9/27 Alice AMPS 195 +5 221 PMPS 80 +2 173 +5.5 341, diarrhea, no appetite, syringe feeding

https://www.felinediabetes.com/FDMB/threads/9-26-alice-amps-151-pmps-122-still-sick.235986/

I think fluids last night did help quite a bit. I’ll do them again after I take a nap. Shot is done.
She had corn syrup last night @ +8.8 for a BGL of 51 I was too tired for.
Still won’t eat solids on her own, continuing to syringe Koha beef.

<3

 

I hope you and Alice feel better Have a wonderful day!

 

I'm glad the fluids seemed to help. I hope she starts eating on her own again. Sending prayers.

 

How can I get more calories in her? Syringe feeding is very distressing for her and I don’t like having to do it. I’m tired and she isn’t getting enough calories. It makes her unhappy which stinks because she is already so unhappy with how poorly she is feeling. And she still needs over 100kcal a day and she is lucky if she gets even half that at this rate.

 

Yay 70-80mL subq in.

 

I went and reviewed this thread about assist feeding and watched this first video that was linked. Alice doesn’t fight me, she is this calm (probably because she is weak and tired and sick), it just takes so so long and clearly causes her stress. I guess I should be buying more syringes and pre-loading them to make this easier on me anyway, but that’s the only new tip I really gained.

How can I make Alice more comfortable with syringe feeding? I’m not sure there is anything more I can do than what I am already doing.

video watched:


FDMB thread:
https://www.felinediabetes.com/FDMB/threads/syringe-assisted-feeding-videos-and-tips.144367/

 

So I was cleaning her litter box and had moved it out of the bedroom. I come back in and she is sitting on the yoga mat it goes on, just laying/sitting in the corner, and finally I realized she had diarrhea and it was all over her back feet.

Poor girl had to have a badly done rinse off in the sink for her back end. She has never ever had to have a bath.

Now I’m scared to keep syringing the Koha beef. What do I even feed her? What are my options?

She finished the antibiotic so I’m hoping somehow it’s just the effects of that but I don’t know. I also still need to get her a probiotic but when I’m this tired I have a difficult time even picking out what to buy.

I have ziwipeak lamb, Koha LID beef, and then the tiki after dark venison and beef liver pate. I’ve been syringing the Koha because I don’t have to use a blender or anything complex to prepare it. (The house is a mess because I’ve been sick and she has been sick, there is so much to keep up with right now that I am behind on, and I’m a zombie. The 4 boys’ litter boxes were a wreck and I just did those too. I’m worn out.)

Could too much corn syrup last night or higher blood sugar today be a cause of the diarrhea? I don’t want it to be the Koha. I really don’t.



I’m so frustrated.

 

Well I made a plate with a teaspoon or so of tiki and one of ziwi. Heated them because they were fridge temp. Gave her a choice of solids. She accepted the ziwi and lightly inspected/nibbled the tiki. It’s still not enough calories but it was nice she ate.

this however is NOT sustainable. She needs way more calories. At what point would you recommend a feeding tube? Is this expensive?

The subq fluids are definitely helping. I do see her more alert. She is still absorbing the fluids from 5 hours ago.

The only thing she seems to particularly want right the past few days is to cuddle on my belly/chest when I lay back. She’s feeling well enough to lightly purr. I sure hope her back legs are clean enough now. I feel some relief that she ate at all on her own but it’s just not enough throughout the day. She needs more calories.

Lately I just feel so in over my head. But she hasn’t given up so neither can I.

 

Aleluia Grugru & Minnie had a feeding tube for her kitty for a while. She knows quite a bit about the topic. Maybe you wanna go to the main health forum and ask about it there, and/or tag her? She is in the USA as well so may know something about the cost, too. It does sound like Alice may need more than the syringe feeding. Anyways, Aleluia is so knowledgeable. I know she has said that a feeding tube requires anesthesia so that may be a consideration.

I'm sorry you're having such a rough time right now.

 

Thanks!

@Aleluia Grugru & Minnie , would you be able to share some of your feeding tube knowledge? I don’t even know if it is what is needed or not but I’m running out of ideas.

 

Hey... anyone... PMPS is 80, I honestly expected it to be much higher.

With her loss of appetite, would it be better to shoot and then try to feed corn syrup on ziwi for extra calories? Or skip the shot?

...I may have just answered my own question when I thought about the corn syrup. I can make something higher carb and she may be more likely to eat it this way. Either way her night ends in corn syrup, which will make her happier, which makes me happier.

