10/12 Butters PMPS 288

That's a low dose for pain med. Ollie got 0.15 every 8 hrs. There are different concentrations though so maybe that's it. Considering how the ER she was at appeared to not help you much, I would try the other. Also not wait for a mobile vet to be in your area. Butters needs help, needs meds that will help her now.
 
The bupe does does seem a little low. OK, Paula just responded the same. :p It is dosed on a scale, based on cat weight. My 14.5 lb girl got 0.22 twice a day for her arthritis, upped to 3 times a day after major dental work.
 
I thought so. :( They also only gave me 0.1mg ondansetron BID for her. :( I feel so sorry for her and so upset at the ER vets. We don't have a decent primary care vet who will make things right. The vet I used earlier this week (anti-hometesting vet) doesn't like his patients' beans to advocate or have an opinion, either.
 
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Was her belly hard before you took her to the ER?

Is still hard now?

That concerns me...

Also, Charlie had a feeding tube three different times. The first was a PEG tube (percutaneous endoscopic gastronomy tube, or more simply, a tube that goes through the skin and abdominal wall of the cat’s side and directly into the stomach). The other two were e-tubes (esophageal tubes) that go through the skin of the neck directly into the esophagus, which is the “pipe” that leads to the stomach. (I saw reference to a tracheal tube, which I’ve not heard of for tube feeding given that the trachea leads to the lungs). There’s also an NG tube (naso-gastric), which threads through the nose and down the esophagus to the stomach. I don’t think Charlie would have tolerated that one well. It sounds like you’re open to a tube if needed — they can be absolute lifesavers.

Thinking of you two and sending positive thoughts.
 
Olive & Paula said:
That's a low dose for pain med. Ollie got 0.15 every 8 hrs. There are different concentrations though so maybe that's it. Considering how the ER she was at appeared to not help you much, I would try the other. Also not wait for a mobile vet to be in your area. Butters needs help, needs meds that will help her now.
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Do you mean now, like right now? Go to the other ER? I'm staring at her face and it doesn't look different from how she looked Friday. Okay. I'm thinking about it.
 
JL and Chip said:
Was her belly hard before you took her to the ER?

Is still hard now?

That concerns me...

Also, Charlie had a feeding tube three different times. The first was a PEG tube (percutaneous endoscopic gastronomy tube, or more simply, a tube that goes through the skin and abdominal wall of the cat’s side and directly into the stomach). The other two were e-tubes (esophageal tubes) that go through the skin of the neck directly into the esophagus, which is the “pipe” that leads to the stomach. (I saw reference to a tracheal tube, which I’ve not heard of for tube feeding given that the trachea leads to the lungs). There’s also an NG tube (naso-gastric), which threads through the nose and down the esophagus to the stomach. I don’t think Charlie would have tolerated that one well. It sounds like you’re open to a tube if needed — they can be absolute lifesavers.

Thinking of you two and sending positive thoughts.
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Thank you.
Yes it is hard now. No it was not hard before I took her to the ER. Why does the hard belly concern you? For something other than constipation?
She hasn't had a BM since overnight friday into saturday. I normally put pumpkin in her diet every day to help her. I've given her a tiny dose of miralax tonight, too.
After hearing @Aleluia Grugru & Minnie and @JaxBenji talk about how much of a lifesaver the tubes were for them and their kitties, and now you're saying the same thing, I am very open to it if Butters needs it.
 
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I don't mean drop what your doing and rush to ER. I don't think 1st ER has not done much for Butters. She needs a Dr who will give thorough exam and the treatment/meds she needs. I would definitely try to get her seen tomorrow is she doesn't have major improvement. For ER to not give cerenia, what appears to be to small dose of pain med, not assist feed an animal not eating. Makes me wonder how competent they are.

The hard belly, few reason it could be. Gas. Backup of stool. Since she isn't eating much, there isn't much to move out. is the pancreatitis worse than believed causing organ to be grossly enlarged. Possible blockage. Accumulation of fluid into abdominal cavity. Abdominal/intestinal mass.
 
Olive & Paula said:
I don't mean drop what your doing and rush to ER. I don't think 1st ER has not done much for Butters. She needs a Dr who will give thorough exam and the treatment/meds she needs. I would definitely try to get her seen tomorrow is she doesn't have major improvement. For ER to not give cerenia, what appears to be to small dose of pain med, not assist feed an animal not eating. Makes me wonder how competent they are.

The hard belly, few reason it could be. Gas. Backup of stool. Since she isn't eating much, there isn't much to move out. is the pancreatitis worse than believed causing organ to be grossly enlarged. Possible blockage. Accumulation of fluid into abdominal cavity. Abdominal/intestinal mass.
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She hasn’t gone since Friday and did she eat okay then? Then she might be constipated.
 
She went friday overnight into saturday morning.
She ate semi-okay on Friday during the day. Vomited at 3am on Saturday and again at 8am. That's when I decided to take her to the ER.
 
Maybe a half dose of insulin is the way to go, just to be safe. I'm about to syringe feed her some more.
I'm thinking bringing her to the other ER in the morning is the way to go. All the specialists will be there.
 
