I really can't believe this - Thumper 6/18

I shot 1 U into a 360 last night
+4 - 336
+8 - 355
she threw up twice last night, first time was at the +8 now she won't get up to eat
+ 13 - 335

When I left the internest yesterday he told me they had an emergency center & were there 24hrs & to call if I needed them so I did. They didn't look anything up, just gave me the standard - don't give insulin if she won't eat you can bring her in for 79.00 basic fee plus anything else she might need. I said I wasn't going back to my vet but the other vet I was looking at knows nothing about what's going on and I don't have any more confidence in the ER. I have no idea what to do. She feels warm to the touch but I have noticed that happening before. I have 4.5 hrs before my vet closes....at least they wouldn't charge me 89.00 to just walk in the door. I just called them...the 2 vets that are there now I've never seen. The receptionist said "you need to bring her if her BG is that high" I told her what the ER said about not giving her any insulin till she gets over 400 the other night & she couldn't believe it either. She is just a receptionist but I'm glad someone else thinks that's weird.

 

Poor ((((Thumper)))). Will you bring her to the vet? Did they do a pancreatitis test when you went in recently?

 

She just threw up again..this time it was that yellow liquid stuff. I guess I'm gonna have to take her back to my regular vet. I don't know exactly what kind of blood work they did....my receipt says CBC - Vet test expanded profile IDEXX T4 total. I thought they had run every kind of blood test there was. Now she's drinking water.

 

I am so sorry for you.

I would take her back to the regular vet office. Maybe it will be good to see someone you haven't seen before.

I wish I had more to offer.

Keeping you and Thumper in my thoughts and prayers.

 

At least if you see a different vet you may get a different prespective and who knows maybe even one who has a little more experience with this stuff.

Good luck today. Scritches and feel better vibes to Thumper.

 

Barbara,

There was a post on health recently that talked about pancreatitis tests....

http://felinediabetes.com/FDMB/viewtopic.php?f=28&t=45602

 

Since you are an hour ahead of me, I'm hoping you've already left and are taking her in. If not, based on her symptoms I suggest you have them test for pancreatitis. It can be done by itself or as an add-on as part of a blood panel. It's the spec-fPL test. She may not have it, but at least you can rule it out or in.

I'm copying the test result ranges from the health post so it's all right here for you:

-----------------------------------
http://vetmed.tamu.edu/gilab/service/assays/pli

Pancreatic Lipase Immunoreactivity (PLI)

≤3.5 µg/L "Serum Spec fPL concentration is in the normal range. It is unlikely that the cat has pancreatitis. Investigate for other diseases that could cause observed clinical signs."

3.6 - 5.3 µg/L Serum Spec fPL concentration is increased. The cat may have pancreatitis and Spec fPL should be reevaluated in two weeks if clinical signs persist. Investigate for other diseases that could cause observed clinical signs.

≥5.4 µg/L Serum Spec fPL concentration is consistent with pancreatitis. The cat most likely has pancreatitis. Consider investigating for risk factors and concurrent diseases (e.g., IBD, hepatitis, Diabetes mellitus). Periodic monitoring of Spec fPL may help assess response to therapy.

-----------------------------------

Symptoms can be so vague and are different in each cat. The biggest one is being "off" and not eating. Sometimes nausea/vomiting, signs of pain (sitting in the sphinx position with the head down, rapid breathing in pain, or just hiding and not behaving like their normal selves) and signs of dehydration. Some cats don't show any signs because they are so good at hiding pain. Pancreatitis is very dehydrating. The only reason Harley was diagnosed was an ER visit in the middle of the night for constipation/obstipation because he couldn't pass stool. Even then they cleared the stool but didn't find the reason for his dehydration.

If it is pancreatitis, treatment includes maintaining hydration with SubQ fluids, pain medication, (buprenex) and anti-nausea medications so kitty can eat. Pancreatitis is very painful and very nauseating but it is easier to manage once you know what you are dealing with.

 

(((((Barbara))))) (((((Thumper)))))

My specialist told me to give 1/2 dose if they aren't eating. I have heard other comments on that as well (there is a Think Tank thread on that topic, I can find it if you are interested), that you do want to give *some* insulin even when they are not eating.

Hope she is feeling better soon, and you get a GOOD vet!!!!!

