Update 11/1 4:00 PM ET: Luna bouncing back from DKA

She looks SO comfortable!!! So much so that I thought it was a picture from when she was home :). Wow! I’m so happy to see that little face of hers ❤️!

Continued love, prayers & healing energy being sent your way :bighug:!
 
She is such a sweet sweet girl. I’m so happy that she looks like she’s getting a bit more energy, and she’s resting more comfortably. We love you Luna. I’m praying for you, precious one.
 
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For_Luna said:
We don't have test results yet from tonight, but this is the first time she's looked somewhat comfortable since she's been there. I haven't seen her do anything other than squat and let her head hang until it hits the floor. My wife sent from the visiting room. She's wrapped up in her blanket
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This precious girl, it is good news that she seems more comfortable.
Come on baby girl we all know you are one tough cookie.
 
She definitely doesn’t look like she’s in a position of pain or nausea.

We are all pulling for you, Luna. I hope you and your wife are getting some rest, Dan.
 
Morning update:
Phosphorus is at 4 and finally in normal range. Sodium and chloride are close. Potassium is still low at 3.1 and the vet said they're giving a big dose and it's not really moving. HCT (red blood cell test) is 18.5 down from 20. Normal range starts around 30. Vet says it's not take action time yet on that, but it needs to turn around soon. He said it's due to inflammation, but didn't say what specifically. They're consulting with the specialist again today and will adjust treatment.

Going to visit again this morning and hopefully get some good news from the techs. This doctor just sticks to the numbers.
 
Sending more prayers and healing energy to Luna :bighug::bighug:.

Dan, you may want to ask if there is able to be a vet tech as an additional contact for each shift so that you are able to get clinical updates by phone if you want or need them in addition to the primary vet’s lab updates. In the larger academic vet hospitals they have the medical student &/or resident as an additional contact & they call you several times a day or you are also able to call them! It is extremely helpful & nice to be able to get the updates regarding eating, mood, behavior. I don’t see why they would mind setting that up for you as long as the techs are sticking to providing that info vs labs & treatment planning.

I see the vet techs as the nurses of the vet world :)! They spend the majority of time with the patients ❤️
 
TSP said:
Sending more prayers and healing energy to Luna :bighug::bighug:.

Dan, you may want to ask if there is able to be a vet tech as an additional contact for each shift so that you are able to get clinical updates by phone if you want or need them in addition to the primary vet’s lab updates. In the larger academic vet hospitals they have the medical student &/or resident as an additional contact & they call you several times a day or you are also able to call them! It is extremely helpful & nice to be able to get the updates regarding eating, mood, behavior. I don’t see why they would mind setting that up for you as long as the techs are sticking to providing that info vs labs & treatment planning.

I see the vet techs as the nurses of the vet world :)! They spend the majority of time with the patients ❤️
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We get updates from them when we're there, which is about 3 times a day. We just need some good news sprinkled in with the not so good tests results every morning. But they do have a number we can call and they've been happy to give us updates
 
She really looks peacefull in her blanket sweet little girl! You are a fighter Luna, you can do it ! Positive energy sended:bighug:.
 
Hoping for more positive news after your visit with your little sweetie. Hang in there Dan, things will get better soon, Luna has so many people praying for her and wishing her well.
:bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug:
 
Just got back. She looked more alert when they brought her in. We sat on the couch again but she didn't spread out this time. Eventually got too tired and her head dropped. The tech said she thought she looked a lot better despite the not so good tests. She said while they need to treat to make sure the tests improve, they also need to treat the patient and Luna has improved since Monday. Maybe as she gets stronger and continues to eat, those numbers will start to come back up.

The gave her some medicine through her IV that stings. She shook her paw and pulled back a couple of times. The third time she jumped to the top of the couch in one jump and hissed at the tech. I hated to see it was painful for her, but at the same time I was kind of excited to see some fight in her. That's closer to normal for a visit to the vet.

They made me do the feeding tube meal while I was there. Overall not too difficult. Just need to go slow and watch her reaction to see if she's getting nauseous. It'll get easier just like giving insulin did. And she sniffed at the food and looked interested for a second, but started licking her lips a bunch so I backed off. The tech says smell can make her nauseous too. They're giving her meds to help, but so far no luck. But it's only 3rd day of feeding tube and 2nd with decent sized meals.

Might have some test results when I go back later. Still no where near out of the woods, but I think we're making a little progress.
 
