(Very long) Cat not eating well for weeks, unsure what to do at this point.

[Somachi]

In late December/early January, we decided to switch Missy (indoor, age 6, spayed) to wet cat food for her health after years of dry. We did not have any issues switching her to wet over a period of a week or so. We had always free-fed dry, so I didn’t really know how much Missy was eating. When her bowl got low, someone would give her more. A bag of food lasted a long time, but she’s only one cat eating it. As we switched to wet, I realized she ate less than I expected. She isn’t overweight, but she isn’t a small cat (she usually weighs around 9.5 lbs). I was feeding her three times a day. She was always excited to eat but never ate all her food. She was eating about 2 3 oz cans of cat food per day spread over several meals.

• 01/10/24: I took her to the vet to make sure she was okay and to discuss her eating. The vet said she looked great. Her teeth weren’t bad, but it was suggested we schedule a tooth cleaning soon. I was a little reassured but still a little concerned. I increased her feedings, but she started eating even less over the next few weeks. She wasn’t acting quite like herself. She is usually very close to wherever everyone is, particularly in the evening, but she was spending more time sleeping in another room. I was getting more worried, so when the office opened on the 22nd, I made an appointment to have her seen again, but I couldn’t get in until the 24th.
• 01/22/24: Missy was very lethargic all day. She would not eat any of her food but would eat a treat. As the day went on she became more and more listless. When she looked at us, it was like she wasn’t even there. That evening, she would not get up and wouldn’t even eat treats. Her meow was quiet and weak. I was scared she was dying, so I took her in for an emergency appointment.

We were not able to see our regular vet; the on-call vet was fairly dismissive. She said Missy was not dehydrated and was probably just picky. She said to give her back her dry food and sent me with several cans of Hills a/d. She gave Missy a convenia shot and said if she didn’t improve in a few days, to come in for bloodwork. Missy continued to eat very little, though not completely refusing. We gave her back dry cat food that she could eat whenever she wanted, but she didn’t. I continued to offer her multiple choices and frequent meals with no luck. Around this time, Missy had one very dark/black stool, but never again.

• 01/24/24: Went to the vet for an exam and blood work. Her GLOB (5.3 g/dL, normal 2.8-5.1) and ALT (138 U/L, normal 12-130) were high. GGT was at the upper end of normal (4 U/L, normal 0-4), and so was her TP (8.7 g/dL, normal 5.7-8.9). The vet did an abdominal ultrasound and said that there was thickening in her stomach wall. We talked about the option to do a biopsy, but the only option at their office was surgical, which is very invasive. She said there were endoscopic scope/biopsy options at MedVet, but she said that they were very cost-prohibitive. She had only had a few clients get them done, and it had been several years ago, but they were around $2000 then. We decided to try medication and scheduled a recheck on 01/30/24 for a follow-up ultrasound. She gave a cerenia injection and prescribed topical miritaz for her appetite, cerenia tablets, and prednisolone.
• 01/27/24: Missy continued to eat very little, roughly a 3 oz can total per day, despite the appetite stimulant. She had stopped drinking any water and was just getting the liquid from her wet food. I was very concerned that she was getting dehydrated. Her gums looked pale and sort of sticky. I was concerned that waiting over the weekend was a bad idea. The vet said she wasn’t dehydrated but understood my concerns. We had been having a very difficult time administering the cerenia tablets because they made Missy foam at the mouth, so she prescribed Zofran. Missy gained over half a pound from her visit a few days ago, but I was told this was likely a side effect of the steroid.
• 01/27/24: (After-hours visit) Throughout the rest of the day, Missy’s stomach became visibly bloated very quickly, and we were extremely concerned. She acted like she was in pain. Her meow sounded different than it usually does. She had x-rays that showed a lot of gas in her stomach and CBC. All her values were in the normal range except MCHC was high (36.8 g/dL, normal range 28.1-35.8). The vet prescribed gabapentin and told me to start mylicon. She seemed woozy/unstable after her first dose of gabapentin, so we reduced the amount to X. Missy improved a little over the next several days, though her appetite was still very low, and so were her energy levels. We started to see more of her personality again.
• 01/30/24: Check in with the vet. Had a follow-up ultrasound after about a week on prednisolone. The vet said she could see improvement, and there wasn’t the inflammation there had been previously, and that if she hadn’t seen the first one, she wouldn’t know that Missy had been inflamed. However, Missy was still not eating very much, maybe 1 ¼- 1 ½ cans of 3 oz cat food a day. I started intentionally choosing cat foods with the highest calories I could find. She always had access to her dry food but wouldn’t eat it. She would still eat treats, though. She continued to drink no water, only the liquid from wet cat food, even though she has a fountain and clean water all over the house. Missy’s weight was up more. She weighed about 1 lb more than her normal weight (10.5 lbs vs 9.5 lbs). Later that day, Missy started having lots of watery diarrhea. I took a sample to the vet for testing, but it came back negative for everything, including giardia. I started her on probiotics with S. Boulardii (Bark & Whiskers), which helped, and I made an appointment at MedVet with an internal medicine specialist. She has not had any more diarrhea since 02/02/24.
• 02/05/24: I took Missy to MedVet Animal Hospital to see an internal medicine doctor for an ultrasound, exam, and bloodwork. Bloodwork showed Globulin was raised (5.2 g/dL normal 2.8-5.1) and ALP was low (13 U/L normal 14-111). Ultrasound showed no thickening of the stomach wall, stage 1 kidney disease, and abdominal steatitis surrounding the stomach and right pancreas. The conclusion was that Missy had had pancreatitis, but it was resolving. The IM vet noted a fluidy sound in her neck when palpated. She speculated that it could be reflux related to her other current issues. She ordered additional testing to check her pancreas, kidney function, and how well her intestines absorb nutrients. We discussed the possibility of a feeding tube if she continued not eating well. She had us stop the Miritaz (it had started to irritate her ears), Zofran, Gabapentin, and Bark & Whisker probiotics. I had been using a bit of FortiFlora on Missy’s food to get her to eat, which she said we could continue but stop the other. She started Missy on metronidazole twice a day, metoclopramide twice daily, and capromorelin once daily.
• 02/06/24-02/12/24 After her visit, her mood did improve for a few days. She was still very tired, but she was spending more time out with the family, even if she was sleeping. Her eating did not improve, though. She started eating less and less and was not drinking any water. We got the results from the B12/Folate, urinalysis, and pancreas tests. Her pancreas test showed no inflammation. Her B12 was good (633, should be >400). Her urinalysis showed a low concentration (1.025, should be >1.04) despite Missy drinking very little. Other elevated values were Urine Protein (1+), Blood/Hemoglobin (2+), and Red Blood Cells (>100). I was told that because of the cystocentesis, these numbers weren’t alarming.

