Poor appetite, weight loss

Hi All,

My 17-year-old kitty, Gwen (Gueneviere), has very little appetite now, even for her formerly favorite foods, salmon and tuna.  The problem started a few weeks ago with diarrhea (very light-colored, loose stool), so I brought her to the vet, and he did x-rays and blood tests, which showed gallstones and chronic kidney disease.  She completed a week of antibiotics and Actigall (to dissolve the gallstones).  The stool is better formed after that and has more color, but her appetite keeps getting worse.  I was just reading up on chronic kidney disease in cats and read that it can cause poor appetite, nausea, etc.  Has anyone else had experience with this, and how can I help her feel better and eat more?  I'm calling the vet again today about it, but would also really appreciate feedback from other people here, as he seemed a little unsure of what the main problem is. Gwen is down to about 6.8 pounds, down from her usual 10 pounds, so I need to do something fast..   BTW, I just got some of the Paul Newman's Organic Beef & Liver food, and that's really the only thing she'll eat except a little of the By Nature Turkey & Chicken..  They're both very soft "mushy" type food.  Vet said he has special food for cats with CKD, but most cats won't eat it (must taste awful!). Oh, the vet also said she has a tooth/gum abscess, but he thought that was a secondary problem to the gallbladder and kidney problems, but maybe that's affecting her appetite as well?  She's never had a teeth cleaning... Do you think that's a good idea for an elderly cat? Thanks for any ideas/suggestions!

With her current condition of not eating, I wouldn't recommend a teeth cleaning.  I would have her kidney levels checked again, though.  Sounds like she needs fluids.

Antibiotics can negatively affect the appetite of some cats, so that may be a factor. Can you get some probiotic capsules from a health food store and mix a tiny pinch in Gwen's favourite canned food (or some plain chicken baby food) a few times a day?
It can, usually when it's in the later stages and toxins are building up in the blood. Do you have a copy of her lab results (including urine specific gravity)?
Raising her food/water dishes a couple inches can help if stomach acid is a factor (common problem in CKD cats). Is she licking her lips and/or swallowing a lot? Does she seem interested in food, but then turns away after smelling it? Those are signs of nausea. Has she been vomiting at all?

Here are a couple great websites with tips on how to get her to eat more:

http://www.assistfeed.com/feline_assisted_feeding.htm

http://www.felinecrf.org/persuading_cat_to_eat.htm

Elssa said:

 

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Definitely stay away from all renal diets. They actually do more harm than good and have no place on a feline menu, especially that of an older cat who needs HIGH QUALITY meat-based protein to keep their finely tuned physiology in working order.

As for the dental issues, not only could they be a factor with appetite, but they can impact kidney health and should probably be looked at as soon as Gwen is stable enough. Pain meds (NOT Metacam!!) and/or another course of antibiotics may help buy some time if the tooth truly is abscessed.

Also, kidney disease is notorious for producing a lot of acid in the GI tract. Ask your vet about giving Pepcid a/c. A 1/4 of a 10 mg tablet twice daily works very well. Sub q fluids given at home can do wonders for appetite as it rehydrates and keeps the toxins being flushed out of the system. Also B12 injections are given just as much for kidney disease as for things like IBD, etc. I'm guessing since she had light colored stool, she had malabsorption which B12 is what is needed to treat that. A great website for kidney disease is: http://www.felinecrf.org/. Very informative and will talk all about the stuff I just mentioned. I agree, no renal diet really helps, it's an all wet food, grain free diet that works best. And NO Metacam, agreed on that also!

Oh, thank you all so much for the helpful feedback!  Well, I just talked to the vet again and am more confused than ever.  (I just switched to him recently because he's closer).  I told him about the articles I just read saying chronic kidney disease causes poor appetite, nausea, etc.

http://www.felinecrf.org/nausea_vomiting_stomach_acid.htm

As mentioned here, they suggested for anorexia something like Pepcid (acid blocker), as too much acid is related to CKD and poor appetite.  When I told the vet what the article said, he totally blew that off!  He just told me not to read articles on line and didn't think that was a factor, but he said trying the Ursodiol (Actigall) for the gallstones again "might help", so I will pick up that medication tomorrow.  Gwen had that and amoxicillin completed over a week ago, and she did seem to do somewhat better after that as far as the stool being formed.  The appetite has been getting worse progressively, though, and I originally thought it was a chewing problem with her tooth abscess, but now even with the very soft mushy food today (Paul Newman Beef & Liver, etc), which she ate yesterday, will not eat today, so I'm very worried it's more systemic.  

I did buy some pet probiotics, and will try that again now.. I agree - infection might well be a factor.  Wasn't sure if it was helping last time I tried, but she was on other medication at the same time, which may have had side effects. 

This vet said if the Ursodiol doesn't help, come back and he'll do more tests.  Gwen already had blood and x-rays, but he said the cat physiology changes much more quickly than people, and so I guess he would take blood again.  Last time, the blood showed only the kidney disease and the x-rays the gallstones (which he said was unusual), but maybe it would show something else this time. 

