Warren - 5/29/2000 - 7/1/2016 rest in peace my furry friend

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The silver lining of course is that 15 years old is a good run for any animal. We had to put our 1.5 year old cat named Baby down due to FIP earlier this year, which came and relentlessly killed her within 2 weeks of symptoms. If you think it's time then I would say you're probably right. Hopefully the vet comes up with a magical cure, otherwise I think you're making the right choice since this all sounds pretty miserable for Warren. Someone said ulcer's, so maybe your vet can help identify if there's any last resorts here.
 
I'm just like you.
People here are wonderful,but you know your cat we all do.
My Foxie is miserable ,and I don't think this will change.
I'm not ready yet,but I'm thinking about.
My great cat is alwayes hungry,thirsty and I know this is not life that she wants.
My best wishes for you,you love your cat.
 
I'm sorry about all this,and wish you to have a clear mind ,you love your cat you know your cat.and you know when is enough.I definitely. Know that my cat is miserable ,and I don't want her to suffer.
I'm sure you feel the same and your decision will be the right one.You love your cat.
 
My wife is certain that what I thought was black vomit was instead diarrhea (she washed it off the curtains and smelled it first). I'm surprised she told me as I had pretty much made up my mind that it was time. But with that piece of info, and with his glucose levels in the 90s today, I have some new found hope and am going to keep trying to regulate him and see how things go.
 
And today he bounced again after dosing at 0.75. So I went to Walmart, bought a big magnifying glass and needles that have half units markings. Want to try to get his doses more accurate rather than winging it. With it making such a big difference between 0.5 and 0.75, I think it's critical to try to get the dosing as accurate as possible.
 
What do you guys think of the latest readings? It almost seems to me like he's bouncing even at 0.5 units. I've now been measuring with the new syringes marked with 0.5 increments and using a magnifying glass. I'm feeling pretty good these 0.5 doses have been measured pretty consistently. I'm starting to wonder if maybe he's gone into remission again. Could use some thoughts on whether I should continue at 0.5, drop him to 0.25 or take him off and see what happens. He did poop on the kitchen floor this morning, which started my wife off on the 'you need to do something and stop making excuses for him' tangent again. I was intending to order some probiotics to help with his diarrhea tomorrow.
 
Hi Rob,

Warren's numbers are definitely better than on the 0.75 IU dose.

Is there any chance that you might be able to get some tests in at AMS+2 and PMS+2 (and +3s for both if possible) ? It would really help to see what's happening in the early part of the cycle. If the dose is a bit high then the Lantus may be dropping his levels a bit fast earlier in the cycle and that might be spiking his BG mid-cycle. When a dose is too high, sometimes you can get an inverted curve. Getting the tests above (and ideally a full curve) would help members here to give you better feedback on what dose adjustment might be needed.

Is there any change in his behaviour in the early part of the cycles? Does he seem any perkier? Also, is there any correlation between the time in the cycle and when he has his peeing mishaps?

Do you have Warren on a B12 supplement, btw? If not, it might help with the litter box issues.

EDITED TO ADD:

Does Warren's appetite perk up early in the cycle? Keep an eye out for cues like this because it can indicate when the Lantus is kicking in.
 
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Hi Aine, I will take some earlier readings, but historically (looking earlier in the chart), the nadir hits him around 7-9 hours. I can try to get a full curve again as well, I just don't want to do it when he's bouncing and sometimes it's hard to tell when that is. He is hungry ALL THE TIME. He gets his food immediately after his insulin and I have to lock him in the bathroom with it so he doesn't push the other 3 cats away from theirs. We were having throwing up issues because of him eating too much, too quickly until I separated him during feeding. He is definitely perkiest when his BG reading is really good (ie, 80-140ish), but I haven't really seen behavior change at various times of the day. He's old, he does a lot of sleeping but he definitely comes running at meal times.

When he does use the kitchen as a bathroom, it's generally in the morning. 6am - 10am. It has seemed like there is not a problem unless his BG is high, so I've been locking him in the bathroom when I get high readings. Today I think was an exception.

Any recommendations for an easy to take B12 supplement? I can order that when I order the probiotic.
 
To help slow down the eating and reduce scarf 'n' barf, these might help
- add a tablespoon of water to help he feel more full
- spread the food thinly over a large plate so it takes longer to eat
- divide the food into mini-meals so he doesn't get too hungry
- freeze part of the meal so it may be eaten after it thaws
- consider a timed feeder to spread out the food
 
robr said:
He is definitely perkiest when his BG reading is really good (ie, 80-140ish)...
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That's exactly the sort of behaviour that I was asking you to look out for. If you catch him behaving like that earlier in the cycle, it'd be a good idea to test then and maybe an hour later, too. It's great for helping to catch early drops and shifting nadirs.

