911 Swallowing issue and swollen lymph nodes

I'm starting a new thread here about my cat Milo because the other one was getting too long and I believe I'm entering an emergency situation with him. To familiarize yourself with Milo 13.5 years old, and the diabetic(?) issues I've had with him since Feb. 1 please refer to my post in the main forum on Feb. 3 labeled "? Low Glucose Readings" where I posted about his first HYPO.

Milo is very, very ill and I do not have access to his vet on weekends. Briefly, Insulin injection (Novolin N 2u once daily) seems to make him worse with the lethargy and anorexia. He is neither eating nor drinking on his own for days. Plus he has been having clear nasal discharge that crusts over, which I clear. His body feels as though his temperature is back. His ears are very hot, too.

Vet currently has him on 2nd round of clavamox but antibiotics are not making a difference. A couple of hours ago I discovered at least one swollen gland on his neck where it meets the jaw. Milo then developed difficulties swallowing today. Thinking it was because of clogged nostrils I gave one drop of neosynephrine each nostril; however, he still does not want to swallow and has begun drooling.

The closest competent emergency room is over an hour away from where I live. I'm supposed to be giving Pedialyte every hour at least. The last time I was able to get any substantial amount of fluid in him orally was at 5:40 pm at which time I administered only 7.5 mL food/water mixed to soup consistency. I'm afraid to syringe at this point for fear of drowning him, and need advice as soon as possible since he is getting weaker and appears to have become dizzy as well. I don't even know whether to have him on a heat pad or off. He seems better when not on it. He is alert and curious about his surroundings when someone comes in or goes from the room, although the 3rd eyelid has started showing. Total fluid given today (food/water or food/pedialyte mix is 70.5 mL in 7 sessions (Sheba Chicken Pate) A final note is that he has lost from 11 lbs. to 8 lbs. in just 6 months.... Any comments, advice, recommendations will be appreciated. Thanks!

 

Here's your other post

I think it's time to get a 2nd opinion from a different vet....this one obviously isn't helping Milo and if he isn't eating and now has swollen glands, I think it's best to see someone else and get some fresh eyes on things

Clavamox makes a lot of kitties nauseous and then they don't want to eat....and if he's got an URI, there are other antibiotics you can use.....if he didn't improve any at all with the first round of Clavamox, there's really no reason to think he'll improve with the 2nd

I don't think you should use Neosynephrine on him....mostly we just suggest saline nose drops....that's enough to possibly be causing the drooling....there are tubes that siphon the medication from the nose to the mouth/throat and I can't imagine it tastes too good

Have you tried putting him in a bathroom with the hot water running? I think I read that you've tried a humidifier, but hot steam can work wonders.....about 20 minutes at a time

Have you asked your vet about changing insulins? I didn't read through all your other posts, but it seems like he's never done well on the Novolin ....it's not a great insulin for most cats

Wish I had a quick fix for you or some better ideas.....Hopefully others will be around later to offer some guidance too

 

If he were mine I would be calling the emergency vet and taking him in. Maybe they will know what to do and save him... and possibly try a better insulin? Hoping he gets better!

 

thank you both, I may drive him to Athens today.

 

Athens? What state? Just asking because I'm from Athens, PA. I know there's more than one but just curious if we are neighbors! Sending good vibes your way! Good luck!

 

I agree second opinion. If the clovomax didn't work the first time, why didn't they give him something different??

Do you have a nebulizer at home? When I was caring for my kitten with pneumonia I would put her in a carrier and drape a towel over it and run the saline nebulizer through the fron.

 

Hi...I'm in mid Georgia. Athens UGAVeterinary College emergency vet is an hour away and super expensive.

 

I don't have a nebulizer. Is that something I can purchase as say a place like Walmart today?

 

Would it work to put him in a covered crate with a warm air humidifier in there with him?

 

I would take him to the emergency vet. This has been going on too long with no improvement. I definitely would not give him Neosynephrine.

