Update on Louis with DKA and question

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agg1966

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I just got back from the vet from seeing Louis. I took him his favorite toy and a shirt of mine to put near him. His BG is now normal.....was 600 around 2 this afternoon. Though is BG is normal, he is still just laying there....no perk to him at all. Is this normal, and if so, when should I see an improvement? Don't get me wrong, I don't expect him to be back to his old self....just need a general idea. He was also dehydrated when I took him in and they have him hooked up to an IV. Thanks!!
 
Good to hear that his glucose levels are back in normal ranges now. It does take a few days sometimes after DKA before kitty is back to their normal self again. Ketoacidosis is a hard thing to go through.
 
Louis seemed more alert this morning. He even stood up and tried to use the litter box. His BG is about 320 and he won't eat. This afternoon he looked like he did when I first brought him to the vet. The Vet said if things aren't better by this time tomorrow, a decision will need to be made. It's only been a little over 24 hours....is she too hasty? Should we give Louis more time?
 
A sick cat will not want to eat and the more a cat does not want to eat the more they will not want to eat. It is really important that they force feed or put a feeding tube in so that kitty does not get hepatic lipiosis (fatty liver) which can be life threatening too. Like others have said, it usually takes days in 24 hour care before kitty really starts to turn around. Give your buddy a few more days.
 
Peach yogurt

Dearest agg1966, and, of course, you too, sweet Louis,

Can you bring whatever food he loves to him at the vet's?

Peach yogurt was the turning point for my darling Gizmo in ICU for DKA at the ER hospital. I know this because after coming home from basically delivering most of my fridge to her via kind people at the front desk, there was a voice talking on my answering machine. Flew to the phone and said, I'm here!

Her ER vet on that shift mentioned a most interesting occurrence. She said that she offered Giz a tongue depressor full of peach yogurt. She said Giz immediately swatted it away thinking it was more medicine. But, this vet also mentioned she saw a softer look in Gizzie's expression after basically everyone near her was dappled with peach yogurt... So, this vet offered her another tongue depressor full of peach yogurt. And, this time, Giz ate it all. And another. And another. It was a start... And, I will always love this vet...

Giz was admitted on a late Saturday morning. This phone call was blissfully received early to mid afternoon the following Sunday. She was released into my anguished care around 5-ish the following Monday.






Dearest agg19666, I will confess the reason I was anguished. It was because the entire ER hospital staff kept urging me to allow them to give Giz a feeding tube. It was the only thing I wouldn't go for. Kept telling them, look at her, she's an eater. If she doesn't want to eat, she's telling us all something...

Hindsight is always 20/20, so they say... I have learned here a feeding tube is far less invasive than you'd think. I have also read of quite a few cats here with feeding tubes chowing down on their own within a couple of days.

I chose not to go the feeding tube route and our initiation to the sugar dance was tenuous, on a good day... Somehow, we muddled through those tenuous first days and weeks... It sometimes took 11 saucers, bowls, and dessert plates of different food to get her to eat. Giz was a cat. Of course, she'd choose the 11th offering...

Knowing what I know now, would I have done things differently and allowed the feeding tube? Yes, I think I would have. Why? Because, just maybe, her tummy would have remembered eating sooner than my anguished 11th menu offering of deli meat on my hand extended under the bed...

Because, just maybe, her healing would have started sooner...

We danced for four more years. There is nothing in the world like dancing with a sugar cat! There is a bond you two will make that you can't even begin to imagine...







My most humble and encouraging suggestion is to listen to your heart. Listen to Louis's heart. Give him more time. Cats are very resilient. DKA can definitely take a lot out of them; but, many many do come back with full furry force!

