|The Tragedy of Tommy Boy
Tommy Boy, my little macho tabby cat, was born in the palms of my hands
to a stray mother cat, Maryann, whom I had taken off the street.
Four litters of Maryann’s kittens had grown up feral in the street, and
come to a variety of awful fates. A nice lady down the block was
feeding them, but she was elderly and unable to TNR. The day I saw
Mary pregnant for the fourth time in three years, I said, “OK lady, that’s
enough. You’re coming with me.” I grabbed her, took her in
over her great protests, and she had her babies, 7 of them, in my home
with my husband and myself as midwives. Breaking the cycle, Tommy
Boy and his siblings began life in safety and love, in a home instead of
Tommy Boy wasn’t a runt but he was the last born. I could always
distinguish him from his brothers and sisters, who were all identical tabbies,
by the white tip on the end of his tail.
As Tommy Boy grew up, I also recognized him by his vanguard personality.
He was the first to do everything; the first to open his eyes, the first
to walk, the first to climb out of his baby bed at only two weeks old.
He was the first to seek out human company, and the first to try to climb
the virtual Everest (to him at 4” long) of our bed. At approximately
three weeks old, Tommy Boy started coming clear across the apartment to
sit on my foot as I worked. That pretty much cemented his status
as a member of our family, and when all the other kittens got adopted to
new families, Tommy Boy stayed.
Tommy Boy had a long, mostly happy life. But the point of
my article is not to write Tommy Boy’s life story, only the end of it,
which broke my heart and was entirely unnecessary, so that other guardians
of diabetic pets can learn from my mistake.
Tommy Boy was 9 years old when he was diagnosed with diabetes.
Along with the detailed and daunting instructions I received about insulin
dosing, one of the first things I was taught was that chronically high
sugar levels leave diabetics open to opportunistic infections. After
instruction #1, which was that he must have insulin or he will die, this
was absolutely basic, must-know knowledge, item #2 in Diabetes 101.
When he was diagnosed, the vet started Tommy Boy off with very low doses
of insulin, fractions of units in a distilled water dilution (1/10 ratio),
and increased gradually over several weeks time until we had an optimum
dose. That turned out to be about 6 full units twice a day.
“Optimum” was determined by observing his overall condition, appetite,
thirst, and a measurement of ½% or less sugar in the urine, tested
with a dipstick. The dosage of 6 units twice a day remained more
or less the same for many years.
Starting at about age 13-14, however, approximately every 6-8 months,
Tommy Boy would have a low blood sugar episode. This is a dramatic
and unpleasant event, but unless you can read tea leaves, it’s virtually
unavoidable with diabetic animals, and sometimes even with people.
Blood sugar levels change every hour depending upon countless factors
including food intake, exertion, stress, and sleep. The only way
to know the exact sugar level is to monitor it with a blood glucose meter.
This is where you prick the finger with a needle, and hold the blood drop
to a strip that is inserted into a small machine that measures the sugar
People can do this easily enough. Theoretically, you can do the
same with cats. But unless you have an absolute angel of a cat who
will let you do anything to him, it’s impossible for an owner to get blood
out of them; doubly impossible to get it in the 12 seconds allowed to get
that droplet onto the strip.
The only practical tool for monitoring sugar in pets is Ketostix or
KetoDiastix. These are colored strips that change color when they
detect sugar in the urine. You hold a strip under the urine stream
(if and when you can catch them in the act), then wait 30 seconds comparing
the strip to the color chart. The patch changes from pale blue to
dark brown over 30 seconds depending upon the concentration of sugar in
the urine. KetoStix measure only sugar. KetoDiastix also alert
you to keytones, a toxic substance that accompanies very high sugar in
the bloodstream, a very dangerous condition.
It’s hard to know what causes the blood sugar level to change so much
as to cause a low blood sugar episode in an animal that eats pretty much
the same thing every day, rests the same, has little stress, and takes
virtually the same insulin dosage very day. For whatever reason,
the sugar is low to begin with, and you give a dose of insulin that, though
it’s the identical dosage he gets every day, is too much for his system
at that moment, and drives the blood sugar down too low.
I was forewarned that this could happen suddenly, how to recognize it,
and that it could be quickly cleared up with a tablespoon of Karo syrup,
and withholding the next two or three insulin shots.
