Monday, 23 June 2014

Diary of a Diabetic Cat -- Or That of A Cat's Person


 
If you are not a 'cat' person or, at least an animal lover, you may want to skip this post.  I share my story, not only because it's a way for me to work through emotions but also in the hopes that my experiences may help someone else.  This is a story about love:  love found, love lost.


Seamus and his Daddy doing a little bonding
It all started back in 2004, when I stopped in at a pet store in Drumheller.  Curled up in the corner of the window was a wee tiny kitten under a great big sign which read ‘DO NOT TOUCH THE KITTEN’.  When the owner asked if she could help, I immediately replied, ‘Yes, I want to touch the kitten.’  He had, only a few short days prior, been abandoned in the parking lot of the pet store.  Before I even knew what hit me, I was not only cuddling this adorable little guy, he was packed up in a box for the ride home with the promise that, if he was free, I would provide him a good home.  I should have known that Seamus, (SHAY-mus, not SEA-mus) as he was eventually named, would be anything but free.  Nothing in life is free, and if it were, it certainly didn’t come in the form of Seamus. 
From the very beginning Seamus lived by the motto, Go Big or Go Home.  He was abashedly unafraid of anything. Initially, his presence was not embraced by his new brothers but, eventually, they overcame their differences.
By the time he was 5 years old, we had fondly dubbed Seamus our $4,000 cat.  Every few months there was a trip to the vet for one reason or another.  As a wee kitten, one day he literally filled the chair he was sitting in with drool.  The vet suggested an upset stomach, perhaps a bad mouse, and he received antacids.  He hunted so voraciously he often came in with rips and tears not only requiring stitches but, on occasion, surgery.  When a lump was discovered in his chest, the prognosis was grim; cancer was suspected but, alas, it turned out to be a piece of a stick which he evidently thrust himself so hard against, it broke off under the skin, only to fester. During a power outage, he crawled into the motor of a visiting neighbour's car.  Fortunately, the damage was relatively minor; a few more stitches, and a very bruised and sore little kitty with some significant bald spots to regrow.


Stoker Welcomes Seamus to the Family
Our cats are outdoos, however, we do everything we can to keep them comfortable comfortable, including a heated cat bed inside an insulated ‘dog’ house, inside an insulated building, with a space heater.  But every winter, we go through a brief period where Seamus becomes listless and unwell.  A visit to the vet usually results in sleepovers, myriad tests, and then, suddenly, he miraculously recovers and no one is any the wiser for the cause.  It finally came to a head in 2006, when he was diagnosed with asymptomatic cardiomyopathy, the prognosis for which is either short or long lived, depending on the ca, and Seamus is, fortunately, the latter.  By this time, we are well aware Seamus requires a higher level  of care and attention than the typical farm cat.  Always a picky eater, the typical kibble fare is not an option as he staunchly refuses to eat it.  He isn't particularly fussy about soft food in any form and is definitely not an 'of the sea' kind of guy.  For him, we purchase 3 different types of high quality hard food, one of which is prescription, and continue to keep him interested in soft food by mixing in raw venison.  Always the first at the dish, although the smallest of the lot, he is quite adept at threatening the others until he has at least picked out the venison and eaten what he wishes.  By this time, Seamus is now our $5,000 cat, not including typical run-of-the-mill vacinations, deworming or high end kibble costs.  

Brotherly Love
 Returning from our 3-week vacation in March, the first thing I notice is that Seamus has lost weight.  Although he is around his ideal weight of 10lbs., he was at least 12lbs. when we left.  So begins my efforts to at least maintain the weight and perhaps even add a pound to his frame.  The first step is a mass deworming program, particularly as we notice a little pin worm on sister, Ruby's, butt.  While our other cats have become, shall we say, robust, with the twice daily feeding regime, Seamus is fed three times, including an extra dollop of venison.  After two months, while he has not lost any additional weight, he hasn’t gained.  He is not only constantly hungry, he seems to be drinking excessively.  Eric doesn't see beyond a bit of weight loss (he refers to it as losing his ‘winter weight’), which leaves me questioning myself when I also suggest that Seamus seems less energetic.  As a prolific hunter who needs to bring his trophy home to show Mama, I can't recall seeing a kill in the last couple of weeks.  A worrier and over-thinker by nature, I don't want to over-react but I don't want to ignore an underlying illness.  I have always harboured the belief that there is something inherently 'wrong' with Seamus and, while most vets have been quick to agree, nobody has put a finger on what that something might be.

