3/26 Smokey Not Really Eating, Vomited 3 Times

Status
Not open for further replies.
What makes it so outrageous? I understand it involves meds, staying several nights and tests, I’m just wondering where the big expenses come from, I see cats on here with it and everyone has stated how expensive it is to treat, geez
 
Bellasmom said:
What makes it so outrageous? I understand it involves meds, staying several nights and tests, I’m just wondering where the big expenses come from, I see cats on here with it and everyone has stated how expensive it is to treat, geez
Click to expand...

It's pretty much round-the-clock intensive care for a bout of DKA, with treatments (short-acting insulin, fluids, etc.) being constantly readjusted. And there are lots of tests being done the whole time to monitor the condition. Beyond that, though, because DKAs are usually triggered by some other health problem, you have to find and fix that at the same time as you are doing the intensive care. It can add up very, very, quickly.

But then, as with everything else, there's a lot of variation among vet practices in terms of just what they choose to do, and how much they charge. You are pretty much assured a large bill with a DKA, but exactly how much, you don't know until you're deep in it.
 
Everything is expensive at the vet. Even an ultrasound is $600 for what exactly? Xrays are $175 for a picture. Good luck with Smokey, glad to hear he is getting the help he needs!
 
Teasel was in my vet clinic's 24/7 ER ICU for three days during his DKA in March of 2016. Final bill (rounded up) was $2700 CAD.
 
Bellasmom said:
What makes it so outrageous?
Click to expand...
Nan & Amber said:
It's pretty much round-the-clock intensive care for a bout of DKA, with treatments (short-acting insulin, fluids, etc.) being constantly readjusted. And there are lots of tests being done the whole time to monitor the condition. Beyond that, though, because DKAs are usually triggered by some other health problem, you have to find and fix that at the same time as you are doing the intensive care. It can add up very, very, quickly.
Click to expand...

I think the most expensive item on our 24H ER stay when in DKA was th e"nursing (billable) hours - just like Nan said :constant monitoring, dextrose drip, rapid acting insulin, syringe feeding, etc. They also, me think, mark up med supplies pretty high. (at least they do in California).

Sending healing vines and support and hoping very much to hear good update soon. @Rusty & Smokey
 
UPDATE: His bilirubin doubled and is now 10 or so. BUT. He ate three times today! We visited him just now and he looks awful, but I'm having a feeling he looks worse than he is. He is still definitely not out of the woods yet, and his ketones are still high, but that's not unusual, the vet said. If his bilirubin doesn't lower tomorrow, she will perform another ultrasound just to make sure he's not developing stones, though she won't charge us the full 360 for it, only 200.:facepalm: He was weakly yelling at us when we were there, so that's good haha. He's also been complaining when being handled for care and such, so that's promising.
 
Rusty & Smokey said:
His liver is actually fine; the bilirubin is from his gallbladder due to the pancreatitis. But still, food is medicine!
Click to expand...
They're closely entwined. Bilirubin is produced when the liver damages/destroys old red blood cells. Liver damage is known to cause the body to produce more bilirubin than it's supposed produce. Elevated/extreme bilirubin is associated with an increased risk of symptomatic gallstone disease.
 
Jill & Alex (GA) said:
They're closely entwined. Bilirubin is produced when the liver damages/destroys old red blood cells. Liver damage is known to cause the body to produce more bilirubin than it's supposed produce. Elevated/extreme bilirubin is associated with an increased risk of symptomatic gallstone disease.
Click to expand...

Ahh I see. Yeah, the vet said he's at risk of developing stones. So the fact he's eating is even more good news than we originally thought, yeah? :)
 
Rusty & Smokey said:
But still, food is medicine!
Click to expand...
It was definitely so for my Ducia - we could not confirm at the time whether or not she had pancreatitis($$$) but eating improved her liver and high bilirubin values.
Did the vet mention the current/ latest BG level?
How long ago since the hospitalization?
I am a bit concerned with ketones being at Large .. but she is the right place to tackle it!
 
Last edited:
Tanya and Ducia said:
It was definitely so for my Ducia - we could not confirm at the time whether or not she had pancreatitis($$$) but eating improved her liver and high bilirubin values.
Did the vet mentioned the current/ latest BG level?
How long ago since the hospitalization?
I am a bit concerned with ketones being at Large .. but she is the right place to tackle it!
Click to expand...

His BG has been very stable. He's been in the hospital since Tuesday morning. :) He is improving, though very slowly and slightly.
 
Tanya and Ducia said:
@Rusty & Smokey How is Smokey today?
Click to expand...