Thanks for the information on his peeing behaviour. I did wonder whether there might very well be a correlation between peeing incidents and higher BG values so it's good to get that confirmed. That might be something to share with your good lady. It may reassure her to know that when Warren's BG is in better numbers the peeing hiccups subside, the tacit implication being that as he becomes better regulated it will hopefully resolve the pee mishaps.

The B12 supplement recommended by many here for diabetic kitties is Zobaline.
 
Ok thanks, I'll read up on B12 tomorrow. In the meantime I put up his +2, 4 and 6 numbers from tonight. Stayed up way past my bedtime, will try to get a full curve starting tomorrow AM.

.... and he's in the 400s in the AM. argggh!!!
 
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Hi Rob,

Just checked Warren's spreadsheet and saw that he was high mid-cycle today. Is there any way that you might be able to snag some PM+10 and PM+11 tests? It might give you an idea of whether he's going lower on the PM cycle and then bouncing during the day.
 
Thanks so much for keeping an eye on him CM, I can plan to do that but need to catch him when he's not coming off what looks like a bounce. That's why I didn't bother with a curve today. His PMPS was 448, so not a great day for him as far as BG, but he did find his way to the litter box tonight when he had a very nasty poop, with a high BG he seems to prefer the kitchen, so I'm proud of him for that :)
 
Does look more like a bounce alright. The reason I was asking about the +10/11 tests was to find a way to help you get a better idea of whether he's going too low at night and then bouncing (and peeing :banghead:).

Well done, Warren, for pooping in the box. (((Scritches)))

What did the stool look/smell like?
 
It smelled so bad even Chuck Norris would have run the other way. It was generally poop shaped, just soft and a medium brown color.

He's still bouncing today it looks like. My wife just came upstairs to my office and let me have it about not having him put to sleep. This is so difficult.
 
Rob, I am going to really blunt here, and I'm sorry if it is unwelcome. Ask her when she gets old and incontinent, does she want you to have her put to sleep? You said she loved Warren until the kids came along, and now he is just a burden. What if when your kids grow up, they see her the same way as she gets older? Again, I'm sorry to put it that way, but I don't know any other way.
 
robr said:
It smelled so bad even Chuck Norris would have run the other way. It was generally poop shaped, just soft and a medium brown color.

He's still bouncing today it looks like.
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Have you had Warren tested for pancreatitis? If not, I strongly recommend asking your vet to run a Spec fPL test for pancreatitis. Really malodorous, medium brown/tan stools are a symptom. If he does have pancreatitis his B12 may be low because pancreatitis can cause absorption problems. Given the ongoing toileting problems, I'd also recommend asking your vet about checking B12, folate and potassium levels (could be a potential cause of hindquarter weakness which might be making Warren slightly incontinent).

I am so sorry that you are under such dreadful pressure on the home front. If you get the right diagnostics and then appropriate treatments, it could make the world of difference to getting Warren's diabetes regulated and hopefully restoring domestic harmony.
 
At over 120 posts, it might be time to start a new thread, and maybe in the Lantus/Levemir forum.

Maybe get a large 48" long dog crate to confine him in. Line it with some chucks (pads for incontinent patients). Put in a litter box, a carrier without a door (provides a hiding nook and a shelf to get up on), and food and water. This would make clean up easier.
 
Thanks BJM, he has a thread there, it just doesn't get much traffic. In fact it was suggested in that forum that I create this post in the main forum as the Lantus forum isn't heavily trafficked. In any case, I haven't been paying attention to what forum I'm in at any given time. I get the email notifications of new responses and just click the link and here I am :).
 
Looks like he's still bouncing on 0.5. I'm dropping him down to 0.25...which is a challenge to get the syringe just right without over shooting to 0. And these Walmart syringes suck for getting out every last air bubbles. I'm using a magnifying glass now and the bubbles even when at the top like to stick to the side of the tube as liquid goes around them. There must be air in the needle even when all the way pushed in and held down forcefully as there's no air in the lantus pen.
 
1. Push the plunger in and out a few times before drawing up insulin so that the movement feels smooth.

2. Try drawing up about 2 units, holding the syringe needle up and flicking to move the air bubble under the needle then express the extra insulin.

3. Try twisting the plunger slightly when you're expressing the excess insulin.

Also get a spare syringe, fill with water and practice squeezing out a drop at a time. When you get the knack, you can then get just above the required dose, squeeze out a drop, check the syringe reading, then rinse and repeat until you hit the mark you're aiming for.
 
