Newly diagnosed, lots of concerns

Discussion in 'Welcome to the Group - Post an Introduction Here' started by Patricia & Noodle, Jan 21, 2015.

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  1. Patricia & Noodle

    Patricia & Noodle Well-Known Member

    Joined:
    Jan 21, 2015
    Hi all! I've been scouring the forums for information and figured it's about time to introduce myself/the patient after a very scary few days.

    Noodle is a 7.5 y/o female who's never had major health problems, until now. We've had a very scary week. I noticed last week she wasn't eating nearly as much and appeared to have lost some weight from her normal, but chalked it up to stress from my roommate packing up + her cat being stressed and lashing out at Noodle. By the end of the week she was somewhat lethargic, but seemed ok enough and would eat treats voraciously, just not her food.

    By Sunday PM, she'd taken a turn for the worse and I brought her to the emergency vet. After bloodwork, we found a BG of 392, elevated ketones (~150), elevated bilerubin, and low electrolytes. She was admitted and given a tentative diagnosis of Ketosis (PH levels were normal) and FHL (enlarged liver shown in ultrasound) along with the diabetes. Monday was very hard with her completely lethargic and not much hope at all from the vets, although she did pick at her food a bit. She was stable overnight and by morning, I insisted they attempt to force feed her before we made a decision about a tube (risky) since her phosphorus and red blood cells droped, and the bilerubin hadn't gotten better.

    By afternoon Tuesday, she seemed much, much better. Started on 1U of Lantus Monday evening, BG staying in the 100s until she's due her next dose when it spikes to the 200s, ketones had dropped to 40 that morning as well. She was alert and much more herself when I visited that night. Moving her head where she wanted scratches, getting comfy in her cocoon, paying attention to her world. Vet said she'd even taken kibble into her nesting corner, apparently saving it for a snack later.

    This morning she is much more active, tolerating the syringe feeding and still nibbling on her own, and all her numbers except bilerubin and ketones are stabilizing. The vet mentioned those can fluctuate during treatment and it's not necessarily a bad thing and we are now "cautiously optimistic." Those words alone made me cry after Monday's fears. The current plan is to keep her overnight again for fluids and meds and have her come home to continue treatment with me tomorrow. I've read a lot of what's available here and I plan to work closely with the vets, but I guess my question is... what next? What do I need to know bringing her home? Has anyone rehabbed a cat from similar circumstances and can offer advice or encouragement? I'm still quite scared.

    A few more specific questions that I can come up with now:
    -I'm planning to continue syringe feeding at home, how should that work with her insulin + does anyone have any recc's for food? I see MaxCal mentioned often, they're feeding her one of the Hills now (wet + dry).
    -Should I keep dry food available while we are working though the FHL? Before this, she would get 1/3c Chicken soup for cats AM/PM which she'd graze during the day, plus ~2oz wet food per day. Usually Trader Joes tuna for cats, Wellness salmon, Best Feline Friend varieties, or Friskies pâtés. She enjoys dry food.
    -She's very treat-motivated, how can I use this in her care going forward? Are there low carb treat options to use when I don't need to give her extra carbs? She seems to like crunching on dry food and I wonder if I can keep that as a motivator when I need her to behave.
    -The vets are timing her insulin now around 5am/5pm, with my work schedule, it's quite hard for me to get home at 5 every day. How difficult is it to shift this over time?

    I'm interested in the TR protocol with lantus since it seems quite successful here, I guess I should post our story there as well? I'm not sure if that's putting the cart before the horse in this situation, though.
     
