Fred: Pulled out his e tube!

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He's not eating voluntarily but I gave him 2.5 ml of FF/ Pedialyte via syringe twice this pm.
Keep trying to get him to eat a little bit very frequently. You might not get much sleep over the next few days.

I hope that the ondansetron will help when you start giving it. If you can get the nausea under control then an appetite stimulant might then help Fred to eat a bit more under his own steam. I'd suggest you ask your vet about cyproheptadine. It's gentler in action than mirtazapine but it doesn't have the risky side effect profile of mirtazapine. (Mirtazapine can induce serontonin syndrome.) Although its clinical benefits don't last as long as mirt, a suitable dose of cyproheptadine can be given every 8-12 hours as needed. It can help a cat keep eating better while nausea symptoms reduce. Once the nausea subsides the appetite usually gets better without the need for a stimulant.

Is that too much ?
Not for his weight. For example, Saoirse was prescribed 0.27ml every 8 hours after a surgery earlier this year and her weight was about 9.5lbs at the time.

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Keep trying to get him to eat a little bit very frequently. You might not get much sleep over the next few days.

I hope that the ondansetron will help when you start giving it. If you can get the nausea under control then an appetite stimulant might then help Fred to eat a bit more under his own steam. I'd suggest you ask your vet about cyproheptadine. It's gentler in action than mirtazapine but it doesn't have the risky side effect profile of mirtazapine. (Mirtazapine can induce serontonin syndrome.) Although its clinical benefits don't last as long as mirt, a suitable dose of cyproheptadine can be given every 8-12 hours as needed. It can help a cat keep eating better while nausea symptoms reduce. Once the nausea subsides the appetite usually gets better without the need for a stimulant.


Not for his weight. For example, Saoirse was prescribed 0.27ml every 8 hours after a surgery earlier this year and her weight was about 9.5lbs at the time.

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He's not taking mirtazapine.
 
Someone mentioned earlier that I should be cautious with Fortiflora? Should I not be adding it to his food?
From the document you gave us a look at earlier I see the vet dispensed it for you so a probiotic may be a key part of the vet's treatment plan.

That said, Fortiflora can make some cats nauseated. Perhaps tonight try a feed with a teensy-weensy pinch of Fortiflora in it and a feed without and see whether Fred shows any difference in reaction to the two. If he does show signs of it disagreeing with him then let the vet know in the morning.

He's not taking mirtazapine.
I noted that from your earlier posts. However, if you ask your vet for an Rx for an appy stimulant s/he may go for mirtazapine as a first choice. Some vets aren't as familiar with cyproheptadine hence the information I provided so that you can discuss options with your vet.


Mogs
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Do all you can to get the ondansetron Rx; based on over two years of managing chronic pancreatitis I found it to be far superior to Cerenia alone for the treatment of nausea.

My hospitalized bub was on Cerenia up until yesterday when we brought him home and started ondaneatrton... And he is finally eating again on his own since last sunday, from his pancreatitis/dka emergency. He had lots of fluids and monitoring as well, but may have not been a coincidence as the other meds still werent helping enough with the nausea (still gagging at smells).. Wish you and your baby the best of luck!!
 
My hospitalized bub was on Cerenia up until yesterday when we brought him home and started ondaneatrton... And he is finally eating again on his own since last sunday, from his pancreatitis/dka emergency. He had lots of fluids and monitoring as well, but may have not been a coincidence as the other meds still werent helping enough with the nausea (still gagging at smells).. Wish you and your baby the best of luck!!
@Justyn are you combining Cerenia and Ondansetron?
 
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It's time for night meds. Bupe, Ondan, metron. He's not energetic at all. He moved from balcony to bedroom. That's all. At least he's not in loaf position which sometimes tells me he's hurting. Pray my man feels better tomorrow. Thank you all for being here for us today.
 
Not eating. AMBG @95 ( a little higher than his norm but still normal BG OTJ)..he jumped up in the bed with me last night. First time in a week. He hasn't voluntarily eaten since Sat AM when I brought him home from hospital. And that was a small amount. He urinated during the night but no BM. The only food/ water he's had is what I gave him with my finger/ syringe. I'm thinking he's gotta go back to vet.
 
