Hi Bonnie,
My heart went out to you reading this thread because I've been through similar. I can fully appreciate how exhausting things must be for you, both physically and emotionally. Oreo Joe is blessed to have such a loving and dedicated mama. You are doing an outstanding job of getting food into him under such difficult circumstances.
Reading through your posts above it really sounds as though Oreo is experiencing real problems with nausea. Also I note the following from your other thread in Feline Health:
He seems to feel cold he curls up on my fake fur spread on the bed and buries himself into a tiny ball. He likes it when I put the mattress heater on low can barely feel it but he is right back there now.
In addition to nausea and inappetence, hypothermia can be a symptom of feline pancreatitis (per
FDMB Primer on Pancreatitis). I recommend letting your vet know about these clinical signs. If pancreatitis is suspected then Oreo Joe may also need pain relief (buprenorphine) to help him to start eating again. Note: a Spec fPL blood test can be run to help diagnose whether pancreatitis is the problem.
The cyproheptadine is listed as Peractin and doesn't list for cats or appetite stimulant.
Cyproheptadine (Periactin) is a human medication that can be used for appetite stimulation in cats. It may not have a licence for use in pets in Sweden. It doesn't have a veterinary licence in the UK but vets here can prescribe it under UK drug cascade rules if other licensed veterinary medication(s) don't work or if the cat has an adverse reaction to the other medication(s). Maybe a similar system exists in Sweden?
Mirtazapin Alternova 15 mg 1/4th tablet every 48 hours. That should have been done on Sunday which was yesterday for me!! Says it is to be used as an anti emetic and appetite.
We've seen here that a not-insignificant number of vets will insist that there is no need to prescribe additional anti-nausea medication when they prescribe mirtazapine. For a seriously nauseated cat, any anti-nausea effect that mirtazapine may exert is typically insufficient to help the cat overcome its eating difficulties. (It's certainly typical of what we see here in pancreatitis and DKA cats.) Let your vet know that the mirtazapine on its own doesn't appear to be helping Oreo Joe and that you are assist feeding round the clock to keep him eating.
It can sometimes take a bit of persistence with the vet (or sometimes consultation with another vet) in order to secure additional, dedicated anti-nausea treatment. If a cat can't get any food down it is a life-threatening situation so if the cat still shows symptoms of nausea on mirtazapine alone don't delay going back to the vet to secure an Rx for specific anti-nausea meds. If the vet insists that mirtazapine alone has worked for all his other patients try to be as clear and firm as you can that it's not working for
your cat, that you don't want your cat to develop fatty liver problems, and that your cat needs more help. The IDEXX document linked below may be very helpful in supporting your case in such circumstances.
IDEXX Pancreatitis Treatment Guidelines
The above document gives very clear information on effective treatments for feline nausea (Cerenia, ondansetron) and inappetence (mirtazapine, cyproheptadine). Whether or not pancreatitis is the cause of Oreo Joe's eating difficulties, the treatments referenced in the IDEXX document for nausea and poor appetite should be generally applicable for these ailments even if the cause of the nausea is something else. (They are also used for cats with ketosis/DKA or CKD, for example.) A notable exception is where the cat is constipated. This, too, can cause nausea and put a cat off eating and the constipation needs to be resolved before normal anti-nausea and appetite stimulant meds will work properly. If your kitty has gone more than 2-3 days without pooping then a physical exam at the vets is needed to make sure that there's no GI obstruction or impacted faeces. Assuming no blockages, a few doses of metoclopramide (Reglan) can help normalise gut motility and with a consequent reduction in nausea symptoms. Thereafter the other meds should be effective. (NB: Check out the IDEXX document for reasons why Reglan is not suitable for general, intermediate to longer term nausea management in cats.)
The above is general advice, Bonnie. I'm not sure whether there might be special circumstances in Sweden. I hope your vet will be able to help: if the right supporting treatments are in place it can make the world of difference to help get a kitty eating properly again and on the road to recovery.
Keep doing what you can to monitor ketones in the meantime. More info
here.
Mogs
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