? Appetite changed

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Barri & Sonny

Barri & Sonny

Member Since 2015
Hi everyone!
My Sonny is doing fine on insulin. Gets 1 unit 2x a day (vetsulin about 2 yrs) Anyway...the past few weeks his appetite has gone up...i just went with it (numbers fine) Yesterday afternoon...he kind of turned his nose up at his food. Long story short...his appetite went dramatically down the past day. Thought he might just be getting finicky with the flavors so i gave him a different flavor that he likes but didnt eat much of that either. Even gave him tuna which he loves but didnt eat much either. Took him to vet this morning. Not constipated, didnt feel any tumors, thyroid felt fine. Doctor took blood and will have results tmrw. He also gave him an appetite stimulant "miratzapine" 7.5mg. Half a tablet every 3 days. Anyone have any info on this? Just concerned about my baby! Thanks
 
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Good for you taking him in right away. Did your vet tell you what he/she is looking for with the blood work? Be aware the mirtazapine can make them act a bit strange - vocalization, agitation, etc.
 
He said that since everything felt fine on initial exam, the bloodwork is checking for problems with organs he said. Thank you for that info on miratzipine. Since i gave Sonny the dose, he has been acting crazy!! He cant seem to relax! I called the vet and he said he shouldnt be acting like that however i did a check online and it said that the drug CAN cause cats to be vocal and restless
 
Barri & Sonny said:
He said that since everything felt fine on initial exam, the bloodwork is checking for problems with organs he said. Thank you for that info on miratzipine. Since i gave Sonny the dose, he has been acting crazy!! He cant seem to relax! I called the vet and he said he shouldnt be acting like that however i did a check online and it said that the drug CAN cause cats to be vocal and restless
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It can also induce serotonin syndrome. Keep a close eye on his body temperature and other clinical signs. If he gets hot intervene to cool him down and contact a vet as a matter of urgency; also do so if the agitation gets worse.

As luck would have it there's a good discussion about anti-nausea and appetite stimulant meds on another current thread. Here's a link to the relevant part of the thread:

http://www.felinediabetes.com/FDMB/...shots-food-changes.169657/page-2#post-1844021

I hope you find the info helpful. If you have any questions or need specific suggestions for Sonny post again in this thread for help.

Here's another helpful link:

Nausea and appetite problems - symptoms and treatments

I hope Sonny's appetite returns to normal soon.

:bighug:


Mogs
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Also if you see any odd twitching or similar contact the vet ASAP.

A kitty called Nova had an adverse reaction to mirtazapine earlier this year and she displayed such a symptom. The vet treated her with cyproheptadine (the 'antidote' to mirtazapine if serotonin syndrome is suspected).

I'm linking below some threads from earlier this year discussing mirtazapine side effects / adverse reactions:

http://www.felinediabetes.com/FDMB/threads/mirtazapine-and-serotonin-syndrome-issue.150325/

http://www.felinediabetes.com/FDMB/...-mirtazaine-side-effects.151035/#post-1586807


Mogs
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Should i shoot tonight or skip? Numbers will be ok if skipped tonite. Is it ok to mix insulin with the miratzipine??
 
Hi Barri,

Sorry you didn't get a timely reply last night. :(

For info, my vet prescribed mirtazapine for Saoirse while she was being treated with Vetsulin (called Caninsulin over here in the UK).

I see from your opening post that you're giving 1.0 IU Vetsulin twice a day.

Barri & Sonny said:
Anyway...the past few weeks his appetite has gone up...i just went with it (numbers fine) Yesterday afternoon...he kind of turned his nose up at his food. Long story short...his appetite went dramatically down the past day
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Can you let us know what his BG numbers have been like (actual values, please, so that we might get a better understanding of where Sonny's at currently. :) ).

Also when he started eating more did he start pooping more frequently? Were his stools well-formed or soft/loose?

Has Sonny lost any weight since all this started to happen (including the time when he started eating more). Here's a body condition chart in case you don't have a scale at home:

Body Condition Assessment Chart


Mogs
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Mogs,

Sonny is consistently in the very low 100's. He is on vetsulin also. I did shoot last night because he went a little high for my liking. At the vet, they weighed him and Sonny actually gained 2 oz (went from 11.5 lbs to 11.7 lbs) His stools were never loose. Always well formed logs or rocks!!

