Not eating/improving despite treatment - HELP!

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tiffmaxee said:
If a cat with hepatic lipidosis isn’t an emergency I’d love to know what is! You are right to be extremely concerned. You need to get as much food as possible into her. AD is fine and she needs to be syringe fed every hour or two. Where do you live? What country or state? You dint need to be specific. Maybe someone here has a vet that they have a good relationship with that can help. Cerenia needs to be given every 24 hours and not every other day.

It’s important to feed small amounts every hour or two and not all at once so she keeps it down.
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We are in northern NY state. (Willing to DM more specifics if there are members who know of vets who are *currently accepting* patients)
 
Caleb & Patches said:
Vet visit:
  • Got IV fluids (saline) 150ml & some to administer @home
  • Food/Nausea:
    • Got Cerenia injection (24hr duration)
    • Got 5 days Cerenia pills to take home. (Vet will not prescribe longer duration).
    • Vet will not prescribe ondansetron. Says there is "no other anti-nausea medication" besides cerenia, when asked directly for ondansetron.
    • Have appetite stimulant (which have had since ~7/1), the cream that rub on ear.
    • Got 2 cans Hill A/D wet food to syringe feed. Have begun syringe feeding.
  • Got paper copies of all bloodwork/labs (updated her spreadsheet labs page w/all known info).
    • They tested for ketotenes on 6/27 which was 1.5 mmol/L; but said that she is not at risk for DKA unless her BG is high (it has been 102-136).
  • Asked if Ursodiol could be increased (they said no).
  • When asked about UTI perhaps not being cleared up, they said they don't think that's the issue, but also would not re-test her.
  • They suspect tumor on pancreas or nearby, contributing to liver/gallbladder issues, nausea, & making her response to insulin unpredictable. (But no vet w/ultrasound tech, even ER vet, has openings).
They said she likely does have hepatic lipidosis at this point, but there's nothing they can do. They do not have ultrasound or needle aspirate type equipment. This vet also does not support feeding tube placement; says if the cat won't eat on her own or w/syringe, then it's end of life situation. (Especially w/her age, her pre-existing gallbladder & blood pressure issues, etc, they say she has too many health problems to have much chance).

Referral to an internist would be ~3-4mo wait. ER vet 3hr away (w/higher tech) will not take her, no space. Non-ER vet ~2hr away will not see until next week. (Don't think she has that long).

We have no options for other medical care, as nowhere will take her this week, besides our vet who is basically just giving us a few days to say goodbye. I don't know what to do (besides administer her meds, fluids, check BG, & syringe feed @home), because nowhere else will take her or pursue aggressive treatment.
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Also they would not do a new urinalysis. They said that it's pointless to look at many potential issues if she's not eating.
 
Caleb & Patches said:
Vet visit:
  • Got IV fluids (saline) 150ml & some to administer @home
  • Food/Nausea:
    • Got Cerenia injection (24hr duration)
    • Got 5 days Cerenia pills to take home. (Vet will not prescribe longer duration).
    • Vet will not prescribe ondansetron. Says there is "no other anti-nausea medication" besides cerenia, when asked directly for ondansetron.
    • Have appetite stimulant (which have had since ~7/1), the cream that rub on ear.
    • Got 2 cans Hill A/D wet food to syringe feed. Have begun syringe feeding.
  • Got paper copies of all bloodwork/labs (updated her spreadsheet labs page w/all known info).
    • They tested for ketotenes on 6/27 which was 1.5 mmol/L; but said that she is not at risk for DKA unless her BG is high (it has been 102-136).
  • Asked if Ursodiol could be increased (they said no).
  • When asked about UTI perhaps not being cleared up, they said they don't think that's the issue, but also would not re-test her.
  • They suspect tumor on pancreas or nearby, contributing to liver/gallbladder issues, nausea, & making her response to insulin unpredictable. (But no vet w/ultrasound tech, even ER vet, has openings).
They said she likely does have hepatic lipidosis at this point, but there's nothing they can do. They do not have ultrasound or needle aspirate type equipment. This vet also does not support feeding tube placement; says if the cat won't eat on her own or w/syringe, then it's end of life situation. (Especially w/her age, her pre-existing gallbladder & blood pressure issues, etc, they say she has too many health problems to have much chance).

