Sissy's medical issues

Mandy S

Mandy S

Member Since 2020
Okay, I offered her the bowl of food again and she did eat a couple bites and started to walk away. I went ahead and syringe fed some Turkey baby food. She took it pretty easily, and as long as she didn't fight I kept giving it. She took about 5 tsps before she started to wiggle and try to get down. I didn't want to overload her stomach. She got her meds. So now I need to give her insulin. She's had a very reduced dose now for 3 cycles now. Do I give her the normal dose or ease her back up? Plus her normal food is between 5-7% carbs I know this baby food is lower...will that matter much? Hopefully the meds will help more today than yesterday and I won't have to do this too much. :/

I did get some sleep last night, but was hoping to start walking back this shot time but not today. Sissy has other plans. urgh
 
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She came back and ate a few more bites on her on. I went ahead and gave her the full 1.25 dose. I can always syringe feed through the day today if needed. I'll be home all day, as far as I know.

Back to the discussion last night about the vet. When I schedule the ultrasound, I'm going to have to tell them she's still on insulin. That will be another big deal I'm sure. Does anesthesia cause problems for diabetic cats? I feel like I read somewhere on here something about it. But maybe not. I hope they don't have to use it, but if so, I'm just wondering.
 
My cats never needed anesthesia for an ultrasound. When Max needed his teeth cleaned my vet had me skip the morning dose. Some here give half. Given your situation with the vet I would skip. You will need to tell the vet you have been giving insulin though.
 
tiffmaxee said:
My cats never needed anesthesia for an ultrasound. When Max needed his teeth cleaned my vet had me skip the morning dose. Some here give half. Given your situation with the vet I would skip. You will need to tell the vet you have been giving insulin though.
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Yeah, I know I'll have to tell her. I wish I was knowledgeable enough to be able to argue my position without my brain going complete blank on me. When I'm well educated about a topic I have no trouble talking about it. But when she starts throwing studies and info at me and all I have is a couple months of experience and what I've learned here I just go blank. Plus she's a very forceful personality which doesn't help either since I barely know anything.
 
Throw the Romp Rand study back at her. I know it’s hard as she’s has the diploma. All you can do is nod your head and do what you feel is right. :bighug:
 
tiffmaxee said:
Throw the Romp Rand study back at her. I know it’s hard as she’s has the diploma. All you can do is nod your head and do what you feel is right. :bighug:
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I think that's the one she scoffed at as being faulty and she listed a few reasons why it wasn't trustworthy. If I remember right...I had given her a bunch of pages I'd printed off from here and it referenced some studies. She said I could find anything on the internet...then she said that they had removed cats from the study and made it sound like they manipulated the data.

I think I'm going to ask on the fb page if there is anyone in central Indiana with a great vet. I might be worth it to find someone who is supportive. This is all hard enough without dealing with that.
 
It would be great to find a supportive vet. They seem so scarce. Sigh. I would not hold off on the ultrasound though due to what you have been experiencing.
 
tiffmaxee said:
It would be great to find a supportive vet. They seem so scarce. Sigh. I would not hold off on the ultrasound though due to what you have been experiencing.
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Sissy is scheduled for 8am in the morning. I called and they had a cancellation. She said normally I'd have to wait a couple weeks. So I took it. They wanted me to not feed her after 10pm tonight. I told them she's diabetic, not sure how that would go, and that she will puke bile if she goes too long without eating and goes down hill from there. So they put me on hold and discussed and came back and said that she can eat and if I need to give insulin I can. Just do it early. So I'll just skip in the morning.
 