Much love and countless gentle hugs for you and Louis, because I know exactly where you are, dear agg1966,
Deb
 
I spoke to the vet this morning. Louis' glucose was off the charts this morning when the vet opened. They have increase his insulin this morning. He has been able to stand because he is peeing in the litter box...which he had not been doing. But, he will not eat. My mother took some food from home to him this morning, but he won't eat. It has been 48 hours since he was diagnosed with DKA. If his glucose level hasn't come down by this afternoon, the vet wants to speak with me about "options." I think I know what option she has in mind. I think the fact that he is able to use the litter box is a good sign...don't you? Some have mentioned feed tubing....should I mention that to the vet? For those of you who have gone throgh this, please respond, as my talk to the vet will occur this afternoon. 48 hrs....is that enough time? How long should it take to get Louis' insulin to be regulated....is 48 hrs long enough. Right now, Louis is just laying there, not moving, but we know he has some energy or he couldn't be getting to the little box. What questions do I need to ask the vet this afternoon when I talk to her. Also, I think I need to point out that right now, the vet where he is, closes at 5:00, so there is no one there at night to check his BG and give him insulin if needed. There is a ER vet here that opens at night when the other ones are closing. Should I transfer him there at night for monitoring so he can have 24 hour care? I just want to make sure I have done everything I can for Louis before the vet suggests that I put him down, and I do believe that is what she is going to do!! I see her this afternoon, so I'm running out of time. Thanks for you help.
 
Dearest agg1966,

Louis needs a 24-hour ER hospital. Why? Because a DKA cat needs both an extremely short-acting insulin administered and it monitored often. They also need fluids -- involving eloctrolytes, potassium, nutrients, and other stuff -- via IV -- often.

He's not eating because he feels like crap. Trust me, agg1966 -- and God, I wish I knew your name -- just trust me, okay?

So, yes, please move him to the ER vet that's open tonight. And, please, don't make any hasty decisions because your heart is worried and you're tired and on emotional overload. Cats do come back from DKA. Giz came back. Mike's Tigger came back. Pam's Layla came back three times. Many more have come back.

But, honey, please understand, this isn't going to regulate Louis. This is to stabilize him. Get him stabilized and we will help you with the rest. I swear to you, we will help you help Louis.

Much love and big hopeful hugs for you both,
Deb and Nikki -- and, Giz...
 
I would transfer Louis to the 24 hour clinic. All day, not back and forth.

I'm thinking your current vet is not really giving the optimal treatment.

And yes, I would definitely consider a feeding tube...sooner rather than later.
 
Our community doesn't have a 24 hour a day vet. We have an emergency vet that opens at 5 when the others are closing. The ER vet is only open when the regular vets are closed. Yesterday morning I had to pick him up at 6:30 am and take him to my regular vet. So, when my vet closes at 5, my only option would be to take him to the ER vet at night. Would that be too much for him....taking him back and forth like that?
 
How about calling the emergency vet and see if they would treat him differently? Would they insert a feeding tube and teach you how to do it at home? Would they use short term insulin? What vets do they usually work with when they see a cat with DKA? Is there a vet they could recommend that is up to date on DKA?

If your alternative (according to your vet) is to put him to sleep and you are not ready to do that yet, I would start making calls and asking questions.
 
ER vet info for Jackson, TN????

Dearest agg1966, and, of course, you too, sweet Louis,

Sadly, the two vets Gizzie trained are in northern NJ...

If your only alternative is to go back and forth, then that's what you do. This isn't forever, as I know you are exhausted. It could just be for another couple of days/nights. These DKA furries can rally when you least expect them to, yet most need them to...

Please hold on to hope. Please hold on to us. We love you. We love Louis.

We believe in you both.

Much love and countless hopeful, healing, hungry hugs for Louis and for you, dear agg1966, who I'm guessing probably hasn't eaten much either...
Deb and Nikki -- and, Giz, watching over us all...
 
If it has been 48 hours since Louis has eaten, then I would STRONGLY urge your vet (or the ER vet) to put in a feeding tube. Louis is at serious risk for developing fatty liver since he hasn't eaten in so long. That is a serious complication you can very easily avoid right now. Louis either needs to be force fed right now or have a feeding tube put in tonight.

