17 year-old tortie, so hard to get blood from her ears

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Oh no, I am so sorry to hear this. Maybe start a new thread with DKA in the title on Health where there will be more eyes. Lots of cats here have had it and lots have survived, but it is very dangerous. There are things that the vets should be doing (i haven't dealt with it so can't advise) and others can give you ideas about what to ask the vets to do.
 
Without knowing the normal ranges s it is hard to tell just how bad the the values are.
The high BG together with the out-of-range electrolytes could indicate DKA or another type of metabolic imbalance.
DIid they test the urine with a dipstick? That is usually how ketones are determined. Mode bloodwork does not incded measure ketones in the blood.

You also said "she is getting phosphorus. they said she was acidic". Are you sure that statement about getting phosphorus is correct?
 
The POTASSIUM number of 2.5 is WAY low and makes the muscles not able to work. This causes her to be very weak, not be able to walk well, breath shallow because it requires strength in the diaphragm muscles to breath well.

I'm really scratching my head why the vet said she was acidic and didn't test ketones. DKA - Diabetic Ketoacidosis. A cat can be 'ketonic' because it's burning body mass for fuel instead of using the food given. When their body chemistry moves to an 'acidic' ph balance, it's full blown 'DKA'. It's a lot harder to move the ph balance off the acidic side and yes, requires IV and medical support.

Meters - the vet doesn't KNOW that human meters will work because they're not taught that way. No they're not 'calibrated' for animals which is why we use different values for a human meter and a pet meter. I AM a bit concerned that your meter may not be giving you accurate results on a consistent basis.

HUGS AND PRAYERS for all of you....
 
Hi Joe and Suloni,

Sorry to hear Twyla's so poorly. Smart move getting veterinary attention. Are the vets getting any food into Twyla?
 
they think she may have an underlying issue with her pancreas, so we are just waiting to see how her levels change over the next couple of days. the severity of this event may have compromised her ability to recover. so we are in a waiting and seeing state and able to visit her in the hospital once a day. we like her weekday doctor, but her night time and weekend doctors will be random, and the center will be under stress with other animals getting emergency care and all that that entails. her kidneys aren't doing great at the moment, so that's something else we are waiting to see how they change over the next couple of days. she is being treated for ketones and that seems to be why she's lost body and muscle mass. today's doctor said home glucometers are fine, but that they tend to read low. does that sound right? although with insulin treatment with them her glucose values are in the same range they were when we were home testing, so we're not sure what caused her system to break down yesterday so significantly. maybe we should just have never stopped the .5u prozinc treatment, realized the 32 score was a mistake and gotten her on antibiotics to be safe earlier.
 
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Hi Joe and Suloni,

I know that Twyla has a lot of things going on at the moment but I just wanted to share something about pancreatitis with you both. Saoirse had a major flare last year and she was very, very poorly - terribly lethargic and wiped-out looking. It was astounding the way she rallied. I've also seen other stories of cats' amazing resilience here.

Should it be the case that pancreatitis is a factor, vitamin B12 injections can work wonders to give a kitty a boost. If it's anything kidney-related, the experienced members of the support group at Tanya's Site are very knowledgeable and helpful (link to support forum is on the home page).

Sending more prayers for Twyla to pick up and feel much better soon. Also sending hugs for you both: it's so clear how very, very much you love your precious girl.

:bighug::bighug:


Mogs
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Joe and Suloni,

You both have been excellent caregivers and did the right thing taking Twyla to the emergency vet right away. Please don't fret over what you should have done or not done. You are doing everything right and clearly care so much about your beautiful cat. It really helps Twyla that you brought her some towels and shirts from home so she can be comforted while she recuperates. Focus on knowing you are doing the best for Twyla.
 
Human glucometers do read somewhere between 30-40% lower than pet lab values, based on international feline diabetes expert Dr Rand of the University of Queensland. That's OK, as we have feline-specific reference numbers to use when evaluating the dose. See my signature link Glucometer Notes and maybe print a copy to share with the vets.
 
