Updates on Kit - DKA, now Gastric Stasis/Ileus (orig Kit in hospital with ketones)

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egwv

egwv

Member Since 2022
Continuing from earlier thread here https://www.felinediabetes.com/FDMB...increasingly-picky-eater.278522/#post-3081913

Hi all,

Continuing Kit's progress in this new thread. Summary up to this point: I took Kit to the emergency vet on Saturday since she had a high ketones on her urine test strip after a few weeks of decreasing appetite. She stayed at the emergency vet until Monday morning (yesterday) when she transferred to the internal medicine department of a different hospital to be seen by an internal medicine specialist. They are trying to identify what triggered the DKA episode and get her appetite back.

I visited Kit this morning before work. She was happy to see me and ate 3 Churu tube treats (she inhaled the first two and took a little more time to eat the third but she finished it all). The vet tech said the overnight nurses had a hard time hearing Kit's heartbeat because she was purring so loudly. Her BG levels are back up in the 300s (I was there when the tech took Kit's 8am measurement and it was 330) and her ketones are 3.2. They are still waiting on the urinalysis results. I am supposed to get an official morning update later, and I will try to visit her again later today when I go home from work.

I don't know yet if she'll be able to go home tomorrow or if she'll have to stay another day or two, but I have been reading the links from my previous thread on tube feeding. The doctor warned me that diabetic cats are at a higher risk of complications from general anesthesia which has me worried about inserting a tube in her if that is the next step. I am also wondering about the timings of tube feeding (and syringe feeding for that matter) for a diabetic cat who needs nutrition throughout the day. I am out of the house for work from about 6:30am-5:15pm and I am her sole caretaker. The timed autofeeder was a good solution for when she was eating on her own (and before her neuropathy set in and I had to move her feeder to be more accessible and then her brother got into her food). With assisted feeding I can't rely on that. Suggestions welcome!
 
egwv said:
Continuing from earlier thread here https://www.felinediabetes.com/FDMB...increasingly-picky-eater.278522/#post-3081913

Hi all,

Continuing Kit's progress in this new thread. Summary up to this point: I took Kit to the emergency vet on Saturday since she had a high ketones on her urine test strip after a few weeks of decreasing appetite. She stayed at the emergency vet until Monday morning (yesterday) when she transferred to the internal medicine department of a different hospital to be seen by an internal medicine specialist. They are trying to identify what triggered the DKA episode and get her appetite back.

I visited Kit this morning before work. She was happy to see me and ate 3 Churu tube treats (she inhaled the first two and took a little more time to eat the third but she finished it all). The vet tech said the overnight nurses had a hard time hearing Kit's heartbeat because she was purring so loudly. Her BG levels are back up in the 300s (I was there when the tech took Kit's 8am measurement and it was 330) and her ketones are 3.2. They are still waiting on the urinalysis results. I am supposed to get an official morning update later, and I will try to visit her again later today when I go home from work.

I don't know yet if she'll be able to go home tomorrow or if she'll have to stay another day or two, but I have been reading the links from my previous thread on tube feeding. The doctor warned me that diabetic cats are at a higher risk of complications from general anesthesia which has me worried about inserting a tube in her if that is the next step. I am also wondering about the timings of tube feeding (and syringe feeding for that matter) for a diabetic cat who needs nutrition throughout the day. I am out of the house for work from about 6:30am-5:15pm and I am her sole caretaker. The timed autofeeder was a good solution for when she was eating on her own (and before her neuropathy set in and I had to move her feeder to be more accessible and then her brother got into her food). With assisted feeding I can't rely on that. Suggestions welcome!
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I’m glad she’s feeling better and I hope they can get her BG down today. Sounds like her ketones are coming down gradually.

We’ve had quite a few cats here over the years that have had to have anesthesia for one reason or another and I can’t think of any that had an issue other than the tendency for the BG to drop a little lower post anesthesia. There have been times when a shot needed to be skipped but that’s the extent of it. My Gracie had to have it for a dental and she had no problem at all. It seems whether they drop lower or not depends on the anesthesia used. It’s just important they closely monitor her BG before, during, and after anesthesia.

The more pressing issue for you is how she gets fed while you are at work. Is it possible to get help from your parents or a sibling or do they also work? What about the vet techs from the clinic or from your regular clinic; do they do house calls? The other option that I’ve seen members do is take time off from work or is it possible to work from home? Others might have some better ideas and options for you.
 
Did you or they try regular food or the AD food yet? If so, will she eat any or just the Churu?

Maybe her apetite is gradually coming back too and she wouldn’t need a tube, just syringe feeding when you’re home. If that’s the case, you could always leave the Churu in the auto feeder for her during the day. Minnie was already diabetic when she had to go under for endoscopy and they added the tube then. It’s been a couple of years and I know I had to tube feed her a few times a day with a lot of water first and after as well as meds. If she doesn’t have any heart issues, the diabetes alone is not a concern for the anesthesia. Once Minnie developed cardiomyopathy, she couldn’t go under ever again.

So, I’d keep trying to offer her regular food before the Churu to see if she’s starting to eat on her own again and then you’d just need to supplement if she’s not eating enough. Minnie wasn’t eating at all and she needed the tube because it took about 2 weeks for her to start eating again.
 
Thanks for the update Emma. It sounds as if Kit is progressing in the right direction.
I agree with Marje that the next pressing issue is getting her fed while you are at work.
I haven't come across the Churu tube before as I feed a raw diet, but I looked them up and they are not very high in calories. 6 calories per tube or 12 with the nourish ones. While it is great she is eating them, moving forward, it would be good to find something with more calories if you can and if she will eat it. Remember any food is OK at the moment, as eating is so important.
 
I talked to the doctor this afternoon and then went straight from work to see Kit.

