12/27 Weekly Cliff Notes--update: Cliff to vet 12/29

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MiCo said:
12/29 amps=442
Did not eat (DNE)-walked away from plate. After much prodding, nibbled.
no shot

Appt at 9a. Will post after.

Once upstairs, he ate some dry food, which I forgot was out from last night (per vet's suggestion) but he only ate a few pieces.

Seems alert, came down for food, just seemed so disgusted by plate when served. :(
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I'm very glad you got on top of this ASAP, Michele. You'll get him turned around.
 
Cliff is staying at the vet a few hours to collect samples-urine and blood. His bladder was not very full, so they wanted to give him electrolytes and fluids and have him stay a while to collect urine. I am fine with that because he is good at the vet, and they are very nice and it's a cat only hospital and he usually does well when he stays there.

He will receive cerenia for nausea and I believe an antibiotic for if he has a uti. I wasn't sure if they were starting antibiotic today, or waiting for results. But I think starting today, because she said urine analysis could take 3 days to get results? I'm not sure, but I will get more info when they call. Or when I pick him up. The antibiotic is one he's had before.

I told them I did not want to give him mirtazapine again.

That's all for now. Hopefully I will pick him up soon and know more. And hopefully fluids will help and the cerenia.
 
MiCo said:
Cliff is staying at the vet a few hours to collect samples-urine and blood. His bladder was not very full, so they wanted to give him electrolytes and fluids and have him stay a while to collect urine. I am fine with that because he is good at the vet, and they are very nice and it's a cat only hospital and he usually does well when he stays there.

He will receive cerenia for nausea and I believe an antibiotic for if he has a uti. I wasn't sure if they were starting antibiotic today, or waiting for results. But I think starting today, because she said urine analysis could take 3 days to get results? I'm not sure, but I will get more info when they call. Or when I pick him up. The antibiotic is one he's had before.

I told them I did not want to give him mirtazapine again.

That's all for now. Hopefully I will pick him up soon and know more. And hopefully fluids will help and the cerenia.
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They might be doing a culture of the urine to see what bacteria might be there. That can affect what antibiotic they prescribe. I'm glad he handles being at the clinic well. Keep us posted. :)
 
Oh good, a culture is the best way to get results. That way, you can be sure. They do sometimes start an antibiotic while waiting for the results...so that he will hopefully feel better sooner. Then they can just switch it or stop it if needed when they get results.

I'm glad he handles the vet well! Let us know what the report is when you get it.
 
Thank you ALL for the positive thoughts!

Vet called with initial results:
  • Blood glucose high (486), which I could've guessed since we skipped two cycles due to not eating.
  • Ketones in urine at 2+?
    • Which surprised us both because I have been blood testing at home and results were low to trace and she smelled his breathe this AM and didn't suspect ketones.
  • She asked me to bring insulin up because she wants him back on. They are gonna dose and monitor there all day. I also took some of his regular LC food and treats and a pillowcase that smells like home.
  • He's on an IV, & I think she said he has a catheter?
  • Gave him cerenia.
They will call me later to let me know if I can bring him home tonight, or if they are gonna recommend overnight stay (which would be at local pet er, since clinic is not 24hrs.) she was leaning towards letting me take him home, since I'm off work right now and can monitor.

Stella/civvie is being a snuggle bug right now. She can always tell when I need to healing power of the purr.
 
A few positives from initial exam that I want to remember:
  • His weight was up from 2 months ago-12.6 from 12.1
  • Gums were pink (good)
  • She felt well formed stool in bowels
  • Just a little dehydrated (I do the skin-bounce test at home)
That's all I can remember. She listened to heart and lungs, but I can't remember any comments. I don't think they took his temp in front of me.
 
MiCo said:
Not sure abt pancreatitis? What are signs/symptoms of that? No mention from vet of this.
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They can have nausea and no appetite, vomiting and abdominal tenderness among other things. There are specific tests for it - a quick in clinic one (SnapflP?) that gives a yes/no result and one that goes out to a lab (SpecflP?), takes a few days for results and gives more info about the amount of inflammation. They sometimes will do ultrasound to look for inflammation.
 
