Jake is in crisis!

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drjsiems

drjsiems

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Due to Jake's recent very fluctuating BGs, My vet took him off insulin (Lantus)on Monday to see if he was going into remission. He had been at 3/4U BID. Subsequently after ceasing the insulin hometesting revealed high numbers, but were mostly lower than some the pre-shot numbers he had been getting when he was on insulin. Anyway, it has gone from bad to worse. Jake quit eating on Tuesday to I took him to the vet on Wednesday for a urine test thinking he had another bladder infection which he did not. He was diagnosed with ketoacidosis and high BUN levels (78) and creatinine of 2.7. Jake is in his third day of receiving fluids at the vet today and will get blood work done again today to see if the BUN has gone down or at least stayed the same. Even though the ketones are gone, he still has some acidosis. He also now has a bladder infection for which he is getting antibiotic Baytril. Jake has been coming home at night. Last night when I picked Jake up, the vet said that if his BUN level does not come down or at least stay the same, I might have to consider putting Jake to sleep. I just talked to vet now - his BUN has gone up to 100 (after 2-1/2 days of fluids) and his creatinine went from 2.7 to 3.7 during that 2-1/2 days. In addition to his unregulated diabetes, bladder infection, anorexia and now obvious rapdily failing kidneys, he is showing signs of jaundice (yellow serum) indicating that his liver is also shutting down.I want to do what is best for Jake. The vet says there is a very small chance of recovery. I want to continue treatment if it will help, but I don't want him to have to go through starving himself or acute kidney failure. I have an appointment at 4:30 p.m. to see him today and to potentially make the decision. Do you think there is any hope for Jake? I just received a message from someone stating that I could syringe feed him. If that is a viable thing to do without causing Jake too much trauma? If that is possible, I could get him back on his Lantus and likely his liver (jaundice) issue would resolve? Thanks so much for badly needed input on this situation. Jake is deteriorating fast.

Judy & Jake
 
Judy, if he is going jaundice, he needs a feeding tube to get him over this crunch. I have no info on his age, etc. but his infection and being taken off insulin could be making everything go crazy. The jaundice is most likely from the liver, he needs nourishment. My civie has a BUN right now of 99 and her creat is down to 3.7. She does have kidney problems. I would fight for Jake and the first thing would be a feeding tube. http://catinfo.org/feedingtubes.htm I definitely wouldn't give up on him but I would consider getting him into an ER, 24/7 care right now.
 
Sounds like hepatic lipidosis. The vet can insert a feeding tube into Jake. It's a pretty easy operation. You'll get more food in him over syringe feeding in that it'll go directly into his tummy. He can also use adenosyl for liver help. IMO this doesn't look like "acute kidney failure". With that you'd see the creat much, much higher. And the BUN can be high if they are eating a high protein diet although 100 is a tad worrisome but with everything else going on...

I personally would give him a couple more days if you can afford it.
 
hepatic lipidosis.

your creat isn't that bad. high, yes, but I've seen cats come back from 3.5+.

he needs a feeding tube or syringe feeding. CALORIES, plain and simple.

With that said, hepatic lipidosis is a tough mountain to climb. I've seen cats whose owners did EVERYTHING, and they still didn't recover. So, euthanasia isn't unreasonable. It is a personal decision.

{{hugs}}
Michele
 
My civvie Luci had hepatic lipidosis years ago - she spent a week at the vet being force fed (I was traveling for business at the time, and DH took her in), and recovered beautifully (no repeats *antijinx*).

Sending healing vines and snowflakes ~~~~~
 
Judy where are you? You should transfer Jake to a 24 hour referral facility and get him under the care of an internal med specialist if possible. The other posters are right --- he needs a feeding tube, his creatinine is not nearly close to "OMG" stage, and it's possible to get through this with good supportive care. Please update us.
 
Here is some more info about Jake---

He weighed about 9-1/2 pounds from when all of this started this week. He
used to weight about 13 or 14 pounds before he was diagnosed.

Yes they have been either tube feeding or syringe feeding him, but I am
wondering how much since they were so vague when I asked. I will find out
later today when I go over there. And yes, Jake was getting 3/4U BID but
obviously that was too much due to the rapid BG drops resulting in rebounds.
One minute I feel like giving up and the next I want to bring Jake home and
fix this myself. I would think that getting lots of food into him would be
the first step.