Not eating. AMBG @95 ( a little higher than his norm but still normal BG OTJ)..he jumped up in the bed with me last night. First time in a week. He hasn't voluntarily eaten since Sat AM when I brought him home from hospital. And that was a small amount. He urinated during the night but no BM. The only food/ water he's had is what I gave him with my finger/ syringe. I'm thinking he's gotta go back to vet.


If he is still not eating on his own then a trip back to the vet is the safest choice. Even with what you have been able to get him to eat with finger and syringe feeding it is not nearly enough and this could end up causing fatty liver disease. Another option if they can't get him eating is to have a feeding tube put it. You can ask the vet about that. But this has been going on too long with not eating.
 
Not eating. AMBG @95 ( a little higher than his norm but still normal BG OTJ)..he jumped up in the bed with me last night. First time in a week. He hasn't voluntarily eaten since Sat AM when I brought him home from hospital. And that was a small amount. He urinated during the night but no BM. The only food/ water he's had is what I gave him with my finger/ syringe. I'm thinking he's gotta go back to vet.
I'm sorry to read this, Jamye. I have no idea if your vet will suggest a feeding tube but if it comes up, don't be put off. It can be the ticket to success in getting Fred back to normal and is easier to manage than you might think. I've lived the experience myself with another cat many years ago. As you know, Justyn is helping Socks this way right now.
 
I'm thinking he's gotta go back to vet.
I think so too, Jayme.

I see that you've been following Justyn and Socks. With the non-existent appetite I think it might be a good idea to discuss the possibility of using an e-tube to help Fred to eat. Fred has gone many days now without eating properly and that raises the risk of hepatic lipidosis. Keep a check on the whites of his eyes and his gums to make sure they're a healthy colour.

Here is the page with info on feeding tubes from catinfo.org:

Feeding Tubes

I recommend you ask the vet to check Fred for ketones. Even though his BG was in the normal range yesterday and this morning yesterday it is safer and wiser to make sure he is ketone-free. The vet will also need to check Fred's hydration levels (and possibly do other diagnostic tests).

WRT the feeding tube a cat needs to be anaesthetised briefly while it's place. Given Fred's possible odd reaction to the sedative last week it would be a good idea to discuss anaesthetic choices with the vet if it turns out Fred may need a feeding tube. I don't know whether this will be of any help to you but any time my cats have needed anaesthetics I always ask if it is possible for them to receive something to reverse the anaesthetic as soon as the procedure is over. I've no idea whether that might be an option for Fred but it's no harm to ask. Be sure to tell the vet about Fred's odd clinical signs the night you brought him home. (Fred might be particularly sensitive to drugs with serotonergic effects.)

The full panoply of meds that can be used for pancreatitis are B12 injections, combination treatment with ondansetron and Cerenia for nausea, bupe for pain, cyproheptadine for appetite (or mirtazapine but I personally don't like the side effect profile of the mirtazapine and worry over drug interactions/serotonin syndrome), metronidazole (if indicated) plus perhaps a one-off dose of famotidine in case tummy acid is contributing to the nausea (helped Socks). I'm worried that Fred has eaten next to nothing over the last few days. Dr Pierson recommends using a feeding tube sooner rather than later if one is required. (When Saoirse had a bad flare shortly after her initial Dx I managed to keep her eating a little bit for me till I got the right meds for her (vet needed some persuading because ondansetron and cyproheptadine were not meds he would normally prescribe) but it required intensive nursing at home round the clock, day and night for several days to keep something in Saoirse's stomach (and enable me to give her her insulin) until the meds became fully effective (about 48 hours later). If that hadn't worked I'd have asked the vet to insert a feeding tube for her. Had I not been able to get some food into her I would not have waited. (I lost a young, beautiful girl to hepatic lipidosis a few years earlier due to a dreadful vet waiting too long to offer e-tube treatment; wouldn't wish that heartache on anyone.)

BTW I forgot to mention yesterday that there is a MAJOR drug interaction between ondansetron and tramadol - the combination can induce serotonin syndrome (potentially life-threatening). Here's a link to the drugs.com interaction checker with details:

drugs.com - Major drug interaction between ondansetron and tramadol

I'm awful tired today so can't be around as much (chronic health issues) but please know that I will continue to keep you both in my thoughts and prayers.

