1May2020\MAXI is in the Hospital\What to Ask Vets For/About?\Please Send Healing Thoughts

bambinaki

bambinaki

Member Since 2010
Last thread: http://www.felinediabetes.com/FDMB/...-pmps-6-258-9-287-11-287.228987/#post-2564688

Hello-

I brought Maxi to the specialists' vet clinic this morning, and I spoke with a smart-sounding doctor who persuaded me to let Maxi be hospitalized over the weekend. For animals, I am a proponent of being at home, not the hospital as it's such a horrifying place. I know how scared Maxi must be, and I HATE to put him through that, but the doctor convinced me. They are going to run lots of tests and get him on IV fluids. They'll call me in a couple hours (I hope). I asked the doctor if they could just run the tests and let Maxi come home and be in my care. I could give fluids and medicine. He said the IV fluids are much more effective than subcutaneous. Maybe Maxi could get the IV all day and then come home...? What do you think? Do you think it's good to leave Maxi in the hospital all weekend? I'm sad and nervous about it. I don't want to make Maxi feel worse than he already does by being in a very scary place for so long. But I definitely want to do what's best for his health.
Some good news is that Maxi seemed much better again this morning.

If you think of anything further I should ask the vets for or about (beyond what was mentioned in the last thread), please let me know.

Please send positive, healing, calming thoughts to Maxi.

Thank you
 
((Karen)), I'm so sorry and I understand how you must be feeling, what a tough decision to make...:( My concerns would be are they keeping a close eye on his BG's? Is there someone there to care for him during the night?

Sending a million healing vines and positive thoughts to Maxi and hugs to you, you must be so worried. :bighug::bighug::bighug::bighug::bighug:
 
Prayers for Maxi. Maybe they will get some answers quickly, it might be the best thing for him.

Did they have any clue as to what they think?

I know when I left Tux in hospital, thought he must be so scared. The staff said he was a total love bug. Wanted to be held and cuddled. He can get that way when scared as long as it's not thunder.
 
I prefer treatment at home as well but I’ve been wondering if this is acute pancreatitis. There were times when my cats were hospitalized for pancreatitis to get IV fluids. Usually one night was all that was necessary. See what the response is and when you discuss next steps make sure they know what you can do at home. Once home it’s important to continue with nausea meds until normal for several days and eliminate slowly one thing at a time over several days. That’s my experience anyway. I’m not telling you what to do but rather what worked for my two who went through it.
 
Sonia & Leo said:
I'm so sorry and I understand how you must be feeling, what a tough decision to make...:( My concerns would be are they keeping a close eye on his BG's? Is there someone there to care for him during the night?

Sending a million healing vines and positive thoughts to Maxi and hugs to you, you must be so worried.
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Thank you, Sonia.
They assured me they would keep a close eye on BG, doing curves.
There is 24-hour care there.
 
Olive & Paula said:
Prayers for Maxi. Maybe they will get some answers quickly, it might be the best thing for him.

Did they have any clue as to what they think?

I know when I left Tux in hospital, thought he must be so scared. The staff said he was a total love bug. Wanted to be held and cuddled. He can get that way when scared as long as it's not thunder.
Click to expand...

Thank you, Paula.
No clue, no news yet.
 
tiffmaxee said:
I prefer treatment at home as well but I’ve been wondering if this is acute pancreatitis. There were times when my cats were hospitalized for pancreatitis to get IV fluids. Usually one night was all that was necessary. See what the response is and when you discuss next steps make sure they know what you can do at home. Once home it’s important to continue with nausea meds until normal for several days and eliminate slowly one thing at a time over several days. That’s my experience anyway. I’m not telling you what to do but rather what worked for my two who went through it.
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Thank you, Elise.
I will follow your advice.
 
