6/17 Henry - re-hospitalized for DKA :(

Is he eating plenty and drinking OK?
is he at all lethargic?
I’m wondering if the ketones strips are OK because these high reading started when you got the new bottle of strips I think.
Can you get a urine sample and test for ketones in the urine? That would tell us if the strips are accurate or not.

How hot has if been when you have left the insulin out of the fridge for 12 hours x3?
 
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Bron and Sheba (GA) said:
Is he eating plenty and drinking OK?
is he at all lethargic?
I’m wondering if the ketones strips are OK because these high reading started when you got the new bottle of strips I think.
Can you get a urine sample and test for ketones in the urine? That would tell us if the strips are accurate or not.

How hot has if been when you have left the insulin out of the fridge for 12 hours x3?
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So the first reading of 5.8 was actually with the last strip I had from the first batch, so I tend to think they're probably accurate, but I do have urine ketone strips around here so I'll try to catch him next time he goes. It hasn't been above 70 degrees F in here, but it's usually 65-67. Eating has been excellent, he's only had one drink from his water bowl today and it wasn't much. I was able to coax him to drink a bit from the water tap earlier and I just had back from the pet store and got him a fountain, so hopefully he'll drink more. The only downside to the fountain is not being able to keep a close eye on how much exactly he's drank vs a glass bowl, but I'll try and figure out a way. Before today he's been drinking 300-600ml per day.

edit: doesn't seem very lethargic. Maybe a bit more than yesterday, but he's pretty alert and moving around/walking fine.
 
John & Henry said:
So the first reading of 5.8 was actually with the last strip I had from the first batch, so I tend to think they're probably accurate, but I do have urine ketone strips around here so I'll try to catch him next time he goes. It hasn't been above 70 degrees F in here, but it's usually 65-67. Eating has been excellent, he's only had one drink from his water bowl today and it wasn't much. I was able to coax him to drink a bit from the water tap earlier and I just had back from the pet store and got him a fountain, so hopefully he'll drink more. The only downside to the fountain is not being able to keep a close eye on how much exactly he's drank vs a glass bowl, but I'll try and figure out a way. Before today he's been drinking 300-600ml per day.

edit: doesn't seem very lethargic. Maybe a bit more than yesterday, but he's pretty alert and moving around/walking fine.
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It’s a bit of a mystery. I’m glad he is eating well and lethargy doesn’t seem to be a problem.
I think the urine ketone test will tell us when we are up to with it all.
Will he go if you just put him in the LB? Sheba was always very obliging if I put her in the LB and would always pee foe me.
 
Bron and Sheba (GA) said:
It’s a bit of a mystery. I’m glad he is eating well and lethargy doesn’t seem to be a problem.
I think the urine ketone test will tell us when we are up to with it all.
Will he go if you just put him in the LB? Sheba was always very obliging if I put her in the LB and would always pee foe me.
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Maybe, he has a habit of jumping in right after I scoop and put in fresh litter, so I should be able to get it then. I've just spent the last 30 minutes searching for those urine strips and I can't find them anywhere. Just put in an amazon order for more and they'll be here Saturday. It's so confusing that while his BG has been kinda high, it doesn't seem anywhere near as high as some other member report in their speadsheets and yet most of them don't seem to be having a problem with ketones. Is it possible he has some other medical problem that's making his body produce ketones? If I understand the process correctly, the ketones are responsible for turning the blood acidic and that's when DKA occurs, so it seems its only going to be a matter of time before he's critical again. I got the fountain setup and he seems to like it, but still not heavily drinking like yesterday.

Thanks for your replies Bron & Wendy

edit: opps, put this comment in the wrong thread -- An interesting thing to note: my dog has been heavily sniffing around his head the last couple days, before I even got that first 5.8 reading. I wonder if she was smelling the ketones. I know they say they can be smelled on the breath and dogs can be trained to alert on the scent.
 
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The Ketostix can be bought from any pharmacy. Are you able to go out and buy some today?
Waiting until Saturday is not a good idea.. …..we need to get to the bottom of this asap.

The BG does not have to be really high for ketones to develop. Some cats are more prone to ketones than others.
Sheba used to get really high BGs at times but she never had ketones.

Ketones form by lipolysis (the breakdown of fat) when the body can’t use the carbs for energy because of a lack of insulin or food, and the body has to find another source of energy, so it breaks down the fat.
Cats can have ketones without the blood turning acidic but as the number of ketones increase so does the risk of DKA increase, and the electrolytes get all out of kilter.

Normally with such a high ketones I would say go to ER but because he is eating well, seems alert and active and not lethargic I hesitate. But you are there and you must make your own decision on this.
I would really try and get that urine ketones test done today.
 
I've heard of some people saying they can smell when their cat has ketones, a fruity smell. I think picking up some Ketostix ASAP is s good idea.
 
OK, going to the 24 hour pharmacy right now to get some. Thank you for the explanation on the ketones. He seems to be liking the new fountain, so that's good. He's sort of been listlessly walking around the house the last few hours instead of just lying in his chair like normally -- not sure if that's good or bad, but definitely not lethargic. First sign of him not eating or drinking he's going straight to the vet. He just ate 2 cans of fancy feast pate one right after another. I don't want to feed him too much, but I think he'd have more if I offered it.
 
