911: Gagging reflex, non eating, diabetic cat

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Kristina

Kristina

Member Since 2016
Took diabetic kitty, Brady to vet yesterday because he was acting somewhat lethargic, had diarrhea and a gag reflex without bringing anything up. BG was 125 which is low for a stressed out cat at the vet. No temperature or anything else noticeable in the physical exam. I did not give insulin that evening and he ate just a tiny bit of raw food. Vet said to call if he still doesn't eat. Today, a square inch of turkey, no insulin and is still having these gagging episodes. He is still lethargic and refuses every type of food. I'm going back to the vet tomorrow, but if anyone has any experience with any of these symptoms, I would appreciate you sharing your information. Thank you!
 
I have a civie who used to do this just before she would throw up a huge hairball, she has not done it in a long time, that may not be the problem with your cat but it may be a possibility.
 
My cat Shita did this years ago, it went on for a couple of days, then she began vomitting some frothy stuff that was pink tinged. Took her to the vet, they xrayed and saw something partly in her stomach and partly out. Ended up doing surgery, she had eaten a 6-7 inch piece of green metallic curling ribbon (it was Christmas time) and couldn't get it out.

Pain or discomfort can make them lethargic. Is your kitty still drinking? If he's still gagging today, I'd take him back!
 
Hi Kristina,

I'm very sorry to hear that Brady is not eating. If he's refusing all food then you need to get that addressed urgently. If he's heaving like that then there's definitely something up - it doesn't sound like ordinary nausea.

I strongly recommend that you get Brady back to the vet as soon as possible. As you've not given insulin and he's not eating and really poorly there is an increased risk of diabetic ketoacidosis (DKA - potentially life-threatening) you need to get the vet to test straight away for ketones. Also ask the vet if they can do a SNAP fPL test today in case it might be pancreatitis (it can cause diarrhoea, vomiting and inappetence). If the vet can do the test in-house you'd get a yes/no answer as to likelihood of its presence. Also, if he were mine I'd ask the vet if Brady might have ingested something to cause this.

If it is pancreatitis, things that can help are:

Cerenia - for nausea and vomiting
Ondansetron - for nausea
Famotidine - for stomach acid
Buprenorphine - for pain
Cyproheptadine - for appetite stimulation (need to give stuff for nausea before this - check with vet about Brady's liver status). Gentler than mirtazapine, doesn't last as long so easier to control dosing.
Mirtazapine - alternative appetite stimulant (WARNING: can cause serotonin syndrome - may interact with buprenorphine and ondansetron- 1/8 of a 15mg tablet can take 3 days to clear system - antidote is cyproheptadine)
Flaygyl - for diarrhoea - tastes foul. Active ingredient is antibiotic metronidazole. Saoirse was given Stomorgyl 2 which contains metronidazole & another antibiotic - apparently not as foul-tasting.
Kaolin paste with probiotic - for diarrhoea (e.g. Pro-Kolin).

Bland food - e.g home poached chicken - mince up finely and give c 1 tbsp every hour with some water and some of the broth from the poaching. Keep to tiny meals for a good while, even if Brady would eat more at a sitting it is easier on the digestive system to give small amounts at a time. (If you're home nursing, timed feeders are a godsend.)

Fluids - ask vet about sub-qs.

Useful links:

IDEXX Guide to Pancreatitis and Treatments

Nausea Symptoms and Treatments

Let us know how you get on.


Mogs
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Thank you all for providing fast information! I have an appointment with the vet today at 10:30. Brady is trying to eat, but everything he touches he can't keep down; it doesn't even get in his mouth and he gags. Tried raw (which he really likes), baby food (turkey) and even tried to rub water on his mouth. He just starts gagging on everything. He gags every 40 minutes or more even if he is not eating. Stopped having BMs since he has no food to eliminate so can't evaluate the waste. Just noticed, that my second cat, Teddy, had runny stool (pretty stinky), so maybe it's a virus or maybe I'm just being paranoid given all the information. Teddy is acting fine. We are getting up to 24" of snow starting today, so I'm trying to prepare by getting everything I may possibly need. Many thanks for the support and I'm taking all these threads with me to the vet! Great advice on the possibilities.
 
