HELP ASAP!! Not Eating- Drinking Lots of water- high ketone test

Discussion in 'Prozinc / PZI' started by Leigh B, Nov 8, 2020.

  1. Leigh B

    Leigh B Member

    Joined:
    Dec 22, 2018
    My Murphy threw up Friday morning. His BG was at 64, so I did not give him insulin. He did eat, and I tested him 2 hours later. He was at 143. 5 hours after that, he was at 503, so I gave him 1 unit.
    I had to go out of town, so my husband fed him and gave him 2 units at dinner.
    Saturday, he had breakfast and had his 2 units, as usual. My husband called around 6:45 pm and said Murphy had thrown up all over our bedroom and was not eating anything. He has been drinking lots of water.
    I told him to avoid the insulin shot, since Murphy was not eating and I rushed home this morning.
    I have tried to get Murphy to eat ANYTHING, and he is not interested. He is parked in front of the water bowl and is very lethargic.
    I was able to catch some urine and do a ketone test. The strip showed that he has a large amount of ketones (80) in his urine (I test every month or so, and it is usually "none" to "Very little")
    My usual vet is closed today. I am going to reach out to his last vet clinic, they open in 30 minutes.

    Any advice? I have not updated his chart, but his numbers have been steady. He DID have a teeth cleaning and extraction over a week ago. All of his bloodwork, other than the diabetes, was normal.

    Oh, and his BG was 326 at 12:30 and 388 at 1:05 today- a little while ago.
     
  2. Leigh B

    Leigh B Member

    Joined:
    Dec 22, 2018
    @MrWorfMen’s Mom
     
    Critter Mom and Deb & Wink like this.
  3. Pookie

    Pookie Member

    Joined:
    Oct 10, 2020
    I think this is an emergency situation that requires you to get him to a vet immediately!
    Signs of Diabetic Ketoacidosis (DKA)
    • Drinking excessive amounts of water OR no water
    • Excessive urination
    • Diminished activity
    • Not eating for over 12 hours
    • Vomiting
    • Lethargy and depression
    • Weakness
    • Breathing very fast
    • Dehydration
    • Ketone odor on breath (smells like nail-polish remover or fruit)
     
  4. Pookie

    Pookie Member

    Joined:
    Oct 10, 2020
  5. Pookie

    Pookie Member

    Joined:
    Oct 10, 2020
    @Critter Mom can you help? Perhaps she's already left for her vets. I hope so.
     
  6. SashaV

    SashaV Member

    Joined:
    Apr 25, 2020
    Please post in the Health forum! It's a 911 situation!
     
  7. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Hi Enid,

    Only just seen this (not been on the board much today).


    Mogs
    .
     
  8. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Hi Leigh,

    If you haven't already managed to get Murphy in to a regular vet, please take him to an ER vet straight away.

    Even if he's not already in DKA, high ketones need to be treated aggressively in a hospital setting. This is very much an emergency situation: DKA is life threatening.

    Sending prayers for Murphy. When you can manage it, please let us know how things are going.

    (((Murphy)))


    Mogs
    .
     
    Last edited: Nov 8, 2020
    Reason for edit: Grammar.
  9. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

    Joined:
    Mar 19, 2016
    I hope you were able to get him to the alternate vet. Be sure to tell them about the dental, and see if they can do a mouth exam, hopefully including a set of dental x-rays if one wasn't done post-procedure. Sometimes there are post-extraction infections, sometimes also tiny little fragments of bone are left behind, causing problems.

    Sending tons of healing vines for poor Murphy-- I hope he's feeling better very soon!
     
  10. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

    Joined:
    Mar 19, 2016
    Yes, I should have said up-front, it's 100% necessary for Murphy to be at a vet today, right now. The ketones need to be addressed as soon as possible.

    :bighug: :bighug: :bighug:
     
  11. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    @Nan & Amber (GA) - Very good suggestion about possible post-dental issues.


    Mogs
    .
     
  12. Leigh B

    Leigh B Member

    Joined:
    Dec 22, 2018
    I have taken him to the vet. He is getting IV fluids now. They want to transport him to an emergency room for overnight observation (they do not have overnight staff at his clinic), but I'm afraid of the stressful environment & transportation. I may leave him on fluids for several hours, bring him home for the night and take him back in the morning. I'm afraid transporting from clinic to clinic will keep his stress level elevated.
    His blood work did show high levels of ketones, but the rest of his blood work looked okay.
    The vet is being wonderful and trying to help me weigh the need for observation versus the stress of all of the transportation and being in a hospital environment.
    Thoughts on that?
    I have about an hour to decide.
    I'm leaning towards bringing him home so he will be comfortable.

    As always, thank you all for the fast response and information.
    I was sure to let them know about the dental. He was due for a follow-up at his regular vet to double check to make sure there was nothing left behind.
     
  13. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

    Joined:
    Mar 19, 2016
    I would go with the ER vet. Cats with high ketones can go downhill very very quickly.

    Some questions: have they given him any insulin? have they gotten him to eat at all?
     
  14. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Hi Leigh,

    I'm so glad you got Murphy to a vet. Thank you for posting an update on how things are going (we worry!).

    I can completely understand your desire for treatment to be as minimally stressful as possible but even if Murphy's ketone levels were to drop after the IV fluids at the general practice vets, there's the risk that they could potentially build up again within a matter of hours.

    I agree with Nan: I think the best thing would be to move him to the ER facility where they will be able to monitor him closely overnight. He might need aggressive insulin therapy to drive down the ketones and they would be best placed to provide intensive treatment and IV sugars as needed - and quickly. Also they need to get a handle on the nausea and inappetence. As Nan says above, when ketones are high things can turn on a sixpence.

    (((Murphy and Leigh)))


    Mogs
    .
     
  15. Pookie

    Pookie Member

    Joined:
    Oct 10, 2020
    When my cat went through DKA, he was hospitalized for 4 days. My vet made it clear that any delay getting him proper treatment would cost him his life.
     
  16. Leigh B

    Leigh B Member

    Joined:
    Dec 22, 2018
    They gave him some anti-nausea medicine and have not given him any insulin. Just IV fluids.
    The vet said she feels okay with me bringing him home as long as I monitor him every 2 hours. Then, if things start to look stressful, I can take him to the ER clinic.
     
  17. Leigh B

    Leigh B Member

    Joined:
    Dec 22, 2018
    Okay. Update... I am headed to my vet to pick him up and take him to the ER for overnight observation. You guys have helped give me information to get me through today.
    I can't thank you enough!
    I will update you on Murphy.
    Thanks for the love and prayers ❣️
     
  18. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

    Joined:
    Mar 19, 2016
  19. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Will continue to pray for Murphy. Fingers and paws crossed that the ER vets will have him feeling much better very soon.

