GA Shorty

Had to take shorty to the vet on 09/22/2016 . He had stopped eating and had no energy. blood sugar was still fine did not jab that day because he was under 200 till we took him the vet.vet stated that he had a uti and was dehydrated and that his ketones where elevated. They have gave him an IV which is now on a pump. they did not shot him that night. He has not been eating they are having to force feed him they are sticking to wet food. his sugar has been fine and in the range that the vet likes 200s. He is still lethargic but will respond some when petted. The vet tested for pancreatitis and that came back negitve. They do not know what is wrong. she can fill no lumps or anything on his body. We are at a lost as what to do. spreadsheet will be updates tonight. They vet is only giving him 1 unit of pro z.

 

You say ketones are elevated? So he has ketones??

 

Yes the vet stated that he had ketones

 

If your kitty has ketones that NEEDS to be treated ASAP regardless of where the glucose levels are DKA can be deadly if not treated. It is caused by not eating enough/glucose too high and/or an infection. Any one or combination of these can cause DKA (diabetic ketoacidosis). This is best done at a properly equipped animal hospital. Please get your kitty in for proper treatment...NOW

 

He has been at the Vet since 09/22/2016.

 

Do they have him on an IV in order to balance his electrolytes? Are they giving him antibiotics? Ate they giving a fast acting insulin to bring his levels down...the 200s is still too high especially with DKA.

 

Some basics on DKA

http://www.felinediabetes.com/ketones.htm

 

I would specifically ask the vet if he is in DKA. I'm not sure why they are confused, but maybe that will help them figure it out?

 

Ok. Kind of an update. I had Kelly post to see if anyone had any ideas. Here is the full situation.

Wed night, Shorty ate, but not like normal. I noticed when I gave him his shot that he was a little dehydrated.
Thur morning, Shorty refused food and water. His AMPS test was only 169. Kelly did not shoot him, and eventually went to the store to get a feeding syringe. No success. When I got up, we took him to the vet.
At the vet, he was diagnosed with a UTI. The vet was fairly condescending about us hometesting, and us using U100 needles to fine-tune Pro-Zinc shots, saying we were complicating things instead of going by the "textbook". She even said "We used to recommend home testing to people, but it became a problem so we stopped mentioning it". His blood test came back with very, VERY elevated liver enzymes (699), his sugar on the lab analysis was only 302 (without a shot, and the stress of driving to the vet and sitting in the vet's office for 30 minutes with a big barking dog, I wasn't too worried about a 302 at that point). He also had Ketones.

The vet herself was so condescending about the home testing with a human meter, that she looked at me and said "So, do you want to take him home and maybe go to an internal med specialist who might know more that us? Because none of us have heard of using a human meter.". I told her whatever process we use at home didn't matter at the moment, she needed to deal with the sick cat. They IV'd him, gave him an antibiotic injection. His IV stopped running Thursday night, so they put him on an IV pump. They have been syringe feeding him. He is not refusing the food, but he isn't getting up and going to the food bowl to eat. He got 1 unit yesterday, when he tested in the low 200's.... but they haven't been shooting him below 200. I don't know if that because I mentioned to her that we don't shoot below that number, or if that is what they decided. He is still lethargic, but his breathing seems to be ok. He feels a little cool to the touch, so I worry about his kidneys. They weren't even going to re-test the ketones until tomorrow (Sunday).

What I hope, is that the UTI messed up his BG, and threw his liver out of wack. But I'm also worried about how high the liver enzymes are, and that there may be an additional underlying liver issue beyond the diabetes. They tested him for pancreatitis and it was negative.

Dan


p.s. - I'm updating his spreadsheet here in a few minutes, I've had additional responsibilities at work recently, and had lapsed at entering the information online.

 

I have not mentioned DKA to them specifically. Her running the ketone test right off the bat made me assume she was considering that. But now, after dealing with her a little more, it concerns me that she might be missing the forest because of the trees. I had previously been happy with her because she has diabetic dogs at home, but her attitude this time around has really put me off.