Vetty vines. Prayers that it turns out to be something treatable causing the inappetence. I my vet me stop food after midnight. Water was fine. :bighug::bighug::bighug::bighug:
 
So after this morning's syringe feed I waited to see if she'd come for more food. At the +2 mark she showed up for a treat...exactly on time. Then went away to hide. Then she showed up again at the +3 mark. She does this all the time. Like she knows how long it's been. I offered food, but she didn't want it...which isn't surprising she usually doesn't eat again for at least 3 to 4 hours after her morning meal. A little bit ago she showed up at +5...and drooling and purring and acting fine, wanting her treat. So I offered her food. She took a couple licks and walked away. So I added water to it, mashed it down and syringe fed most of the meal to her. I stopped when she started to fight it, which was probably 3/4 of that little 3oz can of food.
I'm a little more concerned than I was...just because the Cerenia has always helped in the past. Other than not eating, she's pretty much acting normal. She's bright eyed and out and about. She is very stand offish with me and has been for a few months. Before he diagnosis, she was in my lap or where I was pretty much all the time. It gradually tapered off to now she only wants in my lap some of the time. She rarely just wants to cuddle anymore. I know they say the ear pricking and shots can change your relationships with some cats, and I think it has here. She's still my sweet girl, but man I miss her snuggling with me at night and when I sit in my chair. It's rare anymore. Kind of breaks my heart.
 
:bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug:

Have you ever tried ondansetron for nausea? You can’t give it with mirt but you can with cyproheptadine as an appetite stimulant. Something to discuss with your vet.
 
Mandy S said:
I know they say the ear pricking and shots can change your relationships with some cats, and I think it has here.
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It made my relationship with Neko much stronger.

I'm glad you managed to get an ultrasound for tomorrow. I hope it provides answers. None of my cats have ever needed anaesthesia for an ultrasound, but Neko did need a bit of sedation for an echocardiogram (heart ultrasound) one time when she was feeling cranky. Food isn't an issue with sedation.

I'm glad Elise mentioned ondansetron. It targets different nausea receptors than does Cerenia and can work better in some cases.
 
At
Wendy&Neko said:
It made my relationship with Neko much stronger.

I'm glad you managed to get an ultrasound for tomorrow. I hope it provides answers. None of my cats have ever needed anaesthesia for an ultrasound, but Neko did need a bit of sedation for an echocardiogram (heart ultrasound) one time when she was feeling cranky. Food isn't an issue with sedation.

I'm glad Elise mentioned ondansetron. It targets different nausea receptors than does Cerenia and can work better in some cases.
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At first I thought it was making it stronger for us too...But Sissy and I have always been bonded. She was one of my 1 day old siblings I bottle raised and she'll be 14 next month. She's always been my baby. She's just not the same and hasn't been for a few months. Maybe it's something else, but I just assumed it was me poking her too much that did it. She literally was my snuggle bug all the time. It's so rare now, and when she does do it, it doesn't last long. :(

I gave her just a slight less insulin tonight. Since we're so off schedule and shooting so late and I have to drive a bit to get her to the vet at 8, I'm hoping I don't have to be up with her too much tonight. She did eat better than she has been for pmps and I well make sure she's on the way up before I sleep for the night...which will still be hard. After I shot her tonight I realized she was lower than her earlier number...so should I have waited to see if she was on the way up before I gave her any insulin? I should have looked before I shot her...but I thought it was higher than it was. Just remembered wrong.

I noticed that her hair is damp from her licking herself a lot when I pet her. She is grooming way more than she should be and I think it's because I was giving her whatever low carb food I could get her to eat. Tomorrow if she won't eat, I'll just have to syringe her food she regularly eats...and hope this doesn't continue or she'll end up bald again.

I will ask the vet about ondansetron. Maybe it would work for her.

I always forget @tiffmaxee 's name is Elise. My 2nd oldest daughter who will be 21 on Monday is named Elise. She always says that she never sees anyone else with her name.
 