I checked in with MedVet several times throughout the week. We were not able to talk to the vet unless we paid for a telehealth appointment, which I guess I understand- they’re busy, but it was frustrating considering her appointment was almost $2000 for her ultrasound and appointment. It has been very rough giving her medication twice a day. She has become more reclusive. Since she spends so little time in the rest of the house, it seems like every time she is out, we have to give her medicine. She frequently hides when we come toward her. We have tried to make it as non-traumatizing as possible, but it hasn’t been very good for our relationship. She foams at the mouth whenever we give her medication, which makes me wonder how much of the dose she is actually getting. It gets everywhere.

We used all the capromorelin they prescribed, and she still ate very little. MedVet called in miritaz pills, which we started on Thursday. MedVet called earlier this week to schedule a follow-up appointment and another ultrasound for $1000 and to talk about doing a feeding tube ($1200-$1500) and a scope/biopsy ($3000-$4000). I feel like the tech has been kind of pushy about it. I want Missy to get better, and I don’t even understand what is wrong with her. But at this point, we are at like $3500 in vet costs and still don’t know what’s wrong. I am fine with spending money at the vet as we try to treat her, but we don’t have unlimited funds. We can’t spend another $6500 at MedVet… and that’s not even including any treatment. We finished tapering off the steroid on February 8th, but Missy’s weight has not decreased. This is confusing to me- she is not eating as much as she should be, and certainly not too much. I don’t understand. Would she feel better if she were eating more?

This brings us to now. I had an appointment with my regular vet on Thursday. We discussed her doing a surgical biopsy and feeding tube but haven’t decided anything for sure. I tried to see if MedVet would do an outpatient ultrasound (since their machines would be much more advanced and the radiologist would be much more experienced than a regular vet), but they wouldn’t. Since MedVet will not do outpatient ultrasounds, my vet had another vet in the same practice do one yesterday since he has the most experience. He said there was a lot of white on the images, but couldn’t say what it was, just that it was more dense than her organ tissue. He advised against the feeding tube since she isn’t losing weight but said he would do the biopsy if it were his cat. He advised trying anxiety medication for her, which my regular vet agreed would be worth a try.

The internal medicine vet has talked to my regular vet on the phone about Missy and what to do. A biopsy could give us some answers so we know how to treat her. My regular vet and the internal specialist both agree that even if we are going to do a biopsy, we should still start prednisolone again for a longer duration with a slower taper and feel if it is lymphoma, it will still show up with tissue samples. One of the positives of the tube would be medicine administration since we are having such a hard time giving it to her, and it’s been so stressful. If she were getting full doses at the times she was supposed to, it would be easier to see if it was working.

