? 2May2020/MAXI/Hospitalization Update & Questions

bambinaki

bambinaki

Member Since 2010
http://www.felinediabetes.com/FDMB/...se-send-healing-thoughts.229045/#post-2565208

Hello-

Maxi is doing relatively well!

He ate about a cup of food overnight -- dry food. He would not eat the canned food I brought. They have given him Purina DM. The doctor said it's been scientifically proven to be effective to maintain diabetic cats. I just glanced online and saw that it's high protein, which makes me worry about his kidney disease, and I don't know if it's *high quality* protein or just high protein.

I was educated by Dr. Lisa Pierson 10 years ago that all dry food is bad. Since then I have fed only high quality canned. I would like to get your informed thoughts on the dry food issue, specifically with regard to how to best care for Maxi moving forward. I am totally anti-dry, but I'm open to doing anything in Maxi's best interest.

I agreed with the doctor that at this point what needs to be done is get him eating, and if it's dry food, it's dry food.

@Wendy&Neko , Maxi did have a chest x-ray and an echo yesterday, and all with his heart is normal - no thickening. (She said the murmur is nothing to worry about). Yay!

He has also been on Unasyn antibiotic. Any pros or cons about that?

Blood pressure is good.

Glucose has been 240s up to 500. BG has been checked every 2 hours and insulin given as needed. They might put him back on Lantus this evening.

She wants to put a Frestyle Libre BG monitor on him. She said it is unreliable in a number of cats, but in lots of cats, it's reliable. They will test by poking his ear the first 3 times and compare it to the monitor, and if anything if off, they will consider it unreliable in Maxi and use traditional poking only.
She wants to use the monitor to lower Maxi's stress. Every time they approach him, he gets nervous. So, after the monitor, more of their approaches will be only for love and not for poking. (Now that I think about it, at home he doesn't mind the glucose testing pokes. I guess it must be scary there, though.)
I would like your thoughts on using this monitor at home --and even using it in the hospital.


The first thing the doctor said after she said Maxi was doing well is that Maxi is a *very* sweet cat.
I asked if he had gotten plenty of love from the Crazy Cat Lady overnight, and the doctor said, "Yes, and also from me."

She does not advise bringing Maxi home today.

I have pick up the monitor at a pharmacy and bring it to them (to get it on Maxi sooner rather than later). When I go, I "will be allowed to give Maxi a kiss." I am not allowed into the ICU. They will bring him to a room to see me. As much as I want to see him, I am hesitant to even put him through being pulled out of the cage and carried to the room. My #1 priority is keeping Maxi comfortable. The doctor said she thinks it won't be stressful for him. I think I might be able to make Maxi feel good for a few moments, so I agreed to visit him. What are your thoughts on this?

Please keep generating healing, calming energy for Maxi.

Thank you!
 
I'm so glad you have got a good report on Max.
I think at the moment as long as he is eating that's the most important thing and if it is dry then that's OK.
I remember when Sheba had pancreatitis she would sometimes only eat dry for a few days. I didn't normally have any dry food but I did have some left over Hills M/D which was still in the cupboard.

I had to laugh.....Purina DM scientifically proven to be effective to maintain diabetics. That's what they told me about the Hills MD dry food as well. Have a look at the ingredients...there is nothing scientific about them. The education vets get about nutrition is from the big food manufacturers......speaks for itself.
Lisa Pierson is right.
 
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bambinaki said:
would like your thoughts on using this monitor at home --and even using it in the hospital.
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My cat's ears became in a bad shape because of poking him several times per day. To give him a break and also because his BG levels are unsteady, we decided to get the FreeStyle libre implant. I really like it. It does not measure blood glucose so you are not supposed to get the same results. I noted that the margin of error is less important when his BG is low. When he was under 10, the difference was around 2. So for instance, when he was at 8.5 on the libre, he was at 10.3 on alpha trak 2. However, in higher values, the margin was more important. Note that the implant will provide you with a graft so when you are asleep, you will be able to understand what happens in Maxi's blood level. The Libre is able to provide you with trends e.g. when the BG is raising quickly or falling quickly.

I understand this is not cheap but in Djoko's situation, it was a reasonable expense because it provides valuable data that the vet can work with for next steps (and call a specialist if needed!).
He is wearing a baby pyjama to protect the implant. One day, he was without his pj and started to groom himself and attempted to remove it.

I hope Maxi does better. Djoko had a pancreatitis episode yesterday so I know the feeling.