Neo-Synephrine (phenylephrine) disease Interactions
There are 4 disease interactions with Neo-Synephrine (phenylephrine) which include:

• Cardiovascular Disease
• Bph
• Diabetes
• Glaucoma

It may be time to consider a feeding tube. Most cats seem to do really well with them, and it might help Milo get over this hump. I agree that the Clavamox doesn't seem to be having any positive effect, I would talk to the vet about trying a different antibiotic. I can't remember - did his vet give Milo a Convenia shot (long-acting AB)? That is something you might want to stay away from if they recommend it.

You need a Rx for an albuterol nebulizer, not familiar with a saline nebulizer but would assume it works similarly to a cool mist humidifier.

 

I agree with Squalliesmom-- this doesn't seem like something you can do entirely with home care at this point. It may just be a matter of a few small interventions by the emergency vet to get him on the right road.

 

I hear everyone's advice and I agree he needs to be seen, but the quotes I'm getting at the ER are around 2500.00 and that is not an option. If I take to ER and they keep, they will not release if not paid in full and if payment is not made, they won't release the animal and it will go to Animal Control. I have to get this cat through the night and back to his regular vet tomorrow at 9:30. Feeding tubes may not be an option on this cat as he is a very frail 8 pounder after losing 3 pounds over the past 6 months. Othre than not eating and drinking due to not being able to breathe through his nose he is stable as of the moment. I've managed to get 3 mL of water in him this morning but it took me an hour and a half to do that. I'm thinking of putting him in a dog crate with a warm mist humidifer to see if I can get the nose clear. I won't be giving him insulin or clavamox today since he has not eaten.
I have no choice but to do home care til tomorrow morning.

 

I'm so sorry-- your ER sounds awful. If it were me I might try calling again, sometimes you get a lousy person working the phones and when the shift changes you might get someone who is more helpful and less discouraging.

In the meantime, the dog crate and humidifier sounds like a good thing to try. Poor little guy.

 

Thank you. I can't begin to tell you the number of times I've been in that ER waiting room with pet mom's pleading with them to accept a payment plan. They are steadfast in this policy and in my opinion should be against the law. My only question til I can get him some help is whether or not to have him on a heat pad or not. I unplugged it last night as I wasn't sure whether it was making matters worse. Thanks for everyone's help!

 

I can't provide any help on the main situation but instead of the heating pad I would put a blanket or towel on one side of the crate so if he wants to get warm he can snuggle into it and if he gets too warm he can hop out on his own. Just my thought. Sending healing vibes to your Milo

 

You may be able to. I know you can buy it on amazon same day delivery with prime and also buy the saline for it. A pharmacy may have them too.

You could run a humidifier in the room with him as well. (Ask a friend if anyone has a nebulizure though as it makes tiny droplets and can be directed right into the carrier). A vaporizer won't make the droplets small enough for the cats tiny sinuses.

 

Are you sure there are no regular vets in the area with Sunday hours?

 

Where are you? Maybe we can help you locate one within an hour of you.

 

I'm in the country in Monticello, GA and though there are a couple that respond to emergencies, being country doctors and all they are ill equipped to handle much more than a common case of diarrhea or a bite wound. If you have a list for our area please do let me know where one may be. I am close to Conyers, McDonough, and Locust Grove.

 

http://www.iheartpets.org/veterinary-clinics/Monticello-GA/services.html

Starting calling around.

 

Thank you! I see some I recognize on the list. But if you find someone open today, please inquire about their ability to handle feral cats as Milo is feral even though he is my indoor pet. So far no one has been able to handle him but his current vet who is Dr. Kreuger on that list. Dr. Kreuger will open again tomorrow.

 

It is up to you to call around. I can't - the US is not on my phone plan. It would cost a fortune.

 

Look on yelp and choose the option to only list places that are open right now.

