2. Java, elder cat

How much longer until test time?

 

10 minutes now.
Edit, he ate some FF right before I picked up the dishes.

 

You can fudge the time a little bit with Prozinc. When Sam gets really insistent about the food, I'll test him and feed him, and then just hold the shot up to 15-20 minutes longer. That way his shot ends up at about the same time, but he gets a little relief from the hunger. I've heard as long as the shot is within 30 minutes of the test it's okay. Hopefully someone else can confirm if that's right though.

 

Oh, and if you want Rachel, you can type the @ sign in front of her name to get her attention. Although it doesn't look like she's on right now. Just in case... @Rachel

 

He was glad to have both YA and FF and I went outside with him so he could drink some rainwater, which apparently is far superior to filtered tap water.

His BG has been crazy high all day. I get really nervous anytime I increase it, so I'm going to look at his SS again, but I'm thinking 1.75 is probably good for tonight.

I'll report back on what the vet says about the NaCl versus ringers fluids. I'm wondering if 1.75 with NaCl fluid is too much.

 

It's your call on the 1.75 u, Lois. It was suggestion only.

 

Hooray! Kris is here!

I love that Java gets to go outside and drink rain water. I wonder if my kitties would like that better? You take such good care of Java!

 

Not for long I'm afraid! It's my bed time. Just doing my before bed check in.

 

But mooooooom!
You know how nervous I get. But it has been crazy high. Here's the thing though, I have just been so tired.... I don't want to have to wake up and test him during the night.
On the other hand, Kris, your suggestions are so good.
argh.

 

I really don't like setting an alarm for overnight tests either. My sleep is poor as it is and that interruption can really do a number on me.

 

Yong was talking about fat and skinny doses, so I think what I'll do is go with a fat 1.5.
I'll talk to the vet tomorrow about what's going re fluids.
Java's been an indoor outdoor cat most of his life. Greater controls were implemented immediately when coyotes expanded into the area. It makes him happy to go outside and drink outside water.
I wonder if any of the outside water could affect his BG. Sometimes he ignores the bowls of clean water. Tonight he was drinking from a watering can full of rainwater with some oak leaves and oak pollen in it.
Id better get some insulin in him.

 

Me neither on those nighttime tests. Before I go to sleep I give Sam a couple of treats, a kiss goodnight, and tell him to wake me up if he goes hypo.

 

Does he?

 

Java is a (probably) once in a lifetime special cat. It isn't just me, everyone who meets him sees it. He's my 6th cat, Lily's my seventh, and I've loved them all, but this guy just has a combination of confidence, curiosity, intelligence, skill, good sense, and affection that's rare and delightful. Boy am I going to miss him; he's such a good companion. And he's so resilient! Look at those #s and his age! If there's such a thing as reincarnation, he's moving up.

 

I don't know. Both times he went hypo I was already awake.

I love this! Ive never seen a 20-year-old kitty before. I think that's testimony to how special he is, and to how well he's been loved.

 

Whoops hey Lois! I was fast asleep last night...2 nights ago, Oreo decided to sing the song of his people...for an hour...at midnight...only stopped when I got up and scolded him. So I was asleep early last night!

I live in Alabama...lord it's hot here! I was a military brat, so I grew up all over and this is about my least favorite place...so naturally I ended up here!

 

You could come live here in Ottawa, Canada, Rachel. It can be 90+F in the summer with humidity and -20+ F in the winter! I think we're the second coldest capital city in the world after Moscow.

 

I used to live in South Dakota and Germany, Kris, so I'm no stranger to cold weather! That's my problem here in the winter...it's . never really that cold but I dress like it is...and then boil!

 

My brother went through basic training in Alabama, Vietnam. We visited him once, I was still in middle school. I just remember being scared all the time because of the South's reaction to civil rights, To Kill A Mockingbird, etc. PA is more like Ottawa. I keep nagging my high school peeps who stayed there to have high school reunions sometime other than muggy overcast hot hot Augusts. I do miss the green though. It's what I love about this time of year here. Droughts aside, it's natural to have zero rain from May to November -- it's a textbook Mediterranean climate. In SF area, we're lucky to have regular summer fog that acts as natural air conditioning. It's a function of the underwater dropoff in the Pacific, the seasons of the ocean currents, and upwelling.

