2/25 Fortune PMPS 122 +1 191 +2 241 +6 279 +11 484

RachelG

RachelG

Member Since 2021
Yesterday

Poor Fortune just wants to be home. He had his onc appt, and that is a big update, but when they discharged him to me I saw that he could not stand on his front paws!

He had been under their care since 8am, and were aware of the ER visit last night, and I brought up the incident - and shared a video of it from this morning. The doctor told me they didn’t see it, but looked at the video and thought it could be because his potassium was low, but to discuss it with the internist. They also prescribed Renal K+ for potassium supplementation.

Well, I picked him up, buckled in his carrier and then went to give him kisses and saw he could not stand! So back in I went. That was about an hour ago...

The tech came out to take him and saw he couldn’t stand and thankfully took him to the doctor to be evaluated. This poor kitty.
 
So it’s polyneuropathy. The onc had a neurologist evaluate him. It may be caused by the diabetes, or it may be from the cancer.

We are going to try a medication to help the nerves respond, while trying to get his diabetes better managed.

Seeing the internist tomorrow and already steeling myself for a fight about dosing him down :blackeye:

Tonight he is due for a .25 increase. Sigh.

They brought him back out covered in urine. Poor kitty was probably holding it since 7am! It’s now 2:30.
 
We got home and Fortune is much worse. He cannot hold himself upright to drink water, he cannot walk on his legs. I’m so devastated- how was he released in this condition?! He is also covered in urine. I had asked them to clean him and idk if they did and he peed again.

I don’t know if this is temporary or not, but this is killing me. He is stressed out and upset and resting now. He kept trying to drink water, he didn’t have any all day and his kidney numbers are so high. I held him up but he kept trying to do it on his own. I’m so scared.

I need to think about his insulin dose tonight, too. He only received one unit, so less than half of his 2.5 dose. Does that mean we cannot increase?

The hypothesis is that this may be neuropathy due to poorly regulated diabetes, but I don’t know how to help him!

I am beside myself that he was released to me in this condition. It’s negligent. They did not explain to me that he would get worse, and I was told he would improve. I just feel so alone and helpless.
 
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Rachel, I just want to cry with you. I agree, it sounds negligent of the vet the way they let Fortune leave. It's possible he still will get better than he is now - at least it would line up with having you think he would get better.

I would increase his dose as planned (unless you see an unusual PMPS). Since neuropathy is often a result of long term high BG, you need that better dose. Healing begins with reaching and maintaining good BG control. It isn't a quick process either - a few weeks to a few months. Tina had a pretty bad case when she started insulin - she was almost dragging her back end. Most improvement was approximately 3-4 months after good BG numbers (mostly green).

I'm concerned with how quickly the neuropathy got worse. I want help for your precious Fortune.

MANY HUGS for you and kisses for Fortune.
 
Thank you so much! Fortune has been on insulin since July 2020, and was in remission briefly in October before relapsing - granted this was all through urine dips and dosing at the guidance of our vet. We have been trying TR since 01/09/21.

He was due for an increase tonight, to 2.75 IU. Can we still move forward with the increase? I’m concerned his BG is dropping...it’s very befuddling.
 
I’m also very concerned with the quick progression especially in his front legs. Usually hind legs are affected - his are as well but it’s so pronounced in the front. All in the last 24 hours!!
 
Tina Marie and Jan said:
Rachel - I reread, and see you were planning an increase, so I quickly edited the above!
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Thank you for clarifying! :bighug::bighug:

Lisa & Oberon said:
Has anyone discussed the possibility of B12 (e.g. Zobaline) to help with neuropathy? With everything he has going on I don't know whether it would be an option, but it might be worth bringing it up.
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In the past, yes, but his neuropathy resolved in late January when his numbers were improving. The neurologist prescribed mestinon pyridostigmine to help “heal the nerve pathway.” It is a symptomatic treatment, and a conservative starting dose. We haven’t given it to him yet because I’m afraid he will choke (it’s liquid) but I need to walk away and let my husband do it...
 
RachelG said:
Thank you so much! Fortune has been on insulin since July 2020, and was in remission briefly in October before relapsing - granted this was all through urine dips and dosing at the guidance of our vet. We have been trying TR since 01/09/21.

He was due for an increase tonight, to 2.75 IU. Can we still move forward with the increase? I’m concerned his BG is dropping...it’s very befuddling.
Click to expand...

Glad his BG is going down - but he's making the planned increase to 2.75 a little more interesting! Great you are using TR too. Give that boy a gentle hug when he's ready:cat: I will always give Tina her daily Zobaline, like Lisa suggested. I do believe it helps, even though good BG numbers would help the most.

I'm looking up your new medicine out of curiosity:bighug:
 
OK! Deep breaths! We spoke to the neurologist. He was presenting as we are seeing him, and she explained that as he exerts his energy it will seem to get worse.