I feel like the miratzipine has not worked. All that happened since yesterday is that Sonny became restless, vocal and hyper (all side effects that i read about...nothing bad regarding seratonin syndrome...i pretty much watched him all nite) however, his appetite is still very small. He meowed for food this morning...i fed him...he ate a few bites and walked away! Waiting for vet to call with blood work results.

I wish i knew what was wrong. Sonny us acting completely normal except for eating.
 
Barri & Sonny said:
I feel like the miratzipine has not worked. [...] however, his appetite is still very small. He meowed for food this morning...i fed him...he ate a few bites and walked away! Waiting
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[Emphasis mine]

To reassure you a little, Barri, if he's meowing for food and then attempts to eat then he does have an an appetite. That's half the battle. From what you describe it appears that he wants food but he may be nauseated (his behaviours are classic for a nauseated cat).

Did your vet give you any anti-nausea medication?


Mogs
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So the vet just called. Said i need to increase his insulin because his number shot up to 400. Said he is also in beginning stages of kidney disease. Something about creatin being normal but SDMA being high? (Normal is 14...sonny was 16-18) Also said i HAVE to put him back on diabetic food! He has been eating friskies pate for a year!!
 
He's displaying behaviours that are very common when nausea is present (wanting to eat, trying to eat and then giving up on it).

If he is nauseated then the appetite stimulant on its own won't do much to help him start eating again.

Could he be constipated at all? That can cause nausea and inappetence.

Hand on heart, I think the wisest and safest thing to do right now is to ask your vet today for something to help nausea and/or constipation. Cerenia can help relieve nausea but it won't work if Sonny is constipated. For constipation, treatment with metoclopramide for 1 or two days could help to get the moving properly again.

Sonny needs to get some food on board, otherwise he could start producing ketones - especially with his BG up in unusually high numbers at the same time (be sure to test his urine with ketone strips today so as to protect him from risk of DKA). Not eating can also lead to hepatic lipidosis - very quickly. Both DKA and hepatic lipidosis are life-threatening. (I'm not trying to nag or to scare you, Barri, just trying to help; cat inappetence really needs to be treated as quickly as possible.)

Testing Kitty for Ketones

Nausea and inappetence - symptoms and treatments

Did your vet check for any possible infections/inflammation? This, too, can increase risk of ketosis/DKA - especially when a cat's not eating properly.


Mogs
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Mogs i think you may be right. May be nauseous. His,eating has,gotten worse. He will eat a bit off my hand or out of the can. Seemed to imporve a little after i gave him his,shot last nite ( he ate enough to give it) Same thing this,morning. He meowed for food...it was around shot time...placed food down...2 bites...walked away. Opened up like 5 different cans and got him to eat enough to shoot. My vet is,closed today. Going to have husband get plain chicken breast. Maybe he will eat that since its bland. Is,there an OTC nausea med i can get for now to give Sonny?? Please someone answer...im a,mess
 
I'm here, Barri. I know just how terribly distressing this is to go through for you (I'd be frantic when Saoirse had a tricky time eating).

:bighug::bighug::bighug:

I'm just trying to find a thread from yesterday with helpful information for you. BRB ...


Mogs
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Critter Mom said:
I'm here, Barri. I know just how terribly distressing this is to go through for you (I'd be frantic when Saoirse had a tricky time eating).

:bighug::bighug::bighug:

I'm just trying to find a thread from yesterday with helpful information for you. BRB ...


Mogs
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Wondering if i can get an otc nausea med until vet opens,tomorrow
 
When did Sonny last have a poop? (I need this info in order to work out what's best to suggest to you right now.)

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Thanks for the helpful info, Barri.

Just preparing a response for you. Will post again very shortly. Keep an eye on the thread.


Mogs
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He eats a little but its forced. I read online also that meowing and not eating is a sign of nausea. I am going to run to store to get a chicken breast to boil. Its bland...hopefully he will eat that at least for today.
 
Barri & Sonny said:
He eats a little but its forced. I read online also that meowing and not eating is a sign of nausea. I am going to run to store to get a chicken breast to boil. Its bland...hopefully he will eat that at least for today.
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Don't go to the store just yet, Barri!


Give me about 10 minutes to type out some info to help you (and things you'll need to look for for Sonny when you go shopping today).

Back as quickly as I can ...


Mogs
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Shopping list:

* Famotidine or ranitidine (acid blockers - please read the info below before going to the store.)