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tiffmaxee said:
Just checking to see how the ultrasound went and thinking of you. :bighug:
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I was just coming to check in. It's been a long day. Sissy's fatty mass isn't her problem. We don't know for sure what is though. I'm going to try to remember everything, I'm really tired. Both adrenal glands are extremely large and round with nodules near them on both sides, could be lymph nodes, but odd that it's bilateral. Her small intestine is thickened, may be some inflammatory bowel issues...her kidney's are smaller than normal in structure otherwise fine. They did some blood and urine tests this afternoon...had to take her back down for that. Her kidney levels are just slightly elevated and her urine is dilute. But she said you usually don't see any problems at this point because it's just so slight, so she doesn't think there is an issue there but they sent her urine off to culture. She said she would think Cushings Disease but she doesn't exactly fit the profile except for the huge adrenal glands. She suggested we do some 8 hour test to confirm it after we get other blood/urine stuff back. There was some other disease she mentioned but I cannot think of it and I don't see it on the notes I took...but it was at the end. That's a specific blood test that would be another $75 on top of everything else. The 8 hour one is under $300...but I told them we have to wait and see what all this brings back first. I spent almost $800 today and I'm HIGHLY stressed about it. I had just paid off all our debt so we could buy our house and this is stressing me out...because I know it's not all we'll have to spend, we still don't have answers and to rule more stuff out it will just be another small fortune. Oh, and they did another fructosamine test because they think that she may not need insulin, that she's overmedicated...this doctor today wasn't thrilled about the human meter, she about freaked out when she asked what her blood sugar was this afternoon and I said 65. I clarified a human meter and that freaked her out more. She was like, I can order you one specifically for animals...I said no thanks I can order one if needed from amazon. Anyway...her urine showed no glucose and no ketones either. So they are like...stop all insulin for a few days at least and see if she doesn't feel better. She also got a B12 shot because they said that might help stimulate her to eat. So tonight she is not eating much at all. She's very unhappy with the world and I don't blame her. I'm very stressed...I was hoping for some kind of answer to this with the ultrasound, even if it was straight BAD news. This is just worse because you can tell they literally have no idea what is going on with her.
I know there is more...and I'm sorry that's all jumbled up. If I think of more I'll add it.
Thanks for thinking of us. Let me know what you think of all this. :bighug:
 
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I forgot to mention that she did suggest cancer is a possibility with adrenals, but she said it was odd that if those are lymph nodes by the adrenals that it's on both sides.
 
Also, they got done with her this morning before time for her shot...since we'd been shooting so late. So she did get her 1.25 dose this morning before we went. She wasn't 65 on her own this afternoon.
And I completely forgot to ask about the meds I was supposed to. But I will call tomorrow.
 
Be careful with the Cushing test. If it's the dexamethasone suppression test, it involves giving dexamethasone (a steroid) and monitoring hormone levels for 8 hours. Steroids can affect diabetes. Oberon had the dexa test done and his ketones went way up right afterwards. However, they stayed elevated for far longer than I would have expected based on how long the dexa would have stayed in his system, so it's possible it was just a coincidence. And he's got IAA on top of the diabetes (which we didn't know at the time), so that might also have affected his response. ECID. But still, best to be aware of a potential issue and find out more before proceeding. It may well be that the benefit of doing the test outweighs the possible downsides. If so, at least you'll be aware that any change in BG could be a temporary result of the test, and not worry that there's something new going on.
 
Lisa & Oberon said:
Be careful with the Cushing test. If it's the dexamethasone suppression test, it involves giving dexamethasone (a steroid) and monitoring hormone levels for 8 hours. Steroids can affect diabetes. Oberon had the dexa test done and his ketones went way up right afterwards. However, they stayed elevated for far longer than I would have expected based on how long the dexa would have stayed in his system, so it's possible it was just a coincidence. And he's got IAA on top of the diabetes (which we didn't know at the time), so that might also have affected his response. ECID. But still, best to be aware of a potential issue and find out more before proceeding. It may well be that the benefit of doing the test outweighs the possible downsides. If so, at least you'll be aware that any change in BG could be a temporary result of the test, and not worry that there's something new going on.
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That is the test. Thank you for that information! Definitely keep that in mind as we move forward.
 
I should also mention that he was already having issues with elevated ketones and his BG was persistently high because of the IAA. This may not be an issue at all for a better regulated cat.
 
