Seeking Thoughts, Opinions on Extreme Meds/Diet Regimen

Hi Everyone,

I haven't posted here at the site in some time, so please forgive me not going back to reintroduce myself at the newbie forum. I'm just really, really REALLY stressed out with what's going on with my kitty Blondie and his vet and am in no mood for cheeriness. Sarcasm, yes, but happy-happy fun times, not so much. I'm hoping for some insight from a) those who have been through GI issues with their kitties (specifically esophageal disorder) and/or b) those whose kitties have been prescribed any of the following: Clavamox, Metronidazole, Sucralfate, Famatodine and/or prescription diet of Hills z/d or d/d. Even if none of that applies, if you want to read on for a case study on what I think is a crazy vet, then please do!

In short, the reason I'm going batty is because of the number and frequency of the meds, along with a COMPLETE diet change for Blondie. I'll make this brief, but it all began with him regurgitating (I learned there's a difference between regurg and vomiting) after eating. Long story short, regular vet was at a loss after imaging/blood work/ a shot of Convenia, so he sent me to an internist. Then internist does more imaging, more blood work, the whole shebang (to give an idea of all that was done, I spent $980 in one visit).  Even after all the tests, the internist still doesn't know exactly what's happening, but it seems to be mostly esophageal. Possibilities: IBD, helicobacter, lymphoma and/or other infectious or inflammatory diseases are possible. 

Thus begins this crazy regimen based on "possibilities." Blondie must eat z/d ONLY for ten days. On top of this, here's the deal with the meds:

Clavamox: 2 times a day

Metronidazole: 2 times a day (side note: I've already made up my mind of NOT giving him this. I've done my research, and thanks, but no thanks; I think I'll spare my cat from neurotoxicity and potential seizure)

Famatodine: Once a day

Sucralfate: 3 times a day, one hour before or 2 hours after feeding.

Now, I won't get into why I initially agreed to do this at the internist's office. I guess I was worried about Blondie, and figured I'd do anything. Not only that, but I guarantee anyone's head would have been spinning from going over 45 minutes of info. I didn't know what hit me. It wasn't until later, much later (and after research) that I realized this whole thing was slightly cuckoo. 

I won't even get started about the fact that even if Blondie gets better, how in the heck are we supposed to know what exactly helped? It could be the z/d food, it could be only 1 of 4 meds, it could all the meds…who knows. Or conversely, if he experiences side effects (which it's highly likely there will be some barf) how will we know if it's the meds or the food, or just his condition? Plus I know Blondie will refuse to eat  just the z/d. I've already tried "sneaking" it in before I go live with this ten-day trial of food and meds tomorrow and he's already eating less. I've done the math on the med dosage times, which, coupled with the food restriction on the Sucralfate, means I've got a kitty who will be near starving. I'm a full-time student law student, and I do have to go to class several nights a week, 4 hours at a time. Luckily the other classes are online. So, the plus side is I'm home a lot more than a nine-to-fiver would be which is helpful to dose and monitor for problems.

But still….

….I don't know about anyone else, but isn't a brand new diet in addition to 4 different meds all at the same time way too much? While were on the issue of meds, isn't the idea of two antibiotics at the same time kind of weird? Would you subject your kitty to this? Am I  myself being the unreasonable one? Has anyone every done anything like this? I could understand if, for instance, we did a course of meds before trying a new diet. But to do both at once? Wowsers.

Thanks for listening; thanks in advance for advice. I really needed to vent about this one and seek confirmation on how crazy this seems. Even if you want to say "yes, Mitzi, you ARE being the unreasonable one, this is a cake walk," then hey, I can take it. But I'd really much rather hear "your vet is certifiably I-N-S-A-N-E, please do not do this to your cat all at once!!"

Mitzi

If all possible testing was done and nothing showed up then I think chances are good that it is IBD.  Normally a steroid is tried to at least initially control IBD.  Metro is often given during a flare, my kitty has been on it a few times.  I am not a big believer in prescription diets except for the A/D for critically ill cats or in some cases the Hills for kitties that are prone to crystals.  Food trials can be done with limited ingredient foods using a novel protein.  I am not a vet however and there could well be a legitimate reason for this regimen.