 

Java's at 538. Vet isn't open until 8. To ask about the NaCl fluid vs. Ringers.

 

Still pondering this. I had concluded that his hypo or near hypos were in large part because I didn't take him enough food, follow him and urge him to eat more. If I don't do that, his #s do drop, but he really won't get enough food, I think. He's so thin now.
I'm waiting on dose to talk to vet, wonder if I should continue on that line. I am giving him NaCl this morning. It does seem to affect dose.

 

On 18 March, Maury's lime greens were also influenced him not eating his "lunch" that day.

 

Vet and i keep missing each other in phone calls. Meanwhile, finally gave him 125 ml NaCl fluid.
Edit, test strips for AT2 that I ordered in plenty of time? Hung up for days in Burlingame, wrong zip code. I won't get them until this Sat., when should've arrived last Sat. Grr. Prob have to switch to HS meter tomorrow.

 

Telephone tag!

 

Does Maury actually have cardiomyopathy? I mean I guess he does or you wouldn't put it down. Java has had a 2, 4 heart murmur his whole life. Echo tests etcetera when he was younger. He's been one of the lucky ones where it's never turned into anything.

 

Both vets detected the heart murmur but I can't afford to get him to a cardiologist for an ultrasound to find out what type . I'm just pretty sure he was not born with it. I check his Respiratory rate, he's slightly higher. Plan to start checking his heart rate too.

 

I'm guessing this is a classic bounce from the blue last night?
AT2-680,. HS-634.
1.75 this am.
Never did connect with vet yesterday, try again today.

 

I think so, that was a pretty good drop from his PMPS

 

So the vet said that the lactated part of lactated ringers = lactose. Java seems to be as sensitive to carbs and sugars as he is to insulin.

 

Ahh well they are both types of sugars; carbs and lactose. So can the NaCl do just as good as Ringers? Hopefully, with less effects on his BG

 

I didn't know that about Ringer's.

 

Me either. Of course I could have Googled it and I didn't until just now. It's sodium lactate.
https://en.m.wikipedia.org/wiki/Ringer's_solution

This entry says it's dextrose.
http://pets.thenest.com/sodium-chloride-vs-lactated-ringers-cats-10987.html

I have to go to help someone out with a ride, but I just found this at Tanyas kidney Cat website. To read later.
http://www.felinecrf.org/subcutaneous_fluids_tips.htm

 

If it's lactate that's not lactose, rather it's salt of lactic acid. Dextrose is definitely a sugar, an alternate form of glucose.

 

Kris, I remember reading somewhere that you said you used to be a teacher....were you a science teacher, by any chance?

 

This doesn't sound good.


Saline Solution (Sodium Chloride or NaCl) 0.9%

Saline solution (sometimes referred to in human medicine as "normal saline") may be suggested by some vets, but it tends not to be the best choice for a CKD cat because:

• it is usually too acidic
  
  
• it lacks the buffer contained in lactated ringers
  
  
• it does not have added potassium, which many CKD cats need.
  
  
• the higher sodium load is additional work for already damaged kidneys to process
  
  
• it is not usually suitable for cats with hypertension or liver problems.
  
  
• it can sting when injected subcutaneously which may make the cat resist sub-Qs
  

However, it is sometimes appropriate for:

• cats with high calcium levels (though Normosol-R may be a better choice); or
  
  
• cats with hyperkalaemia (high levels of potassium), who may initially be placed on intravenous sodium chloride in hospital
  

Fluid Sodium Chloride pH Buffer
Sodium Chloride 0.9% 154 154 4.5 - 7.0
None


One possible compromise would be to use half strength (0.45%) sodium chloride fluids. ISFM consensus guidelines on the diagnosis and management of feline chronic kidney disease(2016) Sparkes AH, Caney S, Chalhoub S, Elliott J, Finch N, Gajanayake I, Langston C, Lefebvre H, White J & Quimby J Journal of Feline Medicine & Surgery 18 pp219-239 state "although a balanced electrolyte solution such as lactated Ringer's solution is often used, a hypotonic solution (half-strength lactated Ringer's or 0.45% saline, with added potassium as needed) may be preferable to reduce the sodium load."