Rob, I've just had a look at Warren's spreadsheet and I really think you need help with dosing from members really experienced with Lantus. I strongly recommend that you start a new thread on the Lantus and Levemir forum and ask them to review Warren's spreadsheet. I don't have enough experience to suggest anything to you but I'm not sure down is the way to go.

I understand the awful pressure you're under to solve the 'accident's problem' and finding a good dose and having some support to help you hold your nerve through the bounces is, to my mind at least, the best and fastest way to get help for Warren and thus help things calm down on the home front.

In the meantime, are you able to get pre-shot and +2 - or better +3 - tests on every cycle. It would help a lot to know where the active cycles are happening (especially at night). Having this extra information every day would go a long way to determining what's going on with Warren's BG over a 24-hour period.
 
Might be worth starting a new thread in L&L with today's date and then putting a link to this thread and the previous Lantus thread in the opening post (that's the recommended posting protocol over there). Also, when you create the new thread, use the question mark icon next to the thread title. It'll help the experienced members there identifiy that you need help faster. Be sure to reiterate in the opening post the type of pressure you are under at home - that Warren really needs as much help as possible as soon as possible.
 
Returning back to this thread from the Lantus forum where we've been having some discussion just to do an emotional dump.

Warren's litterbox habits have gone downhill severely this past week (all documented in the spreadsheet and marked in purple).
Changes about the time this started were to add the probiotic to his diet and I slightly upped his dosage by a hair, I'm calling it from 0.5 to 0.6 (just got calipers last night with the intent of being able to micro measure). His numbers I think look much better now than they have perhaps ever, wish it translated to better litterbox habits.

I finally agreed with my wife on Sunday to have him put to sleep Monday, but couldn't do it. I was up all night with him and I was a wreck. I'm a wreck now just writing this (with Warren in my lap). I was hoping a few days with the better numbers would turn around his litterbox habits, but I know that takes time. Today he peed on the kitchen rug and in my son's backpack in the living room. My wife is slamming doors around here she is so mad. I was just given an ultimatum to have a plan, and if there is one more accident he's done. She believes this is behavioral rather than medical, and I don't blame her at all for not wanting cat pee all over the house and our things. Cat Attract litter and Feliway collars have not helped. As you all know, he's had three UTI tests and gone through multiple weeks of antibiotics. I'm out of ideas. I need a miracle now, he and I are both out of time. It just sucks because he looks healthy, has great coat, he's playful, he cleans himself, his weight is good, he just won't use the litterbox consistently.
 
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((((((((Rob))))))))

Warren's numbers have improved so much!!! That is going to make such a difference to things.

Is he getting a B12 supplement? If not, could you start an aggressive B12 supplementation programme with your vet straight away? Now he's in better numbers his nervous system will have a chance to recover from any damage due to higher BG levels. If Warren has subclinical diabetic neuropathy this could be at the root of his elimination problems. Now that you have made such an advance in regulating his numbers, if it is neuropathy in play then the B12 could resolve the problem. I've seen it resolve the problem in a number of cats since I joined FDMB. If this is the problem, then it may take a little while to help BUT with the better-regulated numbers Warren is likely to be drinking less and peeing less because his kidneys won't be working overtime to get rid of excess glucose.

I really do have great sympathy for you all with the inappropriate elimination difficulties: there is no denying that it's unpleasant. That said ...

robr said:
My wife is slamming doors around here she is so mad.
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^^^ This ^^^ is really not going to help matters. Stress can bring on UTIs in cats, and anxiety can cause elimination problems, too. I appreciate tensions are running very high, but it is possible that displays of anger about the situation may actually be a major factor in perpetuating it.

I would suggest:

1. Talk to your vet about the B12.

2. I know it's awkward but let the vet know that there are some 'life stresses' in the home environment (no need to be specific) and you're concerned Warren may be picking up on it. (NB - I can hear how anxious you are, too, and Warren may also pick up on that.)

3. Ask the vet to double-check that Warren doesn't have a UTI or cystitis (stress can induce the latter).

4. Maybe ask him about something to help Warren with anxiety. Obviously tell him about lack of success with the Feliway collar. I have read that fluoxetine (Prozac) may be prescribed to help cats who are struggling with inappropriate elimination problems.

Note: I've never given any of my cats anti-anxiety medications so I don't know what the risks and contraindications might be. Please ask your vet to detail risks and side effects if he does consider prescribing something to help Warren. (I have read that diazepam isn't great for a cat's kidneys.)

