Pics of my cat's leg weakness.(Update-Krystal is Gone)

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steve a

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Here are the latest photos showing Krystal's leg weakness, apparently a symptom of her diabetic neuropathy. Note how the front legs bend more than usual when she bears weight on them when walking.
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I've talked to my vet about Methylcobalamin. She's going to talk to a colleague of hers and get back to me on that.
She's currently on Lantus 3 units each 12 hours. Food is Hills Prescription M/D. I try to feed her the moist version, but she doesn't always eat that, so sometimes I give her the dry Hills M/D, figuring dry is better than none. I tried Cyphroheptadine for her appetite, and it helped for only two days, but now doesn't seem to make a difference.
Any thoughts on the photos here would be appreciated.
 
Re: Pics of my cat's leg weakness.

Steve, many vets know nothing about using methylcobalamin for neuropathy.......we've been telling the vets about it. Krystal is newly into diabetes and Lantus actually is probably the best insulin for a newbie to start on. If you are not hometesting yet, I would strongly urge you to learn. Please read all the info on Jasper's site. Getting Krystal on methyl and hometesting to get insulin dose correct are the two most important factors in helping her with the neuropathy.
http://www.laurieulrich.com/jasper/
 
Re: Pics of my cat's leg weakness.

Hi Steve,

I am always looking for pictures for my website to help out cat guardians.

Would you mind if I used one of Krystal's pictures for my Diabetes page linked below?

Regarding neuropathy - I have noticed that the specialists on VIN are skeptical regarding the benefit of methylcobalamin..... feeling like the only 'cure' is simply rescuing the nerves from glucose toxicity. I don't have a strong opinion regarding its use since I don't have any direct experience using it but I do wonder if some of the credit it gets with *some* patients is false....ie.....those patients would have improved just as much with insulin therapy and no cobalamin.

I am fine with using methylcobLamin but I want to emphasize tha the most important issue is to rescue her from glucose toxicity with insulin and ***home testing***
 
Re: Pics of my cat's leg weakness.

Lisa dvm said:
I am fine with using methylcobLamin but I want to emphasize tha the most important issue is to rescue her from glucose toxicity with insulin and ***home testing***

I'd agree with that.

On the German forum there have been severe cases e.g. where the cat could only "walk" 1 meter at a time. In all cases where the cat was properly regulated with insulin, the neuropathy completely disappeared irrespective of whether methylcobalamin was used or not. In such severe cases, it can take some time for the nerves to recover (up to several months).
 
Re: Pics of my cat's leg weakness.

Lisa dvm said:
Hi Steve,

I am always looking for pictures for my website to help out cat guardians.

Would you mind if I used one of Krystal's pictures for my Diabetes page linked below?
Not at all, go ahead.
 
Re: Pics of my cat's leg weakness.

I guess my big concern right now while she still has the neuropathy: Are her bones more delicate as a result of this symptom, and is she more at risk of fracturing something if she jumps down from a couch? Since she has a hard time jumping up to be with me on the couch or bed, I often help her by lifting her up to the bed or couch. Then when she wants to leave, she jumps down herself.
 
Re: Pics of my cat's leg weakness.

Welcome Steve. As everyone has said, getting your kitty regulated is also an important step in the neuropathy. Here is a beginning site for hometesting:Newbie hometesting site and Video for hometesting Three units twice a day is a big starting dose and you need to be able to see if it is helping or taking your cat too low in the cycle.

We feed non prescription food. Ingredients as good or better and lots less expensive. Pick a wet lo carb food your cat will eat between 8 - 10% carbs: Janet and Binky’s chart And check out Dr. Lisa's site for tips on transitioning from dry to wet: http://www.catinfo.org/ Dr. Lisa’s site But don't start the new diet until you are testing at home; Oliver's bg levels went down 100 points overnight when we switched from dry to wet. If we had been giving our regular dosage, he would have hypoed.