Gwen has not thrown up (diarrhea only), but she just sniffs the food briefly now and walks away, so maybe she is nauseous? She often hides out in her little cat tunnel, which she never used to do, so I know she is feeling bad.  

I've been trying everything to whet her appetite, her favorite tuna, but she just won't eat.  I bought grain free food (even though the vet said don't bother), and that seemed to help with the stool being formed, but that was when she had an appetite.  Thanks so much for the articles about getting her to eat more - will study those.  Will also try raising the cat dish.

Also, kidney disease is notorious for producing a lot of acid in the GI tract. Ask your vet about giving Pepcid a/c. A 1/4 of a 10 mg tablet twice daily works very well.

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I'm going back to the former vet.. she listened much better..  will ask about that Pepcid you suggested.  I guess that's not something I should/could give myself? 

Well that's not for me to say. If you can call your vet on the phone and ask that would be perfect. Also, yes, nausea for anyone would make them not want to eat. Make sure she doesn't go more than 1 day without eating because you risks fatty liver disease setting in if she doesn't eat. If you have to, syringe feed her some baby food (NO garlic or onions). She needs that nourishment and tomorrow at the latest. If she still doesn't eat on her own, ask the vet about cyproheptadine which is an appetite stimulant.

I did ask the current vet today about the Pepcid, but he pooh-poohed that - said that would not help!  The articles I read did say it is helpful, though.  I am going back to the old vet Monday hopefully and will ask her.  I have bought the Gerber baby food (first stage), so it's like a gel, pureed chicken and chicken broth, nothing else in it.  She has eaten that in the past, but today is refusing everything except a little of the Newman beef & liver this morning, refused to eat after that.  I was also curious about the appetite stimulant mentioned in the article, but the vet said he only wants to give her the Ursodiol again for the gallstones. He doesn't seem to want to try anything else. 

BTW, my last cat, Elsa, died of chronic pancreatitis.  We finally had a tube inserted, but that didn't help much and we had to let her go finally at age 20.  Does the pancreatitis always show up on the blood tests?  This vet just mentioned the kidney disease and gallbladder problems with Gwen. 

Thanks so much for your help!   

Well this vet can pooh pooh it all they want but it's used alllll the time for kidney disease and it does indeed help many, many kitties. One being my sister's cat Midnight who takes it daily! No, with pancreatitis, they need to send the blood for a PLI at a special lab; either Texas A & M or Idexx. I prefer Idexx as it takes only 48 hours. I'm sorry you lost your sweetheart to pancreatitis. It's nasty, I lost my beautiful girl Alex to a pancreatic infection and it was horrible. It still haunts me.

Yes, well, after reading that article, it sure sounded to me like the Pepcid or some acid blocker might be the answer, so I was upset when the vet dismissed it right off the bat.  The only thing he wants to try now is the Ursodiol (Actigall) again (she already had a week of it ending over a week ago)...  He did say the x-ray showed a lot of gallstones and he thought that might put off her appetite, but as with everything he wasn't really sure.   Well, I'll try that Ursodiol again but I also want to give the Pepcid a try and will tell him so.  If he refuses, will have to change vets. He also pooh-poohed it when I said I was only giving her a total grain-free diet  now and he told me to go back to the store brands that I was giving her before, such as Fancy Feast and Whiskas.  I had tried one grain-free food years ago (think it was Wellness), and that had given her diarrhea, but I see that has carageenan and fruits and vegetables in it, so who knows why it bothered her.  Overall, in the past month or so, though, the grain-free food brands now (Newman and By Nature) have definitely reduced the diarrhea and produced more formed stool. When I try the Fancy Feast again, the diarrhea comes back. 

 I'm so glad to hear that the Pepcid did help your kitties with appetite, and you've given me the courage to be persistent and try to get this vet to prescribe it - otherwise I'll go to another. 

That's interesting about the pancreatitis.  I did tell this vet about my Elsa dying of pancreatitis, but he didn't say anything about special testing needed - will check into that.  I do remember the diagnosis of pancreatitis with Elsa was long in coming and they weren't ever too sure about it, so she probably never had that special test.  She passed on in 2004.. 

Gwen was able to get down a little tuna tonight, first thing she had eaten since this morning, so am a little relieved about that.. Basically, though, it's as if she can't even smell the food.  She just looks at the food as "what's that"?  Perhaps the tuna had a strong enough smell to get her appetite back a little bit - that's always her favorite.  I'll just give her whatever she wants and can eat.. Thanks again all - will stay away from those renal diets. 
 

Well things have changed greatly since 2004 so that may be why. I don't know if they had that test back then frankly. It's just a simple blood test but it must be sent to a special place. Also, I think they might have you fast her but it depends on how she's doing so that is something to discuss with the vet. Be persistent, learn everything you can and know that you are the parent!!! Vets know a lot but I have come across some wonderful ones that will go above and beyond to help a kitty and some that have let some of them die because they refused to try a medication that we KNOW works!!! Makes me mad.

