Please help - kitty with ketones | Page 2 | Feline Diabetes Message Board - FDMB

Please help - kitty with ketones

Blood glucose @ 181.
Fed ~7cc more food and more water, too.

It must've been the site backup.. I must have tried to log in at the exact wrong time.

Need to decide when to give insulin tonight and how much to give.
 
Where are you up to with the 181? That is +?
I am finding your SS difficult to read. When did you last give the insulin?
Was it at what you called +3 this morning? (12 hours after the previous extra dose??) If so you need to give the next dose at 12 hours after that last dose of insulin which will be the new PMPS time. It should always be given 12 hours apart. Give 1 unit again and stay with that dose unless you are advised otherwise. Keeping up the insulin is very important.
 
Just looked at the SS again. It looks like the 181 is +9 right? Which is really +6 because you gave the insulin 3 hours later last time. So insulin is not due for another 6 hours. Is that correct?
The red and blue further along that line on the SS is confusing. Are you able to get rid of those two colours in the +3 and 4 of the current pm cycle?
Also with the explanation you wrote with why you gave the insulin late, can you put that in the remarks column, and put what you now have as +1 +2 and +3 into the previous pm cycle as they were +13 +14 and +15 and put them on top of each other in the +11 column. Then start the AMPS today with the current +3 BSL as that is when you gave the am dose of insulin. Does that all make sense?
Can anyone else think of a better way to do it.?
Ketostix strips are only about $10 or &12 I think at Walmart.
You are doing a great job looking after Ty!!
 
Bron and Sheba said:
Just looked at the SS again. It looks like the 181 is +9 right? Which is really +6 because you gave the insulin 3 hours later last time. So insulin is not due for another 6 hours. Is that correct?
The red and blue further along that line on the SS is confusing. Are you able to get rid of those two colours in the +3 and 4 of the current pm cycle?
Also with the explanation you wrote with why you gave the insulin late, can you put that in the remarks column, and put what you now have as +1 +2 and +3 into the previous pm cycle as they were +13 +14 and +15 and put them on top of each other in the +11 column. Then start the AMPS today with the current +3 BSL as that is when you gave the am dose of insulin. Does that all make sense?
Can anyone else think of a better way to do it.?
Ketostix strips are only about $10 or &12 I think at Walmart.
You are doing a great job looking after Ty!!
Click to expand...

Sorry. People are getting confused by the SS so instead of confusing myself too much, I duplicated today's row (6/14/2019) and put it at the top of the spreadsheet. What I had before is still there, but I put a strike through it and made a comment to ignore. does that help?
 
Blood glucose (+7 after making the adjustments in the SS) is now 195. Have been feeding in small doses every 45-60 min. Over the last 3 hours he has had about 1 can of FF (mixed with water) via the syringe and I've also spoon fed him at least a few tsps of water during every feeding. He is not happy about it but tolerating everything with growls.

Should also say that he would usually have eaten ~1.5-2 cans of FF by this time of day. So we are behind on the amount.

Not vomiting, but still lethargic. Also hasn't urinated again for me to check ketones. Hoping he will soon.

@Bron and Sheba - vet newly recommended yesterday afternoon (before we learned of the ketones) to do 1U in the AM, .5U in the pm. What do you think based on his numbers.
I will stick with **12** hours apart.
 
How frequently is he urinating, today?

I was also going to say, the ketostix are fairly cheap. Cheap is relative though and I understand financial constraints. Going to simpler ketone test strips did help me a lot though.

Could you please remind me, was there infection? Antibiotic? When? What?
 
First, with respect to your spreadsheet, the convention here is that the older numbers are at the top. The most current numbers are at the bottom. It will make those of us who have been looking at spreadsheets for years very confused since for this site, your spreadsheet is upside down. When you have a chance, can you rearrange the page?

If you decide to ditch the pet meter, you may want to consider buying a blood ketone meter. The strips are pricey but you don't have to wait hours for your cat to urinate in order to test for ketones. NovaMax makes a good ketone meter, as dose Precision Xtra and they are available on the ADW website.

