10/15 Butters AMPS 317 / -evening update: ate, doing better

Butters & Lyla

Butters & Lyla

Member Since 2020
Yesterday
No update overnight. No news is good news. I don't have any new BG readings to report, yet.

When I spoke with the IM Specialist yesterday, she also wanted to talk about Butters' FD. She recommended that they put a Freestyle Libre on Butters and set it up so the curves get sent direct to the IM Specialist. The problem is, she thinks Butters could be in remission and wants me to stop giving her insulin. She is basing this decision on Butters' BG numbers while she has been in the hospital and the fact that they haven't been giving her any insulin. :confused:

It is frustrating to have to explain to four vets in one week why I'm not going to stop giving Butters insulin. I have nothing against the Libre but I don't want it when it comes with the expectation that Butters doesn't get insulin anymore.

Have a great day, all. I hope all your kitties surf safely.
 
JL and Chip said:
Great that Butters nibbled on some food today.

I hate to say that it’s good news that it’s “only” pancreatitis (pancreatitis sucks, I know!) but that’s good news in the sense that concurrent illnesses could have made things so much more difficult.

Are they sending Butters home with subQ fluids too?
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I agree. Although they think she may have early CKD, also. Her lab work over the past week seems to tell different stories on that one. I'm waiting for this vet hospital to send me all of the results that they received. They suggest I do another round of labs for Butters once she is feeling better and eating and drinking, which makes sense I think.

I brought up subQ fluids on my call with the IM Specialist yesterday. She didn't raise it. She did not seem keen but said we could discuss it today. I'm trying to think of what the downside could be and why they wouldn't want me to do this for her? I can't figure it out.
The ER I took her to over the weekend refused to send me home with subQ fluids. I don't get it.
 
tiffmaxee said:
I like that the IM is not rushing for a feeding tube yet says to only give it 24 hours!
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The 24 hours doesn't entirely sit well with me, either. I think the IM had actually said give it 12 - 24 hours, but I said I want to give it at least 24 hours.
She only works Monday - Friday and would do the e-tube placement. She would want to do it prior to the weekend. I just don't like the idea that Butters might end up with an e-tube without giving her enough time to eat on her own, because of the IM's schedule. :( This, and her being hesitant about subQ fluids, does not sit right with me.
 
Does Butters have a cardiac issue (or a suspected cardiac issue)? Fluids can be tricky in those cases — too easy to overload the heart. Otherwise, I’m not sure what their concern would be other than not being comfortable with owner compliance. If they say no, I’d ask what their hesitation is.
 
JoyBee&Ravan said:
I'm glad to hear she's coming home. Maybe some baby food?
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Red & Rover (GA) said:
Check the labels for onions and garlic. Both are toxic.
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I have quite the homemade baby food repertoire. I made baby food for my nieces when they were babies. I'm going to make homemade for Butters, just without the veggies I'd put in for them. Except for the pumpkin I always add to Butters' food. And no garlic or onions.
 
JL and Chip said:
Does Butters have a cardiac issue (or a suspected cardiac issue)? Fluids can be tricky in those cases — too easy to overload the heart. Otherwise, I’m not sure what their concern would be other than not being comfortable with owner compliance. If they say no, I’d ask what their hesitation is.
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She has a heart murmur but there are occasional times when the vets don't even hear it. No concern was expressed to me over this and no other heart issue noted. I'm definitely going to ask about the hesitation.

I asked the weekend ER why they don't recommend subQ fluids and they said that if Butters isn't eating and drinking on her own and requires subQ then she is too sick and needs to come back to the hospital so they can manage it!?
 
Butters & Lyla said:
She has a heart murmur but there are occasional times when the vets don't even hear it. No concern was expressed to me over this and no other heart issue noted. I'm definitely going to ask about the hesitation.