It depends on what is going on with your kitty, yes it is extreme, but my cat Munchie right now is on 5 different meds, with about 5 different supplements for his heart condition.  My cat DeeJay had a bout of pancreatitis and she had quite a few medications each day for that.  I have dealt with Helicobacter with both my cat and my dog, we treated it with Doxycycline and Famotidine.  We gave the Famotidine twice a day for about 4 weeks if I remember correctly.  10 days isn't long enough to notice a difference in the diet IMO it can take weeks for the effects of the previous diet to get out of the system.  If you are dealing with IBD here is an excellent resource about it: http://ibdkitties.net/  My cat DeeJay may have intestinal lymphoma that is one of her possibilities however we think we have ruled that out as she is doing really well right now.    Here is a good source on the helicobacter http://www.gvma.net/files/public/Leib_Helicobacter Sat 2.pdf  it says treat with bismuth however cats can't have that as it is derived from aspirin.  did the vet scope the eosophagus to check for eosophigitis?

Thank you so much for responding, and I agree with both of you that it could be IBD because I did a ton of reading and sort of narrowed down his symptoms to either that or megaesophagus. The one positive about the vet is she said that if I decide to do research and I find a condition I think sounds like what Blondie could have, she's open to listening. I told her about the megaesophagus and she said it could be ruled out. The IBD theory I have not yet been able to discuss. Thanks for the links too, they are fantastic. 

As far as scoping, that could be the next step. She says that this novel protein diet and med regimen will give her an idea of what to do next, and on his discharge papers it literally says: "An endoscopy or surgical biopsy may be discussed if treatment fails." So, I know that no matter how extreme this all sounds to me, I simply must do it in order to help the vet in diagnosis and next steps. I just feel terrible having to put Blondie though all of this. Poor thing. Today is day one, and already I'm dreading having to start the meds. Right now, its t-minus 40 minutes and counting before I begin! I've pilled him before, so I know the drill, but it'll take more practice again before I steel myself against making him miserable. I wish I could tell Blondie what's happening. I always tell my husband if I could have one wish granted, I wouldn't ask for money or fame, or anything material. I would ask for just one 24-hour day of being able to talk to my pets. I would ask them all kinds of questions, but more importantly I'd explain why I had to do all the things that they hated for the sake of their health. 

I have no room to whine, because it sounds like Munchie is on a pretty intensive regimen. How is Munchie with receiving meds? Are they liquid or pills or both?

And Denice, you mentioned that you had to give your kitty Metro. How did that go? Any symptoms? Metronidazole is the one that scares me the most. I went through countless posts online about the dangers of Metro in cats, so I'm a little worried. I also found a thread here about a member's kitty that had scary problems with the drug. Eeeek. Convenia is another one that's terrifying, but that's a whole other thread...

Mitzi

My kitty didn't have any issues with it other than the taste.  It is very bitter.  The vet that I have now cuts up the pills and puts them in empty gel caps so he doesn't taste them.  Several people here do that with medicine, they use either size 3 or 4.  They are available on Amazon, someone also found them at The Vitamin Shop.

For what it's worth, one of my cats has had metronidazole several times for IBD flares and clavamox once for a nasty bacterial bladder infection, though she has not had them both at the same time. She didn't seem to suffer any ill effects from either, aside from the metronidazole making her a little sleepy, and both did what they were supposed to do.

If you're concerned about the number of meds all at once, maybe talk to your vet about breaking up the treatments into 10-day spurts, and feed the prescription diet the entire time? You really need at least a few weeks on a new diet to tell if it's making a lasting/big enough difference anyway; my cat still had flare-ups every few weeks for about 4 months on the Hill's i/d even though her problems were immediately less. She was on the z/d first and did even better on that, but refused to eat it after about three weeks.

I hope everything goes well and it turns out to be IBD! That's what happened with my kitty (we ruled out everything but IBD and lymphoma, then put her on a restricted diet and metronidazole and hoped), and she's had four healthy, happy years since we got it mostly under control with just the occasional flare. It takes a little while to figure out the best way to treat, because every cat is different and what works for one may not work for another, but with patience hopefully you will get it all figured out!

Denice said:

 
My kitty didn't have any issues with it other than the taste.  It is very bitter.  The vet that I have now cuts up the pills and puts them in empty gel caps so he doesn't taste them.  Several people here do that with medicine, they use either size 3 or 4.  They are available on Amazon, someone also found them at The Vitamin Shop.

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I was going to suggest getting some empty gel caps and putting as much of his meds in ONE as possible so you can cut down on the amount of times you have to pill. 

