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Looking For Input: Ming And His Chronic Illnesses

mingking

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Feb 8, 2015
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Hi everyone :) This post will be loooong. And what I'm really hoping for by posting Ming's situation is to gather input from everyone since everyone has had different experiences with their cats. I love the cat community and I think it's incredible the amount of knowledge there is amongst us all!

Thank you in advance for reading and I hope the post isn't so long that it's unreadable! :p

To start with, I've been posting on the Feline Diabetes Message Board. There's a play-by-play of what has happened during the week with Ming HERE but I will be summarizing it all in this thread anyway. (I hope it's okay to post another message board here.)

When I adopted Ming in 2015
The first sign of any illness I noticed was of him coughing. I went to a small clinic where they did x-rays and found his heart was slightly enlarged but no signs of asthma or obstructions. I would go in about 2-3 times more to make sure his coughing wasn't anything serious. I eventually accepted that his coughing is probably some weird thing he does. He was sometimes prescribed pred or l-lysine but that was about it.

He also had times where he would stop eating and/or vomit. We would bring him in. Do blood tests and find that no, he doesn't have pancreatitis. He'd be given steroids or antibiotics afterwards.

His diet has always been wet foods that he'll eat. I would sneak in raw freeze dried whenever he would take it. He ate a lot - almost 12 oz a day, even more sometimes. He was a chubby 18-19 lbs kitty up until 2018.

March 2018 - Diabetes
I decided to bring Ming to another, larger vet hospital. We'll call this vet hospital, Hospital #2. We did a check up in November of 2017. All good!

When Ming is sick, he drinks water or hangs out near his water bowl. We noticed he was drinking a lot of water and peeing like mad. And hungry all. the. time. But I didn't think too much of it, honestly.

March 2018, he stops eating and vomits. He's hospitalized for almost a week. We come back to find out he is diabetic now. That explains the water-drinking and increased appetite. He's down to 16 lbs.

Between March and September, he has about 5-6 pancreatitis flare ups - each time he is hospitalized at Hospital #2. We do two ultrasounds and just see LOTS of inflammation and at one point, necrotizing pancreatitis.

He goes from 1 unit of Prozinc to 6 units in September. Hospital #2 did not advocate for home testing even when I asked if I should. We would just do fructosamine tests.

I start working at a vet hospital (Hospital #3) as a vet assistant (they call it ward nurse so I do a lot of the cleaning, administering medications, and looking after hospitalized patients. Different from the technicians that does the tests and works with the vet to come up with plans for patients).

Ming ate canned DM for a month after his last pancreatitis flare up before I spoke to a vet at Hospital #3 who said, yes, try the raw diet. I was able to transition Ming to raw for a good month. His poops were less massive and his coat felt much shinier and he didn't look so fat anymore.

I start doing Blood Glucose curves and home testing because I've learned how at the hospital and from talking to another coworker (night nurse) that has had diabetic cats all her life.

I find out 6 units is TOO much. So, with the help of the great people at FDMB, we reduce him to 4 units twice a day and went from there.

October 2018 - Diabetes, Micro Abscesses on the Pancreas, Ketacidosis, and Asthma
Ming does his whole spiel again: vomits and doesn't eat. I bring him to Hospital #3 where I work.

Now, there are 4 vets that Ming has seen. All varying degrees of knowledge and different styles of treatment. I'll make up fun names so it's easier to follow.
  1. Vet A or Boss lady: She is a vet that takes risks and who initially saw Ming for a check up when I started working at Hospital #3. She talked to me about trying steroids even though it's a big no-no for diabetic cats. The vet at Hospital #2 always talked about wanting to avoid using steroids.
  2. Vet B or Fairy: She saw Ming when he started his pancreatitis flare up. Boss lady was off for the weekend so Fairy was the next best vet. She is more conservative compared to Boss lady but definitely has experience.
  3. Vet C or Princess: Fairy only works 3 days a week so she had to transfer Ming's case to Princess. Princess is a newer vet and from my observations, likes to stick to what her textbooks tell her.
  4. Vet D at Hospital #2 or Dr. S: He was the one that diagnosed Ming and who knows Ming the most since he's been at Hospital #2 a million times. I love him but I think his approach was more to treat Ming's symptoms and support Ming and err on the safe side. It's why he always talked to me about wanting to avoid steroids. He's great at getting Ming back to health clinically but I knew Ming's issues were never resolved.
Friday, October 12, NIGHT
I came home to find Ming had vomited upwards of 12 times. He would not eat. I texted Fairy to ask if she can see him the next day. She said yes, of course!! I gave Ming bupe, cerenia, and 4.6 units of insulin and monitored his BG levels all the night. He went as low as 10 mmols which was good. But he wasn't eating so I was a little afraid he would get hypoglycaemic.