I asked the weekend ER why they don't recommend subQ fluids and they said that if Butters isn't eating and drinking on her own and requires subQ then she is too sick and needs to come back to the hospital so they can manage it!?
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I think if she needs subQ fluids, it's entirely possible that you should be able to do it at home. If you have the experience, no problem. If you don't, then maybe they are hesitant because they can't teach you due to Covid? That's all I can think of for not allowing it at home
 
Good luck today, Lyla :bighug: I agree with Sue about just one step at a time - it's so hard not to worry about the what ifs of every piece. Hoping for a good morning report:bighug: and I remember those nights of NOT getting a phone call with Jax was in the hospital - no news overnight IS good news but it sure didn't help my sleep...I'd stay awake waiting for a phone call :confused: Lots of hugs :bighug:
 
Morning Lyla just read yesterday's condo, I'm happy that Butters ate a little bit on her own.
I'm so glad she's coming home and hopefully she'll start to eat for you,being home
might make all the difference. I'm praying that everything will go smooth
and she won't have to return to the hospital.
My thoughts are with you and Butters Lula ♥♥♥
 
Placing an e-tube doesn't mean they will stop trying to get Butters to eat. With a tube you still give them food, if they don't eat it or enough then give through tube. It's also great for meds than trying to pill or give liquid meds to a sick animal and stress them even more. I wouldn't wait on putting a tube in. She hasn't eaten well enough for quite some time now. Think of it as a necessary safety net for awhile.

Ask why not subqs fluids at home, they must have a reason. Are they going to do anymore ultrasounds, xrays, or cardiology tests?
 
Butters & Lyla said:
why they wouldn't want me to do this for her? I can't figure it out.
The ER I took her to over the weekend refused to send me home with subQ fluids. I don't get it.
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$$$$$$$ Same reason a lot of vets don't approve of you testing at home or tell you you should use an expensive pet meter.

I hope she comes home & doesn't need that feeding tube. I'm sure after all she's been thru she'll need time to adjust.

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I am happy to hear you didn’t get any calls overnight :bighug:

Unfortunately, Butters has been sick since last week & has not been able to eat or eat as much as she needs for awhile :(. The good news is that it sounds like she was able to get some solid traction in the hospital because of the more intensive treatment available :). The unfortunate (and frustrating) thing with this illness sometimes is, and you will not know until you try, you find out that there is not quite enough traction to keep them moving nicely in the right direction and they get stuck or decompensate. If they do have enough traction, and with the continued support of
anti nausea and pain meds, they will eat and it will not be a struggle at home. A 12-24 hour period will give you that information.

Hopefully, if she does do well within that period, she stays on course:). Sometimes they will have a great day and the next day they may need a little more help. It is definitely not always a nice linear course of recovery. It can be more like a roller coaster with some twists and turns, ups and downs. The key is as long as they keep eating and the overall trend is improvement, you are good to go.

Hypothetically, someone may potentially be able to manage a cat with more significant issues at home with meds, syringe feeding, subq fluids & eventually get the cat back on track. However, most often, when a cat has a severe enough case of pancreatitis, it really just slows down the recovery and drags the illness out vs a much more rapid recovery with the help of more intensive treatment if they are needed (ie feeding tube, additional hospitalization for fluid resuscitation).

Fluids and heart murmur....that is something to talk with the IM about. T had no prior murmur or cardiac issue but one day after subq fluids at home, he had some change in breathing. A specialist let me know that with cats, if there is a heart issue, it can go from nothing happening to a bad situation pretty fast so it was best to have him seen. We ended up in the U ER to get the full work up and cardiology consult. Thankfully, he was fine but I learned that with a heart issue, it definitely is best to be cautious. Even if the IM hasn’t raised the concern and/or it’s not her primary reason for not wanting to send fluids home, I would definitely discuss it with her/him just to be safe :)....including what to look for if you do give them at home.
 
Butters isn't coming home today. :( Not the update I was hoping for. She worsened overnight. The IM believes this is because they removed her from the methadone and put her back on bupe, and her pain worsened. :(The plan being to send her home with gabapentin and buprenorphine to manage her pain. So there was no eating overnight. She is staying for another 24 hours at least. They are switching her back to methadone and then onto a fentanyl patch, in the hope that she could come home with the patch, but it is only good for 72 hours from the point it starts to release, which is around 12 hours after placement.

Everything you say makes perfect sense. I know the best thing for her right now is to stay there and continue to get intensive treatment. Poor girl. I did not like how the weekend ER was handling her care so I'm glad she ended up coming home if only so that she wound up at a better hospital. Because I have to recognize that her pain wasn't being managed when she was at home. She was suffering. :( I'm so glad this place is on top of her pain.

