11/13/12--Tidus at the ER with Fever

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Venita

Member Since 2009
DCIN's foster kitty Tidus is at the ER with a fever of 105.9. I know we all have been concerned about his ketone status, but this is not ketones. He is lethargic and was vomiting overnight but his exam with the ER vet was "unremarkable." Tidus's BG level has shot up into the 400s in just the past couple of hours. This is not the first time Tidus has been to the vet for an extreme fever. Various diagnostics in the past have not given us any information about the reason for this condition.

Tidus is presently on supportive IV fluids to try to reduce his fever. When he is transferred to the internal medicine vets after 8am, he will get baseline bloodwork, an abdominal ultrasound, and a chest X-Ray.

Please, best wishes for Jennifer's dear black boy Tidus.
 
Oh no! Poor Tidus! Prayers and healing vines being sent your way bug guy. Please get well, your foster family loves you so much!

((((Jenn and Marc))))
 
I spoke with Tidus's internal medicine (IM) vet. The initial DX is pancreatitis because the abdominal XRay showed an inflamed/enlarged pancreas. Tidus is on supportive care--IV fluids, pain meds (Bupe), anti-nausea meds (cerenia and famotidine), and ABx (Ampicillin).

The abdominal US and Tidus's medical history gives the vet concern for IBD/lymphoma (thickened stomach and intestinal walls and enlarged lymph nodes). Tidus is having a final needle aspiration (FNA) of his stomach wall today. We will get the histology back within 24-48 hours.

The vet says there is no evidence of diabetic ketoacidosis (DKA). His BG level in his blood work was back down to 282. All other bloodwork was "good."

The chest X-Ray shows no lung tumor but it does show an enlarged heart--the left atrium. Tidus also has a heart murmur. There is no evidence of heart failure but they will be careful with the fluids. Also, Tidus cannot undergo anesthesia until he has a cardio consult (thus the FNA instead of a biopsy for possible IBD/lymphoma). Because Acrocats have enlarged hearts, I asked about Acro. The IM vet is not thinking Acro. He says that Tidus has none of the physical abnormalities of an Acrocat even though he is a big cat. The ER clinic's cardio vet is not in until next Wednesday. We have an appointment for Tidus with the cardio vet next week.

For now, Tidus is getting supportive care for P'titis, will have a FNA of his stomach tissue today, and will get a cardio evaluation next week. The estimate for his care (before the cardio) is about $3K. He will be able to come home to JennF when (1) his temperature is back to normal, (2) he is feeling better, and (3) he is eating well. JennF will be visiting Tidus to encourage him to eat. If Tidus does not eat on his own, he may get an NG tube put in tomorrow. (That tube can be placed without anesthesia.)

Tidus is being a very cooperative boy. Please send him the best vibes for a quick recovery.
 
Test for acro; do it.

I had issues with the vet..... 'Shadoe can't be acro because she does not look acro or have any of the signs of acro, and she is female.' Well, what do you know.... I pushed and had her tested. Positive.
 
Blue, it is on our "to dos" to have Tidus tested for Acro/IAA after we see how he responds to the Levemir (which was going well), as I told you in response to your private message a few days ago. At this time, we are dealing with pancreatitis and possible IBD/lymphoma. Thank you for your suggestion. At this time, however, Acro and IAA tests are not on the front burner. Acro/IAA does not cause a cat's body temp to soar to 105.9 degrees Fahrenheit (confirmed by the IM vet).
 
Dear Venita

Please please I mean no disrespect to anything that has been done or what all you have been doing. I hope you know that. Many of us have been following Tidus' case.

This poor kitty has been thru so much. So much of what he has been thru is so typical of what an acrocat presents with many times. The thickening of the intestine, the enlarged atrium, the cardiac murmur, the 'pancreatitis" he is now experiencing, and that he is a large cat altho NOT the typical signs of an acrocat. The incredibly hi sugars despite going up on insulin doses and now changing insulins. The cough he is experiencing is most likely due to narrowing of his airway due to enlargement of tissue there. YOu really aren't "just" dealing with pancreatitis right now. I could go on more about more of the signs he is showing that you have all talked about.

Please I hope you can understand how I am saying this but this cat is most likely an acrocat. With all the money you are spending on everything - an acro/iaa test SHOULD be one of the tests they are running right now. It would explain everything. And it would help determine the next step in so much of this cat's care - such as getting him started on heart meds sooner than later. Literature suggests that the sooner we get these cats started on this the better their prognosis. Please I'm not understanding why so much is spent on everything else and the delay on this. Is it the vet that is not believing -

I hope you know me well enough that I don't jump in on every cat to say they are acro - but this one is showing all the "subtle" signs there are - and it would be worth every penny to have that test sent while he is there already having other tests sent. He is so sick now.

