Ilnesses That Wax and Wane

cc0000 · Sep 18, 2016

Since the end of August, my cat has had symptoms that go back and forth each week. Part of the week (for half a day typically) he will be lethargic and not want to eat or drink.

He hacks sometimes like he has a hairball and the symptoms usually last half of a day and fade away after given Laxatone. Then, he'll be fine until the next week.

He has had several vet appointments. First, they said URI because he was sneezing and coughing that time. They treated him (fluids, antibiotics) and he was better by the end of that day, at least until the next week.

Then, it was right back to lethargic, won't eat, won't drink. He went back to the vet again and had a full geriatric panel, ant-nausea and anti-pain meds, fluids, and an appetite stimulant.

The pain medicine made him a zombie and then overly affectionate for 3 days, but he was eating, drinking, and feeling better.

Because he seems to struggle with hairballs and something is clearly seriously wrong, I scheduled an ultrasound for next Tuesday. Unfortunately, though, the blood tests show the possibility of kidney disease. The vet said it may or may not be the case because dehydration may have messed with his results.

Also, in June he had bloodwork and his kidneys and everything else checked out fine.

I also don't understand how it would be kidneys when he has clear hairball issues (I was thinking IBD/lymphoma) and never drinks or pees excessively.

I've heard cats with kidney issues will drink and urinate a lot because their kidneys are failing. That never occurs with him, and I don't understand how he could have failing kidneys when his kidneys checked out perfectly in June and his creatinine was normal this last time.

Also, he was diagnosed with pancreatitis in April so I wonder if that could have damaged him, even though his bloodwork was fine in June.

missmimz · Sep 18, 2016

How old is he? Was a urinalysis or SDMA test ran? Those will help confirm CKD. What food is he eating? Is he vomiting hairballs, food, or bile?

cc0000 · Sep 18, 2016

He is 12. They couldn't do a urinalysis due to an empty bladder. They said try again at the ultrasound. The SDMA was run and was higher than normal 16 ug/dL when normal is 0-14.

He eats a mix of dry and wet now. I struggled for years to get him to eat wet food, though.

He doesn't vomit outside of hairballs. But, what worries me is when he appears to have a bad one and is given Laxatone he will eventually vomit violently (stopped using that now).

He will cough up a hairball but will throw up yellow, egg-smelling liquid (bile?) in multiple spots, projectile vomiting. This never happens (with the exception of when he had pancreatitis in April) unless he is given Laxatone after having a hairball that isn't coming out. He does cough before given Laxatone and there is always a hairball that comes up.

His symptoms just confuse me. The SDMA scares me and makes me think he has to have kidney issues. But, how could they come on so suddenly and why does he have the hairball and hacking issues? Also, why no excessive drinking and urination which I always hear about are big symptoms?

missmimz · Sep 18, 2016

cc0000 said:
He is 12. They couldn't do a urinalysis due to an empty bladder. They said try again at the ultrasound. The SDMA was run and was higher than normal 16 ug/dL when normal is 0-14.

He eats a mix of dry and wet now. I struggled for years to get him to eat wet food, though.

He doesn't vomit outside of hairballs. But, what worries me is when he appears to have a bad one and is given Laxatone he will eventually vomit violently (stopped using that now).

He will cough up a hairball but will throw up yellow, egg-smelling liquid (bile?) in multiple spots, projectile vomiting. This never happens (with the exception of when he had pancreatitis in April) unless he is given Laxatone after having a hairball that isn't coming out. He does cough before given Laxatone and there is always a hairball that comes up.

His symptoms just confuse me. The SDMA scares me and makes me think he has to have kidney issues. But, how could they come on so suddenly and why does he have the hairball and hacking issues? Also, why no excessive drinking and urination which I always hear about are big symptoms?

Did they run a T4? SDMA is a good indication of early kidney disease. If you haven't already start reading around on Tanya's site, which is well known as the "bible" for CKD information. Ideally you're going to want to get him off kibble, or at least put him on a low phos kibble. The problem with low phos kibbles are they're high in carbs, so better to cut out the kibble if you can. She's got a list of low phos high protein canned foods, too.

Doesn't sound like hairball vomits to me it sounds like he's having bile pukes, which is common with CKD. You're probably going to want to start giving pepcid to help control that stomach acid. Info on that on Tanya's site, but ask your vet too. I'd also suggest giving some slippery elm syrup too. It'll help with hairballs (although this doesn't sound like hairballs to me) as well as help with vomiting/nausea.

http://www.felinecrf.org/

http://www.littlebigcat.com/health/slippery-elm/

cc0000 · Sep 18, 2016

T4 was normal. I always feared kidney disease was in his future because he wouldn't eat much wet food. He did drink each time he ate dry food, though.

