New here! Need help please...

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Sounds like a real good visit. Too bad they are 1 hour away (2 hour round trip). The important part is to get him eating again.

Ketones are bad. Test strips are cheap at Walgreens ($11 for 50 strips). Not sure why the vet is so hesitant to retest.

Renal threshold is around 200 BG. Above that, the kidneys filter out glucose. Below that, the body processes glucose mostly normally. So at BG = 350, there will be a lot of drinking and peeing. And there will be reduced glucose being absorbed by the body's cells because of low insulin levels.
 
JeffJ said:
Sounds like a real good visit. Too bad they are 1 hour away (2 hour round trip). The important part is to get him eating again.

Ketones are bad. Test strips are cheap at Walgreens ($11 for 50 strips). Not sure why the vet is so hesitant to retest.

Renal threshold is around 200 BG. Above that, the kidneys filter out glucose. Below that, the body processes glucose mostly normally. So at BG = 350, there will be a lot of drinking and peeing. And there will be reduced glucose being absorbed by the body's cells because of low insulin levels.
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Thanks, JeffJ. Idk why they won't test again other than why they told me. I'll have to ask the vet to retest tomorrow.
 
Tritt3180 said:
Glucose was 336, but no insulin was given. I believe I was told he won't get any until he's >350. Still seems super high to me, but I'm also told cats tend to drop out of nowhere and go hypoglycemic really fast. So, they don't give insulin until he hits 350. 250-350 is his supposed sweet spot.
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I do hope your home vet is a little better educated.....controlling the glucose is also important to getting everything else in line.

Yes, hypo's kill, but if they're testing, there's no reason for them ever to have one either.

Normal blood glucose for cats is 50-120 on a human meter, 68-150 on a pet meter.

Getting him regulated will take time....it can't be done in a few days at a vets office, but I sure don't understand not giving him any insulin at all with numbers in the 300's.

Do you have any idea which insulin you're going to be using at home? Lantus, Levemir and ProZinc are the 3 that work best in cats (but it's totally normal for ER vets to use R since they need to get the glucose down quickly to help treat the DKA)
 
Chris & China said:
I do hope your home vet is a little better educated.....controlling the glucose is also important to getting everything else in line.

Yes, hypo's kill, but if they're testing, there's no reason for them ever to have one either.

Normal blood glucose for cats is 50-120 on a human meter, 68-150 on a pet meter.

Getting him regulated will take time....it can't be done in a few days at a vets office, but I sure don't understand not giving him any insulin at all with numbers in the 300's.

Do you have any idea which insulin you're going to be using at home? Lantus, Levemir and ProZinc are the 3 that work best in cats (but it's totally normal for ER vets to use R since they need to get the glucose down quickly to help treat the DKA)
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Idk what he will be on. He is getting Humulin R now, I think. I'll find out more from his regular vet since he's not coming home yet.
 
Tritt3180 said:
2130 update: Glucose was 336, but no insulin was given. I believe I was told he won't get any until he's >350. Still seems super high to me, but I'm also told cats tend to drop out of nowhere and go hypoglycemic really fast. So, they don't give insulin until he hits 350. 250-350 is his supposed sweet spot.
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That's ridiculous, we always aim for cats to be under 200 which is the threshold but some vets believe that no insulin is required if a cat is at <120 however in this world of diabetic cat care we would still be shooting until a cat was down to 50 because that's the only way to get a cat into remission. Into the 300's and no insulin, that's negligence.
 
Dropped Cat off at the Vet hospital this morning and just spoke to the Dr. He started him on ivf again and gave him pzi (a long acting insulin). His glucose was 385 when the vet checked him. The next check is at 3:45p. (6 hours later)

He's walking and standing on his own. He was able to get from his carrier to me and back, to the back seat and back up front, and then to my seat and back when I stopped to get a coffee on the way to the vet.

I forgot to ask about ketone testing there, but they will do an ultrasound to check for pancreatitis since the ER couldn't.

Had to call back and ask the tech if pain meds or zofran have been given yet, and she said not yet, but shell ask the Dr about them.

Dr is talking about him going home either today or tomorrow. We'll see... I don't know that I'm ready for that yet.
 
