911: Gagging reflex, non eating, diabetic cat

[Critter Mom]

Oh, dear. Poor Brady. Poor you!

Did you ask whether they're giving nausea and appetite stimulant meds?

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[Kristina]

No anti-nausea or appetite stimulant meds were given.

Thank you for asking and I'm glad I had that question on my list.

 

[Critter Mom]

Why aren't they at least giving an anti-nausea med? Lots of cats also have trouble with excess stomach acid if they fast too long and that can put them off their food, too. Did they give a reason why they're not giving Brady any supportive meds?

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[Kristina]

I am getting another list of questions to ask. Can you think of any others? Thank you - it's hard to think straight when they are telling you all the information. Your thoughts are helpful. Also, I do not see using a feeding tube as a good prognosis. I would think that we can assume some kind of bowel disease and just treat presumptuously?

My thoughts:

Assumptions - some kind of bowel disorder

1) he is not eating, can we try appetite stimulate and anti nausea meds? I'll go over and try to feed him to see if it helps if I'm there with his favorite foods.
2) can we treat for IBS or other bowel disorder to see if that works? I don't really want him to have a feeding tube continuously and will try to get him to eat on his own.
3) if the bowel issue is a long term illness, what can we do to manage at home?

 

[Critter Mom]

Feeding tubes sound scary but they aren't as awful as we imagine and they really can be life savers. It can be really scary when a cat is off its food but if you can break the cycle of inappetence things can improve fairly quickly.

Here is an article about feeding tubes written by Dr Lisa Pierson (of catinfo.org):

Feeding Tubes Can Save Lives

Should major nutritional assistance be necessary, feeding via the tube should only be a temporary situation and it can actually be far less stressful on both the cat and guardian (and it's certainly a more reliable way to get sufficient nutrition into a cat compared to assist feeding). Minimising stress can also speed recovery. Dr Pierson's advice about not waiting too long before placing a feeding tube is wise advice. (I lost my Danú to hepatic lipidosis a few years ago because the vet waited too long before offering the feeding tube option. Sadly I didn't know as much as I do now about what to do to try to help a cat who's having trouble eating.)

I have no experience with endoscopies so can't really suggest anything about them. The general consensus from the vets who have treated Saoirse is that she most likely has low-grade IBD as well as pancreatitis but both myself and our main vet were reluctant to perform an endoscopy after her ultrasound showed that there wasn't anything majorly out of whack with her intestinal wall thickness. IIRC, a biopsy is needed for a firm IBD diagnosis but certain clusters of symptoms may point in its direction. I think a lot of vets treat on an 'as if' basis when IBD is strongly suspected. I am tagging Shane (@granadilla) to see whether she's online. Shane has more knowledge about IBD than I do, and she may be able to suggest questions for you to ask the vet and give you more information on the condition and its management (and it can be managed).

I think that you going to visit Brady is a very, very good idea. I think that it might be an idea to bring in some home-cooked chicken and broth because it might tempt him. If I were in your situation I would ask the vets if there was any medical reason not to give an anti-nausea medication. If it was OK as a treatment option I would ask them to give the anti-nausea treatment ASAP and PRIOR to my visit so that it might have a chance to start working before I arrived to try to encourage my cat to eat. I'd also ask the same about appetite stimulants. (NB: It's better to give the anti-nausea treatment prior to the appy stimulant.) Famotidine can also help if stomach acid is a problem (not uncommon if a cat has been fasting for a long time). Overall, speaking for myself after losing a cat when the treating vet adopted a wait-and-see approach to her treatment it's not something I would be comfortable with ever again. However, every cat is different and there may be clinical reasons for your vets not responding to Brady's inappetence with more aggressive treatment. That said, if I were in a situation like that with one of my cats I would insist - really insist- on the treating vet giving an extremely comprehensive justification for not adopting an aggressive treatment strategy and what the expected outcome might be.

When you do try to entice Brady to eat, he may eat something out of your hand instead of a dish.

When you go to visit, bring a t-shirt or nightshirt with you; it will carry your scent and it will be a comfort to Brady.


Mogs
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[Kristina]

A huge thank you for the information. I am sending my questions, requesting anti nausea them going to pet store for all Brady's favorite foods. Will also take the poached chicken. I'm making a visit later this afternoon and hoping he will eat for me.

 

[Critter Mom]

Sending prayers that he will eat for you, Kristina. Please give Brady some scritches from me.