* Slippery Elm Bark - pure powder with no additives (if you can find a health food store open, or maybe a pharmacy).

* Plain meat and broth baby food (NB: must NOT contain garlic or onions, just meat and broth. I've seen mention of Beech Nut and Gerber baby foods in other posts (I'm in UK so can't be more specific). Many cats will eat this even though they have problems with their regular food.

* Chicken breast (as you wisely mentioned in your earlier post)

* Ketone test strips !!!! (unless you already have some; for safety you really need to check Sonny for ketones today.)

* More Freeze-dried Chicken Treats (if you're running low on them at home)

* Temptations treats - Heresy normally, but as a last resort you could try crushing two or three treats and sprinkling them over some food; it might tempt Sonny to eat a little bit.


ACID BLOCKERS

If a cat is nauseated and doesn't eat enough stomach acid may possibly build up. Giving an acid blocker may do something to help with the acidity problem (but you may still have to continue assist feeding). You can get famotidine over the counter. I think the brand name is Pepcid AC. You need to make sure that the one you buy has ONLY famotidine as the active ingredient - check with the pharmacist before purchasing! (There are other products in the Pepcid range but they are NOT safe for cats.)

Another acid blocker is ranitidine (Zantac 75). If you've got nothing else the acid blockers might do something but I've found that with major nausea they're not much help. Of the two, I've found that famotidine seems to have a stronger and longer effect than ranitidine.

You can find dosing information on these medications plus other treatments and helpful suggestions on this page:

http://www.felinecrf.org/nausea_vomiting_stomach_acid.htm

SLIPPERY ELM BARK

If you were able to get hold of some powdered slippery elm bark (the pure powder with nothing else added) you could make up a syrup of it to give to your kitty. It can help with nausea issues. See the "Simple Natural Treatments" section on the page linked above. Also here is more info on using slippery elm bark:

Re slippery elm bark, here's more info from Tanya's site about it (including dose suggestions and how to use SEB):

http://www.felinecrf.org/holistic_treatments.htm#slippery_elm_bark

It coats and soothes the digestive tract. Many members here have recommended it for GI issues, including nausea (though it's not as powerful in effect as the medications for nausea management).
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* * * Will post more info in a little while but for now you're good to go with the shopping expedition.


Mogs
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PS - I think the right baby foods to look for are the ones for very young babies (stage 1 or stage 2??? Wish I could give you better info.)

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@Tuxedo Mom -

Why, oh why, oh why do so many vets fail to prescribe anti-nausea treatment alongside appy stimulants for nauseated cats??? Really wrecks my head. :banghead:


Mogs
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Critter Mom said:
@Tuxedo Mom -

Why, oh why, oh why do so many vets fail to prescribe anti-nausea treatment alongside appy stimulants for nauseated cats??? Really wrecks my head. :banghead:


Mogs
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The very FIRST thing I look for is anti-nausea. Next pain relief, then fluids if necessary, then an appetite stimulant (which I have never had to use). If a kitty is nauseous they are not going to eat not matter what you give them until the nausea is dealt with. Imagine yourself with a terrible tummy ache being given something to make you want to eat!!:eek: Until the tummy is settled NOTHING is going to make you want to eat.
 
Barri & Sonny said:
So the vet just called. Said i need to increase his insulin because his number shot up to 400. Said he is also in beginning stages of kidney disease. Something about creatin being normal but SDMA being high? (Normal is 14...sonny was 16-18) Also said i HAVE to put him back on diabetic food! He has been eating friskies pate for a year!!
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You do not have to put your cat back on prescription food! Vets like to push that food on to their clients. I was giving smoky prescription food for years, royal Canin SO for urinary issues. He gained a lot of weight on it. I stopped giving it to him and switched him to canned food. I believe that the high carb royal Canin may have contributed to him getting diabetes. Smoky started losing too much weight and it was then I found out he was diabetic.
 
If I read correctly the kitty was interested in food then would turn away. That has always been a red flag for nausea with my two.


ETA Some people equate nausea with vomiting. When my guy has had his pancreatic attacks he never threw up, but would attempt to eat then turn away and keep coming back. For a kitty who is a food vacuum this is a major warning sign of pancreatitis with him, for which I have always used an anti-nausea and pain relief at a minimum.
 
Woodsywife said:
OP kept saying it wasn't nausea.
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True, Paula, but if we as lay people can recognise the clinical signs then surely a highly-trained veterinary professional should be able to?

