New here! Need help please...

Discussion in 'Feline Health - (The Main Forum)' started by Tritt3180, Dec 24, 2017.

  1. Tritt3180

    Tritt3180 Member

    Joined:
    Dec 23, 2017
    About 6 weeks ago my 11-ish year old cat was diagnosed with asthma when we took him for a wellness check for increased aggression and nighttime vomiting. A lot has changed lately with moving multiple times, work and sleep schedules changing, and family members dying, so a lot of his aggression was chalked up to that, but he was also given famotidine to be given q12° and a steroid shot for his breathing. Instructions were given that of our seemed to help he could get one each month, but we'd have to watch his organ function closer and would need a new baseline bloodwork before getting more steroids.

    6 weeks later (Thursday last week), we took him in again for the labs and shot. I got a call Friday morning that his glucose was high and she was concerned he may be diabetic. So, with my permission they ran a fructosamine level on him and it was positive. I was called again at 9pm Friday we needed to come in the next day to learn how to administer the insulin.

    Saturday morning my friend commented on how much weight he looked like he lost. I agreed! We took him in early to his appointment because he was very lethargic and not eating. He did make urine that morning, though. We learned he lost 2 pounds in 6 weeks. They showed us how to give sub-q ivf boluses at home and said his sugar was 211, so they didn't want to give him insulin and bottom him out. So we were to just give supportive treatment at home until they were open on Tuesday.

    When we got home, he emptied his stomach on the living room floor, most of which was digested, and didn't go near food or water the remainder of the night. I had only been giving him the famotidine if he was nauseas or vomited, so I gave him a ml at 3:30p and watched him. I gave a fluid bolus at 7:30p, and he was just limp. What would've been a growl if he didn't want to be touched was now a weak moan. No more urine was expelled since being home either.

    I took him to the emergency dept, and his sugar was >380 and ketones were found in his urine. They admitted him for 1-2 nights last night at 11pm. He did urinate on my mom who was holding him (he tried to find a litter box beforehand) after they catheterized him for the sample.

    His last sugar at 0600 was just over 200, he's sitting up and makes it to the litter box (still making urine). The Dr was concerned for pancreatitis, but the test for cats has to be sent out to a lab. Apparently, his lipase and amylase were wnl because the Dr didn't bring them up. He said treatment would be similar to what they're doing now - ivf, and glucose monitoring. I have to call again, but they said that at 0900 they would try some food. He isn't showing interest in water, though, but he has the iv running too. He was really dehydrated when we brought him in.

    What does it sound like to you? I have a feeling it is more pancreatitis, but the diabetes/dka hasn't helped the situation. Would it hit him all at once this fast? Could the steroid shot 6 weeks ago made him resistent to insulin and/or caused the pancreatitis? If it is pancreatitis, can I know without that blood test? Also, can I treat that at home?

    My cousin recommended this site and said someone here may be able to help me. I just signed up, so I haven't had time to look around the site yet. I just found out how to post. lol

    I'm an RN, so I understand medical jargon and am used to being a caregiver to my family. I just feel helpless because I don't really know what to do for cats in this situation.

    Thank you, in advance, for any help/understanding you can give.
     
  2. JanetNJ

    JanetNJ Well-Known Member

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    Jun 8, 2016
    Pancratitis can be treated at home. The treatment is sub q's, cerenia for nausea, and bupe for pain.
     
  3. JeffJ

    JeffJ Well-Known Member

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    Jul 7, 2016
    Hello. Ketones are pretty bad, especially if the levels go up. I use ketone strips for our testing at home.

    Here's a link to more information on ketones, ketoacidosis, and blood ketone meters:
    Ketones, Diabetic Ketoacidosis (DKA), and Blood Ketone Meters

    It sounds like your kitteh may be diabetic. Food is important. That weight loss is critically bad and must be resolved. If your cat is diabetic, then insulin therapy can resolve it. Since your cat is at the emergency vet, I would get as much info as you can from them about the conditions. After all, you are basically paying for it.

    Pancreatitis doesn't usually manifest immediately, but it can be treated at home.
     
  4. JeffJ

    JeffJ Well-Known Member

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    Jul 7, 2016
    Steroids often accompany the treatment because of intestinal inflamation. This would include either prednisone or prednisolone.
     
  5. Teresa & Buddy

    Teresa & Buddy Well-Known Member

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    Jan 2, 2017
    As I am sure you already know since you are a RN, even if your kitty was not diabetic, prednisone or prednisol0ne could cause this.
     
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  6. donnalea

    donnalea Member

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    Jun 18, 2016
    Take your time and read the information at the top of each forum for the different kinds of insulin. Have you been testing his BG? Once you get him home be sure to test him before feeding and giving him his insulin. We will all be rooting for his recovery. Don't hesitate to ask questions.
     
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  7. Critter Mom

    Critter Mom Well-Known Member

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    Jun 16, 2014

    I'm sorry to hear that your little one has been in the wars.

    If the vets didn't run a ketone test at the same time that was remiss of them. Ketones can build up really quickly and major clinical signs of ketosis include lethargy, nausea, inappetence and dehydration. It's true that pancreatitis has a very similar symptom profile but ideally you'll need to ask your vet to make a differential diagnosis as pain management and possibly antibiotic treatment may be needed if pancreatitis is present. If your vet offers it, an in-house SNAP fPL blood test will give an immediate Yes/No result to indicate whether or not the pancreas is inflamed. To assess the severity of inflammation a Spec fPL blood test should be run (needs to be sent to an external lab - results usually take a few days to come through). If required an ultrasound of the pancreas can be performed. Here is a very helpful link about pancreatitis diagnosis and treatment:

    IDEXX Labs - Pancreatitis Treatment Guidelines

    Famotidine isn't ideal as an anti-nausea treatment: it reduces stomach acid production (as you probably already know) but ondansetron and Cerenia are much more effective treatments for nausea in felines. Here is helpful information on a variety of anti-nausea and appetite stimulant treatments:

    Nausea, inappetence, vomiting - symptoms and treatments

    When DKA and/or pancreatitis symptoms are at their most acute then the cat may require both anti-nausea and appetite stimulant medications. Based on my own experience of managing a cat with chronic pancreatitis and also reading about many cases of cats with DKA here on this board I cannot recommend strongly enough that when you go to collect your kitty to bring him home that the vet provides you with the following meds for continued home treatment at minimum:

    - a 'proper' anti-nausea medication (ondansetron, Cerenia), not a mere acid blocker.

    - an appetite stimulant. (For cyproheptadine, check that liver function and blood pressure is OK. NB: if buprenorphine is prescribed for pain note that co-administration of mirtazapine can produce a highly adverse reaction in some cats due to effect of combo on serotonin levels.)

    Needless to say, in addition to inappetence being a major issue for an otherwise healthy cat, inappetence in a diabetic cat who needs insulin makes for a massive treatment complication. It's critical to keep a kitty eating when recovering from DKA. We've seen many, many cases here where kitties get stabilised at the vets only to be discharged too soon and then they quickly relapse because the treating vet fails to prescribe appropriate supportive meds for the caregiver to administer in the home setting. Some vets prescribe only an appetite stimulant but that's not enough: effective nausea management is key to a successful treatment outcome. Your cat may start eating without supportive medication BUT it is far better to have an on-hand supply of meds available so that one can respond immediately to signs of nausea/inappetence than being forced to wait for another vet visit before starting treatment.