 

I used yelp.com as you suggested and lo and behold! I found a vet that is open 24/7 that also has a triage unit on-site. The have both regular exams and "triage" (ER) assessment and treatment at this place. No appointment necessary for either. Can't believe after being in this area for 15 years that I didn't know this place exists. The only disadvantage is if they deem triage is necessary,a $400 deposit must be made if I choose to let them treat. If treatment doesn't cost that much, then you get the remainder of your deposit back. Not sure how the rest of that end works, but it's good to know someone else is there when I need them. The other good part is that it's about equal distance to that place as it is our local terrible ER.

Right now it seems as though Milo's nose must be clearing up. I moved the humidifier closer to him, and when I did, he turned around and moved closer to the warmth of the unit with the steam jetting just above his head. I believe as a result of this is why I have been able to finally get some fluids in him again. Been giving him about 3 mL every half hour or so, taking it very slowly, and have been able to get 21 mL of chicken broth / pedialyte mix down. He is swallowing better and the lymph node seems a bit smaller this afternoon. So his nose must be clearing. Additionally, He is more frequently shifting positions in his bed with less effort; whereas, before he almost didn't have the strength to switch positions.

So I've taken him out of his bed twice since this morning and stood him up to evaluate how he is doing. He actually seems a bit stronger. Both times he got in the litter box to tinkle and then returned to his bed as quickly as he could. He is no longer snoring and his breathing seems steadier. With these developments I am thinking he is stable enough to get through the night so he can see his regular vet in the morning. I will be sleeping on the floor next to him again tonight to catch it if things go south. If that happens, I'll be headed to the vet I found today.

Thank you all so much for your help!

 

Thank you for that URL. That will come in very handy!

 

The antibiotics may be kicking in. Is ask tomorrow if they can give you a different /stronger one. So glad he's feeling better and the steam is helping.

 

UPDATE: Good morning. Milo is not eating on his own still, of course. I withheld cat food from his regimen for 24 hours and only fed broth and water all day yesterday. Was able to get 37.5 mL into him at 3 to 6 mL per sitting every 1 to 2 hours. Last night he asked for food, but couldn't do it on his own although he was very interested. I diluted it down to a little thicker than milkshake consistency and he eagerly took down 6 mL of the mix. I am taking Milo somewhere today for help. If his regular vet still insists he won't give IV fluids and still doesn't want me to do sub q I am requesting any lab sheets and taking him somewhere else to try to get help for him. I am also going to ask for B12 injection.

 

I'm so glad you got something in him. Get a copy of all lab work anyway even if you stay with this vet. I hope he's feeling better soon.

 

Was very concerned this morning as he wanted no part of water and only wanted to sleep when I first checked on him. Just now he eagerly lapped and swallowed very well 12 mL of warm water without needing to rest between syringes.

 

I hope you can get a good diagnosis and some treatment for sweet Milo.

 

Have you tried some bone broth or maybe a liver shake? I'm glad Milo will be seeing the vet again today. Please keep us updated, we will worry!

 

Vet said Milo isn't strong enough for the sedation needed for his hospitalization because he is extremely aggressive and hard to handle outside of his domain. He feels that sedating him with push him on over the edge to the point of no return. And because he is a high stress cat (very feral) the stress of attempting it while not sedated was also risky in his condition and could also be detrimental to his life. He gave me sub q fluids and a b12 injection to do at home and told me to discontinue insulin until he is stronger, but with the swollen gland on his neck he absolutely must continue antibiotics since where the gland is located it could indicate an abscess.

 

Thank you! That means a lot to me. I gave milo homemade chicken broth (no salt) when he wasn't taking syringe food yesterday. I added pedialyte to it. Today he is swallowing better andI've been able to get just shy of 3 oz of undiluted Sheba Perfect Portions in him (chicken flavor). Vet didn't think it would be a good idea to stress him with the transport since he is maintaining where he is. I Just got back from picking up Sub-Q fluids and a B-12 injection. I fed him and gave his first injections minus the insulin. He purred through the whole process. I am hopeful.