Doctor updates:
-They are done running tests and are now just focusing on treatment.
-Kit still won't eat from the vet techs so she is getting nourishment through the NG tube
-They are planning on discontinuing her IV insulin and switching her back to Lantus tonight. When we spoke the doctor was still deciding whether to start her conservatively at 2 unit or start her at 3 units since that was what she was getting before. He agreed that the weekend ER doctor raised her dose too fast with taking her to 3.5 and then 4 in a day. (Writing this I just remembered that it might be useful for him to see Kitsune's spreadsheet so I just emailed it to him).
-I need to start thinking about how to transition her to a regular protocol.
-The most important thing is that she needs to be eating twice daily on her own (meals in between are good too, but he stressed the twice daily).
-I should also start thinking about the e-tube option if it doesn't look like she will eat on her own.
-She needs 250-280 kcal/day which is hard to administer by (mouth) syringe (assuming about 1kcal/mL food).
-Her potassium levels normalized this morning but they are still monitoring and supplementing (I don't know the importance of potassium so I will have to read more about this).
-Her ketones (as I reported earlier today) were 3.2; ideally they should be 0.1-0.9.
-Her GI panel came back normal - no strong evidence of pancreatitis/intestinal disease/intestinal malabsorption. The only think he could think of was maybe there was an IBD flareup (but not definitive).
-Her ultrasound showed the same as the one my regular vet took last week (so, same slight enlargement of pancreas/liver and slight thickening of the intestines).
-Her urinalysis didn't show any UTI
-We are still waiting on the urine culture results (they take 3-5 days to come back). This is basically the last thing that might show up as a trigger since all the other tests were normal.
-They are giving her Mirataz for appetite stimulation.
-They are giving her 3 different antinausea meds.

About the e-tube: I have to make a decision by tomorrow morning whether or not to have this done. The doctor would want to install it tomorrow afternoon, keep Kit overnight, then discharge her Thursday. There is timeline pressure because his last day in the clinic is Thursday and then he is out all next week, so if I choose to not install an e-tube and then she ends up not eating on her own, I'll have to wait over a week until he is back to get a tube put in (unless I want to take Kit to yet another clinic and have them put one in, which sounds stressful for all involved).

When I visited Kit she accepted 3 syringes of a/d food (probably 25-28mL total accounting for some mess) -- the first syringe she actually started lapping on her own, but the second two I needed to squirt into the side of her mouth. She ate 3 Churu tubes on her own. The vet tech put some baby food (Gerber beef) in a dish for her but she wasn't interested. The vet tech said that Kit hasn't been using the litterbox and she's not moving much, but that doesn't surprise me given her neuropathy and the general stress of being in a small kennel with strange noises and smells going on 24/7. Kit did slightly sit up for me on her front paws only. I stayed and pet her until she got drowsy.

Given the fact that she still only eats Churu tubes on her own, and that she totally rejected the baby food tonight and the Purina Pro DM this morning, I am currently (tentatively and with lots of worry) leaning towards an e-tube. I just really need to know that she is getting enough nourishment, especially if we can't pin down a trigger for her DKA. But I wanted to run everything by this community since you have much more experience with this sort of thing!
 
This is pretty much what happened to Minnie minus the ketones and plus pneumonia. Huge IBD flare up. She wasn’t eating in her own at all and also had so the tube was the only choice. Can they do an endoscopy while she’s under? It’s what they did with Minnie and it’s the only way to diagnose IBD. The tube area needs to be cleaned once a day but it was such a relief to be able to feed and medicate her easily with it that I didn’t mind the maintenance. It can only stay for up to 2 weeks which is why I feel the endoscopy should be done. If it is IBD, they can get her started on budesonide.
 
egwv said:
I talked to the doctor this afternoon and then went straight from work to see Kit.

Doctor updates:
-They are done running tests and are now just focusing on treatment.
-Kit still won't eat from the vet techs so she is getting nourishment through the NG tube
-They are planning on discontinuing her IV insulin and switching her back to Lantus tonight. When we spoke the doctor was still deciding whether to start her conservatively at 2 unit or start her at 3 units since that was what she was getting before. He agreed that the weekend ER doctor raised her dose too fast with taking her to 3.5 and then 4 in a day. (Writing this I just remembered that it might be useful for him to see Kitsune's spreadsheet so I just emailed it to him).
-I need to start thinking about how to transition her to a regular protocol.
-The most important thing is that she needs to be eating twice daily on her own (meals in between are good too, but he stressed the twice daily).
-I should also start thinking about the e-tube option if it doesn't look like she will eat on her own.
-She needs 250-280 kcal/day which is hard to administer by (mouth) syringe (assuming about 1kcal/mL food).
-Her potassium levels normalized this morning but they are still monitoring and supplementing (I don't know the importance of potassium so I will have to read more about this).
-Her ketones (as I reported earlier today) were 3.2; ideally they should be 0.1-0.9.
-Her GI panel came back normal - no strong evidence of pancreatitis/intestinal disease/intestinal malabsorption. The only think he could think of was maybe there was an IBD flareup (but not definitive).
-Her ultrasound showed the same as the one my regular vet took last week (so, same slight enlargement of pancreas/liver and slight thickening of the intestines).
-Her urinalysis didn't show any UTI
-We are still waiting on the urine culture results (they take 3-5 days to come back). This is basically the last thing that might show up as a trigger since all the other tests were normal.
-They are giving her Mirataz for appetite stimulation.
-They are giving her 3 different antinausea meds.

About the e-tube: I have to make a decision by tomorrow morning whether or not to have this done. The doctor would want to install it tomorrow afternoon, keep Kit overnight, then discharge her Thursday. There is timeline pressure because his last day in the clinic is Thursday and then he is out all next week, so if I choose to not install an e-tube and then she ends up not eating on her own, I'll have to wait over a week until he is back to get a tube put in (unless I want to take Kit to yet another clinic and have them put one in, which sounds stressful for all involved).

