appetite stimulant not working for Etta

Following the internal vet specialist visit, Etta got mirtazapine 3.75 mg every 72 hours to keep her interested in food. I gave her the first dose Thursday at 8:30 PM. Thursday night she ate okay because I couldn't feed her before her ultrasound and they kept her all day so she was hungry. after the Mirtazapine I made her a plate at about 10 PM. She was only mildly interested.  Friday morning she ate her pill pockets with gusto and then nibbled at breakfast. I got some Weruva with the chicken and some of the Steak Frites Friday for her supper. That was a bomb. But later she ate a few pieces of boiled chicken breast.

She sniffs at the food and eats a bit, grazing style. She was recently diagnosed as hyper thyroid and is on the first week's dosage of Methimazole for the thyroid. She's also on atenolol for the rapid heart beat. She had fluid in her abdomen that the internal vet specialist drained most of it to make her more comfortable.  And she got a complete ultrasound. They took a sample of her omentum and the fluid. (probably cancer since there were nodules on the omentum and slight thickening of her intestines). I'll find out Monday.

In the meantime, she's lost a lot of weight because of both things. Until her abdomen filled with fluid, she ate okay but always has been a grazer. This afternoon I got some cans of A/D thinking I might start syringe feeding her. She ate about 1/2 of a can of kitten food and licked some of the gravy off of a packet of Wellness Indulgence later.

If I give her baby food, she will lick that up but not before getting stalked by the rest of the cat crew who also want the baby food.  ​I wonder if the 2nd dose tomorrow of the appetite stimulant will kick things up more, or should it have done so immediately?


 

My little girl, Callie, was on Mirtazipine for many, many months.  Sometimes it worked great, and sometimes it didn't do anything.  It just depended.  I think it really depended on how she felt in general.  If she was having bad days, then no matter what, she just didn't want to eat much, but if she was having good days,then it really help increase her appetite. 

I think finding the right foods might have something to do with it too.  Just keep trying to find something Etta really likes.  Since you've got other cats, if she doesn't like something, then at least it won't go to waste, right?   I think I tried every canned cat food known to man, and finally found something she really liked, although for her, that was fish, and for your girl, that might not work since she is hyperthyroid.  Your choices may be somewhat limited, but maybe not...did the Vet say to steer clear of any foods in particular?  My girl was stage 4 kidney, so we figured anything was ok, just needed to get food into her and make sure she was happy for as long as possible.

for Etta's test results.  Hopefully it's not what you fear.  BTW, I read your other thread about her, and I'm so sorry about Charlie.  .

MsGreenJeans, that's good to know that it can have good effect and not so good effect.

The vet only said to feed her a variety of cat foods if she isn't eating well. No mention of staying away from fish. Maybe the fear of the fish stimulating a haywire thyroid is secondary to just getting her to eat. She stopped at another plate that had some fish in it and took a couple of bites of that. Maybe now is not the time to worry about it, but just get food into her.

She'll be up to the 1/2 pill 2 times a day for the methimazole starting tomorrow.

Later this AM I encouraged her to eat some kitten food and she took a few bites. I notice that when she swallows, it's like she swallows twice. I wonder if she's having some trouble swallowing and so it makes eating not enjoyable? It reminded me of how a human would swallow if they had peanut butter.  There's no gagging and when I syringe fed her a portion of the A/D this AM she didn't exhibit any problem. She may have taken too big of a bite of the kitten food (because she's hungry).

The internist vet did look into her mouth because he noted "tarter" on her teeth. The regular vet didn't do that primarily because the focus was on the presenting condition.

I hope so much it isn't cancer but "nodules on omentum" and "thickened." Also some thickening on her intestines don't seem to lead to that but the ultimate answer is the test, right? In any case, she's still being her great self.

She sleeps on the bed (her favorite spot), gets down, wanders around, asks for pets and then hangs out in her usual spots in the living room. After her syringe feeding I wiped her down with a warm cloth and gave her a brush. Later we clipped nails. She purred.