  2. BJM

    BJM Well-Known Member

    Joined:
    Oct 6, 2010

    You'll need 4 things to manage her at home:
    1) you - your commitment improves success
    2) good insulin - Lantus, ProZinc, Levemir, or BCP PZI. For Lantus and Levemir, get the pens, remove the needle caps, and use a syringe to withdraw the insulin
    3) home testing - before changing anything else, pick up an inexpensive human glucometer ( the pet ones will cost you way too much) and use the feline-specific reference ranges in my signature link Glucometer Notes
    4) after getting home and stabilizing, take a look at Cat Info for low carb, over the counter canned or raw food with under 10% calories from carbs

    It can be helpful to learn how to give subcutaneous fluids as those can help flush the ketones and offset dehydration.
     
  3. Patricia & Noodle

    Patricia & Noodle Well-Known Member

    Joined:
    Jan 21, 2015
    @BJM Thanks for the reply. I've checked that out and have an idea about what foods I'd like to transition to, lots of things she's had already on there (she's just sooo picky!).

    Any ideas about what I can expect when I get her home, if everything goes well tonight? What type of set up should I have, etc?
     
  4. phlika29

    phlika29 Well-Known Member

    Joined:
    Sep 14, 2014
    Hi and welcome. I am sorry your poor cat has been so ill.

    There have been many situations similar to yours so you are not alone.

    @The Rock momma's boy has been going through something similar just this weekend and has so far managed to help her cat feel better.

    My advice would be to make sure that you can get your cat to eat when she comes home. In order to aid that I would speak to the vet about an anti nausea medication such as ondansetron or cerenia. It might make all the difference.

    Getting lots of water into her is going to help flush out the ketones. You can do this via sub q fluid if the vets will allow you and you want to try or by carefully syringing water into her mouth via a 5 or 10 ml syringe. You have to do it very slowly and aim from one side of the mouth to the other.

    Home testing blood glucose is also something we recommend. Human meters that you buy from the store are fine. So you might want the vet to show you how to get blood from her ear.

    http://www.felinediabetes.com/FDMB/threads/hometesting-links-and-tips.287/

    With regards food. Low carb is the way to go but ideally you should transition over slowly and be home testing as it can really lower the blood glucose and hence the need for insulin. However I think that at the moment I would ask the vet what is best. If they believe your cat has hepatic lipidosis you will probably want a high calorie food.

    http://www.felinediabetes.com/FDMB/threads/transitioning-your-cat-from-dry-to-wet-food.956/

    Low carb food list

    http://www.felinediabetes.com/FDMB/threads/list-of-low-carb-healthy-treats.9172/
     
  5. phlika29

    phlika29 Well-Known Member

    Joined:
    Sep 14, 2014
    Forgot to add you can alter the dose time by 15 minutes per shot. Any more than this can act as a dose increase or decrease
     
  6. phlika29

    phlika29 Well-Known Member

    Joined:
    Sep 14, 2014
    I hope you don't mind all these links!

    I would make sure I had a supply of
    Syringes (you just need a couple as long as you wash them out and store them clean)
    Blood glucose testing kit and a supply of strips
    Hypo kit http://www.felinediabetes.com/FDMB/threads/jojo-and-bunnys-hypo-tool-box.2354/
    Print out guidance on hypos http://www.felinediabetes.com/FDMB/threads/how-to-treat-hypos-they-can-kill-print-this-out.15887/

    A lot of what you need is time to read and digest information

    Other suggestions for getting a kitty to eat
    http://www.felinediabetes.com/FDMB/threads/suggestions-on-how-to-stimulate-kittys-appetite.130770/

    How to store your lantus

    http://www.felinediabetes.com/FDMB/threads/sticky-lantus-levemir-info-proper-handling-storage.151/

    I would recommend that you start a thread on the main forum when you get kitty back or have concerns. More people read that forum.
     
  7. BJM

    BJM Well-Known Member

    Joined:
    Oct 6, 2010
    An oral syringe for syringe feeding, in case you run into appetite issues.

    Food list from Cat Info
    - Anything under 10% calories from carbohydrates is good for routine feeding.
    - If you've got feeding issues, anything the cat will eat is better than nothing.
    - When you're concerned about low numbers, high carb gravied foods are good to have on hand.
     