I know I'm soap-boxing a bit about this but we see this problem so often here and it makes me feel really sad that both kitties and their caregivers can end up going through a lot of potentially unnecessary distress and discomfort because their vets don't offer effective treatment for nausea soon enough (doubly so in the case of diabetic kitties where eating difficulties can lead to problems with insulin administration - or possibly diabetic/other complications). :(

As @Tuxedo Mom says above, so many times an anti-nausea med (and sometimes additional pain relief if required) will resolve an eating issue without any need to resort to appetite stimulant meds.


Mogs
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Thank you all! He ate a teaspoon of baby food (chicken & chicken broth) Gave him another teaspoon and he took a lick then walked away. I am boiling a chicken for him now (since he is still eating his freeze dried treats i figured a chicken breast is good since its bland) At first i did
 
He ate a whole plate of boiled chicken mixed with baby food. This is all he will be given today. I know its not a solution...but its food! And he ate it! He had Cerenia once last year and it helped so i would rather wait to bring him to vet tomorrow morning and get that for him. I dont feel comfortable giving him something OTC right now
 
@Critter Mom I know, so many times I had to ask for certain things or insist on stuff. I think some vets just have a nonchalant attitude.

I remember my Patchy had 7 teeth pulled. I asked about pain meds (many years ago). Was told it's not needed. It will be fine in the morning. I'd like to see vet have 7 pulled and get nothing for pain.

Unless parent speaks up, I think vets are not going to "look to hard". One associate in the practice I go to, answers for everything is prednisone.
 
Barri & Sonny said:
He ate a whole plate of boiled chicken mixed with baby food. This is all he will be given today. I know its not a solution...but its food! And he ate it!
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Fantastic news, Barri! And such a relief!!! :D

Did you keep the broth from the boiled chicken? If you mix a little of that through the mixture of chicken and baby food it will help with hydration. (Dehydration can make nausea worse and make a kitty feel generally icky; think 'hangover'.)

If his keenness for food wobbles the rest of the day try puréeing the boiled chicken/baby food mix with a little water and offering it to Sonny to lick off your fingers. Sometimes if you can get a little bit of food into them it can settle the tummy a little bit and, with a bit of coaxing, they'll eat a little more. If you offer small amounts every 2-3 hours it can help reduce build-up of stomach acid and thus keep the digestive discomfort damped down a little.

Another thing to try if he gets a bit reluctant is to blitz up some freeze-dried chicken treats into a powder and sprinkle some of that onto the food. Warming the food slightly and serving it in a bowl raised up a few inches from the floor can also help.

Barri & Sonny said:
I dont feel comfortable giving him something OTC right now
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I know exactly where you're coming from. With meds it is always safest and wisest to get veterinary input.

NB: Cerenia and ondansetron are both used to treat feline nausea. There's a warning on Tanya's Site that ondansetron and mirtazapine when used together may increase risk of serotonin syndrome.

FWIW, Saoirse reacted badly to mirtazapine the one and only time she received it (vet didn't have ondansetron and I was desperate; she'd hardly eaten anything for days). I treated Saoirse with ondansetron for nausea and cyproheptadine for appetite. The combination worked well for her. Cyproheptadine is gentler in action and the dose wears off in about 8-12 hours. It's great for giving appetite a bit of a 'nudge'. Mirtazapine to me is a bit of a sledgehammer and nut drug. (I've been prescribed mirtazapine for myself in the past and had to stop taking it after only a couple of doses; my brain went absolutely haywire on it. Horrible experience.)

I know that your vet has ordered some blood work and that you're waiting for test results to come back. If he hasn't already ordered a test for pancreatitis (Spec fPL) I suggest you ask him to run one for Sonny. (He might be able to do an on-the-spot SNAP fPL test.) Ask the vet to do an examination of Sonny's abdomen and also his back to see whether Sonny is experiencing any pain. (If pancreatitis is present the pain can radiate around to the back.) If a pancreatitis test has been run already and it is positive, buprenorphine can be used for pain relief.

You mentioned above that Sonny sometimes has hard stools. Check with your vet about whether any meds he prescribes are constipating (ondansetron and buprenorphine can be constipating). With nausea in the picture you need to make sure Sonny keeps regular because if he were to get bound up it can make nausea worse. Useful information on constipation can be found here:

www.felineconstipation.org

Sending special anti-nausea vibes for Sonny. Hope things go well with the vet tomorrow.