Ruby Jean on her favourite perch: 
the roof of the house
 Here begins my personal search for answers, until I eventually decide upon two:  either his cardiomyopathy is escalating or he is diabetic.  A trip to the vet confirms the second. . . and in one single day, Seamus has rocketed from the $5,000 cat to $6,000.  It is small comfort to meet someone at the vet who has spent close to that on her cat in a single year!  Armed with the results of another battery of tests, insulin pens, and some less-than-stellar instructions, I begin a journey to bring Seamus back into the realm of healthy. . . or at least stable.  If caught early, it’s possible to reverse feline diabetes, or at least control it with diet.  The first thing is to remove all hard food, more akin to ‘kitty kandy’ as it is far too high in carbohydrates for our carnivorous feline friends.

Which takes me to another topic.  Am I the only one who has noticed the change in pet foods, certainly over the last 30 years but conspicuously over the last 10?  Am I the only one who remembers going to get groceries and finding a half-dozen options on the shelf to choose from?  Clearly, pet food has become a multi-million dollar industry with options that include lamb, duck and rabbit; gluten free; high protein/low carb; sweet potato; holistic; organic; and the list goes on.  I mean, really, who is this marketing directed at?  My cats are pretty darn smart but I’m pretty sure none of them read and, if they did, I’m going to go out on a limb and guess, it wouldn’t be for the purpose of reading labels.  But I am a label reader and it should come as no surprise that, if we have spent this much money on a cat, I would be interested in what we were feeding them.  It’s really quite amazing what comes out of those cans.  While the first ingredient might be meat (or water), it is quickly followed by a myriad of fillers such as corn, wheat, peas rice, sweet potato. . . in fact, without feeding a ‘raw diet’ (and that’s an entirely different pursuit altogether) we are, in essence, feeding our pets pretty much the same thing we are eating ourselves. . . and isn’t that exactly what we have always been advised NOT to do?  Cats are carnivores, where as we are omnivores.  The fact that we need different diets should come as no surprise.  But I get ahead of myself.  Let's start at the beginning.
 

Day 1:  May 23th 4.52kg  After spending the day running back and forth to the vet, attending a 10-minute ‘diabetes clinic’ with a technician, and armed with prescription cat food, I am off to the pharmacy to collect a bottle of Glargine Insulin (brand name Lantus) and syringes.  This is a first for me; I have always collected medications from my vet.  After hitting 3 pharmacies without success of finding a vial of insulin, with a sick cat waiting in the car, (thankfully, it's a cold and blustery day) I bite the bullet and purchase the much more costly loaded insulin pens and a box of 100 needles.  I am unconvinced the DM food is necessary but, if you’re going to drop $1,000, what is the point of quibbling over the price of a few cans of cat food?   After his first shot, Seamus has noticeably perked up but whether that is due to the insulin or the fact that he was stressed from being in a crate, travelling back and forth to the vet, and is finally home, in familiar surroundings, who knows.  In fact, he did much better with his first shot than I did.  The ‘ultra fine’ needles recommended by the pharmacy are problematic.  They are not only very short, they bend.  It doesn’t help that I am not adept at administering but we do, after a fashion, get it done.  I’m really hoping Seamus has nothing that can be transmitted to me; I managed to poke myself as many times as I poke him.  I admit, he is not ecstatic about the pricey DM food.  The plan is to regulate his food and start him at a very low insulin dose, after which he will be given a glucose curve test to help determine dosage.


the fan belt incident
Day 2:  May 24th  While outright perky in the morning, perhaps because he feels like he is starving, and a not-so-great 2nd shot (another bent needle), Seamus definitely becomes sluggish mid morning.  Water consumption and urination are back up.  My issues with the needles leave me questioning what insulin dosage he might actually be receiving.  After reaching out to Facebook Friends, I feel somewhat vindicated when a nurse tells me that she too struggled with giving her cat insulin shots.  She has, after all, never had a patient that was quite so hairy!  After a bit more reading, I am also able to glean a few more tips and, although Seamus remains very hungry and thirsty well into the evening, I definitely rock that PM shot!  I’m positive he never even felt it and I am actually even able to leave the needle in for the required 10 seconds.

Day 3:  May 25th  Once again, Seamus is perky but starving and thirsty this morning.  While my injection is not quite as smooth, we manage not too badly, likely more in the realm of 5 seconds than 10.  My reading continues and I am all the more convinced that ANY canned food is acceptable, but some moreso than others.  The web based suggestions provided by the vet are well organized and informative and unequivocally state prescription DM food is unnecessary and even goes so far to provide some nutritional information on numerous commercial brands.   Although I am advised by the vet to give insulin with food, additional reading suggests feeding about ½ hour prior to injection is preferable.  After feeding Seamus, he becomes considerable calmer which makes for much more successful administration of his insulin.  While the technician showed me a ‘tenting’ technique for the injection site, one of the chat sites offered a better tip.  It is much easier to scratch your cat, all the while, parting the hair to find a place where you can actually see skin.  Although you still tent the area up, you role the skin over your finger – the hair parts and voila!  You have your site.  Everyone remains calmed (even me) and I am once again able to maintain the contact for the full 10 seconds. 
I am undecided whether eating and the shot affect Seamus or whether his prior ‘alertness’ is due to his extreme hunger.  He is definitely focused on stuffing his face, stopping to drink several times, he doesn’t appear to have the extreme thirst and constant urination.  I let him outdoors a couple of times so he can do his business the good old-fashioned way.  As Seamus prefers to drink from the rain barrel, I am also providing rainwater for his indoor needs. Although still low energy, he seems much more alert this evening.  So far, so good.

