Pancreatitis with diabetes and renal issues

This is a follow on from the following thread:

http://www.felinediabetes.com/FDMB/threads/18-year-old-poppy-renal-diabetes.216003/

I've taken Poppy to the vets today and we decided to admit her for IV fluids amongst other things. Ideally, she would have remained at home but she wasn't eating and starting to become dehydrated. I would have started SQ's today but decided IV fluids would be the way to go (for 48 hours at least).

The vet was more positive than some of the other vets I've seen. Her weight was now down to 3.18kg from the 3.45kg it was about 2 weeks ago. But the vet said she wasn't as dehydrated as he expected her to be and that she seemed quite lively and responsive. I mentioned that some people might question whether it was worth treating her. He said that if I'd have mentioned euthanasia he would be surprised because he didn't think she was at that point and that there is every reason to treat her.

He also agreed with me that her kidney function has probably not deteriorated over the 1-2 years. Pancreatitis hasn't been diagnosed with the fPLtest and I may suggest they try that. But he was quite convinced this was pancreatitis due to the sudden onset of high BG numbers amongst other things. She had 5 days on IV's and was eating. Maybe she just needed a little more time on IV's?

Anyway, I think they're going to check her electrolytes and potassium levels and probably her kidney valiues too.

One option after the weekend could be for me to take her home for the day (leaving the cannula in) and taking her back to vets for 12 hours of IV fluids at night.

If she recovers from this, I'm going to have to look at managing things at home (inc SQ's when needed, stimulants and maybe antinausea meds).

 

Sounds promising

 

Happy to hear Poppy is feeling better

 

Wonderful news that your vet is optimistic! Please keep us updated, with love, Nikki

 

I've just dropped off her insulin and some of the senior food she enjoyed eating before this episode. The vet said I could phone later this evening but he wouldn't expect much change until the best part of 24 hours have passed. I might wait until the morning, go down and see her and see how she's done and what the vet thinks (I'll probably see a different vet tomorrow as it is Sunday, but I'll be back to seeing the usual vet on Monday).

I wonder whether it is the pancreatitis that has affected the appetite or whether it is the fluctuating glucose levels (the vet said he suspects it will be a combination of both). Looking back at the alphatrak diary I've been using (noting all the details of each BG test and the appetite at the time) I noticed that her appetite was always quite good when her bloods were below 17. As soon as they hit 20 and above she tended to show no interest in food. 3 or 4 times she did attempt to eat food when her BG was up at 30, but she never ate much.

Of course, since she had the crash down to 3.3 on Thursday she hasn't had much of an interest in food. My vet did say that the numbers fluctuating a lot will impact on appetite. He likened the higher numbers to a feeling of having eaten a big box of chocolates and feeling a little sickly. It's quite possible that with her being older and having renal issues (and maybe her lack of teeth) that her appetite is more sensitive to this sort of BG change?

Moving forward, if she comes through this and returns home with her BG under control I'll have to start looking at using SQ's when needed and syringe feeding whenever she turns her nose up to food. The problem is, controlling her insulin dose and the BG numbers is harder if her eating is stop/start. Syringe feeding could solve this problem.

 

The vets called me earlier and told me that the creatinine in Poppy's bloods was up over 700, which is very bad news because that suggests her kidneys are failing. Those sorts of numbers are the numbers of kidney failure. My only hope is the fact that this test was done early in her IV fluid treatment, so there is a chance that with 24 hours of fluids that those numbers could back down. But it is very precarious right now and not looking good unfortunately.

 

I'm hoping that's the case with the high creatinine being done early in her iv fluid treatment,

 

Scott, I'm so sorry to hear this...I hope the fluids will help bring her creatinine numbers down. I know Poppy's had crf for a while, but I don't know if you've found Tanya's CRF website; it's an amazing resource, well organized and kept very up to date. Here's a link to the "how bad is it page" discussing creatinine values. There's also a support group for parents of CRF cats linking off the page.
Please keep us updated, thinking of you with love, Nikki

 

I've used Tanya's website a lot over the years. Unfortunately I had a cat with kidney disease a few years ago. In fact, after he died Poppy started yowling whenever she came into the house, almost like she couldn't understand where he was. There are two things giving me a tiny little bit of hope. The first is the fact that this blood test was done very early in the fluid treatment and would only have shown where she was when I brought her in. The second is that Poppy was showing no signs in her behaviour of kidney failure. When it happened with my other cat, he was completely withdrawn, in the loaf position and very clearly unwell. He had 48 hours of fluids and the numbers didn't come down at all. Poppy was up and about and quite alert. The vet even said that he didn't see her in a condition that suggested she was near the end.

