911 Euthanasia scheduled for tomorrow, want second opinion

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Wonderandawe

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Last Wednesday, my 8 year old male shorthair, Nemo, was diagnosed with DKA, fatty liver, and beginning heart disease. He stayed in the hospital until Saturday when he was eating and taking one unit of insulin once a day. When we got him home, we had trouble getting him to eat. We called the pet hospital so many times and had one late night visit where the vet tech gave us Entyce. He ate a bit that night and the next morning, Nemo did not eat. At this point it has been 48 hours since Nemo was discharged.

We dropped him off for some tests and for an overnight. We got a call saying Nemo is back in DKA and while we can admit him again (and do the feeding tube, IVs, etc), his prognosis was not good as Nemo went back into DKA so fast. We may be fighting with DKA for the rest of his life. His quality of life would be poor.

We decided to bring Nemo home and schedule an at home euthanasia at 3pm tomorrow. Since we have some time and Nemo doesn't seem like he's on death's door, I want to get a second opinion.

I know he's probably perky because of the IV fluids the vet gave him, but it's so difficult to euthanize when Nemo is still Nemo. But I don't want him to devolve into a undignified and painful end. I'm going to call some Cat Hospitals here in Houston when they open tomorrow for a second opinion.

Am I deducing myself about Nemo's state? Is the Blue Pearl vet right about him having less than a forty percent chance of recovery with falling into DKA twice in a week?

I don't want my cat to be in pain or have a poor quality of life, but it's hard to euthanize when he's just not eating and looks a bit tired.
 
I can't tell you what's best for Nemo, but I do question the advice you've been given. First question I have is what type of insulin is Nemo on?

No matter which insulin it is, all insulin's are supposed to be given twice a day. There are none that are only once and if that's all he's been getting, that could be part of the reason he went into DKA in the first place as well as going back into it a second time.

The "recipe" for DKA is Not enough insulin + not enough food + infection/inflammation. Do you have any bloodwork you could share? I'm curious if his WBC is elevated which would indicate infection somewhere and if there's infection that's not being treated, that's another big reason why he may not be doing as well as he would be if he were treated properly. Has he been checked for pancreatitis?

While eating is hugely important, especially in cats that have a recent history of DKA, using a feeding tube (which can be done at home too) or syringe feeding to make sure he's getting the calories he needs is something else that needs to be considered. Feeding tubes, while sometimes scary looking to us, have saved a lot of kitties lives.
 
The documentation says Glargine for insulin.

From what I understand, his white blood cells count is normal and his pancreas has been checked for pancreatitis and apparently came back negative.

The vet was most worried about his liver, though he doesn't have jaundice or anything beyond fatty liver.

I don't have his current blood work but I can pm the blood work results from two days ago.
 
Entyce is OK, but there are better options to help them eat. As Chris pointed out, food is a key part of the equation. You should get an anti nausea drug, I recommend ondansetron, as well as an appetite stimulant. Mirataz is a cream you put on their ears and easy to give.

The other thing to consider is a feeding tube. I fostered a fatty liver kitty from our local shelter. They didn't want to or couldn't afford the feeding tube, so I ended up syringe feeding frequently him for a couple weeks before he started eating on his own. Wish I'd known then what I know now about anti nausea and appetite stimulants. Don't let the phrase feeding tubes scare you, they can save a kitty. More in this website: https://catinfo.org/feeding-tubes-for-cats/
 
Here is the bloodwork she sent to me: https://drive.google.com/file/d/1ip_rYrf5P9MHCJjDuky3oI18xHf73mC8/view

I am not the best here at reading and evaluating labwork, but other than his electrolytes being slightly abnormal and some pretty clear signs of hepatic lipidosis (which isn't unusual if he hasn't been eating enough), I don't see anything that screams at me that Nemo needs to be put down.

Hopefully @Wendy&Neko will also take a look and give her opinion.

If Nemo were my cat, I'd probably get him back into 24 hour care where they can stabilize his electrolytes and either put a feeding tube in or syringe feed him to see if his liver can recover.

