Hamlet has gone to Biker Cat Heaven

After our own vet gave Hamlet some Lasix for the congestion in his lungs last week, he rallied a bit, and each time I warmed him a little Fancy Feast Liver and Chicken, (his favorite), he would valiantly push it around the dish and consume some of it.  On Sunday he worked his way through a whole half can and his breathing seemed to have settled down.

Yesterday the breathing was intermittently bad and Hamlet ate little, although he still tried to drink a fair amount.  He would look at me longingly in hopes of getting his hunger assuaged, and would try to bend down to eat his Royal Canin dry food, but could do no more than lick the surface.  He struggled desperately when I was trying to give him  subq fluids, which he had never done before, and we think it was panic because he couldn't breathe at the angle he was lying on the floor.  He WAS frequently having to change position to be comfortable.

Today we decided we had to take the next step as recommended by the vet, even though she wasn't in the office.  Luckily we had an old acquaintance and workmate of Margie Scherk who made us feel we had the best advice we were going to get for our boy.  She referred us to the major emergency clinic for ultrasound and the ability to cope with a possible difficult scoping of his throat to see what the obstruction was.

We never would have guessed on our own, and it turned out to be his nemesis.

Hamlet had a collapsed larynx.  Part of the time he was taking in food and water it was ending up in his lungs, which was why we had the intermittent issues needing lasix to reduce the congestion.  Never could I have been more relieved that the vet had insisted I not force feed Hamlet any further last week as I would only have caused him so much more distress.

When we originally rescued Hamlet all those years ago, he was not able to use his voice.  He would try to talk to us but there would be a silent meow all the time.  Intermittently he would manage to be vocal but it wasn't a normal cat sound - we would call it bellowing.  Now we know that there was much more history to his life than we were aware of, and he was probably a number of years older than the 20+ we could trace.

This afternoon Hamlet was starting to show that the constant gasping in of air, that often ended up in his stomach and intestines, was draining his energy to a level that we could see he really wanted us to fix, or he wanted to escape, so we listened to his expression of exhaustion and let him be put to sleep.  He was too old and too weak to have any chance of surviving a tracheotomy.  Along with the possible surgical complications due to his seizure risk, and other factors, it would have been for us that we kept him alive, and we really did want to do that.  We agreed, together, that we needed to let him be at peace.

He was a wonderful gentle soul who wouldn't hurt a fly, but was prepared to hurl his body at any cat that insulted him when outdoors.  Dr Lim who had rescued him called him a "Biker Cat" and he was a tough survivor to the end, trying so desperately to take in air.  We will miss the dear soul who would come and bellow at us if we started raising our voices at each other.  We are two very strong individuals who learned, at his paw, to treat each other with more respect, and hopefully that legacy will continue with us for the rest of our lives, in his honor.

Hamlet was about 10 pounds back in October, but today he had dropped to 7½ pounds.  When he was starving as a stray he was 8 pounds, so this episode had drained him of all reserves.

For future reference for other cat owners, we knew Hamlet didn't have asthma, but were always disturbed by the strange sound of his breathing.  It was brushed off as possible polyps, but if we had taken the time and money to investigate when he was healthy, there would have possibly been a chance for him to succeed in his determination to overcome yet one more obstacle.  As it is, he is now with his old pals Marmaduke and Max, and hopefully they are making hims as happy and comfortable as they all where when alive.

I have mentioned elsewhere that I believed Hamlet's condition wasn't caused by his battle with diabetes, however, co-incidentally I received an emal this evening that has provided information on this very subject, in which there is reference to neuropathy, which was a condition that Hamlet battled.  Click on this section to see the Winn Foundation information on this.

Just Getting Too Old. )-:

About a month ago Hamlet had an 'accident' in his bed, unloading a whole bladder full of urine.  He is always a trooper about getting to the litter box, so this was a very unusual behavior uncharacteristic of him.  He had 'leaked' urine the odd time when having seizures, but never like this.  Since that episode he has been having a bit of difficulty breathing, and when it became so bad he had open mouthed breathing, we rushed him to the emergency veterinarian.

After running all the tests that would eliminate possible deterioration or disease in Hamlet's system, and trying different medications that might improve his breathing, the vet sent X-rays to a specialist online for assessment.  The online veterinarian, and our own vet, have concluded that there is a possible mass that could be cancer restricting Hamlet's ability to swallow or he may have had a stroke back in December when he had his accident.  All methods of searching further for answers would be more painful for Hamlet, which we don't want at this point, so we are taking our lead from his behavior and symptoms.

We have assumed that he is about 20 years old, but an X-ray also showed up previous damage to Hamlet's shoulder that happened before we rescued him, suggesting a possible longer history than we are aware of as it was completely healed by the time we took him in.  His muscle tone has been deteriorating quite markedly for the past year, and his spine is very prominent as the result of the type of muscle wasting that happens with old age.