    If pancreatitis is also a factor then pain management may be necessary. Pain levels may vary (cat may show some signs of discomfort after eating or, in more severe cases, more marked abdominal pain may be present - and pain may radiate to the back). Buprenorphine is commonly prescribed for management of pain associated with pancreatitis flares. A course of B12 injections can help resolve a pancreatitis flare and improve appetite. Please refer to the IDEXX document for comprehensive coverage of meds that may be used to treat pancreatitis/nausea/inappetence.

    With DKA in the mix then, in addition to home testing blood glucose levels, it is very important to check daily for ketones in the urine (using Keto-diastix or other urinalysis strips featuring a ketone test). More helpful links here:

    Are you testing for ketones?

    Urine testing tips

    If your cat is underweight then extra caution is needed when choosing a suitable food. Underweight cats may need a somewhat higher carb load than the usually recommended <10% to reduce the risk of their going too low when they start insulin treatment (even on a tiny dose). This is even more important in cats who are ketone-prone. The somewhat higher carb load may allow for larger doses of insulin to be administered and also promote faster regaining of weight that has been lost. Once they regain the necessary weight to restore ideal body condition and stabilise on insulin one can then revisit and optimise dietary choices for long-term diabetic control.


    Mogs
    .
     
    Last edited: Jan 4, 2018
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  8. Tritt3180

    Tritt3180 Member

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    Dec 23, 2017
    Ok... I've done my best to collect info you've shared and ask my questions this last call. Here is where we are:

    1615 update: There hasn't been a differential diagnosis made yet. They started an insulin drip at 3p of Humulin-R. His urine today showed 2+ ketones.

    No appetite stimulant has been given, but the tech i spoke to said he will ask about one since its been >24° without eating. They cannot do tpn in their office because thats more of an inpatient order than "emergent."

    A long term antibiotic was given last night at 11p when he was admitted. That should last about 14 days I'm told. I don't know the name of it.

    They gave him Cerena for nausea, but cannot repeat it until tonight as it is a 24° drug. The tech didn't think he could have zofran intermediately (I don't understand why because in humans we can give other meds between zofran doses).

    No pain meds were given since he was so out of it, but the tech said he'd ask about trying a dose. His vitals don't indicate pain, but i keep thinking of patients I have had where vitals are not the best pain indicators. They didn't want to make him more drowsy, and he seems more alert, but really depressed. I'll ask when I call back in a couple hours if it might help to see us and if its possible, take a drive out there.

    The test for pancreatitis is a lab that needs to be sent out to confirm pancreatitis. There isn't one in house for cats - just dogs. They do not do ultrasounds here unless its a life or death situation. So, this will not be able to be diagnosed at this facility.

    What do I do next other than pray? Also, what kinds of questions do I need to ask next time I call?
     
  9. JeffJ

    JeffJ Well-Known Member

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    Jul 7, 2016
    It is important for your cat to ingest food. Since there are ketones, that will help break the ketone cycle.

    If your cat was eating fairly well at home, but is not eating at the vet center - you should consider options.
    - syringe feeding
    - or taking him home so he will start eating

    We had an esophagus tube put in Leo in mid-2017, for about 4-6 weeks. He got diagnosed with small cell lymphoma. The subsequent prednisolone treatment (daily) helped with hunger stimulation. Prior to e-tube, we did syringe feeding.
     
  10. Nan & Amber

    Nan & Amber Well-Known Member

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    Mar 19, 2016
    If they let you visit him, ask if you can leave him something (a t-shirt, towel, etc.) that smells like you. It might help relieve his depression a bit-- he must be very confused right now at where he is.

    Have they been syringe-feeding him at all? He definitely needs some insulin to get rid of the ketones, but he needs food too. Have they given any fluids since the ones you did last night?

    I'm guessing that the antibiotic was Convenia?
     
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  11. Nan & Amber

    Nan & Amber Well-Known Member

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    Mar 19, 2016
    I would be very cautious about taking him home while there are still substantial ketones in play. Ketones are difficult to treat at home, and can worsen dramatically very very quickly.

    An e-tube might be an option later if he continues to not eat on his own for a while. They can be lifesavers!
     
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  12. Tritt3180

    Tritt3180 Member

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    Dec 23, 2017
    They had him on ivf... Not sure if they're still going now that the insulin drip is going. I would imagine they are. And no, they haven't given him any food. They've offered it, but haven't syringe fed him yet. The tech said he will ask the Dr about that. So, I'm hoping they will. I'll be calling in about 1.5 hours so they can have the next sugar reading checked. Good idea about the shirt/towel. I'll ask that too. Thanks Man & Amber! He was eating, but not great since he had the last steroid shot Thursday. Saturday he threw everything up when we came home from the vet at 3:30pm. He hasn't eaten since. So, hopefully they syringe feed him. I can't take him home yet as he's on the insulin drip due to still being in DKA. Argh!! It's such a vicious cycle!!
     
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  13. Tritt3180

    Tritt3180 Member

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    Dec 23, 2017
    What's an E-tube? Like a nasogastric tube for humans? Or is it a surgical placement like a gastric tube for humans? I have no qualms about doing feedings at home if it can be reversed.
     
  14. Tritt3180

    Tritt3180 Member

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    Dec 23, 2017
    Oh, nvm. I figured it out.
     
  15. JeffJ

    JeffJ Well-Known Member

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    The e-tube goes in the side of the neck into the esphagus and is routed directly to the stomach. Leo was a trooper while he had it in.
     

    Attached Files:

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  16. Tritt3180

    Tritt3180 Member

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    Dec 23, 2017
    Thank you! I could do that!
     
  17. Critter Mom

    Critter Mom Well-Known Member

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    Convenia perchance?

    See the IDEXX document linked above for guidelines on appropriate antibiotic treatment for pancreatitis.

    Both DKA and severe pancreatitis can make a kitty lethargic/depressed. Both can make the cat feel really lousy. If I were in your shoes I'd be looking to visit with my cat. I think it's a comfort to them while they're hospitalised and also, even if the hospital staff can't get your kitty to eat much at the moment, your kitty might be a bit more encouraged to eat a little bit for you when you visit. Maybe bring a t-shirt or jumper with your scent on it to pop into your kitty's kennel for comfort and reassurance?

    I second the recommendations above about syringe feeding in the interim and enquiring straight away about feeding tubes. If a feeding tube is needed it is better to act sooner than later - see this vet-authored page about feeding tubes.)

    catinfo.org - Feeding tubes

    Timely deployment of a feeding tube has saved the lives of DKA kitties here.

    Again, I can't stress the importance of anti-nausea support. I found that Cerenia might give some bit of an uptick in interest in food but I found ondansetron to be more effective overall, although it took about 24-36 hours to reach full therapeutic effect in my girl.


    Mogs
    .
     
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  18. Tritt3180

    Tritt3180 Member

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    Dec 23, 2017
    So, am I looking at having to admit him somewhere after his stent is through at this emergency facility if he doesn't respond to the drip?
     
  19. Critter Mom

    Critter Mom Well-Known Member

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    Jun 16, 2014
    Strongly second this.

    Your kitty needs to be ketone-free with electrolytes normalised before coming home. And eating. As Nan quite rightly says, DKA really needs intensive treatment in a hospital setting.

    Sending prayers for a speedy recovery to your little one.


    Mogs
    .
     
  20. Nan & Amber

    Nan & Amber Well-Known Member

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    Mar 19, 2016
    You mean to do a feeding tube? I'd think that the emergency facility could probably do that, although you/they might prefer your own vet to handle it for one reason or another (cost, for example). Something to ask about when you talk to them.

