Cat currently hospitalized, doing okay but no answers

[Christina&Pants]

Hi all

Pants and I have a long and complicated story, apologies in advance for my spreadsheet being behind, but we have not been following a typical regulation schedule and he has a lot going on to juggle. Current state: From all the diagnostics done so far, Pants does not seem to have had any diabetic emergency, but my primary and er vets have not determined what's going on. We may have to drive 4 hours to see the vet college internist Pants has been with before, but I'm really feeling the pressure of cost and time away from work. Figured I would come here in case anyone has insight, or at least emotional support.

Pants is FIV+/FeLV+. He has been anemic since FIP dx last September, which he beat, but the anemia has stuck around. Following a third round of treatment for haemominutum and first round of treatment for supected bartonella, he seemed to be doing well, so his internist recommended tapering down his prednisolone Friday 7/31, which I proceeded with. I was very wary of this potentially causing complications with his blood sugar, appetite, and notoriously bad dental hygiene. But his appetite got worse and worse until he was hardly eating at all Tues 8/4, yet his glucose was fairly high. I had him at my primary vet 8/5: bloodwork still as stable as it has been (on CBC and Chem17), ultrasoud OK, but lost 2 lbs in 3 weeks. Elevated bilirubin and something else that started with a u in his urine, but no ketones. Blood sugar had been pretty consistently 150-250 with no real effect from insulin. He is currently hospitalized receiving fluids and food through a tube, doing well. fBLI came back normal, so nothing pancreas related. I think they did another ultrasound and it was normal, introducing fluids did not cause his bloodwork to worsen either. ER vet doesn't really have any idea of root cause or prognosis based on what they're currently seeing, no red flags jumping out. He continues to do better and better with the fluids and tube feeding, but it's hard seeing him go through so much.

Would love any insight into other questions to ask the ER vet and/or our internist, especially if we end up having to drive back down to the internist. But mostly would love some emotional support. I visited Pants in the hospital last night, and he was a bit groggy from the sedation but otherwise pretty alert and himself. He made himself comfy on my lap and even purred softly. He seems to have plenty of fight in him still, but it's really hard dealing with a completely unknown issue and unknown prognosis right now even if he's making improvements

 

[Wendy&Neko]

Wow, who thought Pants could be become even more complicated! . Is he eating on his own yet? I'm glad the fluids and food eems to be helping him.

The only time I had something similar is when I tried to taper my IBD kitty off of steroids. At one point her body said no, and she got ileus as a result with no warning. Which meant off her food as her intestines were not moving properly, and weak from low potassium without enough food. Once back on steroids, though not quite as high a dose, she got better. That would be something that should have been seen in an ultrasound, so not suggesting that is what Pants has. But I am wondering if there is something about the steroid taper that is involved. How long has he been on pred? IBD girl had been on pred a long time, so needed a very slow taper. We'd go months on a dose before taking the next stop down. And reduce by a half mg at a time.

Not eating enough for long enough can cause fatty liver (hepatic lipidosis), and cause high bilirubin. If the urine U thing is Urobilinogen, it could indicate same. Years ago I fostered a hepatic lipidosis kitty from the shelter back to health. Feeding tube is part of the solution. Though the shelter couldn't afford that so I did the assist feed thing for a few weeks.

That's all I can think of as questions to ask. Good luck and keep us posted. I have done the long travel for treatment thing, so I can sympathize on how hard that is.

 

[Christina&Pants]

Wow, who thought Pants could be become even more complicated! . Is he eating on his own yet? I'm glad the fluids and food eems to be helping him.

The only time I had something similar is when I tried to taper my IBD kitty off of steroids. At one point her body said no, and she got ileus as a result with no warning. Which meant off her food as her intestines were not moving properly, and weak from low potassium without enough food. Once back on steroids, though not quite as high a dose, she got better. That would be something that should have been seen in an ultrasound, so not suggesting that is what Pants has. But I am wondering if there is something about the steroid taper that is involved. How long has he been on pred? IBD girl had been on pred a long time, so needed a very slow taper. We'd go months on a dose before taking the next stop down. And reduce by a half mg at a time.

Not eating enough for long enough can cause fatty liver (hepatic lipidosis), and cause high bilirubin. If the urine U thing is Urobilinogen, it could indicate same. Years ago I fostered a hepatic lipidosis kitty from the shelter back to health. Feeding tube is part of the solution. Though the shelter couldn't afford that so I did the assist feed thing for a few weeks.

That's all I can think of as questions to ask. Good luck and keep us posted. I have done the long travel for treatment thing, so I can sympathize on how hard that is.

He is not eating on his own yet unfortunately, I just got a call not long ago that his hematocrit has really dropped and he's not tolerating syringe-feeding well anymore. His demeanor seems to have really shifted this afternoon. The docs still really want to try ramping up the steroids.

"Meds" tab of my spreadsheet is accurate to at least before the most recent taper, even if the glucose tab is out of date. He has been on steroids of varying dose since he was hospitalized with this same emergency clinic last September and received a blood transfusion to limp us through until he got FIP meds. He was on 7.5mg 2x daily until 5/6/2026, which is when he went down to 5mg 2x daily and started the doxycycline, then veraflox a week later (though he had to be switched to Marbofloxacin halfway through that course bc it was a crazy huge dose of veraflox, which tastes terrible). His bloodwork 3 weeks after finishing those courses was stable on 7/10, and then we got the direction to taper down to about 3.75mg 2x daily starting 7/30. That's when things quickly went downhill.

ER vet and primary vet seem to feel this is likely haemolysis more than anything, a flareup of whatever is causing the anemia. Vet college internist felt this is not IMHA when they ran all the diagnostics in February, but that's what ER and primary vet keep calling it. The think the elevated bilirubin etc. is due to haemolysis. No real word from the vet college internist for the past 24 hours, which is par for the course unfortunately. I had made sure to send updates while it was still working hours yesterday, to no avail.

Not feeling very optimistic at all. My usual rule of thumb for when to call it is when their demeanor changes like that, but the docs still really want to try pushing the prednisolone up. With their current med schedule, they can't safely do so for another 2.5 hours. Not sure how long to let them monitor him for a response, but if he doesn't respond to that, I think that's it

 

[Wendy&Neko]

. Do you get a chance to go see him soon?

 

[Christina&Pants]

. Do you get a chance to go see him soon?

Yeah, visiting hours start an hour after they're wanting to push up the prednisolone (pred ramp up is 2 more hours from time of posting). I just made myself shower in case they call with bad news any time before then. Debating bringing a pillow and blanket, because I intend to be physically at his side at all costs whenever the time comes. It's the waiting and not knowing that's the hardest part. Thank you for helping keep me company