Ok. 2pm update from Vet's office (PM vet on duty now, 3 vets total in clinic, all working in coordination with me and Cliff):
  • Giving him 1/2 a dose of insulin now since he's still not eating. 2units. Will test glucose before he leaves to see how he is doing with that.
  • Still not eating for them, but there's been a lot of testing going on and it's the clinic. No one is surprised by him not eating there.
  • Giving fluids, just trying to keep things quiet for him.
  • They will write Rx for antihistamine for me to have tonight: cyproheptadine (the one Kris mentioned above!) low dose to start to make sure no crazy side effects. 1/4 to 1/2 pill twice daily.
They want me to call back at 5:30 to see how he's doing. They know I can test at home, so I believe everyone is leaning towards releasing him to me for the night. I have a room with a door that we will have a slumber party in-me and Cliffy time!!

The only questions I asked were:
  • Everything we are giving him works together and is ok with his diabetes?
    • Answer=yes.
  • Is priority food, any food, or his LC diet? He did eat dry food that I kept here since his Dx in October.
    • Answer=whatever he will eat.
    • I have lots of options on hand, but may stop at petco or the store on the way to pick him up. Any suggestions? Tuna in a can is ok, right? I might put some juice on his food to see if that will help.
 
MiCo said:
Ok. 2pm update from Vet's office (PM vet on duty now, 3 vets total in clinic, all working in coordination with me and Cliff):
  • Giving him 1/2 a dose of insulin now since he's still not eating. 2units. Will test glucose before he leaves to see how he is doing with that.
  • Still not eating for them, but there's been a lot of testing going on and it's the clinic. No one is surprised by him not eating there.
  • Giving fluids, just trying to keep things quiet for him.
  • They will write Rx for antihistamine for me to have tonight: cyproheptadine (the one Kris mentioned above!) low dose to start to make sure no crazy side effects. 1/4 to 1/2 pill twice daily.
They want me to call back at 5:30 to see how he's doing. They know I can test at home, so I believe everyone is leaning towards releasing him to me for the night. I have a room with a door that we will have a slumber party in-me and Cliffy time!!

The only questions I asked were:
  • Everything we are giving him works together and is ok with his diabetes?
    • Answer=yes.
  • Is priority food, any food, or his LC diet? He did eat dry food that I kept here since his Dx in October.
    • Answer=whatever he will eat.
    • I have lots of options on hand, but may stop at petco or the store on the way to pick him up. Any suggestions? Tuna in a can is ok, right? I might put some juice on his food to see if that will help.
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You can thank @Critter Mom for the cyproheptadine recommendation! ;) Is he being sent home with Cerenia or other antinausea med? Might need the two in tandem.

Yes - whatever he'll eat is the way to go. Canned salmon or tuna, sardines, kibble, high carb gravy cat food, anything. The eating issue is the priority item right now. What have they recommended re insulin dosing?

Keep posting with updates. Is he at the regular or ER vet clinic at this point?
 
Kris & Teasel said:
You can thank @Critter Mom for the cyproheptadine recommendation! ;) Is he being sent home with Cerenia or other antinausea med? Might need the two in tandem.

Yes - whatever he'll eat is the way to go. Canned salmon or tuna, sardines, kibble, high carb gravy cat food, anything. The eating issue is the priority item right now. What have they recommended re insulin dosing?

Keep posting with updates. Is he at the regular or ER vet clinic at this point?
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I will ask abt cerenia for home, as well as insulin dosing recommendations when I call back at 5:30.

He's at his regular vet, which is open 8a-7pm, and offers boarding/medical care, but they are not there round the clock--so if he needed to stay overnight, the would want me to take him to the nearby ER hospital which is 24hr care. Hoping they let me bring him home though--better chance of him eating here/less stress.
 
MiCo said:
I will ask abt cerenia for home, as well as insulin dosing recommendations when I call back at 5:30.

He's at his regular vet, which is open 8a-7pm, and offers boarding/medical care, but they are not there round the clock--so if he needed to stay overnight, the would want me to take him to the nearby ER hospital which is 24hr care. Hoping they let me bring him home though--better chance of him eating here/less stress.
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Sometimes they inject Cerenia at the clinic. When Teasel was getting it I was given tablets:
"Cerenia Green 16 mg/half tablet daily until eating well and no vomiting."
Those instructions are from the label on Teasel's prescription bottle. I have no idea what the "Green" means.
 