 

I asked & they had not tested for pancreatitis. I just assumed they had checked for everything, they have taken so much blood from her! He was gonna go ahead & run the test but they couldn't get any blood from her, they said she's just bruised from all she's had done since Wed. He told me to bring her back the middle of next week for that. He gave her an injection for the nauseau & also a pepcid injection. He wasn't concerned with her BG being in the 300's, said that's good. It seems like all of them I've talked to think that's good. He told me she really needed to calm down from all she's been through the last few days & told me the time he will be at the clinic tomorrow morning (they are closed) in case she's still not eating. He said unless BG gets over 400 just leave her alone. She got under the bed & went to sleep when we got home so I'm gonna leave her for a bit. Hopefully she will not go too high & will eat tonight so I won't have to worry about it. If she doesn't eat & is still mid 300's should I give her insulin?

 

The old school thought is that 300 PSs are good, and 100 nadirs are good. So that makes sense they would tend to think 300 is ok.

I totally disagree on the don't give insulin unless she is over 400, where are they getting that? ohmygod_smile If she hasn't had insulin in 12 hours or longer, I would go ahead and give her 0.5u or something like that. Even if she isn't eating I wouldn't be worried on that dose given her #s. She may need more than that even, but you don't want to add to your stress by shooting something that will make you nervous.

I'm glad they gave her some meds at least, hopefully that will help.

I agree let her be - I would just pop 0.5 into her if you can reach under the bed, and then try to test again at your PMPS time. I wouldn't worry about spot tests today, she will be fine. See if the meds help her get feeling better, and take it from there.

 

If she's not eating but still high I think I would give her a little something. Booster shot sort of. Hard to say.

I can't believe that all the vets think that 300 & 400 is ok. ohmygod_smile

 

When I looked up pancreatitis, the symptoms sound right - lethargy, fever, vomiting, no interest in food. I did find this thread with food ideas: http://www.felinediabetes.com/phorum5/r ... sg-1179876

Hopefully the nausea meds will help and she will be eating by this evening. Even chicken and rice would be okay for today if she would eat it. Yes, with her ketone issue, insulin is important. Just the balance between not eating and insulin makes it hard.

I am so sorry you and Thumper are having such a difficult time. Even getting a diagnosis will be a relief. There are certainly lots of people here dealing with both diabetes and pancreatitis, if that is what it turns out to be, so you would be able to get advice and support.

Hang in there, Barbara. You are such a dedicated Mom to Thumper.

 

Yes, Barbara, you're being a great Mom to Thumper. Sometimes, I'll get all panicky about Alex and then I'll step back and remind myself that I'm doing the best I can.

My vet told me in the beginning that our goal was to get Alex's BG under 350. Last time I talked to him (a week or so ago), it sounded like he would be happy if Alex remained in the 250s. I certainly don't agree with that. I guess I'll use him primarily as my supplier, but will continue to come here for solid advice.

Thanks again, everybody!

 

I'm going to second Laura's and others suggestions to get a spec fPL test done. Pancreatitis really can be hard to diagnose, and it is usually misdiagnosed or symptoms are written off because of how vague the symptoms are. As one of the articles I read stated, any cat that simply "ain't doing right" is a candidate, and they have found it is much more common than people realize, even in cats that show no overt symptoms. With a cat with diabetes already, I could see how pancreatitis could eventually be a problem since it involves the same organ. When Shaikha is in serious pain, she usually gets spooked easily, but she'll also sit around looking miserable and lying down in sort of guarded positions. It is terribly painful for them and makes them feel just miserable. Often though, cats hide pain so well we just don't realize how bad they are until it gets severe. But usually it starts with her not being interested in food and lying around, progressing to hiding and just plain being miserable. She has IBD so there are GI symptoms too. Since she's developed diabetes the other thing that precedes a flareup is her glucose levels go wild.

Did the vet give you any type of medication to give her this weekend or did they just give an injection? The others won't last more than 12-24 hours, so if she's feeling badly it would help if she had some on-board support. You can buy zantac or pepcid in the grocery and use that. I use zantac because both of my pancreatitis cats felt nasty on pepcid, but others seem to do fine with it. If you go with zantac, get 75 mg tablets and give 1/8 tablet twice per day. I hope they gave you more anti-nausea drugs to use over the weekend though, in addition to pain meds?

If it is pancreatitis, Lauara is right -- dehydration is a big concern. I think that my GA Tabriz had undiagnosed pancreatitits and IBD for a long time, and that it likely brought on one of his episodes of acute renal failure. Shaikha I think has hers kicking up again too, so she's been getting subQ fluids. She's drinking plenty and doesn't seem dehydrated, but she is soaking up the whole lot by the morning each day (I give her subQ before bed), so I know she needs the extra fluid. The pancreas needs to be perfused well, so if it is inflamed, fluid is its friend.

