GA Please help - my Shmoo is dying

Hi there,

My cat, Shmoo (14), was admitted to the hospital yesterday morning with severe DKA and the vet (and my husband) seem to think its time to put him to sleep. Shmoo has had DKA before and I was able to get him to recover from home, but it took 11 days of syringe feeding, bg testing every 2 hours, you know the drill. I am happy to do that again, but no one seems to think that will make any difference and I would be prolonging his suffering.

Shmoo is my very best friend. After his initial attack three years he became diabetic and I have altered everything in my life to care for him - he really is the bestest kitty there ever was, and caring for him has never felt like a burden.

I don't know how to 'make the call' when I have successfully helped him recover before. The vet charges $1,200/day for the care he is getting - and, while I absolutely would pay that and am someone who would go into debt for the well-being of a family member - others seem convinced that he will not get better. At what point do you determine that a cat with DKA will not get better? He's been there for 30 hours and is showing no improvement, no interest in eating, he is incredibly depressed and almost looks like he's not there, and his BG levels are not coming down.

Does anyone have any advice to offer, please? I would hate to regret losing my very best friend.

Thanks,

Jacqui & Shmoo

 

So sorry you are faced with this decision . I have no personal experience with DKA but can you tell us exactly what the Vet is doing to treat him right now?

 

Oh Jacqui. I just want to give you the most massive hug ever.
I'm so sorry you are going through this, it's such an awful thing to have to go through.

I don't know how to determine if it's the right time or not. Only you will know.
Maybe if you think back to the original episode and how he responded then? Did he recover more quickly?

There is always regret no matter when you decide.. many people say better too soon than a moment too late.

Sending prayers for you all.

 

They have him on an IV drip with R insulin (apparently a very high dose that he is still not responding to), syringe feeding, and they are giving him pain, nausea and appetite-stimulant medications.

 

Thank you so much for your thoughts. In his first round, it took him 10 days to come around and start eating on his own. He hasn't been hospitalized with DKA before, and I was told that was his best chance, but I don't know when you would typically start seeing a shift?

 

It can take several days for them to start to turn around.....If it's only been 30 hours, I wouldn't make the call to PTS just yet

If he won't eat soon, they may need to put in a tube so he gets enough nutrition....food is a very important part of getting them better. Feeding tubes aren't nearly as scary as they sound and they have helped a lot of cats survive even when they were very ill to begin with

Lots of good information on this page about Feeding Tubes for cats

 

I wish it was more than just thoughts.

So 30 hours isn't that long in the scheme of things. Would your vet consider a different treatment- say after 48 hours? These are just things to ask - suggestions if you will.

DKA isn't something I know a lot about, I'm hoping someone with experience will chime in with how they dealt with it, turn around times etc then you would have something to gauge it by.

 

That's what my impression is too - the vet said that if a cat is going to improve they will usually see *some* form of improvement, clinical or otherwise, even marginal within the first 24-36 hours. I really hope someone who has hospitalized their cat chimes in too as I am unfamiliar with rebound times using this protocol and my vet doesn't seem happy with his lack of progress. My husband seems to think I am just delaying the inevitable - and of course this is a tremendously emotional and difficult decision that I'm falling to pieces over - and I love the little munchkin too much to think rationally right now.

 

Tagging @Sylvia & Millie because her girl has been through 2 DKA's, one just a little over a week ago, I think. I'd have to check her SS again but I've tagged her to maybe chime in for you

 

I'm with Chris & China here I wouldn't make the call just yet.

 

@Tanya and Ducia has been through DKA several times....Hopefully she'll be on soon to give you some helpful information

 

Thank you so much! Heading to the vet in an hour - so any input is so so greatly appreciated.

 

I agree, too early to make that call! I would say at least give it a few days before thinking about it. Just make sure your vet is actively doing everything they can to make your sweet Shmoo better, and not just palliative care.

 

My cat had a bout of DKA a year and a half ago. He was very sick and spent 3 days in the vet clinic's ICU getting the things you've listed: R insulin, fluids with electrolytes, etc. I don't recall the exact point at which he began eating on his own though. Once he was home it took him a few weeks to get back his strength. It's a little early yet to make an irreversible decision for your kitty.

I have experience with a feeding tube in a different cat many years ago and it's not as daunting as it sounds.

 

Thanks so much for your input! I asked the vet to do another panel that we can discuss at his appointment this evening. If things are improving then I will elect to continue treatment. If they are not, I'm considering the following options:

1. Euthanize tonight (though my heart tells me its too early to make that call)
2. Take him home with the goal of at least keeping him comfortable. Then if we have to euthanize him tomorrow or in the following days, at least he's comfortable at home.