If there's anything else I can do to help, just let me know.


Mogs
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[Critter Mom]

PS ... see if he will take some warmed broth first. Sometimes when they get past the initial tasting and it doesn't upset their tums they are more inclined to eat some mashed-up solids.

 

[granadilla]

Thanks for tagging me, Mogs. Kristina, I'm so sorry to hear about Brady not being well. Yes, IBD can be managed. Did they do an ultrasound of his stomach and intestines? If they agree the symptoms might match IBD, they may recommend a steroid. Ask for budesonide rather than prednisolone, which can raise BG levels. Budesonide is a newer steroid that only targets the gut instead of the whole system, so it's good for kitties with diabetes. It's a pill that you give once a day on an ongoing basis.

Kitties with IBD can have problems with nausea, diarrhea and/or constipation. For now the most important thing is to get him to eat. A feeding tube is fine if that's what you need to do for now to get him to eat. If he'll eat a little bit on his own, maybe managing his nausea will help him eat more. Once he's back home and eating more normally, there are things you can give him to help with diarrhea and/or constipation on a regular basis.

-- Ask for an appetite stimulant (Cypro, not Mirtazapine. Mirt can give kitties hallucinations and they act spacey on it. Cyproheptadine has less side effects.)
-- Ask for a nausea med. They can inject Cerenia or give you Cerenia tablets. Standard dose is 1/4 tab once a day.
-- Ondansetron is a human prescription med that helps nausea. You can give it at the same time as Cerenia if his nausea is really bad. Standard dose is 1/4 tab twice a day. You'll have to get this filled at a human pharmacy.
-- You can get OTC Pepcid (famotidine is the generic name, 20 mg) to reduce stomach acid. Standard dose is 1/4 tab twice a day. If the vet doesn't want to give Cerenia or Ondansetron for some reason, you can start with the Pepcid and see if it helps.
-- Raise his food bowl a few inches. If nausea is an issue, then hunching over to eat will bring up the stomach acid. Mogs told me when my kitty was sick to raise her bowl, and it worked. I just put a couple of paperbacks underneath the bowl to lift it up 4-5 inches. This sounds like a small thing to do, but it can make a big difference.

-- Lastly, if this vet won't get more aggressive with his treatment, find an Internal Medicine vet if you can at all afford it. They are more specialized. And yes, more expensive. But they have more experience in complicated cases and their equipment is human-grade.

Hang in there and please keep us posted about Brady's progress.

Shane

 

[Critter Mom]

@granadilla -

Hi Shane,

I'm so glad you got the tag. Thanks for weighing in to help Kristina and Brady.


Mogs
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[Kristina]

Thank you! I'm grateful for all the advice. I am going to see Brady this afternoon and I will talk to the Internal Med vet on staff. Note: I have not been good at giving pills. I can only hope that some of your suggested drugs come in liquid form.

 

[Critter Mom]

Kristina,

Visit this link and print out the section on nausea symptoms to take with you to the vets. Ask if they've observed any of the behaviours and see if you notice any yourself. Sniffing food, seeming interested, perhaps licking a little then giving up is a very good 'tell'.

Shane is spot on. If - if - nausea is the problem then it's a case of getting supportive measures into place to turn the vicious circle (hungry but queasy; eats then feels queasier; stops eating; stomach acid builds or system gets off balance; feels queasier; won't eat) into a virtuous one (meds suppress nausea; food starts to taste OK again; system gets back in balance/stomach acid doesn't build up; nausea reduces; increasingly easier to eat).


Mogs
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[Critter Mom]

Thank you! I'm grateful for all the advice. I am going to see Brady this afternoon and I will talk to the Internal Med vet on staff. Note: I have not been good at giving pills. I can only hope that some of your suggested drugs come in liquid form.

Cerenia can be injected. So can famotidine. Right now just let the vets worry about the administration of the meds but to reassure you a little, I give Saoirse two doses of ondansetron (another anti-nausea med) every day. I crush the dose and mix it up in her food. Sometimes she gets a hint of the taste and wobbles a bit but if I crumble a freeze-dried chicken treat on top of her grub she eats it fine. Also, other members here may know where to get meds compounded into a form that is easier to administer than a pill.