Alright, got the urine ketone strips, and I can't believe how easy it was to actually get a reading with them. I just scooped his box, put fresh litter in it, and sat next to it for about 10 minutes til he came over and used it. Unfortunately the result was very dark. At 15 seconds the color was almost as dark as the darkest square on bottle (labeled "100") and much darker than the next closest shade (labeled "80") both of those squares were classified as "major". After 30 seconds it was the same shade as the darkest square (100), but the test was meant to be read at 15 seconds, so yeah. lots of ketones. confirmed :banghead:
 
John & Henry said:
Alright, got the urine ketone strips, and I can't believe how easy it was to actually get a reading with them. I just scooped his box, put fresh litter in it, and sat next to it for about 10 minutes til he came over and used it. Unfortunately the result was very dark. At 15 seconds the color was almost as dark as the darkest square on bottle (labeled "100") and much darker than the next closest shade (labeled "80") both of those squares were classified as "major". After 30 seconds it was the same shade as the darkest square (100), but the test was meant to be read at 15 seconds, so yeah. lots of ketones. confirmed :banghead:
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Ok. I’m glad you were able to get the test done and now we know for sure that he has ketones. And a large number of them.
I think even though he seems well and is eating well, I would at least either ring the ER or take him to the ER. It will be far better to catch it earlier rather than later, both health wise for Henry and financially for you.
I can’t explain why this is happening. He may just need some IV fluids.
Please let us know what you decide to do and any updates as we will be anxiously waiting to hear.
 
Bron and Sheba (GA) said:
Ok. I’m glad you were able to get the test done and now we know for sure that he has ketones. And a large number of them.
I think even though he seems well and is eating well, I would at least either ring the ER or take him to the ER. It will be far better to catch it earlier rather than later, both health wise for Henry and financially for you.
I can’t explain why this is happening. He may just need some IV fluids.
Please let us know what you decide to do and any updates as we will be anxiously waiting to hear.
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I'll ring the specialist who has been dealing with his case tomorrow, before she's off for the weekend. If she seems dismissive or doesn't have any useful suggestions, I'll get him in for an emergency visit with his normal vet. I'm afraid there isn't going to be much they can do besides fluids, but what do I know? I really hope the ketones go down tonight.
 
John & Henry said:
I'll ring the specialist who has been dealing with his case tomorrow, before she's off for the weekend. If she seems dismissive or doesn't have any useful suggestions, I'll get him in for an emergency visit with his normal vet. I'm afraid there isn't going to be much they can do besides fluids, but what do I know? I really hope the ketones go down tonight.
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They can do blood tests to see how the electrolytes are and the acidity of the blood and do any corrections before it gets worse. Even some IV fluids could make a big difference. You should maybe ask about subQ fluids to do at home.
I would really rather you ring the ER tonight (because it’s not even midnight for you is it?) and ask them what they think. The ketones can rapidly progress to DKA and we don’t want that!
In the meantime giving him as much fluids as possible, either through drinking or in the food may help and keep him eating. But remember he already has very high ketones in his blood and we don’t know when they will progress to DKA.
 
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Bron and Sheba (GA) said:
They can do blood tests to see how the electrolytes are and the acidity of the blood and do any corrections before it gets worse. Even some IV fluids could make a big difference. You should maybe ask about subQ fluids to do at home.
I would really rather you ring the ER tonight (because it’s not even midnight for you is it?) and ask them what they think. The ketones can rapidly progress to DKA and we don’t want that!
In the meantime giving him as much fluids as possible, either through drinking or in the food may help and keep him eating. But remember he already has very high ketones in his blood and we don’t know when they will progress to DKA.
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I just called the ER. They said they didn't have techs available, so they can't see him til 8am. I talked to the on call doctor and asked "How long can his ketones be over 5 before his blood acidifies?" and she said "We don't like to see that for more than a day" Well it's been 3 full days since they've been over 5. He vomited for the first time in a long time in the last hour. Make that twice. Just did it again. ugh. I'm planning to drive down there for 8, so in just a few hours. I'll keep you updated.
 
John & Henry said:
I just called the ER. They said they didn't have techs available, so they can't see him til 8am. I talked to the on call doctor and asked "How long can his ketones be over 5 before his blood acidifies?" and she said "We don't like to see that for more than a day" Well it's been 3 full days since they've been over 5. He vomited for the first time in a long time in the last hour. Make that twice. Just did it again. ugh. I'm planning to drive down there for 8, so in just a few hours. I'll keep you updated.
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I am glad you are going to do that John. Do you have any cerenia or ondansetron with you that you can give him to stop the vomiting?
Take food, water, insulin and the ketones meter with you and keep feeding him. In case you are kept waiting at the ER, you want to have the things with you to keep doing what you have been doing.
I see the latest ketones test is 5.2 which is lower than the previous 2 tests.
 
