4/30 Silver in the hospital

[Juliet]

http://www.felinediabetes.com/FDMB/...8-scared-i-am-losing-him.194837/#post-2181081

Thought I'd better start a new condo. Vet not in for another hour so I left Silver with the vet tech and admitted him to the hospital. Home now with Sasha waiting for the phone to ring. I've never seen Silver looking so miserable. I've not heard from my work but as this is my fifth sick day this year I don't think they'll be happy especially as it's month end billing.

 

[Juliet]

Question. Is bupe meant to be in the fridge?

 

[Gill & George]

Keeps us posted when you can. Keeping all paws crossed for your boy.
Sending prayers and vines.

 

[Gill & George]

Question. Is bupe meant to be in the fridge?

According to this site https://www.uofmhealth.org/health-library/d00840v1
it should be stored at room temp

 

[Shawna & Davidson (GA)]

Sorry to hear about Silver, paws crossed for a speedy recovery

 

[Juliet]

According to this site https://www.uofmhealth.org/health-library/d00840v1
it should be stored at room temp

Thanks. Thought I'd better check. I hope the vet knows what to do - what to look for. I am really hoping this is connected to his teeth. I am pretty sure this is DKA given the HI reading on the meter and if it's not connected to the dental then o don't know why two incidents of DKA in the same month. What am I doing wrong??

 

[Kris & Teasel]

Question. Is bupe meant to be in the fridge?

I don't think it's necessary but I was told specifically to keep it out of light as much as possible. There's a sticker to that effect on my bottle.

 

[Judy and Boomer]

Question. Is bupe meant to be in the fridge?

I don't think so? But I believe I was told to keep it in a dark place.

 

[Gill & George]

I don't think it's necessary but I was told specifically to keep it out of light as much as possible.

I don't think so? But I believe I was told to keep it in a dark place.

The link I supplied above says the same Room Temp and away from direct sunlight.

 

[Juliet]

I don't think it's necessary but I was told specifically to keep it out of light as much as possible. There's a sticker to that effect on my bottle.

That's fine then. I'm in a basement. Don't get much light.

 

[Mandy & Rex (GA)]

 

[Gill & George]

Thanks. Thought I'd better check. I hope the vet knows what to do - what to look for. I am really hoping this is connected to his teeth. I am pretty sure this is DKA given the HI reading on the meter and if it's not connected to the dental then o don't know why two incidents of DKA in the same month. What am I doing wrong??

I do believe that it may well be related to the teeth. The bad teeth were likely infected and post op a little of the bacteria were more than likely still hanging around. Another thing I would wonder about is if his UTI is all cleared up, they can be difficult to get rid of. Throw into the mix, Silver going off his food( and as a result not getting enough calories), stress of the op, post op inflammation, elevated BG, recent episode of DKA/Ketones .....it's all a recipe for it happening again.

The symptoms signs I've listed above should become a red flag to you going forward.
I like @Stacy & Asia suggestion of having some cerenia at home, in a cat that is prone to developing Ketones it is important to make sure they get their insulin, and also get enough calories, so having something at home to hand when they go off their food out of normal working hours can be a godsend, as you have seen the situation can go from moderate to Hi in the blink of an eye, and of course it is always going to happen at the most inconvenient time.
Perhaps having a DKA kit for Silver, feeding syringe, cerenia, high calorie food that he will eat, baby food (meat variety without onions/garlic/spices)... (there is probably more that you can think to add to that list)

Perhaps ask the vet why they believe it's happened again??

 

[Bobbie And Bubba]

Keep us posted about Silver. I know how stressed out this must make you. If it is not teeth related, sometime surgery stress throws them into developing ketones. After teeth extractions and then 6 weeks later his eye was removed was when the ketones started.

 

[Juliet]

I do believe that it may well be related to the teeth. The bad teeth were likely infected and post op a little of the bacteria were more than likely still hanging around. Another thing I would wonder about is if his UTI is all cleared up, they can be difficult to get rid of. Throw into the mix, Silver going off his food( and as a result not getting enough calories), stress of the op, post op inflammation, elevated BG, recent episode of DKA/Ketones .....it's all a recipe for it happening again.

