Cat in DKA but vet refusing to treat

Discussion in 'Feline Health - (Welcome & Main Forum)' started by manxcat419, Jun 2, 2019.

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  1. manxcat419

    manxcat419 Well-Known Member

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    I've been trying to help in a Facebook group, but would appreciate input from here too.

    Kitty (named Inka) is currently being treated for hepatic lipidosis with fluids, Cerenia, a/d syringe fed, rx vitamins and milk thistle (not Denamarin). However, glucose has been very high on blood work and when I queried that, I was told that the vet confirms she is diabetic and in DKA but is refusing to treat with insulin unless the cat is hospitalized which is unaffordable currently. DCIN have been contacted to see if there's any help possible there. Mom has Lantus on hand for another cat but vet will not advise on dosing as they say it's "risking a crash" to give insulin without hospitalization. I've covered the written starting dose protocol for Lantus (1 unit as Inka weighs 9.6 lbs currently). Home testing is possible. Ondansetron instead of Cerenia is an option and is available.
     
    Last edited by a moderator: Jun 4, 2019
    Reason for edit: Removed 911 as Sharon has been receiving help. Feel free to put it up again if it should become necessary.
  2. manxcat419

    manxcat419 Well-Known Member

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    @SharonKurtz - hopefully you will be able to follow the post even though you had trouble creating a new post. If I've missed anything (and I'm sure I have) please feel free to add details.

    @Kris & Teasel @Meya14 - I know you both have experience with DKA. If you can think of anyone else to tag, please do as although I know it in theory, I haven't dealt with it in my own diabetics.
     
  3. Amina&M'row

    Amina&M'row Member

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    When your crisis is over, have you considered changing vets? Some vets are great with diabetes, others not so much. Frequent home blood glucose is a vital part of best-practice feline diabetes management, and I dont hear from you that your vet is down with this. Best luck!
     
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  4. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Not sure who is around at the moment. I haven’t seen Meya online for ages and I think Kris may be taking a break.
    Can you create a spreadsheet for Inka’s Mom to fill in the numbers? That would be very helpful for anyone giving advice.
    It’s most important that Inka is getting enough insulin, enough food and fluids, and is having any infection or inflammation treated. Any food at all is ok at this point as long as kitty is eating. Higher carb food can be given if necessary to make sure that enough insulin can be given.
    Another anti nausea med which can be given at the same time as cerenia is ondansetron.
    Are they monitoring for ketones as well? Ketostix is available at Walmart and pharmacies.
    I’ll try and find a thread that kris has answered about DKA and post it for added info.
     
    Last edited: Jun 2, 2019
  5. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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  6. manxcat419

    manxcat419 Well-Known Member

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    As far as I know right now, there are only 2 numbers - 504 on May 29th and 405 of May 31st - both readings done in-clinic as part of blood work. My personal feeling is that there may not be full-blown DKA at this point. Electrolytes are a little off, but not massively deranged - slightly low potassium, all else within range. And the cat is still alive despite not receiving any insulin as yet. However, definitely ketotic and clearly headed in the wrong direction without insulin and a total lack of appetite.
     
  7. manxcat419

    manxcat419 Well-Known Member

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    I agree - my immediate response to the lack of treatment was "don't walk away from this vet...run!"
     
  8. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Is she willing to test the BSLs? I agree the insulin needs to be started now.
    What a pathetic vet. I say run too!
    Good luck
     
  9. manxcat419

    manxcat419 Well-Known Member

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    Absolutely willing, yes. She already has one other diabetic cat and has all the supplies ready to go - including Lantus even though the vet refuses to a prescribe a dose for this cat. I'm sure she will update when she's able - as we all know, for people more used to Facebook, this site can take a little bit of figuring out initially.
     
  10. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    I agree with 1 unit start. Has she got some higher carb food to give to keep the BSLs up if necessary.
    We’ve had several DKA cases here lately.
     
  11. manxcat419

    manxcat419 Well-Known Member

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    She has syrup that she could mix with the A/D and syringe if necessary as Inka currently isn't eating on her own at all. I know it's a risk with a cat that isn't eating to start insulin, but it sounds as though she does pretty well assist-feeding, so I'm not sure there's a lot of choice but to start and be ready to boost the numbers if necessary.
     
  12. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Yes it’s a different situation. I wish her well. She will get a lot of support and help if she posts here. She’s lucky to have you.
     
  13. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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  14. manxcat419

    manxcat419 Well-Known Member

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    Thank you. I'm just really grateful I knew where to recommend for more help. I can help with the lack of appetite and the HL, but there's nothing quite like some hands-on experience with DKA for being able to advise someone else...and that's something I just don't have.
     
  15. Bobbie And Bubba

    Bobbie And Bubba Well-Known Member

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    Jun 15, 2015
    This is a sad situation for sure! I have had experience with moderate ketones but not DKA. She is lucky to have Lantus already. She can help by adding lots of water to the food and if she is syringe feeding she will be doing that anyway. Prayers.
     
  16. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    I have never looked after a DKA kitty either but we seem to get a lot here needing help. Both Bobbie and squeaky and KT have
     
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  17. AliceMeowliss&Cassandra

    AliceMeowliss&Cassandra Well-Known Member

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    Jan 8, 2019
    I nursed Alice post DKA. Keep up fluids!!! I hope DCIN can help. If not, if this person sets up a donation page or something, I can share it in some of my crazy cat groups.

    Fluids, any wet food that will be accepted, start a low dose of insulin, test test test, treat for infection, check for ketones. And if kitty acts like they are in shock, GO to ER vet ASAP. (I have a disturbing picture of Alice in severe DKA shock.)

    I don’t know anything about hepatic lipidosis though. My advice could be off, with that in mind.
     
  18. Squeaky and KT (GA)

    Squeaky and KT (GA) Well-Known Member

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    I'm sorry, just now getting online and seeing this tag.

    At this point, there's almost too much happening in Inka's body to not be hospitalized...but with this vet, that concerns me too. I fully agree insulin needs to be started - start at 1u for now. My instinct tells me it may need to go up to 1.5 fairly quickly tho. Lantus isn't the best insulin to start with but if that's what's available, then the sooner it's started, the sooner the depot starts building and a bit starts precipitating.

    Hepatic Lipidosis aka 'Fatty Liver' - this is from not being able to get any nutrition from food or not enough food or not eating at all. This causes the body to burn stored fat - nasty 'fuel'. If a cat is ketonic for very long, it causes the ph balance to become more and more acidic. When you hit that ph acidic point along with the ketones, you have 'Diabetic Ketoacidosis'. FLUIDS - LOTS OF FLUIDS. Lactated Ringers SubQ's at 100ml/day if no heart problems, water added to food, no dry whatsoever. Lactated Ringers will help rebalance the electrolytes too. FOOD - ALL you can syringe feed....all day long.

    I'm really concerned this baby is too far into this to be able to be pulled thru at home... :(
     
  19. Squeaky and KT (GA)

    Squeaky and KT (GA) Well-Known Member

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    @manxcat419 - after spending a bit more time thinking about this, this kitty REALLY needs a fully working insulin dose NOW. Lantus isn't going to give you that. I would suggest that she go to Walmart and get a $25 vial of 'Novolin N' (NPH). Start that at 1u altho' that's not going to be enough. The liver's trying to feed/save the body without insulin, when you give any type, it's going to still panic BUT some will still start working. You MUST have that key to unlock the cells to get that glucose and potassium into those cells QUICKLY right now....that key is insulin.
     