Bron and Sheba (GA) said:
I am glad you are going to do that John. Do you have any cerenia or ondansetron with you that you can give him to stop the vomiting?
Take food, water, insulin and the ketones meter with you and keep feeding him. In case you are kept waiting at the ER, you want to have the things with you to keep doing what you have been doing.
I see the latest ketones test is 5.2 which is lower than the previous 2 tests.
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I gave him some cerenia last night after he vomited. He was not looking very good at all this morning. I honestly thought he was going to pass lying next to me in bed this morning. Scary how fast they go down hill. Still, he did drink a bit of water right before I left for the vet, but he wasn't interested in food, and hasn't eaten since he vomited last night @ about 2:30am PST. I just got back from taking him to the vet and I was not happy. I'm usually a very laid back person (to a fault actually), it takes a lot to get me angry, but this vet who totally wrote off the fact that his ketones were through the roof Wednesday morning and told me to stop checking them so often :banghead: I did not go lightly on her. I wasn't yelling or anything, but I made it perfectly clear I was not happy she wasn't more concerned on Wednesday, and she actually admitted she messed up and apologized which seemed like it was really hard for her to do. I got more to say on this, but I'm really busy trying to figure out what to do (considering taking him to UC Davis... 9 hours away which would probably be cheaper and is one of the top vet schools in the world).

Just got off the phone with them (they didn't want me to just stay in the waiting room, so I went home) and they're checking his blood chemistry right now. Will update as I know more.
 
Update: His blood pH is 6.9 and electrolytes are off. They said his ketones were too high to be read by their meter too. Vet was very apologetic and said I'd be getting a discount this time (well, I guess thats something). She said they're going to do another ultrasound and look for other reasons why the ketones may be occuring besides high BG. Liver enzymes and kidney values only off slightly. Slightly high white count (again).

Edit: Said they'd be keeping him for the night and re-asses tommorow and keep me updated. Thank you Bron for urging me to take him in. Who knows how worse it could have been if I'd waited longer.
 
Yikes. I am new to your story but I have had similar situations with my Minnie and repeated DKAs - the last 'one' was last year, where 3 times they sent us home from the ER and 3 times I took her back in. Ketones leading to issues balancing electrolytes, and turned out she has a condition that keeps her potassium low. She had a feeding tube for about a week, too. But - once we got through it all, she has been doing much better. At the time, her internist vet had me give R (regular) insulin as well to control ketones as needed - though I know this is not usual treatment for most diabetics, it's certainly proven to be a useful tool for us.

Wanted to let you know there are others who know what you're going through and their kitties have got through it. My lesson learned is not to hesitate about taking her in! Sending strong fighting thoughts to you and your boy. :bighug::bighug::bighug:
 
I'm glad Bron was around to help you last night. :bighug::bighug::bighug: So glad you got Henry in to see the vet and it sounds like they are on it now (finally). Higher white cell count means infection or inflammation, that's part of the formula for DKA. We did have one member who lived near UC Davis who had a great experience with them. But that's a long way to drive. You anywhere near Oregon State U?
 
It's inexcusable (of the vet) to not admit a DKA cat into emergency vet immediately. Thank God you have him getting veterinary care. This happened to my cat. Very high white count and fever very high. Extremely sick boy. They told me he would not make it. With appropriate care (and a feeding tube) he did make it. I have been watching this thread with great fear. I wanted to shout, take him to the ER vet, but it seemed like they weren't willing to take him in. And you were already getting good advice from Bron. It's very important to balance those electrolytes and to treat any infection. If his white count doesn't go down he needs antibiotics whether or not they know the source of the infection.
 
Omg so sorry to hear this. Poor Henry. Rooting for him. Do you have a cat only doctor near you? I found them much better than the regular vet. Also Blue Pearl 24/7 emergency pet hospital is generally good not sure if they are in your area. Typically ridiculously expensive though. I would change vets if possible but that is just me.
 
I am totally crying reading all your replies right now. Thank you for much for all the kind words and your experiences. It means so much to have people that care when going through such emotional times. :bighug::bighug::bighug:

It makes me feel a bit better the vet admitted she messed up. I thought I was going crazy when I told her on Wednesday the ketones were at 5.7 and she told me "maybe I was checking them too often". It's like... I'm not a vet, I literally said that to her at the time, "I'm not a vet, I'm relying on YOU (the vet) to tell me when that number is an emergency". I'm glad I talked to the on-call attending last night who told me anything over 5 for more than 24 hours, needs immediate treatment--at least now I know.

Suzanne & Darcy said:
And you were already getting good advice from Bron. It's very important to balance those electrolytes and to treat any infection. If his white count doesn't go down he needs antibiotics whether or not they know the source of the infection.
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At this point I'm convinced there must be something other than high(ish) BG causing those ketones. I really hope they can find it. I'll keep in mind asking about an antibiotic, even if they can't find a cause. You've all been so helpful, but Bron especially has been a true angel, always here with an amazing amount of knowledge. Thank you Bron :bighug:

Wendy&Neko said:
We did have one member who lived near UC Davis who had a great experience with them. But that's a long way to drive. You anywhere near Oregon State U?
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I'm in Portland and I haven't seen Oregon State U pop up in the Portland/Vancouver area as a 24 hour vet but I'll look into it. My biggest hesitation with taking him to UC Davis is him missing 9 hours of treatment. I've been looking into it and it sounds like they're just as busy as all the other emergency hospitals in Portland/Seattle/Sacramento with the associated potentially long wait times. I believe where he is currently is the biggest or second biggest specialty hospital in the Portland/Vancouver area. The upside of Davis is they have some of the best vets in the world. His current attending did undergrad at Cornell and med school at Colorado state. Cornell is like the east coast version of Davis and I've heard Colorado State is good too. I don't think she's a slouch, I just don't think she's been aggressive enough in monitoring and recognizing an emergency situation. I'll look into Oregon State U.

