5/14 Ruby AMPS 223 Ultrasound results

Katherine&Ruby

Katherine&Ruby

Very Active Member
Yesterday’s drama.

Ruby ate about ⅓ of her PMPS meal last night and nothing else since even though I gave her a Cerenia and Mirtazapine. She slept curled in a tight ball next to me last night as I kept trying to ply her with food. Shocked by her number today. Taking her to AMC now. Hoping they can help my sweet girl.
 
I've been thinking about Ruby all morning and wondering how she was. That BG is so odd for Ruby. Poor baby. I hope you get the answers today. I will be thinking of you all day. Paws crossed for Ruby and vetty vines and all good things are zooming your way (I'm pointing them north and slightly east). Hang in there Katherine!! Ruby needs you to be calm, at least externally.
 
The doctor examined Ruby and now we’re waiting for an ultrasound. They asked if I wanted to admit her to the hospital and I said no, do the ultrasound and we take it from there. They wanted to do blood work to check her ketones but this morning’s number was a jump from 86 last night at +3, so ketones would not have built up since then. I have all of the appetite meds at home, and I can ask the vet tech to come and do subQ if needed, so I am thinking she will not need to be admitted even though she hasn’t eaten in 16 hours? What would you do, @Suzanne & Darcy @Butters & Lyla @Liz & Minnie , you women warriors of veterinary care?

ETA: ER vet said all outward and vital signs show nothing unusual.
 
Well, if she’s not critical, then I would not admit her. And she is not critical according to the ER vet. I agree about the ketones. Do you have a way to check them at home? For that matter, they can check them if. they are collecting urine or blood. I would do the same. Do the ultrasound and make decisions from there. For example, if they see something that they want to sample, they may want to do a FNA. That is an outpatient procedure. Endoscopy does require sedation, but usually you can take them home a few hours later after making sure they are stable.
 
Hopefully they can get her feeling better today so she will eat at home. Can you syringe feed her if she refuses to eat at home for a day or so?
 
Suzanne & Darcy said:
Well, if she’s not critical, then I would not admit her. And she is not critical according to the ER vet. I agree about the ketones. Do you have a way to check them at home? For that matter, they can check them if. they are collecting urine or blood. I would do the same. Do the ultrasound and make decisions from there. For example, if they see something that they want to sample, they may want to do a FNA. That is an outpatient procedure. Endoscopy does require sedation, but usually you can take them home a few hours later after making sure they are stable.
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The vet said that after the ultrasound the results would go to an IM first before any decision would be made about further diagnostics like a biopsy. It would not be today. What is an FNA? I can check ketones at home, I have the Ketodiastix and the crazy litter box with the aquaphobic pellets and pee drawer to check urine easily.
 
Suzanne & Darcy said:
Hopefully they can get her feeling better today so she will eat at home. Can you syringe feed her if she refuses to eat at home for a day or so?
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I have the syringes for feeding and tried to unsuccessfully squirt some water into her mouth this morning. Remind me what the best food for syringing is? Is it Hills AD? I don’t want to syringe raw and create any aversion. I have the Magic Bullet to purée anything.
 
You can better care for her at home, unless they give you a compelling reason to keep her there. Less stress on Ruby too. Maybe they should give her some sub-q fluids today. Sometimes that really perks the up, even if the outward signs don’t indicate dehydration. Doc may suggest it?
 
PerfumedCatMom said:
I have the syringes for feeding and tried to unsuccessfully squirt some water into her mouth this morning. Remind me what the best food for syringing is? Is it Hills AD? I don’t want to syringe raw and create any aversion. I have the Magic Bullet to purée anything.
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Yes A/D is good, but very high fat and can cause diarrhea. Anything you can purée with water in a blender will work.
 
PerfumedCatMom said:
I have the syringes for feeding and tried to unsuccessfully squirt some water into her mouth this morning. Remind me what the best food for syringing is? Is it Hills AD? I don’t want to syringe raw and create any aversion. I have the Magic Bullet to purée anything.
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Is there any commercial food that her tummy is accustomed to or used to be accustomed to before going raw? It will cause less gastrointestinal upset. Weruva?
 
