lady_curmudgeon: (Lars)
2016-05-25 09:17 am

State of the Lars: tentatively optimistic?

The trip out to VCA Aurora was a busy one. It included an ultrasound and a complete renal evaluation. The following is a summary from the summary we got from the internal medicine service.

Physical Examination: Coat is unkempt in appearance, patchy loss of hair or thinning hair; oral exam presents mild to moderate dental tartar; abdomen is distended and mild discomfort on palpation; cardiovascular presents stage II/VI parasternal heart murmur (this is down from a stage IV/VI heart murmur previously--must've been previously misdiagnosed somehow at VCA Aurora, as our regular vet has always insisted Lars had a stage II vs stage VI)

Diagnostic imaging: abdominal ultrasound revealed small left kidney with moderate renal pelvic dilation (we already knew this from last year's ultrasound--this kidney is basically thought to be non-functional); the right kidney has caudal infarcts which appear to have worsened since the last ultrasound; crystals noted in the urinary bladder (not stones as Dr. E and Dr. L thought); the renal pelvis contains a single stone; pancreas is mildly thickened in comparison to previous studies; mildly hyperechoic liver.

labratory testing: paraphrasing the tech-blood gas analysis came back as being unremarkable; blood glucose came back as hyperglycemic under their parameters at 217. We consider hyperglycemic to start around 250 for Lars ever since his hypoglycemic event back last February, so at 217 we personally consider that to be a pretty good number; kidney values: BUN at 45 and Creat at 2.6--on Saturday they were at 66 and 3.7 respectively, so both of those numbers have come down nicely with the daily 100 ccs of subcutaneous fluids.

Blood pressure: normal at 140/90 This is important because cats in renal failure tend to have high blood pressure.

Pending tests: PTH/Ionized calcium; urine culture and sensitivity; urinalysis

Diagnosis**Open for urinary straining: cystitis vs. urinary tract infection
**Stage II Chronic Kidney Failure
--Renal calculi (stone) with no evidence of obstruction
--Renal infarcts (right)

medication: No medications prescribed or changed today. Continue any previously prescribed medications/treatments as directed.

diet: A renoprotective diet is recommended (ha, good luck with that)

TL;DR: "The ultrasound performed on Lars today shows a single non-obstructive stone within the pelvis of the right kidney. There are suspect crystals in the urinary bladder. There is no sign of urethral obstruction. We are sending urine out for analysis to determine the presence of a urinary tract infection.

"As we discussed, the increased chronic elevation of calcium can cause an increased risk for soft tissue mineralization and stone formation. Once we receive additional blood work we may suggest medication changes."

So after all of that, and A Lot of $$Money, no blockages were found and Lars' kidney values are actually improving again. Figures, right? :o/ Regardless, it was worth the peace of mind to rule out The Worst Case Scenarios. Now we get to wait up to seven business days for the pending results; the ionized calcium test gets sent to a university in Texas if I'm not mistaken, so...yeah...

I think the best part of the day, aside from the most wonderful news of decreasing kidney values and no urethral obstructions, was the vet tech telling us what a good patient Lars was! He was so good, in fact that they didn't need to sedate him for the ultrasound! That's a bit unusual as far as I've heard. I'm still so very proud of my good boy!! :o)

I will definitely keep you all posted on how things progress!! :o) Thanks again for all your support, good thoughts/mojo/prayers/etc.
lady_curmudgeon: (Lars)
2016-05-22 09:58 am

State of the Lars: Sigh...

Things did not improve after his last vet visit and the daily sub-q fluids. His appetite still waned despite the Mirtazepine appetite stimulant kick-starter, which was a concern. What sealed the deal was yesterday morning when he both downloaded a watery deuce in the litter box and followed it up by vomiting what remained of his dinner the night before twice about five minutes after that.