Also, mom is bringing some wet food choices to try different things. The ER vet said to try to get him to eat anything right now. The store she stopped at doesn't carry Fancy Feast, but she got Caesar's Classic chicken flavor and a can of the wet dog food he gets into at home (Pedigree). Plus, they have the special diet food there. I mentioned the E-tube to the Dr because the ER vet tech suggested it. And the Dr said maybe as a last resort he'll think about it. So... That's where things stand unyilbi call back. The Dr said to call around 3pm. I may try to wait until his sugar is checked to call in. Gonna be hard waiting 5 hours as opposed to 3!
 
Tritt3180 said:
Also, mom is bringing some wet food choices to try different things. The ER vet said to try to get him to eat anything right now. The store she stopped at doesn't carry Fancy Feast, but she got Caesar's Classic chicken flavor and a can of the wet dog food he gets into at home (Pedigree). Plus, they have the special diet food there. I mentioned the E-tube to the Dr because the ER vet tech suggested it. And the Dr said maybe as a last resort he'll think about it. So... That's where things stand unyilbi call back. The Dr said to call around 3pm. I may try to wait until his sugar is checked to call in. Gonna be hard waiting 5 hours as opposed to 3!
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http://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf
 
A tech just called and said Ringo's glucose is at 148 with just 2 units of pzi! They are going to keep him over night to monitor him close. Their plan is to keep him on2 units BID. If it works and he can go into remission, it works for me!

When I asked about eating, the tech said they had been force feeding him, but he's not showing interest on his own. She didn't know anything about zofran or bupe, and she said it didn't look like anything was being done for pancreatitis. Not even an ultrasound. :-/ She said she is going to have the Dr call me when he can to talk about those things.

Maybe he's not nauseas if he's holding down the food they're forcing down him?... Idk I wonder if this could all just be DKA related and not pancreatitis... His amylase and lipase levels were wnl, so it's possible? I guess I'll find out later when the Dr calls.

It's nice that I didn't have to call, but would like to get all the info as soon as I can.
 
Tritt3180 said:
A tech just called and said Ringo's glucose is at 148 with just 2 units of pzi! They are going to keep him over night to monitor him close. Their plan is to keep him on2 units BID. If it works and he can go into remission, it works for me!

Oops! 158
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Tritt3180 said:
Ringo's glucose is at 148 with just 2 units of pzi!
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Oh, we like news like this! :cat:

Tritt3180 said:
When I asked about eating, the tech said they had been force feeding him, but he's not showing interest on his own.
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Tritt3180 said:
Maybe he's not nauseas if he's holding down the food they're forcing down him?
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Even if Ringo is holding food down, if they're having to assist feed then something's preventing Ringo from eating under his own steam. Whether it's due to DKA/pancreatitis/both the most likely culprit is nausea. I suggest keeping on the case with the vets to get the Zofran treatment reinstated. You've got evidence from the previous vets showing that he did eat by himself when he received it. (If that's not enough then the bupe may also still be needed.) If treatment with Zofran is successful then it would be a much gentler solution to Ringo's appetite problems than an e-tube.

If a cat has been having major problems with nausea/inappetence the general approach is to start with anti-nausea treatment - possibly reinforced with an appy stimulant at first. As the cat gets back to eating regularly on its own the appy stimulant may not be needed but typically the anti-nausea treatment needs to be continued for some time thereafter until the kitty is eating voluntarily and reliably. Reliability of food consumption is critical to any cat and even more so when the cat is recovering from DKA and needs insulin.

Tritt3180 said:
I wonder if this could all just be DKA related and not pancreatitis...
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It's possible it might just be DKA. Without the results of tests/scans for differential diagnosis one can't tell. I'm keeping my fingers crossed for you both that it is DKA alone. (Pancreatitis is the pits.)

Keeping fingers and paws crossed in the Shire.

(((Ringo)))


Mogs
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Critter Mom said:
Oh, we like news like this! :cat:



Even if Ringo is holding food down, if they're having to assist feed then something's preventing Ringo from eating under his own steam. Whether it's due to DKA/pancreatitis/both the most likely culprit is nausea. I suggest keeping on the case with the vets to get the Zofran treatment reinstated. You've got evidence from the previous vets showing that he did eat by himself when he received it. (If that's not enough then the bupe may also still be needed.) If treatment with Zofran is successful then it would be a much gentler solution to Ringo's appetite problems than an e-tube.

