More help - a little more serious

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Milo & Norman & Sarah

Milo & Norman & Sarah

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Thanks Jayne & Sweety and Hillary & Maui for the food information.

I do need some more help though. I can't get a hold of Norman's vet...and he isn't doing so great. His BG is still at 241 and I can tell he's not feeling well at all. He is vert lethargic, but he is eating some. Not his normal eating habit, but he will eat in small portions. I'm getting really worried now, and I know my vet won't have the best advise. This morning I ran out and got him a different cat food. How soon might I see his BG come down if the old cat food is the issue raising his numbers again? I still have some insulin in the refrigerator from his major flare up in August of 2007...should I give him some (is it even still good?) or wait till the food has time to try to work? Poor Norm just looks miserable...and what worries me the most...when he has the strenght, he is following me around the house...everywhere I go. Not a normal Norman habit. I'm scared...
 
Hi Sarah

couple of things,
possibly vet wasn't opened when u called, keep trying
also, maybe retest the BG - has it been about an hour since u got that 241?

Hows the litterbox? straining? doing business outside the box?
hows the water? drinking more? drinking any?

do u have a ketostix box so u can test for ketones?

not sure about shooting insulin, what kind do u have? it's from 2007? I dont think most insulin lasts that long, is there a date on it?
try to stay calm and try your vet office again
 
Thanks Ronnie & Luna...I'm still trying the vet with no luck...it just keeps ringing. I'm hoping they didn't take President's Day off... Litter box and habit is normal, maybe even a bit on the dryer side. Norm has never been much of a drinker once we started him on the wet food...still the same habit here too, drinking a little, but mainly getting fluids from the wet food. I do not have a ketostix box, do you know where I could pick one up...at a pharmacy? Can a blood test detect the keytones? The vet just ran a full panel of blood work on him Friday evening...all was normal outside of the BG. I don't want to do the insulin if I don't have to (it is probably out of date now anyway)...is the 241 ok for him to be at for a while longer until I get this figured out? He has been in that range for 3 days now. Sorry about all of the questions. I'm full of guilt that I haven't kept up with his diabeties better. Once he was diet controlled (within 2 weeks of his diagnosis), we completely lost touch with his situation since he has been doing so good for 2 years. I"m going to keep trying the vet. Thanks so much.
 
I would recommend you monitor the BG a bit today , 241 is just one number, a couple more BG tests thru the day may give u a bit more insight, and post here for feedback on that...u may want to keep a record of those numbers - others will want to know previous numbers.

ketostix are available at pharmacies, usually under $10, if your cat had ketones, I'm pretty sure your vet would of told u, I'd like to think they would anyways.

and it's possible vet's office is closed due to the holiday.
 
Sarah,

I don't know where you live, but is there a 24 hour facility nearby? Maybe you could call and get in today on an emergency basis.

As Ronnie said, I don't believe any insulin will be good from 2007, especially if already opened. Unopened insulin will be good until the expiration date. Opened insulin may only be good for several weeks or months, not 3 years.

What insulin are you using?

How about trying baby food? Beechnut stage 2 - chicken or turkey would be best, you could get lamb too (just don't buy beef at this point).

I recommend this brand as it doesn't have any additives or starches like Gerber brand.

You could see if this interests him and maybe even spoon feed him if necessary.

Also, following up on Ronnie's suggestions, monitor his BG's, pick up ketostix and test his urine to see if he has ketones.

And if there is a 24 hour place, give them a call and see what they recommend - a visit there just may put you at ease and that really is what's important here (not the cost).
 
Sarah, I just read your previous post and am wondering how the vet diagnosed the cholangiohepatitis. Between the recurring flare ups and the current symptoms (including the elevated glucose), I'm wondering if you might be dealing with pancreatitis instead.
 
Thanks everyone. So far over the past three days of testing twice a day his BG has hovered between 240-250. This morning was 241 and my husband is going to test him in a few minutes since he had the new food this morning. Although...since Norm isn't eating well, he keeps picking at the food, so I don't know how accurate the numbers will be.

Deanie, in Aug. 2009 he got really sick...he was continuously vomiting and stopped eating and was bright yellow...jaundis. Upon initial examination the vet said it could be pancreatitis, liver disease, liver cancer, or liver failure. After multiple blood panel tests, they did see 3 items that were extremely elevated (all dealing with the liver and kindeys). They gave us IV fluids to give him and an antiobiotic and liver regeneration meds. He bounced back literally within 1 or 2 days of starting an antibiotic. He was playing again like he was a kitten...a 12 year old kitten...but still very happy and healthy.

