10/11 Butters AMBG 137 Home from ER...for now...

[Red & Rover (GA)]

See if she will eat out of your raised hand (i.e., hand not on the floor). Try raising the food bowls 4-6 inches. A couple of books you no longer want or an upside down cookie tin (the bottoms usually have a rim).
Not a creature on the planet wants to lower their head if they are feeling nauseous.

Warm up a bit of the food. Makes it smellier.

Some of what you are seeing now might be side effects from the mirtz.

 

[tiffmaxee]

You can not give her ondansetron today because she was given mirtazapine. There is a major drug interaction that can cause seratonin syndrome. Check it out on drugs.com.

 

[Bellasmom]

Thanks for the link!
Just spoke with the office. They 100% refuse to give me cerenia for her. What should I do? Try to get her cerenia from the primary care vet...who won't be open until Tuesday? And I don't know if he will give it to me. I imagine he will at least let me bring her in for a shot.

Yes they will give me bupre.

Is it ok to bring her home and just give her ondansetron once the cerenia shot wears off?

Apparently they are sending her home with an antacid...something no vet discussed with me. Omeprazole. Do I need this? Why?

Going to hold off on the ultrasound. They aren't keen to do it anyways, but will definitely schedule one.

They give me cerenia for dog and I break it in quarters

 

[tiffmaxee]

All cerenia pills are for dogs but work for cats. Only the injections were tested on cats so
the pills are used off label but have been used for years.

 

[Wendy&Neko]

How much does Butters weigh? The ondansetron dose is likely low. My 8lb cat gets 2 mg. Learned too late I had underdosed Neko. Thankfully she was also getting Cerenia.

Mirtazapine and ondansetron target the same nausea receptors, mirtazapine usually wins that battle making onda not so effective if given the same time. You really want to address nausea first, then appy stim if necessary. Giving appy stim to cat with nausea leads to food aversions. How long ago was the mirtazapine given? It doesn’t last that long so you still might be able to give ondansetron later today.

I got a feeding syringe from Petsmart, have seen some baby feeding syringes in people pharmacies too. Assist feeding can also lead to food aversions, so assist feed a food you don’t need necessarily want to feed regularly. Like the a/d, which is more like medium carb. Neko actually liked low carb Royal Canin Recovery and it was easy to syringe too. But it’s chicken and I turned my hepatic lipidosis foster off of chicken for ages by feeding it. Neko did not turn off chicken, ECID.

Sorry, you must feel like we’ve turned the fire hose of info on you. Scritches to Butters. Tell her the FDMB aunties say she has to eat.

 

[Butters & Lyla]

LOL, I told her.
I have shredded chicken, tuna and turkey out for her on three separate plates. All warmed and raised higher. All apart from one another. She has sniffed each of them thoroughly. I have offered her some of each out of my hand. Anytime I go to her food, she jumps off the bed and comes to investigate the plates. But she will not take a bite. If she won't eat for her FDMB aunties, who will she eat for?

The mirtazapine was given at 8pm last night. I read online: Mirtazapine has a half-life of 20 to 40 hours, so most of the drug is out of the body within four days after the last dose.
Butters weighs around 10.5 lbs or so. I'm sorry you were underdosing Neko.
They only gave me 2.5 4mg pills of ondansetron and said to do 1mg BID.
The mirt was given to her yesterday at 8pm.

Definitely feeling like I'm drowning but I want to figure this out.

 

[tiffmaxee]

I originally underdosed Max with ondansetron as well. @Wendy&Neko The ER gave IV mirt to Butters . I’m worried about seratonin syndrome.

 

[Butters & Lyla]

I do have a baby syringe hanging around that I could use. If I am going to assist feed her, at what point would I do that? When have I given her enough time to eat on her own? I would use the a/d.

The ER said they'd want me to bring her back within 12 hours or so (but then another vet said within 12-24 hours) if she hasn't eaten so they can treat her more aggressively. I'm not sure what that means, though. They did say they'd insert a feeding tube most likely.

 

[Ale & Bobo & Minnie (GA)]

Ondansetron should be 2mgs at least. Minnie gets 4mgs x2 a day. If she got the Cerenia shot before coming home, that will last 48 hours so it should give you time to get a refill at the vet on Tuesday. Minnie is also on metoclopromide which helps her no regurgitate the food she eats back up.

