Update on Tara

[Ken & Tara]

We have Tara's BG under reasonable control, but she's not doing well. We believe she's in pain, possibly severe pain, but it's also possible the metronidazole is making her feel bad. Her vet prescribed that 3 days ago, after discussing her symptoms (likely triaditis and acute diarrhea). In looking over her food-consumption data, she started refusing food a few hours before the first dose. She's had 4 once-per-day doses of mirtrazapine. Her wet food consumption began falling 5 days ago, and we've been concerned about her weight. On our last vet visit, her weight was 3.74 kg, down about 1 lb from the vet's highest for her (since her diabetes was diagnosed, just a few months ago). She has never been a fat cat, always trim, but now is skin and bones (and fluffy hair). I talked to our vet today, he gave us some maropitant citrate (cerenia) for possible nausea. If she isn't feeling better by tomorrow, we may decide to euthanize, my partner and I have evidently reached this same line of thinking independently of each other. Tara's obviously very uncomfortable, an extended life of misery for her is not desired by us. Starving to death is not a good way to go.

 

[Larry and Kitties]

She's had 4 once-per-day doses of mirtrazapine.

What was the dose in mg? The standard does was 3.75 mg every three days but that is too much
http://www.qualityshop24-7.com/news...landing&catid=1&scatid=3&cid=103&indexid=2107
there are alsoother doses like 2 mg every other day
http://www.medschat.com/Discuss/Cats-Mirtazapine-205165_s2.htm
Too high a dose can cause problems

 

[jayla-n-Drevon]

maybe she would eat A/D?? from the vet--high calorie organ meat-easy to syringe
also ordanestrom is great for nausea-cerenia is for vomiting -

 

[jayla-n-Drevon]

sub Q fluids can make a world of difference as well-- you can do at home.

 

[Ken & Tara]

What was the dose in mg? The standard does was 3.75 mg every three days but that is too much
http://www.qualityshop24-7.com/news...landing&catid=1&scatid=3&cid=103&indexid=2107
there are alsoother doses like 2 mg every other day
http://www.medschat.com/Discuss/Cats-Mirtazapine-205165_s2.htm
Too high a dose can cause problems

The prescription bottle says each pill is "15 mg", and she gets "1/4 tablet by mouth once daily". Thus, 3.75 mg. There was only one pill in the bottle, already divided up.

 

[Ken & Tara]

maybe she would eat A/D?? from the vet--high calorie organ meat-easy to syringe
also ordanestrom is great for nausea-cerenia is for vomiting -

That's a great idea, I think they close in 1/2 hour. I'm leaving for 30 minutes or so.

 

[jayla-n-Drevon]

The prescription bottle says each pill is "15 mg", and she gets "1/4 tablet by mouth once daily". Thus, 3.75 mg. There was only one pill in the bottle, already divided up.

It might be the dose that is "normal" but maybe to much for her... each cat is different--maybe crush the whole thing and split it into 6-8 doses?? just a sprinkle....or you could just shave the edges so it is a smaller dose. Cats can turn around as fast as they fall--especially with fluids and some high protein/calorie food-
good luck!!

 

[Critter Mom]

Our vets dose mirtazapine at 1/8 of that size of tablet every 2-3 days for a 10lb cat.

Nausea is very challenging initially but it is treatable. Ondansetron works very well for nausea (unless constipation is an issue, in which case the constipation needs to be addressed alongside the anti-nausea treatment). It can take a day or so for the ondansetron to kick in. (Cerenia kicks in faster for Saoirse but it tends to peter out less than 24 hours after the dose is given.) Famotidine can help if stomach acid is an issue (not uncommon in cats that haven't eaten for a while). If Tara's not eating much at the moment then she may be dehydrated and that makes a body feel lousy (cat or human) but it can be addressed in a relatively straightforward fashion (either at home or at the vets).

Cyproheptadine is an alternative appy stimulant. It doesn't have the duration of mirtazapine (our vet said it can be given once every 8-12 hours) but the advantage of that is it's more tailorable to the cat's needs (and it doesn't carry the risk of serotonin syndrome).