May 26, 2014  One thing I can count on is a little face staring at me in the morning, anxiously awaiting breakfast.  It seems to me, Seamus is a bit of a bottomless pit. . . always has been, I suppose, and while I have not been adverse to waiting him out for a bit in the past, I’m reluctant to do so now.   He is calmer after he has eaten.  I can sit him on my lap, give him a scratch, a poke and a scratch in that order, and all is well.  I’m not convinced he feels well after his shot, but I don’t know whether it is the effects of his super-sized meal or the insulin. Let's face it, if I ate the equivalent of two turkey dinners every day I'm pretty sure my ass would be dragging too.  That will be a question for the vet. 

May 27, 2014  As usual, an eager little face is pasted against the door, doing whatever is required to capture our attention.  The insulin shot does not go well today, I think because Seamus is feeling starved and just can't sit still.  The first shot goes into his coat and he won't sit still to tolerate the 10 second injection required for the full dose of insulin.  He sneaks outside while we are working in the house and, again, he finds a way to sneak a snack.   When he begins to pace and whine around 5pm, I know he is never going to last until 6:30 so I feed him around 6:15, with his shot about 6:45, after which he immediately finds himself a sunny spot on a chair and begins to doze.  Insulin goes easy peasy; I simply scratch his belly for a bit, to which he rolls over and begs for more, and I give him a belly shot.  He doesn't feel a thing. 
May 28, 2014  For the first time, lil’ ol’ Seamus seems to be almost himself, except that he continues to be excessively hungry and licks his plate absolutely clean. . . food that he never-before would have touched.  But he seems to have lost that dozy look after his meals. . . for today, at least.  He did try to hork up his breakfast this morning and I’m guessing that’s because he is stuffing his face so fast and furiously.   He’s terribly unhappy being kept in; terribly unhappy being stuck using a little box.  . 

May 31, 2014  Seamus is, I would say, completely back to his old self; always starving and even supplementing his own diet with a mouse.  Man, is he pleased with himself!  Although not what I would call lethargic, he is sleeping quite a bit. . . mostly, I think he’s bored being stuck inside and is always ecstatic to see Stoker and Ruby.  He isn’t even picking on Ruby Jean. . . hmmm, 3 years in and he has finally accepted her.
June 2, 2014 - 4.3 kg.  Seamus just completed his curve test. He went from 17 (`not terrible`) and nadir (low blood glucose leve) was 8.  The plan is to continue with our current regime. After much reading, we might be further ahead picking up a glucose monitor; otherwise, we will be running to the vet every week to find out whether he is stabilizing.   Not to mention, it appears most folks are taking BG (blood glucose) levels at least twice daily, before each insulin shot, to ensure they don't overdose.  Who knew?  Not me! Sadly, when I asked the vet tech whether monitoring was necessary, rather than explaining the purpose of the monitor, she simply said 'no'.

June 4, 2014 - 4.5 kg  Another challenge in the day of a diabetic cat, for both Seamus and us.  As I become more confident with the insulin shots, I figure the glucose test would be no biggie but not so.  Lancing to get a blood test which is, BY far, the biggest challenge to date.  In order to get one test I poke the poor little guy at least 10 times!  He just won't sit still!  He is perky for awhile but by midmorning he looks unwell and his balance was off.  He tries to jump up on a bench and it wasn`t pretty; in fact, he almost falls off.  This is rather startling as he is naturally filled to the brim with grace and agility.  I decide I should test his blood, which, after quite an ordeal, is now 16.2.  When I call the vet clinic, I am told to bring him in which, of course, I do because I have no idea what is going on.  I know too high or too low is dangerous. . . but what is 'too high' or 'too low'?.  There is a thought that, for whatever reason, we screwed up with the insulin shot and he didn`t get the initial dose.  This was Eric`s first go at it and we both thought he handled it like a champ.  Apparently not.  Suffice to say, it continues to be quite a learning curve for us.
After a discussion with the vet, this is what I have learned.  There is a good chance Seamus` diabetis can be controlled with diet alone.  Seamus is a wee bit more difficult to regulate because his pancreas is still producing insulin, however, there is no way to know how much it is producing and how often, hence the need for blood glucose readings before each dosage.  In a cat who is not producing any insulin, readings will typically be as high as 30, but we have had none of that.  Diet is a HUGE factor and, while we are feeding a completely canned diet (a significant improvement), I have deliberately mixed the brands in order to provide my fussy little eater with a bit of variety. . . bad move says the vet.  Brands and flavours vary widely in the amount of carbohydrates.  For the next week, we will feed the DM prescription food only to see if we can regulate the blood . . . all he wants to eat in two meals but two meals only.   We shall see how that works.  And onward we go.