Carol makes a good point about ketones. Did the vet check urine or blood for ketones and by what method? I know you have a blood ketone meter but you'd had good readings recently. Did you ask why the discrepancy between your blood test and the ketone result at the clinic? I can tell you from my experience with Teasel's DKA that you don't necessarily smell ketones on the breath. I didn't for Teasel. Also, he went from OK and eating to not OK very quickly.

I certainly don't want to scare you, Michele but dealing with ketones ASAP can reverse the problem more quickly.
 
Kris & Teasel said:
Sometimes they inject Cerenia at the clinic. When Teasel was getting it I was given tablets:
"Cerenia Green 16 mg/half tablet daily until eating well and no vomiting."
Those instructions are from the label on Teasel's prescription bottle. I have no idea what the "Green" means.
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Thank you for sharing that info from teasel's bottle! I did write down cerenia injection, I will ask how long that lasts. We are not far from the clinic, and they are open thru midday Saturday, if I need to pickup addlt Rxs.
 
Kris & Teasel said:
Carol makes a good point about ketones. Did the vet check urine or blood for ketones and by what method? I know you have a blood ketone meter but you'd had good readings recently. Did you ask why the discrepancy between your blood test and the ketone result at the clinic? I can tell you from my experience with Teasel's DKA that you don't necessarily smell ketones on the breath. I didn't for Teasel. Also, he went from OK and eating to not OK very quickly.

I certainly don't want to scare you, Michele but dealing with ketones ASAP can reverse the problem more quickly.
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The AM vet said the IV/fluids was to flush out ketones. She also said the ketones and high BG is why he needs to get back on the insulin. I will inquire more abt the ketones level and dka concerns at next call.

In terms of blood testing ketones, they had never heard of that. He was .9 last I checked, I think. We haven't gotten a urine ketones test at home since before Christmas. From what I've read, those can go up fast? They tested urine at clinic for ketones. What els can/needs to be done to address ketones?
 
Positive Ketones +2 early DKA warning. I believe (correct me if I'm wrong) at +2.4 reading begins the critical stage as it can advance extremely quick. 24 hr monitoring is really the only way to treat because of monitoring the other systems and electrolyte imbalance.
 
MiCo said:
The AM vet said the IV/fluids was to flush out ketones. She also said the ketones and high BG is why he needs to get back on the insulin. I will inquire more abt the ketones level and dka concerns at next call.

In terms of blood testing ketones, they had never heard of that. He was .9 last I checked, I think. We haven't gotten a urine ketones test at home since before Christmas. From what I've read, those can go up fast? They tested urine at clinic for ketones. What els can/needs to be done to address ketones?
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Ketones - at clinic when not in DKA:
  • fluids
  • food
  • insulin in large enough doses
Ketones - at home:
  • testing
  • food
  • good hydration (wet food, add warm water to each meal)
  • get BG numbers down
Bungled this - complete post is in yellow quote box below.
 
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MiCo said:
Thank you for sharing that info from teasel's bottle! I did write down cerenia injection, I will ask how long that lasts. We are not far from the clinic, and they are open thru midday Saturday, if I need to pickup addlt Rxs.
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Cerenia is given every 24 hrs.
 
Kris & Teasel said:
Ketones - at clinic when not in DKA:
  • fluids
  • food if they'll eat
  • insulin in large enough doses
Ketones and DKA - at clinic:
  • fluids
  • electrolytes
  • maybe dextrose drip to raise BG enough to allow higher insulin dosing
  • regular insulin and bolus dosing of fast acting insulin to get numbers down
  • food if/when they'll eat
  • 24 hour monitoring and supportive care for 2+ days
  • very sick kitty
  • very large vet bill - $2K++
Ketones - at home:
  • testing
  • food
  • good hydration )wet food, add warm water to each meal)
  • get BG numbers down.
If there's any hint of Cliff being in a near DKA state he'd be safest at the ER clinic. Things can go down hill fast. Again - not meant to scare you just sharing what I've lived through.
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Got it, thanks Kris. The 2nd vet seemed reluctant to say if she would release him to me for the night. Said to call back at 5:30 for next update, they are open until 7p, but I believe they are there a little later for pickups. As much as I don't want him to stay at ER, if that's best, we will do that. 2k is a lot (not money that I have right now) but we will do what we can. Thanks for info, much appreciated.
 
