9/13 Mačka is very sick - update: ate a little + pic

Penelope and Mačka

Penelope and Mačka

Member Since 2019
http://www.felinediabetes.com/FDMB/...-regarding-vacation-dose.219061/#post-2438905 Thank you to all of you who helped me during my trip!

Hi all,

I came back from my 5 day trip and all seemed fine at home. We had a huge flight delay and when I got home, I gave Macka some Tiki velvet mousse in the middle of the night as a snack. FYI He was doing just fine with his pet sitter. I could see him on the camera and he was greeting her, walking around happily, all looked normal and she said he was eating well.

The next morning, he ate only half of his usual breakfast, but I thought it was because he ate later that night. He had a pre-dental appointment at 8am, we went and he looked grumpy but okay. We came back home, he finished his raw food, and then felt sick. He stopped eating and became quite lethargic. He has had diarrhea since.

That was 3 days ago, and he is still feeling very lousy. The only food he will accept to eat sometimes and in very small quantities are baby food and dry food (low carb). I took him to his regular vet yesterday and here are the blood results that are weird are:

BUN 53 16 - 37 mg/dL HIGH
AST 11 16 - 67 U/L LOW
TRIGLYCERIDE 237 20 - 90 mg/dL HIGH
AMYLASE 3906 2 623 - 2239 U/L HIGH
WBC 20.6 3.9 - 19.0 K/uL HIGH
RBC 7.06 7.12 - 11.46 M/uL LOW

CREA and SDMA are normal. Lipase too.
fPL is normal.
T4 normal.
Urine normal.

I just don't understand what happened between the moment we got home and the next morning. I was thinking that maybe:
- the raw food gave him a gastro enteritis,
- or because he licked some water on the bathroom floor?
- Or he caught a very fast acting bug at the dentist vet (that would have been a matter of 2 hours).
- I weaned him off the steroids and last 1/2 dose was the day before I came back (I am giving a token dose right now for safety, but the vet said I could stop altogether): would stopping steroids make any IBD symptom happen in 24 hours? I wouldn't think it'd be so fast, and also he didn't have these symptoms before taking them
- Pancreatitis? happening overnight?

My vet does not think it's pancreatitis because of normal fPL results. She also thinks the triglyceride and amylase are consistent with diabetes. So what's left? I am confused and ultra worried.
Right now he's having odansetron, buprenorphine, and just got fluids this afternoon because I suspected he was dehydrated with the diarrhea.

His BG is still elevated despite the fact that he does not eat much (ketones were okay until this morning, I still have to catch an evening stream).
3 days ago, I asked the pet sitter to reduce his dose in the PM because he had blue numbers that same day and the pet sitter was going to leave right after his PM shot, and would not come back anymore, and we were told our flight was not taking off at all because of bad weather. I got really scared that he would have a potential dangerous curve without anyone around the whole night.
In addition, with steroids weaning, I didn't want to risk a huge dive the next day. After that, he lost his appetite and the vet said it could influence the BG, so I kept the dose at 2.75 for 2 days. I never saw the dive, so I increased again this morning (please do not shame me for all that, I tried to keep him safe). It might have been a bad move, but I wouldn't think it's the cause of his sickness right now.

Please send good vines to Macka, as he really need some right now. It breaks my heart to see him so down and sick and with no appetite. I am so worried. I am not sure what the next move is.
Have you had good results with Mirtazapine? Thank you.

PS: I switched to human meter today.

Edit: Just read that steroids stay 36 hours or more in the body, so it's unlikely weaning them off is the cause
 
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I'm sorry I don't have insights, but I'm sending lots of vines for your sweet guy and hope it's just a transient thing. I wouldn't think the dosing would suddenly make him sick, but I'm glad you went back up. :bighug::bighug:
 
Wish I had answers. AND suggests infection somewhete. But level isn't that high if I'm reading it correctly. Did the dental dr do anything?
 
Susan&Felix said:
I'm sorry I don't have insights, but I'm sending lots of vines for your sweet guy and hope it's just a transient thing. I wouldn't think the dosing would suddenly make him sick, but I'm glad you went back up. :bighug::bighug:
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Thank you. I hope that the 3u without eating will not cause any dramatic drop though... He does not look like he is going to accept food any time soon sadly :(

Ketones were negative again tonight.
 
Penelope, I'm glad to see your post, but I am so sorry to hear Macka is feeling bad. Sending good healing and calming vines to Macka and to YOU :bighug::bighug:

I wish I had real advice. All I can really offer is, maybe try to make sure his environment is calm and low-stress... as much as you can..

Does the vet offer any solution? Especially for the diarrhea, if it's been going on for days I'd hope the vet would want to address that asap...
 
Figaro's Liz said:
Does the vet offer any solution? Especially for the diarrhea, if it's been going on for days I'd hope the vet would want to address that asap...
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She only offered probiotics for now, but since he's not eating....
I am going to write her an email now.