    Try to do the best you can to get a someway decent night's sleep, Leigh. I know it's not easy but it's the best thing you can do for Murphy tonight. It will stand to you while you're caring for him during his convalescence.

    (((Murphy and Leigh)))

    :bighug:


    Mogs
    .
     
  20. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    DKA can also mean the electrolytes are out of balance, and more than the normal IV fluids could be required. Glad you decided to get Murphy to the ER vet clinic.

    Please, let us know how it goes. As Mogs said, we worry.
     
  21. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

    Joined:
    Mar 19, 2016
  22. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Fretting over here too.


    Mogs
    .
     
  23. Leigh B

    Leigh B Member

    Joined:
    Dec 22, 2018
    Murphy did okay overnight at the emergency clinic. However, he is still not eating. They have given him an anti-nausea drug and are going to give him an appetite enhancer.
    If he is still not eating, they are wanting to do an esophogastamy placement to get some calories in him. They said they can treat him for a while at the clinic and that is something that I can also administer at home.
    This is certainly not news I was hoping for. Have any of you had experience with this?
    I don't want to put this little fella through too much. I trust the vet but all seems so extreme, possibly because it's not what I am expecting or hoping for.
    He was feeling great just three days ago.
     
  24. Leigh B

    Leigh B Member

    Joined:
    Dec 22, 2018
    Thank you both for your concern. I've just talked with the vet after getting him from the ER back to the vet clinic. Posted an update ^. Would love your feedback.
    Still feeling very unsure.:(
     
  25. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

    Joined:
    Mar 19, 2016
    Feeding tubes can be literal lifesavers, they sound a lot scarier than they are.

    Tagging @Aleluia Grugru & Minnie who had one for Minnie, I know there are others around here with recent experience with them, she will know.

    How is he doing other than not eating? What is his ketone level?
     
  26. Lisa and little

    Lisa and little Well-Known Member

    Joined:
    Sep 24, 2018
    Praying for Murphy and you
     
  27. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

    Joined:
    Mar 19, 2016
    I tagged Ale because I don't have personal experience with feeding tubes, but I can tell you what I've observed from reading posts around here. Positive reviews all around, basically. Having a cat who isn't eating and probably also needs regular medications to get over something is incredibly stressful. You know that if they would just eat they would start to feel better, but they don't know that and they can be very very stubborn. Having a feeding tube in place gives you the security of knowing that, whatever happens, they'll get enough food and their meds. You don't have to stay up all night trying to coax them, stressing out the whole time.

    Frankly, if the vet is offering a tube, I'd probably take it as long as it seemed like eating was Murphy's main obstacle to wellness. I completely understand not wanting to put him through too much, but again, this is usually something that seems more drastic and extreme than it usually turns out to be. I wouldn't do it as part of a large suite of last-ditch efforts for the reason you state, but if he's got a good chance of recovery with just this, I think it's an excellent option, and I'm glad the vet offered it so relatively early here.

    No matter what, though, it is 100% your decision. You're the one that is there and able to talk to the vet and get the really detailed view of the situation with Murphy that we don't have. And you also know your own situation and what is and isn't a reasonable course of action for you. We're here no matter what you decide.

    :bighug: :bighug: :bighug: :bighug:
     
  28. Leigh B

    Leigh B Member

    Joined:
    Dec 22, 2018
    Thank you all so much.
    I'm praying very hard that I will know the right path.
    I'm torn because I don't want to put him through any more stress, especially another sedation. (Again, he had a dental procedure not even two weeks ago. His blood panel was fine, besides his glucose at that point in time.) I can't help but worry that the dental procedure has somehow caused this? It is the only thing that has happened with him in the last year.
    I'm also wondering if he's not eating is a result of his body just being worn out.
    On the other hand, I feel like if I can get him over this hump, he may be okay.
    Praying that his appetite stimulant will work. If it doesn't, I may try to bring him home before going to the extreme of the feeding tube. The stress of being out of vet clinic for 2 days has got to be taking its toll. He is a cat who is more prone to stress then other cats I have had.:(
    Also, if this really is getting to the end of the road, I don't want to use a feeding tube to extend the inevitable. Poor fella
     
    jt and trouble (GA) likes this.
  29. Leigh B

    Leigh B Member

    Joined:
    Dec 22, 2018
    She did not check his ketones this morning. She said her main concern is getting him to eat. She feels certain they are probably still pretty high.
    I wonder if I could get him home and comfortable, I could get him to eat and then give him some insulin.
    He has only had one unit of insulin since Saturday morning.
    I thought that would help with ketones? I'm confused!
    I wish I knew the magic answer to keep him comfortable and happy.:arghh:
     
    jt and trouble (GA) likes this.
  30. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

    Joined:
    Mar 19, 2016
    They should be checking ketones and BG and administering short-acting insulin, yes. That is worrying to hear that they are not doing those things.

    Another alternative is assist (syringe) feeding. It's hard to do for any length of time, but sometimes you just have to get them jump-started. You can do that at home, obviously, but are they at least trying to do that while he's at the vet, too? He needs to get some food into him!
     
  31. Aleluia Grugru & Minnie

    Aleluia Grugru & Minnie Well-Known Member

    Joined:
    Dec 21, 2019
    The feeding tube is not as extreme as it sounds and it did save Minnie’s life I’m sure. She did very well on it. She jumped and played and it didn’t limit her quality of life at all. I swear I wish it could have stayed on forever because to be able to feed them and give them all the meds so easily is a God sent. If the vet is suggesting it and recommending it, I’d definitely let them do it. Minnie has a traqueal tube and it was very easy to use and clean. It started on for 2 weeks. I can give you tons of tips of how to handle it if you do it.
     
  32. Leigh B

    Leigh B Member

    Joined:
    Dec 22, 2018
    THANK YOU!!!
    He is not responding to the appetite stimulant. She is going to try another food.
    I talked with my husband, and we both agree that Murphy has been in a good place lately. Again, he had blood panels done on 10/28, and everything looked ok (besides the expected elevated bg). Just Thursday, he was playing around the house with the energy of a kitten.
    That said, I am hoping this is a "hump" we can move past.

    Did Minnie eventually go back to eating normally? And, only 2 weeks with the tube?
    Is Minnie back in a good place? One of my struggles is whether or not I should "put him through this" if he is just on a decline to the inevitable.

    Thanks for the insight! I was not expecting this option. It is so hard to make these "sudden" decisions. Having this group as a resource has been TREMENDOUS!
     
  33. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Hi Leigh,

    I'm reading through latest info. At first glance I'm concerned about your vet's approach: if a cat's ketones are high that's what makes them feel awful and not want to eat. Also if the ketones aren't dealt with the cat will tip over into DKA.

