Please help-bring to ER?

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Gave subcutaneous fluids this evening! It went so well! He didn't seem to mind at all and didn't flinch when we got the needle in. Thank you so much for your encouragement. I am grateful for this afternoon and our good luck with the sub q's. This afternoon, Prince went outside in the garden for a bit (supervised of course) and is now sitting in the window looking at a bluejay. I am really hoping to get some more time like this with him. I am really relieved that we listened to our gut and brought him home last night. Otherwise, he would still be there, likely getting the same treatment he is here at home, but completely miserable and stressed. I can't thank everyone enough for all the support.

PS-the pain med is Buprenorphine .3 mg every 12 hrs. So far he is eating, so I don't know if we need the anti-nausea meds yet.
 
That's fantastic news! I'm so glad you've got what you need to do his treatment at home now. Hopefully he'll be there with you for a long while still, but even if it's just for a short spell, he'll obviously have an enjoyable time vs. a terrifying one and there's really not much that's worth more than that. Bravo to you for fighting for him to get what he deserves!
 
.3ml is in the ballpark for a dose - if he's loopy from it, you could give a little less with the next dose, like .2ml.

i'm so glad to hear the update! We're all about what's best for the cat, and quality of life really matters. I suspect with the treatment you've got going you're going to see some improvement pretty quickly. I agree with Elise about adding on an anti-nausea med, like cerenia or ondansetron, for as long as his appy is still not up to normal.

do you know the tricks for tempting a kitty to eat? here are a few:

- warm up the food - smellier is more appealing to kitties
- sprinkle on parmesan cheese, oregano (relative of catnip), catnip, tuna water (not broth as it may contain onions/garlic) or freeze dried meats
- use your finger to put a little in his mouth. sometimes "priming the pump" with a little food is enough to get them eating
- rotisserie chicken is pretty irresistible to most cats

great job getting the subq's done! that can be a little intimidating.

fingers crossed for a quick recovery for your sweetie!
 
Hi Everyone-

Should I be changing the title of this condo? I know I am not very good with the more technical stuff here.

The pain meds seem to be okay-he does not get loopy or funny from them. Last night he didn't seem to eat quite as much, so I gave him a 1/4 of a 15 mg tablet, which had really helped him recover from his previous hepatic lipidosis. This morning, he ate much better. Still not quite like he was before, but quite a bit. I have tried every trick in the book for feeding him. Last night he had bluefish after his wet food. What seems to work the best is hand feeding or re-offering over and over.

What would be causing him nausea? Pain meds? He seems a little bit better this morning, but so far has had only 1 dose of his new antibiotic. He is still much better than he'd be in the hospital, and was purring and happy to see us this morning. You think I should still request anti-nausea meds? I am trying to limit the number of pills he has, because he absolutely hates those. Luckily, the pepcid is tiny and if I follow it immediately with treats, he doesn't seem to mind.

Also, I mistyped the Buprenorphine dose. It is .3mg/ml, and he gets .5ml, so it is really .15mg per 12 hours that he is getting. Does that seem ok? He is 16lbs.
 
Hi Emily. I'm glad Prince seems a little better.The fact that he needs an appetite stimulant means he is likely nauseous. I didn't realize Max was nauseous because he never vomited. It was explained to me that the not eating was caused by nausea. Once I got it under control he ate without stimulants. If you feed a nauseous cat they sometimes will later refuse to eat the food and develop a food aversion. When you can, if you get some gel capsules size 3 from either thrivingpets.com or capsuline.com, you can combine pills into one capsule and then you won't need to give as many pills. Pepcid is very bitter so you are lucky Prince will take it easily. I had a cat that tasted it in a pill pocket once and then never would eat a pill pocket again.

We usually start a new condo each day. To do that go to the tight regulation form and click on new. Type in the date, Prince and your topic in the subject bar. Then begin your condo.

I hope you and Prince have an even better day today.
 
i agree - i'd give him the anti-nausea meds. pancreatitis makes cats feel yucky and they really help.

re: bupe - i'm uncertain what concentration I had for punkin. His dose was .2ml twice a day, but it could be a different concentration. I'd go with what your vet told you to start with, decrease it if he seems loopy or stoned, and increase it slightly if you think he needs a little more.

also starting a new condo (thread) each day is really helpful.

sending our best for you guys today!
 
Hi Emily,

Instead of decreasing Prince's dose of Bup, what you can do quiet effectively is to give it to hi 3x a day, rather than 2x per day. That is how I did if for Jomo, always. It was a way to make sure that she was in as little of pain as possible.