Thanks, Paige. Have you seen my second post regarding all of the other stuff
that is going on now also. Do you think that ketoacidosis accelerated the
kidney and liver damage? By the way, the ketones were no longer there, as of
yesterday, but the kidney values rose anyway. There is still some acidosis
however. I would hate to think that this is my vet's fault for taking him
off the insulin. Actually I talked to a feline specialist yesterday about a
possible second opinion and she said that it is not unusual for a vet to
stop insulin for a couple of days when the numbers fluctuated like Jake's
are.

Jake's blood glucose this morning was 542 and as of a little while ago, it
was 400 something at the vet. I think that the vet either gave him his
Lantus or short-acting Regular insulin, the latter of which to date has not
yielded much results. By the way, he was not even getting 1U before all of
the rebounds started taking place - more like 3/4U. I should also mention
that he is 17-3/4 years old.
 
I will echo the others, PLEASE get Jake to a facility where he can be monitored and on IV 24/7. You cannot do this at home, he really needs the IV, and probably a fast-acting insulin and constant monitoring for that. Don't try to do this at home, especially on a weekend when you probably can't get him to the vet as easily.

My Lucy was very sick with DKA/HL when diagnosed, her kidneys and liver were failing, they couldn't keep her temperature up, she was incontinent and her urine looked like pure blood. She is a fighter and 6 days later, she started eating and was able to come home! She made a remarkable recovery, and I've seen others here have that kind of recovery. Some, unfortunately, do not. As someone else said, it is a personal decision. Look into Jake's eyes and see what he is saying to you. Somehow when I looked into Lucy's eyes, I knew she was still there and I couldn't give up until she did.
 
Judy,

Any update?

Paige - Just want to thank you for providing the additional information from the other board. It's very helpful to know history when trying to help someone with this kind of situation.

Hopefully, Judy's read the posts and is on her with Jake to a 24 hour facility.
 
I am new to the board so I am not sure if I am putting this in the right spot, but here is an update on Jake!

Jake is now in good hands. I took him to a very reputable emergency
veterinarian clinic in the Twin Cities where I live. I have had many of my
animals over the years and I feel much better knowing Jake is there. I even
got the same doctor I have dealt with several times before. I have always
liked and respected him. I did not realize he knew so much about feline
diabetes and its complications and feline health in general until after
talking with him tonight. Turns out that his spouse owns a kitty clinic!!
Still, Jake is quite critical. The doctor said that the worst thing that I
could have done was take Jake off his insulin which I did on Monday
according to recommendations from my regular veterinarian. I will deal with
that situation later as right now I am focused on Jake. The doctor gives
Jake about a 50/50 chance of survival with treatment; my regular vet gave
him 10 to 20 percent chance. All of his vitals are normal and his liver is
not shutting down as the other vet said. He has higher BUN and creatinine
probably due to dehydration and all of the things that have been going on.
Jake probably does have some elevated BUN and creatinine levels because of
his age (hopefully they will go back t0 52 and 2.4 respectively. Jake is
17-3/4 years. The doctor did not agree with putting Jake to sleep. He said
that he developed ketones from being taken off the insulin and even though
the ketones are gone, the residual acidosis is not good. They will be
treating the acidosis and dehydration (the other vet said that they have
been giving Jake fluids for three days so I can't figure out why he Jake is
so dehydrated) and checking for pancreatitis and a lymphoma one of which he
likely has. Jake is not critically ill directly from diabetes, renal
disease, or liver dysfunction. So even though I am still scared for Jake,
this is a much better prognosis. I feel relieved that Jake is where he is -
they are feeding him through a tube as we speak as this is the most
important thing since he has not eaten for three or four days. Jake will
also have 24/7 care and will have access to state-of-the-art critical care
equipment. They are very awesome people there, and I know they will do their
very best. The outcome is never up to us; only the footwork! I believe that
Someone is really watching out for Jake. Thank you all for your responses
and getting me to this clinic. Sometimes I get so overwhelmed I can't think
straight. Thanks for always being there!

Judy & Jake

_____
 
(((Judy)))

my prayers continue to go out for Jake and you. I am glad to hear the update and glad he's where he is now, although being at home ideally is best, right now he needs the help of these experienced dr's.
 
So glad to see this update.......

and to know Jake is in good hands. Prayers that your beloved boy will pull through this and please keep in touch with us.
 
Thank you for the update. and more importantly thank you for listening to the people on this board and taking the necessary action to help Jake.

It is very scary and sad that too many vets do not understand the treatment of diabetes and instead of saying " I don't know", researching the disease or referring the client to another vet, they attempt to treat the client and end up doing more harm.