Our protocol of wet lo carb food and hometesting to determine the right amount of insulin has helped hundreds of cats to regulation or remission.

Yes, help her around until she feels better. You might fix a step up to the bed or couch that she can use.

Eited because Vicky reminded me not to change diet until testing.
 
Re: Pics of my cat's leg weakness.

Hi Steve,
Although I am not a Lantus user, it is a long acting insulin like the kind I use, brand name Levemir. 3U of a long acting insulin is a lot to begin with, so I am curious how long your cat has been using that dose and how the dose was determined.

I will share Gandalf's story to help you understand why I am asking, because others are right that the key to neuropathy recovery is regulation of blood glucose. Over the course of 3 months after his initial diabetes diagnosis, Gandalf was getting up to 6U of PZI type insulin. I watched my beautiful Maine Coon type boy go from 18 pounds to 13 pounds in 3 months and begin to walk on his hocks. I found this message board and site and learned about neuropathy and that he was getting too much insulin, even though it was the amount prescribed by the vet.

Getting too much insulin can work almost as if the cat is getting no insulin at all - in other words it can make their symptoms much worse. The phenomenon is called Somogyi Rebound. Please read more about it here: http://petdiabetes.wikia.com/wiki/Rebound

So it is very possible that 3U of Lantus twice a day is too much and as a result her blood glucose is remaining high all day with occasional low dips, which starts the Somogyi cycle all over again. This is a very simple explanation, but I hope you follow and understand how crucial getting the right dose of insulin is.

We can help you do that. Home testing is a crucial element and I hope you have gotten started on that. Diet is another crucial element and I hate to tell you, but the prescription M/D food is not the best quality or lowest carb food on the market. If Hill's M/D is affordable for you, then I recommend the Wellness brand canned food, it is grainfree and has several varieties so you should easily find one or more your cat likes. Even Fancy Feast or 9Lives or Friskies canned offer varieties lower in carbs than M/D if you need a cheaper alternative.

But please begin hometesting before you change to a lower carb food. Sue offered the best links to find this information. Sorry if I repeated what others have said, but all this is that important to helping Krystal.
 
Re: Pics of my cat's leg weakness.

Thanks all for your responses. A couple questions I should get out before I forget to ask them:
1...How important is it to get the cat to eat a certain amount of food before the insulin dose? I ask this because currently Krystal is having appetite problems. Sometimes, though, I'm able to get her to eat more after she's had her insulin shot.

2...She's had these appetite problems on and off ever since the diagnosis. Recently I got the vet to prescribe Cyphroheptdadine for her appetite, and for the first couple of days it seemed to work. I'd give her the pill, then five minutes later I'd put the food in front of her and she'd start going to town on it. But in the last couple of days the Cyphro hasn't worked at all. Tonight she refused to eat either the dry or the moist M/D, so I had to force-feed her the moist M/D. The only thing she willingly ate on her own were some treats, which I only gave her as a positive affirmation for putting up with me force-feeding her. Other than telling the vet about this when I take her in on Monday, I don't know what else to do about this...

3...I'm planning on traveling out of the country (Ecuador) from January 6-13. How much of a risk am i taking here? I'm planning on having my next door neighbor take care of her and give her insulin shots, etc... I've trained the neighbor on the injection and the importance of getting her to eat, and about taking her to the vet if there are any bad signs. I imagine many of you are saying I should cancel my trip until she's more stable, but this is a trip I'd planned since before the diagnosis, and I didn't get trip cancellation insurance. Not only that, but if I resolve not to take any long trips until my cat "gets stable", well, I have no idea how long that might take, it could take years for all I know, and that could drive me nuts.

Vicky & Gandalf said:
Hi Steve,
Although I am not a Lantus user, it is a long acting insulin like the kind I use, brand name Levemir. 3U of a long acting insulin is a lot to begin with, so I am curious how long your cat has been using that dose and how the dose was determined.

