08/08 Butters AMBG n/a PMBG 90 - butters is home

Butters & Lyla

Butters & Lyla

Member Since 2020
Yesterday

This morning, I'm still awaiting an update from the ER vet. Because it is after 11am here, hopefully the delay means that the IM vet made in this morning to do her ultrasound. Either way, the ER vet assured me that no news is good news and that she is being monitored very closely. The vet can see right into Butters's cage from her desk. I'll post when I know anything.

Have a good day, all.

Surf safely, kitties:cat:
 
The IM vet came in this morning at 5am. He did the ultrasound but the ER vet wasn't on shift yet so she didn't get to speak with him about what he saw. She had to read to me off of his notes:
-Intestines, lymph nodes, pancreas and kidneys all looked perfect. Not even 1mm of inflammation.
-There is no pancreatitis flare.
-Her liver was slightly enlarged and he says this is diabetic hepatopathy.
-Her stomach has been emptying normally.
-There is no mass.

I'm sorry, but on Friday's ultrasound there was so much inflammation: enlarged lymph nodes, very inflamed pancreas and intestines. Her vet said for sure she should be getting an endoscopy and biopsies done based on what she saw and the report from IDEXX. And then less than 48 hours later everything looks awesome to the boarded IM vet (except the liver, which apparently there is nothing to do about that), and he is saying there is no need for an endoscopy. See my confusion? Apparently he explained away all of her on and off symptoms as either just a pancreatitis flare or in the case of constipation, due to the CKD.

What should I tell Butters? Hey, Butters, guess what? Turns out you weren't actually sick after all. Faker:rolleyes:!

I'm going to ask her vet to review both reports and call this IM vet and speak with him. I don't know what else to do right now, really. The ER vet suggested I get her into the IM vet for a consult and have him care for her as a regular patient, and then maybe once he is on her case and sees her ups and downs he will suggest more diagnostics.

The ER vet doesnt even see signs of pain anymore. She hasn't had methadone since yesterday afternoon. She is being managed on 25mg of gabapentin. They give a half dose to CKD cats, the vet told me. Non-CKD cats would get 50mg.

So basically the instructions are to take her home and give her appy stim and pain meds if needed and keep feeding her fancy feast. It was Turkey Fancy Feast that she has been enjoying, apparently. Not salmon as I was told yesterday. I'm happy she is coming home but so worried she will end up feeling ill again soon, because there has to be something going on here.
 
Hi Lyla, so happy to hear this last report. I understand why you feel conflicted, she was ill or the best faker ever :rolleyes: and her previous ultrasound was not good. I don’t know how you work with those two results. You would have been treating something based on the first ultrasound that was no longer there with the second. Wishing you both all the very best. Will look forward to seeing what her vet thinks of the two reports. Just tell Butters she is going to be feeling good now and enjoying Fancy Feast Turkey, maybe that’s what Butters end game was. :p Take care Lyla. Prayers for continued good reports and your baby is finally coming home!!!!
 
Hmmm. I disagree, Adrienne. I'd lean toward that there is some disease there that she is now not going to be getting diagnostics for and treating based on today's ultrasound and this IM vet's decision not to pursue further diagnostics. Her vet's clinic had sent over her recent history and Friday's ultrasound report and images to the hospital. I have to assume he never read the file.

So unless I get traction from her vet's clinic to either decide something different and take action based on all of the info, I'll end up continuing to struggle with managing her constipation and on again, off again symptoms of pain and inappetence. And she will continue to feel crappy more often than not. Then throw in the occasional crash that requires hospitalization. Fun times.
 
Did they stop giving cisapride? I am always tentative about this med for gut motility. I wonder if it could have affected the first US? No idea though…

Good BG Butters! Yahoo!
 
Butters & Lyla said:
Hmmm. I disagree, Adrienne. I'd lean toward that there is some disease there that she is now not going to be getting diagnostics for and treating based on today's ultrasound and this IM vet's decision not to pursue further diagnostics. Her vet's clinic had sent over her recent history and Friday's ultrasound report and images to the hospital. I have to assume he never read the file.

So unless I get traction from her vet's clinic to either decide something different and take action based on all of the info, I'll end up continuing to struggle with managing her constipation and on again, off again symptoms of pain and inappetence. And she will continue to feel crappy more often than not. Then throw in the occasional crash that requires hospitalization. Fun times.
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Hi Lyla, I agree with you and sorry if I implied all would be sunshine and roses. I never meant to to sound like I was making light of any of this and apologize for anything I said that made it sound that way. Every time I take Dolly to the vet because I feel she is not right, I’m told she is fine and no one can seem to hear the awful nasal congestion I can hear from across the room. I’ve watched you struggle with Butters bowel issues and often speak over a long period of time about her stomach feeling hard, my words may not be exact, but often mentioning her tummy, her not eating, her constipation over too many days. I hope and pray that someone looking at the second ultrasound see’s something the IM vet missed or the ultrasound is just wrong based on her position or something hidden that the first ultrasound picked up. I have obviously no idea but they are not going to treat something they can’t find. I can’t begin to imagine your frustration. I hope you can get some answers that address the obvious problems. Sending prayers.
 
