Dorothy - Vocalizing & Water Splashing

I'm new here but not new to feline diabetes. One of my prior cats had diabetes well managed for several years.

However, my senior cat, Dorothy, needs some help. Quick background - she's 22, has had IBD for several years. In the last year, she was diagnosed with hyperthyroidism which we've been managing. This last December, she was also diagnosed with diabetes. Up until the last week, we'd been managing her with 1u glargine twice a day. In the last month, she was regularly between 120 and 200 when checking twice daily.

In the last week, she's suddenly stopped eating well. And now, almost at all. In addition, the last few days her glucose values have been jumping into the 300-400 range. I'm thinking she has some low level pancreatitis, but is not vomiting or having lose stools. Not painful to the touch. 5ps are all good. We started her on Cerenia and Entyce in the last few days, but her eating has gotten worse. She won't touch her home cooked food which she's eaten for over a decade. But she will gobble down some crunchy cat treats.

I'm not sure where to go from here and could use some advice. More detailed info:

Dorothy (22 years)
Medications:
Insulin - 1u/2x
Budesonide - 1ml/1x
Methimazole - Hyperthyroidism 0.1ml/2x Ear
Denamarin – Liver 1 pill/1x
Viralysis – URI scoop 3x
Dasuquin - Joints/Arthritis 1 pill/1x
Zylkene - 1 pill/1x
Trixsyn – Joints/Arthritis 1ml/2x
Durlactin – Joints/Arthritis 1 pill/2x
Assisi Loop – Joints/Arthritis 15 minute/1x
Proviable – Probiotic 1pill/1x
Lactulose – Constipation 0.25ml/2x
Gabapentin – Joints/Arthritis 0.5mg/1x
Zobaline - 1 pill/1x Diabetes
Entyce - 0.4ml/2x Appetite
Cerenia - 1/2 tab/1x

Medical Issues:
Diabetes, IBD, Arthritis, Hearing Loss (?), Eye infection (recurrent), Kidney infection (recurrent)

Home Cooked Diet:
3 daily servings – Chicken thigh/chicken liver with fish oil, taurine, calcium carbonate, lite salt, b-complex, Centrum Adult
5 daily servings – Tilapia/salmon with taurine, calcium carbonate, lite salt, b-complex, Centrum Adult

 

My girl - https://photos.app.goo.gl/LXGFbKxR4xQEhnuM9

 

What a beautiful girl and a wonderful age!
Has the vet checked her for an infection of any kind.
Only thing I would suggest is to check for ketones in the urine. Buy a bottle of Ketostix from Walmart or a pharmacy.
Obviously dry food is not great but she does have to eat. She may be associating her home cooked meal with nausea. Try some canned food and see if she will eat that.
Did the vet do any blood tests to check the pancreas or the kidneys?

 

Vet has blood and urine sent out to the lab. Hope to have results tomorrow. Originally they thought UTI since she's had them before, but the food issue seems now like the pancreatitis I dealt with in my other cats in the past. I'll ask about the ketones. There were none when checked in December.

I'm also thinking subQ fluids and maybe some syringe feeding to get her over this hump, hopefully. Is it normal for glucose values to jump with pancreatitis?

She's my golden girl - sweetest animal I've ever had, and happy to do whatever necessary to help her. BTW that video was from just a few days ago. She's really enjoying watching birds on YouTube too. Very engaged too. Just really weird.

 

Yes the BSLs will jump with any type of infection or inflammation.
You may need to assist feed if she wont eat. Ask the vet about Sub Q fluids.
Keep asking questions
There is no need to ask the vet before testing for ketones. Being tested in December has no bearing on a test now. They develop quickly. If Dorothy is not eating I would test for ketones. It is a simple urine test.

 

Have you checked her teeth. They can be the cause of not eating and high BSLs

 

Overnight she refused any food at all. EXCEPT her cat treats which she inhaled. So I'm guessing not teeth. Last check a couple weeks ago, they just saw a little tartar. Taking her back to the vet this morning for additional testing to see what's going on.

 

She may need an injection of cerenia not just the tablets for nausea.
Also ask if you can have some ondansetron tablets for nausea. They act on a different part of the brain for nausea and can be given up to three times a day and also at the same time as cerenia.
Cats must eat so give her whatever she will eat at this point.

