Anesthesia fasting/dosing advice

[Jennicat2012]

Hello, I made a long post of my cat and his most recent situation in the Facebook group yesterday, but am moving here for dosing advice. I was able to speak with the doctor today about fasting/giving insulin for Cairo’s CT scan/biopsy appointment on Thursday, March 17th. She said no dinner after midnight and give 1/3 of his normal dose. I was originally told they upped his dose from 4U to 5U when hospitalized, but his main doctor told me they were giving 6U am and 5U pm and to keep this dose. She isn’t worried about raising the insulin dose because he had such a high IgF-1 result, she just wants me to make sure there are no ketones in his urine. This makes me super uncomfortable, I’ve been giving 4.5U since he’s been released since i thought they were giving 5U and he was just raised to 4U on March 7th. Her recommendation is 2U on Thursday, no food after midnight. He has been eating great since being released, no ketones in his urine since he’s been back.

Unfortunately i haven’t been able to complete a curve until recently. With the current world events my work/home life has become pretty hectic. I feel horrible because i haven’t been able to give Cairo the time he needs and he had to be hospitalized again. I really want to be be able to keep this appointment if possible. I’m scared he may have lymphoma. His weird poops, enlarged lymph nodes, and out of range values are constantly brushed aside. They won’t entertain anything until a CT scan is done for acromegaly. The only reason he is getting a biopsy done is because i asked since he will under anesthesia for his CT scan.

His IgF-1 test is on the labs tab on my spreadsheet.

 

[Jennicat2012]

My original post.

My cat was hospitalized for DKA in January and was hospitalized for a couple days this week to receive fluids because he had ketones in his urine. I noticed trace ketones Tuesday night, took him to the vet where he received sub q fluids and cerenia. They wanted to hospitalize, but he was super stressed last time so i decided to take him home for the night and see how he did. His ketones raised the next day so he was hospitalized Wednesday afternoon. They called Thursday evening and asked me to bring him home for the night because he was so stressed he started having blood in his urine. I took him home and he immediately started eating, tested for ketones and they were gone. Tested again in the morning and still nothing. The wanted to hospitalize him for the day on Friday to continue fluid therapy. I took him home Friday night and has been eating fine, still no ketones in urine. He was receiving 4u Lantus prior, but they were giving him 5u while hospitalized. They also weren’t sticking to his 7:30/19:30 dosing schedule. I tried to explain that it is a depot insulin, not in/out, but it was hard with the language barrier. I am in Italy and this vet only uses Caninsulin. (Lantus was prescribed by another clinic, they’re not able to hospitalize.)

My concern is he has a CT scan/lymph node biopsy scheduled for Thursday, March 17th at 12:00pm. It’s at a specialist clinic about an hour away and was scheduled through his main clinic. It was hard to get this appointment. I know he’ll need to be fasted for this, but what about insulin? With his DKA history and ketones in urine this week I’m scared to skip either.

Reasons for CT Scan/ biopsy

CT Scan: When he was hospitalized in January an IgF-1 test was done, they suspect acromegaly. Basically all other concerns I have have been ignored since this test. I just want the CT scan done so we can move on from it. I’m not saying it’s not possible, i just feel there is something else going on.

Biopsy: He had an eye infection on January 29th, so i took him to the vet. While i was restraining so the doctor could stain his eye i noticed his lymph nodes under his jaw were swollen, almost golf ball sized. The doctor examined him and said his axillary and inguinal lymph nodes are also enlarged. He came back a couple days later for an FNA. We seen the doctor who originally diagnosed him with diabetes (late November) and she said they were a little swollen then, but didn’t think it was an issue and never told me. He was given clavaseptin after FNA results. Didn’t see any noticeable difference. His FNA results (Google translated): in both samples the cytological picture is indicative of chronic nonspecific hyperplastic lymphadenopathy. Should clinical doubt persist, further investigations may be useful.

He also had a Trypsin-like-immunoreactivity test. Vet said folate was high suggesting gut dysbiosis, has been on metronidazole for the past couple weeks. It’s helped a little, but not much. He also gets proviable. He has had consistent stool issues since January. They go from loose pale clay colored to black tarry. I have brought this up multiple times even bringing in samples showing how much it changes in a day, but it has not been a concern and is always brushed aside. I’ve also added his ultrasound results from when he was last hospitalized which showed inflammation. I’ve asked for another ultrasound, but they don’t feel it’s necessary. He has only received metronidazole, but that was after his TLI test.

 

[Bron and Sheba (GA)]

I would ask if you could do the subQ fluids at home. Most of us that need to do the subQ fluids, do them at home with no issues. We can help you get started. I would ask the vet.
Is Cairo eating well? Food and lots of it is important in keeping ketones at bay as well as the insulin and the fluids.
I am going to tag @Wendy&Neko about the dose of insulin as she is very experienced with Acro kitties.

 

[Jennicat2012]

I would ask if you could do the subQ fluids at home. Most of us that need to do the subQ fluids, do them at home with no issues. We can help you get started. I would ask the vet.
Is Cairo eating well? Food and lots of it is important in keeping ketones at bay as well as the insulin and the fluids.
I am going to tag @Wendy&Neko about the dose of insulin as she is very experienced with Acro kitties.

Thank you! I asked about doing subQ fluids at home and she suggested purina hydro care. I picked some up, but I’m going to try to get subQ for home again. He is eating great now! He usually eats at least 1 1/2 cans ff at a time, but i noticed his appetite decreasing on Monday which is why i began testing for ketones.

 

[Wendy&Neko]

Have you asked the vet what they would do with the CT scan results? The only people I've seen get CT scans for those with acrocats is if they are planning to proceed with hypophysectomy (surgical removal of the pituitary), or radiation therapy.

As for dosing, was he giving insulin the night of 3/9 or the mornings of 3/10 or 3/11? The entries in the spreadsheet are blank. If you could put in the vet dosing as best you can, it'll help me to help you. As is, he does look like he needs more insulin.

For the GI system, a GI panel, including B12 is helpful. Was that not tested along with the folate?

 

[Jennicat2012]

Yes, she said he would be referred to another clinic to either have it removed or start radiation. I have been to 3 clinics and all want a CT scan done to confirm.

Sorry, i updated it with the dose when hospitalized and added his TLI test results. They said B12 was fine.

 

[Larry and Kitties]

I think 2 units w/fasting is fine. Even going to 3 units wouod be fine based on the SS that shows little drop in BG with 5-6 units and food.

 

[Wendy&Neko]

Yes, she said he would be referred to another clinic to either have it removed or start radiation. I have been to 3 clinics and all want a CT scan done to confirm.

I think the clinic that is doing the surgery (either the Netherlands or UK for you) would prefer to do the CT scan themselves, rather than rely on one done elsewhere. You may end up paying for a second CT scan at those clinics. As for radiation therapy, the results from the scans are fed into the systems that plan the radiation paths. Again, those clinics will want their own CT scans so you'd be paying for a second scan there too. And more importantly, that's a second time he'll have to have anaesthesia. With acros, I strongly recommend not having them go under anaesthesia unless medically necessary. So many of our acros have heart issues. I would encourage you to not proceed with the CT scan until you get to the clinic where he'll be treated, should you go that way. He'd need to be out for quite a while for both a CT scan and surgical biopsy.

As for dose before anaesthesia, I agree with Larry that you could probably do to 3 units. I'd even recommend changing his current dose to 5 units while at home. 4.5 units isn't enough insulin.