June 5, 2014  This morning, Seamus was ‘not a pig’ which means he ate an entire can of DM plus his 2 tbsp of deer meet but did so over a half-hour time period without completely gorging himself.  He is extremely bored so on occasion, I let him out for a spell.   Alternatively, I let his brother in for a bit of companionship; his sister lacks indoor manners and is not the least bit interested in acquiring them.  The first thing Seamus does is walk over and bite poor Stoker in the butt.  Haven’t seen that in awhile.  We take that to mean he is happy to see him.  We have resigned ourselves that he will eventually be a housecat.   Try as we might to keep him off our bed, we have also resigned ourselves that he is most content sleeping with us ON the bed rather than BESIDE the bed.  Hope the other cats don’t find out.

June 6, 2014  I am in town most of the day so no doubt, Seamus spent his day laying around, contemplating the meaning of life.  I have joined a couple of chat groups and a diabetic cat FB page where I am immediately advised my 13-15 range is not all that great and that I may want to speak to the vet about ketones. . . that means I have to try to catch a midstream pee . . . this is not going to be good. 
June 8, 2014  Last night Seamus horked up a few chunks of catfood and a bunch of brown gelatinous liquid.  He horked (mostly) clear fluids several times through the night.  While he appears hungry, he picks all the venison out and leaves all the expensive DM.  As he is not adjusting to his indoor status, we clip his nails in hopes that this will reduce his hunting abilities and let him out.  First stop is the herb garden for a pee, and then off to catch a mouse, which he did.  Lethargic but alert; hind quarters don’t appear to be coordinated.  Pukes again, sometime between 3 and 6pm.  Looked like mouse hair to me; no more unsupervised outdoor visits.


freedom
June 9, 2014  We continue  the roller coaster.  Eric took Seamus' BG this morning; the original reading was 3.6 so he took it again and it was 4.1.  Now Eric is certain he screwed up with the testing.  I'm guessing Eric didn't screw up at all and what we are seeing are the results of a diabetic cat trying to become accustomed to a new eating regime.  I admit though, it's a bit scarey.  I have not been officially advised how to handle low BG levels or what to do if he becomes becomes hyPOglycemic and slips into a coma.  All he needs is one slighly 'off' facial expression and I have the testing kit out.  All documentation has been emailed to the vet so we shall check in a few hours that it was received and hope for a quick call-back to assure this neurotic mama that we are doing what needs to be done or, alternatively, provide more direction. 

June 11, 2014  After much reading and taking note of Seamus' behaviour, I have decided to change his eating protocol back to 4 smaller meals/day.  The lethargic, staggering, etc. noted almost immediately upon his insulin shot is not what we saw during Week 1.   2 hours after partial breakfast there is no sign of lethargy and staggering.  Portions have been halved and meals spread throughout the day.  He is considerably more active and 'his old self'. Whether that is related to a reduced/missed insulin dose or eating smaller portions, we do not know.
June 12, 2014  Eric tends to be less inclined to over-thinking situations and has accused me of going overboard on the entire research thing.  I explain I am getting little direction from the vet and have been pretty much left to my own resources.  We begin to think, after 30+ years of being loyal to the same clinic, perhaps it is time for a change.  There seems to be a total lack of empathy and I'm sure I'm considered as a 'helicopter mom'.  Have they looked at my records?  They should know better!  I miss the days of building a relationship with a vet, or even two, similar to that which I have built with my own family physician.  The 'training' I got to take care of a diabetic cat was, in my opinion, less than is required and the information sheets referred me to websites that refer to drugs that have not been available for years!