I really hope you can get this sorted out soon, Barbara. The spec fPL test is very sensitive, but it needs to be run when symptoms are acute. If the cat isn't having an active attack, it may not pick up on it despite it being present.

 

She has eaten a little & drank some water. We are at +21.5 and she is @ 320. I'm thinking I will just hold off & shoot at regular time? Hoping she will eat dinner?

 

They didn't give me any additional medicine. He told me to bring her back in the morning if she's still not eating & that she would probably need fluids. She has eaten a little bit & she was drinking some water. I don't know anything about pancreatitis. Over the last few weeks she has thrown up maybe twice, then of course the episode last night. This is the first time she would not eat at all. How do you know if they are having an active attack? He told me not to bring her back till maybe Wednesday since they could not get any blood this morning. I didn't ask a lot of questions about that either. I know she had an IV in one leg but I wonder about the others. I wasn't gonna push it, she's been through a lot the last few days. The way things are going I will take her back but the test will be negative even if she does have it. I will take her on Wed. morning, hopefully she will be ok till then.

 

That is great that she is eating. I think you could shoot now or wait a little bit, either way. If you shoot now, then you could do the morning shot at the regular time, so that would be later than +12, so it's just a matter of whether the gap w/o insulin is now, or in the morning. I'd probably shoot now if it were me, to go ahead and get something in her system, catch her before she goes any higher, and then have more chances for a couple spot tests tonight to see how she is responding to it. But you're not that far from regular shot time, so I think waiting is ok if that's your preference.

 

I think shooting now or regular time would be fine. If you wait maybe she'll eat a little more.

 

she's now @ 288 dropping for some reason? and she ate about 1/4 can FF. I was going to shoot 1 unit, it will be 13 hrs till the next shot. She hasn't had any insulin for about 23 hrs.

 

Just since I can't decide what to do I haven't given anything yet. We're now almost 24 hrs without. I was a little surprised to see her dropping so that's one reason I didn't give anything but of course she ate that 1/2 can so now if she's rising when I check again I can't be sure if it's the food.

 

I'd test again and see if she's rising, I know there is food on board but we can figure that in.

 

That's not a bad number for having no insulin.

 

I hope you're still here she's 260 and she was eating again! Why is she dropping?

 

I'm not sure, if she's eating and she's coming down that would suggest that her P is working right now.

What do you want to do? Wait and see if she'll come down some more. Her bg's aren't low so you could still shoot now if you want, but I would reduce the dose.

 

So maybe give her .5? I gave her 1 unit last night.

 

She was 100 points higher last night and she wasn't dropping. I don't think she's in any danger shooting now, what were you shooting on a similar PS as this one.

 

I went and looked. Maybe we could split the difference and do a .8u. How does that feel to you.

 

At this point I don't know what I think. I'm ok with shooting .8

 

I just keep thinking that the 1u & 1.1u seemed a little to much and since she's coming down on her own .8u would give her a little more room if Ms. P helps out.

 

Hi Barbara, Sorry I had to dash out and go errands for my mother and this is the first chance I've had to check back with you. So glad to hear they gave an anti-nausea injection and Pepcid (famotidine). But as Wendy said they only last about 24 hours max so if she is truly nauseated you will see her eat better for while and start to taper off again as the medicine wears off. If you do go in tomorrow morning for fluids, which I highly reccommend even if she is eating a little, please ask again about the spec-fPL test. I know they told you to wait until Wednesday but that may be too much time. As Wendy said in order to pick up anything, the test has to be run when she is having an acute flare-up and the catch-22 is that you don't know she's having a flare-up unless they run the test. ohmygod_smile The symptoms are often specific to each cat. Harley's symptoms are a little different from Wendy's Shaihka's, but they both have pancreatitis. That's why it's so hard to diagnose and more vets don't test for it.

Based on the things you've mentioned pancreatitis is the most likely suspect right now: Thumper's vomited 3 times within the last week including last night, she's kind of "off", her BG's are now higher than the were and we don't know exactly why, she doesn't want to eat, and thanks to the vet who gave her Lasix, we know she got very dehydrated. As Wendy said, the pancreas requires proper hydration in order to function properly.

You and she have been through so very much these last few days, you've spent a lot of money, and the two of you have got to be exhausted. I really feel for you as what you are going through now reminds me so much of the countless vet visits and stress that Harley and I went through to finally get a diagnosis and start treatment. Whatever you decide to do you are not alone, we are all with you and rooting for you two 200%!