 

Try the liver shake for him. It can be used as a complete food for a limited time while he get back on his feet and gets his appy back.

 

Do you have a link to a recipe or is it easily googled?

 

It's in the "Health links/FAQs" forum:

http://www.felinediabetes.com/FDMB/threads/the-liver-shake-for-sick-cats.30432/

 

Thank you!

 

I included the link in my first post regarding it. Just click on liver shake. I also included the recipe for bone broth. Anything in light blue print is a link you can click and follow.

 

You know, this is a digression, but I've always found the light blue of the links hard to see on a computer screen. I wish they were automatically a brighter color, or bolded or something.

 

I agree!
Taking your advice, I went back to my earlier post and put the links in bold blue text!

 

Another food option is to puree the food in as blender or food processor with water to make it very soupy. That is what I do when my cats won't eat.

 

Great advice here! I never would have thought about a Liver Shake or putting the food through a blender. I did get his latest lab results (from 6 months ago) When I can catch my breath I will scan and upload.

 

UPDATE: In collecting a sample today to check ketones I noticed Milo's urine was very orange. I rushed a sample to the vet expecting kidney failure or terrible kidney infection. By the time I got back home the vet called me and asked me to check for yellow ear flaps and yellow gums. Both are slightly yellow. He said based on certain levels in the urine (something related to the bile duct) he said that Milo has pancreatitis. I am to continue the treatment I am currently doing. If anyone has had to provide home care for pancreatitis, please let me know of your experiences and what helped yours.

 

LOL I tried the liver shake and he wouldn't touch it, but with a diagnosis of pancreatitis that's understandable. Next question would be should I syringe feed it.

 

There is an excellent primer on pancreatitis in the Health Links section of the forum, here.

The main things to address are nausea and pain-- did your vet suggest any meds for either? There are several suggestions in the primer. Once any nausea is addressed, an appetite stimulant may be helpful (it will be counterproductive if he's nauseated). Additional supportive care can include sub-cutaneous fluids and/or B12 shots, both of which can also be done at home. There are lots of folks here who have dealt with pancreatitis in their kitties-- sadly, it seems to go hand-in-hand with diabetes.

If you get a chance, could put diagnoses and the meds Milo is currently on in your signature? It'd be helpful for those giving advice (otherwise you'll get the same questions over and over!).

 

Also, I just realized this thread is getting kind of long, and has had a 911 on it for a long time. You might have better luck getting answers and help on a new problem (pancreatitis) if you start a new thread on that specifically, with a link to this thread for people to get more of Milo's history.

If you do, be sure to mention the concentrated uring and the jaundiced ear flaps and gums. I would have thought it was indicative of something liver-related, so I was a little surprised at the pancreatitis diagnosis. I'm curious as to what some of the folks with much more experience have to say about that (I learn a lot here!).

 

I agree with @Nan & Amber, the jaundice would indicate liver problems, to me. I would be very concerned about hepatic lipidosis, especially with accompanying jaundice. Hepatic lipidosis needs immediate veterinary intervention and can be fatal. I don't mean to scare you, you can also have jaundice with pancreatitis, but has the vet tested him for liver problems? Cats develop hepatic lipidosis very rapidly when they stop eating, or drastically reduce the amount they eat; that's why it's so important to make sure to get all the food into them that you possibly can.

Lots of people here have had cats with pancreatitis, and can undoubtedly answer your questions about it. I suggest you start a new thread and title it something like "Need help with Pancreatitis". You should get a good response.

 

His lasts blood work was done in May 2016 where everything was normal with "nothing to be concerned about..." During that examine, to my knowledge the liver was included in that test, but that was at least 6 months ago. When I saw that Milo wasn't eating, I stepped in to assist because I know how serious liver lipidosis can be, but vet didn't think I needed to be concerned since I was feeding.