? 3/23 Sir Thomas AMPS 7.8

Discussion in 'Lantus / Levemir / Biosimilars' started by Charlene0718, Mar 23, 2021.

  1. Charlene0718

    Charlene0718 Member

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    Mar 19, 2021
    Hi everyone,

    Struggling with insulin dose for my newly diagnosed diabetic cat.
    Please see my original thread for details:
    https://felinediabetes.com/FDMB/threads/introduction-and-help-pls.244898/page-2

    He recently reduced to .5 BID unit shot as of last night, but his AMPS is 7.8.Vet wants to stop all insulin, but I was advised to reduce to .5 here on this group to avoid abrupt stop and development of DKA> negative on keytones so far.

    Do I still give shot? He is eating treats and some other food with some coaching but not eating well like he used to still.
     
  2. tiffmaxee

    tiffmaxee Well-Known Member

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    Nov 15, 2013
    Welcome. I’m sorry nobody saw this sooner. I need to look at your ss. I just tried to quickly read your post in main . Can you be off schedule? Did you feed?
     
    Last edited: Mar 23, 2021
  3. Charlene0718

    Charlene0718 Member

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    Mar 19, 2021
    Not off schedule, but we are having difficulties with insulin.
    He stopped eating again now that I restarted insulin so i could do the feed and stall. I tried everything for him to eat, he even stopped eating treats but was eating them at 530am

    The vet thinks maybe starting on insulin restarted his own bodily processes and advised us to stop yesterday, but this group informed me of risk if dka and to reduce dose and continue.

    I so also have another second opinion from a vet as recommended by someone on this site for tomorrow at 10.

    Thanks for looking at my post!
     
  4. tiffmaxee

    tiffmaxee Well-Known Member

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    Yes. Stopping too soon is not a good idea and he would likely need to come back n insulin with a higher dose. Is there a favorite food he might eat, regardless of the carbs in it?
     
  5. tiffmaxee

    tiffmaxee Well-Known Member

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    When you see the new vet if he’s not eating well id ask if the vet thinks he could have pancreatitis? It’s safe common in cats but often gets missed and a SpecFPL blood test might be worth getting. He might be nauseous and need cerenia or my fave ondansetron, a human drug for nausea.
     
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  6. Charlene0718

    Charlene0718 Member

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    Ive tried everything including his fav treats , chicken in crab broth etc, but will keep trying!
     
  7. Charlene0718

    Charlene0718 Member

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    Thats very helpful thank you!
     
  8. tiffmaxee

    tiffmaxee Well-Known Member

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    My cat had chronic pancreatitis for a few years before becoming diabetic and who knows how long he had it before it was figured out. He was eating but got picky. When a friend suggested he might be nauseous it never occurred to me that he might be. With help from a yahoo group it was figured out before a vet who did an ultrasound could convince me to have exploratory surgery. That vet didn’t run the test when I fasted Max for the ultrasound. Went back to my regular vet who had another ultrasound done by a boarded radiologist and ran the blood tests. Max never had surgery and lived to be 19 1/2. All this to say a good vet is so important.
     
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  9. tiffmaxee

    tiffmaxee Well-Known Member

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    I think he’s nauseous. Have you ever syringe fed him?
     
  10. majandra

    majandra Well-Known Member

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    Do you think he loses his appetite when his sugars go high?
    Did you get the lab results from your vet yesterday?
     
  11. tiffmaxee

    tiffmaxee Well-Known Member

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    If you have labs please post them.
     
  12. Charlene0718

    Charlene0718 Member

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    Yes I was reading on pancreatitis today and I can see why you say that! Your story is hopeful though :) I will ask the new vet tomorrow about it too

    I can syringe feed, he just fights me something fierce but I am successful with med by syringe with atopica twice a week. If he sees me coming, I'm done for though. I have 4 cats and he is the only one I struggle with syringes and pills; he was a stray for years before I got him and the fight is real. Even the last "kitty burrito" (pre diabetes) took me and my husband to succeed and resulted in him fighting so hard he bit his tongue and there was blood everywhere. I HATE needles but for this reason I much prefer injection with this cat, lol. I can try to syringe feed, but it will be long because I have an 11 month old and no help with covid right now so once I start the syringe, he will not tolerate sitting there for much time to get much in but I can do it little by little because he is so social he can't resist coming back to me in a half hour or so.

