Diabetic cat hasn't eaten since breakfast yesterday - Help??

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Critter Mom said:
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Justyn - please, please, please ask your vet ASAP about treating Socks with ONDANSETRON.

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Cerenia helps more with vomiting and some nausea. Ondansetron is an anti-nausea med used in humans for nausea caused by chemotherapy. Ondansetron is usually very effective and well-tolerated in cats. (It saved Saoirse's life when she was treated with it.) It is recommended by IDEXX Laboratories as a treatment for nausea. (See their Pancreatitis treatment guidelines for their recommendations on nausea treatments.)

My vet prescribed 2mg ondansetron twice a day for a 10lb cat. (@Marje and Gracie - do you know the maximum dose a cat can be given for ondansetron per day?)

I've not used an e-tube. One of my cats developed hepatic lipidosis and the vet treating her at the time put in a nasogastric tube temporarily. She told me they are not as effective as e-tubes in terms of delivering sufficient nutrition and that e-tubes are easier to manage in a home nursing situation. (Unfortunately she delayed the procedure to put in the e-tube and I lost my girl as a consequence.)

Sending more prayers for Socks to eat.

:bighug:


Mogs
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If he's over 10 lbs, you could give him up to 2 mg ondansetron every 8 hours. However, many of us have found that giving 4 mg cerenia every 24 hours plus 1-2 mg ondansetron (dep on cat weight) every 12 hours is an excellent combination. The two drugs hit nausea via different modalities and sothey work quite nicely together. In the old days, you could only give cerenia 3-5 consecutive days but that's no longer true. Also, cerenia acts as an anti-inflammatory. I have found some vets are in the know about using the two together and some are not. Let's hope yours are in the know!

I would also opt for the etube over the nasal tube. It's just easier to manage. One of the differences is they have to anesthetize to do the etube but not the nasal tube, in general.

Sending prayers and hopes he will do better at home.
 
Update: Sock's is still at the vet, they are trying water (hopefully by now) and will be trying food down it in about 2 hours.. He had tube inserted around 330pm, so not sure what the standard time is of recouping before being able to put anything down it but i can only trust that they didn't want to rush it for reasons i'm unsure. But he was very loopy until about an hour ago now so they said they had wanted him to wake up a bit from the anesthesia before trying anything. Will keep you guys posted..
 
Marje and Gracie said:
If he's over 10 lbs, you could give him up to 2 mg ondansetron every 8 hours. However, many of us have found that giving 4 mg cerenia every 24 hours plus 1-2 mg ondansetron (dep on cat weight) every 12 hours is an excellent combination. The two drugs hit nausea via different modalities and sothey work quite nicely together. In the old days, you could only give cerenia 3-5 consecutive days but that's no longer true. Also, cerenia acts as an anti-inflammatory. I have found some vets are in the know about using the two together and some are not. Let's hope yours are in the know!

I would also opt for the etube over the nasal tube. It's just easier to manage. One of the differences is they have to anesthetize to do the etube but not the nasal tube, in general.

Sending prayers and hopes he will do better at home.
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Will talk to DCIN and the vet about the combination, definitely would like to try anything that helps.. And Socks had his e-tube inserted earlier about 5 hours ago, as we wanted to try the nasal tube but as he had been sniffing a lot due to nausea, they were worried he'd sneeze it out. Luckily he did great under anesthesia and is recouping well so far.. will update when i get one.. But thank you so much for sharing!
 
Marje and Gracie said:
However, many of us have found that giving 4 mg cerenia every 24 hours plus 1-2 mg ondansetron (dep on cat weight) every 12 hours is an excellent combination. The two drugs hit nausea via different modalities and sothey work quite nicely together. In the old days, you could only give cerenia 3-5 consecutive days but that's no longer true. Also, cerenia acts as an anti-inflammatory. I have found some vets are in the know about using the two together and some are not.
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Thank you, Marje.

:bighug:


Mogs
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Another thought:

If your vets have not yet given Socks a B12 injection it is something well worth asking the vets about BEFORE Socks is discharged to your care. B12 helps with food absorption and it can exert a gentle boost to appetite. (Again, IDEXX recommend an initial course of B12 to help with nausea and appetite issues for pancreatitis in their treatment guidelines for the latter. Nausea is the primary issue to be kept on top of when treating pancreatitis and other conditions where lack of appetite may be a big problem. If I were in your situation I would be asking the specialist whether a similar treatment protocol would benefit Socks' post-DKA appetite issues.