When I visited Kit she accepted 3 syringes of a/d food (probably 25-28mL total accounting for some mess) -- the first syringe she actually started lapping on her own, but the second two I needed to squirt into the side of her mouth. She ate 3 Churu tubes on her own. The vet tech put some baby food (Gerber beef) in a dish for her but she wasn't interested. The vet tech said that Kit hasn't been using the litterbox and she's not moving much, but that doesn't surprise me given her neuropathy and the general stress of being in a small kennel with strange noises and smells going on 24/7. Kit did slightly sit up for me on her front paws only. I stayed and pet her until she got drowsy.

Given the fact that she still only eats Churu tubes on her own, and that she totally rejected the baby food tonight and the Purina Pro DM this morning, I am currently (tentatively and with lots of worry) leaning towards an e-tube. I just really need to know that she is getting enough nourishment, especially if we can't pin down a trigger for her DKA. But I wanted to run everything by this community since you have much more experience with this sort of thing!
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It’s really vital she get those calories and fluids. It’s up to you as to whether you can deal with it & work. There isn’t a downside to doing it. If you can get her to eat enough calories on her own in a few days, you can have it removed once you are sure she will keep eating. But I’d you don’t do it and she needs it, you might be hard pressed to find someone who can do it. What does the vet recommend?
 
Interesting update.
Post DKA Kit needs to be eating one and a half times as many calories every day as she normally does. And she needs extra fluids as well.
I know an e tube sounds scary to you but I think it would be the way to go.
She will definitely need much more food than twice a day and giving the food and fluids via the feeding tube is so much less stressful for you both.
You will be able to give the food at set times and know she is getting it. Much harder if they wont eat or you have to try and syringe feed.
If she is getting enough food and fluids and getting enough insulin, she should recover more quickly.
If you are able to take some time off work, I would be thinking along those lines.
 
I think I'm going to get the tube put in. Kit's doctor thinks it's the best way but of course he has to inform me of the risks. I was already planning on taking tomorrow and Friday off of work and I think I will ask for some more time next week too. Luckily it's a slower and more flexible time of the year at work right now.

I appreciate the input and the anecdotes from all of you who have gone through similar situations; I'm still scared but it's comforting to know that this is a manageable situation that so many of you have dealt with just fine. I know I'm going to be a nervous wreck all afternoon and overnight until she's in the clear but I will update as I can.
 
I think you have made the right decision. We all worry when our kitties have to have an anaesthetic..that’s normal.
We will be able to help you each step of the way once she gets home.
 
Are you asking them to do the endoscopy as well? This is the time to do it since she’ll already be under. If the not eating is caused by a bad IBD flare up, the only way to control it is with budesonide moving forward, but you won’t know what caused it for sure without the endoscopy. I’m surprised your vet didn’t suggest it. Will you ask him? I’m concerned about what happens after the 2 weeks with the feeding tube. They’re treating the symptoms but it doesn’t seem like they figured out the underlying issue. What’s the plan if she’s still not eating and they don’t know why?

If you have any questions about the feeding tube just tag me. Are they putting it on her neck area or the stomach?
 
Had a nice long visit with Kit this morning. She even stood up and meowed when she saw me. She's fasting before her surgery but the vet tech let me give her a couple Churu tubes as a snack since her surgery won't be until late afternoon. Her BG levels have been in the mid-200s. She's on 3 units of Lantus again. Ketones still close to 3 so they didn't come down much since yesterday.

About having an endoscopy: Kit's doctor wants to focus on her diabetes first. IBS didn't sound like a major player since her GI panel was normal and she didn't have other symptoms of IBD. I will ask the doctor about the length of time she can have the tube in because when he was explaining to be about e-tubes he mentioned some cats have them for months. I believe it will be put in her neck area (I will be looking into the Kitty Kollar once she's out of post-surgery danger zone).

The hope is that when we get her insulin dosing correct, and she's had enough nutrition, she'll remember she likes to eat food again. It is definitely frustrating that none of the tests have shown a conclusive trigger (unless something shows up in the urine culture which hasn't come back yet). I wonder if her UTI a few weeks ago was the trigger?

Hopefully I'll be able to take her home tomorrow and she can relax back in a safe familiar place (and reunite with Henry). My boss has OK-ed any sick time I need to take next week to get Kit through this first recovery stage (hooray for empathetic bosses and jobs that provide sick leave) and I'll check with my catsitters if they have any experience with tube feeding just in case I need backup help after next week. I might put my parents through a crash course in tube feeding as well even though they are still skeptical of all this effort and expense I'm putting into Kit (I figure, I don't have human children and even though this is costing me a lot it's still cheaper than 4 years of college).
 
Very glad to hear she’s acting like she’s feeling better :bighug:

Im not sure I agree that the diabetes is what’s causing her not to eat. It can take months to get a cat regulated not just days so it seems highly unlikely. If the ultrasound revealed thickening of the intestine walls and an enlarged pancreas, one of those could be the culprit and I’d want to know more about them, but let’s see what others think @Marje and Gracie and @Bron and Sheba (GA)?
 
egwv said:
Had a nice long visit with Kit this morning. She even stood up and meowed when she saw me. She's fasting before her surgery but the vet tech let me give her a couple Churu tubes as a snack since her surgery won't be until late afternoon. Her BG levels have been in the mid-200s. She's on 3 units of Lantus again. Ketones still close to 3 so they didn't come down much since yesterday.

About having an endoscopy: Kit's doctor wants to focus on her diabetes first. IBS didn't sound like a major player since her GI panel was normal and she didn't have other symptoms of IBD. I will ask the doctor about the length of time she can have the tube in because when he was explaining to be about e-tubes he mentioned some cats have them for months. I believe it will be put in her neck area (I will be looking into the Kitty Kollar once she's out of post-surgery danger zone).

