Prognosis??

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Morpheus1967

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Good afternoon. It has been awhile since I posted, but I come to you in dire circumstances.


We have a 15 year old diabetic male cat. His name is Miller. Other than the diabetes, which was diagnosed 2 years ago, he has been generally healthy. Diabetes is under control with 3 units twice daily. He is neutered.

We brought him to the vet last Tuesday due to some excessive drooling. He was diagnosed with some bad tooth disease. They ran blood tests and took chest X-rays to determine if he was healthy enough for the needed oral surgery. He passed all tests on Wednesday, and the surgery was scheduled for October.

Two days later, on Thursday, we ended up at an emergency vet hospital. His breathing had become very congested, and the sound of his breathing was terrifying. At the emergency vet, he was diagnosed with an upper respiratory infection, most likely caused by the bad teeth. We were sent home with Clindamycin for the infection and some nose drops for the congestion. He was also given an injection of a broad antibiotic and sub cutaneous fluids.

Starting on Thursday night, he quit eating and drinking. Early this morning (Saturday around 6:30am), we were back at the emergency vet. He still had not eaten or drank anything since receiving the fluids Thursday night/early Friday morning, so about 36 hours.

They ran a full set of bloodwork and a set of chest X-rays. He had lost a pound (13.9 down to 12.9) and his sodium levels were through the roof. His X-ray also showed possible fluid on the lungs and a slightly enlarged heart, possibly indicative of heart disease. White cell count was also elevated. He was severely dehydrated.

We were given two options. The obvious one, euthanasia, or try to save him, at a cost of $4,000-$6,000. We chose to try and save him, meaning a couple of days in the hospital. That was at 9:00 this morning.

They just called, about 7 hours later. While they said he is “handling the intravenous liquids like a fighter”, his sodium levels actually went up, despite the fluids. Euthanasia was mentioned again, but it was decided to give him the night to see how/if he responds.

Are we hoping against hope here for a recovery? Or are we simply prolonging his suffering? The vet hasn’t come right out and suggested euthanasia, but having mentioned it twice, are we just not getting her hints? With the enlarged heart, and possible fluid on his lungs, and the highly elevated sodium levels, is there any chance for a meaningful recovery? Knowing what I have told you, if this were your cat…
 

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Hi. If it were me, knowing only what you told us, I would say give him a chance. But, you need to ask what they think is behind the increased sodium level, was his enlarged heart missed with the testing they did to approve him for dental treatment or a new development (and, if so, why), and to have a thorough and complete discussion with the vet about everything - in terms you can understand with the opportunity to have clarifications given to you when you don't. You deserve to have all the information you can have to make any decision and I am not sure you are there yet.
 

stephanietx

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The URI was most likely caused by the stress of going to the vet. The inappetence is a side effect of Convenia, if he was given a Convenia shot. If he's not eliminating yet, it may affect his sodium level.
 
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Morpheus1967

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The URI was most likely caused by the stress of going to the vet. The inappetence is a side effect of Convenia, if he was given a Convenia shot. If he's not eliminating yet, it may affect his sodium level.
Thank you for your reply.

I actually made an error. He was given the antibiotic shot by his regular vet on Tuesday, along with an injection of Cerenia (I have still not received a logical explanation for the Cerenia injection as he was not suffering from nausea at the time). At the ER vet on Thursday, here is what he was given or sent home with:

Robenacoxib 20mg/ml (at ER)
Fluids Subcutaneous (at ER)
Buorenorphine Transdermal (at ER)
Clindamycin 25mg/ml (He received two doses of this at home 24 hours apart) (Sent home)
Maropitant 10mg/ml (Sent home but never used)

He never had any issues eliminating. He was severely dehydrated when we brought him back in this morning (thus the 1 pound weight loss in two days).
 
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Morpheus1967

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Hi. If it were me, knowing only what you told us, I would say give him a chance. But, you need to ask what they think is behind the increased sodium level, was his enlarged heart missed with the testing they did to approve him for dental treatment or a new development (and, if so, why), and to have a thorough and complete discussion with the vet about everything - in terms you can understand with the opportunity to have clarifications given to you when you don't. You deserve to have all the information you can have to make any decision and I am not sure you are there yet.
Thank you for your reply.