If he has enough energy to get to the litter box, then that is progress yet again. Do you know what type of insulin they are giving him right now? Are they giving Regular insulin (Humulin R) or just a longer acting insulin?
 
What I would do, if I had the money to do it?

You are 1.5 hours from Memphis TN. I would find the best 24-hour ER vet there, or somewhere else within a reasonable distance. I would ask my vet for a referral.

But, if I had to stay local, I also would do the back and forth, and push the local vets to be more proactive with the fluids, insulin, and food.

Our best!!
 
I went to see Louis late this afternoon and spoke with the vet. They still can't get his BG to stay down. They give it to him and it comes down, but within a short while, it's back up. He still will not eat. I brought some food from home and he wanted nothing to do with it. The vet did insert a feeding tube tonight. The inside if his ears are beginning to turn yellow, but his eyes are clear. He did turn and look at me, but isn't able to stand for long periods of time, but is able to get into the litter box. I know the tube feeding will help to nourish him, but will it also help the insulin bring down the BG levels? How long should I give the feeding tube to do its job. It's know been a little over 2 days since thins began. I'm not sure what kind of insulin he's getting, but I know she said it was made just for cats. Is there still hope here?
 
Good to hear they put a feeding tube in. I would think it would take at least a day of feeding that way for him to regain strength. I'd get pretty weak too if I hadn't eaten anything in over 2 days!

As far as the insulin - it sounds like they are only giving a PZI insulin (BCP PZI or more probably prozinc), which is the only "just for cats" insulin on the market right now. In the beginning especially, the glucose levels will go down and then go right back up. It also depends on how often they are giving it. At this point, it needs to be given at least twice a day. I am really surprised they aren't using R insulin, because that one is usually used in DKA because it just about has an immediate onset and can get levels down quickly so the body can start to heal a little bit. Do you know if Louis is still shedding ketones into his urine?
 
I don't know about the ketones. I will ask the vet tomorrow about the R insulin. You said it would take a day before I would know about how successful the feeding tube will be. Will the geeding tube along with the insulin help with thebg levels? Can you think of anything else I need to ask the vet?
 
Dearest agg1966, and, obviously, you too, sweet Louis,

I'm guessing they're giving Louis a combo of both R because you said "they give it to him and it comes down, but within a short while, it's back up" and PZI, which is made for furries.

I'm glad you allowed the feeding tube. Cats can be quirky about eating. Sometimes their tummies need to be reminded to eat when they haven't eaten for a while. And, then, when you least expect it and most hope for it, they just suddenly chow down.

In hindsight, I probably should have allowed a feeding tube for Giz. Perhaps her recovery wouldn't have been so hard on us both. I'll never know. But, recover she did.

Eating along with insulin is a good thing. I can't explain it scientifically, just as a sugar cat's mom. I'll do my best for you, dearest agg1966. A diabetic cat needs to eat. Period. They need the insulin because their pancreas has decided not to work, for whatever reason that may even be temporary or not. I was never really good at math and this probably involves some sort of math; but, food and insulin properly combined definitely help with diabetes, or BG levels. It can be tricky and takes patience, and home testing certainly helps; but, finding the right combination can happen. Louis can be Louis again.

DKA can take a lot out of a cat. I know. It took a lot out of Giz. But, and sometimes buts are good. I watched this incredibly ornery girl make a complete incredibly ornery comeback. It took a while, but when she came back, she was most definitely Giz.

I just have this feeling about Louis and you, dearest agg1966. I just feel him being him again, and you being you again.

Please keep the faith. And, please don't give up hope. It's been my humble experience that hope is probably the only thing we truly own. Please don't give yours away...

I believe in you both.

Much love and our continued hopeful, healing hugs for you both,
Deb and Nikki -- and, Giz, still being ornery in my heart...
 
agg9166: The following was posted in the Community forum. I have copied it here.