    While I'm reading,
    There is something very wrong here. The core treatments for a cat throwing ketones are calories AND insulin. A vet competent in the treatment of ketosis / DKA should know this and treat accordingly.

    .* Is there any way you could check whether the ER vets gave Murphy any insulin overnight?

    * Also are there any other veterinary practices near you?


    E-tubes sound much worse than they are in reality. Great for getting food and meds into poorly kitties. They save lives.

    BRB when I've read through the most recent info.


    Mogs
    .
     
    Last edited: Nov 9, 2020
  34. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Ketosis and DKA are both treatable and cats can go on to make a complete recovery after receiving timely, appropriate treatment.


    Mogs
    .
     
  35. Leigh B

    Leigh B Member

    Joined:
    Dec 22, 2018
    Yes, the ER gave him a LITTLE insulin (1 unit). They've got him on IV fluids and are checking his BG. I was concerned about that, as well. That is how I understand things (insulin=lower ketones=increased appetite). I explained to the vet that I am concerned that he's not had much insulin since Sat. am.

    Everyone seems to agree that the tube is not as daunting as it sounds.
    If it is possible to do that and get him back to a "normal" place, I will not hesitate.
    My concern is putting him through that and him not recovering. In other words, I don't want to put him through it if it will not do any good.
    The vet is going to call me to discuss the details before the procedure. She said she understands me weighing my options, but that he does not need to go much longer without any food. She said much longer will result in increased medical complications.

    Yes, I will consult my usual vet, once I get him home.
     
  36. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Leigh, please can you clarify straight away: is Murphy still with the ER vets or back with your regular vet?


    Mogs
    .
     
  37. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
  38. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    From the Dr. Pierson link:

    Unfortunately, when most people hear the term “feeding tube,” they tend to panic – feeling like this is the end of the road for their cat. However, feeding tubes should not necessarily be viewed as a doom and gloom overly heroic measure.

    I often hear people say “oh, I would never put my cat through that!”

    Unfortunately, these folks are not recognizing the tremendous value of feeding tubes to support ill patients while they heal from a temporary illness or injury. Most cats are not bothered by the tubes at all! The human is the one who is bothered by it as the cat just goes about its daily routine.


    Mogs
    .
     
  39. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

    Joined:
    Mar 19, 2016
    I agree with Mogs; it sounds like there's more that could/should be done by the vet. I hope your conversation clarifies what's going on and the options.

    Hang in there. These things always seem to arise suddenly and change rapidly, making it hard to figure out the best course of action. That's so hard to deal with on top of the emotions when your little guy is sick... We'll help as much as we can with info and ideas :bighug: :bighug: :bighug:
     
  40. Leigh B

    Leigh B Member

    Joined:
    Dec 22, 2018
    Regular vet
     
  41. Leigh B

    Leigh B Member

    Joined:
    Dec 22, 2018
    He is at the regular vet clinic. She is going to try another type of food and call me in about an hour. I'm going to get the full rundown on his levels and all of that before she proceeds with the feeding tube.
    Once I get him stable and at home, I'm going to get a second opinion from the vet I usually see. unfortunately, my typical clinic is not open on Sundays, so I had to go to my previous vet clinic.
    Hoping we will not need to go back to the ER at all during any of this
     
  42. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    You are correct in your understanding, with the additional proviso that the cat also needs calories in addition to the insulin.

    You are right to be concerned.

    If cat is not in DKA then fluid therapy along with aggressive insulin treatment - typically including use of rapid-, short-acting insulin - is needed to get glucose into the cells and drive down ketone production. This needs to be done in a hospital setting with the kitty on a dextrose drip to prevent hypoglycaemia. At the same time all efforts need to be made to control nausea and stimulate appetite in order to get the calories needed to stop ketone production into the cat. If the meds alone aren't sufficient to restore appetite then a feeding tube is the best next step.

    If cat is in DKA then, in addition to the above, intensive treatment and monitoring are needed to correct electrolyte and acid-base imbalances and restore normal metabolic function.

    Intensive treatment as described above is not something that can be done at home.

    If the feeding tube is placed it should make the continuing treatment needed at home much, much more reliable and successful. You'll be able to ensure that Murphy gets the food he needs. This in turn means that it will be much more straightforward and safe to administer the insulin he also needs to stabilise normal metabolism and aid recovery. The feeding tube will also make it very straightforward to give Murphy any anti-nausea and appetite stimulant meds he needs to help him along the way to eating normally on his own again.

    Note: Ketosis and DKA arise due to the following:

    Not enough food + not enough insulin + infection, inflammation, or other systemic stressor.​

    In addition to getting food and insulin into Murphy, the vets also need to identify what is causing the third problem, i.e. checking for infection/inflammation - dental? UTI? other? - and treating the problem. Please ask them about this.

    Another thing to check for is whether Murphy might be constipated. If he became dehydrated before you took him to the vets there is the possibility of constipation. If a cat is constipated then anti-nausea and appetite stimulant meds won't work properly (for obvious reasons). Treatment of the constipation can be a help towards restoring normal appetite (possibly with a few days' treatment with a prokinetic like metoclopramide to improve gut motility).

    As I said above, ketosis/DKA is a treatable condition. It's like a 'metabolic hiccup', albeit a serious one. With timely and appropriate veterinary treatment, cats can and do go on to make a complete recovery from it. As you posted above, Murphy's recent labs were very good just a week and a half ago and he was happy and playing like a kitten only a couple of days ago. That sounds to me like a kitty with a whole lot of living left to do! :) With ketones high, Murphy is probably severely lethargic at the moment and that's quite scary to see. (((Leigh))) However, Murphy is young and cats are extraordinarily resilient little creatures. I am in awe of their powers of recovery. All going well, with the right treatment he will again be back to his happy, playful self.

    Keeping you both in my prayers. Please keep us updated with Murphy's progress and shout for any help you need.

    (((Murphy and Leigh)))


    Mogs
    .
     
    Last edited: Nov 10, 2020
    Reason for edit: Grammar.
  43. Leigh B

    Leigh B Member

    Joined:
    Dec 22, 2018
    You have brought tears to my eyes. Thank you for the kind words and guidance.
    I have made notes for the vet and will let you know what she says.
    Thank you!!!!!:bighug:
     
  44. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Is your vet going to run more blood work today? Please get them to check Murphy's electrolytes before you take him home to make sure he's not in DKA and that he is negative for ketones. If ketones are still high - quadruply so if the electrolytes are also out of whack - then Murphy needs to be in a hospital where the vets know how to properly treat ketosis/DKA and can provide the intensive insulin, fluid and electrolyte therapy necessary to return Murphy's metabolism to normal (as outlined in one of my earlier posts above).

    I'd also suggest that you purchase a blood beta ketone meter for home use. The strips are pricey but you would be able to test Murphy for ketones at any time, as easily as testing blood glucose levels (using the ear). Ketones are detectable in blood sooner than in urine. It's a good safety measure.