    Not necessarily, it seems to be when his sugars get lower or are going down fast. A couple hours after insulin it gets harder and harder to feed him. He was still taking treats at 530a this morning, but nothing else and when we stopped insulin (even though his sugars went up) he ate chicken, fish, and broth.

    Still waiting on getting the lab results but request is in, will post and update SS when I get them!
     
  13. majandra

    majandra Well-Known Member

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    you will want those labs before you go to your second opinion appointment! and it wouldn't hurt to get some Royal Canin recovery or Hillls a/d as well, just in case. all my cats will eat that when they eat nothing else.

    ETA: Did you shoot this morning? make sure to say in title if you are stalling or NS
     
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  14. tiffmaxee

    tiffmaxee Well-Known Member

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    Not all my cats have liked AD and none liked Recovery but worth a try. My go to was Gerbers seconds all meat baby food. Ham, beef, Turkey, and chicken although some weren’t crazy about chicken. My current girl who I tried to get to eat it wouldn’t touch baby food. First one ever! The baby food just needs to be 100% meat without any garlic or onion.
     
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  15. Charlene0718

    Charlene0718 Member

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    I got the lab work, it is ordered different than in the spread sheet but so far I have put in the results that are abnormal
    I tried to upload the pdf to this thread but it says i do have permission

    I did not shoot this morning due to being under 9 and i was not able to feed to stall. He has dipped to 4.2 so I syringed him 8ml of blended food
     
  16. Charlene0718

    Charlene0718 Member

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    Okay I will try any and all options! Nothing can hurt, thank you :)
     
  17. majandra

    majandra Well-Known Member

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    Can you put in the reference ranges? The US folk may have issues otherwise. You can copy paste from mine if you'd like. They should be close to yours if not the same

    ETA: can you put in the normal values too?
     
    Last edited: Mar 23, 2021
  18. tiffmaxee

    tiffmaxee Well-Known Member

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    Nov 15, 2013
    Since no insulin was given and he’s in normal range he is likely going to need a decrease.
    I tried to view the labs but need the ranges. If all that you input are abnormal I think there are other issues besides diabetes.
     
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  19. tiffmaxee

    tiffmaxee Well-Known Member

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    No need to test again until pmps. Try feeding small amounts every 30-60 minutes. Don’t feed two hours before pmps though so the BG is not food influenced.
     
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  20. Charlene0718

    Charlene0718 Member

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    Done, thank you! I finished putting in the abnormal results but I will upload the normal ones too once I have time. I am going to go retake his BG in 15 here
     
  21. Charlene0718

    Charlene0718 Member

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    Oh okay, so even though his last read was 4.3, i dont have to keep testing BG? Instead I have to just keep giving the small amounts of food right?

    All the results in red are abnormal so it seems like a lot, i hope its something treatable too!
     
  22. tiffmaxee

    tiffmaxee Well-Known Member

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    He hasn’t had any insulin for how many hours? I believe at least 16. Then if he eats it won’t be low due to insulin.
     
  23. Charlene0718

    Charlene0718 Member

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    Yes 16 hours no insulin. Right, thank you!
     
  24. tiffmaxee

    tiffmaxee Well-Known Member

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    One more question. Did you change the ranges on your ss? If they are correct it looks like there could be a liver issue. Some are pretty high. Pancreatitis did raise Max’s ALT.
     
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  25. Charlene0718

    Charlene0718 Member

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    Yes they said he has liver damage, prob from uncontrolled diabetes. They gave me a liver support pill but i havent had a chance to administer yet but i will work on that now too
     
  26. tiffmaxee

    tiffmaxee Well-Known Member

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    Since you skipped this morning you can choose the time you like best to be his insulin time. I’d grab a test at +11 so we can see how much he goes up by that time. Are you happy with the current insulin time?
     
    Last edited: Mar 23, 2021
  27. Dyana

    Dyana Well-Known Member

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    Did the vet say anything about the potassium be low?
     