If a cat has been having major problems with nausea/inappetence the general approach is to start with anti-nausea treatment - possibly reinforced with an appy stimulant at first. As the cat gets back to eating regularly on its own the appy stimulant may not be needed but typically the anti-nausea treatment needs to be continued for some time thereafter until the kitty is eating voluntarily and reliably. Reliability of food consumption is critical to any cat and even more so when the cat is recovering from DKA and needs insulin.


It's possible it might just be DKA. Without the results of tests/scans for differential diagnosis one can't tell. I'm keeping my fingers crossed for you both that it is DKA alone. (Pancreatitis is the pits.)

Keeping fingers and paws crossed in the Shire.

(((Ringo)))


Mogs
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Thank you. I'll keep at it until I get a differential diagnosis. Would his labs be normal if he has pancreatitis, or do land not always tell the whole story in these cases?

The appetite stimulant was given either Saturday night or early Sunday. I was told he can have it every 3 days... So, he'd be about due for another dose tonight or tomorrow. I'll be sure to ask about that when I talk with the Dr. And even push for the zofran, at least. The tech didn't seem to know what I was talking about when I mentioned both names of the med... I'm hoping they have it at this facility.
 
Is that too big of a drop over 6 hours? And do any of the reg labs flag an indication for pancreatitis, or just the special lab tests and ultrasound? If not, would an ultrasound alone be sufficient to diagnose it? Just trying to figure out how to approach the Dr when he calls.
 
Tritt3180 said:
Would his labs be normal if he has pancreatitis
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Sometimes with pancreatitis the liver values and lipids/enzymes might be off but one needs the SNAP/Spec fPL tests (possibly with supporting ultrasound scan) for a positive Dx.

Saoirse had an abdominal ultrasound as part of her workup when she was first Dx'd with diabetes. (The treating vets at the time were absolute pants with cats and, after her physical exam (very distended abdomen) they initially suspected ascites when the actual problem was Saoirse's bladder being full to the brim from drinking over a litre of water in the previous 24 hours. Long and angry-making story ...) The scan picked up the pancreatic inflammation. Thereafter I monitored her status by getting periodic Spec fPL tests run (after switching to a different veterinary practice).

If the appy stimulant is being dosed every three days then pound to a penny they're treating Ringo with mirtazapine. For general information, an alternative appy stimulant is cyproheptadine. An antihistamine, cyproheptadine's appetite stimulant effect is gentler and of shorter duration than mirt but it can be dosed as frequently as q8 hrs if needed, making it really helpful for 'fine-tuning' appetite stimulation in a somewhat more 'real time' fashion - if appetite is OK, you can skip a dose; if it stalls you don't have to wait very long before giving the next dose. (Note: Cypro is metabolised in the liver so need to check it's OK with the vet.) Cyproheptadine is less likely to adversely interact with buprenorphine and less likely to cause behavioural changes (mirtazapine's a tetracyclic anti-depressant, often dubbed 'miaowzapine' because it can cause unusual vocalisation and agitation). Saoirse had a major adverse reaction to her one and only dose of mirtazapine (pupils dilated to the size of dinner plates, ravening hunger, severe agitation and aggression - mirtazapine can cause serotonin syndrome) but she did great on the cypro; the only side effect was slight drowsiness that wore off about 1 hour after dose administration. Other cats get on famously with mirt. As they often say here, every cat is different (ECID)!

For convenience I'm reposting a couple of links for you below. I found them invaluable in helping me to manage Saoirse's nausea and inappetence issues. In particular, the IDEXX document (a suitably authoritative source! ;) ) is great to wave around the place when discussing/pushing for anti-nausea and appetite stimulant meds from the vets, including a supply for administration during recovery at home! It's far safer to have a supply of meds that are not needed than to put the kitty at risk of a relapse; prompt response to appetite problems makes the world of difference and is key to the kitty making a solid recovery from DKA.