 

If I recall correctly, Kris was a high school physics and chemistry teacher.

 

Makes sense! I always know Kris will have a good, scientific explanation for things...and she is great at explaining in a way even a plain Jane English major like me can understand!

 

Yes, physics and chemistry as a matter of fact!

 

It's lactate. Duh Lois. The ingredients are on the bag.
Each 100 milliliters contains sodium chloride 600 milligrams; sodium lactate, ANYHD 310 mg.; Potassium chloride 30 mg; calcium chloride, dihydrate 20 mg in water four injection may contain HCL or NaOH for pH adjustment.
Electrolytes per 1000 ml, not including pH adjustment: sodium 130 meq; potassium 4 mEq; calcium 3 meq; chloride 109 meq; Lactate 28 meq.

 

I'm sorry I'm just getting here to give you a lab report review. My kitten had two surgeries on Monday and I've been focused on her all week.

I'm glad you found the discussion on Tanya's on subcutaneous fluids. My preferred fluid is lactated ringers and, no it does not have lactose in it. It is a sodium salt from lactic acid. There may be reasons to use a different type of,fluid like Normosol but the latter does sting.

You obviously are already starting to treat the CKD. Just a few things I see on his labs:

Potassium is at 3.9 and ideally should be at 4.0 or a bit higher. If the serum level is 3.9, then the cellular level is less than that and the cellular level is where it is needed. You might want to discuss with your vet potassium supplementation with potassium gluconate. Keep in mind that giving a potassium supplement needs to be under the supervision of a vet and it does have to be monitored as you can go too much in the other direction which is just as bad.

His phosphorus is also higher than it should be. I've found that the number one predictor of how a cat does with CKD is the P level. The more you can get it down towards 4.5 using low P foods, the better. Binders se not usually started u til the P gets to 6.

His hematocrit is creeping towards 30. I don't think it is too early to start vitamin B12 supplementation to help co troll the anemia. The more you can keep it in the high 20s, the better. Usually cats are given 250 mg of methylcobalamin twice a day as well as a multi B vitamin like Jarrows B Right. If you use the latter, the dose is 1/10 a capsule a day but divided into two doses. I bought the #4 gel caps and would put the 250 mg of methylB 12 and the small amount of the multi B into one capsule and then gave one of my homemade capsules twice a day.

I'm not too worried about his other values that are in the high category although the Precision PSL is out of the normal range. This test is not as good as the specfPL for determining pancreatitis. Please let me know if you have any questions.

 

Marje, thank you so very much. I hope your kitten is doing well after surgery?

It's late, and this might be unanswerable without more patient info, history, yet my immediate query is - should I give him fluids tomorrow, and if yes, Ringers or NaCl? I have both.

Can do Longer history tomorrow, more immediate history is Java wasn't seeming to feel well a week ago, took him to vet, he was dehydrated despite 125 Ringers day before. Vet gave NaCl and Vit B shot. Java did much better after, including insulin worked. After Ringers, it is as if he'd had no insulin, high #s for 12 hrs.

Talk to vet and relayed improvement. He suggested Java get Fluids daily, Ringers one day, NaCl the next. [It could have been the Vit B] Tried it, same thing again with Ringers, as if no insulin. Back to vet today to talk, he said Ringers had sugar, just give NaCl daily.

I decided to wait, no subq today/ Fri. He had NaCl at 4 pm Thurs/2 days ago.

He's getting Zobaline daily. I have Jarrow's, tried, bitter in food, didn't want any reason for Java to not eat his FF classic. He's getting so skinny.

He's 20 yrs, 4 months mine; prob 20 yrs 8 month old.

 

@Marje and Gracie
Hi Marje,
I hope your little girl is recovering well from her surgeries. So worrying for kitty parents ...

 

Hey Marje! I hope your baby is doing well...those surgeries can be very scary, but I know she's getting the best care possible with you. Thank you again and again for your wisdom and expertise. You've always been a blessing to this board!

 

@Kris & Teasel
(Ah! That's how that works!)
He's at 324 this morning, surprise because he had so much FF last night. He must've not eaten at all during night.
1.75 seems like a lot. It's similar to a week ago (3/26) when I was heading out to event in Sonoma and he dipped down to 70s around +4, +5. Back off to 1.5? He had 1.5 then, go to 1.25?