I recognise that Socks is currently being treated with mirtazapine. A small dose may last three days but I found that the appetite stimulating effect waned quite a bit after about 24-36 hours but one then has to wait until the next dose is due. (Need to be VERY, VERY careful with mirtazapine as it can induce serotonin sysndrome). Cyproheptadine, an alternative appetite stimulant, is gentler but not as long-lasting as mirtazapine. The advantage with cyproheptadine is that it can be given up to 3 times a day (1/8 - 1/4 tablet every 8-12 hours for a 10lb cat*) so you can be much more responsive to the cat's appetite stimulant needs in real time. FWIW, I noticed that when Saoirse was treated with cypro it improved both her mood AND her appetite. I think the brightened mood gave her greater interest in food throughout the day. I also think its antihistamine qualities seemed to have an unexpected benefit of making eating more comfortable for her and that this in some way enhanced the action of the ondansetron she was receiving for nausea. Have a chat with your vet about this and maybe ask for an Rx for cyproheptadine so that you will have it at home and ready to use should it be needed.

More prayers on their way ...

:bighug:


Mogs


* Note: Too high a dose of cyproheptadine can cause subdued mood and drowsiness.

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yes yes hope to have him snug and comfy in no time... so so happy he wont be in a cage anymore..
 
they are starting him on maxcal food for the tube until we can confirm how much we can give him, and then hopefully give him something he's more used to..
 
I've been following this thread from the beginning though I didn't comment...and I just wanted to say that I am SO happy that Socks is coming home! PLEASE keep us updated..we're all rooting for you!
 
Just got home and saw your GREAT news!!! YAHHHHHH!!! Socks is coming home!!!!
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:bighug: :bighug: :bighug: :bighug: :bighug:
 
Yes yes yes sorry all i had napped with my sweet boy after his (tube) feeding that he handled so perfectly! We slept for a few hours and i am as happy as he is to be back home.. He has been cuddling and snuggling since walking in the door! The first thing he did was walked over to his water bowls and just went back and forth between both and just drank for a solid few minutes! I was going to take it away to make sure he didnt drink too much but he stopped and hadnt gone back for much but a sip, since!!!

Socks was not moving to go pee the whole time at the vet, poor guy, and i was worrie that he may have some accidents at home- but after drinking lots of water, i pushed his butt a tad and made him walk in the direction of bathroom/litterbox, and HE WENT STRAIGHT FOR IT AND PEED! I was SO happy to see he wasnt just feeling so lousy he didnt want to move, but he went for it immediately!

He is taking his feedings like a champ! Just got done with giving his meds nice and slow! Got him on the 'ondestrenon' (spelling wrong probably) and quite a bit to help with appetite, including 1/4 tablet pepcid even. Potassium supplement, antibiotics, etc. But words cannot describe how wrong i was in worrying so much, as he is doing so great and everything has been smoother than i even imagined. But he truly is SO happy to be home! As am i for him to be!! He even started smelling and licking food!!!! So maybe later tonight when we try again he may be ready to get some down!! Thank you all for the kind words and support but we are currently doing good and stable
 
Justyn

What a great update. I am sure Socks is SO happy to be back home with his Momma and that the feedings are going well.

Sending more prayers and healing energy for Socks with hope that he will start to eat on his own soon.

:bighug: :bighug: :bighug:
 
Yes thank you all... So very happy to say socks is eating on his own so far as of this morning! I knew he loved the taste of rx m/d so just have him munching on that for now but his appetite is almost already back up to normal.. He is just a hungry and sleep kitty, but his BGs have been quite high. Pmps number was 495, and this morning's amps was 470.. Hes on 2u bid, but have a feeling that as th m/d is pretty high carb - explains why are numbers are quite high.. Will call vet soon to discuss..

As far as it goes for the e-tube, does anyone know how long they will want/need to keep it in? As my fiance wants to get it out as soon as possible as he thinks its unneccessary now as he's doing everything on his own. The plus side to the tube is giving his meds, so i am going to try to start giving them orally and see how that goes.

Another thing, is that Socks has a cute little wrap around his neck designed for the tube, but the hospital didnt mention any instructions for cleaning the site as ive read some do - but rather have instructed me to bringing him back tuesday to check the site/clean... But their only appts are between 11am-3pm and i work about an hour away from the hospital, and work 8-5. Seemingly impossible to arrange, im wondering if even neccesary if I clean myself.

Im going to check with another vet to see if they have any early or late times, but i dont believe they do... The vet hospital wants him to have his blood work redone on tuesday, but i feel as that's so soon to have to bring him back in.. I will try to listen to the vet, but i dont know how im going to be able to accomadate..
 