While we could explain away the diarrhea (his constipation med is stimulated by hydration, so with the added hydration of the daily sub-qs along with not lowering the dose of his constipation med...that could be an explanation), we could NOT explain away the vomiting. Vomiting in a CRF kitty can be a sign of worsening renal failure (more toxins in the body making kitty sick), so I called Brookville and go Lars squeezed in onto Harlow's already scheduled laser therapy appointment.

Physical exam was unremarkable, but Dr. E agreed that we were probably right that something might be up, especially in light of the recent discover of all the stones in his bladder and working kidney. A blood chem panel was in order.

Results were not good. Kidney values continue to worsen, and badly. Dr. E and Dr. L talked about things and they both agreed that it's a pretty good bet that Lars probably has some sort of blockage in his urinary tract/system from one of the stones, and that surgery is probably indicated, and soon. The thing is, neither of them is willing to do it with their skill sets on such a chronically ill cat...

Dr. E said, given the worsening numbers, the best bet would be to bring Lars out to VCA Aurora or Arboretum View to one of the specialists for a more experienced/skilled vet's look see. We've been going out to VCA Aurora to Dr. Medinger for awhile for Lars' myriad health issues, but Dr. E likes the specialist (whose name escapes me right now) out at Arboretum View better because he's got "a much better bedside manner". We've never really had a problem with Dr. M out at Aurora, save for he talks too fast sometimes and he's always in way too much of a hurry, but...yeah...We're going to stick with Dr. M and VCA Aurora because they know Lars and his issues pretty well...

I was actually able to get Lars into Dr. M's schedule tomorrow at 1100 for a longer initial consult appointment for his current issues. Whew! I'm to bring all of Lars' current meds with us and to arrive 15 minutes early for paperwork. Can do, though it might be interesting, what with me having to wrangle him by myself as J absolutely cannot take tomorrow off. The cage puttings in are going to be the hardest, I think. I think I can handle the meds carrying by putting everything in a backpack, LOL; the hardest thing to tote will be the fluids bag, which is sorta too big to safely put into even my biggest purse.

So...yeah...Preparing for A Large Vet Bill tomorrow, as well as Really Bad News about my boy. I'm heartbroken, scared, and totally worried for my Lars cat. :o( I simply cannot fathom life without this floofer nutter. I just can't. :o(

If you're the praying/chanting/candle lighting type, could you please add Lars to your healing energy rituals for awhile? If you're not into that sort of thing, could you send some good thoughts his way anyway? We'd all appreciate it out here... :o/ <3
lady_curmudgeon: (Lars)
2016-05-20 07:43 am

State of the Lars: Bladder and Kidney stones...

As of the last couple of weeks, Lars' appetite has been less than optimal. We've tried introducing different, non-Rx food, which he really appreciated initially, but then quickly became disinterested in. So...A trip to the vet was in order.

Took him in last Saturday. Physical exam was uneventful, though he'd lost a couple of ounces from the last time he was seen. Dr. E suggested a short blood draw to make sure his kidney functions were still stable. Nope--his kidney values were a slightly elevated, as was his calcium levels, which could indicate dehydration, or, obviously, that his kidneys were getting worse. Switch from diabetic diet to renal diet, and introduce twice weekly sub-q fluids.

At first Lars ate the renal stuff, especially the kibble, with a fair amount of gusto. But that only lasted the first few days. Then...Meh. Call Dr. E back. She asks if Lars pees a lot. Of course he does--he's both diabetic and in stage 2 renal failure! Could you bring him back in for a urinalysis? Sure!

Urinalysis shows visual signs of blood and, of course test positive for same. X-rays are done to determine if there's any crystals or stones in the bladder/kidneys/urinary tract. Jackpot! Several small stones in both the good kidney and in the bladder, and a undefined blob in the bladder that could either be an uncalcified stone or, more likely a blood clot. Ultrasound could be done to try to determine the exact nature of the blob, but it'll probably come back inconclusive and Dr. E doesn't want to waste our time or money on that just yet.