Referral to an internist would be ~3-4mo wait. ER vet 3hr away (w/higher tech) will not take her, no space. Non-ER vet ~2hr away will not see until next week. (Don't think she has that long).

We have no options for other medical care, as nowhere will take her this week, besides our vet who is basically just giving us a few days to say goodbye. I don't know what to do (besides administer her meds, fluids, check BG, & syringe feed @home), because nowhere else will take her or pursue aggressive treatment.
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I am so sorry that the vet visit didn't go so well and your vet will not give ondansetron, she needs to go back to medical school after what she said about it .
My heart is just breaking for both of you ♥ How old is Patches
That vet is a piece of crap!
I'm going to tag
@tiffmaxee and @Suzanne & Darcy

Labs are on his SS
 
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Caleb & Patches said:
Thanks I will ask the vet about these anti-nausea med options. It would be great if this were the main issue with her lack of appetite that could very much be remedied!

How common is nausea in diabetic cats? And how do you tell if a cat is nauseous? (aside from not eating, especially if there is no throwing up)
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Nausea is a BIG thing with Lando and has caused him to stop eating a few times. He has been on cerenia daily for months and some of the signs i see when he becomes nauseas are : licking plastic, eating dust, licking his lips at food then walking away.
Good luck, i know how frustrating this can be. You seem to be doing your absolute best. Wishing you strength
 
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Caleb & Patches said:
We are in northern NY state. (Willing to DM more specifics if there are members who know of vets who are *currently accepting* patients
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Caleb I would start another post on the Main Forum and say NEED HELP that you are looking for a vet it's an emergency say you are in northern NY State does anyone know of a vet I can go to .

I'm looking at her pic such a gorgeous girl
@Caleb & Patches

I'd like to ring that vets neck or worse !
 
I'm so sorry to hear this news. Caleb never would have made it this far without a good home.
If your vet thinks this is an end of life situation they should have offered you some form of pain management. I'm not for one second suggesting this is the end but it's something we've all dealt with. The standard medication is oral BUPE / Buprenorphine and it is by no means dangerous or life ending, I've used it many times on some of the cats at my feet right now.
Little miracles happen all the time, maybe it's your turn. :bighug:
Could someone please post the link to the pain chart?
 
Noah & me (GA) said:
I'm so sorry to hear this news. Caleb never would have made it this far without a good home.
If your vet thinks this is an end of life situation they should have offered you some form of pain management. I'm not for one second suggesting this is the end but it's something we've all dealt with. The standard medication is oral BUPE / Buprenorphine and it is by no means dangerous or life ending, I've used it many times on some of the cats at my feet right now.
Little miracles happen all the time, maybe it's your turn. :bighug:
Could someone please post the link to the pain chart?
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Hi Dickson his kitty's name is Patches, Caleb is her daddy :cat:
 
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Diane Tyler's Mom said:
Caleb is Patches accepting the syringe feeding ok ?
The labs you put in your SS were from 6-22-22 those were the most recent?, Except for the glucose which was on 7-1 -22?
@Caleb & Patches
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she doesn't love it, i'm still concerned she's not getting adequate nutrition, but she's not fighting as much as could be. how many syringes do you give per day?

she is also eating (a little bit) by mouth (1.5 jars chicken baby food, ~90cal total). today she is laying around a lot more, a lot more lethargic & weak seeming. though she perked up a little bit after fluids this morning.

the labs are from 6/22 & urinalysis is later (all dates are when drawn). surprised to see how few labs were acutally done when i had the lab papers in hand
 