 

You’ll need a vet to tell you if it’s an option or not. I’m sorry I don’t know her history. Has she had any pancreatitis or IBD? Minnie stopped eating and had severe diarrhea for about 24 hours so I rushed her to the ER and given that she’s diabetic the vet recommended the feeding tube so she could come home and I could feed her. She had an endoscopy and while she was under for that they inserted a traqueal tube. It’s not cheap. I paid for everything together so I’d say at least $2,000. It’s a great option and a life saver as far as getting food and meds into them, but it’s not long term. It stayed on for 2 weeks while we were waiting for the endoscopy/biopsy results to figure out how to treat her. What does the vet say or suggest?

 

I’m a chicken with low numbers so I don’t think I’d shoot at 80 unless you’re used to doing that at low numbers...?

 

When she is eating, yes we shoot low! As long as she has had an appetite I have found the aggressive low shoot is the best way to keep her healthy ish. But her FD has been a handful!


Thanks for sharing your feeding tube experience. So this was one inserted into the skin or through a naturally existing opening? How do you keep it clean around the area if it is inserted through the skin? I kind of know a little about feeding tubes for humans. Kind of. Not much. I assume cats are different.
Her history is in her signature kind of (I can barely fit it all!) She has had mammary cancer, presumptive IBD solved with diet kind of, and recently dx’ed with kidney disease. History of UTIs/infection of unknown etiology (presumed UTIs), sometimes her wbc count is really high on labs. Before we figured out the cancer or IBD were there, it was suggested by one of the emergency vets when she was in for a DKA that she probably had something underlying because she did not have any FD risk factors prior to developing it, she wasn’t on steroids and she wasn’t overweight.

as for my vet, my vet hasn’t suggested a feeding tube yet and she might never do so if I don’t ask. I’m not sure what her experience is with them in cats. I’m somewhat on my own, my vet works with us for Alice’s best health, but a lot of the time if I just do my research first and tell her what I need then we work out a care plan together. They don’t have an in-house ultrasound or some other fancier equipment there, The facility itself is kind of limited by size/stock. I also stopped calling them unless I know what my specific questions are because otherwise I take up so much more of the vet’s time than she has to give.

Sorry I always try to be more succinct than I really am.

Thanks again.

 

I got her to lick at some ziwi lamb blended in my tiny smoothie blender cup with a little water. Good feeding. But if I have to keep doing multiple small feeds like this I’ll never get sleep!

 

I’ll write more in the morning about the feeding tube logistics but yes, through the skin and you have the clean the area once a day. Have you tried budesonide for the IBD?

 

We have not tried steroids yet. I’m so unsure how much of her problem is the IBD, what is the kidney disease.... I feel sometimes like we are not getting much help in terms of diagnostics.

 

173 @ +2.15 yay food! This was without adding corn syrup yet. So glad I still gave her shot.

 

At this point, I don't think steroids would hurt. Sometimes they have a side effect of improving appetite too. Neko had about stage 3 CKD when she got her IBD or SCL diagnosis. Budesonide did help her, and brought back some appetite. Course, she had a couple other meds added for her heart at the same time, so not sure exactly which one helped the most. Anyway, it wasn't the budesonide which caused her kidneys to get worse. This one might be worth a discussion with the vet. Alice really does have to eat.

 

Thanks, I always appreciate hearing from you.

So the good news is that she is showing appetite improvement. I’m wondering now if her kidney levels are what is causing her nausea and inappetence, but her teeth still make this scraping sound when she chews so I think those might also be a problem. The subq fluids seem to have helped.

I’m also unsure if the beef is sitting well with her. I went back to using the ziwi lamb today because that’s the safest thing she has ever had, a decor for the constipation leading to appetite loss. She used to eat a dry lamb-based expensive food and she didn’t get sick until I switched her to a chicken one, and chicken has proven to be her nemesis.


How was Neko’s IBD/SCL diagnosed? How often do they actually differentiate between the two? If they suspect possible cancer do they still only treat it as IBD?? The ER vet recommended an abdominal ultrasound because of her cystitis, but they don’t have one in-house at my regular vet and I cringe at the costs since she gets assistance with some of her care. Maybe other kitties need that money.

Anyway if I go with steroids, even just budesonide, how much does that typically affect BGLs? What is dosing? (I love my vet for many reasons but I am beginning to feel that she is not fully equipped for so many chronic health issues in one cat. It helps if I can go in with a suggestion or additional research/information to guide Alice’s care.)


What were you still able to feed Neko by the end of your journey with her?

 

So good news, I got a great feeding in!

I stuck the last half of this can of ziwi into my little smoothie cup blender with a bit of water (it’s too thick to blend without water, the ziwi lamb is very dense).

I refrigerated it for an hour or two.

It turned out to be this thick whipped texture so I let her lick it off the spoon. Better than her licking up the soupy stuff I made before, because she didn’t leave the heavier dregs of protein behind after lapping up the watery parts.

