Maverick has DKA again, large ketones

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Mathilda and Maverick said:
I am still debating whether to give him the fluids tonight or not, I'm leaning towards not give it tonight, but I'll check his RR, try get another ketone test, and then make a decision from there. He keeps on asking for food so plenty of small snacks all day (and night) :)
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He's really lucky to have you. You're doing an awesome job.
 
UPDATE: So, I ended up rescheduling the vet app to today instead of tomorrow (luckily they had a time today open), because Maverick was kind of off yesterday, I saw him breathing with open mouth several times, I thought his belly had been bloated under the ribs, his RR has been 27-31, and what really scared me was that when I checked him in the middle of the night and he was just sleeping and I pet him under his chin he started to cough. He cough like my moms cat used to do when he had water in his lungs, so obviously I freaked out thinking something was up with Mavericks heart with all these symptoms (and he also had anemia a couple of weeks ago). Anyway, the vet didn't find anything on the reg examination so we did a x-ray. Luckily no fluids could be seen by his lungs and the heart seemed normal. However, one kidney was about double size than the other and there was a mild increase in bronchial pattern that may suggest asthma. He got Chlorpheniramine for cough.

The kidneys worries me, the vet want to do an ultrasound to rule out lymphoma. Today the left kidney measured 1.22" and the right 2.37" and the vet can't say if this is a normal variety or not. I looked back at the ultrasound results form the ER November 17, and this is what is stated there regarding the kidneys: "Right kidney: Moderately decreased corticomedullary distinction with irregular cortical margins. There is a hyper echoic wedged-shape lesson in the cranial polo the right kidney. Scant pyelectasia without dilation of the right ureter. Left kidney: Mildly decreased cortecoedullary distinction. Small cortical cyst present (0.1cm x 0.2cm) within the cranial pole".

I will call my vet tomorrow and ask if she can make sure to check his ultrasound report from the ER before we schedule a new ultrasound and hopefully she can make out if there has been any change in size of the right kidney since Nov 17, and explain for me in simple English what those notes really says. I called the ER and they said that if the findings were that one kidney was so much bigger than the other at the time, that would have been noted in the report. I'm doing my best trying to understand the medical wording but it only makes me think that my Maverick and I will lose this fight. Does anyone have a good understanding of what the ER notes says. I am freaking out over this now- perhaps I need to get him on a novel protein diet good for kitties with IBD, diabetes, and kidney issues? Am I doing something/feeding him wrong and that causes cysts to grow on his kidney? I had hoped for some clarifications today, but I didn't expect this added to his already so complex case. Maverick is still doing ok, eating good, but still tired and not quite himself at all.
 
UPDATE: Its been a terrible day. It looks like we are losing Mavericks fight even though he is the greatest fighter I know. Mavericks BG shot went through the roof yesterday. I had skipped the Cerenia in the morning and he got high, vomited in the afternoon and despite giving him Cerenia then he vomited again and he was very miserable and nauseous all night. He had a hard time eating, but was licking some food that was not his regular. I gave him an app stimulant at 4AM. Called the vet at 8AM, was told to only give him half the dose insulin and wait with net Cerenia until 24h mark. Maverick seemed much better at this point and was very busy chasing squirrels through the window. Fast forward to 11:30AM and he was looking tired and nauseous hanging out in bed. His BG then read Hi! and right after he vomited all food up I had managed to get him to eat. I called the vet and they had me give him the rest of his insulin dose and were able to take him in over the day.

All his kidney values were completely normal 12/26/2020, but they were shockingly increased today. This was today: BUN 99 (normal 10-30), CA 11.8 (normal 8.0-11.8), PHOS 14.5 (normal 0.3-2.1), CRE 6.8 (normal 0.3-2.1), GLU 648 (normal 70-150). Vet said he'd need 3 days on IV at the ER to flush out kidneys and then start investigation with Internist, do a biopsy to see exactly what causes the different size in kidneys and his rapidly elevated values. She mentioned potential blockage of the enlarged kidney, or lymphoma. Theres also potential of kidney failure. She also did another ultrasound and is gravely concerned. Now, Maverick is fragile as is with everything going on and I am leaning toward letting my boy fly free. It deeply herts me, but I do not have the funds for potential kidney surgery or chemo treatment, nor do I think it's in the best interest of my poor baby. But at the same time, as you all probably know, it's a terrible hard decision to make and I am hoping for a miracle, but I don't see it coming. I just want my happy go lucky-healthy high on life-pain in the butt-trouble maker boy back.
 
Wendy&Neko said:
Sorry to hear the latest developments. Kidneys numbers could be high because he's dehydrated. Sending you calmness as you make your decision. :bighug: At this point with recent DKA, you don't need to be too fussy about food, just whatever he'll eat. Have you seen these three posts:
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Yes, the vet also mentioned dehydration. Although, checking the "tent" he seem very well hydrated and have seemed like that for days now. Can he still be dehydrated without showing it in his skin?
Thank you, I appreciate it!
I'll check the posts out thank you! We do have experience of syringe feeding and he's very good at it so that's probably what we'll do tonight.
 
tiffmaxee said:
See if his gums are moist or tacky. Tags another way to check hydration b
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I'd say they are moist, and that's what the vet said both today and Monday when we were there, I din't understand it was hydration she was talking about when she mentioned that they weren't tacky, so thank you- it makes sense now
 
Bron and Sheba (GA) said:
I’m so sorry Maverick is so unwell again.
Is he at the vets now?
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Thank you! He is home now, our reg vet does not do overnight and we did not want to put him in the ER. He got SubQ, Cerenia shot and seems pretty comfortable at home right now. I was able to get some DM dry food and some other wet food in him and his PMPS was 354. We are just trying to make a decision of what direction we're going, but its terribly hard. We have the option to get him back to our reg vet tomorrow morning and keep him there for fluids over day, but she mentioned he'll need 3 consecutive days/night to flush his kidneys so I'm not sure that would help much, and he gets so stressed there. I so wish SubQ at home would do the trick but it doesn't sound that it would. And then wed still need to put him through a bunch of procedures and diagnostics to try understanding whats causing all this.
 
