Chucky deteriorated after vets hospitalisation

Discussion in 'Feline Health - (Welcome & Main Forum)' started by Ewa Michalczuk, Aug 1, 2020.

  1. Ewa Michalczuk

    Ewa Michalczuk New Member

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    Jan 1, 2020
    Hi everyone

    As you are bunch of great and experienced folks in the cat diabetes subject, maybe you can shine a light on what happened to my kitty Chucky...

    So me and my partner went away for 3 nights and boarded our chucky with our vets, as he's very timid and wouldn't let anyone do injections at home apart from me. He just runs away from everyone.

    After night number 2 vet is ringing me saying that chucky is refusing to eat and his glucose keeps going up and asking if I'm happy for them to treat him if necessary. So I said yes, and I was quite surprised as he's always first when food is out. We came back in the morning, went to pick him up, nurse said his glucose is back to normal now, but to let them know if he's not eating when back at home. She said they had to syringe feed him and put him on a drip. I thought,maybe it's just anxiety and he'll be fine at home.

    But he is a different cat. He doesn't want to eat, his back legs are wobbly, he's very lethargic, drinks a bit but refuses food completely. Can only walk few steps and then lies down again. I managed to check his pee for ketones and they were moderate/high. Can't test his blood as never enough comes out of his ear, pricked him so many times but no luck. He won't give me his paw, it's just how he is. Partner is taking him back to vets now as he's not OK. I know it's a long shot to ask this, but does any of you have an idea what could have gone wrong? How in the space of 2 days, regulated, happy cat goes downhill like that? I can't get my head around it. I thought at vets he'll have best care as he won't miss his injection. Obviously I was wrong. Could stress cause this? My vets have very good reviews and they've been operating for years.

    Any advice greatly appreciated

    Thank you
     
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  2. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

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    Feb 21, 2015
    I am so sorry to hear this about Chucky.
    If you cat has moderate/high ketones please take him to the vet immediately. He is at risk of developing DKA which can be deadly.
    Do not leave it until tomorrow. Go to the vet or the ER immediately.
     
  3. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

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    Mar 19, 2016
    Oh no. Yes, he needs to go back to the vet immediately to deal with the ketones. Insulin, food, fluids, and careful monitoring of his blood chemistry is what is needed. It's not something you can deal with at home.

    As for your question, the stress of the vet stay might have caused this (along with not eating), but the vet should also look for other physiological stressors-- infection, pancreatitis, even teeth problems. It seems like quite a coincidence for any of these to have popped up in just the few days he was at the vet, but you never know. There could also be an interaction, ie for something like pancreatitis, it could be something like he has mild issues normally but the stress of the vet stay made them flare up into huge issues.

    Hope he's feeling better very soon, poor little guy.
     
  4. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

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    Dec 28, 2009
    Sending prayers and best wishes sighhhhh:(
     
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  5. Critter Mom

    Critter Mom Well-Known Member

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    Jun 16, 2014
    So glad to hear that you're taking Chucky back to the vets. You did a great job catching that he's throwing ketones. With moderate to high levels and inappetance, he is at risk of developing diabetic ketoacidosis.

    If a diabetic cat doesn't get enough insulin AND food then the cat starts to metabolise fats which then produce ketones. If the ketones aren't flushed out and food and insulin intake corrected urgently they can throw the cat's whole metabolism out of whack (diabetic ketoacidosis, DKA, which as other members have pointed out is life-threatening BUT DEFINITELY TREATABLE!). The metabolic imbalances require veterinary intervention and constant monitoring to correct. The vets can keep him hydrated and administer glucose and insulin intravenously while they stabilise him. FYI, the wobbly back legs could be due to electrolyte imbalance. If this is the cause then restoring proper electrolyte balance should resolve the weakness.

    As Nan mentions above, the vet should also check for possible underlying issues as DKA typically arises due to lack of sufficient food and insulin PLUS some underlying infection or other illness/systemic stressor.

    DKA makes a cat look and feel really, really ill. It also makes them feel really nauseated and that means they have difficulty eating. But with rapid treatment and supportive home care they can and do make good recoveries! Cats are extraordinary creatures.

    Your vet will need to flush out Chucky's ketones and because it's vital to get food and insulin into him ASAP they should need to prescribe anti-nausea medication (Cerenia and ondansetron work well, and they can be used in tandem if required). Chucky will probably also need an appetite stimulant (appy stimulants alone don't tend to work in a badly nauseated cat). If the anti-nausea and appy stimulants don't work quickly then don't hesitate to ask your vet about placing a feeding tube for Chucky. An E-tube can save the life of a cat who's having major eating difficulties.