Justyn said:
The vet hospital wants him to have his blood work redone on tuesday, but i feel as that's so soon to have to bring him back in.. I will try to listen to the vet, but i dont know how im going to be able to accomadate..
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Post-DKA that blood work is very important, Justyn.

Very glad to hear that Socks is eating under his own steam. If he were my cat I would not rush to remove the e-tube until sure that Socks is well in the clear; it does take a while to fully recover from DKA. If he were to have a hiccup on the path to recovery the ability to ensure that Socks is able to eat regularly would make the world of difference.


Mogs
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Jamye and Fred said:
Thanks. He's home but not wanting to eat. He ate 2.5 ml via syringe
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Awww gosh... poor baby... I've been giving socks 1/4 tablet of pepcid before meals in addition to his mass amount of other meds, and had so many different kinds of canned food at home to try to appeal to him, but i opened just 1 of the cans i knew he loved and he is very content with that same flavor so far...

I'm sorry you've had to be syring feeding, i know how messy/stressful it is.. hope your fur ball starts feeling back to themselves soon!


Critter Mom said:
Post-DKA that blood work is very important, Justyn.

Very glad to hear that Socks is eating under his own steam. If he were my cat I would not rush to remove the e-tube until sure that Socks is well in the clear; it does take a while to fully recover from DKA. If he were to have a hiccup on the path to recovery the ability to ensure that Socks is able to eat regularly would make the world of difference.


Mogs
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Yes yes, I absolutely know we need to get the bloodwork done, but it was just the debate if it was necessary Tuesday, or something that can wait until next Saturday. But i spoke with the vet and they advised they will try to accommodate after or before normal hours so I will find out tomorrow. And i definitely understand keeping tube in as a precaution but my fiance thinks it could be bugging him (which you could not tell at all as socks is calm and comfy), so we will talk with vet as It would be good to have in case he stops, and its especially great for his meds but sure that's not a reason to keep it..

But wish they sent me home with some cleaning instructions.. I'm scared to take the bandage off especially but I've read most tubs people recommend cleaning every day, but when i spoke with the vet, they said tuesday 'should be fine'. But yeah..wouldn't want to risk anything.. so will be looking into some tips in a bit..
 
Justyn said:
But wish they sent me home with some cleaning instructions.. I'm scared to take the bandage off especially but I've read most tubs people recommend cleaning every day, but when i spoke with the vet, they said tuesday 'should be fine'. But yeah..wouldn't want to risk anything.. so will be looking into some tips in a bit..
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I suggest starting a new thread on Feline Health asking for advice on how to keep things clean when cat has an e-tube. (No experience of them so can't help you myself.) Nothing wrong with paranoia, Justyn; the best helicopter parents I know have a healthy level of paranoia!

:bighug:


Mogs
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I cleaned my kitties surgery site with the etube with a wash cloth with warm water. I was just gentle. After cleaning I applied some neosporin around the tube and put fresh bandages on. I did it twice a day.

I kept the tube in for about two weeks after my kitty was completely eating on her own. The tube didn't bother her. It was in case she decided to stop eating. It was also super easy to get the meds in that way.

I had follow up blood work done About one week after I brought her home from the DKA episode. :bighug:
 
Osha said:
I cleaned my kitties surgery site with the etube with a wash cloth with warm water. I was just gentle. After cleaning I applied some neosporin around the tube and put fresh bandages on. I did it twice a day.

I kept the tube in for about two weeks after my kitty was completely eating on her own. The tube didn't bother her. It was in case she decided to stop eating. It was also super easy to get the meds in that way.

I had follow up blood work done About one week after I brought her home from the DKA episode. :bighug:
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Oh wow!! Thanks for all the feedback.. I will see if possible/what's neccesary with vet but thank you sooo much. Socks tube seems to not bother him AT ALL, whatsoever, so that may be a good option to keep it in longer .. just worry about any risk of infection, etc. But vet said no worries with that as everything looked good when they checked last.

Critter Mom said:
I suggest starting a new thread on Feline Health asking for advice on how to keep things clean when cat has an e-tube. (No experience of them so can't help you myself.) Nothing wrong with paranoia, Justyn; the best helicopter parents I know have a healthy level of paranoia!

:bighug:


Mogs
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And yes will do! Thank you so much!!!
 
Hi Justyn.

I haven't been able to get back to your condo since Friday and was soooo excited to read that all is going well with the tube and that Socks is eating on his own (anti-jinx)!
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I also encourage you to leave the tube in for a while (see what the vet says). It's better to leave it in longer than needed than to take it out too soon.

When my Kisa had a tube, they had me change the little sock that covered his neck whenever it got dirty (which was every day), but they did not have me clean the site. He had no issues with the tube or the site.

