JUst an update on Sandy's vet visit, 12/6

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Sandy96

Sandy96

Member Since 2012
Good morning All!!! First of all...

CONGRATS TO MISTY and BAST for going OTJ!!! WOO HOO!!


Now that's out of my system sorry I missed it yesterday ohmygod_smile
Bug had a vet visit yesterday and as I was afraid of her recent round of good numbers and a few way to low numbers isnt due to her going into remission, its due to the fact that she isnt eating near enough to support getting insulin. SHe has lost almost another full pound (down to 7.3 from 8.1 on the 14th of Nov) and has not much of an appetite despite all the tips and tricks we have used in order to get her to eat and the fact that we were giving her food and watching her eat little bits (no more than half an ounce) at a time at least every 3-4 hrs. I was offered a feeding tube and as Brian and I had discussed earlier declined it so we discussed a 10 day course of treatment (subject to continuation or not at the end) including syringe feeding her 2 10cc syringes of food with each meal (min of 4 times daily) after she eats what she will on her own first, famotidine 10mg bid for her belly and as an appetite enhancer, nutrical paste 1tbsp bid at shot times and starting her Lantus at 1u and adjusting it from there as well as obviously continuing her glucose testing 4-6 times daily or more if needed, Also will be giving 50cc subQ fluids EOD. Right now the goal isnt remission but to get some calories/nourishment into her and hopefully getting Bug to gain a few lbs and improve her quality of life, however it is subject to change based on how she reacts to the new feeding regimen and the rest of the plan. I hope she will turn around and get better but we are prepared to provide her with a peaceful crossing if that is what she needs.
 
Re: Sandy's vet visit yesterday

I'm really confused. The vet is talking euthanasia without any idea of what's wrong? Did the vet send blood out for a pancreatitis test (i.e., a Spec fPLI or in-house Snap fPLI)? Did the vet examine Sandy's teeth to make sure that dental pain isn't the problem. Were any x-rays or other diagnostic tests done? If your vet doesn't have a clear plan for treatment, how about asking for a consultation with an internal medicine vet? Put this in the context of your going in to see your doctor and your symptom was loss of appetite accompanied with weight loss. What would your physician do? I suspect your doctor would have a list of problems that he or she would systematically test for in order to determine how to best proceed. It shouldn't be any different for Sandy.
 
Re: Sandy's vet visit yesterday

I'm saying a prayer that Sandy bounces back and her appetite gets better so she can gain her weight and be strong. And then one or two for you and Brian also. give your little Bug an extra scritch from me.

Sending hugs to you all from us all
mary and oliver
 
Re: Sandy's vet visit yesterday

I'll be keeping Sandy, and you and your DH all in my thoughts and prayers, and I also wish for Sandy to make a full and speedy recovery.
 
Re: Sandy's vet visit yesterday

Sending healing and appy vines to your sweet Bug. I hope she rallies. I see on her profile she is a Manx. My Maggie is also a Manx and close to 14 years old. Keep us posted.
 
Re: Sandy's vet visit yesterday

Dani

First of all, 10mg of famotidine bid is WAYYYYY too much! The starting dose is usually 1/4 of a 10mg Pepcid AC sid, building up to 1/4 of a 10mg bid. From Tanya's CKD website

Below are suggestions for famotidine dosages for CKD cats, but be guided by your vet. You should only use famotidine with your vet's approval. Do not start with the maximum dose, it could be risky.

Starting dose:
2.5 mg once every other day (i.e. quarter of a 10mg tablet once every two days e.g. on Mon, Wed, Fri)
Intermediate dose (if starting
dose does not seem to be helping):
2.5mg once a day (i.e. quarter of a 10mg tablet once a day)

Maximum dose:
2.5mg twice a day (i.e. quarter of a 10mg tablet twice a day, 5mg a day in total)
Click to expand...

The bold is mine. The reason you have to be careful with dosing is because it is processed by the kidneys.