 

"
Patients suffering from diabetic ketocidosis most commonly present with dehydration, weakness, depression, vomiting, and an increased respiratory rate. Treatment must be initialized immediately to correct this rapidly progressive and deteriorating disorder, using fluid, insulin, and possibly bicarbonate therapy. Tfrom thhe increase in both glucose and ketones within the urine creates an osmotic diuresis. Free water and electrolytes are lost in the urine causing a severe and perpetuating state of dehydration. Intravenous 0.9% saline is the fluid of choice for most cats since sodium levels are often significantly depleted. An initial intravenous rate of 60-100 mL/kg/day is recommended, however adjustments are made depending on hydration, ongoing losses, and shock status. Potassium supplements are often added to the fluid therapy, due to most cats being in a deficient state from urinary and vomiting loss and to prevent life-threateningly low levels e increase in fluid volume and co-administration of insulin. Potassium and sodium levels should be carefully monitored both before and during fluid therapy and supplementation to ensure levels stay within an appropriate range.

Insulin therapy is instituted to allow for a gradual decline in blood glucose and ketones over six to ten hours. Regular small doses of crystalline insulin are given hourly and carefully monitored and adjusted depending on frequent glucose monitoring. The use of bicarbonate therapy is controversial since the acidosis is usually corrected by the metabolism of ketone bodies with the administration of insulin. Therefore bicarbonate supplementation is only used when metabolic acidosis is severe, with pH of 7.10-7.15 or lower. It is important to note that diabetes predisposes a cat for concurrent illness such as bacterial infections, pancreatitis, congestive heart failure and renal failure. Therefore therapy may vary from patient to patient in regards to antibiotic usage and fluid administration. Generally one to three days of hospitalization is required to stabilize a cat and correct its negative energy state. Once the cat is stable, eating and drinking on its own, and no longer receiving intravenous fluid support, the cat may be switched to a longer acting insulin for long-term regulation of blood glucose concentration."

http://zimmer-foundation.org/sch/cbc.html

Any animal whether feline or canine or human if presenting ketones needs to be treated immediately as not treating ketones, can lead to DKA which can be life threatening. Have you vet read this article. Whether they agree with home testing or not has NO bearing on what they should be doing for your kitty at this moment. arguing about things that are not of critical importance only delays the required treatment.

 

Dan, sounds like she's trying to apply dog diabetes to cats and that just doesn't work. Shorty may be just 'ketonic' and not yet 'acidic' so is technically not 'DKA' but ketones for very long will cause the body to develop metabolic acidosis. Lots of liquid will help flush the ketones so that IV is good. Testing for ketones is simple, even just a ketone test strip available at any pharmacy will show those so not sure why they're putting off testing for them. I'd be looking for a new vet....one that has that attitude has a 'God Complex'.

This stinks for Shorty, you and Kelly too...HUGS

 

I know... if it hadn't been for the fact that they already had his history, and we had dealt with them before, I might have bailed and tried to find a new vet. The office has been around almost 40 years, has 9 or so docs, and is one of the more popular offices in town. I was fuming when she was raking me over the coals over using a human meter. Dr Pierson and Dr Hodgekins both say human meters are fine, and I'd trust their years of research over a vet who goes "I keep up on the extended learning, and online classes, and nothing has been said about conversion charts for human meters". At least she didn't balk when I said "He's on a low to no carb, all wet diet. No dry food".

 

ANY meter is only a guide to see how a kitty is doing. I personally use a pet meter, however my vet uses a human meter. I do comparisons between my AT2 pet meter and the lab machines when I have blood work done and the results are very very close. However my vet also calibrates her meter One Touch Ultra and that particular one is also very close to the lab results. The whole fact that a person is home testing should be praised...I know of several kitties personally that were "doing well" with periodic vet testing that had hypo episodes and one (RIP) passed away before she could be saved.

