My cat is not eating right and we don't know why?

[guinness10]

Hello, hoping so much to find an answer.  I have been dealing for a month with a 10 year old Siamese cat who has not eaten properly for that long and probably for a while before that. A month ago, he was taken to the emergency vet with dehydration, foaming at the mouth, sick eyes. They did bloodwork and said his kidney numbers were high (3). He was treated with I.V. and sent to my regular vet who continued treatment. He got much better but my vet does not think that Creatine levels of 3.0 would cause a cat to get as sick as he did. He wanted no parts of the special kidney food as he likes to lick the gravy of the regular food and doesnt eat pate. (This has been going on for a while. He got very particular a few months back and I tried many different foods).  I think this pickiness is part of what is really going on.  

Prior to this emergency vet visit last month he was been taken to the vet a few months earlier on 2 different occasions with an unknown illness. He hid behind the tv and sat in the meatloaf position one of the times but still ate and drank.  I took him to the vet, his neck was swelled strangely. They did a blood panel and said about his kidney levels rising but that they were not to the point of concern but something to watch out for. Also put him on antibiotics. He got better.

The time before that he just got swollen around his neck area but showed no other signs of illness. Also put on antibiotic and got better quickly. Bringing you back to today. For the past month I have tried every food - his favorites included and his appetite isnt where it should be. I supplement with baby food. We have had ultra sound, which revealed a spleen that was enlarged roughly by 1/3 of its normal size but nothing else. Xray yesterday revealed inner lobe of right lung collapsed but reported that it was not of concern and asymptomatic. He appears to be in pain at times and sits in the meatloaf position often. He is given pain meds, Pepcid AC and is currently on Metronidazole. He has been on Clavomax and prednizone. Also gave him Mirtazapine to try to stimulate appetite. Only did that once because I really didnt like how it made him act. At one point he appeared to be doing better eating 4 days after the Mirtazapine was given but that better eating went away. I dont know what else to do. I know we could do better spleen testing or pancreatitis blood work. I have only so much money and want to go the correct direction. He drinks on his own and nibbles at food but just isnt getting enough in him. No diahrea, he poops and pees. He has only spit up 3 times in the past month and 2 of them were clear liquid with undigested food and one was regular throw up. He was not throwing up before he got so sick either. I am at a loss. He purrs he plays he walks around like normal for the most part.  The last 3 days he has almost eaten normal.  I didnt syringe feed him all weekend....today he went backwards again, started sitting in the meatloaf position again and isnt really eating again.  He comes running when he hears the food bag, or sees me with a can, but when he gets up to it, it is either a few licks of gravy or a sniff and he walks away!!!!  I am so frustrated!!!!

Anybody???? Anything????   Thinking of going the Pancreatitis test route for chronic pancreatitis,

 

[vball91]

The flares could be pancreatitis and/or IBD, but the neck swelling really doesn't fit. I can totally understand why you're frustrated. Did the vet ever mention trying prednisolone? I'm not sure if his kidney numbers are bad enough for pred to be contraindicated??? IBD is so hard to diagnose even with a biopsy so oftentimes, it's a diagnosis by elimination. www.ibdkitties.net has a lot of info on IBD and pancreatitis and triaditis.,

Oh, and being interested in food but walking away is a classic symptom of nausea. I would try an anti-nausea med like Cerenia. And maybe try a different appetite stimulant like cyproheptadine. Mirtazipine does seem to have stronger side effects in some cats.

One last thought, was his mouth checked thoroughly? Sometimes the lack of appetite is due to a painful mouth or rotten teeth. That could account for antibiotics working sometimes if there's an infection.

 

[ldg]

Well, I would think you'd want to discuss further diagnostic options vs your budget with your vet. We're always up front about things like that, and ask them to help us figure out which way to go....

It sounds to me like there are several different things going on, and the CRF is unrelated to whatever else it is going on. The swollen neck - were lymph nodes mentioned? Swollen lymph nodes there can cause that, and that can be due to infection or cancer.

You mentioned trying an appetite stimulant - but has an anti-nausea medication been given? For our Lazlo, when he felt his worst, an anti-nausea medication did more than the appetite stimulant. We did use mirtazipine, but cyproheptadine is an alternative. It does need to be given 2x a day, which is why vets tend to prefer mirtazipine if kitty tolerates it.

If the pancreas isn't swollen on x-ray, I would at least get the Spec fPLI test done. Pancreatitis is very painful - what pain meds are being given?

In Lazlo, he was hungry, but then wouldn't want to eat. I never considered this to be "fussy." I always believed it because he felt nauseous, and he was very sensitive to smell.