Mogs
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[Kristina]

Thanks you for the link to the list. I noticed right away that "licking their lips" is a possible indication for excess stomach acid. Brady has scabs from licking too much. I feel better educated in such a short period of time thanks to everyone's helpful information. Naturally, he won't want to eat if his tummy is upset. Wouldn't it be nice if it was that easy? I'll be in touch. THANK YOU!!

 

[Critter Mom]

Good observation about Brady's nose. Rooting for you both in the Shire.

 

[Critter Mom]

You can get OTC Pepcid

Is that Pepcid AC, Shane? I know that there are different Pepcid formulations in the States but I'm never sure which one is the OK formulation for pussy cats. (Over here, I have to get generic famotidine for Saoirse.)


Mogs
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[Kristina]

Just spoke with the internal medicine vet and Brady was given an acid reducer. I will get all drug info from his records before I leave. He ate! Only about 1 ounce, but that is better than nothing. He scoffed at shrimp, poached chicken, turkey lunch meat but ate the smelly tuna tiki cat I had in my arsenal of foods. Maybe it was the familiarity of his bowl or the strong smell but I was happy he ate.

Next steps is steroids which may also increase his appetite. They showed me how to do blood glucose, but to be honest, I do not think I can do it at home. Brady was hissing and biting (he has a lot of catitude even when sick, if he is healthy, it's worse).

Just spending some time with him now and he seems to be calmer.

 

[Critter Mom]

Delighted to hear that Brady ate something for you, Kristina, and lovely to see his picture.

but ate the smelly tuna tiki cat I had in my arsenal of foods. Maybe it was the familiarity of his bowl or the strong smell but I was happy he ate.

[Emphasis mine.]

Just wondering whether Brady might have some nasal congestion with his nose being sore at the moment? Worth asking the vets to check; cats won't eat things they can't smell.

They showed me how to do blood glucose, but to be honest, I do not think I can do it at home.

There can be a world of difference between vets testing a cat and you doing it at home. Saoirse was terrified of the vet techs testing her after she was first diagnosed. When I think of how their 'technique' compared to how I test her I can't say I blame her; it took two of them forever and a half to get a sample from her, but I can do it in minutes and she purrs contentedly the whole way through. If you use positive reinforcement - lots of fusses and protein treats - Brady might surprise you. Even if you decide you can't manage regular testing, Kristina, I can't emphasise strongly enough how valuable it is to have a glucometer and test strips at home for emergencies.

I bet Brady is thrilled to have you there with him. Be sure to give him some scritches from all of us here at FDMB.


Mogs
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[granadilla]

I'm so glad he ate! Did they have any idea of what set him down this path? Did they give you any nausea meds to take home? If this happens again, you can get Pepcid (no more than 20 mg) at any store and try give him 1/4 tablet at home and see if it helps.

There are some cats on this board who started out as semi-social, formerly feral, and yet they adjust to BG testing. Did the vet show you how to do it by pricking his ear? We condition our cats with treats and then it seems like *most* of the kitties get used to testing. There are some good links on this site that taught me how to test at home, along with some advice from veterans. I never thought my Marshmallow would put up with it because she was pretty skittish but she got used to it just fine.

If Brady is on steroids he may need an increased dose of insulin since steroids (usually not budesonide) make the BG level go up in most kitties (but not all kitties!). Then you will probably need to learn to check his BG so you can make sure you're keeping him below the renal threshold (below 300; above 300 means their kidneys can start to get affected). I promise it's not as hard as it probably seemed at the vet!

Sounds like he's feeling better today and the antacid is a good step forward, and the steroids will hopefully increase his appetite even more! With the acid reducer and the steroids, hopefully it will end the vicious cycle Mogs mentioned.

Shane

 

[granadilla]

Is that Pepcid AC, Shane? I know that there are different Pepcid formulations in the States but I'm never sure which one is the OK formulation for pussy cats. (Over here, I have to get generic famotidine for Saoirse.)


Mogs
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Yes, Pepcid AC is the standard OTC/over-the-counter Pepcid we use for kitties in the US. Or you can buy generic famotidine which is a little cheaper. You're right, there are other formulations but I only ever bought it for Marshmallow so I don't even know what those ones are!

 

[Critter Mom]

Thanks for the confirmation about the Pepcid, Shane. Pepcid AC isn't available over here any more. Ironically, the generic famotidine is the most expensive med that Saoirse is on. I don't know why it costs as much as it does.

 

[Critter Mom]

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.

