*+10 BG reading "HI" + 598* what do I do? Agatha isn't eating AGAIN!

The vet called: here's the summary as best as I can describe in my current mindset.

She still has a fever- it's104°, CBC showed white blood cell count is even more elevated than last week. Weight went from 10.8-11.2.

If it is an infection of sorts than the antibiotic may not be the right strain for it. He thought that was unlikely.

It could be her body trying to fight cancer causing the elevated white blood cell count + fever.

He doesn't have the equipment to do the FPL snap. He said he could only do the test you send off, the FPL spec.

He thinks that it is either cancer or the acute form of pancreatitis (which he described as being autoimmune, and treatment would be prednisone and that would only mess with her blood glucose even more), either of which will show up on an ultrasound of her belly. If it is the chronic form of pancreatitis it would not show up. And he didn't want to do the spec because anything could trigger a positive, for example he said if she were to eat a rock respect would show up positive. He recognized that all the supportive care is exactly the treatment for the chronic pancreatitis, and she's not getting any better but in fact has gotten worse.

He strongly suggested doing the ultrasound, it will be $400 and I will need to bring her back in early Wednesday morning, ideally fasted but since she has diabetes he said to give her very small meal so that I could give insulin. I told him I did not want anything to alter the accuracy of the test, seeing as how I decide to treat her is dependent on this ultrasound. If they find any growths etc they'll have to send them off to A&M university to be read at additional cost.

I let him know that if it is cancer I do not want to try to treat it. So if it is, we'll have to decide what's best for the rest of the time she can reasonably live out (if any) or if it means putting her to sleep immediately.

I hope this makes sense. If anyone has any suggestions or advice, please let me know.

 

Ah. Poor aggy. I hope she isnot in too much pain. So stressful for both of you.

 

Sometimes people want to do supportive type care, hospice type care. Other people will go all out to treat what is happening with their cat.

It's a very individual decision, that only you can make.

 

Sam I am sorry you are both going g through this. I hope the ultrasound helps with a diagnosis. Is he going to change the antibiotic as the current one is not working.
I am going to tag @Marje and Gracie tl see if she can comment on the vets evaluation of the situation.

 

I found both these posts in the Health Links forum helpful.
Quality of Life

• Feline Pain Scale
• Making "The Decision": Help to know when and how

 

10:45am took to Dr. Metzger, PMPS/8:52pm BG 333, voracious- ate 2 large handfuls of soft chicken treats and a little bit of Verne's kibble but didn't want pate, gave ondansetron 2mg, Cerenia 12mg, Veraflox + 100ml fluids, purring + appears happy to be home, she continues to eat the dog kibble. Now she's resting.

Thank you Wendy, I read "The Decision" + there are streams + streams of tears falling down my face. Agatha + I share the look, and I will take care of her to the last.

 

Reading ‘The Decision’ is very hard. Especially if you have a sick kitty

I’m so glad she is eating for you. That’s progress!
I’m sure she is glad to be home.
Did you give insulin this morning?
There is nothing in the SS for this mornings dose.

You are doing a wonderful job caring for her

 

I naively assumed the vet would administer what she needed while there but I was wrong. I did let them know she had nothing so far when I left her with them. I hope she will be okay from missing her morning dose. I will test her before I go to bed. She walked from the bedroom to the kitchen and is eating here and there, appears to feel okay. Y'all have been like angels helping me with our journey.

 

Just write in the AMPS square ‘at vet, no insulin’ so we can see what happened if you don’t mind.
Just check the urine for ketones when you can. She should be OK.

I hope you can both get some sleep.

 

AMPS/8:59am BG 523, appetite diminished, didn't want to eat treats, tried licking FF pate, head in water bowl, ondansetron 2mg, negative ketones, syringe fed 20ml a/d, she's listless.

Thank you, I got a bit of sleep. Headed to work for a couple hours, one of my sisters is with Aggy.

Yes I'm wanting to know what @Marje and Gracie thinks about his evaluation too.

It seems like he really thought about the testing he wanted to implement. I read that the only way to break a feline fever is with antibiotics, this evening will be day 9 of the Veraflox antibiotics. This antibiotic is not strong enough to break it, I don't know the exact strength of it but it really seems like it would be able to break a fever.