Hi Kristina,

I'm very glad to hear that you managed to get an appointment for Brady.

Forgot to add:

Course of B12 injections - can help appetite, can give a real general boost, and diabetic cats are often deficient in B12/folate.

If both of your kitties have GI issues at the moment that might point to a food issue? Diabetics tend to have more sensitive digestive systems so that could potentially be why - if it is a food problem - Brady might be more affected than Teddy (speculating here). I wonder whether it would be a good idea to bring Teddy in for a check up, too?

With the snow forecast, I'd suggest asking your vet to give you a prescription for the anti-nausea and appetite stimulant meds so that you have some at home. You may not need to use them but with the inclement weather it would be invaluable to have the meds you need at home so that you can help Brady without further delay should the need arise. If your vet doesn't have them in stock, cyproheptadine, mirtazapine and ondansetron are all human medications so you should be able to get the Rx filled at a regular pharmacy. Famotidine is a human med too under the brand Pepcid. Note that there are different formulations and some contain ingredients that are harmful to cats. From what I've read here I think that Pepcid AC is OK but please ask your vet for the right type (and if in any doubt whatsoever don't use it). I assume that your vet will give you any pain meds/fluids that Brady might need. If you don't have ketone test strips at home (e.g. Keto-diastix) it would be a very good idea to pick some up at the pharmacy so that you can monitor Brady's urine to make sure he stays ketone-free while waiting for him to be able to eat properly again. It might be worth asking your vet if there is a high calorie recovery food that you might be able to give to Brady while he's having difficulty eating enough. It's the calories he needs to keep ketones at bay. Even if the carbohydrates may be higher you could ask your vet about managing the insulin around Brady's energy needs.

It's good that Brady wants to eat. That's over half the battle. Sending wishes for all to go OK at the vet visit. I'll check in later to see how you got on.

:bighug:


Mogs
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PPS:

Just to cover all bases, ask the vet to check that Brady isn't constipated. Sometimes liquid faeces can escape around a stuck stool, and constipation can cause vomiting.


Mogs
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After two hours at the vet, no diagnosis. Waiting for radiologist to review x-ray as the radiograph shows signs of a dilated bowel and vet can not rule out obstruction. No insulin until he is eating. No glucose in urine. BG 282, WBC high at 19 (probably due to stress). Vet provided fluids and Convenia, Cerenia, Metronidazole, Buprenex. Vet would prefer I take cat to emergency room given we are expecting so much snow. When Brady came home, he ate 3/4 can of Fancy Feast with gravy (didn't have time to poach a chicken!) and I haven't seen him gag. Taking the conservative approach until I get more info from the radiologist but opinions are welcome!

This forum has been so nice to have and thank you for helping me with this cat issue!
 
Thanks for the update, Kristina. Glad you got back home safely. They're covering the US snow situation on the UK news tonight.

Glad we could do a bit to help you earlier.

Did the vet check for ketones?


Mogs
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More questions:

1. Which insulin is Brady on?

2. How long is it since his last dose?

3. Is the vet doing any blood tests?

BTW, keep an eye on the litter box for poops or diarrhoea. If it's possible it might be an idea to keep Brady to an area where only he has access to the litter box for the time being so that you can be sure that any bowel movements are his.

Glad to hear the gagging has eased. It sounds like the Cerenia might be helping. Never having been in a situation where a cat may have a bowel obstruction I don't have any suggestions for how to proceed or what to expect. There is a site called www.felineconstipation.org where you might find something to help you.


Mogs
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Hi @Mogs,

1. Brady is on 5 units glargine twice a day
2. Last insulin shot was Tuesday evening, when he ate a full meal. Vet said no insulin until eating regularly.
3. Vet did not do the pancreas blood test because they don't have the testing equipment in-house and with the snow, they can't send it out. They did a CBC, Lytes and CHM 17 and urine dipstick. Items out of range, but vet did not think significant, were Glucose (high), BUN (low), WBC (high), NEU(high), Mono (high), everything else within normal range.
4. No ketones in the urine test.

