10/14 Butters +8 131 /AMBG 158/+4 142/ Afternoon update

Butters & Lyla

Butters & Lyla

Member Since 2020
Yesterday
The overnight ER vet called this morning with a Butters update:
Overall no change. Her vitals are stable. She is currently receiving: plasmalyte fluids, gabapentin and methadone for pain, mirtazapine for appy and cerenia for nausea.
She still will not eat. It has been 24 hours now since she last ate, when I syringe fed her 15 grams of food with pumpkin and water.
I asked about the "5 P's". Not a single one has happened. But they believe she has been resting much more comfortably since being switched off bupe and on to methadone.

The good news is she is being transferred to the internal medicine specialist for primary care today, though probably not until mid-afternoon. I asked the ER vet: please do not wait until a crisis develops before getting some food into her, either through an NG tube or an E-tube. The vets continuing to let her go without getting any food into her is really bothering me. She assured me that they are on top of things and won't let her go for much longer. The IM specialist will decide which tube to do today, and will do it this afternoon.

In FD related news, Butters' BG continued to slowly slide down overnight. They didn't give her insulin last night and likely won't this morning unless her next BG reading is high. I should note that they are using a pet meter to check.

Well, I wrote a lot of words now didn't I? I'm still pretty tired. Anyways, thank you all for your good thoughts/wishes/vines/prayers. I know they are helping my girl. And I'm so incredibly grateful for your support and advice and expertise.

All kitties be good today and surf safely! Beans have a wonderful day! :bighug::bighug::bighug:
 
Sounds like a good plan:). It is really great that they are communicating with you and you are able to express your concerns, be heard and be a part of Butters team. Hoping you get an equally awesome IM.

Does Butters BG typically drop when you take her to the vet? I ask because that is what Ts does. We did rule out Addison’s disease so it’s just what he does when he gets stressed. It works in his favor when he’s been in a flare....offset the glucose rise from inflammation and pain vs adding to it.
 
Butters hadn't had to go to the vet until this week, so I don't have much data on that.
I note that her BG dropped quite a bit the day she got her shave about three months ago. Done at home but I still think it could be a clue that she might be a cat who drops when stressed?
Her BG was up a very tiny amount after the vet visit on Wednesday of last week. That could have just been her normal pattern as of late.
And she had a shave this past Thursday and didn't go up or down. She was very good for this shave and seemed not stressed at all. Very playful after. Happy her thick fur was gone. But now I'm wondering if stress from the vet visit and shave both played a role in causing this pancreatitis flare.
 
Lyla ,it definitely seems like they are on top of things and that the the methadone seems to be helping.
Hopefully getting the tube she will start to recover and get stronger.
You know I'm always praying for Butters and you are in my thoughts.
I know you will keep us updated ♥:bighug::bighug:
 
Butters & Lyla said:
Butters hadn't had to go to the vet until this week, so I don't have much data on that.
I note that her BG dropped quite a bit the day she got her shave about three months ago. Done at home but I still think it could be a clue that she might be a cat who drops when stressed?
Her BG was up a very tiny amount after the vet visit on Wednesday of last week. That could have just been her normal pattern as of late.
And she had a shave this past Thursday and didn't go up or down. She was very good for this shave and seemed not stressed at all. Very playful after. Happy her thick fur was gone. But now I'm wondering if stress from the vet visit and shave both played a role in causing this pancreatitis flare.
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First and most important.....even *if the stress played any role, the issue of inflammation was still there (& is more common in cats with DM) & would have presented itself at another time regardless.

Butters may very well be a cat whose BG either stays steady or drops with stress vs the more common response which is that the BG rises. Looking back, this most likely caused a delay in my Ts diagnosis. His BG has plummeted as much as 100+ with a vet visit. Typically it is less than that but his BG has never increased with stress like most cats BGs do.
 
It’s good she is comfortable. Max’s BP went up at the vet. I’d think gd was bordering on a reduction. He would be normal there and higher by the time he got home. He refused to eat when he had surgery after a vet pierced his bladder. They said he needed to eat and poop to come home. I brought all kinds of food he refused but finally ate baby food for me so he got to come home. Eating vines and prayers being sent.
 
I do have a question, though: They are giving Butters plasmalyte, which stings when delivered subq. She is getting it through an IV. Would that also not sting and why are they giving a cat who is in great pain something that will make her even more uncomfortable? The other ER also gave plasmalyte.

Do you know if there is a better fluids option for pancreatitis kitties? I'm going to ask about it on the next call. My brain was fried this morning and from my notes it looks like I forgot. But I did put in a call to ask for someone to call me back.
 
tiffmaxee said:
It’s good she is comfortable. Max’s BP went up at the vet. I’d think gd was bordering on a reduction. He would be normal there and higher by the time he got home. He refused to eat when he had surgery after a vet pierced his bladder. They said he needed to eat and poop to come home. I brought all kinds of food he refused but finally ate baby food for me so he got to come home. Eating vines and prayers being sent.
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Poor Max and you went through so much. :bighug: I hate that I can't go in there and see if I can get her to eat. They won't even allow me to drop off an article of clothing so that she has my scent to help comfort her because of covid no personal articles are allowed in. I feel helpless. If they want her to eat and poop before she comes home....I could be waiting a long time to get her home.
 