Just dragged this post down for easy reference re possible respiratory issue.
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[Meya14]

The symptoms sound consistent with a condition called Ileus where the musculature of the bowel for one reason or another cannot contract enough to move things through. In ileus, you'll have symptoms such as dry heaving, vomiting, diarrhea followed by no BM, abdominal distension, and bowel dilation with no obvious obstruction on imaging scans. Many things can cause this, so it's important to look at all angles.

Here are some common issues that can lead to ileus:

medications - esp. narcotics
anesthesia
nerve compression/spinal disorder
blood vessel compression
IBD
Infectious colitius, especially C. Diff
Cancer
Twisted bowel
Electrolyte imbalance (Esp. Low potassium)

Treatment for ileus depends on the cause, but non-stimulating/irritant and non-fiber based laxatives such as miralax are commonly used.

@Critter Mom - Good advice on the insulin dosing/DKA prevention. I have been working a ton lately, and haven't been able to check messages every day.

**If you can, ask your vet to print out all the labs and imaging reports that you had done, and post them here. It might help to narrow down the cause.

 

[Kristina]

Delighted to hear that Brady ate something for you, Kristina, and lovely to see his picture.


[Emphasis mine.]

Just wondering whether Brady might have some nasal congestion with his nose being sore at the moment? Worth asking the vets to check; cats won't eat things they can't smell.


There can be a world of difference between vets testing a cat and you doing it at home. Saoirse was terrified of the vet techs testing her after she was first diagnosed. When I think of how their 'technique' compared to how I test her I can't say I blame her; it took two of them forever and a half to get a sample from her, but I can do it in minutes and she purrs contentedly the whole way through. If you use positive reinforcement - lots of fusses and protein treats - Brady might surprise you. Even if you decide you can't manage regular testing, Kristina, I can't emphasise strongly enough how valuable it is to have a glucometer and test strips at home for emergencies.

I bet Brady is thrilled to have you there with him. Be sure to give him some scritches from all of us here at FDMB.


Mogs
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Hi @Mogs,

I think Brady is leaving with a respiratory infection from the hospital, or perhaps it was brewing before he was admitted. Hard to know. I will pick him up tomorrow and have requested an arsenal of drugs in a formula that I can handle: shot, liquid or transdermal. I have not done well with pills.

Ok, I won't completely give in on BG home testing, but I have to view some more videos and other resources. The process the tech showed me was scary for me and for Brady. Maybe there is a better way.

 

[Kristina]

Just dragged this post down for easy reference re possible respiratory issue.
.

That's a possibility but I haven't changed anything obvious lately. I did get a new rescue cat a few weeks ago. Can they prescribe anything for post nasal drip? Is there a feline friendly version of an antihistamine? My head is spinning but these are all good ideas and areas to investigate. Thankful for such wonderful people!

 

[Critter Mom]

Hi Meya,

Thank you for responding to my tag.

nerve compression/spinal disorder

Kristina noticed that Brady was limping but the vets seem not to have given any weight to this problem.

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[Kristina]

The symptoms sound consistent with a condition called Ileus where the musculature of the bowel for one reason or another cannot contract enough to move things through. In ileus, you'll have symptoms such as dry heaving, vomiting, diarrhea followed by no BM, abdominal distension, and bowel dilation with no obvious obstruction on imaging scans. Many things can cause this, so it's important to look at all angles.

Here are some common issues that can lead to ileus:

medications - esp. narcotics
anesthesia
nerve compression/spinal disorder
blood vessel compression
IBD
Infectious colitius, especially C. Diff
Cancer
Twisted bowel
Electrolyte imbalance (Esp. Low potassium)

Treatment for ileus depends on the cause, but non-stimulating/irritant and non-fiber based laxatives such as miralax are commonly used.

@Critter Mom - Good advice on the insulin dosing/DKA prevention. I have been working a ton lately, and haven't been able to check messages every day.

**If you can, ask your vet to print out all the labs and imaging reports that you had done, and post them here. It might help to narrow down the cause.

@Meya14 - thank you. I only have x-rays at the moment. I can ask for the ultrasound pictures or video. Not sure what format they are but will ask for a copy.

Meds:

They gave him:
famotidine
Ondansetron

tonight he will get a steroid.