Vet is treating for possible pancreatitis/triaditis and waiting for x-ray review.

Brady just resting and will try to watch his litter box activity. Thanks for the thoughts and suggestions!
 
Yay! Brady's a black kitty! :D (Not that I'm biased or anything ...)

I'm glad to see the ketone test was negative at the vet's, but I'm still very concerned about your vet's advice not to give ANY insulin. It increases the risk of DKA.

Can you let me know ASAP if you're home testing Brady's blood glucose levels? Also can you confirm which food he's managing to eat at the moment and its carb level if you know it.


Mogs
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Hi @Mogs,

Actually, the black kitty is my new senior rescue, Teddy. Brady is grey and white, sorry to disappoint you ;-)

The vet indicated she would call as soon as she received a radiologist reading on the x-ray so I will ask her about giving insulin to decrease the risk of DKA. I need to learn how to home test - sadly, I have been remiss in getting trained, and this is the time I should be checking. He ate a high carb food (the one I know he will eat and I never give him because very high carb) : Fancy Feast with gravy (~17%carb).

Grateful for your help!
Kristina
 
Kristina said:
Actually, the black kitty is my new senior rescue, Teddy. Brady is grey and white ...
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I can live with that! :D

I know the carbs aren't ideal but sometimes the right food is the one a kitty can eat right now. When you're speaking with the vets, be sure to let them know that Brady's eating a higher carb food than normal. It might give a bit more bandwidth to the vet when considering perhaps a token dose of insulin for Brady to tide him over till he's ready to get back to his normal diet.

Be sure to post updates when you get them.


Mogs
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The lab tests are suggesting infection to me. That, plus not eating, plus not enough insulin is a recipe for diabetic ketoacidosis.

Given that his normal dose is 5 units, giving a token dose of 1-2 units might bring the glucose down some and help perk up the appetite (dropping glucose often triggers the desire to eat).

Can you pick up some KetoDiaStix (tests for ketones and glucose) or KetoStix (just tests for ketones) tonight to test the urine? You may need to call a pharmacy to check and because they are small, they may be behind the counter

Would you be able to get an inexpensive glucometer, such as the Target Up and Up or the WalMart ReliOn Confirm (or Confirm Micro or Prime), matching test strips, and lancets labeled for alternate site testing (25-28 gauge and more likely to get a blood drop starting out)?

See my signature link Secondary Monitoring Tools and use as many of those as you can to report back to us. Especially tell us the result of the dehydration checks.
 
Thank you, @BJM . Unfortunately, everything closed today at 3:00pm and is suppose to remain closed until after the blizzard. It's suppose to be very bad here tonight through Sunday morning. I'm hoping the vet will call me so I can repeat what has been said in this thread. Brady just ate another 1.5 oz of lower carb food, and he has perked up a bit. I think the medications are helping. Less gagging and he just had a semi-soft stool. As soon as the pharmacy is open and I will take your shopping list and get busy. I now how important it is to monitor the subtleties in BG values; I'm just not sure if I will be successful getting the specimen from Brady the cat with major catitude.

I'll try a conservative 1 unit of glargine based upon your recommendation. He did just eat, so it might help as you suggested.

I am so glad I found this forum!
 
Do what you can with the Secondary Monitoring Tools for now, then. - water drunk, urination, dehydration are some of the signs of diabetes, so if you see improvements in those, it suggests you're making progress.

If you can get to a pharmacy tomorrow, come h*ll or high snow drifts, to get a meter (Bayer and Abbott are good brands if you haven't got a Target or WalMart to get to), test strips, and lancets, please do so!
 
You know, there's something I've been thinking about...Have you possibly changed any cleaners in the house? Or started using a new fabric softener? Something that might cause an allergic reaction and cause your cat's nasal passages to gunk up? He wouldn't necessarily have a runny nose..he might have the cat equivelent of a post-nasal drip. That would irritate his stomach, and sometimes actually make an animal gag..especially when trying to eat, because his airway isn't clear and creates a sort of mini-vaccuum at the back of his throat.