IDEXX Labs - Pancreatitis Treatment Guidelines (inc. recommended meds for managing nausea and inappetence)

Nausea & Inappetence - Clinical Signs & Treatments


Mogs
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Critter Mom said:
Sometimes with pancreatitis the liver values and lipids/enzymes might be off but one needs the SNAP/Spec fPL tests (possibly with supporting ultrasound scan) for a positive Dx.

Saoirse had an abdominal ultrasound as part of her workup when she was first Dx'd with diabetes. (The treating vets at the time were absolute pants with cats and, after her physical exam they initially suspected ascites when it was actually Saoirse's bladder being full to the brim from drinking over a litre of water in the previous 24 hours. Long and angry-making story ...) The scan picked up the pancreatic inflammation. Thereafter I monitored her status by getting periodic Spec fPL tests run (after switching to a different veterinary practice).

If the appy stimulant is being dosed every three days then pound to a penny they're treating Ringo with mirtazapine. For general information, an alternative appy stimulant is cyproheptadine. An antihistamine, cyproheptadine's appetite stimulant effect is gentler and of shorter duration than mirt but it can be dosed as frequently as q8 hrs if needed, making it really helpful for 'fine-tuning' appetite stimulation in a somewhat more 'real time' fashion - if appetite is OK, you can skip a dose; if it stalls you don't have to wait very long before giving the next dose. (Note: Cypro is metabolised in the liver so need to check it's OK with the vet.) Cyproheptadine is less likely to adversely interact with buprenorphine and less likely to cause behavioural changes (mirtazapine's a tetracyclic anti-depressant, often dubbed 'miaowzapine' because it can cause unusual vocalisation and agitation). Saoirse had a major adverse reaction to her one and only dose of mirtazapine (pupils dilated to the size of dinner plates, ravening hunger, severe agitation and aggression - mirtazapine can cause serotonin syndrome) but she did great on the cypro; the only side effect was slight drowsiness that wore off about 1 hour after dose administration. Other cats get on famously with mirt. As they often say here, every cat is different (ECID)!

For convenience I'm reposting a couple of links for you below. I found them invaluable in helping me to manage Saoirse's nausea and inappetence issues. In particular, the IDEXX document (a suitably authoritative source! ;) ) is great to wave around the place when discussing/pushing for anti-nausea and appetite stimulant meds from the vets (including a supply for administration during recovery at home!).

IDEXX Labs - Pancreatitis Treatment Guidelines (inc. recommended meds for managing nausea and inappetence)

Nausea & Inappetence - Clinical Signs & Treatments


Mogs
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Thank you so much for all of this info!! Lord knows there's a ton I could research and find, but you're saving me from sifting through a bunch of fluff that comes with it! :-)
 
I'm so glad this is of help to you; 'tis knowledge that was hard won and 'twould be a sin not to share it ... (((Saoirse)))

Like you, I found that I had to gen up on stuff and drive Saoirse's treatment. Thankfully the vets we switched to are much more collaborative in approach than the previous shower. In particular, Saoirse's main treating vet at the practice had a diabetic cat himself which was very helpful. Over time a very beneficial vet-caregiver team relationship developed which made many things easier.


Mogs
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An afterthought:

Ask the new vets about whether it's OK to give a course of B12 injections. It can help a lot with appetite/GI disturbances. It's recommended when treating pancreatitis but I don't know whether or not it might be contraindicated when DKA is an issue. See the IDEXX document for more info on the benefit of B12 supplementation.


Mogs
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So, they did an ultrasound and the Dr said it was difficult to see. I'm thinking that would be a good thing, right? They don't have the snap test, and have not sent out blood work for the spec fPL. Should I still push for it?

I told the Dr when he got the bupe and zofran he ate on his own, and no one will be home to force feed him during the day like they are. He said he is not vomiting and doesn't seem to be in pain, plus he hasn't had a bowel movement in 5 days (even though he hasn't been eating) he doesnt want to continue to constipate him. With the force feeding something should be coming out by now, right? Not sure if the amylose (sp?) is contraindicated with pancreatitis.

They want to give him another 2 units of insulin tonight. I had to talk the Dr into getting a tech to stay all night to make sure he doesn't go hypoglycemic since he won't be eating then because no one will be force feeding him through the night. This Dr doesn't seem to respond comfortably to mt questions and concerns... He said, "sure there is a possibility he could go hypoglycemic so if you want someone to be there in case he goes into shock it will cost you about $250." Ringo's normal vet isn't there until Thursday. Super frustrating!!!