But of course, all cats are different and it is entirely possible that Poppy's behaviour was masking what was really going on. After all, with numbers of 700 most cats would be very subdued, lethargic and disengaged. Her demeanor was not that of a cat on the verge of kidney failure but the numbers are.

I remember reading lots of stories on Tanya's site about cats admitted with high numbers who saw those numbers drop with IV treatment, so I know that sometimes the numbers can give a false representation of the kidney function. After all, 2 weeks ago the numbers were steady at 390-420 in 3 different blood tests. But it is entirely possible that the remaining 10%-15% of functioning kidney has suffered in the last 2 weeks.

I wasn't home when the vet phoned, so I don't have all of the info but I know that they are planning on doing an ultrasound to see what is going on. I'm not really sure if the numbers drop from 700, how much of a drop would signify that she possibly hasn't lost more kidney function from 2 weeks ago. If they drop to 600, is it possible that another 24 hours on IV could see them drop again to below 500 or maybe back to the 400 they were 2 weeks ago? I don't know but I would expect that if they don't come down to at least 600 after 24 hours then things are not looking good. Fingers crossed!

 

Sending many strong vines to Poppy for improved results.

 

I had a cat that was being treated for lymphoma and the oncologist missed a UTI. She was hospitalized and on fluids for almost a week. I brought her home and she was on fluids and lots of supplements after that but she was with me for another 9-10 months. I lost to to cancer and not kidney disease.

 

I'll be going to the vet's today (probably in 3 or 4 hours). I left Poppy with them just before midday yesterday and I assume she was put on fluids fairly swiftly after that. Therefore, by midday-1pm today she will have had 24 hours on fluids and I assume they will check her bloods again at that point. I assume the blood results yesterday were from a blood sample taken when she was admitted because that's the usual practice. Get an idea of where the patient is in terms of numbers before the fluid therapy and then check again 24 hours later.

I suppose it largely depends on how hydrated she was when she went in. The basic test of pinching the skin and seeing if the snaps back quickly suggested that Poppy was mildly dehydrated and she was showing signs of dehydration with her drinking. The vet did say that the test on the skin isn't always reliable and it was possible Poppy was more dehydrated than she seemed. If she was, then that would lead to a concentration of toxins like creatinine. That can lead to further damage to the kidneys but it also means there is a reasonable chance that the numbers when admitted are not a true reflection of the kidney function. Her BG was in the 30-40 range the day or two before she was admitted which could also suggest dehydration.

I suppose this will all be revealed when I check on her in a few hours. Hopefully those creatinine numbers have come right down below 500 and possibly back down 400. If they haven't really budged after 24 hours and she is rehydrated, then the prognosis is very poor. I also am told that the creatinine levels are less affected by dehydration, so even when a cat is dehydrated the creatinine levels tend not to rise too much.

 

Please keep us informed. I have seen several kitties numbers improve after having iv fluids.

 

The vet also mentioned that Poppy's phosphate levels were very high (essentially, she has Hyperphosphatemia). This is another worrying thing because as the kidneys fail the phosphate levels tend to rise considerably.

I think I am going to visit the vets in about 30mins time to have a chat, see Poppy and get more info.

 

I hope the fluids re helping your baby. Hugs and pets to Poppy!

 

Thinking of you both, with love, Nikki

 

I wasn't able to see Poppy, but the vet just called and I had a conversation. Essentially, she said it's not looking good. They tested her bloods at the very start of the fluids yesterday and will test again today, 24 hours later. She said that the creatinine of 780 is really high, which of course I knew. If it gets to 1000 then we are at risk of all kinds of other problems, which doesn't surprise me. From what I know, cats really struggle with anything above 650 and she's possibly feeling very unwell because of that. She was reasonably alert and reactive when I brought her to the vets yesterday and the creatinine reading was taken 2 hours later, so I'm not sure it was troubling her massively as it can with other cats.