The symptoms signs I've listed above should become a red flag to you going forward.
I like @Stacy & Asia suggestion of having some cerenia at home, in a cat that is prone to developing Ketones it is important to make sure they get their insulin, and also get enough calories, so having something at home to hand when they go off their food out of normal working hours can be a godsend, as you have seen the situation can go from moderate to Hi in the blink of an eye, and of course it is always going to happen at the most inconvenient time.
Perhaps having a DKA kit for Silver, feeding syringe, cerenia, high calorie food that he will eat, baby food (meat variety without onions/garlic/spices)... (there is probably more that you can think to add to that list)

Perhaps ask the vet why they believe it's happened again??

I will ask those things. He didn't have a UTI tho that was confirmed. I thought Cerenia was anti nausea? We don't know he was feeling nauseous. I think his teeth hurt and he didn't want to eat so what would Cerenia do for him?

I tried to force feed him yesterday. It does not work and he won't accept it. If he ever goes off food again I'll take him right back to the vet as I did. I could have taken him to the out of hours clinic last night but I was holding off to see how the night went. He would have had to have been moved from that clinic at 8am and, at that point, did not see the logistics of trying to switch him from one vet to another and get to work. I have high calorie food that he loves - Recovery from the vet. But he wouldn't even take that. Not even sardines at the end. I did everything I could have done for him.

 

[Juliet]

Keep us posted about Silver. I know how stressed out this must make you. If it is not teeth related, sometime surgery stress throws them into developing ketones. After teeth extractions and then 6 weeks later his eye was removed was when the ketones started.

Am waiting for a call from the vet. I hope they know. The vet didn't know why he developed DKA in the first place given the amount of insulin he's on. I'm not hopeful they know what to do.

 

[Tracey&Jones (GA)]

I have no experience with DKA so that is all I can offer right now.

Healing vines for Silver.

 

[Cyndy]

I hope the vet will tell you soon what's happening and that Silver is alright.

 

[Kris & Teasel]

I suspect they can't always find a specific cause to point to if DKA arises. It's probably a function of an individual cat's response to stress, infection, inappetance and propensity to develop ketones. What isn't a problem for one cat can send another into ketosis just as they vary a lot in their carb sensitivity, responses to insulin, proneness to pancreatitis, and so on.

 

[Juliet]

Just had a call from the vet. He sounds clueless to me to be honest. He says he's dehydrated and needs fluids. He wasn't dehydrated on Wednesday when he had the dental and I've been putting a tonne of water in his food so what more can I do?

He said he has an infection in the socket where the tooth came out and is giving me antibiotics.

He says he's not getting nearly enough insulin. Then he weighed silver and said he should be getting ten units per day for his weight. He is already on 5.25u and he said he's not getting nearly enough.

Okay guys now I need your input. I think this guy has done nothing useful except we now know there is an infection and therefore this is likely DKA. Again. The vet would not say it's DKA and shied away from that term. I specifically asked about the ketones and he said that due to not enough insulin. We know that's not the only factor. I am on my way down there now with his insulin and they were aging to take him home with bag of fluids but I am not sure I want to take him home when he is that sick. I mentioned the use of short acting insulin but he didn't bite. Pleas someone help.

 

[carfurby (GA)]

I hope the vet can get the right treatment for Silver and get him feeling better soon. Sending prayers.

 

[carfurby (GA)]

It does sound like the infection in his mouth is the cause of the problems. I'm not sure about the ketones. I don't really know anything about DKA. I would not raise his insulin that much. That would be dangerous and most likely cause a hypo episode. That is a huge jump.

 

[Kris & Teasel]

Then he weighed silver and said he should be getting ten units per day for his weight.

We all know that this is not the way Lantus dosing is determined when kitty has been on it for some time.

He said he has an infection in the socket where the tooth came out and is giving me antibiotics.

This is a good thing.

The vet would not say it's DKA and shied away from that term.

Lethargy - check. Inappetance - check. Dehydration - check. Infection - check. High blood ketones - check. I'm not sure what other criterion has to be met for a diagnosis.