    VERY IMPORTANT: It can take a while for post-DKA cats to re-establish proper eating patterns and the supportive meds are invaluable for ensuring they keep eating and continue to get enough insulin during the convalescent period. Post-DKA cats who can't get enough food and insulin during the home recovery can very easily relapse into DKA and end up back in veterinary hospital again. Therefore, when Chucky is able to come home, please please make sure that you get the vet to prescribe anti-nausea and appetite stimulant meds for you to take home (be insistent if they don't automatically offer them). Prompt treatment of nausea and appetite issues is the best way to prevent a relapse.

    It would also be a good idea to make sure that you have a variety of foods with a range of carb values ready for Chucky's return home. The flavour varieties can help whet an iffy appetite, and it may be necessary during the recovery period to feed a slightly higher carb food so that you can, if necessary, give a little more insulin to prevent ketones from developing again. Sometimes dosing is a bit tricky post-DKA, especially if a kitty's underweight. Feeding a diet with a somewhat higher carb load can help with insulin administration in such circumstances.

    If you're in the US, I believe there are baby foods (Beechnut, maybe?) made of just meat and broth (NB must not contain onions or garlic!). Some cats will eat these simple, easily digestible baby foods even when they're turning their noses up at other options.

    Going forward, it is really helpful to learn how to spot warning signs for nausea and appetite issues (see link below for further info).

    Here are some useful links with further information:

    Information on Ketones and DKA

    Feeding Tubes for Cats

    Nausea and Appetite Problems - Symptoms and Treatments

    Fingers and paws crossed that the vets will help Chucky to feel much better very quickly. :bighug:


    Mogs
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    Last edited: Aug 1, 2020
  6. Panic

    Panic Well-Known Member

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    Apr 10, 2019
    I agree, it sounds like he could have gotten something like pancreatitis. Please let us know what the vet says.
     
  7. Diane Tyler's Mom

    Diane Tyler's Mom Well-Known Member

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    Sep 21, 2018
    I hope Chucky starts to feel better , please keep us posted :cat:
     
  8. Ewa Michalczuk

    Ewa Michalczuk New Member

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    Jan 1, 2020
    So vet advised we let him go....

    His liver is enlarged, got fluid retention, his skin showing sings of jaundice

    Vet said they can put him on a drip, but he doesn't think this will do anything and that he won't get better. He suggested he might even have a tumour

    He's so poorly, it's sad seeing him like this

    I just don't know how is it possible he's gone downhill in a couple of days when on Monday he seemed fine

    But what is best decision to make? How do I know vet is right? I don't want him to suffer and he clearly is in distress...

    It's hard to make such decision, I don't want to let him go...
     
    Last edited: Aug 1, 2020
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  9. Red & Rover (GA)

    Red & Rover (GA) Well-Known Member

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    May 18, 2016
    Throwing out some ballpark thoughts.

    1. Elevated liver enzymes can sometimes be seen in DKA cats. DKA requires round the clock care for a couple of days – IV fluids, meds, assisted feeding or feeding tube.

    2. Since Chucky wasn't eating for a few days, ask the vet about the possibility of Hepatic Lipidosis (fatty liver disease). It would require round the clock care and usually a feeding tube.
    https://www.vet.cornell.edu/departm...mation/feline-health-topics/hepatic-lipidosis

    3. Is there an internal medicine vet near you? Or an urgent cat vet (they may have more experience than a general practice vet)?

    All of these options are expensive.

    Sending vines and prayers for Chuck and his humans. :bighug:
     
  10. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

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    Mar 19, 2016
    Ugh. That is really really hard...

    Why does the vet think the enlarged liver is a tumor? Is this all by "feel" or did he do some imaging that showed something?

    Do you know if he ate at all at the vet before they started syringe feeding him? Two days without food is a lot and can cause serious problems, I'm not sure whether or not it's enough to see jaundice. I guess the question is, is what you're seeing all a function of him not eating and sending himself into throwing ketones/possible DKA, or does he really have a problem like a tumor that only came to the fore under the stress of the vet stay.

    What did the vet have to say about the ketones? Is he doing anything to address them other than suggesting "a drip"? Does he have any experience with treating a DKA cat?

    Just saw @Red & Rover (GA) 's post, I agree with it all. I think if it were me I would lean towards trying to get a second opinion, but that would be expensive, especially on a weekend where you would have to go to an ER vet. I don't think Chucky can wait until Monday, though.

    I don't think there's a wrong answer here, honestly. Letting Chucky go when he's suffering is a loving choice, as is going another step or two to see if you can bring him back from the suffering. Whatever you decide, we'll be here to help in any way we can.

    :bighug: :bighug: :bighug: :bighug:
     
  11. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

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    Dec 28, 2009
    Oh my this is so sad...My prayers are with you at this most difficult time. sigh:(
     
  12. Critter Mom

    Critter Mom Well-Known Member

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    Jun 16, 2014
    Hi Ewa,

    I'm sorry to hear about your distressing situation.