  20. Squeaky and KT (GA)

    Squeaky and KT (GA) Well-Known Member

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    There is a full tie between glucose and potassium....they must combine at the molecular level to enter a cell. Without insulin to unlock the ion channel to feed that cell (each cell), the glucose and potassium combine then 'fail' at the door. Glucose numbers go up, potassium goes down - potassium must have an external 'feed' such as food while glucose is somewhat stored within the body. The lower the potassium goes, the weaker the body gets. The weaker the body, the less it can 'do' to continue. There's a whole lot more scientifically required surrounding this but this hopefully gives you enough of an idea of the requirements to help you understand.
     
  21. Tanya and Ducia

    Tanya and Ducia Well-Known Member

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    that's what we did for Ducia past her DKA - with Lantus BID and the the SQF was Lactated Ringer's Solution to replenish K, and she had short course of Metranidazol AB.

    But I wanted to stress that food - up to 300Kcal/24h via E-tube - was the main medicine.
    It was fed as a slurry in about 1/4 can of 5.5 oz Friskie Pate a session x 3 - times each cycle.
    Orally taken water - in addition to SQF - up to 300 ml a day mixed to the wet food.

    I do hope the kitty pulls thru. very best wishes!

    I'd start insulin right now, vet doesn't need to know.
     
  22. manxcat419

    manxcat419 Well-Known Member

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    Thank you all. @Squeaky and KT (GA) - my concern was that Lantus isn't the ideal insulin for this too unless it's being given IV which can only safely be done in the hospital where they can IV dextrose at the same time. Of course when it's all there is, it's better than nothing. Fluids are already being given at 100 ml/day. Novolin N, much as I don't like it for general use, might just be the answer temporarily until she's more stable. @SharonKurtz - I know you're having trouble with the site, but hopefully you can read everyone's comments even if you can't reply at this point.
     
  23. Squeaky and KT (GA)

    Squeaky and KT (GA) Well-Known Member

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    This type of situation is the only time I do suggest NPH. It's single cycle, the working method will give more available insulin. A good vet in a hospital setting would use a faster acting insulin while providing glucose support and test more often. I would go back to Lantus as soon as this medical crisis is averted remembering the depot has to build before it's capable of providing a 'full dose'.
     
  24. SharonKurtz

    SharonKurtz New Member

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  25. SharonKurtz

    SharonKurtz New Member

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    Jun 2, 2019
    Hi All,
    I think I found out how to get in here. (at least for today, by tomorrow I'll be scratching my head again)
    Tested Inka's glucose this morning at 10:30 and got 206. That is down quite a bit from 504 the other day so I did not give the insulin because I was afraid. I followed April's advice and upped her feedings. I give her 20cc of A/D as a slurry every 2.5 hours during the day. She tolerates it well. No vomiting. I am not sure about her bowel movements as I have 9 rescue kitties here so it is hard to know who does what. I actually sleep downstairs on a couch to watch my other newly diagnosed diabetic kitty (Mookie) and my 19 year old CKD kitty (Mushka)I am planning on checking her BS again in an hour ith her last feeding for the day. She is getting 100cc of Lactated Ringers daily. I did give her a B12 injection and 0.45cc of Cerenia. She is getting the Rx Vitamin Hepato Support which is milk thistle and B vitamins. She seems more alert today. Grooms herself after I syringe feed her. Still not eating on her own but I think I'm giving her plenty of food so maybe she is just not hungry when I put the plate in front of her. Her jaundice seems less severe than it was but she is still yellow. Just so you know her background....I was asked in 2011 to help with placing cats that were in the home of an elderly woman. Someone else was going to NYC and taking cats from the shelter, collecting $200 a cat and bringing them to this lady's barn. The elderly woman had money and had people coming twice a day to feed the cats. If someone said they needed veterinary care (as long as the stepchildren didn't know), she would pay for the vet. When I walked in, there were 200 cats. The place was disgustingly dirty. Some cats were visibly ill. My husband gutted the place, put up new sheetrock and laid linoleum floors to be able to keep it clean. My then vet (who was good) came to the barn, did FELV/FIV testing and vaccinated them all. Some were so ill that they had to be euthanized and the woman that brought them there brought in FELV cats too that were in the general population without isolation. Some FELV cats went to a sanctuary in New York and I placed all but 65 by May 2012. The elderly woman fell, broke her hip and the stepkids came in and gave me until July 31st to place them all or they would be euthanized. All were place except 11 and I brought them home with me. I had one cat at home already (the one that is 19 and CKD). Inka and Mookie, the newly diagnosed diabetic are from that barn situation. I never expected or wanted this many cats but I couldn't let them be put down.
    In the past month I have spent close to $7,000 on the two cats and when Inka got sick, I never expected this. I just moved three years ago to Ocean County, NJ and finding a good vet has been a chore. I had one that was good but she went out on a sabbatical. Her husband has his own practice elsewhere so I tried him. Another one that looked at the age of my cat and didn't seem interested. Plus she needed a medication that he said was too expensive for him to carry in hos office. So I went back to the place that the vet left on sabbatical and got this new vet. She is a year out of school and I thought originally was very thorough. She told me that Inka should be hospitalized on Friday. Inka was there on Wednesday and she didn't even do a urine then. When I asked she said it wasn't necessary. Turns out Inka also has a UTI. Inka stopped eating last Saturday and I couldn't get an appt with the vet until Wednesday due to the holiday.Vet gave her a shot of convenia on Wednesday. She told me to only give Cerenia every other day because of Inka's high liver enzymes and that daily may make her have seizures. She said their hospital wasn't equipped to handle anything serious. I'm an RN and my old vet would have sent me home with an IV and a pump for the cat. This vet won't. I can't afford the specialty hospital after having spent the $7,000 already. I'm a senior, out of work for a bit due to a health issue and I'm scheduled to have surgery.
    Sorry to be so long with this post but I want you to understand that I am not a bad pet owner and will do whatever I can to help her. I have a total of 14 animals here and will never have this number again because I can't afford all the vet bills. All of my critters are old. 3 dogs, 9 cats and 2 parrots.
    Anyway, just so you have background on the situation. I appreciate any and all suggestions offered. The vet gave me two options...hospital or euthanasia. I, in my heart, do not think Inka is ready to go yet so I want to be able to help however I can.
    And if anyone knows a good vet in NJ, please let me know. Or what questions should I ask when I start calling around tomorrow for another vet?
    Thank you so much! God bless you all
    Going to feed now. Hopefully I can find this page again :)
     
  26. SharonKurtz

    SharonKurtz New Member

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    Jun 2, 2019
    BS 241. It’s down so much. Not sure that damned vet knew what she was talking about. What should I do? Insulin or no?
    She is very fiesty when getting her feedings. Eyes look much brighter. She grooms herself after each feeding. She’s resting a lot but she always did that. No clue as to her age but the vet said 12 or better but I don’t trust her guess on age either.
    Forgot to mention before that she gets Mirataz cream on her ears for appetite stimulant. My other cat gets ciproheptadine and I think that works better. Opinions on that?
    She will not eat on her own. She sniffs the food and walks away. She drinks water. Tolerated syringe feeding well. No vomiting.
    Thank you again for your suggestions and support. It is appreciated more than you will ever know. Inka says thank you too!
     