He chose not to do the FPL spec because anything could create a false positive. And the supportive care she has been getting would have taken care of the chronic form of pancreatitis. Yet he decided an ultrasound of her belly would be able to show both the acute form of pancreatitis or a growth/cancer.

I'm still confused as to the difference between the acute and chronic forms of pancreatitis.

I'm headed to work, but I do check frequently if anyone has written. Thank you all so much. -Sam + Aggy <3

 

Here is some information about pancreatitis
https://www.felinediabetes.com/FDMB/threads/a-primer-on-pancreatitis.83108/

 

Thank you, I read it all. I have to wake up early to get her to the vet at 8am (vet is an hour away). I'm going to assist feed 40ml a/d + administer all other supportive care right now.

They want her fasting. Will it be ok to shoot on an empty stomach before I drop her off?

I'm having so much anxiety about tomorrow. She looks so vibrant + beautiful and wants to be petted. It's so difficult to think I will probably have to say goodbye.

 

I want to share a sweet picture of us yesterday evening but when I go to upload it says error and that I am not authorized to do this. Is there any way to share this?

 

You can upload by copying and pasting the photo. The upload a file is not working at the moment sorry.

 

I’m going to tag @Wendy&Neko about when to last feed and the insulin dose. Usually we say a half dose but let’s see what Wendy suggests.
Will they monitor her BG levels?

It is sounding as if Aggie is improving and eating a bit better.....what do you think? .
You don’t have to make any quick decisions tomorrow. If it is pancreatitis it is very treatable. Some cats just need more support than others to get over it. Don’t let them tell you otherwise.
If it is a cancer, as long and she is comfortable and not in pain, you can bring her home to think about how you want to proceed.
I’m looking forward to seeing the photo

 

First, when it comes to infections and elevated or low blood counts, that’s way out of my base of knowledge because there are so very many things that can cause those issues. So I am not much help there.

The acute form of pancreatitis is not autoimmune. Autoimmune diseases are chronic, not acute, but I’ve never heard of any cat who had pancreatitis caused by an autoimmune disease. Not saying it can’t happen but I’m just not aware if it.

Any type of pancreatitis will show up on the ultrasound. He is correct that using a specfPL alone is not completely diagnostic in and of itself because if the liver, gallbladder, or intestines are inflamed, it can raise the specfPL. Supportive treatment like fluids, pain meds, anti nausea and vomiting meds definitely help but some cats may take a bit of time to get over pancreatitis. I don’t know how long Aggy has been sick but it can take up to a couple weeks.

My vet spoke to Texas A&M and for the spec fPL, a 6 hour fast is good if you entertain that idea. I’ve had many, many of my cats ultrasounded and have never fasted a single one. When I’ve asked vets, they say it is usually in case the cat is fractious and needs anesthesia. A good radiologist can tell what they need to even if the cat has had food. I would not skip insulin. I would give her a small meal and give insulin. It’s very likely her BG will elevate due to stress but you really can’t afford to skip a shot.

Many prayers for your little girl.

 

I will ask them to + bring all my supplies so they can. I'm confused by her being off the charts high the past couple days to today +3 196, +7 93, +8 162 + PMPS 553. Maybe that is just the insulin working. It seems that there have been a lot of fluctuations. There are many moving parts to what's going on.

This is very encouraging. I just don't want to have to make any split second decisions. Some have criticized my wanting to do an ultrasound for $400 despite not being able to treat if it is cancer, but I have to know for my own peace of mind what is going on with her. She's only really eating the soft chicken treats, will only lick pate, smells around at the kibble. So I am not sure if she's getting better.

I will give insulin on schedule. Thank you so much for your response. -Sam + Aggy

 

https://photos.app.goo.gl/jn3tNEtiQUAUTduz7

https://photos.app.goo.gl/5UsZwpgzvzf9mx3t6

https://photos.app.goo.gl/bVE2i6Eu7csHe5pX8

https://photos.app.goo.gl/XatMMwzZpiFbs8CU7

https://photos.app.goo.gl/Zdu495NPZH9L6MHG6

Here's a rare sighting that makes my heart happy! Sweet Aggy playing with a catnip toy. Two weeks ago:

https://photos.app.goo.gl/16wrGNrehFiQL3AC7

 

The photos are beautiful. She certainly doesn't look like she is ready for any 'decision'. She looks bright and alert. Didn't you say she had put on weight?