I've no experience giving ANY meds together, but one of my cats could not tolerate Clavamox well, always got very nauseated on it, therefore had no appetite for anything.  The Famotidine might help with that, since it's basically Pepcid A/C,or he may end up needing an anti-emetic as well   It's interesting to me that they have him on the Famotidine AND the sucralfate, since they basically do the same thing...one is just stronger than the other, as far as I know. 

Not to throw anything into the mix of what you're giving him, but when you give antibiotics, it's a good idea to give probiotics at the same time, just to avoid MORE digestive issues.  (same as with humans)   Lots of us give our furkids the same probiotics WE take, and, thankfully, they can be mixed right into their food (assuming you can get him to eat his Z/D)  The only thing you would want to do is make sure if you give him the antibiotics in the am and pm, that you give the PRObiotics at mid day. 

Hopefully this regimen will make him feel better, then as you taper off, you will be able to see what triggers what

Big thanks to ALL who read and posted! I just knew I could count on everyone here! 

So far, things haven't been working out too well. Blondie gave us one heck of a fight when it came time for meds. Growling, hissing, etcetera. It got to a point that when he heard me making the slurry for the sucralfate, he'd take off and hide. The metro made him vomit four times within 10 minutes. The Clavamox seems to be okay for now. Good news is, the Pepcid AC is working out very well. I crush the 1/4 dose into a powder and sprinkle it onto a little smear of Cool Whip. The vet said she didn't really like the idea of Cool Whip, but since the Pepcid AC is once a day, he should be alright for now. If we find it's something he has to be on permanently, then I should switch to yogurt. I noticed on the first day of Pepcid, he had much more of an appetite and even better, no vomiting or regurgitating. He was even being more social and playful than usual. This tells me his tummy must be feeling way better.

The diet thing didn't pan out. He refused to eat for 24 hours, and by then (coupled with the medicine problems) I wanted to pull my hair out. The vet said keep giving him what he can tolerate physically, what he'll "let" me give him as far as the meds go, and what he'll eat without refusal. I'm back to feeding him plain cooked chicken, and for dry food I'm doing a slow introduction of his old dry (Blue Buffalo) with the z/d, with plans of eventually completely changing to over to z/d. I'm planning on asking the vet if it's okay that I cook up some duck or pheasant for him since she wants a novel protein diet. Since he hates the z/d canned food, I've got to substitute with something. 

Thank you, Denice, for the gel cap recommendation; I think this is a fantastic idea. I feel that the problem with him is getting meds in liquid form. It's too long of a process (taking into consideration the amount of medicine and time needed to swallow and breathe) and makes for a high-stress situation. I know I can pull off pilling him, so I'm going to try gel caps for sure. 

And to mrsgreenjeens, the probiotic idea makes so much sense. I have 2 different kinds I take for myself, so I'm sure one of them should be okay for him. I'll talk to the vet about this for sure. And I wondered the same thing as you did about the sucralfate and Pepcid. I guess it's good I can at least give him one of them if they pretty much do the same thing!

Next week we go back to the vet. She says it may be time for scoping and/or biopsy, or even a feeding tube! I really don't want to put him under just yet. I'd much rather he be a little more healthy and have more weight on him. She did say we don't necessarily have to take that road, so I'm curious to hear what the alternative is. It's kind of weird to me she wants to go surgical already when we haven't even seen the results of a new diet and if the meds have helped. 

If anyone has any more ideas I'd love to hear them! I'm not as stressed out as before, but still feel like I'm lost...

Mitzi

I really don't have anything more to suggest (at THIS point until your next Vet visit).  Just sending some vibes that things start getting better as far as pilling, etc. 

Well...maybe one or two suggestion.  Can his meds be compounded into chicken or fish flavors, or even made into transdermal gets?  Some meds can and some can't.  A compounding pharmacist would know. 

As far as him not liking the Z/D, if he absolutely doesn't like it, I'm wondering if you could discuss with your Vet trying him on a limited ingredient food like Nature's Variety Lilmited Ingredient Rabbit or Duck or Venison?  It comes in both wet AND dry, and most cats really like it.

Mitzi – First and foremost - You are such an amazing fur mommy!