Some links:

Detailed article on elimination problems and clinical / behavioural signs that may give more clues as to the nature of the problem.

Advances in Understanding and Treatment of Feline Inappropriate Elimination - Vet-authored, very comprehensive article. Includes things to check when making a diagnosis (has recommended tests to order, and also includes diabetes as a potential cause of elimination problems - maybe show your other half this as evidence that elimination problems most definitely can be as a result of diabetes). This article goes into fluoxetine treatment, guidelines and side effects (most relevant for a diabetic being that it may suppress appetite a bit.)

I hope some of the above helps. I've only scanned the article in that second link: it looks really good.

I am really hoping your wife will be amenable to giving you a chance to let Warren recover further. It is so heartening to hear how well he is looking and acting now. I think you've turned a corner. I hope you will be able to persuade your other half to explore all treatment options. My heart goes out to you ... :bighug::bighug::bighug:

(((Rob & Warren)))


Mogs
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TAMU B12 Dosing Guidelines

From the TAMU document:
Every 7 days for 6 weeks, then one dose after 30 days, and retesting 30 days after the last dose. If the underlying disease process has resolved and cobalamin body stores have been replenished, serum cobalamin concentration should be supranormal at the time of reevaluation. However, if serum cobalamin concentration is within the normal range, treatment should be continued at least monthly and the owner should be forewarned that clinical signs may recur sometime in the future. Finally, if the serum cobalamin concentration at the time of reevaluation is subnormal, further work-up is required to definitively diagnose the underlying disease process and cobalamin supplementation should be continued weekly or bi-weekly.
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B12 is water soluble. Any excess is excreted via the kidneys.
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Dear Rob: I haven't followed you & Warren lately, but certainly can tell you are torn & heartbroken.
I am so sorry. I can feel your hurt from here.
Since I haven't kept up, please forgive me if this option has already been discussed..
Could you get some help in finding him a home with an understanding cat person? Even for awhile!
Maybe it would break the "cycle" he's in ?? Maybe he's picking up on the wife's stress..and should get out of there.
Maybe that's your miracle.
I know you're torn..but I'm thinking, so is he.
Just a thought. God bless you both.
 
My heart goes out to you ... :bighug::bighug::bighug:(((Rob & Warren))) Mogs
.[/QUOTE] (Just now reading through all of this ...) My heart goes out to you, too! Have all fingers & toes crossed for you.:bighug: - Robin
 
Thanks everybody for the replies.

Critter Mom, I shared (an edited version) of you post with my wife, she doesn't want to hear anything I have to say on the subject any longer, it's just seen as excuses. Hopefully coming from someone else, it will make a difference. Assuming she's receptive to the idea, I'll talk to the vet about B-12.

Is there a way to do home testing for bacteria? ie, urine test strips? I've shelled out a ton of $$$ at this point for 3 UTI tests, I don't think my wife will be on board for spending more $$ when in her mind Warren should be put to sleep immediately. I understand if they come up positive, it would not mean he has a UTI, the bacteria could be introduced from another source, but if it's negative it would indicate he does not have one. Something like this perhaps? http://www.cvs.com/shop/home-health...nary-tract-infection-test-strips-skuid-870916
 
UTI strips can be purchased at most pharmacies for a few dollars and may be a good screening tool for him. I think you mentioned that you have tested (negative) and treated multiple time for UTI based on symptoms, and no improvement. I'd use the strips for now to screen, but I'm not sure UTI is your main issue based on this history.

I know when Jane was having her arthritis issues she started peeing/pooping on the rugs in the house instead of the litter box. After a few times, it became a habit for her because of the smells so we had to block off all of her "favorite" places and give her time to get used to the litter box again. I never considered neuropathy, but this could make it hard for him to feel he needs to go until it's too late, and he may have trouble with muscle control. Constipation issues can also lead to inappropriate elimination and may be more of a problem if neuropathy is an issue. It's so hard to figure these things out sometimes, I wish cats could tell us. In addition to the B12, perhaps pain control may help and laxative if he appears constipated.

When Jane was going through this, and with other cats I've had who had issues, I often wondered what I would do if it didn't resolve. Bathroom issues are some of the most frustrating issues to deal with, especially if it looks like there isn't hope. Hang in there.
 
robr said:
I understand if they come up positive, it would not mean he has a UTI, the bacteria could be introduced from another source, but if it's negative it would indicate he does not have one. Something like this perhaps?
http://www.cvs.com/shop/home-health...nary-tract-infection-test-strips-skuid-870916
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I've no experience of the above so don't know if they'd be suitable for cats. Multistix 10SG strips check for blood in the urine. @Meya14, @BJM - do either of you know if there are any suitable reagent strips for home use in cats?