The usual course of action for so many stones in the bladder especially is surgical removal. Because of Lars' multiple health issues (asthma, diabetes, stage 2 renal failure, stage 2 heart murmur, etc), he's not a good candidate for surgery as he might not survive anesthesia. The second course of action is daily sub-q fluids to flush out the stones, which brings the obvious risk of urinary tract blockage, especially in a male cat. :o( Our choice, as Henry Rollins' old monologue bit goes, is fish--it's got to be the sub-qs for now. We're to administer 100=150ccs of fluids every day for a week, then return for follow-up x-rays to see how many stones have been evacuated.

How the hell did we miss this? Lars has been straining in the litter box for awhile, but he's got chronic constipation among his chronic health issues, too, so we thought he was straining from not being able to poop. The blood? Well, we use a combination of grey colored Cat Attract litter and brown colored World's Best cat litter and the brown stuff turns a lovely dark brown, which to mind, disguised any signs of blood that might have been present. Sigh.

All that on top of J and me being distracted with my recovery from my back surgery...yeah...We've now got a fairly seriously sick(er) cat. My heart is breaking and I feel like a rotten cat parent for not noticing sooner and taking action sooner. I know, I know--cats are good at hiding their discomfort and illness, we're dealing with multiple illnesses to boot with him so it's harder to tease out what might be wrong, we've got our own life distractions in the way, etc. But...yeah...Still beating myself up for this.

Will keep y'all posted on what happens... :o/
lady_curmudgeon: (Lars)
2016-03-03 09:47 am

State of the Lars: our first diabetic hypoglycemic event...

We had to go out of state for a funeral (my Uncle Fred, who lives in Ohio, died) over last weekend, so we had to board the kittehs while we were gone. Things went well according to all reports. They did mention that he'd been picky with his wet food but that he'd eaten his kibbles pretty well, and that he'd only needed insulin that morning when I'd come to pick him up.

Brought him home and he was acting normally initially. He disappeared not long after I got home, but that's not unusual for him. J got home from work around 1830, was looking for the kittehs to say hello again after not seeing them since Friday morning, but couldn't find Lars. Weird...

Fast forward to around 1900-1915; we hear one of the cats start howling. Sounded like a Dorene howl when she saw a strange cat outside. Happens again, but it's coming from the den. Look around and find Lars hiding under the Fancy Chair, looking Not Right. Eyes dilated, panting. I ask J--should we take a blood glucose reading? Yes...

Do it, comes back at 23!!! WTF?!?! Shit!!! We know to give him sugar right away, but the only liquid form of sugar we have in the house is maple syrup--okay, that's gonna have to do. Give Lars a bit via syringe while I'm calling up Brookville trying to get ahold of a vet there to let them know/ask how the fuck to proceed as they're about to close for the night and do not offer overnight care. Dr on site says to it's better to use light corn syrup, but maple syrup will work, too. Give 2cc every 10 minutes, then test blood glucose (BG). Call back right after. We manage to get the BG up to 28, lather/rinse/repeat, it goes back to 25.

Time for the e-vet. We bundle a very limp and unresponsive Lars into his carrier and drive him out to Lisle's Emergency Veterinary Services. They do a quick triage on him and determine he needs to stay overnight. We tell them his extensive medical history, give him all the vet information for both Brookville and VCA Aurora, and go home to try and rest so we can get up in time for the 0730 deadline for pickup.

We get a call around 2330 from Dr. S at the E-vet--Lars' BG is not coming up very quickly. In fact it goes up a little bit, then goes back down again. They've been giving bostules (like bursts) of dextrose along with the constant dextrose drip, feeding him, and giving him a high calorie gel supplement. She wants to run blood work on him to rule out any other issues going on--I give consent. All blood work comes back normal, thank Bast. Also, Lars had a couple of bouts of diarrhea--probably related to stress. Probably wouldn't want to give Lars any of his Lactulose constipation medication for a couple of days once he was home...

