Worried about Howie

[Howiesmom]

I’m getting worried about Howie as he’s just not himself lately. He’s currently getting 1 full Ondansetron every 12 hours (more if he has a pancreatitis flare up). He’s also on Mirataz occasionally (as needed).

1. He doesn’t hardly want to be picked up although will sit in my lap for a while before he gets up to go lay in his bed in the kitchen. We used to have a nightly routine in which he would sleep for a a couple hours in my lap while watching TV at night but that doesn’t happen any more. He’s very stiff walking these days with his arthritis.
2. He doesn’t come sleep with my anymore, although it is getting warmer out. He also comes up to wake me up in the AM but doesn’t stay to hound me any longer like he used to. I’m not complaining about the extra sleep, but it isn’t like him!
3. He’s not going potty as regular. Today, I cleaned pee out of his litter box from sometime the previous night, but he hasn’t gone pee or #2 since (so almost 18 hrs of no potty). He gets about 1/8 tsp Miralax daily. I was giving closer to 1/4 tsp but he was having anal leakage from that much. He usually goes #2 every other day and it is solid/formed.
4. Most concerning is his eating. He doesn’t hardly eat his mini meals any more and he takes forever to eat his main meals. He starts off good but then walks away several times. When he does eat, it’s almost like he has a hard time swallowing. He shakes his head and really struggles to eat. I’ve had the vet look in his mouth many times for a tumor, ulcer, etc and there is nothing he can see. After a while, I end up holding his food plate and he will usually eat more/most of his food then. So I’m not sure if he’s trained me into a bad habit or not!

So I don’t know if this is related to his arthritis (gets monthly Solensia injections and Adequan every other week), pancreatitis issues (what the Ondansetron and Mirataz are for along with Cerenia when I know there is a flare-up which raises his BGs), the fact that my rescue kittie is now exploring the house more and he’s annoyed/jealous, something related to his acromegaly, or something new/different. I just know he’s not feeling good.

I appreciate any thoughts/prayers. I don’t know what I would even take him to the vet for if I went.

 

[Wendy&Neko]

My non diabetic kitty doesn't sleep on my lap in warmer weather, so that could be part of it. It also sounds like his arthritis is bothering him some. Other things I did for Neko when her arthritis got bad was pain meds - she was on buprenorphine full time, it was a game changer, and also starting taking her to acupuncture vet, which also really helped with pain and mobility. Most acros end up on full time pain meds, either bupe or gabapentin, due to issues from the growth hormone. One sometimes works better than the other, depending on the cat.

He might also be a bit nauseous, you can try increasing ondansetron to 3 and even 4 times a day and see if that helps. Ondansetron doesn't last the full 12 hours. Neko had issues with eating towards her end, and it was soft tissue growth around her gums, which a dental vet identified and later her acupuncture vet saw. Is Howie maintaining his weight?

 

[Larry and Kitties]

He’s currently getting 1 full Ondansetron every 12 hours

That is not definitive since Ondansetron comes in 4, 8, 16 and 24 mg tablets. I suspect you are using the 4mg tablets.

 

[Howiesmom]

That is not definitive since Ondansetron comes in 4, 8, 16 and 24 mg tablets. I suspect you are using the 4mg tablets.

Yes, I have the 4 mg pills from Chewy (generic version).

 

[Howiesmom]

My non diabetic kitty doesn't sleep on my lap in warmer weather, so that could be part of it. It also sounds like his arthritis is bothering him some. Other things I did for Neko when her arthritis got bad was pain meds - she was on buprenorphine full time, it was a game changer, and also starting taking her to acupuncture vet, which also really helped with pain and mobility. Most acros end up on full time pain meds, either bupe or gabapentin, due to issues from the growth hormone. One sometimes works better than the other, depending on the cat.

He might also be a bit nauseous, you can try increasing ondansetron to 3 and even 4 times a day and see if that helps. Ondansetron doesn't last the full 12 hours. Neko had issues with eating towards her end, and it was soft tissue growth around her gums, which a dental vet identified and later her acupuncture vet saw. Is Howie maintaining his weight?