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  27. Tanya and Ducia

    Tanya and Ducia Well-Known Member

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    Feb 25, 2017
    IMHO she needs insulin ETA: if she is DKA, the number is ok to shoot but you may need to stay up a bit later, not too late, and take another test and perhaps feed again. What do you think? Can you stay up?
    @SharonKurtz

    if you bookmark the page it'll be easier to find later.
     
    Last edited: Jun 2, 2019
    Reason for edit: to clarify
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  28. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Feb 21, 2015
    Are you giving her anything for nausea ?ETA I see above you gave cerenia injection. She could have some ondansetron as well as the cerenia. They work on different parts of the brain and may help the nausea.
    Have you done a recent urine test for ketones?
    Is it the Lantus insulin you will be giving or did you get a shorter acting one?
    If it’s lantus maybe start off with a smaller dose seeing the BSL is not as high as first thought. Maybe 0.5 or 0.75 units. See what others think.
     
    Last edited: Jun 2, 2019
    Reason for edit: Added ETA.
  29. Tanya and Ducia

    Tanya and Ducia Well-Known Member

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    I am afraid there maybe some site navigating difficulties....

    I think 0.45cc Cerenia was administered. Vet suggested this dose every other day.
    I did not see anything re: ketones but if vet confirmed DKA...

    @Bron and Sheba If no R is available would you start with the smaller dose or 1 U?
    Ducia was 6.5 lb when had DKA and her dose was 1U to start.
    ETA: Inka is 9.6 lb.
     
  30. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Feb 21, 2015
    Yes I read back and saw that cerenia had been given and added an ETA to my post.:)
    I unit is the correct amount for kitty’s weight. I just thought if Sharon was anxious about giving the insulin with the BSL lower than it was at the vet ( in the low to mid 200s) she might be more comfortable starting with a lower dose. I do think it needs to be started ASAP and if Sharon can test frequently the 1 unit would be better. She can add syrup to the syringe @manxcat419 said if needed.
     
  31. Tanya and Ducia

    Tanya and Ducia Well-Known Member

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    @SharonKurtz
    Sharon,
    I hope you will figure out your way here to post.
    It was extremely confusing for me in the beginning to navigate this Board but then I got used to it.
    I am going to bed but I will check in for what I hope would be a happy update on Inka tomorrow.
    Very best wishes to both of you.
     
  32. SharonKurtz

    SharonKurtz New Member

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    Jun 2, 2019
    Ketones were +2 on Friday. I’m not trusting anything this vet is saying. BS was 504 on Wednesday, 350 on Friday and today at 10:30 am was 206 and tonight at 10:15 pm 241. All with NO insulin
    To make it more concise:
    Mirataz transdermal— every day to alternating ears
    Lactated Ringers—100 ccs every day
    Cerenia—0.45 every other day or she said 0.22 every day
    B12–injection 0.4 weekly
    Syringe feeding 20ccs of A/D every few hours with water added to make a slurry
    Rx Vitamins Hepato Support 1 ml twice a day
    She is not eating on her own. Walks away from bowl when offered. Bowls of everything out both dry and wet. No vomiting. Urinating in litter box ok. Do not know about bowel movement. Still jaundiced. Was 9.6 lbs on Friday. Will reweigh on baby scale in the morning.
    I will follow your suggestions and will be looking for new vet in morning.
    I contacted DCIN as April suggested. I know they have read my message but no one has responded back to me.
    I have Lantus here now for my other newly diagnosed diabetic kitty. I can buy any other insulin if that’s what is best
    I have a glucometer to test
    I have bags of fluids
    Think this is everything in short form
    Thank you all again!!
     
  33. SharonKurtz

    SharonKurtz New Member

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    Forgot one thing...she got a Convenia shot on Wednesday too
     
  34. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Feb 21, 2015
    Do you have a bottle of Ketostix to test the urine for ketones? If ketones are in the picture it is really important to test for them at least once a day so you know which way things are heading. It is an easy test. Just dip the test strip
    In the collected urine and read exactly 15 seconds later against the side of the bottle.
     
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  35. SharonKurtz

    SharonKurtz New Member

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    Jun 2, 2019
    How do you collect the urine?
    I have 9 cats
     
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  36. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Feb 21, 2015
    Will she let you pop a small container under her while she pees? Or a large spoon? Otherwise I think you would need to isolate her and put some crumpled plastic in the litter, or a container where she likes to pee most. And wait for her to pee. You only need enough pee to stick a strip in.
    The other option is to buy a blood ketone meter which I think would be too hard for you at the moment financially.
     
  37. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Feb 21, 2015
    I can’t help you with giving R insulin or NPH insulin as I have never used them, but I do think you need to start something.
    Not knowing what the ketone level is clouding the picture really as we don’t quite know what is going on. But if her BSL is over 200 with a human meter or 240 approximately (with an alphatrak meter) then I think you should start insulin. The longer you leave it the riskier it is for Inka.
     
  38. Tanya and Ducia

    Tanya and Ducia Well-Known Member

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    Feb 25, 2017
    @SharonKurtz
    Good morning Sharon,
    how things are this morning with Inka?

    I want to second @Bron and Sheba about starting insulin.
    Inka's BG in 200s is really good but presence of ketones is worrying.
    Having even small dose of insulin should help it.

    What are your thoughts on starting insulin, Sharon?
    Please let us know.
    ETA: a few more BG tests prior to insulin can help making the decision.
    If she had eaten then a test 2 or 3 hours after would be good data.

    I use old large table spoon to collect a little urine and then dip the stick into it.
    (make sure you don't take that spoon back into the kitchen ;))
    Read instructions on the vial of strips - if you wait longer than needed the testing pads turns darker and reads "positive" which in fact maybe false read.
    With so many cats testing one in particular is certainly a challenge.
    Will Inka pee for you if you put her in the Litter Box(LB)?
    She is having enough liquids to want to pee 2 or 3 times a day,it might be possible she'll pee if you put her in LB.
    Knowing where ketones are has huge bearing on the treatment (insulin dosage in particular).
     
    Last edited: Jun 3, 2019
    Reason for edit: to add eta
  39. Squeaky and KT (GA)

    Squeaky and KT (GA) Well-Known Member

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    Jul 19, 2011
    Right now you're walking a tight rope! It's hard to know which was to go.

    I'm wondering if the lack of food is causing the lower bg. Right now a ketone test will tell us a lot.

    NO 'R' INSULIN! ..unless hospitalized.
     