Lars' BG finally comes up and maintains a low normal in the 150s around 0500. We get sent home with an almost full bag of IV fluids with glucose, a tube of the high calorie supplement, the Cone of Shame that Lars had been wearing because he'd been fussing with the catheter during his stay, and Lars with the capped catheter still in his leg. He's to go straight to his regular vet for further monitoring, so I take him right to Brookville. No docs were in when I got there, but they had the faxed over docs from the e-vet and knew that Lars was to continue on the Dextrose IV drip, so they did that until one of the docs arrived.

I had my pre-op screening with my GP at 1000, so I did that and just drove right back out to Brookville after my appointment was done to get a Lars update in person. Dr. Lyn told me Lars' BG was stable in the 150s and I could take him home, to go back to our regular routine of checking his BG twice a day, and to let him "run hot" as the e-vet recommended for several days, meaning no insulin even if his BG was over 200 to let his body systems recover a bit. Also, reminded me to forego the Lactulose for a couple days, too.

Get home and notice the first thing Lars is doing is fussing with the compression bandage where the now removed IV catheter had been. I knew it was too soon to try to remove same, so I put Lars back into the Cone of Shame for an hour before I called back Brookville to see when I could remove the bandage safely.

I got the all clear around 1215. Take the Cone of Shame off of Lars so it's not in the way and get to work. It was a bitch to get off. In fact...Yeah...I couldn't get it off. I tried to find the loose end on the wrap, but it was so tight I couldn't get it off. Lars was uncomfortable and showed it with gentle licks and nips until...all of a sudden...CHOMP!!! Bit my left thumb in the middle of my cuticle line very VERY hard--so hard I thought I heard a crunching noise. I leave Lars where he is on the bed, grab the phone with my good hand, and race to the bathroom to go put my thumb under hot water to start flushing the wound. It was bleeding quite well and it hurt like a mother fucker.

GPs office tells me to go directly to Urgent Care, where they've got more means to care for me than their office. I go, get seen right away. Betadine soak immediately after initial exam, then x-rays of my thumb at my stern prompting to make sure no bone chipping happened from the bite because of the crunching sound I heard. X-rays came back clean. Get a scrip for high dose Augmentin for ten days, instructed to soak thumb at least twice a day in warm water, to wash it at least twice daily with antibacterial soap and to keep it bandaged up for at least the next 2-3 day and then to leave it unbandaged overnight thereafter.

Go home and find that Lars has partially chewed some of the compression bandage off his leg. I'm out of give-a-fuck calories at this point and decide to just let him chew at it until his daddy gets home. :o/ Once J gets home we try again, have no luck, and finally dig out the first aid snub nosed safety scissors and do what I should've done in the first place and cut the fucking thing off. We're all happier for the fact that the bandage is finally off.

How's Lars doing now? Yesterday's BG numbers were in the mid 150s again, but this morning he turned in somewhere in the 270s if I'm remembering correctly; I don't feel like getting up to look at his log book, so...yeah, LOL. He's acting like his normal self for the most part. Active when he should be, seeking out attention. His appetite could be better, but it's not terrible by any means. Downloads are still a little soft, but coming around. J gave him 1 Cc of his laxative this AM, so we'll gradually ramp him back up to his normal dose on that.

That was some scary fucking shit. I hope we don't have to go through that again any time soon... :o/
lady_curmudgeon: (Lars)
2015-10-29 11:49 am

State of the Lars...Sigh...Confirmation of the Diabetes.

Dr. Medinger ordered blood work a couple of weeks ago--TLI and PLI to rule out pancreatitis skewing the glucose results; they came back with numbers indicating pancreatitis. But that didn't nullify the diabetes Dx...

After those results came back, Dr. M wanted to do a home based urine drop; evidently glucose levels in cat's urine are higher when they are stressed, and almost every cat is very stressed when at the vet's office. Got special litter from Aurora Cat Clinic, bought a new box for the proceedings, and plonked Lars into the guest/safe room for the morning last Friday morning.