Just sayin..my poor old BarneyBob got his first nasal infection when he snorted a piece of catnip up his nose..a larger chunk. He pressed his face against the dusting of nip on the floor, and inhaled a tiny piece, which then lodged in his nose and he developed an infection.

From that time on, he had trouble, and when presented with anything strong smelling, even food, he would GAG. I almost forgot this..knew something was nagging at me.

So think about that, he might even have backsnorted some food into his nose, and also think if you have added new cleaning substances, aerosol sprays like lysol, (which can make a cat seriously ill all by themselves), and even tiny bits of 'salt' like the crystalline stuff used to get traction on the roads and sidewalks in winter. Folks bring that stuff in on their boots, and little chunks of it fling into corners and embed in carpets.
 
Hi Kristina,

Following on from @BJ's posts (thank you, BJ!), as a temporary measure is there any way that you could keep Brady in a separate room for the time being? If yes, then you could measure his water intake and check how much he's urinating far better and easier. It would help you monitor his poops, too. (Good that he has had a bowel motion. Was it a bit whiffy by any chance?)

Also - and this is a long shot - are any of your neighbours diabetic by any chance? They might have a glucose meter they could lend you till the stores open again (and maybe some ketone strips). Brainstorming here.

Try to make sure that Brady drinks well - if there were any ketones brewing it would help to flush them out of his system.

It goes without saying that we're here for you. :bighug:


Mogs
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Interesting that you would mention his breathing.nose. I noticed a scratch down the center of his nose this morning which wasn't there yesterday. However, it may have occurred when I tried to unsuccessfully give him a pill. He got his paws out and scratched me (and maybe himself). He was sort of "snoring" lightly yesterday. Still waiting for the vet to contact me but we are up to 20" already and roads are unpassable. Brady won't eat this morning. Managed to give him the pain medicine and not sure why he is growling when I pick him up. Hope it's not pain, but he could be nervous that he is going back into his carrier or I'm taking him near my other cat.

May need to try and syringe some water into him as it appears he is not drinking much. He did urinate this morning.
 
Morning, Kristina.

Kristina said:
Brady won't eat this morning. Managed to give him the pain medicine ...
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If Saoirse's a good yardstick, buprenorphine may suppress appetite. I'd suggest making sure he eats before giving the next dose of bupe.

Kristina said:
May need to try and syringe some water into him as it appears he is not drinking much.
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Have you any chicken at home? If you have, poach some (just in water) for Brady and keep the broth. See if he'll drink some of the broth. If yes, then try mixing 50/50 broth to fresh water. If he'll drink that then it will help you stretch out the broth so it lasts longer (worried about you being snowbound and unable to get more chicken for the foreseeable) otherwise give him the broth on its own. If you mince up the chicken he might eat a little bit of that with some broth.

Try mixing a teaspoon or two of water into his food - that will help increase his fluid intake.

If neither of the above work then it'll have to be water via syringe.

Are you using clumping litter? If yes, then if you record the size of each clump in your secondary monitoring log; it will give you a rough idea of how much fluid he's losing through urine.

If the vets don't call soon then, given the weather conditions over there, it might be an idea to proactively call them - especially if they can only be reached via landline (worried about phone service disruption).

Sending get better very soon vibes for Brady and a :bighug: for you.


Mogs
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Thank you, Mogs! Thankfully, I have some frozen chicken that I could poach. Brady drank at least a tablespoon of chicken broth and even ate a few minced chicken pieces. I will continue to offer some to him.

We continue to have blizzard conditions here.
 
I'm delighted to hear that he's managing some of the chicken and broth! It helped Saoirse so much. The chicken is bland and easily digestible and because I could get the fluids into her I was able to nurse her through the pancreatitis flare at home. Try to keep him drinking. The hydration will help him to feel better and flush toxins out of his system.

I'm sorry the weather is so bad where you are. Keep warm and safe.