Did your vet run labs when treating Ty's DKA. If so, get a copy. The recipe for DKA is an infection/inflammation + not enough calories + not enough insulin. If Ty wasn't given an antibiotic, I'd be very surprised unless the white count was normal and there was no indication of a UTI. Do you know if your kitty has any dental issues like gingivitis? It can also contribute to the infection/inflammation issue. When Gabby was diagnosed with DKA, she was discharged from the ICU with an antibiotic, an anti-nausea med, an appetite stimulant and something else. (It was a long time ago an I didn't put the meds on her spreadsheet at the time.) Please keep in mind that water is good but food is necessary. Ketones develop when a cat is burning stored fat rather than metabolizing newly ingested food.

The other anti-nausea med is ondansetron (Zofran). It's a human med. The tablets are expensive. The injectable form is much less costly but it stings when injected. Some cats need both Cerenia and ondansetron to get past nausea.

You might want to try giving Ty baby food. Many cats love the stuff and it's a great way to get a cat eating. You would want to find a Stage 2 food that is only a protein and broth. The downside is that it's fairly low in calories.



 
AliceMeowliss&Cassandra said:
How frequently is he urinating, today?
Click to expand...

Relatively infrequently.
He went last night (large amount) around 11pm, when we tested.
Did not go again today until noon (large amount, again) when we tested.
Hasn't gone since noon. He just pooped (diarrhea - very runny), no pee.

AliceMeowliss&Cassandra said:
I was also going to say, the ketostix are fairly cheap. Cheap is relative though and I understand financial constraints. Going to simpler ketone test strips did help me a lot though.

Could you please remind me, was there infection? Antibiotic? When? What?
Click to expand...

We have lots of urine strips for now to test for ketones, but will look into Ketostix when we run out.
The problem is the AlphaTrak2 test strips for the glucose meter.. 50 strips on Amazon = $50. Definitely how they make their money, because the entire AlphaTrak2 meter was only $25.

No antibiotics, no infection.
 
CCG said:
@Bron and Sheba - vet newly recommended yesterday afternoon (before we learned of the ketones) to do 1U in the AM, .5U in the pm. What do you think based on his numbers.
I will stick with **12** hours apart.
Click to expand...
I disagree with your vet. Ty needs enough insulin to keep the ketones from forming. Give 1 unit both cycles. If necessary give some higher carb food to keep the BSLs from dropping low. Enough Insulin and enough food is what he needs.
Can you tell us your name please. Can’t keep calling youCCG;)
 
Blood glucose now at 165. Fed more. He has had about 1.25 cans of FF total today through the feedings
 
Someone answered this already and I am having difficulty finding it on the thread - losing track of messages.
How long before his next dose of insulin (2.5 hours from now) should I stop feeding Ty? Should I stop feeding him now? 2 hours before?
 
CCG said:
Someone answered this already and I am having difficulty finding it on the thread - losing track of messages.
How long before his next dose of insulin (2.5 hours from now) should I stop feeding Ty? Should I stop feeding him now? 2 hours before?
Click to expand...
2 hours before. There would be exceptions if blood sugar was dangerously low, etc. you’re fine at 165 generally. :)

[eta: “generally” I say because ECID]
 
As for difficulty finding info: at the top right of the page there is a search feature where you can search the boards.

It’s a great help when you’re feeling frantic and no one has popped into your thread yet! :p
 
CCG said:
Relatively infrequently.
He went last night (large amount) around 11pm, when we tested.
Did not go again today until noon (large amount, again) when we tested.
Hasn't gone since noon. He just pooped (diarrhea - very runny), no pee.
Click to expand...

This concerns me.... I feel like there should be a little more output. Especially since now he has diarrhea, I would be concerned about dehydration. What options do you have available to help increase fluid intake? Do you know how to pull the back of the neck to check for hydration?

A tsp of pure pumpkin may sometimes help with constipation or diarrhea, either one. Make sure it is the plain pumpkin kind, no spices etc added.

Also here is a fecal score chart link, helps me sometimes describe allllll the weird weird poops Alice has had since the FD. https://images.app.goo.gl/U5ZLEzysSz1a2aCDA
 
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AliceMeowliss&Cassandra said:
This concerns me.... I feel like there should be a little more output. Especially since now he has diarrhea, I would be concerned about dehydration. What options do you have available to help increase fluid intake? Do you know how to pull the back of the neck to check for hydration?

A tsp of pure pumpkin may sometimes help with constipation or diarrhea, either one. Make sure it is the plain pumpkin kind, no spices etc added.