  8. Patricia & Noodle

    Patricia & Noodle Well-Known Member

    Joined:
    Jan 21, 2015
    Thank you so much for all the information. I'll be printing all of it out so I can build myself a reference for home.

    Just got back from a visit, she seems so much better. Purring and walking around, giving me little headbutts, meowing, making biscuits in my jacket...which she tried to jump on a chair to get to in her bandaged IV'ed up legs... They said when she wasn't sleeping today she was eating, they haven't felt the need to syringe feed today at all. The hope is her numbers will catch up to how she is acting and we will be set for release tomorrow. I know this doesn't mean its over, but it's a start! I suppose I should repost this on the main health forum to get some more eyes and advice?
     
  9. BJM

    BJM Well-Known Member

    Joined:
    Oct 6, 2010
    Lets get a few tidbits added to your signature, to help folks give you feedback, then pop over to Feline Health and let 'er rip.

    Editing your Signature

    In the upper right corner of the screen, within the dark blue bar, you will see ID, Inbox, and Alerts

    Click on your ID.

    On the left, under Settings, Click on Signature.
    This is where you will put information that helps us give you feedback.
    This is where you paste the link for your spreadsheet, once it is set up.
    Add any other text, such as
    your name,
    cat's name,
    date of Dx (diagnosis)
    insulin
    meter
    any other pertinent issues like if there are any food issues, history of DKA, hepatic lipidosis, pancreatitis, allergies, IBD, etc.
    Click the Save Changes button at the bottom.

    Always click the Save Changes button at the bottom when you have changed anything.
     
    Last edited: Jan 21, 2015
  10. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Yup. Feline Health (The Main Forum) is where we expect those questions and will give you feedback. This forum is mainly for the introduction.
     
  11. The Rock momma's boy

    The Rock momma's boy Member

    Joined:
    Jan 17, 2015
    My vet upon closing on Friday gave us a phone number of a vet who is lower in price and open on the weekend. I set a timer and gave him water every 45 min, via advice/info from this forum. I learned to force feed and give shots but they all thought it was too late for him. The Rock is now "like our old kitty boy is back" according to my husband. Even with our financial limitations we are nursing him back to health. You can do it!!!
     
  12. Patricia & Noodle

    Patricia & Noodle Well-Known Member

    Joined:
    Jan 21, 2015
    I read your threads and think it's just amazing what you did for him! Thanks for the encouragement. Hopefully the worst has passed for both of our babies. How's he doing today?
     
  13. Marciegee

    Marciegee Member

    Joined:
    Jan 9, 2015
    Welcome Patricia and Noodle! My cat, Moby, was diagnosed this month and we've had a whirlwind of an experience, too. (Also resulting in a two day stay at the vet) Anyway, I just wanted to say hello. I have found everyone here to be extremely helpful with any questions. I wish I had enough wisdom to answer your questions, but we're just learning all about testing, treating and documenting our experience to get our kitty regulated. I look forward to connecting! :)
     
  14. The Rock momma's boy

    The Rock momma's boy Member

    Joined:
    Jan 17, 2015
    He is doing well, his jaundice is practically gone!!! He is eating good but has been on an appetite stimulant that works for 72 hours at a time. I pilled him like a pro today, he was easier than my less feisty one. He gave the vet techs trouble when they pilled him for me on Monday. I decided to give it to him because I put his snack down at the right time and he was not very interested. I got scared we would revert so I gave him one. Keep us updated, everyone else can offer advice and info....I cannot, all I can say is if I can do it you can too! Hang in there, read up on stuff and get informed. It is your best tool. The vet techs can teach you everything about home care, but go in informed. I was a crying mess on Thursday and Friday. But as of today, he is acting normal and pinking up! Hope your little one continues to improve!!!!!
     