I am not sure I want to take him home when he is that sick.

I wouldn't take him home if it was my kitty. Ignoring cost for now, he needs proper treatment that you can't provide at home.

 

[LuanneP]

I'm sorry you & Silver are going through this

The vet said 10 units per DAY and Silver is getting 5.25 units twice per day so he's in that range. Or did the vet mean 10 units twice per day? I don't think I'd make that big a jump, that doesn't sound safe at all. If you leave Silver there I would make sure they are *not* going to double his insulin dose.

Hopefully when the antibiotics kick in the Ketones will start to go away.

 

[Nan & Amber (GA)]

Can you talk to the DCIN folks? I'm wondering if it's worth trying to find another vet that is more on top of things. That dosage recommendation is a) probably based on some canine formula (dogs can usually be dosed by weight), and b) crazy-high. Silver may indeed need more insulin than what he is currently getting, but that is too big a jump.

 

[Kris & Teasel]

Here's a very technical vet-oriented paper:
https://www.vin.com/apputil/content/defaultadv1.aspx?id=5709925&pid=11372&print=1

 

[Juliet]

It does sound like the infection in his mouth is the cause of the problems. I'm not sure about the ketones. I don't really know anything about DKA. I would not raise his insulin that much. That would be dangerous and most likely cause a hypo episode. That is a huge jump.

I think you misunderstood. He didn't mean ten units twice a day. He meant in total. He obviously didn't check that he is on more than that already.

 

[Kris & Teasel]

I'm sorry you & Silver are going through this

The vet said 10 units per DAY and Silver is getting 5.25 units twice per day so he's in that range. Or did the vet mean 10 units twice per day? I don't think I'd make that big a jump, that doesn't sound safe at all. If you leave Silver there I would make sure they are *not* going to double his insulin dose.

Hopefully when the antibiotics kick in the Ketones will start to go away.

Thanks for pointing out 10 units PER DAY. I missed that.

 

[Kris & Teasel]

Also - what formula is used to come up with a daily total like that?

 

[carfurby (GA)]

I think you misunderstood. He didn't mean ten units twice a day. He meant in total. He obviously didn't check that he is on more than that already.

I did read that wrong. I'm glad he doesn't want you to increase that much. That scared me.

 

[Juliet]

Can you talk to the DCIN folks? I'm wondering if it's worth trying to find another vet that is more on top of things. That dosage recommendation is a) probably based on some canine formula (dogs can usually be dosed by weight), and b) crazy-high. Silver may indeed need more insulin than what he is currently getting, but that is too big a jump.

It's too late for new vet now. He is already here and being treated. Believe me. I won't find a vet that has a clue. I've been to several. Don't like them. But I think I will leave him here 24 hrs and get him stable. Then they will send me home with fluids and antibiotics.

 

[Kris & Teasel]

This is from the Vetsulin site but it's clear and concise:
http://www.vetsulin.com/vet/Cats_Diagnosis_Ketoacidosis.aspx

 

[Kris & Teasel]

It's too late for new vet now. He is already here and being treated. Believe me. I won't find a vet that has a clue. I've been to several. Don't like them. But I think I will leave him here 24 hrs and get him stable. Then they will send me home with fluids and antibiotics.

You can only do so much - and you're doing that.

 

[Stacy & Asia]

Am waiting for a call from the vet. I hope they know. The vet didn't know why he developed DKA in the first place given the amount of insulin he's on. I'm not hopeful they know what to do.

The amount of insulin he is on is relative, it doesn’t matter how much, it matter if it’s enough, I don’t understand your vets logic there one bit. Pig is on like 50 units twice a day, that could be enough for Pig whereas 47 might not be and if Pig were ketone prone, even on 47 units of insulin ketones could develop. Silver’s numbers are still pretty high, I can’t remeber if you switched back to the more accurate meter or not, but remeber all those yellows were pink on the more accurate meter. Curious what his lab BG will be at the vet.

What’s done is done and you can’t beat yourself up over woulda, shoulda, coulda, you did what you thought was best at the time, but you can take measures to prevent this as much as that is possible in the future. I love @Gill & George ’s idea about a DKA kit.