Prince is feeling nauseas for a few reasons. Number one, he has ketones in his blood. You must keep giving him the sub-qs every single day until his appetite is fully back to normal. Number two, he likely has pancreatitis, which causes both pain and dehydration due to a lot of vomiting and sometimes diarrhea too. The Buprenor will ease his internal pain, and the sub-q's will also help TREMEDNOUSLY to revive his ailing pancreas. (Dr. Gardner, Jomo's old vet, told me this.). The sub-q's will also help with nausea related to dehydration.

The pills to help him feel like eating are good, but they do nothing to treat the underlying cause of his nausea. You must continue to give him the sub-qs, and if you don't see improvement at home with yourself giving the sub-qs, I would consider putting him in the hospital for at least 48 hours to really get those fluids circulating in him.

About his getting upset at the vet/hospital-- they WILL give him the Buprenor there, it makes cats very sleepy, and Prince will sleep while those IV fluids are being pumped through his veins 24/7 at the hospital, so his upset behavior will be gone. IV fluids is something that you cannot do for him at home.

You can try the Cernia for his nausea, but if it doesn't work right away, watch out. You've really got to watch him and make sure that he is eating everything. If Prince is not eating enough, or stops eating even with the cerenia, it's time to admit him into the hospital. He can slip into a full blown DKA case, as well as pancreatitis, plus fatty liver disease, ALL at the same time. This could happen not because of something you did, but because of something you couldn't do for Prince at home. If Prince won't eat even after you've given cerenia, it is highly possible that the sub-qs you are giving him are not enough fluids to knock out the toxins (ketones) from his blood, nor enough to relieve his stressed out pancreas.

You, yourself, must also be less fearful of taking Prince to the vet. He can definitely feel your stress.
 
My vet is unable to prescribe pain meds due to them being a controlled substance. I called the hospital back and they refuse to prescribe pain meds long term. I really am unsure of how much pain he is actually in, so I thought of cutting back the dose in order to extend it, and gauge how he does with a lower dose. I am pretty furious at the hospital. I also asked them to prescribe anti-nausea meds, and they refused and said he had gotten a longer-lasting anti nausea at the hospital and the pepcid at home should be enough. My regular vet just went away for the week, and the attending vet said she was not willing to prescribe them, either.

I know that it seems harsh that I will not bring him to the hospital, but I really feel it is the right thing to do. I plan on calling a visiting vet if/when needed. I was given the name of someone that my regular vet works with. It is just too traumatic for him to travel. He defecates, urinates, hyperventilates, and will also butt his head against his cage if I don't hold him all the way there. They gave him a sedative and oxygen while he was there, but it does wear off and we have the ride home. I plan on doing all I can here, and if it doesn't work out, I am going to make him as comfortable as possible and then have the vet do an at-home euthanasia. I have to ask myself what quality of life it is for him to keep putting him through test after test, medication after medication. Even if this was fixed, it would likely be something in the future, whether it be 3 months or a year. It is extremely stressful for him to go through that.

As far as now, we will continue doing daily fluids and the medications. He is eating, but not with as much appetite. I wanted to ask, what do people think about giving him his old dry food? He still has an absolutely voracious appetite for that.

I just tested for ketones again, and unfortunately there are still moderate ketones. Like I said, we will continue giving fluids.
 
J.D. went into DKA about 8 years ago. He was hospitalized though. I'm just saying that Prince could have a lot of years after this, without any more problems.

I think it is advised to feed him more than his normal amount of food and give plenty of water and/or fluids to flush the ketones, and to try to keep his BGs down with insulin. That's just what I remember reading in all my years of being on this board. Did the ER vet say he was in DKA or just had ketones? Sorry, I didn't read your whole condo, but have been trying to follow along.
 
It's really too bad your vet is not there because the one you are talking to is increasing Prince's suffering due to her lack of knowledge.

Yes, buprenorphine is a controlled substance. That is why you have to get a written prescription and take it to the compounding pharmacy. There are very many of us here who use it in chronic pain management. It's the kind thing to do and your vet doesn't understand that. They probably gave him cerenia for the nausea but ondanestron (zofran) tends to work better. I got a script from my vet and bought the injectable (2 mg/ml for $19.95 in a 20 ml vial) from ThrivingPets.com. That way, if my kitties ever get nauseous, I can inject it subq and it's much cheaper than the pills. I, personally, don't like to give pepcid unless I know there is an overabundance of acid and an acid tummy. My vet said that too many people use pepcid too frequently; it, in effect, not only gets rid of the overabundance of acid but also acid the tummy needs to digest food. I have used it for a CKD kitty who did have too much acid but only after slippery elm bark powder stopped working.