  28. Charlene0718

    Charlene0718 Member

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    I just took and he keeps going down and down. he is at 3.8 right now. I have left food out and syringed about 15mls today

    No he didn't

    The vet called to see how he was doing, I said not good and explained. He said to take him to this one ER right now that has a specialist they can consult with so I am doing that as soon as my MIL shows up to babysit my baby here which should be soon.
     
  29. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Let us know how you get on Charlene. Ask for the fPL as Elise suggested.
    He could have pancreatitis which would explain why he’s not eating.
    If he does have that he will need antinausea meds and pain meds as it’s painful and maybe some subQ fluids.
    Ask for an antinausea drug such as cerenia or /and ondansetron. He needs to eat.
    Keep testing for ketones.
     
  30. tiffmaxee

    tiffmaxee Well-Known Member

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    So sorry to hear this. Let us know what the vet says. It's good you have been feeding him You don't want fatty liver too.
     
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  31. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Looking at the labs you posted, there are several things that need to be looked at by the vet. Make sure you have them with you when you go.
    And the potassium is below normal levels.
     
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  32. majandra

    majandra Well-Known Member

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    Hope everything goes well!
     
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  33. Charlene0718

    Charlene0718 Member

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    Thank you! I re-went through the thread, wrote notes and told the emerg vet all the recommendations here. Gave them my spreadsheet and the bloodwork. It was sad because they came and got him from my car due to covid so i couldnt go in to say goodbye, so i really hope he makes it.

    They are going to do iv with potassium, full blood work urinalysis, keytones, and ultrasound. As well as admit him overnight in the animal hospital to monitor him. They are generalist vets who do the intake but have access to all different kinds of specialists as they need. Anyone in the edmonton area, Purge Animal Specialists and emergency animal hospital seems really resourced and staffed 24/7. Plus you can call as much as you want to check on your pet :). They will test for pancreatitis as well as take any biopsy etc as they find and need during the ultrasound procedure. They will work on finding what is making him nauseous
     
  34. Charlene0718

    Charlene0718 Member

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    Fingers crossed, they really seemed to take everything I said very seriously which made me feel hopeful!
     
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  35. tiffmaxee

    tiffmaxee Well-Known Member

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    Fingers and paws crossed. Sounds like a good ER. Keep us posted please. :bighug:
     
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  36. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    It sounds as if he is in the best possibly place. I’m sure you hated seeing him go in there without you. It’s tough!
    I’m glad they listened to you. That’s really good.
    Please keep us updated.
    Sending many get better vines to Sir Thomas.
    :bighug::bighug::bighug:
     
  37. Charlene0718

    Charlene0718 Member

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    Thank you both (and everyone else) for helping me get him there. I will most definitely keep you updated
     
  38. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

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    Wishing Sir Thomas all the best and they can figure out the problem.♥:bighug::bighug::bighug:
     
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  39. Charlene0718

    Charlene0718 Member

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    Update on Sir Thomas :)

    So, of course there was one hour in my entire two days with this cat that I wasn’t very available, and that is when the ER vet calls me- as I am getting a cavity filled at the dentist; good ol’ Murphy’s law. It was very distracting to have all my dental stuff going on while I was talking but I think I caught most of Sir Thomas’s situation.

    Last night, his BG went from 3.8 when I dropped him off at the ER to 29! I’ve never seen him that high. My poor stressed, Sir Thomas. His ultrasound came back clear, aside from liver damage showing.

    Essentially, they don’t think he has a “true” diabetes, and if he does, he would fall into the type 2 category. Their best guess so far, is that he has had some disease causing liver damage for some time, which then caused inflammation of the pancreas, which then caused problems in insulin production/regulation etc. They didn’t say pancreatitis, as they were focused on what is causing the liver problem. His results were in consult with an internal medicine specialist who was still consulting.