    Hope you get to see him soon and that it perks him up a bit. Poor little guy, he must be feeling pretty yucky with all of this going on...
     
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  21. JeffJ

    JeffJ Well-Known Member

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    Jul 7, 2016
    Above advice is correct. A small amount of ketones can be handled at home. But once the levels go up, it is critical care. The ketones need to get flushed.

    The feeding tube should come after other emergency measures, which you are doing. I would have them try syringe feeding first. It could stimulate more eating. In Leo's case the syringe feeding did not work very well. The goal is to get some food into the cat and restart the normal process
    - eat
    - process into glucose
    - soak up glucose into cells with insulin
    - stop body from processing fat into ketones
    - resume normal kidney regulation of blood

    Some cats won't eat at the vet at all. Little Dude was at the vet this year, after a cat fight. He didn't eat at the vet for 6 or 7 days, and he lost all his fat. Don't worry, he gained it all back:eek:
     
  22. Tritt3180

    Tritt3180 Member

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    Dec 23, 2017
    I left the shirt I slept in last night. He snuggled up to it.
     
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  23. Tritt3180

    Tritt3180 Member

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    Dec 23, 2017
    They do have ivf running still with the insulin. He's not"looking" and better - his eyes are half open and he doesn't appear to be interested in much. Laying with his head facing the back of the cage, but he knew that we were there. We got to pet and talk to him, but not hold him. He would eat the tiny bit of food I put on my finger, but he licked his lips when I pulled the finger away. The vet tech that was with him all day called before leaving to tell me he ate a tsp of food after they changed it. So, they're not going to force feed him in the case of pancreatitis. He also got pain med around that time. He was laying in his litter, so they removed it and put a towel in it's place.
     
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  24. Nan & Amber

    Nan & Amber Well-Known Member

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    I'm glad you got to see him, but worried at this report.

    He needs more than a couple tsp of food. It's not the pancreatitis that is the concern right now, it's the ketones, and for that he really really needs to get some calories into him. Syringe feeding isn't fun for anyone, but sometimes it is necessary, and I do not understand why this vet is so casual about the situation.

    I hope the tsp he ate on his own is a sign of a change-- sometimes you just have to get them started and then they feel better enough to keep eating on their own, so maybe that's why the vet is not very concerned?
     
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  25. Critter Mom

    Critter Mom Well-Known Member

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    Jun 16, 2014
    Sounds like nausea.

    I could not agree more: part of the DKA treatment protocol (fluids, anti-nausea, appy stimulant) should have an automatic knock-on benefit for any pancreatitis present, but to treat DKA successfully the cat must get enough food and insulin to clear out ketones and restore normal glucose metabolism.


    Mogs
    .
     
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  26. Tritt3180

    Tritt3180 Member

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    Dec 23, 2017
    I will try to talk the vet tech into trying more pain meds then syringe feeding when I call again. It's a different one than earlier, but the same one that was with him last night. Fingers crossed... They had said before they were hoping the little bit he ate was a sign he would eat more, but I have a feeling he was just tasting it, and the pain med didn't have time to kick in before it reached his digestive system. Hopefully tonight is different. We have until Tuesday 6am before I have to take him home, or somewhere else.
     
  27. Tritt3180

    Tritt3180 Member

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    Dec 23, 2017
    No, I meant by "stent" does it sound like I need to figure out where to take him when he can no longer stay at the emergency dept.
     
  28. Tracey&Jones

    Tracey&Jones Well-Known Member

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    Dec 12, 2016
    I have no more advice to offer you that hasn't already been given.
    I agree though - the vet should really be focusing on the DKA vs. the pancreatitis.

    I am just sending some really big healing vines for your kitty and these are for you.:bighug::bighug::bighug::bighug::bighug::bighug:
     
  29. Tritt3180

    Tritt3180 Member

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    Dec 23, 2017
    Question: if his glucose is not regulated by the time he needs to leave the ER, what is the protocol? I have to work till 5p, but would have to take him home by 7am. I'd need to take him earlier to make it to work on time, but would need to put him in a hospital to regulate the insulin drip while I'm at work until we can take him to a bigger hospital where he can be admitted... Which is 1.5 hours away when the roads are good. Will my personal vet be able to do that for me? Will I need to take off work for an appointment, or would they have appointments in the evening? I feel kind of at a loss of what to do next.
     
  30. Tritt3180

    Tritt3180 Member

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    Dec 23, 2017
    2150 update: Cat's glucose went back up to 385, so the drip was increased to 5ml/hr from 4ml/hr.

    He's not eating. I have asked that they give him onadesterone (zofran) until he can have the other med again. The tech will talk to the Dr.

    The previous tech said he ate and got pain med at "about the same time." This tech tonight found in his chart that he tried eating at 4p and got the pain med at 6pm. NOT at the same time!! Pancreatitis is PAINFUL, so it's no wonder he didn't eat more when it caused him pain! So, I asked to give him the zofran and since the pain med should be working by now (supposed to have a 8-11 hour span it works) to try and syringe feed him.

    I'm super frustrated... WHY DO I HAVE TO ASK FOR ALL THIS STUFF??? I know I'm not a vet, but they seem to agree with my recommendations when made. So thankful for friends to guide my questions.

    I did learn, however, that Forest South should be able to get him regulated at their facility and I won't have to go to U of I or somewhere far like that once he leaves the ER.

    I have a headache.
     
  31. Vader723

    Vader723 Member

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    Dec 12, 2017
    I’m so sorry you have to go through all of this. Bless you for being the voice of your kitty, and an advocate for his care. As others here have posted, and I continue to see evidence of in the stories of other people on this board, the unfortunate fact is that many vets lack the knowledge and experience to provide best practice medical care for our sugar babies. Hoping and praying they can get him over this rough patch and back on track :bighug:
     
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  32. JeffJ

    JeffJ Well-Known Member

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    Jul 7, 2016
    The critical issues are:
    - ketones
    - lack of food
    - high BG, requiring insulin

    in that order. If your cat eats, they should record the exact amount. If you are working, but you can afford to leave him under 24/7 care, then you should check him into the other facility.

    I don't know about Forest South, but I hope they can resolve these issues for you. Yes, it is very frustrating. You and only you - are the best hope for your cat. The more interest and interaction you have with the vet techs, then generally the results will be better.
     
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  33. Tritt3180

    Tritt3180 Member

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    Dec 23, 2017
    0100 update: zofran was given, finally, at 1015. The tech said she doesn't remember what time it was, but she walked by twice for something (like his pump was beeping or something and she had to fix it) and she saw him eating on his own both times. She didn't do his treatments, and didn't record how mich he ate. No syringe feedings were given. Now to keep the pain and nausea away so he can continue this.

    I forgot to ask... Anyone know how often zofran can be given?
     
  34. JanetNJ

    JanetNJ Well-Known Member

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    That's very hopeful news
     
  35. JanetNJ

    JanetNJ Well-Known Member

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    I believe zofran can be given every 8-12 hours as needed. Is he on bupe for pain yet? When my cat was diagnosed with pancreatitus the bupe made a huge difference. He was eating within a half hour of taking it.
     
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  36. Tritt3180

    Tritt3180 Member

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    Dec 23, 2017
    0500 update: Cat ate half of the food he was given around 0300! His glucose came down from 352 to 285(?) at 0300 also. He ate on his own. He's due for more pain meds and zofran, but they don't feel he needs them at this point. I disagree. Hopefully we're not going to go backwards again. I'll call before shift change (7am) again.
     