    Mogs
    .
     
    Last edited: Nov 9, 2020
  45. Red & Rover (GA)

    Red & Rover (GA) Well-Known Member

    Joined:
    May 18, 2016
  46. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Very helpful video on how to give food, water and meds using an e-tube:





    NB: If attempting to use Coca Cola to unclog the tube it must be REGULAR Coke, not Diet Coke (latter has artificial sweetener).


    Mogs
    .
     
    Last edited: Nov 9, 2020
  47. JaxBenji

    JaxBenji Well-Known Member

    Joined:
    Jul 10, 2020
    Hi @Leigh B :bighug::bighug::bighug: First lots of hugs to you and Murphy :bighug:

    Here to share about our feeding tube - Jax had an esophagostomy tube (e-tube). At the time, he was dealing with a severe infection (infected ulcer, suspected sepsis, low potassium) - the ER admitted him and transferred him to the internal medicine team - the internal med team did the e-tube. His records say he was on Hills a/d for food (which makes sense now that I've been on this board - it's super easy to water down and syringe feed). His tube was in for about 3 weeks but I only used it for feeding for about a week (rest of the time was his cocktail of meds) - we fed e-tube and then always offered food out too - one day, he started eating the food out.

    So, in summary, I pushed food, water, and meds down the tube. I flushed it with water every time I pushed something down - I never remember it being dirty or gunky; the IM would check on it too at his follow-ups; I personally never had to do anything with the stoma site (where it entered his esophagus).

    After Jax started eating food on his own, I still pushed extra mls of water as well as his meds. I would totally get one again if he needed it and was stable for it. I totally think it helped save him - it gave him energy to heal and helped him accept the meds we were throwing at him.

    Here's a pic of Jax eating with his tube in place as well as his kitty kollar (and all of his water and food choices...ugh he was so sick here but on his way up).

    Hang in there :bighug::bighug::bighug: Try to trust you'll make the best decision for you and your kitty no matter what it is. We all do the best we can :bighug:

    JaxTube.jpg
     
  48. Leigh B

    Leigh B Member

    Joined:
    Dec 22, 2018
    Just spoke with her. She said he is pretty bad right now. His BG is at 500, so they're giving him insulin. They are also about to do the tube insert.
    They are going to feed him and observe/monitor him overnight (at their clinic, not the ER). I talked with her about my concern that he's not gotten insulin. She said he REALLY needs food right now. She's concerned about hepatic lipidosis (sp?)...I am about to research that. She said they are giving him insulin right now, but giving insulin with no food since Saturday am (that he threw up) could cause more problems- it is a delicate balance, etc.

    Any thoughts there? (on the lipidosis??)

    It was a sad conversation for me. She said that we need to discuss the feeding tube as an option, or move on to the hard discussion about euthanasia (because of his current state- said he is obviously lethargic and in a depressed state).
    I told her, again, that 12 days ago he had a good blood panel and Thursday was very active. It does not make sense to me that he is this bad.
    We discussed the success of the feeding tube (I know that no promises can be made that it will work), and she said that one of the vets there had one for his cat recently.

    Your posts have helped me feel like I am doing the right thing, and that he will be able to handle it. Hopefully, it will be days/weeks, and not months before he is eating again. It has NEVER been an issue. In fact, I've had to closely monitor his food choices b/c he eats so much.

    At this point, he is at the vet and she is moving forward with the procedure. She said they'll try to feed him within the hour of him waking up. They are going to keep him overnight and monitor his blood, urine, etc. before sending him home to me.

    It is frustrating to me, too, to have to leave him there. He is a cat who stresses more than cats I have had in the past. Ready to get him home and comfortable. And, I can't go in the clinic b/c of Covid.

    Anyway, I am rambling because I am nervous and exhausted.
    Thank you all for the great information, love and prayers...

    I will post updates.
    It is hard knowing that he is struggling so much right now. I hope I am doing the right thing. :(
     
  49. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

    Joined:
    Mar 19, 2016
    :bighug: :bighug: :bighug: :bighug:

    He's relatively young, and starting from a strong base, even if he's in a weakened state right now. Hopefully, that will see him through.

    I wonder if keeping him overnight is really necessary? As I said, I've never had a cat with an e-tube, so I don't know what is standard procedure here.

    Fingers and paws crossed here, please update us when you can.
     
  50. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    That's why cats with ketones should be given IV dextrose so that they can receive insulin safely while they're having difficulty eating. (Insulin should not be withheld from cats throwing ketones: it's a cornerstone of the treatment.)

    He needs both food AND insulin to fight the ketones. I'm relieved to hear that they've finally given some.

    Due to the nature of a cat's metabolism, if it goes without food for any length of time fatty deposits start to build in the liver (hepatic lipidosis, potentially life-threatening but also preventable/treatable if the cat gets timely help with nutritional support). This is the reason why it's critical for a cat having difficulty eating due to nausea to get strong enough anti-nausea treatment straight away - possibly with additional support from an appetite stimulant - to help them to eat again. An appetite stimulant on its own is extremely unlikely to work. If the meds don't work fairly quickly to help the cat start eating under its own steam then a feeding tube is the right course of action to take. As Dr. Pierson advises in the page I linked earlier, if the meds don't work quickly it's better not to delay placing a feeding tube.

    I'm very glad to hear that Murphy's going to be intensively monitored. Tomorrow, when you're collecting Murphy, I suggest asking for a copy of his blood and urine test results for your own records.

    Before you take him home, please, please make sure that the vet gives you an adequate supply of anti-nausea meds (ondansetron, Cerenia). It's so important to have these meds at home to support adequate food intake during the recovery period and prevent relapse. See the section on nausea control in the following document for details of appropriate treatments for feline nausea:

    IDEXX Pancreatitis Treatment Guidelines

    Although the document's focus is on pancreatitis, the treatments described are also applicable for nausea due to other conditions, including ketosis and DKA. It's a good guide as to what to ask the vet for.

    Did the vets say anything about infection/inflammation, and did they double-check that Murphy's not constipated?

    ETA: What treatment has the vet been giving for nausea? Is Murphy getting the anti-nausea meds often enough? (Ondansetron at an appropriate dose can be given every 8 hours.)

    Also, did the vet test for pancreatitis to rule it out? (Sorry, should have thought to suggest this earlier: diabetes and pancreatitis often travel together.)



    Mogs
    .
     
    Last edited: Nov 9, 2020
  51. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    I very much think so.


    Mogs
    .
     
  52. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
  53. JaxBenji

    JaxBenji Well-Known Member

    Joined:
    Jul 10, 2020
    Yes, Jax came home with mirtazapine - I'm looking at his records (this was in 2018) and it said 1/4 of 15mg tablets once every 48 hours until he eats on his own. I remember using a pill cutter and then putting it in a syringe with a little water and giving it to him.