HOWEVER..at this time and point dealing with the ketones is the most crucial issue and any disagreements between the vet and what you are doing should have no bearing on the vet dealing with the present situation. If they don't know what they are doing then they need to tell you and have you go to a proper pet hospital where they DO know what to do.

 

I'm just banging my head against the wall right now. I'd read up on everything for hypo incidents, and DKA just slipped my mind. But when I visited him a few hours ago, before visiting hours stopped, his dehydration was much better.

 

Hydration is important but keeping the electrolytes ( sodium and potassium) in balance is also important, as is treating any infection with an appropriate antibiotic. Glucose levels must be kept down, for which they use a fast acting insulin and then give IV glucose if the levels fall too low. It is not a matter of give a pill and check again in 4 or 6 hours to see how the kitty is doing. Having ketones is "similar" to having bronchitis...if you don't treat it before it gets too bad you can end up with pneumonia. If you don't treat ketones aggressively it can turn into DKA.

 

Well, they gave him an antibiotic shot Thursday for the UTI. I figured that would take probably 2 days to really take a good hold and start working. But because of his lack of eating, his glucose has stayed low, since he's been in there, they've given him 1 shot I think, of 1 unit, and that was Friday morning. As a matter of fact, when I made it in this afternoon, 5:45 pm Central time, they had just tested him, and he was only at 168.

 

They seem to be doing some of the correct things. However a BG of 168 is still on the higher end of where a kitty's numbers should be. It is workable but in a controlled environment it is not the optimal level. With ketones it is very necessary to be eating the proper amount of calories. The antibiotic shot they gave is quite likely convenia which may or may not be the correct antibiotic for a UTI.

Some info on Convenia:

"
Cats
CONVENIA is indicated for the treatment of skin infections (wounds and abscesses) in cats caused by susceptible strains of Pasteurella multocida."

https://www.drugs.com/vet/convenia.html

In order to get the correct antibiotic for a UTI there should have been a urine sample taken and sent to an outside lab for a culture and sensitivity test ( C&S) to make sure the right antibiotic is being used.

 

oh my, I hope Shorty will be fine soon.
Keep us posted

 

Keep us updated on how Shorty is doing!

 

Just updated the title for now. Thanks for the support, love, and advice everyone. I'll post more later when I can.

 

I'm so very sorry.
Fly free sweet Shorty, land softly

 

I'm so very sorry. My thoughts are with you.

 

Oh no! I'm so so sorry. Fly free sweet Shorty!

 

I am so sorry for your loss.

 

I am so so sorry that Shorty has crossed the bridge.

 

Be at peace Shorty.

 

I'm so sorry that you've lost Shorty.

 

I'm speechless. Sorry for your loss

 

Looking back across the week, I just don't know what to say.

A lot of little things added up to a big deal, basically. Here is what I think happened....

Living in an apartments, right off of the courtyard, we are always fighting fleas. We had them under control for a couple of months, until about a week or so. Sudden explosion of fleas.

Monday night or Tuesday morning, I kept catching Shorty sitting in the tub.

I'm not concerned with his numbers, around this time, AMPS caused us to delay his shot around this time too. I think we're doing good.

Wed, we weren't home most of the day. He only ate about half of his dinner that night, and when I gave him his shot, the needle actually dragged and caught on his skin on the way out. I just thought, bad needle.

Thu morning, no eating, low BG, took in to vet early afternoon. Dehydrated, ketones, BG wasn't too high in my opinion, since he hadn't gotten his shot, and had sat in the waiting room with a 50 lb dog barking the whole time. No shot, plus stress, 300 isn't a terrible number, I think.