Saturday, October 13
Went to the vet. Fairy saw him and we did x-rays, blood test, and urine.
His tests:
  • Asthma in the lungs. Fairy sent his x-rays to the ultrasound specialist to confirm he has asthma.
  • High lipase, something indicating acute inflammation in his blood. There were other things that were of note but I can't quite remember and some of it resolved during the week
  • No ketones in the urine, thankfully
Fairy put him on IV fluids, cerenia, and bupe and his normal dose of insulin for the night. Ming ate A LITTLE bit for me before I left for the day.

During the night, the night nurse saw that Ming almost went hypo. He went as low as 4 mmols. There was some discussion and argument whether Ming received 4.6 units on the u-100 syringe or if he got some other weird dose.

Sunday, October 14
Fairy was off and Princess took over Ming's case. She put him on antibiotics (ampicillin) and gave 3 units of insulin in the morning.

Ming's BG stayed high in the 20s. He was only eating a little bit of dry food. He got 3.5 units that night and the same thing happened.

Monday, October 15
Princess decided she wanted to "restart" his insulin dose. She was concerned about him becoming hypo. Ming was eating a little and seemed brighter, according to her. She said I could come take him home and maybe he will eat much better at home.

So I brought him home. The first thing I noticed when I went to pick him up was that... no... he was NOT brighter. But the night nurse (with the diabetic cats) said maybe Ming will do better at home. Dr S NEVER let me take Ming home until he was eating like his normal self but I thought, sure, why not. Maybe Ming hates it at Hospital #3 so he won't eat.

I bring him home.

Not eating. He's warm. His breathing is fast and deep. He slept like a rock for a few hours to a point where I kept waking him up to make sure he was alive.

I gave him 4 units of insulin despite Princess telling me she wanted him on 2 units. Night nurse even said 2 units was ridiculous and glad I gave 4 units. The lovely people at FDMB wanted me to give him his usual 4.6 units. But I was so frazzled I decided 4 units was safe from the dangers of everything. In retrospect, I wish I had given 4.6 units to help decrease Ming's BG.

His BG that night stayed high in the 20s. And I tested his urine for ketones and he had them.

So I brought him back to Hospital #3 right when the morning started.

Tuesday, October 16
They do a urine test and yes, he has high amounts of ketones. They start him back on IVF and fast-acting insulin IM (humilin). For a good portion of the day, he stays under 15 mmols.

We repeat this regimen: humilin when his BG is 18 and above. But his BG CONTINUES to be 18 and above. Even at one point, he was 32.

From Tuesday to now, his BG has been in the 20-28 mmols range. We went from 2 units of Prozinc to 10 units today and humilin if his BG doesn't get lower than 18.

Last night, his lowest was 17 mmols for the first time and he was on 8 units of Prozinc. I hope today, he hits lower numbers with the 10 units.

Thursday, October 18
Ming has his ultrasound. He was microabscesses on his pancreas. Boss Lady takes over Ming's case and puts him on a stronger antibiotic called Zenquin. She puts him on 4 units of insulin again at night. Ming's BG stays in the 25s. He has ketones of 4 mmols in the middle of the night but by morning, he has trace ketones again.

Boss Lady discusses with me about starting steroids and referring Ming to an internal medicine specialist. Boss Lady also will be sending an email to a vet that advocates for the use of steroids in diabetic cats to get her opinion.

Friday, October 19
I finish my night shift and wait for Boss Lady to arrive for the day. I ask her a lot of questions and stress that I don't like Ming being so high and that he had ketones again. Boss Lady agrees 100%. We bring him up to 6 units of PZI with humilin support. He only goes as low as 17 mmols.

We start him on pred (1/2 tab, I believe once every 24 hours?)

Boss lady decides to try 8 units PZI for the night. Ming has ketones again.

Saturday, October 20 (TODAY!)
Clinically, Ming is doing good. He's eating and actually bright. Boss Lady sets me up with a time with the Internal Medicine Specialist on Monday.

She decides to give Ming 10 units today. I don't know how it's going now but I'm going to go see Ming in a few hours.

