11/23 Simon PMPS 461 +2 417 + 4 313

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Georgia and Simon (GA)

Georgia and Simon (GA)

Member Since 2010
I need advice fast. All last week, Simon was reading BG higher than normal on some days, even going into the 400's. He also seemed more stiff and his back legs were weak. I brought him to vet yesterday to do a senior blood panel and urine culture and check up. That info won't be back until probably Tues. They checked his blood pressure and it was high (170). He has always been normal before but wanted to wait till the bloodwork was back before putting him on anything.

All night, he has not wanted to eat anything and just wants to stay in his bed. I thought he might be hurting from the needle stick for the bloodwork, urine culture and adequan shot, but he usually has not had this problem before where he does not eat. This morning his BG was Hi on the meter. He has never had this reading before so I am really worried. He still does not want to eat. He is drinking.

I am wondering if anyone else has had this happen before after going to the vet for bloodwork? I do think it might be something else since all week he has been a little "off". Last blood work 6 months ago, Simon's kidney values were a little bad so maybe they have become worse. He already is on Pepcid and ondansetron and fluids about 3x week. Should I go ahead and give him more fluids this morning? With the high blood pressure, I'm worried that too much fluids may not be the best thing with blood pressure problems but I also think he may have some nausea. Just not sure. This is a new thing for me to go through.

Once it gets later, I am going to try and contact Simon's vet, but if I can't get in touch with him, should I go to the ER?

Thanks. Simon and I have not been on the board very consistently so I know there are a lot of new people that probably do not know us. Simon has been diabetic for 4 years now and has been doing really well up until now. I am very worried.

Georgia
 
Re: 11/23 Simon AMPS Hi Need Advice - Worried

Hi Georgia - I'm so sorry Simon is having a hard time this morning. Have you tested for ketones? I wouldn't give fluids without talking to a vet...if you can't get in touch with his personal vet soon, I would take him to the ER...with the HI reading and the lack of appy, it could be many things, including possibly an infection which you would want to start treating ASAP.

Sending tons of prayers....please keep us posted!
 
Re: 11/23 Simon AMPS Hi Need Advice - Worried

Amy, thanks for the quick reply. I haven't tested for ketones yet -- I have strips but now I just need to catch him at the litter box. I will hold off on fluids until I get in touch with the vet. I have a cell number for him, but since this is not his normal day to work, I have a feeling he won't answer it. I hate to have to go to ER if they are going to do all the same tests I just did yesterday, but if he doesn't start feeling better soon and eating, I will take him. He has had an issue with tummy problems before when he stopped eating and I had to assist feed, but he didn't have any blood pressure issues with it. I still am wondering if it has anything to do with pain and stiffness in his legs from the needle sticks and arthritis together.

My computer is very slow today and is taking forever to post my reply. :YMSIGH:
 
Re: 11/23 Simon AMPS Hi Need Advice - Worried

Sending Eating Vines and Feel Better Vines to Simon.

If he doesn't eat soon, I would take him to the ER. You can also just try to leave a message on your regular vet's cell phone. Maybe he will listen to it and get back to you.
 
Re: 11/23 Simon AMPS Hi Need Advice - Worried

Dyana, thank you for sending eating vines. I have been thinking about you every day and sending healing vines to you. You are going through so much, yet still reach out to others. You are a wonderful, caring person that is always thinking of others. Thank you and I am going to leave a message on the cell phone and see what happens.
 
Re: 11/23 Simon AMPS Hi +2.5 Hi Need Advice - Worried

Thank you.

Let us know if he calls you back.

Have you tried a little slightly warmed up baby food, like chicken with broth (without onions or garlic), yet? Maybe even just a tad on your finger tip, and putting it in his mouth to kick start his appetite. I hope he feels better soon. What is your ondansetron dose?
 