I held the bowl and spoon in front of her face and she kept going and got through at least 2 Tbsp of food. Maybe 3. that’s enough for at least one pound of body weight sustained per day.

Also did the math on the ziwi, if she will eat just a half can each cycle, then we roughly hit target caloric goals. Minimum caloric goals. But better than her being on the equivalent of a human eating 600 calories a day!!



So I guess tomorrow is Monday. I need to organize my thoughts for calling and pestering the vet again.

 

Neko was never properly diagnosed between IBD and SCL, because diagnosis requires anaesthesia, and her heart could not take it. So the internal medicine vet conferred with the oncologist and it was best guess of SCL based on the ultrasound. Proper diagnosis requires a sample of the GI wall being send out to the lab for analysis. The treatments for IBD and small cell are different. SCL treatment includes a mild chemo drug you wouldn't want to give unless necessary. SCL treatment also includes steroids, as does some severe cases of IBD. Diet doesn't make any difference to SCL, but makes a world of difference to IBD.

Budesonide did not impact Neko's BG, but I have seen it impact some cats. Less so than prednisolone though. Neko was not allergic to any proteins, another clue it probably wasn't IBD. I could feed her anything that was low carb and low phosphorus. I bought a cheapo imulsion blender for her food. I had to add water to it too. Sometimes she'd eat on her own once I got a syringe or two in her. Two of the ones she'd eat were Royal Canin Recovery (already a good texture for syringing) or Weruva Lamburgerini. Nausea management was key - I did find out later I probably could have been giving her higher doses of anti nausea meds. I was going by what the IM vet said. Mouth noises when eating can be a sign of nausea too.

 

what doses were you giving?

What kind of mouth noises?


For the rest.... Thank you, I have worried about another cancer happening but it seems that what she eats matters. I can worry a little less after your clear explanation of Neko’s differences.
And I think I need to plan ahead what all Alice needs done next time she is under anesthesia. She needs so many things....

Do you think, with what you know of Alice’s history, that an abdominal ultrasound is very important at this point? It’s important that I try and not waste the funds for her care. They’re not my funds entirely and I don’t want to be a drain on others because I didn’t plan her care right.

I’m unsure what direction to pursue next. There’s a lot on the plate.

Thanks for your time.

 

341 @ +5.5, food influence now that she is eating a little more? Slightly higher carbs in ziwi lamb?

Unless it looks like a bounce to anyone else, I may go back to her 0.75 dose instead of holding at 0.5, as long as she is taking in some food on her own.


Got another tablespoon or so “whipped” ziwi in her, she licked it off the spoon. I can safely sleep about long enough for a full sleep cycle if I try right now, and still have enough time to give one more feed before preshot fasting! So So happy she is feeding a little more.

 

I think the ultra sound definitely has to come before even considering a feeding tube. I don’t know that any vet or IM would do the tube first without trying to get to the root of the issue. It’s a bandaid not a treatment. An endoscopy would be the next step in trying to diagnose the IBD. Like I said, the tube is not long term, it will only stay on for 2-4 weeks at the most. It doesn’t make sense to do that without knowing the issue. As Wendy said, if you know you’re not going to go for the endoscopy, then start on the budesonide now. It’s a localized GI steroid so it shouldn’t affect her BG

 

Yeah I don’t know that we will put her through an endoscopy. It’s expensive and that money could help someone else. We know that diet changes help. So that in itself helps to rule out SCL, for as long as it has been that she’s having issues.
The thing is I think we know what the issues are, except for her needing the culture done for her cystitis thing right now. I just don’t know which issue is causing her problems most right now. My guess is kidneys, that it’s not just the IBD. In this case I think of a feeding tube option as being to get her over this hump so she can recover from her infection and improve her kidney issues.

I wonder if it is more or less stress on Alice, tube vs feeding by syringe.

 

Well the tube feeding is less stress because it bypasses her mouth so she doesn’t feel the stress of being force fed. But you have to weight that against the stress of anesthesia and surgery to actually insert the tube and then the removal later. I’ve heard of the tube through the nostril being an option for at home care as well, but have no experience with that. I think it can be done without anesthesia. You do need to discuss this with a vet. If you’re not happy with your current one, maybe look for an internal medicine vet...?

 

I honestly just don’t know that a vet will agree to inserting a feeding tube without a bunch of other tests first @Wendy&Neko wdyt?

 

My vet? She might. This is where I am starting to question her diagnostic skills. She’s easy to work with but I wonder if she is really equipped for all of this.

I don’t know where to start. Meds or feeding tube or testing but which tests....

 

Also here is today’s thread if we want to move over there: https://www.felinediabetes.com/FDMB/threads/9-28-alice-amps-443.236068/

 

You definitely need an ultrasound and maybe the pancreatitis tests if you haven’t done those yet. I’d look for a second opinion from an internal medicine vet