  40. SharonKurtz

    SharonKurtz New Member

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    Jun 2, 2019
    Hi all,
    First let me thank you all for your guidance with Inka.
    Update:
    — she ate a bit on her own this morning. I went into the cabinet, picked up a can and thought to myself that she would never eat it. Weruva Green eggs and Chicken. Well, low and behold she ate it. If anyone saw me doing the happy dance I did, I’m sure they would have called the funny farm for me. But that was short lived. Refused everything else, so syringe feeding it was.
    —I saw a reply that had asked if maybe her BS was lower because she was not eating. I think she is getting enough food. I give her 20ccs of A/D slurry every 2-2.5 hours. It ends up being a can and a half by the end of the day. Is that enough?
    —I weighed her and she is exactly the same as she was in the vet’s on Friday. I looked at the sheet from there and it said 9.1 lbs. My baby scale weighed her at 9 lbs 11ozs
    —the “vet” called to see how she was. I Gave her the update. Her BS was 204 this morning. Asked her about mirataz as opposed to cyproheptadine for an appetite stimulant and was told that the practice there used mirataz and she couldn’t comment on the other. I asked about Cerenia as opposed to ondasteron and again she said that that practice used Cerenia and couldn’t comment on the other. She tried to talk very fast, using a lot of medical terms ( didn’t lose me, I’m a nurse). I decided not to ask anymore questions and try to be as pleasant as I could until she said I was always welcome to get a second opinion from another vet in that practice. Then she said maybe it wasn’t DKA, maybe it was pancreatitis or gallbladder. That’s when I lost it. I’m not a person to argue but I will make my point very clear. I told her that I had every intention of getting another opinion and it would not be with that practice as it seems they are limited in using different medications so another vet wouldn’t change what she has done, and what she hasn’t done. She became annoyed ( poor baby) and said she wanted to examine Inka again. Told her I would pass on her offer.
    —made a bunch of phone calls to a few vets offices and asked some questions but I was only speaking to the receptionist and really wanted to pose these questions to the vet. I have an appointment tomorrow (Tuesday) at 3:00 with a vet. He is alone in his practice. 20 years a vet. I’ll try him and if he is another jerk, I have another one lined up.
    —Inka seems stronger today. A little less yellow. Tonight I noticed a little clear discharge from her left eye and nose. Great. That’s all we need
    —I haven’t seen her in the litter box except for once. I will try putting her in it to see if she goes. On Friday they used fine needle aspirate to get urine and she said it was +2 ketones
    “Vet” told me not to give Cerenia 0.45 every day because of her liver issue. She said to either give it every other day or every day at half the dose. What do you think?
    “Vet” said mirataz transdermal was their practice drug of choice. I said I read on manufacturers website it said it can take up to 1-2 weeks to be effective. She responded that should it take that long to work they would have to look into why the cat was not eating ( ya think, donkey?) Do any of you use Cyproheptadine? I use it on my 19 year old CKD kitty and within an hour she is looking for food
    I will let you know about this new vet tomorrow. Say prayers that he is good!
    Thanks again!!
     
  41. SharonKurtz

    SharonKurtz New Member

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    Jun 2, 2019
    Found another vet. Seeing him tomorrow. If I don’t like him, I’ll find another
     
  42. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Feb 21, 2015
    Sharon, I am so glad Inka ate for you this morning. I'd have been doing a happy dance as well!
    I'm sorry she didn't eat again, but that is definitely a step forward.
    I would certainly ditch your vet. I would have lost it too. She is very rigid in her thinking and is not open to new ideas or discussions at all.......
    Areyou able to get a copy of the blood tests that were run? We have someone here who is very knowledgeable about cat pathology tests and may be able to give you some insight into what may be happening. I'd also want to take them along to the new vet. They should email them to you as they are yours....you paid for them.

    Did you say earlier that you had ondansetron? If not I'd ask the new vet for some. It often works when cerenia doesn't, and if you can only give the cerenia every other day, the ondansetron would be good for the others days.
    I've had no experience with appetite stimulants so can't really comment, except to say that they shouldn't be given if the cat is nauseated and that is why they won't eat.
    If the vet has the blood work in front of her, she should be able to make a diagnosis, or an educated guess at least. To now say that it might not be DKA but pancreatitis or gallbladder is troubling. Where does she think the ketones came from?

    Really you need most of all to get a urine sample to test for ketones. Otherwise it is all a bit in the dark.
    Good luck with the new vet. I hope he has some answers and is willing to work with you as part of team Inka.
     
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  43. JL and Chip

    JL and Chip Member

    Joined:
    Dec 28, 2009
    Sharon, best wishes with Inka. A sick cat can be grueling.

    As for the a/d ... that sounds like a reasonable daily amount. If Inka is handling 20cc fine, you might be able to bump up the amount a little at each feeding and spread out the feedings a little farther to give you some sleep.

    As for cyproheptadine ... Yes, I have used it with much success. It was first prescribed years ago for one of my cats and then seemed to fall off the radar of the newer generations of vets in lieu of mirtazapine. I have had a couple if cats have dramatic reactions to mirtz -- pacing, yowling, dilated eyes, restlessness and distress -- and it was dramatic enough that it even made me a little on edge (I used to do quite a bit of rescue so have seen a lot and don't panic easily). It wore off in hours and they settled back down, but I hate to risk putting a cat through that. Some do fine with it but I still tend to ask for cypro.

    Liver issues can be daunting but at least the liver has hop for healing. I just took a cat through liver problems last winter and had to syringe feed and give subq fluids for quite some time. I didn't catch it but are you using liver supplements such as SAM-e and milk thistle (e.g., Denamarin)?

    I'm surprised the vet wasn't clear about ketones vs DKA vs liver vs gallbladder. Hmmm ...

    I'm glad you're getting a second opinion.

    Edited to add: another medication that seems to be used less these days is famotidine (Pepcid AC). Regardless of what recent studies might have shown, that was a GO TO drug that made a huge difference in many of my cats. At his sickest, Charlie would eat like clockwork 20 min after his dose and never otherwise. I've seen it with other sick cats too. Dosage is 1/4 of a 10 mg pill. Note that this is Pepcid AC and NOT Pepcid Complete.
     
    Last edited: Jun 4, 2019
  44. manxcat419

    manxcat419 Well-Known Member

    Joined:
    Jan 14, 2015
    I think that seals the deal - you definitely need a different vet. She may not use ondansetron or cyproheptadine all that often, but she absolutely should be aware of what they are, what they do, and the indications for using them. That's basic knowledge - as you've seen, many of us know what they're for and when you might want to try one instead of the other without being vets!

    And seriously - NOW she says it might not be DKA? So why put you through the diagnosis of it and her refusal to treat if she's just going to change her mind later? Presumably she wasn't that sure to begin with - maybe she was hoping you'd hospitalize and it would give her a chance to do more tests and figure out what's really going on.

    ETA - the electrolytes are the big clue as to whether or not there's true DKA or simply ketones. I think I mentioned to you in the FB group that her electrolytes weren't off enough to really indicate DKA although she might be heading in that direction if you couldn't get her turned around.

    We actually do use mirtz currently on an as-needed basis for our Roxi. She seems to handle it pretty well and it does turn her into an eating machine...we put food right in front of her, she eats the food, no questions asked. Then again, she's not all that yowly in the general course of things, so if she is ever so slightly noisier, it's not so much that we really see much change.

