2/18 Fortune AMPS 302 +8 210 +12 58 +12.5 77 +13 102 +13.5 128 +14 164 PMPS 206 +2 201 +4 212+5 314

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Sorry I have been so quiet. I have been so tired and emotionally drained, and feel such guilt that Fortune has spent most of February hospitalized and not at home. Thank you for reaching out and checking on me.

TL;DR

Fortune is coming home today! BG numbers have been all over the place, they bumped him from 2IU to 2.5 to 3 IU over two cycles and we are worried about him crashing. His kidney numbers have been stable at 2.8 and potassium is normal. No kidney infection, possibly an acute kidney injury or CKD. Still waiting for the biopsy results, and have a recheck appt next Friday. Pick up this afternoon!

Longer update

We got to see him again Tuesday night, and spend more time with him in an exam room. He was happy to see us. He indicated he wanted to go on the floor so I put him down (he can't jump because of the surgery) and immediately made a beeline toward a stray pill pocket treat! haha that's our boy!

After about 20 minutes, he was able to relax a bit (he had been looking/twitching his ears at every door open or dog bark). He must be so so tired. That's when we noticed that he was nauseous - lip smacking, some gulping - and seemed to be in pain (squinty eyes, ears a bit flatter). We brought him one of his beds and "helped" him lay in it for some rest. Afterwards, we spoke to the criticalist managing him and shared the signs we say. He is such a good eater so it throws them off! She heard us and added in ondansetron, as well as gabapentin. We also discussed buprenephrine if the gaba isn't effective. It was so so hard to leave him again.

They were also doing a curve on him, to make sure they figure out his nader. We discussed moving him to 2.5 IU because he numbers had stayed high, which we supported. She wanted to keep him til Thursday to make sure that his numbers didn't crash off of fluids and support.

Yesterday morning, Fortune's case was transferred to an internist. His creatinine was still elevated at 2.8, but they aren't sure if that was with fluids because the IV stopped working at some point in the night. 2.8 may be his "new normal," and his potassium was now normal, and he could go home(!). We explained "the plan" that we had discussed with the criticalist to make sure he is stable before coming home. She was "fine" with that, but now I have guilt that we could have brought him home sooner. But what's the point if he is going to be brought right back? The criticalist thought it was an acute kidney injury from the anesthesia and that he may continue to improve, but this IM said he has "kidney failure," which was hard to hear, but I know it's just another harsher name for CKD progression.

He was kept on 2IU yesterday morning, because he was "mostly in the 100-200 range with some outliers." That's when she told me control of diabetes "isn't perfect" and "he has a lot going on."

Last night they bumped him to 2.5 IU based on the day's curve. The IM emphasized he is "bright, and eating," he also had some diarrhea so they added in probiotics. I thought that was interesting - he was on probiotics, but was taken off at Blue Pearl and put on metronidazole. He is also on antibiotics right now because of the potential kidney infection, so that may be why...

This morning -

Dr said he is "happy, bright, and active," but I'm not sure what that means? I actually didn't find that reassuring tbqh!

He was bumped to 3IU over 2 cycles! I'm concerned about the bounce quite honestly, so will need a lot of help/guidance/support when he gets home. I have a feeling that is WAY too high. He was doing *ok* on the 2.5 until he crash on 2/3, and had skirted hypo on 2.75. He was in the 500s overnight with the 2.5 so that's why they bumped it but WHAT ABOUT THE DEPOT?! Yeesh.

She referenced the discharge instructions for any questions about meds, but we aren't starting subQ right now, she will determine if it's necessary at the recheck next Friday.

His urine culture was negative. Potassium stayed normal, and creatinine "stable." I forgot to ask about foods however. Grateful to everyone who provided the list in the old thread!

I have already requested photo copies of the chart for the BG numbers, and will get the full digital record with labs emailed as well.

I'm heading out in a snow storm to get my bunny rabbit from the hospital! Pick up is at 2pm, so I'll be leaving plenty of time for the roads in snowy NJ.

 

YAY!!!! Stay safe and happy

 

I'm so glad he's coming home! Sending more prayers.

 

I've been wondering how he (and you) are doing. Doing the little happy dance that he's coming home.

Antibiotics can cause nausea, a probiotic can help, provided they are given at least two hours apart. I also share your concern on the insulin dosing. Increasing that much/that fast? Let's see the numbers in the SS when you get home and go from there.

Be safe out there.

 

Rachel!!! I'm so happy to read this. I was sooo worried when you did not post, but wanted to give you space... so I understand. Sounds encouraging. I'll be praying for your journey to be safe.