    I should note feline drugs are way out of my comfort/knowledge zone but I am reading his records :)
     
  54. JaxBenji

    JaxBenji Well-Known Member

    Joined:
    Jul 10, 2020
    Thought I should add I noticed he came home with Cerenia too for antinausea - 1/4 of 16mg tab every 24 hours. I don't remember details but I'm guessing we stopped cerenia and mirtz when he started eating on his own.
     
  55. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    @JaxBenji -

    Thanks for this, Susanne. I know that anti-nausea meds are absolutely critical but I wasn't sure whether appy stimulants would be used when a feeding tube was placed. Thinking about it further, it makes sense to give both meds because it could hopefully help the kitty to eat on its own sooner.


    Mogs
    .
     
  56. Leigh B

    Leigh B Member

    Joined:
    Dec 22, 2018
    Dr. Michael just called. She said he did great and was waking up. She is going to slowly introduce the food. They ARE testing his BG every 3 hours.
    He is not constipated.
    They are going to keep him tonight with fluids and observation.
    She hopes he will be stable and have readings that make them feel comfortable to send him home tomorrow. She said she has LOTS of stuff (info, food, meds) to send home with me. They will review everything with me when I go pick him up.
    THANK YOU ALL for the information. I am making very detailed notes with questions to ask- some I will ask when I call at 4:00 for follow up.
    I am sure I will have lots of questions for you as I ease into this. Will try to get them all answered with the vet, but it is reassuring to have you all as a resource.
     
  57. Leigh B

    Leigh B Member

    Joined:
    Dec 22, 2018
     
    Deb & Wink likes this.
  58. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Leigh,

    FYI, ondansetron is a human medication. If your vet doesn't carry it in stock you can get a written Rx from the vet and get it filled at a regular human pharmacy. It is a very good anti-nausea med.


    Mogs
    .
     
    Last edited: Nov 9, 2020
  59. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    I am SOOOOOOO pleased to read this.

    I am *** delighted *** to read this.

    (((Murphy)))


    Mogs
    .
     
  60. Pookie

    Pookie Member

    Joined:
    Oct 10, 2020
    When my Sporty was so desperately, desperately ill, the only consolation I had was knowing that he was receiving the best care in the area. I could never have done what the acute care team did for him. (I remember when we visited him they would wheel him out on a gurney/cart and we couldn't hold him because he was pumped so full of fluids that he just peed constantly.)

    But he pulled through and went on to live another 10 years without issue. He was a street stray I took in so I don't know how old he actually was, but he was at least 18 when circumstances unrelated to FD took him over the bridge.

    I'm wishing you both strength.

    Enid
     
  61. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Another thought, Leigh. Whiie convalescing after ketones/DKA, the key to recovery is ensuring that the kitty gets enough calories and insulin. If your vet puts Murphy onto a higher carb food than normal for the time being that's OK: the extra carbs can provide support for administration of sufficient insulin to keep ketones away.


    Mogs
    .
     
    Last edited: Nov 9, 2020
  62. Aleluia Grugru & Minnie

    Aleluia Grugru & Minnie Well-Known Member

    Joined:
    Dec 21, 2019
    Yes, Minnie was kept overnight because they wanted to make sure tube was working well and observe her eating via tube after anesthesia worn off. I think it’s standard procedure. She came home with the same apetite stimulant and also anti nausea ondansetron. I was suppose to give stimulant if needed and ondansetron every 8 hours.

    make sure they send you home with different size syringes. I used the large one for water as you need to flush their system before and after feeding with water and then I used the medium ones for food and small ones for meds. They should also give you some cleaning solution since you’ll need to clean around the tube once a day to avoid infection. Minnie seemed to enjoy that and would even stick her neck out so I could really get in here with the cotton ovals. I would also always apply a think layer of Neosporin before closing everything back up. She should come home with a protective collar so the site is kept clean. The key with the food is bleeding it really well so no particles get stuck on the syringe when you’re trying to fill it. I would always pound the pills into powder and mix with the food. I would also always offer her food first before tube feeding. After the first week, she started eating on her own so the tube was just for fluids and meds.
     
  63. Aleluia Grugru & Minnie

    Aleluia Grugru & Minnie Well-Known Member

    Joined:
    Dec 21, 2019
    Do it very slowly at first until you get used to the tube and to how your cat takes the feedings. Minnie would burp sometimes so I’d stop and give her time then start again. Always hold the tube up so it’s easier for the food to go down and I’d wait to make sure nothing was coming back up before lowering the tube and closing it.
     
  64. JaxBenji

    JaxBenji Well-Known Member

    Joined:
    Jul 10, 2020
    @Leigh B - I can DM you a link to feeding tube info and Jax's med schedule if that would help. I was giving meds around the clock and had to keep everything straight. I also don't want to overwhelm (Jax had a LOT going on).
     
  65. Leigh B

    Leigh B Member

    Joined:
    Dec 22, 2018
    It does seem quite daunting. Still hope I made the right decision.
    I just have to know whether or not food would get him back into a good place and this is the only way to know that.
    I'm sure I will be reaching out tomorrow.
    Sounds like there's a whole lot more to this than I realized. I guess just a part of the new routine.
    Really ready to have him home!
    Thank you
     
  66. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
  67. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

    Joined:
    Mar 19, 2016
    Try to get a good night's sleep tonight, if possible. Murphy's going to need a lot of your attention when he gets home, you'll want to be as well-rested as you can before you start.

    Treat yourself to some ice cream or chocolate, or whatever else you want, too. You deserve it after today!
     
  68. Aleluia Grugru & Minnie

    Aleluia Grugru & Minnie Well-Known Member

    Joined:
    Dec 21, 2019
    It’s really not daunting I promise you. First day is hard but you get the hang of it and then off you go. Just like home testing
     
    Last edited: Nov 9, 2020
  69. Aleluia Grugru & Minnie

    Aleluia Grugru & Minnie Well-Known Member

    Joined:
    Dec 21, 2019
    Minnie was on a ton of meds too for pneumonia and cardiomyopathy. I had the list taped to the fridge and the schedule so I knew what meds went with each feeding. I’d pull the next ones out and set them on the counter next to her food I wouldn’t mess it up!
     
  70. JaxBenji

    JaxBenji Well-Known Member

    Joined:
    Jul 10, 2020
    And I tested the limits of my cell phone alarms :) Thankful it wasn't for a long time though it was hard to keep that in mind during that phase of life.
     
  71. Leigh B

    Leigh B Member

    Joined:
    Dec 22, 2018
    No news yet, except that he made it through the night. The vet is making a few rounds and is calling me soon.
    I was able to sleep, thankfully.
    I will give a report as soon as I have it!
     