I finally receive my call-back from the vet, from the information submitted Monday morning.  If it isn't bad enough that I had to follow up by telephone to get someone to actually retrieve the email, the promised Tuesday morning call is a wee bit late.  I report that I have changed Seamus' feeding protocol because it just wasn't working for him and, when I explain why, she is in total agreement.  She is clearly unprepared to have a conversation.  When I mention I am blood testing 4 - 6 times daily, she seems surprised but pleased; why would she be surprised?  If she looked at the information I emailed, that should have been the first thing she saw.  When I ask if Seamus' pancreas was tested, she doesn't know; she doesn't have his chart.  Then go get it or, at the very least get back to me with the answer.  When I ask about a 'tight regulation' protocol, she tells me that is ineffective with glargine because it is such a long acting insulin.  Is she not aware that there are established protocols for glargine?  Why is Seamus having hypoglycemic symptoms (lethargy, staggering, etc.) when he is clearly not hypoglycemic? Is it diet related?  She doesn't know.  Her final comment is to take a 'wait and see' approach; perhaps he'll go into remission, perhaps he'll stay the same, perhaps he'll get worse.  Gee, that was a rocket science . . . does she think I am a total moron?  When I ask about urine testing she says that is totally unnecessary as I was testing BG levels.  This is contrary to what I have read.  She assuredsme at his current range, there will be no ketones.  Is this true?  I don't know, but I don't have confidence either.  Then she quickly wraps up the phone call by telling me that she has appointment scheduled for 9:00 am and has to go.  Why then, did she call me shortly after 9:00 a.m.?  I am not being heard!  Worse yet, I'm not being listened to!  I'm being blown off!
I feel like I have not been provided with sufficient information from the onset to make good choices.  I now have needles that will need to be replaced if I ultimately go the route of tight regulation because dosage goes in single unit increments only.  Except for being sold prescription food from the vet, I have been given no other options except the advice to 'choose a food and stick with it'. 

I now phone the office and asked for all of Seamus' medical records as Seamus and I are going to see a vet at another clinic.  I am loathe to leave my long time clinic but I am frustrated and, if nothing else, I need a second opinion.  I need a vet more interested in participatory care, one willing to work with me and answer my questions, not leave me hanging, not understanding what it means to have a diabetic cat.  I could have done real damage if I would have given Seamus insulin when his BG was low.  Thankfully, I not only know how to read, I can think too.  I feel disheartened, but I also feel like I'm going to do everything I can to give this little critter the best chance of remission.
housebound
June 13, 2014 (Vet Check) 4.1 kg  I have a great THREE HOUR meeting with Dr. Lisa!  Can't believe the time she takes to go over every aspect we can think of in regard to Seamus.  Lisa feels we are doing well but Seamus isn't stabilized.  She confirms what I believe to be true; that the previous clinic has followed typical protocol, with the exception of, perhaps diet.  She agrees diet is extremely important and, as such, rather than take an 'off the shelf' approach, her protocol is to discuss the specifics with a specialist and follow whatever protocol is set out.  A thorough review of Seamus' file, and a physical examination indicates that all the boxes have been ticked to rule out pancreatic or thyroid complications.  Bloodwork suggests that there is no other underlying problem.  So why has he lost a little bit more weight, going from 4.5 to 4.1 kg.  We discuss whether to start feeding a bit of dry kibble, which helps put weight (but also raises sugar levels).  She agrees, there is some underlying issue that has not yet been discovered. A thorough review of the medical records suggest some red flags, particularly in regard to higher than normal glucose levels.  Ultimately we decide to make a few changes with the insulin needles and go from there.  She is concerned the needles I have are giving doses subdermally rather  than subcutaneously.  It is an amazing experience to have someone fully engaged in a conversation about my cat's health and wellbeing. Stay the course with the new insulin needles, see how that does, and update Dr. Lisa Tuesday.   
June 14, 2014  Sticking with the DM is going to fast become problematic. This evening Seamus picked out the wild meat and left everything else which smells of a boycott; wish he would have thought of that yesterday while we had the full attention of a vet.  Hopefully he has a mouse today because he’s really only eaten 1 full can and 4 tbsp of venison.  Wonder how Eric feels about feeding all his deer meat to his cat.
 
Eric and I discuss the quality of life issue when I was telling him about reading stories about cats hospitalized to be force fed.  I explain that it is not uncommon for human diabetics to end up hospitalized in cases of bad flus simply because they are unable to take their insulin if they can’t keep any food down.  His comment is, if we get to that point, it would be unfair to Seamus.  I guess we will cross that road when we get to it but I tend to agree, depending on the length of time we are talking about.  Our conscience has served us well in the past with our pets; once quality of life is diminished sufficiently or we see a long road ahead of suffering, we have always tried to put our pet’s interest (rather than ours) in the lead.  That has resulted in our ending the lives of two of our lovelies, diagnosed with cancers that had progressed enough that anything else would just be mean.  For the rest, we have lost them at fairly advanced ages:  Merlin (14); multiple strokes; Teddy (16) who went to bed with us perfectly healthy and died of a massive heart attack right there with us in our bed; and then there is good old Stoker, still chugging along at 19.  The only thing missing for him right now is he can’t figure out for the life of him what he has done to be left out in the cold while his brother is living the high life with house privileges.  If it were only him, I know where he would be (and so does he btw) but that leaves Ruby Jean, the misguided outdoor cat who, as much as she thinks she would be an ideal house pet, has absolutely NO house manners or any inclination to acquire house manners.  What a pain in the ass she would be indoors!