Many of us on this board, came here out of confusion, frustration, desperation and learned to trust the advice from the folks here. We are not vets, but collectively we have learned about this disease and know more than many vets when it comes to treatments, symptoms, etc.

We also are caring for our own cats and care about the welfare of all the other cats on this board.

So, thank you for listening to everyone and following the advice.

You and Jake are in our thoughts.

When Jake stabilizes and you are ready to think about list diabetes treatment, please come back to this forum and post. We will walk you through the process, your options, the do's and don'ts. Now that you found us, you are not alone. And together with the help of the ER vet that you trust, we can help you, help Jake.
 
Oh Judy.... something told me to check health today. I'm in the Twin Cities too. Not sure where you are, I got great care for my Charlie at the Eden Prairie ER... Great doctors too. There was just nothing that could be done for my sweet 18+ year old baby.

I'm praying for Jake's recovery and glad you found a vet knowledgable in Diabetes.... I'll PM you my phone number if there's anything I could do to help you....
 
Re: Jake is in crisis! UPDATE!!!

Here is an update from Judy via Yahoo group---
Judy - when you get a chance please check FDMB. Not sure how often you on
there, but there is a member who lives near Twin Cities as well. She is
going to PM you and some others were concerned.

I am sure you are busy busy making sure Jake is doing better. Just wanted to
let you know.

Paige
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Paige,

I saw that! Thanks for checking with me. Since I am new to FDMB, I am not
totally sure how to navigate it! The person who you are referring to lives
in a Minneapolis suburb near me and highly recommended the E.R. that Jake is
already at! In addition Jake is a spittin' image of her cat Charlie.
Coincidences? I don't think so!! I think Jake is just where he needs to be.
I am anxiously awaiting a call from the E.R. vet with an update and a time
that I can go see Jake. Good news that I know so far is that he is getting
plenty of food in his tummy per the feeding tube and is keeping it down,
that his condition has gone from critical to guarded, and that his blood
sugar is down to just over 200. Not so good news is that some ketones have
redeveloped (a 1 on the dipstick so just over "trace) and that there is
still acidosis they are battling, which by far is the most serious I think.
The tech tells me it can often be cured, but just takes a while to get it
out of his system. Have you or others had experience with the ketoacidosis
being resolved?

Thanks, Paige!!!
Judy & Jake
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You don't know how wonderful it sounds that he is in a better place and slowly
getting better. I am praying for you both.

As far as anyone with their kitty getting over this---
Libby and Lucy had posted this to your thread yesterday at FDMB...
My Lucy was very sick with DKA/HL when diagnosed, her kidneys and liver were
failing, they couldn't keep her temperature up, she was incontinent and her
urine looked like pure blood. She is a fighter and 6 days later, she started
eating and was able to come home! She made a remarkable recovery, and I've seen
others here have that kind of recovery. Some, unfortunately, do not. As someone
else said, it is a personal decision. Look into Jake's eyes and see what he is
saying to you. Somehow when I looked into Lucy's eyes, I knew she was still
there and I couldn't give up until she did.

Do you mind if I post your update from here to FDMB? Users are asking...
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Actually that would be wonderful if you would post that for me I am getting
ready to go out the door. The vet has not called yet, but I am going anyway
armed with catnip toys to see if it will help with Jake's depression that is
still there. I will have more updates later. Thanks so much again for
everything you are doing for us (and Boomer - non diabetic cat and Emma (the
beagle) too - they miss Jake also and know something is wrong. Judy & Jake
 
Paige, thanks for the update. As far as DKA, Mishka pulled through full blown DKA several times when I first adopted her and she has also battled a few ketones showing anywhere from trace to maxed out on the strip. DKA is usually called by the number of the blood pH. So glad to know Jake is where Carol's Charlie was and that he is slowly improving. Also good to know the food is staying down. Please ask Judy when she gets a chance to hop on to FDMB and keep us posted. Hopefully she will also call Carol.....a wonderful person and our resident poet.
 
I've been reading your posts and am so happy to see the update on Jake - sounds like he's doing better. We visited Carol and Charlie (the other FDMBer) you spoke about and her Charlie was absolutely gorgeous.

I've (fortunately and thankfully) never had to battle ketones with Dude so I can offer no advice - but know that I'm sending many healing vibes and prayers your way for your sweet Jake. Will be watching for your updates.