Doesn't sound like she's feeling too bad since she's out and about.  That's a good sign

So the food my Callie went crazy for was Iams Purrfect Delights Tunatopia.  AND it's pretty high calorie and very low carb, so it's actually a decent food, aside from being fish

The vet e-mailed me the results Sunday, which I thought was an awesome thing to do. Waiting to connect with him on the phone too. The cytology does not show strong evidence for any cancer. The thought is that the nodules on the omentum and the thickening are from a response to inflammation.  The ideal next step he says on the sheet, is laparoscopy to perform a visual exam and get a biopsy.  But in the meantime treat for vasculitis with a steroid. He mentions pentoxifylline and prednisolone. And " afuture consideration is empirical treatment of neoplasia carcinomatosis/mesothelioma."

The cytology report said there are focal areas with aggregates of macrophesa , reactive mesothelial cells and neutrophils. She said "I strong suspect the changes are due to reactivity/concurrent inflammation vs a true neoplasm. I do not see any cells that show features typical of feline carcinomatosis. The fluid total protein is not high enough to strongly suggest FIP."

The internal medicine vet is focusing on treating the vasculitis and wants to do the endoscopy to take a sample.  I am leaning towards treating the vasculitis and not doing the endoscopy. He had assured me previously that chemo for pets is much different than it used to be and they won't make the pet sick. But I already have a cat that isn't really eating and has medications for her heart beat and the thyroid. She used to be very chubby and now she is quite thin.

I worry that chemo with her would simply exacerbate what I am seeing now. Of course, leaky vessels happen for a reason. And he doesn't think the fluid build up will return but I'm not sure about that either. They didn't remove all of it for electrolyte balance reasons

The super duper ultrasound and exam and medications cost $910.00 I'm sure the endoscopy would be similar.And then she will be recovering from that.

I cooked her some chicken livers and hearts and took someone else's advice here and got a Baby Bullet and made that combo into a disgusting looking liver juice. She loves it but still doesn't sit down and eat the whole thing. I put it with kitten food and the A/D and Wellness to give her a variety of things to choose from. The combo seems to be magic for some of the other cats who come in and snarf it down before she can come back to it.

Even in Etta's heyday of chubby, we never saw her eat much. She never planted herself at her dish and ate it all. She was a dry food aficionado which I had out in small quantities for snacks. When I totally removed it, she started losing weight. The vet said "diets are never successful." I remember thinking that was odd considering I got a lecture every time I brought her in. the other cats are lean, mean fighting machines :-) so she was the one with the weight issue. Now she is still the one with the weight issue---on the other end.

I would ask about Pepcid and Cerenia. sounds like she has some nausea going on. Pepcid is over the counter but Cerenia is prescription. you can get empty capsules and put all her pills in one to pill once. coat with butter and use a pill popper.

nausea can cause them to pick at the food. worth a try.

the empty capsules may be the way to go. I ordered a pill popper.  I have to say that the pill for her fast heart rate won't do much good if she's stressed at getting a pill. She forgives me right away so far.

Etta might have some nausea. I've tried offering her butter and she makes a gagging gesture at the smell of it.  She's not vomiting her food though. I'll ask about the pepcid/cerenia.

I'll admit I don't understand most of what the doctor said, but am a little confused about why there is even a discussion about chemo if there is no evidence of cancer at this point.

Seems to me that starting with the steriods for the inflammation is a good plan, then if that does the trick, there's your answer.  If not, then you could proceed with a biopsy, etc.

Callie used to eat several small meals every day.  The other cats just had to learn that THEY didn't get to eat that many meals.  I would give them each a treat or two when she got her meals, just so they didn't feel too left out, but she got between 7 - 9 meals every day, and two of those were in the middle of the night.  What I did was freeze two bowls with food in them, and then right before bed I took them out of the freezer and put them in ziploc sandwich bags.  I set one on a towel on my nightstand, and the other on an icepack on a towel on my  nightstand.  This allowed one to start thawing immediately, and Callie knew to come in in a couple of hours to eat.  So about 2 a.m. she would come in and I would hold her bowl and she would eat the thawed food, then I would move the bowl from the icepack over to the towel so it could start thawing.  About 5 a.m. she would be back for her next feeding .  Everyone would be on the bed, but The Boys would wait patiently for her to finish because they knew they would get a couple of treats for their good behavior.  (I also kept some treats under my pillow in a another ziploc bag for them - grainfree, of course!)   Then during the day wherever Callie was, I took the bowl to her and fed her, aside from regular meal times, just to keep weight on her.  If The Boys noticed me doing that, they would get a treat, if not, that was ok too.  That was our life for months and months and months.  It's been almost 6 months since she died, and I still wake up a couple of times during the night!  I guess my body just got so used to doing that that it became second nature.  Anyway, that might be something you could do. 