Re the vet: things are so critical now that I would strongly, strongly recommend you ask him about the kitty Prozac AND the B12. If I had to choose between the two in your current situation and the window was short, I think I'd probably go for the Prozac first. Until you get Warren to settle back into proper toileting habits, your worry is going to be pretty much constant. Warren will be feeding off all the worry and tension (all cats do) and if anxiety is feeding into his elimination problems that cycle needs to be broken ASAP. Anti-anxiety medication might be the fastest way forward.

I've just found this article about treating elimination problems with Prozac.

From the article:

After explaining to the couple that many medications have been tried and failed, prozac for cats urinating inappropriately seemed to work the best. So this is what the couple tried as a last resort before putting the cat down. After just one dose at night, the cat completely stopped urinating, except for in it’s own litter box. They said the cat has also stopped yeaowing at night and keeping them awake at time, and now comes out in the light during the day, instead of hiding all day and only coming out at night.

Prozac for cats for inappropriate elimination and urinating is the best treatment when all else fails.
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[Emphasis mine]

I do hope that some of this will help you all.

(((Rob & Warren)))



Mogs
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PS ... as a precaution, ask your vet for a small dose of cyproheptadine as well as the Prozac. Prozac is an SSRI. These and similar drugs can induce serotonin syndrome. Cyproheptadine is used as an antidote. It is used as an appetite stimulant in cats (small dose, e.g. 1/8 of a 4g tablet BID for a 10lb cat) so it is generally safe. (NB - this last addition is me appeasing my inner Safety Nazi; not meant to alarm or discourage you. Your vet should be able to advise you further.)
 
Meya14 said:
I know when Jane was having her arthritis issues she started peeing/pooping on the rugs in the house instead of the litter box.
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Excellent point, Meya. (Wish I'd thought of it. ;) )

Rob, if you are taking Warren to the vet (and I really hope you are ;) ) ask him to double-check Warren for any signs of joint pain. A basic physical exam should pick up any discomfort. (NB - if exam is positive, don't let vet prescribe Metacam for pain - it's major bad news for the kidneys.)
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Warren

I completely agree with Critter Mom.
That bolded text in the article gave my heart an excited jump for you!
PLEASE TRY.

And if writing your good lady a few lines will help..then WE'LL ALL DO IT. :woot:

Thank you Àine! :bighug:
 
Luna pees on the carpet about once week. She's declawed though so I think it's a behavioral thing or perhaps the sand hurts her paws.
Critter Mom said:
PS: Some forum members have had great success when they switch to the Tidy Cat Breeze litter system.
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I'm about to watch the video on that page with the mad scientist Hans... We have 2 boxes and they fill up insanely quick and keeping them clean is hard, and the second they're dirty Luna refuses to use them, though Mushu seems to think the dirtier the better, he's always hanging out inside scratching the sand.
 
The human test strips should work for cats too. They usually test for nitrates that the bacteria produce, as well as blood, protein, and pH.

As for substrate preferences, sometimes that's an issue. If your cat prefers to pee on carpets or towels, you can try placing an extra large puppy pad (or 2!) in a clean, empty litterbox and put only a handful of litter on top of this. We did this with Jane for a while too, as she'd find any throw rug in the house to use instead of the box.
 
UTI test strips show negative for nitrates but positive for leukocytes (it was the darkest color on the chart).
I think that means he has some sort of infection but not necessarily a UTI.
He went in an empty sterilized litter tray and I tested within 30 minutes, so I'm pretty confident there was no contamination by third party white blood cells jumping into the urine :)
 
I strongly encourage trying the Prozac too...it really can work wonders.

Without going back through all the info, I just want to add one thing I just remembered...is there any chance the rugs Warren is peeing on have rubber backing? For some reason, a lot of cats just can't resist them and when you get rid of the rubber, you go a long way to getting rid of the problem....Just another thing to try if you haven't

Wishing only the best for you both
 
Chris & China said:
is there any chance the rugs Warren is peeing on have rubber backing? For some reason, a lot of cats just can't resist them and when you get rid of the rubber, you go a long way to getting rid of the problem....
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Now that's a very insightful observation. That rubber backing tends to have quite a distinctive odour slightly reminiscent of urine. Someone gave me a prezzie of a mouse mat once that stank to the high heavens. You'd swear it had been used to line the bottom of a litter tray. Needless to say it got turfed out.

robr said:
Today he peed on the kitchen rug and in my son's backpack in the living room.
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Your son's backpack - is that by any chance made of something rubberised, too?
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