Emmy & Dude (& Mittsi too)
 
Hope - yes I have posted both of the threads here in Feline Health for her to come and check when she gets time. I am also going to add your post to the Yahoo Group in case she goes there first. I know what she is dealing with alot right now and FDMB can be overwhelming at first. However, I can be pushy when needed ;-) and will continue to request that she come over here more often. :-D
 
Judy... so glad to know Jake is at 'our' ER. I was very impressed when then treated my boy. I live in Victoria thus we're not far apart... (no not Canadian one) Hope told me that Jake and Charlie could have been twins.... please kiss his sweet nose for me... I'm still praying he'll pull through quickly... DKA is treatable...
 
Well, I just came from the E.R. where I got to see Jake and talk to the attending doctor. Jake is very sick and in still guarded condition, but there have been definite improvements. I looked at him eyeball to eyeball, as I held him, and there is still some fight in there. Fortunately, after a second ultrasound, cancer(a lymphoma) is not suspected. But Jake does have a severe case of pancreatitis in addition to some acidosis. The doctor is very hopeful that Jake can be successfully treated, but that it will likely take several days. We were concerned about his state of mind, because he would just lay there until right after I talked to the doctor the first time today which was this morning. It was right after that he got up and started moving around some so that is a good. He is getting a lot of food (body heal thyself) via a feeding tube and keeping it down. Good, too! Getting Regular (short-acting) insulin as well as lots of fluids. His blood sugar was high (400s) for a while today, but came back down into the 200s (they want it even lower) after they administered pain medications when they confirmed the pancreatitis. No metacam - they are using fenolol (sp?) as to not stress the kidneys any more than they probably are. In all the excitment, I forgot ask about the kidney values, but I am sure I would have been told if any thing was up other than the mild elevations he has that usually go with aging. Also, the enzyme? bilbury (SP?) (for liver function) is back to normal. Pancreatitis and accompanying pain might explain why I have been not been able to get Jake regulated since he was diagnosed in July 2009. He is not out of the woods yet, but the E.R. people have a lot more hope today than they did yesterday and even then there was some hope (50/50). So maybe now it is 60/40? These people are simply awesome. I had forgotten how awesome they truly are. My other cat had a run in with an Easter lily last spring and had to be at the E.R. for a couple of days to get his system cleared out after eating a lily leaf (I think - I will never know for sure!). So I will keep you updated as I get more information about my dear gray guy fondly dubbed Jakey Gus. I am not sure where I came up with that name, but he has had it for 17-3/4 years. Thanks so much for your genuine care and support. I can feel it, and it helps so much in getting through this.

Judy & Jake
 
One thing we often suggest for cats in hospital is to bring in some dirty t-shirts -- something that smells strongly of you -- and ask the techs to put it in their cage. It gives them something familiar and loving to associate and reminds them that folks love them very much. (I usually bring 2; one for the cage, the other as a replacement for when the one in the cage gets soiled for whatever reason.)

Many hugs to Jake and to you!

-- Jean and her Gwyn
 
Deep breaths help when reading your post. I was crying picturing you there, where I stood six months ago... But Jakey Gus is getting better... I'm so very glad.. relieved and hopeful.... Please tell him Carol said to fight hard so that he can come home with his mommy very very soon.

I'm feeling as if a part of Charlie will be going home from ER when Jake does.... and everyone knows Gray guys are tough... I know Charlie is rooting him on from his side also. ''

Well... hope we can talk soon... (((Hugs)))
 
lol, well, i wouldn't say dirty, but something that has your smell. you could put a sock in your bra or wear an old sweatshirt or t-shirt to bed so it has your smell and ask the ER to put it in your cat's cage. one you don't mind getting lost.
it'll be comforting to have something with your smell on it for your cat to snuggle up against.

sending you good vibes for a quick, full recovery for your little boy. :)
 
I just received another update this morning from the E.R. doctor. He said that Jake continues to get better. He is walking around now rather than just laying there, but still a little wobbly which is to be expected. His bilrubin (sp?) is still normal and his BUN went way down to 50 - lower than it was pre-crisis which was 52. Jake's potassium is still a bit low, but doc is not too concerned. The ketones that redeveloped at "1" status are now in "trace" status. He is not concerned about that either. They are aggressively treating the pancreatitis that they believe is being successful - pain meds, fluids, etc. And last, but not least, Jake is eating baby food on his own with just a little bit of assistance!! However, they are still using the feeding tube also. The only real concern right now is that they are having trouble keeping his blood sugar in a good range, but the doctor thinks that with time that will improve. Jake is not getting his normal insulin of Lantus, but rather Regular insulin (short acting) through an IV. You recall that this doctor, whom I have had the pleasure of working with several times over the past 15 years or so, has a spouse who owns a kitty clinic in a northern suburb of the Twin Cities. When I asked the doctor for a referral for a new vet after Jake is through this crisis, he recommended another kitty clinic with a specific doctor because that clinic is closer to me and that doctor is just as good as his spouse is and that the new doctor works more days out of the week than does his spouse which would be better for Jake. What does this tell you about the integrity of this E.R. doctor?? He has restored my faith in veterinarians! Most of all, however, it doesn't look like it's time for Jake to leave us yet. And for that, I am so grateful. I will be seeing Jake again this afternoon, and will bring something smelly :-) from home! H will likely be at the E.R. for another day, maybe two.