It sounds like she’s thinking there are lots of possibilities and she doesn’t know which it is. So no mass was seen. That’s good. Thickening could be IBD. How much thickening? We’re measurements taken? That makes sense given her inappetence. It’s ridiculous to say stop insulin to see if she feels better. Max had glucose in his urine when I diagnosed him but once on insulin and regulated he didn’t. He never had ketones. As Lisa said, the insulin is doing its job.

Make sure you get a written ultrasound report and copies of all labs. I don’t really know anything about Cushing so I’m no help on that.

I’m so sorry the vet managed to simply confuse and worry you.
 
I am confused and worried...mostly stressed. If I had endless recourses to do all the test they want to do I wouldn't be stressed...just confused and worried. lol
I just see endless ruling things out...I honestly don't know what to do next. I hope whatever tests are still outstanding will offer some more information and can help direct what's next. She kept saying that she doesn't fit the profile for Cushing except the huge adrenals, yet wants to do an expensive test for it and the risks are there for that mentioned in the post above. My husband thinks we should try not giving her insulin for a few days like they suggested. We just paid them $800 to try to figure out what's wrong with her and if we trust them for that, we should give this a try. If I hope to have support in more testing I need to let that go. My husband loves Sissy and he's stressed out too, he's just frustrated with all the things she was throwing at us and all the estimates going forward.
I did not give her insulin last night. I left a can of food out..3 oz and she ate on it between 2am and finished it off now. So I'm going to have to feed her through a syringe it looks like. I fell asleep on the couch last night after I replied above, woke up at 2, dumped the food in her bowl and went to bed and slept until 8:30 when the dogs woke me up. I can't believe I slept that long. But I feel functional for the first time in days.

I will attach the papers they gave me. One is just a list showing what they did and the other is all I got from the ultrasound.

My husband asked last night if it would be cheaper for them to just do a biopsy to see if it is cancer. Both of her siblings had cancer, so it seems like a good chance she might. I feel like we're just not going anywhere here.
 

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I wish this could have been done by a boarded radiologist. My first ultrasound of Max listed all kinds of stuff yet the second the following week said it was normal. Before this your were told there was a big mass. Fortunately it’s not seen in this ultrasound. It seems the intestinal thickening is not severe. My lymphoma kitty had severe thickening but no masses. What would she biopsy? I’m so sorry you are left with more questions than answers. I would not stop insulin. That’s the one thing we know has her headed in the right direction, her diabetes. I wish I could be of help. :bighug:
 
tiffmaxee said:
I wish this could have been done by a boarded radiologist. My first ultrasound of Max listed all kinds of stuff yet the second the following week said it was normal. Before this your were told there was a big mass. Fortunately it’s not seen in this ultrasound. It seems the intestinal thickening is not severe. My lymphoma kitty had severe thickening but no masses. What would she biopsy? I’m so sorry you are left with more questions than answers. I would not stop insulin. That’s the one thing we know has her headed in the right direction, her diabetes. I wish I could be of help. :bighug:
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Yeah, the x rays from the ER said there was a mass in there pushing her organs aside. She read me that report yesterday and it did say in there that sometimes fat cats "quarantine" fat deposits and it can look like that...and they thought that's what it was since the ultrasound didn't show a mass like they thought. I wish it had been done by a boarded radiologist too. I just saw your other message post above. I emailed the vet just now and asked for them to email me a copy of her bloodwork and that her ultrasound results be sent out to be read by a board certified radiologist. They told me they had the ability to do that so I requested it. Idk if it will do any good but we'll see.
I don't have any idea what she'd biopsy. I think he was thinking of adrenals/lymph nodes since that was where the cancer discussion started.