@granadilla - holding his bowl higher (such a simple suggestion) enticed him to start eating. Thank you.
@Critter Mom - the ibd website has lots of good information. Seems to be overlap with many of these "abdomen" issues.
@Jeanne Skadowski - I think I'll have to ask for an antihistamine if he has a respiratory issue. The vet did mention that the sore on his nose could also be herpes. Like humans, they can become evident under stress or when they have a cold. So many threads to follow.

....and a completely different view of my kitty is uploaded.

 

[Critter Mom]

If it is respiratory/herpes infection then this may be of interest (no experience of using this myself):

https://www.vetinfo.com/controlling-cat-herpes-l-lysine.html

Saoirse had problems with sneezing last year and our vet prescribed Piriton for her (antihistamine).

Kristina, particularly in light of Meya's post above I suggest that before you depart the vets you bring up the issue of Brady's limp again (to be on the safe side).



Mogs
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EDITED TO ADD:

Not used l-lysine for a cat, but I have taken it myself and it works very well for herpes inflammation. (I've had cold sores in the past and when I was going through antidepressant withdrawal hell the dormant virus flared up. I had really severe, painful inflammation of the trigeminal nerve in my face. The l-lysine started to help straight away.)

 

[Kristina]

Hi Meya,

Thank you for responding to my tag.


Kristina noticed that Brady was limping but the vets seem not to have given any weight to this problem.

.

I never did get a good report on the x-rays so I will ask tomorrow. @Meya14 and @Critter Mom may have a point.

This group is better and discussing possibilities then all the vets to date!

 

[Critter Mom]

Amazing how focused one gets when one is an actual stakeholder!

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[Meya14]

She may have some scoliosis near her bottom most ribs, there should be a curve, and not as sharp angle as there is. Maybe it's just a funny position that they took the x-ray from too? It may or may not be significant.

If you can get copies of any blood work that might help too. If she hasn't had blood work, ask for at least a CBC, thyroid, and chem/electolyte panel be drawn.

 

[Critter Mom]

@Meya14 - That angle immediately caught my eye, too.

 

[Kristina]

I'll post all chemistries tomorrow when I receive the updates that were done 1/25. Note: BG has been in the 135 range and he has not received any insulin for several days.

Lab Results from 1/22 attached. Thank you!

 

[Kristina]

If it is respiratory/herpes infection then this may be of interest (no experience of using this myself):

https://www.vetinfo.com/controlling-cat-herpes-l-lysine.html

Saoirse had problems with sneezing last year and our vet prescribed Piriton for her (antihistamine).

Kristina, particularly in light of Meya's post above I suggest that before you depart the vets you bring up the issue of Brady's limp again (to be on the safe side).



Mogs
.

EDITED TO ADD:

Not used l-lysine for a cat, but I have taken it myself and it works very well for herpes inflammation. (I've had cold sores in the past and when I was going through antidepressant withdrawal hell the dormant virus flared up. I had really severe, painful inflammation of the trigeminal nerve in my face. The l-lysine started to help straight away.)

...interesting Lysine info I just read:
L-lysine also has very good immune system support and is commonly used in the treatment of Feline Herpes Virus and its associated respiratory and ocular symptoms. It can be used for other inflammatory diseases such as IBD and has been shown to ward off attacks from colds, allergies, asthma, etc. due to a low functioning immune system. For a cat with an already compromised immune response, this may give them a leg up should they develop symptoms of something else.

 

[Jeanne & Dottie]

Yes, that looks like a pinched spine, and that could mean a very ouchy back. See how the two vertebrae are compressed? Leaning over a low food dish would definitely make Brady's eating a painful process.

I just found this raised food dish on amazon and am ordering two for my furkids. Ceramic and microwave safe. It's different from most raised dishes... actually has a small lip only on the outer edge, so that cats who push food around while they eat (aka...toothless cats or cats who gobble)..won't lose the grub out of their dish, and it will eliminate the necessity of holding the bowl for kitty.

Unlike a lot of the raised dishes, this one comes at a very affordable cost. There's a clear picture of the dish which shows that it also has an top incline which helps to keep kitty's chin from getting coated with food, *(feline acne..*shudder*...is not fashionable) as well as keeping them from bending their neck too much while eating..important in a senior cat who might have arthritic problems.

