Syringe feeding, feeling hopeless

Hey all. I'm in a really tough spot with my cat and I'm looking for some words of wisdom. Frankie has just started back up on insulin after a year of remission, but this time it's looking a lot worse. When he was first diagnosed, he was somewhere in the 500s (mg/dl) but the only symptoms were the drinking, peeing, and a little touch of lethargy. But for some reason this time around, he's become like a vegetable... only laying in one or two spots, never walking around -- and when he does, he trips and wobbles. He's been just laying down for several days so I'm assuming he's very weak at this point. He's lost a lot of weight, around 0.6 lbs over the past couple months, and the ridge of his spine is visible.

I've had to syringe feed him previously, when the vet diagnosed him with IBD and figured he was refusing to eat because he had been so backed up it was making him sick. His symptoms then were excessive gulping, retching, and occasionally vomiting mucus. I had to put him on a dry GI food for a while to help him with that situation, and it did, he got a lot better...normal BMs and eating normally... however, I think that dry food triggered a relapse.

I just don't understand why he's so frail and refuses to eat (or even drink) now. The vet said he probably was feeling too bad because of his BG to eat, but that doesn't really make sense to me because in clinic his highest was 370. They said the glucose in his urine was. "1000". Why would that make him completely refuse to eat, when only 2 years ago his BG was in the 500s and that didn't affect his appetite at all? He got full bloodwork and urinalysis and everything else looked okay. He is not displaying the same symptoms of bowel obstruction as before, only the refusal to eat.

It's just tough syringe feeding him twice a day, and then shooting afterwards... I was honestly happy to put him back on insulin because of how much energy it gave him last time around (he acted like a young cat again), but this time it seems to not really effect his energy at all. I'm waiting for an Alpha Trak to come in the mail, but in the meantime I've been taking crude BG tests using an old ReliOn meter and he's not bottoming out. (I say crude because I'm not yet able to produce enough blood to really get an accurate result on a human meter.) Some readings I got were 166, 230. The 166 was 2 hours after shooting, and the 230 was 5 hours after.

Has anyone here gone through something similar, having to force feed while on insulin? My heart hurts to think that Frankie might reaching the end of his life.

If I'm still having to force feed by Monday I'm calling the vet, but I don't know what that could even accomplish at this point...

Some info:

• Male, neutered
• 12 Years old (born 2008)
• Domestic shorthair / siamese
• 12.4 lbs and underweight for his size
• Vetsulin, 1 unit BID (I want to switch him to Prozinc if he's not looking better by the end of this weekend because that's what I've used in the past)
• Fancy feast Beef Pate Senior 7+ 3 oz can BID
• I gave him 1/8 tsp MiraLax this morning
• On insulin Jan 2019-June 2019, Remission until now (October 2020)

 

What comes to mind is DKA – diabetic ketone acidosis – which is life threatening and requires vet treatment.
DKA = not enough insulin + not enough food + something else going on (infection or inflammation).

Can you get him to a vet today? Like, now?

• Ketones/Diabetic Ketoacidosis (DKA): Ketones, Diabetic Ketoacidosis (DKA), and Blood Ketone Meters

 

I’m sorry Frankie isn’t feeling well. I suspect it’s not just diabetes with those symptoms or else DKA.. Was a full blood panel run and a urinalysis? It also could be pancreatitis. I agree with Kel.

 

I had suspected DKA as well, but he was at the vet all day yesterday, in the exact same condition, and they did not find ketones.

 

Yes it was full bloodwork and urinalysis, he said everything else looked normal. I was thinking it was DKA all day Thursday but ketones were not present.

 

Did they test for pancreatitis? Do you have or can you get a copy of all tests run?

 

Frustratingly, my vet never has Frankie's labs available for me to look at. I even asked him at what time the insulin peaked during his curve on Friday and he could not give me a straight answer. But I'm not sure what a pancreatitis test entails--would that come out in a full bloodwork and urinalysis panel?

 

The test for pancreatitis is not part of the panel. Max had chronic pancreatitis for a few years before becoming diabetic. It’s very common with diabetic cats for unknown reasons. He was eating less and less and then just stopped eating. Common symptoms are inappetence, pain, just not acting right. They are usually very nauseous but don’t always vomit. That’s why I missed that nausea was part of his problem.

 

The test you need is the SpecfPL. It’s a blood test sent to the lab. You have paid for the tests and he has to give you a copy. I would be looking for another vet but for now insist the labs be emailed to you. I can’t tell you how many times I was told all was normal but when I looked at the labs saw warning signs. A friend informed me my cat was becoming anemic. The vet said normal labs.

 

Okay, I found a vet that's open now and I'm gonna take him there to be tested for DKA and pancreatitis.

 

The pancreatitis tests - Snap fPL and Spec fPL - need to be ordered in addtion to the standard blood panels.

Do you have urine test strips at home? If not I'd suggest grabbing some and monitoring for ketones at home. They can build up very quickly. It's a good general safety precaution, better to keep on top of things so that if they were to appear you would be in a position to act quickly.


Mogs
.

 

Great. Please let us know. You will need cerenia a vet medication for nausea and if you can get it from the vet an RX for the human nausea medication, ondansetron. Buprenorphine is a good pain medication. This is all if it’s pancreatitis.

 

Very glad you've found a vet who can help. Ask if they can run a Snap fPL test as well as the Spec fPL, as the first test can give an on-the-spot, yes/no/unclear result (works a bit like a pregnancy test), which means the vet might get a faster indication of treatments needed while waiting for the results from the external lab's assessment of the Spec fPL test.

I'd suggest asking about potassium levels too - if they're off that can affect appetite. Not sure when your kitty last pooped but a check for constipation is a good idea too.

If it is pancreatitis, your little one will need meds for anti-nausea, appetite stimulation and pain relief. This is a very helpful guide to treatment and what to ask the vet about if the Snap test is positive:

IDEXX Pancreatitis Treatment Guidelines

Be sure to let us know how you get on.


Mogs
.

 

Sending prayers sigh
I sounds like you old Vet was not serving you . Glad you found a new one.

 

Glad you found a vet open, prayers for Frankie, poor baby, please keep us updated

 

Just got back from the vet. It was DKA. Doc showed me his labs, and as a pharmacy student, I was horrified. Frankie is now hospitalized, probably throughout the weekend. He also had a UTI and protein in his urine (BOTH of which my previous vet said he did not have -- yes I am changing vets.)

I am so overwhelmed. I hope he can pull through. Doc said "he's been sick for a long time."

Thank you again for all of your advice. If I hadn't made this post, I probably would have waited until Monday.

 

(((Alayna and Frankie)))

Thank goodness you found that vet today! Frankie's in the right place to get the help he needs now. Fingers and paws crossed that he'll soon be feeling much, much better.

When he's ready to come home, be sure that the vet gives you some anti-nausea and appetite stimulant meds for home use so that if Frankie needs a bit of help with eating during his recovery you'll be able to respond straight away. (Difficulty eating during convalescence can lead to relapses and having the meds immediately to hand is a great preventative measure.)

Sending prayers for a speedy recovery for Frankie. Again, thank the gods that you found a good vet.




Mogs
.

 

PS: Cats can go on to make a full recovery from DKA.




Mogs
.

 

Vet confirmed DKA. Ketones present,

thank you!! I actually have some mirataz from his last visit. I'll make sure to ask for anti-nausea as well.

 

PPS: The UTI may have been what tipped Frankie out of remission and likely contributed to the DKA. Thankfully he'll now get the treatment he needs to clear it up.


Mogs
.

 

Once this is passed and you feel a bit more centered, I’d strongly suggest you report the other vet. He or she should not be practicing if they could not make this diagnosis after your cat being there an entire day

sending prayers for Frankie

 

Do get the anti nausea because the apetite stimulant is not good if the cat is nauseated.

 

Alayna, if you're in the US, check out the link below for recommendations on cat-friendly baby foods. They can often tempt a kitty to eat when they're not so keen on their regular foods. Might be an idea to add some to your home nursing kit.

Tanya's Site - Persuading Your Cat to Eat

Lots of other helpful tips on that page too.


Mogs
.

 

Thank goodness you went to a different vet. Get all the records from the other one. If you don’t feel comfortable asking or the vet is uncooperative ask the current vet to get them for you. Please let us know when you bring him home.

 

^^ One hundred percent this. ^^


Mogs
.

