Not Eating Well - Still not eating well??

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Ele & Blackie (GA)

Ele & Blackie (GA)

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On 12/23 Blackie started not eating as well as usual and he vomited several times. By 12/24 he wasn't eating at all and I started syringe feeding and got him to a vet (not my regular one). His blood work wasn't bad - it was better than it had been in several months. You can see all bloodwork in my signature.

The vet we saw said that his WBC was elevated for an older cat even though it was in the normal range. He thought he might have a kidney infection. They couldn't do a U/A, but the vet said kidney infections often don't show up in the urine. So they put Blackie on Zenequin and Cyproheptadin for appetite. He told me to continue the Pepcid that I was giving (2.5mg bid). He hasn't vomited since Friday morning.

On Monday we went back to my regular vet. He did an exam and didn't see anything obvious - normal heart, temp, no masses, bumps, pain, etc. He increased the dose of Zenequin and switched us from the Cypro to Mirtazapine 1/4 tab every 3 days.

Last night Blackie acted like he was very itchy and I thought it might be a side effect of the Mirt, but this morning he seems fine. Over the last few days he has been eating a little on his own and I have been syringe feeding too. I had stopped his supplements on Friday, but I'm starting them again today in hopes they will make him feel better. These supplements are Potassium, Renal Essentials, Dasuquin. I had not stopped his other meds, Gabapentin (for arthritis) and Calcitriol. He also gets 100ml of LR daily.

What I find most frustrating is that his renal numbers are pretty good, but he's still not eating like he should. I just don't understand why. I'm also concerned about getting the necessary food in him when I go back to work next week. I have lowered his dose of Lantus and I'm trying to find the best dose while he's not eating as well.

I weighed him this morning before his shot and I'm going to continue to do this daily so I can see if he's getting enough food. On the good side, he hasn't lost much weight. He was 12 lbs 9 oz this am and he is usually between 12 lbs 12 oz and 13 lbs 2 oz (this has been mid-day after fluids & food). Several weeks ago I measured out Blackie's food over a 24 hr period and he was getting 13 Tb of food. So I'm going to aim for 8 to 10 Tb of food now and see what happens. If he eats more great, but if not I can at least syringe feed that much.

Several people have suggested we have Blackie tested for pancreatitis. What is the most reliable test and where do they send it? My vet said that he doesn't think the test is reliable and I want to be able to give him more info.

Blackie is such a sweetie and I've been feeling really depressed over this. Other than the not eating well, he seems okay. He's peeing and pooping normally and he's cleaning himself. I would really appreciate any feedback you can give me on this. Thank you!!
 
Re: Not Eating Well - Pancreatitis Test??

I would get the fPLI test done. Though I believe it has to be done (blood taken) when the cat is having a flare-up to show a positive result. So I would request it being done soon. My vet, which is a cats-only vet clinic, uses this test and I believe many cats here on the FDMB have had the test.

Gump recently was having similar symptoms. He lost his appetite and pretty much stopped eating (normally he loves to eat) and became lethargic (also vomited a couple times). Initially we used appetite stimulants, buprenex, pepcid ac, fluids, but after a couple days he still wasn't eating much. We also did a blood panel which looked good. We then did the PLI test (along with TLI, folate and cobalamin tests) and the PLI came back at 36.5, where normal is 3.5 or less. Also his TLI was elevated and his cobalamin (vitamin B12) level was low. The PLI test takes several days to come back; and I believe it has to be sent to Texas A&M. Again it needs to be done during a pancreatic flare-up - that's what the concerns may be (and also waiting at least several days for a result may be a concern).

I'm not sure what turned Gump around, though he did seem to improve after finally getting some antibiotics (we used amoxidrops, because the vet was concerned about Clavamox upsetting his tummy). But now he is back to himself and eating great. I am glad I got the info from the PLI test, so if he gets sick again we'll have more info since it may likely be a flare-up. I also have started giving Gump weekly vitamin B12 injections since his cobalamin levels were low.

Here is a link with some info: http://www.felineoutreach.org/Education/Pancreas.html

P.S. Gump has also been in remission (since last spring) after almost 3 years on insulin. His bg numbers were pretty good during during this and seem to have even improved a bit since he started getting the B12 injections. When he was sick we also had x-rays and an ultrasound, which also made me feel good that there likely isn't something underlying that caused him to go off the juice after being a longer-term diabetic.
 
Re: Not Eating Well - Pancreatitis Test??

My Stinky's PLI test mirrored Jen & Gump's situation - same numbers and all. I believe it's the best test to accurately dx pancreatitis. Symptoms sound like it would dictate that test. Good luck.
 
Re: Not Eating Well - Pancreatitis Test??

Thank you all for your quick replies. Since Blackie has CRF too, I had looked at the site that Sue put up. I got some info on the IDEXX fPL test and emailed it to my vet. Do you think the Texas A&M test is better than the IDEXX one? IDEXX references the docs at Texas A&M. Thanks again!
 
Re: Not Eating Well - Pancreatitis Test??

Yes get the test. You can also get the full GI panel too while you are at it.

If your vet uses IDEXX then you can go that route. Last I knew Antec was not doing that test - they would send out to UT.

Always get bloods drawn on a Monday morning. This will ensure your best results with the lab and maybe some time left over at the end of the week to actually do something about it.

The UT site notes sample handling procedures that are inadequate IMHO.

Whenever sending to a University it is important to send via FedEx or UPS overnight. USPS can get caught up in their internal mail systems and cause the sample to wait. Also send on Monday so the sample does not sit over the weekend.