The hope is that when we get her insulin dosing correct, and she's had enough nutrition, she'll remember she likes to eat food again. It is definitely frustrating that none of the tests have shown a conclusive trigger (unless something shows up in the urine culture which hasn't come back yet). I wonder if her UTI a few weeks ago was the trigger?

Hopefully I'll be able to take her home tomorrow and she can relax back in a safe familiar place (and reunite with Henry). My boss has OK-ed any sick time I need to take next week to get Kit through this first recovery stage (hooray for empathetic bosses and jobs that provide sick leave) and I'll check with my catsitters if they have any experience with tube feeding just in case I need backup help after next week. I might put my parents through a crash course in tube feeding as well even though they are still skeptical of all this effort and expense I'm putting into Kit (I figure, I don't have human children and even though this is costing me a lot it's still cheaper than 4 years of college).
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I’m encouraged by all this great news and that you will be able to take time off work. She might start eating better when home.

I think it’s likely the UTI started it. It might be she didn’t get strong enough antibiotics to treat it completely. Sometimes, there can be a kidney infection called pyelonephritis which doesn’t necessarily show up on a urinalysis. You could ask the vet but usually it’s diagnosed by ultrasound.


Ale & Bobo & Minnie (GA) said:
Very glad to hear she’s acting like she’s feeling better :bighug:

Im not sure I agree that the diabetes is what’s causing her not to eat. It can take months to get a cat regulated not just days so it seems highly unlikely. If the ultrasound revealed thickening of the intestine walls and an enlarged pancreas, one of those could be the culprit and I’d want to know more about them, but let’s see what others think @Marje and Gracie and @Bron and Sheba (GA)?
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Not likely as those are not bacterial infections. Good thought, though :)
 
Whew, what a day. There were a lot of crying breaks at work and I'm exhausted.

I visited Kit about 3 hours after her procedure. E-tube is in, and also a Freestyle Libre glucose monitor. She was pretty groggy still so I just stayed and petted her gently for an hour. I decided I needed to take a break from asking questions for one evening but I have a whole list of them for the doctor tomorrow. Crossing my fingers for nothing scary overnight since we're not in the clear yet for anesthesia reactions. If all is well the hospital will call me when Kit's ready to go home tomorrow.
 
I got a quick update from Kit's doctor's assistant (her doctor will be calling me later this morning).

Kit is not tolerating being fed through the tube. The food is just staying in the tube and she is not digesting it. They have been feeding/checking every 4 hours and are giving her every possible medication but nothing's working. The doctor says it's Ileus so I'm reading up on that now. She might have to stay in the hospital longer (honestly I don't think I can afford this at this point) or I might be able to take her home and see if she relaxes enough to digest food here with the knowledge that she might still not get the nutrition she needs.

Gotta say I'm super discouraged by this.
 
egwv said:
I got a quick update from Kit's doctor's assistant (her doctor will be calling me later this morning).

Kit is not tolerating being fed through the tube. The food is just staying in the tube and she is not digesting it. They have been feeding/checking every 4 hours and are giving her every possible medication but nothing's working. The doctor says it's Ileus so I'm reading up on that now. She might have to stay in the hospital longer (honestly I don't think I can afford this at this point) or I might be able to take her home and see if she relaxes enough to digest food here with the knowledge that she might still not get the nutrition she needs.

Gotta say I'm super discouraged by this.
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From a quick google, it sounds like it happens when they need fluids or there’s something else going on in the intestines…?
 
Just a housekeeping fyi, I edited the title of this thread to add Ileus and put a ? prefix to bump this.

I’m waiting to speak with the doctor now about my options and will update when I can. If anyone has experience with Ileus I would love any/all advice.

I just want Kit at home. I worry if I keep her in the hospital she will continue to be stressed out which also won't help her eat. And I don’t think I have enough money for an extended hospital stay now. This is so tough.
 
Hi Emma,

I'm re-posting the stuff I wrote on the older thread about Sally's ileus, in case it's not being monitored:

I'm so sorry you and Kit are going through this. I'm happy to share what I learned from Sally's ileus experience, though many questions remain unanswered.

The day after Sally's SRT procedure at NC State, we noticed that her abdomen had become very distended. She was lethargic and seemed very uncomfortable. A vet we consulted expressed dire concern and recommended that we drive her back down to NC State for treatment. There, she was diagnosed with post-procedural ileus; her nervous system was not recovering from the anesthetic and her GI tract was basically nonfunctional (she couldn't even pass gas). It took her several days of supportive care in the hospital, but she did recover. They were able to get the gas out with a nasogastric decompression tube. They also administered motility drugs...I have since read that these may not actually be effective (I can send you a link to the study, if you're interested), but who knows. In any case, I think it was about three days before things started moving in her GI tract again.

In Sally's case, I think it was the correct course of action to have her hospitalized; the pressure would have been unbearable without nasogastric decompression. Is this kind of gastric distention happening to Kit? Frankly, we were left feeling like decompression was perhaps the only real help the hospitalization offered, and that otherwise her return to normalcy was spontaneous, but again it's possible that the motility drugs helped more than we realized.

Sally's ileus was somewhat unusual: her procedure (SRT for pituitary tumor) had nothing to do with her GI system, and her ileus seemed to be caused by the anesthetic itself. This does sometimes happen, but ileus is even more common following procedures on the GI tract. Kit's ileus could be a result of the anesthetic she underwent, or it could be the result of handling/manipulation of her esophagus during the procedure (which is not to say that the person doing the procedure mishandled it in any way--it's just that the GI tract seems to "dislike" (for lack of a better word) being handled, and it can temporarily dysfunction when it is).