I had mentioned the murmur to the ER vet who did Butters' initial exam but I admit I don't think I spoke to the IM vet about it. I am going to speak with her about it the next time we connect on the phone and see if we can get her an echo while she is there.
The other vets brush off the heart murmur as a non-issue when they cannot hear it.
 
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Cheryl & Jazzy said:
I think if she needs subQ fluids, it's entirely possible that you should be able to do it at home. If you have the experience, no problem. If you don't, then maybe they are hesitant because they can't teach you due to Covid? That's all I can think of for not allowing it at home
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My experience has been the vets all tell you to learn from videos now if you don't know how. Maybe it is different with subQ? I had to learn how to do her insulin from videos. Hometesting I learned from here...specifically Janet's home testing video.
They didn't ask if I had administered them previously, though. It was really about them thinking a cat who needs subQ is too sick to be at home.
 
Olive & Paula said:
Placing an e-tube doesn't mean they will stop trying to get Butters to eat. With a tube you still give them food, if they don't eat it or enough then give through tube. It's also great for meds than trying to pill or give liquid meds to a sick animal and stress them even more. I wouldn't wait on putting a tube in. She hasn't eaten well enough for quite some time now. Think of it as a necessary safety net for awhile.

Ask why not subqs fluids at home, they must have a reason. Are they going to do anymore ultrasounds, xrays, or cardiology tests?
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Nothing else scheduled right now. I did make it very clear to the IM that if she feels Butters needs a tube, that I am on board with it. No hesitation on my part. The IM is very focused on getting Butters' pain under control and wanting her to eat on her own.
I know @Tomlin yesterday talked about how much energy it takes for them to eat. And with what you're saying I do wonder whether she might ultimately benefit from a tube. I'm not going to bring her home until I have had a thorough discussion with the IM about it.
 
I’m sorry she isn’t coming home today, but glad she is getting the treatment she needs :bighug:

Our first subq was at the vets office, where they showed us how to do it in the exam room. That was many years ago, and with COVID-19, they can’t really demonstrate or instruct on it. Might be why?
 
Oh Lyla I'm sorry to here this, I'm glad they are putting her back on the methadone, the the fentanyl patch. I know it only lasts for 72 hours, my husband was in it once.
Maybe they will send you home when the time comes with another patch or more methadone.

When I just read the update , I can't tell you what I said, not lady like lol
I just feel awful for her and you.

They seem to be really taking excellent care of her and hope it gives
you some comfort.
Will be checking back in :bighug::bighug::bighug::bighug:

My vet let me in to show me how to give fluids to Perry and that was the end of June during the Covid-19 ..Just had to wear my mask. I went in after all of her appointments.

Don't remember if you ever had to do them but believe me it's so easy. Perry would lay on his
side and purr during them.
I was given 2 different type of needles, one would make the fluids flow faster and the
other slower.
The slower one was of course thinner but I always used the larger one and it never
bothered Perry.
I'd say it took less than 5 minutes , probably 4 minutes
 
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I am sorry Lyla. I know that is not the news you were planning on getting :(. The fentanyl patch is going to be so helpful as are the additional days with the fluid/electrolyte therapy. She just needs more time and help to get more traction. As much as I really hated to read this news, I was relieved that it happened while she was still in the hospital vs when she returned home for a trial. Sometimes it’s unavoidable but when that happens, it is stressful.

Continued prayers :bighug::bighug:. —Amy (& T :))
 
Thank you for that video :). Since I haven't done them, it will come in handy.
I know Butters will not be compliant at all, certainly wouldn't lay there and purr like Perry did. ;)
They haven't asked whether I've done them before or not, so I don't think that's the reason.
The fentanyl patch sounds pretty scary to me. I'm glad to hear you've had experience with it, Amy, because it seems terrifying. The side effects from the drugs have me worried as much as the pancreatitis.
And I have to stop thinking that it is just going to be an upward recovery. I have to get into the mindset that it will be a roller coaster. Very sad today. I hope she starts to feel better soon.