As Jayla says, cats can turn around as fast as they fall. Inappetent cats can look extremely miserable and lethargic at the trough, but they can rally amazingly well once the right supportive regimen is put in place to help them. Fingers and paws crossed that you'll get the right supports in place to help Tara regain her appetite, regain weight and get back to being a happy kitty again very soon.




Mogs
.

 

[Blamethecats and Hannah]

She's had 4 once-per-day doses of mirtrazapine.

When Hannah was on mirtazapine, she was prescribed a very small dose, given every 3 days. At the time, Hannah weighed only about 7 pounds and was in terrible condition. If I remember correctly, the dose was 1/8 of a 15 mg tablet. Keep in mind that too much of this drug can be toxic. Mirtazapine didn't agree with Hannah. It entirely changed her personality and she developed serotonin syndrome. As an alternative to stimulate her appetite and reverse the serotonin syndrome, we put her on cyproheptadine, with much better results. She now weighs 9 pounds and has returned to being a happy kitty. Best wishes.

 

[Critter Mom]

PS: if gut motility is an issue then ranitidine may be a better choice of acid blocker than famotidine. Useful link below (from Tanya's Site):

Nausea & stomach acid symptoms & treatments


Mogs
.

 

[Ken & Tara]

Thank you to everyone who has offered suggestions! They are much appreciated!

It might be the dose that is "normal" but maybe to much for her... each cat is different--maybe crush the whole thing and split it into 6-8 doses?? just a sprinkle....or you could just shave the edges so it is a smaller dose. Cats can turn around as fast as they fall--especially with fluids and some high protein/calorie food-
good luck!!

For me, dividing a pill is easy enough, it's giving them a pill I've had trouble with, cats seem to like to work it back up from deep in the back of their throat. I have a mortar and pestle, and a 1/1000 g readability scale (cheap one from ebay), so dividing a pill into precise mg doses is pretty easy via weight and spreadsheet. To administer, I use the mortar and pestle, make a powder, then I take about 1/2 mL of pate, and mix it with the medicine, then put that in the plunger end of a feeding syringe, followed by another 1/2 mL or so of pate without any medicine, and feed that to them. Seems like more work than giving a pill, but most of the time this method has worked better for me. I wish I had known regarding the dosing schedule being wrong, but I now know.

BTW, she did decide to eat some of the A/D. If she keeps that up, I'll get some more cans of it tomorrow.

Our vets dose mirtazapine at 1/8 of that size of tablet every 2-3 days for a 10lb cat.

Nausea is very challenging initially but it is treatable. Ondansetron works very well for nausea (unless constipation is an issue, in which case the constipation needs to be addressed alongside the anti-nausea treatment). It can take a day or so for the ondansetron to kick in. (Cerenia kicks in faster for Saoirse but it tends to peter out less than 24 hours after the dose is given.) Famotidine can help if stomach acid is an issue (not uncommon in cats that haven't eaten for a while). If Tara's not eating much at the moment then she may be dehydrated and that makes a body feel lousy (cat or human) but it can be addressed in a relatively straightforward fashion (either at home or at the vets).

Cyproheptadine is an alternative appy stimulant. It doesn't have the duration of mirtazapine (our vet said it can be given once every 8-12 hours) but the advantage of that is it's more tailorable to the cat's needs (and it doesn't carry the risk of serotonin syndrome).

As Jayla says, cats can turn around as fast as they fall. Inappetent cats can look extremely miserable and lethargic at the trough, but they can rally amazingly well once the right supportive regimen is put in place to help them. Fingers and paws crossed that you'll get the right supports in place to help Tara regain her appetite, regain weight and get back to being a happy kitty again very soon.




Mogs
.