She advised us to keep everything close (water, litter, food) so he can push himself using his legs to where he needs without getting too tired, and to put him in the litter box every few hours.

She expects the medication to work by the second dose latest (in the first 20-30 min of administering or by the second) and will also be evaluating him tomorrow when he comes in for the internist check up.

We discussed that if he didn’t have diabetes or cancer she would expect this to be an autoimmune presentation but expects it to be related to the diabetes or possibly a “remnant” of the cancer. We will be discussing more in depth how to rule it out.

Fortune is always surprising us! The good news is his BG is looking much much better today (ofc) so I think we are in for a late night with this increase!

I will try and post a better update about his cancer dx and treatment, and the CKD progression, but I’m a bit overwhelmed.

TL;DR Fortune is a great candidate for the chemotherapy, all of the studies have been done in most dogs and some cats (it’s more rare) who had it diagnosed in their spleen, and usually showed spread. Fortune didn’t have it on his spleen or in his liver (a common spread place), didn’t show signs of spread, and because it was on his kidney (no studies, very rare) the hope is that it was somewhat “walled off” during the bleed and spread more slowly. We hope to improve his QoL with treatment for the diabetes and CKD, and this is usually a well tolerated chemotherapy that should help too.

Of course Fortune is super rare and special and if we are going to get a terrible diagnosis at least we have some hope layered in.

What a roller coaster!!
 
I do hope the medication helps with his prompt recovery! Try to be patient...I know it's a difficult time...but sometimes these kitties can surprise us!

Hang in there - sending you many healing vines and prayers this evening! :bighug::bighug::bighug::bighug::bighug:
 
Oh Rachel, my heart breaks every time I read something about Fortune.
I'm so glad his BG has come down. I hope the new medication works quickly.
I just want to hold him and kiss him all over.
Praying for his appointment to go well tomorrow.
We all love you Fortune ♥:bighug::bighug:
 
So I may be developing at heart condition from these numbers. Already dreading the bounce!

Do we feed him? He only had 3/4 of a can at PMPS +9 because of the early appt this morning, and was given only 1 IU today, so this must be the 2.5 depot at work...I guess?
 
Oh my . . .

I am just bumping this. Personally, I wouldn't increase tonight the way it looks now.
Hopefully someone else will pop in!
It could be the depot, and an interesting response to this day. I don't know!
 
Hi Rachel :bighug: Hugs to you and Fortune :bighug::bighug::bighug: Sending lots of love and positive energy.

Nice to see the greens - when you get your PMPS reading, don't feed and post here and see if someone can help. FWIW, I wouldn't increase...
 
Tina Marie and Jan said:
Oh my . . .

I am just bumping this. Personally, I wouldn't increase tonight the way it looks now.
Hopefully someone else will pop in!
It could be the depot, and an interesting response to this day. I don't know!
Click to expand...

Thank you! Yeah, I'm inclined to hold the dose. My goodness, Fortune is just keeping things interesting, isn't he!
 
JaxBenji said:
Hi Rachel :bighug: Hugs to you and Fortune :bighug::bighug::bighug: Sending lots of love and positive energy.

Nice to see the greens - when you get your PMPS reading, don't feed and post here and see if someone can help. FWIW, I wouldn't increase...
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Ok, thanks! We are almost at food time (we have been trying to give him 30-60 minutes to finish food before the insulin), so I'm hoping I get input on +11 (about to do that now!)

Goodness how the plan has changed. Fortune is steering and I'm just holding on for the ride!
 
You can feed up to +10 without impacting PMPS. Today is the result of the 2.5 unit depot. Plus some cats go lower at the vet - this is not the first time Fortune has done that. And maybe relief from some meds?

With TR you'd hold a dose giving you greens for 10 cycles, though I suspect he'll still need more insulin.
 
Yes, he has been blue at the hospital before, so that makes sense. Today was also very unusual, he didn't eat much, got underdosed, etc. It seems like he is holding steady now and not going lower. Can this be the norm, please?!

I'm really worried he won't eat tonight because he was already nauseous before, and inappetence is a side effect. We tried to give him a little nibble at +8 and he was not interested. He is somewhat lethargic now - I understand because of the day he has had, side effect of the sedation, plus the neuropathy are all probably making him feel zonked. On top of it it's tremendous effort for him to lift his legs :(

I guess my question is - if he eats 50% + we will hold the 2.5IU, but if he eats less, do we decrease to half? (I think I know this, but my brain is mush)

Secondly, do I need to mentally and emotionally prepare for the bounce?
 
Oh - also he seems to be intermittently able to stand on his paws again!!! Still very weak, but I think that's a good thing. (anti-jinx, hamsa, etc)
 
Did the vet send you home with anti-nausea meds today? He's also not used to greens, so may be feeling off cause of that. Think of the analogy of high blood sugar = high caffeine. What happens if you don't get what you are used to? Lethargy and irritable until you get used to it.