And there is the matter of her BG. They refused to give poor Butters any insulin at all, insisting that she may be in remission. Until this morning, when she is at 317. So they gave her .5u. I am very annoyed and borderline angry with them for messing around with her insulin so much. I begged them to give her .25u last night....just a little something. They refused. They won't listen to me at all. I get all of the factors in play here but she is not a cat in remission and would benefit from even getting a very little bit.
Okay, I realize I ranted.
Thank you everyone for the support. :bighug:
 
Butters & Lyla said:
Thank you for that video :). Since I haven't done them, it will come in handy.
I know Butters will not be compliant at all, certainly wouldn't lay there and purr like Perry did. ;)
They haven't asked whether I've done them before or not, so I don't think that's the reason.
The fentanyl patch sounds pretty scary to me. I'm glad to hear you've had experience with it, Amy, because it seems terrifying. The side effects from the drugs have me worried as much as the pancreatitis.
And I have to stop thinking that it is just going to be an upward recovery. I have to get into the mindset that it will be a roller coaster. Very sad today. I hope she starts to feel better soon.

And there is the matter of her BG. They refused to give poor Butters any insulin at all, insisting that she may be in remission. Until this morning, when she is at 317. So they gave her .5u. I am very annoyed and borderline angry with them for messing around with her insulin so much. I begged them to give her .25u last night....just a little something. They refused. They won't listen to me at all. I get all of the factors in play here but she is not a cat in remission and would benefit from even getting a very little bit.
Okay, I realize I ranted.
Thank you everyone for the support. :bighug:
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Rant away all you want, why they won't listen to you about the insulin , and will not take your word for it that she's not in remission really pisses me off.

I'm glad they saw the 317 this morning , I'm sure you will talk to them to make sure
she gets it tonight. Yes we get all the factors that are in play, but cone on,
she needs her insulin.
They will just have to keep testing her and call you tonight 12 hours after her morning shot and tell you what her BG is.

I wish I could show you in person how to do the fluids ♥:bighug::bighug:
 
Hang in there Lyla :bighug: It's all so draining and exhausting.

You know I loved Jax's e-tube - in addition to feeding and meds, I would push water down it (you could do this and sub-q fluids from the little I know...I have no experience with sub-q fluids). Food is fuel. Fuel helps the body heal. Whatever decisions you make, everyone here supports you. As with anything, there is more than one path to healing :bighug::bighug::bighug:
 
Butters & Lyla said:
Yesterday
No update overnight. No news is good news. I don't have any new BG readings to report, yet.

When I spoke with the IM Specialist yesterday, she also wanted to talk about Butters' FD. She recommended that they put a Freestyle Libre on Butters and set it up so the curves get sent direct to the IM Specialist. The problem is, she thinks Butters could be in remission and wants me to stop giving her insulin. She is basing this decision on Butters' BG numbers while she has been in the hospital and the fact that they haven't been giving her any insulin. :confused:

It is frustrating to have to explain to four vets in one week why I'm not going to stop giving Butters insulin. I have nothing against the Libre but I don't want it when it comes with the expectation that Butters doesn't get insulin anymore.

Have a great day, all. I hope all your kitties surf safely.
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prayers for you little girl to come home soon.

it seems that we have the same problems.

my little girl admitted 2 days ago, vet suspect fatty liver or triaditis :(.

I had bad days waiting for a good news, she ate on her own yesterday and today which give me some relief but they have hard time controlling her diabetes.
https://www.felinediabetes.com/FDMB...fatty-liver-or-triaditis.236819/#post-2657677
 
Rant away :banghead::)!! It is good that you will talk it over with the IM as well because that will also help. Nothing worse than the unknown & hopefully they are able to explain the thought process.

If it makes you feel any better, it has not been uncommon for Ts insulin to be held as well, especially if he is in a safe range and especially when other factors are driving the blood glucose during an illness. It is best, if the cat is is in a safe range, to hold vs giving insulin because as the inflammation &/or pain is reduced, and Butters rgans begin to be able to function well (receptors, hormones etc) , it’s a big question mark as to what happens with the BG and exactly how fast (or slow) it happens, so you don’t want to put the cat at risk of hypo. Now that the BG has increased, they may decide to add some insulin or they may wait to see what happens as the pain patch takes effect. This is another reason why they may want to add the Libre. It is much easier to monitor and see what is happening & how fast it is happening....and they don’t have to bother Butters to get BGs.