Good luck!
 
Marj & Djoko said:
when you are asleep
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asleep...?? ;)

Thank you, Marj.

I am worried about the inaccuracy, and I'm also worried about it bothering Maxi so that he'd try to get it off. Not sure he'd take to wearing a pj.

I also think I'm going to have to get readings at all hours of the day and night in real time too. We'll see when the time comes what my advisors think.

I'm sorry about Djoko's episode and hope he's much better now. What do you do for him when he has a pancreatitis episode?
 
asleep...I am trying to sleep at night. When I wake up, I use the reader and scan the implant but I could not do it and wake up and see what happened during the night because the reader provides you with a curve automatically.

I have a little pharmacy at home: pain killer and anti nausea. Normally, it does not last more than 24 hours.

Djoko does not like when we put the pj on (he growls) but he tolerates it very easily afterwards and no issue with going to the bathroom. He is a very good cat though.
 
When Max was first diagnosed with pancreatitis he had started only eating dry food too. His first ultrasound showed lots of abnormalities and was done by a mobile vet at a cats only vet office. The recommendation was a surgical biopsy. I went back to my internal medicine vet I had used for years. I only tried another vet because she was highly recommended and my vet was very conservative. Well he had me get another ultrasound by his boarded radiologist who said all was normal. He also ran the test for pancreatitis that the other vet “forgot” to run. Bingo. Max was not a diabetic at the time. All this to say this all could be a bad case of pancreatitis. So take one step at a time. I agree with all Bron said as well.

I’m wondering about the freestyle too. You aren’t having issues testing. Then again while my boy was easy to handle, he was also very sensitive so I might be biased.
 
bambinaki said:
I would like your thoughts on using this monitor at home --and even using it in the hospital.
Click to expand...
Glad to hear that Maxi is feeling better and eating, even if it is dry. Raw diet may be an option if he continues to not eat canned (I don't have experience with raw but there are a number of people on this forum who feed raw).

I had a Freestyle Libre placed on Freckles when she had her dental done and was sedated. It was more of an experiment to see the accuracy of it. Unfortunately for us, the Libre was not very accurate with high numbers but was more accurate with low numbers - but what it did do was show me whether Freckles was going up or going down. Jan 10, 2020 we started the Libre and entered some of the numbers on the SS. The Libre comes with an adhesive back, but my vet used a animal tissue glue in addition and the Libre stayed on for 14 days. It only started bothering Freckles at around day 13 (she started scratching) and I think it was because it was starting to come loose/hair was growing etc. The vet put it just off to the side of her spine, in between her shoulder blades.
 
Great news Maxi's heart is fine! Heart issues can also cause inappetance, so good to know that's not a worry. It's always something in the back of my mind for acros.

Out of curiosity, what are they doing at the vet that you couldn't be doing at home? It's good he's eating, even if it's junk food.

If you look at the DM label, they had to rename it "dietetic" management, not diabetic food, because it really isn't "proven" for diabetics and the name was misleading. However, I am really impressed with the marketing done by these companies and how many vets they've managed to convince. And I know in some of the veterinary schools, Hills kindly comes in and teaches the classes on pet nutrition. :mad: Stick to what you learned from Dr. Pierson. Plus, as you know, dry is also very bad for kidney cats. Feeding dry also means you have to go to SLGS for dosing, and sometimes acrocats need faster increases. Each vet is different. I always argued with Neko's general practice vet on food, but both her internal medicine vet and acupunture vet (now my current regular vet), were happy with the raw diet. Anyway, I could go on but will stop there. So for now, get Maxi eating whatever, and worry about transitioning when he's home. He may very well decide he likes to eat his regular food when he gets home again.

As for the Libre, it's your dime. Some people have had success with it. For some people the cat has taken it off within a day of getting home. Maxi is stressed by them doing blood tests, not by you doing blood tests at home. If Maxi stays at the vet and it makes his life less stressed there, there's no harm. Sounds like they are keeping him in high numbers anyway. You can keep it on him if you want when he gets home. It'll give you more data. But it only lasts two weeks, not sure I'd replace it when it comes off.

As far as seeing Maxi, I would if in the same situation. Maybe take an old unwashed T-shirt, or old towel you have rubbed over your body to put your scent on it. Leave it with him so the smell is comforting.

Tons of healing energy being sent for Maxi. :bighug: I hope he can come home soon.
 