The bottom of this raised dish is hollow..our floors are so cold in winter that it's as if I leave my furkids' food in the refrigerator, then give it to them ice cold. Cold food can screw up digestion..it'll sit in kitty's stomach like a rock..and can cause cramping. Perhaps a raised dish won't keep the food so cold.



http://www.amazon.com/Raised-Feeder-food-ceramic-stand/dp/B00KAV98ES/ref=sr_1_fkmr2_1?ie=UTF8&qid=1453872600&sr=8-1-fkmr2&keywords=cat raised bowl 12.99

Additional note: The bottom of this raised dish is hollow..our floors here are so cold in winter that I might as well leave my furkids' food in the refrigerator, then drag it out and give it to them ice cold. Cold food can bollux up digestion..it'll sit in kitty's stomach like a rock..and can cause cramping.

There's 205 reviews on this item at Amazon, and 82% of them are positive. I've been looking for a dish like this for years.. WOOT! Dunno why I didn't spot it before! I guess all dishes look alike after a while, lol.

 

[Kristina]

@Jeanne Skadowski - the raised cat dish is functional and pretty! Thank you for all your comments and I hope your fur baby is doing well and let us know if the raised dish works for you.

 

[Critter Mom]

I've got raised bowls for Saoirse; they really help.

 

[Critter Mom]

Hi Kristina,

I hope you managed to get some decent rest last night. Any news of Brady?


Mogs
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[Meya14]

So, the labs look very good, except for the WBC/neutrophil which is an indicator of infection. So perhaps that's a UTI or colitis? Looks like the vet gave covenia and flagyl to cover those possible infections. Did the vet mention anything about starting her on a laxative? In people, miralax is used or lactulose in more stubborn cases of ileus. Also, you might want to ask the vet if she ruled out an actual obstruction. She might not have gotten a good view from the x-ray, and cats can get pretty severe obstructions from things like hair/plants/string/etc.

 

[Kristina]

Good morning, @Critter Mom. Yes, it has been nice to rest and not get up several times a night to check on a sick kitty. However, I do miss him! The vet called this morning and they gave him the steroids and he is eating well. They will discharge him this afternoon with injectible steroids for me. I will talk to my local vet to get some B12 and I am stopping by the pet store for lysine. I know they have the human form, but I believe I saw feline specific formulations that may taste better. There is a pharmacy near the pet store so I can compare. I asked the vet about spine/limp and she will have radiologist review but she didn't see anything. {sigh}

The aggravating thing about the medical field - no diagnosis unless I opted for the $2500 endoscopy so I will just have to go with all the great information and possibilities in the forum...ileus, IBS, pinched nerve, and treat them accordingly. I have received a test kit (for emergencies and if I get the nerve to poke Brady even more) for BG from a neighbor. I need test strips. It's OneTouch ultra mini which I may need to review to ensure it can be calibrated for cats.

So, I'm happy I'm getting Brady home and that he is eating. One step at a time.

I am gracious to have found this wonderful group of smart, concerned and compassionate cat lovers!

 

[Kristina]

So, the labs look very good, except for the WBC/neutrophil which is an indicator of infection. So perhaps that's a UTI or colitis? Looks like the vet gave covenia and flagyl to cover those possible infections. Did the vet mention anything about starting her on a laxative? In people, miralax is used or lactulose in more stubborn cases of ileus. Also, you might want to ask the vet if she ruled out an actual obstruction. She might not have gotten a good view from the x-ray, and cats can get pretty severe obstructions from things like hair/plants/string/etc.

Hi @Meya14 - the radiologist that did the ultrasound said there was no obstruction. I intend to get his entire medical record from the hospital today. Yesterday when I asked for all the meds that Brady was given in the hospital, it took forever to get an answer. It was like they didn't have all that information available! Anyway, the good news is that he is eating and I have several directions to get him healthy again, thanks to yours and others experience.

 

[Critter Mom]

Hi Kristina,

I'm very pleased to hear that Brady is eating better (anti-jinx, anti-jinx). Also pleased to hear that you've secured a glucometer. When you're getting the test strips for the glucometer be sure to pick up some ketone test strips if you haven't already done so.

The human meter readings need to be assessed based on a cat-specific glucose reference range. Unless otherwise specified, all the glucose reference numbers on FDMB documents are for people using human meters. We can help you familiarise yourself with the correct range to use.

Are the vets sending home any stomach acid/nausea/appetite meds with Brady? I can't emphasise strongly enough how valuable they are to have to hand should Brady's appetite stall. Be sure to give him some scritches for us.