    Agree - I've had a few discussions about this with people. Research aside, so many people absolutely do see a difference in their cats with it. I would say, it's pretty safe as meds go - if you want to try it and your vet's OK with you trying it, it isn't likely to hurt. If it works, great - stick with it. If it doesn't, there are other options you can try instead. If our cats were so straightforward that every med worked the same way for every cat, we wouldn't need more choices. But we all know that isn't the case.
     
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  45. Squeaky and KT (GA)

    Squeaky and KT (GA) Well-Known Member

    Joined:
    Jul 19, 2011
    Any vet that can't spot the signs of DKA in a cat not only shouldn't be a licensed vet, they should be under a rock somewhere. DKA is very simple to diagnose - you have ketones, you have a ph acidic base and the electrolytes are WAY off.
     
  46. SharonKurtz

    SharonKurtz New Member

    Joined:
    Jun 2, 2019
    Met the new vet today. At first I didn’t like him because of his mannerisms but the more we talked, I think he knows what he is doing.
    He wants her fluids upped to twice a day. Gave me two antibiotics Amoxicillin and Metronidazole. Said she needs that for her liver. Gave me oral mirtazapine instead of transdermal. Said they work better. B Vitamins. Syringe feed 20ccs every two hours while awake and once during the night. He wants me to keep checking blood sugars. Hers was 204 on my meter this morning but 290 on his after a few meals. He was annoyed the other Vet didn’t run a whole urinalysis or thyroid levels. He isn’t a believer in the liver support herbs but said he would be more than happy to get them for me since the group suggested them. Asked about the ondansetron and he looked it up in the vet site on the computer. It states that it is more toxic to the liver than Cerenia. He doesn’t use it routinely but wanted to check if it was ok for Inka. Don’t forget... we have the liver issues with her and gave to be careful. She is still yellow. He gave her a 50/50 chance. Wants to study the bloodwork because he is confused why her BS dropped so low and she is being fed. Will also have the urine to check ketones. We’ll talk tomorrow morning about the results. One thing I didn’t like was that he will not order stock meds for me. Bring in rescueI have always had injectables on hand.
    The other vet I would have gone to if I didn’t like him is out of the question. I was talking to one one who found out after months of going to this other vet, she found out her dog had been in kidney failure and didn’t even know. The dog died at 5 years old. She now swears by the one I saw today. She said at first she was taken back by his mannerisms too. But he’s from Brooklyn (and so am I) so he talks a little rough.
    And his bill was a quarter of the cost. He gave me rescue prices. Only charge $15 for the office visit and $10 for each bag of fluids with the lines. Medication was discounted too. It’s always hard to start a new vet but I had to walk away from the other one (although she was really good with my CKD cat)
    What do you guys think?
     
  47. Squeaky and KT (GA)

    Squeaky and KT (GA) Well-Known Member

    Joined:
    Jul 19, 2011
    Just with the amount of time that's passed since this thread started and Inka isn't getting worse, she wasn'/isn't in DKA. Bluntly, she'd have crossed by now due to no insulin. If she's ketonic, it's most probably from the liver issues. If the ketones were increasing since this thread started, she'd probably be DKA now but many things say she may be tetering on the edge but she's not.
    I think I like this vet
     
  48. SharonKurtz

    SharonKurtz New Member

    Joined:
    Jun 2, 2019
    DCIN got back to me today. I sent them a message on Saturday and I know it was seen. All they offered was a suggestion for liver support. I know it was suggested so I thought you should know the result
     
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  49. Lisa and Witn (GA)

    Lisa and Witn (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    I am glad the new vet is working out. Hopefully Inka is on the road to a full recovery.
     
  50. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    I like the sound of the new vet. I’m glad he gave you good rates. Sending vines to Inka
     
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  51. manxcat419

    manxcat419 Well-Known Member

    Joined:
    Jan 14, 2015
    They may also be rather unconvinced by the DKA diagnosis. And if it isn't DKA, it generally doesn't require hospitalization. I do agree she was very likely on the verge of a DKA, but I really think you caught it in time - her electrolytes just weren't far enough off. Borderline low potassium is pretty normal in a cat that hasn't been eating, and all the others were in normal range...and that's not something you see with a DKA cat. I would think the lack of appetite and liver issues were her main problem. I do wonder if she had an infection somewhere - the antibiotics seem to be helping her. And infection can raise glucose in a borderline diabetic.
     
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  52. SharonKurtz

    SharonKurtz New Member

    Joined:
    Jun 2, 2019
    Vet called. Inka’s liver values were worse. Bilirubin went up. He thinks it’s gallbladder. He feels she is diabetic but her Bs have been in the low to mid 200s. With all that is going on, he wants to wait on insulin or maybe glypizide he said. He called me three times today to discuss how he feels and what we should do. He wants her on a drug called Ursodiol (Actigall). Her strength has to be compounded but he was afraid for her to have to wait so he had some for a dog and cut it down so she would have a dose today. I called the compounding pharmacy and was going to have it overnighted but they consider tomorrow the first business day so it wouldn’t get here until Saturday. So I’m going to make a four hour round trip ride to get it.
    The other vet also said there was a “ shadow” on her X-ray and it could be a mass or fluid. She wanted an ultrasound. He looked at it today and shook his head. It’s the cat’s full bladder she was looking at.
    Inka’s potassium is low so he added a supplement. He is afraid the gallbladder is not draining so the ursodiol can help that.
    Brought my other cat (Waddles)in to him. Diarrhea and vomited x2. She always has loose stool. Other office had seen her and tested her stool which was negative and they did nothing. He says IBD, gave her (Waddles) a steroid injection and metronidazole. Know what my charge was for today? $61.00.
    We talked about giving her a few more days to see if she can turn around. I’m so angry that all of this could have been started last week.
    I also have a newly diagnosed diabetic kitty(Mookie). Doing a curve on her today. Lantus insulin 1 unit twice a day. There hasn’t been a reading below 390 all day ( doing glucometer every two hours). Guess shrine the next one in to see him
     
  53. manxcat419

    manxcat419 Well-Known Member

    Joined:
    Jan 14, 2015
    If she has gallbladder issues, then ursodiol is the medication of choice for dealing with gallbladder "sludge". I would not do glipizide - it tends not to work well for cats and most of them need insulin eventually anyway. Plus, because it makes the pancreas work harder when it really needs to rest, it has a tendency to destroy any chance of remission that the cat had to begin with.

    Was the first vet actually qualified? Sorry, that's a little sarcastic, but to misdiagnose DKA, miss the gallbladder issue, and not know what a full bladder looks like on an X-Ray really isn't acceptable.

    Good idea. It's very likely from her lack of eating, but you can always stop the supplement later on if she doesn't need it. And diabetic cats do tend towards low potassium in a lot of cases.

    That's awesome - exactly what you need. It makes it all so much easier when you're not having to worry about bills in the $100s every time.

    You may be able to do a short-term feeding tube for her if she's going to need assist-feeding for much longer. It does require a short anesthesia (around 15 minutes), but it really can be a game-changer for a cat that has no appetite.

    Mookie very probably simply needs a little bit more Lantus. That's very normal with a newly-diagnosed diabetic. There's a calculation for starting dose, but that really is only a starting point - diabetes is great for providing you with a constantly moving target in terms of dose and glucose levels, so dosing often has to be adjusted fairly frequently.
     