I'm sorry I wasn't here earlier. I would agree with you...a half dose is better than nothing at all. So many other factors right now.

I hope she can get through the night as comfortably as possible and you guy get to the ER first thing...it's been such a stressful day all around. Sending you hugs and prayers Lyla!
 
Let's hope she'll get a little help from the juice. It's really hard to tell..pain can cause elevated BG's, constipation...so many things going on now...

Just don't put too much emphasis on that number - look at the whole picture. She's got a lot on her little Buttery plate tonight to deal with. :bighug:
 
Amen to the “don’t put to much emphasis on the number”.....other than to take note o_O. Hopefully you have a one and done situation here, but if not, you are and will gain valuable information that is able to help you in the future with knowing:

1) Could there be an increase in inflammation returning? Is something about to go sideways on me?
2) Is there pain? Sometimes when there is more subtle pain, there may not be the more obvious facial expressions or body language

BUT with inflammation and/or pain, you will get hit with an out of “character” BG that feels like a slap to the face :eek:o_O.....what the?! You will then think “hmmm....keep an eye on this...maybe inflammation creeping up? Is there pain...;)?

Again, this is all a learning process just like the DM was & it does become easier to manage. It is still stressful at times but you become super proficient on picking up on the signs (like you are already :)) & knowing which tool (med/food) to reach for in your toolbox to get things under control, how to adjust the insulin and also when your toolbox just isn’t cutting it and you need the vet or ER premium toolbox instead :bighug:
 
Butters & Lyla said:
Yes it is hard now. No it was not hard before I took her to the ER. Why does the hard belly concern you? For something other than constipation?
She hasn't had a BM since overnight friday into saturday. I normally put pumpkin in her diet every day to help her. I've given her a tiny dose of miralax tonight, too.
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There are quite a few things that a hard belly can be. Sure, it might be constipation, and dehydration can make it even more difficult for her to pass stool. What’s nagging on me slightly is that you said she ate ok Friday, passed stool late Friday or early Saturday, then vomited at 3 AM Saturday and hasn’t really wanted to eat much since. Vomiting is common with constipation, but it’s not ongoing. And the ER did an abdominal x-ray, correct? I’d think that would have shown lots of stool were she “backed up” and that Fri/Sat poop was “incomplete.” They don’t generate a lot of stool when they’re not eating.

I’d suggest you also keep testing for ketones, for good measure.

You can also try putting your hand on one side of her belly and tapping gently on the other side with your other hand. If their belly is full of fluid, you can often feel the percussion on the other side.

I looked at her blood work and the liver values weren’t bad, at least when the blood was drawn. But it did look like the SDMA and creatine have increased since her last bloodwork. Did the ER vet mention anything about kidneys? I don’t want to alarm you — dehydration and illness can impact a lot of things — but if the reference ranges are valid, you might want to at least inquire at the new vet what they think. And there’s no way she got into anything other than her regular food, correct? (Didn’t eat any plants, etc)

I’m really disappointed the ER didn’t send you home with sub-q fluids. It’s virtually impossible to get enough fluid orally into a cat who isn’t eating well. Keep trying. It’s good that she’s keeping food down now.
 
JL and Chip said:
There are quite a few things that a hard belly can be. Sure, it might be constipation, and dehydration can make it even more difficult for her to pass stool. What’s nagging on me slightly is that you said she ate ok Friday, passed stool late Friday or early Saturday, then vomited at 3 AM Saturday and hasn’t really wanted to eat much since. Vomiting is common with constipation, but it’s not ongoing. And the ER did an abdominal x-ray, correct? I’d think that would have shown lots of stool were she “backed up” and that Fri/Sat poop was “incomplete.” They don’t generate a lot of stool when they’re not eating.

I’d suggest you also keep testing for ketones, for good measure.

You can also try putting your hand on one side of her belly and tapping gently on the other side with your other hand. If their belly is full of fluid, you can often feel the percussion on the other side.

I looked at her blood work and the liver values weren’t bad, at least when the blood was drawn. But it did look like the SDMA and creatine have increased since her last bloodwork. Did the ER vet mention anything about kidneys? I don’t want to alarm you — dehydration and illness can impact a lot of things — but if the reference ranges are valid, you might want to at least inquire at the new vet what they think. And there’s no way she got into anything other than her regular food, correct? (Didn’t eat any plants, etc)

I’m really disappointed the ER didn’t send you home with sub-q fluids. It’s virtually impossible to get enough fluid orally into a cat who isn’t eating well. Keep trying. It’s good that she’s keeping food down now.
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Thank you for this!
Yes, the ER did an xray. They said everything looked good in the xray, just that her bladder was a little large. But they felt it and it felt fine, just that she was holding in a lot of pee, was what they said.
She had a Spec fPLI which was a 9. So pancreatitis.
I got another 20mls into her. Even though I feel like I spent the entire day prepping or feeding, I know she didn't get enough. :(

I'm in Canada and it is a long weekend here, so the regular vet practices are closed today or I would have taken her somewhere. I specifically asked the ER vet for subq fluids and syringes for feeding, and they wouldn't provide me with any of it. They told me if she doesn't eat and drink on her own, I have to bring her back because it means that something is wrong that needs further investigating. At the same time, they were very supportive of me taking her home because they said she was very nervous there and not eating. Then they don't want to equip me with the tools so that I can care for her properly? It is disappointing.