There are many things that can cause lack of appetite: dehydration, high phosphorus levels, anemia, fluid retention/heart problems, mouth ulcers, antibiotics, constipation, hyperthyroidism meds, and dental problems.

Also, I've never heard of Nutri Cal being used as an appetite stimulant and I do not believe it is one. It is to provide extra calories and it is loaded with sugar and also soybean oil....neither of which would I give any of my cats. If you want to add something to help her weight, I would suggest you try Tropical Traditions Coconut Oil. My vet prescribed coconut oil for our 16 year old CKD kitty, Gus. He gets 2-2.5 mld/bid to gain weight and he has gained about 4 ounces. I also give it to Gracie and Tobey but only 1 ml bid for hairballs. It is FD friendly and that small amount for the two younger ones has not affected their weight.

If your vet has recently done bloodwork, I would encourage you to post it and please forgive me if you have and I missed it. If she's eating less, it could possibly affect her liver values and then you have a vicious circle that could result in hepatic lipidosis. Her profile states she has had "liver involvement". A cat does not have to be anorexic to go into FHL; if calories are greatly reduced, it can occur. If your vet has not done bloodwork in the last week or so, I'd be asking for it including the spec fPL that Sienne referred to; I'd also go with the xrays and then the next step would be U/S. Just to give you a reason why all of this.....cats are notorious for "hiding" medical issues. A few months ago, Gracie was doing absolutely fine but one morning, she vomited clear, foamy liquid which is a sign of acid tummy. She was totally normal other than that but it is not like her to vomit. I ran her into the vet, did bloodwork and her liver enzymes were really elevated. The vet put her on A/Bs and I took her to a specialist and had an U/S done and found her bile duct was infected. He said if I had ignored the vomiting, she would have gotten sicker and sicker; luckily, we caught it early and completely reversed it with A/Bs.

I'm sorry if I might have missed out but why not the feeding tube? The etubes are easy for the vet to put in and cats adjust very, very well to them. While it might not be necessary for you to do RIGHT now, I would not totally dismiss this. If she eats less, it's going to be difficult for you to syringe feed her as many calories as she needs. You would have to be feeding her every couple of hours.
 
Re: Sandy's vet visit yesterday

I'm sorry to hear that Sandy is having such a hard time. I agree, there has to be an underlying cause for the lack of appetite and weight loss. It is way to early to give up. Just treating the symptoms is a first step, but won't really solve the problem. Sienne and Marje are a wealth of information on the meds, listen to them and double check w/ you vet. I know it is easy to mishear details when you are at the clinic, dealing w/ a stressed cat and are upset.

If you are starting to assist feed this is a great step by step video. Use a different food that she isn't that fond of anyway, they can develop a dislike of the foods that you syringe feed and refuse them later. Also go for the highest calorie foods that you can find, of ordinary cat foods the Wellness grain free foods are about the highest, around 40 kcal/oz. There is a prescription food Iams Maximum Calorie Plus (55 kcal/oz.) that would be great too, if you vet has it or can get it or you could call around to other vets. As a guideline cats need a minimum of 15 kcal per pound of weight. Usually maintenance is 20 to 30 kcal/lb. depending on how active they are and more if you want them to gain weight.

It takes time for cats to regain weight, it took Tess over a year to gain back half a pound. Remember too, that Sandy just may be a small ca. Many FD cats are overweight on dx even if they aren't terribly heavy, it's part of the disease. At dx Tess was 9.75 pounds, went down to 8.2 and is looking just right at 8.75 now.
 
Re: Sandy's vet visit yesterday

I would like to jump in here if I may.

Sandy's blood work is completely normal, from pancreas to kidneys. As the vet says, "A PERFECTLY HEALTHY 17 year old cat who happens to have diabetes."

Yes she has had a history of dental problems, but the vet looked at her teeth, and didn't see anything that would cause this, and as I have just stated and my sistter has previously many times, llabs are normal. except the diabetes.

As far as the feeding tube goes, it came down to quality of life, not quantity. She has none.

Please stop, I have seen certian you's helpp owners through this offering support for pts, why can't you do this for her?