My basic philosophy when it comes to sick kitties is the best food is the one it will eat. However, with Prince, if you give him the dry food, you absolutely must be prepared to take his insulin dose up because he is showing ketones and you don't want to get him into a situation of those getting worse because he doesn't have enough insulin on board. And when you stop the dry food, you have to wean him off of it so his BG doesn't plummet.

While I'm not advocating dry food, I wonder if you should try the Young Again zero carb dry food? I do believe it has some carbs in it but if it's dry food he wants, that would likely impact his BG the least and you could get calories in him.
 
Re: Your Terribly Cruel Vet & Vet's Office - Change Vets!

I don't think you're going to be successful with treating him for moderate ketones at home, Emily, I'm sorry.

It doesn't sound at all like this is a good vet for Prince. It sounds like they will do nothing for you to help ease his suffering, besides killing him, or increasing his pain, like Marje said. This is truly an unkind vet and vet's office. I think you need to call around and ask some other vet offices and tell them that your cat needs Buprenor, is taking Buprenor, and your vet will not prescribe it for him. In addition, I would tell them that he is not eating and you'd like to give him cerenia, but your current vet won't prescribe that either.. would they?

Or, are you not willing to do that for your Prince? :roll:

There are many, many other wonderful vets in this world, and in your area, who would do everything they can to ensure Prince's quality of life. Those things include: prescribing the narcotic Buprenor to ease Prince's pain, and also prescribing anti-nausea medicine so that he will ease his pain.

You, yourself, must be willing to do all that you can to help him live and feel better, as well, even with his bully behavior in the car. We would not put a child to sleep just because he threw a temper tantrum on the way to the doctor's office to get the shot he knows he must have..Being the caretaker of a cat means that you will need to take your cat to the vet at some point in his life, whether he behaves gracefully or like a brute.

At this point, Prince cat cannot take care of himself. It's up to you to help him, and to find the vet who will help him to heal and to live.
 
I call the visiting vet that your regular vet recommends. I'm not sure about the laws in Mass. but here in CA The license to prescribe those restricted meds are pretty expensive. That could be why your regular vet can't give you bupe. Check w/ the traveling vet and ask what he can and can't do for Prince. If he too is unable to Rx the meds Prince needs I'd keep looking. You should be able to interview him on the phone without the cost of a visit. :YMHUG: :YMHUG: :YMHUG: cat_pet_icon cat_pet_icon
 
it sounds like you're really between a rock and a hard spot, emily.

we're here to support YOU in whatever way is helpful - people will continue to give you advice on what might be helpful, but only you know what will work or not in your life for you and Prince.

One trick for a dry food addict that can work is to pulverize the dry food and sprinkle it on top of the wet food. Little decoy, y'know!? :lol: That may get him eating without overdoing the carbs too much. You can also adjust his insulin dose as needed to cope with increased carbs.

Fortiflora, available only from vets locally, but widely available online, is another substance that many cats love. you sprinkle it on top of the food. it's a probiotic but apparently is similar to the stuff sprayed on dry food that makes it so attractive.
 
:? Well, the reason cats like Fortiflora is because it has the sme flovoring that pet food companies spray on dry food to make cats think it is edible!
 
Just wanted to do a quick update-
Prince's pain meds have long worn off and he seems to be doing quite a bit better than when he was on them. I am wondering if I should hold off a bit, because maybe they were not making him feel very good? He does not seem to be in any pain. We spent an hour and half outside in the garden (and he hadn't wanted to go out earlier), and he was wandering around, smelling the air in his happy way, and watching birds. He came in and did not hide, instead was purring and trying to sniff out the kibbles. We did the fluids and gave him his pepcid without any problem. Tonight I am going to try sprinkling pulverized dry food on the wet food. We have fortiflora, but I actually have to mix it into his food to get him to eat it. My other cat goes crazy for it, but Prince doesn't love it. I am also going to up his insulin by a half unit. Thank you everyone for your support and suggestions.
 
great update, emily! i'm glad to hear he's doing better.

the subq's will help with the ketones - add water to his food as well. the more water he gets (another plus for canned food over dry food) the more it will help flush the ketones.
 
I'm glad Prince is doing so much better. It seems you are making good decisions so far, if he's improving.

Besides the forti flora and pulverized dry food, a trick that works with Cinco is sprinkling crushed Freeze Dried salmon on his food (you can do chicken or turkey, etc. Cinco only likes the salmon). He cleans the whole plate when we do that, and no extra carbs added.

Sending many healing and appy vines.
 
I really think you should call the mobile vet now to discuss Prince. Maybe he/she could visit now and prescribe any meds Prince might need. I think you will want to establish a relationship with the mobile vet so, if the need for euthanasia does arise, you will know you can call on this vet. Some mobile vets resent being called only for euthanasia. They want a practice that involves more than euthanizing pets they have never seen before.

