9/3 Sushi - Eating Minimal - AMPS~278 | +4~82 | +5~266

[Sushi (GA 5/05-3/14)]

We are still on the mend from Friday's episode with ketones in the small to mid range + our trip to the vet. Sushi was almost back to normal Friday night and all day Saturday, but his eating took another nosedive yesterday and has continued to be minimal today. If the vet were open, I'd take him in for more sub-q fluids. I've dropped his dose to 2 units until his eating resumes.

Yesterday, he let me sleep through my alarm for our AM shot time. He was snacking on his sister's food sometime in the early morning, but even still, letting me sleep has NEVER happened in the history of Sushi!!!

Overall, he seems happy and healthy. None of the other symptoms I described in the post linked above when I picked him up from boarding. He's sleeping a bit harder and more than usual, but that's it! He's even cheering for food today! Here he is in a little tent he made for himself:

I'd like to get more ketone tests, but Sushi likes to "hold it." And he's very quiet about his trips to the litterbox. After waiting all day yesterday, I had to resort to putting him in the litterbox :? to get a test last night. Thankfully it was negative despite the drop in appetite.

I found it odd that he jumped from 82 to 266 in an hour. I know it has to do with food, but that's such a significant difference!



I'm just super discouraged and frustrated by all of this. I just wish he'd eat, dammit! ohmygod_smile I don't have unlimited resources to bring him to the vet every other day. And I'd love to be able to enjoy my long weekend instead of spending it as a nervous wreck trying to hand-feed Sushi.
Because this is happening so often lately, I wonder if there's something going on bigger picture. I'd like to know what continues to cause these urinary tract/bladder infections, etc. and treat it as a whole instead of treating each individual flare up.
Oh, and BTW:

Also, it would have been better if the vet did a sterile urine draw (cystocentesis) and run a culture and sensitivity (C & S). It the antibiotic didn't clear up the infection before, it may be the wrong antibiotic for the bacteria. The value of the C & S is that you know what bacteria is present and the correct antibiotic can be prescribed.

I was reviewing the invoice from our trip, and it looks like they did do a cystocentesis.

Hope you're enjoying a nice Labor Day!! : )

 

[max&emmasmommie]

Hey, just had to give you a thought quickly -- get a used baby monitor -- you'll need a good one as the cheap ones pick up too much interference, and put the receiver next to the litter box. It really helped me when I was trying to catch Max's urine for ketone tests.

Also: RE:

Sienne and Gabby wrote:
Also, it would have been better if the vet did a sterile urine draw (cystocentesis) and run a culture and sensitivity (C & S). It the antibiotic didn't clear up the infection before, it may be the wrong antibiotic for the bacteria. The value of the C & S is that you know what bacteria is present and the correct antibiotic can be prescribed.

You wrote:
I was reviewing the invoice from our trip, and it looks like they did do a cystocentesis.

\

And did they also do a Culture or did the vet skip that part?

Have a good day.

 

[Sushi (GA 5/05-3/14)]

Hey Dale!
The baby monitor's a great idea! Thanks so much for that thought.
I believe they did a culture as well?:

I just called the vet. The ER side is open today. They said they're super busy right now, but I can bring Sushi by later and they'll do more sub-q fluids. Would that be a good move?

 

[Sienne and Gabby (GA)]

A culture and sensitivity takes at least 3 days for results. I doubt they did one. I can't tell from your print out if they did a cystocentesis. I bet they simply looked at the urine under a microscope. It's not the same.

FYI: Here's how ketones develop --

ketones = not enough insulin + infection + not eating​

Do NOT cut back on Sushi's insulin. Instead, feed high carb or whatever he'll eat. I said this to Desi when Tawny was so sick with DKA: I don't care if you have to feed your cat a hot fudge sundae. Give whatever he will eat and we can adjust the amount of insulin. You may have to assist feed. If you do, use a food that you don't regularly feed since cats can develop a food aversion from being assist fed. If you reduce the insulin, you risk DKA.

I would take him in for fluids. You may also want to ask about an appetite stimulant (mirtazepne or ciproheptadine). That will help to get LC food into Sushi. Also, if you're going to the ER, ask if they have a feeding syringe or MaxCal. It's a calorie dense food.