Twyla17 said:
they think she may have an underlying issue with her pancreas, so we are just waiting to see how her levels change over the next couple of days. the severity of this event may have compromised her ability to recover. so we are in a waiting and seeing state and able to visit her in the hospital once a day. we like her weekday doctor, but her night time and weekend doctors will be random, and the center will be under stress with other animals getting emergency care and all that that entails. he kidneys aren't doing great at the moment, so that's something else we are waiting to see how they change over the next couple of days. she is being treated for ketones and that seems to be why she's lost body and muscle mass. today's doctor said home glucometers are fine, but that they tend to read low. does that sound right? although with insulin treatment with them her glucose values are in the same range they were when we were home testing, so we're not sure what caused her system to break down yesterday so significantly. maybe we should just have never stopped the .5u prozinc treatment, realized the 32 score was a mistake and gotten her on antibiotics to be safe earlier.
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32 score could have been a mistake, but we had no way of knowing - we also had no idea Twyla had ketones developing so rapidly. Ketones develop from lack of food/water/insulin and presence of infection/inflammation. I'd definitely discuss with the vet what dose they think Twyla should be on especially with the ketones, you typically need to be pretty aggressive with insulin if ketones and especially DKA are an issue. It could have been the lower amount of insulin wasn't a problem either, and perhaps Twyla has severe infection/inflammation issues leading to ketones being formed.

DKA can be vicious from what I've heard and you guys did the right thing taking her in. You can buy something called a Precision xtra blood ketone monitor and test strips, $30 for the monitor $30 for 10 strips - to test ketones at home, or you can use urine strips, for when she's home.
 
Twyla is still at the emergency vet, but doing better. still very lethargic and on IV fluids, insulin, and antibiotics, but she is eating and drinking on her own now. they suspect cancer in her pancreas and are not very optimistic, but we're hoping we will get to take her home Sunday or Monday and may have a couple more months with her in palliative care. this has pretty much ruled out any vacations for a year or so. thanks for your concern guys.
 
Oh my gosh, Joe and Suloni, this is such heartbreaking news. Cats have an amazing way of defying odds so perhaps Twyla will give you more than a few month. I know you will cherish your precious time with her. Please know we are all here for you and care. Sending lots of healing vines (vibes).
 
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Dear Joe and Suloni:
I wanted you to know that although I've not posted on your thread, I have been watching and praying with all my heart for yourselves and Twyla.
Once again, do not "buy in" to a "cancer" dx. They could be wrong. Keep your POSITIVE attitudes as I know you will.
I am so very sorry all of you are going through this and wish your beautiful kind hearts and spirits, resilience and peace.
I am keeping a candle lit for Twyla.
 
Twyla17 said:
they ... are not very optimistic
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Dear Joe and Suloni,

If there's one thing I've found over the last number of years it's that the vets I've had dealings with tend to be pessimistic as a default position. I know that probably is of little comfort to you but as others have said, without a biopsy they can't be sure of a Dx.

Here are the IDEXX pancreatitis treatment guidelines. I hope that they may help you work out a treatment regimen for your darling Twyla. Saoirse has chronic pancreatitis, as have a number of other kitties here. It is a condition that can be managed with the right treatments. I found the above document very helpful when requesting specific prescriptions from our vets.

I really feel for you both, and also for Twyla.

:bighug::bighug::bighug:


Mogs
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good news and continuing unknowns. good news first: her kidney values and potassium are normal again. the last time they tested, she was still positive for ketones, but we're hoping when they test at 10pm tonight she'll be free of ketones. she is still very lethargic and underweight, and they say she's not eating or drinking much. they're not sure if the two antibiotics she's on are necessarily targeting her specific infection, but possibly Monday we should have results as to the specific infection and appropriate antibiotic. they say she's getting more feisty which is a good sign. they still have her on an fast, short-acting insulin drip, but will probably switch her to our Prozinc tomorrow hopefully as that will help transition her to our being able to care for her. it's costing about $1000 a day at the emergency vet, so as soon as it is feasible for us to adequately care for her i am anxious to get her home, and personally believe that she might eat and drink better when she's home. so the only remaining unknown is the perceived mass in her pancreas. i am ready to wait to deal with that, obviously following her symptoms very closely. they will send her home with fluids that we will administer as shots into her scruff to help with dehydration.
 