I know you want to trust your vet, but I’m so very wary that he hasn’t been concerned over your ketone readings this whole time and discouraged you from checking for them. Just because he may not be on top of one thing doesn’t mean he’s not useful or you can’t work with him. You don’t have to have 100% faith in a vet to have a good vet, and even if you have an amazing vet, nothing wrong with sharing your own concerns and things you’ve learned so you can be a good team and work together to help Silver.

Going forward, he needs lots of calories, like lots, even if it raises his insulin needs, it will balance out. Lots of calories until such time as ketones are nil and perhaps even a bit past that. Leave food out always when you are at work and sleeping, high calorie food, heck even high carb food for the immediate future. He does need more insulin, but it’s your job to do a curve before an increase so you can make reasonably sure he’s not going too low, don’t assume, especially when new things are in the mix like a dental or possible infection/inappetance. Having things on hand to help in crisis, like the DKA kit: different food options, feeding syringe, fluids, Cerenia, appetite stimulant, pain meds, extra ketone strips, water in his food, food enticements (temptations, freeze dried treats, catnip, parm cheese, FortiFlora, whatever will work for when he isn’t eating and many options to try). If you know something (like a dental with extractions) has a reasonable potential for infection while he is already having ketones, insist/beg/haggle do what you have to do to get a preventive antibiotic (and have some probiotics on hand to help with the side effects). All this because an ounce of prevention is worth a pound of cure.

Many people with DKA experience have shared with you, take the suggestions to heart that they are only trying to save you from some of the bad experiences they have dealt with, it’s never meant to criticize or discount your situation. Do what you can do and if it’s not in your wheelhouse, toss the advice to the side but know that it’s all coming from a loving place.

Piling on more vines to you and Silver. I hope you get an update soon and Silver is doing better.

 

[Gill & George]

I thought Cerenia was anti nausea? We don't know he was feeling nauseous. I think his teeth hurt and he didn't want to eat so what would Cerenia do for him?

It's not uncommon to feel nausea after anesthetic. I felt really sick after surgery, for about 24hours. Also as Silver vomited last night, I assumed he was feeling nauseous??

But it's more to have on hand for the future, as nausea can be one of the reasons a cat may not want to eat, and the electrolyte imbalance that results from DKA can also make them nauseous. And in Silver's case the not eating is one of the 'ingredients' that contributes to DKA.

I

 

[Juliet]

The amount of insulin he is on is relative, it doesn’t matter how much, it matter if it’s enough, I don’t understand your vets logic there one bit. Pig is on like 50 units twice a day, that could be enough for Pig whereas 47 might not be and if Pig were ketone prone, even on 47 units of insulin ketones could develop. Silver’s numbers are still pretty high, I can’t remeber if you switched back to the more accurate meter or not, but remeber all those yellows were pink on the more accurate meter. Curious what his lab BG will be at the vet.

What’s done is done and you can’t beat yourself up over woulda, shoulda, coulda, you did what you thought was best at the time, but you can take measures to prevent this as much as that is possible in the future. I love @Gill & George ’s idea about a DKA kit.

I know you want to trust your vet, but I’m so very wary that he hasn’t been concerned over your ketone readings this whole time and discouraged you from checking for them. Just because he may not be on top of one thing doesn’t mean he’s not useful or you can’t work with him. You don’t have to have 100% faith in a vet to have a good vet, and even if you have an amazing vet, nothing wrong with sharing your own concerns and things you’ve learned so you can be a good team and work together to help Silver.

Going forward, he needs lots of calories, like lots, even if it raises his insulin needs, it will balance out. Lots of calories until such time as ketones are nil and perhaps even a bit past that. Leave food out always when you are at work and sleeping, high calorie food, heck even high carb food for the immediate future. He does need more insulin, but it’s your job to do a curve before an increase so you can make reasonably sure he’s not going too low, don’t assume, especially when new things are in the mix like a dental or possible infection/inappetance. Having things on hand to help in crisis, like the DKA kit: different food options, feeding syringe, fluids, Cerenia, appetite stimulant, pain meds, extra ketone strips, water in his food, food enticements (temptations, freeze dried treats, catnip, parm cheese, FortiFlora, whatever will work for when he isn’t eating and many options to try). If you know something (like a dental with extractions) has a reasonable potential for infection while he is already having ketones, insist/beg/haggle do what you have to do to get a preventive antibiotic (and have some probiotics on hand to help with the side effects). All this because an ounce of prevention is worth a pound of cure.