If I bring him home, my concern is whether I can keep him comfortable and pain free. I can and do give insulin (testing bg every time), b12, and also can do all other subq injections. What are the risks here? Could he die a painful death in the middle of the night if I choose this route? Do pain meds keep DKA patients pain free? I am so so nervous about making the wrong decision and just want to ensure that all is considered.

 

I can't answer all your questions because I have never had to deal with DKA, but my understanding is that it is best and most successfully treated at the vet's. I think I would give him another few days at the vet's before making any decisions. Just my 2-cents worth.

 

Thank you, and I would and do appreciate it, but sadly, I cannot afford another few days - my heart is just breaking at this reality.

 

If there's any way you can do it, I'd leave him there at least overnight to continue with the IV fluids.....the ketones have to be flushed out and that's the best way

Another 6-12 hours may tell you a lot more about how things are going

 

I agree with Chris. Also, there are places that may be able to help you with costs. Here is a link to some of the options that may be available to you. http://www.felinediabetes.com/FDMB/threads/financial-help-links.131190/

 

Thanks for the input! I would leave him there over night if there is hope that something will start working - right now though, his bg keeps going up and he's not responding to treatment. Is it possible for that to turn around?

 

Yes...it really can take longer than you've given him to turn the corner and start to improve

The best thing for him now is to stay on IV fluids to help flush the ketones, get as much food into him as possible, (by syringe or tube) and increasing the insulin to get the blood glucose down. While he's at the vet, they can give higher doses of insulin safely that you can at home. He should probably be on both a basal insulin (like Lantus or Levemir) and a bolus insulin (like R)

Have you ever applied for Care Credit?

 

Another member with lots of DKA experience is @Meya14

 

Hi

My Layla was diagnosed Oct 2015 with DKA. She spent 3 days in the hospital . We brought her in on a Sunday & She was discharge that Thursday. She didn't start eating till Wednesday night. She went into remission a month & 3 wks later, Dec 2015

Prayers & positive thoughts

 

Hello Jacqui,
I am so very sorry for what you and Schmoo have to go thru.

I do hope that you will listen to your heart and to the advisers above and do not PST. 30 hours is way too early for that.

I have some question :

What is his ketones level at this time?
Is he syringe fed at the clinic?
What is current BG level is like?

 

My cat had DKA and we have to pick her up from the clinic after only 24 hours stay and still with trace amount of ketones in her urine. Her electrolytes improved a little but were far from norm @the discharge. She would not be eating at home before the ER and not when admitted @the clinic so an esophagus tube was inserted. I think it saved her.

I never heard that DKA was painful condition: Ducia never received any pain killers. She was dying from DKA but not in a painful state. The priority was to get the ketones out and to bring the BG down. We achieved it at home after over a month.

 

That seems like a super high price. I wonder if there there may be a more budget oriented care facility in your area.

Leo just had an esophagus tube for 3 or 4 weeks. He had stopped eating. It was a life saving measure and it worked. It sounds horrible, but he didn't mind it from a pain perspective. I think it bugged him from the thick collar on his neck. I think it was $800 for the install and all followups. In summary, it got us through a tough time, and he is doing well and eating now.

 

I think that it is too soon to tell if she will turn around. Unless there is an underlying issue causing DKA to occur (ex. cancer), DKA is a treatable condition although still very serious.

To make you feel a little better about allowing her to be treated: DKA itself is not acutely painful. As ketones increase and cause the blood to become more acidic, quite often, there will be mental status changes that lead to coma prior to death. For severe metabolic acidosis, patients are usually tired, confused, very weak, or comatose - but not symptoms of pain. The major discomfort that may happen is nausea in the early stages of acidosis. But also, you know her best - it's a hard decision to have to make.

I have a type-1 diabetic friend who's had several episodes of pretty severe DKA, and she said that she really wasn't feeling pain at all. Her major complaint was some nausea and unquenchable thirst. She said these weren't even too bad because of the amount of confusion she had.

DKA is very expensive to treat at the vet. If this is a consideration, you may want to ask about a feeding tube which may allow you to take her home sooner and treat her at home. Getting in enough food and enough insulin are the major factors in recovery.

 

I'll add that Leo has been in severe crisis mode several times in the past 2 years. In each case we went the extra mile. Some of it money, but mostly our time. He recovered in each case, so it was really worth it to us since he is a great fur-kid.