Praying for little Luna to get better by the minute. They can have nausea from quite some time, weeks.... but if she seems interested in food a little, then that's good news already! And she jumped! :bighug::bighug::bighug::bighug:
 
The hiss was for the vet talking bad about her labs this morning & not giving her the appropriate props for her mad tenacity & perseverance......how dare he do that!! She's turning up her cattitude & letting them know "labs....WHATEVER!" :p In true female cat form, she is probably thinking "stupid human":cool:!!!

I am always thankful that cats are not impacted by such things & are able to just stay focused on getting better. What a blessing:bighug:!!

This is all such great news Dan! Also wonderful to hear that you have a ton of communication available with people there--SO nice!!
 
Sending my prayers to Luna ,so sweet i hope shes healing well !! Praying she gets well fast ! those visits helped my Salem he wouldnt eat vet told me its not mental its all phyical ! No its not after we visited Salem that very morning he started eating ! Thats my baby mommie told you to try and you did ! Lots of Love does heal ! Tried to tell me my baby was dying he might not make it thru the night ! Salems home still very tired but hes eating, hes on his way to a better day !
 
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Vet came in to speak with me this afternoon. He said she looks a lot better and he's shocked at the turnaround considering the day we had Monday. And while the numbers still aren't good and she needs a high dose of supplements, they're not at the point anymore that he's worried about her dying. He said he's never had a cat this difficult to treat and I said I've been dealing with that for a while, so it's nothing new for Luna. Only major concern is the red blood cells, but we'll get those numbers tomorrow morning.

Plan is to keep going with the supplements and treatment, keep tube feeding, and just wait to see what happens. She's not ready to go home for a few more days unless something big happens, but maybe we can worry a little less.
 
This is such great news :bighug:!!! I’m sure you were like “welcome to my world!!!” It’s great that he gets it—USE that! He sounds like such a team player. Have him drop whatever calls to whoever you would love some input from :p. It’s nice to have all that back up now from people who really understand what you’ve been going through!

Continued prayers & positive energy to you, your wife & Luna :bighug::bighug:
 
Finally some good news with her tests.
Potassium is 5 this morning! up from 3.1 yesterday. Sodium and Chloride are the low end of normal, and calcium is close.

Red blood cell count is down to 16.5 but the vet said for the first time since Monday, they have Reticulocytes of any significance detected in her blood. From what I understand, they're released by the bone marrow and turn into red blood cells (?). He was the most excited about that and said that means the inflammation is starting to go down and if those Reticulocytes keep improving, we'll see the red blood cell count improve.

Still not there yet, but she's working hard. Going to visit soon. Really excited to see how she looks today
 
I'm so happy for you Dan! That's wonderful news, sounds like Luna has really turned a corner!! Give her our love when you see her!! :bighug::bighug::bighug:
 
Update from our morning visit:
Luna looked pretty good this morning. She kept her head up while I was feeding her through the feeding tube and tried to bury her face whenever someone walked by.
They had her in a new blanket, so I think she made a mess of hers at some point. It's a lot bigger and softer, and the techs said she borrowed inside of it last night and slept.

The tech needed to replace her IV lines and Luna put up a little bit of a fight. She kept trying to fold her paws under her so the tech couldn't get to them and then started backing up when she realized that wasn't working. They said she was up and walking around a little bit last night and making a bunch of noise at one point.

They reduced the supplements today and are testing electrolytes again around 2 PM. If that goes well, they'll reduce again and are going to try to be off of them this weekend.

For the first time, we're making preparations for her coming home. Our ketone meter will be here tomorrow, and we're getting a baby gate or some kind of room divider to keep her close at night until she's back to full strength. We're going to email the diabetes specialist at Penn ( thanks @TSP ) and see if they'll look over Luna's spreadsheet and everything from the last week so we can have a gameplan in place for when she's home. The insulin drip she's on now is keeping her in the high 100s to mid 200s, but I'm afraid she'll go back to her bouncing self when we switch back to Lantus. Hopefully they'll do a day or two of Lantus in the hospital to see how things will go.
 
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Great news, Dan! That’s wonderful about the potassium and the reticulocytes indicate she’s starting to regenerate red blood cells.

I would talk to them about an ondansetron prescription for nausea. It works so much better than cerenia. You can even get a vial at thriving pets to inject it subq. I don’t know but it’s possible it can go in the feeding tube but you’d have to be sure about that. They might only want food and water in the feeding tube.

Last,y...be sure they teach you hoe to flush the tube. Does she have an Etube or does it go into her tummy? The tubes are easier but I didn’t see it in the photo.
 
For_Luna said:
Update from our morning visit:
Luna looked pretty good this morning. She kept her head up while I was feeding her through the feeding tube and tried to bury her face whenever someone walked by.
They had her in a new blanket, so I think she made a mess of hers at some point. It's a lot bigger and softer, and the techs said she borrowed inside of it last night and slept.