Thank you so much! Your experience and perspective gives me something to go off of. I’m getting nervous that I’m going to start missing more signs of problems when I return to the office on June 5.

 

[Howiesmom]

My non diabetic kitty doesn't sleep on my lap in warmer weather, so that could be part of it. It also sounds like his arthritis is bothering him some. Other things I did for Neko when her arthritis got bad was pain meds - she was on buprenorphine full time, it was a game changer, and also starting taking her to acupuncture vet, which also really helped with pain and mobility. Most acros end up on full time pain meds, either bupe or gabapentin, due to issues from the growth hormone. One sometimes works better than the other, depending on the cat.

He might also be a bit nauseous, you can try increasing ondansetron to 3 and even 4 times a day and see if that helps. Ondansetron doesn't last the full 12 hours. Neko had issues with eating towards her end, and it was soft tissue growth around her gums, which a dental vet identified and later her acupuncture vet saw. Is Howie maintaining his weight?

Hi Wendy, how does dosing for buprenorphine work and what forms does it come in? I sometimes get some old-school dosing from my vet so like to know what I can/should actually give!. I tried transdermal Gabapentin with him before we could get Solensia last fall and it didn’t really do much for him. Thanks!

 

[JL and Chip]

Acro is such a debilitating disease.

Using the litter box less frequently could be simply because the arthritis is making it harder or more uncomfortable to move around so he’s “holding” it longer. Are the pee spots larger than usual? How far away is the litter box from where he hangs out? Are there any stairs involved? Sometimes adding another litter box or one on each floor of the home (if you have a multi-story house) helps them out.

I’d keep an eye on his litter box habits as a precaution. As Tubby’s acro advanced, he developed a sort of bladder neuropathy and also had problems with sluggish bowels. In hindsight, the initial clues were that he used the litter box less frequently but his bladder was huge, meaning he should have been peeing but perhaps didn’t have the sensation that he had to go.

Like Wendy said, buprenorphine and acupuncture can work well; I’ve used both for ortho/arthritis issues in my crew over the years (bupe can be constipating, fyi). I also used low-dose Metacam in one cat. I tried Solensia recently but I’m not sure what I think of it — it seemed to help but I’m conflicted over some of the things I’ve read about it. Like everything, we have to pick our battles and weigh the pros/cons of each option. The answer is rarely clear, so sometimes we just have to tinker.

As for eating, I found elevating Tubby’s bowl a bit helped him out. You might experiment with that given you said holding the plate encouraged him to eat more.

Have you checked Howie’s resting respiration rate lately?

 

[Wendy&Neko]

Buprenorphine is usually dosed as a liquid that is applied to their gums or inside cheek. Dose is based on weight of cat, and concentration of the bupe, but there is a range as well. Some cats need more, some less. I got it compounded, for two reasons. First, it was really expensive to get preloaded syringes from the vet. Second, compounding meant I could get chicken flavour, which Neko liked (chicken soup version, not so much the roasted chicken flavour - cats!). I also got a vial and could load syringes myself. It is a controlled drug. Where I live, that means the vets have to use a special prescription pad, that not all vets have, and file paperwork so it's used can be tracked.

JL made some good comments on the potty habits. You might want to see if a lower side or entrance helps him get in. When Neko's arthritis got worse, she didn't squat down as much, so pee pads around the outside helped catch any "overage". I also made sure she didn't have to go far to get to a litter box.

Also a good comment about testing resting respiration rate (RR). It can help detect any issues with the heart, which can impact appetite. When he's resting, count the complete number of in and out breaths per minute. You want in the 20-30 range. I used my phone timer.

 

[Howiesmom]

Acro is such a debilitating disease.

Using the litter box less frequently could be simply because the arthritis is making it harder or more uncomfortable to move around so he’s “holding” it longer. Are the pee spots larger than usual? How far away is the litter box from where he hangs out? Are there any stairs involved? Sometimes adding another litter box or one on each floor of the home (if you have a multi-story house) helps them out.