Hi Karen - we haven't met, but I had a similar (though less severe) situation with my cat in the fall. It wasn't pancreatitis, but a really bad reaction to a UTI/antibiotics that made her quite sick. I had the same fear that being in the hospital would be worse for her stress levels, but had them keep her for a night + full day for IV fluids and monitoring in hopes that it would make her feel much better than anything I could do at home. FWIW it seemed to do the trick and her nausea was much more manageable at home after inpatient treatment. I hope Maxi does well there and is feeling much better soon. :bighug:
 
Patricia & Noodle said:
Hi Karen - we haven't met, but I had a similar (though less severe) situation with my cat in the fall. It wasn't pancreatitis, but a really bad reaction to a UTI/antibiotics that made her quite sick. I had the same fear that being in the hospital would be worse for her stress levels, but had them keep her for a night + full day for IV fluids and monitoring in hopes that it would make her feel much better than anything I could do at home. FWIW it seemed to do the trick and her nausea was much more manageable at home after inpatient treatment. I hope Maxi does well there and is feeling much better soon.
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Thank you, Patricia, for sharing that. The doctor said they gave Maxi a "hidey box," and that Maxi "likes" it.
I hope Maxi has the same luck as Noodle.
 
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The doctor just called. Maxi is on IV fluids. They have done an ultrasound: thickened pancreas, lit up kidneys and liver. No diarrhea. They sampled liver and cultured urine. Blood pressure 120s. Heart murmur. Thyroid ok. No ketones. Some (not much) fluid in belly.

They didn't give him his morning Lantus, but his BG was only in the 240s. They will start regular BG monitoring this afternoon and give short-acting insulin. He said he doesn't typically recommend using long-acting and short-acting insulins together.
Could you suggest a paper that I could share with him that supports using Lantus in combination with R under close monitoring?

Thank you

@Marje and Gracie @Wendy&Neko @Sandy and Black Kitty


FYI:
This is the doctor: https://www.avsspecialists.com/doctor/kevin-s-kirchofer/
And this is who will call me this evening: https://www.avsspecialists.com/doctor/pamela-n-smyth/
 
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Sending lots of healing thoughts for Maxi.:bighug:
bambinaki said:
The doctor just called. Maxi is on IV fluids. They have done an ultrasound: thickened pancreas, lit up kidneys and liver. No diarrhea. They sampled liver and cultured urine. Blood pressure 120s. Heart murmur. Thyroid ok. No ketones. Some (not much) fluid in belly.
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Thickened pancreas is typical of acros. With an acro with heart murmur and fluid in belly, any discussion of a chest x-ray?
bambinaki said:
Could you suggest a paper that I could share with him that supports using Lantus in combination with R under close monitoring?
Click to expand...
Acromegaly in 14 Cats by Mark E Peterson, Deborah S. Greco, John F. Randolph, Scott D. Moroff, Clinton D. Lothrop
Journal of Veterinary Internal Medicine, Volume 4, Issue 4, Feb. 2008
http://onlinelibrary.wiley.com/doi/10.1111/j.1939-1676.1990.tb00897.x/pdf
Although this is an older article, it has a good description of what is happening inside the acromegalic cat, including symptoms and X-rays and CT scans. It also mentions the use of the shorter acting insulin R in managing the cat's diabetes.

FYI - Mark Peterson is quite well known as a researcher in acromegaly. For what it's worth, even Neko's internal medicine vet was cool with me using R. Of course, he was trained in Europe, perhaps more knowledgeable in acromegaly.
 
Sending prayers and hugs for you and Maxi. This is a stressful time...take a breathe...try to trust that the doc knows best. I'm sorry to hear that you're both going through this difficulty....hang in there...:bighug::bighug::bighug:
 
Wendy&Neko said:
Sending lots of healing thoughts for Maxi.:bighug:
Thickened pancreas is typical of acros. With an acro with heart murmur and fluid in belly, any discussion of a chest x-ray?
Acromegaly in 14 Cats by Mark E Peterson, Deborah S. Greco, John F. Randolph, Scott D. Moroff, Clinton D. Lothrop
Journal of Veterinary Internal Medicine, Volume 4, Issue 4, Feb. 2008
http://onlinelibrary.wiley.com/doi/10.1111/j.1939-1676.1990.tb00897.x/pdf
Although this is an older article, it has a good description of what is happening inside the acromegalic cat, including symptoms and X-rays and CT scans. It also mentions the use of the shorter acting insulin R in managing the cat's diabetes.

FYI - Mark Peterson is quite well known as a researcher in acromegaly. For what it's worth, even Neko's internal medicine vet was cool with me using R. Of course, he was trained in Europe, perhaps more knowledgeable in acromegaly.
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Thank you, Wendy. (I hope your family is well.)