Also here is a fecal score chart link, helps me sometimes describe allllll the weird weird poops Alice has had since the FD. https://images.app.goo.gl/U5ZLEzysSz1a2aCDA
Click to expand...
I do know how to pull the back of neck to check, but unfortunately I just don't have a great eye for it. His skin seems to fall back into place and at the speed that it usually does. It looks the same as my other cat who is healthy.

I have been continuing to spoon feed him water. I'm not sure what else to do because he does have a heart murmur so I don't know if anything else is a good idea without professional supervision. Ideas welcome.
 
243 seems pretty good for the hour you are at, all things considered. It’s not “healthy cat” good but that takes time to achieve as part of the process of getting kitty regulated..... to me with a lot of wild numbers, anything in the yellow for the beginning and end phases of a cycle makes me pretty happy overall. Alice always acts like she is feeling better even in yellow. ECID.

What are current clinical signs? Moving around on his own? Purring? Accepting petting? Drinking water on his own at all, showing interest in food or not, etc.......?
 
Sienne and Gabby (GA) said:
First, with respect to your spreadsheet, the convention here is that the older numbers are at the top. The most current numbers are at the bottom. It will make those of us who have been looking at spreadsheets for years very confused since for this site, your spreadsheet is upside down. When you have a chance, can you rearrange the page?

If you decide to ditch the pet meter, you may want to consider buying a blood ketone meter. The strips are pricey but you don't have to wait hours for your cat to urinate in order to test for ketones. NovaMax makes a good ketone meter, as dose Precision Xtra and they are available on the ADW website.

Did your vet run labs when treating Ty's DKA. If so, get a copy. The recipe for DKA is an infection/inflammation + not enough calories + not enough insulin. If Ty wasn't given an antibiotic, I'd be very surprised unless the white count was normal and there was no indication of a UTI. Do you know if your kitty has any dental issues like gingivitis? It can also contribute to the infection/inflammation issue. When Gabby was diagnosed with DKA, she was discharged from the ICU with an antibiotic, an anti-nausea med, an appetite stimulant and something else. (It was a long time ago an I didn't put the meds on her spreadsheet at the time.) Please keep in mind that water is good but food is necessary. Ketones develop when a cat is burning stored fat rather than metabolizing newly ingested food.

The other anti-nausea med is ondansetron (Zofran). It's a human med. The tablets are expensive. The injectable form is much less costly but it stings when injected. Some cats need both Cerenia and ondansetron to get past nausea.

You might want to try giving Ty baby food. Many cats love the stuff and it's a great way to get a cat eating. You would want to find a Stage 2 food that is only a protein and broth. The downside is that it's fairly low in calories.


Click to expand...
Here was an update I received while he was in the hospital.

Physical Exam:
Wt: 4.44 kilograms
Temp: 102.5 F Pulse: 188 bpm Resp: 40 rpm
Mentation: QAR
MM/CRT: Pale pink/<2 sec
Pulse Quality: Moderate
Body Condition Score: 4/9
CSU Pain Score: 0/4
Hydration: persistent 3-5% dehydrated
EENT: Clear AU. No ocular or nasal discharge. Normal menace and palpebral responses OU. Pupils equal and reactive. Fundic
examination not performed. Oral examination not performed due to demeanor. No palpable thyroid slip
LYMPH NODES: No peripheral lymphadenopathy
CARDIOVASCULAR: Grade II/VI parasternal heart murmur NOT auscultated today. Femoral pulses strong, synchronous, symmetrical
RESPIRATORY: Resolved increase respiratory rate, with normal respiratory effort. No crackles/wheezes. Normal bronchovesicular
sounds
INTEGUMENT: No significant findings
ABDOMEN: No pain or masses noted
MUSCULOSKELETAL: Ambulatory x 4 but generalized weakness, full orthopedic examination not performed
NEUROLOGIC: Quiet,Alert and mentally appropriate. Generalized weakness. Full Neurological exam not performed
UROGENITAL: External normal
RECTAL: Not performed.