I have to take the dog food he gets into at home up there tonight to see if he will eat something. Mom didn't bring it, I've learned. Idk if he will even want to eat having a full stomach like he has.

What do I need to ask for given the above info, other than a different Dr? He's the only one there right now.
 
He's still at the vet. I bought a tech for the night to stay with him and monitor him. I agree 2 units is way too much to give when he's not eating at night - esp if nobody would be there. Now there will be. The Dr sluffed it off as if it wasn't a big deal, which really upset me. Scary stuff. I don't like this guy at all!
 
You'll feel a lot better once your kitty is safe at home if you take on the FD treatment yourself. Learning to test BG at home seems daunting at first but it's actually easier than you think. Once you have this tool to monitor how your kitty is doing at home you'll feel so much calmer and in control. Most of even the best vets aren't very good at treating FD which is why we all ended up here and took matters into our own hands. :)
 
Tritt3180 said:
He said he is not vomiting and doesn't seem to be in pain, plus he hasn't had a bowel movement in 5 days (even though he hasn't been eating) he doesnt want to continue to constipate him. With the force feeding something should be coming out by now, right?
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Poor boy! :( Five days is a long time without a BM.

If Ringo is constipated then that could very well be contributing to the nausea/inappetence at the moment and ondansetron is likely to have little or no therapeutic benefit at the moment. Bupe and ondansetron can contribute to constipation problems (plus bupe can sometimes affect gut motility). For constipation-related nausea issues, a day or two on metoclopramide (Reglan) can help normalise gut motility and 'get things moving'. (Note: In such a case, it's the relief of the constipation that reduces/resolves the nausea, not the effect of the medication. While metoclopramide may be beneficial to other species as a nausea treatment, it is not the case with cats: as the IDEXX guide notes, cats have very few of the receptors targeted by this drug for nausea reduction.) If nausea is still present after the constipation is resolved then ondansetron would be the treatment to go for (starts working properly again once the cat's no longer backed up). Once the ondansetron's on board it might be necessary to deploy an appy stimulant after an hour or two to kick start eating type activity. Thereafter feeding little and often can help (fasting for too long can cause stomach acid build-up which may then cause/exacerbate nausea problems).

Adding plain canned pumpkin can help to keep a kitty regular and Miralax is beneficial if a stool softener is required. Needless to say, the vet needs to do a proper examination to make sure that there's no obstruction or impacted faeces before starting any treatment to resolve constipation/motility problems. Helpful info here:

felineconstipation.org

Tritt3180 said:
This Dr doesn't seem to respond comfortably to mt questions and concerns... He said, "sure there is a possibility he could go hypoglycemic so if you want someone to be there in case he goes into shock it will cost you about $250."
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My, but he's all heart! :rolleyes:

Tritt3180 said:
The Dr sluffed it off as if it wasn't a big deal, which really upset me.
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I'd be very upset, too. I shudder to think what could potentially happen if a client didn't actually force the issue of overnight monitoring ...

Tritt3180 said:
I don't like this guy at all!
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And I don't blame you!


Mogs
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Went to see Ringo tonight. E brought Fancy Feast, and he tried to eat twice, but started to dry heave both times. :-( Finally the vet gave him famotidine. Not zofran, like I wanted, but he got something.

His glucose was 180 and he received 1 unit of pzi. The night tech will be with him all night tonight. Fingers crossed, and Lord willing, he will eat tonight on his own, and his glucose will not bottom out.
 
When you take him home, be sure you get a copy of his records. This vet does not seem to be one that I would want. I'm glad you have a vet tech stay with Ringo. He will feel better having someone to keep him company. Just petting and attention can help him feel better.
 
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I'm glad to hear that you got to spend time together again this evening.

It's very encouraging that he wants to eat; that's more than half the battle. Keeping fingers and paws crossed here that the vets will work with you tomorrow to tackle constipation/nausea and your little fella will be able to get back to eating regularly again.

Saying a little prayer for a safe night for Ringo. I'm very glad that the night tech is there to watch over him. I hope you'll be able to get some restorative sleep, too.


