Back home from the ER, but things aren't improving

[Frasier's Mom]

Hi Friends! This is a follow up from my introductory post here, but I'm in desperate need of help and advice.

Frasier came home yesterday afternoon after spending two nights at the ER. He looked very rough around the edges, but the doctor said he was doing better - eating, drinking, and his blood sugar went down to 101. I was really surprised and very excited that things were turning around. She warned me that he would be exhausted and would most likely sleep heavily when he came home (which he did). He was prescribed Metronidazole and Cerenia, and we were told to continue 2 units of Lantus twice daily unless things change. We were also told to continue using the Denamarin and Clavamox in addition to what he was prescribed.

So When we get home, I notice he seems more alert, he's not wincing in pain, and his breathing looks better. He drank some water and ate a little bit of food before falling asleep. He didn't eat or drink for the rest of the night, and the next morning I noticed he didn't seem as alert as he did before. I check his BG and it's jumped to 401. I put out his favorite plate of Friskies Turkey Pate, but he wouldn't eat any of it. He usually has a strong appetite (his nickname is meat cat) so I knew there was something wrong when he didn't even bother licking his food. His doctor couldn't make sense of it either since he ate so well in the ER. She told me to increase his dosage to 3 units and keep an eye on him. I gave him all his meds (which he would later throw up), and hoped and prayed that things would get better.

His numbers only got worse through the day, though, and he started to become dehydrated. He slept a lot and would find places to hide while he rested. He occasionally would walk around, but it was mostly to say hi to our other cat (who was none too pleased with his new scent). I was becoming really concerned about his appetite, so I called our vet again to get a prescription for Mirtazapine. He became hungry, but still wouldn't eat!! I tried feeding him three different brands of wet food but he would only lick at it before walking away. I found he liked turkey and turkey broth baby food, so I decided to force feed him so I could administer his next shot of 4 units (recommended by his doctor).

It's now almost 2 hours past his pm shot, and his BG is at 516. I've once again been crying my eyes out because I worry we'll never find a resolution, but I'm not giving up on my meat cat! We're waiting to see how things change tonight before we take him back to the ER. Any suggestions or tips would be much appreciated!!

 

[Squeaky and KT (GA)]

Do you have something like essential oil burners or any kind of 'aroma' by chance? If so please stop those. Anything in your home environment that might be different than the 'air' at the vet? Have you tried taking him to the garage or even outside for a while and see what happens? Something definitely isn't normal. IMHO, I don't think it's related to diabetes. Truly looks more neurological.

HUGS and thoughts and prayers....

 

[Frasier's Mom]

We do have a wax burner but we haven't turned it on since he got back from the vet. He's been very twitchy, though. He's always had a funny head twitch (usually when he kneads or purrs loudly), but now I can see it in his front legs. He has gone outside a few times. He kind of walks around aimlessly in the yard while I follow him, but seems to be alert and enjoys it.

 

[Chris & China (GA)]

Clavamox is notorious for making kitties sick to their stomach. When a cat is nauseous, they'll sniff at food like they want to eat, but then usually walk away, licking their lips.

It's not a good idea to give an appetite stimulant to a cat that's sick to it's stomach.

You might want to d/c it and see if his appetite perks up....if it does, try a different antibiotic.

Has he had any cerenia today?

 

[Frasier's Mom]

He did this morning. He threw up about 3 hours after he was given his meds, though. The vet told us to wait on the medication until he starts eating again. I did put some ice in his water dish which has helped him drink more water, and he's starting to eat his food rather than lick it.

 

[Frasier's Mom]

Update on my meat cat! I gave him 4 units last night which helped bring his BG down to the 300's. He's eating a lot more, but I haven't seen him poop yet. He did have an enema at the vet...could that effect his bowel movements two days later? His pre-shot numbers this morning (7 am) were at 351, so I decided to give him 3 units instead of 4. It's currently 12:28 pm and his numbers are at 281. Any advice on dosage this evening? Is it too soon to go back to 2 units instead of 3?

 

[Lillie]

No advice on dosage but anytime my cat had an enema or had diarrhea that really cleaned him out he didn't poop for a couple days after even though he was eating. Not sure this happens with all cats but it always happened with mine.

 

[MrWorfMen's Mom]

Just wondering how Frasier is doing now?

 

[Frasier's Mom]

Just wondering how Frasier is doing now?