I keep remembering more of the conversation. It's hard because I couldn't go in, had we had to have phone consults in the car and it's hard to process that way, for me anyway. We put her on speaker but just not the same. She was saying that another reason she thought she might be getting too much insulin was because of her twitching and not wanting to eat...that it could be from that. I told her she's had this twitching long before the dose she's at now, for months. Btw, this is not the regular vet we've seen, just the lady that does the ultrasounds, she's even more stressed out about the human meter/numbers than anything else I think...at least the regular one didn't care we were using the human meter...even though she can't read the spreadsheet and tell what's going on apparently, since she wants us to stop insulin for 2 weeks, not just a couple days like this one. On the paper she had written "Do NOT administer insulin tonight. Dr. will be giving you a call." Which she did and that's when said that she thinks she's over medicated and then about the urine not having glucose and that it was good there were no ketones. I asked her instead of sending out another fructosamine if she would like to see Sissy's spreadsheet so she could see that she's really not in remission and she said she doesn't really care what her numbers are at 4pm on a Thursday, she'd rather see her average over the last few weeks. Because cats fluctuate so much from stress and environment she thought it would be more accurate. I looked back at her spreadsheet and her no eating seemed to start right after I bumped her to 1.5, so I think it's probably a coincidence, but I do remember that she doesn't seem to feel as good when she's in the lower green numbers...but it still doesn't explain what's going on and her appetite is weird. She acts like she wants food, she comes in the kitchen when I'm in there, she takes a few bites and is done. She devours the freeze dried chicken treats though...she about takes my finger off and will keep eating as long as you want to give them. She flat out refuses to eat any of the food that she has been eating. She will eat on most of the foods we got from petco that are different but still doesn't eat anywhere near what she used to or enough. Before when she's been sick, she will hide, won't act interested at all and just look ill. This time she's not hiding, she's just not being as social and she looks bright eyed and purrs when you pet her...not like other times. So I'm just really confused.
 
It must be so hard not being in the room. When my vet calls with results it’s always at a time when I can’t get to my notes or my cat’s records and I often forget some of my questions.:banghead: Sissy is showing classic symptoms of nausea. Did you remember to ask for an RX for ondansetron? It often works better for cerenia for nausea. Sometimes when the nausea is really bad both cerenia and ondansetron are needed as they work in different ways as @Wendy&Neko explained.
 
tiffmaxee said:
It must be so hard not being in the room. When my vet calls with results it’s always at a time when I can’t get to my notes or my cat’s records and I often forget some of my questions.:banghead: Sissy is showing classic symptoms of nausea. Did you remember to ask for an RX for ondansetron? It often works better for cerenia for nausea. Sometimes when the nausea is really bad both cerenia and ondansetron are needed as they work in different ways as @Wendy&Neko explained.
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Yes, that's exactly how it is sitting in the car for the appointment. I went to get a pen out of my purse and it wasn't even in there. So I had to make notes from memory when we got home.

I didn't remember about the ondansetron, I know they are going to call today, so I was going to ask then. Do you know anything about Famotidine? You can get it over the counter it's like pepcid...for stomach acid. I had said Sissy will be just as relaxed and comfy as possible and she'll jerk up lick her lips a bunch and jump and run to get a drink. I wondered if she could be having reflux issues. So they said to try that but that it wasn't as helpful as cerenia, so I didn't get it since cerenia isn't doing much.

Okay, I went ahead and called and left a message for them for them about the ondansetron. The person on the phone hadn't heard of it...asked what the active ingredient is, I said I believe it's just zofran...but not sure. Wanted to know how if we'd used it before and I said no but a friend has and it helped her kitty. So we'll see, she'll give the message and hopefully I will hear back....without attitude. :/
 
I posted recently a vet conference and it’s rarely needed for cats. Let me find the link. I’ve been reading that a lot lately. It’s not even recommended for most CKD cats any more.
 
I agree with Elise, skip the famotidine and go for the ondansetron. I have a cat at home with GI issues and I can tell when it's bothering her because she becomes even more fussy. But she still will eat her treats. :rolleyes: So freeze dried gets sprinkled on and embedded in cat food, and that sometimes works. And when that doesn't, ondansetron does. You need a prescription to get filled at a human pharmacy. Zofran is the brand name - and pricy, the generic ondansetron will be as good and cheaper. The paper in this post [URL='http://jfm.sagepub.com/content/18/3/219.full.pdf']Consensus Guidelines on the Diagnosis & Management of Feline Chronic Kidney Disease [/URL]has a table under the nausea section that talks about ondasetron and dosing.