Working Diagnosis/Problems:
Lethargy
Hyporexia
Diabetes, ketoacidosis
Chronic nephropathy
Hyperechoic hepatomegaly
Heart murmur (Not auscultated 6/9/19)
Stress leukogram
Thrombocytopenia: resolved
Mild hypokalemia
Mild hypocalcemia

Diagnostics:
ER 6/8/2019:
Serum Ketones: 80 mg/dL
Glucose: 500 mg/dL
CBC:RBC 8.17, Hct 41.48, Hgb 14.8, WBC 18.92, Neut 16.66, Lymph 1.11, Mono 0.70, Plt 274 (L)
Chemistry: Glu 345 (H), BUN 27, Crea 0.9, Phos 3.8, Ca 7.6 (L), Na 149, K 3.6 (L), TP 7.5, Alb 4.5, Glob 3.0, ALT 75, ALP 47, tbil 0.2,
amyl 313
CG8: pH 7.178 (L), pCO2 17.6 (L), PO2 126, BE -22, HCO3 6.8, TCO2 7, SO2 98, Na 149, K 3.7, iCa 1.27, Glu 361 (H), PCV 38, TP 11.2, L
fPL: Negative
NIBP: 142 mmHg
UA:SG >1.050, Pro 30 mg/dL, pH 6.0, Ket 80 mg/dL, Gluc 1000 mg/dL, Neg bld, bil, rbc 0-3 hpf, 0-2 wbc hpf, no casts, crystals,
bacteria obs; epithelial 0-2 hpf
UCS: Idexx
TXR:
Findings
Thorax (Right lateral, Left lateral, VD images; 3 total images):
The cardiac silhouette and pulmonary vessels are normal in size and appearance. The pulmonary parenchyma is normal and there is
no evidence of soft tissue pulmonary nodules or pulmonary infiltrates. No abnormalities noted within the pleural space or
cranial mediastinum. Included portion of the abdomen is normal. The osseous and extra-thoracic soft tissue structures are
normal.

Conclusions
Unremarkable thoracic study however chronic lower airway inflammation (i.e. asthma) cannot be ruled out.

Treatments:
NormR 12 ml/hr (45 ml/kg/d + 1 ml/kg/hr losses) + 10 mEq KCL + 10 mEq KPhos
Maropitant 1 mg/kg IV once
Ondansetron 0.5 mg/kg IV BID
Insulin CRI after 4-6 hr on IVF ***Total IV rate IVF plus Insulin CRI to equal 15ml/Hr***
Serial BGs
Recheck Lytes, serum ketones
Monitor for fluid overload (Increase RR/RE, weight gain, serous ocular or nasal discharge, chemosis, etc)

Daily update to owner:
9:50a: Called owners with an update. Ty is doing fairly well. Still a bit weak but is eating. Still a bit dehydrated. I do not hear a
murmur on auscultation today. No abdominal pain or discomfort. Plan is to restart unasyn pending urine culture submitted by
2 of 3ER, continue to monitor BG q 2 hours and adjust insulin CRI, then re-evaluate general labs and serum ketones in am. Owners are happy with todays plan.
 
AliceMeowliss&Cassandra said:
243 seems pretty good for the hour you are at, all things considered. It’s not “healthy cat” good but that takes time to achieve as part of the process of getting kitty regulated..... to me with a lot of wild numbers, anything in the yellow for the beginning and end phases of a cycle makes me pretty happy overall. Alice always acts like she is feeling better even in yellow. ECID.

What are current clinical signs? Moving around on his own? Purring? Accepting petting? Drinking water on his own at all, showing interest in food or not, etc.......?
Click to expand...

Current clinical signs are not great.
He is alert when I walk by and will accept pets but does not seek them out.
He can move around on his own (he tries to get away from me while I am feeding him and giving him water), but is pretty content to lay in his spot so he has barely been moving.
Not purring, but has never been much of a purr-er.
Not drinking water on his own. Not interested in food.
 
CCG said:
Current clinical signs are not great.
He is alert when I walk by and will accept pets but does not seek them out.
He can move around on his own (he tries to get away from me while I am feeding him and giving him water), but is pretty content to lay in his spot so he has barely been moving.
Not purring, but has never been much of a purr-er.
Not drinking water on his own. Not interested in food.
Click to expand...
Grooming at all?

