3/29 Minnie PMPS 277, +2 280 - 0.5uR, +4.75 260

https://felinediabetes.com/FDMB/thr...-1-2u-r-gave-ondansetron-but-appy-off.245372/

Still being picky with food. Talked to ER dr last night, said to come back and re-check potassium levels if still off in the morning. Failed to get any meds down her. Blood ketones up on Novamax to 5.9 (was 1.3 yesterday afternoon when we got home), urine trace and beginning to smell them on her.

 

Oh no! Sending vines. Please keep us updated.

 

So sorry. Prayers and hugs.

 

Oh no, I hope it's only a pit stop and not a stay. Maybe they can show you how to pill her too.

Following on @Suzanne & Darcy question from yesterday, you probably do need to be giving ondansetron at 3 times a day, possibly 4. How much does Minnie weight and what is the dose you are giving? So many vets underdose this drug. I sadly know from experience. Getting injectible ondansetron could also be a real help.

 

Oh no. That's awful. I don't understand how her ketones go up so high so quickly. I guess not eating.... but it's such a jump. I'm so sorry. I'll be praying for little Minnie.

 

Yes. Ondansetron can be given every 6 hours (when she gets back home.)

But right now I'm upset about Minnie being back in the hospital.

 

OK, we're back. Treating as outpatient. The internist was back and gave fluids with potassium, said to come back tomorrow for more of the same. She thinks it was the crushed potassium pills (bitter) which stopped her eating. She doesn't seem worried but I still am! We're home, Minnie drank a lot of water and still seems off to me.

Ordered potassium powder and gel online, following up on ondansetron.

QUESTION/ADVICE please @Wendy&Neko would like advice regarding ondansetron (for when she's not eating) - which do you think is better (effective and price-wise)?

Vet said

• ondansetron can be compounded into a transdermal gel through Wedgewood Pharmacy (online). This way of medicating may not be as effective as doing the oral medication but may work for those days where she will not take the pill by mouth.
• Some have tried ondansetron SQ in cats. Reportedly it is effective but can sting. [question - what's typical dosing on this, unit wise??]

thanks

 

Her dose is Ondansetron (Zofran) 8 mg Tablet - Give 1/2 tablet by mouth every 12 hours as needed for nausea/vomiting. She weighed 11lb yesterday afternoon at home. 5kg at the vet last Weds 3/25.

 

Felinecrf.org has very extensive information on both Cerenia and Ondansetron (also slippery elm bark) under the section entitled Appetite Loss, Nausea, and Vomiting.

 

From the paper in here: (2016) ISFM Consensus Guidelines: Diagnosis & Management of Feline Chronic Kidney Disease page 232,
0.5-1.0 mg/kg every 6-8 hours subq. Since she's 5 kg, the dose size is good. If you did injections, you might start half that starting dose and work your way up to 1.0 mg/kg of weight. Though you are right that it stings. I think it was Suzanne who also suggested you could get the sublingual melting tablets that might be easier to give. I was offered that one time, but pill in pill pockets work for me. There have been a few studies now that show it doesn't last long enough in the cat to just give twice a day, so I'd start with at least 3 times.

Apparently you can get it in liquid or compounded as chew treats by some of the larger online pharmacies like BCP, Roadrunner, Diamondback. Here is the link to the page Suzanne referred to.

 

Healing prayers being sent

 

Thanks. To be honest I am feeling as overwhelmed now (maybe more) than when I first joined. I am having to make decisions about things I know nothing about and asking the vets for things they don't know about.

When she is eating, Ondansetron pills are easy in a pill pocket - this is fine when I see she is eating less than usual and can address it early. Problem is right now she won't touch anything. They showed me how to pill her at the same time they showed me the subq fluids but I couldn't even get her mouth open this morning though I did get a good strong smell of her ketones.

I'm trying to figure out what's the best ondansetron option for these circumstances - injectable that stings, transdermal that doesn't work as well or melting tabs that I may not get into her mouth. Based on the felinecrf info (thanks) looks like transdermal is eliminated. So my fear would be the injectable stings so much it will make her resist all injections including the insulin?

I just don't know what to do, feels like I'm just watching her get worse and worse as I spend more and more AND fail to do basic things like get pills and fluids and food into her.


ETA - Greenies have discontinued the allergy-free pill pockets

 

Sending prayers.

 

If you're doing subq fluids, giving the injectable ondansetron in the fluid bubble may make it sting less.

 

I know you're trying to do your best right now and maybe another suggestion won't be very helpful, but I use slippery elm with George's aloe juice on Ruby before I use the anti-nausea meds because sometimes that does the trick and I don't have to pill her. It can be mixed with water and syringed: https://felinecrf.org/holistic_treatments.htm#seb_what_is_it

 

Oh Liz, I am so sorry. Your having such a difficult time.
I always used the mini melts. They dissolve so quickly that the cat doesn’t have time to spit it out because it’s already melted. I never had a cat foam at the mouth or anything. This was before I started sticking them in a gel cap with other meds like cerenia and blood pressure meds to minimize pilling. But I know your Minnie has strong jaws that she can keep closed.

I’m holding you and Minnie in my thoughts and prayers.

 

Thanks, everyone. Guess today is my day for mini melt...down. She is definitely still not right but mysteriously just before PM shot time she came and gave me the "feed me" look. Then pretended she didn't like anything I offered even though the floor looked like a game of twister with all the different dishes...a few minutes later, she decided to eat and continued for an hour moving from bowl to bowl.