 

Went to the vet this morning. No signs of ketones in her urine. Urinalysis from earlier this week showed no growth yet, so not likely UTI. Bloodwork from earlier in the week looks very good - slightly elevated kidney values, but that's been the case for a while now. Need to get the hyperthyroidism better managed, so going to increase her meds. Physical was good. Weight was actually up. No pain to palpation. Clear eyes. No temperature.

Best guess seems to be IBD flare up or pancreatitis. Doc is sending blood to Texas A&M to check for pancreatitis and cobaline levels. Should know middle of next week (I hate how long labs take).

In the meantime, based on our discussion, we gave her a shot of cerenia, shot of buprenex for pain, and a shot of B12. Doc also suggested giving her another food to see if she'll eat (since she was eating treats just fine). Doc sent me home with buprenex, already have cerenia, and sent me home with B12 shots to start in one week. As for the food, he sent me home with Purina ProPlan DM Dietic Management which I'm sure isn't good long term (I'm sure carbs are too high), but since we want her to eat, I gave her a little. She literally devoured it like she hadn't eaten in a week. So, good news, she is eating - she just has NO desire to eat her normal, home-cooked diet.

So, any thoughts? What would be a good low carb canned food that I could pickup at my local Petco/Petsmart? I think we used Merrick's in the past, but wasn't sure if they're still considered a good option? And yes, I know about the chart on catinfo.org, but going through 67 pages of results is kind of confusing. Any experience would be appreciated.

 

Most of the Merrick's are good options - any of the pates or limited ingredient varieties. There are a couple you'll need to stay away from - some Cowboy something, can't recall - but the Turducken, Grammy's Pot Pie, and Thanksgiving Day Dinner are all acceptable and are favorites around here.

 

Great! Good to know - thank you!

 

Here you go - not formatted nicely, but the numbers are %protein, %fat, and %carbs. Anything under 10 is okay.

MERRICK Limited Ingredient Turkey 32 64 4
MERRICK Limited Ingredient Chicken 30 65 4
MERRICK Limited Ingredient Salmon 28 68 4
MERRICK Limited Ingredient Duck 26 59 15
MERRICK Purrfect Bistro Beef Wellington 47 45 9
MERRICK Purrfect Bistro Tuna Nicoise 47 41 12
MERRICK Purrfect Bistro Turkey 46 50 4
MERRICK Purrfect Bistro Cowboy Cookout 45 37 18
MERRICK Purrfect Bistro Beef 43 52 5
MERRICK Purrfect Bistro Chicken Divan 42 45 13
MERRICK Purrfect Bistro Chicken Casserole 42 46 11
MERRICK Purrfect Bistro Surf & Turf 41 54 5
MERRICK Purrfect Bistro Tuna 37 60 3
MERRICK Purrfect Bistro Salmon 36 62 2
MERRICK Purrfect Bistro Chicken 34 64 2
MERRICK Purrfect Bistro Duck 31 64 5
MERRICK Purrfect Bistro Granny’s Pot Pie 30 64 6
MERRICK Purrfect Bistro Thanksgiving Day Dinner 30 64 6
MERRICK Purrfect Bistro Turducken 30 64 6

 

I appreciate the information on the Merrick foods. Another question - is it normal for a cat to quickly associate nausea with a food requiring additional switches? Reason I ask is after less than 2 days, Dorothy is seeming less enthusiastic about her DM food from the vet. Still gobbling up treats, and I have been able in the last 2 days to get a can and a half of food into her. I'm just worried that she's starting to pull away a little. Do I just need a collection of foods to switch between until this pancreatitis or IBD clear up? Or is this a loosing battle?

 

It’s not a loosing battle.
Cats recovering from pancreatitis or have IBD need support with anti nausea meds and possibly pain meds for a while. You just need to try different foods until you hit the jackpot. Any opened foods freeze for later. That’s what I used to do.
Have you tried sprinkling Parmesan cheese on her food?

 

Have you read this.
http://www.felinediabetes.com/FDMB/threads/suggestions-on-how-to-stimulate-kittys-appetite.130770/

 

Thanks for that link. I think I've seen it before. I have done parmesan when wet moved her to home cooked diet years ago, but found she was a little lactose intolerant. I'm going to get some Fortiflora as I've had good results with it in the past. Been a while since I've had to do this again.

How long does pancreatitis typically last in diabetic cats?

 

Some cats get over it quickly and others can take weeks. It’s usually the appetite that is affected most. If the cerenia is not working ask for some ondansetron. It is very good too. You need to address the nausea, the pain and making sure they are not dehydrated.... some cats need subQ fluids for a while.
Have you tried Dorothy with other meats such as steak or ground beef? Or raw chicken hearts. Or chicken mince? Or chicken gizzards? I feed my cats a completely raw diet and they love it.