:bighug:


Mogs
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Hi Kristina,

Just checking in to see how Brady's doing today. Is he eating and drinking? And are you all OK in spite of the snow?
:bighug:


Mogs
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Thanks for checking in. We have completed a lot of shoveling so we can drive if necessary. However, all the nearby vet emergency rooms said they do not have staff to do an abdominal ultrasound. I made an appointment for tomorrow. Brady is eating, so I feel better. Loose stool and urinating okay. Vet said only 1 unit of insulin twice a day, max. She wants the abdominal ultrasound but it appears that can't happen until tomorrow. The roads are still bad.

New ailment he is limping - rear right leg, I believe. This is new and perhaps that is why he growls if I attempt to pick him up. It's not neuropathy, because he wouldn't feel it, so it must be something new. Vet has no idea without seeing him and they are closed. The vet also mentioned that the radiologist has not gotten back to her on Brady's x-rays. Thankfully, he is eating and looking a bit better today because no medical treatment is readily available.

I'm a little frustrated, but this is par for the course after a major snow fall.

Thanks for letting me vent!
 

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Great to hear that Brady's eating, peeing and pooping (albeit loosely) and that he's getting some insulin, too.

Vent away; your frustration is completely understandable, Kristina. I've no experience with limping kitties so can't suggest anything. (Perhaps other members may have some input?) Hopefully the vet will be able to sort things out at your appointment tomorrow. Keeping fingers and paws crossed that you will be able to travel safely. Assuming that you can travel OK, I recommend picking up a glucometer, plenty of blood glucose test strips, and also some urine test strips. It makes all the difference in the world to be able to do basic testing at home; the information they provide are invaluable when making treatment choices, and also for your own peace of mind.

Your snowscape scene is most picturesque. Snow can be very beautiful to look at when you're all tucked up safe and warm, but it does tend to lose its charm when it prevents us from getting to where we need to be - especially at times like this.


Mogs
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Kristina said:
Thanks for checking in. We have completed a lot of shoveling so we can drive if necessary. However, all the nearby vet emergency rooms said they do not have staff to do an abdominal ultrasound. I made an appointment for tomorrow. Brady is eating, so I feel better. Loose stool and urinating okay. Vet said only 1 unit of insulin twice a day, max. She wants the abdominal ultrasound but it appears that can't happen until tomorrow. The roads are still bad.

New ailment he is limping - rear right leg, I believe. This is new and perhaps that is why he growls if I attempt to pick him up. It's not neuropathy, because he wouldn't feel it, so it must be something new. Vet has no idea without seeing him and they are closed. The vet also mentioned that the radiologist has not gotten back to her on Brady's x-rays. Thankfully, he is eating and looking a bit better today because no medical treatment is readily available.

I'm a little frustrated, but this is par for the course after a major snow fall.

Thanks for letting me vent!
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I hope all goes well at Brady's appointment today! Please keep us posted!

You have my sympathy about the snow - we got hit hard, too, couldn't get out at all over the weekend and still dicey in places today.
 
Hi @Squalliesmom - thanks for the well wishes. I'm anxious about today's visit but hoping for a very good outcome. Brady will see the radiologist then I have a consult with the internal medicine vet.

Be safe if you do go out today. I understand many secondary roads are bad and there are icy patches in many places.
 
Fingers and paws crossed for you and Brady, and sending prayers and healing vines. It's so scary when we don't know what's going on inside our babies that's making them sick/hurt. If love was medicine none of us would ever have sick kitties!

Yes, I understand that black ice is a problem today. Be careful and stay safe! {{{HUGS}}}
 
Wishing you both a safe trip today. Ask if they can test Brady for ketones during the consult. If you can, bring a urine sample (although they may have a blood ketone meter). Ask them about a supply of anti-nausea and appy stimulant meds. (Double-check with them about interactions between mirtazapine and buprenex. Cyproheptadine is an alternative, gentler and more controllable appy stimulant but you need to check liver is OK.)


Mogs
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Update: Ultrasound didn't show anything conclusive : slightly enlarged kidneys but that could be because Brady is a large cat and/or diabetic; possible crystals or bacteria in the bladder; no enlarged other organs.