Sorry for the late reply, but life has been a complete rollercoaster lately. Frasier hasn't been doing very well, and we can't seem to pin down what is causing his BG levels to increase. After a few trips to the vet, we've discovered that he has pancreatitis, arthritis, a heart murmur, and his heart is slightly enlarged. He makes a raspy sound when lying down, and he gets sniffly when he eats (sometimes sneezes when he sniffs at his food) so I thought he might have a cold, but his doctor didn't think there were signs of inflammation in his x-rays.. His eyes tend to stay dilated too, but we're not sure what the cause may be. We're having a talk with his doctor this week to figure that out. I'm concerned he might be going blind because he doesn't seem to see very well....or he's just REALLY spaced out all the time. He never bumps into walls or furniture, but he stands very close to me and sits in strange places around the house.

We were giving him Denamarin, Cerenia (as needed), Cosequin, and Gabapentin. The Gabapentin made him woozy, so we've discontinued using that and are giving him .1 ml of Bupex once or twice daily. He went in for another visit this week and now we're taking Benazepril, Famotidine, Orbax, Cerenia (as needed) and Metronidazole. We're still giving him Lantus, but his dosage is now 4 units twice daily and we're still not seeing any changes to his BG. His doctor thinks it might be time to switch him to Prozinc.

He's eating and drinking well, using the bathroom normally, sleeps regularly, and seems more alert than usual....but he's constantly showing signs that he's in pain. He always sits in the loaf position or lays on his side and winces in pain. His stomach gurgles like a jug of water is sloshing around, and his breath smells really sweet. To top it off, I watched him have another collapsing episode. I almost feel like I can't keep up with the changes in his health anymore. The last conversation I had with his doctor led me to believe that though we might find the answer to the problems he's having, resolving them might be impossible. He's definitely not the same cat anymore. All of the behaviors and quirks that made him who he is are gone.

I think the pancreatitis may be the culprit to a lot of his problems, but I can't keep him regulated when he has a flare up nearly everyday. Are they generally this often? He's still eating Friskies pate, but I'm considering changing his diet to something that is lower in fat. His doctor recommended Royal Canine, but I really can't afford it. I'm willing to try anything, though, so if anyone has any advice, I'm all ears!!

 

[MrWorfMen's Mom]

his breath smells really sweet.

I'm so sorry to hear Frasier is still under the weather. Is Frasier eating well? Chronic pancreatitis is a challenge and can cause elevated BG levels. Making sure kitty gets adequate pain control is key. I've never dealt with chronic pancreatitis but I think it usually comes and goes at variable intervals.
Orbax is an antibiotic. Did/does Frasier have an infection?

Your comment regarding his breathe smelling sweet leads me to wonder if you are testing for ketones. Given his high BG and ongoing medical issues, I would strongly suggest you get some Ketostix from your local pharmacy and test for ketones in his urine. Some folks can put a "designated" long handled spoon under kitty's butt as he is peeing or they use bunched up plastic wrap in the litter box to catch some pee to test. The test strips are time sensitive so read the label and make sure you are in good light when reading them. Alternately, you could ask your vet to test for ketones.

 

[Frasier's Mom]

He had a UTI. I actually just tested him for ketones, and he's between negative and trace levels. He's been eating like a champ, but tonight is the first time in a while that he's turned his nose up at his food. He's meowing at his water right now instead of drinking it. I gave him Cerenia about 5 hours ago so hopefully that perks him back up, and I have an appetite stimulant on hand if he refuses to eat. His BG about half an hour ago was at 316 (Relion Prime) which is fairly lower than what it has been.

 

[MrWorfMen's Mom]

I'm happy to hear the ketones are negative to trace. I'd definitely keep an eye on that aspect of his care though especially if he is showing signs of inappetence. Ketones can develop suddenly and can be dangerous.

On the diet side, have you checked out Dr. Lisa Pierson's food chart for something Frasier might like that is lower in fat and not so taxing on the budget? The link to the document is HERE.

 

[Chris & China (GA)]

After a few trips to the vet, we've discovered that he has pancreatitis, arthritis, a heart murmur, and his heart is slightly enlarged. He makes a raspy sound when lying down, and he gets sniffly when he eats

I don't want to add to your worries, but something to keep in the back of your mind is acromegaly. We don't usually suggest testing for it until a cat is on over 6 units, but a lot of these symptoms can be signs of acromegaly too.

@Wendy&Neko is the person here that knows the most about it. Hopefully she'll see the tag and offer some of her wisdom.

 

[Chris & China (GA)]

We're still giving him Lantus, but his dosage is now 4 units twice daily and we're still not seeing any changes to his BG. His doctor thinks it might be time to switch him to Prozinc.

While it's true that some cats respond better to a different insulin, I think I'd try Levemir before I tried ProZinc.

