1/2 Radar -ER visit update - pmps 441

Jan Radar (GA)

Jan Radar (GA)

Member Since 2015
yesterday's post

Radar spent yesterday and last night at the ER getting fluids for severe dehydration and elevated kidney values. The ER Dr. just called and said he is much more hydrated after all the fluids they gave him which he tolerated very well. The kidney values are normal this morning and he can come home. :joyful:

She said that his blood pressure was consistently elevated above 200 so they have started him on blood pressure medication - I think it's called Maledapine?? I asked about his heart and she said the only way to evaluate the heart is to make an appointment with the heart specialist who is not in the office until next week. She also said that his heart is fine otherwise he wouldn't have tolerated all those fluids. :nailbiting:

Then she launched into a lecture about his insulin dose and how cats never need more than 4 units even when they are on steroids. She said he was not hypoglycemic during his stay in the hospital, but was steady in the 200's. Her discharge instructions for his dose are to give 2 units if he's not eating and 4 if he is eating. She said I'm changing the dose too often and allowing him to be hypoglycemic which has contributed to his illness :banghead: Her final comment was that he should be in the 100-300 range all the time.

My first reaction after hanging up the phone is that I'm really glad this dr. is not my regular vet and I'm really glad that I can go get him in a little while. Once he's home, then I'll work on educating myself about this new condition. :bookworm:
 
I am glad you can pick Radar soon. And that his kidney values are OK now.:)

You may want to see if your own vet can do blood pressure tests. Neko’s blood pressure was greatly increased under stress. First attempt, delay in appointment due to vet emergency/barky dogs/in waiting room/techs new to equipment, result was over 220 bp. Next attempt a puppy got too close to her carrier -180. Third attempt at dental vet, after spending time in cat waiting room, darkened and with Feliway going, 146. There is a certain increase in bp allowed for, called white coat syndrome. After the first attempt, both vet and I called it an epic fail. Even the second reading was close to needing bp meds.

ER doc needs some refresher courses. X-ray is a good first start at checking the heart. As for the diabetes knowledge. :banghead:
 
I'm SOOOO Glad you have another vet to work with. That ER vet could seriously use some education in Feline Diabetes - her recommendations are way off and she's giving advice that will lead to a certain early demise if not CKD and other issues with FD cats -shame on her for not becoming more informed... I'm sorry to be so blunt - but my blood just boils when I hear that a supposedly educated person is providing such poor and downright incorrect advice - obviously having no time to read any of the literature about FD :(
 
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I'm happy to report that Radar is home. :) He was eager to be out of the carrier and far far away from all the really scarey dogs he was surrounded by in the ER. The tech told me that he had barricaded himself behind everything available in his cage so no one could see him :eek: I'll let him patrol his domain a bit and then test him and see where we are and then maybe he'll be ready for a snack and a nap under his favorite blanket while I enter the information from his stay at the ER on the lab tab on his ss. :cat:

I can't see his regular vet until next week when she returns from vacation. I expect another vet in the practice will call me when she has a chance although they are super busy on the day after a holiday. If you have suggestions about the questions I need to ask, please let me know. My main questions are should I continue giving the bp medication when I'm pretty sure the super scarey conditions in the er and being surrounded by dogs for 24 hours could easily explain the elevated bp. What should I do about the Budesonide dose? continue tapering or continue giving it every other day?
 
Sue and Luci said:
I'm SOOOO Glad you have another vet to work with. That ER vet could seriously use some education in Feline Diabetes - her recommendations are way off and she's giving advice that will lead to a certain early demise if not CKD and other issues with FD cats -shame on her for not becoming more informed... I'm sorry to be so blunt - but my blood just boils when I hear that a supposedly education person is providing such poor and downright incorrect advice - obviously having no time to read any of the literature about FD :(
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My thoughts exactly, Sue. Thanks for your encouragement. Now that he's home and happily hiding under the bed, I'm focused on breathing deeply and drinking a nice cup of soothing hot tea while I try to calm my boiling blood.
 
So glad Radar is okay!!!

