Not eating/improving despite treatment - HELP!

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Caleb & Patches

Caleb & Patches

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My 14 yr cat was diagnosed with diabetes a couple weeks ago, after we took her to the vet since she wasn't eating well & seemed unwell.

Vet Visit #1: (A couple days)
  • Diabetes diagnosis
  • Kept a couple days (to determine insulin dose)
  • Did bloodwork & found:
    • normal kidney, pancreas, etc,
    • elevated liver enzymes (continuing)
    • gallbladder issues (continuing)
Before this vet visit, we knew:
  • she has high blood pressure for past 2-3 yrs & is on med for it
  • she has gallbladder problems, also on med for that
  • she's had elevated liver enzymes for some time (at least 1yr)
  • she has been drinking/urinating much more for ~9mo
They sent us home with insulin (PZI). (Also told us that it was impossible to monitor cat's BG at home, which we've since realized is inaccurate). She seemed better, but very soon, again barely eating, not playing, not being social, not coming upstairs, & we found her laying in the litterbox. We brought her back to the vet.

Vet Visit #2: (5 Days)
  • gave fluids
  • found an UTI (gave antibiotic shot)
  • administered anti-nausea/diarrhea drugs (to help appetite), & appetite stimulant
  • thad trouble getting her to eat anything (except a little chicken)
  • her blood sugar was very erratic (swinging between ~400 & ~60)
  • they did NOT do a glucose curve as they should have
  • they did not give her the daily prescriptions she's been on (for blood pressure & gallbladder), because they "forgot" she was on them, didn't ask us to bring in the meds, & we didn't find out until days later
Vet said they suspected soft tissue tumor which made her less responsive to insulin, as she wasn't getting better the way they'd expect a diabetic cat to do. (But they don't have imaging tech to rule in/out).

We brought her home 7/1, to see if she'd eat better at home (vet unwilling to try more insulin w/o eating adequately). The vet gave us the appetite stimulant to apply every morning.

By hand-feeding chicken, deli turkey, chicken baby food, high-protein wet food, & pumpkin, every couple hours, we gradually got her to eat a bit more (still vastly below her normal caloric intake & she has lost a LOT of weight, going from ~8 to ~5lbs), but her normal appetite wasn't back. If we didn't hand-feed her, she probably wouldn't have eaten anything.

She was laying around a lot, moving awkwardly (especially hind legs, looking a lot like diabetic neuropathy, but no diagnosis), not meowing for food, barely grooming herself, etc, seemed to be not feeling well in addition to lack of appetite. (But still pooping & peeing & drinking water).

Gradually she started to eat a little more, enough that mid-week the vet OKed resuming insulin (starting at low dose). Last Wednesday-Friday she seemed a little better (being on the insulin), she was again meowing for food, walking less awkwardly, had better appetite (but still under normal), & it seemed like maybe she was stabilizing.

Friday evening we got a glucometer (Pet Test) to measure her BG at home, with the goal to optimize her insulin dose at home, rather than at the vet's. Her BG was 118, so we didn't give her insulin that evening. (Now realize the meter likely gave false low, as it beeps before has enough blood to make accurate reading).

The next morning (Saturday), her appetite was again decreased significantly, we had to hand-feed her to get her to eat anything, and she seemed to experience more discomfort (in how she moved, chose to lay, etc) and was not meowing. She seemed back to where she was before the couple days of improvement.

We did resume insulin (0.5 units 2x/day) at vet's recommendation, but it hasn't brought her appetite back the way it had earlier in the week. Which makes us wonder, is there something more going on than only diabetes in her? Is she experiencing liver or gallbladder failure? Is there a tumor?

Do you have any advice on:
  • how to get a cat to eat (we've tried multiple wet foods, baby foods, plain meat, canned tuna juice, treats, warming the food, appetite stimulant, etc) -- she's dangerously underweight right now, & if we can't get her to eat, this is the most immediate life-threatening thing
  • how to tell if symptoms are due to insufficiently-regulated diabetes, or an underlying issue -- and how to know whether that issue is treatable
  • any other things we can try, any avenues we could explore, or treatment options -- anything that will give us more time with her, because if we can't get her to eat, we're going to lose her
I don't understand why she seemed so much better (though not fully stabilized) for two days, only to be right back to how she was before. I felt so much hope, seeing her meowing again, that she could be regulated & we could have more time. Now I am very afraid that she has some secondary life-threatening issue we cannot see. BUT if there is any chance that what's causing her issues IS treatable, I don't want to miss that opportunity, don't want to lose her if there was a treatment option we could have pursued.