 

I have to go to work and don't have much time to write, so I just searched and found a post I wrote years ago and copied it here.
My kitty had DKA around Christmas time of 2005 I think it was. I took him to the ER in the middle of the night where he was diagnosed. Because the next day was Monday, and they (used to) close at 8:00am when most regular vets open, I was instructed to take him to a 24 hour hospital where he could be monitored all day and night. I had a choice between one to the east that was 90 minutes away or one to the west that was 90 minutes away. Alas, at 7:00am on a Monday morning, with all the commute traffic, we were headed to the University of Pennsylvania Veterinary Hospital in Philadelphia, with J.D. in critical condition. He made it, but it was scary. Each day he stayed there became a little less expensive. He started at the most expensive, like critical care, and then a day later was transferred to ICU (I think it was called, I am soooo bad with medical terminology), stayed there for 2 or 3 days, and then was transferred to Internal Medicine, which was the least expensive (like $120 or $150 a day, I think, it was a long time ago). In total he was hospitalized for 8 days. Each day he would get just a little bit better. The first day he recognized me, but just laid there. The second day, he lifted his head, when I came to visit. The third day, he I actually saw him get up for a sec to reposition himself. The fourth day, he got up and came to me, crawled into my lap, with a tube in each leg, weak, and with yellow (urine) all over his white legs, but he got up and came to me and got into my lap :razz: God, that was a good sign. Then, on the fourth day, he also began to lick his stained yellowed fur, and I knew that was a good sign. Every day that passed, he got a little bit stronger. He had to have two blood transfusions, and I don't know what all else, but he made it. He would not eat the whole time he was there, even I tried to bring him treats and his favorite foods, but he just would not eat. He had a feeding tube in, and the vets said he could go home as sood as he was eating. Well, now it was almost New Years, and they finally let me take him home with the feeding tube. What joy it was to get my baby home. The feeding tube lasted like a day, and he was soon eating, and gaining weight, and getting stronger and happier.
J.D. was 11 when he had this bout of DKA and lived to be 20.

 

Hi everyone,

Thank you so much for your advice and support. I went to see Shmoo last night and he perked up for a few minutes when I walked in. I was with him for 3 hours and apart from that three minutes he was basically in a completely comatose state - he wouldn't blink if you were going to touch his eye and couldn't move. The vet indicated that he likely had brain damage at that point and while he *could* continue to show signs of marginal improvement, it was highly unlikely. I asked the vet what they would do and he said he would say goodbye while there is still some dignity because continuing this, even though there may be blood and urine signs of improvement, he could also easily start to seizure. I fought the decision so hard, but when I tried to comfort my best friend he didn't even know I was there and I had to let him go.

I will forever be wracked with guilt that another X number of hours could have made a difference, or that I could have and should have done something differently. I don't know how to cope with this loss... it wasn't a slow or steady decline, it's so sudden. He was my best friend, my constant. All the years of poking and prodding, he would just purr through treatments... he would follow me around the house, chirp at me and heard me to bed at 9pm so we could snuggle. I was his human and he was my best friend. Any advice you have on coping with the thought that you could have or maybe should have done something differently... My heart is so broken.

 

*big hug* I'm so sorry that your wonderful Shmoo is gone. It would be lovely if you could share a picture of him in his happier days as a tribute.
Making that call is one of the hardest yet bravest things we ever have to do for our fur babies. It takes all the strength we have in that moment to do the right thing. But you did, and he died with dignity, there is no what ifs here or buts.
You allowed him to leave when he needed to leave, and his paw prints will forever be a part of your heart, so he is with you in spirit if not in body.

I had to let my old boy go a few years ago, he was 27 and he couldn't walk, he didn't want to go, but it would have been cruel. It's not what I wanted but I loved him enough to allow him dignity and let him run free.
It's still difficult and it still makes me cry. I still miss him but I know it would have been worse if I'd held on for me.

It's hard to get past the could I have done more, or what if, but then I ask myself would I have put him through anything more just for me, so he could linger a few more weeks, months or years possibly in pain.

Grieve, allow the feelings you feel for you need to feel those, but don't stay there in that sad place, remember the good times, the happy times and be glad that you had the time you had. He wouldn't want that for you.

Run free little Shmoo.. land softly on the other side.

 

So sorry for your loss. I hate to see you have to go through this. My thoughts and prayers are with you.

 

I shed tears for you and my heart goes out to you for your loss HUGS

 

I'm so sorry it was Shmoo's time to leave you.

You made the decision with the best of hearts, and with all your love for him. Cherish what you two had together. So, please don't beat yourself up with guilt and "what ifs". You know, and we all know, you did the best thing in an awful situation.

 

Many places have pet loss support groups these days. It's important that you find someone to talk to who will understand. I know you have all of our support, but it's different to speak and cry with a person who's right there. You have to cry it all out. It seems silly now, but when I lost my soul-mate cat, I went to a Buddhist temple with a photo of him I had taken only 2 days before and cried my eyes out. The other people probably thought I was nuts, but I didn't know any of them, so it didn't matter. Since then, I have lost several cats and they are all buried in my backyard under my bedroom window. I throw seeds on their graves so they will give me flowers. Sometimes, at night, they come to visit me. I am crying as I write this and I feel so badly for you.