Many people with DKA experience have shared with you, take the suggestions to heart that they are only trying to save you from some of the bad experiences they have dealt with, it’s never meant to criticize or discount your situation. Do what you can do and if it’s not in your wheelhouse, toss the advice to the side but know that it’s all coming from a loving place.

Piling on more vines to you and Silver. I hope you get an update soon and Silver is doing better.

Good advice but you're forgetting many things. I can't leave food out for him. I told you guys that over and over. I am already giving him high calorie food. I didn't cause this DKA and your message infers I did. He has a infection after the dental. Not my doing. I did and am doing all I can. I can't do what I can't do and leavin food out is one of those things. Don't push doe something I can't do.

Right now I have dropped off insulin. Vet is giving it regardless of the fact he hasn't eaten as he registers 17.7 at vet. You guys multiple the calculation. Don't have calculator here for US conversion.

He will send me home later with fluids and antibiotics. I am pretty sure once his mouth infection is fixed then he will be fine as his ketones has already drastically reduced before this infection.

I am heading home for the day and Silver is getting subq fluids and insulin for now. I could have done that at home but I don't want him home until he is stable so he may stay here until I get home from work tomorrow night.

 

[Juliet]

It's not uncommon to feel nausea after anesthetic. I felt really sick after surgery, for about 24hours. Also as Silver vomited last night, I assumed he was feeling nauseous??

But it's more to have on hand for the future, as nausea can be one of the reasons a cat may not want to eat, and the electrolyte imbalance that results from DKA can also make them nauseous. And in Silver's case the not eating is one of the 'ingredients' that contributes to DKA.

I

I believe all this is caused by the tooth infection.

 

[Kris & Teasel]

Best advice ever from @Stacy & Asia. I went through a DKA episode with my guy two months after his diagnosis. He had NO infection at the time, had missed only two insulin doses (another story), lost his appetite and went from zero to high ketones in maybe 12 hours. My clinic is a big vet hospital with 24 hour ER/ICU and they're well equipped to deal with complex situations like this. My vet stressed to me the absolute seriousness of high ketones and outlined the many interventions that would be needed to get Teasel moving in the right direction. It took three days to stabilize him and when I visited him I could see that he was a very sick boy. Not for a single moment did they downplay any of the symptoms he had and certainly not the elevated ketones. I'm very lucky that he came through it.

 

[Kris & Teasel]

I believe all this is caused by the tooth infection.

Very likely the tipping point.

 

[Amy&TrixieCat]

Hopefully the tooth infection is the root of the cause here, but it's good to tuck away all the knowledge that everyone is sharing for future reference, just in case. Unfortunately, some kitties simply are prone to developing ketones, and there really is no what to know for sure if Silver is one of those kitties or not until a fair amount of ketone-free time has passed. It would be better to be prepared and never have to use the supplies and knowledge than to be caught off guard if Silver decides to throw ketones again at some random time in the future. And remember, everyone is sharing experience and knowledge out of love and caring!

Many prayers that the AB kicks in quickly.

 

[Juliet]

Hopefully the tooth infection is the root of the cause here, but it's good to tuck away all the knowledge that everyone is sharing for future reference, just in case. Unfortunately, some kitties simply are prone to developing ketones, and there really is no what to know for sure if Silver is one of those kitties or not until a fair amount of ketone-free time has passed. It would be better to be prepared and never have to use the supplies and knowledge than to be caught off guard if Silver decides to throw ketones again at some random time in the future. And remember, everyone is sharing experience and knowledge out of love and caring!

Many prayers that the AB kicks in quickly.