You just don't want to use her usual food in case she develops a food aversion to what you're syringing.
I've gone so far as to puree boiled chicken and water and syringed that when all else has failed. Hopefully you don't have to do it for long if you have to do it at all.
 
Suzanne & Darcy said:
Is there any commercial food that her tummy is accustomed to or used to be accustomed to before going raw? It will cause less gastrointestinal upset. Weruva?
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Yes, I fed her some la Weruva yesterday and she ate it. I can purée that. I will also go and buy some Gerbers baby food. It’s the Stage 2 food that’s good, right? Will also have to watch those syringe feeding videos.
 
Butters & Lyla said:
You just don't want to use her usual food in case she develops a food aversion to what you're syringing.
I've gone so far as to puree boiled chicken and water and syringed that when all else has failed. Hopefully you don't have to do it for long if you have to do it at all.
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Yes. And you could add some EZ Complete to it if you wanted to.
 
PerfumedCatMom said:
The vet said that after the ultrasound the results would go to an IM first before any decision would be made about further diagnostics like a biopsy. It would not be today.
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The only question & potential issue is the wait given the state of things due to the pandemic. I would ask about the wait time if they see something on ultrasound and the decision is made that an FNA or biopsies are recommended. Oftentimes, if you leave, you need to wait for an IM read (ask how long it will take if you leave vs admission) & then make an Appt for an IM visit (another wait)and then additional diagnostics are scheduled from there....more wait times. The risk is having to return through the ER because of the backups with scheduling.

Every place is different right now, but it is worth asking to determine the best plan.
 
Tomlin said:
The only question & potential issue is the wait given the state of things due to the pandemic. I would ask about the wait time if they see something on ultrasound and the decision is made that an FNA or biopsies are recommended. Oftentimes, if you leave, you need to wait for an IM read (ask how long it will take if you leave vs admission) & then make an Appt for an IM visit (another wait)and then additional diagnostics are scheduled from there....more wait times. The risk is having to return through the ER because of the backups with scheduling.

Every place is different right now, but it is worth asking to determine the best plan.
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Indeed. That’s why I asked if she could have a biopsy today if the US indicates that it’s necessary and vet said no, that I’d have to have a consult with an IM. When I called for an appt yesterday with an IM I was told the wait would be one month. However I came to AMC specifically to do the US on the chance that I could be fast tracked for a biopsy if needed.
 
So, the work around/fast track is usually an admission which then moves the patient from the ER to the IM group. That at least removes the wait time for the read of the ultrasound & an Appt with IM & potentially (not guaranteed) a wait for additional diagnostics if they are recommended and you decide to move forward.

If you don’t admit, the patient stays assigned to the ER & now you have to wait for an Appt with IM.
 
Suzanne & Darcy said:
Yes. I was wondering- if you don’t admit her .. will you go to the back of the line, as it were, for getting any further diagnostics done? You should ask
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I will ask. I also asked if the US shows bad changes if we could start on budesonide and chlorambucil while we wait for a biopsy and she said no because she would not want the drugs to affect the biopsy.
 
Tomlin said:
So, the work around/fast track is usually an admission which then moves the patient from the ER to the IM group. That at least removes the wait time for the read of the ultrasound & an Appt with IM & potentially (not guaranteed) a wait for additional diagnostics if they are recommended and you decide to move forward.

If you don’t admit, the patient stays assigned to the ER & now you have to wait for an Appt with IM.
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I guess I will have to see what the US says, ask about wait times and then go from there...Thank you for the heads up about this.
 
PerfumedCatMom said:
I will ask. I also asked if the US shows bad changes if we could start on budesonide and chlorambucil while we wait for a biopsy and she said no because she would not want the drugs to affect the biopsy.
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I REALLY hate to say this....but given how overwhelmed the systems are right now, if you can manage it & given the situation, I would admit.
In normal times, getting the follow up IM Appt wasn’t the problem it is now.
 
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Tomlin said:
I REALLY hate to say this....but given how overwhelmed the systems are right now, if you can manage it & given the situation, I would admit.
In normal times, getting the follow up IM Appt wasn’t the problem it is now.
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Just called Ruby’s primary and he concurred with what you said. If they find a large mass, god forbid, they can do an FNA. If not, she will have to be admitted because she’s not eating and we can’t wait a month.
 