One more thought: as Wendy mentioned in the other thread, rectifying any electrolyte imbalance is an important part of ileus treatment (see, for example, this article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7533151/). You mentioned that Kit has been exhibiting hind-leg weakness recently. Could hypokalemia be a factor in this and, if so, is the vet doing supportive care? Sorry if you've already said something about this; I skimmed the threads about Kit's illness and didn't see anything, but I'm pretty out of it (our other cat is really unwell right now).

I understand your wanting to have Kit home with you; hospitals are stressful places and it's hard for anyone to recover there. If they are doing nasogastric decompression, of course that's something that can't be done at home and it might be best for her to remain hospitalized. If not, and if her blood work doesn't indicate that she has a problem that needs to be addressed in the hospital (e.g., an infection, a severe electrolyte imbalance that needs to be treated with IV fluids, etc.), and if she can be monitored carefully at home, perhaps you could try bringing her home, seeing whether she improves, and bringing her back if necessary?

Hoping things are improving,
Maia
 
Kit is home.

Her doctor thinks this is gastric stasis (same as ileus, but the affecting the stomach rather than the small intestines) brought on by the anesthesia and with luck will resolve itself over the next couple days. He said it was a wait-and-see situation so I made the call to wait and see from home instead of keeping her in the hospital. Her electrolytes are fine and her abdomen's not distended.

Her current regimen is food through the tube 4 times a day (25mL Royal Canin recovery liquid or 30mL Purina DM slurry). Starting very slowly by giving her half her serving, waiting 15 min to make sure she doesn't vomit or regurgitate it back up, then finishing the rest. She has a variety of meds on all different time schedules: Cisapride to help propel her stomach and intestines, Ondansetron antinausea, Clindamycin antibiotic, Mirtaz appetite stimulant. And he said I can add in the Methyl B12 for her neuropathy. She's back on 3 units of Lantus.

I've given her her first tube meal and she didn't vomit any back up, but the test will be later tonight when I aspirate her tube. She's very weak and couldn't walk out her carrier so I ended up giving her the meal where she was flopped down in the hall. Later I skooched her over to one of her regular sleeping mats and she was able to wobble onto it on her own. I doubt she will be able to make it to the litter box tonight so I hope she stays on the pee pad I put under her.

Just for curiosity's sake I took her preshot glucose reading with my ReliOn Premier meter after I took it with the Freestyle Libre. ReliOn Prime reading was 214, Freestyle reading was 255. I'll continue to take both (at least for preshot and +4hrs).

Is anyone here familiar with a type of insulin called Toujeo? He said that sometimes cats don't respond well to Lantus and might do better on Toujeo. It's a newer long-lasting U300 insulin. If Kit gets through this episode of gastric stasis/ileus and gets her appetite back, he might look into switching her to Toujeo. He would want to keep the Freestyle Libre meter on her if we do that. I'm focusing on one day at a time of getting food in her, and will think about insulin types later.

Henry is suspicious of the hospital smells and after sniffing Kit he's keeping his distance but at least he's not attacking her. Hopefully she'll start smelling normal soon and she and Henry will be snuggle buddies again.
 
egwv said:
Kit is home.

Her doctor thinks this is gastric stasis (same as ileus, but the affecting the stomach rather than the small intestines) brought on by the anesthesia and with luck will resolve itself over the next couple days. He said it was a wait-and-see situation so I made the call to wait and see from home instead of keeping her in the hospital. Her electrolytes are fine and her abdomen's not distended.

Her current regimen is food through the tube 4 times a day (25mL Royal Canin recovery liquid or 30mL Purina DM slurry). Starting very slowly by giving her half her serving, waiting 15 min to make sure she doesn't vomit or regurgitate it back up, then finishing the rest. She has a variety of meds on all different time schedules: Cisapride to help propel her stomach and intestines, Ondansetron antinausea, Clindamycin antibiotic, Mirtaz appetite stimulant. And he said I can add in the Methyl B12 for her neuropathy. She's back on 3 units of Lantus.

I've given her her first tube meal and she didn't vomit any back up, but the test will be later tonight when I aspirate her tube. She's very weak and couldn't walk out her carrier so I ended up giving her the meal where she was flopped down in the hall. Later I skooched her over to one of her regular sleeping mats and she was able to wobble onto it on her own. I doubt she will be able to make it to the litter box tonight so I hope she stays on the pee pad I put under her.

Just for curiosity's sake I took her preshot glucose reading with my ReliOn Premier meter after I took it with the Freestyle Libre. ReliOn Prime reading was 214, Freestyle reading was 255. I'll continue to take both (at least for preshot and +4hrs).

Is anyone here familiar with a type of insulin called Toujeo? He said that sometimes cats don't respond well to Lantus and might do better on Toujeo. It's a newer long-lasting U300 insulin. If Kit gets through this episode of gastric stasis/ileus and gets her appetite back, he might look into switching her to Toujeo. He would want to keep the Freestyle Libre meter on her if we do that. I'm focusing on one day at a time of getting food in her, and will think about insulin types later.

Henry is suspicious of the hospital smells and after sniffing Kit he's keeping his distance but at least he's not attacking her. Hopefully she'll start smelling normal soon and she and Henry will be snuggle buddies again.
Click to expand...
I’m glad she’s home and she did well with the food. She needs time to rebuild her strength.

I can only think of one person who used Toujeo here. The issue with it is because it is a U300 insulin, there are no syringes so you have to use the pens so that means dose changes have to be made in 1u increments which might be way too much.

Levemir and Tresiba can give flatter curves. Many members here, including me, use or have used Levemir. I loved it for my kitty. We have a separate forum here for Tresiba so you can check in there and ask questions of users.

Did they teach you how to flush the tube and when to do it?
 