If I was a betting person, I'd bet on a bounce. ;) As for dosing, can you syringe feed? When Neko was off her feed, I'd give her some 8% carbs as a little boost over her normal food.
 
Wendy&Neko said:
Did the vet send you home with anti-nausea meds today? He's also not used to greens, so may be feeling off cause of that. Think of the analogy of high blood sugar = high caffeine. What happens if you don't get what you are used to? Lethargy and irritable until you get used to it.
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We have our usual stockpile of ondansetron, cerenia and mirtazapine. Though I think DH used the mrtz ear for one of the tests!

Wendy&Neko said:
If I was a betting person, I'd bet on a bounce. ;) As for dosing, can you syringe feed? When Neko was off her feed, I'd give her some 8% carbs as a little boost over her normal food.
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We can try - it did NOT go well when I tried it back on 2/7. What has been working is hand feeding and presenting food in intervals. He also got the mrtz late, so hopefully it will kick in soon! :arghh:

Will you be there to hold my hand through the bounce? :smuggrin:
 
78 PMPS!!!

We are giving him 30-45 minutes to eat 50%+ and then shooting and praying and have honey on standby. Guess who isn't sleeping tonight?
 
DH pointed out that in the past we wait and stall to make sure it goes up. Should we do that now?

Sorry for the repeat questions - my brain is MUSH tonight.
 
A stall means NOT feeding, to see if his numbers go up on his own without food. If you are OK shooting 78, then it's not so much an issue.
 
Wendy&Neko said:
A stall means NOT feeding, to see if his numbers go up on his own without food. If you are OK shooting 78, then it's not so much an issue.
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Right, we have been stalling...Am I ok shooting 78?? Last time he was this low (on 2/18) we stalled...

Do you mean am I ok if he drops? In terms of supplies, we are ok (simple syrup and DH just ran out to get Karo to be sure.) But I would prefer if he wasn't hypo on top of everything else. What does "ok" mean?

Sorry if I'm being thick. I feel like I have lost brain cells.
 
Oh wait, we are planning to feed then shoot, so it should be fine? Sorry. I'm on 2 hours sleep today!
 
Did you retest before shooting? Did he come up from the food? I'd get a +1 and a +2 to see if you need to intervene early.

RachelG said:
Do you mean am I ok if he drops?
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OK means if you are comfortable shooting green numbers and shooting at a 78. The lowest you've shot full dose was 129. I'm not saying it was a bad thing to shoot, but it would have been better to know if he was on his way up or down without food.
 
We didn't shoot - he hasn't eaten. :(

He is very tired - I imagine from the neuropathy, the CKD, the BG and the chemo + the overall long day at the vet are all contributing.

We are trying to see if the ondansetron and cerenia will kick in, and maybe the mirtazapine.

Retested at +12.5 - still 73
 
OK HE ATE! Not a whole lot (3/4 of a can) but we are going to keep coaxing him (sent DH to get KFC) and hand feeding him. I need to remember to wear gloves because of the chemo, but I forgot.

I'm just happy he ate! I know it's the meds kicking in, but this kitty LOVES to eat and if he needs a little extra help so be it. Ooof.

Anyway, I wasn't able to get another test at +13 - he got up when I was poking him to eat and well, I didn't stop him because he was falling down trying to eat so of course I helped him. I know it's going to suck to have to test all night, but what else can we do? Lower the dose?

Still trying to get him to eat more before we shoot. Debating holding the dose if he is plummeting.
 
Rachel, just stopped by to visit and see you're in panic mode. If you are feeding him his numbers will go up, so you might as well shoot if you are prepared. I can hold your hand. :bighug: EDIT: I probably would not increase tonight. Too much going on.
 
He ate so little compared to normal, and his numbers are so low that I’m scared to shoot his normal dose. Totally not raising it, but not sure if we should adjust?

Tested at +13 with 3/4 of a can (his normal is 1-2 cans) and he is at 88
 
We mixed the remaining 1/4 can with his gabapentin and potassium. Apparently potassium smells bad :banghead:

Tried a different variety with just gabapentin and he is devouring it!! :joyful:

He is just so low, we have never shot this low before...
 
He is on his way up, though some of it may be from food. Your call on how late you want preshot to be as tomorrow is 12 hours after whenever you shoot tonight. If you are OK with stalling a bit more until he's in your comfy zone to shoot full dose, do that. If can't stall much longer, shoot 1/2 dose. Note that at some point, the reduced dose this morning and insulin wearing off, and possibly a bounce will most likey cause his numbers to zoom up. Stalling also acts a bit like a reduction. But you have to be comfortable with whatever happens, and with kitties, there are no guarantees. :cat:

Is it potassium gluconate you are using? It's a bit gritty, I learned to soften with water.
 
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