I already have the supplies but he would not be force fed. He was not nauseous and vet didn't say Cerenia would be a good plan for now. He wants the antibiotics and dehydration sorted. I'm not going to argue with the vet. I do not have the strength for that. I have to and must trust him. The only thing I will not flatly do is raise his insulin in too big a jump. I won't take him home until he is eating and stable. Once that is in place then likely he will be fine again. It is the dental that caused this. I was advised to get a dental done in case infection caused DKA now it's the dental that's now caused an infection. So I am confused, upset and ready to trust the vet to get him better for now. I need to sign off for a few hours. I am physically and emotionally exhausted. I will check back in tonight once I hear again from the vet. The advice is great but I can't take in anymore. No one knows my cat but me. I can't leave food out. I can't do anymore for him than I have been doing and I hate that I am being made to feel I have failed him.

A DKA kit is no good @Kris & Teasel @Stacy & Asia if he won't be force fed. The vet will not prescribe Cerenia and I don't feel it's needed as nausea has not been confirmed. I have a 24 hour vet available and I will just take him to vet if his appetite goes and ketones run high. I have the fluids and I will continue to put water in his food. I did that before and he was no longer dehydrated. This episode is purely down to the dental infection.

 

[carfurby (GA)]

I hope you get some good news from the vet soon. You are doing your best for Silver. Take some time to rest with Sasha. Sending prayers.

 

[Stacy & Asia]

Good advice but you're forgetting many things. I can't leave food out for him. I told you guys that over and over. I am already giving him high calorie food. I didn't cause this DKA and your message infers I did. He has a infection after the dental. Not my doing. I did and am doing all I can. I can't do what I can't do and leavin food out is one of those things. Don't push doe something I can't do.

I remember many things about your situation, sure it’s possibly I forgot one or two, but I think I got most of it down. I know you generally can’t leave food out for him because you’re concerned his sister will eat it and she has a weight issue. But this is an immediate crisis. You’ve also said you’re reasonably sure Silver will beat her to the food bowl. So at least until ketones are in the rear view, or anytime ketones are in the picture, leave food out if you think Silver having ketones at that time trumps his sister gaining a couple ounces, that’s all I’m saying.

I’m not blaming you for anything, Juliet, I promise you, nor am I implying this is all your fault, there is no point in doing that and it’s not at all my intention. I’m merely restating some suggestions that have been given before (that conflicted with your vet) which will prove useful going forward to prevent ketones in the future since the ways your vet suggested to do that didn’t pan out the way we all hoped for. You were following your vets instructions and nobody will fault you for that, we all want to believe our vet knows best. Your vet didn’t want you to give higher calorie or higher carb food, he only wanted you to increase the insulin. He didn’t want you to be concerned with the readings, only the symptoms. You did what you thought was best and you listened to him, I think most of us have been in that situation, it’s completely understandable. Don’t know many people here who didn’t start their FD journey shooting blind. We are only human and we do the best we can and are apt to trust people (vets) with expertise in a field we do not have expertise in. That goes double when your vet has FD cats so you really trust they know what they are talking about.

I’m only using recent references like the food or the dental to illustrate how you can be proactive in preventing episodes in the future based on the many DKA experiences here that may conflict with how your vet handles things. He could develop UTI symptoms, for example, and no bacteria grows in the urine culture (which doesn’t mean no infection is possible), so vet says no antibiotics. (Real example, this happened exactly to Asia a couple weeks ago). If you know he is ketone prone and this happens, or say he has ketones the same time as the UTI symptoms, you know that you need to be heard by your vet that your concern of infection outweighs the lack of concrete proof of bacteria and you make a strong case to get the antibiotics (and hope you are successful in your efforts). DKA is a worse risk than unnecessary antibiotics.

 

[Amy&TrixieCat]

No one is saying you've failed him at all. Things can happen very quickly and very out of our control. Sometimes there are subtle warning signs, and that is what folks are sharing their experience with - all in an effort to assist (both now and for the future) and nothing more. As you've mentioned, you know Silver best. This weekend, he shared very important information with you - signs to watch out for if an issue with ketones is on the horizon.