The poster is "Domino and Puff"...you can contact her with a PM (Private Message).


Re: Looking for help in Jackson Tennessee

Postby Domino and Puff » Wed Mar 16, 2011 6:21 am
I live about an hour from Jackson and am familiar with the emergency vet clinic that she is referring to. About two years ago I carried my diabetic cat, Domino, there after the vet we were seeing at that time sent him home because "they did not have anyone to watch him over the weekend". At the emergency clinic we happened to see a vet who was from Bethel Springs. He is one of the vets who works the emergency clinic in Jackson after working at his own clinic during the day. He is now the only vet any of my animals see, and I have been amazed at the difference and level of caring at his clinic.

I carried Domino to the emergency clinic on a Saturday. He went to the vet clinic in Bethel Springs on Monday. He was a very sick cat and could not even hold his head up or walk. He had lost way too much weight -- from about 18 pounds down to 8 pounds (all this while I was trying my best to follow our old vet's recommendations). After about 4 days of IV's and hospitalization, he came home. He regained most all his weight, but has now settled down to around 14 pounds (which is a good weight for him).

When I had Domino boarded there about a month later, this vet took Domino home with him to monitor him at night. He really seems to care about his patients. He trusts me to test both my diabetic cats at home, and pretty much trusts me to do what is best for my kitties. He had not previously used Lantus insulin, but was open to letting me try it.

I'm not sure if I am allowed to post names and phone numbers on here, but I would be glad to give those to her if going to Bethel Springs is an option for her. Just let me know.
 
Oh my dearest Karen, and, precious darling Smokey, forever in our hearts...

Thank you. And, thank you, too, Domino and Puff.



Dearest agg19666, and, of course, you too, sweet worrisome, Louis, who's name just makes me smile...

Domino and Puff's vet sounds like a true keeper. Would it be possible to for you to get Louis to see him?

We are all rooting for you honey, just as we are all rooting for Louis.

Please let us know how you both are doing when you can, okay?

Much love and I'm so not giving up on you both kind of hopeful hugs,
Deb and Nikki -- and, Giz, forever whispering in my heart...
 
I went searching for this post I wrote some time ago, so forgive me if some information does not pertain.
This is my expericence:
J.D. had DKA at Christmas of 2005.
I took him to the ER because of not eating and lethargy on a Sunday night. Because the ER closed during normal vet hours, I had to drive him to the University of PA School of Veterinary Medicine. He was in critical condition and it was a 2 hour drive and during commute hour. He was just laying there, and I was so scared. The next day he was transferred to ICU and stayed in there for about 3 days. I went to visit him every day. I brought him his food and treats and tried to get him to eat, because he would not eat for them at the hospital. Each day, he got a little bit better. He could lift up his head on the second day, and sit up a little bit on the 3rd day. On the 4th day he was transferred to internal medicine. He had to have a blood tranfusion, and we found out he had a very rare blood type. I was scared again. But it was okay. On the 5th day he was put into a bottom level cage, and I could sit on the floor and open the cage door to visit him. He weakly walked out of his cage with a tube in every leg, and sat on my lap. Every day he got a little bit stronger. They said he could go home if he would start eating. He would eat maybe a treat or two, from me, but nothing for them. Finally, on the 8th day, they released him home to me with a feeding tube. I was sooooooooooooooooooo happy to get him home. He was all I thought about that Christmas. He managed to get the feeding tube out somehow, the following day, and while I was on the phone to his regular vet to ask what I was supposed to do, I looked down and there he was eating on his own.
Today, I test his BGs a lot, and test for ketones when he's high.
 
Dearest Dyana, and, of course, you too, sweet J.D.,

Sometimes tears are happy...

Hugs for you both,
Deb

PS: I was a goner with his bowtie...
 