 

[Leslie and Jasper]

Hi Ashley, Glad Sushi seems happy and healthy even he is if not eating much. A couple thoughts:
There were some posts recently how sub-q fluid affects bg numbers, something about timing or spacing out the fluids and bg tests and shooting, I dont recall the specifics. You may want to search the board and also modify yor original post to add the sub-q question and question icon so those who know more about it can respond.
If Sushi will need sub-1 regularly, you may be able to administer them at home. I did that with our 2 CRF cats and home treatment was easier on all of us than taking them to teh vet for that. Marje made a video showing how she does it, there is a link on this board.

 

[Ann & Tess GA]

Have you done a skin pinch test to see if he is dehydrated?

Perform the Skin Turgor Test on Your Cat

Now test your cat. Here’s how to do a skin turgor test for dehydration on your cat: http://virtuavet.wordpress.com/2010/09/01/how-to-tell-cat-dehydration/

• •gentlypinch some skin on the back of the neck/shoulder area.
  •If the skin stays up and does not go down, your cat is so severely dehydrated you have to get to a veterinarian urgently.
  •If the skin takes a second or two to go down, you have to go to the vet’s because of moderate to severe dehydration.
  •If your cat’s skin snaps back in place, you annoyed your cat with the test, fur is thick and shiny, and your cat is lively and happy, why are you reading this? Prepare a cup of organic green tea and leave your cat alone!

 

[Sushi (GA 5/05-3/14)]

Hi!
Ann, no skin test; I've never heard of that! Sushi is very fluffy; he'll need trimming to do this. I guess one of my biggest questions is:
Will giving him fluids increase his appetite? Will they help?

Sienne, my question with the insulin level is how much insulin is the "right" amount? His numbers are high, but about the same as they've always been even though he's at 2 units. That's what's throwing me off in gauging his insulin level.

I actually have been feeding him high carb food, just trying everything to get him to eat! He's not eating it, but he is licking the gravy off of it. So he's got some high carb food going on in his diet, less insulin, and his #s are still the same as usual. @-)

 

[Roni and Moonie]

Hope Sushi is coming down & will feel much better soon--Sienne's post was totally right--Feed him anything that he will eat...cant worry abpout the numbers today, and 278 isnt that bad...
Healing Prayers to Sushi today-Hugs from us!

 

[Sushi (GA 5/05-3/14)]

...I bet he'll eat dry! :shock:

 

[Ann & Tess GA]

How about baby food or plain tuna? Chicken, cooked or raw?

 

[Sushi (GA 5/05-3/14)]

He'll eat canned chicken, I do know that. But last time this happened, everyone discouraged this as it didn't have enough calories.

 

[Ann & Tess GA]

Right now getting him to eat anything is what's important.

 

[Wendy&Neko]

I'm sending some "eat your fuds" energy over to Sushi. Hope he feels better soon.

When I was at CSU last month, the IM vet gave me a trick to test ketones. I haven't tried it yet, but it's worth trying for a "shy" kitty. In her words on the discharge notes "mix a urine clump of litter with a few tablespoons of water to release the urine. Then, dip the stick in the water/urine." She was recommending it with KetoDiastix but I'd think Ketostix would work the same way.

 

[max&emmasmommie]

As for dehydration, If he's drinking water, he is probably at least a little dehydrated, but that doesn't tell you how badly UNLESS he keeps coming back to the
bowl over and over again.

Another way to check for dehydration. If the skin turgor test shows that the skin doesn't go back very quickly at all, that's enough of an indication that you have a big problem. However, if you are having trouble figuring out how bad it is because it goes back mostly at first, but doesn't "snap back" then, someone very experienced told me that you can put your finger on his gums and if they are "tacky," he's dehydrated. She said the gums should feel "slick." She thought this was a better way to determine dehydration than the skin turgor test for the moderately dehydrated kitty.