It may or may not be the dental that caused this. He was throwing ketones before the procedure, so until this infection is cleared up and he's been ketone free for a while, it's important to remember he MAY - hopefully not - but may decide to throw ketones again. Or maybe not. It's unfortunately one of those unpleasant unknown issues that can come with FD.

Any cat who is vomiting and refusing to eat is doing so because he or she is nauseated. I know the vet hasn't mentioned Cerenia, but having some on-hand, just in case, is an excellent idea. There is no harm in asking the vet to prescribe it - you won't be questioning his skills at all.

Everyone truly is here for you and Silver.

 

[Juliet]

I remember many things about your situation, sure it’s possibly I forgot one or two, but I think I got most of it down. I know you generally can’t leave food out for him because you’re concerned his sister will eat it and she has a weight issue. But this is an immediate crisis. You’ve also said you’re reasonably sure Silver will beat her to the food bowl. So at least until ketones are in the rear view, or anytime ketones are in the picture, leave food out if you think Silver having ketones at that time trumps his sister gaining a couple ounces, that’s all I’m saying.

I’m not blaming you for anything, Juliet, I promise you, nor am I implying this is all your fault, there is no point in doing that and it’s not at all my intention. I’m merely restating some suggestions that have been given before (that conflicted with your vet) which will prove useful going forward to prevent ketones in the future since the ways your vet suggested to do that didn’t pan out the way we all hoped for. You were following your vets instructions and nobody will fault you for that, we all want to believe our vet knows best. Your vet didn’t want you to give higher calorie or higher carb food, he only wanted you to increase the insulin. He didn’t want you to be concerned with the readings, only the symptoms. You did what you thought was best and you listened to him, I think most of us have been in that situation, it’s completely understandable. Don’t know many people here who didn’t start their FD journey shooting blind. We are only human and we do the best we can and are apt to trust people (vets) with expertise in a field we do not have expertise in. That goes double when your vet has FD cats so you really trust they know what they are talking about.

I’m only using recent references like the food or the dental to illustrate how you can be proactive in preventing episodes in the future based on the many DKA experiences here that may conflict with how your vet handles things. He could develop UTI symptoms, for example, and no bacteria grows in the urine culture (which doesn’t mean no infection is possible), so vet says no antibiotics. (Real example, this happened exactly to Asia a couple weeks ago). If you know he is ketone prone and this happens, or say he has ketones the same time as the UTI symptoms, you know that you need to be heard by your vet that your concern of infection outweighs the lack of concrete proof of bacteria and you make a strong case to get the antibiotics (and hope you are successful in your efforts). DKA is a worse risk than unnecessary antibiotics.

No that's not correct. Vet didn't say not to feed high calorie or high carb food. Vet did not say to ignore ketones he said to focus on bringing his BG down (which would reduce the ketones). Hard to get everything down in the written word. The leaving food out issue - I have no clue or guarantee Silver will get it. So leaving food out will likely mean Sasha will eat it as she now tries to push Silver out of the way to get his food once she's done hers. So I can't put food out and have her eat it or I have her in the hospital. You have to understand my situation. Or at least try.

 

[Juliet]

No one is saying you've failed him at all. Things can happen very quickly and very out of our control. Sometimes there are subtle warning signs, and that is what folks are sharing their experience with - all in an effort to assist (both now and for the future) and nothing more. As you've mentioned, you know Silver best. This weekend, he shared very important information with you - signs to watch out for if an issue with ketones is on the horizon.

It may or may not be the dental that caused this. He was throwing ketones before the procedure, so until this infection is cleared up and he's been ketone free for a while, it's important to remember he MAY - hopefully not - but may decide to throw ketones again. Or maybe not. It's unfortunately one of those unpleasant unknown issues that can come with FD.

Any cat who is vomiting and refusing to eat is doing so because he or she is nauseated. I know the vet hasn't mentioned Cerenia, but having some on-hand, just in case, is an excellent idea. There is no harm in asking the vet to prescribe it - you won't be questioning his skills at all.

Everyone truly is here for you and Silver.

The only reason this happened is the dental. AS SOON AS the warning signs appeared I was at the vet. I live alone with the cat. I immediately see when something is off. The dental was a bad idea.