  72. Leigh B

    Leigh B Member

    Joined:
    Dec 22, 2018
    Not good news. She said he is still very sick. His ketones were in the 300's, and his bg is still around 382.
    He is keeping his food down, but it sounds like he is quite miserable.
    She is going to do another urinalysis to see if she can detect further infection and see if he needs some sort of antibiotic treatment.
    The next step is CRI, which she explained is using human insulin that absorbs more quickly. They have been using his prozinc for the last few days, and he's not responding.
    If we move forward with CRI, he may be in the hospital for days. He will need constant monitoring, etc.
    The thought of putting him through all of this is heartbreaking. I just want to hold him and make him feel better. I know he is miserable in the hospital and clinic.
    I should know more about the urinalysis soon, but am not feeling very hopeful.
    Please keep us both in your prayers.
    I had this hope that getting food in his system would cause him to start to turn around quickly. That is not happening.
    I feel like I am about to have to say goodbye to my sweet boy, and I am so so so very sad about it.
     
  73. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

    Joined:
    Mar 19, 2016
    :( :( :(

    I'm glad they're going to be using the fast-acting insulin-- he really really needs it to get control of the ketones. I hope that that plus the food starts to turn things around for him.

    Even if they won't let you visit, they might let you bring him something familiar-smelling (an old t-shirt of yours, his favorite towel/blanket, etc.). Sometimes that really helps to bring down the stress of being in the hospital. Poor little guy.

    :bighug: :bighug: :bighug:
     
    Leigh B likes this.
  74. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Hi Leigh,

    I understand how worried and distressed you must be feeling right now.

    It sounds like the vet is finally giving the appropriate treatments to bring down BG levels, stop ketone formation and balance electrolytes. I'm so sorry it has taken so long for them to get to this stage. :(

    Please check that the sample will be acquired by cystocentesis, not free-catch, and also that a culture and sensitivity is being run.

    Also, make sure she tests for pancreatitis, if only to rule it out. A SNAP fPL test will give an on-the-spot yes/no/unclear result (works a bit like a pregnancy test). A Spec fPL test gives a numerical result indicative of both presence and severity of inflammation but it needs to be sent to an external lab so takes a little longer to get the result. Should pancreatitis be present then pain relief (buprenorphine) would be needed on top of the anti-nausea and appetite stimulant meds.

    Here is an extract from the WSAVA guidelines for treatment of ketosis/DKA:

    Concurrent disease has been documented in approximately 90% of cats with DKA, with the most common being hepatic lipidosis, chronic kidney disease, acute pancreatitis, bacterial or viral infections and neoplasia (Bruskiewicz et al. 1997).

    Also:

    Those cats with systemic signs of DKA such as anorexia/vomiting/lethargy need hospitalisation and therapy with regular insulin and intravenous fluids. Monitoring of sick ketoacidotic patients is intensive. Acid-base, electrolyte and blood glucose levels can change rapidly during therapy, and close monitoring of these parameters is mandatory. For example, it is not uncommon for 3–4 changes of fluid type to be required in the first 24 hours of therapy. If in-house monitoring of electrolytes and acid base status is not available, referral should be considered, unless an outside laboratory can supply a result in a couple of hours.

    [Emphasis mine]

    Leigh, I strongly recommend you ask the vet currently treating Murphy to confirm that they have the facilities to offer the intensive treatment and monitoring described in the above paragraph. If they don't then I think you should consider asking them for an urgent referral to a facility that can provide this level of intensive care.

    Keeping both of you very much in my prayers.

    (((Murphy and Leigh)))

    :bighug:


    Mogs
    .
     
    Last edited: Nov 10, 2020
  75. Leigh B

    Leigh B Member

    Joined:
    Dec 22, 2018
    YOU ALL ARE RIGHT!! That first vet did not test for infection in his urine. I am SO INFURIATED!!
    The current vet is helping me with it.
    He has a UTI. They are starting him on antibiotics.
    I am about to speak with the clinic manager. We are TWO DAYS behind on his treatment.
    I asked all of the questions to the previous vet, and she reassured me she was doing the right things. She was NOT!
    They think we can turn it around but he's been in DKA for 2 days longer than he should have, so it will be several days of CRI in the hospital to get him back to a good place.
     
    Critter Mom and Nan & Amber (GA) like this.
  76. Leigh B

    Leigh B Member

    Joined:
    Dec 22, 2018
    The new vet did say that it was intensive treatment. She said they check his bg and adjust if needed every hour. It can get very expensive. I have told them I think they should help with the finances, since they wasted 2 days worth of treating the infection.
    I feel like she knows what she is talking about. I did not have a good feeling with the last one.

    I will let y'all know what happens...
     
    Critter Mom likes this.
  77. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

    Joined:
    Mar 19, 2016
    :eek: :eek: :eek: :eek: :mad: :mad: :mad: :mad:

    I guess "better late than never," but I'd be steaming mad, too!

    So glad the current vet is on top of things. Fingers and paws crossed for Murphy, your poor boy!!!!
     
    Critter Mom likes this.
  78. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    I could not agree more. They did not run adequate initial diagnostics and they delayed the intensive treatment Murphy needed as soon as you brought him in, introducing unnecessary jeopardy to the situation.

    I am sitting here apoplectic with anger on your behalf, Leigh. Fingers, paws, and everything else possible are well and truly crossed that the vet now treating Murphy will get things going in the right direction.

    I really appreciate your posting of updates to let us know how things are going. As always, if there's anything we can help with just shout.

    (((Murphy and Leigh)))

    :bighug:


    Mogs
    .
     
  79. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    He also needs his electrolyte levels and acid-base status monitored/balanced.

    The WSAVA DKA guidelines I linked to above are very helpful. Although they're a bit 'technical', there's enough of it in plain English to help you understand what treatments are appropriate, typical time needed to treat, and also what to ask the vet about.


    Mogs
    .
     
    Nan & Amber (GA) likes this.
  80. Leigh B

    Leigh B Member

    Joined:
    Dec 22, 2018
    Thank you. I am so mad! He has been continuing to suffer since Sunday, to the point of a feeding tube...and it is because of a "not-so-uncommon" UTI infection!!:mad::mad::mad::mad::mad: That could have been caught if she'd just done a thorough urinalysis.
    They are taking their time calling me back, so I hope that means they are coming up with a plan to assist me.
     
    Critter Mom and Nan & Amber (GA) like this.
  81. JaxBenji

    JaxBenji Well-Known Member

    Joined:
    Jul 10, 2020
    ((Leigh)):bighug:((Murphy))

    Keeping you all in our thoughts and prayers.
     
    Critter Mom likes this.
  82. Lisa and little

    Lisa and little Well-Known Member

    Joined:
    Sep 24, 2018
    Here too!
     