 

I added a video from 2 weeks ago. The vet said she gained 4 oz.

 

It looks like the new dose is working well. The highs could be bouncing from the lower numbers and the high carb treats she is getting.
They will need to monitor her BGs if she is dropping to the 90s.

Take no notice of people who say things like that to you. We have all experienced it. I feel sorry for them that they can't love an animal as we do and know the love we get back. Of course you need to know what is happening. You are doing the right thing.

 

She is very cute.

 

my cat has had ultrasound to diagnose pancreatitis and he was sedated, the vet agreed that I could get up extra early and feed him a small amount of food and give him half a dose of insulin. Cats are regularly sedated for ultrasound in the UK!

what a beautiful girl thanks for the photos

 

I hope all goes well at the vet. I’ll look in when I wake up.
Fingers and paws crossed for a good result.

 

I gave a handful treats + 1u insulin. Got her to the vet at 8:20am. Now I wait.

Such a beautiful girl <3<3<3

Thank you Bron, should have information when you wake up.

 

Hello friends,
Aggy doesn't have cancer! .... It's pancreatitis. That's what the ultrasound showed. I have way more details but I'm just so exhausted from the past several days. I will fill you in more as well as her SS tomorrow. For now, he wants her to eat Science Diet w/d bc it's low fat for pancreatitis (I'm a bit skeptical of that brand). For the next 48 hours 200ml fluids twice daily, Cerenia/ondasetron, gabapentin 50mg twice daily + at least 1 can of wet w/d daily. He wants her to have Pepcid AC as well, 100mg? Because all the pills in her tummy will be harsh. I will need to get that at the store tomorrow.

I got her home this evening, administered all supportive care (today was last day of Veraflox and she has a regular temp!). She ate on her own!!!!! almost ⅔ can of a/d. The gabapentin was making her stumble a bit so I put her in the bedroom with me for the night + I'm going to pass out for the night.

I never did get any answer from my vet what to do if/when she gets a flare of pancreatitis. We were all glad there was no sign of cancer but he had a subtle air of caution that we aren't in the clear yet. If she's not completely eating on her own in 2-3 days I must contact him + he'll tell me to use the prednisone which I was sent home with.

Thank you all for being here with me + please share any thoughts with me. Love you all! -Sam + Aggy

 

Pabay has 25mg tablets of gabapentin. You can cut them in half with a sharp knife. I use a fish filleting knife. If she eats try giving her half a dose when you recommence.

Very very pleased to hear news of aggy's improvement and that she does not have c.

 

I am so glad to hear the result of the ultrasound. When you didn’t post I was very worried.
That is a big dose of gabapentin but I’m glad she is having something for pain. I would try half (25 mg) as Ro suggested.
Also 200 mls twice a day is too much subQ fluid .
I don’t agree about the W/d dry food but will talk to you tomorrow. You must be exhausted at this moment.
Big hug to Aggie
Sleep well.

 

Sam. Eating anything is most important thing right now I think. Do check the hills food. I looked on their Web site and is has 46.1% carbohydrate by % of dry matter. That is the UK version of the food and the USA version may be different. My husband has created an apple numbers spread sheet to calculate the carbs. I can send that if it would help. I'm sure your usa based members can come up with a high protein low fat low carb food. Just watch out many companies increase the fat to decrease the carbs.

Sleep well. I

 

I love the pictures, thanks for sharing and I'm happy to hear she is cancer free, and her temperature is back to normal, and she's eating on her own
I would confirm with the vet the dose of Pepcid AC. I used to give 1/4 of a 10mg pill, so 2.5mg was the dose.

 

Hi Sam

What great news!!! Unfortunately, FWIW, I really disagree with his treatment plan. No, I’m not a vet but I do have a lot of knowledge about this stuff.

First and foremost, 200 mls of subq fluids once a day is way too much. If she has any undiagnosed heart issues, that could be her at risk. But to prescribe 200 mls twice a day is ...well, really putting even a healthy heart at potential risk. Most cats can handle 100-150 mls a day if their heart is healthy. If Aggy is small, under 10 lbs, I’d stick with 100 mls a day. More fluids does not mean she will get through the pancreatitis faster. If you’ve never give subq fluids at home, here is the video we did to help members.