See if you can sneak in a little egg yolk into that liver/heart mixture, or into any other of her food.  Raw or cooked, doesn't matter.  It's VERY healthy for them, and good calories too.  Egg whites have great protein in them, but don't feed RAW egg whites and Raw egg yolks together.    Cooked is ok, or separate meals is ok if they are raw. 

Good suggestions! I'll try the cooked egg.  Yeah, I feel the same as you, about the searching for cancer and then perhaps treating for that. I wondered if he meant that regardless of the endoscopy, treat for cancer, or after the endocscopy if it is still questionable, treat for cancer? I'll find out more when we talk.   I'm with you on trying the steroid and seeing what happens. Etta's regular vet wondered if an abscess had ruptured and that what was leading to the problems, but it doesn't really explain vasculitis. I think that as a friend of mine said, it's a puzzle and they want to find another piece of the puzzle or eliminate it completely as a concern.

also if they want to figure out to do biopsies for cancer-you cant get a good biopsy if you start on steroids=I wasn't sure if you were thinking of getting biopsies done.

But back to the original issue=I bet the nausea is causing this for her not to eat or just pick at food. what about hydration? How is the hydration??

I am also confused about this cancer treatment they want to do. generally if its lymphoma=there are two types and each is an entirely different medication. So I am confused why they would treat for something without knowing exactly what we are treating.

forgive for the repeat questions-did you guys start pred or injections of pred? IF so then I think you have to wait 2 weeks after stopping steroids to get a good biopsy as the steroids change the cellular structure of the cancer and may make it harderr to diagnose it via biopsy so now they usually recommend biopsy first then start steroids if its the correct type of cancer. pred is normally given for small cell lymphoma and this is a slow growing cancer that generally you don't see affects until 2 months after starting steroids. large cell cancer is a totally different beast and normally is a faster growing type of cancer.

Hope they get you the Cerenia=it could be easier on the cat to get this med as injection instead. I found injectable Pepcid was $12-$19 a vial and that's a lot of injections. the dose is usually .25ml once or twice a day and the Cerenia is once a day. the Cerenia is very expensive in the vial BUT I found this easier on my cancer kitty. She was an absolute BEAR to pill and we decided sub fluids and injection meds was easier on all of us and less bites. She used to spit the pills out. so you can order the Cerenia and Pepcid online and have them fax your vet for the script then opt for 1 or 2 day shipping. my vet set me up with enough injection meds for a week while we waited for the mail. This I hope may help take some of the anxiety out.

She's really good on the hydration. She loves drinking out of a cup so I keep it on the night stand (saves my own glass of water).  Her hydration results on all the tests were excellent. Kidney function excellent. The only thing wrong on the blood test was the thyroid results.

I haven't started her on anything new yet. Still waiting for the doc.

How is her cholesterol? Lower cholesterol and thickening of the intestinal wall could be a sign of inflammatory bowel disease. Hoping for the best. Not sure why the vet would automatically jump to a "maybe cancer" diagnosis.

Ask your vet is B-12 shots will help. Just started my boy on this today (after lots of diarrhea associated with pancreatitis) and WOW! What a difference! The appetite stimulant has nothing on b-12!!!! I can't believe how much he's eating today! Now, his medical history isn't the same as your girls, but ask about it. It can't hurt as this will just excrete through the urine if not needed.

Hugs to you!!!

I talked with the vet. He says that even though the tests weren't strongly indicative of cancer, he thinks that is still what's going on. I asked him about the cytologist report that said that there weren't cells indicative of cancer.  He said that was true, but that the symptoms and the ultrasound leaned toward that. I won't put her through surgery. Regular vets don't do endoscopic biopsies and so he said that if my regular vet did the exploration, it would be open up her gut and take a scrape. I am not doing that. The endoscopic surgery through them would be $3,000.