With the early stages of CRF, I would consider dropping the kibble - the more water you can get moving through your kitty, the better. You might want to invest in a number of freeze dried treat options (most are sold in the dog section if you're in a store - I order them from Amazon, though I don't know where you're located). You can crush bonito flakes, or powder freeze dried chicken, liver, salmon, beef liver, shrimp, cod... there are a lot of choices that are just plain meat, and they powder up nicely, to help change the smell of the food. I found Lazlo would be tempted by something at one meal, and not necessarily the next, or something would work for a few days and then not.

If you're able, you may also want to consider feeding lots of small meals.

Sites that may help:

http://www.ibdkitties.net
http://www.felinecrf.org/

Vibes for your boy! :heart2:

 

[guinness10]

Hello, thank you so much for responding to my thread!  I need this conversation with people for both comfort and suggestions!  I will mention these other medications you have suggested to my vet, as we have not tried them yet and I have read about them.  I think we are going to have the pancreatitits test done on Wednesday.   It was a toss up between that test and the lymphoma in the spleen "test".  Leaning more towards the Pancreatitis test now, but that doesnt explain his spleen.  His teeth were checked several times.  It really is more of a nausea reaction.  He gagged last night twice like his stomach was upset.  He had a few days where he wasnt for whatever reason.  He ate a little this morning. 

 

[guinness10]

Thank you for your response, this is most helpful for my sanity.  My vet has been fantastic.  He knows the budget is tight but that I wont let that stop me, I just have to be smart about it.  Still paying for the 2 nights he spent at 5 star hotels in early October.  We were tossed between testing for Pancreatitis or lymphoma in the spleen first and things being as they are again, we are leaning towards the Pancreatitis test.  Wednesday.  The vet found the swollen neck more of a mystery, not lymph nodes.  It hasnt happened this last time that he has been so sick.  Many months ago his only symptom was a swollen neck and it was gone as quick as it had arrived.  Very strange.  He also doesnt have diarrhea and hasnt at all throughout this, sometimes softer stool but rarely, and the only vomiting through this entire thing was 3 times plus the foaming at the mouth when he was so sick.  Is that conducive to Irritable Bowl?  I thought they needed to have those symptoms more often.  Guess it depends on the cat.   I am very thankful that he drinks like he does through this.  Not drinking would be so much worse.  I bought freed dried treats yesterday while I was at the store buying any kind of food I could think of to try and he looked at me like I was crazy but yesterday was a low eating day anyhow.  I will try powdering it.   As far as his meds, his pain medicine is Buprenor.  I can give him the cyproheptadine 2 xs a day, we have been doing that with some of the pills we have tried anyhow.  I have learned to adjust my life with three kids to work around the feedings and pills of the cat which some require a full stomach and some and empty one.  I am not saying it isnt taking a toll on me, but I love my sweet boy and he still purrs, loves, drinks, poops, pees and plays.  Some days are better than others of course. 

 

[mrsgreenjeens]

Many cats with kidney disease do not like the kidney foods.  It's better the have them eat something than nothing.  That's my adage and I'm sticking to it.  So...exactly what ARE you trying to feed him?   I've kind of got the same issue with my girl, who is also in the beginning stages of kidney disease, but doesn't have the other issues you describe except the non-eating.  Luckily she likes pate, WHEN she eats, so I can take any food and toss it in my magic bullet and make it into a pate.  Your cat may surprise you and change his mind, so don't limit yourself to just shredded or chunks or whatever.  I even add quite a bit more water to my mixes to make it quite soupy so my girl can just lap it up, that way she kills two birds with one stone, so to speak.  Gets her food and water at the same time. 

Your boy's spleen is worrisome.  I would think that would be causing him some pain, and I would think that would be of major concern, but I supposes he could have had this condition his entire life.  Hard to know.  The entire thing, swollen neck, enlarged spleen, etc., is quite a mystery.

 

[guinness10]

I started off when we got home from the vet stay with the kidney food and was told to give him "tough love" and stick to the kidney diet.   I followed him around, tried every kind I could get my hands on, prescription of course, fed him when he first woke up (heard this works and it does).  He just wouldnt do it on his own.  After a concerned call to the vet I was told feed him whatever you can get in him.  I tried tuna (in water), I tried those Bonito flakes or whatever they are called, I tried the food he always ate before the kidney food and pretty much he wasnt interested in that either.  Not enough to sustain him.  It definately was and is belly related to some extent, as he wanted to eat but just would try or sniff and walk away or look at me like "feed me" when there were 8 cans of food open in front of him.  I have blended, added water, flipped over for freshness, mixed varieties, added no salt chicken broth, raised the food bowls, moved the food bowls, tried plates, you name it....no dice.  At least now he eats some, just not near enough to sustain him.  Mystery added, he was eating better a few days ago and his belly seemed a bit better too (not sitting in the meatloaf position, and just didnt look like his stomach was upset).  This would be the second time in this month long venture that he seemed to be doing better, although I do believe there were some days where I fed him and he maybe would have done ok, but who wants to leave it up to chance and then have to shove 2 jars of baby food in him at the end of a day to play catch up.  I dont want him to have pancreatitis but I want an answer if it means we can move forward with the right medicines, also he is a Siamese and they are more prone to it.  But that spleen just hangs out there and doesnt match the pancreatitis diagnosis AT ALL.  Sigh.  Thanks for the message.  I am hoping if we can get past this, I can get him eating and eating the right stuff for his kidneys. 