I'll send more healing and appy vines to Socks, and keep you all in my prayers that his recovery continues.:bighug:
 
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Tricia Cinco(GA) & Harvey said:
Hi Justyn.

I haven't been able to get back to your condo since Tuesday and was soooo excited to read that all is going well with the tube and that Socks is eating on his own (anti-jinx)!
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I also encourage you to leave the tube in for a while (see what the vet says). It's better to leave it in longer than needed than to take it out too soon.

When my Kisa had a tube, they had me change the little sock that covered his neck whenever it got dirty (which was every day), but they did not have me clean the site. He had no issues with the tube or the site.

I'll send more healing and appy vines to Socks, and keep you all in my prayers that his recovery continues.:bighug:
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Awww thanks for the kind words! And yes ive convinced fiance to relax and vet said no harm is waiting a while to ensure he keeps eating (agreed with your anti-jinx!!) but yes im going in tonight for wound care instructions and will be changing the guaze daily (he has a little collar they gave him and theyll give me an extra to swap out and wash the old)
. But thank you much and my fingers are crossed that he starts feeling much better soon!!
 
Critter Mom said:
Hi Justyn,

Just checking in to see how Socks is doing today.

:bighug:


Mogs
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Hi Mogs, meant to post this here and hadnt had a chance:

Spoke with nurse and confirmed what tests need to be done:
Full Chemistry Panel
w/ electrolytes
& PVC w/ total protein.
The vet did give me the 'OK' that it would be fine to wait until Monday for tests (as long as his diarrhea doesn't become too bad). But he's drinking lots of water and im even giving him a bit of water through the tube after meds (as required) so i think he's fine on hydration. Nurse said it's not unexpected as all of the craziness with sickness/hospitalization last week, in addition to the total of 4 different foods we've had him on at the vet/at home. So that's ok for now.

His BGs are starting to look much better, as he is still maintating interest in his low carb food he had been on prior to this. I let myself get some sleep last night after seeing a PMPS of 360, and this morning woke up to AMPS of 375. So glad to see they're similar and will definitely check tonight mid-cycle for a lower number.

And after explaining my concerns with his tube-site at home, the nurse happily advised that we come in anytime to be taught the wound care and be given some extra supplies so will be taking him in tongiht for that.

But socks is doing good - sleeping lots, getting up for food/water/litter, grooming, napping in cat tree. Only issue is his brother has absolutely wanted nothing to do with him or his 'smell' since we've been home... have tried lots of things like leaving blankets with each other then swapping, and vanilla extract\ - but tonight i will try to wash everything in the house that could still smell like the vet..
Socks doesn't care much about his brother hissing but it does seem to put him on edge if he's in the room with us (but he naturally stays in aunts room even with door open). Hope the jerk kitty gets over his attitutude soon...
 
Update on Socks as i'm in tears writing....

he seemed fine last night and yesterday, ate all his food well, just having a bit of diarrhea but the vet said that may be normal with the adjustment. BUT, last night, i was able to catch Sock's pee and tested his Ketones with a human strip kit from walmart, and got a positive result back of 'small' amount of ketones.... I tested him on Sat when we brought him home and he showed 'negative' so i was so relieved, but last night it was the 2nd out of 5 colors for positive, so the step above 'trace'... The other issue is that he didn't want much of his breakfast this morning as he wanted yesterday.. but still eating, but drinking lots of water more than eating.. I called aspen and their only recommendation was to 'bring him back in for hospitlization to avoid it getting to the point that he was at before'.. I'm in tears thinking he'd have to be rehospitlized SO shortly after bringing him home that i cannot truly imagine how we will even be able to get him regulated at home without getting ketones in the meantime... as its only been 3 damn days... I don't know what to do or think... I will recheck the ketones as soon as i can after work and see if theyre anyworse.. but the nurse said its possible that they COULD clear up on their own IF we get his sugars regulated, which to me is just to increase the damn dose as we keep getting these high numbers (this mornings AMPS was 370... so not that bad..) and i was going to do a curve on saturday to get a better idea of what he needs and it doesnt seem like ill be able to do that...
 
And im working on trying to update my SS but Socks AMPS was 370 this morning... So i am just so furious that it's even possible to have to be re-hospitalized after 3 days of just trying to get him regulated...
 
If Socks is showing a trace of ketones in the urine then it could be even higher in the blood. Urine ketones usually show up long after they are in the blood. Anything trace or higher on the ketodiastix needs to be treated ASAP


ETA Saying that ketones 'may" clear on their own is a very unprofessional statement. At the very least he needs Sub Q fluids if not more intense treatment.
 