The tech needed to replace her IV lines and Luna put up a little bit of a fight. She kept trying to fold her paws under her so the tech couldn't get to them and then started backing up when she realized that wasn't working. They said she was up and walking around a little bit last night and making a bunch of noise at one point.

They reduced the supplements today and are testing electrolytes again around 2 PM. If that goes well, they'll reduce again and are going to try to be off of them this weekend.

For the first time, we're making preparations for her coming home. Our ketone meter will be here tomorrow, and we're getting a baby gate or some kind of room divider to keep her close at night until she's back to full strength. We're going to email the diabetes specialist at Penn ( thanks @TSP ) and see if they'll look over Luna's spreadsheet and everything from the last week so we can have a gameplan in place for when she's home. The insulin drip she's on now is keeping her in the high 100s to mid 200s, but I'm afraid she'll go back to her bouncing self when we switch back to Lantus. Hopefully they'll do a day or two of Lantus in the hospital to see how things will go.
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Lots and LOTZ of prayers for Luna ❤️... the power of pray is unspeakable and they are flowing in from all over the world :bighug: ❣️
 
This is wonderful news, been so worried about her, afraid to check for updates. I recall those harrowing times when they are in the hospital, the visits, etc. But, never had one as critically ill as Luna. I know she will be so happy to get home. Sending healing thoughts and hugs to all of you.
 
Marje and Gracie said:
Great news, Dan! That’s wonderful about the potassium and the reticulocytes indicate she’s starting to regenerate red blood cells.

I would talk to them about an ondansetron prescription for nausea. It works so much better than cerenia. You can even get a vial at thriving pets to inject it subq. I don’t know but it’s possible it can go in the feeding tube but you’d have to be sure about that. They might only want food and water in the feeding tube.

Last,y...be sure they teach you hoe to flush the tube. Does she have an Etube or does it go into her tummy? The tubes are easier but I didn’t see it in the photo.
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She has an Etube. They showed me how to run water through it after feeding and how to do little pulses if a piece of food is attached to the inside of the tube. Also went over cleaning the ports and how to detach if the swabs couldn't get everything. Still not super comfortable with it, so I asked her to start eating soon. We'll see how that goes.
 
So happy to read all your positive reports on Luna, Dan. That is wonderful.
What a little fighter.
You must be exhausted from all the worry.
Make sure you get plenty of sleep before she comes home.
 
Keep up the good work Luna. Lots of great news in today's reports for your beautiful girl. Praying that the electrolytes settle in and that she gets to come home on Monday.
 
Dan -

The downside of @Marje and Gracie suggestion regarding ondansatron in the injection form is that it stings like a mother! My kitty would allow me to do almost anything when it came to managing her health. She flatly told me I was nuts when I gave her a shot of ondansatron. It does come in pill form.

Think about getting some blank capsules. If Luna is going to be coming home on a bunch of medications, if you can put more than one pill in a capsule, you will save yourself from having to give a lot of pills. Capsuline makes cat sized capsules.
 
Sienne and Gabby (GA) said:
Dan -

The downside of @Marje and Gracie suggestion regarding ondansatron in the injection form is that it stings like a mother! My kitty would allow me to do almost anything when it came to managing her health. She flatly told me I was nuts when I gave her a shot of ondansatron. It does come in pill form.

Think about getting some blank capsules. If Luna is going to be coming home on a bunch of medications, if you can put more than one pill in a capsule, you will save yourself from having to give a lot of pills. Capsuline makes cat sized capsules.
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That could be what they're giving her now. They injected something for nausea and she shook her paw a bunch. 3rd time was just saline to get the last bit through and that's when she jumped to the top of the couch and hissed. And she's not eating yet, so pills aren't an option unless they can be crushed and blended with her feeding tube food
 
Happy to hear preparations for Luna’s return home are in the works. :cool:

We battled ketones and DKA early on. Black Kitty was hospitalized twice. Sadly we never were provided any guidance around what to do once he was able to come home. I believe that to be the case for most kitties.

Know that you will be entering a period of intensive care.

I’m sure by now someone here must have made you aware of the recipe for ketone development but it bears repeating:

Insufficient calories + insufficient insulin + infection/inflammation or other systemic stress. ​

Forewarned is Forearmed. Testing is your first line of defense. Vigilance will be required. Since I watched BKs urine ketones go from ‘negative’ to ‘large’ in exactly 24 hours I recommend checking for ketones at least once per cycle until your kitty is well out of the woods. Glad to hear you will be using a meter for that, they were just coming onto the scene when we were in the thick of it all.