  15. phlika29

    phlika29 Well-Known Member

    Joined:
    Sep 14, 2014
    @The Rock momma's boy I am glad you are being proactive. With anything like this it is better to give the supportive meds for as long as you can. It is all too easy for them to slip back. If you do have trouble pilling the rock in the future then you might like to try empty gelatine capsules -size 4. They are tasteless, smooth and you can more than one tablet in the same capsule. Always follow with at least 3 ml of water.
     
  16. The Rock momma's boy

    The Rock momma's boy Member

    Joined:
    Jan 17, 2015
    I followed with water, I think I will hang on to the syringes and tips. It makes it way easier. My Smokie, the 23 yr old I had when I was a kid was a chill kitty but stubborn to pill. I could watch her for 10 min after pilling and she would spit it out. Crazy cat was highly allergic to flea bites and would over groom until she had a wound. I had to give her the antibiotics and it was hard. I was a teenager when it happened for the first time and my mom said "it is your cat, if you want her to get better you do it!" Unsuccessful sometimes but enough to get it cleared up and get her better. The syringe with water is way easier than dumping a cup into her tiny mouth, per my mom's suggestion.
     
  17. The Rock momma's boy

    The Rock momma's boy Member

    Joined:
    Jan 17, 2015
    How is Noodle? How are you?
     
  18. Patricia & Noodle

    Patricia & Noodle Well-Known Member

    Joined:
    Jan 21, 2015
    Thanks for asking. We are doing pretty well! She didn't eat as much as I'd have liked this morning, but just ate like a champ before her evening shot. When we got home, she was urinating a lot. She wanted to be on the bed with me, but was still struggling to get up and down off the bed urinating that much and had an accident. So, I set her up on a towel over heavy duty plastic and let her be when I couldn't get her to the litter box. She's still pretty constipated, but her hairball remedy (Vets Health) was Ok'ed by the vet and has psyllium, so I gave her half a tablet to see if it helps her digestion.

    She is not a happy camper with her pills, but I've managed to get them all in. She doesn't mind the water syringe either! Her behavior seems great and she even started grooming a little. She's loving getting brushed a lot, too. I called the vet (her regular vet is the emergency hospital as well) 4 times already just to clarify things and get advice! Still scared to take my eyes off her so I didn't sleep much, but feeling good about how she's doing. I'm allowing myself to leave her and go run tomorrow, I have to live my life, right? I feel ok that it's 2 hours after her AM shot.

    How's your kitty?
     
  19. phlika29

    phlika29 Well-Known Member

    Joined:
    Sep 14, 2014
    Hi

    I find siting my cat in front of me and the chair and talking him through what I was doing and why helped us both when I got started. I am lucky he is very complaint but I feel it goes better the less I constrain him.

    Re the lack of strength you might want to get hold of some MethylCobalamin. It can help with any diabetic neuropathy.

    http://www.felinediabetes.com/FDMB/...and-methyl-b12-questions.130942/#post-1348246

    They did give you anti nausea medication such as ondanestron didn't they and not just an appetite stimulant? Forcing a cat to eat if it is nauseous isn't the best way to go.
     
    The Rock momma's boy likes this.
  20. Patricia & Noodle

    Patricia & Noodle Well-Known Member

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    Jan 21, 2015
  21. The Rock momma's boy

    The Rock momma's boy Member

    Joined:
    Jan 17, 2015
    The Rock is acting normal today, I blended his meaty shreds food in the blender and he is gobbling it down now. He eats hard kibble, I know it is bad for the diabetes but good to get food in him for his liver....maybe I am paranoid but he seems a shade more jaundice to me today. I give him about 60 mL of water through out the day, he does drink on his own so I have been backing off but added more today. He is playing with his milk jug rings and watching the birds. He is my helper chef in the kitchen again. So I think he will make it to the 3 week sugar curve check at the vets!!! I bug him and he grumbles. He even swatted at me when I was messing with his feet, it has been a while since he has done that. He is doing good over all!
     
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