Fluid Retention with Metacam?

Hi there, i'm new here! This site seems like a great place for information and to learn about peoples experiences with cats, so i hope someone might be able to help me with this.

One of our two fur babies (15y/o) was put on Metacam a couple of weeks ago as he had lost a large amount of weight over the last 6 months to a year which seemed as though it may be down to dental pain (he actually had two abscesses this year). However in the last week we have noticed his stomach ballooning in size though at first put it down to his increased eating on the Metacam.

However after going to the vests this morning and them doing an x-ray, we actually learned that his abdomen is filled with fluid. The thing is that his blood test results prior to being given the Metacam all seem to be slap bang in the middle of the recommended range, except for very slightly higher than recommended ALT levels 67.8 u/l (but otherwise no other signs of liver problems). Diabetes, thyroid problems and pancreatic problems seem to have been ruled out by the vet.

Considering his weight loss this was very puzzling and has led us and the vet to surmise that his teeth have been paining him to the extent that he was not eating as much food as we thought he was.

Curiously his brother has gone from being very lithe to a fat blob in the same time period, which seems to suggest it is a decrease in food consumption causing the weight loss and not inability to digest the food, since his brother has clearly been vacuuming up the left overs...

The vet seemed to believe that the prognosis with the abdominal fluid was not particularly brilliant and has put him on diuretics. However i have the distinct gut feeling that the Metacam may have caused the fluid build up, since the cat was otherwise in reasonable health according to the blood tests (though getting very skinny) and since fluid retention is listed as one of the uncommon side effects of Meloxicam.

Though the vet said to keep him on the Metacam we have come to the conclusion that the potential of him not eating as much for the next couple of days due to possible dental pain (till he has an abdominal scan on Tuesday) is less of a risk than potential continued fluid build up. Also, having his old kidneys processing two sets of medication didnt seem like the best idea.

So, i wanted to ask; has anyone else had a similar experience with Metacam causing fluid retention in cats? I did read somewhere someone saying that it caused some fluid retention in their dog, but i havent been able to find anything relating specifically to cats other than the list of side effects. We are all very worried about him, though i have a special bond with him since he has been my constant companion for 13 years since we rescued them.

I have read the horror stories about Metacam in cats, but here in the UK we do have Metacam specifically for cats which has a decreased concentration, and of course it has been a great help to many people, but i cant help but think the start of the sudden ballooning of his abdomen has coincided very closely to the start of the second week on Metacam.

Any help or advice, or experiences would be very much appreciated! If anyone wants to see the blood test results i would be more than happy to scan and attach them!

Luke

Here is an interesting article about Metacam written by a good vet in Canada.

http://www.thecatsite.com/t/293396/dr-kriss-views-and-personal-story-on-the-use-of-metacam

Has the vet drawn out any of the abdominal fluid and looked at it and/or tested it chemically?

Thanks for the link! I am very careful when processing information found on the internet. In fact at first Sam showed no adverse signs of being on the Metacam and given the severity of his weight loss we were happy to try it even knowing some of those horror stories.

However this abdominal fluid has just appeared out of nowhere over the course of a week, in a cat who's recent blood tests suggested he was otherwise almost completely within normal range. Having cross referenced his blood results with the causes of abdominal fluid, along with the results which would diagnose those issues, his bloods didn't fit any of them really. Though i am certainly no vet i do find that baffling!

Nothing else has changed except for giving him Metacam, though they do eat foods from different manufacturers because they are very picky, they go off flavours and brands quickly, onto another, and then back again. But that has been happening for a long time so it isnt really anything new.

The vet hasn't taken any samples of the fluid yet, she seemed concerned about infection or jabbing something else in there. We will bring that up with her again on tuesday when Sam is going for an abdominal scan.

There is one other thing though, a couple of days after starting him on Metacam, we started giving him this:  to get some extra nutrients down him.

That being said i have been unable to find anything online to suggest it has any side effects at all. But that is the only other new thing that he has had!