Hamlet may have exhausted all the lives he is going to, and it is likely we will have to let him go.  We are asking too much to expect the old guy to go on forever, and he has had a great run at life's experiences.  I just wish we could give him more as he has given us so much over the years.

The Evils of Fructose

Toward the end of May we became concerned about the fact that Hamlet was starting to slow down his elimination of feces to about twice a week.  Previously we had needed to take him to have his anal glands cleaned out as they were preventing him from elimination regularity, (oh the perils of old age!).  We started him on a regular dose of Lactulose and he did fine as long as he was receiving this aid, but nothing else would work so he was getting it on a daily basis.

At the beginning of June I suddenly wished I had looked into the ingredients in Lactulose more closely as Hamlet's numbers went through the roof as you can see in his chart.  We clearly put too much of a load on his pancreas.

There are a few theories floating around about why this happened, but personally my education in glucose control and experience with Hamlet tells me that the reaction to Lactulose must have been very similar to the reaction caused by corn syrup when we give it to cats to pull them out of a hypoglycemic episode.  Fructose works where other carbohydrates don't with cats because fructose is absorbed through the membranes of the mouth into the blood stream, just as happens with sublingual meds given to a number of species including humans.

Luckily we have found a working alternative to the Lactulose for Hamlet and I highly recommend it to anyone with a diabetic cat so that you don't overload the demand on the pancreas.  We use EVOO, (olive oil), and it is working fine.  We are, in fact, managing to back off its use a little at this point, which I like as I hate making Hamlet take meds he doesn't have to have at his age.

At this point, we have Hamlet stabilized again, but back on his insulin, unfortunately.  As it is summer we may get him back off it for a period of time, but only time will give us that information.

HAMLET BACK OFF INSULIN AGAIN!

Our dear fellow is getting on.  The vet equates him with a human of about 100 years old.  We estimate, based upon the time we have known and experienced him, that he has to be 19 this year.  His formal birthday is July 31, which is the day we rescued him.  And, our prince is once again giving us a holiday from a tight schedule of insulin shots.  His glucose readings while on Lantus, and since, are recorded here.

Hamlet is still in need of a minor dose of phenobarbital to prevent a return of night time seizures that brought about the last regression back to insulin.  The previous time we stopped him completely after dropping his insulin but are taking this much more cautiously.  We don't want to lose our boy to anything other than very old age. (-;

We can feel Hamlet's spine quite prominently these days, which hurts as it reminds us he could be older than we think, and that our experience with him is not going to go on forever.  We still take him for daily walks.  Smaller walks happen indoors on rainy days, but those have not had to happen too frequently.  In spite of the consistent exercise Hamlet has developed arthritis, so is being given Sasha's Flexibites.  He has only been on them for a couple of weeks but I swear they are working as he is standing a little taller on his haunches and starting to venture out onto the deck on sunny days instead of staying in his bed.  He is also having constipation issues as his activity level reduces so we need to keep an eye on him and give him a boost of Lactulose once in a while to keep things moving.  We haven't found Metamucil to be of much use, although it was recommended to us.

Well, off I go to take Hamlet out to enjoy his garden with the birds, squirrels, and sundry wildlife he likes to sit and enjoy a bit before trudging back the 200 feet to his bed.

We wish all the geriatrics in our family were doing as well as our dear boy.

At right, when DH takes Hamlet for a walk they go way up the street.  Hamlet usually takes his walks with Harley, (dog), for safety as we have a healthy population of coyotes, large owls, bobcats, and bears.  Hamlet has been through enough lifetimes for two cats, so we don't need the added expenses of preditory attacks.

As the other cats are active enough not to need this extra exercise they stay in safety on the deck where they bellow at us,  or indoors with noses pressed to the windows.

Going into Remission so Soon?

Hamlet has only been on Lantus since the beginning of last December, and has already shown a very sharp decrease in his need for insulin.  We had to back off completely until consulting with our vet, and looking at his low point getting a little high.  Just one unit brought him back to being "within range", so we expect to have to keep a close eye on him for a while, to see if this trend continues.  Our experience with Lantus is outlined on his chart.  What we have been able to learn about Lantus and how it shoud be handled is now added to the Diabetic Cats Dietary Management FAQ called "tamingthecurve".

A Seizure Strikes Again.......

December 13, 2009

We have had Hamlet on a new insulin for him, (Lantus), for about two weeks now. It was rather an exciting experience as our vet was away, and we were just handed a prescription to take to the drug store. Needless to say, the insert in the Lantus was for human use!   I had to do a lot of scrambling online to figure out what was needed for our boy and was once again thankful to Jacquie Rand and her associate Rhett Marshall for devoting so much of their time to researching and writing on this subject. 