 

Thank God you did post today I'm praying for your Frankie , and glad you said you are changing vets. Poor baby . please keep us updated

 

Hi Alayna,

Thinking about yourself and Frankie. You've had such a rough time of things recently. I know it's hard when you're worrying about your fur baby, but I hope you can get a good night's sleep for yourself while the vets are watching over Frankie for you. It will be a help to both of you to grab the chance to recharge the battery a little.

Sending more prayers for your little fella.

(((Frankie)))




Mogs
.

 

Thank you so much for your kind words! It has been difficult, I feel like I've shed enough tears to last a lifetime -- but I know I'll be okay. You're right, I'll definitely be able to sleep better while he's at the hospital. <3

 

Keeping everything crossed that poor Frankie is feeling much better soon - he's so lucky to have a mum like you who wouldn't be fobbed off and got him to another vet.
Sending you both hugs.
Gill

 

Any news, Alayna? I hope you managed to get some sleep.

Prayers continue.

(((Frankie)))


Mogs
.

 

I have an update for y'all -- I got a voicemail from the tech this morning (they are closed today) and she informed me that this morning Frankie was sitting upright, perked up, and watching the techs do their work around the ICU! This is incredibly huge news for me and I couldn't be happier. They're keeping him on fluids for a while because he's still dehydrated, but definitely feeling loads better. His BG was 166, which she said is normal given he's so sick that his levels go all over the place, but he was given insulin yesterday morning and last night. She will check again this afternoon and give him insulin again if he's higher.



Also I'm going to call the previous vet tomorrow when they're open and request all of Frankie's labs up to date be emailed to me.

 

Great news and so glad you acted quickly.

 

So glad to read such an encouraging update, Alayna! I'm very happy for you both. Keeping up the prayers for your little fella.

(((Alayna and Frankie)))




Mogs
.

 

That's wonderful news - hoping Frankie will be back at home with you soon!

 

Whew! Prayers continue

 

This is such great news, continued prayers for Frankie, he's a tough boy

 

Best news ever!!! You literally saved his life and I couldn’t be happier to hear he’s feeling better and on his way to recovery. Thank you for acting so quickly!

 

Frustrating call this morning from a tech. Asked me if I would be willing to come by the clinic to hand feed him because he was still not accepting oral food. I asked if he had received nutrition over the weekend and she said no. I told him I had been syringe feeding him, not hand feeding. She asked me what she should syringe feed him. I told her any wet food mixed with water so she can get up into the syringe is fine.

I am once again back in my little hole of hopelessness!! Is IV nutrition for feline not a standard practice? Or at least syringe feeding?? My goodness, Frankie has not eaten all Sunday... surely won't make him get better any faster. Not to mention now I'm worried this tech might make my guy aspirate. Geez. Also, he apparently was given Cerenia this morning.

BG was 230 this morning.

 

This doesn’t sound right to me. Yes, they should have been feeding him via a nasal feeding tube. Can you call and ask to speak to the vet who is working this shift?

@Critter Mom and @tiffmaxee thoughts?

 

AGREE with Ale!

 

I agree with Ale also, hasn't eaten all day Sunday, what is wrong with these vets, poor boy, I hope you get an answer

 

Here are Frankie's labs from Wednesday October 21st. He was sent home on Friday. Let me know if y'all can't open it.

https://drive.google.com/file/d/1T0sVTEKtLyhBnWLTVuM1Xw2t2rb2U32M/view?usp=sharing

 

NO CLUE what is wrong with the vets in my area. There are plenty, and I have a feeling I'll be searching a very long time to find the right one....

 

I'm gonna make sure they know to syringe feed over the weekends, and I'd prefer it that way over the week. He generally accepts the syringe very well and the idea of Frankie having an NG tube upsets me... but I know I'm probably being too sensitive

 

I would be upset too as not eating for a cat can lead to hepatic lipidosis. How long were you needing to syringe feed him? When an ER suggested a feeding tube as a possibility for one of mine I felt like you. It was my first experience with a cat on so many meds and so sick. I might feel differently today. How is he otherwise? Some cats won’t eat at the vet. Do you know what medications they are giving him? Is he getting an appetite stimulant?

 

I syringe fed him twice on Friday and once on Saturday before bringing him to the new vet. The old vet had been syringe feeding him daily while he was in their care. I tried giving him Mirataz but that of course did not help as he was too sick to eat anyway, so I just resorted to the syringe. If they tried an appetite stimulant in clinic I'm sure it didn't work for them either. And apparently they also gave him Cerenia.

 

A feeding tube helped save Ale's Minnie.

 

It’s true it did! The feeding tube was a god send. I could feed her and give her all her meds and for 2 weeks until we had a treatment plan in place, I didn’t have to worry about her eating. She had a traqueal tube inserted and I’m not saying that’s the one you need as it requires anesthesia and surgery but since she was going under for the endoscopy already, it made sense. However, a nasal feeding tube is something they can do while your cat is awake and it’s how an ER will feed a cat who is not eating. It’s standard procedure so I’d really press them on why they didn’t do that. Minnie wasn’t eating when I brought her to the ER and they did that right away. Then they switched her to the traqueal tube 2 days later.

 

Frankie's urine ketones were through the roof on Wednesday 21 October!

Alayna, did that vet run any subsequent blood and urine tests before discharging him on Friday?


Mogs
.

 

Food is a cornerstone of DKA treatment. Adequate calories and insulin are key to restoration of normal metabolic function.


Mogs
.

 

I know right? No more tests after those on Wednesday, just glucose curves. But I think those values from Wednesday are evidence enough that he should not have gone home.

The tech said she syringe fed him this morning and will again this evening. I brought up the NG tube, but she confirmed that he was easy to syringe feed and she would continue to do so BID. The vet wasn't in the clinic today for some reason so I couldn't speak directly with him.

 

Hey all, Frankie is doing well. Still mostly refusing food and having to be syringe-fed. He did lick up a bowl yesterday but that was it. Vet says she doesn't believe he's a candidate for anesthesia for tube-feeding... I think she might have misunderstood me because I didn't think NG tube placement required anesthesia. As long as he's eating, I suppose. They also got him on PZI insulin yesterday and his BG got down to 116, which is exciting news. Vet says he is looking brighter and brighter each day. I requested a urine culture to make sure he doesn't have a UTI. I ordered some Prozinc for when he gets home.

Since he's been in the unit since Saturday with multiple tests and services, I'm beginning to slightly worry about the cost of his stay. I just hope it's at least less than $5k. I have the funds to cover it if it's over but it is still a bit distressing to think about. I might ask for a rough quote next time I get a call. Still, I'd pay anything to have him come home the right way.

 

if they wont...insist on it. You need to know this information and they should be able to provide it.

 

Agree... I'm actually surprised they didn't give you an estimate before admitting him. In my experience, they like to tell you before treating so people don't give them an "I'm not paying that!!!!!" at the end of treatment.

 

exactly
Actually when I first typed that I said, "DEMAND it" but thought that might have been a little too aggressive.

 

Hi Alayna,

Great to hear that Frankie's recovery continues apace.

That sounds like nausea-related behaviour. Do you know what they're doing to manage nausea and stimulate Frankie's appetite? (The first needs to be dealt with before the appy stimulants will work.)

Do you know whether or not Frankie might be constipated? That can negatively impact appetite as well. If he is then a couple of days' treatment with a prokinetic like metoclopramide can help 'get things moving' again once any stuck stool or other GI obstructions are dealt with/ruled out.

(((Frankie)))


Mogs
.

 

Sorry Alyana but it sounds like you’re really going to have to push back and have your questions answered. You need to know for sure everything that’s happening so make sure they answer all your questions and don’t get off the phone until they do. What are they actually doing? I’m confused if they didn’t add the nasal feeding tube to make sure he’s eating well, are they only giving him fluids? What anti nausea meds are they giving him and what else are they doing?

It’s absurd that you don’t have a quote for this treatment. I’d call them back today and demand it as JT put it.

 

Where I live they give you a quote and ask for a credit card daily. Demand it. I agree. No vet there. Who is making decisions when that happens? Is this an ER?

 

Meant to add earlier that metoclopramide alone is not enough to treat feline nausea because it is considered that cats have very few of the receptors it targets to control nausea in other species (see link below). Additional anti-nausea support is needed (Cerenia and/or ondansetron).

[ETA]

IDEXX Pancreatitis Treatment Guidelines (See section on nausea control.)