They will likely put in a feeding tube and send her home. If not for Covid you would be able to try and get her to eat. The tube will make meds and insulin easy should she not eat there and will make it easier for you to go to work without worries. It sounds like she has what Max had, plain pancreatitis so the proper meds and doses should get her back to normal once she is home. Even IF early CKD nothing else needs to change at this time. :bighug:
 
Awww...poor Butters. I do hope they're pulling out all the stops for that precious girl!

Glad to hear they're getting that pain under control.

I just saw your post...perhaps this article would be helpful: https://www.veterinarypracticenews.com/secrets-of-fluid-therapy-revealed/

It discusses plasmolyte and uses...sounds like it's a good choice.

I'm so sorry they won't allow even the smallest thing in for her - you don't have COVID - for gosh sakes!

I don't understand why the simple screening (of the patient's parents) aren't enough...you know the 5-6 questions they ask you when YOU go for health care...same one's would apply to vet practices...
 
:cool::cool:The Plasmalyte is important and helps replace electrolytes as well as water. Fluid therapy is the cornerstone of pancreatitis treatment due to the inflammatory cascade that occurs.

I know it is hard that you cannot go into the hospital :bighug::( but make no mistake that you are helping....you are just behind the scenes :).

At this point, and many times with acute pancreatitis, the absolute best treatment is exactly what is happening right now—IV fluid resuscitation, pain management & possibly a feeding tube. Even if you could go in and get her to try to eat again, it takes a lot of energy to eat, especially when they are so ill. A feeding tube enables them to get the appropriate nutrients quickly and easily into Butters body so that her energy can be conserved & used for recovery instead.

As for Covid, I personally am thankful that they do not allow people in, especially and most importantly, in critical care areas where pets are so vulnerable to catching illness. The reality is, most people do not have access to the amount of repeat testing that would actually be necessary to be “sure” they don’t have it. Now if we went NBA or NHL Bubble style....and no one left the bubble...that would be different :)
 
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I'm glad that at least Butters seems to be more comfortable. A feeding tube seems to be her best option so she can get what she needs to recover. Poor girl, what an ordeal to go through. :bighug:
 
I finally got a call from the IM Specialist. I called twice to get an update but no vet tech ever got back to me. Not a complaint. I have to remember that these are very unusual times (Thanks COVID!), and all the staff have a bunch of extra protocols they have to follow to keep everyone and patients safe (lots of time and energy spent on that), and they also run slightly short so if there is an outbreak that there are enough staff who can keep the place going. I am so grateful to all of the healthcare workers out there. I agree with you, @Tomlin, much as I hate not being able to go in and see her, I think it is a good thing right now that they are being strict. An outbreak could bring them to their knees.

Anyways, here is the update:

The IM specialist took over her care this morning. She is aware I'm supportive of a feeding tube, but she opted to try to continue to get Butters to eat on her own because she felt she was seeing an improvement in her.
She thinks Butters' pain is well controlled now.
Butters ate on her own. A little bit of a/d wet food.
Definitely pancreatitis as far as she is concerned. However, she is also investigating triaditis. But she said nothing else showed up on the ultrasound so I'm not sure why she'd be concerned about triaditis.
She said not to worry about Butters' kidney values, based on the labs from the weekend ER visit (in my spreadsheet, from October 7th).

Then she said she recommends that Butters comes home tomorrow for up to 24 hours, during which time I see if she will eat on her own. If she won't, then I bring her back and they put in an e-tube. Because of COVID, she'd normally have me come and try to get her to eat, but this is not an option. She doesn't recommend doing an e-tube until Butters has time to relax at home and see if she will eat.

so I need to get a lot of tasty foods that Butters might enjoy. I'll definitely have some a/d food for her. I'm not sure what else might appeal to a sick kitty. I'll try that Royal Canin variety as well. And then perhaps some cooked meat.

Her plan for tomorrow is to send Butters home with the following:
Cerenia
Cyproheptadine
Gabapentin
Buprenorphine

She will call me tomorrow morning to confirm that Butters continued to improve overnight and if so, then I'll be able to pick her up. She said wait to discuss subq fluids at that time.
 
Interesting the specialist doesn't want to immediately do a feeding tube, right? I'm a bit concerned by this. Of course i'd rather she not have one if she doesn't need it....but it seems like she'd benefit from one. Her poor body must be exhausted.

The other option could be for her to stay until Friday and if she isn't eating more, they will put in an e-tube at that time. The problem is if they discharge her on the Friday and something happens on the Saturday, she'd have to wait until Monday to have an e-tube placed by the IM specialist.

I feel suddenly unsure with the plan. I think she'd like to be home for a bit. But if she doesn't have energy to spare for eating, then I'll just be causing her more discomfort.
 
