Update: Civvie Problems, mostly just sharing, but happy for thoughts

[Shenandoah]

This is mostly just a release, since I know people here understand. But I'm happy to take any thoughts or suggestions. I just feel helpless at the moment.

The whole story... brought my kitties to the vet for regular checkup last Tuesday, and shots for my civvie. Shenandoah is doing great
My civvie's only issue was an infected tooth and tarter, needs dental work.
So they pulled blood to do labs before anesthesia.

Next day got lab work back, and it was bad. Hyperthyroid, advanced chronic kidney disease, diabetes (BG 405). I was in tears all afternoon.

But when I started reading about the diseases, it didn't make sense. She had no symptoms. I know cats are good at hiding things, but lack of symptoms in advanced stages seemed odd. But what really got me was when I took her BG. 56 on the Relion Confirm. Now, even accounting for vet stress and using a human glucometer, that difference made no sense.

Meanwhile, vet started questioning the protein numbers, called the lab, and they agreed something wasn't right. She called me and said the lab would re-do the test at no charge. I had an appointment to go in Friday to get her blood pulled again.

Thursday night I started noticing odd behavior. Not eating, curled up in the corner, not wanting to play, generally lethargic. Worried, but knew we were headed to the vet in the morning.

Friday morning she was normal. Came and ate, played, ran around, tried to trip me, all the usual stuff. Also left a normal looking poo in the litter box. So when I went to the vet I mentioned the Thursday evening incident, but we were't too concerned.

So I brought her back home, and starting that afternoon we were back to the odd behavior. She didn't want to eat at all, in fact the only thing that made her get up was if I put food near her - she'd walk away, then she'd come back after I removed it. Threw up a few times early Saturday morning.

So Saturday morning I call the vet and they say to bring her in. Bloodwork results are back and all looks good (yay!). She has borderline kidney values - very top of the normal range - so we probably will be dealing with that down the road, but not yet. BG was 112, thyroid was normal. So that part is a relief...

I dropped her off for the whole morning so they could get to her in between patients. X-rays and exam later, she only seems to have a lot of gas and maybe some constipation (she had one kind of large poo in the x-ray, but vet didn't think it needed an enema). She got sub-q fluids, and an antibiotic to hopefully help her mouth feel a little better. Was told to try chicken baby food and tuna in water if she doesn't eat her regular food.

So now we've been home about 6 hours. She had a bunch of water when she first got home (and pee'd, she had a huge bladder in her x-rays since she held it while at the vet's all morning). She's eaten a few bites of the baby food, and two small pieces of tuna. So at least she has something inside her, although not much. I have some Cerenia to give her tomorrow if she's throwing up (so far she has not thrown up again), and Mirtazipine tomorrow if she still isn't eating.

I just feel so bad for her. I don't know what to do for her. Since nothing was obviously wrong, maybe just the stress of the two vet visits this week, along with probably tooth pain? I wish I could make her feel better

I'm sorry for the long message. Not sure the two things going on (false bloodwork and lethargy) are at all related, probably just coincidental, but they occurred together so it's all part of my own stress. I just feel helpless and overwhelmed. The week has been an emotional roller coaster.

BTW, my civvie is my "young" one, at 15 (Foxy on the left, Shenandoah on the right, a few years ago)

 

[Squalliesmom]

Your kitties are beautiful!

You have my complete and total sympathy. I have been going through very similar issues with my Squallie (thank heavens, I didn't have the added upset of the "bad" lab results!). I wish I had some answers for you. I certainly understand the stress and worry you are going through. It helps to be able to vent to others who can relate, I know!

The throwing up was probably because she had excess acid in her tummy, from not eating enough Friday evening. Squallie is on Cyproheptadine as an appetite stimulant, but even with that sometimes I have a hard time getting him to eat much. I have gone through all kinds of different flavors and brands of cat foods, and it doesn't really seem to make much difference. My vet says he's a mystery. That doesn't really help me! And now I have two civvies who don't want to eat, as well, probably from all the upheaval in their diets.

So, although I can't offer you any advice, I hope it helps a little to know that you are not alone!

 

[Shenandoah]

Thanks. I wish they were able to talk to us
I was able to get her to eat a bit more by putting some food on her nose and lips for her to lick off. She hasn't thrown any of it up, so I think you are probably right on it just being the stomach acid earlier. She still isn't showing any real interest in eating on her own, though.

 

[Squalliesmom]

I wish I knew what goes on inside those pretty little heads of theirs! My one civvie, who is already underweight and needs all the calories she can get, has walked away from every meal today, and I have tried different foods at each meal. Just now, an hour and a half after I put it down, she circled back to her dinner dish and ate about three mouthfuls before walking away again. She and another civvie have hardly eaten anything for the past two days now.

Do you have a different brand of food you could try, or a different flavor? I opened another can and got one of mine to eat a couple of bites, not so much the other one, tho'. Right now I am looking at four bowls of basically untouched cat dinners. Guess I try still another flavor.

 

[Squalliesmom]

I would definitely try the Mirtazipine tomorrow and see if that helps. I know with the Cypro, I have to give it (to my sugar kitty) around an hour before meal-time to allow it to kick in. I don't know how long before feeding you need to give Mirtz but I imagine it needs time to work, too.

 

[Shenandoah]

I've tried a few different flavors of her usual Fancy Feast Classics, the chicken baby food, and some plain tuna. Other than a couple tiny bites of tuna, the chicken baby food is the only thing she's shown any interest in at all (I don't know why, it smells disgusting, haha), but even that hasn't been much.

They pretty much have food down at all times. I mix it with some water so it stays fresh, and put more down approximately every 3-4 hours. So if it takes time to work, food will be available whenever she wants.

I'd like to see her have a bowel movement, too. She usually goes about every 1.5 days, and we're a bit past that now. Last was Friday morning. Hoping once that happens, some of that gas can escape and she'll feel better.

 

[Squalliesmom]

That's also been an issue for us. Strange. You're about the third person I've spoken to lately who is having similar problems. Does she normally eat Fancy Feast Classics? My cats have been eating them again lately, too. Wonder if the manufacturer sent out a bad batch or something? I haven't heard of any FF recalls.

 

[Shenandoah]

Hmm, interesting. They've been on FFC since November. Shenandoah (sugar cat) isn't having any issues, though, except her poo has seemed a little larger than normal the past week or so.

 

[Squalliesmom]

Mine were on Wellness and seemed to be happy with it, then one day one of my civvies just absolutely refused to even look at it. I though he might have developed a food aversion, for reasons unknown to me, so put them all back on FF, which was their favorite, anyway. That was a couple of weeks ago, and they started out all eating the FF with great gusto, but now the two won't eat it and my other two aren't seeming any too fond of it, either. I also tried Evo and they didn't like that , either.

Mine have been having very large poos and nowhere near as often as they used to. Maybe FF changed something in their formula? But my guys don't really seem to like any foods at all, at the moment!

 

[Critter Mom]

Oh boy, oh boy, oh boy! The intermittent lethargy, nausea and vomiting sound very, very familiar to me. Saoirse had a fairly unpleasant period when I couldn't get one of her regular meds last year and the different generic constipated her. She has chronic pancreatitis and early stage CKD so I think she may feel quite 'toxed up' as a consequence. That was tough but she had an even worse time when she was recovering from eye surgery earlier this year and she got really badly constipated. Her clinical signs were uncannily similar to what you're describing in Foxy.

Saoirse constipated (left) vs. Saoirse when normal service has been resumed (right):

Member @Meya14 kindly recommended I briefly treat Saoirse with metoclopramide (Reglan). It's not great as an anti-nausea treatment in cats (they don't have many of the receptors it targets) and it has a rather unpleasant side effect profile (messes with the dopamine system and may cause irreversible side effects like movement tics or tardive dyskinesia if used regularly) but as a short-term treatment it is very helpful for getting things moving as it speeds up gastric emptying and boosts peristalsis in the upper part of the intestines. More info here. Meya also advised that conventional anti-nausea treatments (e.g. Cerenia, ondansetron) tend not to be worth a light if the root cause of the nausea is a constipation problem and I found this to be true in Saoirse's case.

Nausea and vomiting (symptom checker) are not uncommon in cases of constipation (see www.felineconstipation.org for more info).

I suggest you do the following:

1. Double-check with the vet that Foxy doesn't have a GI obstruction before starting any treatments to get things going again. (Dangerous not to do so as interventions when a blockage is present could result in rupture of the intestine.)

2. Assuming no blockage is present, ask your vet about the following meds and treatment measures:

- Metoclopramide to kick start things. (For info, a single 0.1ml dose was enough to get things going for Saoirse. She weighs just under 10lb.) This may be enough to resolve the nausea and inappetence issues.

- Ranitidine if stomach acid build-up is an issue. It's an acid blocker similar to famotidine but unlike the latter ranitidine may have a beneficial effect on gut motility. It did help Saoirse in this respect (kept her on it for a few days while I worked to get her eating better). Dosing per Tanya's Site is 1/8 of a 75mg tablet q12; see the nausea link above for more info.

- A conventional anti-nausea med such as Cerenia or ondansetron (Handy to choose one you can administer at home. Cerenia may help a little more with nausea vomiting. I've found that it kicks in faster than ondansetron but it also wears off faster, too. I've also found that it may take a few doses before ondansetron's anti-nausea benefits reach full effect; thereafter it helps Saoirse enormously. See nausea link for dosing info.

- All going well the anti-nausea treatment and improved motility should be enough to restore appetite. If not, an appetite stimulant may be in order. I posted about this on another thread earlier and it may be helpful to you:

[It] might be worth your discussing with your vet the use of an appetite stimulant. Cyproheptadine is fairly gentle in action and usually a very small dose (1/8 of a 4mg tablet or less for a 10lb cat) can provide just enough support to get a cat more interested in food and also to eat a bigger portion at a sitting. The appetite stimulating effect typically lasts about 8-12 hours, possibly a bit longer. You can dose 3x per day so you can fine tune the med support to the cat's needs. Things to check with the vet are liver function and also blood pressure (it's an antihistamine so may have a vasoconstricting effect). The other appetite stimulant commonly used in cats is mirtazapine. An antidepressant med, it can have an excessively strong appetite stimulating effect, even a small dose can make a cat crazed with hunger (not pretty) and the appetite stimulating effect typically lasts for 2-3 days so it's less controllable. Mirtazapine also carries the risk of inducing serotonin syndrome which can be potentially life-threatening (antidote is cyproheptadine, BTW). The risk of serotonin syndrome may be increased by interactions with other drugs, especially anything that affects serotonin levels. It can interact with buprenorphine (bad case on here a few months ago).
​

3. Once normal service is resumed take immediate steps to try to keep them that way. See www.felineconstipation.org for info on proper hydration, dietary fibre (I maintain Saoirse by adding a little canned pumpkin to all her meals; psyllium makes her stools too big), and medical treatments (e.g. Miralax).

Hope some of the above is helpful to you, and I also hope that Foxy feels much better very soon. I'm sorry you've been on such a roller coaster over the last few days so here are some for you.


Mogs
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[Shenandoah]

Thanks Mogs. I'll definitely be having a discussion with my vet again tomorrow, when the office is open again. You provided some good information for feeding into our discussion.

I got her to take her Mirtazapine this morning, as prescribed, but other than some initial drooling I haven't noticed any changes. That was about 5 hours ago now. I've been debating if I should give the Cerenia. My vet said that was mainly if she was vomiting, and she has not since yesterday morning.

The x-rays showed one somewhat large stool, which she said could be causing some constipation but she did not believe was a blockage. But so far there have been no poos since Friday morning.

She continues to lick up the little bits I put on her lips, although she gives quite a fight each time I try. Her diet is FFC and pumpkin mixed with a bit of water every meal. Vet said I could start her on Miralax, but without her eating anything I can't really do that. So for now I just continue to give her small bits of either the FFC or the baby food on her lips every 30-60 minutes, and let her be the rest of the time.

I did offer her a little cat grass, which has always been her favorite thing ever, under supervision (to prevent eating more than a small amount). At first she practically ran over and buried her head in it. But then she only ate a couple bites before wandering off. When I offered again a bit later she just sniffed and turned away.

 

[Squalliesmom]

Jen, did she have her dental yet, or does she still have the infection in the bad tooth?

 

[Shenandoah]

Do you mean me? I'm not Jen.
But in any case, Foxy has not had her dental yet. I'm sure her mouth is in pain, and could very well be contributing to this. The dental was scheduled for last Friday until we had the mix-up with the blood test, then it was canceled since we thought much more serious things were going on and anesthesia would be too high a risk.
We got the new bloodwork back the same day that Foxy went in for stopping eating (Saturday). So vet had to deal with that in between appointments, but we will schedule the dental tomorrow, hopefully there will be an opening soon.