I’d keep an eye on his litter box habits as a precaution. As Tubby’s acro advanced, he developed a sort of bladder neuropathy and also had problems with sluggish bowels. In hindsight, the initial clues were that he used the litter box less frequently but his bladder was huge, meaning he should have been peeing but perhaps didn’t have the sensation that he had to go.

Like Wendy said, buprenorphine and acupuncture can work well; I’ve used both for ortho/arthritis issues in my crew over the years (bupe can be constipating, fyi). I also used low-dose Metacam in one cat. I tried Solensia recently but I’m not sure what I think of it — it seemed to help but I’m conflicted over some of the things I’ve read about it. Like everything, we have to pick our battles and weigh the pros/cons of each option. The answer is rarely clear, so sometimes we just have to tinker.

As for eating, I found elevating Tubby’s bowl a bit helped him out. You might experiment with that given you said holding the plate encouraged him to eat more.

Have you checked Howie’s resting respiration rate lately?

Thank you so much for these suggestions! His litter box habits are now scattered. When I wrote my original post, he hadn’t gone in 18 hours or so. The next 12 hrs, he went pee twice and #2! So I’m not sure sometimes he has big pees like he’s holding it and other times are more normal. I’ve been considering getting some different boxes for him that have the low entry. However, he still jumps up on counters and table tops too. Like humans, I’m sure the weather makes his arthritis variable. He mostly stays on the lower level of my house 95% of the time and has access to 2 boxes of his own plus my rescue kittie’s box if he went in there. I also elevated his food plates and auto feeder a few months ago to approximately the same height as when I hold them but may need to do it a bit higher. I have hardwood floors all over so wonder if that makes his eating a bit more difficult if his arthritis is really acting up in his back end. I’m aLao wondering if he has some gum tissue growth like Wendy had discovered with Neko.

Thank you again for all these things to start paying (more) attention to. It is greatly appreciated!

 

[Howiesmom]

Buprenorphine is usually dosed as a liquid that is applied to their gums or inside cheek. Dose is based on weight of cat, and concentration of the bupe, but there is a range as well. Some cats need more, some less. I got it compounded, for two reasons. First, it was really expensive to get preloaded syringes from the vet. Second, compounding meant I could get chicken flavour, which Neko liked (chicken soup version, not so much the roasted chicken flavour - cats!). I also got a vial and could load syringes myself. It is a controlled drug. Where I live, that means the vets have to use a special prescription pad, that not all vets have, and file paperwork so it's used can be tracked.

JL made some good comments on the potty habits. You might want to see if a lower side or entrance helps him get in. When Neko's arthritis got worse, she didn't squat down as much, so pee pads around the outside helped catch any "overage". I also made sure she didn't have to go far to get to a litter box.

Also a good comment about testing resting respiration rate (RR). It can help detect any issues with the heart, which can impact appetite. When he's resting, count the complete number of in and out breaths per minute. You want in the 20-30 range. I used my phone timer.

I will definitely monitor respirations. I hadn’t even thought of that.

 

[Wendy&Neko]

I have hardwood floors all over so wonder if that makes his eating a bit more difficult if his arthritis is really acting up in his back end.

I have mostly hardwood too. Strategically placed mats might help him navigate around.

 

[Pixie's Mom]

However, he still jumps up on counters and table tops too. Like humans, I’m sure the weather makes his arthritis variable.

My other girl Edie was diagnosed with arthritis a few years ago when she had a huge flare up and couldn't put weight walking on her front leg and when she did she was seriously hobbling. BUT she still refused to take it easy and stay off the tall cat trees, counter etc. LOL I agree with asking your vet to try the buprenorphine. My prior boy Rambo - lost him in 2015 - had arthritis and in his flareups the vet at the time would prescribe this med and it was a life changer. It is a controlled substance. You could ask your vet for 1-2 doses to try to make sure it works better than gabapentin for your boy.