The doctor said so many things that I'm not sure if he mentioned a chest x-ray. I've made myself a note to ask when they call in the morning.

Thank you for the article. I've e-mailed it to them.

The second doctor asked why I was treating Maxi with cabergoline; she said there was no evidence to support using it. The only research I could find was that article about the 3 cats, and I sent it and also said there was anecdotal evidence.

She wants to talk about using octreotide. What do you think of that?

They said he is a very good boy, but he is nervous. They're going to give him gabapentin for that. I want him to be calmed. As I said, the scariness of it for him kills me. But I'm not sure I like gabapentin. I know I am very wary of using it in humans. I told the doctor that, and she said it's fine for cats. What do you think?

They assured me that Maxi would get affectionate attention every 4 hours all night.
He has not eaten. They assured me they would try to coax him.
Their "crazy cat lady" is working all night tonight and will attend to Maxi.

Do you think I should push for him to come home tomorrow or go along with keeping him there all weekend?

Thanks again.
 
Sue and Luci said:
Sending prayers and hugs for you and Maxi. This is a stressful time...take a breathe...try to trust that the doc knows best. I'm sorry to hear that you're both going through this difficulty....hang in there..
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Thank you, Sue.
It's so hard, and I know however hard it is for me, it's much harder for the most important person: poor little Maxi.
Please send more healing, calming thoughts out to him.
 
bambinaki said:
The second doctor asked why I was treating Maxi with cabergoline; she said there was no evidence to support using it. The only research I could find was that article about the 3 cats, and I sent it and also said there was anecdotal evidence.

She wants to talk about using octreotide. What do you think of that?
Click to expand...
RVC did say something to one of our members that cabergoline, together with octreotide, had some good results. I remember it's very expensive. Anyway, start reading here where there is discussion about combining the two. Get the vet to get a quote on it. It might open his eyes.
bambinaki said:
But I'm not sure I like gabapentin. I know I am very wary of using it in humans. I told the doctor that, and she said it's fine for cats. What do you think?
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There are quite a few cats here who have had it. Medications don't always work the same in humans can cats. Neko tried it for a bit, just made her sleepy. I've seen several people use it to calm their cats for a vet visit. You could also try a low dose.
Bronx's dad (GA) said:
every vet needs a "crazy cat lady" working with them
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My current vet is self professed crazy cat lady.:)
bambinaki said:
Do you think I should push for him to come home tomorrow or go along with keeping him there all weekend?
Click to expand...
This is a day by day question. If he won't eat at all, that's a consideration. Maybe see how he is in the morning. At least he was eating something for you. The only time Neko was in intensive care, I was able to visit. Made a huge difference to me being able to see how she was really doing.
 
bambinaki said:
They said he is a very good boy, but he is nervous. They're going to give him gabapentin for that. I want him to be calmed.
Click to expand...

A light dose of gabapentin is commonly prescribed for cats who are stressed by visits to the doctor.

One of my civvies, Becca, really, really hates visits to the vet. One time she bloodied both our vet and me, to our respective professional and personal embarrassment. Since then 50mg of gabapentin sprinkled on top of her food two hours before the appointment has made a world of difference. She's not dopey or anything. Just calmer, less scared.
 
Tom & Thomas (GA) said:
less scared
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Thank you, Tom. Less scared is what I hope for.

I notice that the anniversary of the passing of your magnificent boy was a few days ago. I'm so sorry. I'm glad you have a place here to talk about him. Talking about loved ones I've lost somehow keeps them alive a little for me and is kind of comforting. I'm sorry you're guilt-ridden but it's clear you have a lot to be satisfied about, too, in your care for Thomas. I can see that you gave him a wonderful life. I'm glad I got to learn a little about him.
 
Wendy&Neko said:
RVC did say something to one of our members that cabergoline, together with octreotide, had some good results. I remember it's very expensive. Anyway, start reading here where there is discussion about combining the two. Get the vet to get a quote on it. It might open his eyes.
Click to expand...

I mentioned that I heard it was very expensive, and she said she thought it cost about as much as Lantus for a month's worth, but she would have to check.

Wendy&Neko said:
The only time Neko was in intensive care, I was able to visit. Made a huge difference to me being able to see how she was really doing.
Click to expand...

Yes, so I guess you know I can't visit under corona conditions.