Sorry I'm late to this. I am SO sorry to read what's going on, and that AMPS is way out of the norm for Ruby so something is definitely going on.

It is unclear to me why the vet was asking you in the first place why she should be admitted? Unless it's for all the reasons @Tomlin mentions and I'm leaning towards agreeing with that.

I guess it also depends how comfortable and proficient and experienced you are with home nursing as an alternative. I was not. I do not have any history of fostering cats, sick or otherwise, so it was a great weight off me to have her under professional care. The not-eating is now my ongoing biggest fear though, and when Minnie was in/out of the hospital last month it was mostly because she refused to eat...which turned out to be because of the low potassium and ketones. Appetite stimulant and anti-nausea didn't work, even the feeding tube didn't although it helped. - there again Minnie had known and treatable concerns that I couldn't resolve at home (low potassium needing IV fluids) despite the feeding tube. She was in the ICU so extremely $$$.

One thing I learned is that taking the ketone readings with a blood meter (I use the novamax) gives you information much earlier than the strips - strips will show negative for quite a while whereas the blood meter starts indicating the increase. Minnie is susceptible to ketones so I check pretty often with the meter - not that it makes a whole lot of difference to what I do. Feed more, add a bit more water to her food and give the R if BG indicates it's needed. And worry a whole lot. Not necessarily helpful.

Beech Nut baby food is another option - turkey or beef, ingredients turkey & gravy only (possibly chicken). They had it at Walmart.

Hill's AD is my go-to for Minnie now if she's refusing all other foods.

Hang in there. We are rooting for you and Ruby. :bighug::bighug::bighug:
 
Liz & Minnie said:
Sorry I'm late to this. I am SO sorry to read what's going on, and that AMPS is way out of the norm for Ruby so something is definitely going on.

It is unclear to me why the vet was asking you in the first place why she should be admitted? Unless it's for all the reasons @Tomlin mentions and I'm leaning towards agreeing with that.

I guess it also depends how comfortable and proficient and experienced you are with home nursing as an alternative. I was not. I do not have any history of fostering cats, sick or otherwise, so it was a great weight off me to have her under professional care. The not-eating is now my ongoing biggest fear though, and when Minnie was in/out of the hospital last month it was mostly because she refused to eat...which turned out to be because of the low potassium and ketones. Appetite stimulant and anti-nausea didn't work, even the feeding tube didn't although it helped. - there again Minnie had known and treatable concerns that I couldn't resolve at home (low potassium needing IV fluids) despite the feeding tube. She was in the ICU so extremely $$$.

One thing I learned is that taking the ketone readings with a blood meter (I use the novamax) gives you information much earlier than the strips - strips will show negative for quite a while whereas the blood meter starts indicating the increase. Minnie is susceptible to ketones so I check pretty often with the meter - not that it makes a whole lot of difference to what I do. Feed more, add a bit more water to her food and give the R if BG indicates it's needed. And worry a whole lot. Not necessarily helpful.

Beech Nut baby food is another option - turkey or beef, ingredients turkey & gravy only (possibly chicken). They had it at Walmart.

Hill's AD is my go-to for Minnie now if she's refusing all other foods.

Hang in there. We are rooting for you and Ruby. :bighug::bighug::bighug:
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There is a local vet tech who I can rely on if I need help managing her inappetence. It’s not something I feel like I need for the hospital to manage for me, although I completely understand why you kept Minnie in the hospital. I don’t have any experience manageing sick cats but I’m learning quickly! I will not hesitate to admit her if I have to wait a month for a biopsy. That’s just ridonkulous.

Still waiting for her to finish her ultrasound. I’ve been here 3.5 hours. o_O
 
:bighug:

Those waits are excruciating. Minnie had her 1st scheduled appt with her new IM exactly as she started getting ill and they kept her in for an U/S and she was in all day. I asked them how long it would take so at least I knew and didn't sit helplessly in the parking lot. Hang in there. We're all in the virtual parking lot with you. :bighug:
 
River East Deli :).....they have some really yummy baked goods :bighug:!! I would send you to the Irish bar but that won’t work with this situation :rolleyes:.