    He may or may not still need insulin, but they were concerned about ketosis (of DK?) as you guys have also warned so they said they will keep him another night in hospital with monitoring while also trying to figure out blood sugars and treatment. I am going to have to be giving liver support medication, and they said an antibiotic as well to work on getting the inflammation down, at minimum. We will see the rest of the recommendations as he get's through this. I forgot to ask about if his atopica could be related at all to the liver damage; a quick google search has not a lot of great things to say about the drug but it was mainly kidney that was the warning with that. Good luck to me, I have NEVER been able to get this cat to take a pill and I am fine with my other 3 cats! Liquid syringe, insulin, BG I have mastered, but even the kitty burrito normally results in him biting his tongue with significant blood and two people to restrain, lol. He will likely be weaker so that might be on my side for that.

    So it is one more overnight hospital stay for this kind gentleman. They said he fights restraint something fierce but then warms up and is the sweetest boy once that's over so at least he is feeling good enough for some fight! I will let you guys know once the final diagnosis is in, however, even if it isn't "true" diabetes, they said he could develop diabetes from this and I'll have to continue BG monitoring for some time.
     
  40. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Thank you for the update Charlene.
    The jump from 3.8to 29 was most likely a bounce from the low numbers nor necessarily from stress although that could have contributed.
    I am a bit concerned they are saying it may not be true diabetes.
    I am going to tag @Marje and Gracie to ask her to comment on the lab results and what the vets have said as she is very knowledgeable about lab results and associated conditions that can go with diabetes which she can identify from the lab results. She is not online a lot atm but hopefully she will see this.
     
    Last edited: Mar 24, 2021
  41. Charlene0718

    Charlene0718 Member

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    Awesome thank you so much! Its so confusing.

    I will continue to ask as many questions as possible, this is the only specialist clinic available in a timely fashion to me so i hope they get it right
     
  42. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    I think they should be testing for pancreatitis as many diabetic cats get it and he is displaying the symptoms of nausea and not eating. Cats are good at hiding pain as well.
    His fructosamine test was high from memory which is the test they do to diagnose feline diabetes
     
  43. Charlene0718

    Charlene0718 Member

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    She said they were redoing his entire blood panel and urinalysis so i will ask about that when they call me tonight.

    I thought she said that if he had pancreatitis it would show up on the ultrasound but i could be wrong about that, i will double check when the vet calls back again. And yes you are correct about the fructosamine.
     
  44. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    It may show up in the ultrasound but a snap fPL will tell you yes or no pancreatitis and a Spec fPL will give you a number as to how severe it is.
    They are both NOT on the routine blood panel and need to be ordered separately.
     
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  45. Charlene0718

    Charlene0718 Member

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    I will talk to the vet tech tonight and the vet will call in the morning so I will make sure to check if that was ordered! Thank you :)
     
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  46. Marje and Gracie

    Marje and Gracie Senior Member Moderator

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    Atopica is oral cyclosporine and the number one side effect is anorexia, vomiting, diarrhea, etc. A small cohort had some elevated liver values and Sir Thomas definitely has something go on with his liver. Something is definitely causing issues with his liver for all of his liver values to be elevated. The ultrasound should definitely help with diagnosing pancreatitis. Because the liver is so inflamed and so close to the pancreas, I wouldn’t be surprised if the spec or snap fPL is elevated even if he doesn’t have pancreatitis. His bilirubin is really high which makes me question if there is a gallbladder or bile duct issue going on.

    I wish they had run a full superchem panel to see what his kidneys look like. His potassium is definitely too low. I don’t agree that he’s not diabetic.

    I hope you get some answers. Poor, sweet boy.
     
    Last edited: Mar 24, 2021
  47. Charlene0718

    Charlene0718 Member

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    Thank you both! Just got off the phone from the vet. I hope I'm understanding this properly, this is all brand new to me. They think his potassium was low due to not eating properly for so long, gave IV with potassium and hydration.

    So the vet and specialist said they expect the pancreas to be inflamed regardless due to his liver damage, so they are going to treat it as if it is pancreatitis and they have done the corresponding IV and meds in clinic. They have also tried anti-nausea and an appetite stimulant, and have had no luck getting him to eat so have been syringing him food, which is is super unhappy with but ya gotta do what ya gotta do in this case, short of a feeding tube, which is an option we'd like to avoid if possible. They will be sending me home with an appetite stimulant and an antibiotic to treat the inflammation (of the liver I think?), and I believe a liver support pill.