The feeding tube may be needed if she continues not to eat. Minnie had it and it was a blessing. Ask what type they’d be inserting traqueal or stomach.

 

[Olive & Paula]

How about smearing a bit of food on her paw. Cats don't like dirty feet, might lick it off and maybe start to nibble a little.

I have read from others mirtz can have behavioural side effects. The shivering could be from that.

 

[Butters & Lyla]

I smeared chicken on her paw and she ignored it. I also tried a tiny dab on her cheek, and her nose, and she wouldn't go for it.
She was doing this shivery/twitchy thing before the mirtz, before I took her to the ER.

 

[Pamela & Amethyst]

Lots of love,hugs and prayers. I know that Mirtz has a very negative effect on Amethyst It makes her very focal,like angry sounds and it makes her act very anxious

 

[tiffmaxee]

I think she’s nauseous. You would add water to food so it will easily go through the syringe. You can also put food with water in the blender or food processor. I used a mini food processor. The AD mixes well with some warm water. I think you said you have a few cans?

 

[tiffmaxee]

Sometimes just getting her eating will trigger more eating. Start small. Just a syringe or two and see if she keeps it down. If so try again in an hour.

 

[tiffmaxee]

Just got my answer. There’s a similar warning with buprenorphine and mirt.

 

[Butters & Lyla]

They put both mirt and bupre into her IV yesterday. I hate that I am having to put her through all of this when every vet I find seems careless in some way. If I could, I would treat her without drugs altogether. But I wouldn't know what to use.

She literally is acting the same that she was before she went to the ER.

The only improvement is I don't think she threw up the small bit of chicken she ate right when she got home.

ETA: Does this mean I shouldn't give her bupre anymore?

 

[tiffmaxee]

It takes time for a pancreatitis episode to go way. Support is needed until normal for several days and then you gradually reduce one item at a time. The first time with Max I didn’t give enough ondansetron and he was on it and cyproheptadine for a month or two. Once I figured out his dose the subsequent tones I started at first sign of inappetence and rarely needed an app stim. That’s why it makes no sense that they won’t give you more cerenia.

 

[Olive & Paula]

You want to give the bupre. I can't answer on mirtz, I never used it.

FWIW, Ollie first episode I know about lasted 6 weeks. She might have had it awhile and no one picked it up. It was the first time I had to deal with it. Never hospitalized (never even suggested) was treated at home and it can be overwhelming to say the least.

 

[Butters & Lyla]

Power tripping, maybe? Or maybe they know I'll be back tomorrow for a shot and then they can make more money off me?
I have cetirizine hydrochloride which I can try as an appy stim. she still has cerenia onboard.

 

[Bellasmom]

Butters is home with five days' worth of meds. Ondansetron prescription is for 1 mg BID.
I opened a can of shredded chicken and fed her two tsps. She ate willingly and seems to want more. I don't want her to eat too much at once.

She peed twice at the ER. Yay Butters.
They fed Butters a bit of m/d kibble, which she ate. They gave me a baggie of kibble and two tins of a/d food. They do not believe in syringe feeding; they don't do it. So they didn't have syringes to give me.
The printed instructions they gave me states to discontinue insulin and to make her chicken and white rice.

Instructions for meds:
Ondansetron pills: 1mg BID starting anytime tonight.
Mirtazipine liquid (15mg/ml): 0.12ml every 24 hours starting 8pm tonight (they don't have the transdermal Miritaz)
Buprenorphine liquid (0.4mg/ml): 0.2ml every eight hours: 6am, 2pm & 10pm. Reduce to every 12 hours if she seems very sleepy...?
Omeprazole liquid (20mg/ml): 0.25ml every 24 hours starting 2pm tomorrow.

It also states to discontinue insulin immediately. I will be ignoring that one.

 

[Bellasmom]

They put both mirt and bupre into her IV yesterday. I hate that I am having to put her through all of this when every vet I find seems careless in some way. If I could, I would treat her without drugs altogether. But I wouldn't know what to use.

She literally is acting the same that she was before she went to the ER.

The only improvement is I don't think she threw up the small bit of chicken she ate right when she got home.