 

[Juliet]

No one is saying you've failed him at all. Things can happen very quickly and very out of our control. Sometimes there are subtle warning signs, and that is what folks are sharing their experience with - all in an effort to assist (both now and for the future) and nothing more. As you've mentioned, you know Silver best. This weekend, he shared very important information with you - signs to watch out for if an issue with ketones is on the horizon.

It may or may not be the dental that caused this. He was throwing ketones before the procedure, so until this infection is cleared up and he's been ketone free for a while, it's important to remember he MAY - hopefully not - but may decide to throw ketones again. Or maybe not. It's unfortunately one of those unpleasant unknown issues that can come with FD.

Any cat who is vomiting and refusing to eat is doing so because he or she is nauseated. I know the vet hasn't mentioned Cerenia, but having some on-hand, just in case, is an excellent idea. There is no harm in asking the vet to prescribe it - you won't be questioning his skills at all.

Everyone truly is here for you and Silver.

The only reason he refused to eat was mouth infection. And the vet will not prescribe Cerenia.

 

[Mandy & Rex (GA)]

Would a feeder like the SureFeed microchip/tag pet feeder be helpful in letting Silver eat when he needs to eat, yet keeps Sasha away? I know it's pricey, but I'm sure we could help in some way!

 

[Tracey&Jones (GA)]

That is a 319 at the vet clinic. I hope those AB's work quickly to get that infection under control. He wasn't given any AB's to go home with was he?


To me any one with an FD kitty should have some cerenia on tap....up and down BG's can be make you feel icky.

The dental was a good idea...he had an issue...you addressed it...unfortunately it got infected...not sure why but there it is. Maybe your vet should of sent some proactive AB home since there was issues with his BG's as he acknowledges (forget the DKA). That is all hindsight.

As it is now, let the vet know he is on 10.5 units a day so that is not the issue and he needs to dig into his medical books for other answers. Others, I think you know the drill. Hydration, high calorie food and keep giving him insulin.


Juliet, please take a moment and catch your breath. If you are home go grab a cup of tea.

 

[Gill & George]

I believe all this is caused by the tooth infection.

I agree, there is always something that will knock them over the edge. (if it's not one thing it's another)

Why do you/the vet think he vomited last night? Perhaps a question to ask.
I just know that when I vomit I usually feel nauseous before hand, don't you?

Don't worry about answering now, but please give it some consideration, obviously a long, very stressful, emotional night for you, so get some rest while Silver is being cared for.

Hope that when you are more rested and read through the recommendations, you can see the reason for them.

We want to Help You, help yourself and Silver, avoid a repeat situation. As Stacey points out above, the vet's recommendations, which you followed, (understandably) ultimately resulted in a critical situation. You were not worried by the moderate ketones that appeared 4/26 just a day after surgery, because the vet told you not to be concerned. Perhaps ask the vet what you and he could do different to avoid being(as much as possible) in this situation again.
The collective experience here has been that ketones need to be taken seriously, anything above trace, especially if cat has had DKA before, or is off in any way at all, has had infection, inflammation, surgery, is not eating (doesn't matter why).

 

[Kris & Teasel]

Take some time away from the forum, rest up as well as you can, think about what's been said here and the positive intentions behind it. I speak from personal experience here: sometimes we have to think outside the boxes we build around things. We do things a certain way, are certain we're doing it correctly given the constraints we live with and, one day, for whatever reason/circumstance, we're forced to try something else and we find out that 1. it helps, 2. you learn something new that works.

BTW - the most likely factor that pushed Teasel over the edge into DKA: my vet wanting to stop Lantus for 48 hours in an attempt to "reboot" his response to it after a very unsatisfying 2 months of doing weekly curves and not being able to figure out his dosing. Do I know NOW why that approach didn't work? Yes. Do I know NOW how to dose him as effectively as I can, given his trickiness? Yes. Did I fault my vet for causing this? No. She was trying hard with the level of knowledge she had which, at the time, exceeded mine. I've outstripped hers for sure at this point. She knows that I've taken his FD treatment upon myself and she trusts my judgment. I have periodic conversations with her to tell her what I'm doing and what I've learned.