The first few times this happened, being armed with these instructions,
I did exactly that, and let the vet know by phone afterward. The
vet made a note to his chart, and Tommy Boy jumped right back into his
regular routine after a few days. This worked fine in about 3 episodes
over about 2 years. And here I’m going to go out on a limb and say
that after six years managing a diabetic cat, 14 years as Tommy Boy's guardian,
and 40 years developing my judgement and intuition, as long as I was managing
his insulin regimen, Tommy Boy was a stable diabetic. The day I let
myself be talked out of my own better judgement was the beginning of the
end of Tommy Boy’s life.
Tommy Boy went in for a yearly check up just before his 14th birthday.
I discussed with his vet this handful of low blood sugar episodes.
His advice during this check-up changed. He told me the next time
it happened, I needed to get Tommy Boy right in to the clinic.
So, the next time Tommy Boy had an episode, I brought him in.
Instead of prescribing that Tommy Boy miss a few doses and get back into
his normal routine, the vet dropped Tommy Boy’s insulin to 1 unit ONCE
a day, and instructed me to start him all over again from scratch with
the gradual build up. This sounded crazy to me, and I questioned
him at length. Why would we do that? How could that be good
for him when he was used to 12 units a day? Wasn’t that way too dramatic
a drop from so high? Wouldn’t the system suffer? Wasn’t something
more moderate the right way to go? Why was this advice so different
from what I had originally been instructed to do? Which had been
working fine so far in these low blood sugar events? I really gave him
the third degree, but he was adamant about his advice, had an answer for
everything, and I’m not a doctor, so how could I argue? I did what
he told me.
It took Tommy Boy 3 months to get back to his optimum dose after this
low blood sugar episode. When we finally reached it, he was his old
self. In the meantime, he was lethargic, irritable, and sick.
He vomited regularly. He had frequent diarrhea. He wouldn’t
play, wouldn’t interact with the other cats, and didn’t want to be snuggled
or touched. At the worst of it, he could take a maximum of ten steps
at a time before he would drop down winded. Obviously this draconian
approach to the low blood sugar episode had been ill advised. But
I’m not a doctor, and I let myself be convinced that while I know my cat
better than anyone, and the evidence of my eyes told me this was wrong
for him, surely the vet’s scientific instruments give more accurate numbers
than my intuition. He had to know what he was doing. Right?
At the time of the next blood sugar attack about 8 months later, I took
him in, and the advice was the same. Again, against my better judgement,
they made me start all over again with this: dropping him down to nothing
and working back up over a laboriously long time. This time, however,
halfway into the process I decided it was ridiculous. The toll on
the cat far outweighed any benefit there might be in this insane insulin
deprivation, and against the doctor’s advice, I accelerated the process
until we reached Tommy Boy’s his last known optimum dose in about half
the time. Tommy Boy went from lethargic, sickly, miserable and cranky
to his old self in half the time.
I was now at the end of my patience with this vet who had disappointed
me in other ways as well. He had misdiagnosed in at least two instances
that I could recall, with rudimentary but serious illnesses that should
have been patently obvious. He had a very nasty associate, and some
true birdbrains on his staff who constantly made me late to refill Tommy
Boy’s prescriptions. The last straw was when he couldn’t wait for
my cab to arrive to close the office one night, insisted on driving us
home, and then dumped me and Tommy Boy out in the street in a rain storm
halfway home because it would have taken him an extra five minutes out
of his way.
I began using a phone-a-vet that makes house calls instead. Little
did I know that in the next low blood sugar episode about 6 months after
the last, the clinic he would take Tommy Boy back to for tests was the
previous doctor’s office, and that the advice would be the same all over
again. However, this vet had an all new language to convince me why
I needed to follow this regimen. And again, contrary to my own intuition
and better sense, I was frightened into this crazy scheme, and dropped
Tommy Boy to 0 insulin for the third time.
We were about a month into the gradual increasing, and at about 3 units
twice a day (half Tommy Boy's proven optimum dose) when on a Christmas
Eve, I noticed his eyes didn’t look right. They were dark, and puffy
and pained. He was rubbing them. He looked so strange that
I asked my neighbor to look in on him at some point during the 2-3 hours
I would be out with family for dinner. On Christmas Day, the eyes
were worse. Very dark looking, swollen. The day after Christmas
I took Tommy Boy to a brand new local vet. She diagnosed him with
conjunctivitis and sent him home with some ointment to administer for 7
days. He also had an ear infection which needed drops.
Of course! This is what I had been warned about in Diabetes 101.
Chronically high sugar will start to cause infections. I was not
doing this crazy insulin deprivation scheme a third time.
But it was too late for that decision. Two days later, I was awakened
at 7AM to the sound of Tommy Boy’s hysterical crying and screaming.