Mogs
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Tritt3180 said:
Would his labs be normal if he has pancreatitis, or do land not always tell the whole story in these cases?
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in Quintus's case his hyperthyroidy "masked" his pancreatitis. The IDEXX test is the way to go. An ultrasound can show inflammation around the pancreas, can also show if there are gallbladder stones, can show if there is damage or a tumor. Sounds like there was nothing very obvious.

Tritt3180 said:
He's still at the vet. I bought a tech for the night to stay with him and monitor him. I agree 2 units is way too much to give when he's not eating at night - esp if nobody would be there. Now there will be. The Dr sluffed it off as if it wasn't a big deal, which really upset me. Scary stuff. I don't like this guy at all!
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If he does have a hypo or drop dangerously low, make sure they don't charge you the money for the night tech or the hypo treatment :mad:

Critter Mom said:
In particular, the IDEXX document (a suitably authoritative source! ;) ) is great to wave around the place when discussing/pushing for anti-nausea and appetite stimulant meds from the vets, including a supply for administration during recovery at home!
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Yes, that guide is great!
 
Tritt3180 said:
Thank you!!!
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You're welcome and just to be sure that I was correct about the pricing of the strips I checked and I found them at Wal-Mart online at 40 strips for $56.00 (4 bottles of 10 strips)
Also at Wal-Mart online you can get the glucose strips for this machine and they are 200 strips for $26.00 (4 bottles of 50 strips)
 
Ringo's glucose went up just over 200 at 0200 and was in the 280's this morning. He will receive a shot of insulin this morning when the Dr gets here. He's not eating on his own other than maybe a nibble on the diabetic food over night. He received more famotidone and will get more later as its a q12° drug. If he doesnt eat later with staff, they will force feed him to regulate his glucose with the insulin.

He is more feisty to the staff, they say, which is good.

The tech said when she checked his temp that she got a little fecal matter on the thermometer, so we're expecting a BM in the next day or so.

I asked if there was anything else he could have for pain since the bupe can have a constipating effect, and she said she'll tall with the Dr and see. Although bupe seemed to do the best, he's not getting anything. He did moan some when we were petting his back end, and pancreatitis radiated to the back in cats and it has not been ruled out yet (unless it has with the ultrasound and the vet just hasn't told me it's confirmed - he seemed a little wishy washy on the topic). So, well see how today goes and pick him up after work, hopefully.
 
He's clear of ketones, then?

He sounds like he might be at a stage where he's just sick of being at the vet and might start eating for you on his own when he's back home, but I'd feel better if they sent you home with anti-nausea and maybe anti-pain meds to use as backup.

I'm not sure why they can't do a pancreatitis test? (ultrasound isn't required, there are blood tests)

So glad to hear he's feeling better!
 
Nan & Amber said:
He's clear of ketones, then?

He sounds like he might be at a stage where he's just sick of being at the vet and might start eating for you on his own when he's back home, but I'd feel better if they sent you home with anti-nausea and maybe anti-pain meds to use as backup.

I'm not sure why they can't do a pancreatitis test? (ultrasound isn't required, there are blood tests)

So glad to hear he's feeling better!
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I sure hope that's the case. I finally had time to read through the IDEXX and nothing g is being followed for pancreatitis except the ivf. And since that's not ruled out, I made an appointment for him to see a different vet (my dog's) tomorrow afternoon. I also asked if the Dr could call me today from my dog's vet to talk about their treatment protocol. I understand they can't give a specific treatment plan over the phone without seeing him first, but to get a general idea is my goal.

They do not have the snap test at the facility where he is at currently. Not sure about the other facility. They have to send the blood out. And since the ultrasound seems to be negative, it didn't seem to be a huge deal when I asked if I should push for the blood test, so I didn't.

I'm just afraid he'll get home and still not eat.
 
I called off work today because my dog's vet actually had an opening today. However, when I called to let the hospital he is at know I'd be picking him up earlier than planned, I was transferred to a Dr. A different Dr. than last night.(thank God!!)

I brought up the IDEXX multiple times and she reacted like I didn't think she knew what she was talking about and was stepping over her and said, "I've treated diabetic cats for over 20 years..." Well, she wasn't with him last night. She was going off the records from yesterday and the ER. No records were made about him eating for us. They never documented the dry heaving he did yesterday when he tried eating for us. And they have not seen any of this themselves.