So if you know of anything, ANYTHING, that could help. Please let me know.
 
Are you giving her an anti nausea med at home? Because without that, if she’s nauseated she won’t eat even with the appetite stimulant. From the symptoms you’re describing it sounds like she may be getting too much insulin but I can’t be sure without seeing some testing data. Did your vet discuss an ultra sound? I’m sorry but for a vet to forget to give your cat her daily meds while she’s there is unacceptable to me and is strongly suggest you look for a new vet. Any specialty vets or animal hospitals near you?
 
Ale & Minnie (GA) said:
Are you giving her an anti nausea med at home? Because without that, if she’s nauseated she won’t eat even with the appetite stimulant. From the symptoms you’re describing it sounds like she may be getting too much insulin but I can’t be sure without seeing some testing data. Did your vet discuss an ultra sound? I’m sorry but for a vet to forget to give your cat her daily meds while she’s there is unacceptable to me and is strongly suggest you look for a new vet. Any specialty vets or animal hospitals near you?
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We had anti-nausea med for the first few days but the vet said she couldn't be on it for longer, so she hasn't had it since about Tuesday. I don't know if there are others OK to be on for longer.

I am working on putting the testing data in a spreadsheet. Will share ASAP.

Vet discussed imaging (to look for tumor) but that would require going to emergency vet (3hr drive) & our vet said that even if they found something, she wouldn't survive any operation, so screening for a tumor would mean more bills & answers, but no more treatment options.

Unfortunately we don't have a lot of options for other vets, we live very rural. This is not the first time they've messed up on care, & I would love to have a vet I feel like we could trust to not miss something important. (Vet dismissed increased drinking/urination as any kind of red flag when we told them 9mo ago!)
 
Put the 3 hour drive off for now and concentrate on her appetite and the UTI. Her numbers won't completely stabilize and some meds won't completely metabolize well until after she starts eating well.
Is she having pain in the litter box?
Is she drinking water? Some cats get almost all their water from wet food.
UTI's can be painful and part of a loss of appetite, is she on any pain meds?
 
Noah & me (GA) said:
Put the 3 hour drive off for now and concentrate on her appetite and the UTI. Her numbers won't completely stabilize and some meds won't completely metabolize well until after she starts eating well.
Is she having pain in the litter box?
Is she drinking water? Some cats get almost all their water from wet food.
UTI's can be painful and part of a loss of appetite, is she on any pain meds?
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She doesn't appear to have any pain in the litterbox, & she's already finished antibiotics for the UTI (completed 7/1). She's been drinking water & getting water from wet food (when I've been able to get her to eat--much less today & yesterday). She's not on any pain meds. I'd expect the UTI would be resolved by now?
 
Caleb & Patches said:
We had anti-nausea med for the first few days but the vet said she couldn't be on it for longer, so she hasn't had it since about Tuesday. I don't know if there are others OK to be on for longer.
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I know members here have given anti nausea meds for quite some time
What did the vet give for nausea Cerenia? I pretty sure that is more for vomiting
A lot of members give ondansetron for nausea
I can tag a few members for you to read your intro post and post #4 I'm not that experienced
@tiffmaxee

@Bron and Sheba (GA)

@Wendy&Neko

@Bandit's Mom

@Suzanne & Darcy
 
I’m pretty sure the anti nausea they gave her was Cerenia. It’s a bit old fashioned thinking that cats can only be on it for 5 days. They can actually be on it for a few weeks at a time. But having said that, I’d call the vet and ask for a prescription for ondansetron. It’s the other anti nausea option and they can be on it for as long as necessary. Minnie was on it daily for 4+ years. It’s a human med that can be dosed for cats which means it’s easier to fill the prescription since you can go to a human pharmacy.
 
Caleb & Patches said:
We had anti-nausea med for the first few days but the vet said she couldn't be on it for longer, so she hasn't had it since about Tuesday. I don't know if there are others OK to be on for longer.

I am working on putting the testing data in a spreadsheet. Will share ASAP.