Seamus & Stoker
 
The other thing Eric and I were talking about last night was Seamus' sleeping position.  While most cats curl up to sleep, Seamus is now stretched right out.  This might be as simple as finding the increased warmth of the outdoor-to-indoor transition. . . I know I certainly find it much warmer now that we have an extra sheet on the bed to keep the copious amount of cat hair off the duvet cover! It might mean that this is the most comfortable position which begs the question 'why?'  I have a lot of 'whys'.  There are some areas where his blood work is slightly but consistently off, including liver and pancreas.  Now that I have gone through Seamus' chart, why is his blood levels no more regulated than when he was diagnosed and not on insulin? Why did his glucose curve test results vary so dramatically from my own?  I have never hit less than a double digit number except that one day when it was too low.

June 15, 2014  It was a L O N G night last night.  Seamus started feeling unwell (lethargic, dialated pupils, loss of balance) around 9pm last night.  As I was worried about his GB, I tested him and he came out at 13.6 so I figured I was safe to go to sleep.  Seems it was not to be.  Starting shortly after we all went to bed at 10:00pm, he began puking and puked almost hourly until 6am.  With the exception of the first puke, which had a wee bit of cat food in it, everything was small amounts of white froth.  Suffice to say, none of us got a lot of sleep last night.  I’m thinking he has a stomach problem.  Read somewhere to try raising his food dish (easy enough) and feeding before bedtime.  Will try both.  More food can never hurt this kitty, I’m thinking.
I was expecting his BG might be quite high in the morning but at 6am it was 11.3.  He has not touched the remaining DM throughout the evening and, though acting somewhat hungry, it is the easiest time we’ve had in testing his blood in several days.  I mixed the regular ½ can of DM with venison; he quickly picks out the venison and walks away.  Knowing how important it is for them to eat with insulin, I mix in a little more venison and some Science Diet canned food and offer it to him and the other two cats.  Once again, he picks out a wee bit of venison and leaves the rest.

While I know the ‘lists’ are not Canadian based, I go through the copious amounts of canned food we have and find a couple of tins on the list  and go by the rule that any food is better than no food.  Seamus simply picks out the venison.  Finally, I put a couple of tbsp. of venison in a little dish, mix in some water and heat it for about 10 sec in the microwave.  He polishes most of the venison again and sits quietly for his insulin shot, no fuss. 

And then I sit down with my coffee and have a bit of a cry.  I know where my line is but I also keep my father’s sound advice at the forefront:  you have to let an animal be sick for awhile in order to know if he can get better.  If he can’t get better, then it’s our responsibility to do the right thing.  Seamus has lost another pound in less than a month and he is getting gaunt.  I have read all these accounts of watching pets waste away until they literally starve to death.  That will not be Seamus.   He is clearly not feeling well.  When he climbs up on Eric’s lap, Eric tries to brush him which he tolerates but there was definitely no encouragement, let alone preening.

I find a site via a link from the FMD site:  http://www.felinecrf.org which has some good information as I have thoroughly researched the links provided by Dr. Lisa.  It suggests the vomiting of white froth is a classic sign of excess stomach acid as is lip licking and eating grass (oddly, he seems to go for the toughest patch of quack grass he can find) which he has always done a lot of when he isn't feeling well.  Will talk to the doc about slippery elm, aloe vera and other natural treatments.

A final sunbathe
Dr. Lisa said she has usually used caninsulin/Vetsulin, insulin specifically developed for animals.  There has been a flurry of activity on the internet of late re the increased price of Lantus.  Many vets see it simply as gouging by the pharmaceutical company as the 10-year safety net is about to be removed and generic products will soon be available.  One vet indicated it was his insulin of choice as he has had good results with remission.  This is in line with what I have read on other sites: 60 - 80% chance of remission during the first 4 - 6 months.  Seamus is still sluggish.

June 16, 2016  We all had a much better sleep last night though, interestingly, Seamus chose the mat in front of the patio door rather than with us.  I don't think he's comfortable on the bed.  I also f ound another good laymen's version of glucose curve: http://www.sugarpet.net/mycurves.html which I thought did a good job of demonstrating what to look for.

Seamus is no longer interested in the DM prescription food. . . perhaps it doesn't agree with him as he seems lethargic within half an hour or so but was ready to go back outside around 2pm.    Supper consisted primarily of large chunks of moose meat that he pick out of the Authority and DM mixed with it.  He was excited to get the venison treat for bednight lunch too. 
 
