Diabetic CHF cat declining

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tecwmn

tecwmn

Member Since 2010
I will start this by saying that Fin has been regulated between 80 - 150 since his hospitalization and insulin was reduced (charts are not up to date).

A few months ago, Fin became constipated and had to go to the doctor to have an enema and the doctor gave him some fluids. He also told me that I would need to give him fluids at home. I took him home and administered the fluids as directed. Fin stopped eating and was not absorbing the fluids. His breathing became labored and I rushed him to emergency care. They drained a lot of fluid from his lungs and told me he has Congestive Heart Failure and only had about 8 months to live maximum - he was in the ICU for three days. History:

http://felinediabetes.com/FDMB/viewtopic.php?f=28&t=73273&p=795930&hilit=CHF#p795930

He came home and never regained his appetite like before this episode when he was a little chowhound.

About a week ago I took him to the vet because I noticed a hole on the side of his genitals. He did a round of antibiotics to clear up any infection. He has lost 3lbs since diagnosis and the other day stopped eating (still drinking water), nothing I do will get him to eat. I force fed him some Nutri-cal last night (BG went up to 280). He is still going to the bathroom and he is still getting up and drinking water. I am trying to catch him going potty so I can test for ketones. He is declining like they said he would. He does not seem to be in any pain and I will talk to his vet first thing this morning. I am wondering if he may need to have fluid drained again like before.

I am struggling with what to do for Fin. Has anyone else had a diabetic cat with CHF decline? I don't want him to suffer and I don't want to jump the gun either. If possible, I would prefer he pass naturally at home - but I don't want him to suffer. I don't want to traumatize him at the end either by taking him to some clinical facility. My vet and I have already discussed home euthenasia if necessary - however, I would prefer to let nature take its course so long as he isn't suffering.

Please, any advice would be helpful.
 
Re: Please help - Diabetic CHF cat declining

I really can't answer your question - I have a diabetic cat and I have a CHF cat but they're not the same cat. Scruffy, my heart kitty, takes enalapril 2.5mg twice a day and lasix 10mg usually once a day unless fluid is heavier. He was diagnosed back in January of this year when his fluid built up so quickly and badly we almost lost him. Since then, I've noticed he isn't AS active but, most days, he's feeling well enough to do his 'normal' things. He's an older rescued cat - 10-11 years old, was not taken care of before he joined us full time about 5 years ago. I don't see him telling me he's tired of handling it so we plod along each day and enjoy each minute of it. Fortunately I don't have an issue with him not eating - he doesn't eat much at a time but he does eat all day and night. That is a change he made himself so it must make him feel better to do it that way.

I hope you don't mind that I make a comment concerning wanting him to pass at home. One of the gifts we can give our sick, hurting babies is an easy crossing - we can't give that same gift to our humans that are suffering the same. Regardless of how you decide to proceed, keep that thought in your mind. Altho' it's one of the hardest decisions we can make, please don't let Fin suffer pain. I've had to help way too many cross - it hurts regardless of how long they've been with me, years or minutes.

I'll include both of you in our prayers and send good thoughts over and over,
 
Re: Please help - Diabetic CHF cat declining

I don't have a cat in that position yet but i do have an acro cat so I know this decision will be mine to make in the future. I look at my cat and see if she is still enjoying life when I can tell she isn't that is when I will make the call.

You say he doesn't eat but will still drink- could he be nauseous? Is he alert and watchful? Does he enjoy being next to you? Petting? Does he play?

These are questions that can help you tell when it is time.
 
Re: Please help - Diabetic CHF cat declining

My Waldo had RCM he did well on heart meds for about a year then decided he didnt like the meds or food. He also had asthma...I cant even remember what all he had...It's kind of painfull as I was trying to fix so many things...I just missed that he wanted to be left alone. That old saying "better too soon, than to wait too long" never rang more true than in our case. Waldo never looked like he was suffering. He just looked very tired. I'm not telling you what you should do, just what happened in our case...Dont miss the signs.

My heart goes out to you. I know how hard this is,

jeanne
 
Re: Please help - Diabetic CHF cat declining

The vet tech called back before I left and said not to come until 12:15 p.m. since he is drinking and his BG's are not too crazy. Thank you for the replies, they help.

Fin is resting in his favorite chair and thanks for the reminder Jeanne, because he does seem like he wants to be left alone. It is so hard when you are so used to being vigilant about care with a diabetic/CHF cat - I am all up on him. He is still walking, but he seems a little lethargic/tired and annoyed. I have backed off and I am leaving him alone to sleep until we have to go to the vet.

His sister Sea, MiAmor, and I are hanging close but giving him space. nailbite_smile
 
Re: Please help - Diabetic CHF cat declining

Ok, the vet himself just called me and said he cannot do much for Fin because he is leaving at 1:00 p.m. for a fishing trip and won't have access to the internet and could not get blood results back until Monday. He recommended a couple of emergency hospitals.
 