I rushed out to the living room to find him stuck behind the television
cabinet unable to extricate himself from the corner. I lifted him
out and when I turned him to face me, I saw the cause of his wailing.
He was blind. The entire visible surface of both his eyes was covered
over with a thick orange-white coating. The eyes were swollen to
about 125% of their normal size. I was horrified. And so was
Tommy Boy. His cries were heartrending and pitiful. In my robe
and slippers I ran from the house into the snow and took him to a large
Manhattan emergency clinic, the only one open for miles during the holiday
I’m going to fast-forward here, and cut a very long story very short.
We fought for two months to save Tommy Boy’s eyes. He got his some
limited sight back temporarily with antibiotics and steroids, but the infection
was too advanced to eradicate it completely. Ultimately he lost both
his eyes. The cause: Bartonella bacterial infection allowed
to flourish in the high sugar environment of his system without insulin.
That’s if you listen to ME. If you listen to one vet, the cause was
“complications of diabetes,” or the other one, “no causative factor identified.”
My heart was broken. My one true phobia is blindness. If
it were me losing my sight, I would jump from the nearest rooftop without
a second thought. To think of my poor Tommy Boy being blind was more
than I could stand, and my friends will tell you I had a near breakdown
over it. If it were as simple as a prospect of losing both eyes in
one fell swoop, I would have put Tommy Boy out of his misery before it
came to that, and called it a blessing. But he didn’t lose his sight
all at once. In the second month after the hysterical holiday ER
dash, one eye deteriorated so much that it had to be removed. But
he still had another eye with limited vision. By the time it was
ascertained that he had completely lost the sight in that eye as well,
he had been living blind for a couple of weeks. The dilemma then
was whether to put down a cat who was blind, but coping. I couldn’t
So Tommy Boy lived three more years as a blind cat. I never would
have dreamed he could do it as well as he did, but he adjusted. In
true Tommy Boy form, he did everything on his own. I didn’t have
to help him with anything. He found his way to his food, his water,
his litter box, and his bed, and took care of all his business without
a stitch of help from me. He took head to toe baths, and even managed
to jump up on the sofa and the bed without help. He amazed me every
Tommy Boy had a few more low blood sugar episodes during the last three
years of his life. However, having paid the dear price of his sight,
which I felt responsible for having three times implemented this insane
insulin deprivation regimen that I knew was wrong, I ignored all such advice,
and I winged it on my own. For almost the rest of Tommy Boy’s life,
I did what I knew was right. I kept his insulin at or near 6 units
twice a day, and monitored him the best I could. And for three years,
though blind, Tommy Boy was a healthy cat.
At a certain point, the vet refused to continue prescribing Tommy Boy’s
insulin syringes without seeing him. So I was cornered. I had
to take him in.
They tested his blood sugar, and reported that while his glucose levels
were within normal range, his “fructosamine” levels evidenced a sustained
period of low blood sugar. This, they explained, could be from something
called “honeymooning” where, for reasons unknown, a cat will suddenly stop
needing insulin. The vet seemed very convinced of what she was saying.
And rather than patronizing me with lay terms, she expressed her diagnosis
in real words. The prescription: drop Tommy Boy’s insulin back to
1 unit 2x a day and……
Wait a minute. This is what I had done four times already!
This is what blinded him!
She pulled out the papers. Showed me the numbers. Explained
in exhaustive detail why what she was saying was absolute fact, and why,
if I didn’t follow her prescription, I would be putting Tommy Boy’s health
in serious jeopardy. We had a half hour conversation/argument about
this, at the end of which, having heard the science, I was compelled to
believe her. Again, I was frightened into following advice I knew
in the bottom of my heart was absolutely wrong, but how could I argue?
She had the numbers. She had the papers. Numbers don’t lie!
So I did it. I did it to him again. I dropped his insulin
to 1 unit twice a day. Over two weeks, I watched Tommy Boy go from
a blind, but reasonably healthy older gentleman cat, to a wasted, skinny,
bone that could hardly lift himself off the floor.
On the 14th day, when he had absolutely collapsed, I called the vet’s
office. “This can’t be right,” I said.
“It can’t be wrong,” she said. “The numbers don’t lie. He’s honeymooning.
I know it’s never been explained to you adequately before, but it is accurate.
What you’re seeing is probably the result of too MUCH insulin. Drop
him back to one unit ONCE a day.”
God help me, I did it. She had frightened me to death with her
numbers and her certainty, and so I did it again.
In two more days, condition worsening, I called again. “Doctor,”
I said, “ this absolutely CANNOT be right.”