Thank you for sharing your thoughts and kindness. Tara just had a more normal bowel movement, I wrote this in the spreadsheet column for poop, "In early evening, after giving her some Hill's A/D, and crating her, she ate a little and had a non-diarrhea poop. It has some dark brown or blackish areas, and some reddish areas, among the more typical brown. ... I wonder if it is some kind of bleeding." Whatever it was, it is beginning to resolve.

​

When Hannah was on mirtazapine, she was prescribed a very small dose, given every 3 days. At the time, Hannah weighed only about 7 pounds and was in terrible condition. If I remember correctly, the dose was 1/8 of a 15 mg tablet. Keep in mind that too much of this drug can be toxic. Mirtazapine didn't agree with Hannah. It entirely changed her personality and she developed serotonin syndrome. As an alternative to stimulate her appetite and reverse the serotonin syndrome, we put her on cyproheptadine, with much better results. She now weighs 9 pounds and has returned to being a happy kitty. Best wishes.

I wonder if that's the issue in this case. Tara had mirtrazapine once before on an identical dosing schedule, when she had her diabetic ketoacidosis crisis, and it did increase her appetite. I forwarded the link Larry and Kitties posted to the vet. Hopefully his staff will forward it to him (they may not). Over the years I've had a lot of different vets, and I really like this one, he and I communicate well, and he's very gentle with the animals. He saved another cat, now deceased, from pyothorax, after treatment, that cat lived for a number of years afterward.

PS: if gut motility is an issue then ranitidine may be a better choice of acid blocker than famotidine. Useful link below (from Tanya's Site):

Nausea & stomach acid symptoms & treatments


Mogs
.

Thanks again. That's a great link, I will try to read through it in the morning when I'm more refreshed. I find myself wondering how do you know if your cat has an acid stomach? Perhaps I'll know tomorrow!

 

[Critter Mom]

how do you know if your cat has an acid stomach

A classic sign is if they vomit up foamy liquid when they've gone without food for a while. (For some cats that can be as short a fast as 2½-3 hours.) Sometimes cats with an upset tum may hide.

I'm glad you found the link to the nausea page on Tanya's Site helpful. Saoirse has chronic pancreatitis and I found that particular page to be an extremely valuable resource in learning how to spot nausea symptoms. It helped me to learn how to 'listen' to Saoirse better and find things to help her. Actually, there is a veritable treasure trove of health information at Tanya's Site that's relevant to lots of cats, not just those with renal insufficiency.

she ate a little and had a non-diarrhea poop. It has some dark brown or blackish areas, and some reddish areas, among the more typical brown. ... I wonder if it is some kind of bleeding."

If the reddish areas are bright red then that may be indicative of bleeding in the lower part of the intestine. (Bleeding higher in the intestine tends to leave black traces since it will have had digestive juices acting upon it.) If some of the stool is tan rather than red, that can indicate an issue with pancreatic enzyme production (perhaps just a hiccup in normal production) or possibly somewhat faster than normal GI transit time. If tan stools persist, it's a good idea to get a SNAP fPL done by your vet (gives a yes/no indication of likelihood of pancreatitis issues).

I'm delighted to hear that Tara ate some of the a/d. Sometimes it can help to feed tiny amounts very, very frequently until appetite stabilizes and then gradually shift back to normal feeding schedule.

BTW, following on from @Blamethecats and Hannah's post, Saoirse had a similar reaction to mirtazapine as Hannah. Saoirse's generally quite a pacific creature (unless she's at the vets) but mirt made her borderline psychotic. Her pupils were like dinner plates for nearly 48 hours. I've been prescribed mirtazapine and I found it to be an absolutely horrible drug in terms of side effects. It absolutely fried my already PTSD-addled brain after only a couple of doses.


Mogs
.

 

[jayla-n-Drevon]

Thank you to everyone who has offered suggestions! They are much appreciated!