:bighug:


Mogs
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If you think the Bupe is causing issues for Fred, ask your vet about Codeine. I used it with my girl after dental extractions. My girl is a kibble addict and I was very concerned about her being able to eat following her surgery. The codeine made her a bit sleepy but didn't have any other side effects and relieved her discomfort sufficiently that she ate without any problem. They gave me a gel compound that I just rubbed into her pinnae which made it super easy to administer.
 
@Justyn are you combining Cerenia and Ondansetron?

No i believe was on Cerenia prior but i do not think he is still on it now... But i agree that a feeding tube may be a good option to get him going and feeling more normal! Socks honestly didnt eat at all for 5 days before we put the tube in, and he was fed some food in the tub at the vets, and the next day when we brought him home he started showing signs of wanting food - and now he's eating all on his own!!! So might just be what he needs as pancreatitis seems to really kick our kitty's butts! :(

Now our issue is getting his BGs under control - they've been high 400s and low 200s for his range mostly...
 
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No i believe was on Cerenia prior but i do not think he is still on it now... But i agree that a feeding tube may be a good option to get him going and feeling more normal! Socks honestly didnt eat at all for 5 days before we put the tube in, and he was fed some food in the tub at the vets, and the next day when we brought him home he started showing signs of wanting food - and now he's eating all on his own!!! So might just be what he needs as pancreatitis seems to really kick our kitty's butts! :(

Now our issue is getting his BGs under control - they've been high 400s and low 200s for his range mostly...
Prayers y'all get that boys numbers down.
 
Still haven't heard from vet re ultrasound results. She did say, this morning when I called, that he is still drooling/ nauseated. I'm grateful that I've been busy with classes/ midterms. But dying to know results of ultrasound.
 
((((((((Fred))))))))

I just want to wave a magic wand and make him better ... NOW!

Have they managed to feed him a bit better with the tube today?

I'm glad you had some bit of distraction from the worry, Jayme; constant anxiety is very hard on body, mind and spirit.

Continuing to send prayers and healing thoughts for your beautiful boy and :bighug:s for you.


Mogs
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((((((((Fred))))))))

I just want to wave a magic wand and make him better ... NOW!

Have they managed to feed him a bit better with the tube today?

I'm glad you had some bit of distraction from the worry, Jayme; constant anxiety is very hard on body, mind and spirit.

Continuing to send prayers and healing thoughts for your beautiful boy and :bighug:s for you.


Mogs
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I completely second the 'constant anxiety being hard on your body and mind'! I really have been taking a toll from the amount of stress from just worrying about how he was doing, what test results were in that they weren't calling me about yet, and then more worry about him! lol but you just have to try to stay calm and positive for Fred's sake! I could hardly eat for the past week and am now having some stomach issues from that... but what happens will happen, but you still have to take care of yourself so you're ready to take care of Fred when he's ready to come home!!!
 
Fred is home again, with e feeding tube and more meds. Ultrasound showed thickened bowel so we are treating for IBD for a week. If he doesn't improve, the big C word comes into the possibility. Pray he gets better.
@Justyn I had upset tummy yesterday! It's a lot for us to deal with but these damn cats are our loves! Hope Socks is doing well.
 

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The diagnosis. And plan. Vet said two of the three triggers were present in this diagnosis. No liver trigger.One of my many concerns is the Royal Canin Selected Protein, which is recommended because it's hypo-allergenic, due to his bowel issue. It's got more carbs. So we've kinda got a catch 22 situation here. His BG was 200 at the vet's today, which isn't terrible, but they gave him RC, obviously diluted, in his ETube last night and this morning. I'll have to keep an eye on the BG. I'm just glad he's back home.
I'll have to start a GOFUND ME.
 

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Relieved to hear that Fred is now getting food again.

For the IBD side of things I very much recommend reading through the whole site at:

www.ibdkitties.net

I know there's an internet support group for IBD cats, too, but can't remember the web link (I have seen posts mentioning it here at FDMB).

Will write further tomorrow (desperately tired here) but sending prayers in the meantime.

:bighug:


Mogs
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I found a list of toxic plants on that website and I have a honeysuckle that Fred could have chewed on. Food allergies are a big factor as well.
Thank you for sharing that website, Mogs! I shared it with my vet.
Goodnight from Texas. Prayers appreciated. Hope y'all are well.
 