I updated the labs tab in her spreadsheet. Her Potassium was fine today, vet thinks she is off her food because of the taste of the crushed potassium though I'm not convinced. She is definitely not behaving normally still. Gave 1/2u R again tonight per Internist instructions when BG >300 (which they would be on vet readings) to help fight the ketones - urine ketones now up to small. It is so weird and hard not to panic - it's been drummed into me that ketones = emergency = vet, but they keep sending me home and saying it's fine.

Thanks for all the ondansetron tips, I still don't know what to do. I did start reading about slippery elm but I think that's what sent me over the edge. Something else to figure out and ask the vet about. I'm thinking maybe the mini melt though it looks like that also comes in various flavors, is that right?

Our cerenia history - I originally crushed it into food. Vet said that it was soluble, so if she wasn't eating I could try crushing it into a little water and syringe into her mouth. That's what made her drool / foam so much - it scared me to death the first time. And I suspect also meant not much of it went down. I realize I need to figure out how to get pills down her at some point but so stressed at the moment I'm having problems even with giving the shots. That's what concerns me about it stinging her.

Paws crossed for tomorrow. Thanks again.

 

Can you tell me a bit more about how you do this? Do you make the syrup described on the website? Do you buy the slippery elm in bulk or capsules? And where does the aloe juice come in? (hmm maybe there is a sticky on this....)

 

Liz you deserve a monument for your patience and perseverance, i cannot imagine how stressful learning all these new things while under pressure of taking decisions that would help your kitty can be. We really pray for Minnie to get better as soon as possible for her own health but for yours as well

 

I gave the ondansetron wafers that melt in the mouth. They are easy to give as they won’t fall out of the mouth, they will stick to moisture. You just have to make sure your hands are completely dry when you handle them.

Slippery elm is easy to use as well. I used to make the syrup for Sheba ....it lasts up to 7 days in the frig.
I use it for one of my cats now and just add it to her food.... I don’t make it up into the syrup.
For Sheba I bought the loose powder but for Clover I use the capsules and just open them and get the powder out.
The only thing you need to be careful of is to not give it within 2 hours of medications as it can stop the absorption of them because it coats the Alimentary track.
I hope things settle down for you and Minnie soon.

 

My “mini melts” are just the ones that come from the human pharmacy. They aren’t compounded into any flavor.

Don’t ever put Cerenia in food (but you already know that now because of all the foaming at the mouth from before. Yes, if you could pill her you could put the Cerenia in a small gelcap and she would never taste it. I bet you’ll get the hang of it soon.

You are amazing just to be still persevering through all this. It’s all for Minnie so I know you will keep going. Melt downs are sometimes necessary. We all have them at times. Then we pick ourselves up, dust ourselves off, start all over again. (That was a song from a Fred Astair/Ginger Rogers movie).

Finally, am so excited about her eating for you! How is Sam taking all of this? If the floor was strewn with bowls, wouldn’t he come and eat the food?

Darcy lived with high ketones for a long time (even after his DKA). He was low when he first got out of the hospital and then they went up and stayed up. My vet would not take the ketones seriously. What I mean is that I would check his ketones using the Nova Max blood meter and take Darcy to the vet telling them about the high ketones. They would check his urine and tell me he was “negative” for ketones. So she doubted the accuracy of my ketone meter. I was so frustrated. This was after he nearly died and had to have the esophageal feeding tube placed (he kept it for about a month.). I was so afraid. His ketones stayed high, but he didn’t get acidosis. A few times I took Darcy in to the vet and insisted they put him on IV fluids for the day... and they did. Ketones went down for a short while and then crept back up. It wasn’t until he started getting the really big doses of insulin that his ketones came down. Fortunately, Minnie is not an acrocat. But I do understand your anxiety over her ketones!

 

THANK YOU. This helps. I think I'll ask about the melting wafers.

@Bron and Sheba (GA) I've made a note of the slippery elm for later - right now I don't know I can manage another variable! ie don't give w/in 2 hrs of another med.

This is all really good info too. Especially the song now on permanent repeat in my head!

Not sure I feel particularly amazing. I feel like a wreck. I have the gelcaps and 3 different pillers but still haven't got it in her yet. Got her mouth open for a second.

Sam is doing ok. I've discovered if I give him a big pile of food, he eats it and mostly leaves the rest alone, though he's also being fussy. I can assess my stress levels based on what I say to him and how (poor Sammy). He's doing well out of all the treats I'm buying - Minnie doesn't like ANY but he does. He's a big fan of the bonito flakes.

And the more I hear about Mr Darcy's back story, the more I admire all your efforts and perseverance. The ketones are a nightmare especially once you've had it drummed in how dangerous they are. I have mixed feelings with the Novamax now - good for normal checking to know when there's an increase (she went from 0.5 to 1.5 to 5.9), but once they're high I'm not sure what it's doing for me. The Novamax does seem to correlate with my urine strips but not so much with the vet's serum tests. They really seem more concerned about potassium levels. With the ketones they are just saying continue treating with - fluids + eating + insulin (+ extra R).

Minnie also was ketotic but not acidotic the last 2 hospital stays - they said there's something else in the blood that was balancing out her pH.

Back to today. I'd like to get a bit more methodical with the R dosing.