Edit, going with flat 1.5, will test, watch, here today.
Found a diff food chart (diff from LP, DVM) at FD FB page. Says FF classics changed, ones I feed Java are too high carb now. Will update, query to main board. After I go outside with him.

 

Hope your kitten is recovering well, @Marje and Gracie

 

Thank you all. Livvie is doing quite well from her spay and a rhinoplasty to open her tiny nostrils. It's a blessing that she can breathe like a normal kitty now!

Lois: I really don't think the LRS is causing the issue with his numbers. I've given LRS to my Gracie and many other members have also given it to their cats and what we typically see is that the BG tends to drop with any subq fluids and, in some cats, it is quite dramatic. It might seem like the LRS is raising his BG but I think he's bouncing so it looks like LRS might be the culprit (see analysis below). There is no lactose in LRS. There is a difference between sodium lactate, lactic acid, and lactose.

One of the reasons I like LRS for CKD kitties is it has potassium in it. I also like it because the lactate is converted to bicarbonate which may help to prevent and can address mild metabolic acidosis (common in CKD cats).

NaCl is really not a good choice for cats with CKD. It has no potassium, it is too acidic, it isn't buffered like LRS, it can sting, it has sodium which is not something that CKD cats need since they are prone to high blood pressure. I feel that perhaps your vet does not know how to treat CKD.

When I look at his SS, I am not seeing any effect on his BG that I would attribute to LRS:
3/15 LRS given, BG came down
3/23 BG already high, LRS given, BG came down
3/29 LRS given, BG increased but it increased from bouncing
3/30 NaCl given, BG increased again due to bouncing

Vitamin B12 injections as usually given to help support the intestines and it will not increase the BG. The Jarrows is bitter and that's why it needs to go into a gel cap. I've never given any B vitamins orally that weren't in a gel cap because I don't like tomrosk my cats not eating.

You've done an amazing job taking care of him for him to make it to 20+ years! Please let me know how I can help.

 

A purposeful nose job!

 

Yes...exactly! She's a Scottish Fold and born with a very flat face and tiny nose (actually, she's pretty tiny). We've been waiting until she grew to do both surgeries and they were both a great success.

 

Thank you very much @Marje and Gracie, for all the information and benefit of your expertise. I really appreciate it.

I take good care of him, except when I don't. Ran off to my class today without testing him first, shouldn't have done any errands after. He had food, but didn't eat it. Low to acceptable in 20 minutes luckily.

 

We have to live our lives too, Lois. Considering his numbers lately, I would have NEVER expected to see that low of a number, so I would have felt comfortable running errands too. Bright side? Those are good, healing numbers mid cycle today!

 

My goodness! Look at that lime green!

 

Thanks for saying that. I feel pretty bad about it. I suspected he'd go low.

I'm glad the meter can talk to me. Anytime he seems off, or I'm worried, I like that I can do a quick blood test and have info ASAP. He seemed fine when I got home, then I found out he was 44. I grabbed, tested the minute I walked in. I thought he might be off yesterday, then his bg was good, so I could eliminate speculation on that. I still wish he could talk though!

 

Your welcome!

 

I know. It's awful.

 

It seems to me that ringers rather than the insulin brought Java to a 326 pmps. I'm thinking either one or a fat one. Anyone?

 

Hey Lois, I'm not usually up right now but Maury gave me an exciting green early in his PM cycle. I think fat 1 will be OK. Are you going to monitor as usual?

 

Yes, up for +2, and +3.5or 4 before bed. I've been setting an alarm for 2-3 am lately. Then another for 5:30 am food pickup.

That's a good green, yes? How do you put a note behind the cell?

 

Thanks, Yong.

 

Sorry Lois, having to start steering Maury. Just right-click the cell you want and scroll down to "Insert Note". I'm a little OCD so I like the row heights to stay the same

 

Lily has had a couple of sneezes over the weekend. Now Java is sneezing every now and then. Trees and flowers are in bloom (see photo, taken 4/2), and cars are drenched with yellow oak pollen. Hoping it's just pollen irritation, not an upper respiratory infection. I actually don't know what you do for a feline upper respiratory infection. Google time.
Sounds like it could be pollen. Something to watch.
http://www.m.webmd.com/a-to-z-guides/why-cats-sneeze

 

When I try to look at Chuck or Teasel's SSs, I can only see part of a page, then everything locks up, and I have to cancel out of FDMB and Chrome entirely, then come back. But I don't have that issue with other SSs like Maury or Sam's. Don't know why. Ideas?