I tend to agree with you on the DM -- it's lousy ingredients. It's also approximately 12% carb. (I think they must have changed the formula. It used to be much higher in carbs.) The FDA has started to step in with the misleading advertising on pet foods. Many, if not most of the prescription foods have nothing "prescription" about them. It was just a vehicle for charging a lot more for the food.

I'd compare the ingredients to something like Young Again Zero Carb or Dr. Elsey's Clean Protein. I suspect the ingredients in these are better than in DM. I had a similar argument with my vet when Gabby was first diagnosed. She wanted me to feed a prescription diabetic food. I pointed out that many of the premium cat foods were lower in carbs and a lot better quality than either the Purina or Hill's diabetic foods. She stopped trying to sell me the Rx stuff.
 
Wendy&Neko said:
Out of curiosity, what are they doing at the vet that you couldn't be doing at home? It's good he's eating, even if it's junk food.
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He's still getting IV fluids (I think).

Wendy&Neko said:
As far as seeing Maxi, I would if in the same situation. Maybe take an old unwashed T-shirt, or old towel you have rubbed over your body to put your scent on it. Leave it with him so the smell is comforting.
Click to expand...

I did go see him, and I brought some of his favorite things (a little cardboard box, his "square" [a fabric thing he likes to lie on], a toy), but they wouldn't take them because of corona. He was still quite nervous and squirmy, so I don't know how much he got from seeing me. They brought him into a separate room to see me.

They told me they've moved him into a larger dog crate, so he has more space - a litter box, a hidey box, and space outside of both boxes.

Wendy&Neko said:
Tons of healing energy being sent for Maxi. :bighug: I hope he can come home soon.
Click to expand...

Thank you!
 
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I think I remember years ago Dr. Pearson told me about a veterinary association website/database that required a paid subscription, and that she was disappointed that not more vets were subscribers because research documenting that dry food and “prescription” food is bad was there.
Do you know what I’m referring to?
Do you know of any research or documentation of factual evidence that I can provide Maxi’s vets to dissuade them from recommending Purina DM or similar food?
Thank you
 
Maybe the VeterinaryPartner website? There is a section that does not requite s subscription:
Diabetic cat diet suggests that canned food is superior but if necessary there are dry foods. I know there is a section to that VIN website is more on natural treatments. I've been at my vet's office when she's browsed that with me. It does require a subscription.

Vetstreet also has a good article recommending wet foods and against prescription foods, especially dry. Feeding the Diabetic Cat.

The article Management of Diabetic Cats that is linked in the Dosing Methods Sticky Notes has a section towards the end talking about diet and recommending low carb wet. Later on in the article the section on acromegaly also talks about using R with the L insulins.

More from Dr. Rand Managing Feline Diabetes: current perspectives (2018) has a section on diet.

And besides, even if the vet recommends junk food, it doesn't mean you have to buy it.
 
FWIW. There are 2 Purina DM foods. The pate I believe is 4% carbs, at least not more than 6%. The other one is Savory DM and that has gravy and is shredded food, it's high in carbs. The dry of course is way to high. Smokey actually liked the DM, but he pretty much are anything.

I just got FF Pate Senior 7+ wet food. Beef flavor. Ingredients do not look to bad. And it's coming in under 2%. I am waiting for confirmation from company. So far so good though.
 
Wendy&Neko said:
Diabetic cat diet suggests that canned food is superior but if necessary there are dry foods. I know there is a section to that VIN website is more on natural treatments. I've been at my vet's office when she's browsed that with me. It does require a subscription.

Vetstreet also has a good article recommending wet foods and against prescription foods, especially dry. Feeding the Diabetic Cat.

The article Management of Diabetic Cats that is linked in the Dosing Methods Sticky Notes has a section towards the end talking about diet and recommending low carb wet. Later on in the article the section on acromegaly also talks about using R with the L insulins.

More from Dr. Rand Managing Feline Diabetes: current perspectives (2018) has a section on diet.
Click to expand...

Thank you, Wendy.

As I remember, it was an official organization like the American Veterinary Association or something like that, but the name was more complicated than that.

EDIT: Now I remember that it was a professional journal of veterinary medicine.

I will look at what you sent and share with vets.
 
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Wendy&Neko said:
Out of curiosity, what are they doing at the vet that you couldn't be doing at home?
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Good question! If I listened to the vet every time Djoko is having a flare-up, he would be staying at the vet overight for iv fluid and would cost more than 1,000$.
I did it the first two times and I stopped (unless it would last more than 24 hours).
 