    They said his kidney's were not great, but also not classified as diseased, but they would expect him to likely develop kidney disease in the next 5 years.

    I asked about the atopica, and they said there might be some correlations there but it is hard to know. They said it is possible it has had an effect on his liver and kidneys, but it is also possible as a immune suppressant that it was keeping some of his symptoms at bay, we wont know which one is which until we go off. He hasn't had any atopica for 8 days and his appetite continues to get worse and worse so they don't think it is the entire picture. They said we risk possibly some symptoms getting worse getting off the atopica, but we won't know for sure if it is also causing problems unless we stay off for one month and re-evaluate that (so that's what we are doing- no atopica for 1 month then re-evaluate.

    I asked about bile duct and gall-bladder being issues, and they said they were able to rule that out (I'm not exactly sure how).

    Since he has not had insulin since the last time I gave it (none yesterday or today), as of today, his numbers have been down to the higher teens when stressed, but have been consistently down around the 11 mark when he is resting, which they said given he will be more stressed there than at home, is pointing to him not being a "true diabetic." They did say, though, given all the conditions, if they were to give him a steroid to increase his appetite it would ensure he would become a "true diabetic" and he still may, but they feel it would be caused by this inflammation, not the other way around which my original vet thought. They still want me to take his blood sugars consistently 4 times daily.

    My head is seriously spinning. Thank you for taking the time to read through everything and advise me. I get to talk to one more vet at 6am tomorrow morning (it is 11pm here now). If anyone sees this and has any further questions you guys would advise, I am all ears! They will send him in with an appt to be re-evaluated in 2 weeks and I am supposed to try to encourage him to eat and syringe feed him last resort if he isn't getting enough calories.

    So far my questions are:
    How much do I have to see him using the litter before I'm concerned?
    What signs do I have to look for before taking him back to the ER?
    Can I get an emailed copy of all the blood lab work?
    What numbers should his blood glucose stay within? Outside what range do I call again to re-evaluate?
    What times of day would should the BG be taken consistently? At what point/ range should I take them more often?
    When do they expect his appetite to return if all goes well?
    At the 2 week follow up can we do a Spec fPL as well?
    Did they do a full superchem panel, if so would that be useful at the 2 week follow up as well?

    Many thanks everyone. I am mentally and emotionally drained so I am going to go get some sleep before I pick him up in the morning so I can rally to be there for him :). Thanks again!
     
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  48. Charlene0718

    Charlene0718 Member

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    Oh, I forgot my last question for the vet: Can I get a referral to a specialist or dermatologist so that I can figure out his allergies and possibly do exposure therapy instead of life long immunosuppressants?
     
  49. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Feb 21, 2015
    Hi Charlene
    I would definitely ask for antinausea meds as well as an appetite stimulant. Sir Thomas has to have had the nausea treated first before giving the appetite stimulant. So ask for some oral cerenia and ondansetron. They work on different pathways and can be given at the same time if needed. We can help you with that at home but you need to have the meds.
    Also ask them to give him IMI cerenia before he comes home and that will last the first 24 hours at home.
    He may well eat for you at home. Cats often will eat for their owners when they won’t eat for the vets. But unless the nausea has been addressed first you can’t expect him to want to eat.
    Don’t be afraid of a feeding tube. They are very good at being able to get the necessary food into the cat and are not hard to deal with......I think much easier than syringe feeding.

    I am still very concerned they are saying he is not a true diabetic. 11 is above the normal range for cats and still too high to go without insulin.
    He may just need a very small amount of insulin. I hope they are testing daily for ketones.

    All your questions are good.
    Definitely get them to email you all the lab tests they have done s they are yours...you
    Paid for them. And Marje can have a look at them.

    I think when you get him home, give him a few hours to settle in and if his blood glucose is above the normal range, he needs insulin. Yes, cats can get stressed at the vet and their BG can go up, but it doesn’t usually stay up for days just due to stress.

    I hope you have managed to get a good nights sleep.
     
