10/10 Butters PMBG 103 Staying overnight in ER

Butters & Lyla

Butters & Lyla

Member Since 2020
yesterday
I tried low P foods for dinner. She ate some.
Vomited at +9. She hadn't eaten anything in the autofeeder. BG 86.
I tried to get her to eat different cans of food, including plain canned fish and her regular food. And her favourite freeze dried chicken treats. She licked each one but wouldn't eat. I'm very worried. Could this be related to her kidney issues? I will have to find a vet to take her to, assuming I cannot get her to eat over the next few hours.
I'm just not sure what I would be asking the vet to test for, if anything? Should I automatically be asking them to check for pancreatitis?
She retreated to hiding away in the basement.
 
I tried tuna and more freeze dried chicken. She ate a couple of small freeze dried chicken pieces. She sniffs everything, so there is definitely nausea in play. She isn't acting much different otherwise. Came up from the basement. On my lap. Gosh I would love some sleep.
She still feels very twitchy.
If she still is refusing to eat around AMPS time, I'm thinking I could give her a half dose.
But my big question is, if anyone could help me with whether there is anything to ask the vet for specifically? And should I get an anti-nausea med and an appetite stimulant? Her appetite has always been very good, but maybe good thing to keep on hand?
 
Several folks recommended Slippery Elm bark (a supplement) to me here previously for nausea.

@Bellasmom @Olive & Paula @carfurby -any of you guys know of anything else for nausea? Isn't Cerena (Rx only) for nausea. I'm sorry to hear she's nauseated...I haven't had to deal with that one much...Luci pretty much sticks to ejecting hairballs.
 
If you go to the vet they may give you Cerenia as a shot. It only last 24 hours. You'll want to ask for pills to take home so you can keep giving it to her if needed. It is off label for cats. It's prescribed for dogs. Usually an appetite stimulant is a last resort, but you don't want to give it with the anti-nausea medicine. I hope Butters feels better soon and starts eating. Sending prayers. :bighug::bighug::bighug:
 
Lyla, when I took Andy he was twitching hiding not eating and nausea if I were I I would take to vet if ur uncomfortable taking to ur vet take er clinic and request fPL test for pancreatitis they don’t eat and flinch due to pain and the treatment is fluids and pain meds
And to let u know Andy is NOT a diabetic but does have CKD for many years and he will be 21 next month
 
Yeah, I think if she is nauseous and if it could be pancreatitis then I'll focus on getting her the Cerenia and testing for pancreatitis and not worry about the appetite stimulant.
She joined me on my bed maybe an hour ago. I left two plates out with her usual food and she ate a very small amount, maybe 1 tsp. Better than nothing.
She wasn't tested for pancreatitis the other day. I had no idea to even ask. I'm going to find somewhere to take her and get the fPL test.
That is really good to know about Andy. Thank you.
I've heard slippery elm for constipation. Didn't know it might work for nausea too. I have some powder.
Butters has never thrown up a hairball. All my previous cats did and I have always been amazed and disturbed by her not ever having done this.
 
Butters & Lyla said:
Yeah, I think if she is nauseous and if it could be pancreatitis then I'll focus on getting her the Cerenia and testing for pancreatitis and not worry about the appetite stimulant.
She joined me on my bed maybe an hour ago. I left two plates out with her usual food and she ate a very small amount, maybe 1 tsp. Better than nothing.
She wasn't tested for pancreatitis the other day. I had no idea to even ask. I'm going to find somewhere to take her and get the fPL test.
That is really good to know about Andy. Thank you.
I've heard slippery elm for constipation. Didn't know it might work for nausea too. I have some powder.
Butters has never thrown up a hairball. All my previous cats did and I have always been amazed and disturbed by her not ever having done this.
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Keep us updated on what they say
 
I will.
I just got her to eat some plain mackerel for cats, so I gave her her insulin. I figure I can always syringe feed later if I needed to...but we don't seem near that point. And I bet she'd eat some MC or HC food right now if I cracked it open.
 