I wonder if you can either have a tech or someone come to your house to take Radar’s BP or borrow some BP equipement. I’m happy to teach you ... somehow lol if you can get the right equipment. However, I haven’t come across people borrowing equipment like that before. I’ve gone to client’s homes to take their pet’s BPs before so I’d see if your vet will offer that.
 
Crista & Ming said:
However, I haven’t come across people borrowing equipment like that before.
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I haven’t heard of clients being offered the chance to borrow equipment. It’s rather pricy. Getting a tech visit sounds like a good idea if you can get it.

Did the vet give you any explanation for why he was off his food other than being dehydrated? Or tell you what caused the dehydration? Just wondering why you think you need to change the plan on budesonide. Hard to say on bp meds, having high bp is not good. Some cats don’t raise their bp under stress.
 
@Marje and Gracie @Wendy&Neko
I updated the ss tab for labs the best I can with information available - I'm still waiting on the blood test results from the regular vet's office.

The new diagnostic they did after all those fluids shows some improvements and a few different things are flagged as abnormal.
O2SAT was 51.9 yesterday and today it's 78.1%
pCO2 was 45.3 yesterday and today it's 27.3 :nailbiting: yikes that looks like a terrible change to me
mTCO2 yesterday was 25.1 and today it's 22.2
pH was 7.342 yesterday and today it's 7.513
Ca++ was 1.27 yesterday and today it's 1.07
Bun was 24 yesterday and today it's 12

Also I asked for copies of all their notes so I could see what they did and at what time. When they admitted him to the hospital his bp was 118. After he'd been there for 6 hours his bp was up to 175. After 12 hours his bp was up to 200. At 13 hours it was 230. At 15 hours it was 200 and at 18 hours his bp was 210. I also see that his pulse was 160 upon admission and after 12 hours it was up to 200 and stayed there. His respiration rate was consistently 40. I have no formal medical training but that looks like fear induced elevation to me.
 
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Wendy&Neko said:
Did the vet give you any explanation for why he was off his food other than being dehydrated? Or tell you what caused the dehydration? Just wondering why you think you need to change the plan on budesonide
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No explanations were offered about why he wouldn't eat or what caused the dehydration other than "the insulin dose was too high which was stressing his body" She also told me to continue giving the Budesonide every other day and to ignore the directive from the regular vet who told me to begin tapering the dose off completely over the next month by giving Budesonide 2x a week.
 
You can test respiration rate at home. When he is sleeping or resting, count the total number of in and out breaths in a minute. I used the clock countdown counter on my phone. For a normal cat, it should be under 30. Neko’s was known to be over 50 at vetty, and low 20’s at home.
 
Wendy&Neko said:
You can test respiration rate at home. When he is sleeping or resting, count the total number of in and out breaths in a minute. I used the clock countdown counter on my phone. For a normal cat, it should be under 30. Neko’s was known to be over 50 at vetty, and low 20’s at home.
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This is useful information. I will do some spot checks when he decides it's safe to come out from under the bed.
 
Crista & Ming said:
So glad Radar is okay!!!

I wonder if you can either have a tech or someone come to your house to take Radar’s BP or borrow some BP equipement. I’m happy to teach you ... somehow lol if you can get the right equipment. However, I haven’t come across people borrowing equipment like that before. I’ve gone to client’s homes to take their pet’s BPs before so I’d see if your vet will offer that.
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Thank you for your kind offer of tutoring me from afar. I will inquire with the vet's office and see if they have such a service available. I've only called them 3 times today so they already think I'm a crazy client... what's another call?? LOL
 
It will be shot time in 45 minutes and I'm thinking I'll return to my dose of 7.5 units. This is the dose on 12/31/19 that had him in blues and greens before he went to the ER for a day. or should I be more conservative and only do 7? or ??
 