  37. Tritt3180

    Tritt3180 Member

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    The bupe was given at 1800 yesterday (6pm).
     
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  38. JanetNJ

    JanetNJ Well-Known Member

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    I agree with you they need to continue the pain meds a few more days. My Zimmy took bupe 5 days. The cerenia (like zofran) I think I have him 3 days.
     
  39. Nan & Amber

    Nan & Amber Well-Known Member

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    Mar 19, 2016
    So glad he started eating on his own! That's the best news.
     
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  40. Kris & Teasel

    Kris & Teasel Well-Known Member

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    Aug 17, 2016
    I'm sorry you seem to be caught up in having to direct the treatment yourself. My kitty had a bout of DKA two months after his FD diagnosis. To say that I knew nothing about the complications of diabetes is an understatement. I was so lucky that my regular vet clinic has ER ICU facilities and vets there 24/7. Looking back, I can see that they knew what to do for DKA: hydration, electrolyte balancing, insulin (fast-acting as needed) and food.
     
    Last edited: Dec 25, 2017
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  41. Tritt3180

    Tritt3180 Member

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    Dec 23, 2017
    I called back and he hasn't gotten any more bupe. He was due at 0600. :-( He got zofran at 11p, so he could get it, but hasn't yet. I asked as soon as he could have these meds to give them to him. He only started eating after receiving them and I don't want to go backwards.

    His glucose was in the 230's at 0600 so they are removing the insulin drip and going to wait for the glucose to increase more and try injections again. The tech I'm familiar with at night said when another tech was trying to check his temp he started to growl. Much better than a moan or nothing at all!!

    To say I appreciate your help with all of this is an understatement. I don't think he could've gotten this far without you guiding my questions.
     
  42. Tritt3180

    Tritt3180 Member

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    Dec 23, 2017
    1000 update: Insulin drip was stopped at 0800 and his 0900 glucose was 243 (from 235). He received his pain med at 8/9am and will be getting his zofran here within the hour. He has not eaten on his own since 3a (when he ate half the food), but he did get syringe fed around 6a. They will try to syringe feed him a little at noon if he isn't eating on his own by then.

    I feel like I'm getting different stories from different people, and that is frustrating. Turns out the person who told me Cat ate and got pain meds about the same time, when he really ate a tsp at 4 and got pain meds at 6p, was a Dr... Not a tech. And the person I thought was a tech all last night I'd been talking to was a Dr, too. She said he hasn't been syringe fed at all, but the tech I talked to this morning said they try to syringe feed here and there when checked. So confusing!!!

    Going up to see him after lunch.
     
  43. Stephanie & Quintus

    Stephanie & Quintus Well-Known Member

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    Dec 9, 2017
    Gosh, what a ride. My thoughts with you. Hold on tight.
     
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  44. JeffJ

    JeffJ Well-Known Member

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    Jul 7, 2016
    Yes, that is quite a ride. Sounds like he was doing pretty good at 10am though. I hope the improvement continues.

    It's important to keep the interest level up at the vet. The squeaky wheel does get the most attention. And they need to start recording the amount of food ingested. That's important.
     
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  45. Critter Mom

    Critter Mom Well-Known Member

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    Jun 16, 2014
    Really glad to hear that the ondansetron has been helping your cat to get some bit down. I found it to be a godsend - and a life-saver.

    Ondansetron dosing from my vet (for a 10lb cat): 1-2mg q8-q12 (to a maximum of 4mg per day - e.g. doses of 1mg/1mg/2mg 8 hours apart).

    (For general info, it is possible to give bupe once every eight hours in cases of severe pain. ETA: may need to tweak the bupe dose a bit lower if administering TID.)

    When Saoirse had very bad nausea I found that the 2mg q12 dosing for several days helped her to stabilise and get back to regular eating. Thereafter I'd try titrating down to 1mg q12, then 1mg q24. If her nausea symptoms became more marked (e.g. lip licking or making 'yawny' faces after trying to eat; licking the food a little bit then walking away) I'd up the dose again straight away, no messing. Sometimes I'd give 1mg in the morning (because I could monitor her better during the day) and then give her a 2mg dose to see her through the night. (I have a sleep disorder and take meds, so I'd use a timed feeder to dispense her night time meals.) I learned not to attempt to withdraw the anti-nausea support until she had been eating steadily and in sufficient quantity for a reasonable period (talking days to weeks here, not hours).

    Note: keep an eye on regularity and consistency of bowel movements. Both bupe and ondansetron may be a little constipating, and constipation can make nausea worse.

    Granted I was dealing solely with pancreatitis issues (thankfully Saoirse was never prone to throwing ketones) but I found that the thing to aim for was to keep her eating little and often, and during a flare that meant keeping her on the anti-nausea meds for several weeks (with pain relief as needed, especially in the earlier, acute phase of the flare). If too many hours go by between feeds stomach acid can build up in a kitty's tum. This just exacerbates the nausea and can quickly lead to inappetence again.

    When Saoirse had her first (really bad) flare it was a nightmare for both of us (vet had prescribed metoclopramide - great for short courses if poor gut motility leads to constipation but pretty much useless for longer term , non-constipation-related nausea management since cats have very few of the receptors it targets). It was only when members here recommended ondansetron and I pestered the vet to prescribe it that Saoirse started eating better - and steadily. I was beyond grateful for the recommendations made by members here - I don't think I would have even heard of ondansetron were it not for their input and they helped to save Saoirse's life. It is both frustrating and downright scary being put into the position where one has to work so hard to direct one's kitty's treatment but I'm certainly grateful that your little one has such a marvellous and loving advocate in you.

    If I were in your position I'd be inclined to work with the vets to keep the anti-nausea meds going (and pain relief if needed) until my cat was well out of danger and properly stabilised. Even then I'd look to gradually titrate the meds down to ensure a solid recovery. I'd do my darndest to make sure I got a supply of anti-nausea and appetite stimulant meds to take home when my cat was being discharged because one thing I've learned is that it is much better for a kitty to be able to give anti-nausea meds at home ad hoc; it can help to stop a potential relapse or recurrence in its tracks. It can take a bit of time for a cat to recover from a severe GI upset. (We've seen DKA cats here who had been successfully stabilised in the hospital setting only to relapse into another DKA episode requiring a second hospitalisation shortly afterwards - and all because they were sent home without a supply of supportive meds to help keep the kitty eating.)

    I'm glad that you've found somewhere to continue your kitty's hospital treatment. What's the latest on ketone/electrolyte levels?


    Mogs
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    Last edited: Dec 25, 2017
  46. Tritt3180

    Tritt3180 Member

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    Dec 23, 2017
    2130 update: Glucose was 336, but no insulin was given. I believe I was told he won't get any until he's >350. Still seems super high to me, but I'm also told cats tend to drop out of nowhere and go hypoglycemic really fast. So, they don't give insulin until he hits 350. 250-350 is his supposed sweet spot.

    Still no real interest in eating on his own yet. He ate a little for me after I syringe fed him earlier today when I visited him, but I also put the food right in front of him. They have been syringe feeding him some, though, I'm told.

    They are holding his bupe right now because there's no sign of him being in pain yet per his vitals. Also, he will get his zofran within the half hour as scheduled.

    He's still making urine, and his metabolic labs were good other than his sugar level. They tested him yesterday for ketones, so they're only going to do that one time as they've told me it may take days for the ketones to be out of his urine. Will talk more with his vet tomorrow about this.

    The tech earlier today mention our vet putting in an e-tube (a temporary feeding tube that inserts into his esophagus) until he is able to eat more on his own. They do not do that at this ER.