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Our Dolly Girl said:
Hi Lyla, I agree with you and sorry if I implied all would be sunshine and roses. I never meant to to sound like I was making light of any of this and apologize for anything I said that made it sound that way. Every time I take Dolly to the vet because I feel she is not right, I’m told she is fine and no one can seem to hear the awful nasal congestion I can hear from across the room. I’ve watched you struggle with Butters bowel issues and often speak over a long period of time about her stomach feeling hard, my words may not be exact, but often mentioning her tummy, her not eating, her constipation over too many days. I hope and pray that someone looking at the second ultrasound see’s something the IM vet missed or the ultrasound is just wrong based on her position or something hidden that the first ultrasound picked up. I have obviously no idea but they are not going to treat something they can’t find. I can’t begin to imagine your frustration. I hope you can get some answers that address the obvious problems. Sending prayers.
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I don't think you did. I just meant the part about treating something that wasn't there anymore. I think there has to be something underlying. One day we're discussing endoscopy and biopsies. Two days later I'm being told she's totally fine, take her home and ignore the enlarged liver. I just think there is some incompetence somewhere, unfortunately I don't know where!
thebigfuzz said:
Did they stop giving cisapride? I am always tentative about this med for gut motility. I wonder if it could have affected the first US? No idea though…

Good BG Butters! Yahoo!
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The vet she saw on Thursday had me stop it. I actually think the last time she had it was Wednesday morning. It hadn't helped her at all imo. The first US was Friday and the clearance time is around 12 hours, so I'm guessing it didn't affect it. I'm not sure though.
 
I would be really upset, too, Lyla. Going in and out of hospitals all the time is not good for you or her. Am I getting it right that two ultrasounds were done at two different facilities with different radiologists? Can the two radiologists talk to each other and come to some consensus? Hope the IM is experienced enough to be able to interpret what might be going on. Is there an internist at the hospital who might specialize in gastrointestinal issues or neurology or endocrinology, to hone in on at least one of Butters's conditions? Sorry I'm plying you with so many questions but I'm looking for ways for you to stop this merry-go-round.
 
Ugh. Hard to take comfort from the good news that she's feeling better and likely coming home when you aren't satisfied anyone really knows what's going on. Time to be the cat advocate...as I know you are already. :arghh::bighug:

And just for some light relief, I loved the bit about 'what do I tell Butters?' Maybe tell her the neurologist is going to check her out to see if it's all in her head. :confused::cat:. Still, glad to hear she's feeling better AND the BG doesn't seem impacted by the skipped insulin doses.
 
Lol, I was going to call it a merry-go-round, too! It may be a contender for one of the least merry, merry-go-rounds.
Thank you for asking all of the questions because it helps me sort it out in my mind, too.
PerfumedCatMom said:
Going in and out of hospitals all the time is not good for you or her.
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Yeah, I really don't think I can do this anymore and she can't either.
PerfumedCatMom said:
Am I getting it right that two ultrasounds were done at two different facilities with different radiologists?
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Correct.
Ultrasound one was done at her vet's clinic on Friday. Imaging was done by a vet there who is trained to do imaging, and then sent to be read and reported on by an IDEXX boarded radiologist. Her vet transferred her to a hospital Friday night because she was still doing terrible, not eating etc, plus they thought there was something very serious going on with her stomach.
Ultrasound two was done at the hospital early this morning by a boarded IM vet.

The IM vet who did the ultrasound handles all of the complex feline GI/endocrinology cases. The ER vet said even though the ultrasound was an in-house consult, I could book Butters in to see him for a general consult without a referral from her vet. I'm hesitant, though.

I'm going to try to get hold of her regular vet and/or the vet she saw on Thursday and Friday at his clinic while he was on vacation and hope he can help sort things out.

As for neuro, one of the other vets in her GP clinic is married to a neuro vet. So her vet is planning to speak with him about butters just to get a gut check on what to do in that regard.
 
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Butters & Lyla said:
Lol, I was going to call it a merry-go-round, too! It may be a contender for one of the least merry, merry-go-rounds.
Thank you for asking all of the questions because it helps me sort it out in my mind, too.

Yeah, I really don't think I can do this anymore and she can't either.