Second, I personally wouldn’t give her Pepcid if she’s not vomiting foamy fluid early in the morning. I’m not a big fan of Pepcid anyway but if you are giving her cerenia and ondansetron, that’s likely enough. If you do decide to give Pepcid, be sure it is only Pepcid AC, 10 mg and only 1/4 of a tablet.

I don’t know why vets have become so enamored with gabapentin but if it isn’t dosed properly, it can cause respiratory distress. IMHO, I much prefer buprenorphine because it has a range of dosing and, since they will usually put it in a needleless syringe for you to put in her cheek pouch, you can start with a half dose of what they tell you and then increase it if she has pain. It’s also one less tablet to put down her throat. I’ve never had a cat stumbling with buprenorphine when starting at a lower dose then increasing.

Also, a higher fat diet is associated with causing pancreatitis in dogs, not cats. I’m going to tag @tiffmaxee because Elise has a lot of experience with chronic pancreatitis and she can help you with diet and some other basic information. I also would be very skeptical of feeding Science Diet w/d regardless of any illness.

i hope that helps and that Elise will be around soon.

 

Here's what the vet wrote as our protocol:
https://photos.app.goo.gl/LteRJ1vDJsnSgcgn7

Are you still able to get SubQ (is that "squids"?) from Walgreens? I really want to save the money. I didn't have any left from Chewy so I had to buy one package (Vetivex) from the vet for $30! I'm used to $10 from Chewy and you said you can get them for $22 for 12 from Walgreens?! And the needles from Thriving Pets? I didn't get to watch the whole video but will watch fully later.

It's extremely frustrating to have to pay for vet's help + also have to be skeptical of his instruction. I look forward very much to hearing from @tiffmaxee + her suggestions.

She's eating the w/d wet food for right now (I only got 7 cans) but not super excited. I had to sprinkle some cheese on top to coax her. She was ravenous last night tho. She tries eating the various pates but they always get stuck to the sides of the bowls (I try to use small shallow bowls) and I add water periodically but she never really seems to get it all out of the bowl. Is there a way around this?

Thank you so much! I gave the 50mg this am but will cut in half tonight.

Edit: I came across this article that says Costco has them, with a script. I need to call asap.
https://thecrazycatladytips.com/where-to-buy-subcutaneous-fluids-for-cats/

 

Pabay weighs 10.35 lbs. When he is poorly I cut the 25mg tables in half and he has 12.5mg x 2 of gabapentin a day so long as he has eaten. 50mg is a massive dose. I do not know the pain relief Marje has suggested. If I were you I would double check the dose with your vet.

 

Wow...I’ve never seen a vet hand write instructions.

Yes, squids but they won’t call them that And I doubt they will be that inexpensive as there was a shortage for a while. I haven’t bought them in ages. You’ll have to shop around but Chewys or Thriving pets might be the cheapest. At Walgreens, you have to buy by the case. Yes, I buy my needles from thriving pets.

 

If you are finding the pâtés are sticking to the side of the bowl, there are other low carb canned foods that are not pates.
I used to feed Sheba the Wereva cats in the kitchen brand. She suffered from pancreatic flares and I didn’t give her a low fat diet. I mostly fed her a home made diet but also some canned foods.
Here is a link to suitable low carb foods. Look for carbs 10% or less.https://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf
Here is the link to the Weruva brand. They publish all their nutritional information so you can see the number of carbs.
https://weruva.com/brand-summary/cats-in-the-kitchen/
I use flat plates to feed my cats. Or even a saucer from a cup and saucer which has very slight curve at the edge, rather than a bowl as they don’t like their whiskers hitting the edge.

Now that you know exactly what is wrong with Aggie you will be able to relax a bit and not worry it is something else.
It sounds as if she is finally starting to turn the corner with her temp down to normal and being hungry yesterday. Great news. Let’s hope it keeps up!
Sheba’s appetite was always the first thing to go when she got a flare and because she was always a great eater, I knew she was unwell.
Sometimes I had the resort to “unsuitable “diabetic cat food to get her to start eating again. She would go completely off her normal low carb diet which she loved, when she had pancreatitis.

