D-Day

Today was one of the hardest days of my life. When I woke up this morning Catcher was extremely lethargic. He's not been eating well the past few days. Over the weekend I was at a seminar in Methuen and he began tanking water and urinating frequently. The poor guy had several accidents in his crate during the day and at night he would scream to wake me up and let him out. I feared I knew what was causing it, but clung to the hope that it was a displacement behavior due to stress. He got better Monday and had a good day. Tuesday he started seeming lethargic again. He has been unable to keep any food down for the last 2 days. Last night his temperature was 102.8. I called my vet first thing this morning. Of course they were closed for a staff meeting until 10:00 but I left a message saying it was urgent.

When they re-opened for appointments they called me back and we rushed him in. His temp was 102.0. We ran a urinalysis and blood work. While waiting for the results I took what I thought may be the last picture I would have of him.

 Here are the notes from his chart:

Findings:
Weight: 37 pounds (he lost close to six pounds in 3 weeks)
weight loss, decreased appetite
started Tacrolimus yesterday, clinical signs of pu/pd (increased water consumption and urination) began prior
run full urinalysis, CBC, chem profile, radiograph thorax/abdomen (suspect blockage)

Urinalysis:
Glucose ++++ Ketones ++
Cloudy, dark
negative for: Leukocytes, nitrite, protein, blood
Normal for Urobilinogen
Specific Gravity 1.020 - 1.033 (two different numbers on two different spots)
Ketones 40
Glucose >2000

At this point I'm sitting on the floor with him in my lap wondering if we're going to survive the morning.

Radiographs: 2 views, lateral thorax and abdomen. Normal findings, no blockage (damn, that would have been the better hope)

They tested his blood glucose it was 448. His ALP - 339. ALT - 132. Na - 135. K - 5.2 (N)

We decided the best course of action (and really only course) was to admit Catcher for the day. They would give him an IV and start him on insulin. He was so sick he could barely move. I left him there and headed to work (as I wasn't being allowed to take the day off). I spent the rest of the day trying to hold back hysterical tears while awaiting news from Mom. I told her that I couldn't lose him one week before his 2nd birthday. That after the 12th I would make any decision needed, but he was having a 2nd birthday.

Treatments for the rest of the day:
IV catheter: 84 ml/hour
0.04 ml (4 u) reg insulin IM & 2 cc Cerenia SQ @ 1pm
Blood glucose @ 2:30: 422
Gave 2 units insulin @ 2:40pm

Notes/Suspected Diagnosis:
Treating for Diabetic Ketoacidosis (frightening words to me). Given recent diagnosis of KCS suspicious of underlying autoimmune disorder. Sent tick panel, TLI, and Immune Profile to Idexx. Currently treating with more aggressive protocol of hourly reg. Insulin IM injections and will switch to SQ reg insulin or Humilin N insulin accordingly. Tentative plan of stabilizing, sending home for the night, then arrange drop off again in AM to continue treatment.

Continued Treatments:
3pm: Brighter. BG @ 2:30: 422 - begin hourly 2 units reg. insulin IM
3:30 - 2 units
4:30 - 2 units
5:30 - Blood Glucose 188

Catcher was sent home with the instructions to give him some dinner at 10:30. I believe we were sent home with I/D but cannot be positive. Then to wait one hour to make sure he held it down and give him insulin at 11:30 pm. He did seem brighter when he got home that night. I kept him with me in the living room. I slept on the couch, and he slept next to me on the floor.