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  54. SharonKurtz

    SharonKurtz New Member

    Joined:
    Jun 2, 2019
    I am syringe feeding Inka now. 20ccs three to four times a day. So she should be getting her food in. She has only vomited once since this all began and it was yesterday after being at the vet’s.
    I’m hoping she will make it now that I’ve found a real vet.
    I’m supposed to see the other one tomorrow with my CKD cat. She actually was good with her. The issue with switching vets with her is that she needs a medication every once in s whole ( darbepoetin) that no other vet carries because it is so expensive. Cost me around $75 a shot. It helps to manufacture red blood cells since the kidneys are not sending out the signal to the long bones to make RBCs. If I bought my own vial it is somewhere around $3500. I’m going to ask the dose she gets because there are a lot of different ones. But I am going to tell this vet face to face what I think of her and her skills. If Mushka needs another shot, I’ll ask the new vet to call and let me go there for the shot only.
    Can you imagine that she didn’t know a bladder from fluid?
     
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  55. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    I would not give the glipizide either.
     
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  56. AliceMeowliss&Cassandra

    AliceMeowliss&Cassandra Well-Known Member

    Joined:
    Jan 8, 2019
    From the study on FD I was reading today, re:meds like glipizide...

    “Oral hypoglycemics may be used in human type 2 diabetes patients with sufficient endogenous insulin secretion to maintain euglycemia without insulin therapy. Sulfonylureas and meglitinides stimulate insulin secretion from pancreatic β cells.82,83 However, the majority of diabetic cats have insufficient β-cell function to achieve good glycemic control using these alone.30,84Similarly, biguanides such as metformin require functional β cells and sufficient circulating insulin to be present if they are the sole therapy.85 In five newly diagnosed diabetic cats treated solely with metformin, only one cat had measurable serum insulin concentration pretreatment, and this was the only cat that achieved good glycemic control.86 While α-glucosidase inhibitors such as acarbose can slow intestinal glucose absorption and reduce peak postprandial glucose concentrations, they are minimally effective in cats eating multiple small meals.85,87 The trace element vanadium supplemented at 45 mg/cat/day improved glycemic control in diabetics treated with PZI insulin, with a mean insulin requirement of 3 U in vanadium-supplemented cats compared with 5 U in cats treated with PZI alone.88

    Insulin treatment is associated with a higher probability of achieving glycemic control and eventual diabetic remission, compared to the sole use of oral hypoglycemic agents, and this continues to be the recommended treatment for diabetic cats.”
    From here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6053045/

    The whole article is good and may be nice to bring to your vet, but it sounds like you finally found a vet who has some sort of clue, at least on this one issue.
     
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  57. Squeaky and KT (GA)

    Squeaky and KT (GA) Well-Known Member

    Joined:
    Jul 19, 2011
    Not only will Glipizide do more damage than good, Inka's not in any condition for any part of her body to be 'forced' to do anything. Everything's in a very delicate balance. Insulin if it's needed...

    Potassium - be sure you have blood work done again in 10 days to 2 weeks after starting a potassium supplement.
     
  58. Lisa and Witn (GA)

    Lisa and Witn (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    It also may be an infection in either the gallbladder or liver. A friend's cat just recently went through the same thing.
     
  59. SharonKurtz

    SharonKurtz New Member

    Joined:
    Jun 2, 2019
    Thank you all. Inka is on two antibiotics, potassium, an herbal liver supplement, Ursodiol, I have Cerenia and mirtazapine to use, sq fluid twice a day, syringe feeding. I know what you are saying about the glypizide. He was just throwing out thoughts. I don’t want oral meds for her diabetes. Years ago I had two diabetic cat’s and I remember the vet saying they didn’t work. This guy is reasonable. He called me several times today to be sure she got all of her medications. And he’s not afraid to say what he thinks of the other vet ( and very colorfully too). He said she had a 50/50 chance but he’s seen worse get better. Clinically she doesn’t look that bad. Walking around as usual. Very feisty when getting meds and feedings. I hope she can make it and stabilize some. I’m going in for surgery next week and we are already trying to figure out a way to smuggle her in the hospital The new vet said she could stay with him if need be. I’m seeing the old vet tomorrow and I will be telling her exactwhat I think
     
  60. SharonKurtz

    SharonKurtz New Member

    Joined:
    Jun 2, 2019
    He thinks it’s gallbladder. How is your friend’s cat?
     
  61. Squeaky and KT (GA)

    Squeaky and KT (GA) Well-Known Member

    Joined:
    Jul 19, 2011
    She's going to make it! From your descriptions as you've allowed us to walk this path with you, she's already pulled thru a lot of the bad part. I think you may have found a jewel in that new vet. You and he may not agree on long term diabetic treatment but he cares, he says what he thinks, he listens...all that is worth a LOT!
     
  62. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    At one point Alex was diagnosed with severe liver disease, but recovered beautifully. It took some work, but I give a whole lot of credit to Ursodiol, Denamarin, and food! Yes, food. We used to have a saying around here: food is like medicine for the liver. The goal was for Alex to consume her normal amount of daily calories plus half of that every day... and if she wanted more, she got it!

    In case it hasn't been mentioned, not all vets seem to be aware of this:

    "There is a possibility that chronic use of ursodeoxycholic acid in cats may deplete the body of the essential amino acid taurine, thus necessitating dietary supplementation with this amino acid."

    Veterinary Partner - Ursodiol (Actigall)

    As a precaution, we were told to mix 1/8 teaspoon Now Foods Pure Taurine Powder in her food twice a day. Adding it to her food never seemed to faze her. We had the Ursodiol compounded into a chicken flavored liquid and gave while feeding.

    To make syringe feeding easier we blended cat food (no water) into a smooth and creamy mousse. Syringe feeding the mousse-like texture eliminated all the mess in my kitchen and on the cat... something both of us appreciated! She could also lick a quarter-sized amount off the back of my hand or a larger amount put on a saucer and held up to her mouth when the mixture wasn't so runny as when water is blended into the food. She seemed to like being able to lick food rather than me 'forcing' a messy slurry into her mouth... one that ended up all over the place. I also gave 5 mL water via syringe in-between each 10 mL of food.

    Wishing Inka a swift recovery! You've got this!
     
  63. Lisa and Witn (GA)

    Lisa and Witn (GA) Well-Known Member

    Joined:
    Dec 28, 2009
    Much better. Initially he was anemic and his liver values we're really bad. When they did an ultrasound, they found he had gallstones and nodules on his liver. The biopsy for the nodules came back as an infection and not cancer. Once they started him on multiple antibiotics along with some other meds, he started improving quickly. The ultrasound they did the following week showed the nodules were shrinking and his gallbladder looked much better. He still has the gallstones, but they don't seem to be aggravating his gallbladder as much. Liver values also improved.
     