There is no vomiting, though, without a hairball being mixed in. The last time there was an enormous hairball so IBD was my concern or, worse, lymphoma.

I have never had an animal with kidney disease so I have no idea what I'm supposed to do to keep him happy and extend his life, other than a change in food.

missmimz · Sep 18, 2016

cc0000 said:
T4 was normal. I always feared kidney disease was in his future because he wouldn't eat much wet food. He did drink each time he ate dry food, though.

There is no vomiting, though, without a hairball being mixed in. The last time there was an enormous hairball so IBD was my concern or, worse, lymphoma.

I have never had an animal with kidney disease so I have no idea what I'm supposed to do to keep him happy and extend his life, other than a change in food.

Don't panic. At early stages it can be controlled and he can live a long life. Start with reading Tanya's site. Also look at joining the FB CKD group. You can post your info there and there are really smart people in the group that will give you tips on food, fluids, meds, and binders if necessary.

https://www.facebook.com/groups/felinecrf/

cc0000 · Sep 18, 2016

missmimz said:
Don't panic. At early stages it can be controlled and he can live a long life. Start with reading Tanya's site. Also look at joining the FB CKD group. You can post your info there and there are really smart people in the group that will give you tips on food, fluids, meds, and binders if necessary.

https://www.facebook.com/groups/felinecrf/

Thanks for all of your help and information.

I have one further question. Do you know if his ultrasound will be able to point towards kidney disease or not?

Thanks.

missmimz · Sep 18, 2016

cc0000 said:
Thanks for all of your help and information.

I have one further question. Do you know if his ultrasound will be able to point towards kidney disease or not?

Thanks.

I don't really know, to be honest, other than it might show if the kidneys are smaller than normal, which would indicate something is abnormal. The tests that confirm CKD are SMDA, Creatinine, BUN, Phos, and urinalysis. I'm not sure that's the right place to put your money right now. You'd be better off getting a urinalysis to see urine specific gravity to confirm what the SDMA is showing. If his phos is high getting that under control could fix the vomiting issue.

cc0000 · Sep 18, 2016

missmimz said:
I don't really know, to be honest, other than it might show if the kidneys are smaller than normal, which would indicate something is abnormal. The tests that confirm CKD are SMDA, Creatinine, BUN, Phos, and urinalysis. I'm not sure that's the right place to put your money right now. You'd be better off getting a urinalysis to see urine specific gravity to confirm what the SDMA is showing. If his phos is high getting that under control could fix the vomiting issue.

He will be getting a urinalysis at the same time. I only want to do the ultrasound because his vomiting and weird hacking beforehand concerns me and I want to make sure there is nothing going on like thickening of the intestines.

Even if he definitely has kidney disease, I worry that he could have something like lymphoma that could be affecting kidney function.

missmimz · Sep 18, 2016

cc0000 said:
He will be getting a urinalysis at the same time. I only want to do the ultrasound because his vomiting and weird hacking beforehand concerns me and I want to make sure there is nothing going on like thickening of the intestines.

Even if he definitely has kidney disease, I worry that he could have something like lymphoma that could be affecting kidney function.

It's hard to detect lymphoma vs IBD even with an ultrasound. Here's more info about that. http://www.rawfeedingforibdcats.org/is-it-ibd-or-cancer.html

cc0000 · Sep 18, 2016

I know you can't say it is lymphoma without a biopsy, but, I feel better doing the ultrasound to at least see if there is any thickening of the intestines and rule that out.

The fact that he had pancreatitis before and the vet said she couldn't be certain if it was kidney disease or dehydration concerns me. I don't want to miss something and regret it later. I also had the ultrasound scheduled before the blood results came in and there is a waiting list.

cc0000 · Sep 21, 2016

UPDATE:

He actually has pancreatitis. The urinalysis came back normal, the ultrasound showed mild inflammation. The vet said his kidneys are fine.

foxxycat · Sep 23, 2016

The gold standard for pancreatitis: fluids/Pain meds/Food/anti nausea meds/Pepcid.

I have experience with pancreatitis. Its very painful. Not all cats vomit. The foamy yellow is bile-that is correct. Often there is inflammation in the upper intestines near where the gallbladder/pancreas is.