MiCo said:
@Carol & Murphy I wasn't sure what the scale was for ketones, I didn't know where 2+ fell on the scale.
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Hey Michelle, When using a human meter to test cat's for ketones the ketones start to show up a 2.4 below is a link to tell you more about that. But with the +2 reading you' want to be on top of this and rellay push water and food let him eat whatever he will eat at this point even if it is the higher carb dry food Syringe water into him if he won't eat wet food that you can mix into .

The latest published research/studies in cats indicate ketones will begin to show up at readings of 2.4 and 2.55 on a blood ketone meter:
Measurement of ketones - Weingart_J VET Diagn Invest-2012(1).pdfMeasuring ketones - JSAP_Zeugswetter - 2012.pdf


ETA while he is at the vets's sub q fluids is idea to help flush the ketones
 
Bobbie And Bubba said:
Hey Michelle, When using a human meter to test cat's for ketones the ketones start to show up a 2.4 below is a link to tell you more about that. But with the +2 reading you' want to be on top of this and rellay push water and food let him eat whatever he will eat at this point even if it is the higher carb dry food Syringe water into him if he won't eat wet food that you can mix into .

The latest published research/studies in cats indicate ketones will begin to show up at readings of 2.4 and 2.55 on a blood ketone meter:
Measurement of ketones - Weingart_J VET Diagn Invest-2012(1).pdfMeasuring ketones - JSAP_Zeugswetter - 2012.pdf


ETA while he is at the vets's sub q fluids is idea to help flush the ketones
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This morning's print out if their plan included sub-q fluids and electrolytes, so he us getting all of that right now/all day.
 
Bobbie - the 2+ ketones were in his urine, not blood which is indicative of a moderate amount, I believe I'm not sure what that equates to in the blood
 
Carol & Murphy said:
Bobbie - the 2+ ketones were in his urine, not blood which is indicative of a moderate amount, I believe I'm not sure what that equates to in the blood
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Thanks for clarifying. I only use the blood meter for ketones and I am not as familiar with the urine strips. Another reason to use the meter is because the ketones show up immediately in the blood and can take as much as 8 hours to show in the urine.
 
Bobbie And Bubba said:
Hey Michelle, When using a human meter to test cat's for ketones the ketones start to show up a 2.4 below is a link to tell you more about that. But with the +2 reading you' want to be on top of this and rellay push water and food let him eat whatever he will eat at this point even if it is the higher carb dry food Syringe water into him if he won't eat wet food that you can mix into .

The latest published research/studies in cats indicate ketones will begin to show up at readings of 2.4 and 2.55 on a blood ketone meter:
Measurement of ketones - Weingart_J VET Diagn Invest-2012(1).pdfMeasuring ketones - JSAP_Zeugswetter - 2012.pdf
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I'm gonna preface this with I'm not trying to be rude, but I've read that article/link several times and maybe i just don't get it? I don't understand "will begin to show at 2.4" I thought I was testing blood ketones at home and he was good... Never got to a 1.0 at home testing blood ketones.

Now that he's tested high at the vet for urine ketones, I kinda don't trust the meter/blood test? I guess I don't need to understand then? He was always 0.9 or less. I dunno...:( I'm just really sad right now. Sorry.

To be clear, vet tested urine for ketones and told me over phone he was 2+. I can't even find the chart for urine ketones to see where this falls, but two plus sounds bad.
 
MiCo said:
I'm gonna preface this with I'm not trying to be rude, but I've read that article/link several times and maybe i just don't get it? I don't understand "will begin to show at 2.4" I thought I was testing blood ketones at home and he was good... Never got to a 1.0 at home testing blood ketones.

Now that he's tested high at the vet for urine ketones, I kinda don't trust the meter/blood test? I guess I don't need to understand then? He was always 0.9 or less. I dunno...:( I'm just really sad right now. Sorry.

To be clear, vet tested urine for ketones and told me over phone he was 2+. I can't even find the chart for urine ketones to see where this falls, but two plus sounds bad.
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The information that I gave in that link is for a ketone meter that test blood. I am sorry and was thinking that is what was used for the ketone test. Ask the vet where the +2 falls as I don't know too much about urine ketone test as I have use the blood ketone meter . Sorry for the confusion.
 