I'll try to describe this to the best of my memory:
She was diagnosed back in October. At that time the vet started her on 1 unit of the Lantus. After the first insulin shot that night, the vet had me take her in to the clinic the next day and leave her there all day so that they could do a glucose curve. If I remember correctly, the vet told me after that first curve that the 1 unit was acting too strong, and that it was possibly because she still wasn't eating enough, and emphasized that I needed to get her to eat like, a half a can of the Hills M/D. I told her she never would eat a half a can in one sitting, even back before she was diabetic. Then the vet had me reduce the insulin dosage to a half-unit twice daily if the cat eats less than 1/8 cup of Hills M/D, dry or moist, before the shot, but giver her the full unit if she does eat at least that amount.
Then, a couple weeks later, she had me up the dose to 2 units, I don't recall why. I think it was because the latest curve they did was still showing overall glucose levels between 300 and 400. Then at one point the vet talked about doing some sort of ultra-sound to see if there was some other issue going on in addition to the diabetes that would be affecting her appetite, and because she was saying the glucose curves they were doing on her at the clinic were inconclusive because she was too stressed out being at the vet all day long. That ultra-sound would have cost me 500 bucks and I told her I wasn't willing to pay that much. At that point she said she would talk to some colleague of hers to explore other alternatives besides the ultrasound. That's when she came back to me with the idea of doing my own glucose curve at home. Why she didn't suggest that from the beginning, I have no idea. The first two curves that they did at the clinic cost me $120 each. So far I've done two curves in which I tested her six times during the day (on my day off, of course). Here's a link to another thread where I posted the numbers of that curve. It showed a low of 236 mg/dL and a high of 322.
Anyway, at some point I think about two weeks ago, my vet suggested I try upping the dose to 3 units since the glucose level is still kind of high, so that's where I am right now.
As I'd described above, I'm going to Ecuador for a week in January, and unless there are any severe changes for the worse in symptoms, the vet doesn't want to change the dose until after I get back from Ecuador.

Vicky & Gandalf said:
Home testing is a crucial element and I hope you have gotten started on that.
I do have a glucometer as described above, and have done some curves, and occasional single tests, but haven't gotten into the TR pattern of testing before each insulin shot. One thing I've also tried the other night just out of curiosity, was use the same glucometer to test my other cat Kramer, who's not diabetic, just to see how his blood sugar compared to Krystal's. Kramer's level was 57.

Vicky & Gandalf said:
Hi Steve,
Diet is another crucial element and I hate to tell you, but the prescription M/D food is not the best quality or lowest carb food on the market. If Hill's M/D is affordable for you, then I recommend the Wellness brand canned food, it is grainfree and has several varieties so you should easily find one or more your cat likes. Even Fancy Feast or 9Lives or Friskies canned offer varieties lower in carbs than M/D if you need a cheaper alternative.
Well, I guess that brings me to the issue of whether I'm seeing the right vet about this. I've had a pretty long relationship with this vet since before she diagnosed Krystal with FD. My vet is convinced that the Hills M/D is the best diet for my diabetic cat right now. I showed her some printouts of articles I'd read online about the importance of wet foods, etc, but there was no changing her mind. She's apparently read all those arguments before. She said she's been to the Hills factory and saw how they make the food, and is convinced that Hills does an excellent job of "engineering" the nutrient content of the food, whether in dry or wet form, to give my diabetic cat the nutrition it needs. I'm not saying that you're wrong, but until and unless I make a formal decision to change vets, I don't know what else to do.
I should mention that my vet clinic is a Banfields. Banfields are clinics that are located inside most PetSmart stores. I don't know, maybe that's a bad thing, because perhaps PetSmart has some relationship with Hills, and so Banfields, PetSmart, and Hills are all in cahoots with each other? I don't know, I'm just throwing out some conspiracy theories now, I really have no idea. I live in the Phoenix area. If anyone else on this board is from Phoenix and knows a vet who they think is good with feline diabetes, your advice and referrals are appreciated.
 