  64. AliceMeowliss&Cassandra

    AliceMeowliss&Cassandra Well-Known Member

    Joined:
    Jan 8, 2019
    I am incredibly impressed by this new vet of yours. I love my vet but she does not call me to check in like that. It sounds like he will be the one to really work with you on what you need!!! :D
     
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  65. SharonKurtz

    SharonKurtz New Member

    Joined:
    Jun 2, 2019
    I just did a four hour round trip drive to a compound ing pharmacy to get the Ursodiol. The vet was worried and didn’t want to wait to start it. He actually had two pills in his office from a dog patient. He said Inka needed a smaller dose of it and ordered it but in the meantime he patiently cut the pill he had into fours so Inka would at least get one dose. ( I think I love this guy...he tries to act tough and moves fast but you can see he really cares)The ones I picked up are 30 mg Ursodiol Tiny Tabs. Given twice a day with food. I’m not sure how long he intends for her to be on it. I actually took it five years ago when I had bariatric surgery to prevent gallstones. Took it for six months. Where do I purchase the taurine powder? I’m leery of ordering things just anywhere on the internet for my animals as there are a lot of counterfeit products. I don’t have to tell or ask him everything. You can’t overdose the cat on taurine, can you? I’m soooo glad you told me. I really appreciate it. Please let me know where you got it so I can order it?
    That is a great idea for the food too. Do you use a hand held blender?
    Another question I have....I’m feeding her A/D critical care cat food. Is that too fatty with gallbladder issues? I just thought of that tonight.
    I’m finding it difficult trying to figure out how to get all this stuff into her. The antibiotics I give together. That metronidazole is nasty stuff for an already nauseous cat. Then the potassium gel and the Ursodiol. Plus my three other cat’s.
    Thank you again! I will get that powder as soon as you let me know where.
    You guys are great!!
     
  66. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    Nice! This new vet sounds like a keeper! :cool:
    I purchased the taurine online: https://www.iherb.com/pr/now-foods-taurine-powder-8-oz-227-g/7425?at=0.

    I've purchased supplements from iHerb.com for years, trust them, and their service is fast. Years ago, Dr. Lisa (the vet who put together the latest food chart listed at the top of the Health Forum) suggested iHerb.com for supplements for those making her raw cat food recipe. However, you can also find taurine at most Health Food stores or places like GNC. The important thing to look for is whether it's "pure"... no other ingredients besides the taurine powder itself. My understanding is one cannot overdose a cat on Taurine. The cat will pee out the excess.
    No, I haven't tried a handheld blender. I have two small countertop blenders: a Ninja and a Hamilton beach. I just grab the one that's easiest to reach in the cabinet at the time. I think blending with a hand held blender may become tedious because it takes awhile to get to that mousse like texture, but maybe worth a try of you already have one.
    Good question for your vet!
    All I can tell you is at the time I was using Wellness Turkey or Chicken. Both have/had a higher fat content than others, but Alex did well with them. If Inka is tolerating the food without any signs of discomfort, she'll probably be fine with it, but like I said... ask your vet.
    I hear ya! Once I figured out what to give when I made up a chart so I could follow it every day. The chart helped me keep things straight.
    You're welcome. Happy to help when I can... just as those who helped me when I needed it. :)
     
  67. SharonKurtz

    SharonKurtz New Member

    Joined:
    Jun 2, 2019
    Update on Inka:
    There is no improvement on Inka. She is still not eating. Not doing much but lying around. Jaundice is no better. Spoke to the vet this morning. He feels she is at the point of no return. We are doing one more blood test to see where her values are. Please send prayers that we do what is in her best interest.
    If you remember, I had said that the old vet was good for my olde kitty in CKD. She brought her out of a crisis recently and that is how I actually came to start going to her. I had an appointment with her set up for yesterday and decided to keep it. When I went in, she took Mushka’s blood and asked when I was bringing Inka in. I reminded her that I brought Inka to another vet. She became defensive and when Mushka’s bloods came out, they were not good. BUN up, creatinine up. She said “well, she’s 19”. I asked what we can do and she said nothing. I requested her records and she sees the newvet tomorrow. I have a call out to the practice manager and a letter to the licensing board. To me that is plain refusal of care. Shame on me for even seeing her again.
    Having major surgery this week and am hoping everyone can just be stable until that’s over.
     
  68. Tanya and Ducia

    Tanya and Ducia Well-Known Member

    Joined:
    Feb 25, 2017
    Hi Sharon,
    I am so very sorry Inka is not feeling better.
    My cat had jaundice as well as fatty liver suspicion after her DKA.
    We couldn't pay for tests to pin the problem and asked how treatment of either - fatty liver , triaditis and jaundice could be altered if we had the tests done. It turned out that the treatment would be just the same - mainly food, water , AB if needed, insulin. Go figure.

    Ducia too was just laying around, hiding. We fed via E-tube which was her life savior.
    I was wondering if some more food would benefit Inka.
    Maybe making it 20ml slurry x 5 or 6 times / 24 h might help - if she tolerates of course.
    Food = medicine for cats in so many cases.

    Your new vet is a treasure! I hope together you and him will find the best solution for Inka whatever it might be.

    Sending you many healing vines for Inka.
    @SharonKurtz
     
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  69. SharonKurtz

    SharonKurtz New Member

    Joined:
    Jun 2, 2019
    Thank you so much. I will up her feedings. What did you feed yours? I asked about the A/D being high in fat but he said to just get food into her. He told me to give up but I asked for bloods again. They drew the blood before. Will have results tomorrow. Is your baby still with you
     
  70. Tanya and Ducia

    Tanya and Ducia Well-Known Member

    Joined:
    Feb 25, 2017
    @SharonKurtz
    Friskies Pate one and a half and later one and a quarter of 5.5oz can a day, all in the 60+% Fat. Dr. Pierson wrote that in general cats do well on fatty diets (better than carby diets for sure). Ducia was 6.5lb, had 100ml LRS SQF SID, and later 75 ml SID. ETA: fed via tube equal portions day and night.
    absolutely, she says "Hi" and sends Inka healing vines.
    3 out 5 vets hinted she won;t make it: Before.jpg
    but she did pull thru: After6Weeks.jpg
     
  71. SharonKurtz

    SharonKurtz New Member

    Joined:
    Jun 2, 2019
    Update on Inka
    Inka is not doing well. More lethargic. Still not eating on her own.
    Had blood drawn yesterday and values are not good. I was ready to leave the house with Mushka to bring to the vet and he called saying I should bring Inka to be euthanized. I couldn’t just rush and put her in a carrier, so I figured I would wait and talk to him. I’m starting to think I hate all vets. This guy is good but he is very fast and goes from room to room and comes back, leaves, etc. when I got there he asked where Inka was and I told him I couldn’t rush that decision. He told me the cat was suffering.
    He examined Mushka and told me I would have to make decisions on both cat’s. Mushka’s BUN is over 130 and creatinine is 10. He said she is at the end. I told him she was acting normal and eating. Her values have been that high in the past and she still enjoys walking around and sitting with us in the couch. She’s 19 years old. So he there was nothing he could do for either cat. I asked about the ondansetron and he said no. I have some here from my last surgery. Ondansetron HCL 4 mg. I would like to try that instead of Cerenia. She is not vomiting. Is this the correct medication and what dose could she have? I asked about pain meds and he gave me Buprenex ink but he doesn’t want me to inject it but rub it on her gums. He doesn’t believe in people doing these injections. Been doing it many years.
    Liver values better. On 6/5 AST was 530, yesterday was 436
    ALT on 6/5 was 806, yesterday was 691
    Her bilirubin is up from14.9 to 22
    Her potassium is down from 3.0 to 2.2
    Glucose was 301. Stool no insulin
    He told me to double the potassium dose
    Everything else the same.
    He said her gallbladder is the issue.
    I don’t know what to think anymore
    I don’t want to be cruel either. What do you think?
     