Another thing to consider: if Frankie's being given an antibiotic by mouth then that may upset the GI tract. Anti-nausea meds can also help counter this issue. (My civvie, Lúnasa, is currently on a long course of amoxycillin/clavulanic acid and I need to give her ondansetron along with it. Even with the anti-nausea support her appetite is quite hit 'n' miss and she needs prompting and encouragement to eat a lot of the time. Without the anti-nausea support I would be struggling to get any food down her at all at the moment.)

Low potassium levels are another thing that may possibly contribute to poor appetite. Have the vets given you any info on how things are going with Frankie's electrolyte balance?


Mogs
.

 

For me too. Both times, Minnie was hospitalized they gave me a high and a low estimate and I had to pay the low estimate as a deposit before they started her treatment. Then anything over that I was billed at the end.

 

Absolutely. Metoclopramide, which Minnie is on btw, needs to be used in conjunction with an anti nausea like ondansetron or Cerenia. It only works to help stop the reflux to regurgitate. It doesn’t address the nausea

 

It also helps gut motility (speeds up gastric emptying).


Mogs
.

 

I think it’s the only way it can be effective for cats.

 

Okay folks, sorry for getting back so late but I think this will be one of my last updates --

Frankie is doing great. He is finally eating on his own, the vet said he cleaned his plate both last night AND this morning. His BG was very high, around the 500s, so still dosing 2 units of PZI. She took him off of fluids today and she says he is ready to come home to me this afternoon. She's sending me home with some Cerenia (oral) and I told her I already had transdermal appetite stimulant (Mirataz).

She asked me about my diet plans, and I told her I wanted to go back to completely wet and carb-free, which she agreed with, but she mentioned it may be best for Frankie for now if I just keep him on dry food for a while to try to get his weight and strength back up before I start the transition back to wet. Her reasoning is that he was eating so well with dry food on his own (They were giving him Royal Canin glycobalance) and she wants to make sure he's eating just as well throughout his recovery. I'm inclined to agree because Frankie oftentimes eats WAY more if I give him dry food vs wet. (He's a crunch addict.) I may consider looking into very low carb dry foods as an option somewhere down the line if the transition back to wet is too troublesome.

I asked about potential infections and she confirmed that he had been given some antibiotics including one that should last him 14 days (she told me the exact drug but I can't remember it now.)

My instructions are 2 units Prozinc twice a day. I ordered Prozinc from Chewy and it might not come in for a day or so so I'll have to dose him with Vetsulin with close monitoring until then. I'll mention that to my vet when I go and see what she thinks.

 

One low carb dry foods are Dr. Elsey’s available from Chewy and Young Again which needs to be ordered from them directly. I’m glad Frankie is coming home and hope you stick around.

 

Thank you so much!! I definitely plan on sticking around because I'm planning on being more stringent with his regimen so I'm sure I'll have a ton of questions, lol

 

We love questions here. It’s nice to have people around almost 24/7, especially if your cats decides to go low in the middle of the night.

 

Hi Alayna,

Very pleased to hear that Frankie's now taking food on board under his own steam.

I'm with your vet re keeping Frankie's eating as stable as possible during recovery. The additional carbs during the convalescent period will also support the administration of a little more insulin than a low carb food would, and that can also be helpful for recovery.


Mogs
.

 

Yes, please dont be a stranger

 

Glad to hear Frankie is doing so much better. Hope to see further updates over the weeks as to how he progresses

 

Great news all around!!! Prozync will be a much better insulin for him. And yes, right now the important thing is that he eats dry or not. Hope he’ll be back to his old self very soon and I hope you didn’t faint at the sign of the bill

 

I want to give a HUGE thank you to everyone who helped me out in this thread, seriously, I don't know what I would have done if I hadn't made this post!!! I might not have brought him to the vet on time... and you guys helped me so much with communicating with my vet and making sure everything got done right. MANY THANKS!!!

And for anyone wondering, his total for the 4 night stay was $985. Not as bad as I was expecting, they definitely helped out and didn't charge for a lot of items.

 

Indeed.

One thing it is helpful for is aiding restoration of normal motility after a general anaesthetic (only a couple of days' treatment should be needed).


Mogs
.

 

I've seen much worse in my time at FDMB.


Mogs
.

 

THATS A STEAL!

 

That’s actually reasonable compared to where I live. It would be that much for one day!

 

Agree same here!