Thank you so much for letting me post - again I hope you know I mean no disrespect to anyone here!
kindly
patti and always in my heart Merlin - an acrocat that took >1year to be diagnosed - something we hope doesn't have to happen any longer
 
Venita,
Thank you for the updates. Praying things improve quickly.

Carl
 
Sending prayers for Tidus. Get well sweet boy.

And (((hugs))) for Jennifer.

FWIW, when Beau was dx with HCM (enlarged left ventricle) he also had a raging case of p-titis with a lot of fluids built up in his abdomen and chest. He was started on diltiazem for the HCM right away (as well as lasix and pred). This was 11 years ago. So, I would encourage starting heart meds as soon as possible.

Jennifer, can you feed raw? That might help with both the pancreatitis and the IBD if it turns out that he has both.
 
Patti and Merlin said:
Dear Venita

Please please I mean no disrespect to anything that has been done or what all you have been doing. I hope you know that. Many of us have been following Tidus' case.

This poor kitty has been thru so much. So much of what he has been thru is so typical of what an acrocat presents with many times. The thickening of the intestine, the enlarged atrium, the cardiac murmur, the 'pancreatitis" he is now experiencing, and that he is a large cat altho NOT the typical signs of an acrocat. The incredibly hi sugars despite going up on insulin doses and now changing insulins. The cough he is experiencing is most likely due to narrowing of his airway due to enlargement of tissue there. YOu really aren't "just" dealing with pancreatitis right now. I could go on more about more of the signs he is showing that you have all talked about.

Please I hope you can understand how I am saying this but this cat is most likely an acrocat. With all the money you are spending on everything - an acro/iaa test SHOULD be one of the tests they are running right now. It would explain everything. And it would help determine the next step in so much of this cat's care - such as getting him started on heart meds sooner than later. Literature suggests that the sooner we get these cats started on this the better their prognosis. Please I'm not understanding why so much is spent on everything else and the delay on this. Is it the vet that is not believing -

I hope you know me well enough that I don't jump in on every cat to say they are acro - but this one is showing all the "subtle" signs there are - and it would be worth every penny to have that test sent while he is there already having other tests sent. He is so sick now.

Thank you so much for letting me post - again I hope you know I mean no disrespect to anyone here!
kindly
patti and always in my heart Merlin - an acrocat that took >1year to be diagnosed - something we hope doesn't have to happen any longer
Click to expand...


Patti,

Thank you for your input. We had planned to have the local vet pull blood for the Acro/IAA tests on Monday next, provided MSU starts the test the Wednesday before Thanksgiving. I still need to call MSU about the lab's holiday schedule.

As I am sure you and the other Acro folks know, MSU only starts the Acro tests on Wednesdays. To have the ER vet pull blood right now as of 1:48pm Eastern time on Tuesday would likely have meant the blood sitting in the MSU lab for a week waiting for the test start next Wednesday (if they are even starting the test that day). It certainly made more sense to me to wait until next Monday to pull the blood. And I saw no need to pay the premium for the ER vet to pull the blood, fill out the paperwork, and ship the blood when DCIN can have the local vet pull the blood and then DCIN do the paperwork and ship the blood.

Even if we had gotten the blood today, gotten the test started tomorrow, there really is no right now with a test with a 4-9 day turnaround on the results. Even if there were a right now on the test results, and the tests said Tidus were Acro (or IAA), I don't see how that would change anything about the course of treatment for the pancreatitis DX or the suspected IBD/lymphoma DX. It might change is his insulin therapy. And, I would not characterize his BG levels as "incredibly high." He hangs out in the mid- to high 200s. Higher than we would like? Absolutely? And we saw a glimpse of reaction yesterday to a reasonably small dose of Levemir (1.5U) with a 175 at +5.

I scheduled Tidus's cardio consult as of this morning at 7am. That will go forward regardless of his Acro status. Some cats do have heart enlargement without Acromegaly. If the cardio vet says he needs heart meds, Tidus will get heart meds regardless of his Acro status. We certainly would not withhold needed heart meds because of a lack of an Acro test, a lack of an Acro test result, or a lack of an Acro diagnosis. If you are saying that the heart medications the cardio vet would prescribe would differ depending on Tidus's Acro status, we will cross that bridge when we get the Acro results back--after the Cardio consult on November 21. Just in case you are suggesting that the cardio vet would not prescribe heart meds unless "pushed" to do so because of an Acro DX, please be assured that we will definitely alert the Cardio vet to the suspected Acro in advance of or during the consult.