 

Please excuse me, I'm up anyway. I wonder if anyone more expert would have time to take a look. Java's SS isn't that bad on the nightime side, it's more magenta and yellow with some blues and the occasional green. But the datetime side has lots of black and red. I wonder why they are so different?
Why is the day worse? Is it that the day time is showing bouncy high #s from the lower numbers overnight?? Or that I'm in and out during day, not always checking him and getting him to eat?

If he's on the low side for him tomorrow am, around 300, should I go less than a fat 1?

 

For allergies, some find 1/4 a 10mg Zyrtec helps. Not sure about using with CKD cat.

I am having trouble seeing some SS's too. Not sure why...

 

You do get pretty good numbers during the day, too, Lois. I know there's still red and black, but you get blues and greens sometimes too.

You might see more pink at night and red during the day due to activity levels or something like that...is your feeding schedule the same at night? Any significant changes to routine at night?

 

Overall his numbers are quite good, Lois, given his senior issues, etc. He's probably doing daytime bouncing from going lower at night - some of the time. Saturday was the exception.

I can't help you with the SS freezing - not very techie. Love your new avatar photo. Very pretty!

 

Wishful thinking, that it's be low this am. Darn it. 541. So, 1.75 I think. And gronk for staying up until 3 am.
Diffs between am and pm....When brain has more sleep. Food for cat now.

 

Maury has seasonal allergies, more so with Spring than Fall, only since we moved to where I am now. I try to give him 1/4 tablet Benadryl but he really doesn't like the taste. Think it's a 25mg pill. Sometimes I don't get the chaser fast enough and he ends up looking like a rabid kitty with pink foam at the mouth

 

Yong, photos!

 

Gonna try for more sleep, class not till 10:30 today.

Lily's a nervous, anxious cat. She's started chewing, eating the fur on her belly and hind legs, and now yakking up huge hair tubes on the furniture, which, naturally, has cat towels on it, hooray. (I now think people's furniture without slipcovers and cat towels looks funny). It may be time for the vet. I feel like I need a better vet, however much I like Dave. More sleep first. anyone have a cat on, say, prozac?

 

My mom's cat has been on prozac a long time because he's a fur puller. It helps quite a bit.

 

Lois, there was a thread about kitties with anxiety: http://www.felinediabetes.com/FDMB/threads/anyone-have-cat-with-anxiety-on-prozac-or-any-med.175457/

I haven't given him any since last year because I feel bad when tastes the pill. He gets scared, backs away from his mouth, and the resulting foam is him trying to spit it all out. I get tied up trying to keep him still and wipe his mouth so he doesn't shake the pink foam all over the room

 

Thank you!

Edit to save room, I've started to read about Lantus, and there's information over there about diabetes in general that isn't in the FAQ, etc, that I haven't found in other places. Interesting stuff. And I found someone really good descriptions about bouncing written I think by steph? In another thread, for someone who was a teacher. Repetition is how you learn, how I learn, I think I'm finally getting it on this bouncing business and reading spreadsheet business. Now I understand why Kris kept saying just keep going, you need more data.

 

Most likely what Kris wrote. Although I think Djamila wrote something in detail recently too.

 

I have amitriptyline for Elektra's cystitis. She's only taken it a few times as she absolutely refuses it usually...and one time I got it in her via pill pocket, but she bit it in half, found the pill, then threw up. Sigh.

But it makes her awfully sleepy when she does get it in her.

 

Java normally turns into a cougar when I try to get a pill into him. He's been accepting the Zobaline in a pill pocket, which is awesome. I used a piller on him once, and it wasn't too bad. The honest truth is, he's lost so much weight and is so debilitated from that, it's easier to overpower him on the subject of pills.
I'm so grateful and lucky that he is and has been so relaxed and calm for every ear stick and every injection, including Sub-Q fluids, which is typical. It's only pills that he fights. I'm going to have to figure out the gel caps for Jarrow's B Right.