Correct.
Ultrasound one was done at her vet's clinic on Friday. Imaging was done by a vet there who is trained to do imaging, and then sent to be read and reported on by an IDEXX boarded radiologist. Her vet transferred her to a hospital Friday night because she was still doing terrible, not eating etc, plus they thought there was something very serious going on with her stomach.
Ultrasound two was done at the hospital early this morning by a boarded IM vet.

The IM vet who did ultrasound two has the absolute best reputation in these parts. He is the guy who handles all of the complex feline GI/endocrinology cases. The ER vet said even though the ultrasound was an in-house consult, I could book Butters in to see him for a general consult without a referral from her vet. I'm hesitant, though.

I'm going to try to get hold of her regular vet and/or the vet she saw on Thursday and Friday at his clinic while he was on vacation. I'd actually look to them to hopefully sort this out with all parties, since the first ultrasound was done on their watch, and also they have a great working relationship with this IM vet, who is considered the best in my part of the world. It was just a coincidence butters got to see him this morning for the ultrasound, but her regular vet had planned to consult with him on Butters's case back in November. So much happened since then, he never got around to making the referral. But he would actually be the guy to put together a plan for her:facepalm:.
Having had this expectation set of a high level of care from him makes what happened even worse.

As for neuro, one of the other vets in her GP clinic is married to a neuro vet. So her vet is planning to speak with him about butters just to get a gut check on what to do in that regard.
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I'm relieved that the doctors will be talking to each other and that they have an existing relationship. Sounds like you're skeptical about this IM, but I really hope that he proves you wrong if he's one of the best in the area. I am having a little trouble trusting Ruby's oncologist too, but she is also one of the best at what she does, and they all had to get that reputation somehow. Gotta have some faith. :bighug:
 
Maybe I missed it, but it does make me wonder if the person who read U/S #2 even looked at U/S #1. I feel your frustration...it shouldn't be so hard, you just want to scream at them "can't you JUST TALK TO EACH OTHER!" or more productively makes me want to say, shall I schedule a conference call so we can all talk together? :facepalm:
 
I should add an update. The ER vet removed her urinary catheter around 6 hours ago. She was hoping Butters would have a pee on her own before I take her home. She just called to say she hasn't peed and asked if I would mind waiting a little while longer because it would make her (the vet) feel better if she saw her pee. I agreed. But we agreed that if she doesn't pee in the next couple of hours, I'll pick her up regardless. I can always follow up with her regular clinic tomorrow.
 
Liz & Minnie said:
Maybe I missed it, but it does make me wonder if the person who read U/S #2 even looked at U/S #1. I feel your frustration...it shouldn't be so hard, you just want to scream at them "can't you JUST TALK TO EACH OTHER!" or more productively makes me want to say, shall I schedule a conference call so we can all talk together? :facepalm:
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My understanding from the ER vet is he said the ultrasound is a snapshot in time and to him it didn't matter what it said. That's what frustrates me the most I think. Given she has chronic pancreatitis and constipation and then inflammation was seen in the intestines, lymph nodes and stomach as well as pancreas...and then he saw inflammation in the liver though the other organs had resolved...I don't get how you don't even so much as recommend a follow up ultrasound or something, anything, given her history.

Lol I'll send everyone a meeting agenda and a Teams invite!
 
I'm going to venture a suggestion based on a human experience.

Make sure the vet didn't confuse Butters' ultrasound with another cat's readings. It happens. (My sister, who was a breast cancer survivor, was told that she had breast cancer again based on her annual mammogram. It was very fortunate that her radiation oncologist looked over the films and realized that the new films were not consistent with her history and pulled out the old ones to compare. A technician had mislabeled her films with someone else's. It was a huge relief for everyone except the woman who had been told her mammogram was fine.)
 
Butters & Lyla said:
My understanding from the ER vet is he said the ultrasound is a snapshot in time and to him it didn't matter what it said. That's what frustrates me the most I think.
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And my question (and yours and everyone's I'm sure) for Mr ER vet is "I understand it's a snapshot in time, but how do you explain such vast difference in only 1 day (or however many days)?" I mean...I understand that perspective comparing u/s from weeks or months apart and I understand he is a wise vet and we are stupid peons, but...DUDE, COME ON. If I remember correctly, all they did was empty her bladder and give some painkillers? So, why the difference? And if he can't give any explanation then you just nod and go to another vet....dr... with the same question. I know that's what you're going to do anyway but I get so irritated. I want to put them on the spot and make them flat out admit they don't know. I'd have more respect for that. (LOL I clearly have too much history...). I have a theory that's how ER drs operate - they don't care about the history or what you already know, they treat every patient as if they are starting treatment from scratch as soon as they walk in the door. :banghead:

And as Elise said, just wow. :banghead: I wish that didn't surprise me.
 