Awwww i am sorry to hear they suspect IBD... My little guy had shown signs of it too on the ultrasound, but it was about the same as it looked on an xray a few years ago so they arent thinking that's what caused this.. But unfortunately socks has had some poop issues since weve been home but hoping some pumpkin will help level him out. Hopefully you are able to get some snuggle-relaxation with Fred and prayers for lots of healing and comfort for both of you!
 
Awwww i am sorry to hear they suspect IBD... My little guy had shown signs of it too on the ultrasound, but it was about the same as it looked on an xray a few years ago so they arent thinking that's what caused this.. But unfortunately socks has had some poop issues since weve been home but hoping some pumpkin will help level him out. Hopefully you are able to get some snuggle-relaxation with Fred and prayers for lots of healing and comfort for both of you!
Thank you! Fred is poopy today. Nauseated. We completed his 2nd e tube feeding this morning. About to do a 3rd ( every 4 hours @30 cc). Hope your guy is better.
 
Thank you! Fred is poopy today. Nauseated. We completed his 2nd e tube feeding this morning. About to do a 3rd ( every 4 hours @30 cc). Hope your guy is better.

My guy was doing really good up until this morning... tested 'small' amounts of ketones in his urine and 'coincidentally' he's not as interested in his food - still eating - but not as much... I'm heartbroken as the nurse at the vet advised their recommendation is to bring him back in for hospitalization.. and i truly dont know what to do because i dont know how we will ever get him regulated at home without the issue of building up ketones in the meantime... I do NOT want to take him back to the vet... absolutely a mess today because of this...
 
Oh man that is so not what we want for our babies. They've been through so much lately. I'm sorry Justyn. I'm sending prayers from Texas! Fred did ok with the 3 feedings but still very nauseated. He's chilling on the balcony now which is good to see vs being under the bed. ❤️
 
Oh man that is so not what we want for our babies. They've been through so much lately. I'm sorry Justyn. I'm sending prayers from Texas! Fred did ok with the 3 feedings but still very nauseated. He's chilling on the balcony now which is good to see vs being under the bed. ❤️

Yes... the last thing that i expected to go wrong so quickly... sorry to hear he's nauseous and hopefully that'll get better soon... Lots of prayers for you guys too! Glad to hear he's enjoying himself!!
 
Why is he still so nauseated? Maybe I haven't given the meds enough time to kick in? No. He's been on Cerenia and Ondan several days, now. He's off Bupe. I posted a list of his meds yesterday. Is it the Mert? :-(
 
Hi Jayme,

Sorry to hear Fred is still queasy. With pancreatitis the nausea symptoms may increase as each med dose wears off. They may also wax and wane on different days, even with the right meds on board BUT the anti-nausea meds help the cat to keep eating. Nursing a pancreatitis kitty through a bad flare can be very tough going. It takes as long as it takes for the flare to subside. Administering a lot of meds is tough, too, but one just has to plough on, one day at a time. Having been there myself I really feel for you and Fred. :bighug:

I've only had to treat Saoirse once with metronidazole but the formulation our vet prescribed was a med called Stomorgyl 2. It's a combination of metronidazole and spiramycin. The vet prescribed this because apparently the Stomorgyl isn't as foul-tasting as the straight metronidazole. (The Stomorgyl tablets are film-coated). Saoirse had always been easy to pill so she didn't have the drooling problems. I have no idea whether the metronidazole may or may not have contributed to her nausea symptoms. Are you giving Fred his meds via the feeding tube?

As I mentioned before, Fortiflora may nauseate some cats. I believe that when treating with methimazole it is necessary to give a probiotic at the same time. Saoirse was prescribed a kaolin + probiotic paste (Pro-Kolin). It might be worth asking your vet about whether they know of an alternative probiotic to Fortiflora just in case the Fortiflora might be contributing to Fred's nausea.

Re the bupe, does Fred crouch into a tense-looking meatloaf position at any time (and particularly after he gets food)? If yes then that might be a clinical sign of pain. Hiding (especially after food) or seeking out cooler surfaces to lie on may also point to physical discomfort. If you notice any such behaviours let your vet know and ask if Fred may still need bupe for pain relief.