Interesting about the Toujeo. I didn't know that U300 syringes don't exist. I actually asked Kit's doctor about Lantus dosing (mainly about if I'm late coming home from work and miss her shot time) and he's not a proponent of fraction doses. For comparison my regular vet told me to do a half doses in various situations (preshot BG lower than 180; miss regular shot time by 1-2hrs).

Back to the e-tube, the protocol I was told to do was aspirate the tube first to remove any liquid (and check for negative pressure), feed lukewarm food slowly over 10-15 min, then flush tube with 6mL lukewarm water. If I aspirate too much liquid (30mL now since it might contain undigested food; 10mL when Kit doesn't have gastric stasis) to skip that feeding and just flush the tube.

Kit was able to wobble about 10 feet across the floor and is now hiding in her taco truck, which will make it tricky for me to take her +2 BG. So her catitude is back, at least in part.
 
How are you aspirating the tube? I never had to do that. I did have to give a lot of water first and the reason was that it signaled her stomach that food was coming. Then I give the food and meds and would flush it down with more water at the end. The only thing I would do after was hold up the tube to make sure she wasn’t regurgitating any food back up and sometimes a little would come up but it would go down slowly again.
 
egwv said:
Interesting about the Toujeo. I didn't know that U300 syringes don't exist. I actually asked Kit's doctor about Lantus dosing (mainly about if I'm late coming home from work and miss her shot time) and he's not a proponent of fraction doses. For comparison my regular vet told me to do a half doses in various situations (preshot BG lower than 180; miss regular shot time by 1-2hrs).

Back to the e-tube, the protocol I was told to do was aspirate the tube first to remove any liquid (and check for negative pressure), feed lukewarm food slowly over 10-15 min, then flush tube with 6mL lukewarm water. If I aspirate too much liquid (30mL now since it might contain undigested food; 10mL when Kit doesn't have gastric stasis) to skip that feeding and just flush the tube.

Kit was able to wobble about 10 feet across the floor and is now hiding in her taco truck, which will make it tricky for me to take her +2 BG. So her catitude is back, at least in part.
Click to expand...
Were you able to read this post on flushing tubes and other tips?

Our methods of regulation call for dosing changes, generally, in 0.25u doses. We’ve found issues over and over again with vets changing doses in 1u increments and even, at times, increments of 0.5u. It’s easy to pass a dose that might work perfectly by changing in 1u increments. My own cat responded to changes in 0.1u.
 
I wonder how much experience your vet has with diabetic cats and dosing. We have great sucess here with increasing and decreasing in 1/4 unit increments.
I am unfamiliar with Toujeo dosing. I used lantus then Levemir and loved the levemir.
Have you had a chance to test for ketones yet?
 
I'm going to try to give Kit another meal in about half an hour. I aspirate the tube by pulling back on the syringe and drawing out any fluid. The plunger should want to return to its original position (if it doesn't it indicates that the tube might have shifted to her lungs). The vet tech who showed me what to do didn't tell me to flush the tube pre-feeding. I will ask tomorrow. The Kitty Kollar post on tube feeding is definitely very informative.

Kit's wobble-walking around a bit more. I tried offering a Churu tube but she wasn't interested. I hope it's because she's so tired from a very stressful 5 days. She just peed on the floor so I was able to do a ketone test and it is still a darker pink than I would like but her doctor said he didn't need her ketones to be perfect when she went home as the priority is getting her eating. I haven't bought a blood meter yet (I read the article comparing the different models; the expense of the test strips if definitely something to consider) but I will probably to that tomorrow since the urine strips are too hard for me to interpret.

Kit's doctor is the only internal medicine specialist at the hospital and is out of town starting tomorrow through all of next week, which has me nervous. Really hoping that this gastric stasis resolves itself soon. I'm going to wake up with every noise she makes tonight.

Updated to add, I just tried feeding her again but I aspirated about 50mL of stomach fluid which is well about the 30mL the vet tech told me was the threshold for feeding. I am supposed to skip this meal, and will try again in the morning. I did end up calling the overnight vet tech for advice and while he was on the line I asked him about flushing pre-feeding and he said it was fine, so I will start doing that. Gotta keep that tube clean!
 
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I have to say I feel uncomfortable with Kit not getting any food over night, especially with the ketones a darker pink.
I would try a few times to see if she will eat for you.

When I was putting in gastric tubes to feed babies who would not suck a bottle, I would test the contents of the stomach which should be acidic (with litmus paper) before I fed them. A cats stomach contents should have a PH of 1 to 2.5 (acidic) as far as I am aware. I would ask the vet if you can check this way.
 
I see so the e-tube is on her stomach then not her neck. Minnie’s was on her neck. The IM was going for the stomach but during the procedure she didn’t feel it was ideal and we ended up with one on her neck. They were adamant with me about making sure I gave her water before and after.

how is she doing today?
 
Kit's really slow and weak today and not responding much to me talking to/petting her, and she didn't react when I tried offering her various favorite treats (even Churu which has been my trusty standby this whole time). I gave her a tube meal and meds early this morning but I won't know until her midday meal if she digested it. She spent all night not moving from one of her mats, but about an hour an a half after her tube breakfast she wobbled over the the litterbox and actually peed in it. She had trouble getting out; it took a long time and I was hovering to help but she eventually got out on her own. She did regurgitate a small amount of food right after that; I'm hoping it was from the physical exertion and not from a lack of digestion. She also wobbled over the couch and meowed at me so I wrapped her in a towel and pee pad and lifted her onto my lap and we've been sitting together for the past hour or so (she's testing my bladder endurance).