I understand, but not sure why they wouldn't offer me sub Q fluids.. they just want him back... and he just will hate that.. And i dont know how im ever supposed to bring him home and get him regulated as the cost of the 24 hour care is just absolutely ridiculous to keep him in there for another week until his pancreatitis clears up...
 
If the ketones are showing as higher than trace, Socks may need the more intense approach, with rapid "R" insulin and IVs to balance out his electrolytes. Raising the dose with Prozinc will not help with ketones and could cause his glucose levels to go hypo.

I am so so sorry you are going through all this with your baby :bighug: :bighug:
 
I'd rather try to get him to lower/even hypo levels and sub Q fluids a home to see if we can get him to level out.. as they think he has pancreatitis, they think that could be causing that but that would be ridiculous for a cat to have to have about 2 weeks for 24hour care until the pancreatits clears up... I don't want to put him through more hospitalization, i dont think he could handle much more, and I'm surely aware of the cost of all of this and I just don't understand how this could have happened... He's so damn happy to be home....
 
Socks ended up eating all of his food, and is ready for lunch... He's up and grooming himself lots.. seems to be feeling fine.. and my normal vet COULD day hospitalize him, but they don't even use short acting insulin - so the only benefit he's getting would be fluids which would be so much more 'relaxed' for him to do it at home... I just don't understand how this is happening as the vet said his sugars at this level shouldn't be causing ketones, so there's something else happening whether it's the pancreatitis, or who knows what else... I don't know how much of a quality of life he could even have if i have to run him to a vet after 3 days of 'not perfect' blood sugars...
 
I am soo sorry to hear Socks has ketones and is not eating as well today.

No one can tell you why this happens but some cats are just more prone to ketones than others and while very high BG is often part of the equation, it isn't always. As Mary Ann said, you need to deal with this quickly and not let it get to DKA again. Any ketones over a trace in urine needs to be treated ASAP. It's possible Socks may not require another long hospitalization if you get him looked at now but if you hold off dealing with it, it likely will be. Socks was just starting to get his strength back so he doesn't have the reserves to fight this off as he had before so delaying treatment is not a good idea. If you take him in and at least get him looked at, if what he needs is SubQ fluids, perhaps they can show you how to do it at home and not keep him too long.
 
Justyn said:
Socks ended up eating all of his food, and is ready for lunch... He's up and grooming himself lots.. seems to be feeling fine.. and my normal vet COULD day hospitalize him, but they don't even use short acting insulin - so the only benefit he's getting would be fluids which would be so much more 'relaxed' for him to do it at home... I just don't understand how this is happening as the vet said his sugars at this level shouldn't be causing ketones, so there's something else happening whether it's the pancreatitis, or who knows what else... I don't know how much of a quality of life he could even have if i have to run him to a vet after 3 days of 'not perfect' blood sugars...
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I'm glad he's eating. Praying for healing for Socks
 
MrWorfMen's Mom said:
I am soo sorry to hear Socks has ketones and is not eating as well today.

No one can tell you why this happens but some cats are just more prone to ketones than others and while very high BG is often part of the equation, it isn't always. As Mary Ann said, you need to deal with this quickly and not let it get to DKA again. Any ketones over a trace in urine needs to be treated ASAP. It's possible Socks may not require another long hospitalization if you get him looked at now but if you hold off dealing with it, it likely will be. Socks was just starting to get his strength back so he doesn't have the reserves to fight this off as he had before so delaying treatment is not a good idea. If you take him in and at least get him looked at, if what he needs is SubQ fluids, perhaps they can show you how to do it at home and not keep him too long.
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I definitely understand but not sure how we will be able to get this under control if we can't determine what's causing them... The issue with the hospitlization is the amount of stress is caused him - he refused to eat, drink, groom, and not once did he move to go potty, he just went all over himself for those days... I truly blame the vet for telling me NOT to raise his sugars WITHOUT having an 'exam' (like that would tell them anything about his sugars) and she KNEW they were high but didnt care.. It just shouldn't have gotten to this point... But now that it has, our only option is sub q fluids as i just can't put him through the hospital when he's feeling great, looks great, just ate some lunch... DCIN agrees that they don't think another hospital stay will be good for him... I'd be happy to get some subQ fluids to try that first... and keep monitoring, as my humane society doesn't do much more than that and we can't afford the ER vet again...
 
Justyn

Did they actually do the testing for pancreatits...such as the snap fPLI or specific fPLI test? The snap test would have given a yes or no answer...the specific would have given a numerical number which would show how serious it was.
 
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