Mathilda and Maverick said:
Thank you! He is home now, our reg vet does not do overnight and we did not want to put him in the ER. He got SubQ, Cerenia shot and seems pretty comfortable at home right now. I was able to get some DM dry food and some other wet food in him and his PMPS was 354. We are just trying to make a decision of what direction we're going, but its terribly hard. We have the option to get him back to our reg vet tomorrow morning and keep him there for fluids over day, but she mentioned he'll need 3 consecutive days/night to flush his kidneys so I'm not sure that would help much, and he gets so stressed there. I so wish SubQ at home would do the trick but it doesn't sound that it would. And then wed still need to put him through a bunch of procedures and diagnostics to try understanding whats causing all this.
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The IV fluids do a much better job than sub Q fluids in helping the kidney values improve. I think your vet is right that the IV fluids will help. Don’t think too far ahead. Get the three days of IV fluids over first and see if they improve the kidney values.

With the food, let him eat what ever he will eat at this point. Remember food is still really important.
You have a lot on your plate at the moment. You are doing a really good job with Maverick...just take a day at a time at the moment and give him lots of love
 
Bron and Sheba (GA) said:
The IV fluids do a much better job than sub Q fluids in helping the kidney values improve. I think your vet is right that the IV fluids will help. Don’t think too far ahead. Get the three days of IV fluids over first and see if they improve the kidney values.

With the food, let him eat what ever he will eat at this point. Remember food is still really important.
You have a lot on your plate at the moment. You are doing a really good job with Maverick...just take a day at a time at the moment and give him lots of love
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Thank you, I really appreciate your words!
I wish I had endless pockets, but money is part of the issue, on top of not waning to pull it too far with Mavericks fragile body. We spent around $13,000 on vet bills the past 1.5 month and the ER vet that will do the fluids if so run an average of $1300/24h. Last time when they wanted to transfer him to the internal specialist, they asked for $850 deposit that would cover a consultation, and all this is already before the deeper diagnostics such as biopsy and continues ultrasound and blood work, and potential chemo is added. It's unfortunate we don't have insurance on him, and that vet care is so outrageous expensive here. Depending on how he'll do overnight I may call around to check internalists openings and charges tomorrow to get an better idea of things. We definitely been living day by day here since our boy got sick and I can't tell you how much we value the extra time we gotten with him, especially my 2 year old son that love Maverick so deeply and purely.
 
Mathilda and Maverick said:
Thank you, I really appreciate your words!
I wish I had endless pockets, but money is part of the issue, on top of not waning to pull it too far with Mavericks fragile body. We spent around $13,000 on vet bills the past 1.5 month and the ER vet that will do the fluids if so run an average of $1300/24h. Last time when they wanted to transfer him to the internal specialist, they asked for $850 deposit that would cover a consultation, and all this is already before the deeper diagnostics such as biopsy and continues ultrasound and blood work, and potential chemo is added. It's unfortunate we don't have insurance on him, and that vet care is so outrageous expensive here. Depending on how he'll do overnight I may call around to check internalists openings and charges tomorrow to get an better idea of things. We definitely been living day by day here since our boy got sick and I can't tell you how much we value the extra time we gotten with him, especially my 2 year old son that love Maverick so deeply and purely.
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I do understand the costs. They are terrible really.. I wanted to be a vet when I was young but just as well I didn’t, because I could never turn away a sick cat because of lack of money.
What about your usual vet. If you could do IV fluids during the day and maybe some subQ fluids at home at night for the three days that may work and would be more economical. Talk to your usual vet.
 
Bron and Sheba (GA) said:
I do understand the costs. They are terrible really.. I wanted to be a vet when I was young but just as well I didn’t, because I could never turn away a sick cat because of lack of money.
What about your usual vet. If you could do IV fluids during the day and maybe some subQ fluids at home at night for the three days that may work and would be more economical. Talk to your usual vet.
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Yes, that was me also! Always wanted to be a vet, but the reality is really harsh, and I'm not sure I could do it. But I'll insure my other cat and will never have a pet without insurance again. I always had my horse and dog insured, but if I knew how much vets charges for cats, I would have gotten for them also from the start.
She did mention I could take him back tomorrow for over the day, but then they are only open 1/2 day Saturday and closed Sunday and she was very convinced he'll need 3x24h consecutive care with IV fluids so I'll see how he's doing tomorrow and consult with her. I think he's feeling little better at the moment, I haven't pricked him for a few hours but I think he's going down as his ears are really warm and he just played a whole bunch and then ate with pretty good appetite (: He's very tricky though as his clinical signs not really match how one would expect him to behave if one only saw his lab work- and he has always been like that. I'm going to catch a little sleep and get up to check his levels and feed again in a little bit and hoping his appetite and good mood I still there then.
 
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