If she were a young cat maybe that test. but it seems drastic for a cat not showing cancer cells. Granted the leaky vessels are serious. But I can't imagine she would do well after either procedure based on her food consumption status. I'll talk to the regular vet tomorrow.

As for the medication, tonight I crushed them up and measured out 1 ml of water and put the water and the medicine in a baby food jar, sucked it into the food syringe and gave it to her that way. Easy peasey. .

Slufferk, I don't know what the cholesterol is. My guess is that isn't part of the panel in the blood test they took. I do know that except for the hyper thyroid her blood test was excellent. I'm not sure the maybe cancer too. It could be because there were macrophages and "reactivity around mesothelial (sp) cells. I think she's definitely nauseous so when I talk to Kitty Klinic tomorrow I'll ask about the IBD possibility but  my guess is that the internal specialist is suspicious about the cell activity and they are going to go for the "ideal" definitive solution.

Slufferk said:

How is her cholesterol? Lower cholesterol and thickening of the intestinal wall could be a sign of inflammatory bowel disease. Hoping for the best. Not sure why the vet would automatically jump to a "maybe cancer" diagnosis.

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darkhorse321 said:

 
Ask your vet is B-12 shots will help. Just started my boy on this today (after lots of diarrhea associated with pancreatitis) and WOW! What a difference! The appetite stimulant has nothing on b-12!!!! I can't believe how much he's eating today! Now, his medical history isn't the same as your girls, but ask about it. It can't hurt as this will just excrete through the urine if not needed.

Hugs to you!!!

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I think I will ask about this! Thank you. As I sit here typing, she's decided the 5th dish of Fancy Feast appeals. She's eating it and not just licking it or taking a couple of bites.

Yipppeee!! I've got my cats on a kidney diet as they had some blood work show the start of kidney disease, but since then, blood work came back normal for that. Yippeee! Anyhow, this new food is being INHALED by both my kitties!!! My male cat looks drunk, sprawled out in front of the AC unit  My female kitty is sprawled on the floor. Hahahahah

I'll take it--love seeing them happy with full tummies. I hope your girl continues to improve! And that the b-12 might be a solution for her too!!

Strange no cholesterol was checked once thickening of the intestine was found. Have you talked with another vet about the findings? It never hurts to get a second opinion. I've come across some real questionable vets. We just put our Francie on Octreotide steroid injections after doing our own research. Perhaps look into it? Seems to be helping our girl it suppose to heal leaky ducts and slow down cancer progression. My vet had never heard of using it until I brought it up.

Slufferk said:

Strange no cholesterol was checked once thickening of the intestine was found. Have you talked with another vet about the findings? It never hurts to get a second opinion. I've come across some real questionable vets. We just put our Francie on Octreotide steroid injections after doing our own research. Perhaps look into it? Seems to be helping our girl it suppose to heal leaky ducts and slow down cancer progression. My vet had never heard of using it until I brought it up.l'​I

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I'll ask if it was part of the test. The Blood test was pre- internal medicine vet. My regular vet said that she can read ultrasounds but that a specialist would be best for a more complete reading. So he is the 2nd opinion. My regular vet started with the thyroid medicine and Lasix for the fluid build up. I know that the internal medicine vet suggested a duel process on the steroids, predisone and pentoxifillene. And then she needs a re-check on her blood count which would sort of coincide with a retest I would need to do anyway on the thyroid medication. Thanks for the tip. I'm going to go read up on Octreotide.

Totally agree on vets. It feels like such a random thing. My vets are pretty good but I get the sense that they don't do much with geriatric cats. My special needs cat has difficulty with nerves controlling his elimination so he gets cisapride. But when he was super constipated, their first course of action was to provide a stool softener when he desperately needed an enema.  In their practice they are less willing to take on non-routine surgery now too.

I would opt out of surgery as well. I think if you can get the nausea controlled and maybe some b12 shots then maybe that's all that is needed in addition to the thyroid meds. Sometimes having high thyroid levels can make them nauseated I have heard.