 

[Squalliesmom]

Do you mean me? I'm not Jen.

LOl, sorry, my bad!

When I first read your post, the dental issue somehow didn't sink into my brain. Dental pain and infection can have a terrible effect on a kitty's appetite, demeanor and overall well-being. Your Foxy may well feel heaps better after she has that bad tooth dealt with!

Just one caveat: I don't know whether or not your vet offers it, or would offer it for a dental, but if you are offered Convenia - a long-acting antibiotic - please research it before agreeing to it! (You may already be familiar with Convenia, so if I'm "preaching to the choir" please forgive me, but the administration of this drug concerns me greatly.)

 

[Shenandoah]

That was one of the things on my list to research, actually. I was given the option - she suggested Convenia because it's harder to get a kitty to take meds if their mouths are hurting after the surgery.
However, she ended up giving Convenia yesterday to try to reduce some of the bacteria in her mouth and maybe make her more comfortable eating. Since it is long-acting, does that mean if we do the dental soon we won't need another antibiotic (since what's done is already done and we can't go back and change it)?

Off to read now and start scaring myself

But my vet is a full time feline-only vet, so I do feel pretty comfortable with her suggestions.

 

[Shenandoah]

Is syringe feeding a good idea in my case? If so, how much and how often?
I just gave her 2.5ml (.5 tsp) of a little FFC and a bit of pumpkin mixed in mostly water. She seemed to handle it well. She didn't fight much, and has kept it down.
I don't want to force her too much, but I also want to make sure she doesn't get dehydrated and has a bit of nutrition until we can talk to the vet in the morning.

 

[Larry and Kitties]

You syringe feed every hour or half hour in order to get enough food in without vomiting. The goal is about 5 1/2 ounces per day. 5 1/2 ounces is about 160 ml

 

[Shenandoah]

Thank you. I'm hoping this is just a short term thing to get us through to morning, or worst case until her dental appointment. But after tomorrow morning we will have vet guidance.

 

[Shenandoah]

So an update. My vet is out of the office today (she works Tues-Sat), but the one in the office recommended a Pancreatitis test.
As luck would have it, she decided to let out a big poo (a huge poo, as in, really really big) a little over an hour before our appointment. We decided to go ahead with the pancreatitis test just to be sure. It came back negative.

Vet suggested an ultrasound next, but I turned it down for now since the big (did I say huge, humongous, gigantic?) poo came out. I want to see if that helps her first. So far I think she looks perkier, but she isn't eating yet - however, we knew from the x-ray that there was gas built up behind it so it might take a little bit before it clears out. She also did sniff at food a little, so at least showed interest.

Up until now she's continued to be fine with the syringe feeding. She fights a bit, but hasn't thrown any up. I'm holding off for a few hours now to see if she'll start eating on her own.

So the plan for now is to wait until tomorrow, see what she's doing, and discuss the status with our regular vet at that time.

 

[Shenandoah]

Another update. We started on buprenorphine Tuesday evening and she has gone back to her mostly-normal self. Hanging out in the windowsill watching outside, grooming, and even eating on her own again!

So at this point I believe the mouth pain was the main culprit. She goes for her dental this afternoon.

I know mistakes happen or equipment malfunctions, but I can't help feeling angry and frustrated over the bad bloodwork. If it had been processed correctly the first time, she was scheduled for her dental last Friday. None of this would have happened. None of my stress, none of her pain, none of this additional cost. I know it's not my vet's fault, and I'm glad the lab gave us the re-do on the bloodwork, but the delay ended up causing a whole lot of hassle

But I'm really hopeful that after tonight she will be feeling much better. Wish her luck with her dental.

 

[Shenandoah]

Back home and 8 teeth lighter, but recovering well. Vet said they offered food there and she stuck her whole head in it, gobbled it up, and got food on everything, including all over her face. Haha. Guess she's feeling better about eating.

 

[Critter Mom]

That's great news! So glad that the dental is safely behind Shenandoah; always such a relief.


Mogs
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[Shenandoah]

This was Foxy, my civvie, but yeah, I'm glad it's done! Shenandoah had some dental work about a year ago, and they said her teeth looked good at her exam a bit over a week ago, so hopefully she doesn't need anything anytime soon.

 

[Critter Mom]

Mea culpa! (Very tired - sorry for the error. )


Mogs
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