June 17, 2016  I am so excited to have him eating, I think I overdid the bednight lunch of venison, about 3 oz in all as he puked up the larger chunks of moose meat.  So much for trying to provide some variety of texture as opposed to eating mush 24/7.  Shortly thereafter he brings up a mouse he caught in the basement, if you can believe it! Hence his interest in the lower levels and the perks of living in an old farmhouse?  For the vast majority of the day, Seamus seems to feel unwell.  He is unwilling to walk any distance and when I picked him up he gave a bit of a cry which makes me again think his stomach hurts.  I lay him down and press around, he doesn't complain.  I still think he has something weird going on with his digestion.  What to do; What to do. . .
 
June 18, 2014  I must admit, yesterday was one of the saddest days yet, going from bad to worse.  Really, Seamus just wants to be left alone, showing little interest in us, himself, the other cats, etc.  When he's outside, he curls up in a corner and stays there.  He has little interest in any food except wild meat.  I have been mixing it with water, warming it up a bit in the microwave and he sucks off the juice and usually eats the meat.  He currently has 4 different types of food in front of him and even mixing older familiar brands of canned food with deer meat is no longer an enticement. 

He did eat a bit of hard food yesterday.  Not sure if it is good for him but the key thing is, he kept it all down but the quantity (or lack thereof) is alarming.  He is lethargic and weak. He continues to display classic signs of hypoglycemia and yet he clearly is not hypoglycemic.   Yesterday was one of those days that I plied him with food about every 2 hours.  Thankfully, he is eating enough so I can give him his insulin shot but all told it isn't enough.  Someone on a support group suggested crushing up the hard food and sprinkling it on top. . . nope.  Pure meat or nothing seems to be the direction we are going.  I am worried he is dehydrated and/or constipated but how does one tell? 

Last night was a difficult night for all of us.  I am not a crier for the most part but last evening I just couldn't stop.   I have seen enough dying animals in my time to know where we are headed.  I am really at a loss as I can think of nothing else I can do for our poor little guy.  I know we are losing him.
 
Back to the vet we go at 3pm.  No doubt Dr. Lisa will be shocked at the difference from a few short days ago.  I know I am.  Even outside he does little more than walk a few steps and lay down.  He quit sleeping on our bed a few nights ago;  i think it is just too much effort and the jump down is not a pretty sight.  While he is somewhat looking forward to his morning feed it is feeble, at best.  Even his morning ear prick is not a struggle whereas a few days ago, it took two of us.
 
I spend considerable time going back through all of his records and all that I can consistently see is that levels to do with liver, blood glucose and pancreas(?) are consistently slightly off. . . not enough to raise a concern. . . just off.  We have known something was 'off' with this little guy from the get go.  Almost every vet who has seen him has agreed there appears to be some unknown underlying symptom to his health 'weirdisms'.  We thought it was his cardiomyopathy.  Perhaps we are wrong.  Even though his blood work is less than a month old, I think we need to start from scratch. . . if it isn't too late.  I fear there may be no going back.
 
June 19, 2014  It seems my instincts are right, there is(and always has been) more than meets the eye with our little Shameless.  After presenting this journal to the vet, a physical examine shows more than a few abnormalities.  Temperature normal (ear and rectally) but palpating his abdomen brought a little squeal out of him.  Even Dr. Lisa is shocked by the difference in him from a few short days ago.  Where to start? Repeat his blood work. This will likely lead into an abdominal ultrasound.  Her expectations: an underlying tumor.

The results of the blood work is, to say the least, alarming.  While everything in his red blood cells appears normal, the portion dealing with internal organs is just plain nasty.  In particular, liver and pancreas levels are literally skyrocketing out of control.  As these two organs are beside each other, there is really no way of telling which one is the culprit as infections and other problems will spill from one organ to the next.  The likelihood of a tumor is narrowed down to one of two organs.  On to the ultrasound. . . .for the full story. 
 
Seamus must be in excruciating pain and yet, still, he makes little protest except a squeak during his exam.  His pancreas, however, is in a full state of uproar, badly inflamed from tip to tip, nodular and at least four times larger than it should be.  Whether the source is a tumor or simply a severe case of pancreatitis, it matters little as the prognosis is much the same.  A tumor is an automatic death sentence.  While there is feint hope with pancreatitis, in this case, the odds of success are very poor and the process to get there is a considerable challenge at best.  The swelling of the pancreas can be treated with anti-inflammatory drugs, and there are other drugs to treat nausea and loss of appetite.  Dehydration can be treated with fluid injections or IV treatment.  It would be necessary to rest the pancreas which means hospital treatment where he is taken off all food for several weeks, and put on an IV drip and feeding tube.  While mild cases can often be successfully treated, a positive outcome of severe cases is unlikely as there is no way to determine the extent of the damage not only to the pancreas but other organs, in particular, the liver.