When my vets find fluid in the abdomen by x-ray, they always draw out some of it.  If it is white, it may be chyle, and if it is colorless and thin, it may be fluid retention, but if it is fairly thick and yellow, for my cats that has been diagnostic of FIP because I know we have the corona virus here.  Usually that only gets young cats, under 2 years of age, but I did have an 8-year-old develop it over a year ago.  Because of his age, I never suspected it, and because he had not been eating, his stomach did not appear swollen when I took him to the vet, but he was starting to get jaundiced.  You can get cats tested for exposure to the corona virus, but that in itself is not diagnostic of FIP.  If the cat tested negative for exposure to the corona virus, that would rule out FIP, but there is no test for FIP, and the blood work usually is normal in the early stage.  They can do tests on the abdominal fluid, and the albumin is low and the globulin is high in FIP if I remember correctly.  I certainly hope  this is NOT what your cat has, but you always have to consider it when abdominal fluid shows up like that, combined with weight loss, lack of appetite and general malaise. 

Please let us know how the vet visit goes.

We will ask if they will take some fluid for testing, though the vet was resistant to poking things in there we need to know where this has come from. Right now i am at my wits end and am terrified and feel physically sick. I honestly thought he could die this morning and yet during the day he seems quite bright eyes although rather weak. We gave him some Metacam again this morning as it seemed like he was in more pain, i'm so confused!

On the one hand two websites for pet medication and one website for side effects for humans all list 'fluid retention' as a possible side effect, but the vet was unable to find anything in here own literature.

The vet did mention peritonitis but seemed to discount it, though i am not sure of the reasoning. His ALT was a little raised and his Lymphocytes were a bit low... apparently two symptoms of peritonitis, but also of many other things. He hasn't had any diarrhea, though he did do a few soft and very smelly poos a couple of weeks ago, they were properly formed. He hasn't had a loss of appetite as such, since he has kept asking for food, however he often sniffs it or takes a few bits and walks away. Other times he gobbles it down then sleeps a lot. We have noticed that he often moves the food around when chewing it and sometimes bits drop out of his mouth, leading us and the vet to believe he was having problems with pain in his teeth. Oddly over the last year he did start visibly drinking from his bowl, which i thought was odd because i had NEVER seen him drink from that bowl for as long as i can remember! Though that said it was not frequent enough to concern us, maybe only a couple of times per day it was odd.

The vet said his heart and breathing sounded ok, and i have just checked the whites of his eyes and there is no yellowing either. His poo's have been quite dry and firm the last few days and he did a darkish coloured one earlier, but not black.

If i may ask, are peritonitis and FIP two different things?

He had a Free T4 test done, which was 26 pmol/L in a reference range of 9-30, i dont know enough to presume whether this is high enough to indicate potential hyperthyrodism?

I have attached scans of his blood results. Please, if anyone understands these and notices anything tell me so i can bring it to the vets attention. I know they go through years of training for this, but sometimes a different set of eyes or someone with a different set of experience can shed new light on things!

Ok so an update: it seems that the Metacam indeed did not CAUSE this problem. Sam had an abdominal scan and it was found that his intestines had thickened, which would explain the weightloss, obviously this has been coming on for some time and he hasn't been absorbing nutrients such as protein properly. I guess it may also have been causing him discomfort which was leading to him not eating as much as we thought he was.

Still the rapid worsening and abdominal fluid is shocking. I cant help but wonder if the Metacam could have made his bowels worse by irritating them? It is odd that the sudden worsening and abdominal fluid came on just a week after starting the Metacam, but of course there is no empirical connection.

His new blood tests seem quite a lot worse; very high white cells and neutrophils, low haemoglobin, MCV and MCH and much raised cholestorol among other things.

Protein and albumin have dropped a fair bit. From reading up on this it seems as though if the cat is not receiving enough protein through digestion it can cause some kind of pressure change causing fluid to leak out of the blood vessels and into the abdomen causing ascites. It seems likely now that this is the case i guess, though what caused the intestinal thickening is uncertain.

I really need some help or advice guys.

Should i post a new more specific topic? Is there somewhere you can direct me? I feel that not many people have had a look here because of the unusual title and i really need some input.

Luke

Unfortunately, thickened intestines can be the result of FIP.  It is a very complex disease and can't be explained quickly.  When the intestines are inflamed, they cannot absorb nutrients, so there is usually a very fast weight loss even before the cat stops eating.  It can strike other organs however.  It is very hard to diagnose, there is no test, only the combination of symptoms and history.  Here is a link to a fairly basic explanation of the disease.  I am just surprised that your vet doesn't seem to be considering it as a possibility as something to rule out when the symptoms are fairly consistent with those of FIP.  Yes, of course any vet would hope it was something else, but the tiny needle stick it takes to draw out some of that fluid is nothing.  If they analyze the blood, why not the abdominal fluid?

http://www.vet.cornell.edu/fhc/Health_Information/brochure_ftp.cfm

Hmmm well we did ask about testing the fluid and she ended up doing that. She rang today with the rest of the results and said she THINKS its cancer, and we are all quite distraught. She has prescribed steroids to reduce the inflammation, either as palliative care or on the chance that it is IBD. She said that the fluid had protein in it and she things it is leaking from his blood vessels.