Today is the day I get to check Hamlet's nadir period in an attempt to be able to increase his insulin to the point of at least getting him out of the black numbers in his chart.

Hamlet hasn't had another seizure, and the veterinarian is hypothesizing that there is a possibility his pancreas may somehow have triggered the seizure when it once again failed.  We had started him on 7.5mg phenobarbitol bid, and as he showed no signs of repeating the seizure we again backed off his daytime dosage to half the 7.5mg tablet, or 3.75mg, when we can keep an eye on him.  The poor fellow does have such a time of it when trying to navigate around the house under the influence of the drugs, and it is harder to ensure he is still getting exercise.

November 29, 2009
We don't yet know whether Hamlet needs to go back to using insulin.  He had a seizure at his strange hour of the night when he has been known to forget to keep regular habits of eating and drinking.  It may possibly be that he was dehydrated as that was how he felt when I checked him.  I gave him fluids when he had recovered from the seizure, (lasted about 10 minutes), which he tolerated for about 50ml and then declared "that's enough" and refused to stay put.  His glucose reading, which we were previously assuming was low at that point in the night time due to lack of eating, was 28.8, (Canadian number), so this is why we are now waiting patiently to get to the vet to check his fructosamine levels.  He is still perky, purrs like no other cat I have experienced, and is doing his little walks indoors to make up for the fact that we can't walk him outdoors in the rain and cold.

Hamlet has also been showing a slight limp with the stairs and now that he is back on the phenobarbital, that is exagerated a bit, so he may have arthritic issues in his right rear leg.  At the ripe old age of 18 or so, I guess that is allowed.

At this point I am making it a daily routine to check Hamlet for hydration.  Since the other night there has been no indication of a repeat performance, so hydration may be the issue rather than glucose concerns.

As Hamlet is starting fresh on insulin and we had previously discussed the possibility of trying Lantus with the vet's encouragement, I am now being taken on a new adventure by Hamlet, which is being recorded on a spreadsheet at the attached URL.

Hamlet kicks the habit again!

Feline diabetes is once again a non issue in our house, after a nightmarish struggle when Hamlet spun out of control, as you may be able to see from postings below. He is now 18 years of age, at least, according to our knowledge of his history. He can't be too much older than that as he is in great shape for an old guy!

Hamlet has been off insulin again, now, for nearly two months. His fructosamines are improving with the amount of time he is in remission, so we are at the point of once again dispensing with his insulin to someone who might benefit more than we would. We have also managed to very slowly reduce his phenobarbital now that night time hypos are not a danger, and from the 45mgs of phenobarbital he was using when the insulin was causing night time hypos without it, we are down to 7.5 per day, and will be dropping to half that this coming week. Three weeks beyond that we hope to stop safely with no ill effects to his body.

Hamlet has also lost about 1/2 a pound since his last yearly checkup, done again recently, and his Geri-panel numbers are improved in spite of the fact that he had been on the phenobarbital for months -- I will be so glad to be safely off that as he basically only has one kidney to care for his body.

Our progress was greatly helped by the dry summer we have had, as I am always aware of the need for physical exercise being a component of defeating feline diabetes. Our boys are all basically indoor cats with a run they use to bask in the sun. Cats don't voluntarily exercise, especially as they age. As Hamlet is not an active enough fellow to escape our supervision, we were able to walk him daily in the yard, ensuring at least 200' of flat/vertical surface was covered. We obviously weren't overdoing his routine as in the more recent days he has bounded up the front stairs to the door at the end of our 'quality' time.

Of course each daily walk has finished with Hamlet being brushed with his favorite wire brush, and you can't stop until he is ready -- or at least 15 minutes have passed. It is wonderful to be seeing our boy back again, and such a happy cat!

On our walks we also included Harley as lookout because Big Burrtha with two new cubs has been checking our corn for ripeness on a daily basis. Needless to say, shovelling 'scat' off the lawn also became a pre-excursion exercise for us on a number of occasions. Now that the rainy season is upon us I will have to conform more to what other owners have available for indoor cat exercise..........I wonder if cats can use treadmills? I will let you know.

One other note is that the ultrasound done in February of this year showed up what we believe to be the scar tissue on Hamlet's pancreas that led the original rescuing veterinarian to predict that he would develop diabetes. One or two of the veterinarians have commented that our difficulty in stabilizing Hamlet when he is on insulin may partly be to do with this in that the lump may become inflamed if Hamlet is showing symptoms of diabetes. There are rumblings out there in new study results suggesting inflammation may be a part of diabetes in general, and studies are showing cats to be very much the same as humans when it comes to the characteristics of this disease.