 

[guinness10]

What a stressful day.  After fasting 12 hours for the Pancreatitis blood test, we came home and he had no interest to even lick the gravy from his food.  He went through alot at the vet though between the blood test and a needle test from a cist that is nothing thankfully.  Back to almost all baby food at this point.  Cant wait for the results of the blood test today.  So we can move forward with some sort of goal or on to the next test.  Giving him the appetite stimulant I had given him once before today, only at a lesser dosage.  Hoping he doesnt act differently on it but that it makes him eat more on his own.  I think his belly is quite upset today.  Just by his behavior.  My nerves are shot.  I was doing ok for a few days but I am sad worrying about him and worrying about money.  

 

[mrsgreenjeens]

Well, here's hoping the appetite stimulant does some good, and that the test's come up with some definite answers.  I forget, is he on anything for nausea? 

 

[guinness10]

Thanks!  The appetite stimulant worked quickly!   He is eating more already.  Also purring alot and slightly hyper which he did the one other time he took the pill.  Even after reducing the dose he still acts slightly off.   Hoping that the eating continues till we can figure out what is going on.  Test takes a few days but my vet personally was shipping it last night.  Hopefully I only have to give him pills today and not feed too.  He is on Famotidine.  I believe that is a stomach settling type pill.  Sort of the cat version of Pepcid AC.  He was originally put on that with his kidney diagnosis.

 

[ldg]

I'm so glad the appetite stimulant is helping! I'm sorry that it's making him a little nuts, but better that he's eating, IMO. :rub:

The famotidine is an antacid. It can help. But when Lazlo had issues with nausea, he was on BOTH an anti-nausea medication (Cerenia) and the famotidine. I gave the Cerenia in the morning, and the famotidine at night, to help suppress acid-buildup during the time he has to go longest between meals.

You might want to ask the vet about Cerenia. It seems to do a really good job for most kitties - and for our Laz, it was a more helpful tool than the appetite stimulant (though he was often on all three at the same time).

 

[guinness10]

That Cerenia sounds like a very good idea.  I feel if his belly felt good he would eat.  Whatever the underlying reason is.  Thanks! 

 

[guinness10]

Sooooo, the eating has been ok with the Mirtazapine.  Now we have VERY soft stool.  Not sure what that is about.  That's rather unusual as he has had normal stool through the better part of this and it was never one of my original concerns.  Is it the Mirtazapine?  Is it that he is eating so much more regular food and it isnt the "right" food for Pancreatitis?  If that is indeed what he has?  Hoping to find out today.   Anybody have any input on this? 

 

[ldg]

I looked at the side-effects of mirtazapine - the list of potential side-effects includes constipation, but not diarrhea (I know it's not that bad). Of course, ANY change can cause a change in the gut environment. I'd consider adding an L. acidophilus probiotic, using 2.5 to 5 billion CFU in the am and 2.5 to 5 billion CFU in the pm. I give all my cats this anyway, it has so many potential health benefits. (Hubby and I take them as well). We use Natural Factors double-strength L. acidophilus+Bifidus with goat milk base, and give 1/2 capsule 2x a day.

 

[goholistic]

So sorry to hear about your boy not feeling well. 

  His system is out of whack. He wasn't eating very good to begin with, and then he had to fast. And now all of a sudden he's eating again because of the Mirt. I could see how this could cause some soft stools. I've used Mirt on all three of my cats at one point or another, and they've never developed soft stools from that specifically.

Do let us know how the pancreatitis test comes out. My Sebastian had (has) this along with possible IBD.

 

[guinness10]

Thanks for all the posts.  The soft stool seems to only be about once a day.  SO IT IS PANCREATITIS.  The Chronic kind.  Happy for diagnosis, sounds weird to say, now he has been prescribed the Cerenia and I am picking that up tomorrow.  Not sure if he has IBD too.  I have to do more reading on that.  I did a while back but my head is spinning right now.  Hoping to get him right with the new pill.  Perhaps it will help his belly enough that he wont need a stimulant.  Or not much of one anyhow.   Then to gear him towards the kidney food to keep that from getting out of control.  Any other input on dealing with pancreatitis kitties would be great!  What's life like?