Vet recommended keeping at hospital for 48 hours to monitor glucose, do additional testing (pancreatitus specific blood test, another UA, other GI tests), provide subQ fluids, etc. I hated to leave Brady, but maybe they can assess and nurse him better and hopefully find a good protocol to make him better.

On a funny note, I had poached two chicken thighs for Brady this morning and in my haste, I let them cool on the stove top when I took him to the vet/hospital. When I came home, I noticed one thigh was gone. Who ate it? Well, take a guess who somehow got in the tall stock pot and did self service....Teddy!
 

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Teddy! :eek: Bad cheetah!!! :D

A lot of positives from the ultrasound, and it's better to know what's happening in Brady's bladder. It's rotten having to leave our little ones at the hospital. :( That said, with his appetite a bit iffy and a possible infection their nursing facilities will make it easier to administer his insulin and make sure he gets the nutrients and fluid he needs. Thank goodness the roads were passable for you.

Fingers and paws crossed that Brady will feel much better really quickly. Be sure to post updates as you get them. And get some rest for yourself; it has been a stressy few days for you. :bighug:


Mogs
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I know it's hard to leave him at the vet's. Hopefully they will have some positive news for you soon. Good that the ultrasound didn't show anything. Sending prayers and healing vines for Brady. Please keep us updated! :bighug::bighug::bighug:

Naughty Teddy, lol!!! :cat:
 
Thanks for all your prayers and nice wishes. The vet called this evening and said blood and urine results were pretty much normal. She doesn't suspect pancreatitis, liver or kidney problems. BG was up to 430 but that should be expected with the stress and no insulin (recently). She is hoping fluids and getting him to eat may be a road to recovery. She mentioned potentially doing a endoscopy but she really doesn't want to do that at this point. Neither do I.

I'm going to investigate, but maybe this is just simple IBS? I don't know much about IBS, but I know it is prevalent with sugar kitties.
 
I'm so glad Brady got such a good report from the vet, must be a HUGE relief for you! I have a civvie with IBD and very frequently she will refuse her food. It is a real struggle to get her to eat, and find something that doesn't give her absolutely terrible diarrhea. Poor little girl really suffers with it.
 
Hi Kristina,

Good news on the diagnostic test results. Did the vets say anything about the limp and the bowel dilation? And how is Brady's appetite at the moment?


Mogs
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I'm waiting for an update from the vet today; they can't diagnose if testing doesn't help them determine what is wrong. I know that normal tests are good news but it still doesn't explain any of his symptoms. I mentioned his limp, but the vet didn't notice much; probably because he didn't walk much. She assessed his scabbed over nose and suspects it is due to licking his snout which could be attributed to hydration.

Brady is still in their care and so I don't know much more at this point. I miss my dear Brady! Thanks for following up and I will update as information is provided by the vet.
 
They told me they would feed him, subQs and watch his BG so I'm not sure. I'm trying to be patient for the vet's call, but I may break down soon and call them for an update :-) I have added that question to my list; if I don't have a list I forget to ask important questions.

Thank you!
 
I'm exactly the same (especially with the PTSD). And the greater the anxiety, the easier it is to miss important queries.

If he is eating, be sure to ask them whether it's under his own steam or whether he's on meds (anti-nausea, appy stimulant, etc.). Also, if they decide to discharge him I'd strongly recommend you insist on getting the necessary supportive meds to continue his treatment at home. Whether or not Brady needs the meds, when it comes to keeping a kitty eating - especially a sugar cat - it's much, much safer to be in a position to tackle potential inappetence head-on.


Mogs
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Update: vet said he is not eating even though they offered him several different types of food. They calculated that he had a teaspoon of food total which is not enough. My choices: 1) go in to see if he will eat for me 2) let them withhold food and get them to do a endoscopy to see if they can determine IBS or any other bowel issues, 3) wait on the endoscopy for another day to see if he decides to eat but then they will have to put in a feeding tube 4) do nothing and just watch and wait.

Any comments? My bills are running up but I feel like I need to give them a fair shot at diagnosing any bowel issues.

If IBS, then I guess he gets steroids and then his blood sugar could get wacky. Oh my, so many things to worry about.
 
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