The other problem they have is that they say they are struggling to control her BG. She told me that in the last 24 hours it has been as low as 1.4 (25) and she was very close to losing consciousness and by last night it was up over 40. She was given 2 units last night and the BG is still high this morning. I'm told that Poppy is very lethargic and unresponsive. Also, there was an issue with constipation (probably from food that she had eaten earlier in the week - I had given her a microlax and helped her have a partial bowel movement a few days ago). They gave her a microlax and helped massage out a bowel movement and that happened with no resistance from Poppy, which the vet said showed how poorly she is.

Anyway, the vet said they can't understand why her BG is fluctuating so much. Surely they're very well aware of bouncing and the body reacting to a low BG (there are a number of vets on duty, so they must know more than enough about this sort of thing?). They're going to do an ultrasound today and have a look at what is going on. It could possibly be an issue with a tumour.

Bottom line is that she is really unwell and on pain relief. The vet said it is looking like I will have a decision to make. I'll know more later today after the blood test and the ultrasound. There is a chance that I will have to make a decision tonight because the vet said Poppy could be heading towards multiple organ failure.

I'll post back with more news in about 9 or 10 hours.

 

I'm so sorry it's so touch and go. It's a very very tough time. You are the most amazing caregiver to Poppy and we know that whatever happens, you will make the right decision for her.
Thinking of you.

 

Thank you for taking the time to update, although it's not the news anyone was hoping to hear. I'm so sorry for both you and Poppy. Thinking of you both with love, Nikki

 

I'm so sorry to hear this, It upsets me just to read about how he is doing, you are a wonderful dad to Poppy and have done everything you can and have taken such good care of him. That poor baby. We are all thinking of you and Poppy

 

Unfortunately Poppy passed away earlier today. The ultrasound found that she had pancreatic cancer - hence the fluctuations in her BG and the inability to control the numbers even in the hospital. The pancreas had started release its enzymes and was causing other problems. On top of this her kidney numbers didn't improve very much at all. Ultimately, at her age and with the renal problems there was no option but to end her discomfort.

 

I'm so sorry for your loss, Scott, but you did the right thing for Poppy. It's so hard to say goodbye. Thinking of you with love, Nikki

 

I'm so very sorry. You did everything you could and more.
Wishing you peace and happy memories of dear Poppy.

 

I'm so very sorry Scott, you did everything you could , and made the right decision , it's very hard , I know , I have had to put 2 cats to sleep in the past and it's heartbreaking. Poppy is no longer in pain, every time I read about a kitty passing I tear up like I'm doing now, it's strange but I look at there picture and just tear up. Just try to remember all the good years you had with her. She was such a pretty kitty. Gentl hugs

 

I am terribly sorry to read of Poppy's journey over the Rainbow Bridge. You did everything you knew to do for Poppy, and she had a good life under your care. Peace and comfort to you and all in the home. You gave a tremendous gift of love Scott, thank you for letting her go in peace and ending any further suffering.

 

wish I could show you the picture I saw on the net -- shows the Pearly Gates with St Peter speaking to a couple of cats: "you know, you can come in"

cats, looking out over a rainbow, say "thanks, but we're waiting for someone"

 

found it

https://www.google.com/imgres?imgurl=https://i.redd.it/9662gteeukj21.jpg&imgrefurl=https://www.reddit.com/r/wholesomememes/comments/awa2yb/patiently_waiting/&docid=YDRae2_0hsLSeM&tbnid=wbW43wjHCK14AM:&vet=10ahUKEwj_zqWLgpLjAhXlLX0KHX9zCyYQMwhCKAAwAA..i&w=960&h=685&bih=625&biw=1360&q=st peter cats rainbow cartoon&ved=0ahUKEwj_zqWLgpLjAhXlLX0KHX9zCyYQMwhCKAAwAA&iact=mrc&uact=8

 

Thanks for all the kind words. I'm certainly very emotional right now. It is almost exactly 18 years to the day that I got her as a 3 month old little kitten. I remember she was a little scared and crawled under a cabinet and I couldn't get to her. I just had to sit there and coax her out. She came to me eventually and then sat on my lap for the next 18 years. Every night she slept on my bed. She'd walk up onto my pillow and then climb in next to me and start purring away in contentment. It's going to take some time adapting to her no longer being around.