We've seen Levemir work really well for a lot of cats on higher doses of Lantus

 

[Wendy&Neko]

Not much to say on the possibility of acromegaly other than Frasier is showing some symptoms that are common with acrocats. One in four diabetic cats has acromegaly. But the symptoms alone are not an indicator of acromegaly, a condition caused by a benign pituitary tumour.

I would try to get a few more night tests if you can. Many cats go lower at night. A consistent before bed test is valuable.

 

[JL and Chip]

He makes a raspy sound when lying down

His stomach gurgles like a jug of water is sloshing around

Has he been checked for fluid in the chest or abdomen?
One way to see if there might be fluid in the abdomen is to hold your palm against one side, for example his right side, then gently tap the left side with your fingers. If you can feel the tapping on the other side of his body, there's probably some free fluid in the abdomen that's "transmitting" the tap. Heart issues can cause fluid to "leak" into areas where it doesn't belong.

His eyes tend to stay dilated too, but we're not sure what the cause may be. We're having a talk with his doctor this week to figure that out. I'm concerned he might be going blind because he doesn't seem to see very well....or he's just REALLY spaced out all the time. He never bumps into walls or furniture, but he stands very close to me and sits in strange places around the house.

Has he had his blood pressure checked? The first clue one of my cats had hypertension was her constantly dilated pupils. It looked odd, and a veterinary opthamologist confirmed that the high blood pressure had caused partially detached retinas and partial blindness (hence the dilated pupils). We started her on BP meds immediately, before the retinas fully detached, and it seemed that she regained at least some sight. Hypertension in cats is often secondary to kidney impairment.

 

[Frasier's Mom]

I don't want to add to your worries, but something to keep in the back of your mind is acromegaly. We don't usually suggest testing for it until a cat is on over 6 units, but a lot of these symptoms can be signs of acromegaly too.

@Wendy&Neko is the person here that knows the most about it. Hopefully she'll see the tag and offer some of her wisdom.

Thank you for sharing that with me. I think you're right about him possibly having acromegaly. We're visiting the vet tomorrow, so I'll be sure to talk to his doctor about it. I'm at a point where I know it's out of my limits to treat any extreme illnesses he may have, but I don't want to let him go without giving him the best possible change. In your opinion, do you think switching to a different insulin will help or am I just buying time?

Has he been checked for fluid in the chest or abdomen?
One way to see if there might be fluid in the abdomen is to hold your palm against one side, for example his right side, then gently tap the left side with your fingers. If you can feel the tapping on the other side of his body, there's probably some free fluid in the abdomen that's "transmitting" the tap. Heart issues can cause fluid to "leak" into areas where it doesn't belong.


Has he had his blood pressure checked? The first clue one of my cats had hypertension was her constantly dilated pupils. It looked odd, and a veterinary opthamologist confirmed that the high blood pressure had caused partially detached retinas and partial blindness (hence the dilated pupils). We started her on BP meds immediately, before the retinas fully detached, and it seemed that she regained at least some sight. Hypertension in cats is often secondary to kidney impairment.

I checked his chest and abdomen and I don't think he has any fluid leaking, but I will ask about it tomorrow. His blood pressure was checked last week, and it was on the high end of the average range. His doctor said it could have elevated from being in a strange environment with barking dogs nearby.

Thank you all for offering your thoughts! I've felt like I've been in the dark the past few weeks, and at this point, bad news is better than no news at all.

 

[Chris & China (GA)]

In your opinion, do you think switching to a different insulin will help or am I just buying time?

In some cats, when they get to higher doses of Lantus, it can start to sting, so we'll recommend Levemir, but if he's not showing any signs of distress, it's not worth worrying about right now.

The BEST thing you can do is start getting a minimum of 4 tests per day in...more if you can so we can see what's going on. The two Pre-shot tests and 1 mid-cycle (5-7 hours after the shot) on the AM cycle and at least a "before bed" test on the PM cycle.

As I said before, we don't usually recommend testing for high dose conditions until they're above 6 units, but if you can get your vet to do it, I don't see any reason not to go ahead if you want. The tests for acromegaly and IAA are only done at MSU so your vet would have to pull the blood and mail it to them for the actual testing.

Have you read the sticky on Acromegaly and other high dose conditions?

Even if he's positive for one or both, there are treatments possible so don't give up hope. We've had several cats recently get a newer surgery to remove the tumor that causes acromegaly (and there was an "angel donor" paying for most of the surgery) but we've also had cats that lived several years after diagnosis with a good quality of life without any intervention at all.