Re: 11/23 Simon AMPS Hi +2.5 Hi Need Advice - Worried

I am also thinking it could be a flare up of pancreatitis. He never had high blood sugar and high blood pressure when he had pancreatitis over a year ago, but you never know. He had to get iv fluids for a few days at the vet.

Dyana, I went ahead and syringe-fed him 1/2 of small can of food. Keep fingers crossed he doesn't throw it up. He usually takes 1/4 tab of a 4 mg. tablet of ondansetron once a day, along with a 1/4 tab of Pepcid twice a day.
 
Re: 11/23 Simon AMPS Hi +2.5 Hi Need Advice - Worried

Hi Georgia. When Max gets pancreatitis he becomes inappetent every time. He sleeps more too so that could be what is going on and because it's just started should not require IV. When it happened the first time was it a one time acute attack or is it chronic. Do you have any nausea medication such as cerenia or ondansetron? I ask because Max is chronic and if I treat the suspected nausea right away I can sometimes get him on track without too much effort. The high BG makes me wonder about an infection though so I hope you hear from your vet. Healing vines are being sent your way.
 
Re: 11/23 Simon AMPS Hi +2.5 Hi Need Advice - Worried

I'm glad you were able to get some food into him, and hope it stays down. Get a ketone test as soon as you can.
I gave 1/4 Ondansetron twice a day during flare ups of Pancreatitis. Did you get the Spec fPL test done yesterday?
 
Re: 11/23 Simon AMPS Hi +2.5 Hi Need Advice - Worried

Morning Georgia ~O) ~O) ~O)

I too am sorry Simon is not feeling well. Be better little one. I too wonder about a p'titis flare, possibly an infection. I remember with Mannie that those HI's were usually a sign of an infection of some sort, for him it usually was a UTI When he went through p'titis he too wouldn't eat, slept alot, higher than normal Bg's etc. I will hope that your vet will return your call. and that Simon will rally enough that you don't have to take him to the ER. One knows they will repeat all the tests you did yesterday. Nice that you were able to get dome food in him.

Wishing you luck today. Healing vines for Simon.
 
Re: 11/23 Simon AMPS Hi +2.5 Hi Need Advice - Worried

Simon has had very small pancreatitis flare-ups previous to the really bad one, but they never required an ER visit, except for that one time. That is why I have been giving him the ondansetron regularly. I will up it to 2x/day. Still haven't been able to get a ketone test because he hasn't gone to his litter box again. He has had a UTI before so maybe the Hi reading is due to something like that. I really hate to have to do all the tests all over again. I can't afford it right now. They did not do a pancreatitis test yesterday so I probably should go ahead and have that done if I take him to ER. And a urine test to rule out a UTI. Everything else should be able to wait (I hope) until test results are back from regular vet.

Still no call back from him as of yet :sad:

Thanks for your advice everyone. I haven't been a regular here lately so I feel bad asking your advice when I haven't been too much of a help to anyone else.
 
Re: 11/23 Simon AMPS Hi +2.5 Hi Need Advice - Worried

FWIW ondansetron works for about 8-12 hours and I think twice a day is important. Max needs 2mg twice a day during a flare. I'd say it is due to his size except if he gets cyproheptadine he only nseeds 1/8 a 4mg pill even though my vet wrote 1/2 on the script. I hope the 2X a day of ondansetron helps.
 
Re: 11/23 Simon AMPS Hi +2.5 Hi Need Advice - Worried

Don't worry about not being around. We're always here for you.

I was thinking the same thing, that if you do go to the ER to get at least the Spec fPL and urinalysis, and a blood ketone test, if you don't get one at home. If he kept the food down, try to feed him or get him to eat again, a few hours after the last feeding. Cats can't go long without food or a large reduction in calories.

Praying your vet calls you soon. Maybe he's at church and will call you soon.
 
Re: 11/23 Simon AMPS Hi +2.5 Hi Need Advice - Worried

Elise, I will definitely do the 2x/day.