I knew this day was coming but it is still tough. Grief is the price you pay for love.

In time I will take comfort from the fact that she lived a long and full life. She was diagnosed with kidney disease over 3 years ago and I managed to get her to a point where she passed away from something other CKD.

 

It is no small thing to share your life with, and be loved by, another for 18 years. You are a wonderful dad to Poppy, and there is no doubt in my heart that she knew she was loved. With love, Nikki

 

It is very very tough, that's for sure. My heart goes out to you..These first few days you will be in shock, things just don't feel right, so take care. I don't know if you're aware but we have a grief forum here which is a safe place to share your memories, thoughts and emotions with others who completely understand. Please feel more than welcome to pop in at any time.

 

Oh Scott I am so sorry to hear that Poopy has passed away. Sheba had pancreatic cancer as well. It is such an awful insidious disease. I know how devastated you must feel. Indeed grief is the price of love. But what a wonderful 18 years Poppy has had with you, filled with love.
You have been an amazing dad and Poppy knew how much you loved her.
Fly free dear Poppy
Hugs to you Scott

 

Yes, the tumour on her pancreas was the reason her BG was all over the place. As of May 15th, her glucose numbers were fine (due to monthly urine tests we were keeping an eye on things like glucose). Within 3-4 weeks the glucose was all over the place. This was obviously due to the tumour taking hold of the pancreas and leading to sporadic insulin production. The insulin injections probably made things more confusing. Essentially, I would advise that any cat (especially an older cat) has a scan when presenting with fluctuating glucose levels to rule out pancreatic cancer.

I have no idea how long the tumour was growing on her pancreas. As of Feb '19 her weight was 4.2kg. 3 months later it had dropped to 3.8kg and she was showing signs of weakness in her hind legs. At her age and with the renal problems, the weight loss/muscle loss was not surprising. Of course, with hindsight it is possible that this weight loss was down to the developing tumour, even though the most obvious sign of pancreas disorder (BG issues) was not displayed until about 4 weeks ago.

One of the vets did talk about an ultrasound when Poppy first went in 2-3 weeks ago. A scan then would have shown the tumour. But of course, I don't think they could have offered any treatment for her then. But they certainly wouldn't had diagnosed pancreatitis/diabetes and started with insulin injections. At her age and with the renal issues, there wouldn't have been any treatment available for this pancreatic cancer.

Her phosphate levels had risen a lot and that probably pushed her kidneys to the point of failure. The pancreatic enzymes were being released into her stomach and causing inflammation. She didn't show it but she was probably in pain and discomfort. I took her home after her first 5 day stay and she had 11-12 days at home (spending a number of days sat out in the sun and sleeping the day away). I suspect if they had discovered the cancer during that first hospital stay, she would never have come home for those 11-12 days.

I had a cat a few years ago who was diagnosed with CKD at just over 6 years of age. Within 7 months his kidneys failed and his life ended. When Poppy was diagnosed with CKD over 3 years ago, my aim was to get on top of it, control it as best I could and see if I could ensure that it never took her life. With changes to her diet, providing lots of water supplies all around the house, regular urine tests, vet visits every 3 months to check her blood pressure and treatment to keep the blood pressure down, I achieved that aim. When she was diagnosed with CKD, I know I would have been more than happy to know that she would have lived to almost 18yrs and 3 months and that she would never have renal failure. Although I am devastated now, I have the consolation of knowing that everything that could have been done for her was done and she lived as long as she possibly could have.

 

The avatar picture shows Poppy with Syi (he died of renal failure just over 4 years ago). Poppy was 6yo when I got Syi (a family with young children could no longer care for him, so I took him and kept his name of Syi). Poppy was none too pleased with this newcomer after living in a house with no other cats for 6 years. But she soon got used to him and they got along well enough after a while. If he got too close to her, she would give him a little slap and he would get the message and move away. Now and then I would come home to find Syi had nestled in next to Poppy and she had allowed him to (just like in this avatar pic).

After Syi died, Poppy would come into the house and yowl a lot - seemingly confused as to where he was. That settled down after a month.

I buried Syi in my garden and today I have just buried Poppy right alongside him. This time she has nestled in next to him.