Vet discussed imaging (to look for tumor) but that would require going to emergency vet (3hr drive) & our vet said that even if they found something, she wouldn't survive any operation, so screening for a tumor would mean more bills & answers, but no more treatment options.

Unfortunately we don't have a lot of options for other vets, we live very rural. This is not the first time they've messed up on care, & I would love to have a vet I feel like we could trust to not miss something important. (Vet dismissed increased drinking/urination as any kind of red flag when we told them 9mo ago!)
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I agree with Noah focus on the eating first. But I’m not sure what your vet meant by imaging. Could he mean an endoscopy? Because an ultra sound doesn’t require an operation or anesthesia of any kind
 
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Diane Tyler's Mom said:
I know members here have given anti nausea meds for quite some time
What did the vet give for nausea Cerenia? I pretty sure that is more for vomiting
A lot of members give ondansetron for nausea
I can tag a few members for you to read your intro post and post #4 I'm not that experienced
@tiffmaxee

@Bron and Sheba (GA)

@Wendy&Neko

@Bandit's Mom

@Suzanne & Darcy
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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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Ale & Minnie (GA) said:
I agree with Noah focus on the eating first. But I’m not sure what your vet meant by imaging. Could he mean an endoscopy? Because an ultra sound doesn’t require an operation or anesthesia of any kind
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The vet meant ultra sound/MRI type imaging---but they said the results of imaging wouldn't change treatment options, so there was no point in spending the money. They said if the imaging found a tumor, they wouldn't be able to safely operate; if it found no tumor, that wouldn't change their treatment approach.
 
Suzanne & Darcy said:
Please, do you have any copies of the labs that you can share.
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Do you mean blood glucose testing? I just made her spreadsheet (linked in signature) & am working to add her data to it. The vet did not give us copies of her bloodwork labs (e.g. actual numbers for her elevated liver enzymes), just told us what things looked normal or not. (Ugh).
 
Please ask your vet to give you some Hill’s AD food. It is very smooth and is high in calories. It os designed for animals who are sick and need to recover. It can be mixed with water and it passes through a feeding syringe more easily than standard wet food. I even mix mine with water and put it in a blender.
 
Caleb & Patches said:
Do you mean blood glucose testing? I just made her spreadsheet (linked in signature) & am working to add her data to it. The vet did not give us copies of her bloodwork labs (e.g. actual numbers for her elevated liver enzymes), just told us what things looked normal or not. (Ugh).
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No. I wanted to see all bloodwork. If you can get copies tomorrow that would be helpful.
Now, about a tumor, what would make them think this is a possibility? Where? Why? Ultrasounds are non-invasive as you know and generally do not require sedation. But if you are going to spend the money then you should get a qualified person to do the ultrasound. A board certified radiologist us best , although a very experienced vet can do it.
 
@Larry and Kitties @Suzanne & Darcy
Thanks, I will ask about Hill's AD!

How do you do syringe feeding? (What kind of syringe? How much do you feed in one sitting? Any tips for a cat that tends to fight administration of oral meds?)

And at what point do you do syringe feeding vs. keep encouraging them to eat on their own? (She is still eating a little, so far today, 1 jar of chicken baby food, 60 cal, but not nearly enough). (I'm guessing it's definitely time to start since the more weight she loses the worse her chances of recovery)

I will ask the vet for bloodwork records & hopefully they will provide.

They don't have anything specific about the tumor (aside from suspecting somewhere in her abdomen like pancreas or liver) aside from her not responding to insulin how they expected, her being harder to regulate, and not getting better very quickly, the appetite issues, etc, which made them think there's something besides diabetes, which they can't see, causing more of her problems. They said she is "not responding like a normal diabetic cat." (Now, I'm not sure how much they know, considering they didn't even do a glucose curve). There's no visible/tangible lumps or sore spots if you touch her.
 
Caleb & Patches said:
How do you do syringe feeding? (What kind of syringe? How much do you feed in one sitting? Any tips for a cat that tends to fight administration of oral meds?)
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That is a bit of a problem is she's a fighter. I would ask my vet about how much to feed and get them to show you how to do it. Alternatively, there are a lot of videos on how to syringe feed your cat. I'm attaching a page from the felinecrf.org site which is very comprensive. About half way down the page is a whole section on syringe feeding a cat and it includes videos.
 
Have you been testing your kitty for ketones?