It didn't take long for him to produce a sizable sample for me to bring out to the cat clinic for testing. The results were then sent to VCA internal medicine for scrutiny.

Many back and forth calls ensued, but the verdict has been handed down: it's official--Lars is diabetic.

What does the mean?

It means he's getting weaned off the prednisolone in favor of using the Flovent inhaler twice daily. Getting off the prednisolone should go a LONG way in getting his blood glucose under control, at least from all I've been hearing. It means Glargine insulin shots--one unit twice daily after his breakfast and his dinner meals. It means learning how to use a blood glucose meter, of course. It means transitioning from a renal diet to a diabetic diet. It means I get to *really* scrutinize his eating, drinking and toilet habits much more closely now.

It's just another crack in my already crack filled breaking heart for my sweet boy. This is becoming A LOT to manage, but I know we'll figure out how to do it all. We have to--Lars' health depends on us. I broke down into a puddle of tears after I got off the phone with the tech who gave me the news/information.


Anybody out there with experience with caring for diabetic cats, any words of wisdom that can be imparted are very welcome...
lady_curmudgeon: me August 2011 (me August 2011)
2015-10-19 09:35 am

State of the Pam...stupid autumn colds...

It started on the 7th with a tickle in the back of my throat, which quickly progressed to feeling like I had a bunch of prickly hay stuck back there. On the 8th the runny nose like a faucet came, and I missed bowling that night because I was in no earthly shape to bowl in that condition. The 9th brought The Cough and the Wheeze, which sent me to the doctor--among my myriad health conditions, asthma is one I live with, so when I get a cough/wheezing I don't play around. Got some Rx non-narcotic cough meds, instructions to use my rescue inhaler every six hours (at least), to up my maintenance inhaler from one puff twice daily to two puffs two puffs twice daily, and to resume using my steroid nasal inhaler for the duration.

Woke up early last Monday morning still coughing like mad and feeling like an elephant was sitting on my chest. This is Not Good. Clearly, things were NOT improving, so I managed to get an appointment with my GP's physician's assistant and ended up getting some of the Good Stuff (cough syrup with codeine) for my cough and told to continue all my other meds as previously instructed save for my rescue inhaler, which I was to use every four hours now instead of every six. Because my nasal discharge and my somewhat productive cough were bringing up clear/ivory/barely yellow crap, it was declared that my condition was still viral, so no antibiotics were prescribed. Also, my oxygen levels according to their finger thingus showed my saturation was still at 98 percent, so no steroid pack was indicated either.

Switching over to The Good Stuff for my cough and changing up my rescue inhaler regimen helped A Lot; while I was still breaking through with some coughing, I no longer felt as though there was an elephant sitting on my chest. So some improvement?

Things were going well enough mid-week where I decided to forego The Good Stuff during the day in favor of the non-narcotic stuff so I could drive to bowling on Wednesday night and I did alright. More coughing, but nothing terrible. Bowled like shit (like about 20 pins under average shitty, but oh wells), but I got through without exhausting myself too terribly. Decided that, in order to conserve the small amount of The Good Stuff, I would continue to take the non-narcotic cough med during the day and save The Good Stuff for nighttime so I could sleep. That meant coughing more during the day,'s the price we pay.

Called the doc's office to speak to the triage nurse to ask how long I could expect to feel crappy/expect to cough and they told me that the average with what's currently going around is at least two weeks. I'm passing that mark right now. Ugh. :/ Was advised to "stack" both my cough meds with some OTC cough med like Delsym, which I've been doing and it's been going a long way to quell the coughing. But when that shit wears off? Yikes, I cough like a multiple pack a day smoker. I'll probably call back the doc's sometime tomorrow or Wednesday if I'm still coughing like I've been to see if they want to see me again.