Right now when he won't eat well, if I were you, I would rather give subQ fluids so that every bite of food is as high in calories as possible and so that the space in his tummy for food is not taken up with water. For the future if you find that dehydration is a recurring problem (and it seems to be for a lot of diabetic cats):

Cat fountain. I don't remember if you have a cat fountain. Mine's a Petmate. The cheap ones make a lot of noise, and some cats are turned off by that; it drives me batty, too. It really seems to encourage my cat to drink. He likes running water instead of still water -- must be an instinct to drink water that is not stagnant and therefore more likely to make the cat sick.

Mixing water into food. Another thing for down the road that helps some cats is mixing water into the food -- making it soupy. My cat hates this, and really struggles to lap up the food. He prefers a chunk that he can bite into. I give fluids at home anyway for CKD. So, I gave up on mixing the water into the food. However, if you can avoid having to give fluids this way, bonus!

Syringe water? Some people syringe feed water; not fun, but better than having to go to the vet if the dehydration is not too bad.

Giving fluids. I second the suggestion to learn how to give fluids at home. There are a lot of posts on this board about giving fluids, and you will get a lot of help learning to do it if you put it in your headline. Chronic dehydration leads to kidney disease (CRF/CKD); not want you want, for sure. I'm sure you can learn to give subQs or "squids" as some call them, and you can avoid the stress of the vet visit for this problem. You just need the right equipment and a prescription for fluids. I read that you want to get "lactated ringers" solution instead of "sodium chloride" solution. Apparently, sodium chloride solution can sting, and lactated ringers doesn't -- anything to make this process easier is good. My vet doesn't stock lactated ringers and gave me a prescription for it instead of helping me get it through his office. It's cheaper to buy a case of these bags somewhere else anyway.

Best of luck!

 

[Sushi (GA 5/05-3/14)]

Okay, I just gave him some dry food, and I'm shocked. He only ate some! Probably as much as he's eating of any of the other 2098423098432 foods I've tried over the past 24 hours.

I did the skin test, and it snaps back into place but takes a second to re-smooth out if that makes sense?

So, my questions:
Does he need fluids? Will that help?
How do I judge "not enough insulin?" in the ketones = not enough insulin + infection + not eating equation? By his regular dose? Or by #s?

 

[Dyana]

Hi Ashley. I'm very concerned with Sushi's not eating much, and his recent ketones. I would take him to the vet, if it were me. I know it's more money, but it's better now than being hospitalized for DKA, later.

Sending eating vines to Sushi.

 

[max&emmasmommie]

How did it come about that you dropped the dose from 3.0u to 2.0u on the morning of Sept 2nd? Please post that info here in this thread, if you would, and see if someone can help you decided what to do about the dose asap. I hope that even though it's Labor Day in the states, you will get answer about the insulin dose issue before too long. I notice that Sienne's post on Sept 3rd said

Do NOT cut back on Sushi's insulin.

and, I don't know if she meant do not stay with 2u -- go back to 3u -- or she meant do not go any lower than 2 units. I would want to find out. Maybe you should PM her or anyone else you know is around and is good with dosing? I'm sure either she or someone else will help you.

As for the subQ fluids, you wrote:

I did the skin test, and it snaps back into place but takes a second to re-smooth out if that makes sense?

That makes perfect sense, and that was exactly my question when I was told to touch his gums to see if they are tacky. However, I'm glad to hear that it does snap back most of the way all at once. At least it appears not to be severe dehydration.

Maybe you can camp out in the room where his litter box is or the room next door? I used to move it to my hang out room, but that can upset the cat. It would be so nice if you could get a ketones negative test result to set your mind at ease for a few hours.

 

[Sienne and Gabby (GA)]

I'm going to say this again:
I don't care if you have to feed Sushi a hot fudge sundae, feed him whatever it takes to get calories into him. If he refuses even kibble and you're then cutting back his dose because he's not eating, you will end up with a cat in DKA. There is no formula for how much insulin. He was on 3.0u and that's probably where he should stay and you can feed him whatever it takes to so you can shoot that dose.

If Sushi isn't eating and doesn't act like he's nauseated, you probably need an appetite stimulant. Do you have any idea what's causing the ketones? Has Sushi had problems with pancreatitis?

Ketones can change to DKA in a very short period of time. DKA can be lethal. I don't know how to get the message across any more clearly that you need to be vigilant with respect to ketone testing and get insulin and food into Sushi unless you want a very expensive hospital stay.