I was hoping somebody might mention AKI! I wanted to mention this, but didn't want to butt in too much since you had so many different vets working on this.

BIG HUGS!

 

Oh, and how long has he been on antibiotics? That would mess up the culture (but maybe he wasn't on them at the time they did the cystocentesis? Also, a lot of times cultures come back negative, but that's not always conclusive.

Anyway... so excited your bunny is coming home!

 

Safe travels Rachel, roads are slick right now. Keep us updated!

 

Thank you! He is home! He was very curious and exploring/checking things out, which was good to see. Poor kitty peed in the carrier on the car ride home, despite a puppy pad he is soaked, so I wiped him down with some wipes. May have to give him a bath anyway (in addition to the bath he is giving himself now). Gave him one on Superbowl Sunday for the same reason - the car ride is so dang long.

They gave us ondansetron! YAY! I really hope that helps him. They also gave us mirataz, even though a. we have it and b. Fortune didn't need it once in the hospital. They love telling me how much and how well he eats.

The IM indicated that his prognosis is "uncertain" due to the pending biopsies, so please keep your fingers and paws crossed that it has not spread to his kidney that was removed or his liver!

I updated the spreadsheet with all of the values I have. The ones from Saturday PM and Sunday AM seem to have vanished, but I think it still gives a good picture.

@Bronx's dad (GA) on my way there the roads were absolute trash! Much better coming home, but parts of the GSP were still very slippery.

As I type this he is just settling into his shark bed after giving himself a bath. I hope he is able to rest and heal after the crazy week he has had.

He has been on them since Sunday I believe, if not Saturday night. They did an ultrasound, urinalysis and urine culture which were negative, but we are completing the full course of antibiotics. They gave us FortiFlora to use at home.

The U/S did show "mild left sided chronic renal changes." As of this morning, his creatinine is 2.9, BUN 57, K 2.8 and PCV 26% - his numbers yesterday were better. I just hope he is able to maintain before our recheck visit next Friday

 

You have no idea how happy I am to hear that Fortune is home. This news made my day..that, and them giving you ondansetron.
Paws, fingers, legs and toes crossed and also prayers that it has not spread.
Give him lots of love.

 

Did they tell you important numbers like urine specific gravity and such from the urinalysis? I would expect the urine to be dilute if it was taken when he was on IV fluids... if it was taken prior to this, then it would be good to know things like that.

Sooooo happy that he's home!!! I bet he will sleep and sleep now ... and of course, eat. Forti-Flora is a good appetite stimulant; many cats love the taste. It doesn't sound like Fortune has a problem with his appetite though. As a probiotic though, it's not the greatest. There's only one strain of "good bacteria" in it. Proviable DC or Visbiome are much better probiotics. Maybe they thought it would help the diarrhea. I have had much better luck with BeneBac for diarrhea with anything from bottle babies to weaning kittens to older cats. There are things like ProPectalin, but you've got to get it in them and a lot of cats are resistant to it.

 

Yay for Ondansetron!!!

 

So happy he’s home.

 

The only labs I can see are from 11/5 and 12/26/20. Oh well... don't worry about any of it right now. Check up on you bunny! Love on him... watch him sleep, etc... get some rest yourself.

Oh... you probably won't use the Mirataz... but don't give the full 1.5" dose and don't do it every day. Take it slow and find out the effect on your kitty. Use half of the 1.5" and see what happens.... really, it sounds like you do NOT need it since his appetite is so good. Good luck finding some new low phosphorus foods. Even if it's AKI, low phosphorus will stress his kidney less.

 

LOL the way they guard it you would think it's kitty crack! I think he just confuses their sense because he eats so well - until he doesn't. I'm so grateful that the criticalist listened to me, and the IM didn't change the plan!

He was put on IV fluids immediately because of how he presented in the ER Saturday night.

I have the urinalysis (pasting below) and all of his labs from the past three weeks of hospitals stays/visit. I'll try and update the sheet later today or tomorrow - appreciate you taking a look!

UA/Microscopy results from Antech Diagnostics
Test Result Reference Range
APPEAR Slightly Hazy
BACTERIA None Seen HPF
BILIRUBIN Negative
BLOOD Negative
CASTS None Seen LPF Hyaline 0 - 3
COLOR Light Yellow
GLUCOSE 3+ H
KETONES Negative
PH 6.0 5.5 - 7.0
PROTEIN Trace H
RBC None HPF 0 - 3
SP GRAVITY 1.025 1.015 - 1.060
WBC 0-1 HPF 0 - 3

He did have trace ketones this morning which isn't great...