Don't know either, but looking at my urine test strips, there is a number under each color/result. Under trace is the number 5. Could 2 be less than trace, but more than a negative result?
 
MiCo said:
Got it, thanks Kris. The 2nd vet seemed reluctant to say if she would release him to me for the night. Said to call back at 5:30 for next update, they are open until 7p, but I believe they are there a little later for pickups. As much as I don't want him to stay at ER, if that's best, we will do that. 2k is a lot (not money that I have right now) but we will do what we can. Thanks for info, much appreciated.
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I gave you the ball park cost of treating full blown DKA, Michele. I certainly hope you don't end up there. Just info ...
 
Did you ask the vet about DKA? That's my concern because with them saying he has ketones, and everything else going on, it could be bad. NOT trying to scare you. Just saying. The not eating, not getting insulin thing is also something that can lead to ketones. I don't know much about it, but I know it's important he eats and gets insulin.

You might try some tuna or something to get him to eat. I think some people have used plain baby food too...just make sure it doesn't have onions and garlic I believe? Might ask on Health about some ideas for food to get him to eat. Dry is fine if that's what he'll eat...just trying to come up with some other ideas for you too. :)

I know you're worried and I'm so sorry this is happening. As for price have you looked into Care Credit? Just a thought.

We're sending tons and tons of healing vines. Let us know.
 
MiCo said:
I'm gonna preface this with I'm not trying to be rude, but I've read that article/link several times and maybe i just don't get it? I don't understand "will begin to show at 2.4" I thought I was testing blood ketones at home and he was good... Never got to a 1.0 at home testing blood ketones.

Now that he's tested high at the vet for urine ketones, I kinda don't trust the meter/blood test? I guess I don't need to understand then? He was always 0.9 or less. I dunno...:( I'm just really sad right now. Sorry.

To be clear, vet tested urine for ketones and told me over phone he was 2+. I can't even find the chart for urine ketones to see where this falls, but two plus sounds bad.
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So sorry for bombarding you with info, Michele. Take a deep breath, write out any other questions you have for the vet, including how the urine ketones were measured and what the +2 means. We're sharing what we've experienced and it's overwhelming for you. Time out? :bighug:
 
Kris & Teasel said:
So sorry for bombarding you with info, Michele. Take a deep breath, write out any other questions you have for the vet, including how the urine ketones were measured and what the +2 means. We're sharing what we've experienced and it's overwhelming for you. Time out? :bighug:
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Thank you, @Kris & Teasel and everyone else on this thread. Hubs just got home and i was updating him on today's vet visit and calls from vet since. I will def ask abt the ketones and what plus two urine result means. And how concerned we are abt dka and what's best--to leave him in 24hr care or bring home. :) thank you.
 
Okay so right now, you don't know if he will be home tonight or go to ER for the night. This a worrisome time for you. So remember to breathe.

I want to give 2 thinks to keep in your mind not to far back.

1. Care credit if you don't have it. You can apply and will know immediately if accepted and receive electronic confirmation to use at hospital. The ER I used let me do it there while I was waiting.

It's has a 6 month interest free period if paid off in the six months, if not then the interest will be retro applied and costly. And can be used for human dentists, eyes if you doctor accepts it.

2. Contact DCIN if you have to. It's an organization dedicated in assisting diabetic kitties. It is non profit using donations and fundraising to help pay for supplies, some vet bills etc. of diabetic cats. If you qualify. Don't think no on this. You won't know unless you ask.
 
Thank you, @Woodsywife. I did not know abt CareCredit. The 6mos interest free is good to know.

Thank you All so much. I read every post and take notes. It's a lot of info, & I'm worried but feel better prepared to ask questions.

I had a little cry, took a nap, but now it's back to being strong for Cliff. He's waiting for me and counting on me.

I truly truly appreciate all of your help. If my answers seem short right now, it's only because I'm responding quickly. Will post later when I have more info/next update.
 
Rachel said:
I know you're worried and I'm so sorry this is happening. As for price have you looked into Care Credit? Just a thought.

We're sending tons and tons of healing vines. Let us know.
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Thanks! I see in re-reading that you mentioned care credit too.
 
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