Sigh. Damned meat suit... :/
lady_curmudgeon: (Lars)
2015-10-06 10:47 am

State of the Lars: Yet *another* health issue!

We took Lars into Dr. B on Saturday the 26th for a check of his serum calcium and his ionized calcium to see how the Fosamax is working out for him. We also mentioned how much water he's been drinking of late and how much he's been urinating. We figured it might be a kidneys issue going on, so we figured an abaxis blood draw to check his kidney values was in order. Dr. B thought differently--he wanted a full blood panel to check for everything.

Good thing, that...

Lars' serum glucose came back at 240; high normal is 170 evidently. A second blood test was ordered (forgive me, but I don't remember the name of it--I'll get the name of it from the paperwork I'll get from VCA Aurora eventually) to help confirm and it came back high normal. Dr. B had us bring Lars back last Friday for the day for a urine capture to see if his urine was positive for glucose. It was.

Lars, it seems, has diabetes, in addition to his other myriad chronic health problems.

Dr. B seems to think it's the Prednisone that's brought it out into the open, that reducing the dose and eventually eliminating it will bring the glucose numbers back under control. That being said, he's deferring to Dr. M at VCA Aurora internal medicine for counsel since Lars is already under primary care for his other conditions there. We're currently waiting to hear back from them.

Sigh. My poor, sweet, broken boy...
lady_curmudgeon: (Lars)
2015-09-05 10:23 pm

State of the Lars:First try with the Inhaler...

...and blood was shed. J's blood to be precise. Lars lacerated J's left index finger in the process of me trying to actuate the inhaler the first time tonight. Sigh...

The AeroKat chamber contraption is really quite something. It came with two masks--one that was about two inches in diameter or Lars size and one that was about 1 1/2 inches or kitten sized--obviously we went with the larger. Got everything prepped, Lars none the wiser, and set to trying to get him properly medicated.

We figured he'd freak so J tried to do it on his own, scruffing Lars and holding his head while I held the inhaler/mask to Lars' face and actuated the inhaler. HA! The lacerating happened within the first minute of that fiasco. Onto the floor we went, with Lars' body pinned to the floor, J struggling alternatively hold back paws, scruff, and hold his face for me. The goal was for me to actuate the inhaler, get Lars to take seven breaths with the mask to his face, then be done with it. He was so squirmy and out of control I think we might have managed two-three breaths before it became futile to keep trying.

But it wasn't over yet! No, it was time for the remainder of his evening meds--the Lactulose and the Prednisolone. That didn't go well, either, with Lars wearing more than a bit of both meds. J was understandably irate that he'd gotten quite nastily lacerated and I was freaked out that my cat was so freaked out AND that my boyfriend was so badly lacerated. Sigh.

We've got a grooming bag we can restrain Lars in if needs be for future use--I bought that "just in case" before I knew he was even an asthmatic cat, because he's so notoriously difficult to medicate and trim his claws, too. Hate to traumatize him with that, but who knows? He might actually get some comfort from being bound down.

Lars is simply NOT good at being a chronically ill kitty. Though he's not done it in the evenings just yet, he's taken to hiding in random places around the house every morning after he eats his breakfast in efforts to avoid getting his AM medications. :/ When he first started doing this, simply shaking the Mystical Bag of Treats would get him out of his hidey holes--reward him with a bunch of treats, medicate him, then reward with a bunch more treats. But now he's gotten wise to that and won't come out for that. :/ We search the house (and it's not a terribly big three bedroom ranch) seemingly endlessly for that fucker every morning, which is a drag, especially on mornings when J has to be at work early. We can't medicate before food because the prednisolone is rough on the tummy and the lactulose isn't much easier on him without a food buffer, either, so the reward with breakfast trick is straight out. Sigh...

He's still my sweet soulmate cat, though, all the troubles be damned. My heart breaks for him; I know how much of a drag it is being a chronically sick being, and I can cognitively understand my situation, whereas he obviously cannot. Poor floofy fella... :/