 

[max&emmasmommie]

That's what I was so worried about -- 3u to 2u is a big, big decrease. You probably won't see it's effect immediately, but when it does hit you could be very sorry you thought it was the right thing to do. Please trust yourself that you can test him and catch a low, and you can bring him up with high carb food in almost every circumstance. What you can't do is help him without vet assistance if he gets DKA, and there are times that the vet can't fix it unless you catch it very early, thus the ketone testing. I'm sorry to see you so scared; I would be, too. Hang in there!

 

[Marje and Gracie]

Ashley

I want to stress that you need to get food, insulin, and fluids into Sushi. You can save money by doing the fluids at home. Dale is right...you want lactated ringers solution. Dale said sodium chloride stings but that is just saline...it doesn't sting; Normosol stings. Hers what I think, IMHO, your plan should be:

1. Take his dose back up to 3u

2. Try to find some maxcal...ask the ER clinic if they have it; if they don't, get wellness chicken and purée it with water so it will go through a syringe. Ask the ER clini for a 10-12 cc(ml) syringe and assist feed him! If he is nauseous, he needs ondansetron for that..is he licking his lips, drooling when he smells food? Here's a link to a great video for syringe feeding:
assist feeding

3. Get a bag of LRS from the vet and 20-21g needles...the smaller the number, the faster the flow. Here is a link for giving subq fluids at home:
subqs

You just might have to stay there and care for him and you might lose sleep but he can slide back downhill fast and then you will be stuck with either a huge bill or having to make a decision you don't want to make. We are all trying hard to help you and let you know how serious this is, ok?

And on the dehydration, if his skin/fur do not snap completely back in place fast, then he's dehydrated....so also check his gums.

Also..from the lab, if they withdrew the urine by cysto, then it looks like they did not do a c&s unless there are other results you don't have.

 

[Sushi (GA 5/05-3/14)]

Sushi and are recovering from this evening's vet visit. I took him in for fluids, and next thing I know, 3 hours have gone by, we're an hour past shot time, I'm about to die of hunger, Sushi's covered in his own urine and poo, all for a vet visit that didn't tell me anything I couldn't have found myself at home. They were able to scoop up the pee from his carrier and test it for ketones. No ketones. His blood glucose was in the 300's. He didn't really need fluids, but we did it anyway. That's all I got.

When we first got there, the vet tech went back to do the sub-q fluids, but came back telling me she thinks he needs to be examined. I told her I didn't think that was neccessary (judging from her explanation and seeing as how we just did all of this 3 days ago), and explained the situation of how he deteroriated to this state in their care. Somehow she ended up dragging me back to the exam room, one thing led to another, and they're doing another full exam. I think she was trying to make up for the horrible experience of boarding Sushi there. Somehow in the process of being examined, Sushi peed and pooped in his carrier...
For the amount of stress it caused both Sushi and I, I just don't think it was worth it. I'm kicking myself for not being more assertive. I knew in my gut that anything other than some fluids and an appetite stimulant was unnecessary. They didn't charge me for the exam, but still.

They did give him some mirtazepne, and prescription for it as well. I hope it starts to kick in soon!

About the 3 unit dose: Sushi's not eating. So what can I do to bump him up if his #s start to drop? I'll be in BIG trouble. I just don't think it's wise to put him or myself in that situation.

You probably won't see it's effect immediately, but when it does hit you could be very sorry you thought it was the right thing to do

What effect is this?

I'm sorry to see you so scared; I would be, too. Hang in there!

THANK YOU!! It means the world to me to have how I feel acknowledged!

I don't care if you have to feed Sushi a hot fudge sundae, feed him whatever it takes to get calories into him. ... feed him whatever it takes to so you can shoot that dose.

He's not eating really much of anything at all. That's my concern with his dose.

Do you have any idea what's causing the ketones?

A UTI

Has Sushi had problems with pancreatitis?

Not that I know of.

Ketones can change to DKA in a very short period of time. DKA can be lethal. I don't know how to get the message across any more clearly that you need to be vigilant with respect to ketone testing and get insulin and food into Sushi unless you want a very expensive hospital stay.