Re: Pics of my cat's leg weakness.

ahhhh, you are lucky. there are several people in the Phoenix area and several of them have really good vets. i'll send out some messages to the phoenix members but with it being the holiday it might be a day or so before they see them possibly.

fwiw, alot of vets worship the prescription foods because that is where they get their education about nutrition from.....from the salesmen who frequent their clinics to restock their shelves or from seminars, etc....put on by the big food companies. i bet if guys from wellness or friskies went out and pushed their product to vet clinics, they'd be on the shelves of many more clinics too. (and fyi, fancy feast and wellness both sit on the shelves in the lobby at my vet's clinic :smile: )

my old vet (she retired from veterinary practice) used to work for one of those big name companies andddddd actually holds the patent on one of the wet food varieties of diabetic foods and even she says the quality is poor in those foods. that and there is nothing natural about dry food for a cat for that matter. that if it weren't for the tasty coating sprayed on those little kibbles, nothing living would ever eat them.

also fwiw, if my cat's wellbeing depended on my giving it the best care, i would just feed what i know makes the most sense for a carnivorous animal and unless the vet comes to your house morning and night to monitor what you are feeding, then who cares what she thinks you are feeding, as long as kitty gets better :-)
 
Re: Pics of my cat's leg weakness.

Steve, what area of Phoenix are you in? I do have a few vet recommendations depending on where you live.

I can also serve as a back-up pet sitter in case your neighbor has any problems. We can trade contact info before you leave for your trip. Not quite sure what my work schedule will be at that time--we're 2 people down and I'm working quite a bit of overtime. WhenI go in to work next week, I can also check on my hours for that time period. The schedule was just revised this week and I don't have a current copy of it at home.
 
Re: Pics of my cat's leg weakness.

Ahhhhh yes.. Phoenix. :smile: I think most of us use Blue Cross, which Deanie sent us to. I live in Chandler, and travel to Phoenix for them because they're so good. I trust every vet there. Well, there's a new vet there I haven't been to yet, but I haven't been to a bad one there yet. Dr Peter & Dr Bennett are my favorites. Not all gung-ho on dry foods or Hills only either. They work with you & really listen to your feedback & questions. Also, I've heard cats just stop eating M/D after a certain amt of time I think? Have you tried something else? Wondering if that's her problem, and not really inappetence.. just not liking the M/D anymore. Try some Friskies, Fancy Feast wet or something like that. The cypro may not be working, because she just doesn't like the M/D anymore.

Anyway, here are the details:

Blue Cross Vet Clinic
4111 N 36th St
Phoenix AZ 85018
602-955-5980
Crossroads: 36th St & Indian School
 
Re: Pics of my cat's leg weakness.

Two bad things that just happened recently:

1...Last night, while sitting on the sofa, she peed on the sofa. I didn't even realized she'd done it until she got up and left. Like a kid wetting the bed.

2...This morning, she vomited. The vomit, though, mostly contained grass from the backyard, that she apparently had eaten the previous morning, or perhaps the morning before that. It did NOT appear to contain any of the moist M/D that I force-fed her last night. Perhaps the grass was from two days ago, and was the cause of the recent appetite problem that I described in my last post? Anyway, she still wouldn't eat the M/D, so I force-fed her some RC Recovery moist.
 
Re: Pics of my cat's leg weakness.

Some things that might help to get her to eat: http://www.felinecrf.org/persuading_cat_to_eat.htm

Also, most kitties really enjoy the non prescription wet food. You might try some of the Fancy Feast or Friskies flavors from the food chart.

The reason it is vital that you test before every shot. Often the insulin takes a while to work, or the wet lo carb diet kicks in, and you get a much lower number than usual. If you don't know that, and give the normal amount of insulin, you have set yourself up for a possible hypo. With Lantus, the mid cycle number (nadir) is an important part of the whole picture. You need to know how low the insulin takes her, so you can adjust the amount - whether too high or too low. So testing around the 6 hour mark is also important.