I don’t know anything about your cat’s condition but I can relate to everything you wrote about the medications and having to give them to your sweet boy. I too have to give my Binky several meds a day (probably for the rest of her life) and I’ve tried them all – pill, liquid, and transdermal gel. Here is what I’ve found, if it helps at all….The liquid is good in that it’s a quick – just open cats mouth, tilt head slightly back and squirt in back of throat but the bad is when cat moves their head and squirms and the liquid lands on the floor or if the liquid is bitter tasting (like one of my cat’s meds), the cat’s mouth starts to foam and the liquid is dripping off her mouth and chin – this is the worst and it puts me in tears every time. I feel like I’m torturing my poor girl. The transdermal gel gets rubbed into inside tip of the ear which is the easiest way BUT it does not absorb very well so be careful if you consider this option. The pills are good if you can hide them in some type of food and the cat actually swallows them. I’ve had a hard time trying to get 2 ½ to 3 pills at once into my cat’s mouth for her to swallow. I do try different things to hide the pills such as small pieces of deli meat that I roll the pills in or sometimes rub them with butter to make them go down easier but this is difficult as well. My cat also hisses, sometimes bites, and makes gnarly growling sounds with I have to try to keep her mouth a little closed so the pills don’t fall out the sides of her mouth. Sometimes she only ends up getting part of the pills and the rest get spat out or dissolve into whatever food I’ve hidden them in that she’s spat part of out or I find it on the floor somewhere later on. I am also thinking of buying empty gel capsules but I’m scared that they may get caught in my cat’s throat. One last thing about the gel caps…Look up pharmacy compounding companies on the Internet in your area as some will actually compound all your pet’s medications into 1 capsule (of course if they can all be mixed together to be taken all at once). This will obviously cost much more but you know as well as I do, PILLING A CAT IS A NIGHTMARE and so very stressful. Hope this was of some help.

Oh man has it been a rough few weeks! Blondie ended up only taking some of his meds, and not really finishing the course. It became way too stressful, to where there was severe behavioral changes (hiding, isolation, fear, skittishness, etc.) so I refused to put him through more.

As of today, he now takes Probiotics and Pepcid AC on a daily basis, and just recently I have begun a search for wet food that he'll accept. He hated the Hill's prescription canned food, so now I discovered he loves Natures Variety (thanks, mrsgreenjeans!) Instinct, and Canidae. But…these may not be around much longer, because I am considering a raw food diet. And, he will soon start on digestive enzymes. Vet check up yesterday revealed his weight is up about one half of a pound, so I'm pleased but I know there's a long way to go. Next steps are continuing with single source protein, then doc wants to try Prednisone. If that doesn't work, or if his health deteriorates, then I must consider endoscopy. Still no concrete diagnosis.

Thanks to all of you who helped! I gained some very useful tips from your posts, especially regarding gel capsules and compounding, both of which I ended up doing.

Mitzi

Glad to hear there is some improvement! I started having similar problems with my cat Tim around the same time you did. He was gone a couple of nights at the emergency and our regular vet, had blood and urine tests, x-rays, and physical exams by three different veterinarians and no one could give us a diagnosis. We were prescribed various medications for the various theories, each of which made Tim worse. Because none of his problems were severe, with the approval of our vet, I stopped most of the medications. Stopping medication is not always appropriate, however, depending on the situation. Because I suspected a food sensitivity, I decided to change Tim's diet, also with the knowledge of the vet, but without much advice or support. A month later, Tim is doing so much better. I also recently took Tim to a holistic vet for another opinion. You can read about Tim here: http://www.thecatsite.com/t/272867/...ion-urinary-crystals-food-sensitivites-asthma.

I would definitely encourage you to keep Blondie on a limited ingredient diet for a long as it takes. My cats eat primarily Natures Variety Instinct Limited Ingredient turkey and duck (Tim did not do well on the lamb), and I just added the regular Nature's Variety Instinct rabbit. I will watch him closely because this contains pork liver; like you, my preference is for a single protein source per meal. Once Tim is off the medication he's been taking for constipation, I will start adding raw. I also just added a probiotic a few days ago and already notice a difference in his behavior and energy level - more energy, more alert, less of the little annoying things we thought were "him" but may have been signs he didn't feel good. GI issues are tough and frustrating. Sometimes it's just trial and error, hopefully not too many errors. It's been hard for me to be patient, and it's hard to helplessly watch when Tim has a "not so good day". Luckily, there are fewer and fewer of those.