I've been there and understand this very well. Sushi had a severe brush with DKA in January 2011. He almost died. This is how I found out he had diabetes.

Please trust yourself that you can test him and catch a low, and you can bring him up with high carb food in almost every circumstance.

That's the issue! I CAN'T bring him up with high carb food because he won't eat!

I need to be honest -- I'm stressed. Beyond belief. I'm facing a myriad of health problems because of it. Sushi is one of the top 3 most stressful things in my life. I feel very close to the end of my rope with caring for him. Testing him, giving him insulin on a regular schedule, dealing with the close brushes with hypo and the regular vet visit are about all I can do. But there just seems to be no end to what I should be doing for him. I can never win. I can never do enough. I can't ever spend enough money or time, both of which I'm maxed out on. I just feel very close to a breaking point and don't know what to do. I love Sushi with all my heart, and I'm doing the best I can, but it's just not enough. I feel completely stuck between a rock and a hard place. :cry:

 

[Deborah & Shasta]

Ashley, I'm so sorry to hear that you are going through all of this. The vet visit sounds like a complete disaster and Sushi probably just wanted to be home with you. I hope he is able to cuddle with you some tonight. I know this doesn't help any, but we are their everything. We are their caretakers; we are their mothers/fathers; we are their providers; we are their nutritionists and their real doctors who know them best when they are ailing.

Just this past week, my freshmen boys asked me to come to their football game. I told them that I couldn't and I explained why...my cat has diabetes and I need to be there for her shot time and to monitor afterwards. One dumb little boy had the nerve to say, "You should shoot it." Plain and simple in his mind. The thought of ending my cat's life terrifies me, as I'm sure it does you and everyone on this board. We also know how expensive it is and how stressful it is, but we all make that sacrifice. I am glad you posted your last post because you are certainly not alone. Someone will come along and have great advice to try to help you and Sushi. Please don't lose sight of the fact that Sushi needs you...stress and money aside (I know...easier said then done.)

I hope this didn't sound too preachy...I didn't mean it to be...I'm worried about both of you. I have no dosing advice, but is there anything he will eat? I know that when Shasta refused to eat, as soon as I opened a can of her Friskies (mid/high carb), she had NO problems with finishing her meal and wanting more. She has also really found a LOVE for the PureBites treats. When she's not feeling much like eating, I crush one up and sprinkle it on top of her meal. Voila! Again, every cat is different and I'm sure you've tried everything. Just wish I could give you guys a great big ((HUG)) and help you and Sushi heal.

Blessings to you and Sushi. ~Deborah & Shasta

 

[Sushi (GA 5/05-3/14)]

Hi Deborah!
I'm responding from my phone, so excuse the typos and the brief-ness. I really appreciate your response!!! I needed the encouragement.
I've tried all you suggested to get Sushi to eat. And then some! ; ) I do appreciate the ideas.
Thanks again!! : )

 

[Marje and Gracie]

(((Ashley))))

Breathe...just for a minute....stop and take some really deep breaths and let it calm you. Exhale slowly. You've been through a lot lately. I'm hoping a little food has also helped you.

There is nothing harder or more stressful than a cat that won't eat. That's why we assist feed. He has to eat or you will also be dealing with feline hepatic lipidosis.

Dale was talking about the effects of decreasing his dose....she meant that the depot from the 3u may carry him over a bit but then you will start to see the effects of the reduction in much higher numbers. Add infection and not enough calories and you are possibly back at DKA.

Most of us have been where you are so we do understand and your feelings are extremely valid. But you can do this...you can take care of him.

One reason I wanted you to ask for ondansetron is because if a cat is nauseous, it is best to not give him an appetite stimulant. Vets miss the mark on this almost every time....why try to make a cat who is nauseous eat without addressing the nausea first.

It's ok that they gave him fluids. Now the focus needs to be on you getting food into him...if he won't eat, then finger feed him by putting food on his tongue (be sure you don't push it down his throat and make him choke). Start with a little. Nif that won't get him eating, you must syringe feed him.

 

[max&emmasmommie]

Ashley,

I would be just as stessed as you are, and I have been. We don't want you to be even more stressed if he gets ketones again. I am so relieved that Sushi had no ketones. Whew! That is good, good news. I'm also really glad they did not charge you for the visit. I think as miserable as the visit was, it was worth it to know that, right now, he does not have ketones. You should relax a little and get to work on getting him to eat and testing him to keep his numbers under control.