Joe and Suloni,

Twyla has been through such a rough ordeal but to hear her rally through and becoming more feisty is very encouraging news. You both have been terrific in your care for Twyla. Please keep us posted on the test results from tonight. Keeping fingers (and paws) crossed for good results and negative results for ketones. I know it will be a relief for both of you when Twyla is back home.

CJ had a suspicious mass that later was determined benign so I am hoping for the same results for Twyla.
 
Hi Joe and Suloni,

I'm so glad that you got some much-needed good news. And we like feisty! ((((Twyla))))

With regard to Twyla's poor appetite, there are meds that I recommend you ask your vets to send home with you:

1. Generic ondansetron - this is for nausea.

2. Cyproheptadine - this is an appetite stimulant. (gentler than mirtazapine, another popular appy stimulant, and with a better side effect profile).

3. Famotidine or Ranitidine - these reduce secretion of stomach acid.

Also ask them to assess whether Twyla has any abdominal pain. If yes, then buprenorphine is commonly used for the relief of pain associated with pancreatic inflammation.

Finally, if they haven't already done so, ask them about vitamin B12 injections. A course of B12 supplementation really helps with pancreas issues - gives the whole system a bit of a boost, may improve appetite, and also it has anti-inflammatory properties.

Sending more healing vibes and hugs ...
:bighug::bighug::bighug:


Mogs
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thank you so much guys. Critter Mom, thanks so much for the recommendations. the vet doesn't think Twyla is in pain. she's on nausea medication, but we'll ask for a prescription, and ask about the other two as well. i've ordered liquid B12 by Douglas Labs to administer to Twyla. does that sound ok?
 
That sounds good. :)

I've found it invaluable to have a little 'toolkit' to help Saoirse with her eating. It stops the queasy-won't eat-queasier-can't eat cycle from getting set up in the first place.

.
 
Great news! no more ketones as of 10pm last night. today she has more energy, is walking around her kennel, and eating more on her own. the results of the infection are back and one of the 2 antibiotics she's been on target her particular bug, so that should be being taken care of. we're not going to worry about the possible mass on her pancreas at the moment and plan on taking her home late tonight. yesterday they switched her to her .5u Prozinc from the fast-acting insulin drip she had been on. we'll follow up with a home vet visit this week and hope for the best. and our liquid B12 is supposed to arrive sometime between tonight and Wednesday.
 
HOME! the vet was very negative, thinking she is dying of pancreatic cancer, but she's home. she is weak, but eating, drinking, she peed after i put her in a litter box. she is walking unstably, but she's home and has improved so much since when we brought her to the emergency vet. we're being very watchfully optimistic. thanks for your kind thoughts guys. once we have 24 hours under our belts i'm going to start posting in the Prozinc forum.
joe
 
Hi Joe and Suloni,

I'm so glad that Twyla is back home with you both, eating and drinking, ketone-free and with more energy. :)

I don't know whether this might help but Saoirse is having a minor pancreatitis flare at the moment. Coincidentally, I started her on Zobaline methylcobalamin twice a day a few days ago and yesterday her pancreatitis symptoms seemed to ease and her coat condition has started to improve for the first time in months. Also she has gone from being very lethargic to being a bit perkier and she seems to feel better in herself than she has in many, many weeks. This is a new discovery for us. I've been reading up and apparently B12 has anti-inflammatory effects. I hope that Twyla's B12 supplement will help her similarly.

Sending :bighug::bighug: for you two, and feel-better scritches for Twyla.