 

I am so very very sorry for your loss.

 

Oh Jacquie, I am so, so sorry that Shmoo has crossed the Bridge. My heart is breaking for you and I am in tears. That last gift of love is always the hardest to give. You knew Shmoo better than anybody; you knew it was time for him to move on to his next adventure, and you helped him cross with dignity and with love. I pray that your wonderful memories of all the time you spent together will help your heart begin to heal, until the day you are reunited.

Fly free, beloved Shmoo, travel safely and land gently at the Bridge

 

I'm so sorry you've lost your beloved kitty.

 

I am so sorry that Shmoo has crossed the Bridge. The kindest and greatest gift we can give to our precious furbabies is indeed the hardest one for us to bear. Shmoo is free now and without pain.

 

So so sorry for your loss. Sounds like you made a very kind and loving decision.

 

I am so sorry. I have had to deal with the loss of many of my babies over the years. It is absolutely horrible, and no matter the circumstances of it, there are always some feelings of regret and self-blame.

What you did was unselfish and loving. Really, you would have been prolonging things for your sake, not for his. Instead, you chose what was best for him. Yes, you are hurting because of the decision you had to make, but you have saved him from having to hurt anymore. You should draw comfort from that.

I am a firm believer in letting go when it is time and allowing them to exit peacefully and with dignity (same thing I would want for myself). I also think that being able to be with them for the end is extremely important. So, to me, you did exactly the right thing. Allow yourself to grieve the loss of your best friend, but try not blame yourself for it.

 

I'm am so very sorry for your loss. My heart is breaking for you. Letting go is the hardest decision. But the most loving & caring thing to do. May Shmoo Rest In Peace. Till you meet again

You are in my prayers & thoughts

 

It is hard to lose our fur kids. Many of on the forum know how hard. Schmoo was the best, and he was loved. I can tell from your postings. You did the right thing. There is a time and a place. You shouldn't feel guilty. You loved Schmoo as much as you could and you provided the best care. Tears here for your loss.

I am sorry for your loss of such a great companion. May Schmoo fly free and land softly at the Rainbow Bridge, waiting for you there.

 

This is my Shmoopie. He was the best and I can't stop crying or keep my brain from racing. I just can't believe he's gone. Thank you for all the support.

 

Sorry for your loss. Losing your baby is never easy. He'll be in your heart forever.

 

HUGS and hugs and hugs....wish there was a way to take away part of the pain you're going thru right now. I'm SO sorry it was Shmoopie's time to cross. Remember - he's not 'gone', you just have to hug him differently.

Soar high on your new angel wings beautiful baby....landing softly back in your family's broken hearts.

More hugs and prayers for comfort - unfortunately so many of us 'get it'...

 

My heart aches for you. Knowing it was the right thing to do doesn't fill the hole in your life or your heart. But it will always be a comfort.

And don't let anyone tell you how long the grieving process should take. It takes as long as it should - no more and no less.

Shmoopie was a beautiful boy and you did right by him.

I'll light a candle in my window for you both tonight.

 

@Yong so sorry I didn't see this. For some reason I did not receive an email notification. So sorry about Shmoo.

 

I am so very VERY sorry!
What an awful time you've had. I'm saying a prayer right now for you.

 

I am so sorry. I know exactly how you feel. I don't have any children, just cats, 2 of them. They are both 14 also. The female has diabetes too. I don't even want to THINK about that happening to her, but I know that one day, UNFORTUNATELY, it will. Hopefully in at least another 10 years. My last 2 cats, I adopted from the SPCA, were 26 yrs. old & 28 yrs. old when they passed. They were just domestic long haired cats. Now, my mother's cat is 25. He isn't doing well at all. But he isn't suffering. Try to do things to keep your mind off of the cat. I KNOW, it's gonna be hard, really, really hard. You did the best thing for the cat if it was suffering. And "yes he did", know that you were there. They can sense it. He knows that you put him in a better place. I cried for 4 1/2 years after my cat died, the one that was 28. I adopted him when he was 9 yrs. old, from the SPCA. They were gonna put him to sleep, because, of course everyone wants kittens. Some people say "that's just crazy", to be that upset over "an animal". But it's not just "an animal" to people like us. They are a miniature family member who just cant ever go out to eat with us, LOL. BUT, they can go to Petco shopping with us. You will feel better in time, don't rush out and buy another cat though, I think it's a BIG mistake. Wait a while. Take care. Again, sooooo sorry for your loss

 

It's ok, Sylvia, I know they act up sometimes. I'm just seeing the update .
Jacqui, so sorry to hear . May fond memories of your beloved, Shmoo warm your heart always

 

so sorry you lost your lovely Shmoo. xx