    I'm in agreement with the post above by @Red & Rover (GA).

    I learned the hard way about inappetance in cats: I lost an absolute angel, Danú, to hepatic lipidosis. She was only seven. Also I managed Saoirse's chronic pancreatitis (a common traveller with feline diabetes) for nearly three years. I've also followed the stories of many cats here who had DKA. In all situations the cats were very ill but with timely and appropriate treatments I've also seen some astonishing recoveries.

    At the time I lost Danú, I don't think I got proper veterinary advice and response. Like Chucky, she was jaundiced upon initial presentation to the vets. They sent off blood samples for her but told me at initial presentation that it was probably a congenital liver issue that led to her symptoms. By the time the diagnostic results came back they showed that there was no underlying disease; she had just lost her appetite and didn't get the right meds to help her start eating again. She could have survived if she had had appropriate - aggressive - treatment to get food into her. Alas, they delayed too long (they should have placed a feeding tube as a matter of urgency). I wish I knew then what I know now.

    First point: anxiety can trigger anorexia and that can lead to both pancreatitis flares and also DKA in feline diabetics.

    Second point: Chucky was OK a few days ago.

    Third point: The initial and only major change in clinical signs was loss of appetite. (Stress from boarding may have been a possible trigger for the inappetance.)

    Fourth point: Based on the brief details you've provided I don't have much confidence in your vet (but you know your vet better than I do).

    From what I can glean from your posts your vet does not seem to have done much in the way of diagnostic testing. Instinct based on what I've seen here over the years and experienced myself prompts me to question how much experience your current vet has in treating DKA (and probably hepatic lipidosis by the sound of it).

    How on earth could the vet ESTIMATE WITH ANY REAL RELIABILITY that there's a liver tumour???? Without diagnostics????

    If there's no other major underlying liver issue then with appropriate and aggressive treatment hepatic lipidosis is potentially reversible. According to the following link, the recovery rate is potentially as high as 90%.

    https://marvistavet.com/hepatic-lipidosis.pml

    If it's DKA, as Red observes above that could be having a knock-on effect on liver function (it really screws up the whole metabolism).

    Both of those conditions have the potential for successful treatment.

    If it were my cat in this predicament, if at all possible I'd want solid information before making any irreversible decisions. I would ideally be looking for a second opinion, as Red suggests above.

    What to do? With ketones in the mix time is not on your side right now. They need to be dealt with urgently.

    OK. Here's what I'd do.

    If I could get my cat to another much more experienced vet straight away (talking hours here, no longer) I'd go there if they could take my cat as an emergency patient - internal medicine specialist, cat specialist, practice with a lot of experience of treating feline diabetes and DKA.

    It's not easy to identify such a vet in a hurry ...

    Second option would be to get your vet to provide fluid therapy to Chucky straight away. With the high ketones he is very likely dehydrated and that can:

    1. make a poorly cat look and feel a lot worse.

    2. really screw up diagnostic test results.

    There's no guarantee BUT fluid therapy can make a poorly cat feel a good bit better. It would start flushing the ketones out of Chucky's system and maybe give him a bit of a lift and make him feel less uncomfortable. Crucially, it could buy you time to investigate potential alternative avenues for him to get better help. At minimum, it could buy time for your vet to run proper diagnostics to confirm what the problem actually is and make better informed decisions.

    I'm sorry this post is so long. I hope it gets to you in time. Sending my prayers for Chucky and for you.

    :bighug:


    Mogs
    .
     
    Last edited: Aug 1, 2020
  13. Teresa & Buddy

    Teresa & Buddy Well-Known Member

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    Jan 2, 2017
    I agree with everything they are telling you, hope you can find another vet in a hurry. This cat looks just like my Kit Kat, I so hope this goes good for Kitty.
     
  14. Teresa & Buddy

    Teresa & Buddy Well-Known Member

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    Hoping things are going well and you find HELP!
     
  15. Ewa Michalczuk

    Ewa Michalczuk New Member

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    Jan 1, 2020
    Thank you everyone for taking time to reply to my post

    My sweet Chucky crossed the rainbow bridge yesterday...

    Don't know if I've made the right decision, I'm torn, I'm crying

    He was so so poorly though, it was heartbreaking seeing him like this, don't know if he was in pain as he couldn't tell me but I hope he wasn't, he looked like he had enough though

    He was on a drip 2 days already at vets, so I could have insisted to keep him on a drip and keep investigating what's wrong, go through tests, scans etc...he hated vets, he was my little timid boy who only wanted to be at home, so was it fair putting him through this? I just don't know....