At this point, I don’t know what to do. Missy is only six, and I thought we would have many more years with her. I wonder about starting an IBD diet, but she is so finicky with food. I have been feeding her whatever she will eat. I try to feed her often and try multiple things. Please believe me that we have tried everything with food. So many brands, varieties, flavors, extras (churus, little soups, weruva mousse, broths, etc), baby food, chicken, scrambled eggs… and so on. Today, she has eaten more than she has in days (more than a whole can of 3 oz food, and it’s only 2 pm), but she hasn’t left her bed a single time. I have been bringing it to her.

I'm sorry, I know this is long. Too long. But I was hoping maybe someone would have an idea or suggestions I hadn’t thought of. All three vets say she looks healthy when examining her, and her bloodwork is pretty good overall. There isn’t really anything obvious that they can say is causing her not to eat or hurt. I don’t want to put her through anything she doesn’t need. But I don’t know how to help her. It seems like a biopsy is the next step here, but I worry about recovery if she already won’t eat and has no energy.

 

[Furballsmom]

Hello - not to worry about a long post. It can act as a good diary.

I apologize if I missed it, but do you have a university medical veterinary department that your vets could consult with?

 

[FeebysOwner]

I am not a vet, but I am astounded by all they have thrown at Missy in such a short period of time. It's almost as if they never let any one treatment plan time to work before they came up with another. And I lost track of the number of ultrasounds done/recommended in such a brief time too. Was there ever any talk about doing a fine needle aspiration (FNA) during any of these ultrasounds? FNAs are essentially non-invasive and can collect certain tissues for analysis.

What do they offer for the reason of the high globulin count?

Is the internal med specialist you see part of a larger specialty group (I know nothing about MedVet, so maybe they are) - one that includes endocrinology, infectious disease, and oncology, and more? If a vet university is not readily available, as suggested above, I'd ask about a specialty group that could get involved and look at all the tests that have already been done.

I know I am not helping any, but you have my total sympathy and commiseration.

 

[mrsgreenjeens]

I don't have any ideas on what might be wrong, but as far as getting her meds in her, are you pilling her or giving her liquid meds? You could try pilling her by putting any pills inside small empty capsules so their taste and smell are hidden. Plus you can usually put multiple meds in one capsule. Then pill her and chase it with a little water and voila.

(they sell empty pill capsules on Amazon, and probably other places as well)

 

[lisahe]

I agree with FeebysOwner about all the things the vets have "thrown at" poor Missy in such a short time. I can only imagine how stressed her body must be by all those new drugs.

Furballsmom asked if there's a university nearby. I might also look into a holistic vet who might be able to help you sort through Missy's diet, tests, and other information that could help you find the cause of her problems.

Non-pharma treatments can work well, too. Our cat with gut issues (presumptive IBD) had patches of inflammation surgically removed from her stomach in the summer of 2022. She has done much, much better ever since, in large part because of a powder/supplement that we started adding to her food during summer 2023. It contains anti-inflammatory herbs and probiotics; she gets small amounts of slippery elm bark syrup a few times a day, too. (Slippery elm bark can soothe an upset stomach, enticing a cat to eat.) She also takes Cerenia sometimes but only as needed. Just as important is that we've become more aware of what stresses her: if she's stresses, she barfs. I realize Missy's symptoms are different but only over the last year have I realized how much stress (from things like noise, the weather, and her humans' stress) affects Edwina. We've also taken lots of ingredients out of Edwina's diet. We hope the combination of dietary changes, herbs, and probiotics can prevent her from getting into another stomach crisis like she had in 2022, when she had to have surgery. (BTW, Edwina's primary, almost sole, diagnostic was an ultrasound, which showed stomach inflammation. The vet said our choices were either the scope with biopsy or exploratory surgery. We chose the surgery and the surgeon removed the patches of her stomach.)

Good luck, S Somachi , I know this is a rough situation to be in.

 

[FrayedNerves]

It has been very rough giving her medication twice a day. She has become more reclusive. Since she spends so little time in the rest of the house, it seems like every time she is out, we have to give her medicine. She frequently hides when we come toward her. We have tried to make it as non-traumatizing as possible, but it hasn’t been very good for our relationship. She foams at the mouth whenever we give her medication, which makes me wonder how much of the dose she is actually getting. It gets everywhere.

Yes, yes, yes. For what it's worth, you are not alone.