“What do you want to do?” she asked me impatiently.
“I want to give him his normal insulin!” I said.
“You’ll kill him,” she said. “He’s honeymooning. I promise
you. Just keep up the program. You’ll see, he’ll start getting
Later that night, he urinated on the floor because he couldn’t make
it to the box. I took a dipstick to the urine. The sugar was
at the top, dark brown, and now, the second stripe, always clear before,
indicated the presence of keytones. Keytones means dangerously high
sugar levels with toxic side effects.
It was 10PM at night, and I called the vet’s emergency number.
In a few minutes, an associate called me back. I said, “Look, this
prescription absolutely cannot be right. The cat is lying prostrate
on the floor. He can’t eat. He can’t make it to the litter
box on his own. The sugar is at the top of the dipstick, and now
it’s showing keytones.”
This doctor said, and I quote, “well, it’s just not possible for a cat
to go from the fructosamine numbers he had to high blood sugar in two weeks.
It doesn’t happen. Are you sure you’re reading the dipstick right?“
If she had been in the room with me I would have kicked her. “Yes,
I’m reading it right. I’ve been reading these sticks for 6 years,
I think I know how to do it. Of course,” I added with some sarcasm,
“this is the first time I’ve ever seen it show KEYTONES!”
Her ultimate answer was, “While I wouldn’t say anything’s impossible,
it’s highly, highly unlikely that he went from the numbers he had two weeks
ago to blood sugar that’s off the charts. But if you believe you have high
blood sugar and keytones, go to an ER.”
I hung up absolutely disgusted with her. With them. With
the whole system. I didn’t know what to do. The only ERs around
here were lousy. I hated to go to any of them. And with the
whole damned bunch of them agreeing that his sugar was low while I was
looking at sugar levels off the chart, who was to say the ER vet wouldn’t
take insulin away from him altogether?!
I had a blood glucose monitor here that I had never been able to make
work, though I had tried many times, he just would not sit still for it.
But now he was absolutely prostrate on the floor. I’d have bet he
was in a near coma if asked to lay money. He wouldn’t be able to
With shaking hands, I pricked a vein in his ear, and took a reading.
The meter said, “HI”.
What? Had it just come on? Was it saying, “hello?”
Or was it giving me a reading? I found “HI” in the manual.
It said that “HI” represented a number so high, it couldn’t be measured
by this meter. “See your doctor immediately.”
I blinked. I must not have done that right. I did it again.
It read “HI” again. Oh My God.
I immediately got the syringe and insulin and gave Tommy Boy 3 units.
It was against all advice. And much too much if I listened to a veterinarian.
But their advice had made this mess. “F--- them,” I said, pardon
my language. I was past listening to that nonsense, and shaking from
fear, and rage. Had any of those veterinarians been present in the
room, I could have done them serious bodily injury.
I waited half an hour, and took another droplet of blood from Tommy
Boy’s ear. This time the blood read 584. The 3 units of insulin
had brought his sugar down from an unreadable number to something the machine
could at least read. But this was an outrageous number! Normal
blood sugar is 70-120. If there were any question in my mind that
those veterinarians had made a grievous mistake, it was erased entirely
by the sight of this number on the meter.
While I stared in disbelief at the meter, my mouth gaping open, Tommy
Boy began to try to stand up. He was shaky on his feet, and not altogether
coherent. But as he came to, he became aware of his discomfort and
began to cry. He tried to pace, and fell down. He tried again,
but listed to one side, and turned round in a circle.
I knew what was happening to him. The sugar, elevated to this
insane level over two weeks time (and the compound effect of all the other
times he had been insulin starved before this) had created nerve damage,
a.k.a. diabetic neuropathy, and probably brain damage. Diabetic neuropathy
can be intensely painful. It causes extreme sensitivity to touch,
shooting pains in the extremities or any affected nerve group, tingling,
burning, cramps, as well as gastric trouble of all kinds, and loss of motor
coordination. I knew I could not manage this crisis at home, and
I HAD to go to an ER whether there was a decent one or not. Perhaps,
an ER could give him fluids, stabilize him for a couple hours while I waited,
and I’d take him to – lord knows where, we’ll figure it out- in the morning.
I took Tommy Boy to the local veterinary ER. The on-call vet took
one look at him, heard a few words of my story, and said, “This is clearly
not low blood sugar.”
I asked the vet to put him on an IV drip, stabilize him, do what they
could for him, and I would find a new vet in the morning (this place was
just an all night ER. They close at 7AM; all animals have to be on
their way to hospitals or their home vets by 6:30.)