You can give both Cerenia once a day as long as you need it as well as ondansetron, which doesn't last as long so needs to be given 2-4 times a day. Both help with nausea, though Cerenia is better for vomiting and ondansetron better for nausea. There may be some contraindications with Cerenia if liver problems, so maybe that's why the vet didn't want it given for a long time. You can also get appetite stimulants (give at least 1/2 hour after the anti nausea drug) such as Miritaz, which is a cream you put on the inside of the ear. It also has some mild anti nausea effects. If giving an appetite stimulant, always give an anti nausea drug.

Depending on what type of antibiotic was given, it can harm the tummy flora. Maybe try a probiotic (multiple strains of probiotics is best) for a while to help. Before the antibiotic, was a urine culture and sensitivity done? Without that, you cannot tell what type of antibiotic should be given. And it's possible it wasn't the right type of antibiotic for the bacteria present.

A couple tips for eating from posts in our Health Links forum:
 
Caleb & Patches said:
And at what point do you do syringe feeding vs. keep encouraging them to eat on their own?
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Since she's lost so many pounds (think of it as a percentage of her body weight.) It is time to do something. Another option is to have an esophageal feeding tube placed. This procedure does require a brief anesthesia (about 15 minutes). Then all foods and meds can be administered through the tube. The cats do not mind being fed this way. You slowly administer the food through the tube and the cat usually does not realize that they are receiving food.
 
Ask your vet to give you Cerenia to give at home. It's once a day. A better anti-nausea drug is Ondansetron, which is a human medication that you obtain from a regular human pharmacy. Your vet would need to write you an Rx for it. It can be given every 8 hours. The tablets are small.
 
The page I just sent also includes more than you will ever want to read about how to persuade your cat to eat. Was it Mirataz that you rub on the ear that was given as an appetite stimulant? Appetite stimulants should not be given unless first dealing with any nausea.

Since you said that an antibiotic shot was given for a UTI, you should know that it is a Convenia shot and is not particularly effective for UTIs. Did they send the urine out for a culture? If so, what was the name of the organism that was cultured? Now, having said that, I have occasionally seen a cat whose UTI did clear up with a Convenia injection. I do hope that Patches will be helped by it. However, the best course of action is to culture the urine and identify the specific bacteria and select and antibiotic that is recommended to treat that bacteria. Convenia injections carry risks that oral antibiotics do not. I will not further overwhelm you with that information now. I only mention it if the vet suggests another one at a later date. Vets often use these shots for any cat whose owner says their cat is difficult to pill.
 
Caleb & Patches said:
We had anti-nausea med for the first few days but the vet said she couldn't be on it for longer, so she hasn't had it since about Tuesday. I don't know if there are others OK to be on for longer.
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I believe someone may have said this, but if it was Cerenia, that can be given daily for an indefinite period of time. Many people give it daily (I am one of those people). No worries there. That's very antiquated thinking that Cerenia is only for four days.
 
Caleb & Patches said:
How do you do syringe feeding...They don't have anything specific about the tumor
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If you're at the point where you have to syringe feed then worry about a possible tumor later. She needs to get some calories into her to fight back.
Syringe feeding can look unpleasant but doesn't have to be, it's something you learn one step at a time. The syringes are something you might find at a pharmacy, it doesn't have to be complicated.
 
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It sounds like your vet won’t give you cerenia or ondansetron. If nauseous she needs medication or she won’t want to eat. There’s potentially a lot going on and you do need medication to make her feel better. Max was on ondansetron, sometimes cerenia, amlodipine and sometimes had high ALT. He had chronic pancreatitis fur a few years before diabetes. Is there an internal medicine vet anywhere close to you? I’m concerned because your vet won’t give use the meds necessary. :bighug:
 
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tiffmaxee said:
It sounds like your vet won’t give you cerenia or ondansetron. If nauseous she need medication or she won’t want to eat. There’s potentially a lot going on and you do need medication to make her feel better. Max was on ondansetron, sometimes cerenia, amlodipine and sometimes had high ALT. He had chronic pancreatitis fur a few years before diabetes. Is there an internal medicine vet anywhere close to you? I’m concerned because your vet won’t give use the meds necessary. :bighug:
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I totally agree with what Elise has said here. If your vet will not give you standard of care medications to address nausea (and perhaps other issues,) then it's time to find another vet (if there is another vet around.) I know this is sometimes easier said than done.
 