His globulin is in the middle of the normal range, but his protein and albumin is low. We did ask specifically about FIP and she didnt think it was that, though we can try and ask for some more information on why.

Right now we bought some special easily digestible food and high protein easily digestible kitten milk to give him. He is still eating, and still wants to eat, just not very much. Can you tell me how much protein he needs a day, or when we should consider syringe feeding him to help him gain a bit of weight?

If it is something terminal i just want him to put on a bit more weight and be comfortable.

Steroids will help him feel better and improve his appetite no matter what the diagnosis is, so that's a good thing.  The most important thing at this point is to keep him as comfortable as possible, no matter what he has. You might want a better pain reliever than Metacam, or any other NSAID.  She might be able to give you buprenex which just takes a tiny bit of the liquid n the gums and lasts for 12 hours.  Our vet give it to us already in tiny syringes with no needles an it works very well.

Thank you so much for the advice! We fear he is going down hill fast, ive been crying and unable to sleep all week. Sam is my soulmate.

The vet said not to give him any Metacam for two days before starting the steroids, will the steroids relieve the pain, or should we ring the vet and ask if she can give us some pain relief too?

The steroids will improve him but whether or not they will relieve his pain depends on what is causing him pain.  It will help with arthritis pain and intestinal inflammation because it is an anti-inflammatory, but steroids in and of themselves are not pain killers.  If he has pain from a tumor or pain from another lesion of some sort, it may not relieve that.  As long as he keeps eating and not hiding under a bed or in the closet, that's a good sign.  Not eating and hiding are signs of illness and often pain.  Sometimes cats will purr when they are in pin, almost to comfort themselves, so don't be fooled by purring especially if it isn't in response to being loved and petted.  You can often tell by their tail.  While the entire cat will be lying still, he will not be relaxed and the tip of the tail will keep twitching.  This is the sign we always used to tell when it was time for more pain med.  After the pain med, relaxation and n twitching tail.  Cats hide pain very well unless it's acute, so you have to be a detective.

The vet said they cannot give him any other pain relief with the steroids. At the moment he is just lying down all day, sometimes sleeping, sometimes with his eyes open. His brother keeps sitting with him and licking him.

He tries to purr when you stroke him, but it is so weak you can hardly hear it, he hasn't purred properly since the Tuesday before last, and that is almost the worst thing for me.

Right now we just want him to stay alive long enough for the steroids to kick in in the hope that maybe he will start eating again. At the moment he is eating less and less; he keeps asking for food but hardly eats any of it, although he is still drinking water and kitten milk formula and having some nutrient gel. I feel like i should be syringe feeding him some of the special food we got from the vets just to keep him going so we can see if the steroids work. Maybe it is naive but we still have some small hope that it could be IBD and not cancer. I feel like i should be doing more but i don't know what to do!

I dont want to have him put to sleep and then wonder whether he might actually have gotten better on the steroids if we had just persevered!

Please help me! I've never been through this before. Part of my own soul is dying, i cant sleep without having to check on him multiple times a night, i wake up in the morning screaming, i had to get some tablets from the doctors because i keep having panic attacks and my food has been going straight through me for the last couple of days. :'(

I'm very sorry you are going through this with your kitty. My heart breaks for you and I understand how anxiety provoking it is on you!

Unless otherwise directed by your vet, I don't see why you cannot supplement his food intake with syringe feeding. Try to take deep breaths and visualize positive memories when you are with your precious kitty, this will help both of you.

Sending positive, healing vibes
You are in my thoughts. Hang in there

Thank you so much!

His belly is so distended, the diuretics he had seemed to help at first but now they dont seem to be having the same effect. I want to try and save him but i just dont know whether we can, im being tortured right now, but how can we make a decision without feeling 'what if'? in the future?

What color was the fluid in the stomach? Did she drain enough for that fluid not to be bothering him?

What I do with my sick Kitty, Is i look at the box with food, how much she is supposed to have a day, then i syringe feed her about 2/3 of that, and let her eat a bit on her own.