ETA: Does this mean I shouldn't give her bupre anymore?

Give the bupre or she will be in pain again, Andy is still on his since Thursday
How often did they say give it

 

[Butters & Lyla]

View attachment 57124 View attachment 57124

THis is what the vets said. They do not do forced feedings.
What would you do, then, if your cats wouldn't eat because of pancreatitis symptoms?

 

[Butters & Lyla]

Every time I bring a plate over for her to try or hold food up to her in my hand, she jumps up like she is excited to try it, then sniffs it and lays back down. I am going to give a bit of syringe feeding a go. I feel like this ends with her barfing it up everywhere. But we'll see.

 

[tiffmaxee]

Eating sometimes gets them eating. Small amounts often is what my vet says. Not eating can cause hepatic lipidosis and end up in a serious situation in days so you gradually want her eating at least half her normal calories within a few days. She’s been through a lot. Give her time.

 

[Cheryl & Jazzy]

I'm so sorry Butters isn't feeling well still. Having any animal that won't eat is stressful. We had to syringe feed Jazzy for a couple of weeks. I was never so happy to see a cat eat once he finally started to nibble food on his own.
At least she's eaten a tiny bit and kept it down so far. I hope she improves a bit tonight.
I don't know anything about all the meds she has or needs, but it would be so much more helpful if all of the vets treating her were on the same page with each other. How confusing to be told so many different things. I'd be a bit angry myself.
Hopefully both you and Butters can get some much needed rest tonight. Thinking of you and sending hugs

 

[Bellasmom]

Every time I bring a plate over for her to try or hold food up to her in my hand, she jumps up like she is excited to try it, then sniffs it and lays back down. I am going to give a bit of syringe feeding a go. I feel like this ends with her barfing it up everywhere. But we'll see.

Zyrtec will make a cat hungry I used to give it to Abby


half a tablet

 

[Cheryl & Jazzy]

Eating sometimes gets them eating. Small amounts often is what my vet says. Not eating can cause hepatic lipidosis and end up in a serious situation in days so you gradually want her eating at least half her normal calories within a few days. She’s been through a lot. Give her time.

Exactly what happened to Jazzy. We had to syringe feed him every 2 hours for days and gradually increase time between meals until he ate in his own after 2 weeks.

 

[Butters & Lyla]

Ahh! Excellent! I just gave some to Butters.
What! 2 weeks of syringe feeding? Wow.

I'm going to wait a little bit longer and then try to get her to eat again. If she won't, I'm going to syringe feed some a/d mixed with water.

 

[Sue and Luci]

I think you should back off on the food and insulin for now. Her numbers aren't that high...just give her a little time...and keep up with the pain meds.

Would you want to eat if you were nauseated and in pain? Probably not.

I'm so sorry she's going through this...that you both are...I wish there was more I could do to help you.

You'll have to go with what you think is best based on her condition at any given time...take it slow and easy. I hope she improves soon!

 

[Wendy&Neko]

Try feeding with a spoon instead of syringe, that sometimes works. Just getting some food in can kickstart the appetite. A syringe or two often got Neko eating on her own. You don’t want to let her go without food, or you might end up dealing with hepatic lipidosis too.

 

[Butters & Lyla]

She just ate two tsps tuna on her own. And she seemed like she wanted more but when I put more in the same bowl, she wouldn't eat it. How much do I need her to eat at once? I figure I could leave her alone for an hour before I try feeding her something else.
After she eats, the shivering/twitching gets worse.

 

[Bellasmom]

They told me small amounts at a time for Andy don’t want the tummy to get upset by to much food

 

[Tomlin]

I’m so sorry that you are going through this! I feel your pain....it is so stressful when they do not eat and they are in pain and nauseated.

Are you using oral Bupe and how are they dosing it? That definitely is pain face in the picture.

I typically gave Bupe and anti nausea medication, gave it a chance to work and then proceeded with food. T received Bupe every 8-12 hours and he definitely needed it every 3 hours when he initially started his flare. ECID and even each flare can be different in the same cat .

It is encouraging to me that Butters not only still has interest in food, but that she will also try something like tuna. T has been in a place where he literally turns away from all food and has lost all interest.