Liz & Minnie said:
Yikes. I am new to your story but I have had similar situations with my Minnie and repeated DKAs - the last 'one' was last year, where 3 times they sent us home from the ER and 3 times I took her back in. Ketones leading to issues balancing electrolytes, and turned out she has a condition that keeps her potassium low. She had a feeding tube for about a week, too. But - once we got through it all, she has been doing much better. At the time, her internist vet had me give R (regular) insulin as well to control ketones as needed - though I know this is not usual treatment for most diabetics, it's certainly proven to be a useful tool for us.

Wanted to let you know there are others who know what you're going through and their kitties have got through it. My lesson learned is not to hesitate about taking her in! Sending strong fighting thoughts to you and your boy. :bighug::bighug::bighug:
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Ugh, 3 times? I really hope it doesn't happen again! I'm glad your girl was able to pull through and I'm very thankful Henry loves food with every fiber of his being so hopefully he won't need the feeding tube this time either. He's eaten so much the last few days, and I'm pretty sure he was probably already in DKA most of that time. It probably explains his extreme water intake. His body knew he needed it to clear those ketones, unfortunately it wasn't enough :( The thing is he wasn't showing any lethargy until right before I took him in. He was walking a little funny, like he'd had a couple beers or something and just constantly walking about the house which seemed odd for him. It sounds like having fast acting insulin (in addition to the Lantus) is a great idea, I'll ask about it. :bighug:

Diane Tyler's Mom said:
My heart is just breaking for both of you John.
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Thank you Diane, this post got me all teary earlier too :bighug:

Bron and Sheba (GA) said:
Sending a plane load of strong Aussie vines to Henry for a quick recovery.
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Thank you again Bron, your such an angel fighting the good fight for all our feline friends. :bighug:

I haven't heard anything back since the last update I posted this morning. She usually calls between 7-8pm PST, so I'll post an update as soon as I have it.
 
Roxana & Henry said:
Rooting for him. Do you have a cat only doctor near you?
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Thank you Roxana. I actually had been taking him to a cat only doctor the whole time I've lived here (especially for the vomiting and the ravenous appetite) and he never caught the diabetes. He's since went out of business (which is odd when it's darn near impossible to find vet accepting new patients at all in his area). There is Blue Pearl that recently opened up around here. The reviews weren't great, the facility looks pretty small and I don't see that they have any specialists on staff. The big name ER hospital in Portland is Dove Lewis but they're always packed with wait times up to 24 hours and you gotta wait in your car. In a way I feel fortunate to have him established where he is with the poor state of ER care in the region. From my research it seems I'm paying about as top dollar as it gets, which I wouldn't mind so much if he is getting top notch care. Hopefully the "sorry we f$*#ed up discount" they offered will help.
 
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Finding a great vet is never easy. I have 3 now that I use for different needs. One close to the house (5 min-libre placement, blood work, easy stuff), feline specialist (30 min) and ER vet (30 min). Each has their own strengths and weaknesses but you know what they say that it takes a village :) Maybe you just need to make your village a big bigger and go interview other vets for second opinions if this one does not make you happy. I first did not even take Henry to the appt with the feline specialist. I wanted to see if she knows her stuff before dragging henry yet again to another vet. it was the best 70 something dollars ever spent for a consult. Wondering if you can do a virtual appointment with UC Davis or other vet and send them the results and they can tell you what else to do or test for. You can tell them you would pay and if needed you can bring him there eventually and explain the situation. Just my 2 cents. I am sure it is very stressful right now for you. Hope you will have some answers soon and Henry will kick DKA's and FD's butts:bighug::cat:
 
Roxana & Henry said:
Finding a great vet is never easy. I have 3 now that I use for different needs. One close to the house (5 min-libre placement, blood work, easy stuff), feline specialist (30 min) and ER vet (30 min). Each has their own strengths and weaknesses but you know what they say that it takes a village :) Maybe you just need to make your village a big bigger and go interview other vets for second opinions if this one does not make you happy. I first did not even take Henry to the appt with the feline specialist. I wanted to see if she knows her stuff before dragging henry yet again to another vet. it was the best 70 something dollars ever spent for a consult. Wondering if you can do a virtual appointment with UC Davis or other vet and send them the results and they can tell you what else to do or test for. You can tell them you would pay and if needed you can bring him there eventually and explain the situation. Just my 2 cents. I am sure it is very stressful right now for you. Hope you will have some answers soon and Henry will kick DKA's and FD's butts:bighug::cat:
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Roxanna, do all those vets “get along” or not resent each other’s interference? I do this to a limited extent- have a close by vet for easy stuff but it’s not even bloodwork. It’s like, a cat needs a depo shot or needs some Clavamox… I already know what I need before I go. Regular vet is very good and handles most stuff and if I need immediate attention we just show up and they will work us in. Emergency Vet is just that, very expensive and reserved for true emergencies that occur on the weekends or at night.
 