Good idea to test for p'titis. If it is that Cerenia, ondansteron (can give with cerenia) also helps with nausea and vomiting. They work from different modalities. Pain med (Buprenorphine) most definitely. Subs fluids help keep them hydrated if vomiting. Is Butters drinking? Vomiting water, projectile vomiting? If so then definitely have checked for obstruction right away.

Smokey and Ollie always ate through their flares. Ollie ate less but ate, the pain was the worst part for her. When it was really bad she hid.

Something to keep in mind. P'titis is common with diabetics, it's always good to have meds on hand so you can start meds right away to help lessen the severity.

ETA- if Ollie was having a particularly bad flare, I let her eat rx food a/d.It was more important to get the calories in and keep her eating than worry about carbs or bgs. I rather her eat than stress her by syringe feeding. And wouldn't develop adversion to her regular food.
 
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Hi. I’m sorry to hear Butters isn’t feeling well and he doesn’t want to eat much.

My T has chronic pancreatitis and, more than likely, IBD at this point. He initially had chronic pancreatitis but his endo said that even if he did not have IBD before, he most likely has some level of GI issue now because of the DM. Very common.

Ts initial signs for flares (every cat is different) are subtle lethargy (he will stay in one place all day vs changing where he goes), lack of appetite due to either nausea or pain or both. This is where having Buprenex for pain & Cerenia & Zofran for nausea is important. It is important to get both under control because they can start to associate their food with both and then wont eat it. Nausea can present as lip smacking or they will approach their food but won’t eat or try to eat and then walk away. Pain tends to present with a wince on the face (sometimes you will see a literally wrinkle in their fur between the eyes) or classic meatloaf position. I will attach some photos of T. Subq fluids as mentioned can also be helpful. Once you get them treated, offering smaller meals is helpful & give them whatever they will eat. You will be able to transition them back to their regular food once they are feeling better.

Initial Tests for pancreatitis and GI-
1) snap fPLI—done at the vets in house and read immediately BUT if you are able to get the TAMU full GI Panel that would be helpful. It will be include B12, Folate, Spec FPl and TLI.
It must be sent out and you will have to wait for results.
2) Ultrasound-won’t always be done initially but will allow them to see if there is any inflammation of the GI tract, pancreas, liver. I have mixed feelings about this being done early as organs can appear normal if it’s early in the process vs a few months later when changes will be visible.

There are options to skip the TAMU panel and the US if there is a financial issue, but both are extremely helpful to make the proper diagnosis and treatment plan.
 
Classic flare body language:

Meatloaf/Guarded/Braced Position
Wince in face
 

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Please be safe driving. If it’s GI &/or pancreatitis and things are really flared, not being able to keep anything down, even water, can happen. ER is best—they may possible choose to get some fluids in Butters by IV and if it is pancreatitis that is extremely helpful vs subq at home.:bighug:
 
Thanks. Im going to request those tests. My credit card is already a horror show at this point....so may as well keep it going.
She definitely has pain face :(.

they just took her inside. I cant even come in with her.
 
Butters & Lyla said:
Thanks. Im going to request those tests. My credit card is already a horror show at this point....so may as well keep it going.
She definitely has pain face :(.

they just took her inside. I cant even come in with her.
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I know it’s hard being outside :( but what I have experienced (and I hope you do as well) through the pandemic is the vet offices being able to be super focused on the patients because it’s just the pets in the office:bighug:.
 
Yesterday i thought she was being clingy even for her and was very twitchy. But i saw twitchiness on tanya’s and thought it was due to high phosphorus. I had no idea i might be dealing with yet another thing. She hasn’t had pancreatitis before. Waiting for the vet to call me.
 
Something is not right and it may not be pancreatitis. Unfortunately, a vet visit and labs are needed to help figure it out. So glad you brought her to get worked up!

Once you get the initial call and plan and if it’s going to be awhile, make sure to get something to eat and drink :). We forget to take care of ourselves sometimes and while they are getting worked up, it is a good break and time to do so!
 
Thanks yeah it definitely sucks being outside but i have found the same thing. Hopefully this one is just as focused too. She has never been here before. It is a 24/7 animal hospital. But when her last vet dumped us, she suggested i bring her to the internal ,medicine specialist here. I never bothered because she suggested it in the context of Butters bounces.

are ondenestran and zofran related? I see suggestions for cerenia and ondenestran and cerenia and zofran.
 