 

[goholistic]

Ugh...so sorry...the dreaded pancreatitis. 

  Why are so many kitties getting this? Why is the pancreas getting picked on so much? And with your cat having kidney issues, you're getting a double whammy. 

It's been a rollercoaster for Sebastian since his first bout of pancreatitis in July. After the second flare-up in September, the vet put him on steroids to keep the inflammation down and a limited ingredient, novel protein diet. When we tried to lower the steroid dose in October, he flared up again. My vet seems to think it's secondary to IBD. It could still be lymphoma, but I declined a biopsy. Sebastian is sensitive to changes, so we take things SUPER slow. We're gradually lowering his dosage of Metronidazole and Cerenia, but by only a 1/4 at a time. If I am adding anything to his regime, I have to introduce that slowly, too. There's a lot going on, so I'm leaving things out, but feel free to ask me questions. Sebastian's thread is here: http://www.thecatsite.com/t/264363/...suspected-pancreatitis-again/330#post_3444987

 

[ldg]

There is a LOT of information in Sebastian's thread. :nod:

I don't know if all of these are in there, but here are some basics on pancreatitis:

http://drnelsonsveterinaryblog.com/2010/08/29/feline-pancreatitis--treatment.aspx

http://www.idexx.com/pubwebresource...ng-pancreatitis-and-concurrent-conditions.pdf

http://www.2ndchance.info/pancreatitisdogXenoulis2008.pdf

http://www.peteducation.com/article.cfm?c=1+2135&aid=334



The PetEducation article sums it up:

The goals of treatment are to:

Correct dehydration
Provide pain relief
Control vomiting
Provide nutritional support
Prevent complications


Included in that list should be control inflammation, which is addressed either with diet, steroids, or both.

Pancreatitis is often very painful - does the vet think pain meds are in order? Our Ming Loy had a bout of acute pancreatitis, and was given buprenorphine. She only needed it for two days. We fed her frequent small meals; used probiotics and digestive enzymes; controlled the inflammation with (for her, because it was acute, not chronic) a short course of steroids (prednisone), and we controlled the vomiting and nausea with Cerenia. We gave her 50ml of fluids daily for 10 days, this seemed to really help.

We used a (human) L. acidophilus+bifidus supplement. For the digestive enzymes, we use plant-based (Prozyme original) because they work in a wider pH environment. I personally like Prozyme Original, because it takes so little of it on each meal.

Given the often close relationship with IBD, a wet-food only, raw, or homemade diet is probably best. Think "species appropriate," and potentially novel protein. Here is another TCS member's experience with Triaditis (that included Noelle having pancreatitis): http://www.thecatsite.com/t/240929/feline-triaditis-my-experience-and-concerns-questions and her diet: http://www.thecatsite.com/t/246201/raw-diet-questions-and-concerns

 

[guinness10]

Yes indeed the dreaded pancreatitis is right....We have dabbled in some of the drugs used for this so I am not overly confident in what the new one will bring, but seeing that it has helped others and knowing that clearly his belly hurts, the Cerenia cant hurt.  Gave him a more natural kind of food today, better on the kidney list and probably the Pancreatitis list as well.  Perhaps we can at least do better than gravy laced friskies.  Not good for what ales him no doubt! 

 

[guinness10]

Thanks for all the reading.  Very overwhelmed and not sure what to think but picked up some things.  As far as pain meds go, he was put on the Buprenorphine in the beginning for pain and given at times when I felt he was in pain.  The Cerenia was given to him once in shot form the day he had the xray, as he seemed to be upset in the stomach that day more than usual.  I didnt honestly see a difference in his behavior from it but I hope that it works when given more than one day.  He is drinking more the last 2 days.  I think the app. stimulant Mirtazipine can give humans dry mouths, not sure if that is the problem.  Hope so.  His kidneys were tested last week and were under 3 (just) for his Creatine.  He is eating.  He is due for his appetite stim. tonight at 5 (72 hours) but I want to schedule it that he is right at the beginning of the dose when I go away Fri-Sun.  My neighbor is watching him and it would be great if she didnt have to be concerned he wasnt eating enough.  Also hoping by then that he will be feeling better on the Cerenia and wanting to eat.  I have to admit, I dont know what to expect here.  With the chronic pancreatitis and no diagnosis of IBD that I know of at this point, do we have a chance of getting this under control to the point of almost normal?  Does it sort of go into a remission?  Am I to expect it to flair up and him be back in the vet overnight with fluids?  I am so happy to have a diagnosis, a reason for it, but honestly is it a good thing?  A very bad thing?  I need to talk further with my vet.  I didnt think of things to ask till after we were done speaking when he said it came back positive.  Do those blood tests show specifics on how bad it is and how to treat it?