Dyana, I am hoping he pees soon because I would love to get the ketone test and a sample to bring with me to the ER to cut down on cost. I am going to syringe-feed him again in another hour. I know how important it is to get him to eat and I am hoping that he will keep it all down.
 
Re: 11/23 Simon AMPS HI Ketones trace amt. Advice?

Finally able to test for ketones. Very small (trace) amounts noted on stick. I also was able to get a urine sample and put it in a container. Is trace amounts of ketones dangerous? Do I increase insulin or should I wait until all results are back from vet? I also noted that his urine looks a little dark, so he may have a UTI. I am going to go to ER and ask them to test urine and also snap fpl test for pancreatitis. Any other things I should ask to do? Test results from CBC should be back tomorrow. Or do you think I can wait until tomorrow morning to go to his regular vet? So confused about what to do!

Best news -- he just ate 2 tbps. of friskies turkey pate!! On his own!
 
Re: 11/23 Simon AMPS Hi +2.5 Hi Need Advice - Worried

((((Georgia)))

We love seeing you and Simon but wish he were not I'll.

A couple things: the high BP is "likely" related to his CKD. How many times did they test him while you were there and was 170 an average? My vet put Gus on amlodipine when he was consistently over 160 with several tests on the same day. I doubt the high BP is related to any tummy or pancreatitis issues. It could be a primary condition but with his CKD, it is more likely related to that.

Also, you can't take in a urine sample for them to test for a UTI. It will be contaminated. They can do a cysto there and get a sterile sample. They should be able to put it on a slide and see if there is any bacteria in it. Our ER has that capability but others might not.

Can you put him in his LB and see if he will pee enough for you to check ketones?

I know you want to be careful of the $ spent, but if you take him to the ER, they could just get enough blood to do a snapfPL and just check his creatinine/BUN. They don't have to run a full lab series. I'd discuss it with the vet.

Gus had severe arthritis and the needles never seemed to bother him or make him more sore. I think you are looking at something more like possibly pancreatitis.

Please keep us updated. Many healing vines for sweet Simon.

Eta: glad you got the ketone test. I'd push the food, watered down, and I would go to the vet if he were my cat. Not just because of trace ketones but the whole picture.
 
Re: 11/23 Simon AMPS HI Ketones trace amt. Advice?

Pls see my post above. Yes, I would increase his insulin tonight to 3.5u. He needs it regardless of what's going on because he's been at current dose six full cycles and he's too high.
 
Re: 11/23 Simon AMPS HI Ketones trace amt. Advice?

Marje,
Thanks for the great advice. I am going to go ahead and take him to ER and ask for the pancreatitis test and check urine. Blood pressure of 170 was an average of the 5 times they took it at the vet.

I'll keep y'all updated about his ER visit. I know he is going to hate going there because of all the dogs. He is such a nervous kitty when he is around dogs.
 
Re: 11/23 Simon AMPS HI Ketones trace amt. Advice?

With average of 170 on one day it could be up some from stress. I would want it checked on at keast one other day before starting BP med and that is coming from someone with a cat that has high BP but no CKD or thyroid issues. I think it could be stress but given it was 220 he is on amlodipine. I hope the vet doesn't find anything seriously wrong.
 
Re: 11/23 Simon AMPS HI Ketones trace amt. Advice?

Hi Georgia :-D

For what it is worth, I agree on the BP, it could be just stress related, and I would not treat that without further testing. 160 is considered "normal" for a vet visit BP test, the white coat effect. Mannie had BP too, due to other health issues, but he would alwyas test at 160/170 when on meds for it, when tested at the vet.

I do believe that the trace ketones is dues to the high BG. We had that issue once too, and once the BG went down the trace disappeared. I think increasing the dose would be good, I hope he will continue to eat for you. That was such an issue with Mannie, making dosing very difficult.