He's much brighter than he was yesterday! Ketones are now Moderate, though his bilirubin went up a tiny bit, but is no longer doubling. He didn't want to eat earlier, but that's normal. His electrolytes are now at normal values. The vet decided not to do another ultrasound, since it's pretty certain that the bilirubin being high is just from the pancreatitis. :)
 
Rusty & Smokey said:
He's much brighter than he was yesterday! Ketones are now Moderate, though his bilirubin went up a tiny bit, but is no longer doubling. He didn't want to eat earlier, but that's normal. His electrolytes are now at normal values. The vet decided not to do another ultrasound, since it's pretty certain that the bilirubin being high is just from the pancreatitis. :)
Click to expand...
:) Thanks for update!
Hurray on the Moderate ketones - big step forward!
Fingers crossed he'll recover quickly.
Please keep us posted on his progress.
 
UPDATE: So yesterday when we visited, they asked for $600 more to bring us up to 75% of the high estimate, which was given as 4700 MAX. Today, a different ER doctor is on, and she's saying as of 8 AM, our bill is now AT $4800, and that they need EVEN MORE money. We're going to try and fight this, because this is just completely unethical at this point.

As for Smokey, his bilirubin is now at 4, his ketones are still Moderate (though the doctor for today said moderate to large, and acted surprised when my mother corrected her...), but he ate and pooped! And he's no longer hooked up to a central line. Happy news!
 
Hooray for eating and pooping!!!! That is fantastic news!

Do you have that high estimate in writing? I'm not sure how binding something like that is (I wouldn't be surprised if they put a clause in about "reserving the right to increase this amount at our discretion"), but it's worth looking into. I would also ask for documentation of every. single. charge. on whatever bill they give you. It is not encouraging that you are getting different totals depending on who is on duty at the time, that suggests a certain looseness in the billing practices (though there was the overnight in between, but that's a pretty big difference in 12hrs when nothing special seems to have happened!).
 
Nan & Amber said:
Hooray for eating and pooping!!!! That is fantastic news!

Do you have that high estimate in writing? I'm not sure how binding something like that is (I wouldn't be surprised if they put a clause in about "reserving the right to increase this amount at our discretion"), but it's worth looking into. I would also ask for documentation of every. single. charge. on whatever bill they give you. It is not encouraging that you are getting different totals depending on who is on duty at the time, that suggests a certain looseness in the billing practices (though there was the overnight in between, but that's a pretty big difference in 12hrs when nothing special seems to have happened!).
Click to expand...

We got an updated treatment plan from the ER doc who has been with him since Tuesday, and it shows the high estimate at $4700. The ER doctor on shift today is a different one, and is saying that our bill is now UP TO $4800, and that we need to leave even more money.

They haven't given us an actual bill yet listing every charge. They only do that on discharge, and they do not bill later. They require money up front.
 
Arrrgh, that is very frustrating. This is out of my league and experience, maybe others can weigh in with opinions on how to deal with this. You want to keep a good relationship with the vet while Smokey is there, but this is very tricky when the treating vet has changed over.

How is the staff in general? The fact that Smokey is eating on his own is such a good sign, he must be at least a little comfortable with them.
 
Nan & Amber said:
Arrrgh, that is very frustrating. This is out of my league and experience, maybe others can weigh in with opinions on how to deal with this. You want to keep a good relationship with the vet while Smokey is there, but this is very tricky when the treating vet has changed over.

How is the staff in general? The fact that Smokey is eating on his own is such a good sign, he must be at least a little comfortable with them.
Click to expand...

The doctor we've dealt with all week will happily be back on shift tomorrow, so that's good. But yes, very frustrating!

The techs are fantastic! And the ER doctor we've had has been great as well. It's this billing crud that's bothering us.
 
UPDATE: When we visited yesterday, the doctor Smokey had been seeing had called in sick, so we had another doctor, who has been AWESOME. She is VERY willing to work with us on financial arrangements for paying the rest of the bill, and has been VERY nice. Yesterday, his ketones were negative, and his bilirubin came down to 2.1, and he was no longer yellow! Happy news!

Today we went to pick him up, but missed a call from the doctor. He had a hypoglycemic episode and she wanted to keep him just overnight to make sure he's all good before springing him loose. She suspects the SoloStar pens are formulated differently than the vials of Lantus, even though they both have the exact same ingredients. An interesting thought that we may consider. He was gobbling diabetic kibble, and was even violent in taking it from my mom! lol The doctor will call in the morning, and hopefully we can take him home tomorrow. Thanks everyone for your well wishes and support! <3
 
Quick update re: Lantus SoloStar

I managed to find the pharmacological information for Lantus, and the SoloStar pens lack an ingredient that the vials have: polysorbate 20, which is an excipient and stabilizer. I printed the segment of the information containing the formulations for the vials and pens and will show the doctor tomorow. I felt I should share on here. I think that's a pretty critical ingredient that the SoloStar pens are missing! It helps facilitate drug absorbtion and it stabilizes suspensions (in this case, the insulin).
 
