ChristinaP
Member Since 2019
Hi Everyone,
18-year-old Nubi was hospitalized last month with uncontrolled diabetes, pancreatitis, and severe anemia, and an esophagostomy feeding tube was placed. I haven't been checking the tube exit site in recent days (because we've been very preoccupied with her worsening anemia and lack of response to Aranesp/darbo) but this morning discovered a huge infected lump in her neck under the neck wrap she wears for the e-tube. It's wet with discharge and smells foul. The lump, presumably an abscess, is adjacent to the tube exit site, not directly on it.
Nubi has had feeding tubes before without a problem, but that was before diabetes. Could this wound be a complication of her diabetes? And could the infection, which I assume has been simmering silently for some time, be responsible for her lack of response to darbo? After three weekly injections of the maximum dose (6.25 mcg), there's been no reticulocytosis and her hematocrit has been dropping; as of Thursday, her HCT is down to 12.4. (Long story, but briefly: she had a blood transfusion on May 3 while hospitalized, HCT was brought up to about 20, but HCT has been dropping since then, despite the darbo. Internist believes that severe inflammation is why the darbo isn't working -- although, the darbo at such a high dose supposedly should be able to overcome any resistance caused by inflammation. Nubi's pancreas is still swollen and her liver is large and firm. We initially expected/hoped that the inflammation would abate with supportive therapy, control of diabetes, and a course of antibiotics. Fluid analysis of mild ascites was inconclusive, though cancer was ruled out.)
Made an appointment for later today with Urgent Care at the 24-hour vet specialty clinic, but brought her in early to be seen in their ER department because of worries about low blood sugar possibly developing in a few hours: I gave Nubi her morning insulin (.75 units glargine) but because of the infection around her esophagus, won't be feeding her again until after she's been treated in urgent care. They had a quick look at her and I was told she's stable and that we're better off waiting for the urgent care appt, bcs we'd be waiting for a few hours in the ER anyway, so we have returned home to wait. Two hours to go. Right now, Nubi is hiding. She's very thin and weak.
If I'm right that this is an abscess, Nubi will almost certainly require sedation for treatment. With her severe anemia, and delicate health from her recent diabetic crisis plus other chronic conditions, will she be able to survive sedation? The urgent care vet may also suggest she receive another transfusion while in clinic today, but is this too much intervention for a cat that is probably just going to decline again in a couple of weeks because her bone marrow isn't responding to the darbo? Or might she start responding if the abscess is dealt with?
It's so hard to know what's reasonable to do.
18-year-old Nubi was hospitalized last month with uncontrolled diabetes, pancreatitis, and severe anemia, and an esophagostomy feeding tube was placed. I haven't been checking the tube exit site in recent days (because we've been very preoccupied with her worsening anemia and lack of response to Aranesp/darbo) but this morning discovered a huge infected lump in her neck under the neck wrap she wears for the e-tube. It's wet with discharge and smells foul. The lump, presumably an abscess, is adjacent to the tube exit site, not directly on it.
Nubi has had feeding tubes before without a problem, but that was before diabetes. Could this wound be a complication of her diabetes? And could the infection, which I assume has been simmering silently for some time, be responsible for her lack of response to darbo? After three weekly injections of the maximum dose (6.25 mcg), there's been no reticulocytosis and her hematocrit has been dropping; as of Thursday, her HCT is down to 12.4. (Long story, but briefly: she had a blood transfusion on May 3 while hospitalized, HCT was brought up to about 20, but HCT has been dropping since then, despite the darbo. Internist believes that severe inflammation is why the darbo isn't working -- although, the darbo at such a high dose supposedly should be able to overcome any resistance caused by inflammation. Nubi's pancreas is still swollen and her liver is large and firm. We initially expected/hoped that the inflammation would abate with supportive therapy, control of diabetes, and a course of antibiotics. Fluid analysis of mild ascites was inconclusive, though cancer was ruled out.)
Made an appointment for later today with Urgent Care at the 24-hour vet specialty clinic, but brought her in early to be seen in their ER department because of worries about low blood sugar possibly developing in a few hours: I gave Nubi her morning insulin (.75 units glargine) but because of the infection around her esophagus, won't be feeding her again until after she's been treated in urgent care. They had a quick look at her and I was told she's stable and that we're better off waiting for the urgent care appt, bcs we'd be waiting for a few hours in the ER anyway, so we have returned home to wait. Two hours to go. Right now, Nubi is hiding. She's very thin and weak.
If I'm right that this is an abscess, Nubi will almost certainly require sedation for treatment. With her severe anemia, and delicate health from her recent diabetic crisis plus other chronic conditions, will she be able to survive sedation? The urgent care vet may also suggest she receive another transfusion while in clinic today, but is this too much intervention for a cat that is probably just going to decline again in a couple of weeks because her bone marrow isn't responding to the darbo? Or might she start responding if the abscess is dealt with?
It's so hard to know what's reasonable to do.
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