I also need to tell you that I completely understand your desire to avoid car trips for Prince. I said this before, but I want to reiterate. I have had cats who are unhappy in the car, but my Snugs gets way beyond unhappy. A car trip of more than 4 miles is so stressful for him that I am convinced the trip does more harm than good. He has a heart condition and I am actually afraid he will have a heart attack. Unless you have a cat who has this kind of extreme reaction, you can't understand how bad it is.

You know your cat better than anyone else. You know in your heart what is best for him. Don't let anyone "guilt" you into doing something you think is wrong for Prince.
 
I am so sorry you have such lousy IM and emergency vets. I sent you a PM message. I can send you some ondansetron .
 
Just wanted to let everyone know we have a new vet coming to the house this afternoon. She will be able to prescribe any meds he may need. Prior to setting up the apt with her, I was able to get more pain meds. Another vet from the hospital called us and let us know he supported our decision. It seems the on call vet hadnt been quite as transparent and apparently there are several major underlying issues that may or not have been treatable at the hospital. Prayers for my Prince please.
Thank you. Emily
 
Sending Prayers for you and Prince. Kudos to you for jumping into action and getting Prince to a much better place than where he was just a few days ago. May Prince experience continued improvement.
 
Great news on the vet and signs of improvement for Prince. You are doing a great job in a very difficult and stressful situation. Sending prayers for Prince and you.
 
Hi Emily:

Wonderful news about Prince and the new vet. Sending good vines for the visit.

When you have a chance, you might want to start a new condo. This one is getting pretty cumbersome. If you start a new one every day, you can add a link to the previous one. Several of us can help you do that, once your new condo is up.

I'll be watching for an update after the vet's visit. :YMHUG:
 
Hi Emily & Prince,

First, I want to say it is so evident how much you love & care for Prince, and I understand & agree with your reasons for not taking him to the vet. I hope you & Prince both like your new mobile vet.

I've given fluids many times to many cats - the worst was my first, but alot absolutely love getting fluids once they get used to the routine. Alot of love and treats afterwards, and warming the fluids to body temperature really helps.

You can also ask your mobile vet for a prescription for fluids. Our Costco Pharmacy sells them by the case for $25-$35 for a case of 12 (1000ml). They are ridiculously cheap. Otherwise you can get them online, but the shipping makes them a bit more expensive. Still less than what you will pay a vet. You can order the iv lines and needles online (Costco doesn't have them). If you are willing, fluids are easy to administer yourself and much cheaper that way.

You are a real trooper and hanging in there. Prince is one lucky kitty to have you in his corner. Sending many healing vines to Prince - things are already looking up for him!
 
Are you still able to get cheap fluids? There has been a shortage and the price has doubled in most places. I don't use them at this time but see posts on sites about the issue.
 
I just wanted to let everyone know that my beloved Prince passed away yesterday at home. Please pray for him. Thank you all for your support. -Emily
 
Oh, Emily. I am so very sorry and saddened by this news.

rb_icon Fly free and land softly sweet Prince. wings_cat


My sincerest condolences.
 
Emily, my heart goes out to you for the loss of Prince. But I am so grateful that you worked so tirelessly to make his final days as happy and pleasant as you possibly could. You were lucky to have each other.
 
{{{Emily}}}

I am so very, very sorry for your loss. I had been thinking of you and Prince and wondered how he was doing. My heart hurts for you. :YMHUG: :YMHUG: :YMHUG:
 
Fly free, dear Prince! Emily we are saddened that Prince has passed. He will have many friends at the Bridge. They will be his pals until that wonderful day when you meet again.

In deepest sympathy,

Ella & Edward, Rusty, and Stu(GA)
 
((Emily)) I am so sad to read this. You did everything you could. Now Prince is free from pain. Take care of yourself.
 
OH Emily....I am so sorry for your loss!!!!


You did such a wonderful job with Prince and did everything right with him....I am sending prayers to not only Prince but you as well as lots of hugs during this very difficult time.
 
So sorry for your loss Emily!

You gave Prince several more days of feeling better and without pain...that's a wonderful gift to give

Fly Free Sweet Prince, and Land Softly...there are many at the bridge to welcome you tonight wings_cat
 
Oh Emily...I'm so very sorry to hear this. I'm glad that your sweet Prince was at home with you and you could have those last days with him.

fly free, sweet Prince.
 
Oh (((((((((((((Emily and DH))))))))))))))) I am so sorry to hear this, your were so devoted and did everything you could to care for Prince. Know that he is free of pain and watching over you now from the Bridge.
 
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