffmaxee Well-Known Member

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    Waiting for those calls us so hard. I would call them.
     
  42. Yuling & Casper

    Yuling & Casper Member

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    I did every other 30 mins. The vet is closed today, we paid to have one technician there 24 hours last night, today and tonight to monitor him. We were promised that the technician will give us a call this afternoon, but now it's 4:40 PM, no one called, no one answered the phone. Left the message, no one bothers to call back. NO matter what we are pulling him out tomorrow. Thought this vet will be different, just another crappy, doesn't care one, AHHA accredited or not.
     
  43. tiffmaxee

    tiffmaxee Well-Known Member

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    I’m so sorry to hear this. How do all these vets stay in business is a mystery to me.
     
    Last edited: Jan 24, 2021
  44. Yuling & Casper

    Yuling & Casper Member

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    I don't know. If any of my team members did this to any customer, 2nd time they are fired. I don't promise the customer one thing and not deliver it. Especially we are talking about a family member in a critical condition, staying at the hospital! AND I am literary *f paying for his/her salary!
     
  45. tiffmaxee

    tiffmaxee Well-Known Member

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    Any news? Is Casper home?
     
  46. Yuling & Casper

    Yuling & Casper Member

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    No update, it has been 41 hours since I got the update from Casper. This is *f ridiculous!
    I called them in the morning, I mean, I have no reason to be mad at the poor receptionist but boy! They do challenge my patience and the ability to stay civilized.
     
  47. tiffmaxee

    tiffmaxee Well-Known Member

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    I would be there pounding on the door. You are very patient. The vets have to be there.
     
  48. Yuling & Casper

    Yuling & Casper Member

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    I was there last night, the parking lot was EMPTY. I don't know what kind of 24 hours monitoring they were doing as they charged and promised. And again I was there this morning before 7, of course, I couldn't get in, just called and talked to the girl who opened the door. She answered the phone at 7, sharp. I was being told that she has no idea why no one gives us any update but she will find out and the doctor will call after 9 once he finished with his patients. I waited until 10, called again, the receptionist said the doctor is reviewing the blood work and reports, will get back to me as soon as he finished. I mean.....I am right there...I can't yell at the receptionist, she did nothing wrong. Good Lord I am so pissed right now.
     
  49. Yuling & Casper

    Yuling & Casper Member

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    Alright, just talked to the vet. He ran a test on Casper to give a BG value over the past 10 days or something, I believe it's A1C, that will reveal the true BG value for Casper. Turned out, he's fine, he is not high, he is not low, he is in range.
    He wanted to release him with anti-biotic, and Sub-Q (I insisted) this afternoon, bring him back on Wednesday 01/27 and next week for follow-ups. He does want us to do insulin or any medication on him at all but just the antibiotic.
     
  50. tiffmaxee

    tiffmaxee Well-Known Member

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    They must have run a fructosamine. It gives a two week bg average To completely stop insulin makes no sense. Did you get copies of everything?
     
  51. tiffmaxee

    tiffmaxee Well-Known Member

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    Which antibiotic?what type of infection?
     
  52. Yuling & Casper

    Yuling & Casper Member

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    Hi Elise, no, I don't have the fructosamine report yet, I requested, the receptionist needs the vet's approval before they can release it to me, the vet is on lunch break.
    I only have a copy of his latest lab result, it's in his SS as well. I don't know what type of antibiotic yet, what type of infection yet, I am requesting all the hospital notes, urine tests, and all the tests they run. I also talked to the tech who is working with the vet on Casper about giving us phosphorus binders, potassium supplement and anti-nausea medicine to be sent home. I did not ask for a B12 injection, told them I have orders placed and prescription request sent to them, please kindly approve them.
    I am going to post in the support group and ask for a new vet. This is outrageous.
     

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