So that's Ming's story in a nutshell. He is a complicated case. Of course, the fast and quick increases to his insulin is concerning but Boss Lady says he needs it and I agree. Boss Lady KNOWS these quick and large increases are crazy too. But Ming isn't budging.

I'm curious to know if any cat owners out there have had or heard of similar cases? Or even had a little taste of what is happening with Ming. I would love your input whether is negative or positive. Anything is valuable to me!
 
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Mamanyt1953

Rules my home with an iron paw
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Oct 16, 2015
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Havelock, North Carolina
Good God, you two have been through the mills. This is a really complicated case, isn't it? And I'm at a bit of a loss.

At this point, although you are actually working at a vet's office, I might consider (if this is possible) taking Ming to a University with a Veterinary Medicine School. The advantages of this are (although it almost will NOT be less expensive, and possibly more), a good University is teaching cutting-edge medicine by the finest specialists in the country, using the most up-to-date equipment and diagnostic tools. I've seen them catch things that very few vet clinics are equipped to handle.
 

Furballsmom

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Jan 9, 2018
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Hi!
I'm so sorry you're going through this with your baby!!
The thing is that every cat is so different, and what works for one feline isn't necessarily good for another.

I think that Mamanyt1953 Mamanyt1953 has an excellent thought for you.

If you go that route, let us know what they say, we are rooting for you and Ming!!


:vibes: :crossfingers: :redheartpump:
 
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mingking

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Feb 8, 2015
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Thank you Mamanyt1953 Mamanyt1953 and Furballsmom Furballsmom !

Yes, we do have something like that in my area and we were going to bring him there for emergency treatment if he wasn't doing well on Wednesday. But he's responding to treatment. I think the internal medicine specialist is kind of like the equivalent of going there?

Anyway, I went in and the 10 units worked. He was at 6.5 mmols for his BG. One of the things the people over at FDMB said was that vets will typically keep raising the dose until they get a nice curve. And then send the pet home where the pet will relax which lowers their BGs. The good thing is I'm there to test him to make sure he doesn't go hypo.

We also got a response from the diabetic cat specialist that uses steroids and she said she would've used a larger dose of pred which Boss Lady was not comfortable with lol. Boss Lady decided to discontinue the pred until I see the internal medicine specialist on Monday.
 

inkysmom

Inky's legacy - Belly rubs CAN tame feral cats!
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Feb 12, 2017
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I had a diabetic cat, Inky, that had uncontrollable diabetes for the first year. His doses were all over the place. He took prozinc too. When I switched to a specialty vet hospital and saw an internal medicine specialist it helped his diabetes. I'd still go to a university hospital as they're more cutting edge.
My dog has seen an internal medicine specialist and so has a different cat for allergies. I wasn't as impressed. It really depends on the vet you get.
Inky also had asthma but vets ignored me about his symptoms until it was advanced. He had to go on steroids occasionally but they did try to avoid them. I hate steroids since I feel they contributed to killing my dog and I won't use them unless very short term.
Inky loved the royal canine canned diabetic food. Raw food is probably better, but inkys weight stabilized and his coat became nice and shiny. He also stopped getting awful skin infections. He's the cat in my avatar.
 
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mingking

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Feb 8, 2015
497
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I had a diabetic cat, Inky, that had uncontrollable diabetes for the first year. His doses were all over the place. He took prozinc too. When I switched to a specialty vet hospital and saw an internal medicine specialist it helped his diabetes. I'd still go to a university hospital as they're more cutting edge.
My dog has seen an internal medicine specialist and so has a different cat for allergies. I wasn't as impressed. It really depends on the vet you get.
Inky also had asthma but vets ignored me about his symptoms until it was advanced. He had to go on steroids occasionally but they did try to avoid them. I hate steroids since I feel they contributed to killing my dog and I won't use them unless very short term.
Inky loved the royal canine canned diabetic food. Raw food is probably better, but inkys weight stabilized and his coat became nice and shiny. He also stopped getting awful skin infections. He's the cat in my avatar.
What did the internal medicine specialist do for Inky?

And I’m sorry to hear about your dog :( I think everyone is very cautious about the steroids here. He’s was on half a tab of 2.5 mg for two days. So he got 2.5 mg of pred in total.