Is Fred eating anything by himself? Also, is he drinking enough? As I said before Saoirse didn't need an e-tube when she had that bad flare not long after her Dx. I was able to keep her eating small frequent amounts with the help of meds and a lot of hands-on coaxing. Consequently I was able to add a generous amount of very light chicken broth (homemade) and water to each meal to keep her very well hydrated (very important when treating a flare). Our vet said I did well to keep Saoirse hydrated because it is very important for a kitty with pancreatitis. I suggest asking your vet for advice about how to keep Fred properly hydrated; I don't know how to go about it with the e-tube in place.

At the height of Saoirse's flare she needed help from an appetite stimulant alongside the ondansetron to keep her eating. I treated her with small doses of cyproheptadine (1/4 of a 4mg tablet every 8-12 hours, 10lb cat). I noticed that she seemed to feel better in herself on days when she was given both ondansetron and cyproheptadine. Cyproheptadine is an antihistamine and I wonder whether it might have had a soothing effect on her system but I have no evidence to support this; she just seemed better in herself with the combination on board. It might be worth asking your vet whether similar might help Fred.

Hope some of the above is helpful to you. Sending more prayers and :bighug:s.


Mogs
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Hi Jayme,

Sorry to hear Fred is still queasy. With pancreatitis the nausea symptoms may increase as each med dose wears off. They may also wax and wane on different days, even with the right meds on board BUT the anti-nausea meds help the cat to keep eating. Nursing a pancreatitis kitty through a bad flare can be very tough going. It takes as long as it takes for the flare to subside. Administering a lot of meds is tough, too, but one just has to plough on, one day at a time. Having been there myself I really feel for you and Fred. :bighug:

I've only had to treat Saoirse once with metronidazole but the formulation our vet prescribed was a med called Stomorgyl 2. It's a combination of metronidazole and spiramycin. The vet prescribed this because apparently the Stomorgyl isn't as foul-tasting as the straight metronidazole. (The Stomorgyl tablets are film-coated). Saoirse had always been easy to pill so she didn't have the drooling problems. I have no idea whether the metronidazole may or may not have contributed to her nausea symptoms. Are you giving Fred his meds via the feeding tube?

As I mentioned before, Fortiflora may nauseate some cats. I believe that when treating with methimazole it is necessary to give a probiotic at the same time. Saoirse was prescribed a kaolin + probiotic paste (Pro-Kolin). It might be worth asking your vet about whether they know of an alternative probiotic to Fortiflora just in case the Fortiflora might be contributing to Fred's nausea.

Re the bupe, does Fred crouch into a tense-looking meatloaf position at any time (and particularly after he gets food)? If yes then that might be a clinical sign of pain. Hiding (especially after food) or seeking out cooler surfaces to lie on may also point to physical discomfort. If you notice any such behaviours let your vet know and ask if Fred may still need bupe for pain relief.

Is Fred eating anything by himself? Also, is he drinking enough? As I said before Saoirse didn't need an e-tube when she had that bad flare not long after her Dx. I was able to keep her eating small frequent amounts with the help of meds and a lot of hands-on coaxing. Consequently I was able to add a generous amount of broth to each meal to keep her very well hydrated (very important when treating a flare). Our vet said I did well to keep Saoirse hydrated because it is very important for a kitty with pancreatitis. I suggest asking your vet for advice about how to keep Fred properly hydrated; I don't know how to go about it with the e-tube in place.

At the height of Saoirse's flare she needed help from an appetite stimulant alongside the ondansetron to keep her eating. I treated her with small doses of cyproheptadine (1/4 of a 4mg tablet every 8-12 hours, 10lb cat). I noticed that she seemed to feel better in herself on days when she was given both ondansetron and cyproheptadine. Cyproheptadine is an antihistamine and I wonder whether it might have had a soothing effect on her system but I have no evidence to support this; she just seemed better in herself with the combination on board. It might be worth asking your vet whether similar might help Fred.

Hope some of the above is helpful to you. Sending more prayers and :bighug:s.