The vet on Wednesday did mention about kidneys. She was there because she had been acting very disoriented and I thought possible infection.
I think he said it looked like early kidney disease and he wanted her on a k/d diet. I'd brought that up here and got advice to get labs run again at some point. Her numbers are a little better on the labs that were run at the ER on Saturday, though they didn't do a SDMA. I just haven't had a moment to type them into my spreadsheet. But the kidneys are definitely on my radar. I feel like suddenly there are so many moving parts to what is going on with her health. Not having reliable veterinary care for her adds a lot of stress. Hopefully the place I'm trying tomorrow works out well.

I'll try the belly tapping tonight when I have to interact with her next (for BG and ketones and bupe). I'm giving her space right now. And I'm so glad she will be at a vet (hopefully a good one) tomorrow. I'll make sure they have copies of all the results from the past several days and I plan to mention everything that has come up, including disorientation, kidneys, FD, pancreatitis.
 
Sue and Luci said:
Let's hope she'll get a little help from the juice. It's really hard to tell..pain can cause elevated BG's, constipation...so many things going on now...

Just don't put too much emphasis on that number - look at the whole picture. She's got a lot on her little Buttery plate tonight to deal with. :bighug:
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Yup. She has a lot going on! I should probably be a tiny bit phased by it but I'm just too tired. Most of my energy is going toward worrying about how to make her more comfortable. :bighug:
Tomlin said:
Amen to the “don’t put to much emphasis on the number”.....other than to take note o_O. Hopefully you have a one and done situation here, but if not, you are and will gain valuable information that is able to help you in the future with knowing:

1) Could there be an increase in inflammation returning? Is something about to go sideways on me?
2) Is there pain? Sometimes when there is more subtle pain, there may not be the more obvious facial expressions or body language

BUT with inflammation and/or pain, you will get hit with an out of “character” BG that feels like a slap to the face :eek:o_O.....what the?! You will then think “hmmm....keep an eye on this...maybe inflammation creeping up? Is there pain...;)?

Again, this is all a learning process just like the DM was & it does become easier to manage. It is still stressful at times but you become super proficient on picking up on the signs (like you are already :)) & knowing which tool (med/food) to reach for in your toolbox to get things under control, how to adjust the insulin and also when your toolbox just isn’t cutting it and you need the vet or ER premium toolbox instead :bighug:
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This is excellent advice put very succinctly.:) I am bookmarking it for future reference, though of course I hope we are a one and done.
Thank you for sharing your experience and knowledge with me these past few days. It has helped me and Butters so much. :bighug:
 
Olive & Paula said:
I don't mean drop what your doing and rush to ER. I don't think 1st ER has not done much for Butters. She needs a Dr who will give thorough exam and the treatment/meds she needs. I would definitely try to get her seen tomorrow is she doesn't have major improvement. For ER to not give cerenia, what appears to be to small dose of pain med, not assist feed an animal not eating. Makes me wonder how competent they are.

The hard belly, few reason it could be. Gas. Backup of stool. Since she isn't eating much, there isn't much to move out. is the pancreatitis worse than believed causing organ to be grossly enlarged. Possible blockage. Accumulation of fluid into abdominal cavity. Abdominal/intestinal mass.
Click to expand...
I am definitely going to get her seen tomorrow at a different place. Maybe it was a problem with the ER and rotating shifts. There were three shift changes during her 27 hour stay and each vet had a different opinion about what meds they would give me for her. I hate that she suffered because of their incompetence.
 
Hang in there, Lyla and Butters! Best of luck tomorrow with the new vet. Hopefully they'll be able to take the time to get the full picture. When I've been taking Oberon in, I've been sending a short writeup of his history and the current important issues, in addition to other vet reports and stuff. Since I can't be in the room with him, I want them to have all that info right away instead of doing an exam and then calling me to ask about his history. Just a thought, in case you have time to write something up. :bighug::bighug::bighug:
 
Actually they did! I kept calling them to ask until they finally relented. So I have everything from that ER visit. Including where it says they gave her gabapentin (which they never told me about) because she was swatting them when they tried to check her BG. :mad: Poor girl's ears were a mess when they were done with her.

Anyways! Thanks @Lisa & Oberon for the idea. I can't be in the room with Butters, either. And thanks @JaxBenji for suggesting I call first to find out what time the specialists arrive. I will get her in there to be seen one way or another.

Thanks again to everyone for so much help and support.:bighug::bighug::bighug::bighug::bighug:
 
Hey Lyla, if you make the new vet a copy of the paperwork from your other vets as well as the ER, you might also want to include a note about the twitching you’ve noticed. That might or might not have been documented by the ER, but could be a clue for the new vet. You could also video it if possible—sometimes seeing an episode is more enlightening to a vet than the client trying to describe it.
 
I have been watching and praying for poor little Butters. I hope she gets what she needs from the vet today, and you get some peace of mind and some much needed rest. :bighug::bighug::bighug::bighug:
 
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