Last night, Ming’s BG stayed in the 20s unfortunately and at one point was at 33.3. I thought maybe it’s a rebound/bounce. The night nurse doesn’t think so and is thinking the prozinc just isn’t lasting long enough. A FDMB member had recommended Lantus a depot insulin. So blah.

No ketones though
 

PushPurrCatPaws

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May 22, 2015
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My last kitty had diabetes for four years (we used Lantus twice daily). In her last year, she developed bouts of pancreatitis and other issues.

Our vet never wanted to use any steroids with her since, already having diabetes and pancreas issues, steroids would raise her blood glucose levels and this would really interfere with us trying to control her diabetes.
 

inkysmom

Inky's legacy - Belly rubs CAN tame feral cats!
Alpha Cat
Feb 12, 2017
477
830
Massachusetts
Sorry for the late reply. Inky stayed on ProZinc only, they just cautiously adjusted the dose and kept him on the Royal Canin diabetic canned and wet food and had me be very strict about the portions. He got from 10 pounds when he was diagnosed to 16 pounds then down to twelve or thirteen pounds which was his ideal weight. As he stabilized his awful skin infections healed and he got beautiful thick shiny glossy black fur, hence his name, with no skin issues at all. His chronic otitus in both ears even started to heal so that I could go down to medicating his ears only once or twice a week. His teeth were bad and falling out I'm forgetting the name of the dental disease but he stabilized enough to have the dental surgery and have extractions he still needed. They left him a couple of very sharp fangs which he freely used to bite me, both in love bites during belly rubs and if I ever raised my voice or told him to behave for nail trims or medications.
He stabilized in under a year and became a beautiful thriving healthy cat. Just as he was doing his best his otitus got bad and they recommended a total ear canal ablation in both ears. I took him to a dermatologist for a second opinion and he got an abscess in his neck so then took him to the ER. They eventually discovered he had cancer in his ears which was supposed to be 90 percent treatable with a low recurrence rate so he had the ear canal ablations and became completely deaf.
He was healthy and pain free and started playing with a toy mouse and the other cats and acting like a kitten which I'd never seen before. After a couple of weeks of some aggression from freaking out from being totally deaf after the second ablation . Calming suppliment and phermones helped.

A month later my dog started frantically washing Inkys ears again. He'd done that when he first had cancer. I took him back to the oncologist and insisted on more biopsies despite his insistence on the 90 percent odds of no recurrence for five years. . It returned and metastasized to the lymph nodes. Two chemo treatments didn't work and the second one made him very sick. He passed away June 5, 2017 despite all my best efforts. On what would have been my mom's birthday. She died from cancer years ago.
His diabetes stabilized from adjusting the ProZinc. He literally went from one unit twice a day to five units twice a day, which sent him into a hypoglycemic emergency and overnight stay in the hospital. He did best around three units twice a day when eating normally.
In the beginning when he was sick and the last few months when he was having so many surgeries and then had pain and nausea from the chemo it was very hard to monitor how much to give him. At home the only way to monitor cats blood sugar is with tests from the ears and his ears had constantly bleeding tumors. I had to keep his whole head swathed in stockings and bandages which he'd take off and literally my bed and apartment would look like a crime scene. But the blood from the tumors was too thick to use to test for blood sugar. I could not bring myself to prick his skin or touch his ears at all except to give him pain meds and bandage him. I couldn't risk causing him any pain especially with the incompetent idiot oncologist who shouldn't even have a veterinary license who abruptly cut him off his pain meds one time and refused to treat him when I had him hospitalized for comfort when I was working twelve hour days and didn't want him alone suffering at home.
So usually I just watched how much he ate and held the insulin unless he ate his usual amounts, figuring high blood sugar was safer in the short term than hypoglycemia.

But I only had to manage him with diabetes for two years, although he seemed to be a tough complicated case for a lot of the time. For whatever reason, they didn't want to switch the type of insulin, just the dosing.

Sorry to ramble so long! I have a different cat with cancer now and always get emotional thinking about Inky. He really taught me a lot since he was the only truly feral adult cat I took in and tamed to be a sweet loving house cat. I think when you're able to bond with a truly wild adult animal and nurse them through a terminal illness and multiple other chronic health issues after years of chronic care, they demand your heart and soul 1000 percent. You have to earn their trust and love and can't hold back yourself, it's an all or nothing bond. And it means the world to win their little hearts when before they'd attack you if you got close.
I hpho Ming is doing better and his diabetes stabilizes. It really is such an all encompassing terrible disease.
 
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