Good luck if you go to the ER. I would let them know what your concerns are, just run the tests you need. Most Er's should be able to accommodate you. I hope Simon will feel better once those BG's are down. Some kitties are so lethargic etc when their BG's are so high. Wishing you guys the best!
 
Re: 11/23 Simon AMPS HI Ketones trace amt. Advice?

We are back from the ER. I truly think the vet and vet tech think I am completely crazy with all the information I gave them, but I don't care. On top of that, when I told the vet that I test Simon's BG about 4x/day, he said "is your vet ok with you testing so much, because it is not good to test cat's BG that much". He went on to say that for people it is very important to test throughout the day for regulation, but for a cat it is different (although he could not be very specific about why they are different). I told him that "I agree to disagree" on the topic of testing and that Simon has been diabetic and in fairly good health for 4 years now so I must be doing something right. He didn't even want to see my spreadsheet of BG numbers for the last week that I brought with me to the ER. Crazy.

Anyway, the good news is that he does not have ketones (his BG at the ER was 594!) and his urine looked pretty good and the vet didn't think it was an infection, although the urine culture done at the vet yesterday will show more information. He did the snap fpl and it came up abnormal. We agreed that it most likely is a pancreatitis flare-up. The ER vet wanted to keep him at the hospital overnight, but I brought Simon home. I can give fluids and Simon is too nervous at the vet to get any better. The vet gave him a cerenia shot and I have bupe for pain. I am also to give Pepcid and ondansetron 2x/day and fluids. He told me that I should give 250 ml of fluids tonight. Do y'all think that is too much? I just gave him 100 ml and will give him more at 8:00 tonight if you think it is ok. I trust you guys more than the vet! Simon ate again on his own when we got home and is now zonking out on the bupe. Tomorrow, I am going to bring him back to my vet for observation for the day. At least that is my plan. And to increase his insulin tonight.
Sorry this is a long post. Thank you so much for the advice and support. It really means a lot to me.
 
Re: 11/23 Simon Back from vet!

That does seem like a lot of fluids to me, but I defer to others with more knowledge than I about fluids.
I'm glad he had no ketones. I can't believe some vets. They are not all like that. The last ER Vet I saw was great.
Good luck with his staying at the vets for observation tomorrow.
 
Re: 11/23 Simon Back from vet!

How much does he weigh! Most give 100ml once a day. I'm glad you brought him home. There was no reason to keep him there ax long as you can get him to eat and give fluids, ondansetron , and bupe. The injection should help a lot. I hope so.
 
Re: 11/23 Simon Back from vet!

Elise,
Simon weighs 15.8 pounds. I have always given 100 ml/day except when my kitty, Cleo (GA), was in more advanced kidney disease. I then gave her fluids 2x/day. I am just not sure about giving him more fluids. It makes me a little scared.

Simon is down from the 594 at the vet, but still high. He did not want to eat all of his dinner and I had to syringe feed him he rest. Maybe the bupe is just making him too groggy. He is going back to his vet at 9:00 tomorrow morning to be monitored for the day.
 
Re: 11/23 Simon PMPS 461

So he's a big guy. I've never given more than 150 at a time and have given 100 twice a day at times as well.
 
Re: 11/23 Simon PMPS 461

Does he have any heart issues that you are aware of? That much does seem really high to me even for his size.

Although this from Tanya's is in regard to CKD, it provides general info and resources regarding giving Subqs:

In Staged management of chronic kidney disease in dogs and cats (2009), a Presentation to the 34th World Small Animal Veterinary Association World Congress, Dr David Polzin states: "In patients with signs consistent with chronic or recurrent dehydration, long-term subcutaneous fluid therapy may be considered. Typically, a balanced electrolyte solution (e.g., lactated Ringer's solution) is administered subcutaneously every one to three days as needed. The volume administered depends upon patient size with a typical cat receiving about 75 to 100 ml per dose."