I think someone gave you the Insulin support forum. The stickies on the top of the page are vital to know how Lantus works: viewforum.php?f=9 (Go down a ways on the page to the starred topics.)
 
Can't even get her to bleed!!!

More bad news:

Tonight she's more lethargic than usual, and won't even eat a treat on her own. Before now, even if she didn't want to eat any food, she was always willing to eat treats or catnip. This morning I tried to do a glucose test prior to insulin, but couldn't draw enough blood apparently, so the glucometer gave me an error code. That was my last test strip, and I had to rush off to work. After work I went to the pharmacy and bought more test strips, and tried to test again. This time, however, I couldn't even get her ear to bleed. I have those spring-loaded lancets, and up until now, pricking her ear was a piece of cake. I've done this so many times with no problem, so I know I'm hitting the vein. But tonight I tried about ten times in each ear, and no luck. A couple of times the lancet went all the way through her ear and into my own finger, making me bleed. Dang it! I'm really worried now. There seems to be a lack of normal blood flow. On one of the pricks it did bleed slightly but not enough to get that droplet I need for the test strip to get a sample. It's got be related to this whole appetite problem she's having. I'm planning on taking her into the vet tomorrow first thing 7am. There's a 24 hour clinic over in Gilbert, AZ, but they say they're pretty busy, it being xmas weekend and all. I think if I were to take her there, we'd end up waiting 5 hours just to see someone, so I don't know if it's worth it.
 
Re: Pics of my cat's leg weakness.

Steve - keep trying to get a reading. Try the lancet freehand - as so many around here do.

Be patient for that blood drop and see if you can get one 'milked up' to the puncture site.

Also...and I know it is too late for this for this evening...but this is where the Precision Xtra meter comes in so handy to get a ketone reading from a blood drop - versus a urine sample.

(This meter checks for glucose and ketones - with different strips.)
 
Re: Pics of my cat's leg weakness.

dehydration can cause that lack of blood. it can also cause inappetance.

remind me if you test for ketones? if not, i'd get that checked asap when you get to a vet.

fwiw, i think the blue cross steph mentioned might have 24hr availability. not 100% sure though.
 
Re: Pics of my cat's leg weakness.

Not sure what you have tried, but heating the ear was really important for Oliver. Also, putting a small smear of Vaseline where you are going to poke will help the blood bead up. We put a small makeup sponge behind the ear to poke against- others use folded piece of kleenix or the rice sack.

Have you tried heating up the food until good and stinky or putting some Parmesan cheese on it? It sounds silly, but sometimes it works if you put some food on your finger and feed her a little that way.
 
Re: Pics of my cat's leg weakness.

Lisa,
I feel pretty exhausted and frustrated right now about this right now, mainly because it's the first time it's happened. I was just reading some other threads where people describe how they have to get their cat's ear to "learn" how to bleed. But I don't think that's the problem. My cat's ears have never had any problem bleeding before from glucometer lancets. I don't understand why all of a sudden I'm having so much trouble making that ear vein bleed. I even tried the conventional way, pricking without the spring-loaded device, but to no avail.
 
Re: Pics of my cat's leg weakness.

It may be cheaper at least if you want to call Blue Cross at the number I posted above. They can usually squeeze you in the same day, but they do charge something like a $15 emergency fee or something. Would save you the 'ER' prices though.. they're very reasonable, and I'd trust them with ANY of my animals' lives!