Fast forward to getting home from burying Shorty Tuesday, and I sat and watched as Nunu and Stretch would look at the water bowl from the desk, or the coffee table, but wouldn't go to it. I walked over, thinking maybe there is something floating in it, and get jumped by about 15 fleas right by the water bowl. And I realize, that Shorty was probably dehydrated for several days, leading to the lower BG numbers. That's why he was sitting in the tub, he was hoping for water without getting into the flea zone. And I had thought he was just being his unique, crazy self. He'd used to just sit anywhere and everywhere, after all. And then the dehydration led to a UTI from the sugar not getting flushed out, and the infection then just compounded the issue for a day or two, until he was DKA.

I'm sure, if we would have taken the offer from the vet, to refer him to an internal specialist at that point, he'd still be here. But I decided to keep him with the office that knew him, had his records, and had experience with him. Monday though, they pretty much said "We can't help him, he needs 24 hour care, an insulin pump, a glucose pump, and hourly checks. We are only here 12 hours a day". What would have happened, if instead of letting them keep him for 4 days, I'd taken him to the 24 hour internal specialist? I had thought the vets offer to refer him was just a challenge on Thursday, with how she acted, especially with her constantly challenging us on both the human meter, and using U-100 needles to fine tune and get more accurate dosages on a U-40 insulin. In hindsight, I should have said "Yup, let's get him out of your care immediately".

I also believe, that since they weren't even attempting any kind of fast acting insulin, and hourly tests and shots, until Monday, that the vets at that clinic were negligent about his DKA. Evidently the clinic's own internal specialist wasn't there over the weekend. We did get verified that they had been giving him potassium and electrolytes the entire time, to help flush the ketones. But from my understanding there was minimal effort to regulate his BG, other than standard testing and insulin treatment, which resulted in minimal / missed insulin shots because of his BG was lower than normal from the lack of eating.

But, well, Monday we had one choice. Empty the bank account, and pay for everything they had done, with barely enough money left to euthanize him. We had another offer, but to walk out of the current vet, and to the other vet, would have cost $1000 more, just for the deposit, with no promises, and no offers of help or discounts or deferral of payment. After being syringe fed for 5 days at that point, IV pump, still refusing food and water, we held him close and ended it.

I keep looking back, blaming myself for missing the dehydration. For not checking his ketones recently. For not having a better vet. For not having more money in savings. For missing all the little things that added up to a big problem. In hindsight, it's so easy to see what went wrong. It's going to take me a while to live with it.

 

Please don't blame yourself. You've done everything that you could for Shorty! And yes it's hard if your bank account says 'no more' but you can only do what you can... Please please please, don't blame yourself! Shorty knows how much you loved him. He has had wonderful parents that gave him everything he needed. When he got diabetes, you've been there for him every step of the way!
I hope you can let this go and have peace with it. Shorty is not in pain anymore right now and that's what counts. You've done the right thing, please know that!.

We are all here for you if you need us.

 

Oh, I'm so very sorry! Please try not to beat yourself up. Everything is clearer in hindsight, and we want to trust our vets - particularly if they're been seeing our cats for a long time. After all, they have had extensive training and are supposed to be experts.

There is always something we could have done differently, always "what ifs" and "should haves" but you did what you could with what you knew at the time.

Hugs, and my thoughts are with you in this most difficult of times.

 

Please don't blame yourself. You did everything you could for Shorty. My cat had DKA 3 weeks ago. He was incredibly dehydrated as well - it comes with the territory. He had access to clean water the whole time and drank a lot. With DKA they simply can't keep themselves hydrated no matter how much they drink - they lose too much electrolytes. I'm so sorry for your loss, and please take heart you did absolutely everything you could.

 

We always see things more clearly after the fact, don't we? Please don't punish yourself. You did what you thought was right and what you could manage during a very stressful episode. Just remember the good years you had with Shorty and how much you loved him.

 

RIP Shorty

You did everything that was humanly possible for Shorty and hold no blame for what happened. You gave Shorty the very best you could and even if you had unlimited finances, there was no guarantee that he would have survived. To make the decision to allow Shorty to escape from the discomfort and pain, is the hardest gift of love that any petparent can ever make. No matter how vigilant you were there was no way to know what could happen. The fact remains that you were there for him and gave him extra quality time by treating the diabetes, something some choose not to do, but you did. Please be gentle with yourself.