John & Henry said:
and I've heard Colorado State is good too.
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Awesome folks, highly recommend CSU! I went there twice with Neko, but it was 24 hours drive over 3 days for me. Not urgent, just treatment for her acromegaly. Flew the second time.
John & Henry said:
I'll look into Oregon State U.
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Neko's cardio vet got his cardio vet ticket at Oregon State U. One of our members, who I later met in person, went there when she had an urgent matter with her diabetic cat and was happy with them.
John & Henry said:
It sounds like having fast acting insulin (in addition to the Lantus) is a great idea, I'll ask about it. :bighug:
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We can help you with that. There are a few of us here who are experienced using R. It does take a little extra monitoring at the beginning, but is a good tool in the toolkit. We usually reserve suggesting it to people who have cats with secondary endocrine conditions needing higher doses, or those fighting ketones/DKA. It's an advanced technique.
 
Roxana & Henry said:
Wondering if you can do a virtual appointment with UC Davis or other vet and send them the results and they can tell you what else to do or test for.
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That's a good idea. I know major (human) medical universities have these programs (stanford, hopkins, etc.). I'll look into it. Thanks for the suggestion. I almost took him to his "normal" 24 hour ER last night when his specialist hospital said he'd need to wait 4 hours to get in, thinking at least I'd get another brain looking at him. Problem is they just don't have the full range of diagnostic gizmos and extensive on-site lab services. I'm pretty sure only Dove Lewis and where he is currently has the full range of equipment. In fact my "normal" 24 hour ER (which is very good, btw), referred him (and my dog when she had a serious problem) to the specialist hospital he's at now because they didn't have the diagnostic equipment and specialists to treat them (lack of a facility like this is one of my major fears of moving to a rural area)

I'm laid back and empathetic person (to a fault) I keep thinking things "Well, maybe she was just having a bad day and vets are so overwhelmed. She did save him the first time" *sigh* At this point they've already started the treatment for DKA, so I guess this is the place for now, but I will look into virtual consults.
 
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Suzanne & Darcy said:
Roxanna, do all those vets “get along” or not resent each other’s interference? I do this to a limited extent- have a close by vet for easy stuff but it’s not even bloodwork. It’s like, a cat needs a depo shot or needs some Clavamox… I already know what I need before I go. Regular vet is very good and handles most stuff and if I need immediate attention we just show up and they will work us in. Emergency Vet is just that, very expensive and reserved for true emergencies that occur on the weekends or at night.
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Yes everyone gets along. I explain why and they understand. The one next to me is not familiar with Lantus and she probably thought I lost my marbles when I told her about this forum and the TR but she was nice about it . And the end of the day we are the one paying and they need to keep us happy not the other way around
 
John, I'm so sorry you Christy and Henry are going through this again. :bighug:
The universe has been against you the past couple of weeks, what with you getting covid, then Christy getting covid, then the higher ketones and the vet telling you that you are testing too much, and then not admitting him overnight but making you wait until the next morning .
But he is in the best place now and getting the care he needs and they know his history which is good.
Being a great eater will be a real plus for him moving forward and he is such a trooper!
Hang in there. We are here to support you whenever you need us.
 
Wendy&Neko said:
Not urgent, just treatment for her acromegaly
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Interesting. His vet mentioned this morning the possibility of looking into acromegaly as this condition can apparently cause excess ketone production.

Roxana & Henry said:
she probably thought I lost my marbles when I told her about this forum and the TR but she was nice about it
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That was good she was nice about it. I did mention the forum and the spreadsheets when we first met which prompted an "uh huh, yeah, we sometimes get clients that go rogue and start playing with the dose, please don't do that" and I swear when I called on Wednesday concerned about the 5.7 ketone reading it seemed her main concern during the whole call was was annoyance about the .25U increase I had on the spreadsheet. I actually brought it up with her in our conversation today, "You didn't seem at all concerned about the high ketones during our call on Wednesday you seemed more concerned I up his dose by a tiny amount" I could tell she was biting her tongue at that point.

Bron and Sheba (GA) said:
Hang in there. We are here to support you whenever you need us.
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Awww, thank you :bighug:

Diane Tyler's Mom said:
I don't know if this would be of any help in the future
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Thank you for that, I was actually just looking into it. Corvallis isn't that far away and it's a beautiful drive. Seems they don't have a 24 hour ER, but do have lots of good specialists. I can tell his attending felt real bad about him going back into DKA and her neglect. I have a sneaky suspicion she won't be so blasé about high ketone readings in the future.

I just spent a bunch of time reading about VECCS certification and AAHA Accredited. It seems Dove Lewis is a Level 1 Emergency and Critical Care Facility and is the only facility in Oregon to be certified on any level (I, II or III). So looks like I should have went there. The reviews are excellent and they're apparently a non-profit. They even a CT scanner AND a price list (DKA est. is 4800-8500), so I guess I didn't overpay too much where I am now.
 
