Tag Archives: Feline Diabetes

Fallout: Rigor Exacts Rigor

End of life care for a companion animal is always rigorous. Everything is hard right now. Taking care of my 17-year old, very ill cat, knowing he will never improve until the final resurrection, is hard.

I’m not heroic. I have multiple energy-diminishing conditions. I need nine hours of sleep at night, and I’m getting up with Coolidge, sometimes for one to three hours, often twice in a night, because I can’t bear to leave him alone. Or he dropped a bit of food in his water and declared it disgusting, and bellows his need for fresh water, several times a night. But those were the good nights: those were the nights he was still eating.

Now Inappetence wields its sword, advancing on my cat’s life. I confront the foe, unarmed except for some sugar-water solution. “Be gone, fiend!” I spritz some sugar water on my cat’s soft food. He is not impressed. He lies on his towel next to his living-room water bowl, guarding it with his arms. Coolidge, like galactic hitchhiker Arthur Dent, is very proprietorial about his towel. He has never had one before.

Things that go bump by day and by night are lack of sleep, grief over the inevitable coming end, not far off, of a longtime companion under my limited protection; frustration with my own limits, and fielding blind good will in the form of cheery optimism, sent by dear people afflicted with the cheery optimism gene. I wish there were a mutagen readily available, but the only known remedy is disciplined grace—on my part, not theirs. Why should they not hope for the best? The clinical realities are my problem. Theirs is to be a friend to me, and that is certainly more than enough of a load.

I proceed through my normal homekeeping routine, but now I stretch it out so that it takes longer. I take a lot of timeouts to tend to Coolidge’s details: clean-up, cajoling to eat, more clean-up, administering medications, more clean-up, consulting with my husband, our vet, etc. With proper pacing, I can work in an adequate spin on my stationary bike, write something, shoot some photos, and do anything else to avoid reading. Reading is exhausting and frustrating right now; the mental gauze of fatigue deploys its allies, depression and anxiety, making it too hard to track anything worth reading.

Only God’s merciful grace has enabled me to accept these days with my sense of purpose intact and the ability to press on; and it will be by God’s abiding grace alone that I will be appointed the strength to continue for the unknown number of days ahead.

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Another day, another diagnosis for Coolidge. . .and an example of when to change vets

I was prepared for it; I have long suspected it. Getting it confirmed required a change in veterinarians—not an easy decision in the late stage of the life of my companion cat of 17 years. Nine years of diabetes, two of hyperthyroid—a destructive enough alliance; confound these further with a UTI and antibiotics—we’re talking systemic overload. Coolidge had no appetite, and his potassium levels were cosmic.

I knew we needed a vet who thought more comprehensively and was more motivated by compound challenges than our vet of five years, which is the time we’ve lived here. The decision to change was hard. (What would the new vet think of our leaving our former vet at a critical time?)

But I already knew where we’d go. We met him three years ago. Providentially, he was the on-call emergency vet the day Coolidge had a clearly painful limp in the foot he had broken years earlier. My husband and I were impressed with the real interest this vet took in Coolidge, the extent of his knowledge, his investigation of the problem at hand, and his clear and affable communication with us.

I called yesterday morning and secured an appointment an hour out. The staff was cheerful and accommodating. I was permitted to remain in the exam room even while the doctor (not a technician!) drew blood—never a simple matter with Coolidge—and for everything else.

The doctor ran the blood sample and obtained the results then and there. I called my husband and asked if he could meet me at the clinic. He rescheduled a client and came over.

The crushing news of advanced kidney failure was mitigated by the doctor’s presentation of strategies for home care. Were we willing to give Coolidge subcutaneous hydration? Yes! The doctor showed us how. My genius husband can do this; it’s in his rancher DNA, even if he is a lawyer now.

Chronic renal failure (CRF) is the worst nightmare a diabetic cat’s person can confront. But we have been given a capable and caring new ally, motivation to meet the challenges before us, and the blessed prospect of a longer and higher-quality life for Coolidge.

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spiral

Coolidge, my companion cat of 15-1/2 years: we’ve gone through some rough diagnoses together. We’ve kept each other comfortable. I’ve treated his diabetes since 2006, and he’s purred at my side and diminished my discouragement since my diagnosis with Addison’s disease in 2007. Now he has also developed hyperthyroid. It seemed a simple thing to regulate—just a very small half-pill, morning and evening.

But the methimazole was treacherous. My cat stopped eating. The pill form of the drug can cause inappetence. He refused any and all low-carbohydrate canned foods he had eaten before the hyperthyroidism arrived. This was especially frustrating because kibbles jack up his glucose so much. I fought back with gradual increases in his insulin. Untreated, his thyroid would blow up his heart. Surgery and radiation aren’t thinkable at his age. Better to stay with methimazole and chase down the glucose numbers.

My vet and I decided it was worth the additional complexity to ditch the pills and go with transdermal methimazole, which doesn’t have the liabilities of the pill form, but it doesn’t have the simplicity, either. This formulation is prepared by a compounding pharmacy. I have to syringe a small amount of the medication into my cat’s ear. It resolves inappetence and GI issues in most cases, but the pills are normally prescribed first because they’re so much simpler to administer. If this would resolve his increased glucose levels, and even more critically, restore his appetite, it would be worth everything.

Inappetence in a diabetic cat can quickly bring on hepatic lipidosis—it took Coolidge only four days back in 2006— and a feeding tube was necessary for nine horrible weeks that summer. Pancreatitis also menaces the inappetent diabetic. And, obviously, so does starvation. So initially we fed him kibbles and the most wholesome treats we could find. They were like junk food, full of carbs, but they were the best food in the world, because my cat would eat them.

I broke into sobs the next morning when the heartless glucose meter read 372. It was 365 the previous evening, after Coolidge’s first transdermal dose. I have a low tolerance for slow progress.

My vet wanted me to try a diabetes management kibble, Purina D/M. I picked up a bag this morning, along with two cans of D/M, in case he might still transition back to the lower-carb canned form. Coolidge is finicky, but by God’s merciful grace, he tucked into the D/M kibbles with renewed alacrity. He snubbed the canned D/M, but at least he can get off the high-carb kibbles. Not only did he eat a small but sustaining portion, which in itself was enthralling, but his evening glucose was only 95!

There’s a reason this chow costs $34 for a six-pound bag. It’s the only Hail Mary trick I have left. Time—I hope not much time—will tell whether the transdermal formulation will restore Coolidge’s appetite and lower his glucose to more tenable levels on the diabetic spectrum.

My cat’s diseases are necessarily complicated because they interact. You can’t treat any of them as a discrete circle, stack the circles, and celebrate a series of victories; you have to chase them through a pernicious spiral formation. You always end up in a broken ring. It’s like Mutually Assured Destruction, only it’s Assured Destruction of Patient. That is because all patients are mortal beings; there was a Fall, remember? And now all creation groans under the sentence of death. It sucks, but it is what it is, and for the very most part it is very beautiful and very wonderful. Still, there are snakes in every paradise.

I can’t know how long Coolidge or I or anyone else has to live in our unique assigned spirals. All I can know is that I’m throwing metaphorical hail Mary passes and we’re keeping each other comfortable, as long as there’s a goal post left standing.

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