Stopped Eating & Drinking, Diarrhea

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Bramble&Amy

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Bramble is a 14 year old large red tabby. He has been on PZI for 3 years, started with a new compounded formula about last March. He's up to 4 units until now. I took him to the Emergency Vet last night because he had stopped eating and drinking and was hiding. He had been having dark and, when I cleaned it up, reddish diarrhea. I assumed blood. The last incidnet was 36 hours ago, and since no more diarrhea. The vet said his blood work is normal but he probably have IBD or Pancreatitis. He came home and to my surprise he ate and drank a bit but now he's stopped again. He hasn't had anything in probably 8-12 hours or so. He is interested in it but when I put his bowl under his nose, he licks his lips but doesn't drink. The Emergency Vet prescribed He doesn't look like his eyes are glazed over but I know he can't go on like this. What can I do? I gave him the presecription that the Emergency Vet prescribed, the name is Metrondiazole, I think is it's name. I gave it to him and he barfed it back up and hasn't eaten or drunk since!
 
You might change your subject to "Pancreatitis or IBD ?"

I think you should call the ER vet back and give an update, and ask for advice. You should also call your regular vet and see what he/she recommends.

If it's pancreatitis, the cat is likely in pain and may need some pain medicines like buprinex. The cat might also benefit from some ciproheptadine which is an appetite stimulant. I don't have personal experience with pancreatitis but I think lower fat diet may help.

For IBD, diet is also very important.

For today, I would get some chicken breast and simmer it in some water for 10 min or so. Then shred it and hand feed it to your cat. They will often eat from your hand even if they will not eat from a dish.

Please let us know what the vet says!
laur
 
It sounds like he's nauseous. You could give 1/4 of a Pepsid AC (not the Pepsid Complete). It's safe to give with metronidazole and will help to settle Bramble's stomach. It may be a good idea to speak with your regular vet if you need an appetite stimulant or if further tests are needed. You'll need an fPLI to rule out pancreatitis if it wasn't done at the ER.
 
I don't know if it'll help, but you may want to check out the poop chart here.


Suggestions for pancreatitis: first off, review this post by vet tech Jojo; it's pretty informative, with lots of info. Then call your regular vet and make sure that the emergency vet faxed over copies of your visit and their diagnosis (most places do). Explain that Bramble is a diabetic who hasn't eaten for however-long-its-been, and that since you can't give insulin you're worried about complications due to his diabetes (like ketones or DKA), as well as heptatic lipidosis (a liver problem that occurs when they don't eat for long periods of time).

Explain that you'd be interested in a small amount of painkillers for Bramble to take through the weekend. Buprenex would be my preference, but your vet (1) may not want to prescribe buprenex without seeing Bramble in person; or (2) may not want to prescribe buprenex. without a formal diagnosis, which may take more time than you're comfortable with (if they actually run the fPLI blood test, it could be up to a week). If your vet balks at buprenex, ask them what you *can* get.

For pancreatitis, you'll also be interested in sub-Q fluids. If you haven't done them already, explaoin to your vet that the weekend is coming up and you're concerned about hydration. Ask your vet if you can bring Bramble in and have someone give Bramble the fluids, while showing you how to give them at the same time. Then you should hopefully be able to bring the bag of fluids home, as well as a few spare needles and you'll be able to treat him at home. Please be aware that some cats need less insulin for the shot or two following the sub-Q fluids, so make sure you test Bramble's blood before giving insulin. Melissa and Popcorn have links to some great tips on giving sub-Q fluids here.

Also, ask your vet for some appetite stimulants. The two main ones are mirtazapine and cyproheptadine. Mirtazapine is preferred by some folks because it only needs to be given once every three days. I prefer cyproheptadine; while it should be given every 12 hours, mirtazapine can make a cat edgy and constantly meowing for 2-3 days. But if all your vet can give you is mirtazapine, take it. Also, my personal preference for appetite stimulants is to get them in transdermal form; that's a little gel that you rub on the inside of the ears. It can also come in pills or a liquid that you squirt into the cheek (not directly into the mouth -- the cat can accidently breathe it into his lungs!) Like I said, the transdermal gel is my personal preference; take whatever you can get from your vet.