I was giving him Proviable DC and digestive enzymes for his diarrhea which helped, before his hospital visit. They did give it to him for the diarrhea - it's not consistent, sometimes loose, sometimes more watery (when he got home it was formed but loose) so I think this was an alternative? IDK, I'll keep an eye on him. Maybe trying a different strain is helpful, I know for humans we are supposed to rotate the strains, but I'm just assuming here.

Never thought I would be writing so in detail about my cat's poop! lol

 

What if anything was said about the protein in his urine?

 

They didn't - I'm reviewing all of his labs from the past three weeks to see if it's new/worsened. Could it be due to the unregulated diabetes?

 

It’s not from diabetes. That’s the glucose. It’s a kidney marker but one test means nothing. You would need another once things settle down and there’s a second add on test if it’s still there. It could be from inflammation.

 

Oh, ok! I'll bring it up at the recheck appt.

I suppose his unregulated diabetes is making his last remaining kidney go nuts.

I'm going through the labs and these abbreviations are really making my brain hurt! Some are obvious (Glu = glucose) but yeesh. PCO2?! Some just may not correspond to the excel sheet...

 

They were feeding him Purina Pro Plan Tuna and Salmon, and a cursory look suggests it is neither low carb OR low phos. SIGH.

 

I'm so happy to hear that your baby is home. I'm praying for the biopsy to be negative ♥ He sure is a good eater. I'm sure he is thrilled to be home with you guys.
He's got the best parents ever. Prayers and more prayers. Give him lots of lovins
from all of us.
I hope you all get a good nights sleep .
So sick of this snow!
I live right by Giant Stadium
I'm watching the news and they say it's going to start snowing again around 6 AM
again
I just wanted to throw something at the TV set lol
Give Fortune lots of kisses ♥♥

 

So happy to hear from you and hear the great update! Great that he's home! I hope he continues to improve and feel better!!

 

Welp, his PMPS is 58. Who is surprised? Now we are at a loss as to what to shoot. Postponing and rechecking in 30 minutes after he has eaten. @Wendy&Neko @Marje and Gracie any advice?

DH just fed him high carb wet food in addition to FF chicken, checking what the carb % is right now...

 

Please update the spreadsheet. The 3 units is clearly too much. Has he had anything to eat since he came home?

 

We are feeding him now. His regular FF + Royal Canin PR veterinary diet which is high carb (15%). 3 IU was WAYYY too much!

 

The spreadsheet should be updated? I have all of his BG's from the hospital except for Saturday night/Sunday morning, including his +8 and PMPS today.

 

Don't feed, you stall without feeding.

One more question, were the hospital numbers on the AT or a human meter?

 

I only see today's +8. You should put 58@+12 for PMPS.

 

CRAP!! I thought you feed. Dammit.

They use AT (that's what they charged me for, lol)

58 is there...maybe it hasn't updated the published version? Hmm...

 

The problem with feeding, is that now his BG will be influenced by the high carbs and you won't know what his BG would be without that influence. Meaning, is it still safe to shoot. So, much later can you stall his shot tonight and still be OK shooting 12 hours later tomorrow morning?

I thought it might be the AT (usually is). Maybe make a comment that his time in the hospital is AT, and the 210 onwards is human meter.

 

Ok will add that comment - didn't even occur to me until you asked, and I only know because of the invoice, ha!

We can stall shooting as long as necessary. In my head it was like what you do with hypo, totally got my wires crossed and should have double checked.

We are both home tomorrow and pretty free so can be available to him for shooting insulin/checking BG. His haunches are dropped since he came home from the hospital - worse than when we saw him on Tuesday - so very motivated to get him whatever he needs.

Thanks for the guidance here!

 

OK, start with a test at +12.5. Let's see what the food did to his numbers. And keep testing on the 1/2 hours. If he starts to really zoom up after that, it could be safe to shoot. But I wouldn't do anymore than 2.25 as his new dose.

140's on the AT aren't bad numbers for nadirs. His numbers overall could still go down a bit though.

 

Ok he is at 77 now - which is not surprising because he ate

We will keep checking at the half hour. I think 2.25 makes sense. We had just moved him from 2.75 to 2.5 when he was hospitalized on 2/3, and they moved it down to 2IU I feel out of principle because he hit hypo at 2.75. I kept that dose because I was nervous and he kept going back into the hospital! Then there was that fun night when he was 113 at PMPS and we shot a half dose and he bounced like crazy. Ooof.

Updated the spreadsheet as best as I could with the +12.5.

 

On the spreadsheet, you can move those readings to the +11 cell. That keeps the PMPS one free for the number you actually shoot at (provided you do). And call the PMPS one a +12. The convention here is PMPS is the one before you shoot. If you don't shoot, it's PMBG (blood glucose) or just +12 which is shorter.