There are two cats (left) in my family: Hope, who's 8, and Mama, who's 11. With Hope, I am currently crawling through a crucible not too dissimilar to what you are going through with Missy. But with Mama, we already have our happy ending. You see, Mama, who has asthma and is no stranger to Depo shots, started having severe (rapid) breathing issues shortly after another cat in our family, my beloved Dickie, disappeared. Another Depo shot straightened out the breathing, but soon Mama was eating and drinking less and less day after day, and she was losing weight as well. This went on for weeks, which of course felt like years. It scared the crap out of me. I got to the point where she was sitting with me in bed, lying flush up against my right thigh as she always does when it's our TV time, while I researched euthanasia for cats with tears streaming down my face. I remember that night well. It was dark, dark, dark. But the VERY NEXT DAY, Mama just started eating and drinking more. And the next day, more yet. Then more and more until she was eating the way she used to. That day was in September of last year, and Mama's now back to her gloriously rotund 16-pound fighting weight.

So Hope is still in danger, but Mama one day just pulled out of her nosedive. Maybe, just maybe, something like what happened with Mama will happen with Missy. I am hoping that it does for Missy, and for Hope as well. Or maybe the vets will actually figure out what's going on with Missy.

But whatever happens, I say this to you (and to myself, for the nth time):

Hang in there. Hang in there. Hang in there!

 

[FrayedNerves]

She started Missy on metronidazole twice a day, metoclopramide twice daily, and capromorelin once daily.

She foams at the mouth whenever we give her medication, which makes me wonder how much of the dose she is actually getting. It gets everywhere.

I forgot to mention that foaming at the mouth was a big problem for Hope, but my vet was able to mix metronidazole with a liquid called "Lixotinic Supplement #223886." I smelled it, and it has a beefy aroma. Since we switched to it, Hope no longer foams when I gave her metronidazole (though the claws still come out, of course).

I likewise don't know if the meds Missy gets are pills, liquids, some combination thereof. But if they're pills, like metronidazole, maybe your vet can crush and mix them into a liquid with something like Lixotinic that masks the pills' repellent taste. And whichever of Missy's meds are liquids, well, maybe the vet can do something similar with those too.

 

[stephanietx]

Did anyone mention that Convenia can cause excessive drowsiness and inappetence? It also stays in the kitty's system much longer than 21 days as well. I've had 2 different kitties get this shot and they were both zombies for 10-14 days following the shot and ate very little.

You might want to try slippery elm bark to soothe the tummy and also help with stool issues. I make a "syrup" and add to wet food for my IBD kitty. Once you figure out what works for your kitty, you mainly just manage IBD. Stick to a single protein. We use venison or duck, but many like rabbit.

If you think she is still bloated or experiencing nausea, then I would give Zofran or Simethicone (Mylicon), or both. You need to figure out a treatment plan because the vets are just throwing things at you and your kitty.

 

[lisahe]

stephanietx raises lots of good points, starting with the Convenia, which has been implicated in all sorts of side effects. (I've noticed so many cases where vets give a shot of Convenia to cats they can't seem to diagnose, something that's inappropriate at best!)

I do the same as stephanietx with slippery elm bark powder. I first started using it about two years ago when Edwina (who loves to eat!) wouldn't eat. She loves "the elm" and started eating with the first little dose. As I mentioned above, she still gets it. Her sister gets it sometimes, too: I use a syringe for her because she won't usually lap it up. Both cats will eat the supplement (Adored Beast's Feline Gut Soothe) that I mentioned above. It's not perfect and it doesn't work for every cat but it works really well to reduce inflammation and avoid/prevent constipation. Both cats are generally under control. Sometimes "generally under control" is a big victory when cats have digestive issues like IBD.

You need to figure out a treatment plan because the vets are just throwing things at you and your kitty.

Sadly, this happens a lot. Given all the digestive symptoms, it sounds like time to really start looking at what Missy has -- and hasn't been eating -- and finding the simplest possible food(s) to feed her. The fewer carbs (potato, peas, lentils, grains, etc.) and thickeners (carrageenan, agar-agar, xanthan gum are among the worst offenders) the better. I know it's difficult to do that while a cat isn't eating but maybe elm or some sort of simple treat (freeze-dried meat?) would help get her eating? After all the vet visits and meds, she probably needs plenty of time alone, too, to destress. I find our cats respond well to having some space... but also enjoy if we sit near them and pat them and talk quietly with them, to remind them that we love them.

 

[silent meowlook]

Hi. I think having the specialist place a feeding tube would be reasonable. You will also be able to give the medications without stress to your cat.

If you are not happy with the specialist, you may need to find another one.

As for costs, make sure you voice any concerns to the veterinarian. Often plans can be altered to a more reasonable cost. Sometimes vets just don’t know that you aren’t made of money.

 

[fionasmom]

I am not that familiar with MedVet as there are none around me, but I know that they are a large specialty/emergency group. They may be doing this, but if not make sure that you get a written, itemized estimate before you approve anything. There should be a high/low quote and they cannot exceed the high one without your permission. Read it and ask why certain procedures or diagnostics are required, if they are being repeated, etc.