I know that folate for instance is very time sensitive.

Also it is a FASTING test. So make sure you fast before which can be tricky with a diabetic cat.

You may want to get the rest of the GI panel done while you are doing the fPL test.

I do not believe they have to be in a flare for the test to register. H had no problem showing a high fPL when he was not in a flare. There is chronic and acute pancreatits. The flare is acute.

As for the disease itself. Some cats are helped by a round of antibiotics - some not. You are doing gab which is good. I didn't have success with bup. The progress of the disease is of waxing and waning episodes. They usually last about 3-5 days. SubQ helps keep them going while they are not eating. Do give the appy stims - try the different ones. I would max the dose when he was not eating. It is very difficult to manage with a diabetic cat because their insulin needs will change rapidly with the amount of food they consume. This is one of the primary reasons I was so happy with the insulin we used - I was able to adapt to the changing needs quickly.

Lastly food. I was dilly dallying about H's food - I knew that the fat content of his diet might be a problem with this P-titis. The first time I saw H in a serious flare [clearly in major pain] I got on the wagon and started cooking/home prepping for him. After that he never had a flare that bad again. But, he did continue to have what I believe to be flares that were mainly accompanied by a little lethargy and loss of most of his appetite. So it is my strong personal opinion that with H, reducing the fat in his diet [from the crazy full on Wellness fat content] did help.

B-12 (cyanocobalamin) is also thought to help. There is some thought that perhaps B-12 might increase or help feed cell division. So if your cat has cancer this might register as an issue for you. For me, it did not. I wanted him to feel better even if in the off chance it made his cancer progress faster. What they don't use they pee out anyway.

And this is a good "classic" article on inappetence:
http://www.vin.com/vindbpub/searchpb/pr ... r00168.htm
As the article points out - cancer among other things is something that can cause inappetence for various reasons. And the article has some good hints about feeding. I fed H on a plate so that his whiskers would not have to touch the side of a bowl - and I do think that helped.
 
Re: Not Eating Well - still not eating well

My vet didn't see any value in doing a fPLI test since we are doing almost all of the treatments for pancreatitis anyway. We started buprenex last night, but it made Blackie very spacy and sleepy and he wouldn't eat at all until seveal hours after I gave it. He still isn't eating much this morning and I'm still syringe feeding. I'm going to call the vet again and see if there's anything else we can do.
 
Did you see this recipe, Ele?

THE '~LIVER SHAKE~' FOR SICK CATS

This liquid food is appropriate for cats suffering from conditions where they are eating very little or not at all such as anemias, leukemias, deficiency states with symptoms of lethargy, listlessness, and weakness.

1 cup RAW LIVER (BEEF, or CHICKEN)
1 cup FRESH CARROT JUICE or V-8, or Tomatoe Juice
1/4 cup *FRESH FILTERED WATER
1 RAW EGG YOLK
1 tsp.KELP POWDER OR SPIRULINA


COMBINE AND MIX IN A BLENDER UNTIL LIQUEFIED. (Note: it will be frothy)

Dosage:

Administer 10cc daily 3-6 times a day. (6Occ per day max)

Some cats will need to be force-fed with an oral syringe, while others will drink it out of a bowl.
 
Thanks, Sue. I just saw it this morning when I was looking through the Health Links. Blackie went low this morning and I'm working to get him out of the 30's. As soon as he comes up, I'll run to the store and buy some liver and try it.
 
If he is not eating currently or the appetite is off those low numbers are so typical. They come and go seemingly without much notice. Then the appetite kicks back in and it is a game of catch up. Except I did seem to get a little notice with H's food maybe one cycle before the numbers actually did drop. But again I was weighing H's food so it was probably somewhat easy for me to spot. And I can't speak for Lantus but with PZI I would usually get a large drop in PSes that would put me on notice to reduce the dose and get ready. Judy went though nearly the same appetite swings with Squamee. But Squamee's appetite swings were worse than H's. But those drops in PSes were typical with Squamee too.

It is so tough Ele.

You can always try lower doses of the bup. For just about any cat med I first give 1/2 the recommended dose [except something like pred or chlorambucil] and then work from that. I'm not sure if you are still doing the gab - but I could imagine there might be a synergy between it and the bup as there are with many other drugs and opiates. So a relatively small amount of bup might go a longer way.

I disagree with the vet. Information is power. If it is not p-titis then you know to keep looking. Also a high TLI too might indicate the potential of other things potentially going on too - but my memory is really foggy about that. You would have to do your reading on that.
 
Hi Ele,
Cody also is on gabapentin, B12, daily fluids, and pepcid A/c, but occasionally seems to have a P'itis flair. The 3 big clues for me:

frog leg position- stomach lying position with back legs stretched out straight behind him
vomiting food
not licking the plate clean

In addition to what you are already doing a couple suggestions:
-antibiotics because the p'itis is the release of errant digestive enzymes into the abdominal cavity- which could "eat" organ walls, and create an abcess which gets infected.
-Bupe is fantastic for p itis pain, but I do seem to remember it has a synergistic effect with the gab which may be increasing its potency for Blackie, as Gator said.
(FYI- Cody is about 13 lbs and is now on 30mg Gabapentin BID with no unusual lethargy)
- I have noticed a correlation with flairs and Friskies Beef and Liver Special Diet, and 9 lives flavors. I'm guessing the fat....

Hope Blackie feels fine again soon :-D
 
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