How much is too much?

I'm sorry I haven't posted lately. I have a lot of photos from Boston. I've been a wreck this last week. Mikey had a severe diabetic episode. For those who may not know, Mikey is my 8 year old polydactyl cat. His diabetes has been well controlled with insulin injections. Apparently he hasn't been eating enough--which for those of you with cats, diabetic or not, if your cat stops eating, take it to the vet ASAP. DH was taking care of the cats while I was away and he is at work all day so he wouldn't have noticed anything unusual per se. The cats also don't hang around him whereas they swarm around me.

On Monday Aug. 3 as I was leaving to drive home, DH called me and said that Mikey didn't come for his kitty treats Sunday night and didn't eat Monday morning. I got very worried, thinking that maybe he was getting too much insulin. I worried all the way home. DH got home at 7 pm and I was just north of Baltimore at the time. I asked him to rush Mikey to the vet (who closes at 7:30). By that time DH had to pull Mikey out from under the couch as he couldn't stand on his own. I got home just as DH was coming from the vet with instructions to rush Mike to the ER Vet whom she called ahead.

Our vet said that Mikey had DKA (diabetic ketoacidosis) and it was a life threatening situation. With DKA, their blood sugar is too high for a long enough time for them to get severely dehydrated and their body creates ketones. Typically the treatment is to hydrate them with IV fluids to get their electrolytes up and they will eventually pee out all of the ketones. I was floored as I suspected the opposite--too low sugar. Mikey also appears to have Hepadic Lipidosis or fatty liver syndrome. This is what happens specifically to cats when they stop eating. The liver basically attacks its own fat reserves and if this isn't treated, they can go into liver failure. The treatment for this is food. Many cats have to be force fed with a syringe and many go on a feeding tube.

I was, and have been completely heartsick. I thought he looked like he had lost a little weight. Why didn't I take him to the vet? I will forever beat myself up over this. The vet gave me an estimate for 3 days of treatment which was $1100 - $1600 and I paid a $900 deposit. She said that typically the DKA clears up in about 3 days but can go as long as a week. Anyway, I went to see Mikey on Tuesday and he was still lethargic, but he purred when he saw me. Wednesday he could pick his head up and he tried to meow, but he seemed to have laryngitis. Thursday, he was very talkative and looked quite bright. He still wasn't eating so they put a nasal feeding tube in since he was too weak for a regular feeding tube. He was also using the litter box. He continued to look better on Friday. His electrolytes were still low and they were still concerned. On Saturday and Sunday, he seemed more tired and he had diarrhea on Saturday night. The weekend vet said she didn't have a good feeling about him and I got the impression that she was basically saying to put him down. She didn't think he was strong enough to undergo the anesthesia to insert an e-tube. On Monday, he seemed better and his electrolytes were in the low normal range. I had kind of decided that I would bring him home Monday and take him to our regular vet to put down that night. The question is--how much do I spend on this? I've spent $2800. Do I just put him down after that or spend another $1000 to nurse him back to health? He is very jaundiced. His ears, gums and his little pink nose are yellow, though they looked a little better yesterday. Do I spend the $350 for an ultrasound to more accurately diagnose if it is pancreatitis or a liver issue or do I put that money into getting a feeding tube for him? The vets are basically treating him for the various conditions it could be.

I've been getting a lot of support from the ladies on the Feline Diabetes board. Four of them told me stories of their cats who were actually worse than Mikey. All of them had an e-tube put in and got their cats on their regular diet that way. An e-tube goes into the esophagus and you use a syringe to put the food in it. You can feed the regular canned diet if it is pureed and thinned a bit. All of these people said that their cats improved quite rapidly with this and they suggested getting the feeding tube asap so that he can get stronger.

I've been so torn and my stomach has been in knots the last 4 days. The other cats for whom I've made end of life decisions have been such clear cut cases--elderly with kidney failure, cancer etc. Mikey is only 8 and this seems treatable. It's just taking longer than usual for the ketones to clear up. The vet last night said that he was actually trying to climb out of his cage and she thought we shouldn't give up on him but she understands the financial need to get him home.

We made a plan. This morning they would take out his nasal feeding tube to see if he would eat. If he didn't eat, then they would insert an e-tube. I will bring his regular diet for feeding as that is essential to regulate his long acting insulin which they hadn't been able to do. He has been getting short acting insulin every 4 hours and he has to be off that to come home.

So this is where I've been all week. I'm an emotional wreck, breaking down in tears at the most inconvenient times. People who aren't pet lovers don't understand. It's hard to put a monetary value on a treatable condition. If Mikey makes it home, he will require a lot of care. I'm hoping that I can get his tube feedings down to 8 hour intervals before I go back to school. I will also have to do home glucose testing, which I should have been doing all along.

Please say a little prayer for Mike!

Kitty Cam: Here's Mikey, looking fairly bright with his new feeding tube last Thursday: