Hi LM,
I'm relieved to hear from you; I was very worried about Chicklet and about
you. I lost a cat to hepatic lipidosis (and a dreadful vet) and when Saoirse would not eat for me when she had the really severe pancreatitis flare I was
consumed with fear so I have a ringside seat appreciation of how very worried you must be.
You'd need to check with your vet about when to give the next dose of mirt to Chicklet. Saoirse's only half the weight of Chicklet and the one mirt dose she had lasted for about 72 hours. All I can share experience-wise is how I administered cyproheptadine to Saoirse. In a nutshell, I gave her a dose then watched her response to food pretty much 24/7 while she was severely inappetent. The vet told me I could give one dose every 8 hours but after Saoirse's mirt scare I was determined to be very cautious with the new med. I logged the time I gave the first dose and then waited till she wouldn't eat under her own steam. Now that I knew she was OK on the cypro I gave her the next dose and again logged the time. It took several (worrying) hours for the appetite stimulant effect to kick in again. Thereafter I would watch her to see when her appetite seemed to be waning. As long as it was later than 8 hours after the previous dose I gave her another dose. Some days she'd only need two doses; some days she'd need three. I aimed to give her the minimum amount of medication to keep her eating. Sometimes I let her go a little bit too long before giving the next dose and there would be a bit of a lag before she'd eat again without coaxing. Saoirse did better when I managed to keep up the momentum of the drug's benefit. As I learned to read her clinical signs better I finally got to the stage where I could optimise the dose timing to keep her eating with ease. I always logged the times I gave the doses and gradually she was able to go longer and longer between doses and I was able to taper her off the cypro.
For information, cyproheptadine can also have an antidepressant effect and I found that it did improve Saoirse's mood. Maybe mirtazapine is similarly helping Chicklet.
An important note; Saoirse also received anti-nausea medication while she was taking cyproheptadine (generic ondansetron). She needed the anti-nausea medication a lot longer than she needed the appetite stimulant. Is Chicklet showing any signs of nausea when you give her the food? Here's a
nausea symptom checker. If she is showing signs of nausea there are details of treatments on that page which you might like to discuss with your vets.
Perhaps if you give your vet a ring and ask about the minimum amount of time you should leave between doses of mirtazapine for Chicklet and an anti-nausea treatment if appropriate it might help you to get a regimen in place which is ideal for Chicklet. It might be an idea to ask your vet if a course of B12 injections might help Chicklet, too; it can help with appetite.
I am very relieved for you that Chicklet is eating again. Even if there is still a way to go before she's eating normally it's a big step forward.
I am, however, worried that your vet is insisting that you completely withhold insulin while Chicklet is having difficulty eating. As discussed previously, the standard recipe for DKA is lack of food + lack of insulin + infection (or other systemic stressor). With the inappetence problem and numbers as high as 20.3mmol/L that really worries me; withholding all insulin will put two of those pillars in place. I'm not familiar with Prozinc but other members here are. I'm tagging
@Sue and Oliver (GA) and
@Meya14 to see whether they're online and might be able to advise you better.
If I were in your boat I would immediately start getting BG readings every 2-3 hours and log when Chicklet eats and how much. I would then go back to the vet as soon as possible with that data since it will provide evidence of where Chicklet's BG levels are and be a guide for safe dosing.
Tell the vet in no uncertain terms that you are concerned about risk of DKA. Ask the vet for a "no shoot" number and advice on a token dose to give Chicklet so that she gets at least
some insulin. I would also ask the vet (and also here) for a recommendation on a very calorie-dense food to give to Chicklet for the time being: she needs
calories right now and if she's only eating very little, the more calories you can pack into the small amount of food the better. Needless to say, monitor very closely for ketones. Both of you have enough to contend with already. I hope your vet will be helpful. If you get nowhere with the vet, post for assistance here.
I hope some of the above helps. We're here for you both, LM. Update us when you can.
Mogs
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