Mogs
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Wow thanks for jumping in so quickly Mogs. I wish I could put my answer where each of your questions are. I'll try to answer as many as I can.
And thank you for helping when I know you are still hurting.
Fred was out from under the bed and on the balcony with me most of the day. My grandson helped me give the 4:00 feeding. He's under the bed now and drooling. All the time drooling. When he's been out today he didn't seem to be in discomfort. He's not wanting to eat on his own obviously because of nausea. The only good is via tube along with water before and after feeding and not drinking water on his own. When I say water, I mean Pedialyte. In his food and before and after feeding. Hope I answered everything. I have a call in to the vet because his BG was 320 tonight before food. The prednisone and higher calorie food are to blame. But I knew this going into this treatment for the IBD. It's feeding time. Back soon.
I'm back. Had to give him a butt bath for poopies. He didn't do too bad in the tub. I did not give Fortiflora tonight and he's not drooling.
Goodnight and thank you!
 
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I have a question about the syringe for B12 injection. They gave us 3cc/ml, 25 G x 5/8 ". I think the needle is too big. I remember the insulin needle being u-100 and was smaller. He will only be getting 1cc 1 x week but I think it's a big needle. Your thoughts?
Update: (should I keep this same thread or start new?) He's still nauseated and I didn't give Fortiflora last night. I gave famotidine about an hour before his feeding/ other meds ( Pred, Cerenia, Metronidazole) this AM. His BG was 235 this AM. (Last night before feeding BG 320. )
He jumped up in the bed with me during the night because we had storms. He's been on the floor mostly. He's not active. He is urinating and had diarrhea last night, had to get a partial bath and wasn't happy.
I'm begging Robert to let me post our GoFundMe.
Hope all y'all are well.
 
I have a question about the syringe for B12 injection. They gave us 3cc/ml, 25 G x 5/8 ". I think the needle is too big. I remember the insulin needle being u-100 and was smaller. He will only be getting 1cc 1 x week but I think it's a big needle. Your thoughts?
Update: (should I keep this same thread or start new?) He's still nauseated and I didn't give Fortiflora last night. I gave famotidine about an hour before his feeding/ other meds ( Pred, Cerenia, Metronidazole) this AM. His BG was 235 this AM. (Last night before feeding BG 320. )
He jumped up in the bed with me during the night because we had storms. He's been on the floor mostly. He's not active. He is urinating and had diarrhea last night, had to get a partial bath and wasn't happy.
I'm begging Robert to let me post our GoFundMe.
Hope all y'all are well.
Insulin needles are usually 28 - 31 gauge (higher number = thinner needle). They might have given you a 25 gauge needle for the B12 if that liquid happens to be thicker than insulin. Just a thought ...
 
Hi Jayme,

Sorry to hear about Fred's accident, poor little love. He is blessed to have such a loving and caring mom. :bighug:

I did not give Fortiflora tonight and he's not drooling
Interesting.

Be sure to give your vet a call at the earliest opportunity about the probiotic. As best I can remember a probiotic should be given alongside the methimazole metronidazole. If the Fortiflora is the culprit causing the drooling then perhaps your vet may be able to recommend an alternative probiotic for Fred. If there's no alternative perhaps ask your vet whether spreading the daily Fortiflora dose across all feeds for the day might be possible.

Sending more prayers and healing thoughts for Fred.

:bighug:


Mogs
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Hi Jayme,

Sorry to hear about Fred's accident, poor little love. He is blessed to have such a loving and caring mom. :bighug:


Interesting.

Be sure to give your vet a call at the earliest opportunity about the probiotic. As best I can remember a probiotic should be given alongside the methimazole. If the Fortiflora is the culprit causing the drooling then perhaps your vet may be able to recommend an alternative probiotic for Fred. If there's no alternative perhaps ask your vet whether spreading the daily Fortiflora dose across all feeds for the day might be possible.

Sending more prayers and healing thoughts for Fred.

:bighug:


Mogs
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Thank you! He's my love! He's my heart! You know what this feels like. ❤️
Methimizole? He's getting Metronidazole. Is that what you mean?
He was still drooling this morning so apparently it's not the Fortiflora.
I Actually gonna go to the vets because they gave me the wrong cerenia yesterday. I just finished the first box. It's supposed to be 16mg but they gave me 60 mg yesterday. Good thing Sim an overly cautious non trusting OCD mommy.
 
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