    Last edited: Mar 25, 2021
  50. Marje and Gracie

    Marje and Gracie Senior Member Moderator

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    May 30, 2010
    I agree with Bron on the anti nausea meds.

    I wonder if his elevated liver enzymes are due to hepatic lipidosis. I would ask. I would also ask about the gallbladder & bile duct and how do they know unequivocally. Ask if they did a bile acids assay. I would also ask if this could be cholangiohepatitis or triaditis although I suspect they will say “no” since they think the gallbladder is not involved. Ask if he is jaundiced.

    Likely they will give Denamarin for liver support. It’s a coated pill you cannot cut and has to be given on an empty tummy. I prefer just giving milk thistle which I buy in powder form from Chewys if they ship there. I use Herbsmith which you can mix with a small amount of chicken or turkey baby food with no onions, garlic, broth and syringe feed if he will let you.

    i don’t know what they mean by his kidneys were not great but not diseased. Makes no sense. Be sure you get copies of all labs and tag me. I’ll look at the kidney stuff, too.

    Sending healing light!
     
  51. Charlene0718

    Charlene0718 Member

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    Mar 19, 2021
    Sir thomas vet notes update/ summarized:

    Emergency Discharge Summary
    Sir Thomas presented to us for evaluation (Note: I brought him in with reported 3.8 BG and administered honey). He had previously been diagnosed with diabetes. All along he has not been eating well. He has been becoming hypoglycemic, even with decreasing doses of insulin. SIr Thomas's vital parameters were within normal limits. On physical examination, we found that he appeared slightly dehydrated.

    Diagnostic test results:
    1. Bloodwork:
    1. Liver values were mildly elevated (improved compared to regular vet bloodwork)
    2. the blood sugar level was high on presentation but became more normal during his stay. We suspect that he had a high blood glucose initially due to stress. His previous high blood glucose and high serum fructosamine were suggestive of diabetes melitus. This change/improvement in his ability to regulate his blood sugar suggests that he either went into diabetic remission quickly and/or was 'pre-diabetic'

    2. Urinalysis
    1. Some glucose and struvite crystals
    3. Abdominal Ultrasound:
    Conclusions:
    1. mild hyperechoic mesentery surrounding the kidneys. Differentials include an acute kidney injury from a toxin vs a inflammatory glomerular or interstitial nephritis vs less likely a pyelonephritis. It is unlikely that this is a normal finding for this patient.
    2. Multiple chronic renal infarcts, left kidney
    3. Diffusely, homogeneously hyperechoic hepatic parenchyma. The differential is an endocrine-associated vacuolar hepatopathy such as the clinically reported diabetes melitus. A component of hepatic lipidosis may also be present.
    4. echogenic urinary debris. Differentials include crystalluria, lipiduria, or cellular debris (hemorrage vs pyuria)
    4. Fine Needle aspiration of the liver was performed, cytology results are pending and we will contact you in 2 to 3 business days with results.

    In hospital treatments:
    1. Provided with continuous IV fluids
    2. We gave injectable anti-nausea medication as well as pain medication
    3. We monitored his blood sugar level
    1. His Blood Glucose was not consistently/ persistently >15mmol/L, therefore we did not start him back on insulin (I will chart on his SS the numbers they gave me)

    Medications to go home
    -discontinue Atopica
    -gabapentin - give 0.9ml by mouth every 8 to 12 hours for pain, may cause mild sedation.
    -marbofloxacin- give 1 by mouth every 24 hours with food until finished. Antibiotic.
    -Mirtazapine- Give 1/4 of a tablet by mouth every 24 hours as an appetite stimulant.
    Aventi Liver- Give 1/4 tab by mouth every 12 hours until finished. Liver detoxifying medication

    Diet: daibetic diet, less than 7% carb content

    Follow up: recheck blood glucose at home, 4-5 samples per day; note times he ate during the day. report info to regular vet and keep a close eye on thirst and urination (drinking more than 90ml/kg/day is considered excessive, appetite, vomitting, diarrhea