Suzanne & Darcy said:
No. I wanted to see all bloodwork. If you can get copies tomorrow that would be helpful.
Now, about a tumor, what would make them think this is a possibility? Where? Why? Ultrasounds are non-invasive as you know and generally do not require sedation. But if you are going to spend the money then you should get a qualified person to do the ultrasound. A board certified radiologist us best , although a very experienced vet can do it.
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Or an Internal Medicine Vet
 
tiffmaxee said:
It sounds like your vet won’t give you cerenia or ondansetron. If nauseous she need medication or she won’t want to eat. There’s potentially a lot going on and you do need medication to make her feel better. Max was on ondansetron, sometimes cerenia, amlodipine and sometimes had high ALT. He had chronic pancreatitis fur a few years before diabetes. Is there an internal medicine vet anywhere close to you? I’m concerned because your vet won’t give use the meds necessary. :bighug:
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No it’s a 3 hour drive per her earlier replies
 
There are a lot of different reasons why a cat won’t eat and we’re all struggling to understand what your vet is basing the nothing else to do but operate advice on. An ultra sound is non invasive and can help reveal a tumor. Minnie’s last ultrasound revealed an intestinal tumor. Likely her IBD that progressed into it. At that point, I made the decision to treat the symptoms only because she had cardiomyopathy and her heart wouldn’t handle anesthesia and frankly, i wasn’t going to put her through chemotherapy so no point in fully diagnosing. But her tumor was sizable which is why the vet could feel it when he examined her and she didn’t have much longer after that. Still, they offered options and different meds to put her on to try to get her eating again. It’s frustrating to hear your vet hasn’t really given you many and I’m sorry you’re trying to navigate through all of this without much support from him/her

You can also do a blood test to rule out pancreatitis but it sounds like your vet did none of these things.

As we all keep saying, first priority is to get her eating because there are a lot of serious health issues that can develop when a cat is not eating enough. Ask, I’d say insist, on prescriptions for both Cerenia and ondansetron. The latter can be filled quickly at any human pharmacy. Start syringe feeding. You need to dilute the wet food with water so you can fill the syringe easily and without getting the food stuck inside. Hill’s Ad is a great option for this as mentioned by someone else earlier. There’s also a convalescence/recovery food made by royal canin. It’s already in liquid form so easier to syringe feed: https://shop.vivapets.com/us/royal-...YSlP4_hjxP9mrrGX0TECy5G1p0Io4qyMaAjL3EALw_wcB
 
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Ale & Minnie (GA) said:
There are a lot of different reasons why a cat won’t eat and we’re all struggling to understand what your vet is basing the nothing else to do but operate advice on. An ultra sound is non invasive and can help reveal a tumor. Minnie’s last ultrasound revealed an intestinal tumor. Likely her IBD that progressed into it. At that point, I made the decision to treat the symptoms only because she had cardiomyopathy and her heart wouldn’t handle anesthesia and frankly, i wasn’t going to put her through chemotherapy so no point in fully diagnosing. But her tumor was sizable which is what the vet could feel it when he examined her and she didn’t have much longer after that. Still, they offered options and different meds to put her on to try to get her eating again. It’s frustrating to hear your vet hasn’t really given you many and I’m sorry you’re trying to navigate through all of this with much support from him/her

You can also do a blood test to rule out pancreatitis but it sounds like your vet did none of these things.

As we all keep saying, first priority is to get her eating because there are a lot of serious health issues that can develop when a cat is not eating enough. Ask, I’d say insist, on prescriptions for both Cerenia and ondansetron. The latter can be filled quickly at any human pharmacy. Start syringe feeding. You need to dilute the wet food with water to so you can fill the syringe with it. Hill’s Ad is a great option for this. There’s also a convalescence liquid food made by royal canin: https://shop.vivapets.com/us/royal-...YSlP4_hjxP9mrrGX0TECy5G1p0Io4qyMaAjL3EALw_wcB
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This may be a long shot but ask friends and family if they have any ondansetron or cerenia. Many people have been given ondansetron for nausea by their doctors.
 