Based on what I have seen over the years, the average 8-10lb cat would usually be given around 100ml a day. Larger cats might need 125ml or even occasionally 150ml for cats who weigh 15lb or over, whilst smaller cats need smaller amounts, 50-75ml a day. Be cautious with cats with heart problems, who may have problems processing sub-Qs, and who may need smaller amounts, perhaps given more frequently, for example 50ml twice a day rather than 100ml once a day. Colorado State University College of Veterinary Medicine states "no more than 5 to 10 ml/lb should be given at each injection site" so giving 100ml in one place should not be a problem for a 10lb cat. Some people interpret this to mean it is safe to give 5-10ml/lb to a cat, but the link is referring to how much to inject in one place, not how much to give generally.
Click to expand...
.

I'm glad you got a dx. Please keep us posted and I hope he feels better soon.
 
Re: 11/23 Simon PMPS 461

Marje, he does have a slight heart murmur so I think is another reason I should hold at 100 ml. a day. I do not want to overhydrate him and cause a heart problem. Thanks for sending Tanya's info on fluids. That website was a life saver for me with Cleo (and you and Claudia, too!).
 
Re: 11/23 Simon PMPS 461

I'm glad you got to the vetty and Simon is now on the road to recovery. I agree - 250mls in one shot sure seems like a lot! My vet had Trix on 150mls a day when she was at the peak of her attack.

Honestly, I do not understand these vets who think cats are "different" from humans with regards to diabetes and insulin, especially when they are talking to someone who has knowledge, experience, and is willing to go the extra mile with her diabetic kitty. I don't know what these vets think we're doing to our cats that is so torturous....grrr!!!

Sending prayers for a speedy recovery!
 
Re: 11/23 Simon PMPS 461

So many vines for your Simon. Glad you got him to the vet, but yikes, what a vet.

I agree with the others that 250 is an extraordinary fluid amount for a cat. I've never been advised by any vet to give more than 150 and even that recommendation was rare. Even a 40 pound dog I once cared for was prescribed only 300 and we did that in two sessions to make it more comfortable for the dog.

Glad Simon's home and in your care. Vines for continued improvement.

Marilyn and Polly
 
Re: 11/23 Simon PMPS 461

we gave punkin 150 every other day - and he was around 13-14 lbs at the time. I'm not sure that more = better, so I'd probably stick with your current plan.

glad that the ketones were negative. *whew*

also glad that you could stick up for yourself and Simon at the vet. As you said, it's been 4 years and you're obviously doing something right. :-D
 
Re: 11/23 Simon PMPS 461

Sending tons of healing vines for Simon, glad to hear you got a dx, and that there were no ketones. My Tiger just had a bout of acute pancreatitis, not a good experience! Truly, I hope Simon will feel better quickly and that there are no other complications.
 
Re: 11/23 Simon PMPS 461

Hi Georgia ~O) ~O) ~O)

I am glad too you brought Simon Home, he will do fine there. and wow on that vet, and the testing issue. unreal. what an afternoon for you. Take care, and Simon, rest well tonight.
 
I never thought I would say that 313 is a good number but I am saying it tonight. Upped his insulin from 3.25 to 3.5. I gave him a little more fluids for a total of about 140 ml today. His nose was very dry and the "hump" was gone from the previous 100 ml after only an hour. I hope it was the right decision. Tonight, he even ran a little bit into his room for food, although once he got to the dish, he only ate a few bites of the LC food. I gave him some MC food and he finished it off. I figure it is more important to get him to eat than worry about how low carb he food is. I can always adjust the insulin to get him through this rough patch. Giving him bupe, ondansetron and Pepcid tonight.

I will be taking him early to the vet for observation tomorrow morning and another shot of Cerenia and will pick him up after work. Please keep the healing vines and prayers coming.
 
Hi Georgia,
I'm just getting caught up here and am glad that Simon is doing better tonight. Sending him lots of vines for tomorrow's appointment.

Hugs and scritches,

Ella & Rusty
 
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