Im going through a lot of the same feelings with my own sick kitty at the moment. I really feel your pain. Im there with you.

Those "what if's" are killers, I know too well.

It's so hard watching our loved ones suffer in any way. I think that I read that he had to be off the Metacam for two days before starting the steroids, correct?
Will he start them tomorrow?

All you can do is what you've done his whole life and that is love him. [emoji]128149[/emoji] You don't have to make the decision today but I know that it is always hanging over your head.

Did I also read that the vet suggested that they could remove some fluid from him to make him more comfortable?

I think you'll know when it's time. No matter how long we have them, it's never enough for us. When they go they take a piece of our heart and leave their little paw prints on the rest.

Carinajosefine said:

 
What color was the fluid in the stomach? Did she drain enough for that fluid not to be bothering him?

What I do with my sick Kitty, Is i look at the box with food, how much she is supposed to have a day, then i syringe feed her about 2/3 of that, and let her eat a bit on her own.

Im going through a lot of the same feelings with my own sick kitty at the moment. I really feel your pain. Im there with you.

Click to expand...

Im sorry to hear you are going through similar feelings right now.

I dont believe the vet drained a LOT, his belly seemed to go down a bit with the diuretics then it seemed like it was expanding again, but it is so difficult to tell. I have been meaning to keep measuring it, but right now i'm only up for 8 hours a day because i am so tired . I already have a sleeping disorder and chronic fatigue and i am spending most of my waking hours either worrying or trying to research as much as possible, i cant keep up. My Mum and Dad have been doing as much as possible too, but sometimes i just feel i should be there all the time, but i cant be. Im either exhausted or i just have to get out of the house for a bit to get away.

On the one hand i keep thinking i should be syringe feeding him fully (have so far kept it to giving him kitten milk formula) but then on the other hand, if these are his last days, i dont want him to think his best friend is trying to hurt him.

LotsofFur said:

Those "what if's" are killers, I know too well.

It's so hard watching our loved ones suffer in any way. I think that I read that he had to be off the Metacam for two days before starting the steroids, correct?
Will he start them tomorrow?

All you can do is what you've done his whole life and that is love him. [emoji]128149[/emoji] You don't have to make the decision today but I know that it is always hanging over your head.

Did I also read that the vet suggested that they could remove some fluid from him to make him more comfortable?

I think you'll know when it's time. No matter how long we have them, it's never enough for us. When they go they take a piece of our heart and leave their little paw prints on the rest.

Click to expand...

Sam has started the steroids now. Honestly last night I thought he might die with his brother sleeping next to him, if not i was preparing for maybe us having to have him put to sleep soon. Yet this morning there he was waiting for food, had lots of tuna water and milk, ate a modest amount of meat then wanted to go out! And yet now he is back to being flopped out on the couch again!

I'm so confused! He still has bright eyes but then his back legs have gotten really weak and wobbly. I keep thinking there is nothing we can do, then he keeps looking like he is doing a little better! We cant let him go without being sure!

I'm afraid we have made the decision to have Sam put to sleep at home tomorrow. He tried to go to the toilet today, but fell over onto the floor after getting out of the cat tray. I think we all felt it was a read line once he could no longer go to the toilet properly. He cant move around any more because his back legs are so weak.

I'm just so scared. I keep thinking 'maybe there is something else we can try, maybe there is something the vet could give him' or 'what if we could just get him to eat plenty, would he get better?' 'what if its just parasites in his intestines and we can make him better?'. I'm so scared in case there's something, anything we could have done that we only find out about later. But then he's so weak he can barely move and his abdomen is so distended it must be very uncomfortable, it just feels like its gone past the point of no return.

But how can i be sure? I'm wracked with guilt and fear, how can i be responsible for the end of my most precious friend in the whole world? Please help me, tell me what happens, are we all doing the right thing?

Right now hes just got up off his chair and after a few steps just flopped over on the floor again. His brother has been licking him and sleeping with him all day, he just knows there's something wrong. I'm scared.

You are doing the right thing for Sam.  I'm sorry it hurts so bad, been there, done that, but you don't want him to suffer and he is not recovering.  I still suspect it is FIP, which is always fatal, 99.99% of the time anyhow, and there is absolutely nothing you could have done to stop it.  We have a forum here called Crossing The Bridge where you can share your memories of Sam with others going through the same thing when you are ready.