Purrs, cat_pet_icon

 

Shot .8

My vet went on about needing to stick with a dose for at least a week to give it time to work. I didn't feel like talking about it but she's had some low #'s in the past so what would happen if I kept shooting 1 unit on those low #'s?

 

I was only supposed to take her in if she's still not eating. It sounded like they were not able to get any blood. I could only think of when they say someone's veins are "blown" I don't really know what I'm talking about. :smile: The vet tech commented when she brought her back that she was pretty bruised. So I think it's gonna be pointless to bring it up to him again.

 

You know what would happen if you kept shooting the same dose into lower numbers.

As far as the test, I would keep asking until they were so tired of me they would do the test to make me go away, then I would go away happily.

 

But what about them saying they couldn't get any blood? I don't want to torture her or have something bad happen. As I said I guess I don't know what I'm talking about but I think I've heard of them not being able to get blood on people before & it's not good?

 

Common symptoms for cats include lethargy, decreased appetite, dehydration, and rapid breathing (this is likely caused by pain). Some get diarrhea or vomit, some may not wish to be touched or may hide (also caused by pain), and others may also develop symptoms of liver trouble like jaundice or an elevated ALT (a liver enzyme). My GA Tabriz used to lower himself to the ground VERY slowly when he got it, while Shaikha tends to hide or jump and run at the slightest sound when hers is really bad due to the pain it causes. Both got very dehydrated and needed subQ fluids during active attacks. Here are some great sources to read about pancreatitis:

http://www.harpsie.com/pancreatitis.htm
http://www.manhattancats.com/Articles/p ... _test.html
http://www.marvistavet.com/html/pancrea ... line_.html
http://www.idexx.com/pubwebresources/pd ... update.pdf
http://www.idexx.com/pubwebresources/pd ... itions.pdf
http://www.idexx.com/view/xhtml/en_us/s ... ticles.jsf (go to the link for Diagnosing and Treating Pancreatitis: A Roundtable Discussion -- long, but worth reading)
http://www.vin.com/proceedings/Proceedi ... &O=Generic

 

Oh Barbara, I really feel for you and Thumper! I have no expertise to draw on and feel totally helpless. I guess you probably do too. It's awful when someone you love is sick and you don't have a doctor you trust. But you are doing a great job taking care of her, and I guess you just have to keep telling these vets your concerns. If she is eating without vomiting, that is great. If not, how about calling the vet and asking about dehydration and also asking them if it is, in fact, pancreatitis, what will happen if you wait till Wed.? Is that safe?

 

I have no idea Judy. So far no more vomiting but from what I can gather these injections might last 24 hrs. If she starts vomiting before 9:00 am or quits eating I can take her to my vet. He will be there checking in on the animals that are there. After that I guess it's back to the ER, so I really hope if she's gonna do anything it's before 9:00 am. They didn't do anything spectacular for me at the ER & at least my vet's not charging me for the office visit at this point, today he only charged for the meds.

 

Have you started giving her the pepcid for the nausea at home?

 

She probably got a Cerenia shot -- that is what Kitty got Monday night.

My vet said that the "official" time they tell clients that it last is 24 hrs, but that it has more of a 36 to 48 hour effectiveness.

 

No, I didn't even think to ask about giving that since she had the injection. I don't know about giving it to her on top of the injection? Did you see my +5?

 

Yes I replied on your other thread.

 

If she is bringing herself down that could be a sign she has a sputtering pancreas. Her #s are still too high though and you have a ketone history, so I would basically ignore it. Yes, you may want to try a little bit reduced dose like you did, but I wouldn't take that too far. If her pancreas is working, let it prove itself to you by giving you PSs that are too low to shoot. I agree too on giving her oral Pepcid, that seems to be pretty standard for helping their tummies. Maybe call them in the morning and ask about it? I don't know how the injection would affect that - normally you do 1/4 of a 10mg tab (regular kind, not the fancy one with other stuff in it) either SID or BID, but I'm not sure how you know which of those to go with (maybe just SID if that controls it?)

 

Barbara, I feel so bad for all you and Thumper have gone through the last few days. You are doing the very best you can for her.
I know you must be so tired and stressed.
I think I would call and ask your regular vet early morning while he is at the office about dehydration and nausea. If the injection wears off as soon as 24 hours she may quit eating again.
Prayers and healing to Thumper.