Needless to say I broke down on the phone with her and told her I wasn't meaning to over-step her, but I was very concerned that a proper protocol of treatment was not being followed for him. She read through the labs she had and said she wants to send our another panel to get a better idea of the whole picture of what's going on. I asked if pancreatitis was definitely ruled out, and she said the spec fPL is included in this test, and will have the results by TONIGHT!!! When I asked if this was a different test, if I was confused, or what (because I understood it may take days to get a result), she said they could do it in their facility, but she wants the full panel of blood work, too, and they can't do that there.

She is concerned with his liver now, too because his bili was 1.4 (0.1-0.8 is the safe range) and his ALT was 209 (20-100 is their normal range). I thought i had heard that if cats stop eating that they could develop fatty liver (maybe in wrong), and asked if it could be because he hadn't been eating, and she didn't think so. Nobody else brought that up until now. I'm curious to what they were last week since the vet said, on Friday, that everything looked OK except his glucose.

He'll be there until I get the results tonight. They don't carry zofran at their facility. Gave him Mirt again for appetite and are only giving him Famotidine for nausea.

An appointment is made at the other vet for tomorrow afternoon.
 
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Tritt3180 said:
I called off work today because my dog's vet actually had an opening today. However, when I called to let the hospital he is at know I'd be picking him up earlier than planned, I was transferred to a Dr. A different Dr. than last night.(thank God!!) I brought up the IDEXX multiple times and she reacted like I didn't think she knew what she was talking about and was stepping over her and said, "I've treated diabetic cats for over 20 years..." Well, she wasn't with him last night. She was going off the records from yesterday and the ER. No records were made about him eating for us. They never documented the dry heaving he did yesterday when he tried eating for us. And they have not seen any of this themselves.

Needless to say I broke down on the phone with her and told her I wasn't meaning to over-step her, but I was very concerned that a proper protocol of treatment was not being followed for him. She read through the labs she had and said she wants to send our another panel to get a better idea of the whole picture of what's going on. I asked if pancreatitis was definitely ruled out, and she said the spec fPL is included in this test, and will have the results by TONIGHT!!! When I asked if this was a different test, if I was confused, or what (because I understood it may take days to get a result), she said they could do it in their facility, but she wants the full panel of blood work, too, and they can't do that there. She is concerned with his liver now, too because his bili was 1.4 (0.1-0.8 is the safe range) and his ALT was 209 (20-100 is their normal range). I asked if it could be because he hadn't been eating, and she didn't think so. Nobody else brought that up until now. I'm curious to what they were last week since the vet said, on Friday, that everything looked OK except his glucose.

He'll be there until I get the results tonight. They don't carry zofran at their facility. Gave him Mitt again for appetite and are only giving him Famotidine for nausea.

An appointment is made at the other vet for tomorrow afternoon.
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I'm happy that there is some progress being made towards a more definitive diagnosis, and that you have spoken to a vet who at least is willing to listen to your concerns, even if it took a breakdown to do it! :bighug:
 
I am so, so, sorry that you are getting all of these conflicting stories about Ringo/Cat's treatment!!!!! That's so frustrating and upsetting when you have a sick kitty! :bighug: :mad: :bighug:

The good news is, it seems like maybe this vet today is more on-the-ball than the others you've been dealing with? And the spec fPL results will be in soon, giving you a solid answer on the pancreatitis. I think that a pancreatitis flare can be connected to an abnormal liver panel, but I'm not sure. You're definitely right to be worried that it might be connected to not eating-- let's hope it isn't, because it would probably mean a longer vet stay, and it really does sound like more than half the battle on the eating might be won if he could get out of the hospital and go home to his family.

Hang in there, you are a great advocate for your kitty! I'm just sorry you are having to work so hard to get him proper care!
 
Oh! I forgot to post an earlier update for today, too... They should actually be switched in their order... Sorry for the mixup.

0830 update: Ringo's glucose went up just over 200 at 0200 and was in the 280's this morning. He will receive a shot of insulin this morning when the Dr gets here. He's not eating on his own other than maybe a nibble on the diabetic food over night. He received more famotidone and will get more later as its a q12° drug. If he doesn't eat later with staff, they will force feed him to regulate his glucose with the insulin.