So just got off the phone with the vet. She went over everything with me very thoroughly and even got technical with me (which I appreciated, and she had lacked providing in the past probably because they make most normal peoples eyes glaze over).

The conclusion: They don't know :(
  • She said the ultrasound showed pretty much exactly the same info as before (big surprise since its been less than a month since the last one).
    • Possibly something going on in the pancreas but can't be sure and it was mild.
    • Possibly something going on in the liver (but this could be caused by diabetes or hepatic lipidosis, damage seems to be relatively mild) recommends aspiration a couple weeks after he's recovered.
    • Possible small cell lymphoma in the intestine, or it could be IBS. not sure. same finding as before
  • She suspects an infection causing the ketones, but can't find the source. Already started him on an antibiotic. Said she was going to start using a wider-spectrum antibiotic. Said she doesn't like giving meds without being able to pin down the actual cause (side note: I had a human doctor tell me one time, "It may fix the problem if we just give you the drug for the thing we suspect you have, but this just isn't the way we practice medicine!") She said he'd be sent him home with antibiotics.
  • His electrolytes are better than this morning and they're giving aggressive infusions (potassium is low, but not as bad as before)
  • They already started him on a fast acting insulin infusion, but BG hasn't budged. Suspects insulin resistance (seems like a reasonable assumption since his BG actually went up about 15 points at +4 after last nights shot and the chart as been showing this trend lately)
  • Didn't mention blood pH and I forgot to ask, but I'm guessing its still low.
  • I asked, "Do you normally see refractory ketones for weeks after DKA recovery?" and she said, "Well, I'm not really sure since most patients don't monitor them, but cats sometimes make small amount of ketones here and there which may show up with the blood test, but doesn't usually show on the urine screen"
  • Seemed quite happy to have the spreadsheet as a reference for spotting trends (Oh, you mean the waste of time thing you said I've been doing which just served to cause me frustration and torture my cat by poking his ears? Huh)
I'm probably forgetting something, but I'll add it if it pops up in my brain. Since it's Friday she'll be off for the weekend and Henry will be managed by the ER/ICU doctor but they'll be providing me daily updates. She said she would check in with the ICU docs daily over the weekend. I'm kind of shocked they haven't called me for a deposit yet as they're usually real prompt about that, but that's fine by me.
 
Did they test for pancreatitis? Specifically, I’m wondering whether they did an fPLI test.

There’s a snap test that can be done in-house that gives a yes/no but no numeric value. Another option (better IMHO) is to send out blood for an fPLI/fTLI/folate/cobalamin. It’s worth checking, especially if there’s concern for GI involvement. We used to send blood to Texas A&M University (TAMU), which was the go-to lab for that type of testing, although I believe other labs might now offer it.

Pancreatitis can make BG run stubbornly higher. And some cats are just prone to DKA, even at lower BGs. However, don’t lose hope. I’ve seen a number of cats over the years have multiple rounds of DKA in the early days after diagnosis who then go on to settle down and not ever have a problem again.

How are Henry’s stools? (color, consistency, odor, frequency, etc). The fTLI tests for EPI. It’s not particularly common in cats, but if his poop is funky and you’re sending out for the PLI anyway, it doesn’t hurt to rule it out.
 
I'm sorry they couldn't come up with a definite answer about the high ketones
Hopefully the antibiotic will work
Maybe you can see if Dove Lewis will do a virtual consult and UC Davies
I will be praying for Henry ,all I have been doing is looking at his picture , his sweet little face.
You hang in there Henry because you are one tough kitty ♥♥♥
Are you allowed to go and see him at all ?You and Christy try and get some rest John .:bighug::bighug::bighug::bighug:
 
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Thanks John for the update. I read it while I was out at a luncheon but couldn't respond.
Generally it sounds as if Henry is holding his own. That is good news the electrolytes are responding to the aggressive treatment and he is getting an antibiotic for a suspected infection and also that they have started him on a fast acting insulin infusion..
I would be surprised if Henry had hepatic lipidosis as he was eating very well except for the several hours before admission after the vomits.
I agree with getting a pancreatic test....fPl snap or fPl spec. It is good thing to rule in or out and its very common in diabetic cats, and usually responds well to supportive treatment of SubQ fluids, pain meds and antinausea meds.

John & Henry said:
I did mention the forum and the spreadsheets when we first met which prompted an "uh huh, yeah, we sometimes get clients that go rogue and start playing with the dose, please don't do that" and I swear when I called on Wednesday concerned about the 5.7 ketone reading it seemed her main concern during the whole call was was annoyance about the .25U increase I had on the spreadsheet. I actually brought it up with her in our conversation today, "You didn't seem at all concerned about the high ketones during our call on Wednesday you seemed more concerned I up his dose by a tiny amount" I could tell she was biting her tongue at that point.
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John I am glad you called her out about her not liking the dose increase but not being overly concerned with the high ketone level. Sounds like her ego got in the way of good judgement there. Hopefully she will learn from her mistake. Some vets don't like caregivers to take any initiative at all :banghead::mad:

Sending another planeload of strong Aussie 'get better fast' vines to Henry who sounds as as if he is fighting like the trooper he is.
I know it will be hard, but do try and get some rest so that you are fresh for when he comes home again.
 