 

I wish I could give him Max cat kibble soaked in butter. Losing so much weight.

The biggest difference between day and night is that he's on the bed at night, and I go in every 30 minutes and put food under his nose, and he'll eat a little bit.

Yet, he's so happy to go outside during the day and sleep on the deck or in one of his favorite places.

I can't tell if he's good for a longer haul, or if we're close to the end. I'm so envious of people whose SS is just blue and yellow.

 

I fed him 45 mins before normal test time, not registering the 2 hr no-food zone.
He's running high, was 504 at +8, that was 3 hrs ago. He's looking for food.
I'd be testing, then feeding in 15 mins. Go ahead?

 

Bouncing today, Lois. The fat 1 u got him down last night but you increased this AM because of a bounce inflated PS. Maybe drop to 1.5 u or 1.25 u in case he has the same plan for tonight?

 

Is he bouncing from the low last night, or from the low Sat. morning? I did Fat 1u because he went low with Feb am magenta ps and I thought it was safer.
I hadn't thought about his dose now yet, I was just wondering about testing and feeding him. I feel confused and worried and like my brain doesn't work. If I go with 1.25 or 1.5 tonight, oh no, super low numbers in the middle of the night again?
I'm going to test him now.

 

717.
Oh dear.

 

All you can do is make a decision and hope for the best. You know how to handle the surprises.

 

You could retest to see if it's a wonky number.

 

Please help me understand the rationale for 1.5 or 1.25. I feel so stupid right now, I can't think.

 

Me too, Lois

 

A slightly higher dose tonight will help level things out tomorrow morning?
Edits. 717 left ear. 649 right ear.
Got it, I'd normally be doing 1.75, and what you are saying is that either 1.25 or 1.5 gives a greater margin of safety in case he goes low again tonight.
Honestly I'm not joking I just could not think for a minute there. If a vet saw this cat right now, he'd say it's time put him to sleep.

 

I was suggesting a lower dose than you gave this AM in case he decides to drop more overnight. Bounces are crazy making but it's best to avoid choosing a dose based on a bounce number. Look for the lowest that a dose gave you to see what it can do and base your decision more on that. If he stays high and flat cycle after cycle then you can boost the dose.

 

Go with a fat 1 u like last night if you wish.

 

Okay. I'm really embarrassed that I didn't think about a dose for him at this time.
Edit, I assume I'm looking for 1.25 and 1.5 linked with a black PS.
It looks like historically 1.5 has been okay with something high like this. I want to get insulin in him and yes I know how to deal with a high.

 

And you know how to deal with a low.

 

That's what I meant. @@

 

Kris, thank you.

 

Just some hugs for you, Lois

 

Think yoga, Lois, yoga ... corpse pose.

 

I'm just crying over here. Thank God for the kindness of strangers. Java's highs and lows are taking a big toll on him, Lily's chewing her fur off and gaining weight eating food that Java isn't eating, and I'm losing my mind.

 

Oh no, Lois! We all have these episodes of thinking it's all too much. Treating FD is really hard and Lily's fur pulling isn't helping. It's a lot to deal with. We can only do our best and hope that we get a decent result at least some of the time.

 

Oh Lois, I'm crying with you now. Sending you all kinds of love tonight. You're such a wonderful kitty mommy! I hope you are able to get some rest tonight and know that you and your kitties are loved by all of us here!

 

Thanks you guys.
I'm walking down the hill to grocery to get some more gravy food, fresh air will be good for me.
Java ate a little more FF, he'll eat more every ~ 30 minutes until I go to bed.

 

He's gone down about 300 pts in 2 hrs. and is a different cat. I carried him to the table to test him, but then he sat and enjoyed looking outside for awhile. (A yellow cat named Scotty lives across the street and comes out at night to watch my house. From my window, Lily and he sit and watch each other. Java's been keeping his eye on him for years also. I adore Scotty and it's mutual, sometimes I go out to see him.)
He could barely keep his head up at 700.

 

Glad he's feeling a little better

 

Lois, I prescribe a good glass of wine for you! You've given so much to Lily and Java, and sometimes it just is too much. You need a relaxing evening with a good meal, some wine, and then a good night's sleep soon to help you reset.