Edit: she actually also mentioned Metronidazole, but again, with him not even wanted to eat a pill pocket, this is going to be tough...
 
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Penelope

Have you or your vet been able to get the ondansetron down him or did your vet think to give him a cerenia shot? Do you have his complete labs? I’m interested in his HCT which would be with the CBC...the WBC and RBC counts.

So this is an odd thing because this exact thing happened to us. We were gone three weeks and Liv, our little girl barely more than a kitten, was great. She was fine when we got home but that night at 11, she wouldn’t eat and then she started in with vomiting and diarrhea. I gave her some ondansetron but she threw it up. I was up with her all night and she clearly felt terrible. I took her to the vet the next morning and her labs looked somewhat similar to Macka’s although her BUN, AST, RBCs were normal where his aren’t. His BUN might be elevated due to dehydration; there is no significance to the AST being low; but if his RBCs are low, I’d be interested to see what his hemoglobin and hematocrit look like and whether he is, for some odd reason, trending towards anemia.

Liv’s amylase, triglycerides, and specfPL were normal; her WBCs were similarly elevated. I agree with your vet that Macka’s values for the first two parameters are likely due to FD.

At any rate, my vet gave her a cerenia shot and sent me home with meds. Liv was drinking on her own so not dehydrated. After she had the cerenia, I gave her 1mg of ondansetron and when she kept that down, started 1/2 cap of Saccharomyces boulardi every two hours for diarrhea. The vet felt she had just picked up a temporary bug based on the elevated WBCs but nothing else showing up. By the time I got her home, she was ready to eat. There was no more vomiting or diarrhea. This whole thing lasted less than 18 hours for her. Possibly hers was quicker because I took her right to the vet but I did that because it was Sat morning and I wanted to have what I needed for the weekend without an ER visit to get it.

It’s definitely more concerning that Macka is still ill but sometimes these GI things can last a little longer. I’m kind of surprised your vet didn’t give him metronidazole and the only reason I didn’t get it for Liv was because she was perking up a bit.

Let me know if you find the HCT or HGB on his labs. You might want to ask the vet about adding in some metronidazole and I always think S. boulardi is the best probiotic for diarrhea. I only had to give Liv 1/2 capsule for three doses.
 
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Hi @Marje and Gracie ,

Thanks so much for sharing. yes, I forgot to mention that the vet proposed metronidazole (I had the pills at home already). I was under the impression that they are antibiotics though, how can they alleviate the diarrhea symptoms? That is, if it's pancreatitis or IBD. I suppose it works for bacteria.

If I need to give him some, it's going to be a real challenge.
I gave him Ondansetron this morning (pilled) and Cerenia tonight (pilled too, all with a lot of drama). He didn't get a Cerenia shot because until yesterday, he was eating his pill pockets.

Tonight he refused to eat, even his favorite Tiki stix.
I can tell he is in pain (he got some buprenorphine an hour ago), because his eyes are semi-closed and he is very grumpy.

Please find attached his full CBC results and thanks so much in advance for the interpretation.
 

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Penelope and Mačka said:
Hi @Marje and Gracie ,

Thanks so much for sharing. yes, I forgot to mention that the vet proposed metronidazole (I had the pills at home already). I was under the impression that they are antibiotics though, how can they alleviate the diarrhea symptoms?

If I need to give him some, it's going to be a real challenge.
I gave him Ondansetron this morning (pilled) and Cerenia tonight (pilled too, all with a lot of drama). He didn't get a shot because until yesterday, he was eating his pill pockets.

Tonight he refused to eat, even his favorite Tiki stix.
I can tell he is in pain (he got some buprenorphine an hour ago), because his eyes are semi-closed and he is very grumpy.

Please find attached his full CBC results and thanks so much in advance for the interpretation.
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Thank you for attaching his full labs. That helps.

He’s not anemic but his HCT and HGB are a little lower than we normally see in cats that are not ill. I’m not a vet but just tossing out some potential causes for that in a cat without CKD, we sometimes see lower HCT and HGB with bacterial infections because bacteria like iron.

We would expect that once the issue of the infection/inflammation is addressed, the HCT and HGB will rise. Again, his values aren’t abnormal but most healthy cats have a HCT above 40%.

Metronidazole is an antibiotic, you are correct, and it’s primarily given for diarrhea.

The pain has me a bit confused, for certain. Liv was tense in her abdomen but not painful. I’m wondering why the bupe isn’t addressing his pain. His labs don’t indicate triaditis or cholangiohepatitis which we would see through elevated liver enzymes, typically.