Re: Please help - Diabetic CHF cat declining

Oh my gosh....I cant imagine WHAT you are thinking right now. Please know I'm praying for you and Fin.
God bless,
jeanne
 
Re: Please help - Diabetic CHF cat declining

I am so sorry you are going through this; we just went through this on Monday, letting our Thomas go. If it comes down to it, may I reccomend a mobile vet. She came, sedated him on the bed, and then I carried him into the living room, where she gave him his final dose. He passed away in my arms while I was rocking him to sleep. It took a little longer but we were able to cry and talk all about how important a member of our family he was. I agree it was somewhat more expensive, but we probably think that it was one of our most worthwhile vet expenses.
Dana
 
Re: Please help - Diabetic CHF cat declining

Have you tried sending a PM to Jess & Earl?
 
Re: Please help - Diabetic CHF cat declining

Three hospitals later...

First hospital, doctor got called into emergency surgery and it was going to be about three more hours - called another hospital. Noticed in route that his ears were turning yellow as were the white areas of his eyes. Second hospital, did an x-ray and in house blood test - his liver is large, but not failing. He has a little fluid around his lungs but nothing alarming. All other results are not too far out of the ordinary to pinpoint anything on the liver. She recommends I take him to another hospital to have a feeding tube installed and calls ahead for us. We get to hospital number three and they want to check him in overnight, I say no - not until I discuss his case with the doctor. The doctor did a more comprehensive panel and an ultrasound on Fin. He is really backed up poop-wise and his liver is very large plus he is dehydrated even though he is still drinking on his own. This doctor is pretty up front and does not feel a feeding tube is a good idea. After an extensive discussion on his case and what is best for him - we decide to get all the poop out and hydrate for a couple of hours at the hospital. He will not stay overnight and will be picked up before they close. They want me to syringe feed him special food and see how he does after cleaning out the poop and rehydrating. I made it very clear that I do not want my animal to pass there and that I was making arrangements for him to pass at home. The goal is to stablize him and get him home. The doctor was very onboard with this as he doesn't think Fin has a lot of time left. If we get through this crisis, a month or two.

I told Fin before I left what they were going to do to him and that I would be back to pick him up so he would be home with us tonight. I have everything to take care of him for the weekend and they are going to give me the number for a mobile vet in case I need it this weekend, which I hope I won't.

This is so hard and I just want to do right by Fin. I love him so much. Thanks to everyone for your support.
 
Re: Please help - Diabetic CHF cat declining

I just got home with Fin. They want me to syringe feed him Critical Care A/D cat food and give him 100 ml of subq's two times a day. They don't know why he is jaundice because he tested negative for hepatic lipidosis. They got a lot of fluids into him so I won't start the subq's until tomorrow and because of the CHF I will probably do smaller amounts in increments to see how he does while keeping him hydrated.

They gave him two enemas and he has still not passed anything - this concerns me.

I just gave him 10 ml of food and will wait a little bit to give him more.
 
Re: Please help - Diabetic CHF cat declining

I don't know who Jess & Earl are, but I will try to track them down here on the board. Thanks Dyana.
 
Re: Please help - Diabetic CHF cat declining

I certainly would err on the side of SQ fluids if he has CHF. there is a fine balancing act you must walk. they said lungs were fine... no fluid build up??

also if no BM after enemas.. have they tried to manually dislodge him and not to scare you but are they sure there is no mass there. (Was the case with my Mr. chubbs)
I am surprised they gave him "A LOT OF FLUIDS" because of his CHF. is or did they put him an anything for his heart or a water pill
 
Re: Please help - Diabetic CHF cat declining

They did an ultrasound that covered his heart, liver, and bowels - no masses. He has not passed any stool and I am going to bring him back in and ask them to manually remove the feces.

He was drooling a lot last night after his first syringe feeding. His numbers were 117 an hour after eating, 121 two hours after eating (no PM insulin). This morning he went pee for the first time since coming out of the hospital yesterday and it tested negative for ketones. His BG this morning was 171 so I gave him 10 ml of AD food (barely watered down) via syringe and then took his BG about 45 minutes later, which was 280, before giving him 2u of insulin.

I did get a PM response from Jess and she gave me some good advice before administering subq's this morning. I am going slow - he got 50 ml of subq's and seems a little better. He is still jaundace, but it seems lighter.
 
Re: Please help - Diabetic CHF cat declining

All right, this is the worst part...waiting. Fin is back at the hospital and is undergoing a manual poop removal and more fluids. This is really dangerous to do in his condition (as the doctor informed me) but if we don't do it he will die (as I informed the doctor). Fin and I talked before they took him and I explained what they were going to do. Had a very special moment with my boy as I played our favorite song and sang to him before they took him. At least if we remove the backup, we have a chance to move forward in a positive way. I am hopeful at how well Fin did last night and at his behavior this morning. Please send good vibes and prayers.
 
Re: Please help - Diabetic CHF cat declining

My prayers are with you too. I have a cat with HCM but he's not in CHF yet (I hate that dreaded little "yet" but I know one day we will have to face it). I am so sorry that Fin is going through this. Sending healing white light your way.
 