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Ale & Minnie (GA) said:
There are a lot of different reasons why a cat won’t eat and we’re all struggling to understand what your vet is basing the nothing else to do but operate advice on. An ultra sound is non invasive and can help reveal a tumor. Minnie’s last ultrasound revealed an intestinal tumor. Likely her IBD that progressed into it. At that point, I made the decision to treat the symptoms only because she had cardiomyopathy and her heart wouldn’t handle anesthesia and frankly, i wasn’t going to put her through chemotherapy so no point in fully diagnosing. But her tumor was sizable which is why the vet could feel it when he examined her and she didn’t have much longer after that. Still, they offered options and different meds to put her on to try to get her eating again. It’s frustrating to hear your vet hasn’t really given you many and I’m sorry you’re trying to navigate through all of this without much support from him/her

You can also do a blood test to rule out pancreatitis but it sounds like your vet did none of these things.

As we all keep saying, first priority is to get her eating because there are a lot of serious health issues that can develop when a cat is not eating enough. Ask, I’d say insist, on prescriptions for both Cerenia and ondansetron. The latter can be filled quickly at any human pharmacy. Start syringe feeding. You need to dilute the wet food with water so you can fill the syringe easily and without getting the food stuck inside. Hill’s Ad is a great option for this as mentioned by someone else earlier. There’s also a convalescence/recovery food made by royal canin. It’s already in liquid form so easier to syringe feed: https://shop.vivapets.com/us/royal-...YSlP4_hjxP9mrrGX0TECy5G1p0Io4qyMaAjL3EALw_wcB
Click to expand...
:bighug::bighug:
 
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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Acting like they want to eat, but hanging head, or licking lips. Or any signs of pain? Sitting in the meatloaf position, howling squinty eyes, go to food sniff it but then walk away that sort of thing.
 
Hi and Welcome to the group @Caleb & Patches . I skimmed through and didn't see anyone mention the possibility of DKA (diabetic keto-acidosis). DKA can be very deadly and my cat Hendrick had to be hospitalized. Symptoms are lethargy, nausea...Hendrick would be hungry, look up at the dish very interested but when I put it down in front of him, take a couple sniffs, maybe a single lick -- then shake his head and walk away and go sit in a corner. He almost died.

I think Wendy mentioned testing for ketones -- YES please do this every day. Use ketostix you stick in kitty's urine or a blood ketone meter like the Nova Max. Get lots of extra food and fluids into kitty at all costs, use a syringe and tube if needed, more info on syringe feeding here, this was already posted by Wendy just re-posting in case you missed it

https://felinediabetes.com/FDMB/threads/syringe-assisted-feeding-videos-and-tips.144367/
 
Hi I do not have the time to read thoroughly but I always recommend people to have Ciaos liquid food like this, when my Fafa had CKD, and Monkey and Penpen have lymphoma, these are the life saver because it is extremely palatable. Worth trying, get them asap, just buy 3-5 favors to test.

https://www.google.com/search?q=ciaos cat&tbm=isch&ved=2ahUKEwjP6er93_D4AhXgTPUHHRI0DHwQ2-cCegQIABAA&oq=ciaos cat&gs_lcp=CgNpbWcQAzIECAAQQzIFCAAQgAQyBAgAEEMyBQgAEIAEMgUIABCABDIFCAAQgAQyBQgAEIAEMgUIABCABDIGCAAQHhAHMgQIABAeUPQDWPgHYNQIaABwAHgAgAGAB4gBgAeSAQM2LTGYAQCgAQGqAQtnd3Mtd2l6LWltZ8ABAQ&sclient=img&ei=2AvMYs-dCOCZ1e8Pkuiw4Ac&rlz=1C1VDKB_zh-HKHK973HK973
 
hi, thank you everyone, I am still reading through your messages.

she is still eating, but less than she needs to. her BG this morning was 102, so didn't give any insulin. today she is more jaundiced than before & hard getting much blood to test her than usual, worried about dehydration.

our vet OKed cerenia every other day but wouldn't prescribe anything else. given her previously elevated liver enzymes, weight loss, lack of appetite, i'm worried about hepatic lipidosis, but our vet is not recommending anything besides "watch and wait." they just seem to have given up on her.

does anyone have experience w/treating hepatic lipidosis? what should i look for in terms of diagnosis/standards of care? can cats recover?

re: diabetic ketoacidosis. the vet previously (on Wed) said we don't have to worry about that, but i don't believe they tested ketotenes. can DKA cause jaundice? her BG has only been between 102-130ish when we've measured recently. (still working on spreadsheet, sorry!)

we wanted to see the ER vet for 2nd opinion & hopefully more competent care, but they are at capacity & won't see her. non-ER vets (2nd opinion ones) won't see her for a week. our only option is the current vet. (the only person who will see her!) we are taking her to pick up cerenia & at least get IV fluids. if it is hepatic lipidosis, i'm concerned they will just say that she has no chance.

how can we advocate for her, to this vet who has seemed to give up on her?
 