The only issue to keep in mind with what you feed Butters right now is it is not absolutely 100% clear whether there is any intestinal involvement in addition to the pancreatitis. I would personally try either AD or if you can get some digestive formulations those are good as well. It’s not hard to transition them back to their regular diet later or to whatever is necessary at a later point. It was important that T are very small amounts many times a day. Even once he would eat on his own, I gave him small meals. You know how it is....get excited to eat and then—ouch—realize too much too soon.

When I had to syringe feed (and it was not forced—he actually would jump up to be fed —he wanted the food but wasn’t ready to stick his face in a plate or mange it in his mouth to eat it himself at first due to some food aversion), I had to do it for awhile. Rule from my vets was that I was able to syringe feed him as long as was able to get the necessary calories in per day and was making progress.

Transition was then to spoon feed 1/2 and syringe half. I then moved onto a soupy mix he could lap up on his own as well as some dry food....yes dry food. Sometimes the texture even becomes an issue for them so whatever It took to get him to eat on his own he ate (digestive formula). He eventually transitioned back to eating on his own.

Thoughts and prayers your way

 

[Bron and Sheba (GA)]

I’m so sorry you are both going through this but you are managing it all so well.
When Sheba had pancreatic flares she often didn’t want to eat her normal food. I found that if I gave her small amounts of md hills dry food, which I know isn’t ideal, would get her eating again when she wouldn’t touch wet food.

She also had both cerenia and ondansetron together. The dose of the ondansetron was 2 mg and I gave the wafers with no trouble.

I’m so glad to hear she is eating small amounts. That’s progress.
Sending a plane load of strong Aussie healing vines.

 

[Butters & Lyla]

I’m so sorry that you are going through this! I feel your pain....it is so stressful when they do not eat and they are in pain and nauseated.

Are you using oral Bupe and how are they dosing it? That definitely is pain face in the picture.

Ugh I know right? That face.
It is oral buprenorphine. They preloaded syringes. The dose seems to be 0.08mg every eight hours.
She had a cerenia shot at 11am. I'll have to take her back tomorrow for another one.

Good point about the food. They gave me two cans of a/d and that is my next food move, happening shortly. And I may as well just stick with that. Either spoon or syringe. I don't think a syringe will be too forced with Butters, either. She clearly wants to eat.
Thank you for the support and suggestions.

 

[Butters & Lyla]

I’m so sorry you are both going through this but you are managing it all so well.
When Sheba had pancreatic flares she often didn’t want to eat her normal food. I found that if I gave her small amounts of md hills dry food, which I know isn’t ideal, would get her eating again when she wouldn’t touch wet food.

She also had both cerenia and ondansetron together. The dose of the ondansetron was 2 mg and I gave the wafers with no trouble.

I’m so glad to hear she is eating small amounts. That’s progress.
Sending a plane load of strong Aussie healing vines.

I'm trying to...with a lot of help.
They gave me a prescription for 1mg ondansetron bid. But they gave her mirtazapine which interacts badly with the ondansetron so I can't give that to her. She did get a cerenia shot this morning at the ER.
They gave me a baggie with some dry m/d because they said she had nibbled a few pieces. I left some out for her earlier today but she wasn't so interested. At this point, I just want her to eat anything. I"m staying away from her normal food.

It just occurred to me, I haven't even thought about her insulin at this point. If I feed her, I could give her insulin.

 

[Bron and Sheba (GA)]

I started out putting just 1 piece of kibble out for Sheba. I agree at this point getting her to eat is more important than what she eats.
Have you tried sprinkling a small amount of Parmesan on the food?

 

[Cheryl & Jazzy]

Ahh! Excellent! I just gave some to Butters.
What! 2 weeks of syringe feeding? Wow.

I'm going to wait a little bit longer and then try to get her to eat again. If she won't, I'm going to syringe feed some a/d mixed with water.

Ahh! Excellent! I just gave some to Butters.
What! 2 weeks of syringe feeding? Wow.

I'm going to wait a little bit longer and then try to get her to eat again. If she won't, I'm going to syringe feed some a/d mixed with water.