See you in 1/2 hour.

 

Got it! Updated - see you in a few

 

Hi Rachel, here's a good site for interpreting blood results.
https://themeowingvet.com/2016/09/09/smarty-pants-interpret-pets-bloodwork/

 

Oh, and I wanted to mention that I've had vets find mild chronic renal changes but tell me that it's probably just age and nothing significant.

 

We are up to 102! How high should we go before shooting?

Thank you! I'll check it out. I have been updating the labs in my sheet (slowly) tonight.

That's hopeful! I am really hoping that his poor remaining kidney is able to pull through and bounce back once we get this BG under control!

 

Can you tell me how much and when he's eaten in the last hour, and the carbs of those feeds?

 

He ate 3 oz of 4% carb, and approx 3 oz of 15% carb.

 

When was the last 15% carb? The problem is that higher carbs can wear off in a couple hours and numbers come back down again. Let's see what his +1.5 says.

 

He was done at +12.25, or 8:15 ET. We removed the rest at that point, so he only got half of the HC, but his normal 6oz dinner (trying to plump him up, he has lost so much weight, especially with the hospital stays).

 

We are up to 128! Poor kitty barely moved and I think I hit a vein in his ear. Not sure if that's because he is exhausted from the hospital or lethargic. I wish he could tell me!

 

+14 is 164. Should we keep waiting for it to go higher so there is less risk of hypo? I imagine we will probably need to stay up for a while to make sure he doesn't drop again?

 

Poor bunny on the poke, something we all have done before. Do you think he'll eat OK for you tonight? Can you stay up a bit yet to monitor? Plenty of strips? Looks like he's still going up, without extra HC. I think you'd be OK to shoot. I'd start with a +2.

 

Oh he will be thrilled if we feed him again! LOL. We do need to replenish our strips, but we have enough to test every hour, maybe not every half hour (about 10 or so).

We can definitely stay up. Whatever is needed.

By +2 do you mean 2 IU? When should we feed, or is it dependent on "if?"

 

+2 is two hours after the shot as your next test. You can feed him a bit at your tonight's shot time. Just make sure he doesn't fill up. I will be up at your +2 (west coast).

I'm a touch worried on the test strip supply. I tried to never go below 200. You also need on for tomorrow morning or until you have time to get more.

 

Yeah, we are running a bit low and need to run out to get more (we have to run to walmart about 30 min away).

Can we feed him another 3oz of the 4%, oras much as he will eat? You had said 2.25 IU, is that still what you think? 2 seems too low, but 3 is wayyy too high

Thank you so much for the help!!

 

Sorry, missed what you said about not letting him fill up. Will give him only a .25 can, or .75 oz to make sure he has a little extra room

 

You can update the spreadsheet at put the 164 in the PMPS cell. Code it 164@+14, so we know there was a 2 hour delay.

Sorry Fortune, there will be more food tonight!

Can you (or DH) get strips tonight? Is Wally World still open? 2 units if no, 2.25 if yes.

 

Ok - just sent DH to get strips before they close. I hope they are in stock! We went with 2.25 and gave him .75 oz

Since it had been about 30 min, we did another spot check and I added that to PMPS. Fortune wolfed down his portion (and Marty convinced me he needed some extra, too )

 

So, spending my time between now and +2 adding Fortune's labs, and as of yesterday his Alkaline Phosphatase shot up from to 105. Vet made NO mention. He does take ursodiol for his liver, but I'm not sure the signifiance and google is causing me to have a bit of a freak out. Is there anyone who can give guidance around what to push the vet for? Very frustrated that this IM is not very collaborative and didn't mention it. I feel like they are taking a similar approach to the other IM we had at the other hospital where they did not think it was worth mentioning/treating things because Fortune has "so much going on."

 

@Marje and Gracie is great at reading labs.

 

+2 is 201! Thinking we can do another test at +4, what do you think? @Wendy&Neko

 

So we put Fortune in his surgical suit and coerced him with about .5 oz of 4%. Does this mean we can go to sleep?! Both us and poor Fortune who we keep waking up and poking.

Noticed that his haunches are very dropped - much more pronounced than I thought earlier.

 

Agree on the +4. Hopefully it will be a quiet night.

 

212 at +4. Setting another alarm...

 

He's flat, go to sleep for the night.

 

Im so glad Fortune is home. I’ll bet he is happy too!

 

He came to bed and fell asleep in my arms. But then he was twitching - probably dreaming but we poked him anyway.

314 at +5. Going to sleep. Thank you!!

 

Goodnight. I hope you all sleep well.
Awwww sleeping in your arms.... he’ll be sooo happy!