I am not sure what else to offer you in suggestions. I will tell you that after Gracie crossed and Tobey realized she wasn’t coming home, the stress put him into a bout of vomiting, diarrhea, and anorexia. I had to give him metronidazole, S. boulardi, fluids, ondansetron, cerenia, and take him off his raw food temporarily just to lure him to eventually eat something with an odor. Since I can syringe feed him, once the ondansetron and cerenia were on board, I was able to get him through the anorexia by syringe feeding him and then offering him smelly canned food.

Sending tons of vines.

Edited to add: I keep Renew Life S. boulardi here all the time in my toolbox but you might be able to find some S. boulardi (although not that brand) at Walmart. Just don’t get Jarrows because, although it’s the best, it tastes terrible. If you can get some, you can mix it with water or broth with no veggies in it or baby food with nothing in it and syringe it. You might want to offer him some Beechnut baby food and see if he might eat that.

If you decide to give the metronidazole, just be sure you separate it from any probiotics by a few hours.
 
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If pilling is difficult and giving injections is easier for you and Macka, you can try to see if your vet will give you injectable cerenia and ondansetron. I believe buprenophine can also be given SQ (somebody please correct me if I'm wrong). If you're doing SQ fluids at home, then you can give all of that through the line so no multiple pokes.
 
Marje and Gracie said:
He’s not anemic but his HCT and HGB are a little lower than we normally see in cats that are not ill. I’m not a vet but just tossing out some potential causes for that in a cat without CKD, we sometimes see lower HCT and HGB with bacterial infections because bacteria like iron.
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That is very interesting... I would have not known and thought of that. it makes a lot of sense if his problem is a bug.

Regarding the pain, i am not sure. All I know is that he is VERY grumpy when I touch his stomach, or even his back. And his eyes are not wide open, but he could be nauseous without pain.
Marje and Gracie said:
You might want to offer him some Beechnut baby food and see if he might eat that.
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Until yesterday he was eating some Beechnut baby food, beef flavor, but not today.
I will see if I can find the S Boulardi tomorrow morning. As for now, I was giving him Proviable forte.

Marje and Gracie said:
I will tell you that after Gracie crossed and Tobey realized she wasn’t coming home, the stress put him into a bout of vomiting, diarrhea, and anorexia.
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Could it be that he fell in love with his cat-sitter who obviously was not after him non-stop like I am, would let him be, wouldn't poke him constantly and would let him sleep at night? She kept on telling me how adorable he was and that she loved him so much. When he realized she wasn't back but it was me instead, could it trigger anxiety? (I'm half smiling but seriously, I hope not)

I just tried the Mirtazapine. Please wish him luck!
 
Penelope and Mačka said:
Could it be that he fell in love with his cat-sitter who obviously was not after him non-stop like I am, would let him be, wouldn't poke him constantly and would let him sleep at night? She kept on telling me how adorable he was and that she loved him so much. When he realized she wasn't back but it was me instead, could it trigger anxiety? (I'm half smiling but seriously, I hope not)
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Omg haha! I can't say if that could be a thing but let's hope if it is, I would think it was just infatuation and Macka remembers his true love: YOU!
 
Crista & Ming said:
If pilling is difficult and giving injections is easier for you and Macka, you can try to see if your vet will give you injectable cerenia and ondansetron. I believe buprenophine can also be given SQ (somebody please correct me if I'm wrong). If you're doing SQ fluids at home, then you can give all of that through the line so no multiple pokes.
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I would be surprised if a vet would carry injectable ondansetron as it is a human drug. And it’s pricey....I paid $13 for five 4-mg tabs. I used to get the injectable, with a prescription, from Thrivingpets.com and kept it here for Gracie. I also a, it sure if any of those drugs can be given in an IV admin port as the same time as fluids; that would need to be cleared through the vet. If yes, all three can be given subq. Really, the bupe shouldn’t be an issue because you are just giving it orally in the cheek pouch, not down the throat.

I love the petsitter idea. I wondered that myself with Liv :woot::woot::smuggrin:
 
Penelope and Mačka said:
How much would you say it works in %? Do you see any side effects?
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Just going to start with a disclaimer that I have no vet med training. All I know is learned through observations, what I've read on the board, and what I've seen at my short career so far at a vet hospital.

I've been told here and from work that appetite stimulants won't work if kitty is nauseas. So it's good you have cerenia and ondansetron on board. A vet I work with doesn't like to give mirtazapine with buprenorphine because she says it can make some cats extra loopy. And then that's when I wonder why mirtazapine is more commonly used than cyproheptadine? But I don't know too much about cypro.

I can't really recall exact details, but from what I've observed, I can remember cats eating after mirtz and of course, some that don't after a day or two on it.