Calories-A kitty recovering from DKA should consume 1.5x the calories required to maintain ideal body weight.

Insulin- The calories need to be metabolized into energy and that energy needs to be delivered to all the cells of the body. Without enough insulin Lunas body will return to breaking down its own protein and fat in an attempt to fulfill energy demands. The byproduct of this process is ketones. I had to add humulin R (‘R’ for short) a fast acting non depot type of insulin into the mix. Know that it’s an option however it should not be undertaken without the guidance of an experienced user.

Infection/inflammation - the source must be discovered and addressed.

I hope this information helps. :cool:
 
For_Luna said:
That could be what they're giving her now. They injected something for nausea and she shook her paw a bunch. 3rd time was just saline to get the last bit through and that's when she jumped to the top of the couch and hissed. And she's not eating yet, so pills aren't an option unless they can be crushed and blended with her feeding tube food
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Ondansetron does come in an oral solution/liquid form. Maybe that would work given the situation. Ask the vet. If they don’t have it they can always get it.
 
Sandy and Black Kitty said:
Happy to hear preparations for Luna’s return home are in the works. :cool:

We battled ketones and DKA early on. Black Kitty was hospitalized twice. Sadly we never were provided any guidance around what to do once he was able to come home. I believe that to be the case for most kitties.

Know that you will be entering a period of intensive care.

I’m sure by now someone here must have made you aware of the recipe for ketone development but it bears repeating:

Insufficient calories + insufficient insulin + infection/inflammation or other systemic stress. ​

Forewarned is Forearmed. Testing is your first line of defense. Vigilance will be required. Since I watched BKs urine ketones go from ‘negative’ to ‘large’ in exactly 24 hours I recommend checking for ketones at least once per cycle until your kitty is well out of the woods. Glad to hear you will be using a meter for that, they were just coming onto the scene when we were in the thick of it all.

Calories-A kitty recovering from DKA should consume 1.5x the calories required to maintain ideal body weight.

Insulin- The calories need to be metabolized into energy and that energy needs to be delivered to all the cells of the body. Without enough insulin Lunas body will return to breaking down its own protein and fat in an attempt to fulfill energy demands. The byproduct of this process is ketones. I had to add humulin R (‘R’ for short) a fast acting non depot type of insulin into the mix. Know that it’s an option however it should not be undertaken without the guidance of an experienced user.

Infection/inflammation - the source must be discovered and addressed.

I hope this information helps. :cool:
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Thank you. I think we have it all covered except for the cause. We'll be testing for ketones now, the nutritionist is putting together a feeding tube plan that includes if she eats anything on her own, and we're reaching out to a diabetes specialist that can hopefully help us get Luna regulated (that might not happen before she comes home, so we'll talk to both of our vets to figure out what the best dose is to start with).

The theory is it was probably some pancreatitis that started all of this. She was only not eating for maybe 6 hours when we brought her to the ER, so her blood work was still normal. And we only went that night because we had a wedding the next day. If we weren't going out of town, we probably would have waited to take her in the morning, and her blood work would have shown something and they would have admitted her sooner. Instead, they just gave her anti nausea, an appetite stimulant, told us to stop insulin until she ate, and we waited another day. We went to our regular vet the next morning and she thought Luna was just constipated and needed to be syringe fed with some gas x and mirilax mixed in. We were still worried so my wife stayed home from the wedding and ended up taking her back to the ER. Still didn't check her blood because of that first test and gave a different anti nausea med. My wife was crying the afternoon I got home from the wedding because everything two vets were telling us to do wasn't working and Luna was only getting worse. It was only when I brought her to the ER for the 3rd time in less than 48 hours that they finally checked her blood again and admitted her. They did xrays and a more comprehensive ultrasound a few days later and saw some inflammation in the pancreas, but by that time the liver was also inflamed, so they couldn't say definitively. Both vets also said they never saw a cat with Luna's BG numbers get DKA which is another reason they didn't do another blood test.

So our vigilance and knowing something was off, mixed with some bad advice about stopping insulin, bad luck, and not testing for ketones turned something bad into something that literally killed her. Only by some miracle did they get her back and she's still alive.

So anyone reading this, make sure you have a way to test for ketones even if it was never a problem before. We share the blame with our vets. We weren't prepared.
 
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There is a truism here, "Know thy cat." You certainly knew something was "off" with Luna. Your gut instincts paid off. Please don't beat up on yourself. Ketones can develop incredibly quickly.

I think the scenario you outline fits what you observed. Going forward, we will all have your back and coach you through the next couple of weeks. And FWIW, maybe the vets don't see it that often because they see a cat that is critically ill, but ketones can and do develop even when numbers aren't off the charts.
 
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