I really feel for you and think your current vet is useless and a bunch of other adjectives I'm not allowed to say.
Caleb & Patches said:
does anyone have experience w/treating hepatic lipidosis? what should i look for in terms of diagnosis/standards of care? can cats recover?
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My cat once had hepatic lipidosis, pancreatitis, and DKA all at the same time. I think the feeding tube was really key to her survival.
I don't have any vet recommendations (other than to say if there's a teaching hospital nearby, that would probably be your best bet), but will be keeping your kitty in my thoughts and prayers and hoping she can finally get the help she needs.
 
Caleb & Patches said:
Vet visit:
  • Got IV fluids (saline) 150ml & some to administer @home
  • Food/Nausea:
    • Got Cerenia injection (24hr duration)
    • Got 5 days Cerenia pills to take home. (Vet will not prescribe longer duration).
    • Vet will not prescribe ondansetron. Says there is "no other anti-nausea medication" besides cerenia, when asked directly for ondansetron.
    • Have appetite stimulant (which have had since ~7/1), the cream that rub on ear.
    • Got 2 cans Hill A/D wet food to syringe feed. Have begun syringe feeding.
  • Got paper copies of all bloodwork/labs (updated her spreadsheet labs page w/all known info).
    • They tested for ketotenes on 6/27 which was 1.5 mmol/L; but said that she is not at risk for DKA unless her BG is high (it has been 102-136).
  • Asked if Ursodiol could be increased (they said no).
  • When asked about UTI perhaps not being cleared up, they said they don't think that's the issue, but also would not re-test her.
  • They suspect tumor on pancreas or nearby, contributing to liver/gallbladder issues, nausea, & making her response to insulin unpredictable. (But no vet w/ultrasound tech, even ER vet, has openings).
They said she likely does have hepatic lipidosis at this point, but there's nothing they can do. They do not have ultrasound or needle aspirate type equipment. This vet also does not support feeding tube placement; says if the cat won't eat on her own or w/syringe, then it's end of life situation. (Especially w/her age, her pre-existing gallbladder & blood pressure issues, etc, they say she has too many health problems to have much chance).

Referral to an internist would be ~3-4mo wait. ER vet 3hr away (w/higher tech) will not take her, no space. Non-ER vet ~2hr away will not see until next week. (Don't think she has that long).

We have no options for other medical care, as nowhere will take her this week, besides our vet who is basically just giving us a few days to say goodbye. I don't know what to do (besides administer her meds, fluids, check BG, & syringe feed @home), because nowhere else will take her or pursue aggressive treatment.
Click to expand...
I am so sorry that the vet visit didn't go so well and your vet will not give ondansetron, she needs to go back to medical school after what she said about it .
My heart is just breaking for both of you ♥ How old is Patches
That vet is a piece of crap!
I'm going to tag
@tiffmaxee and

@Suzanne & Darcy

Labs are on his SS
 
Caleb & Patches said:
she doesn't love it, i'm still concerned she's not getting adequate nutrition, but she's not fighting as much as could be. how many syringes do you give per day?

she is also eating (a little bit) by mouth (1.5 jars chicken baby food, ~90cal total). today she is laying around a lot more, a lot more lethargic & weak seeming. though she perked up a little bit after fluids this morning.

the labs are from 6/22 & urinalysis is later (all dates are when drawn). surprised to see how few labs were acutally done when i had the lab papers in hand
Click to expand...

I'll tag Elise and Suzanne about how much you should syringe the AD
@tiffmaxee

@Suzanne & Darcy
 
His urine was diluted but if they gave fluid that might explain it. There were ketones.
I would try and give 2 syringes hourly or every 2-3 hours. and see if it stays down. I know I ended up with food on my cat and me too every time I fed. Try and work up to a can every day. How much did he weigh before he got sick? Eating baby food is good. Try for a jar of it if he will eat on his own and half a can of AD spread out.
 