  72. SharonKurtz

    SharonKurtz New Member

    Joined:
    Jun 2, 2019
    I’m not sure if I’m doing something wrong here but I’m not seeing any replies.
     
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  73. Idjit's mom

    Idjit's mom Well-Known Member

    Joined:
    Apr 3, 2018
    I don't think you are doing anything wrong, sweetheart. Just not very many people that I can see on the board today so far and probably none that would be able answer your questions about medications. I wish I could.
    As far as making the decision to either help your lovely kitties cross over, or to keep trying, that is just unanswerable by anyone else. And it's heartbreaking that you are having to consider the eventually. I can only go by my own experiences and when a kitty was suffering and there was no other treatment or alternative, then it was time. I wish you clarity, peace and comfort with whatever you decide, when you decide. Many hugs and much love as you negotiate these troubled waters. :bighug::bighug::bighug:

    @Marje and Gracie might be able to shed some light on the lab tests and medications.
     
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  74. Tanya and Ducia

    Tanya and Ducia Well-Known Member

    Joined:
    Feb 25, 2017
    Dear @SharonKurtz
    :bighug::bighug::bighug:
    I am so sorry about your furkids
    :bighug::bighug:

    it is a tough one. No one would like their little ones to suffer and the vet's opinion has to be taken into consideration. But not just blindly followed. Not just yet if you have doubts. And I understand how recently you met Inka but still you are the one who fed her, nursed her - listen to your heart now. It must be so overwelmed with all the pain you , Inka and Mushka are going thru. I know you were not long together...and you may not read the signs well yet but I am not there to see her or "talk" to her... Nor am I able to read the tests properly to tell you what is going on. DUcia's liver values were off but improved, so did the bullirubin but my Ducia was 8 years old and all of these was her first ever illness.
     
  75. Squeaky and KT (GA)

    Squeaky and KT (GA) Well-Known Member

    Joined:
    Jul 19, 2011
    Sharon,
    This whole situation just sucks. There's NO ONE ELSE but YOU and INKA and YOU and MUSHKA that get to make that decision. Your vet has a right to his opinion but that's ALL it is, his OPINION. Sit down quietly with each one, look into each other's eyes and ask...you'll know. Even tho' you've not been with Inka long, your souls are already connected. Then follow that answer. If they're tired of fighting, you'll know. If one is ready and the other still wants to fight, you'll know.

    HUGS and hugs and hugs along with continued thoughts and prayers,
     
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  76. SharonKurtz

    SharonKurtz New Member

    Joined:
    Jun 2, 2019
    I feel like I can’t breathe. Inka is just down. Mushka is her old cranky self at 19.
    I find this situation so bizarre as I had my gallbladder out in March, my husband in April and now Inka. Isn’t that weird? Wish surgery would be a fix for her but they charge over $5,000 for it and she has other things going on, so I don’t believe she would survive it. I’m having major surgery this week. If she turns around a little I will cancel to care for her.
    Is there any way on this site to private message someone?
    Is there anyone out there that has seen this and the cat got better? I feel helpless
     
  77. Squeaky and KT (GA)

    Squeaky and KT (GA) Well-Known Member

    Joined:
    Jul 19, 2011
    In browser, very top right of page, you see your UserID Inbox Alerts. Click on Inbox, allows you to create a message. It will give you a list of User IDs when you type the first 2-3 characters of a name.

    I know nothing about and haven't had experience with anything 'gallbladder' so I'm absolutely NO help there. I can't even think of anyone that does have experience with that... :(

    HUGS and hugs and right there with you as close as virtually possible...
     
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  78. Tanya and Ducia

    Tanya and Ducia Well-Known Member

    Joined:
    Feb 25, 2017
    same here Sharon, sorry
     
  79. Idjit's mom

    Idjit's mom Well-Known Member

    Joined:
    Apr 3, 2018
    Best of luck with your upcoming surgery, and wishing you an easy and speedy recovery. I am so sorry about Inka :bighug:
     
  80. SharonKurtz

    SharonKurtz New Member

    Joined:
    Jun 2, 2019
    Thank you
     
  81. SharonKurtz

    SharonKurtz New Member

    Joined:
    Jun 2, 2019
    Thank you
     
  82. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    Ondansetron 2 mg is the dose I gave my cat. Can have up to three times a day.
     
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  83. Paula Nowak

    Paula Nowak Member

    Joined:
    Sep 9, 2018
    Hi this is Paul and Nowak with Elvis the cat. I would do anything and everything to never have my baby put down. There is a homeopathic company called homeoanimal.com I would give them a call and see what they think and explain what is going on. At first when you call the automated person sounds kind of happy and cheesy but when you actually talked to the one of the experts there that always answers the phone but you will have to wait just a tiny bit, and they are very knowledgeable. I have talked to them before about other people wanting information on their cats it can't hurt and I really do think that they will have a remedy for you.
     
  84. JanetNJ

    JanetNJ Well-Known Member

    Joined:
    Jun 8, 2016
    I use a blood ketone meter. Much easier.
     
    Paula Nowak likes this.
  85. SharonKurtz

    SharonKurtz New Member

    Joined:
    Jun 2, 2019
    Thank you all for your help. Inka crosses the Rainbow Bridge today. She was a gentle soul and will be sorely missed
     
    Paula Nowak likes this.
  86. Larry and Kitties

    Larry and Kitties Well-Known Member

    Joined:
    Dec 28, 2009
    Sending purrs and prayers at this difficult time.
     
  87. Tomlin

    Tomlin Well-Known Member

    Joined:
    May 30, 2019
    I'm sorry for your loss & sending prayers your way. Peace to Inka as she crosses the Rainbow Bridge & is free from her illness :rb_icon:cat_wings>o
     
    Amina&M'row likes this.
  88. JanetNJ

    JanetNJ Well-Known Member

    Joined:
    Jun 8, 2016
    Oh no! I'm so sorry. :(
     
  89. Amina&M'row

    Amina&M'row Member

    Joined:
    Jan 2, 2019
    Am so sad that Inka crossed. They live in our hearts forever
     
  90. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
    I am so sorry.
    Fly free Inka and land softly at the rainbow bridge :rb_icon:cat_wings>o
     
  91. AliceMeowliss&Cassandra

    AliceMeowliss&Cassandra Well-Known Member

    Joined:
    Jan 8, 2019
    I am so sorry for your loss.
    Light and love to you Inka, always.
     
  92. nslade001

    nslade001 Well-Known Member

    Joined:
    Nov 12, 2018
    Thinking of you with love, nikki
     
  93. Paula Nowak

    Paula Nowak Member

    Joined:
    Sep 9, 2018
    Sorry but I haven't been on here for a while. I am so sorry to hear about Inka but she is in heaven now and you will see her again one day !
     
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