We are definitely giving him a chance, at least through tomorrow morning. The ER vet thinks the sodium level is directly related to his severe dehydration, which was most likely caused by not eating or drinking anything for 36 hours or so. I have read that the clindamycin can cause inappetence, but I have no first hand knowledge of this, just what I read online. That's why I came here, you guys are a wealth of information.

We will definitely be calling his regular vet Monday morning. They are aware of his current situation (thankfully the er vet has communicated everything to his regular vet.) My issue with my regular vet is that when he was there Tuesday, he saw the "on site" vet because they were able to squeeze me in as I didn't have an appointment. I called them today to let them know that under no circumstances is that vet to give any advice regarding Miller's care, and instead to reach out to the two vets who have cared for him since we moved here in 2010.

It is just so damn hard. We had three cats, Mozart, Maggie and Miller. Mozart and Maggie passed at age 16 4 month apart about 3 years ago and with them there was really no decision to be made as their prognosis was dire (Mozart quit eating, absolutely no bowel movements for a week, lost a large amount of weight. And despite daily vet visits for 10 days, he never recovered. Maggie went in for a routine wellness check and they found a large tumor on her lower jaw, and she was euthanized the same day.)

And right now, my biggest concern is his lack of improvement after 7 hours. The er vet sounded surprised about it when she relayed the info to us.

This sucks.
 

FeebysOwner

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Yes, it does suck. I know how hard it can be. I just lost my 19+ yo cat 7 weeks ago today. She had numerous health issues, but never a respiratory one. She was misdiagnosed with an enlarged heart at one time a few years back, due to being older, the muscle tissue that holds the heart in place loses its elasticity, so the heart 'sags' and can make for the appearance of enlargement, so I know that can sometimes be the case. Not saying it is the case with your Miller, as you are working with an ER, who I would expect would know better.

I am a little surprised that they gave him transdermal Bupe, since he is in a hospital setting and can be given it other ways. There are some forms of Bupe that are a bit suspect, but there is nothing to be done about that once it has been administered.

Maybe 7 hours is just not enough to turn him around? I hope that is the case. Keep us posted if you don't mind.
 
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Morpheus1967

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I’m so sorry for your loss. It is such an absolute gut punch. I’m still not over losing my buddy Mozart.

I was surprised by the transdermal as well since we were there. But it was literally the middle of the night, stressful, and I didn’t even think to ask why.
Here’s my boy Miller:
IMG_0917.jpeg
 

silent meowlook

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Your cat is adorable.
Can you get a referral to an internal medicine specialist?
What are you doing about insulin since he isn’t eating?
 

Krienze

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Ohhh, he looks like my Sammy! LOVE tuxies!!

Praying and sending thoughts your way! BIG TIME. He sounds like a fighter!
 
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Morpheus1967

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He’s in the hospital now, and we brought his insulin with at their request. We had paused his insulin because he wasn’t eating, and I think he missed 3 injections. His glucose was wicked high this morning (400+).
 
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Morpheus1967

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I just wanted to update. Miller crossed over the Rainbow Bridge this afternoon. There were just too many things for him to overcome. I am glad we tried, but we just couldn’t let him suffer any more.

Thank you all for your help throughout the years. This site is invaluable to cat owners.
 

Krienze

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I just wanted to update. Miller crossed over the Rainbow Bridge this afternoon. There were just too many things for him to overcome. I am glad we tried, but we just couldn’t let him suffer any more.

Thank you all for your help throughout the years. This site is invaluable to cat owners.
I'm so so so sorry for your loss. Sending you hugs across the distance. You fought hard for him and he knew that. He was a very loved kitty.
 

Meowmee

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I am very sorry for your loss of Miller 💔…run free Miller 🌈🐾❤ watch over your family.
 

fionasmom

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I am very sorry for your loss of Miller. You provided a wonderful life for him and his friends, Mozart and Maggie. Both Miller and yourself fought as hard as you could and he is at peace now.

When a cat passes on, we lock the thread out of respect. If you would like to post a tribute to Miller, as you did for Mozart and Maggie, you are more than welcome to do so.
 
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