Liz & Minnie said:
Maybe I missed it, but it does make me wonder if the person who read U/S #2 even looked at U/S #1. I feel your frustration...it shouldn't be so hard, you just want to scream at them "can't you JUST TALK TO EACH OTHER!" or more productively makes me want to say, shall I schedule a conference call so we can all talk together? :facepalm:
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They don’t like to look at each other’s ultrasounds. Max had one that said everything was wrong with him but his pancreas when he first got pancreatitis. My internist then wanted his radiologist to do another a week later. I brought the prior disc that I had to go to retrieve. My vet said he doubted it would be looked at. The second ultrasound looked good. It saved Max from exploratory surgery or endoscopy for cancer he never had in the 7+ years after. Oh and chronic pancreatitis was diagnosed via the SPECFpL I asked the first vet to run but based upon the ultrasound she didn’t do it. She was in surgery when I picked Max up so it didn’t get done there.
 
tiffmaxee said:
They don’t like to look at each other’s ultrasounds. Max had one that said e everything was wrong with him but his pancreas when he first got pancreatitis. My internist then wanted his radiologist to do another a week later. I brought the prior disc that I had to go to retrieve. My vet said he doubted it would be looked at. The second one looked good. It saved Max from exploratory surgery or endoscopy for cancer he never had in the 7+ years after.
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Grr. I know. This makes me spiral into a whole tirade about cost of the medical system...
 
Oh my goodness, Lyla. After all that you and Butters have endured! … to end up with THIS! Crazy different results…. Just a few days apart. I’m not buying it! Something is going on. And somebody is missing it. I would still be very worried. This is so perplexing and frustrating!! I was hoping for real answers and so were you, of course! You will need to really think through your next move.

I’m so glad she’s not in pain now. I hope she will keep eating!
 
What a rollercoaster you are going through, Lyla! I'm so sorry you have to deal with this, and even with the "good news" update they gave, it's definitely suspicious and I hope you get more answers and a very clear answer to every single one of your questions. I wish I could offer advice but I'm just here to send my love and support to you and Butters.

Also reading some of these other comments, WOW what a terrible headache healthcare for both humans and animals can be. Communication people!!!!
 
I was going to float the idea that Butters' US results may have been mixed up with those of another cat, but I see that Sienne beat me to it! I hope that the vets will figure it out. It seems that one has to watch them and question them all the time. Bummer! Anyway, I'm glad that Butters is feeling better. FF Turkey Pate Classic is our civvie Gus' favorite food, too.
Hang in there Lyla!

:bighug: Hugs to you and scritches for Butters.
 
Butters is finally home and eating Fancy Feast sliced Turkey and won't stop hounding me for more...it has gravy. Ingredients include wheat gluten, corn and soy flour. Doesn't seem diabetic friendly to me, or good for a cat whose first ultrasound showed so much GI inflammation. The ER vet told me keep feeding it to her and not to make any changes to her food for at least two weeks! I'll figure out something tomorrow. Maybe get a few classic plates.

She is doing okay. She is happy to be in her home and she looks okay all things considered.

She wasn't blocked but she has this tendency to hold in her urine for way too long. The ER vets wanted to try to get her to pee there, but they said she'd be more likely to do it at home. If she was a blocked cat, they'd never have discharged her without her peeing on her own.

I'll respond to the comments and suggestions tomorrow. I need to try to sleep.

I checked her BG when she got home and it is 95. I'll have to figure out her insulin for tomorrow.

Thank you all so much for taking the time to stop by to check on Butters and/or to leave your thoughts and suggestions regarding what happened today. I truly appreciate it:bighug:
 
Glad she's home! (and still smiling about the photo of her after being shaved..) AND since I'm sure you have too much going on to check, I've checked the Dr Lisa list for FF Sliced Turkey in Gravy - 13%. Fat 37%. 275mg P/100kcal.

Hope you can have a relaxed evening. Don't feel obliged to reply to my ramblings! :bighug:
 
My very first thought after reading your comments on the two extremely different result reports - they're reading someone else's results! Time for a re-evaluation on their part.

I had a skin cancer removed from my face some years ago - after it was all said and done I visited the plastic surgeon for a final follow up - he came in and presented me with a photo of 'before me'....I looked at the picture and said, 'that's not me'...he was stunned! But your name, your registration number...duh duh...I said that lady has brown eyes...look at mine...

So yes, it happens and it happens all the time! Unfortunately it's too easy to do...and happens frequently.

And even so far as marking the wrong patients name on the 'photographic evidence'...

I doubt that Butters was 'faking it'... Get another evaluation...something's not right there.
 
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