? 06/01 Blue AMPS 139 PMPS 160 (the vet nurse asked!)

Hello here is yesterday.

https://felinediabetes.com/FDMB/thr...t-did-not-give-insulin-pmps-214-8-135.278120/

Concerned this morning:

These are his discharge instructions:
Blue is able to urinate on his own now, however, he will need to be closely monitored to ensure he continues to urinate voluntarily without straining. Please keep him inside, and monitor his litter box closely. Please keep him separated from other cats so we can ensure that he is continuing to urinate.
It is normal for the next few days for Blue to urinate more frequently than normal, smaller volumes than usual, and even to show some mild discomfort or mildly bloody urine. However, if he seems excessively lethargic or painful, has not urinated in over 8 hours, or has made attempts to urinate with none produced, contact a veterinarian to determine whether he should be assessed on an emergent basis.

Last night Blue had dinner and his insulin and meds. I gave the Buprenorphine as a good measure.

Unfortunately, this morning he wasn’t very interested in eating. He licked his food and walked away. I liquified his food and syringe fed him so that I could give him insulin. His BG last night before insulin was 11.9, 8 hours later it was 7.5 and this morning it was 7.7. I’ve given him the Prazosin this morning but not the Buprenorphone as I’m thinking it’s making him a bit out of it.

I’ve tried to monitor his kitty box activity. He did go into it this morning but I don’t think too much happened…as I checked when he got out. I’m home today and will monitor him. The discharge instructions say that it is normal for the next few days for him to urinate more frequently than normal, smaller volumes than usual and even to show mild discomfort, which is what I think I’m seeing. I’ll watch him and if necessary will bring him to his vet.

I woke up feeling quite refreshed but now am stressed again. I wonder if I should just bring him in. He's isolating himself and, as I said, not showing he wants to eat on his own.

 

What dose buprenorphine and how much does Blue weigh? Is he on Restoralax or the equivalent? Bupe can be constipating. Which can make them not want to eat.

 

Blue weighs about 10kg. The buprenorphine (300mcg/ml) dose is 2.4ml.
He is on Restoralax (daily in his food, although they didn't give him any at the clinic, I'm pretty sure). I really think now he's constipated...What to do!?

 

Big kitty! You sure that isn't .24ml dose? That would be a LOT of bupe. Neko's dose was .22ml of a 100mcg/ml dose and she was 6.5 kg.

 

that's what it says on the discharge instructions but the syringes are 0.24ml. Oh, well, accuracy is over-rated in some places...

Anyway, I'm getting increasingly worried. He's just lying quietly in the living room (where he goes when he doesn't feel social) and he has not urinated nor has he had a bowel movement, for that matter. Their instruction say if he hasn't urinated in over 8 hours he needs be seen by a vet.

 

Can you feel his bladder again and see if it's full? The Prazosin may have helped him empty his bladder fuller so he might not need to go.

 

They told me at CanWest it was quite difficult to feel Blue's bladder, which is why they used an ultrasound. He looks pretty low so I'm erring, as usual, on the side of caution and bringing him in. I'll update as I can.
I feel awful.

 

Update: Blue is staying at the vet. A lateral xray shows that he truly has not had a bowel movement for a too long and we are going the route we went about 1.5 years ago: the PEG CRI.

Just going to bring his medications to the vet as he has to be in overnight.

I'm glad I took him (but OMG I'm hemorrhaging $$$$$$$). More to come.

 

Sending prayers.

 

Thank you, Carla!

 

I hope you and Blue (and your wallet) can catch a break soon. Did they try an enema?

 

I discussed enema but since he’s had this procedure before and it worked really well I opted for it. It’s a different kind of invasiveness and a little slower. Like 18- hours. They are giving him some bup for pain and Cerenia for nausea. I’ll call back in a few hours and keep checking.

 

I'm glad they are giving Cerenia. It's anti inflammatory properties also helped by cystitis boy.

 

Did they say whether they thought the urine retention could be related to the constipation?