    The gap in my updates is largely due to us being at the hospital for 4 hours today. We waited 2 hours to be able to see him (after driving almost an hour to get there and an hour back) because so many pets were being brought in. It was just too busy. We got to spend 2 hours in the waiting room with him though! He was a different cat than when we saw him last night!! He is still weak, understandably. He stood to change positions a couple times. Like I said before, he took some liquid from the syringe, but then ate some from the bowel when the food in the syringe was too thick to push out. He curled up on my chest and snuggled for a good while (one of his fav spots). At one point he was purring. He didn't really wag his tail, but his eyes were wide open and super bright when he first came out until he got sleepy. At the two hour mark, they hooked him back up to his ivf. Super thankful for that time they gave us!!

    Lots to talk to the home vet about tomorrow after his ER discharge. Will be going to pick him up early in the morning so he can be at the vet in time for me to make my own occupational therapy appointment before work. The ER tech/Dr (idk) said he'll be admitted right when our home vet opens, so that's what I'm banking on. Thankful they are a VCA facility!
     
    Last edited: Dec 25, 2017
  47. Tritt3180

    Tritt3180 Member

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    Dec 23, 2017
    Pics from earlier today.
     

    Attached Files:

  48. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    If they're doing regular blood tests they should be able to include a ketone test in that.

    FWIW, going forward with a ketone-prone kitty it is well worth considering investment in a blood beta ketone (BBK) meter. The strips ain't cheap by any means but it makes it so much easier to monitor ketone status. I was very pleased with my one. If you streamline your testing set-up you can get your BG test and BBK test from the same blood droplet (and it saves an awful lot of messing around trying to catch urine samples). Checking blood ketone levels can also act as an early warning system; the ketones will show up sooner in a blood test than a urine test.

    I'm delighted that you all got to spend time together today and to hear that he is perking up in himself. Sending some 'get well soon' scritches for your little fella. What's his name?


    Mogs
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  49. Critter Mom

    Critter Mom Well-Known Member

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    Thanks for sharing the pics; he's a very handsome boy. :cat:
     
  50. Tritt3180

    Tritt3180 Member

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    Dec 23, 2017
    Thank you, Critter Mom! His name is Ringo, but he responds better to Cat or Kitty Cat. lol I'm pretty sure he was owned previously, but was a stray for a while, too. My brother adopted him from our vet. Ringo never stuck with him, so it's more of a formality I guess.

    I'll look into the kit. Thanks for the suggestion. Did you buy yours on Amazon?
     
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  51. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    Sounds like a real good visit. Too bad they are 1 hour away (2 hour round trip). The important part is to get him eating again.

    Ketones are bad. Test strips are cheap at Walgreens ($11 for 50 strips). Not sure why the vet is so hesitant to retest.

    Renal threshold is around 200 BG. Above that, the kidneys filter out glucose. Below that, the body processes glucose mostly normally. So at BG = 350, there will be a lot of drinking and peeing. And there will be reduced glucose being absorbed by the body's cells because of low insulin levels.
     
  52. JeffJ

    JeffJ Well-Known Member

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    He looks alert, and very handsome.
     
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  53. Tritt3180

    Tritt3180 Member

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    Thanks, JeffJ. Idk why they won't test again other than why they told me. I'll have to ask the vet to retest tomorrow.
     
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  54. Critter Mom

    Critter Mom Well-Known Member

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  55. Chris & China

    Chris & China Well-Known Member

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    May 10, 2013
    I do hope your home vet is a little better educated.....controlling the glucose is also important to getting everything else in line.

    Yes, hypo's kill, but if they're testing, there's no reason for them ever to have one either.

    Normal blood glucose for cats is 50-120 on a human meter, 68-150 on a pet meter.

    Getting him regulated will take time....it can't be done in a few days at a vets office, but I sure don't understand not giving him any insulin at all with numbers in the 300's.

    Do you have any idea which insulin you're going to be using at home? Lantus, Levemir and ProZinc are the 3 that work best in cats (but it's totally normal for ER vets to use R since they need to get the glucose down quickly to help treat the DKA)
     
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  56. Tritt3180

    Tritt3180 Member

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    Idk what he will be on. He is getting Humulin R now, I think. I'll find out more from his regular vet since he's not coming home yet.
     
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  57. Chris & China

    Chris & China Well-Known Member

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    May 10, 2013
    Yeah, R is commonly used in DKA's because it works quickly to bring down the blood glucose, but it's not a good insulin for use at home except in very special circumstances and with a lot of guidance from somebody that's used it before.
     
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  58. Stephanie & Quintus

    Stephanie & Quintus Well-Known Member

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    Such a sweetie!
     
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  59. Sieden

    Sieden Member

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  60. Sieden

    Sieden Member

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    Apr 25, 2016
    That's ridiculous, we always aim for cats to be under 200 which is the threshold but some vets believe that no insulin is required if a cat is at <120 however in this world of diabetic cat care we would still be shooting until a cat was down to 50 because that's the only way to get a cat into remission. Into the 300's and no insulin, that's negligence.
     
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  61. Tritt3180

    Tritt3180 Member

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    Dec 23, 2017
    Dropped Cat off at the Vet hospital this morning and just spoke to the Dr. He started him on ivf again and gave him pzi (a long acting insulin). His glucose was 385 when the vet checked him. The next check is at 3:45p. (6 hours later)

    He's walking and standing on his own. He was able to get from his carrier to me and back, to the back seat and back up front, and then to my seat and back when I stopped to get a coffee on the way to the vet.

    I forgot to ask about ketone testing there, but they will do an ultrasound to check for pancreatitis since the ER couldn't.

    Had to call back and ask the tech if pain meds or zofran have been given yet, and she said not yet, but shell ask the Dr about them.

    Dr is talking about him going home either today or tomorrow. We'll see... I don't know that I'm ready for that yet.
     
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  62. Tritt3180

    Tritt3180 Member

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    Thank you!!!
     
  63. Tritt3180

    Tritt3180 Member

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    Dec 23, 2017
    Also, mom is bringing some wet food choices to try different things. The ER vet said to try to get him to eat anything right now. The store she stopped at doesn't carry Fancy Feast, but she got Caesar's Classic chicken flavor and a can of the wet dog food he gets into at home (Pedigree). Plus, they have the special diet food there. I mentioned the E-tube to the Dr because the ER vet tech suggested it. And the Dr said maybe as a last resort he'll think about it. So... That's where things stand unyilbi call back. The Dr said to call around 3pm. I may try to wait until his sugar is checked to call in. Gonna be hard waiting 5 hours as opposed to 3!
     
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  64. JanetNJ

    JanetNJ Well-Known Member

    Joined:
    Jun 8, 2016
    http://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf
     
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  65. Tritt3180

    Tritt3180 Member

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    Dec 23, 2017
    A tech just called and said Ringo's glucose is at 148 with just 2 units of pzi! They are going to keep him over night to monitor him close. Their plan is to keep him on2 units BID. If it works and he can go into remission, it works for me!

    When I asked about eating, the tech said they had been force feeding him, but he's not showing interest on his own. She didn't know anything about zofran or bupe, and she said it didn't look like anything was being done for pancreatitis. Not even an ultrasound. :-/ She said she is going to have the Dr call me when he can to talk about those things.

    Maybe he's not nauseas if he's holding down the food they're forcing down him?... Idk I wonder if this could all just be DKA related and not pancreatitis... His amylase and lipase levels were wnl, so it's possible? I guess I'll find out later when the Dr calls.