The biggest thing right now=fluids. Is your kitty getting sub fluids or IV fluids? pain meds next. Once the fluids have an hour or so to get absorbed into the body along with pain meds working then we give Cerenia or Zofran-to calm down the vomiting reflex. Then Pepcid every 12-24 hours also helps. Usually within 12-24 hours of starting this regimen you should see some improvement BUT the meds and fluids need to be given for quite a few days. antibiotics as well incase its infected inside the pancreas.

how is your baby doing this morning?

I had a cat who used to get pancreatitis all the time. She would get lethargic, not eat, not move and just look at me with her pain stare. She also struggled with constipation for all her life. We think it was constipation that would set it off. I had to keep her on miralax and canned pumpkin to keep things moving. she used to eat grass all the time and vomit it up. That's when I knew she wasn't feeling well. So when I finally got her bowel movements regular we pretty much kept her comfortable. the pain meds bupre worked wonders. Although she became a bit spacy on them she was able to lay comfortably. She used to lay on hard cold surfaces when it acted up. Then she would hide. Sometimes you don't notice the little changes...

My angel Floey was not able to be pilled-I learned to give her injections and subfluids. She was not able to by syringe fed either. She just got so stressed out that she would pant. She was one of the most independent strong cats I have ever seen. She lived with this condition for about 4 to 5 years before we had to let her go due to lymphoma. We didn't biopsy as it came on fast within 6 weeks. Sadly we couldn't save her but I do recommend an ultrasound. I waited. I put it off. I thought it was a bad bought of pancreatitis so yes get the ultrasound done.

We had ultraed her last summer and there was a very small growth on her adrenal gland but at the time she wasn't loosing weight or not eating..so we didn't do anything...keep us posted.

cc0000 · Sep 23, 2016

foxxycat said:
The gold standard for pancreatitis: fluids/Pain meds/Food/anti nausea meds/Pepcid.

I have experience with pancreatitis. Its very painful. Not all cats vomit. The foamy yellow is bile-that is correct. Often there is inflammation in the upper intestines near where the gallbladder/pancreas is.

The biggest thing right now=fluids. Is your kitty getting sub fluids or IV fluids? pain meds next. Once the fluids have an hour or so to get absorbed into the body along with pain meds working then we give Cerenia or Zofran-to calm down the vomiting reflex. Then Pepcid every 12-24 hours also helps. Usually within 12-24 hours of starting this regimen you should see some improvement BUT the meds and fluids need to be given for quite a few days. antibiotics as well incase its infected inside the pancreas.

how is your baby doing this morning?

I had a cat who used to get pancreatitis all the time. She would get lethargic, not eat, not move and just look at me with her pain stare. She also struggled with constipation for all her life. We think it was constipation that would set it off. I had to keep her on miralax and canned pumpkin to keep things moving. she used to eat grass all the time and vomit it up. That's when I knew she wasn't feeling well. So when I finally got her bowel movements regular we pretty much kept her comfortable. the pain meds bupre worked wonders. Although she became a bit spacy on them she was able to lay comfortably. She used to lay on hard cold surfaces when it acted up. Then she would hide. Sometimes you don't notice the little changes...

My angel Floey was not able to be pilled-I learned to give her injections and subfluids. She was not able to by syringe fed either. She just got so stressed out that she would pant. She was one of the most independent strong cats I have ever seen. She lived with this condition for about 4 to 5 years before we had to let her go due to lymphoma. We didn't biopsy as it came on fast within 6 weeks. Sadly we couldn't save her but I do recommend an ultrasound. I waited. I put it off. I thought it was a bad bought of pancreatitis so yes get the ultrasound done.

We had ultraed her last summer and there was a very small growth on her adrenal gland but at the time she wasn't loosing weight or not eating..so we didn't do anything...keep us posted.

The last two days Brillo has been much better. He has had good days and bad days since this started, though. The multiple vet visits stressed him a out a lot so I'm sure that didn't help.

He has been back and forth to the vet so much recently. The gave him fluids multiple times, anti-nausea meds, and a shot of pain medicine (bupre.). He also had an antibiotic shot a week ago when he displayed signs of an URI.

At the last visit (after the ultrasound and pancreatitis test) the vet gave me a bland, prescription diet (Hills Digestive) and said to see how it goes the next few days. If Brillo continues to have problems, he will have to be put on steroid medication.