One thing I use to check how Alice is feeling and also to get her some exercise when she is well (and not recovering from surgery or DKA) is a laser pointer. When she is weak but feeling kind of okay, she will move her head to watch the red dot, but if she is exceptionally well (for her), she will chase it for a brief stint.
—with DKA so recent, I do not suggest Ty get exercise. That could just burn more body tissue like fat and build up too many ketones. But something like that can help indicate alertness, and also mood/ability to be interested in something beyond -pee poop eat drink sleep.- It is an extra thing....

I also put some weight on ability to fight back and act cranky. If kitty expresses unhappiness, they are choosing to exert precious energy. This can (but does not always) help indicate improvement. Alice wouldn’t fight me over anything when she was a sickly bag of bones.

I feel like if you are seeing persistent dysregulation and other issues that there just is something underlying going on. I wish I could be of more help.
 
Bron and Sheba said:
Did they restart the antibiotic that they were giving? They say in that report they are waiting for a urine culture. Really important to follow that up because if he still has an underlying infection (UTI) it needs treating.
@Marje and Gracie are you able to look at this report and comment please?
Click to expand...
I am pretty confident he does not have a UTI. He was checked at our normal vet appt just shortly before he went into DKA again. But it is weird that they never followed up with me about the culture. Given the amount of money we spent, they should have been more thorough in reporting and communicating with us. I just called the hospital but the internal medicine dept is not there. They are going to call me back tomorrow.
 
AliceMeowliss&Cassandra said:
Grooming at all?

One thing I use to check how Alice is feeling and also to get her some exercise when she is well (and not recovering from surgery or DKA) is a laser pointer. When she is weak but feeling kind of okay, she will move her head to watch the red dot, but if she is exceptionally well (for her), she will chase it for a brief stint.
—with DKA so recent, I do not suggest Ty get exercise. That could just burn more body tissue like fat and build up too many ketones. But something like that can help indicate alertness, and also mood/ability to be interested in something beyond -pee poop eat drink sleep.- It is an extra thing....

I also put some weight on ability to fight back and act cranky. If kitty expresses unhappiness, they are choosing to exert precious energy. This can (but does not always) help indicate improvement. Alice wouldn’t fight me over anything when she was a sickly bag of bones.

I feel like if you are seeing persistent dysregulation and other issues that there just is something underlying going on. I wish I could be of more help.
Click to expand...

Yes. He is grooming after I feed him.
And agreed on the crankiness. Last week when he slipped into DKA, his mood shifted immediately. He was lethargic, not alert at all. I could pick him up and move him and he was limp, and would sometimes get up to slink away somewhere else, but generally rotated between two spots. He would lay completely flat on his side.

Today is different. He is lethargic but "alert" - he opens his eyes when I walk by and watches me. He sits up when I pet him and even when he's just hanging out, instead of fully on his side.

I feel the same way about something underlying but so far they haven't been able to pinpoint anything.
I think it also makes it tough that we have never really landed on an insulin dose/regimen that has seemed to REALLY work for him. Other than today, his glucose levels have ALWAYS been above 200... with a few rare occasions... since I started testing.
 
CCG said:
I feel the same way about something underlying but so far they haven't been able to pinpoint anything.
I think it also makes it tough that we have never really landed on an insulin dose/regimen that has seemed to REALLY work for him. Other than today, his glucose levels have ALWAYS been above 200... with a few rare occasions... since I started testing.
Click to expand...
Alice wasn’t regulated ish until she was either on NPH 3x/day, or Lantus after about a month at a high ish dose (especially for her size) with a lot of food. ....... Over time you can gather more info on the underlying issue. For now, I really think someone who can better advise on fast track dosing might be helpful for you. I cannot do that. Maybe you just need to give Ty some time and keep nursing him. I know it gets exhausting and feels so desperate at times.

It’s a good fight though. You’re doing well, really. A lot of people would not have come this far. :)
 
Dosing consistently twice a day is key and with a DKA kitty it is important to increase the dose more rapidly than a normal
FD kitty. You are on the right tract now you are giving 1 unit twice a day. If that is not enough we can increase the dose.
Do you have plenty of higher carb food there? Because if needed Ty can be given higher carb food and the dose of insulin can be increased. But let's wait and see how he goes with this and how the ketones are going. Others may weigh in with suggestions.
 
@CCG , Courtney,

Thank you so much for typing in the entire page - the vet's log, extremely valuable. I had mine too.
I hope Marje will be online soon to help

but I have a question:
what was the plan post hospitalization?
A follow up with your regular vet? When?