Saturday evening report from vet:

Maxi is doing quite well. He is less scared and comes out to see them when they approach him, doing his signature loud purr.
They've started holding back on the dry food as he's eating so much of it. She called him a social eater. Yesterday he would not eat the canned food I brought. I brought more kinds this morning. They will try to get him to eat that instead of dry tonight.

He hasn't had a bowel movement (no diarrhea!). Is peeing, but not excessively.

He *is* still on IV fluids.

They find the Freestyle Libre to be accurate.
His glucose is in the 400s at the last measurement (200s earlier today). They will give him Lantus this evening.

They just SMSed me saying he is "so happy about snuggle time and interested to see what's going on" with a photo of him looking good, peering out of his big dog crate surround by soft, comfy-looking things.

Vet said he will probably go home Monday and after a week we'll talk about octreotide.
 
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Glad you’ve gotten a good report!

When you have a sick cat, the best food for them is the one they will eat. If they can coax him to eat what you brought as he is feeling better, great, but anorexia is not ok so you may have to roll with the dry for now. I will say I disagree about feeding the prescription diet food if he will eat his regular canned food. The ingredients are not good and there is no data that supports it as being better than feeding a LC food with better ingredients. I wouldn’t worry about the protein insofar as CKD. It’s old school that CKD cats should have a low protein diet.

You don’t need to justify why you don’t want to feed the prescription diet food. I’d just tell the vet that the ingredients are not what you prefer him to have. Many of these vets are hard-wired to feed prescription diets. He’s your cat. Be polite and respectful but firm.

I also have no opinion in the Libre. I’ve seen the same info that Wendy has. Here is a thread that discusses what some members have found.

Sending more vines. Get as much sleep as you can while he’s visiting the vet!
 
tiffmaxee said:
This is wonderful news. @Brittanyb5353 is new here. Her cat is on her second Libre if you want to ask her about it. She hasn’t done any testing herself yet.
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That's right - I'm happy to help answer any questions you have on the device, we've had a great run with it so far and am on the 2nd one with Bijoux who was diagnosed in the beginning of April. It's been so helpful and she doesn't seem to mind it at all. Also has given me piece of mind as we've found the right dosing for Bijoux.
 
Brittanyb5353 said:
That's right - I'm happy to help answer any questions you have on the device, we've had a great run with it so far and am on the 2nd one with Bijoux who was diagnosed in the beginning of April. It's been so helpful and she doesn't seem to mind it at all. Also has given me piece of mind as we've found the right dosing for Bijoux.
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Thanks, Brittany! I'm glad Bijoux is doing well. Are you implementing Tight Regulation protocol?
 
bambinaki said:
Thanks, Brittany! I'm glad Bijoux is doing well. Are you implementing Tight Regulation protocol?
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Hi there - I am doing SLGS given how Bijoux is responding to insulin as well as her diet changes (she fully switched from dry Science Diet kibble to Tiki Cat wet food only). And I think it would depending on what time you're giving the shot. I usually will feed/shoot around 7:30-7:45 and then get her numbers at +1 and +2 as well as right before bed around +4 or +5. Depending on how those are looking I'll know if I have to stay up longer or set an alarm to wake up test - I can also usually kind of monitor her vitals and physical symptoms to see how we're doing. As I see here on the board a lot, ECID (every cat is different) and it couldn't be more true! You'll have to adapt a bit depending on how your kitty responds and make it most comfortable/stress free for you both. Happy to answer any other questions you have!
 
Brittanyb5353 said:
Hi there - I am doing SLGS given how Bijoux is responding to insulin as well as her diet changes (she fully switched from dry Science Diet kibble to Tiki Cat wet food only). And I think it would depending on what time you're giving the shot. I usually will feed/shoot around 7:30-7:45 and then get her numbers at +1 and +2 as well as right before bed around +4 or +5. Depending on how those are looking I'll know if I have to stay up longer or set an alarm to wake up test - I can also usually kind of monitor her vitals and physical symptoms to see how we're doing. As I see here on the board a lot, ECID (every cat is different) and it couldn't be more true! You'll have to adapt a bit depending on how your kitty responds and make it most comfortable/stress free for you both. Happy to answer any other questions you have!
Click to expand...

Thanks, Brittany.
I hope Bijoux continues to do well.
 
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