Marje and Gracie said:
I would be surprised if a vet would carry injectable ondansetron as it is a human drug. And it’s pricey....I paid $13 for five 4-mg tabs. I used to get the injectable, with a prescription, from Thrivingpets.com and kept it here for Gracie. I also a, it sure if any of those drugs can be given in an IV admin port as the same time as fluids; that would need to be cleared through the vet. If yes, all three can be given subq. Really, the bupe shouldn’t be an issue because you are just giving it orally in the cheek pouch, not down the throat.
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Yes, great points. Definitely clear with a vet! My vet does have injectable ondansetron on hand but I do usually just get it at the pharmacy but they always have to order it in. Here, I pay $45 CAD for 5 vials of 2mL and I heard a whole big bottle is $90+ so yeah, it's super price-y. Also those 2 mL vials need to be used within 3 days, I believe. I really just pop open the ondansetron during "emergency" situations when Ming is puking a lot.
 
Crista & Ming said:
I've been told here and from work that appetite stimulants won't work if kitty is nauseas. So it's good you have cerenia and ondansetron on board. A vet I work with doesn't like to give mirtazapine with buprenorphine because she says it can make some cats extra loopy.
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Argh, well, he had 0.1ml of Bupe and 1/2 dose of Mirtz (I'm very conservative). Right now he is sleeping. Let's see in an hour if he is high or feeling good. Poor Macka, I just want him to feel great, and hate giving medication.
 
Crista & Ming said:
My vet does have injectable ondansetron
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That’s amazing because most do not and our clinic is an AAHA certified one. Lucky you!

Penelope and Mačka said:
Argh, well, he had 0.1ml of Bupe and 1/2 dose of Mirtz (I'm very conservative). Right now he is sleeping. Let's see in an hour if he is high or feeling good. Poor Macka, I just want him to feel great, and hate giving medication.
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I hope it works. In my experience, it made my GA cats really anxious so I haven’t used any appy stimulants in well over a decade. I just make sure my cats are taught to eat from a syringe as babies and then control the nausea.
 
Marje and Gracie said:
I just make sure my cats are taught to eat from a syringe as babies and then control the nausea.
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Have I known at the time.... He does not accept the syringe. I am going to try to syringe feed him though tonight, because a full day without eating, that's not good.
Right now he seemed a little high, drank a full bowl of tuna juice, but then went back to hide under a furniture :(
 
Penelope and Mačka said:
Still not eating anything. The syringe feeding failed, he gets really mad about it and gags.
I feel terribly helpless.
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((((Penelope))))

I truly believe one of the hardest things to deal with is a kitty that won’t eat. Until you’ve had to deal with it in an older kitty, as you are, that won’t eat from a syringe, it’s just not something we tend to think about when they are kittens. I, too, learned as you are.

I’m sure you’ve seen the list of things you can offer or doing a smorgasbord. One thing that seemed to usually get my sick cats eating was a/d. It’s not great ingredients and it’s 12% carbs but it might be worth getting a can from your vet tomorrow and trying it.
 
Bron and Sheba (GA) said:
Is there anything he loves you could tempt him with.?
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Tuna juice was the only food he accepted.
He ate 2_3 dry kibble like he was a maniac, and the second later he stopped being interested. I need to take a break. I was after him all day. He hasn't eaten anything since 9am this morning (it's 9pm now in Oregon).
 
Penelope and Mačka said:
Thank you. At this point, anything will do. Is it more palatable than other food?
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It seems to be. It’s a little softer than most pate foods. It was specifically designed to give a few more calories but also to be extra smelly and tasty for cats not eating. It was always my “go to” food for a cat not eating before I resorted to syringe feeding.

Hope you get some rest and Macka will start to eat.
 
I hope you rest well. You’re doing everything you can right now and that’s what counts.

Maybe get some baby food tomorrow as well. Meat only, of course. The a/d is great and is also easily syringe fed. Heating up the food a bit helps make the food more smelly.
 
Thank you so much for all your good vines and prayers, it's working.

6 am update: he was walking around the house, ate 1/4 cup Young Again dry plus some bone broth, and a few spoons of kitten food. He was also purring a little. Now he is resting again and I am going to do the same. I also gave him Ondansetron in a pill pocket and he gobbled it. Let's hope he wants some more food at +3!
 
Penelope and Mačka said:
Thank you so much for all your good vines and prayers, it's working.

6 am update: he was walking around the house, ate 1/4 cup Young Again dry plus some bone broth, and a few spoons of kitten food. He was also purring a little. Now he is resting again and I am going to do the same. I also gave him Ondansetron in a pill pocket and he gobbled it. Let's hope he wants some more food at +3!
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Excellent news! Paws crossed and more vines and healing light.
 
9am: he ate 1/4 can of Fancy Feast kitten, it's not much but better than nothing, right? He is weak and wobbly though. Treats are acceptable again. Ketones were negative still, I feel so lucky about that. I haven't seen a poo since last evening, hopefully it's forming well inside his little black tummy?

Here's a photo of him in his garden, may the power of plants heal and comfort him!
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