I might be good to check the electrolytes levels again.
I do think Ty would benefit from daily LRS SQF, small dose like 50 - 70 ml but only if the vet thinks it is ok with his heart. I noticed that the ER doc didn't hear the murmur. It gives hopes that SQF therapy at home short term might be allowed.
It could help not only with the electrolytes but the appy, too.
He was up to 5% dehydrated on the day of the records - fluids should help.

You spent a lot but the treatment listed above is just what was needed, IMHO.
All very common in treating DKA patients.


If it is any consolation: some of Ducia's reads were worse then Ty's. And her weight was less than 3 kg.
And she pulled thru.
 
Bron and Sheba said:
Dosing consistently twice a day is key and with a DKA kitty it is important to increase the dose more rapidly than a normal
FD kitty. You are on the right tract now you are giving 1 unit twice a day. If that is not enough we can increase the dose.
Do you have plenty of higher carb food there? Because if needed Ty can be given higher carb food and the dose of insulin can be increased. But let's wait and see how he goes with this and how the ketones are going. Others may weigh in with suggestions.
Click to expand...

Thank you. I just took his blood glucose (287), fed him ~25cc of FF which is a little less than half of a can, and gave him more water. Going to give 1 U in about 10 minutes from now.
 
We don't currently have higher carb food - our other cat and Ty both eat the FF pate. But we do have corn syrup and honey ICE. We also live in a big city, there are lots of 24 hour places within a few blocks where we can go and grab something at any time if needed.
 
Tanya and Ducia said:
You spent a lot but the treatment listed above is just what was needed, IMHO.
All very common in treating DKA patients.
Click to expand...

This.
Over $2,000 spent on Alice’s DKA and that was 3 days, plus I had my own insulin for part of it, my own food, any little thing that could save a few dollars. Never mind all the other bits here and there, and surgery this week to address some underlying issues. She needed all this stuff to survive. It sure does stink though that survival has such great costs. It’s frustrating. :(
One thing we do is learn how to reduce those hospitalizations when possible by doing a few more things at home. For example, you don’t need a fructosamine if you are home testing regularly! And subq fluids can turn things around before they get critical, sometimes. :)


If it is any consolation: some of Ducia's reads were worse then Ty's. And her weight was less than 3 kg.
And she pulled thru.
Click to expand...

I don’t know about labs but Alice’s weight was as low as 1.8kg!!!! Now she is about 3kg.
 
Tanya and Ducia said:
@CCG , Courtney,

Thank you so much for typing in the entire page - the vet's log, extremely valuable. I had mine too.
I hope Marje will be online soon to help

but I have a question:
what was the plan post hospitalization?
A follow up with your regular vet? When?
Click to expand...

There was not much of a plan, to be honest.
They chalked up his first episode of DKA (in April) to persistent high blood glucose. That was when he was on 1.5-2U of Humulin 2x/day. After that they recommended we switch to Lantus.
They chalked up his second episode of DKA (last week) to something environmental. Stress, or a GI flare-up, or acute pancreatitis that they couldn't detect in his bloodwork. So they wanted to stay the course with 1U of Lantus 1x/day. They also basically said we are doing everything we can :(, which is hard to hear... because I am sure there are things we could be doing better. I already learned from all of you that we should be feeding him more often than just 2x/day. I think they are very cautious and want to avoid hypo.

Our regular vet is great and really cares. Called us on Tuesday and yesterday to talk through everything. He too was wary of staying the course because of the issues we have. That is when he suggested 1U in the morning, .5U in the evening. (Before we knew of the ketones). I tried to call him today but he was not in the office, and will be tomorrow morning.

Tanya and Ducia said:

I might be good to check the electrolytes levels again.
I [U]do[/U] think Ty would benefit from daily LRS SQF, small dose like 50 - 70 ml but [U]only[/U] if the vet thinks it is ok with his heart. I noticed that the ER doc didn't hear the murmur. It gives hopes that SQF therapy at home short term might be allowed.
It could help not only with the electrolytes but the appy, too.
He was up to 5% dehydrated on the day of the records - fluids should help.

You spent a lot but the treatment listed above is just what was needed, IMHO.
All very common in treating DKA patients.
Click to expand...

I am going to call our regular vet first thing tomorrow morning again, especially if Ty has not improved significantly.

