D. E. Larsen, DVM
Charlie’s horses were pretty well managed, and after the breeding season, there was not a lot to do around the farm. Betty managed to keep their account pretty active.
“What brings you in today?” I asked Betty when she eased through the front door. Betty was a slightly built lady with black shoulder-length hair. She seemed a little shy most of the time when Charlie was around, but I suspect that she could hold her own in most situations.
“This darn cat of mine is peeing everywhere,” she said with some concern in her voice.
This darn cat was named Foster; he was an old guy. He was approaching the golden year for male cats in the 1970s. I seldom saw a male cat over 15, and if I remembered correctly, Foster was going to be 15 this summer. Betty had found him as a kitten under the dumpster at Glen’s Market in Foster. He pretty much had the run of the place now.
“Peeing all over the place, small puddles or large puddles?” I asked.
“Oh, they are large puddles when they are on the floor. He peed on the bed this morning. That is why I am here, it woke up Charlie, and he was none too happy,” Betty explained.
“Well, let’s get him in an exam room and look at him and see if I can get some urine out of him.”
Pulling him out of the carrier, I noticed that he was much thinner than he was in the past. There was urine in the kennel.
“Oh my,” Betty exclaimed, “how could there be so much urine already?”
“We will get a quick look at this urine first, then I will do an exam,” I said as I drew up some urine from the kennel.
This urine would do fine for a dip stix, but we would need a better collection if we were going to have to do additional testing. I handed the syringe to Dixie and returned my attention to Foster. He was quite thin, ribs were showing through his hair coat. His eyes had early cataracts, sometimes these old guys just have trouble finding their way to the litter box. He was dehydrated also. My guess was either advanced kidney failure, the most common cause of death in an old cat, or possibly diabetes. I seldom saw diabetes in the cat, but it was definitely on the list.
Dixie popped into the exam room and laid the results of the dip stix on the counter. A four-plus urine glucose and normal specific gravity just about confirmed a diabetes diagnosis.
“Betty, Foster probably has diabetes. We need to do some blood tests to make sure and to check his liver and kidney function. Then we need to give him some fluids and get him on a stable insulin dose. He is probably going to have to stay with us a day or two.”
“Doc, I can leave him for the day, but I don’t want to leave him overnight. If he is going to die, I want him to die at home,” Betty said in a stern voice. I had not heard that voice from her before.
“We can probably work with that, but I will need to see him every morning for a week or so. We will start off with a pretty low dose of insulin and work it up slowly,” I explained.
“The other thing we need to discuss is what we can expect with his treatment. He is almost 15, and I don’t see very many male cats older than 15. Diabetes is a difficult disease to live with for people. For people to manage the disease in pets is even more difficult. Top that off and cats are also difficult to treat when they have diabetes. A high percentage of pets with diabetes are euthanized within 6 months of diagnosis, just because of the difficulty of living with the disease.”
“We will do whatever we need to do to keep Foster alive,” Betty said. “I know he is old, and I know he won’t last forever, but we won’t be the ones to give up on him.”
With that, we kept Foster for the day. His blood glucose was well over 400, and other blood tests were normal. We gave him 300 ml of Ringers Lactate by SQ injection and started him on a low dose of insulin.
Betty was waiting at the door every morning with Foster. My guess was the barn chores would wait until his treatment was done. Testing at the time was cumbersome. The first few days, we did both a blood test and urine glucose. Foster was obviously feeling much better, looking brighter, and Betty reported him to be much more active and peeing less. My goal was to get his glucose to somewhere around 200, just to a level he could live with and not have much in the way of a hypoglycemia risk.
By the third day, we were there. “I think this is the dose we use for a couple of weeks,” I explained to Betty. We had been showing her how to do the injections all week. I want to see him still for a couple of days, just to check his urine glucose and give the dose in the morning, Then we will turn you loose at home.”
Thursday morning, expecting a quick check, Foster’s urine showed no glucose. Great, so much for a simple case. We drew a little blood. Blood Glucose was 50, pretty low.
“No insulin for Foster today,” I explained to Betty. “Sometimes, in the cat, we will see a remission or sometimes a fluctuation in insulin requirement. So no insulin today, and we will check him in the morning.”
Friday morning, and there was still no glucose in his urine. We decided to go the weekend without insulin and recheck on Monday. This might prove to be a complicated case to manage.
On Monday, Foster’s urine showed a 4+ glucose, and his blood glucose was over 300. So we started over where we left off.
“That would be great if you could check his urine every morning, but I am not sure that you could get urine out him,” I said. “We will have you check his glucose every morning, give insulin if it is positive, and don’t give insulin if he doesn’t have glucose in his urine. That is not perfect, but we will see how that works. You just call in the mornings and let Dixie know how things are going so she can keep his record up to date.”
So that was the program, Betty was happy, Foster was delighted, I was hopeful that we would not have a wreck. I could not believe that Betty could get urine every day.
Two weeks later, when Betty was in for a recheck, I noticed that the daily record was complete. There was a two-day stretch where she did not give insulin. Foster had gained almost 2 pounds and starting to look like his old self.
“Things look like they are going well,” I said. “But it looks like you are going have to check his urine every day, his insulin demands are just going to fluctuate enough that we have to have a daily check. My concern is, how are you going to get urine out of him every day?”
“That is no problem, I just have him pee in a coffee cup,” Betty said with no expression, just like that was something everybody would do.
Betty was able to manage Foster for another 3 years with this simple program of monitoring. Consistently during those years, Foster would have several days each month where he would have no need for insulin. We could have managed him closer and done away with those days, but I am not sure that his quality of life and the quality of life for Charlie and Betty would have been improved.
Charlie and Betty Land continued tomorrow, #4 The Fish Pond