    It's nice that I didn't have to call, but would like to get all the info as soon as I can.
     
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  66. Vader723

    Vader723 Member

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    Dec 12, 2017
    Sending positive vibes out :bighug:
     
  67. Tritt3180

    Tritt3180 Member

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  68. Critter Mom

    Critter Mom Well-Known Member

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    Jun 16, 2014
    Oh, we like news like this! :cat:

    Even if Ringo is holding food down, if they're having to assist feed then something's preventing Ringo from eating under his own steam. Whether it's due to DKA/pancreatitis/both the most likely culprit is nausea. I suggest keeping on the case with the vets to get the Zofran treatment reinstated. You've got evidence from the previous vets showing that he did eat by himself when he received it. (If that's not enough then the bupe may also still be needed.) If treatment with Zofran is successful then it would be a much gentler solution to Ringo's appetite problems than an e-tube.

    If a cat has been having major problems with nausea/inappetence the general approach is to start with anti-nausea treatment - possibly reinforced with an appy stimulant at first. As the cat gets back to eating regularly on its own the appy stimulant may not be needed but typically the anti-nausea treatment needs to be continued for some time thereafter until the kitty is eating voluntarily and reliably. Reliability of food consumption is critical to any cat and even more so when the cat is recovering from DKA and needs insulin.

    It's possible it might just be DKA. Without the results of tests/scans for differential diagnosis one can't tell. I'm keeping my fingers crossed for you both that it is DKA alone. (Pancreatitis is the pits.)

    Keeping fingers and paws crossed in the Shire.

    (((Ringo)))


    Mogs
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  69. Critter Mom

    Critter Mom Well-Known Member

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    What's 10mg/dL between friends! ;) It's still a great improvement. :)


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  70. Tritt3180

    Tritt3180 Member

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    Thank you. I'll keep at it until I get a differential diagnosis. Would his labs be normal if he has pancreatitis, or do land not always tell the whole story in these cases?

    The appetite stimulant was given either Saturday night or early Sunday. I was told he can have it every 3 days... So, he'd be about due for another dose tonight or tomorrow. I'll be sure to ask about that when I talk with the Dr. And even push for the zofran, at least. The tech didn't seem to know what I was talking about when I mentioned both names of the med... I'm hoping they have it at this facility.
     
  71. Tritt3180

    Tritt3180 Member

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    Dec 23, 2017
    Is that too big of a drop over 6 hours? And do any of the reg labs flag an indication for pancreatitis, or just the special lab tests and ultrasound? If not, would an ultrasound alone be sufficient to diagnose it? Just trying to figure out how to approach the Dr when he calls.
     
  72. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Sometimes with pancreatitis the liver values and lipids/enzymes might be off but one needs the SNAP/Spec fPL tests (possibly with supporting ultrasound scan) for a positive Dx.

    Saoirse had an abdominal ultrasound as part of her workup when she was first Dx'd with diabetes. (The treating vets at the time were absolute pants with cats and, after her physical exam (very distended abdomen) they initially suspected ascites when the actual problem was Saoirse's bladder being full to the brim from drinking over a litre of water in the previous 24 hours. Long and angry-making story ...) The scan picked up the pancreatic inflammation. Thereafter I monitored her status by getting periodic Spec fPL tests run (after switching to a different veterinary practice).

    If the appy stimulant is being dosed every three days then pound to a penny they're treating Ringo with mirtazapine. For general information, an alternative appy stimulant is cyproheptadine. An antihistamine, cyproheptadine's appetite stimulant effect is gentler and of shorter duration than mirt but it can be dosed as frequently as q8 hrs if needed, making it really helpful for 'fine-tuning' appetite stimulation in a somewhat more 'real time' fashion - if appetite is OK, you can skip a dose; if it stalls you don't have to wait very long before giving the next dose. (Note: Cypro is metabolised in the liver so need to check it's OK with the vet.) Cyproheptadine is less likely to adversely interact with buprenorphine and less likely to cause behavioural changes (mirtazapine's a tetracyclic anti-depressant, often dubbed 'miaowzapine' because it can cause unusual vocalisation and agitation). Saoirse had a major adverse reaction to her one and only dose of mirtazapine (pupils dilated to the size of dinner plates, ravening hunger, severe agitation and aggression - mirtazapine can cause serotonin syndrome) but she did great on the cypro; the only side effect was slight drowsiness that wore off about 1 hour after dose administration. Other cats get on famously with mirt. As they often say here, every cat is different (ECID)!

    For convenience I'm reposting a couple of links for you below. I found them invaluable in helping me to manage Saoirse's nausea and inappetence issues. In particular, the IDEXX document (a suitably authoritative source! ;) ) is great to wave around the place when discussing/pushing for anti-nausea and appetite stimulant meds from the vets, including a supply for administration during recovery at home! It's far safer to have a supply of meds that are not needed than to put the kitty at risk of a relapse; prompt response to appetite problems makes the world of difference and is key to the kitty making a solid recovery from DKA.

    IDEXX Labs - Pancreatitis Treatment Guidelines (inc. recommended meds for managing nausea and inappetence)

    Nausea & Inappetence - Clinical Signs & Treatments


    Mogs
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    Last edited: Dec 26, 2017
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  73. Tritt3180

    Tritt3180 Member

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    And what's the name of that test that should be ie vets office to check?
     
  74. Tritt3180

    Tritt3180 Member

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    Dec 23, 2017
    Thank you so much for all of this info!! Lord knows there's a ton I could research and find, but you're saving me from sifting through a bunch of fluff that comes with it! :)
     
  75. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    I'm so glad this is of help to you; 'tis knowledge that was hard won and 'twould be a sin not to share it ... (((Saoirse)))

    Like you, I found that I had to gen up on stuff and drive Saoirse's treatment. Thankfully the vets we switched to are much more collaborative in approach than the previous shower. In particular, Saoirse's main treating vet at the practice had a diabetic cat himself which was very helpful. Over time a very beneficial vet-caregiver team relationship developed which made many things easier.


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    Last edited: Dec 26, 2017
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  76. Critter Mom

    Critter Mom Well-Known Member

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    Jun 16, 2014
    An afterthought:

    Ask the new vets about whether it's OK to give a course of B12 injections. It can help a lot with appetite/GI disturbances. It's recommended when treating pancreatitis but I don't know whether or not it might be contraindicated when DKA is an issue. See the IDEXX document for more info on the benefit of B12 supplementation.


    Mogs
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  77. Tritt3180

    Tritt3180 Member

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    Dec 23, 2017
    So, they did an ultrasound and the Dr said it was difficult to see. I'm thinking that would be a good thing, right? They don't have the snap test, and have not sent out blood work for the spec fPL. Should I still push for it?

    I told the Dr when he got the bupe and zofran he ate on his own, and no one will be home to force feed him during the day like they are. He said he is not vomiting and doesn't seem to be in pain, plus he hasn't had a bowel movement in 5 days (even though he hasn't been eating) he doesnt want to continue to constipate him. With the force feeding something should be coming out by now, right? Not sure if the amylose (sp?) is contraindicated with pancreatitis.

    They want to give him another 2 units of insulin tonight. I had to talk the Dr into getting a tech to stay all night to make sure he doesn't go hypoglycemic since he won't be eating then because no one will be force feeding him through the night. This Dr doesn't seem to respond comfortably to mt questions and concerns... He said, "sure there is a possibility he could go hypoglycemic so if you want someone to be there in case he goes into shock it will cost you about $250." Ringo's normal vet isn't there until Thursday. Super frustrating!!!