Olive & Paula said:
Keeping meds on hand for Andy goes for you also. He may never have it again, however, once they do it's not uncommon to have flare ups. As soon as you can start meds, normally it's less severe and shorter duration. It's more like a tummy bug.
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Thanks Paula good to know!!!!!
 
Yeah....i feel so bad. It wassnt until she vomited at 3am that i realized something might be really wrong. I am terrible at picking up on signs.
 
Olive & Paula said:
Keeping meds on hand for Andy goes for you also. He may never have it again, however, once they do it's not uncommon to have flare ups. As soon as you can start meds, normally it's less severe and shorter duration. It's more like a tummy bug.
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Im definitely going to be asking for meds to take away.
 
Butters & Lyla said:
Yeah....i feel so bad. It wassnt until she vomited at 3am that i realized something might be really wrong. I am terrible at picking up on signs.
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It can be tricky sometimes, so don’t beat yourself up! Even with T, when he moves from the obvious signs and starts to improve, my husband and I will find ourselves calling each other in to look at T to determine nausea or pain? Sometimes it’s a tough call & at times we’ve had to start with anti nausea and wait and then determine “nope” it’s pain.
 
Butters & Lyla said:
Im definitely going to be asking for meds to take away.
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And keep the meds stocked! Due to the pandemic there have been shortages of drugs, including Bupe so make sure you have a decent amount on hand in case you need it and then have to wait to get more. I’ve asked my vets to provide more than they usually would because of this issue.

Also—Zofran is the brand name for Ondansetron:)
 
So I have try to lighten the moment...because sitting in the vet parking lot is the worst:arghh:! Do they have a nice porta potty available for you :eek::woot::nailbiting:? Our U setting allowed us in to use the bathrooms but the local ER had a blue porta potty for us to use. Hey,
Better than nothing if I needed it and didn’t have time to run to an alternative :rolleyes:
 
LOL! That made me laugh.
Nooooo. They don't. It's basically tough it out or find a coffee shop nearby that will take pity on me. :facepalm: Actually, the vet said it would be at least an hour before they call me again and to go get breakfast or something so I opted to just drive home.

The vet says Butters is dehydrated, but otherwise is suspecting pancreatitis or a thyroid issue...not likely GI, but going to do an xray. She reviewed the blood results and urinalysis from Thursday and said she didn't see a point in repeating the latter seeing as Butters is dehydrated. I agreed.

They are going to do:
CDC + chem + elecrolytes + total T4 + spec fPLI (no snap)
xray....she said it would likely capture her heart.
maybe blood pressure (I asked, she said maybe?! I think it is because they are an emergency room and just want to deal with the acute stuff)

They don't have snap fPLI available right now ?!?! She had offered it and then called me back to say they don't have it. So it sucks that I won't even know for certain if it is pancreatitis for 2 days. She said this won't influence the treatment...so, uh, that's good. It is clear to me she is in pain, nauseous and needs fluids.

She said she didn't want to have to take even more blood for the TAMU Full GI, and to do that later with a regular vet.

I'm waiting for them to call with the results.
 
Tomlin said:
And keep the meds stocked! Due to the pandemic there have been shortages of drugs, including Bupe so make sure you have a decent amount on hand in case you need it and then have to wait to get more. I’ve asked my vets to provide more than they usually would because of this issue.

Also—Zofran is the brand name for Ondansetron:)
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Oh! Lol. Good to know.
I really hope they will give me these meds.

ETA: A note about how I feed Butters. She gets small meals throughout each 12 hour cycle, each one between 1 - 3 tsps of food, and always made into soup, basically adding 2 tsps water for every 1 tsp of food. I upped it to 1 tbsp water : 1 tsp food after her kidney issue showed up on her labs.
 
