Rehab from Severe Hypo Event Advice

Hi everyone,

I'm Susan and my sweetheart's name is Baxter. I've been posting on the FDMB board on facebook but this is my first post here -- please forgive me if I'm posting in the wrong place. Sorry if this too long and rambling, but I want to provide the details for better context.

For some background, I adopted Baxter from the shelter that I was volunteering at in 2008. It was love at first sight and we've been inseparable with a special bond ever since. He has helped me heal from a broken heart of losing both a beloved kitty and my mom to cancer. About two months ago he was diagnosed as diabetic. My vet said to start him at 2 units of Langus 2x daily and bring him back for a re-check in a week or two. She mentioned the possibility of home testing at some point if we were having trouble regulating him, but it didn't seem that imperative at that time. After a recheck, his BG was 536 so she said to give him 3 units 2x day. I had been doing that for about a month, and his symptoms were definitely better, so I thought all was well, and was about to reschedule his next recheck. Then disaster struck. I gave Baxter his insulin dose after his breakfast and an hour after that he was fine, so I left for work. I came back home about 12 hours later and I initially thought he was dead. He was still, unresponsive and cold. Utter devastation. Then I realized he was moving but in coma and/or seizures. I rushed him to the emergency vet in a hysterical blind panic while putting Karo syrup on his gums and tongue. Baxter almost didn't make it, and I'm beat myself up everyday for not home testing and for the fact that I wasn't home when this happened and I don't know how long he was in that shape alone, without me. So please, don't mention that I should have been home-testing, I know that now, and I beat myself up over it more than anyone else ever can. I will scream that from the roof tops now to any vet or diabetic cat owner that I talk to.

Anyway, Baxter was having ongoing seizures but then responded to propofonal (sp?) and hasn't had seizures since. He is now in the road to recovery, slow by steady. It's been two weeks, and he can stand for short periods of time, and just yesterday has been able to take a few wobbly steps. Myself and the vet staff are doing ongoing range of motion exercises, massage and general PT work with him. He has limited vision right now but it looks like that may be improving a bit. We are working on his strength so that he can be more mobile and start using a litterbox again. Ironically, his blood sugar has been stable without insulin for over a week, so maybe this happened because he went into remission and I didn't even it (ugh). Despite all of this, he is himself, very sweet and loving and snuggly and all the vet staff are in love with him.

So, with all of that -- my question is if anyone has ever experienced this severe a hypo episode and if so--how did your kitty recover? Any tips or tricks in general to help him in his rehab? I'm hoping to bring him home from the vet as soon as he's strong enough. And I've already brought home testing equipment, so that I'll be ready to go.

I also want to thank all the amazing people who supported Baxter and I on the facebook board, sometimes their words were all that kept me going through the day. If you have a cat that diabetic, take it from me that home testing is MISSION CRITICAL no matter what your vet says, or if someone else with a diabetic cat hasn't done home testing with no bad effect. Baxter had NO hypo symptoms whatsoever, and this came on suddenly -- please don't let this happen to your kitty!

 

{{hugs}} So glad you were able to save him.

My housemate misread some new syringes and gave Spitzer 10 units instead of 1. I came home from rehearsal and asked how it went. He mentioned being a bit confused by the syringes (artist, not scientist type). I put up my fingers and said "about this much"? And he suddently realized he'd overdosed the cat.

I grabbed a can of A/D that we had, put some on a plate and rushed upstairs. It had been about 3-4 hours after the dose. I put down the plate and Spitzer started eating ravenously, confirming the overdose. The housemate said "I'll drive"; I thought "D*mn right you'll drive, you may have killed my cat". We went to MedVet in Worthington (north Columbus) Ohio. Spitzer stayed on an IV dextrose drip for about 2-3 days. I was fortunate that he got treatment before going into seizures and coma.

A cat may be extremely sensitive to insulin after a hypo due to insulin overdose. This may wear off in time or not. Only testing will tell.

Methylcobalamin, a form of B-12 vitamin, may help if there was any pre-existing neuropathy. I don't know if it will help post hypo. Won't hurt him - its water soluble and if unneeded will be excreted through the renal system.

Sticking with the low carb, high protein canned or raw foods will help support him. A canned kitten food, such as Fancy Feast Kitten Tureky & Giblets may help more if he needs to put on any weight. There's a great food list over at Cat Info plus lots of great info on feline nutrition.

The physical therapy to "re-pattern" the nerves in how the legs work should help. Some of that may be done with play therapy, making use of a cat's natural instincts to catch prey. Go slow enough that he succeeds as that reinforces making the effort to try.

 

Susan,

My only advice is to keep loving Baxter as much as you obviously do and keep visiting him at the vet.

For you, only lots of {{{{{hugs}}}}} for you and tons of healing vines for Baxter. My best wishes that Baxter gets to come home soon when he is feeling better.

Give him lots of love and praise and tell him what a good boy he is being during his recovery.

Hoping our sweetheart Baxter gets to come home soon to your loving arms.