He will lick the gravy off of the food, right? And he went from 82 to over 200 after he licked gravy. That's good, too. If gravy does that, think what Karo syrup on his gums will do. If you can't get him to lick gravy, you can syringe feed him as long as he's alert, but if he gets too low, you can rub Karo on his gums. It works so fast and so hard that most of us let the BG get as low as 39 or lower before we even want to try it. You can try a little when you get scared. It will absorb through the gums, and it doesn't matter that he didn't take it willingly.

I'm willing to bet that if he gets low enough for Karo he will lick the gravy. This is because he did when he was only at 82, right? I hope you have lots of cans of the gravy food. You can give Karo when the BG is in the high 40s -- which is usually NOT low enough for Karo, but when you are scared, well -- whatever works, right? Just give a little bit rubbed into the gums and then test him a few minutes later before you give more. You don't want him to shoot too high. You will see what it does, and you will become much more confident.

Also, in a worst case scenario you can put Karo in his bottom -- yup, that's right. It's nice to have an eye-dropper or an oral syringe for this, of course, but it works. It absorbs through the tissue. This is what you want to do if he is not really awake and won't wake up, or if he's groggy or, of course, passed out. The point is you can get his BG up whether he co-operates or not in almost every circumstance by using Karo.

The problem with dropping his dose that much -- by 1/3rd -- when he has recently had ketones is that you may have had a full shed through the cycle directly after you shot the last 3u dose. You may not have, but let's assume you did, and you were getting pretty decent numbers. You have an infection and he's not eating. So, keeping those numbers good is of paramount importance. (I can't tell you what dose to give him specifically, but I, personally, would trust Sienne's judgment on this.)

If you had a full shed back then, you will not see the effect of the 2u dose for the next cycle, and maybe not the next, and maybe not the next. It can take up to 6 cycles to see it. This is why the fact that you are getting the same numbers, or at least Yellows which are better numbers, after shooting 2u ONLY three times/cycles means nothing. You won't know for sure if dropping the dose was a mistake until you have either a) sky high numbers OR b) you get to the end of the 6th cycle. The stakes are too high to be wrong right now. Even dropping the dose by 0.25 -- one- quarter as much as you did -- would have been much, much better than by a WHOLE unit. By the end of the 6th cycle you will have been giving him only 2u for 3 full days, and you will be way behind. His BG might shoot up very high, and you have the other two risk factors for ketones all ready happening. You can't risk having the third. You won't be able to make up for it fast enough. Hopefully, it's not too late.

This is from my experience: I feel that by shooting 2u three times, you have already depleted the shed enough that you are going to start to see higher numbers quite soon, and if he starts to eat again and the antibiotics start to work, you might be ok in both directions IF you raise the dose again now -- said directions being DKA on the one hand and hypo on the other. However, antibiotics sometimes don't work at all or the BG goes down even 10 days AFTER the course of antibiotic is finished, if ever.

I've never used an appetite stimulant, but I'm glad you have it now. [Hopefully someone will chime in here with some advice about watching out for nausea. Maybe Sienne will.] Were you able to get the MaxCal food, too?

I hope this makes sense, and makes you feel more confident both in giving a higher dose, and in your ability to deal with any potential issues that do that may cause. Please keep posting and letting us know where his numbers are, whether he's eating, and what else you need from us.

 

[MelanieAndRacci]

Hi Ashley,

Sorry you're having such a rough time of it. Will you be home with Sushi tomorrow or do you have to go to work? Were you able to start the new medicine yet? Did it help?

Sometimes they'll eat some baby food or tuna fish when they're not eating anything else. You could also syringe feed him a little food every couple of hours. If you could even get 5-10 syringes of watered down pureed food in him that way it would be enough to keep food in his stomach and maybe once the medicine starts working he'll start eating again. Just keep offering food in between syringing.

If he won't eat you can always bring his bg up with honey or syrup on his gums or given with a teaspoon. Is the diarrhea from the antibiotics?

Melanie & Racci