Vets like this make me want to shoot myself. The labs they did are on the borderline of worthless; I mean really.....look how little they checked. I will say that his urine specific gravity pre-fluids is on the low end and that can be indicative of early stages of CKD so I’d stay on top of his labs and have him checked again soon. If it were me, I’d have a full Superchem, CBC, and urine done. If your vet uses Antech, the cheapest way to go and get all of that plus thyroid is called the Senior panel. If she uses IDEXX, they also include an SDMA which is excellent to help further dx if this is really CKD or not (USG can vary during the day).

I would not change the way my vet prescribed me to use budesonide. I also wonder how they did the BP. It’s supposed to be taken 3-5 times each time they want to check it and the numbers averaged. The fact that his BP was totally normal when he got there really throws a red flag up to me. At this point, I would see whatever vet is available in your clinic although I would ask if you can even just come in for a BP check. In our clinic, the vet techs, not the vet, do the BP checks and so you don’t have to wait to see a vet as the techs have more flexibility. We usually go in later in the day when it’s quieter, sit quietly for ten minutes in a sort of darkened room and they play soft music. Then they do the BP check.

IMHO, I’d go back to your regular dose. That vet also obviously does not know what she’s talking about if she thinks cats don’t need more than 4u. I’m glad he’s home and feeling better!
 
Marje and Gracie said:
Vets like this make me want to shoot myself. The labs they did are on the borderline of worthless; I mean really.....look how little they checked. I will say that his urine specific gravity pre-fluids is on the low end and that can be indicative of early stages of CKD so I’d stay on top of his labs and have him checked again soon. If it were me, I’d have a full Superchem, CBC, and urine done. If your vet uses Antech, the cheapest way to go and get all of that plus thyroid is called the Senior panel. If she uses IDEXX, they also include an SDMA which is excellent to help further dx if this is really CKD or not (USG can vary during the day).

I would not change the way my vet prescribed me to use budesonide. I also wonder how they did the BP. It’s supposed to be taken 3-5 times each time they want to check it and the numbers averaged. The fact that his BP was totally normal when he got there really throws a red flag up to me. At this point, I would see whatever vet is available in your clinic although I would ask if you can even just come in for a BP check. In our clinic, the vet techs, not the vet, do the BP checks and so you don’t have to wait to see a vet as the techs have more flexibility. We usually go in later in the day when it’s quieter, sit quietly for ten minutes in a sort of darkened room and they play soft music. Then they do the BP check.

IMHO, I’d go back to your regular dose. That vet also obviously does not know what she’s talking about if she thinks cats don’t need more than 4u. I’m glad he’s home and feeling better!
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My thoughts exactly. I will return to my dose. :) My vet's office has me scheduled at 9am in the morning with a tech so we can see what the bp reading is without the stress of an ER full of barking dogs. The tech also told me the vet on duty said NOT to give the bp meds from the ER until we determine if there is actually an issue with the bp. :) I'll keep you informed.

Thank you, Marje :bighug::bighug: These are from Radar. He's so glad you are here to help me figure out what to do. :bighug::bighug:
 
Jan Radar said:
My thoughts exactly. I will return to my dose. :) My vet's office has me scheduled at 9am in the morning with a tech so we can see what the bp reading is without the stress of an ER full of barking dogs. The tech also told me the vet on duty said NOT to give the bp meds from the ER until we determine if there is actually an issue with the bp. :) I'll keep you informed.

Thank you, Marje :bighug::bighug: These are from Radar. He's so glad you are here to help me figure out what to do. :bighug::bighug:
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I’m glad they told you that. I don’t like to make those kinds of suggestions when it comes to BP but it seems to me the ER really rushed to put him on meds.

Hugs and squeezes for your little guy!
 
Sienne and Gabby (GA) said:
The medication is amlodipine - it's a calcium channel blocker that's used for blood pressure control It's label name is Telmisartan. It's a human medication.

ER vet also needs to updated with regard to basic cardiology tests. IDEXX now has a blood test, proBNP. It tells you if the heart muscle is damaged.

I'm glad Radar is home!
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Idexx and Antech box have cardiac panels you can send out for them since most clinics don't carry the packs for in house bloodwork. I prefer to send out so that I can get the general range in more exact numbers.
 
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