    Leigh B and Critter Mom like this.
  83. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

    Joined:
    Mar 19, 2016
    It's not just lost time; neglecting to do a basic search for infection in a diabetic cat who is already throwing large ketones, and then also not doing the intensive care necessary to take care of the ketones themselves, has put Murphy's health and even life at risk. And now it has necessitated a longer course of extremely expensive treatment. It's absolutely inexcusable, in my view.

    Please keep us posted!
     
    Leigh B and Critter Mom like this.
  84. Lisa and little

    Lisa and little Well-Known Member

    Joined:
    Sep 24, 2018
    Makes me so angry. Happens too often
     
    Leigh B likes this.
  85. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    A thought: maybe you could request a hard copy of Murphy's treatment records and test results then use the WSAVA feline DKA management guidelines as a foundation for any discussions with the vets. The WSAVA recommendations are pretty standard in terms of what one should automatically expect a vet to do when treating a feline patient with ketosis/DKA. If there are incongruities between the guidelines and their actions, perhaps ask them for a full explanation of the reasons why? Preferably in writing.

    I am so sorry about what's been happening/not happening, Leigh. :(

    Prayers continue for both of you.

    (((Murphy and Leigh)))


    Mogs
    .
     
    Leigh B and Nan & Amber (GA) like this.
  86. Leigh B

    Leigh B Member

    Joined:
    Dec 22, 2018
    Thanks, again, to all of you.
    The good news is that the new vet seems to be extremely competent. She has mentioned things that you all have told me to be sure to mention, before I have even had a chance to ask. (he is getting the supplements with his insulin, getting the anti-nausea, etc. and she has tested his pancreas).
    She is sending me text updates with BG and feeding info every hour.*
    I am going to pick him up at 7:00 from that clinic and take him to the ER for overnight observation. The tiny silver lining in that is that I will be able to see and love on him (husband is driving, so I can be with Murphy in the back seat <3). I hate that he has to spend more time away from home, but glad I get some time with him. And, I'll take a t-shirt for him to sleep with. <3

    Anyway- he is certainly not out of the woods yet. And I am certainly not finished with my discussions about the first doctor's neglect.
    But, I have been holding onto the anger of the situation all day, and it is not doing any good. I need to focus on positive prayers and energy for Murphy and deal with the initial neglect once we (hopefully) get him stable.
    I have told them several times that it is overwhelming for me to think about the fact I contemplated putting him to sleep today, only to learn he had an infection that should have been treated with antibiotics, and caught immediately. ESPECIALLY because of what he is going through. He has two IVs and a feeding tube!!!! ARG...getting mad again....

    *His info: 12:46- BG 383/ 2:33 BG 335/ 3:01- BG 434- but he had just been fed/ 4:00 BG 418

    She said they are going to have the ER put him on a freestyle libre so that they can wave a reader over it to get his bg reading. I have seen commercials for these (my husband has jokingly asked if we could get one for Murph-now we know). She said they last 2 weeks and will save him from as many glucose sticks and save a little money, too.

    Hoping that he will be as comfortable as possible at the ER tonight. With the antibiotic and CRI insulin administration, I hope that those ketones are under control SOON.

    Again, will post updates.

    THANK YOU....My support group:bighug:
     
  87. Leigh B

    Leigh B Member

    Joined:
    Dec 22, 2018
    BG 333....going in the right direction
     
  88. Leigh B

    Leigh B Member

    Joined:
    Dec 22, 2018
    What a long day!! Just took him from the vet to the ER. He is pitiful! He was drooling a bit and had a hard time holding his head up. I think some of that was from the feeding tube stuff around his neck. Anyway, he slept on my hand and I was able to love on him.
    The NEW vet is wonderful. She said she feels like he is heading in the right direction, even though he still looks pitiful. She reviewed all that she had done today, including supplements to his IV to target his low heart rate this am. That appears to have worked.

    ANYWAY- so tired...as much from worry as from anger. But, praying hard that tomorrow will be a better day.

    I DID have a realization...I was thinking through what could have contributed to his UTI. Last weekend, I went to get them (I have 2 kitties) more litter, and the store was out of my usual brand. I had to get a different brand. I wonder if that could have contributed to his infection? I DO have more of their usual litter ordered and on the way through Chewy, because my pet store keeps selling out.

    Good night! Hope to send a good report in the morning.
     
  89. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

    Joined:
    Mar 19, 2016
    Aw, I'm so happy you got to see him and love on him (drool and all)! And that the new vet is a good 'un! Sounds like he is in good hands, which is all you can ask right now...

    Dunno about the litter, hmm. I don't think it could cause a problem directly (unless it were contaminated with bacteria, which I've never heard of). I definitely wouldn't worry too much about the possibility. UTIs happen, especially in diabetic cats.

    Sleep well, hoping for a good report about your little guy in the morning!
     
    Critter Mom and Deb & Wink like this.
  90. Deb & Wink

    Deb & Wink Well-Known Member

    Joined:
    Jan 31, 2013
    Be kind to yourself. Hope you are able to get a good nights rest. There is always hope for tomorrow, when the sun will shine.

    Drool away little Murphy! Bet he is extra tired too. Could still be groggy from all the treatments at the vets today.
    Progress. Tiny little baby steps, but Murphy sounds like he is making progress. All paws crossed here for his recovery.

    Think of it this way. A sugar rich environment, like the urinary tract system of a diabetic cat, is a perfect environment for bacteria to thrive, with all that extra sugar to feed on.
     
  91. JL and Chip

    JL and Chip Member

    Joined:
    Dec 28, 2009
    Got the earlier tag re: feeding tubes but am a bit late to the party. Sorry about that. Anyway, I’m glad you went forward with the feeding tube. They can be absolute life savers and often the fear of “putting them through that” is more in our head than based in reality. I’ve dealt with feeding tubes several times and have no regrets.

    It sounds like you finally found a good, competent vet who has a handle on how to treat Murphy’s issues and that’s exactly what he needs right now — proper medical care and time. Sounds like you’re finally exiting the “Twilight Zone” of confusion and that the world is starting to make sense again. The whole process can be so stressful and confusing. Whew! :)

    Cats can look like absolute heck warmed over in the early days and that is to be expected, though it’s very jolting to see. Your vet saying that Murphy is improving gives reason for cautious optimism. Hang in there, it might take awhile.

    Just curious, but have you been testing before every shot and getting any mid-cycle tests leading up to this? I know you said the spreadsheet isn’t up to date, I just wasn’t clear whether you had the data but hadn’t entered it, or whether you weren’t testing as regularly. I mention this because after this episode, it will be even more important to be diligent about BG testing as well as more frequent ketone tests. Murphy now has DKA in his history, which changes things.

    Sending positive vibes for both you and Murphy. I hope the news continues to be good.
     