He is more feisty to the staff, they say, which is good.

The tech said when she checked his temp that she got a little fecal matter on the thermometer, so we're expecting a BM in the next day or so.

I asked if there was anything else he could have for pain since the bupe can have a constipating effect, and she said she'll tall with the Dr and see. Although bupe seemed to do the best, he's not getting anything. He did moan some when we were petting his back end, and pancreatitis radiated to the back in cats and it has not been ruled out yet (unless it has with the ultrasound and the vet just hasn't told me it's confirmed - he seemed a little wishy washy on the topic). So, well see how today goes and pick him up after work, hopefully.

The Dr from last night is not following the IDEXX recommendations for pancreatitis, so until he tells me it is for sure ruled out, then I feel I need to keep pushing for these things - onadesterone for nausea, cypro for appetite stimulation. Etc.
 
If his ketones are down, and if you can test and dose insulin at home, then I would take him home tonight. Otherwise it doesn't sound like he is getting much actual medical treatment at the vet. And that is costing you.
 
Tritt3180 said:
I asked if there was anything else he could have for pain since the bupe can have a constipating effect, and she said she'll tall with the Dr and see. Although bupe seemed to do the best, he's not getting anything.
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Be careful about pain meds and Zofran. Tramadol is another commonly used pain reliever for cats BUT there is a MAJOR adverse interaction between Tramadol and Zofran (IIRC I sourced this info from drugs.com).

Not sure whether or not Tramadol may have constipation in its side effect profile. Check online to be on the safe side.


Mogs
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Sieden said:
Hi there, here is the glucose / ketone meter that I use. It's only 20.00 for the meter and the ketone strips for the meter are very reasonable.
http://www.novacares.com/nova-max-plus/
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This is a human one though, right? I'm shopping today and need to get things together for when he comes home today. Can I use a human glucometer? My vet tech friend said no because they measure serum, not whole blood like human meters do...
 
Tritt3180 said:
This is a human one though, right? I'm shopping today and need to get things together for when he comes home today. Can I use a human glucometer? My vet tech friend said no because they measure serum, not whole blood like human meters do...
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I've never seen or heard tell of a veterinary ketone meter for home testing.

You can use either a pet meter or a human meter to monitor BG at home. While the meters do give different values because of the difference between the way glucose is distributed in a cat and human blood, as long as a reference range appropriate to the meter type is used then either meter type is equally effective as a tool for keeping a cat safe and improving BG regulation in a home setting.

Most of the members here use human meters because the test strips are much more affordable than those used in pet meters. In the US, Walmart's Relion Confirm and Relion Micro meters are popular; reasonably-priced strips that only need a very small blood sample. Small sample size makes testing easier, especially in the early days of treatment. (Relion Prime strips are cheaper but the meter needs a bigger blood sample.)

For info, I've attached a copy of the Roomp-Rand study on treatment of diabetic cats with long-acting insulins. [ETA - see my post below this one for the attachment.] Within the document you will see that they provide dosing tables which include reference numbers for both human and veterinary glucometers.

Nag the vet for the ondansetron. NB: Zofran is c-r-a-z-y expensive over here (c. £100 for 30 4mg tablets). The generic is much more affordable (less than £10 for 30 4mg tablets). At a guess I'd say similar applies on the other side of the Atlantic.It's a commonly used human medication so if they give you a written Rx for generic ondansetron you should be able to get it filled easily at a regular pharmacy. Same applies for cyproheptadine.

Be sure to pick up some ketone test strips if you haven't already got some (so you can keep a daily check on Ringo's ketone status). Also have a look at the following sticky post for a list of supplies recommended for keeping at home to use in the event that a kitty starts running in low numbers.

Hypo Tool Kit

Sending scritches for Ringo. :bighug: Keeping everything crossed over here that he starts eating well when he gets home. As you correctly mention above, lack of food can cause hepatic lipidosis. You're already dealing with nausea/post-DKA/possible pancreatitis; Ringo doesn't need anything else going on. (Note: pancreatitis can also be a possible cause of elevated liver values.)


Mogs
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