    I have to take the dog food he gets into at home up there tonight to see if he will eat something. Mom didn't bring it, I've learned. Idk if he will even want to eat having a full stomach like he has.

    What do I need to ask for given the above info, other than a different Dr? He's the only one there right now.
     
  78. JeffJ

    JeffJ Well-Known Member

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  79. Tritt3180

    Tritt3180 Member

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    He's still at the vet. I bought a tech for the night to stay with him and monitor him. I agree 2 units is way too much to give when he's not eating at night - esp if nobody would be there. Now there will be. The Dr sluffed it off as if it wasn't a big deal, which really upset me. Scary stuff. I don't like this guy at all!
     
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  80. Kris & Teasel

    Kris & Teasel Well-Known Member

    Joined:
    Aug 17, 2016
    You'll feel a lot better once your kitty is safe at home if you take on the FD treatment yourself. Learning to test BG at home seems daunting at first but it's actually easier than you think. Once you have this tool to monitor how your kitty is doing at home you'll feel so much calmer and in control. Most of even the best vets aren't very good at treating FD which is why we all ended up here and took matters into our own hands. :)
     
  81. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Poor boy! :( Five days is a long time without a BM.

    If Ringo is constipated then that could very well be contributing to the nausea/inappetence at the moment and ondansetron is likely to have little or no therapeutic benefit at the moment. Bupe and ondansetron can contribute to constipation problems (plus bupe can sometimes affect gut motility). For constipation-related nausea issues, a day or two on metoclopramide (Reglan) can help normalise gut motility and 'get things moving'. (Note: In such a case, it's the relief of the constipation that reduces/resolves the nausea, not the effect of the medication. While metoclopramide may be beneficial to other species as a nausea treatment, it is not the case with cats: as the IDEXX guide notes, cats have very few of the receptors targeted by this drug for nausea reduction.) If nausea is still present after the constipation is resolved then ondansetron would be the treatment to go for (starts working properly again once the cat's no longer backed up). Once the ondansetron's on board it might be necessary to deploy an appy stimulant after an hour or two to kick start eating type activity. Thereafter feeding little and often can help (fasting for too long can cause stomach acid build-up which may then cause/exacerbate nausea problems).

    Adding plain canned pumpkin can help to keep a kitty regular and Miralax is beneficial if a stool softener is required. Needless to say, the vet needs to do a proper examination to make sure that there's no obstruction or impacted faeces before starting any treatment to resolve constipation/motility problems. Helpful info here:

    felineconstipation.org

    My, but he's all heart! :rolleyes:

    I'd be very upset, too. I shudder to think what could potentially happen if a client didn't actually force the issue of overnight monitoring ...

    And I don't blame you!


    Mogs
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    Last edited: Dec 26, 2017
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  82. Tritt3180

    Tritt3180 Member

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    Dec 23, 2017
    Went to see Ringo tonight. E brought Fancy Feast, and he tried to eat twice, but started to dry heave both times. :-( Finally the vet gave him famotidine. Not zofran, like I wanted, but he got something.

    His glucose was 180 and he received 1 unit of pzi. The night tech will be with him all night tonight. Fingers crossed, and Lord willing, he will eat tonight on his own, and his glucose will not bottom out.
     
  83. donnalea

    donnalea Member

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    Jun 18, 2016
    When you take him home, be sure you get a copy of his records. This vet does not seem to be one that I would want. I'm glad you have a vet tech stay with Ringo. He will feel better having someone to keep him company. Just petting and attention can help him feel better.
     
    Last edited: Dec 26, 2017
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  84. Critter Mom

    Critter Mom Well-Known Member

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    Jun 16, 2014
    I'm glad to hear that you got to spend time together again this evening.

    It's very encouraging that he wants to eat; that's more than half the battle. Keeping fingers and paws crossed here that the vets will work with you tomorrow to tackle constipation/nausea and your little fella will be able to get back to eating regularly again.

    Saying a little prayer for a safe night for Ringo. I'm very glad that the night tech is there to watch over him. I hope you'll be able to get some restorative sleep, too.


    Mogs
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  85. Stephanie & Quintus

    Stephanie & Quintus Well-Known Member

    Joined:
    Dec 9, 2017
    in Quintus's case his hyperthyroidy "masked" his pancreatitis. The IDEXX test is the way to go. An ultrasound can show inflammation around the pancreas, can also show if there are gallbladder stones, can show if there is damage or a tumor. Sounds like there was nothing very obvious.

    If he does have a hypo or drop dangerously low, make sure they don't charge you the money for the night tech or the hypo treatment :mad:

    Yes, that guide is great!
     
  86. Sieden

    Sieden Member

    Joined:
    Apr 25, 2016
    You're welcome and just to be sure that I was correct about the pricing of the strips I checked and I found them at Wal-Mart online at 40 strips for $56.00 (4 bottles of 10 strips)
    Also at Wal-Mart online you can get the glucose strips for this machine and they are 200 strips for $26.00 (4 bottles of 50 strips)
     
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  87. Tritt3180

    Tritt3180 Member

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    Dec 23, 2017
    Ringo's glucose went up just over 200 at 0200 and was in the 280's this morning. He will receive a shot of insulin this morning when the Dr gets here. He's not eating on his own other than maybe a nibble on the diabetic food over night. He received more famotidone and will get more later as its a q12° drug. If he doesnt eat later with staff, they will force feed him to regulate his glucose with the insulin.

    He is more feisty to the staff, they say, which is good.

    The tech said when she checked his temp that she got a little fecal matter on the thermometer, so we're expecting a BM in the next day or so.

    I asked if there was anything else he could have for pain since the bupe can have a constipating effect, and she said she'll tall with the Dr and see. Although bupe seemed to do the best, he's not getting anything. He did moan some when we were petting his back end, and pancreatitis radiated to the back in cats and it has not been ruled out yet (unless it has with the ultrasound and the vet just hasn't told me it's confirmed - he seemed a little wishy washy on the topic). So, well see how today goes and pick him up after work, hopefully.
     
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  88. Nan & Amber

    Nan & Amber Well-Known Member

    Joined:
    Mar 19, 2016
    He's clear of ketones, then?

    He sounds like he might be at a stage where he's just sick of being at the vet and might start eating for you on his own when he's back home, but I'd feel better if they sent you home with anti-nausea and maybe anti-pain meds to use as backup.

    I'm not sure why they can't do a pancreatitis test? (ultrasound isn't required, there are blood tests)

    So glad to hear he's feeling better!
     
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  89. Tritt3180

    Tritt3180 Member

    Joined:
    Dec 23, 2017
    I sure hope that's the case. I finally had time to read through the IDEXX and nothing g is being followed for pancreatitis except the ivf. And since that's not ruled out, I made an appointment for him to see a different vet (my dog's) tomorrow afternoon. I also asked if the Dr could call me today from my dog's vet to talk about their treatment protocol. I understand they can't give a specific treatment plan over the phone without seeing him first, but to get a general idea is my goal.

    They do not have the snap test at the facility where he is at currently. Not sure about the other facility. They have to send the blood out. And since the ultrasound seems to be negative, it didn't seem to be a huge deal when I asked if I should push for the blood test, so I didn't.

    I'm just afraid he'll get home and still not eat.
     
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  90. Tritt3180

    Tritt3180 Member

    Joined:
    Dec 23, 2017
    I called off work today because my dog's vet actually had an opening today. However, when I called to let the hospital he is at know I'd be picking him up earlier than planned, I was transferred to a Dr. A different Dr. than last night.(thank God!!)