Diane Tyler's Mom said:
Caleb I would start another post on the Main Forum and say NEED HELP that you are looking for a vet it's an emergency say you are in northern NY State does anyone know of a vet I can go to .

I'm looking at her pic such a gorgeous girl
@Caleb & Patches

I'd like to ring that vets neck or worse !
Click to expand...
@Hendrick Cuddleclaw do you know of any northern NY vets?
 
Caleb I can see in the labs that the ketones are up to 1.5 which means you really must try and get your kitty into a vet urgently as Patches is in danger of diabetic ket (DKA) which is a medical emergency.
Please ring one of the Er vets and say Patches has ketones in the urine, won’t eat and needs to be seen urgently.
 
Suzanne & Darcy said:
@Hendrick Cuddleclaw do you know of any northern NY vets?
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replied in the other thread with the ER vet where I took Hendrick, "Northern NY" is anywhere from 4-7 hours from me depending on what is meant by Northern NY so, not sure if helpful. Being as she mentioned VT, I'm guessing she is in the woods basically and looking at a 6-7 hour drive to Rochester. Something in Syracuse, Utica or Binghamton is probably a better plan.
 
Hendrick Cuddleclaw said:
replied in the other thread with the ER vet where I took Hendrick, "Northern NY" is anywhere from 4-7 hours from me depending on what is meant by Northern NY so, not sure if helpful. Being as she mentioned VT, I'm guessing she is in the woods basically and looking at a 6-7 hour drive to Rochester. Something in Syracuse, Utica or Binghamton is probably a better plan.
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I saw that you responded. Thank you so much for the suggestions!
 
tiffmaxee said:
His urine was diluted but if they gave fluid that might explain it. There were ketones.
I would try and give 2 syringes hourly or every 2-3 hours. and see if it stays down. I know I ended up with food on my cat and me too every time I fed. Try and work up to a can every day. How much did he weigh before he got sick? Eating baby food is good. Try for a jar of it if he will eat on his own and half a can of AD spread out.
Click to expand...

Yesterday she ate 1.5 jars baby food & 9 syringes (~1/2 can) of A/D. She weighed about 8lbs before (maybe a little more but she's always been tiny), now she's 5.8lbs (measured yesterday, the same as measured around 6/30).

She is not vomiting at all (has not been this entire time) so has been keeping the food down.

Re: the ketotenes -- so it is possible to have DKA even with low blood glucose? (She hasn't ever gone above 136 since we've measured).
@Bron and Sheba (GA) @Suzanne & Darcy

I have been calling some of the vets mentioned. Syracuse ER is one of the closest but that's the one w/no availability.
 
I would beg, cry, show up at the ER and see if you can get help. Unfortunately dka can happen with low bg too. I’m not saying it’s happening now. Her symptoms could be due to the other issues, especially hepatic lipidosis.

Since food is staying down try and feed even more. Sounds like her ideal weight is 8 pounds. She’s lost a lot which is why she’s got hepatic lipidosis.
 
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It sounds like are doing a good job with the feeding. Cats with DKA typically have a concurrent condition that works against the insulin. Some of the conditions include Urinary Tract Infection and pancreatitis. So yes a cat can still go into DKA if there are ketones present. Ketone bodies are acidic and cause the blood to be acidic. We don’t know exactly what’s going on because your vet has refused to take proper care of Patches.
 
My cat had DKA when he had an infection. His BG was in the 200s at the time for the most part. It was an infection that put him into DKA. Did they take Patches temperature? Did she have a fever?

We have had members here who just showed up at the ER and explained their cat’s situation and they agreed to admit the cat.
 
Caleb, if you get a moment, please let us know what is happening with Patches. We care. I mean, I am on vacation in the woods and I just wanted to check in on Patches. I soooo hope that you have gotten her to an Emergency Care or a really good vet hospital.
 
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