Hooray for Smokey!!! Though, that's a bummer about the hypo and not being able to come home immediately. Hope that all clears up soon and you can have your little guy back home!

I'm not sure about the hypothesis about the pen-vial difference. Maybe when you see your vet, ask how long the vial had been opened? The insulin does lose effectiveness after a while, and there's a large amount in a vial so they may have been using it for a long time. What dose did they have him on?
 
Nan & Amber said:
Hooray for Smokey!!! Though, that's a bummer about the hypo and not being able to come home immediately. Hope that all clears up soon and you can have your little guy back home!

I'm not sure about the hypothesis about the pen-vial difference. Maybe when you see your vet, ask how long the vial had been opened? The insulin does lose effectiveness after a while, and there's a large amount in a vial so they may have been using it for a long time. What dose did they have him on?
Click to expand...

Actually, they had us bring in his pen to reduce costs. So they were using the exact container of insulin we've been using. They had him on the SLGS starting dose of 1 IU, which made his BG plummet. At home, we had him on 0.75 IU, which directly contributed to the pancreatitis flare up and subsequent DKA episode. So they are giving him his insulin from home, rather than their own insulin there. It's very frustrating! 0.75 IU was too little, and now 1 IU is too much! What the heck?! Vet suspects he may just be hypersensitive to the insulin at the moment while his pancreas settles down. Let's hope it's just that, and that he doesn't need another change in insulin!
 
Oh, OK, I misunderstood, thought they'd switched from vial to pen and then gotten a hypo.

He may very well be more sensitive to insulin for a while. Glad you home test!
 
I'm really glad to hear Smokey is doing so much better.

FWIW, when Gabby was diagnosed with DKA -- probably close to 10 yrs ago -- the ICU cost was estimated to be around $1000/24 hrs. I think I ended up putting $3000 down but did get some of that back.

 
I am glad to hear Smokey is better now and coming home.


Scrutinize that bill! Jones ended up in the ER for breathing issues and not eating (never found out the issue) - 3 days ER in oxygen cage - $2800 CAD. The nursing hours was the most significant amount. I noticed they only charged that over the night time hours vs. the day hours, however the 12-16 hours charged each day added up. And I was lucky as his IM vet is part of the ER hospital - his time was not charged once he took over the case.
 
So we brought Smokey home today! He is on a half unit of the Lantus. He's been very sleepy, though not lethargic, if that makes sense. We called the vet and asked, and she said that's normal, though we can't help but be nervous wrecks! lol He's in his pumpkin house and has been there since we got home, and he's due for BG check, food, and then insulin at 8:15. :)

What are your experiences? Have your kitties been pooped when they first came home after a DKA episode?
 
My Rufus was at the vet for 6 hours for dental (anesthesia) and and ultrasound. He was pooped for the rest of the day, and most of the next!
 
Rusty & Smokey said:
So we brought Smokey home today! He is on a half unit of the Lantus. He's been very sleepy, though not lethargic, if that makes sense. We called the vet and asked, and she said that's normal, though we can't help but be nervous wrecks! lol He's in his pumpkin house and has been there since we got home, and he's due for BG check, food, and then insulin at 8:15. :)

What are your experiences? Have your kitties been pooped when they first came home after a DKA episode?
Click to expand...
When Teasel had his in March 2016 it took him a couple of weeks to get back to normal. He was very tired.
 
Rusty & Smokey said:
my anxiety is through the roof
Click to expand...
My cat has had 3 DKA's in a year. I thought she was going to die because she was so lethargic, but shortly after the vet got fluids into her, she came to life again. Actually, a similar thing happened to me many years ago. I got food poisoning and couldn't eat or drink for 3 days. Finally, after going to the hospital, they put an IV of liquids in my hand and presto! I felt normal again after only about an hour. I had been dehydrated.
 
Just now reading this thread. How is Smoky doing?
As to the charges, you're very lucky the empathic vet came back! I understand why they want money up front, but I do not understand why, after taking so much money from one, they insist on more, meanwhile withholding treatment until they see yet more cash. This can, of course, result in the animal's death.
I know others will disagree, but under the circumstance, and I have experienced such, I think it's close to malpractice. The animal ERs are way out of control.
 
Status
Not open for further replies.
Back
Top