I have a cat with neuro damage who can’t urinate on his own. I have to express his bladder a couple of times a day and have noted over the years that it’s significantly more difficult to empty his bladder when he’s “backed up” with stool.

Also, Tubby had “sluggish bowels” throughout our acro journey and managing it was an ongoing battle. It was initially constipation (so bad it required at least one surgical intervention), but later seemed to be more of a lack of peristalsis (stool consistency was normal, it just didn’t “move” through the intestines quickly). At one point I measured one of his “downloads” at over 13” long. Anyway, Tubby also ended up with an issue with urine retention, despite urinating lots. I didn’t realize what was happening (nor did his IM vets) until late in the game, but I started monitoring his bladder size even after he urinated and expressed his bladder supplementally as needed. We hypothesized that it was a form of bladder neuropathy secondary to acro, but in hindsight I wonder whether the backed up stool contributed as well.

Urine retention / stagnant urine can increase risk of UTIs and also be hard on the kidneys. I’d probably discuss with the vet whether it would be a good idea to show you how to palpate Blue’s bladder so you can monitor its size (and perhaps even how to express his bladder if they think that might be warranted down the road).

What is the noticeable “lump” that protrudes from Blue’s right side? Is it consistent or sometimes variable in size? Tubby had organomegaly, which is relatively common with acro, but Tubby seemed to be pretty symmetrical in his pot belly and oversized appearance.

 

Hi JL, thanks for checking in. They did say that the constipation might exacerbate the situation but it's really a chicken and egg thing, too. I think the urine retention is also linked with being in the clinic (for the MRI) and them deciding to fast him and not giving him insulin and then feeding him sporadically. They said he used the kitty box in the clinic and was able to produce good amounts of urine but things started to go south after the MRI and his "recovery". I picked him up and brought him to the hotel and he immediately tried to pee but to no avail but he did want to have a snack. Then things started going haywire resulting with me taking him at 2:30am, as I've described.

Blue really needs consistency and hospital life isn't the best for that. I just spoke with the nurse at this clinic where we live and he's resting comfortably with the tube in place and they will "offer" him food. The last time this happened to him he didn't really want to eat until the morning. I'm just glad if not anxious about him enduring all this. Of course not eating means they won't give him insulin.

The bulge on Blue's right side is a feature of acromegaly but his is not uniform...I used to live with a kitty who had lost her tail and was not able to do anything kittybox wise. I had to express her bladder, too, and she lived for 6 years after her injury...

I got an email from Tina Owen from WSU and they are looking at his MR images and I'll be having a meeting with her tomorrow afternoon. They are so generous there.

I'll post again after I've spoken with the nurse later this evening.

 

Oh Jodey just seeing this, Poor Blue, my heart breaks for him.
Saying prayers for you precious boy. I hope he will have a bowel movement soon.
Try and get some rest you must be physically and mentally exhausted.

 

Does WSU do SRT? I heard they had stopped doing that. It's great they continue to do follow on with their clients. I'm sure the more complicated ones peak their interest too.

 

Update: I just came back from walking my dog and was feeding Eddie and getting his medications ready and the phone is ringing; it's the nurse from the clinic to say that Blue is eating (!) and feels better and asking should they give him insulin (PMPS 160). Asking!!! Not just assuming one way or the other and I was so happy to hear he's eating and moving around that I forgot to ask if he's kittyboxing yet. But things look like they are headed in the right direction (in so many ways). I'll call back in a few hours and see if there was any other news.

 

No, they don't do SRT (although they are in the process of upgrading their technology so maybe in the future). They don't stand to benefit financially at all.

We'd be going to VCA Calgary where I was last with Eddie. They are great there.

 

I have to admit to feeling like not the sharpest knife in the drawer. But I did just get some good news: Blue is eating!! I was so excited I forgot to ask if anything was going on (or out) and will call back! Please keep those prayers in the air. I'm sure they are helping!!!

 

I'm definitely keeping those prayers coming , thanks for the update