I also agree on the treatments... didn't mean to imply that anyone was doing a poor job or that they were doing too much. My main issue is with the communication that we've had this second round. Like I said, they kind of told us that we were doing all we could and didn't have any major suggestions or plans to shift treatment. It feels a little bit like they gave up. But that is my interpretation, not at all what they said to me at the hospital.


[QUOTE="Tanya and Ducia, post: 2390786, member: 18193"][USER=27597]
If it is any consolation: some of Ducia's reads were worse then Ty's. And her weight was less than 3 kg.
And she pulled thru.[/QUOTE]
That is so helpful to hear. I am hoping for the best. Preparing for the worst.
Clearly he isn't loving life right now and he does not like me sticking a syringe in his mouth full of food and water. So we can only do that for so many more days before we need to take different steps.
Selfishly I want him to live forever. But for his sake I only want to keep him going if I think that his quality of life will still be good.[/user]
 
AliceMeowliss&Cassandra said:
This.
Over $2,000 spent on Alice’s DKA and that was 3 days, plus I had my own insulin for part of it, my own food, any little thing that could save a few dollars. Never mind all the other bits here and there, and surgery this week to address some underlying issues. She needed all this stuff to survive. It sure does stink though that survival has such great costs. It’s frustrating. :(
One thing we do is learn how to reduce those hospitalizations when possible by doing a few more things at home. For example, you don’t need a fructosamine if you are home testing regularly! And subq fluids can turn things around before they get critical, sometimes. :)




I don’t know about labs but Alice’s weight was as low as 1.8kg!!!! Now she is about 3kg.
Click to expand...
It is frustrating, I agree. On the other hand, I get it. These places need to stay in business and they can't do everything for free. The technology they use to do all of the things they do is expensive. As is their education so that they can know what to do. I don't blame them for keeping their doors open. But it does stink when you're the one having to pay. I feel so fortunate that we have been able to pay for Ty's care thus far. At the very least it has given us more time and more happy days with him.

Wow. 1.8kg. I can't imagine. I already think that Ty looks like skin & bones.
 
:bighug::bighug::bighug:Blessings to you both. I know how hard it is. I had one with leukemia years ago. He was my first kitty and my beloved. It was a hard decision but it was time for his suffering to end. We support you whichever way it goes. I pray for a rally but if it doesnt come then I pray for yours and his sweet peace.
 
Sybil and Zoe said:
:bighug::bighug::bighug:Blessings to you both. I know how hard it is. I had one with leukemia years ago. He was my first kitty and my beloved. It was a hard decision but it was time for his suffering to end. We support you whichever way it goes. I pray for a rally but if it doesnt come then I pray for yours and his sweet peace.
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Thank you for your sweet note.
I am also hoping for a rally.

Ty is my first kitty. My first pet that I decided to get and care for on my own.
I've had him since I was 18 and we have been through so much together. I had to go to probably ten shelters to find one that would let a college kid adopt a cat. I understand their logic, but I do think Ty got pretty lucky by getting adopted by a college kid :). It is hard to see him suffering.
 
CCG said:
There was not much of a plan, to be honest.
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I see.
It was recommended to us upon ER discharge to go and see our regular vet in 3 days which we could not do and instead we proceeded at home with insulin, feeding via E-tube and SQF. Finished all the meds and run another blood test. Some reads improved a great deal, some - not so much. Got equipped with Cerenia pills for nausea, appy stim, a paikiller, a bag of LRS and took it from there. Run another blood work in a month or so - great improvements yet.
I keep Ducia's results in the LAB Tab at the bottom of the SS - it shows the progression.

I think you should go and see your reg vet and discuss what's next.
He (supposedly) will receive a copy of all ER papers but I would take what you have posted above with you to the appointment - just in case there is a delay on the ER part. The part on the chest exam suggest (to a lay people like you and I, not medics)it is ok to try SQF. If it is so and the vet agrees - ask him to teach you how to give it at home. (it is much easier than you can imagine at the moment).

Not eating is very worrying. It can open a Pandora box of ailments in cats and thus having all tools to remedy not eating is a must. Ask you vet about Cerenia - Ty got it at the ER.
CCG said:
fPL: Negative
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CCG said:
They chalked up his second episode of DKA (last week) to something environmental. Stress, or a GI flare-up, or acute pancreatitis that they couldn't detect in his bloodwork.
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I might be wrong but this fPl test rules out pancreatitis.