Thanks, Wendy.
 
More on octreotide and it's use (and failure) in acromegalic cats from this paper in the 2015 WSAWA conference:

Somatostatin Analogues


Somatostatin is a hypothalamic hormone that acts on the pituitary gland to inhibit growth hormone release. Somatostatin analogues are commonly administered in people with acromegaly and have efficacy rates of 50% to 60%. In addition to acting centrally by suppressing growth hormone release and peripherally by interfering with growth hormone receptor binding on hepatocytes, somatostatin analogues are also thought to result in tumor shrinkage of pituitary adenomas by promoting apoptosis.


The somatostatin analogue octreotide has been evaluated in a few cats with acromegaly with limited success. In a study of four cats with acromegaly, no change in serum growth hormone concentration was noted after treatment with octreotide. Another study, which measured the short-term effects of octreotide in five cats with acromegaly, found a decrease in growth hormone concentrations for up to 90 minutes after octreotide administration. However, a recent study evaluating a long-acting somatostatin analogue (Sandostatin LAR Depot - Novartis) showed no benefit in cats treated for three to six months.


The failure of these drugs to inhibit growth hormone release may be related to differences in somatostatin receptor subtypes found on pituitary adenomas. Future studies to identify the somatostatin receptor subtypes in feline growth hormone-secreting pituitary tumors are required to determine if these subtypes are similar to the ones found in people and if human somatostatin analogue therapy, at least in theory, may be beneficial in cats with acromegaly.

And another paper from the 2018 Journal of the Endocrine Society, by the folks at RVC.

Spontaneous acromegaly/hypersomatotropism (HST) in domestic cats (Felis catus) is 10-fold more prevalent than in humans, affecting an estimated 1 in 800 cats [12–14]. Acromegaly in cats parallels the disease in humans as far as being diagnosed in middle-aged to older subjects and is associated with insulin resistance, acral growth, and cardiovascular complications [12, 15]. Cats affected by acromegaly have achieved long-term clinical and biochemical response to pasireotide and cabergoline but no other medical therapies [16–19]. The somatostatin and dopamine receptor profile of feline GH-secreting adenomas is not known. The receptor expression profile of these tumors might explain the poor response of feline acromegalics to octreotide, which has high binding affinity for, and preferentially binds to, somatostatin receptor (SSTR2), and l-deprenyl, a monoamine oxidase B inhibitor that prolongs the activity of dopamine, but a favorable response to pasireotide treatment
 
Wendy&Neko said:
More on octreotide and it's use (and failure) in acromegalic cats
Click to expand...

Sigh.

So this strongly suggests not using octreotide, right?

But that second paper suggests that pasireotide is effective, right?

And now I'm worried about Maxi's heart with the use of these medicines.

I could get the first paper from your link, but the second took me no where. Could you please re-link me to that 2018 paper?

Thank you very much, Wendy!
 
I shut my eyes this afternoon for a few minutes, not really asleep, but entered a dream-like state -- images kept flashing: medicines, powders, liquids, capsules, tablets, syringes...

Hoping I can sleep tonight since I have the opportunity without interruption for the first time in a long time.

Thank you all for your kindness and support. Good night.

I hope you're sleeping comfortably, Maxi.
 
Wendy&Neko said:
Trying a different link. RVC had some success in using both cabergoline and octreotide. Octreotide by itself was not helpful.

@Olive & Paula That's good, I'd seen another site where it was much higher, but still not as high as pasireotide.
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Actually just did price search on octreotide and I can get it near me for under $20 for a vial. Given daily. I am going to have to check this out. The longer acting one is approx $50-60 month. Given monthly.

Check this out. https://www.pharmacychecker.com/octreotide acetate/50 mcg%2fml/?formulation=Vial&zipcode=18436 The more you get the cheaper it is. Haven't read the links yet and to techy for me but is it worth trying? Really worth it?
 
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Prayers for Maxi and prayers for you. :bighug:

For what it's worth, I've taken gabapentin / pregabalin / Lyrica. It really helps me. Several people have said it helps their cat, does anyone know if it helps dogs? My dog whimpers non-stop the whole time we are at the vet. (Don't worry, I'm not going to give her some of mine. I would get a prescription for her.)

:bighug: Maxi :bighug:

:bighug: Karen :bighug:
 
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