He said, “This cat is in desperate condition. He needs at least
a week of intensive care to pull through this. IF he makes it through
the night. He can’t go home tonight.”
I asked him, with my heart in my throat, “Are you saying he’s dying?”
“Can’t you do something to stabilize him? At least give him an
IV? Some hydration? He’s obviously dehydrated…..”
“This is way beyond that,” the ER vet said, his message implicit.
At that moment, Tommy Boy stood up and began to vomit. Nothing
came out. He had no strength to stand, and fell down on the slippery
stainless steel table. I wrapped him in a towel and held him to me.
He lay in my arms and panted. He was just a bone. And I knew
it was time. I had promised him after the surgery that removed his
second ruined eye, when he was hysterical with pain and fear, that I would
not put him through any treatments or procedures that required him to be
away from home. A week in intensive care, in this atrocious condition,
without the ability to even see where he was or who was doing what to him,
was more than I could dream of subjecting him to after all the rest.
This was it. It was over.
I spent five minutes alone with Tommy Boy cradling him, crying my eyes
out, and apologizing to him for the egregious lapses in my judgement that
brought him to this point. I begged him to forgive me. Then
I allowed the ER vet to euthanize Tommy Boy. My little 3” pioneer.
The little tabby fur person that was the first to do everything.
The best and bravest and smartest animal I ever knew.
I will never forget Tommy Boy or the lesson I learned from his life
and his death. I will never, ever, EVER in all my days, ever again
doubt my own instinct. I have known for a very long time that the
only absolute and infallible protection a person has is their intuition.
That small voice inside that tells you without the aid of research or education
or parental advice what is right and what is wrong for you and your own.
If you listen to it, you will never come to harm. If it speaks and
you ignore it, you go wrong every time.
I tell this story not to break hearts and make people cry, but to warn
guardians of diabetic pets to BEWARE the stories of HONEYMOONING.
It may be true of some cat somewhere. That cat may be your cat.
But it was not my cat. And it was not my cat on all four occasions
that I was assured it was. BEWARE also the PROOF of honeymooning.
I saw it with my own eyes, the papers, the reports, the numbers.
All were wrong. They “couldn’t be”, but they were. LEARN FROM
MY STUPIDITY. I did the draconian prescriptions these veterinarians
recommended because I WAS FRIGHTENED INTO IT by the assurances. The
absolute certainty they evinced that they were right convinced me to set
aside my own better judgement, my “mother’s intuition”, which had never
failed Tommy Boy before, in favor of advice I knew was wrong. It
looked good on the paper. But how stupid does it all sound now?
It was my first lesson in diabetes: “If he doesn’t get his insulin he will
The hard truth is that I killed my cat. I killed him with the
stupid refusal to put my own instinct before the almighty word of a veterinarian
even when I KNEW I was right. When I had PROOF, and FOUR SEPARATE
AND DISTINCT EXPERIENCES TO PROVE that I was right. But I did it
anyway. I killed Tommy Boy.
It took me 10 months to be able to tell that truth. I thank Judy
Dick for asking me to write Tommy Boy’s story when I had contacted her
only for the name of a feline diabetes charity to donate to in Tommy Boy’s
name… for seeing the value to others in this story and prompting me to
write it. Had she not asked, I would not have done it. It was
hard to relive, and to face that truth in black and white, but writing
it has helped me get some closure on his death, and if it helps one person
avoid making the mistakes I did, it’s worth every painful word.
Name of Author being withheld at this time
THE RAINBOW BRIDGE
"Just this side of Heaven is a place called Rainbow Bridge.
When an animal dies that has been especially close to someone here,
that pet goes to Rainbow Bridge.
There are meadows and hills for all our special friends so they can
run and play together.
There is plenty of food, water and sunshine, and our friends are warm
All the animals who had been ill or old are restored to health and vigor;
those who were hurt or maimed are made whole and strong again,
just as we remember them in our dreams of days gone by.
The animals are happy and content, except for one small thing;
they each miss someone very special to them who had to be left behind.
They all run and play together,
but the day comes when one suddenly stops and looks into the distance.
His bright eyes are intent;his eager body quivers.
Suddenly he begins to run from the group, flying over the green grass,
his legs carrying him faster and faster.
You have been spotted, and when you and your special friend finally
you cling to each other in joyous reunion, never to be parted again.
The happy kisses rain upon your face;
your hands again caress the beloved head,
and you look once more into the trusting eyes of your pet,
so long gone from your life but never absent from your heart.
Then you cross Rainbow Bridge together........"
Author - Unknown