 

I am glad he is doing a bit better.

I am sure there are many people here who'se cats have had hypos and survived.. or didnt. Not all are as strong as you to admit they should have home tested but decided not to.

My cat Bailey had a hypo despite my testing.. I got a bit blase and decided to test only preshot. He was only getting 0.25IU - so I thought how could it happen? Yet one morning I woke up at +8 and decided to test him and he was semiconsious on a stair. Syrup etc brought him back but it scared me crazy. I wonder how often that had been happening at night. He also has bad vision and has minor twitches which I think could be minor siezures but that was also due to high blood sugar that was untreated for a very long time, and he had DKA - also untreated.

Anyway I believe Baxter should recover to some degree with time. Immediate recovery as well as long term improvement as the brain rewires. He may never be 100% but I am sure you will love him the way he is. You will probably feel the impacts more than he does because animals adapt - they dont feel sorry for themselves when they have an issue.. its more like "well thats inconvenient.. now wheres my dinner?". I have a totally blind rabbit.he developed cataracts over the period of a few months so it happened fast. But she runs round my feet and doesnt bump into things as long as I dont move things about or get in her way too much. She is happy and healthy and nobody would know she was blind - i didnt even believe my vet when they told me! The same with your cats other symptoms. Keep up the PT - it can take months or even a year for full effects.

The good news is that he may alsp be in remission (2 weeks of 40-130 and its official). We can help with home testing tips if you need them.

And I have a favour to ask. I am on this board advising all the time. There are a number of newbies who dont/won't home test - it would mean a lot if I can PM you whenever I have one and you chip in with your personal experience... maybe that will encourage them more.. do you think you could?

Wendy

 

First - please stop berating yourself. You didn't know and the vet obviously didn't suggest it or I'm sure you would have tested. What's done is done and you can't fix the past, you can only go forward from here and with the knowledge you now have, use it and always ask questions in the future. If you don't get answers from the vet, then come online and ask.

That being said, my Buster has intermittent seizures. She is not diabetic, so I don't know if it's different or not. But I get how scary they are and the fear of not coming out of it. Fortunately, Buster hasn't shown signs of damage as a result and recovery for her is pretty quick.

I don't have any suggestions, just keep doing what you are doing - search online about cats hypo seizures and see what else you can find and if there any tips you can try that you haven't already. It may just be that time is needed for him to recover and hopefully he will recover with no permanent damage.

I'm sorry this happened.

 

Thanks everyone for the very kind words and support!

Yesterday the vet took out Baxters feeding tube which is good because I think it was bothering him. Also one of the nurses said that he purred for her! I haven't heard his purr since this happened, so I'm excited to see him and maybe hear his purr for me His back legs are still really weak, anyone know what I can do to help him with that (Beyond his range of motion and exercises)

Wendy -- I would absolutely love to help talk to those that are resistant to home testing. In case I didn't see the post, feel free to email me to let me know and I'd be happy to chime in. I'd imagine that they feel very much like I did -- the whole diabetics diagnosis is overwhelming, especially having to stick your beloved cat and get the insulin right. And then if your vet mentions home testing, but makes it sound only necessary for difficult cases, you think well one step at a time maybe I'll do it at some point if it's necessary. Especially if you've known other people with diabetic cats that never did home testing, and their cat did fine for many years until they passed from something else.

But of course, now I've experienced the terrible other side where a disaster comes out of the blue that most probably could be have avoided with home testing. I would do anything to go back in time and have started home testing him from the beginning. If I had, he wouldn't have almost died, and he would be in my arms right now instead of fighting to walk at the vet.

 

Hi Susan and welcome to FDMB.

I followed Baxter on the FB site and was very glad to hear he survived the hypo. I suspect you and Baxter may become the poster pair for home testing!

It's entirely possible that Baxter will be sensitive to insulin. Usually, this occurs immediately after a hypoglycemic event. I imagine that the vet is still closely monitoring Baxter's BG so he will be on a good dose of insulin.

At this point, it may be most important to keep assessing his level of functioning. Are you seeing any neurological impairment and how much return to his previous level of functioning are you seeing? I'm going to ask one of the Lantus users who has a great deal of experience with rehabilitation with humans to stop by. She may have some valuable insights.

 

Ok great, I saved your email address. You probably should delete it from the post above though since there are these automated bots that scout the web for email addresses to spam (not related to fdmb)

 

Hello Susan, I too have been following Baxter's story and progress on Facebook. It's great you are here, there is such a wealth of information and support. Sienne asked me to drop in. I am a physical therapist, with a background in neurological rehab, of the human variety. Feline central nervous systems (the brain and spinal cord) are remarkably similar to ours. With a hypo episode, the brain is deprived of oxygen. The neurological damage is fairly widespread or scattered (rather than focal, or in one spot, like when you hit your head on something) so symptoms can vary. Most commonly after brain injury from anoxia (when the brain doesn't get enough oxygen), you see impairment in the entire body, and it usually presents like weakness or incoordination in the extremities. And you may also see some changes in personality and some confusion. Seizures can also take place, especially in the early phases as the brain is trying to sort itself out.