For me, dividing a pill is easy enough, it's giving them a pill I've had trouble with, cats seem to like to work it back up from deep in the back of their throat. I have a mortar and pestle, and a 1/1000 g readability scale (cheap one from ebay), so dividing a pill into precise mg doses is pretty easy via weight and spreadsheet. To administer, I use the mortar and pestle, make a powder, then I take about 1/2 mL of pate, and mix it with the medicine, then put that in the plunger end of a feeding syringe, followed by another 1/2 mL or so of pate without any medicine, and feed that to them. Seems like more work than giving a pill, but most of the time this method has worked better for me. I wish I had known regarding the dosing schedule being wrong, but I now know.

BTW, she did decide to eat some of the A/D. If she keeps that up, I'll get some more cans of it tomorrow.




Thank you for sharing your thoughts and kindness. Tara just had a more normal bowel movement, I wrote this in the spreadsheet column for poop, "In early evening, after giving her some Hill's A/D, and crating her, she ate a little and had a non-diarrhea poop. It has some dark brown or blackish areas, and some reddish areas, among the more typical brown. ... I wonder if it is some kind of bleeding." Whatever it was, it is beginning to resolve.

​

I wonder if that's the issue in this case. Tara had mirtrazapine once before on an identical dosing schedule, when she had her diabetic ketoacidosis crisis, and it did increase her appetite. I forwarded the link Larry and Kitties posted to the vet. Hopefully his staff will forward it to him (they may not). Over the years I've had a lot of different vets, and I really like this one, he and I communicate well, and he's very gentle with the animals. He saved another cat, now deceased, from pyothorax, after treatment, that cat lived for a number of years afterward.



Thanks again. That's a great link, I will try to read through it in the morning when I'm more refreshed. I find myself wondering how do you know if your cat has an acid stomach? Perhaps I'll know tomorrow!

So glad she liked the food !!!

 

[Larry and Kitties]

The prescription bottle says each pill is "15 mg", and she gets "1/4 tablet by mouth once daily". Thus, 3.75 mg. There was only one pill in the bottle, already divided up.

That dosing is three times the old dose of 3.75 mg every three days and that three-day dosing has not been determined to be too high. the 3.75 mg every days is a likely cause of some of Tara's problems

 

[Critter Mom]

She now weighs 9 pounds and has returned to being a happy kitty.

This makes for very happy reading, Carol.




Mogs
.

 

[Ken & Tara]

That dosing is three times the old dose of 3.75 mg every three days and that three-day dosing has not been determined to be too high. the 3.75 mg every days is a likely cause of some of Tara's problems

Yes, I had determined that from your earlier link, which I sent to the vet, although I'll probably have to mention it the next time I see him, as he doesn't seem to get any emails when I ask him if he got them, even though his office staff has them on their computer. Thank you for pointing it out. I have a poor memory myself, and am generally absent minded, so when something occurs to me, I write an email right then. If I have a question for the vet, email is the best way for me to communicate with him, and this is something that bothers me about this vet. Yet, he is honest to a fault, that is a very rare personal or professional characteristic and highly valued by me.

This morning Tara is not well. We crated her last night with food (Hill's A/D which Jayla suggested) and water, and she didn't appear to eat any overnight (haven't weighed it yet), although my partner observed her drinking a little. Her eyes are of a glazed appearance, and her reactions to me are delayed, she is very lethargic. I'm going to try a sub-Q Ringers this morning as a last ditch effort to save her. She's probably sick enough that she will let me do that, like she did when she had her ketoacidosis crisis. Normally she is just too wild and reactionary for me to keep her still enough for that big needle, even in a grooming bag. I watched a video on that a few days ago, and it asserted that freezing the needle was helpful.

The veterinarian said the dosage of mirtrazapine was deliberate, and cyproheptadine was not indicated. He said "We're losing the battle." Her weight decreased 0.2 kg in the last 4 days. Even though Tara is diabetic, I'm going to give her high-sugar nutritional support, Nutrical, in addition to some forced feedings, to see if we can pull her through until the end of the metronidazole, which ends in 3 more days. The metronidazole may be the issue, along with unknowns about her entire condition (we can't afford a lot of diagnostics). Her wet food consumption began falling before we started metronidazole.