I am so worried about the lack of nutrition and her ketone level, but her doctor told me yesterday that if her stomach isn't accepting food then they wouldn't be able to feed her at the hospital either. NG tube or E-tube, they all end up at the same place which isn't digesting. That's why I chose to take her home yesterday. Yesterday I left the hospital feeling a little optimistic but today seeing her so quiet and slow has me thinking this might be close to the end for her and I'm starting to try to wrap my brain around accepting that. She doesn't seem to have any pain or discomfort, at least.
 
Hang in there. I think you made the right decision bringing Kit home to rest and recover. Try not to lose the optimism you felt yesterday; in ileus cases it can take several days post-procedure for things to start moving again.
 
I had to take Kit back to the hospital for a brief visit for them to suction out her stomach -- I noticed some food was coming back up her tube a couple hours after her midday meal, so I called them to ask what it meant and they said to bring her in. They inserted a longer, skinnier tube in her e-tube and suctioned out a bunch of fluid. They want me to do this before each of her meals, and if I get lots of liquid out (30-40mL or higher) I am supposed to delay her meal 2-3 hours. I asked about when to give her insulin and they said I could delay it and give it after her full meal, or give a 1/2 dose at the regular time with a 1/3-to-1/2 meal. Tonight I opted for a delayed shot of the full 3 units with her delayed meal. Because of the amount of liquid the vet tech suctioned out she told me to only give the one meal tonight to prevent too much stuff going back in Kit's stomach. I will also have to change the time of her shots over the next couple days to account for today's delayed shot and move her back to her 6am/6pm schedule (unless I keep having to delay her meals because of drawing out too much fluid).

When it was time for her delayed meal I suctioned her stomach and got about 30mL fluid which was right on the threshold of "if too much fluid then delay her meal" so I made the decision to go ahead and feed her. Fingers crossed her stomach starts digesting soon. She's so skinny and wobbly and going back to the vet stressed her out. I feel like each day presents an unexpected challenge/setback.
 
What did the vets say about her hydration and the ketone level? Did they talk about giving her some SubQ fluids or IV fluids? I am concerned she is getting enough fluids.
I am also concerned about delaying the insulin doses if you do not feed, and giving a 1/2 dose with a smaller meal.
I am going to tag @Marje and Gracie
and @Wendy&Neko to get their input.
What was the last ketone result?
Is she lethargic?
Is she showing any interest in eating any food at all?
Are you giving the antinausea meds and the appetite stimulant Meds?
 
Bron and Sheba (GA) said:
What did the vets say about her hydration and the ketone level? Did they talk about giving her some SubQ fluids or IV fluids? I am concerned she is getting enough fluids.
I am also concerned about delaying the insulin doses if you do not feed, and giving a 1/2 dose with a smaller meal.
I am going to tag @Marje and Gracie
and @Wendy&Neko to get their input.
What was the last ketone result?
Is she lethargic?
Is she showing any interest in eating any food at all?
Are you giving the antinausea meds and the appetite stimulant Meds?
Click to expand...

Those are all important questions and I'm afraid I don't have good answers. I'm having trouble taking the advice from Kit's doctor and the vet techs, and then getting advice here that is different, and I'm so new to this disease I don't know what to do.

The current main issue as I understand it is Kit's gastric stasis/ileus is preventing her from digesting any food. That's why her stomach gets filled with fluids and backs up her tube, and why I have to suction it out before her feedings. Until she can digest food it's going to continue to mess up her ketones (they were between 4 and 8 on my strip color scale this morning), but it's up to her body to start digesting and me feeding her through the e-tube or the vet feeding her through the ng tube has the same result of undigested food in her stomach.

I am also concerned about her hydration and her skin isn't springing back. But I am also concerned about taking her back to the hospital because it really stresses her out. When we got back from our trip today, she just laid limp on the floor for a while. She has since started walking a bit more around the room, and even drank some water out of her mug - the first time I've seen her drink on her own (or take anything orally) since she's been home.

She is incredibly lethargic and not interested in any food/treats, and barely responds when I call her. This is killing me. I'm worried about incontinence now as she has peed on the floor several times this evening. I'm hoping she's just exhausted from another hospital visit and a long car ride and that she can find her way to the litter box again like she did this morning.

She's on antinausea (ondansetron), appetite stimulant (mirataz), a med (cisapride) that is supposed to help move her stomach and intestines, and an antibiotic (clindamycin).

I can't take her back to the hospital to stay. She was so unhappy there. I also don't have any more funds (her treatment and overnight stays since Saturday has come to about $18,000 USD). If the ileus goes away in the next few days and she can digest food again, then I can look further ahead to trying to tackle appetite, ketones, and her insulin dosing and type. But if she continues to be unable to digest food, I want her to be calm at home for as long as she is not in pain.
 
I can see you are in an incredibly difficult place.
Do you know how to do subQ fluids?
I think if she is not eating, she really needs to be back on IV fluids. But if you can't afford to take her back, then subQ would be the next best thing.
She needs to be having them every day at least. Maybe smaller amounts twice a day. She needs these fluids while her body resolves the ileus. THis is very important and I am surprised the vets did not say this.
I would ring the vets asap and ask them about giving fluids.
Being so lethargic and barely responding to you is not good
 
I took Kit to her regular vet today for subQ fluids. I will check in with them again on Monday morning about giving her more, or them teaching me how to do it depending on Kit's status.

Kit is still slow, mostly staying in one place for a long time, then wobbling to another place nearby where she will stay for a long time. Her BG is high today, possibly because of going back to the hospital yesterday for her stomach suction. I suctioned out a lot of fluid this morning, but not much before her midday meal but I don't think I got the tube all the way into her stomach (inserting the tube correctly has been a difficult learning curve for me). Kit did drink a little bit of water on her own today, but is still not interested in food.

I'm just trying to spend as much time near her as possible now.
 