I would highly recommend you join the Yahoo CRF group. Those folks are wonderful and very knowledgeable!

http://pets.groups.yahoo.com/group/Feline-CRF-Support/?yguid=353539644
 

stephanietx said:

I would highly recommend you join the Yahoo CRF group. Those folks are wonderful and very knowledgeable!

http://pets.groups.yahoo.com/group/Feline-CRF-Support/?yguid=353539644
 

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Good idea! But don't listen to their diet advice - they tend to push the renal diets.

finnlacey said:

Well things have changed greatly since 2004 so that may be why. I don't know if they had that test back then frankly. It's just a simple blood test but it must be sent to a special place. Also, I think they might have you fast her but it depends on how she's doing so that is something to discuss with the vet. Be persistent, learn everything you can and know that you are the parent!!! Vets know a lot but I have come across some wonderful ones that will go above and beyond to help a kitty and some that have let some of them die because they refused to try a medication that we KNOW works!!! Makes me mad.

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I'm mad as well..  Before I joined here I'd read that article saying that Pepcid can help a lot, but he just dismissed it..  I don't know why.???  I'm supposed to call him this morning and then pick up the Ursodiol, for a second round treatment. I'm going to tell him that I would also really like to try out that Pepcid, as I've read it can be very helpful for cats with chronic kidney disease.  Well, she just ate a little of the By Nature Beef & Liver, so I'm happy about that..  She does have trouble chewing, picks up a little, struggles to chew and shakes her head, so I'm still wondering how much the abscess (which he showed me in the office) is involved in all this.  The vet said he wouldn't recommend the CKD cat food he sells (KD or NF?) because the cats won't eat it, so I give him a little credit for being honest about that at least.  I just can't understand why he doesn't want to try the Pepcid..  I will have to tell him either give me a prescription for it or I'll have to go to another vet.  Want to try the appetite stimulant as well.  Thanks again, all.  I really appreciate it.

Pepcid is over the counter.

How much can I give her of it, then?   I have Tagamet at home, but not Pepcid.  Thank you.

finnlacey said:

Also, kidney disease is notorious for producing a lot of acid in the GI tract. Ask your vet about giving Pepcid a/c. A 1/4 of a 10 mg tablet twice daily works very well. Sub q fluids given at home can do wonders for appetite as it rehydrates and keeps the toxins being flushed out of the system. Also B12 injections are given just as much for kidney disease as for things like IBD, etc. I'm guessing since she had light colored stool, she had malabsorption which B12 is what is needed to treat that. A great website for kidney disease is: http://www.felinecrf.org/. Very informative and will talk all about the stuff I just mentioned. I agree, no renal diet really helps, it's an all wet food, grain free diet that works best. And NO Metacam, agreed on that also!

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Hi,

Oh, I see now:    "A 1/4 of a 10 mg tablet twice daily.."   Sorry, this is all new to me and still trying to absorb it all, but I will try this amount.  Thanks again!  Gwen is my world and I want to do everything possible for her.  Really appreciate all the great advice and websites provided here at this wonderful site.

Yes, CRF leads to lose of appetite but so does old age.  The sense of smell goes a bit, food becomes less appetising.  You might find that strongly flavoured foods encourage her to eat.  At 17 I personally would be concentrating on quality of life rather than quantity, so I would feed hermore or less anything she will eat rather than worry much about how good for her it is.  The tooth/gum problem is a cleft stick - if her mouth is sore she will be less inclined to eat, but because she is thin and not well she's a bad anasthetic risk for fixing it.  Painkillers might help.

NO Tagament! It has side effects for CRF you don't want. Stick with Pepcid. You can get the generic kind at Target, it's much less expensive, that's what I do. Make sure it's regular strength. It's okay, you will learn all of this. I do agree with joining the Yahoo CRF group.

Thank you all so much..  I'm getting the generic form of Pepcid AC now.

For the past couple days, Gwen had been refusing her favorite foods, tuna and salmon, so that's why I've been in a panic, but I did finally get her to eat a little tuna last night, so that was a relief.  The vet had said "fish just once a week", but I'm just going to give her whatever she wants, as you say - want her to enjoy her meals!

The vet also wants to try the ursodiol again for her gallstones, so I'm going to give her that again, too. 

What's everyone's advice about how to treat diarrhea? She won't eat that clay stuff in the food.  Thanks again. 

Actually really try to get her off fish for good. It's not good at all for renal disease, too much phosphorous. You know what works fantastic for stopping diarrhea AND kitties LOVE LOVE LOVE the taste? It's called Eaglepack Transitions Solutions: . This stuff is amazing and works so great! There is nothing bad in it and it's a probiotic as well but gentle.