:bighug:


Mogs
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Thank you Mogs. The bloodwork came back and apparently Sonnys bg was 400. Also said beginning stages of kidney disease. He said that last February also. Creatine was normal...SDMA? was a bit elevated. I increased his insulin to 2 units. I boiled the chicken in water so i didnt save the broth...i did though mix up some of the baby food with the chicken and he ate it
 
And his poop has seemed less hard the past 2 days. Solid logs but not "hard" He felt his abdomen and said he wasnt constipated
 
Glad the stools aren't too dry; constipation can make a kitty feel depressed, nauseated and lethargic.

Any changes in stool colour (paler/darker/tan) or odour (e.g. more smelly)?


Mogs
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No...not at all. Im very upset with my vet for not giving anti nausea meds. I think i need to find a new one. I am bringing sonny there tomorrow though for Cerenia. I believe all of you more than the doctor!! For today...its chicken only
 
Hope all goes OK at the vet tomorrow. If Sonny's BG is still higher than normal something is up and it needs to be identified - and the root cause of the nausea.

I see above you increased the insulin dose. Keep a very close eye on Sonny's BG. Also, please test his urine for ketones today. Ketones can develop suddenly and levels can rise quickly - especially if the cat's not eating properly. Also ketones can be a cause of nausea and inappetence.

Forum sticky: Are you testing your cat for ketones? If not, do it!

Urine Collection and Testing Tips

If a trace ketone result is obtained contact a vet by phone straight away for advice.

If ketones are higher than trace the kitty should be seen by a vet immediately to get treatment to flush the ketones out of the system (and prevent DKA).


Mogs
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Hi all!
1st- Sonny has been eating boiled chicken mixed with a little baby food since yesterday a.m and eating good sized portions. Should i continue this bland diet for another day or 2? Im afraid to reintroduce his friskies just yet

2nd- I am going to go into my vet this morning. I dont want to have to stress Sonny out by bringing him in again. What exactly can i ask him for some kind of anti- nausea med that doesnt require a vet visit? If you all think i SHOULD bring him back in for a cerenia shot i will....but between cost and stress i really dont want to.

Thanks everyone!!
 
Barri & Sonny said:
Hi all!
1st- Sonny has been eating boiled chicken mixed with a little baby food since yesterday a.m and eating good sized portions. Should i continue this bland diet for another day or 2? Im afraid to reintroduce his friskies just yet

2nd- I am going to go into my vet this morning. I dont want to have to stress Sonny out by bringing him in again. What exactly can i ask him for some kind of anti- nausea med that doesnt require a vet visit? If you all think i SHOULD bring him back in for a cerenia shot i will....but between cost and stress i really dont want to.

Thanks everyone!!
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What a sweet face Sonny has! :)
I suggest keeping him on whatever he'll eat until his appetite is back to normal and/or you have antinausea meds to give. Even with those I'd stay with what he likes for a bit. Not eating can begin for one reason and then take on a life of its own.
 
Hi Barri,

I'm so pleased and relieved to hear that Sonny has eaten better for you overnight. It should be OK to keep him on the chicken and meat/broth baby food for a few days but it's not a complete food. When you do try to reintroduce the Friskies do it slowly (start with adding just one teaspoon to a single meal in each day then gradually increase Friskies/decrease chicken & baby food). I also suggest you start with a different date batch of the Friskies (just in case the current batch you have might be disagreeing with Sonny; it happens from time to time.) If Sonny has a problem with the Friskies causing nausea again (look for lip licking/'yawny' faces after eating, licking/sniffing food then walking away) try another food. If necessary (and if you get an Rx) treat ad hoc for nausea. Don't push the transition if he really doesn't like the Friskies; try another food. Watch for loose stools as another sign that something in the food may be upsetting his tum.

I understand only too well not wanting to stress a kitty unnecessarily, especially when they're feeling poorly. However, you do still need to try to find out what has caused Sonny's nausea. I suggest ringing the vet first to get his opinion about whether he needs to see Sonny today and take it from there. If he has examined Sonny very recently he may be prepared to issue the Rx for an anti-nausea med in tablet form without needing to re-examine him. If the vet does prescribe ondansetron I suggest that you don't give any mirtazapine because of the potential adverse reaction between the two drugs (may increase risk of inducing serotonin syndrome).

Sending scritches for your little fella.

:bighug:


Mogs
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