I agree with Marje about the amount of fluids (I gave Sheba 100mls daily when needed) and fed her a normal low carb diet. I didn’t feed a low fat diet.
I am also not a fan of gabapentin but if you keep it at a small dose she should be OK. You may like to look at the bupe as Marje suggested.Hopefully she won’t need it for long.
Some cats need to keep an antinausea medication going for a while until things settle down.

You might like to start a new thread soon as this one is getting very long.

 

Hi. Sorry I am just finding the time to respond. I disagree with your vet’s plan for the same reasons as Marje. Max had chronic pancreatitis for over 3 years becoming diabetic. I think it caused his diabetes. He never had prednisolone or gabapentin. I know of cats here that have had breathing issues with gabapentin. His treatment consisted of ondansetron mostly but sometimes cerenia for nausea, cyproheptadine as an appetite stimulant, buprenorphine for pain as needed, and 100ml of fluids once a day when he wasn’t eating and drinking at least 3/4 of his normal amount. A low fat diet is not needed for cats like it is for dogs but it’s probably best not feed a high fat diet. If there’s a hidden heart issue that much fluid can lead to CHF, congestive heart failure.

Max always became inappetent with a flare. Once I figured out the results get amount f ondansetron to give he rarely needed more than one or two doses of his appetite stimulant.

It’s true that recently some vets have started to give prednisolone for pancreatitis but I would try the other treatments before giving it. It can take weeks or even months for some cats to return to normal. Some cats need support meds forever but do well with them.

 

I should add tgat cats here have given gabapentin without any issues too.

 

Thanks, Elise!

 

I got a small saucer out and will try that. She flicks food about with her tongue something fierce! I also recently learned about whisker trauma.

I gave her 100ml tonight + only 25mg gabapentin.

I will be at the ready with ondasetron + Cerenia and fluids for her. I wish I had known this before all the heartache. I noticed the very first day she turned her nose up at the food. What I still do not understand it's why/how she got an infection, and so badly?

This makes me very sad to know. I don't want her to always struggle.

This. This is huge. From what I understand/all the testing she's had, other than the diabetes + pancreatitis, everything else is good.

 

It’s not unusual for diabetic cats to get pancreatitis. It is nothing you did. It’s just one of those things. Now you know what to look for you will be able to pick it up early and put the support treatments in place early
You are doing a great job looking after her. She is lucky to have you.

 

@Pabs&Ro @Bron and Sheba (GA) @JanetNJ @Marje and Gracie @Dyana @tiffmaxee @Deb & Wink @Wendy&Neko @Red & Rover (GA)

You have all helped us so much, I can not ever repay you or thank you enough for your spirit of generosity, focus on our situation + kind, supportive words. I hope I can help someone one day the way you have helped us. Much love + respect, Sam + Aggy <3

 

(((Sam and Aggie)))
Thank you for those lovely words.
It has been pleasure helping you. You are a wonderful caring mamabean and it is so good to see Aggie starting to improve and having her diagnosis sorted out. She still has a way to go but I think you are on the right track.
I hope you can get some much needed sleep now.
And I’m sure one day you will be able to help others when they arrive here not knowing where to turn.

 

Thank you. Just remember you are never alone when you are up through the night worrying.
We are off on holiday next week so won't be around so much on the forum. Will check in though to see how you guys are doing.
Pabay comes on holiday too!

 

Tonight ^__^
https://photos.app.goo.gl/Xq8yGnSANfNV2tgb9

March 15
https://photos.app.goo.gl/jJUKXchq1voyVQW56

Feb 23
https://photos.app.goo.gl/HxhuWckto9pMCxhH9

Feb 12
https://photos.app.goo.gl/vq6U6UzaLFZPP4YCA

Just wanted to share a couple more recent pictures of Agatha <3

 

Tonight's picture: aggy looks so bright. Fab. Thanks

 

I’m so glad she’s doing better. Knowledge is power!

 

What a gorgeous kitty! She looks much better tonight. You are doing a great job with her.

By the way, I am one of those whose kitty had a heart condition (unknown at the time) and giving 100 ml a day to a 6 kg cat for her CKD. It was too much and sent her into heart failure. Thankfully she got over it. Anyway, it just makes me cautious about fluids so I'm glad to see the others jumped in.

 

50mg is not really a high dose. I have a civi who weight about 9.5 lbs and she has been on 50mg twice daily for years. She uses it for joint pain (in addition to adequan and cosequin.