Pancreatitis is so strange to me with the back and forth nature of it. Was it like that for your cat, where it would go back and forth for weeks with good days and bad days?

Also, do you know how long an attack can last? Even with all of Brillo's treatment, it has lasted a few weeks.

Sorry to hear about your cat. I had a cat who developed lymphoma as well because he was a stray who acquired leukemia. It seems like so many cats get lymphoma now.

foxxycat · Sep 24, 2016

there was no rhyme or reason to when she would get attacks. It seemed to come out when she gets blocked up. Often I would forget to give her the pumpkin because she would be going ok. then three days go by then opps I got to do it again. I couldn't give it daily otherwise she got messy stools. I take the blame for not sticking to a regimen. Yes it can wax and wan. The stress from the vet visits don't help. Did they send you home with bupre? I know some places are not doing this anymore. My vet makes me bring her in and they have to administer it.

you can ask to send you home with a setup for fluids. I really think doing fluids on a consistent basis is very necessary. I found it made a world of difference. Ask about Pepcid. Most cats who get pancreatitis stay on Pepcid long term. Those are two things you can do at home.

I don't know about the bland diet. My cat Floey couldn't eat corn and often those prescription diets are loaded with corn. I found dry food at tractor supply 4Health was one of the ones she didn't barf on. It does have peas and potatoes. Maybe that is why she was able to keep it down most of the time. We didn't have good luck with higher quality foods like wellness and Orijen. She would puke it. I was told its just too rich. so I just stick with 4Health and she ate that for 2 years. very rarely was she barfing on that food.

The other thing she loved-fancy feast pate style turkey and giblets. I put it in a dish-mash with fork=add a can of HOT water/miralax- (make sure miralax dissolves in the hot water prior to adding to food) and this was her regular food for about a year. She loved her slurry. I was able to cut back on kibble a bit but she was getting frail this year so we no longer restricted her. She lost quite a bit of muscle mass at that point. She was 17.5 so either way we had a good life together. In her younger years she would not be caught dead eating wet food...in her older years she loved it. maybe you can try this=I did this because she had rising kidney values so we needed to up the fluids..and it helped..

cc0000 · Sep 24, 2016

foxxycat said:
there was no rhyme or reason to when she would get attacks. It seemed to come out when she gets blocked up. Often I would forget to give her the pumpkin because she would be going ok. then three days go by then opps I got to do it again. I couldn't give it daily otherwise she got messy stools. I take the blame for not sticking to a regimen. Yes it can wax and wan. The stress from the vet visits don't help. Did they send you home with bupre? I know some places are not doing this anymore. My vet makes me bring her in and they have to administer it.

you can ask to send you home with a setup for fluids. I really think doing fluids on a consistent basis is very necessary. I found it made a world of difference. Ask about Pepcid. Most cats who get pancreatitis stay on Pepcid long term. Those are two things you can do at home.

I don't know about the bland diet. My cat Floey couldn't eat corn and often those prescription diets are loaded with corn. I found dry food at tractor supply 4Health was one of the ones she didn't barf on. It does have peas and potatoes. Maybe that is why she was able to keep it down most of the time. We didn't have good luck with higher quality foods like wellness and Orijen. She would puke it. I was told its just too rich. so I just stick with 4Health and she ate that for 2 years. very rarely was she barfing on that food.

The other thing she loved-fancy feast pate style turkey and giblets. I put it in a dish-mash with fork=add a can of HOT water/miralax- (make sure miralax dissolves in the hot water prior to adding to food) and this was her regular food for about a year. She loved her slurry. I was able to cut back on kibble a bit but she was getting frail this year so we no longer restricted her. She lost quite a bit of muscle mass at that point. She was 17.5 so either way we had a good life together. In her younger years she would not be caught dead eating wet food...in her older years she loved it. maybe you can try this=I did this because she had rising kidney values so we needed to up the fluids..and it helped..

They only give the bupre. in shot form at the vet. The fluids and Pepcid are something I would like to try after the bland diet trial is over. I can hear Brillo's stomach rumble before an attack hits, then he has sulfuric burps and gas in the beginning. I don't know if that is because of stomach acid or what, but, I thought the Pepcid might help with that.

I also don't love him being on Hills because of the fillers and expense. I want to try him on a bland wet food that gives him more fluid and less grain. I just don't know what to try or what's best for him. All the vet said is a chicken and rice diet like Hill's Digestive is good. He didn't say to watch for fat, spices, or ingredients like carrageenan so I don't know what specifically sets off an attack when it comes to food.