The wait times have become out of control. They have literally stopped accepting new IM consults at our U because of how backed up they are :(. Definitely have no choice but to circumvent the system these days depending on the situation.

Hang in there & if you get baked goods...eat a slice of their banana bread for me :p!
 
Liz & Minnie said:
:bighug:

Those waits are excruciating. Minnie had her 1st scheduled appt with her new IM exactly as she started getting ill and they kept her in for an U/S and she was in all day. I asked them how long it would take so at least I knew and didn't sit helplessly in the parking lot. Hang in there. We're all in the virtual parking lot with you. :bighug:
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I did spend two hours outside in a park by the East River watching kids play and ate an egg and bacon on a roll. It’s a beautiful day here so I can’t complain too much. Thankfully AMC allows people to come inside so I’ve been in the waiting room, one of the happiest and saddest places on earth.

Tomlin said:
River East Deli :).....they have some really yummy baked goods :bighug:!! I would send you to the Irish bar but that won’t work with this situation :rolleyes:.

The wait times have become out of control. They have literally stopped accepting new IM consults at our U because of how backed up they are :(. Definitely have no choice but to circumvent the system these days depending on the situation.

Hang in there & if you get baked goods...eat a slice of their banana bread for me :p!
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Would be fun to go to an Irish bar right now. NYC is allowing drinking at the bar again. I’d be hanging out with the diehard UES afternoon drinkers. :woot:
 
Prelim US report definitely shows abnormalities, thickening everywhere (I missed the parts she described). ER vet said def IBD but further exploration is necessary to be sure. She said it is more likely that she can get an endoscopy or biopsy if she is admitted, so I left my sweetness there alone and scared for at least a day. If she starts eating again soon then I can take her home but I will still be at the top of the line to get a biopsy because the IMs will have seen her by then. At least I think that is what she told me. Ugh. My head is spinning! Where’s that Guinness?!
 
:bighug: Diagnosis is the path to treatment. While she is admitted, go home and try to sleep well and take care of all those other things that you've put on pause (like, yourself). This is time to regroup. And cuddle Olive if she'll tolerate...Sam was surprisingly needy when Minnie was out. The Guinness might help with the sleeping! Like the ad says - Guinness gives you strength!

I had a friend in England who said they used to give her mother Guinness after donating blood. All that iron! A far cry from juice and cookies....

Take care and I hope you are feeling some small level of relief that they can move forward quickly with treatment. I found that the hospital stays were definitely a fast-track to getting an IM. Even if they don't speak to you, the ER and other doctors on hospital duty will talk to them. And as you say, you get to the top of the line.

:bighug:
 
Big hug. Very hard situation but the best decision—jump that line!! She is definitely so sweet that the techs and docs will be giving her a lot of attention :bighug: so she won’t be alone :(.

Time for you...Re group and have that Guinness and some food :bighug:.
 
PerfumedCatMom said:
Yesterday’s drama.

Ruby ate about ⅓ of her PMPS meal last night and nothing else since even though I gave her a Cerenia and Mirtazapine. She slept curled in a tight ball next to me last night as I kept trying to ply her with food. Shocked by her number today. Taking her to AMC now. Hoping they can help my sweet girl.
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Sending prayers that Ruby has something treatable, that she starts eating, that you get answers and a plan of action today, that you can manage her care. So sorry Katherine, I don't understand the acronyms everyone uses but it all sounds scary. Our kitty Funny Face had all of the not eating, nausea, vomiting and diarrhea that Ruby has gone through. She had so many things wrong with her. Including an ultrasound that showed possible small cell intestinal lymphoma. Definitely IBD. We chose to not do a biopsy. She had high BP, IBD with constant diarrhea and nausea, hyperthyroidism, diabetes.
I kept notes on her progress and I definitely remember the constant worry and fear. My heart is with you and I know you will do whatever feels right for Ruby. These are hard decisions and you have all of us supporting you and Ruby with our love and prayers :bighug::bighug::bighug::bighug::bighug:
 
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