ETA: I don't see any pancreatitis testing. The Ultrasound showed the pancreas as normal, but that doesn't mean he doesn't have pancreatitis and the fact that they did say "Abdomen: Tense, mildly painful." means pancreatitis is a possibility.

There are 2 tests for pancreatitis. One is a SNAP fPL which is usually done in the office but only gives a "yes or no" results. The better option is the SPEC fPL which gives a level of severity but usually has to be sent out.

The usual treatment is mostly supportive care. Fluids (as tolerated considering the heart condition), antibiotics and pain medication. Pancreatitis is very painful so pain control is important. Here's more information in this Primer on Pancreatitis

Also, while he was hospitalized, it said he should get the Lantus every 12 hours. I don't know why they said he only needed it once a day later but it is very rare that a cat only needs insulin once a day.
 
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I'm no expert by any means but I had a similar experience with the vet telling me to administer Lantus (fancy name for glargine) 1x per day. As @Chris & China (GA) mentioned above, insulin should be administered every 12 hours. I spent couple of months following the vet's advice with no results. When I learnt better and started injecting 2x per day, Stela's BG started improving right away. She doesn't have any other conditions apart from DB so it could be very different for Nemo, but to me it seems like there are still some options to consider before putting him down.
 
Looking at the bloodwork ... on 4/4 his glucose was 85, on 4/5 it was 57, and on 4/6 it was 119. Those are not diabetic numbers. And he was negative for ketones on 4/4. Maybe I'm missing something but how did he get diagnosed with diabetes???
 
If Nemo was my cat I would definitely NOT be scheduling euthanasia tomorrow.
I can only see one test for ketones and that was on the 4/4 and it was negative. And his electrolytes are not that much out of whack.
I’m not sure he has had DKA. Even if he has had it and he had to be hospitalised again…that doesn’t mean he won’t survive and live a normal life afterwards. I think you have been given some bad advice to be honest. Cats that have been discharged too soon and given bad advice can end up back in hospital.
Insulin is given twice a day in cats not once a day. And if in fact he does have DKA it is vital he gets twice daily insulin.
And they said to only feed before giving the dose of insulin and no snacks. THIS IS VERY BAD ADVICE.
Diabetic cats (especially those that have had DKA and hepatic lipidosis) need as much food a you can get them to eat. They need 1 and 1/2 times as many calories as they normally eat.
I would take your kitty back to get a feeding tube put in and to be stabilised with the electrolytes if in fact they are not normal now. I would also query the DKA diagnosis and ask them have they checked again for ketones and what are the electrolytes now. A feeding tube is not hard to use and has saved many kitties lives with DKA and hepatic lipidosis. Don’t be afraid of a feeding tube. It is your friend!

We can help you with Nemo once he comes home again. Make sure they give you some ondansetron as Wendy suggested for nausea which is will most likely have for a while…this is not unusual.
 
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Have you been asked to check for ketones in the urine by the vet? If not I would get a bottle of Ketostix from Walmart or a pharmacy and check it and let us know the result please.
Also I can see by your notes that he has not been eating while at home. I see you have given maropitant (cerenia) twice within 24 hours.it should only be given once a day (24 hours apart. It looks like he is still nauseated so I would ask for ondansetron as it is better for nausea in cats. Don’t let the vet fob you off. Jump up and down and make sure you get some ondansetron.
 
Good morning.

My cat has declined overnight and we are on the way to our normal vet. We don't hold out much hope if a good outcome.

The case summary (I removed public access because it has my personal information on there) was from his first stay in the hospital, where we did accept the nasal feeding tube and everything. I don't not have the blood/urine results that prompted the pet hospital vet to give a negative outcome of another hospital stay.

I want to thank everyone for their responses. If I had found this forum sooner, I could have been more educated and insisted on different treatments for my cat. We relied on the pet hospital vets for guidance, which in hindsight was a mistake as we ended up dealing with a different vet every two days.
 