 

We had been doing a home cooked diet based on chicken and fish from Dr Lisa Pierson (she consulted with us almost a decade ago for another of our cats who was fighting oral squamous cell carcinoma). It was cooked, not raw, but the cats enjoyed it for a long time.

We ended up grabbing some quality canned foods this morning (varieties of Tiki and Merricks). Once she had an opportunity at the new food, she gobbled it up. Guess I'll just have to keep swapping foods to keep her eating until she gets over this. Also grabbed some healthy treats as well. Fingers crossed.

 

That’s great she is eating!
She might be associating her normal food with feeling sick at the moment. I found the same thing with Sheba. She would go off her homemade food when she has a flare of pancreatitis but would eat some canned foods.

 

Yup this exactly. I had a dog several years ago who had a bad pancreatic attack and I kept having to change his dog food on a weekly basis to keep him eating for several months after. I hope it's not this long with my cat, Dorothy. Not cleaning her plate even with the variety, but she is eating. So, baby steps...

 

I’m glad she’s eating some.

 

Kudos to you Derek for taking care of such a fine old lady. Dorothy is so lucky to have you for a parent, and taking such good care of her for so many years.

You are getting good advice from others. For our cats we feed:
Fancy Feast Classic - mixed with warm water to form a thick stew, there are 10 varieties
Freeze dried chicken breast treats - they really like these, and they are pretty healthy

 

Fancy feast classic; you could try sprinkling a bit of catnip on top. What a beautiful sugarbaby you have, awwwwww

 

Thanks so much. I could use some prayers tonight.

This afternoon Dorothy started having respiratory difficulties. After a fast quick to our family vet and an x-ray, we were sent to the 24 hour emergency center. They said there appears to be fluid around her lungs and heart. They've started her on lasix and are trying to get the fluids out. She'll be in the hospital for 24-48 hours at least. Just beside myself right now. This was from left field.

 

Oh I am sorry to hear this news Derek. Dorothy is in the best place to get the care she needs. I know how worried you must feel. Sending prayers and vines for a full recovery.

 

Healing vines for your sweet kitteh Dorothy. I hope she pulls through.

 

Thanks for the well wishes. Dorothy came back home today after about 36 hrs in the 24/7 ER. They were able to get the fluids off her heart and lungs, and got her breathing without oxygen or exertion. Lots of new meds - diuretic, heart med, and antibiotic. They said she was eating at little at the hospital which surprised them, so hopefully I can keep her eating. She is going to be headed to see a cardiologist next Wednesday to see if we can get a better idea of her heart issues and if we need to change the heart medication that she's now on. Hopefully it goes well. But for today at least, she's home resting.

 

That's a great update Derek. I'm glad to hear that Dorothy is recovering. With luck, you will be celebrating her 23rd birthday sometime soon!

 

So glad to hear Dorothy is home again. I’ll bet she is happy to be back with you.

 

Thanks so much. She did OK yesterday eating. Not so interested in her food today, so I'm syringing a little food to make sure she's getting a little at least. Trying not to push her too much and get her feeling really nauseous but also not wanting her to have liver issues from not enough. Such a tough balance.

 

I could use some additional thoughts. In the last two days, Dorothy has begun vocalizing - I mean yelling - at all hours day and night. And has been very anxious and agitated - walking all over the place. We think adding the buprenex to her treatment was one too many meds, but I can't tell if it might be the diuretic or the ace inhibitor. So hard to know for certain. Any one heard of this before? I mean we got NO sleep last night - she wouldn't sit still for more than 10 min at a time.

She has also started to splash her water bowl all over the place, although she's drinking very little of it. She's never splashed before and the bowl is the same one she'd had for the last month or so. Any ideas? I know fountains are popular, but I hate to have something else she's not going to use.

 

Derek I can't help with this but I would suggest you change the subject line to reflect your latest questions and get more eyes on it for you.
All the best to you and Dorothy.

 

...or open a new thread with that subject. I don't have experience with Leo doing that either. Leo has been on bupe, but did not exhibit those behaviors.

 

Has she been given the appetite stimulant mirtazapine? That's known to cause symptoms like this.

 

Nope - using Entyce. Had that issue with mirtazapine as well with our previous cats, so opted not to use it.