JL and Chip said:
Did they test for pancreatitis? Specifically, I’m wondering whether they did an fPLI test.

There’s a snap test that can be done in-house that gives a yes/no but no numeric value. Another option (better IMHO) is to send out blood for an fPLI/fTLI/folate/cobalamin. It’s worth checking, especially if there’s concern for GI involvement. We used to send blood to Texas A&M University (TAMU), which was the go-to lab for that type of testing, although I believe other labs might now offer it.
Click to expand...

Interesting. I really don't know, but I'll definitely ask! Thank you for the suggestion.

JL and Chip said:
Pancreatitis can make BG run stubbornly higher. And some cats are just prone to DKA, even at lower BGs. However, don’t lose hope. I’ve seen a number of cats over the years have multiple rounds of DKA in the early days after diagnosis who then go on to settle down and not ever have a problem again.
Click to expand...

Oof, please no more rounds after this! :nailbiting: Glad it's able to "settle down" eventually.
JL and Chip said:
How are Henry’s stools? (color, consistency, odor, frequency, etc). The fTLI tests for EPI. It’s not particularly common in cats, but if his poop is funky and you’re sending out for the PLI anyway, it doesn’t hurt to rule it out.
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Large -- Very large, both in size and volume (assumed it had to do with all the eating). The color is also weird (I did mention this to them last time around) they've been a light shade of pink. I'll research all these things and add it to my questions (which is very sparse at this point)

Diane Tyler's Mom said:
I'm sorry they couldn't come up with a definite answer about the high ketones
Hopefully the antibiotic will work
Maybe you can see if Dove Lewis will do a virtual consult and UC Davies
I will be praying for Henry ,all I have been doing is looking at his picture , his sweet little face.
You hang in there Henry because you are one tough kitty ♥♥♥
Are you allowed to go and see him at all ?You and Christy try and get some rest John .:bighug::bighug::bighug::bighug:
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Awwwww, thank you for all the kind words and prayers :bighug: I probably looked through 200 pictures and changed it about 5 times before settling on this one. I thought it looked like he was waving, "Hi!"

I'll be looking into the virtual consult, maybe even just take him to dove lewis after he's recovered for a second opinion.

Diane Tyler's Mom said:
I guess she learned a thing or two looking at your SS
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Yep, like how can it not be helpful to see the trends? She even commented on how well they looked in the beginning (got in the blue one day)

Bron and Sheba (GA) said:
I agree with getting a pancreatic test....fPl snap or fPl spec. It is good thing to rule in or out and its very common in diabetic cats, and usually responds well to supportive treatment of SubQ fluids, pain meds and antinausea meds.
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Yep, will definitely bring this up

Bron and Sheba (GA) said:
Sounds like her ego got in the way of good judgement there. Hopefully she will learn from her mistake.
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Yep, I could tell she really regretted not doing something sooner, and I kept hammering the point home, "Why weren't you more concerned the high ketones were going to turn the blood acidic?"

Bron and Sheba (GA) said:
Sending another planeload of strong Aussie 'get better fast' vines to Henry who sounds as as if he is fighting like the trooper he is.
I know it will be hard, but do try and get some rest so that you are fresh for when he comes home again.
Click to expand...

Aww, thank you again for everything Bron :bighug: Just had a nap because I didn't really sleep last night. Going back down in a minute.
 
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I’m so glad to read this update. I feel like he’s on the mend. I hope they will watch his electrolytes closely (I am sure they are.) When Darcy was in the hospital with DKA, they finally got his potassium up... but then it went WAY up, which as I am sure you know is dangerous for the heart. Of course, the treatment for that is some fast acting insulin. My boy did get hepatic lipidosis due to not eating (also vomiting all his food up and then they let him not eat for more than three days despite my warnings over and over when they told me he was not eating anything in the hospital.) But he had a feeding tube place and then was able to take in the calories he needed. The ultrasound showed his liver was hyperechoic and they did a FNA and sent it to pathology -- nothing very significant was found. Liver enzymes were not elevated either. He also failed the pancreatitis test, but it was the rapid test and so it's unreliable. After the ultrasound, my vet was convinced that he did not have pancreatitis. It's worth getting the Spec fPL though for Henry. I hope Henry is eating. I'm very glad about the antibiotics.

I don't know why vets seem to dismiss high ketones. My blood ketone meter would show me that Darcy had high ketones (as high as 6.9!!) I would take him into the vet and tell them. They would do a urine/dipstick test and say he really didn't have many ketones. My vet questioned the accuracy of the blood ketone meter (NovaMax), which led me to do some research on the reliability -- I was pursuaded that they were reliable. I used to run him to the vet quite a bit at this time. The finally just did whatever I asked (which for high ketones was usually some IV fluids for the day.) Keep us posted on Henry as you get updates. We are all pulling for him.
 
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Glad to read your update and hope they are able to figure out what's going on. If you're like me, there's an element of stress-relief once he's in the hospital. I hate that period of trying to figure out whether to go or not.