I’m so sorry to hear this. He didn’t really eat overnight or get the second dose of insulin he needed. That is most likely why he’s feeling unwell
I hope the vet can help him.
Our thoughts are with you.
 
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Wonderandawe said:
Last Wednesday, my 8 year old male shorthair, Nemo, was diagnosed with DKA, fatty liver, and beginning heart disease. He stayed in the hospital until Saturday when he was eating and taking one unit of insulin once a day. When we got him home, we had trouble getting him to eat. We called the pet hospital so many times and had one late night visit where the vet tech gave us Entyce. He ate a bit that night and the next morning, Nemo did not eat. At this point it has been 48 hours since Nemo was discharged.


We dropped him off for some tests and for an overnight. We got a call saying Nemo is back in DKA and while we can admit him again (and do the feeding tube, IVs, etc), his prognosis was not good as Nemo went back into DKA so fast. We may be fighting with DKA for the rest of his life. His quality of life would be poor.

We decided to bring Nemo home and schedule an at home euthanasia at 3pm tomorrow. Since we have some time and Nemo doesn't seem like he's on death's door, I want to get a second opinion.

I know he's probably perky because of the IV fluids the vet gave him, but it's so difficult to euthanize when Nemo is still Nemo. But I don't want him to devolve into a undignified and painful end. I'm going to call some Cat Hospitals here in Houston when they open tomorrow for a second opinion.

Am I deducing myself about Nemo's state? Is the Blue Pearl vet right about him having less than a forty percent chance of recovery with falling into DKA twice in a week?

I don't want my cat to be in pain or have a poor quality of life, but it's hard to euthanize when he's just not eating and looks a bit tired.
Click to expand...

sorry for what you are going thru, I cannot imagine.
I can tell you that for the appetite, you can get at your Vet's MIRATZ
it's incredible, you get it at your Vet you place a small drop in the inner ear where the fold is, rub, switching ears daily for a few days once a day, you will amazed yourself that in less than an hour he your baby will devour whatever you put in from of him he will devour it
Of course you consult with you Vet if with his condition .
Wonderandawe said:
Last Wednesday, my 8 year old male shorthair, Nemo, was diagnosed with DKA, fatty liver, and beginning heart disease. He stayed in the hospital until Saturday when he was eating and taking one unit of insulin once a day. When we got him home, we had trouble getting him to eat. We called the pet hospital so many times and had one late night visit where the vet tech gave us Entyce. He ate a bit that night and the next morning, Nemo did not eat. At this point it has been 48 hours since Nemo was discharged.

We dropped him off for some tests and for an overnight. We got a call saying Nemo is back in DKA and while we can admit him again (and do the feeding tube, IVs, etc), his prognosis was not good as Nemo went back into DKA so fast. We may be fighting with DKA for the rest of his life. His quality of life would be poor.

We decided to bring Nemo home and schedule an at home euthanasia at 3pm tomorrow. Since we have some time and Nemo doesn't seem like he's on death's door, I want to get a second opinion.

I know he's probably perky because of the IV fluids the vet gave him, but it's so difficult to euthanize when Nemo is still Nemo. But I don't want him to devolve into a undignified and painful end. I'm going to call some Cat Hospitals here in Houston when they open tomorrow for a second opinion.

Am I deducing myself about Nemo's state? Is the Blue Pearl vet right about him having less than a forty percent chance of recovery with falling into DKA twice in a week?

I don't want my cat to be in pain or have a poor quality of life, but it's hard to euthanize when he's just not eating and looks a bit tired.
Click to expand...

can use it
 
I don't have much advice to give but wanted to share that I went through a similar situation. Charlie stopped eating and drinking and was very lethargic. He spent the day at the vet with DKA, getting insulin and an IV. We discussed euthanasia and decided it was time. Right then, Charlie got up and started eating. Little by little he made a recovery. I owe so much to this community that has helped and taught me how to manage his diabetes. We still aren't fully managed but we've made a huge amount of progress. You are in the right place to get help and guidance.

It's so hard to know when it's time. I'm hoping for the best for you and Nemo!!:bighug:
 
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