Brillo is just like your cat when it comes to food. He never would eat any wet food before he was sick. Now he has no problem eating it, thankfully.

Thanks for all of the information. It helps a lot coming from someone who has been there. Brillo is 12, and while that it old to some, it is still young to me and I want to keep him healthy and happy for as long as possible.

foxxycat · Sep 24, 2016

I would call vet and ask about Pepcid. This may very well help get him eating. gas and upset tummy could be making him feel yucky. What about his hydration? Did they send you home with fluids?Would you feel comfortable doing this? dehydrated kitties won't eat. I wouldn't hold off on the fluids and Pepcid. the diet won't help him feel better if his stomach is upset. you can do all three together.

Do you know how to check hydration?

You can slide your finger on their gums-if your finger slides around-then its hydration is good. if your fingers stick or feels tacky-then he will need fluids.

The other way is the skin on the back of the shoulders-you pull it gently up and let it go-watch how fast it snaps back in place. if it goes slowly back then he needs fluids.

Often cats can have what is called tenting-the skin not returning-and gums will feel slippery. other times I have had a cat whose skin snaps back but gums tacky.

Once you get the fluids into him= for heart kitties its 50-100 ml and normal kitty 150ml then you can put the Pepcid in a gelcap. ask the vet for dose. The Pepcid takes about half an hour to work. if they can send you home with Cerenia=this together is what will help him feel better.

Even if you change his food without giving fluids/meds it's still not going to help that stomach. the pain meds help but fluids/Cerenia/Pepcid help even more.

If he will eat boiled chicken try it.

you can also try canned kitten food-its high in calories and at this point-any food is better than no food.

babyfood meat chicken/turkey are good choices. my cats love ham!

cc0000 · Sep 24, 2016

I am going to ask about the Pepcid and fluids on Monday when his vet is open. Brillo is eating and drinking very well now, is active, and has been doing so much better since we switched to the vet's food.

At his worst, I had to syringe feed him food and water. That would only last for half a day before he would perk up and eat and drink normally again, but, it is never something I like to do because you have to be so careful. If the Pepcid helps me avoid that, it would be great. Even with pain meds, fluids, and anti-nausea meds Brillo would still feel lousy sometimes so hopefully the Pepcid helps with that.

The only thing they sent me home with was the prescription diet since Brillo was doing better. If he starts to feel lousy again (not eat, drink, lay around), I have a walk-in vet where I live and an emergency vet so I will take him for fluids and meds.

The vets where I live never said anything about the Pepcid or doing fluids at home. They only talked about special diets and steroid treatments.

Yes, I know about checking for dehydration through a cat's skin. I've done it before. I never knew about checking through the gums. That's good to know.

I took him to his regular vet and a walk-in for fluids and the anti-nausea and pain meds several times. They never told me I could do fluids at home or gave me medicine to give him, other than an appetite stimulant. They give everything in shot form for nausea and pain at the vet and then send him home.

I'll be asking about the fluids and Pepcid. His regular vet prescribes steroids for pancreatitis that doesn't respond to the change in food.

foxxycat · Sep 24, 2016

I guess it depends on if the client asks. I always ask and after my cancer kitty they finally sold me a set of fluids and needles. It was a life saver for my girl. she was NOT pillable. AT ALL. So I got everything as injection and we just did the home nursing care.

Some vets don't ask clients as maybe they are not sure if the client feels comfortable with fluids. I think more often its offered for kidney kitties. I just happen to keep pestering my vet because it was the 3rd visit in two weeks and it was royally stressing out Floey.

I am glad your guy is eating better and acting more like himself. I don't know why they always jump on the steroid bandwagon. Maybe because it is a good med for inflammation and pain. And during an acute attack it probably makes a big difference...

cc0000 · Sep 24, 2016

Before reading on this site, I never knew you could give fluids at home so I didn't think to ask. The Pepcid is new to me too because I've always heard that cats can't have anything like that (used for people) because everything is so dangerous for them.

Fluids don't seem like they would be too difficult to give. As long as they are not outrageously expensive, I have no problem giving them everyday if needed.

This pancreatitis flareup is Brillo's 2nd but was so different from the first. The first cleared up after one vet visit and fluids, pain meds, and anti-nausea meds. This time it has flared up off and on.

Brillo did start eating new food (Rachael Ray Nutrish and wet food) recently so I wonder if either food has something in it causing the pancreatitis to flare.

Ilnesses That Wax and Wane

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