See the paper link in this post if you want to read more about Cushings. There is a section on diagnostics. The UCCR as a screening test could be easier and involves getting morning pee samples at home.
 
They just called. Said they'd fill the rx and we could pick up the script before they close tomorrow. So, it would have been nice to have gotten some in her tonight but at least they called back...I was pretty put out that they hadn't. :/
 
Got the email for her labs.
That one is her Fructosamine. They said it wouldn't be back for a several days...but that's it, right? They didn't mention it when they called. So she should be on insulin then?
 

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Normal fructosamines can also be the sign of a reasonably regulated cat. :) Missy's was 457 and normal is 143-373. So yes, she needs insulin. Many vets are upset/worried if neither the blood glucose and urine glucose are negative. Partly cause they aren't used to clients doing a great job with home testing. I was annoyed if either one was positive on Neko's labs. :p
 
I could tell yesterday that vet thought I was a nut for using a human meter, and she thought I was over dosing her and just freaking out in general. If she brings it up again tomorrow I'll just ask what they all used before the Alpha Trak came out. I've considered getting an Alpha Trak just to use at certain times if needed, or so when I tell them numbers they don't freak out.


So since the middle of last night night, Sissy has eaten almost 3 3 oz cans of cat food. On her own, just a few bites at a time. She's had freeze dried treats, but she stops eating those too after a couple. I haven't syringe fed her because she is eating some, but is it enough, should I syringe feed her some baby food? She has done nothing but lie on her bed or on the foot of my daughter's bed all day. She is drinking and peeing, although her output isn't quite as much as normal. I know I can add water to the baby food to get more fluids into her. She's very picky and she doesn't like her food in her bowl watered down. I have not given her insulin. Her BS is 105 as of 9pm est and this morning she was 120 10am. She had Cerenia and Mirtazpine this morning but again it doesn't seem to help...unless what little she is eating is because of those meds. :/ We were shooting 2 hours late when we went off insulin, so tomorrow I can get her back on better shooting time.

I'll get the ondansetron tomorrow...they didn't tell me she couldn't have it with Mirtazapine, but it wasn't either of the doctors we've seen that rx'd it, just whoever was on today and go the message...so they might not know she's even on it.
 
If you need an appetite stimulant try cyproheptadine. It’s a human drug with less side effects than mirtazapine and can be given twice a day. I’ve given anywhere from from a sliver to a quarter of a 4 mg pill once or twice a day.
 
tiffmaxee said:
If you need an appetite stimulant try cyproheptadine. It’s a human drug with less side effects than mirtazapine and can be given twice a day. I’ve given anywhere from from a sliver to a quarter of a 4 mg pill once or twice a day.
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Okay, thanks for that.

Do you think I should syringe feed her?
 
Yesterday at the vet she was 15.28 pounds...which is 2 pounds more than she was when diagnosed...but I don't know if she's lost weight in the last few days, she hasn't been weighed since the last time she was at the vet quite awhile back.
All I have is an old bathroom scale here and it's not very accurate.
 
Gosh, I don't know. When we started on the rx food, the doctor told us to give her the amount for a 12 pound cat because she was a bit over that and they wanted her to lose some. So I assume 12 pounds is...but even then she's a big chunky cat.
 
In that case it’s important that she not lose weight quickly, even if that means syringe feeding. Max gained weight on Lantus. I think it might be a side effect. When I looked it upstairs is for humans.
 
Okay, I'll get some food down her. I'm always afraid of over stuffing her. So I usually stop when she starts to fuss...but the last time few times I did it yesterday she fought it pretty hard, growling and fighting. I'll do little bits at at a time.
 
This feels so much like other times when we've lost one of our babies. I'm trying not to be negative, this road just feels familiar and it has never been a good outcome at the end. I hope Sissy is different.
 
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