They also had difficulties keeping Minnie's potassium up - one tip for you in case you don't already know, if they want to send him home with potassium (either pills, powder or gel) - it's much cheaper to get on Amazon. I mix it in her food since she refused the gel, but it was exactly the same as what the vet had.

Just for interest, when I was trying to learn more about ketones and meters (I use the Novamax too) I came across this post. It's long with a lot of chatter about meter vs strips, but I found the posts by Hope had some interesting info about the 3 types of ketones. Can't say it changed how I handle Minnie, but helped me feel like I was doing something when she was in the hospital and I wasn't sleeping!

Hope he gets better and gets home soon.
 
Just got a call from the vet. Henry is doing well and eating. Might be able to come home tomorrow. Not much detailed info other than his blood pH is up to about 7.09, electrolytes looking better, they said they haven't checked ketones yet today. BG in the 200s. They said they're using about twice the amount of insulin they'd normally use (he's on continuous infusion), probably due to insulin resistance.

They just texted me this photo. He looks a little dirty as it's probably tough to groom himself with all those tubes hooked up.

5c046c126ad93534fe216847ae8b4ddc8b063124-1.jpg

Liz & Minnie said:
Just for interest, when I was trying to learn more about ketones and meters (I use the Novamax too) I came across this post. It's long with a lot of chatter about meter vs strips, but I found the posts by Hope had some interesting info about the 3 types of ketones. Can't say it changed how I handle Minnie, but helped me feel like I was doing something when she was in the hospital and I wasn't sleeping!
Click to expand...

That's very help info, thank you! They didn't send him with potassium last time, but he's a very good eater so that may be why.

Hendrick Cuddleclaw said:
oh dear poor Henry I am sorry to read this. I hope he gets better quickly!
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Aww, thanks!

Suzanne & Darcy said:
When Darcy was in the hospital with DKA, they finally got his potassium up... but then it went WAY up, which as I am sure you know is dangerous for the heart.
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Yes, it sounds like a really delicate dance with the potassium and the insulin.

Suzanne & Darcy said:
My boy did get hepatic lipidosis due to not eating
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So glad I don't think I'll ever need to deal with that problem Henry. That boy loves eating, just like his papa haha

Suzanne & Darcy said:
I don't know why vets seem to dismiss high ketones. My blood ketone meter would show me that Darcy had high ketones (as high as 6.9!!) I would take him into the vet and tell them. They would do a urine/dipstick test and say he really didn't have many ketones. My vet questioned the accuracy of the blood ketone meter (NovaMax), which led me to do some research on the reliability -- I was pursuaded that they were reliable. I used to run him to the vet quite a bit at this time. The finally just did whatever I asked (which for high ketones was usually some IV fluids for the day.) Keep us posted on Henry as you get updates. We are all pulling for him.
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This is very helpful information. I think this was the point the vet was trying to make with me on Wednesday and caused her to dismiss the readings. I mean, these meters are FDA approved for humans, they would have to be accurate! I'll always check both blood and urine going forward so she can't make that argument if problems arise in the future.

Suzanne & Darcy said:
Keep us posted on Henry as you get updates. We are all pulling for him.
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carfurby said:
Sending prayers.
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Thank you :bighug:
 

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John & Henry said:
Just got a call from the vet. Henry is doing well and eating. Might be able to come home tomorrow. Not much detailed info other than his blood pH is up to about 7.09, electrolytes looking better, they said they haven't checked ketones yet today. BG in the 200s. They said they're using about twice the amount of insulin they'd normally use (he's on continuous infusion), probably due to insulin resistance.

They just texted me this photo. He looks a little dirty as it's probably tough to groom himself with all those tubes hooked up.

View attachment 64566


That's very help info, thank you! They didn't send him with potassium last time, but he's a very good eater so that may be why.



Aww, thanks!



Yes, it sounds like a really delicate dance with the potassium and the insulin.



So glad I don't think I'll ever need to deal with that problem Henry. That boy loves eating, just like his papa haha



This is very helpful information. I think this was the point the vet was trying to make with me on Wednesday and caused her to dismiss the readings. I mean, these meters are FDA approved for humans, they would have to be accurate! I'll always check both blood and urine going forward so she can't make that argument if problems arise in the future.




Thank you :bighug:
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He has a determined look in his eyes..."I'm going to get better and GO HOME!!!"

Sending positive thoughts and prayers for a speedy recovery :bighug:
 
Awww, bless his little heart. Sending healing thoughts for the little guy and I hope he gets to come home feeling as good as new soon.
 
Thank you for the update John. Make sure the electrolytes and acidity is back to normal before they discharge him. I’m so glad he is eating well. That is a big plus. The dear boy is trying so hard to get better for you.
Remember to ask about sub Q fluids to do at home.
Sending many more vines to Henry….
Hope you and Christy are holding up ok.
 
Hi John. I'm thinking about Henry, too. Poor boy looks thin in that photo. Agree with Bron to make sure he's not dishcarged until all his electrolytes are back in balance. It's too hard to manage that at home - IV fluids with the right balance in there is the way to go. I hope he's holding his own in that department by now, though.
 
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