I sent her here because I thought ..... can't figgure out how to say it.... I was wrong. The faroriteism is crazy here. Not everyone, just some. I didn't see it because Tash was only on inuslin for about 2 weeks, I have seen it however with my sister. I have seen her post witbh no vet stuff just normal stuff and get lamblasted.

I don't know what else to say.
 
Re: Sandy's vet visit yesterday

When Tiggy was first diagnosed he wasnt eating properly either.. which made iu wonder if he was diabetic because I thought they were supposed to be hungrier! But after a while and getting a better dose, he started eating better. Also he stopped eating again when he was approaching OTJ later on (not sure why - maybe he was going too low all the time). So there can be many reasons.

i do think there is still a lot of good advice above and things to try yet.. dont give up hope yet!
 
Re: Sandy's vet visit yesterday

Bug was eating like a horse the week or so prior to the diagnosis, but for her shes always had a good appetite so it wasnt a red flag to see her that way. The lack of appetite has started since diagnosis. I havent given up, but I am going to follow my vets plan and see if it works, maybe in 10 days we will have better news. Until then I am gonna take a vacation from posting, I will continue posting her glucose levels on her spread sheet if anybody is interested.
 
Re: Sandy's vet visit yesterday

ok I will keep watching your SS. We are here for you if you need us though. will you be checking your PMs?
 
Re: Sandy's vet visit yesterday

OK now that I have gotten my previous post out of my system...

There is one thing here that is being forgotten. Everyone says what are the numbers, lab results ectc.

What about Sandy, not the diabetic, not the test and labs, but the cat. My sister is treating the whole cat, not just the numbers. She sees what is\, and what is not happening. Foremost in my mind is the fact that the other kitties are having nothing to do with her, when before she was mama bug to them all.

You don't see the quality of life she has, all you know is what she posts. So please stop running her down for doing what she feels is right. She hasn't given up on Sandy. She is feeding her with a syringe 3-4 times a day if not more, she is giving her sub q's every other day, and she IS giving her nutrical.

Again, she is treating the WHOLE CAT, not the numbers.
 
Re: Sandy's vet visit yesterday

You are very right Karisa...no one but your sister knows what's going on and how Sandy's QOL is. But, I don't think anyone was trying to run her down. I think that because we don't know the Whole Cat Report, it sounded very abrupt that crossing the bridge is being considered - almost as if the vet - not your sister - had not only given up, but hadn't even tried to find out what was going on with Sandy. I really haven't seen many other BugCondos, but in this one, it sounds to me like people are offering support and suggestions, given the information at hand. I know that sometimes it starts sound very technical and overwhelming and not about the Whole Cat and only about the numbers and tests...but I think that's just the way of online communcation, since vocal inflection is missing. Everyone here responds out of genuine concern, despite the way the tone sounds.

Just curious, since I'm not all that familiar...did you change foods when Sandy was diagnosed? I was just wondering if something food related could be bothering her...a sensitivity, or a flavor that she just doesn't like.

I do hope Sandy starts to feel better...you have my prayers. Please keep us posted.
 
Re: Sandy's vet visit yesterday

I was trying to weigh in here too. And lost connection for an hour. :evil:
I have observed that everyone here encourages "living" for all our kitties until the decision is made to pts or even past the decision point.
And then everyone is greatly sympathetic... cat_pet_icon ... as we all know we could be in the same situation any year , young or old.

Prayers and sympathies as you try to work out just what to do. It's never easy when you care so much about animals suffering.
I have a similar issue with my son's cat here, 16, sick, sickly, ruining my hardwood floors... he won't do anything for her... and she's not mine.
I can't afford her, nor will I take her on. I have my own Shadow to take care of. His cat has a few more days...
I don't want to watch her suffer.


So everyone here just wants to help.
I don't think anyone is trying to send guilt trips or be anything less than sympathetic and encouraging...
 