Judy & Jake
 
Great news. I was a little fearful at first when I saw the candle icon, because we usually use that to indicate a cat has GA (gone ahead). It is wonderful that Jake is in skillful hands, and will be home soon.
 
Judy I am very happy to hear that Jake is improving! I have been watching this thread and praying for a good outcome. Please keep the good news coming. I am sure Jake can't wait to get home to mama.
 
Judy regarding the low potassium...FYI, insulin lowers potassium levels; food raises potassium levels. So since he isn't eating normally right now, his potassium may be lower.
 
Thanks, Dale, for that information. I did not know that. I just got another update from the E.R. doc. He said that Jake is doing the same as yesterday - no improvement over night. He said Jake was quiet, and ate little on his own. Still, he walked around some and did some headbutting all of which he wasn't doing two days ago. Jake is naturally very timid and quiet, but I am not sure why he did not eat much on his own. Maybe it's just that he wants to come home and doesn't want what they are feeding him? His BUN is now down to 30 so that is good. Still a trace of ketones, but doc is not concerned. Maintaining good blood sugar levels is still a concern. An internal medicine specialist is coming into the E.R. to examine Jake this morning. There is some vague talk of Jake coming home within the next day or so. So I think this is all good? I took the candle icon off my last update - didn't realize what it stood for! Thanks everyone! Judy & Jake
 
You can do this Jake.... Yes you can.

Judy, I light a candle every Christmas Eve.... I want my children who have sometimes been all over the world... Iraq, Germany, etc... to find home if they need to..... It's silly I guess, but my mother used to say... "I'll keep a candle burning".....

I pray Jake comes home soon, though I don't envy you the drive to pick his sweetness up today.... My deck must have an additional foot of this snow already..... and they're saying one entire day more of snow.... and folks we live in Twin Cities not DC or Maryland... Wow....

Edited to add.... Maybe he just wants to cuddle up next to his mommy's smell.... I know my Spunky cuddles with my clothes each night.. (I toss them on the chair till morning... then they go to the laundry)
 
Dear All - I just came from the E.R. again, and Jake is doing well. Acidosis is gone, acute pancreatitis is healing, and last but not least, his blood sugars are between 150 and 250 - levels at which he is likely to stay near, which is just fine with me. After what we have been through, insulin twice a day for the long-term will be a breeze. E.R. doc says that remission is maybe possible down the line some. BUN is 30!!! Jake did not eat real well today so I brought him his favorite Fancy Feasts so I will find out tomorrow about what he ate when I meet his new post E.R. stay vet - an internal medicine specialist in Jake's needs. She is "officed" within the E.R. - Yes! They are going to keep him another 36 hours for monitoring, etc. Then the big day - he gets to come home if I can get through the 1 to 2 feet of snow that is predicted. We have a bunch already, right Carol? I pray that everything goes according to what the E.R. docs are predicting with no setbacks. Judy & Jakey Gus
 
Oh (((((Judy))))) this is such wonderful news. WIshing Jake to get better and stronger every day. I am so happy for you and happy that you found a great place to care for him. :mrgreen:
 
Thank god you found the second vet. I was reading through your original crisis, saw the "stopped insulin two days ago" and "ketoacidosis" and thought that was it for him. Your first vet should never be consulted by anyone with a diabetic anything.

And don't take your cat totally off insulin for any reason until his blood sugar stays normal all day. Some vets (and some people here) blithely talk about skipping insulin for a couple of days as if it's okay. It's not. DKA is a high risk for diabetics without insulin.

So glad he's pulled through, please keep the insulin up. If he gets too much, reduce (but don't stop) the dose.
 
Judy, how is Jake doing? Would suggest you start a whole new post so it goes to the top and easier for us to see. Maybe title it Jake update, etc. Something like that. Hoping for some good, good news on your boy.
 
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