If you are ever looking for a vet who will give the cold hard facts, Dr. Lisa is your girl.  As we do not have a history together, I could see her evaluating what information I needed in order for me to make the 'right' decision.  Clearly, having spent 3 hours going over everything we could possibly imagine about managing Seamus' diabetes, Lisa was astute enough to start at the beginning, making every effort to explain what all the various markers meant.  Because we have no prior relationship, she did not know that I was only too well aware what the next step is going to be.  I already knew where this was all going to end.  In fact, I knew two nights ago which I spent in tears, not only trying to assuage my wounded heart  but trying to figure out what more I could do or, worse yet, what I may have done wrong.  Be assured, this farm girl has seen enough sick and dying animals to understand the implications. 

When Dr. Lisa got to the part where she championed what was best for Seamus, I had to stop her.  She did not know that Eric was on notice that his presence was needed at the clinic and, in fact, he is enroute.  After all, Seamus' best interest is what got us to this point.  She will get no argument from us.  We love our animals enough to know when it is time to let them go.  We are both devout supporters of the right to die with dignity, and fervently hope that one day, we too will have that right to make the same decision for ourselves.

Dr. Lisa pulled out all the stops for Seamus and for me, making sure he was kept as comfortable as possible throughout this last ordeal and for this, I am truly grateful.  I have had vets suggest I take suffering pets home for a few days 'to say goodbye'; seen paralyzed animals lying in cages because families cannot come to terms with the inevitable.  I 'get' that sometimes it is necessary to mollify people but what I do not 'get' is when a vet, whose very job is to put their patient -- the animal -- first, not only accommodates but actually instigates continued suffering.  Perhaps being prepared to take that hard line is the real dirty work of being a vet.  If challenged, it is clear Dr. Lisa will be coming down squarely on the side of her patient for this, she earns my deep respect.


better days
 
So it seems we have finally solved the mystery health issues of our little Seamus.  I strongly suspect all those trips to the vet for lethargy and general loss of appetite were all minor bouts of pancreatitis that he was (thankfully) able to recoup from without the aid of treatment.  From what I have learned, cats suffering from pancreatitis often have bouts of vomiting, abdominal pain and fever, but Seamus didn't present with these symptoms.  And, let's face it, loss of appetite and lethargy isn't much to go by; through this entire ordeal, I have had these symptoms and I'm pretty sure my pancreas is working just fine.  Cats with pancreatitis have an increased level of white blood cells which I believe Seamus had but tests results are skewed by blood glucose levels, throwing everyone off the pancreas track and firmly onto the diabetes wagon.   During his diabetes treatment, while I continued to report many episodes which appeared to be hypoglycemia when he was clearly not, there were also some pretty darn good days and most of those were at the vet, like last Friday's visit, when he was his perky little self, a day I will forever be grateful to have had with him.

 
At the end of the day, we have lost our little guy.  We laid him to rest, with a dead mouse at his side, in our flower garden where two of his predecessors, Fletcher and Gabriel, lie.  He will not be alone; he will not be hungry.  We take some consolation in the knowledge that he was a stray picked up from the streets of Drumheller who, under different circumstances, could have had a very different life or not have had one at all.   He is, without doubt, the most expensive little critter we have had the pleasure of living with; perhaps we were just fortunate in the past or perhaps Seamus was just 'high maintenance' (like his mother) but in a different way.  His unique personality brought out the full range of emotions in us, from annoyance, sometimes even anger, to amusement and mostly joy.  He gave us reasons to laugh; reasons to moll over all his quirks; reason to marvel at his extreme athleticism and pure voracity and single-minded purposefulness in pretty much everything he did, from playing a game to hunting.  He packed a whole  lot of power into that runty little body of his. At the very least, we will miss his insatiable and relentless pursuit of mice; no doubt we will suffer in this area alone (his brother is 19 and we haven't actually seen him with a mouse in a couple years, and his sister?  try as she might , on a 'nimble' scale of 0 - 10 I'm thinking she's somewhere between a 1 and a 2). 

 
We are not the folks who are out the next day shopping for the replacement pet. We will first be letting our hearts heal and, in all likelihood, will not look for another pet at all because eventually a needy cat will find us.  That's the way it is; that's the way it has always been. Over the past 37 years we have had 11 cats in all.  While we have loved them all dearly, there are a few that stand out in the crowd and Seamus is definitely one of the latter.  We knew, from the get go, there was nothing normal about this one.  We knew he would take us on a wild adventure and that, he surely did.

God speed little one.  You are dearly missed but we will not hold you back from continuing your journey, even it means continuing it without us.