Re: Please help - Diabetic CHF cat declining

Sending possitive outcome vines, to todays vet visit.
 
Re: Please help - Diabetic CHF cat declining

The doctor just got out of surgery with Fin and he did well. He said there was a lot of poop and he would not have been able to pass it. The colon is inflamed so they are putting him on an antibiotic and a stool softener. They want to continue a slow drip IV of fluids to rehydrate him for about three more hours and then I can bring him home.
 
Re: Please help - Diabetic CHF cat declining

that is good. you can add mirilax 1/8 - 1/4 tsp BID to help keep him from binding up again. I think a lot of us give our cats this. works great especially when adding extra water to canned food.
some cats just naturally have harder poos and need an extra something.
hang in there
 
Brought Fin home last night and he was certainly out of it. They asked me not to feed him last night and to just give him the Baytril and Lactulose, monitor his BG's and let him sleep. His BG's last night were PMPS (no shot given) 127, +3.5 = 165, +6 = 198 and then we all went to bed and I woke up every two hours just to check on him. He seemed to rest well - myself, on the other hand, is an entirely different story. ~O)

This morning at 6:00 a.m. we fed him 10 ml of pure AD, his fluids were good and he was drinking on his own so no subq's (but watching this). About 45 minutes after feeding he was 300 so we gave him 2.5 u's as I felt we were out of puking range. He was seeming more himself, obviously sore and still weak. He is not eating on his own yet, so I gave him another 15 ml of pure AD at 10:00 .m. I am not watering down the food because I want to get as many calories into him as I can - he needs them. After a full day or two of feeding, I will be curious to see how he is as he regains his strength and hope he starts eating on his own.

Thanks again for all the well wishes - you guys are the best!

Barbi, Fin, Sea, and MiAmor
 
tecwmn said:
This morning at 6:00 a.m. we fed him 10 ml of pure AD, his fluids were good and he was drinking on his own so no subq's (but watching this). About 45 minutes after feeding he was 300 so we gave him 2.5 u's as I felt we were out of puking range. He was seeming more himself, obviously sore and still weak. He is not eating on his own yet, so I gave him another 15 ml of pure AD at 10:00 .m. I am not watering down the food because I want to get as many calories into him as I can - he needs them.
Click to expand...
Just thought of a couple of points that I'm sure you've already thought about, but I know how stressful these situations can be, so it can't hurt to state some basic things you have probably already considered:

As he's recovering Fin's BGs may be all over the place, so make sure you're testing throughout the day, especially around his nadir points - he's eating less, so may need less insulin. Keep on recording those nadir readings, and post to let us all know what they are. I'm sure some of the lantus connoisseurs will be able to advise further, and help you determine the correct dosages to administer from one cycle to the next, if necessary. Fin's BG nadirs may fluctuate greatly from one day to the next at the moment, what with the stress of the procedure, the change in the amount of food he's eating, his little body putting more energy towards healing, and his pre-existing health issues. So as you no doubt are aware, it's really important you BG test as often as practicable at the moment, just to ensure he isn't getting too much insulin.

Also, in my opinion, I think watering down the a/d food could be quite a good idea. I understand that you want Fin to get as many calories as possible, but if watering it down helps him eat it, he may end up eating more than he would compared to if he was trying to eat the unwatered down food. Additionally, the extra fluid intake will help to keep him hydrated, which will not only help him heal and keep his BGs stable, but also help to prevent any further blockages developing.

Good luck to Fin and you.

H
 
Hi Helene. Thanks for the feedback.

Fin is eating very well with the unwatered food and I was able to get an entire can of A/D into him over the course of today! Yay! He is drinking consistently (but not excessively) and I gave him 50 ml of subq's to make sure he stays hydrated (need to go slow with the CHF). He really needs every calorie I can get into him right now because of the anorexia and liver issues. I usually add water and pumpkin to his meals.

I am pretty comfortable with curving and dosing Fin as we have been doing this for several years. Just ordered another two packages of test strips for the upcoming weeks. His numbers are fluctuating as expected (from 300 to 127 today alone).

It is always good to have a friendly reminder during times of crisis. It's people like you that make this community so great!

Much appreciated,

Barbi, Fin, Sea, and MiAmor
 
Fin took his first couple bites of food on his own this afternoon! Not enough to stop syringe feeding, but it is a start. His numbers today are really good and not fluctuating like I thought they would - but still curving him. AMPS 140, +2 135, +4 144 and so on ranging between 130 - 145 - no AM shot) and fed him another 1/2 can of AD so far. He is improving, slowly, but definitely heading the right way. No subq's today so far and hopefully won't need any. Spoke with the doctor today and he is going back in on Wednesday for a recheck.

:smile:
 
How is Finn Doing today? The ffact that he took bites of food on his own is definitely a reason to cheer
YAY Finn!!!
:RAHCAT party_cat
 
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