In humans, rehabilitation consists of exercise, exercise, exercise including exercise for the body and the brain. So, moving the joints around, massaging the body and having Baxter stand up on all fours just to weight bear is a good place to start. Playing that would be typical for a kitty is the perfect rehab. Whatever kind of games or play Baxter liked to do is a good place to start. He will get tired much quicker than before, and when he poops out, it will happen all of a sudden, so lots of rest is important. Also games where your kitty has to make some decisions, like having to choose between a few toys to play with or chasing a string, or a laser light. In the meantime, making your home as accessible as possible will be a help, most people (and I imagine animals) like to "do it by themselves". For example, ramps to get up on things, or a series of steps, so no jumping is necessary until strength and coordination improves. We stack up plastic storage boxes to make steps and cover them with rugs or towels fastened on with bungy cords, so our kitty has something to sink his claws in to help him get up. Also, an accessible litter box is helpful too. We use large plastic storage boxes (nice high sides) and cut a square opening with only an inch or two of plastic at the bottom to keep things in. Using just a thin layer of litter will be easier to walk on and encourage litter box use. It's like walking on a flat surface for us is much easier than walking in sand on the beach. If you would like to see some pictures, just let us know and we can send them to you.

The nervous system is amazingly plastic and we don't really know what to expect, so patience and persistence is always helpful. I hope this helps! Go Baxter go!

 

Thanks Sienne and Anne! I really appreciate your support, I've been so awed by everyone's support. Like I said, on some days it was really what kept me going. It's so amazing to know how many people are rooting for my boy!

Where Baxter is right now, is vitals and BG are stable. Actually, he hasn't had any insulin at all in 10 days because his BG has been stable without it. Neurologically, he is making slow but steady progress. In the last few days he has been walking a few steps, and today he was really going far, about 10 feet before he got tired and his legs slid back down. It was also the first time that he's been able to walk on the slippery floor, rather than the "Baxter track" of towels set up for him. He is quite the determined little fighter guy! His Baxter personality of sweetness, gentleness and pure love is completely there. Right now he has limited vision (dazzle reflex but not menace). I'm hoping that comes back, but even if not I'm not worried about that, I can totally manage it. His pupils do properly dilate according to light or when he hears something interesting.

The things that we are working on for him to be able to go home are eating and his litter box. He's eating (happily) from syringe feeding, but he seems to have sort of forgot how to eat himself from a plate or bowl. I suspect it's because he can't see, although I imagine he can smell. Also, the vet staff are helping him to express his bladder. He seems to be holding it in because he doesn't want to go on himself, but he's still confused by a litterbox (maybe because he can't see it?).

He is getting round the clock PT, the vet staff and I do his range of motion exercisers, stand him up and encourage him to walk. Sometimes if I am being too annoying (too much massage and fawning over him) he will stand himself up and walk away. Any thoughts on how we can get him to eat on his own or use his litterbox? I love the idea of getting him to play, in fact today I had brought him a ball with a bell inside to see if he would play. He was very interested in the bell sound, but he couldn't really see the ball. Even before this episode though, he wasn't big on playing-- he would mostly just want to chill and snuggle

Thanks for all the great suggestions, very helpful! I agree that we don't know what to expect so patience is key. So far, he has shown me an incredible will to survive and get better, so I will do everything that I can to support him so that we can be together again, happy and healthy!

 

I have been following Baxter's story on FB too and am so happy to hear of his progress and his fighting spirit! Keeping you both in my thoughts and prayers for a full recovery. They are so resourceful (cats) and he may very well surprise everyone and figure out a way to be Baxter again, despite any limitations this episode has wrought on his poor body. Thank you for telling everyone about the importance of home-testing. I agree 100%! Best to you both! :smile:

 

For the litterbox, maybe put some of his urine in it so it smells like a litterbox. And when he is expressed do that in the litterbox, too. Sort of re-associating the texture, smell, and activity together.

For the eating, if he'll eat off a finger, each time lower the finger down a bit more when offering food and maybe bring the plate up a bit. Are you warming it so he can smell it? Maybe that will help, too.

 

HI SUSAN! I'm LD Squeaky with that funny little tophat mouse on fb...

GO BAXTER GO BABY!!!!

 

We are all routing for Baxter and cheering him on in his recovery. Go Baxter!! :RAHCAT :RAHCAT :RAHCAT

Thank you so much for the update here on the FDMB.

Sending lots of hugs to you {{{{{{{{{{Susan}}}}}}}}}}. You are on an incredible journey trying to rehab Baxter from his hypo episode.

There is a cat in my local shelter with nerve damage in the hind quarters from an accident and tail amputation. She has never been able to urinate on her own so the shelter staff and volunteers express her bladder every day. I know that is something you can learn to do on your own if necessary.

Positive thoughts and healing vines are winging there way to you and Baxter.