 

Thanks guys. He was the first one of ours who adopted me. Stray, just sitting outside, and just walked in the door when he had the chance. It's really a cute story. I don't know how to describe it. He walked in, took over the cuddle spot on the bed with me, and was.... well... he was Daddy's Guy. I even sang little 20 second songs about him..... "Shortround little kitten pound... famous kitty known all 'round town".... or "Little Shorty lookng out the window, looking out the window at the birdies, the birdies looking back at Shorty, hoping they aren't the food for the party."

We've got two more cats we love, including one who should probably be discussed on some feline psychiatry website. Insecure, separation anxiety, nervous tendancies.... he'll lick you 300 times in the exact same spot, over and over, and over, and over, and over, until you go to the other room, and then he follows you, and starts to lick the same spot, over, and over, and over....

 

Dan,
Please quit blaming yourself for not seeing those things before - absolutely NONE of us are perfect altho' we want to be. You and Kelly provided the most important thing in his life - you gave him 'home' where he knew boundless love. You'll never know how things would have played out if it had been different...the end result may have been the same.

HUGS and HUGS to both you and Kelly and headbutts for Nunu and Stretch.

Soar high on your angel wings sweet boy....landing softly back in Papa's and Mama's broken hearts....

 

I'm so very very sorry! I really am, on several levels. I want to send you so many hugs to make you all feel better. I really do!

Long winded bit coming please ignore if you want! I'm both upset and angry (for you) and horrified this happened to you and Shorty and part of me wants some justice for you all. You should never ever had to be on the receiving end of any of that! Especially while Shorty was so unwell.

. It's so hard not to trust the medical professional or person who has more knowledge than we do, because we have to place our trust in someone - we have to believe that someone knows what they are doing and that they are doing it with the best professional training they have and that they are fit to do the job we are asking of them and paying them for!

How they conduct themselves, (in this instance the vet) is so important towards their clients. And yes you are a client - a paying client! I do not care if they think they are better than anyone else (those sorts don't last long around me l eat them for breakfast! zero tolerance for bad manners) at the end of the day you are the one paying their wages and putting food on their tables and a roof over their head.

If you are In the position you were put in (as you describe) then the fault lies solely on the veterinarian here. They seemed to display inappropriate behaviour, focusing on menial things such as how your home testing seems to them (opinion) rather than the appropriate and meaningful task of making your fur baby better. They should not be there to judge but to put the needs of their patient first, it seems to me they have not!
Had they said to you clearly that they did not feel it was in their knowledge and power to treat the cat effectively and that it was beyond their capabilities and suggested you were referred to another practice that has the ability to give the cat a better chance then they should have done so.

My current practice while treating a young dog With severe mvd at 2 years old referred me to a specialist cardiologist as they did not have the facilities or specialist knowledge to adjust her meds during the later stages of CHF, they did not have the facilities to give her emergency 24 hour care and offered me the choice of whether I wished to transfer my dog completely to the cardiologists care or continue with them, and all of us work together With the hospital and my vets sharing notes. The fact I had the choices and options presented to me clearly made my decision mine, it was not forced, I was not lied to and I was able to make an Informed decision - it was presented clearly.

You are not me of course and I understand entirely what you are feeling and going through. But honestly (if and when you feel ready) I would be making a written formal complaint to the practice - about the attitude of what you had to tolerate while going through an already highly emotionally charged time.
I would also be waiting to see what response they give you, and if you are not satisfied with it then I would be taking it further to whoever governs the veterinary field in your area of the world.

And further more I think they should be reading this too - They are failing not only their patients but the parents of these patients. They need to know where their shortcomings are and where they need to rethink and adjust their client care as well as their patient care.

 

I am very sorry for your loss