Then in Dec. 2009 it happened again, I didn't think he would pull through this time, he was so bad. With the same regimine they gave us last time, he bounced back again. They have ruled out the liver issues and pancreatitis because of his response to the meds and the MULTIPLE panels of blood test they have run on him. Granted, they admit are just guessing that it is the cholangiohepatitis (thanks for the correct spelling!) because I cannot afford the cost of a biopsy and ultrasound. But, all of the symptoms, his reaction to the antibiotics and how it is reoccuring leads them to feel it is the hepatitis. This past week Norm stopped eating again, but there was no vomiting this time (the major vomiting occured in both episodes prior) so I knew something else was wrong. And, he is sneezing like crazy right now. When they ran the panel on his blood on Friday everything was perfect except his BG AND he was running a fever. They sent me home Friday night with the IV fluids agian to keep him well hydrated, he is on another antibiotic, a stomach med to help keep vomiting away, pepsid AC to calm his belly, the Denamarin for liver regenaration, and an appetite stimulant. We have been testing his BG twice a day...they thought it might be elevated due to stress. After the BG stayed high I knew his diabeties flared up again for some reason. Only difference in his diet is the new long term antibiotic they have had him on since January and the fact that his food changed names and style. That is why I was wondering if they changed the food too. We will know soon if his numbers go down from the change of food.

Any thoughts?
 
Thanks Hillary, I will test his urine the next time I see him head for the litter box. Do I have to catch it in mid stream or how would I get the sample?

Thanks again...
Sarah
 
if you can catch mid-stream great, if not, catch it before it pools into the litter.

did they do a fpli test? this is a blood test to determine pancreatitis. From my understanding it's the most definitive way to know if he has it or not and there are two types - acute and chronic.
 
I can't address most of your questions, but 241 is higher than you'd like, but it's not awful high. It's probably elevated due to whatever else is happening.
 
Thanks again to all of you for calming my frazzled nerves. Last night before dinner Norman tested at 253. We had given him a different brand of food for dinner and I finally talked to the vet, they had me pick up a different antibiotic. As I was going to bed last night, I noticed a mood change in Norm and he looked like he felt much better. Sure enough, his BG was a 181 this morning. I don't know if the drop in BG was from the new antibiotic helping what ever is going on with him or from the change in food. Now I have a few cases (boxes of 12 cans) of FF that I don't know if I should donate somewhere else or try on Norman again? Anyway, thanks again...
 
Hillary,

I asked the vet last night about the keytones and the fpli test you suggested. They said the ketones "were fine" and that they did the fpli blood test in the large panel they had sent out to a lab. The results were "just fine". Thanks for all of your help and advise.

Sarah
 
That's good. If the fpli is normal - that means he doesn't have pacnreatitis.

However, while the ketones may be fine in that particular test, it is still important when dealing with a diabetic cat on insulin to test for ketones, so if you haven't already, may I suggest that you pick up a pack of ketostix. And as far as how often to test, I'd recommend whenever you can catch him peeing.
 
Sorry for the confusion Hillary, Norman is not on insulin now. He only needed 4 days worth of shots initially back in 2007, then became instantly diet controlled. Should I still check his keytones anyway?

I spoke with my vet again earlier today to give her Norman's BS update and she said that she feels he has a triad diagnosis (or something like that) where the liver, pancreas, and I think the urinary tract are all affected by whatever infection he has. She said she cannot 100% rule out pancreatitis since there is no real test that can diagnose it...outside of an ultrasound, biopsy, and a post mortum autopsy. So with how they are treating him right now, they would be following the same protocol for pancreatitis anyway. I guess Norm is covered. The infections Norm keeps encountering are triggering his already compromised blood sugar levels to elevate. Hopefully after this bout of a different infection we can keep things under control. I just hope these flare ups stop happening...Norm can't take much more.
 
Oh, I did want to mention... The vet did say he might have pancreatitis, but the fact that he has an instant response to antibiotics (especially Orbax) in his system causes them to turn to other issues since antibiotics don't typically help pancreatitis. Does that sound about right?
 
I don't see much on this message board about people using antibiotics for pancreatitis but it really seemed to help a friend's cat so....
 
Hi Sarah,

I only know some very basics about pancreatitis as one of my cats was diagnosed with "possible" pancreatitis. You are now way out of my league of knowledge.

Sorry I can't offer anymore advice on this matter.

I will leave it to others with more experience to respond.
 
the test for pancreatitis is the fPLI but it isn't always definitive. for example, cleo always tested negative for pancreatitis via the fPLI but the pancreas was clearly inflamed via ultrasound. other cats will not have a definitive ultrasound but a positive fPLI. important thing is to get the fPLI when the pancreatitis is active rather when the cat is starting to feel better.

treatment we use is subQ fluids, pepcid AC, and pain meds. cleo gets buprenix (bupe) for her flare ups. i'm also careful to add water to her wet food. she really appreciates it (doesn't substitute for getting subQ fluids, tho).

any time i hear a diabetic cat (even if he's diet controlled we don't say they're not diabetic any more) is acting lethargic my ketone alarm bells go off. please get the ketone test strips at your pharmacy and test norman's urine whenever you see lethargy, high numbers, or are lowering his dose for any reason. a cat can go positive for ketones in a matter of hours. (cleo had negative blood ketone tests, negative urine tests, then 3 hrs later showed small to moderate ketones and was in a bad way).

guessing norman may need to start insulin again. hoping your vet will stay on top of this.
 
Thanks everyone. I will be doing a ketone test tonight when I see him head for the litter box. After having a lower number this morning (180's down from 260's), we tested him before dinner and he was back up at 268. I'm going to test him before bed and hopefully get a ketone test in too...if he will go. I hate that I have to work, I am not able to monitor him like I should be. Anyway, thanks again for all of your advise.

Sarah
 
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