Otherwise, if you're looking for another ER vet, I've used the one by my house in Chandler. It's on Alma School & Warner.. First Regional Animal Hospital. http://www.firstregionalvet.com/

Of course, the ER vets can get pricey though.. I think it's approx $100 to just walk in the door.. an 'office fee' of $100 right off the bat. I took Missy there (my youngest) when she was puking every hour for awhile.. I thought she possibly had an obstruction. With going to that ER vet & getting x-rays to find out, it was around $300-$400 I believe. Thankfully, it was only gas, but the most expensive gas dx I've ever had. :razz:

But anyway.. please keep us posted! I hope your kitty starts perking up soon!

P.S. Are you still giving insulin? It's important that if you can't test, you get her into the vet soon. With her not eating much, and not sure if she's still running high or not.. she could develop ketones, and that turns serious fast. You also don't really know if you gave insulin w/o her eating anything, if she's too low too (if you can't get a test). Is there any way you can try to test her paw pad? I used to test Cuddles that way, and she was fine with it. You set the lancet on the deepest setting, and prick the biggest pad in the middle (doesn't matter which foot..but you use the 'palm' pad, not the 'toe' pads).. then squeeze to try & get some blood out. It usually takes the deepest setting, as those pads are way tougher than the ears!
 
Re: Pics of my cat's leg weakness.

Cindy + Mousie said:
fwiw, i think the blue cross steph mentioned might have 24hr availability. not 100% sure though.
They do actually, but I'm not sure if they'll see someone on an emergency basis if they're not a customer already. They know nothing about the cat yet, so would probably send them to the closest ER vet. I believe they did that to me with Cuddles, when she was having seizures. I took her to First Regional that night, but then eventually got her into Blue Cross. Once you're a client of theirs, then you can call their afterhours # for emergencies & discuss things.

I believe they have the afterhours # on their main #, but if not, and someone wants to try it, it's: 480-303-1843

At least I hope it's the same! Haven't used it in years!
 
Re: Pics of my cat's leg weakness.

Steph & Cuddles (GA) said:
Cindy + Mousie said:
fwiw, i think the blue cross steph mentioned might have 24hr availability. not 100% sure though.
They do actually, but I'm not sure if they'll see someone on an emergency basis if they're not a customer already. They know nothing about the cat yet, so would probably send them to the closest ER vet.

No, they do not have 24 hour service. They have a vet on call until 10 pm in the evening but that service is not available to new clients. After 10 pm, someone would have to go to the nearest emergency clinic. Also, the vet on call may or may not meet you at the clinic. Based on the info they get from speaking to you, if they feel they cannot treat that problem at the clinic, they will refer you to the ER at Sonora Veterinary Hospital. There is also an after hours charge--last time I needed it I paid $75 but that was several years ago. It' s high but not as high as the ER. (and closer to home for me)
 
Re: Pics of my cat's leg weakness.

Oh, good to know Deanie! The only time I had to use it, was the night I put Cuddles down. :sad: They were willing to meet me at the clinic, but it wasn't too late, on a Saturday. It was only $70 more to go to the ER vet 2 miles from me, so I did that instead. (First Regional)

Can try calling Blue Cross in the morning though to see if you can get her in. (If you want to try there.) I know you can pay extra to have them squeeze you in between appointments, but it's only around $20 extra.
 
Re: Pics of my cat's leg weakness.

Sue and Oliver said:
Pick a wet lo carb food your cat will eat between 8 - 10% carbs: Janet and Binky’s chart

Okay, I just looked at Binky's chart, and read the FAQ's on how to interpret the chart. Excuse my French, but holy crap! How am I supposed to make sense out of that? I'm even more confused than I was before. Could you tell me what specific kind of moist you use and I'll try that with my cat?
 
Re: Pics of my cat's leg weakness.

Look in the 'Carb' column & look for any percentage under 10% those are the low carb wet foods. Examples of what I use is all Friskies 'pate' foods.. like Supreme Supper, Mixed Grill, Liver & Chicken, etc..

Avoid anything in gravy or shredded.. most of those aren't low carb. Also try to stay away from all fish unless your cat isn't eating.. then try to get them to eat anything!

Sorry so short..on my phone.
 
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