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Thanks for the update :bighug: I hope Butters feels better soon! Good call on the emergency vet this morning.

why do they always get sick on long weekends?!?:confused:
 
Ondansetron worked for my cats for nausea. I have gotten an RX and purchased from Costco as well as on line pharmacies. It’s available at all pharmacies. It does sound like nausea. If in the gray zone you would not know from the Snap so just as well it’s being sent out. Treatment is based on symptoms so no worries about that. It does sound like pancreatitis. It might be better not to take her BP when not well as it won’t be accurate. :bighug::bighug::bighug:
 
So, we all need puppy pads for vet visits ! I am happy you could go home!

Sorry about the fPl not being available. I sure hope manufacturing hasn’t hit them as well :banghead::(.
But they got the Spec fPLI which is great....even with the wait. With that you will be able to get a lab value which is good to know. The BP—not the biggest deal...will need to be repeated multiple times anyway.

Hope the rest of the labs turn out ok !
 
Just catching up on this... so sorry Butters is feeling that bad. Waiting outside (or at home) is no fun. Fingers crossed they're able to (a) treat the symptoms so she feels better asap and (b) get a clear diagnosis so you know what to do moving forward. :bighug::bighug::bighug:
 
Nothing found on the xray. She fought them quite a bit apparently (they didn't want to sedate her), so they couldn't get a good picture of her heart. But they did see her kidneys and liver in addition to her GI tract, all of which look fine. Nothing seen in GI tract.

Her GGT is elevated, and based on that the vet suspects pancreatitis. They want to keep her for 12 hours to give her IV fluids, anti-nausea, potassium and pain meds, and make sure she starts eating well before they send her home. I am fine with this. They don't have glargine insulin, so I ran over with her insulin and cans of her normal cat food. I wrote on the bottle exactly how much they should give her and when, and to administer only if they have gotten her to eat.

Other results mentioned on the phone:
Her BG is 54 so I put that on her spreadsheet and asked them to spare no expense on doing some additional spot checks and giving her something, anything, to bring it a bit higher.
Potassium is low, probably because she hasn't kept anything down in a while.
BUN and Creatinine are down and somehow the vet thinks her kidneys are fine. I (admittedly not a science person!) wonder is it because she has vomited her recent meals and had an empty stomach.
Phosphorus is 1.36, compared to 1.6 on October 7th. Same reason as above? I wasn't under the impression it could drop so much in 3 days.

The focus with the ER vet is treating the immediate acute problem. And she said they won't give me a prescription for any of the drugs (pain or anti-nausea). She said go to my regular vet and see if they will. I'm very frustrated by this...like poor Butters will have to suffer and I'll be forced to take her into a vet every time she is in pain and nauseous?
 
tiffmaxee said:
They might want to keep her overnight. :bighug::bighug::bighug:
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They do...kind of. Poor Butters. They said at least 12 hours and then maybe another 12 hours. Maybe I should just tell them to keep her for the 24 hours? It is my call. She can get more IV fluids that way. I don't know. What if she isn't eating by then?
I suppose I can play it by ear. I want to do what is best for her.
I have to find a way to get prescriptions for her for the medications. I could tell they weren't going to give them to me.

ETA: I told them not to take her BP. That makes sense. :bighug:
 
They won’t give her any nausea or pain medication while she is there? That’s crazy. Can you get in touch with your vet to get an RX called in for ondansetron? I seem to recall vet issues but I could be mixing this up.

Yes, play it by ear.
 
tiffmaxee said:
They won’t give her any nausea or pain medication while she is there? That’s crazy. Can you get in touch with your vet to get an RX called in for ondansetron? I seem to recall vet issues but I could be mixing this up.

Yes, play it by ear.
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Oh yes they will give her more nausea and pain meds while she is there, but they will not give me an RX for me to have any meds on hand for her.
I have been trying to find a new vet for her. I rushed her to her old vet on Wednesday evening because I was very desperate. I could see if I could get him to give me an ondansetron RX...when they open on Monday.
 
IV fluids are extremely helpful with pancreatitis so depending on how things look at 12 hours the additional 12 would be good.

Either way, 12 or 24, still lands you on a Sunday and your vet office will be closed. It is unacceptable to discharge Butters without medication—ask to speak with a supervisor/‘manager.

It’s common for them to send you home with a limited supply so that you follow up with your regular vet or with one of their IMs if they have a specialty service in addition to the ER
 
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