Finally, ask your vet if they can sell you a bottle of injectible B-12. This is a very safe vitamin, so hopefully there shouldn't be any problem with it unless your vet doesn't have any available. If they don't have any on hand, ask how long it would take to get in, or whether they'd be willing to call in a script to another vet. (Many states will let one vet call in a prescription to another vet; if your vet is willing to call in a script, go home and call around to other vets until you find one with a spare bottle of B-12 on hand, then call your vet and have them fax over a script.) You give the B-12 exactly like you give insulin, and you can even use insulin syringes to give it.

A separate possibility is that your vet will add the B-12 vitamins to the bag of sub-Q fluids. If this occurs, please know that B-12 is a light-sensitive vitamin. You should keep it in a dark cabinet when it's not directly in use.

And that covers most of the stuff that I got from the vet for Gwyn. On your way home, stop at the pharmacy and pick up some Pepcid A/C (as Sienne said, not Pepcid Complete), which will help with the nausea. The standard dose is 1/4 of a 10mg tablet once or twice a day. I also wrote up a few tips on what we did to make Gwyn's pancreatitis easier here.


Suggestions for IBD (in no particular order): The metronidazole the emergency vet gave you is an antibiotic that can kill off bacteria that can cause diarrhea; and, even if those bacteria aren't present, it can still help lessen diarrhea (they're not really sure how). The vomitting of the metronidazole may be due to nausea, so try some Pepcid A/C for the presumed IBD as well. Note that metronidazole is very bitter and Bramble may just not have liked it. You can try disguising it in a pill pocket or an empty gelcap (usually available in vitamin stores).

Vitamin B-12 is also used in the treatment of IBD: IBD and other intestinal problems can inhibit the absorption of B-12, and a lack of B-12 in the body can increase the IBD symptoms. Most folks start with the TAMU protocol here, and then adjust it to their needs. (Not all vets have seen this article, so you may want to print it out for your vet, just in case it *is* IBD.)

You can ask for, or your vet may decide to prescribe steroids for IBD. If my Gwyn were diagnosed with IBD today, the steroid I'd opt for would be budesonide, which specifically targets the intestines. Please note that most steroids *may* affect the BG levels in some subset of cats. If Bramble does go onto steroids, please keep an eye on his BG levels and adjust insulin if necessary. FWIW, many cats just need a short course of steroids to help get their IBD under control, though some cats may need to stay on steroids permanently. (My Gwyn was on prednisone for 16+ years.)

Many cats with the diarrheal form of IBD have had marked success in controlling it by switching to a raw food diet. (Standard disclaimer here: raw food is fine for most 'normal' cats; it can be very beneficial in cats with diarrhea issues; and it can be beneficial or contraindicated in cats with constipation issues. For any cat who has the constipating form of IBD, *please* monitor bowel movements carefully after switching to a raw food diet!!) When we tried Gwyn on a raw food diet, we tried Nature's Variety, solely because they had a buy-one, get-one-free offer here. To get the coupon, you'll need to know a store near you that carries it; you can do that here.

And, if Bramble *does* have IBD, you may want to consider joining the feline_IBD YahooGroup here. They have lots of information and support, though their first two suggestions will be to try B-12 injections and a switch to a raw food diet.


And ... I think that's about all that's coming to mind ATM. Hopefully this helps without completely overwhelming you ;)

-- Jean and her Gwyn
 
Thanks to you all for the advice! My vet is on vacation so I've talked to a couple of other vets who have been helpful but I don't have a good answer yet. I've been sitting with him holding his dish and encouraging him to eat. He seems to like beef Fancy Feast with some extra water stirred in and an ice cube in his water dish, and me holding it was enough to make him drink. He's now eating and drinking on his own. He's feeling better but pooped yesterday after a couple of days and it is still really dark and could have blood in it. I think changing gradually to a raw diet is a good thing. I was up again last night reading and it sounds like supplements and enzymes might be in order. I have a great pet food store near me and I think I'll get some good advice there in addition to yours and to reading some more! It's nice to have a place to go to ask these questions and to feel that someone is listening and understands how hard it is to have a sick kitty.
 
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