Yes. He went a long time without eating. Our other cat was eating his food for him, so we didn't realize. When we did realize it, we tried giving him wet food. He just kept vomiting every time. He absolutely would never touch wet food in his whole life, he would rather starve. He ended up with hepatic lipidosis. He was so jaundice. It was a VERY long two weeks. Luckily he now loves wet food.
Come to think of it, I think maybe his meds from that may have caused his diabetes. He used to be a huge chonk. After he got better from that issue, he started losing weight. Which he needed, but then he lost too much. So here we are now.
I'm glad Butters ate a little bit more for you. Hoping she keeps it down. So much information to take in all at once.

 

[Tomlin]

If she would be happy with a syringe feeding some slightly watered down food it’s a great way to get them what they need . If I bang a syringe together to this day, T comes running . He’s a BIG baby .

Baby steps! T was also one of the unusual cats who didn’t do well with higher fat when he had a flare....maybe he is really a beagle ! Royal Canin makes a GI formula moderate calorie (squares in gravy)’that is able to be smashed and easily syringed and digested. Just another option. Doing syringe feeding definitely helped with being able to give insulin.

 

[Butters & Lyla]

I started out putting just 1 piece of kibble out for Sheba. I agree at this point getting her to eat is more important than what she eats.
Have you tried sprinkling a small amount of Parmesan on the food?

No...how about nutritional yeast? I have no cheese, but I would go out and buy some parmesan for her if it would help. She really seems to want to eat but can't.

I did successfully syringe 10ml: 5ml of a/d plus 5ml of water. She would not eat it off a spoon. She didn't fuss too much. I think I need to leave her alone for a little bit, though. And I doubt she will come running to me if I bang the syringe, lol.
So far:
2 tsps chicken @130pm DST
2 tsps tuna @715pm DST
5ml a/d + 5ml water @900pm DST

I haven't even thought about her insulin at this point. I did to a BG test before I syringed her and she was 166. SHould I be worrying about giving her insulin?

 

[Wendy&Neko]

The dose of the ondansetron was 2 mg and I gave the wafers with no trouble.

The problem with wafers is splitting evenly in half, not so much the giving.

They gave me a prescription for 1mg ondansetron bid. But they gave her mirtazapine which interacts badly with the ondansetron

How long ago was the mirtz? Half life of it in cat is 9 hours. If mirtz was given a while ago, you can give onda. Worst case it won't be as effective as if there wasn't any mirtz in the system.

SHould I be worrying about giving her insulin?

Wait until tomorrow. Both of you need to relax and get some sleep.

 

[Bron and Sheba (GA)]

The problem with wafers is splitting evenly in half, not so much the giving.

The trick with the wafer is to make sure you have dry hands when splitting the wafer.

 

[Tomlin]

Another idea for the Ondansetron is a pill cutter
I look like I’ve got stock in pill cutters with how many I have! Slice that baby! Just need one with a V guide since it’s small and you need it stay centered to cut it evenly.

 

[Butters & Lyla]

The problem with wafers is splitting evenly in half, not so much the giving.

How long ago was the mirtz? Half life of it in cat is 9 hours. If mirtz was given a while ago, you can give onda. Worst case it won't be as effective as if there wasn't any mirtz in the system.

Wait until tomorrow. Both of you need to relax and get some sleep.

I need to feed her and get a lot more fluids into her before I can sleep. They would not send me home with subq fluids.

The mirtz was last night around 8pm.

 

[Butters & Lyla]

I'm so tired. I hope I don't sound too cranky. I didn't mean to.
I'm so glad I have tomorrow off work.

 

[Butters & Lyla]

After I syringed the 10ml, which she was pretty accepting of, she shivered more. And she would not eat from the buffet of foods. It didn't kickstart her appetite unfortunately.

 

[Bron and Sheba (GA)]

Try and get some sleep. You will feel much more able to cope tomorrow if you can get some sleep under your belt.

 

[Butters & Lyla]

I will syringe feed a little more and then get some sleep. She isn't drinking anything, either. But pretty willing to be fed.
Thank you.

 

[Wendy&Neko]

The mirtz was last night around 8pm.

Good, you should be OK to give ondansetron now. Leave her food out, hopefully she'll feel better over night and investigate the buffet.

 

[Tomlin]

She will get some fluids from the syringe feeding/wet food as well.

You are doing an AMAZING job !
I don’t find you to be cranky at all

I hope both you & Butters get some much needed rest and tomorrow is a little better!