    I now regret going away for those few days, if I didn't he would still be here...feel somehow guilty of this

    He wasn't there this morning for his food, it seemed so empty

    I have 2 other boys and they are comforting me

    Sorry about my rambling, just trying to figure out how to deal with the grief, hope he's in a better place now where he can chase all the flies he wants

    Thank you guys for your kind words, it's nice to talk to someone who relates
     
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  16. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

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    Dec 28, 2009
    Oh dear... I am so very sorry for your loss. If it is any comfort to you, it sounds like Chucky may have been suffering. Its the hardest yet kindest gift we can give to end suffering. my heart goes out to you :( I know you are blaming yourself but Chucky wouldnt want that.
    You are an amazing care giver but sometimes these things are beyond what we can do.

    Dear Chucky,
    Fly pain free little man. Land ever so softly in the broken heart you left behind:bighug::rb_icon::bighug:
    jeanne
     
  17. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

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    Dec 28, 2009
    Please know you have many arms and prayers wrapping you with love. Chucky is still with you. You just have to learn how to hug him a little differently.:bighug:
     
  18. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

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    Mar 19, 2016
    I am so sorry.

    I know it's impossible not to, but please try not to second-guess yourself on this decision, or on the decision to go out of town. Cats hide discomfort so well, perhaps the stress of the vet stay made it harder for him to hide what he was feeling, but it didn't cause it.

    In the end, you gave him the most difficult, but most loving, gift that you could. He knew how much you loved him, and he is pain-free now. :rb_icon:

    Take care of yourself, this is so hard. We are here for you :bighug: :bighug:
     
  19. Noah & me (GA)

    Noah & me (GA) Well-Known Member

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    Dec 3, 2016
    There is no reason for guilt. Over a year ago we had to board our last diabetic cat, he was beyond nervous and had never been crated once in his life. He went to the vet with End of Life instructions, that's how bad it was. I know exactly how you feel right now, you have all of us to lean on.
    :bighug: :bighug: :bighug:
     
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  20. Briere Fur Mom

    Briere Fur Mom Well-Known Member

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  21. Critter Mom

    Critter Mom Well-Known Member

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    I'm so sorry to read your sad news, Ewa.

    I know it's nearly impossible but try to be gentle on yourself and go easy on the what ifs. :bighug:

    You're the one that knows Chucky the best in the whole wide world and you have been guided by what you felt in your heart was best for him. No kitty could ask for more than that from their human. He's no longer experiencing any distress or discomfort and you gave him that last and greatest gift because you love him so very much.

    It is good to know that you have two little fellas to comfort you. My heart goes out to you.

    :bighug: (((Ewa and Spirit Chucky))) :bighug:


    Mogs
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  22. Teresa & Buddy

    Teresa & Buddy Well-Known Member

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    So sorry, for your loss.
     
  23. Liang & Nathan

    Liang & Nathan Member

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    May 15, 2020
    I am so sorry for your loss.
     
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  24. Ewa Michalczuk

    Ewa Michalczuk New Member

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    Jan 1, 2020
    Thank you everyone for the kind words

    I'm coming to terms with my decision and I think it was the right one. Wouldn't want my baby to go through loads of different tests, be at vets for days as he really hated it and was a very anxious about it

    In his last hours he was so weak, his pupils were dilated, he looked so so sad...hard to describe it

    It was just so quick, I had only 2 hours with him from time he came back from vets to the time I had to say goodbye

    He looked so peacefully after he was gone and not in pain anymore

    This is first time I had a pet put to sleep and it's extremely hard to deal with this

    On the way there and at vets I just cried and cried...on the way home I felt numb...as soon as I got home I just sat there crying for ages, soon as I think about him I cry

    I guess it will get better with time

    Thank you for letting me to say how I feel, it helps a lot ❤
     
  25. jt and trouble (GA)

    jt and trouble (GA) Well-Known Member

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    Dec 28, 2009
    Ewa you come and vent or even cry whenever you feel you need to. We have ALL been through the same horrible PTS . It comes from love. I could have kept my Waldo going by shoving pills down his throat (something he detested) The last time I did that to him and looked in his eyes I knew. He was telling me "ma I'm done". (ok tears welling) Its just very hard ... we know. sniffcat_wings>o
    jeanne
     
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  26. Critter Mom

    Critter Mom Well-Known Member

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    Jun 16, 2014
    (((Ewa and Spirit Chucky)))

    (((Jeanne and Spirit Waldo)))

    :bighug::bighug::bighug:

    .
     
  27. Critter Mom

    Critter Mom Well-Known Member

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    Jun 16, 2014
    Thinking of you, Ewa. :bighug:

    I am half hoping that maybe you've been crying enough to be able to get some sleep. What you're going through is so hard, so any bit of recharge from sleep you manage to grab, however sporadically, will help you through this oh so painful time. And maybe don't fight against any numbness - the little bit of a cushion it gives is something to be grateful for in the early days.

    Blessings for you and for your furry angel. :bighug:


    Mogs
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