I am SO happy :bighug::bighug: to hear she ate and is doing well enough that they are wanting to try one last go at eating at home....that is great news!!

The fact that she ate well enough today while at the clinic is a really, really good sign. Maybe speak with the vet about an afternoon pick up tomorrow and ask if she could get the extra hours on IV fluids/electrolytes before taking her home. Every little bit helps. If you have any hesitation, trust your instincts and talk to the IM about it.

With respect to Triaditis, unfortunately, it doesn’t always show up on initial US. There can be inflammation deep and it won’t be able to be seen.
They are on top of it though! This is a focus of the GI & endo specialists today......often there is more than just the pancreas involved, especially with cats who also have DM.

The Royal Canin Gastro Moderate Calorie may be a safe choice to work in with the A/D. Fat may or may not be an issue for Butters. The old thought was fat content only mattered with dogs with pancreatitis but now that thought process has changed and they believe higher fat diet may be a contributor as well as an aggravating factor for some cats.
 
I'm so glad they got back to you - and that Butters appears to be doing a bit better! Eating anything at all in that environment is a definite sign of improvement!

Get plenty of rest tonight Lyla...the next few days are going to be busy! I hope you can find plenty of great tasty foods for Butters' homecoming!

Have a good evening!
 
So glad to hear Butters ate something! Great that her pain is well controlled now. :) The other food I suggested was Royal Canin Recovery, which for some reason seems appealing to some kitties, and is very easy to syringe. It is 3% carbs, whereas the GI Moderate Calorie is listed as 29%. It is a tradeoff in fats. Both have similar protein amounts, one trades %fat for %carbs. I'm sure the IM vet will have thoughts on what is the best food for Butters right now.
 
Just a heads up on that analysis....I spoke with RC directly last Spring because there was a formulation change to the food and this is what they provided me:

Royal Canin Rx GI Moderate Calorie Wet 3oz Cans

Typical Analysis gram per 1000kcal & %:

Fat 1.6g and is 2.63%
Carb 65.8g and is 5.63%
Protein is 6.5g
Phosphorus is 0.2% or 2.89g

So keep in mind you aren’t going to feed 1000kcal a day so it will be less than one is listed above :)

As Wendy noted, talk to the IM and at the end of the day Butters needs to eat so whatever she wants to eat at this point is a win! My T has even taken down some dry food when he has been in a flare....they dictate what they eat in these situations :bighug:Sometimes the “ideal” goes out the window!!
 
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Tomlin said:
Just a heads up on that analysis....I spoke with RC directly last Spring because there was a formulation change to the food and this is what they provided me:

Royal Canin Rx GI Moderate Calorie Wet 3oz Cans

Typical Analysis gram per 1000kcal & %:

Fat 1.6g and is 2.63%
Carb 65.8g and is 5.63%
Protein is 6.5g
Phosphorus is 0.2% or 2.89g

So keep in mind you aren’t going to feed 1000kcal a day so it will be less than one is listed above :)

As Wendy noted, talk to the IM and at the end of the day Butters needs to eat so whatever she wants to eat at this point is a win! My T has even taken down some dry food when he has been in a flare....they dictate what they eat in these situations :bighug:Sometimes the “ideal” goes out the window!!
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Cosmo was given this as treatment for megacolon. We discontinued it in favour of MD wet because of the carb content. We keep it on hand for any low number events because of the yummy gravy.

I can’t help but be sceptical about the 5% carbs...attached are the ingredients from a recent can purchased.

But...Cosmo thinks it is delicious and if Butters will eat it as she recovers, eating anything is a great thing! Our Elie ate the recovery food after a bout with pancreatitis.

Hope Butters is well!!!
 

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Thank you everyone for all your helpful advice and thoughts on what might be okay to feed my girl when she comes home. I will of course ask the IM specialist what she thinks, and will be getting baby food for her as well as a wide variety of cat foods. I think she will especially like the baby food. However, if Cosmo gave the GI Moderate Calorie Wet five stars out of five, then I'll have to give it some extra serious consideration. :D

I am so lucky to have all of you in my and Butters' corner. :bighug:
 
Butters & Lyla said:
Thank you everyone for all your helpful advice and thoughts on what might be okay to feed my girl when she comes home. I will of course ask the IM specialist what she thinks, and will be getting baby food for her as well as a wide variety of cat foods. I think she will especially like the baby food. However, if Cosmo gave the GI Moderate Calorie Wet five stars out of five, then I'll have to give it some extra serious consideration. :D

I am so lucky to have all of you in my and Butters' corner. :bighug:
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Cosmo started on the RC Mod Cal but changed to MD which is a Hills Food for lower carb :). So now you’ve got several options to try in addition to whatever the IM suggests and the yummy baby food :). Your house will look like a pet food store with all the options :bighug::p!

Have a great night and get some rest :D
 
Great that Butters nibbled on some food today.

I hate to say that it’s good news that it’s “only” pancreatitis (pancreatitis sucks, I know!) but that’s good news in the sense that concurrent illnesses could have made things so much more difficult.

Are they sending Butters home with subQ fluids too?
 
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