Re: Sandy's vet visit yesterday

Dani and Karisa:

Amy summed up my reaction well. I knew there were issues with Sandy's appetite. As far as other medical issues, I know that Sandy's Profile indicates there have been no past medical issues but just like with humans, illness can occur within a matter of hours. We've seen cats develop pancreatitis within 24 hours and certainly have seen cats in DKA in even less time. The concern over Sandy by her caregivers is evident. It was the vet I was questioning. From the information posted, it reads like there was no apparent effort made to figure out what the underlying problem may be. That's what I was asking about and what Marje was asking about. If anything, the intent was to provide information and support as a means of interacting with this vet. If that intent wasn't clear, my apologies.
 
Re: Sandy's vet visit yesterday

Dani and Karisa:

I'd like to echo Amy and Sienne's comments. There is no intent here to judge. We are only trying to help and give you the best advice we can. I'm sorry you feel there is favoritism....I've never experienced that here and it is most definitely not the intent of anyone who posted here today.

I asked about the bloodwork just because I hadn't seen any mention of it but I also said I hadn't read all the condos so please forgive me for asking again. Adding on to what Sienne said, any given bloodwork is just a snapshot for that moment. I'm also a proponent for treating the cat, not the numbers because our kitties are so much more than numbers. But the labwork just gives us an idea if there is something that the vet has missed. I've had it happen....I'm sure others have as well.

I also offer my apologies. We were only trying to help you with things to ask the vet. I hope and pray Sandy gets better and Dani enjoys many more healthy years with her.
 
Re: Sandy's vet visit yesterday

Apologies accepted. I understand that I may have seemed a bit abrupt but my Vet actually said we will do this before considering PTS, Doc Sherman isnt one to give up on kitties unless there isnt anything left to be done or the animal is suffering. Right now Bug is suffering because she isnt eating so that is first and formost in all of our minds she is also suffering because her "babies" arent taking care of her the way she has alwasy lavished love and discipline on them. I dont plan on giving up on Bug unless she tells me she is done, right now she isnt the kitty shes always been but I am willing to do what I can for the moment to see if she will bounce back.
I had a post prepared telling what all has been done, what decisions have been nmade and why, all of which are subject to change based on her reactions good or bad to what we are or possibly could be doing, Karisa beat me to it in short anyways. I will say this, other than running bloodwork yesterday Doc Sherman did a full exam from head to tail and back again and determined that besides the fact that she is failing to thrive that until we get her hydrated and fed a bit more bloodwork can wait esp since it was normal 2 weeks ago and she is asymptomatic other than being anorexic for anyhting that would make her be this way.

Actually the only real change I have made to her foods is giving her what she will eat low carb wise, which is little bits of different foods, mostly poultry flavors and some fish. She was eating beef but other than some the occasional FFC she doesnt eat the beef ones anymore.
I will be checking back and forth and also checking PMs and I will post what is going on, and if you all will try to remember I am taking care of my entire cat not just the numbers I will try not to take offense or feel that i'm being run down as Karisa put it for what I am or am not doing.

Marje, We decided that, after being nurses for several yrs and having taken care of several people (i know not cats) including mine and Karisa's Grandpa with feeding tubes that we didnt want to put Bug through that esp at her age and with her underlying heart murmur. ALso we have 2 little boy kitties (5yrs old but still pills about stuff) who will most likely try to attack the tube and or Bug and may cause her harm whether they mean to or not.
 
Re: Sandy's vet visit, update 12/6

AT this point Bug is tolerating the Assisted Feeding well, tho she does fight it towards the end. She also tolerated the Sub Q fluids which I have to give her this afternoon again. She is still weak and not eating more than .5oz at a time. She is Drinking and using the litterbox (pee anyways I have 3 other kitties so cant tell about poop).
I had tp adjust her feeding schedule a bit so she isnt to full to eat when she needs too, esp around indulin time and midpoint. She is stilll at 1 u, am contemplating an increase depending on the readings I get today
 
Morning, glad Bug is tolerating the Assisted Feeding and Sub Q fluids. I hope she's feeling a little better. Sending good thoughts and vines for Bug and you.
 
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