Mogs
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Twyla's liquid B12 didn't come today, but hopefully it will come tomorrow. we're anxious for anything that will help her.
 
they said she didn't need subcutaneous fluids after all. she is eating and drinking so they didn't give us prescriptions for nausea or appetite stimulants. they gave us 2 weeks worth of Zeniquin. we're making an appointment with our home visit vet for early this week.
 
I'd suggest still putting forward the case with your vet to give you a supply of the meds - especially the anti-nausea treatment. You may not need to give it to Twyla, but I have found that it makes a world of difference being able to respond to Saoirse's nausea immediately. It really has been the cornerstone of her pancreatitis management regimen.

Sending feel-better scritches for Twyla.


Mogs
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Forgot to add earlier that I add 2-3 teaspoonfuls of water to each of Saoirse's feeds to help with hydration (she ignores her water bowl since switching to wet food). If Twyla doesn't seem to be drinking much from her water bowl, adding a little to her food might help her to get adequate fluids on board.

It also helps to keep a daily log of Twyla's water intake (from food and drink). BJM's signature has a link to useful secondary monitoring tools.

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Thanks Critter Mom, we'll ask our home visit vet about those prescriptions when he visits this week. we're not sure how soon of an appointment we can get yet, just definitely this week. i've updated Twyla's glucose readings on the google doc for anyone who is following that. it's a sad roller coaster.
joe
 
Hi Joe,

Can you change the permissions in your spreadsheet, please (can't access it)? On a PC look to the top right of the screen to see Share then go through the options to allow anyone with the link to view the spreadsheet.

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I'd suggest posting on the Prozinc Insulin Support Group's board. They might be able to help you with dosing. That 54 on the evening dose of 15 August was quite low. It may be that the high AMPS numbers are bounces from Twyla going lower at night.
 
Twyla17 said:
Great news! no more ketones as of 10pm last night. today she has more energy, is walking around her kennel, and eating more on her own. the results of the infection are back and one of the 2 antibiotics she's been on target her particular bug, so that should be being taken care of. we're not going to worry about the possible mass on her pancreas at the moment and plan on taking her home late tonight. yesterday they switched her to her .5u Prozinc from the fast-acting insulin drip she had been on. we'll follow up with a home vet visit this week and hope for the best. and our liquid B12 is supposed to arrive sometime between tonight and Wednesday.
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Great to hear. Was it DKA/ketoacidosis that put her into this situation? Please continue to monitor Twyla @ home, just to make sure she's not dropping too low. With ketone history you need to be pretty aggressive with insulin - hopefully .5 is a perfect dose to keep her out of ketone territory. Make sure she gets plenty of water + food! Good work and sorry for all the vet $$$$ expenses!
 
So good to hear the update on Twyla! Such encouraging news! As pevsfreedom mentioned in an earlier post, it will be very important to test ketones at home so hopefully this won't happen again.
You can do that with ketones strips (found at any place that sells diabetic supplies, Walmart, Target, etc) or a special monitor @pevsfreedom mentioned.
Again, so happy for the news! You are terrific!
 
the B12 methylcobalamin arrived-Douglas Labs liquid. it's naturally cherry flavored like the pills i found locally and tastes a little sweet. that's not a problem is it? i'm confused about testing for ketones. are there standalone strips that you put in the urine flow and then also a blood monitor that tests for them as well that requires its own blood-testing strips? do the same strips for the monitor check glucose and ketones? i would assume the monitor is cheaper in the long run, is that right? speaking of which, if my wife wasn't the breadwinner of this family, Twyla has used 5 months of my take-home pay in the past month. i imagine sad stories like this can really hurt working families and the elderly and leave them with impossible choices.
 
There are 2 ways to test for ketones:
- urine testing with KetoStix (ketone test only) or KetoDiaStix ( ketone and glucose test)
- blood ketone testing with a meter such as Precision XTra or NovaMax, which is more expensive per test, but worth it if your cat has ever had ketones or ketoacidosis as it will detect them before urine testing will.
 
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