  92. Leigh B

    Leigh B Member

    Joined:
    Dec 22, 2018
    Thank you for the information and encouragement. Everyone here is helping me get through this!
    Yes, I am diligent with his bg monitoring. He's been doing so well that I have not taken the time to enter the numbers to his spreadsheet.
    Once we're through this, I will be sure to enter the numbers.
    I have ketone test strips, and use them when he seems a bit off (only about 3-4 times over the last few years) This is the first time he's been over the "low/ little detected" level.
    I will certainly look into further ketone testing. It was suggested here that I get a test that I can use when I check his BG.

    I am at the ER now picking him up for transport back to the vet. Really anxious about today, and hoping I have answers about a more clear path for him.
    This is also killing me financially. I have CareCredit, and I'm willing to do what I need to to get him better, but it's just one more added stress.
    Anyway, thank you and I will follow up soon.
     
    Deb & Wink and Nan & Amber (GA) like this.
  93. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Sending some very gentle scritches for Murphy.

    (((Murphy and Leigh)))

    :bighug:


    Mogs
    .
     
  94. Leigh B

    Leigh B Member

    Joined:
    Dec 22, 2018
    I picked him up from the ER, and he was a little more awake/aware. He definitely looked better than he did when I took him last night.
    His bloodwork is getting much better:
    9:00 pm 298/ 10:00 258/ 11:00 218/ 12:00(midnight) 228/ 1:00am 229/ 2:00am 279/ 3:00 321*/ 4:00 297/ 5:00 281/ 6:00am 266
    *at 3:00 they had supplemented his IV and it caused his bg to go up, so they added a bit of dextrose for a few minutes.

    My vet called me as soon as she got to work to review his information and check on him. I absolutely love her. The first thing she asked me was "how did you sleep?" I told her that I had certainly had better nights. She said that she had woken up a few times in the night thinking about Murphy, too. <3
    Anyway- his potassium dipped overnight and that was addressed in the ER. Now that it is under control and his BG is getting/staying lower, his demeanor is improving.
    Her plan today is to continue the insulin IV and try to let him rest. Yesterday, he had an additional IV, a bladder stick, bloodwork and a freestyle libre. On top of tube feeding, that is so much for the little guy!! Glad that she is taking that all into consideration.
    Hopefully, we will get his insulin regulated and ketones down so that I can bring him home.

    Will update again later.

    Hope you are all having a great day. I feel like I can actually go to work and be productive today. The last few days have been tough and exhausting.
    Oh, BTW, I told Dr. Bellman about this group. She was thrilled to hear about the support and information you have all been giving to carry me through!:bighug:
     
  95. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

    Joined:
    Mar 19, 2016
    Any updates?
     
    Deb & Wink likes this.
  96. Leigh B

    Leigh B Member

    Joined:
    Dec 22, 2018
    Just picked him up from the ER. His numbers are in the 100s!!!
    Once I get all of his readings I will share them.
    He is moving around a lot more and they said he has been meowing a lot more.
    Now that he is alert, he seems annoyed by all of his tubes. Hoping he will start eating food soon. And we can unplug all of this.
    :cat:
     
  97. Nan & Amber (GA)

    Nan & Amber (GA) Well-Known Member

    Joined:
    Mar 19, 2016
  98. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    C'mon, Murph! Attaboy! :cat:

    I'm so glad to read this update, Leigh. How are you doing?

    (((Murphy and Leigh)))


    Mogs
    .
     
    Deb & Wink and Nan & Amber (GA) like this.
  99. Leigh B

    Leigh B Member

    Joined:
    Dec 22, 2018
    Dr. Bellman (the ANGEL vet) is off today, and I am working with Dr. Todd (She is my former vet at this clinic. We moved several years ago, and started using a vet that was closer to our house. But, I have always LOVED her, too. She sat in the floor and cried with me when I lost a cat years ago (from old age))
    ANYWAY- all of that to say that I have the most AMAZING vets taking care of him now. Dr. Todd blew me away on our last phone call. She said that she'd spoken with Dr. Bellman twice today already (reminder- it is her day off) because she wanted to check on Murphy. Dr. Todd said that Dr. Bellman said "I'm invested in Murphy and just need to know how he is." :D
    THEN Dr. Todd offered to take Murphy home with her overnight. That way, she can continue his treatment and help me a bit with finances.

    ***As I was typing, Dr. Todd called. I don't really know how to take the news. The GOOD news is that his electrolytes are better, no ketones or glucose in the urine, much less bacteria in the urine. His bg is also hanging out in a good range.

    The BAD news is that his bilirubin levels are REALLY high (showed in urine, which is very abnormal in cats unless it is REALLY high), and his white blood cell count is really high. You may all know that those are indications of infection and liver issues. They did an echocardiogram(?) to look at his gall bladder and liver. Gall bladder looks fine, but the liver showed abnormalities. The vet doing the exam said that it showed up as a different color, but that there was no mass or tumor.
    SO- they are adding a THIRD antibiotic, and she is going to take some fluid from his liver and send it to the lab.
    I keep asking her if I need to let him go. She keeps reassuring me that if it gets to that point, she will be honest. She has his wellbeing ahead of everything else.
    She explained that the liver is one of the few organs that can regenerate. The infection reflected in the white cells can, in fact, be tied with the liver abnormality.
    She said he seems to be comfortable, and is responding to them when they have him walking around and call out his name, etc.

    Any experience with liver issues from any of you.
    I am wearing thin. It is crushing to me that he keeps having new issues...:arghh::(:(:(:(:(:(

    White cell count- 16,000 is considered "the high side of normal"- his is at 32,000 (as reference, Sunday, when this all started, he was at 19,600. Tuesday, when the antibiotics were started, he was at 7,000)
    Bilirubin-his was at 3.5 and has gone up to 5.5 Again, she said she knew it would be elevated when she saw it in the urine because that is very unusual for cats (not unusual to see it in dog urine, but unusual for cats) unless it is REALLY high

    :(:(:(:(:(:(
     
    Deb & Wink likes this.
  100. JaxBenji

    JaxBenji Well-Known Member

    Joined:
    Jul 10, 2020
    Just stopped by to check on you and Murphy :bighug: I don't have experience with labs and numbers but someone here will :bighug:

    BTW, can the vet email you his labs w/ reference values? When members on the board have asked for help w/ labs, it helps to have all the info - you can enter the labs on your SS (on the labs tab...and update the reference values) or black-out your personal info and upload as picture.

    I had bookmarked this site if I ever needed it - perhaps it will help - someone posted it on the board at some point - http://felinecrf.the-colonel.info/Documents/index.html?Interpreting_Labwork.html

    Hang in there Leigh :bighug::bighug::bighug:
     
    Deb & Wink likes this.

Share This Page