    I brought up the IDEXX multiple times and she reacted like I didn't think she knew what she was talking about and was stepping over her and said, "I've treated diabetic cats for over 20 years..." Well, she wasn't with him last night. She was going off the records from yesterday and the ER. No records were made about him eating for us. They never documented the dry heaving he did yesterday when he tried eating for us. And they have not seen any of this themselves.

    Needless to say I broke down on the phone with her and told her I wasn't meaning to over-step her, but I was very concerned that a proper protocol of treatment was not being followed for him. She read through the labs she had and said she wants to send our another panel to get a better idea of the whole picture of what's going on. I asked if pancreatitis was definitely ruled out, and she said the spec fPL is included in this test, and will have the results by TONIGHT!!! When I asked if this was a different test, if I was confused, or what (because I understood it may take days to get a result), she said they could do it in their facility, but she wants the full panel of blood work, too, and they can't do that there.

    She is concerned with his liver now, too because his bili was 1.4 (0.1-0.8 is the safe range) and his ALT was 209 (20-100 is their normal range). I thought i had heard that if cats stop eating that they could develop fatty liver (maybe in wrong), and asked if it could be because he hadn't been eating, and she didn't think so. Nobody else brought that up until now. I'm curious to what they were last week since the vet said, on Friday, that everything looked OK except his glucose.

    He'll be there until I get the results tonight. They don't carry zofran at their facility. Gave him Mirt again for appetite and are only giving him Famotidine for nausea.

    An appointment is made at the other vet for tomorrow afternoon.
     
    Last edited: Dec 27, 2017
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  91. Vader723

    Vader723 Member

    Joined:
    Dec 12, 2017
    I'm happy that there is some progress being made towards a more definitive diagnosis, and that you have spoken to a vet who at least is willing to listen to your concerns, even if it took a breakdown to do it! :bighug:
     
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  92. Nan & Amber

    Nan & Amber Well-Known Member

    Joined:
    Mar 19, 2016
    I am so, so, sorry that you are getting all of these conflicting stories about Ringo/Cat's treatment!!!!! That's so frustrating and upsetting when you have a sick kitty! :bighug: :mad: :bighug:

    The good news is, it seems like maybe this vet today is more on-the-ball than the others you've been dealing with? And the spec fPL results will be in soon, giving you a solid answer on the pancreatitis. I think that a pancreatitis flare can be connected to an abnormal liver panel, but I'm not sure. You're definitely right to be worried that it might be connected to not eating-- let's hope it isn't, because it would probably mean a longer vet stay, and it really does sound like more than half the battle on the eating might be won if he could get out of the hospital and go home to his family.

    Hang in there, you are a great advocate for your kitty! I'm just sorry you are having to work so hard to get him proper care!
     
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  93. Tritt3180

    Tritt3180 Member

    Joined:
    Dec 23, 2017
    Oh! I forgot to post an earlier update for today, too... They should actually be switched in their order... Sorry for the mixup.

    0830 update: Ringo's glucose went up just over 200 at 0200 and was in the 280's this morning. He will receive a shot of insulin this morning when the Dr gets here. He's not eating on his own other than maybe a nibble on the diabetic food over night. He received more famotidone and will get more later as its a q12° drug. If he doesn't eat later with staff, they will force feed him to regulate his glucose with the insulin.

    He is more feisty to the staff, they say, which is good.

    The tech said when she checked his temp that she got a little fecal matter on the thermometer, so we're expecting a BM in the next day or so.

    I asked if there was anything else he could have for pain since the bupe can have a constipating effect, and she said she'll tall with the Dr and see. Although bupe seemed to do the best, he's not getting anything. He did moan some when we were petting his back end, and pancreatitis radiated to the back in cats and it has not been ruled out yet (unless it has with the ultrasound and the vet just hasn't told me it's confirmed - he seemed a little wishy washy on the topic). So, well see how today goes and pick him up after work, hopefully.

    The Dr from last night is not following the IDEXX recommendations for pancreatitis, so until he tells me it is for sure ruled out, then I feel I need to keep pushing for these things - onadesterone for nausea, cypro for appetite stimulation. Etc.
     
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  94. JeffJ

    JeffJ Well-Known Member

    Joined:
    Jul 7, 2016
    If his ketones are down, and if you can test and dose insulin at home, then I would take him home tonight. Otherwise it doesn't sound like he is getting much actual medical treatment at the vet. And that is costing you.
     
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  95. Tritt3180

    Tritt3180 Member

    Joined:
    Dec 23, 2017
    He is definitely coming home tonight!
     
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  96. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Be careful about pain meds and Zofran. Tramadol is another commonly used pain reliever for cats BUT there is a MAJOR adverse interaction between Tramadol and Zofran (IIRC I sourced this info from drugs.com).

    Not sure whether or not Tramadol may have constipation in its side effect profile. Check online to be on the safe side.


    Mogs
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  97. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    PS:

    Will check back in later if I can.

    .
     
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  98. Tritt3180

    Tritt3180 Member

    Joined:
    Dec 23, 2017
    This is a human one though, right? I'm shopping today and need to get things together for when he comes home today. Can I use a human glucometer? My vet tech friend said no because they measure serum, not whole blood like human meters do...
     
  99. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    I've never seen or heard tell of a veterinary ketone meter for home testing.

    You can use either a pet meter or a human meter to monitor BG at home. While the meters do give different values because of the difference between the way glucose is distributed in a cat and human blood, as long as a reference range appropriate to the meter type is used then either meter type is equally effective as a tool for keeping a cat safe and improving BG regulation in a home setting.

    Most of the members here use human meters because the test strips are much more affordable than those used in pet meters. In the US, Walmart's Relion Confirm and Relion Micro meters are popular; reasonably-priced strips that only need a very small blood sample. Small sample size makes testing easier, especially in the early days of treatment. (Relion Prime strips are cheaper but the meter needs a bigger blood sample.)

    For info, I've attached a copy of the Roomp-Rand study on treatment of diabetic cats with long-acting insulins. [ETA - see my post below this one for the attachment.] Within the document you will see that they provide dosing tables which include reference numbers for both human and veterinary glucometers.

    Nag the vet for the ondansetron. NB: Zofran is c-r-a-z-y expensive over here (c. £100 for 30 4mg tablets). The generic is much more affordable (less than £10 for 30 4mg tablets). At a guess I'd say similar applies on the other side of the Atlantic.It's a commonly used human medication so if they give you a written Rx for generic ondansetron you should be able to get it filled easily at a regular pharmacy. Same applies for cyproheptadine.

    Be sure to pick up some ketone test strips if you haven't already got some (so you can keep a daily check on Ringo's ketone status). Also have a look at the following sticky post for a list of supplies recommended for keeping at home to use in the event that a kitty starts running in low numbers.

    Hypo Tool Kit

    Sending scritches for Ringo. :bighug: Keeping everything crossed over here that he starts eating well when he gets home. As you correctly mention above, lack of food can cause hepatic lipidosis. You're already dealing with nausea/post-DKA/possible pancreatitis; Ringo doesn't need anything else going on. (Note: pancreatitis can also be a possible cause of elevated liver values.)


    Mogs
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    Last edited: Dec 27, 2017
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  100. Tritt3180

    Tritt3180 Member

    Joined:
    Dec 23, 2017
    Never mind... I shopped around and the only place to get a cat glucometer is online. Called them back and the tech actually suggested a human one. Off to Walmart I go!
     

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