One other thought...since your hospital partners with the U why don’t you request that they consult with the endocrinologist at the U? I would think they would be open and respectful of that request :). You know....”partner” on the case :rolleyes::p
 
Lyla - :bighug::bighug::bighug: Not the news I was hoping to hear today, but it does sound like Butter's in the very best place for her right now.

If you need to get to it: How to Give Subcutaneous Fluids (Video) That gave me the refresher I need to to it with Neko. With her, fluids became a problem for her heart, just. few months after getting a clear echocardiogram.
 
I spoke with a vet tech, finally, some good news. Since being put back on the methadone Butters has been much more comfortable. She ate this afternoon. The tech thinks her pain is under control now. Plan is to keep her on the fluids overnight and keep getting her to eat, as well as switch her over to the Fentanyl patch. The tech is going to note that I want an echo done before she leaves, and the IM will speak to me about this when she calls me tomorrow morning.
 
Wendy&Neko said:
Lyla - :bighug::bighug::bighug: Not the news I was hoping to hear today, but it does sound like Butter's in the very best place for her right now.

If you need to get to it: How to Give Subcutaneous Fluids (Video) That gave me the refresher I need to to it with Neko. With her, fluids became a problem for her heart, just. few months after getting a clear echocardiogram.
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We cross posted. Butters is eating now. Of course, she ate yesterday and deteriorated overnight. Hopefully she shows improvement tonight.
Your poor girl. :bighug: :bighug::bighug: I am hoping to get an echo for her so at least I'll know for sure whether her heart is okay to handle fluids...for now anyways.
Thank you for the video link.
 
This is the news I've been hoping for all day!

I'm just so glad that she's finally showing some improvement!!! I cannot tell you how much better that sounds than the earlier updates...

You'll learn a lot in the next few days...keep the faith! Lots of us are rooting for you and Miss Butters! It does sound like she's getting the very best of care! You're fortunate in that regard that you have excellent veterinary facilities within reach!

Please get some rest this evening! When Butters comes home you'll be wearing that doctor/nurse/mama bean hat all at the same time!

Let us know if we can help in some way! Sending hugs and prayers your way!!:bighug::bighug::bighug::bighug::bighug:
 
Tomlin said:
Rant away :banghead::)!! It is good that you will talk it over with the IM as well because that will also help. Nothing worse than the unknown & hopefully they are able to explain the thought process.

If it makes you feel any better, it has not been uncommon for Ts insulin to be held as well, especially if he is in a safe range and especially when other factors are driving the blood glucose during an illness. It is best, if the cat is is in a safe range, to hold vs giving insulin because as the inflammation &/or pain is reduced, and Butters rgans begin to be able to function well (receptors, hormones etc) , it’s a big question mark as to what happens with the BG and exactly how fast (or slow) it happens, so you don’t want to put the cat at risk of hypo. Now that the BG has increased, they may decide to add some insulin or they may wait to see what happens as the pain patch takes effect. This is another reason why they may want to add the Libre. It is much easier to monitor and see what is happening & how fast it is happening....and they don’t have to bother Butters to get BGs.

One other thought...since your hospital partners with the U why don’t you request that they consult with the endocrinologist at the U? I would think they would be open and respectful of that request :). You know....”partner” on the case :rolleyes::p
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It does make me feel better, yes. Your reasoning makes sense. I just find it interesting that they wouldn't give her any insulin until she got over 300, but then at 360 they would give an extra dose of short-acting insulin to bring the number down. I know it is all far more complex than I can truly comprehend just yet. It takes me a while for things to sink in but I'm working on it. :)

I think I'm going to need some help working out doses while this is going on...I will definitely err on the side of caution. For now, I think her regular 1u is off the table when she comes home, hopefully tomorrow.