So, please, trust me when I say that provided we see no reasonable reaction to the Levemir by next Monday, which we likely will not given the pancreatitis set-back. we will be having blood drawn for the tests, provided the MSU Acro testing is being started next Wednesday despite the Thursday holiday. OK?
 
People who have had IGF-1 and IAA tests have never contacted MSU to coordinate times for draws for the tests. Owners just have their vets do the draw and ship it. Since Tidus was already at the vet and having blood drawn, it would have been more economical to have the draw for the two MSU tests done at the same time. Waiting and paying for a 2nd blood draw is costly, I would think.
That 175 means little; Tidus got a 174 on 11/2/12 at the 6.5u dose on Lantus..... sorry.
 
I seem to have upset you Venita and I truly did not mean too. I guess I didn't word things correctly.

As far as sending the acro test right away - why not? So what if it sits for awhile. It doesn't affect the test. It's there right away to be tested and doesn't miss that testing time - just in case. And it's not necessarily how high the BG's are? it's not just the dose of insulin either but what the numbers are doing? The subtle signs, etc. And it's the entire picture all put together.

I guess that is where I'm coming from.

And as far as a reasonable reaction to the Levemir on a lower dose.... he's getting IV fluids too. That also helps lower the sugar

What I will say again - I have seen WAY TOO MANY of cats like this over the 6 years I've been involved in acro cats. It never ceases to amaze me that for every step forward we seem to make in getting people to accept this diagnosis - there is a huge step backwards. I so wish I could be shown to be wrong a million times over. I am not here to gain cats into the acro club. And you can point out a handful of cats here and there that have gone up to a certain dose of insulin that has come down again. And I'll show you a LIST of acro cats that have gone thru this similar situation. I never understand why we put so many of these cats thru changing insulins after going up to higher doses, dropping them to 1 unit doses, then going thru ER visits, or running every other tests in the book or in other cases blaming it on needed dentals only to FINALLY admit to an acro test that costs somewhere around $100 that in the long run would have saved so much money. I know there are other sites (YDC, DCH, DCC to name a few) that still basically refuse to even believe in acro - it breaks my heart because basically those cats are missing out on some great therapy that's out there now.

I will not add anymore. I'm not here to argue or cause trouble and forgive me again if that is how this was taken. I truly hope all the best for Tidus. I so hope he turns around and gets the help he really needs.
 
one last post - look up triaditis on this cat - that's probably where he's at right now - also part of the info on pancreatitis in our acro calendar in the month of June - it's all explained there with the treatment for it - many of the acro moms/dads are well aware of this complication
 
As you all can imagine it's been pretty crazy here. Tidus came home last night with an NG feeding tube. He is able to eat on his own but doesn't eat much. His favorite is Stella and Chewy's and he'll eat about 5-7 nuggets 2-3 times a day. He "licked" some baby food (chicken only) and a bite of Fancy Feast. I bought some chicken today and will try to feed him the raw. I spoke with one of his IM doc's this evening and she suggested I get him on better diet, high protein ( I forgot the name she called it, starts with an "N" I think)

Wednesday he will have a consult with the cardiologist and also a follow up with his regular vet who will draw the blood for us to have the ACRO test done. The Hospital he was in treat for Acro, however Tidus is not physically able to receive that treatment at this time due to his current condition.

His BG's have been pretty good. Last night PS was 143 (no shot given) this AMPS 212 gave 2u of Lantus. The Hospital did not have Levemir and even though I brought some there, they would not use it. I am keeping him on Lantus because if there becomes an issue with his health I don't want the doctors to blame me for not listening to them. His ketones are still negative (tested via blood and urine)

Thank you all for the well wishes for him. He has been through so much since we rescued him from NYCACC and I just want him to be happy and healthy.
 
(((Jenn)))
Thank you for the update. Overall, it sounds like good news? Decent BGs, no ketones, and eating a little bit.
Praying things continue to improve, and glad he's home!

Carl
 
Thanks for the update, Jennifer. Did they determine the cause of the fever? Do they still think it was pancreatitis? Will you be continuing fluids and pain meds at home? How about pepcid? Those are all things helpful in treating p-titis.

I hope he gets his appetite back soon. Is he acting like he feels better? he is probably glad to be home!
 
He's back on Lantus so I will resume posting in LL just to keep my head less confused.

He is getting pepcid (famotidine-I think that's pepcid) 10mg 1/2 tab BID and metronidazole 250mg 1/2 tab BID

He is eating on his own but VERY little(3 or 4 bites). I'm feeding through the NG tube 60ml of Clinicare. He was always very easy going and his demeanor is pretty much the same. He is not playful (has not really been since he's been with me) he just likes talking to his catnip toy. Yesterday he took a nap on my bed with a few of the other cats which he has never done before.
 
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