Mogs
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[Meya14]

One caveat with anti-acid medications to be aware of: The acid dump from the stomach to the small intestine is part of the process that initiates the bile release and muscular contractions of the small intestine. Anti-acid medications can slow down peristalsis in some cases so should be used carefully in ileus. I'd start with anti-nausea meds first.

 

[Critter Mom]

One caveat with anti-acid medications to be aware of: The acid dump from the stomach to the small intestine is part of the process that initiates the bile release and muscular contractions of the small intestine. Anti-acid medications can slow down peristalsis in some cases so should be used carefully in ileus. I'd start with anti-nausea meds first.

Thank you for that valuable information, Meya. Do you know whether slippery elm bark has a similar effect on intestinal peristalsis? (Gut motility and bile acid levels are hot issues for me with Saoirse.)

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[Meya14]

Slippery elm makes a sort of gel/lubricant and doesn't actually reduce the acid, so it is ok and shouldn't slow anything down. The use of anti-acids can disrupt the stomach acid/bile system (they neutralize each other) and in people are NOT indicated for long term use, although they are often mis-used. Metoclopromide PRN is used in people with delayed stomach emptying and intestinal motility as it increases peristalsis, but it has nasty neurologic effects . In people, drinking small amounts of acidic things can actually reduce acid overall as it increases overall motility (ie. apple cider vinegar). If motility problems are originating in the lower GI and causing backup to the upper GI, then laxatives are probably the answer.

 

[Critter Mom]

Thank you, Meya, for all the additional information. I appreciate it very much. Saoirse has been on famotidine for a while now and I'd prefer to try to move her onto SEB. I give her pumpkin in her meals and now she's back on Lantus her GI transit time has thankfully gone back to normal but I worry about nutrient absorption (she has coat issues) and her bile acids were off in her last set of labs.

Metoclopromide PRN is used in people with delayed stomach emptying and intestinal motility as it increases peristalsis, but it has nasty neurologic effects .

Indeed it does muck up the dopamine system. Our vet prescribed metoclopramide (aka Reglan) for Saoirse when she had the bad pancreatitis flare as he was reluctant to prescribe the ondansetron I had requested after getting the steer from Elise and Hellen. She was on it for a couple of weeks till I could persuade the vet to give me an Rx for ondansetron (which I was not one bit happy with, given its side effect profile and the fact that cats don't have many of the receptors it targets. ) Part of his reluctance to prescribe was that none of his patients had been treated with it before, and the rest was down to price. He could only get Zofran from their wholesaler - retail of nearly £100 for 30 4g tablets. I was a bit annoyed about the latter because Saoirse's well-insured (plus I'd have found a way to pay for it if she hadn't been). Thanks to Tanya's Site I got in touch with a pharmacist who advised that cats tend to do better on the Bristol Laboratories generic than the branded drug anyway. I now get the Rx filled at a human pharmacy - vet's written Rx and the 30 tablets set me back less than £20.

Saoirse's head started to twitch after only the few weeks on metoclopramide. Thankfully the slight tic disappeared on discontinuation of the offending med. What annoyed me even more was that Saoirse was having major problems with diarrhoea and vomiting at the time: if she went more than 3 hours without eating she would get really painful vomiting bouts. That went down to 2½ hours on the metoclopramide. The last thing she needed was a med that sped up gastric emptying. The other worrying thing is that metoclopramide can lower the seizure threshold. My vet reassured me that none of his other patients had had such a problem but the prospect of having a drug with such a side effect on top of giving insulin (and Caninsulin at that!) made me deeply, deeply uneasy. I was very relieved when I switched her to ondansetron. She did great on it; and it saved her life.


Mogs


(@Kristina - apologies for the slight frankenthread! )
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[Kristina]

It's always nice to see the shared information. I'm getting educated! Hoping to have all the meds on hand for when Brady returns home tonight. So happy Stopping by the store to get lysine, test strips and ketone strips.

 

[Critter Mom]

I can see your smile from way over here!

 

[Kristina]

I can see your smile from way over here!

Here is one happy kitty (with scabby nose) finally at home. The steroids are working, but my work is undone - need to read and study all the information to make sure he doesn't relapse.

 

[Critter Mom]

Oh, my! What a handsome boy!!

I'm delighted for you both that he's home and on the mend (anti-jinx, anti-jinx). Sending a little kiss better for Brady's nose.


Mogs
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