    If he conitnues to have poor appetite, blood sugar is difficult to interpret, or you have any other concners, we recommend you recheck with your regular vet and also seek out an internet medicine consultation for further work up and diagnosis (she told me to do this asap to get on a wait list). Ideally recheck full bloodwork including urinalysis) in 10 days prior to discontinuing marbofloxacin

    Monitoring: Please monitor for vomiting, diarrhea, not eating, tremors. If you notice any of these signs or have concerns, please contact ER or your vet
     
    Last edited: Mar 25, 2021
  52. Charlene0718

    Charlene0718 Member

    Joined:
    Mar 19, 2021
    Thank you so much.She said they were monitoring for DKA, but it didn't say much on the discharge notes but I will also keep monitoring with the at home strips. I asked for the anti-nausea, he is home as of this afternoon and acted as he was ravenous, sniffing all the food I put out (DM, fancy feast, friskies) but declining all when he smelled them. He will eat temptations treats and beg for them (that is an improvement from before but not sure if he should really be eating those) and he ate about 40 cals of a fillet treat. He also really wanted to eat my cheese off my plate but no go on every kind of fancy feast, friskas and DM. It was weird because he acted hungry eating the treats.


    Thank you so much for your input, the vet said it is not classic fatty liver, but they will find out more when they get results. They said they did a bile acidsessay (SP???) to rule out fall bladder and bile duct issues. He is also not jaundiced. She said when I redo my bloodwork it might be helpful to ask for a feline comprehensive geriatric screen.

    I am still worried about him not eating. I am going to get another internal medicine specialist referral tomorrow for follow up. They also agreed that they would not have started him at 3 and never go up more than 1 unit at a time, just as you guys said as well.
     
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  53. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    I will tag @Marje and Gracie to comment on the vet report.
    Did you manage to get the latest lab results from the ER vets?

    It looks as if they did not give you any antinausea medications to bring him....do you know if they gave him a cerenia injection before discharge..
    Acting hungry and sniffing then walking away are classic nausea signs in a cat.
    Can you ring your regular vet and ask for some cerenia and or ondansetron?
    They do mention a component of hepatic lipidosis may also be present (this occurs when the cat is not eating enough food ....cats must eat) so the treatment for that is food and plenty of it.
    Is it is really important that he starts to eat .....another reason to get those antinausea medications. Don’t just leave it and wait and see. I would get onto it now.
    I would let him eat whatever he will eat at the moment. It doesn’t matter if it is suitable for a diabetic cat or not at the moment because eating anything at all trumps everything else.

    Keep monitoring the BG and the ketones and updating the SS please.
    Sending lots of cuddles to Sir Thomas
     
  54. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    Hills a/d from the vet is easy to syringe if you need to syringe feed him.
     
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  55. Charlene0718

    Charlene0718 Member

    Joined:
    Mar 19, 2021
    Keytones negative today:)

    Finallly got an anti-nausea prescribed, by a third covering vet and they will call me tonight when it is ready to pick up

    Sugars are up again but i think the plan is food trial first, but i cant do that if he only will eat treats so hopefully this helps!
     
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  56. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

    Joined:
    Jun 4, 2020
    Yes the kidneys not great comment was strange. But the fact that they said he would get kidney disease within five years indicates to me that his SDMA was elevated.
     
  57. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

    Joined:
    Jun 4, 2020
    So glad you got anti-nausea meds. I can’t understand why it is so hard to pry this stuff out of vets ... especially Ondansetron since it’s the best darn anti-nausea med out there for cats. My vet originally tried to give me Reglan, which is not great and can have some nasty side effects.
     
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  58. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    There doesn’t appear to be an SDMA and I believe they were making this assumption from looking at his kidneys via U/S.
     
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  59. Suzanne & Darcy

    Suzanne & Darcy Well-Known Member

    Joined:
    Jun 4, 2020
    How is Sir Thomas this evening?
     
  60. Charlene0718

    Charlene0718 Member

    Joined:
    Mar 19, 2021
    They said although his kidneys also were in the normal range, the tends looking at all his bloodwork over the years is pointing to worsening kidney health at a greater rate than would be contributed with age. They also did say the ultrasound was consistent with that too. I am going to start another thread today and I will link :)
     
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