DKA typically happens when a diabetic cat stays in the higher BG numbers for an extended period of time, combined with not enough food and/or water. With her BG in the low 100s it is less likely I think. I don't know about DKA causing jaundice but I do not believe it does.

as far as advocating for your cat I would just be assertive and demanding, you are the customer, you are the caregiver -- if you want extra steps taken that should be 100% up to you not the vet. Be pushy if needed!
 
Caleb & Patches said:
hi, thank you everyone, I am still reading through your messages.

she is still eating, but less than she needs to. her BG this morning was 102, so didn't give any insulin. today she is more jaundiced than before & hard getting much blood to test her than usual, worried about dehydration.

our vet OKed cerenia every other day but wouldn't prescribe anything else. given her previously elevated liver enzymes, weight loss, lack of appetite, i'm worried about hepatic lipidosis, but our vet is not recommending anything besides "watch and wait." they just seem to have given up on her.

does anyone have experience w/treating hepatic lipidosis? what should i look for in terms of diagnosis/standards of care? can cats recover?

re: diabetic ketoacidosis. the vet previously (on Wed) said we don't have to worry about that, but i don't believe they tested ketotenes. can DKA cause jaundice? her BG has only been between 102-130ish when we've measured recently. (still working on spreadsheet, sorry!)

we wanted to see the ER vet for 2nd opinion & hopefully more competent care, but they are at capacity & won't see her. non-ER vets (2nd opinion ones) won't see her for a week. our only option is the current vet. (the only person who will see her!) we are taking her to pick up cerenia & at least get IV fluids. if it is hepatic lipidosis, i'm concerned they will just say that she has no chance.

how can we advocate for her, to this vet who has seemed to give up on her?
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Tagging @Suzanne & Darcy

@tiffmaxee

@Sienne and Gabby (GA)

@Wendy&Neko

@Bron and Sheba (GA)
You might have to read Caleb's intro post to catch up on what has been going on






This poor cat
Caleb you never mentioned Patches was jaundice until now
As far as I know that would have to do with the liver
Can you start adding the BG tests to your spreadsheet
Tell them to give you a copy of the blood work they ran! You have every right to get it
Unbelievable how this vet doesn't think anything is urgent
Tell them what if it was their pet and was told don't worry about anything!
Get the blood work and post it on here
As Suzanne said
Please ask your vet to give you some Hill’s AD food. It is very smooth and is high in calories. It os designed for animals who are sick and need to recover. It can be mixed with water and it passes through a feeding syringe more easily than standard wet food. I even mix mine with water and put it in a blender.
Ask for some ondansetron insist on it
Vet can write you a script to bring it to a pharmacy to fill because it's for humans
Since you are going there today for more cerenia and fluids have them check for ketones
Please let us know how you make out
 
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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.
 
We know you're in a difficult position right now. A three hour drive to the next clinic, a vet that doesn't get it and possibly spending a lot of money. It's not your fault but this should never have gotten to this point.
We have members all over the world and someone may know of a clinic or vet college that is closer and can offer better help. Caleb's medical records are your property so if you need copies of anything or want everything transferred your vet has no right to object. This is the time to act and take advantage of the help you're getting here.
 
I really feel for you. It’s so terrible that no one will see her. She needs emergency care it sounds like - and competent veterinary care. Days and even hours can make a difference. If they didn’t check ketones then they cannot know if she could have DKA. I’m not saying that she does, but clearly something is going on with her liver or she would not be jaundiced.

My cat did have hepatitic lipidosis and survived. This occurred when he had DKA and would not eat. What saved him was the esophageal feeding tube so that I could get enough food into him as well as liver supplements to heal his liver. Of course, he was on IV fluids every day and they were rebalancing his electrolytes.

I am really upset about this situation. It does seem like the vets have given up on her. It also seems like they are not being truthful/transparent with you.
 
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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