There are online videos that my vet’s assistant sent me when I had to give Bobo fluids at home. Mind you, I had already done that for my late cat Deanna. It’s fairly simple especially when they’re slow and not putting up much of a fight. It would probably be better for her if you got the solution and gave it to her at home.
 
I think that Kit drinking voluntarily is fantastic news. I hope it will be the first of many small victories on her road to recovery.

I wish I had more to offer than our anecdotal experience with Sally. For whatever it's worth, I was once stricken with severe food poisoning (I think it was botulism) and it stunned the nerves controlling my GI tract so badly that it took three years for me to teach myself how to swallow solid food again. It was tough, but I managed (without any medical help, either--no one knew what the heck to do with me). This is absolutely *not* said to discourage you--to the best of my knowledge nothing like that has ever happened to someone with post-procedural ileus, though perhaps the mechanism is similar (something stuns the nervous system, causing dysfunction to the autonomic processes governing the muscle contractions that move food along the GI tract, and some degree of dismotility occurs). Rather to say that it can take awhile, but things do sometimes sort themselves out. It's not at all uncommon for ileus to last a few days, and for symptoms like delayed gastric emptying to persist even longer. I'm way, way out of my depth, so I hope I'm not being overly optimistic and seeing only one side of things. Reading about your experience, though, I really do feel there is every reason to hope that Kit's gastric stasis will gradually resolve.
 
I agree subq fluids at home would be a smart thing to do but don’t overdo it. Be sure to ask your vet because too much can be an issue if she were to have any undiagnosed heart issues. I would think 50-75 mls a day would be safe but it’s best to ask the vet. Any more than 100 mls a day is most likely too much.

I have no experience with ileus and have to leave that to Wendy or others who have dealt with it. I did have a cat who needed a tube once but it’s been 27 years ago and it was a stomach tube so I’m not much help with any of what you are dealing with there.

I also think we need to be a bit more aggressive on dosing if you are able to get any food in her that stays and is digested. If things go ok, and if her BG is still where it is after four cycles on 3.25u, I’d increase to 3.5u twice a day.
 
It's still a rough, frustrating ride with Kit.

She's had some good bits today, like how she is more frequently going to her water cup, and that she walked around a little bit more (slightly longer distances before flopping down), and that I think she is just ever so slightly less wobbly when she walks. She started propping herself up on her front legs a bit more when she's flopped on the floor, and she came to me to rest her head on my leg during a couple of her feedings. I took a nap on the floor next to her this afternoon and she wrapped her paws around my wrist. She's been looking around more, looking at me, and occasionally turning her head when I call her. She leaned into my pets and turned on the faintest purr.

And there are still worrisome bits. When I suction out her stomach and her e-tube I've been getting less fluid, but I don't know what the definitive sign is that she is starting to digest more. She hasn't defecated at all. She pees where she is seated on the floor, and she doesn't move away so I have to lift her gently aside and clean her up. Henry hasn't acknowledged her at all since she came back home on Thursday which breaks my heart.

About potassium, I don't know what her levels were but her doctor said her bloodwork was normal, and her electrolytes were normal.

I am hoping to take her back to her regular vet tomorrow for more subcutaneous fluids and an honest assessment of her condition and quality of life. I am also going to call the hospital since the internal medicine department will be back in the office to ask them more specifically about the gastric stasis/ileus, what signs to look for that it might be clearing up, and how long do I "wait and see".

Yesterday I was very sad and cried a lot. Today was mostly better because Kit was more alert, but now that it's night and I have to talk to vet tomorrow I am getting sad again. I'm so exhausted from going into every feeding worried about how much fluid she might have, is she going to regurgitate up her food, am I going to clog the pipe (I'm really worried about clogs in her smaller stomach suctioning tube for her next feeding since today was the first time I blended up her food slurry and I didn't do a good enough job, which I didn't find out until syringing it into her feeding tube).
 
I am sorry you are feeling so down…but I think that is pretty normal when you have a sick kitty as you do.:bighug:
We all understand how you are feeling.
It is good to hear the positive news.
What are you using to feed through the feeding tube?
Did the vets suggest using some hills a/d food to feed which is suitable to tube feed and has some added nutrients in it.
I would suggest getting some of that at the vet tomorrow and using that. You won’t have trouble with lumps.
I would definitely ask about more subQ feeds until you can use the feeding tube properly. Ask the vet if her heart is OK to give the sub q fluids and then ask if you can do them at home.
Here is a link to the HILLS A/d for you to have a look at.
 
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It’s a great stress. I do remember that from having a cat with a gastric tube. One morning, was so exhausted that in removing a bandage, I also cut through his tube and had to rush him to the ER. Things got better for him but it took a bit of time and it’s a roller coaster.

hang in there….you are doing a great job. Write all your questions down for the vet so you don’t forget. Try to get some rest.
 
It is stressful when your babies are not feeling well and you don’t know how to help them. I was thinking about the AD food too. I know you got some to offer her before. Is that what you’re feeding her through the tube? It’s a lot easier to blend because it’s smoother than regular cat food and it’s alto more caloric so it would be better for her right now.
 
Kit crossed the rainbow bridge today.

She developed breathing issues last night and declined throughout today. I took her to my regular vet for an assessment and we decided it was kindest to let her go. This is the hardest thing I have had to do in my life.

Please no questions about what was wrong (the doctors still don't know) or suggestions of things I could/should have done. My poor girl couldn't eat, couldn't walk, and in the end couldn't breathe easily. It doesn't surprise me that Kit decided her last act would be to confuse the heck out of medical experts, she's always been smarter than humans.

Thank you all for your support and your knowledge. You have helped me so much these past weeks.

I'm sure there are logistical things I will need to wrap up Kit's info on this forum; I'll get to that in due time.

Goodbye, beautiful baby girl. I'm so lucky to have spent the last 12 1/2 years with you.

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