Again, I hope some others will chime especially with regards to the blood works and Xrays. In case not - try to get your vet tomorrow. Something needs to be done about eating asap and lytes levels checked in case they are dropping again.
 
CCG said:
Clearly he isn't loving life right now and he does not like me sticking a syringe in his mouth full of food and water. So we can only do that for so many more days before we need to take different steps.
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I am huge advocate of the Esophageal Tube - it saved Ducia's life, and many more cats.
Care at home requirements are easy - provided you have to "home care" kit that is usually dispensed to ea patient upon discharge.
The procedure is it out patient,a few hours only and ,amazingly, not as expensive as one would think - $160 in 2017.
Then nursing hours are added along with materials and you got a hefty bill. Nursing at home cuts at least half the cost, and I do believe very strongly tubes saves lives. Dr. Pierson wrote about it in her blog. Please consider the idea or talk to you vet about it.
 
He also got 0.5 mg/kg ondansetron bd (twice a day) at ER so you could ask for that as well for nausea. I think you definitely need to get cerenia and ondansetron from the vet. And ask about subQ fluids.
 
CCG said:
He is now at 363 blood glucose 1 hour after receiving insulin and eating ~3/4 can of FF (thru syringe)
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I think he might have decided that he stayed in low blue numbers long enough for one day and it is time to go up for a bit. There is no need to test hourly unless BG drops dramatically which I doubt but cats had proven me wrong in the past.
If it is possible take a test at +3 but I believe he is going to be high. If you are up anyway to feed grab a quick test.
If it is possible to set an alarm and check between + 6 and +9 it would be even more informative than +3 for the dose assessment in the near future.

I hope you both will have quiet and restful night.
Looking forward to read a good update on Ty tomorrow.
 
Sybil and Zoe said:
:bighug::bighug::bighug:Blessings to you both. I know how hard it is. I had one with leukemia years ago. He was my first kitty and my beloved. It was a hard decision but it was time for his suffering to end. We support you whichever way it goes. I pray for a rally but if it doesnt come then I pray for yours and his sweet peace.
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Also, I am sorry for the loss of your sweet boy. I hope he is happy wherever he is now.
 
Tanya and Ducia said:
I think he might have decided that he stayed in low blue numbers long enough for one day and it is time to go up for a bit. There is no need to test hourly unless BG drops dramatically which I doubt but cats had proven me wrong in the past.
If it is possible take a test at +3 but I believe he is going to be high. If you are up anyway to feed grab a quick test.
If it is possible to set an alarm and check between + 6 and +9 it would be even more informative than +3 for the dose assessment in the near future.

I hope you both will have quiet and restful night.
Looking forward to read a good update on Ty tomorrow.
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Thanks so much. I tested at +2 before I read this and he still high (347).

I will be setting alarms tonight to feed him & to check BG. Will do +3-4 to make sure he isn’t dropping and between 6-9 as you suggest.

We got another ketone reading. He urinated and has diarrhea again. Ketone reading looked the same as this morning. Negative or trace, so hard to tell even with lots of different light.

As others have suggested, I feel like this is either a tummy/nausea issue, or he has some underlying GI issue that could be more serious and is now starting to display signs, since he doesn’t have ketones (at least they aren’t high) but still refuses to eat or drink without my coercion. Will be hoping for the best and checking with vet tomorrow.
 
CCG said:
Thank you for your sweet note.
I am also hoping for a rally.

Ty is my first kitty. My first pet that I decided to get and care for on my own.
I've had him since I was 18 and we have been through so much together. I had to go to probably ten shelters to find one that would let a college kid adopt a cat. I understand their logic, but I do think Ty got pretty lucky by getting adopted by a college kid :). It is hard to see him suffering.
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One of Alice’s litter mate sisters went to a college kid. They were all bottle babies. Had her (and her brother who passed at 7) since I was 20 years old! Same sort of story. She’s been by my side for so much.

No matter what, I hope you do know that you have done your best and you have done much, much more than many others would ever do, and most importantly you have loved him and been his best support for his whole life. You’re going to love him no matter what, but I hope you have more days together. :bighug:
 
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