The IM wants to install the Libre on her before she comes home, not for monitoring in the hospital. Interesting, right? My assumption was she wanted to put it on for her stay but she corrected me and said no, for when she goes home. I may as well give it a try. My issue was that she said that if Butters wears it that I wouldn't have to wake up in the middle of the night to test. Maybe I'm missing something, but is the device going to deliver MC food into Butters if she drops too low?
 
Butters & Lyla said:
My issue was that she said that if Butters wears it that I wouldn't have to wake up in the middle of the night to test.
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WHAT???

I'm sure they saw your SS...do they think you feel that sleeping is more important than getting her BG readings? How odd that they would say that...

No, it's not going to help at all if she gets low...and you have to test anyway...I understand that the readings are delayed...??? I've never used one so I shouldn't talk...just what I've heard...
 
Sue and Luci said:
WHAT???

I'm sure they saw your SS...do they think you feel that sleeping is more important than getting her BG readings? How odd that they would say that...

No, it's not going to help at all if she gets low...and you have to test anyway...I understand that the readings are delayed...??? I've never used one so I shouldn't talk...just what I've heard...
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Oh yeah and i guess I never finished that thought. THis vet happened to ask how often I was waking up and I said usually every three hours or less unless I feel I can safely sleep a little longer. She felt so sorry for me.
I said as long as I am giving her insulin, Butters could drop low in the middle of the night so I still have to wake up to check her, with or without the Libre on. I said if you're trying to get me more sleep by putting on a Libre, I appreciate the thought but I'm fine, thanks for the concern. I never complained to any vet about waking up overnight.
 
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They are concerned for your well being also.

I don't know about the libre system. Can you set alarms on it so if it reads to low, an alarm will go off to wake you? Just wondering.
 
I'm so glad she's doing better. It's great that she's eating. The Libre sounds like a good idea but obviously you still have to be awake to check it! (And test her yourself if she starts to go low, since there's a lag.)
 
I’m so pleased that Butters is eating again, that’s a relief! And the pain under control.
I can’t see the point of the Freestyle Libre to be honest. I don’t think vets ‘get‘ how much we test at night if needed and of course if the BG is low, you need to intervene with food . It would just be an added cost I think, but entirely up to you.

Have they been testing for ketones while they have been withholding insulin.......that is a concern for me because Butters is not eating much and she has the inflammation of the pancreatitis.....all those together can cause ketones. I don’t want to add to your worries but I think that needs to be checked.:bighug:
 
Bron and Sheba (GA) said:
I’m so pleased that Butters is eating again, that’s a relief! And the pain under control.
I can’t see the point of the Freestyle Libre to be honest. I don’t think vets ‘get‘ how much we test at night if needed and of course if the BG is low, you need to intervene with food . It would just be an added cost I think, but entirely up to you.

Have they been testing for ketones while they have been withholding insulin.......that is a concern for me because Butters is not eating much and she has the inflammation of the pancreatitis.....all those together can cause ketones. I don’t want to add to your worries but I think that needs to be checked.:bighug:
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Thank you:bighug: I'm relieved too. But....I didn't think about ketones. I check her at home for ketones but I never asked them if they were checking. I haven't been able to shake this exhaustion and I'm not thinking clearly. I'm going to call them about this. But I hope at least the IV fluids would help keep them at bay if there is a concern...I hope.

Why is it so tough to find a vet who understands FD.:(

tiffmaxee said:
I also think the Libre might bother her. They seem to think cats mind being tested but we know they don’t.
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I know some people here are fans of it and it can provide lots of data, sure. But I agree with both of you. we do lots of nighttime testing and I think it might bother her also. The ear testing doesn't bother her. She has already been in so much discomfort I'd rather not electively add things to her plate.

Which reminds me, it was very difficult to get blood from her ears when I had her home on the weekend between ER visits. I wonder if that was a sign of dehydration. I'll have to look into that. Just an observation.
 
I’m intrigued by the libre and can see the maybe value of it, especially when a kitty is coasting green all the time...I wonder if there are cost savings at all with the libre vs. $/strip?

If it had an alarm or warning settings on the app, that could be nice (except for the lag time). And...maybe you only need to roll over an look at your phone vs. getting up if not in shark territory?

Not sure, and not really making a suggestion, just thinking out loud...
 
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