This morning Louis's BG level was at 200.....which is a BIG improvement. They put the feeding tube in the morning and it's going good. He got 10ccs this morning and 10ccs this afternoon. This afternoon his BG was too low, so they were not going to give him any insulin tonight. He is standing a little....but not for long periods of time....but all in all has a little more energy. She thinks that by tomorrow afternoon he will be doing even better because of the tube feedings. He is still a little jaundice, but thinks that may clear up now that he's getting something in his stomach. She thinks he can come home friday...thinks it would be good for him to be in familiar surroundings. She showed me how to do the tube feedings and believes that by friday his insulin level should be stable. She cautioned that he is not out of the woods, but she thinks the window of hope has opened a little wider. She said another week and we will know. Keep the prayers coming!!
 
Dearest agg1966, and, of course, you too, sweet Louis,

YAY!!!!! You go, Louis!!!!!!

Much love and my countless hopeful, healing, hungry thoughts, prayers, and hugs continue for you both,
Deb and Nikki -- and, Giz, smiling on us all...
 
I wanted to let everyone know that Louis passed away last night. There had been a little improvement yesterday, but I think he was just sooooo tired. I want to think everyone for their thoughts and prayers. God bless you all!!
 
I am so sorry to read this, we were all pulling for your baby Louis and were really hoping that he could pull through.

Hopefully all those happy memories of the time you two have shared will comfort you during this sad time. But know that he is now happy, and healthy while he waits for you at the Rainbow Bridge. No more pain, no more sickness just happy and playing in a body that is young again.

Fly free sweet Louis and land softly back in the hearts of those that loved you best. wings_cat

Mel, Max & The Fur Gang
 
Oh my...I'm so sorry. Louis was a fighter but I guess even the best warriors get tired. Fly free Louis land ever so softly, you've earned those beautiful wings now fly.
jeanne
 
I am so sorry that you lost your sweet Louis. You and he really fought the good fight. I hope someday soon memories of your time together will bring you smiles and laughs, rather than the tears and sorrow you are feeling today.
 
I'm so sorry Louis has gone ahead. He is your guardian angel for you now, as you were for him when he was here with you physically. Fly free, Louis.
 
Oh gosh, dearest agg1966,

I am so truly sorry.

I just saw the candle by your post and burst into tears because I have really come to love your Louis...









Truly.












Please accept my heartfelt condolences and deepest sympathies. And, please be gentle with yourself, dearest agg1966. Grieving hearts take time to mend... But, one day, you will find yourself smiling because your heart will be flooded with great memories of Louis...


















Fly free, dear, precious Louis! Wear your handsome new wings with great pride! Dance with Gizzie at The Bridge. She'll tell you how to visit your parent's dreams and tell them you're okay now...

Much love and countless, tear-filled gentle hugs,
Deb and Nikki -- and, Giz, forever whispering in my heart...




Poem For Cats

And God asked the feline spirit
Are you ready to come home?
Oh, yes, quite so, replied the precious soul
And, as a cat, you know I am most able
To decide anything for myself.

Are you coming then? asked God.
Soon, replied the whiskered angel
But I must come slowly
For my human friends are troubled
For you see, they need me, quite certainly.

But don't they understand? asked God
That you'll never leave them?
That your souls are intertwined. For all eternity?
That nothing is created or destroyed?
It just is....forever and ever and ever.

Eventually they will understand,
Replied the glorious cat
For I will whisper into their hearts
That I am always with them
I just am....forever and ever and ever.

Author Unknown
 
I am so so sorry that your sweet Louis had to leave you. Sometimes they just are unable to fight and remain with us and it's a heartache.

You fought so hard as did your boy - my heart goes out to you.

I'm so sorry.

Emmy & Dude (& Mittsi too)
 
I am so very sorry for your loss. Wrapping you in many cyber hugs. Louis is flying free now, whole and healthy over the Rainbow Bridge rb_icon

wings_cat
 
We are so sorry for your loss. Louis will now be chasing butterflies in the sun at the Rainbow Bridge, his health fully restored.

Fly free Louis

Love
 
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