 

[Noah & me (GA)]

I can't offer much except that for Noah transdermal BUPE was a real lifesaver. With all he already had to deal with he just hated the oral even triple fish or triple anything. He loved having his ears rubbed so getting his BUPE was the highlight of his day. Also much easier to metabolize for a cat that's not eating well or throwing up.
C'mon Howie buddy!

 

[Howiesmom]

I can't offer much except that for Noah transdermal BUPE was a real lifesaver. With all he already had to deal with he just hated the oral even triple fish or triple anything. He loved having his ears rubbed so getting his BUPE was the highlight of his day. Also much easier to metabolize for a cat that's not eating well or throwing up.
C'mon Howie buddy!

Where do you get the transdermal from? Is there another name for it? All I’ve read about is the form you put in their mouth or an injectable.

 

[Larry and Kitties]

Where do you get the transdermal from? Is there another name for it? All I’ve read about is the form you put in their mouth or an injectable.

You can get the tandermal from Wedgewood pharmacy and other compounding pharmacies. You can get the oral (absorbed in mouth membranes) also from a compounding pharmacy. The injectable is expensive and is typically what you get from your vet since it can also be used orally.

 

[Noah & me (GA)]

Is there another name for it?

I don't know what else you could call it. A lot of meds are transdermal and BUPE is BUPE unless someone wants the full spelling. Mine came in a syringe with the consistency of toothpaste. I didn't bother with the gloves, you're not going to get high from a little finger smudge. It's not a time release so you can easily break up the dose from twice a day to every four hours. I'm not exaggerating about how much Noah detested oral meds, it would be like your mom pinning you to the floor forcing you to gulp down a smoothy of liver and onions. Noah needed all his teeth pulled and would never have survived general anesthesia so the transdermal BUPE literally gave him three more pain free years with us.
It does indeed have to come from a compounding pharmacy and some have a sketchy reputation. There's one down the street that looks like a used car lot and smells like a tire fire. Mine came from a vet college.
https://en.wikipedia.org/wiki/New_England_Compounding_Center_meningitis_outbreak
The strength I got was 0.16mg/0.1ml and the daily dose was 0.05ml every 8 to 12 hours. I also used it on Andy's broken leg and more than once when Marco had frequent UTI's. That info is always near the top of my profile.
There's nothing worse than being sick and in physical pain. I really hope Howie gets better soon, I know none of this is easy for either of you.

 

[Howiesmom]

You can get the tandermal from Wedgewood pharmacy and other compounding pharmacies. You can get the oral (absorbed in mouth membranes) also from a compounding pharmacy. The injectable is expensive and is typically what you get from your vet since it can also be used orally.

Thank you so much for that info! Any idea on the cost of the transdermal from Wedgewood? My vet will be thrilled with yet another prescription request that I’m not going to get filled by his online pharmacy! I just can’t afford their prices despite the kickback his clinic gets! At least I’m already a customer of Wedgewood for his Cabergoline.

 

[Howiesmom]

I don't know what else you could call it. A lot of meds are transdermal and BUPE is BUPE unless someone wants the full spelling. Mine came in a syringe with the consistency of toothpaste. I didn't bother with the gloves, you're not going to get high from a little finger smudge. It's not a time release so you can easily break up the dose from twice a day to every four hours. I'm not exaggerating about how much Noah detested oral meds, it would be like your mom pinning you to the floor forcing you to gulp down a smoothy of liver and onions. Noah needed all his teeth pulled and would never have survived general anesthesia so the transdermal BUPE literally gave him three more pain free years with us.
It does indeed have to come from a compounding pharmacy and some have a sketchy reputation. There's one down the street that looks like a used car lot and smells like a tire fire. Mine came from a vet college.
https://en.wikipedia.org/wiki/New_England_Compounding_Center_meningitis_outbreak
The strength I got was 0.16mg/0.1ml and the daily dose was 0.05ml every 8 to 12 hours. I also used it on Andy's broken leg and more than once when Marco had frequent UTI's. That info is always near the top of my profile.
There's nothing worse than being sick and in physical pain. I really hope Howie gets better soon, I know none of this is easy for either of you.

Thanks a ton! Just need to be armed with all the info for my vet. How many pounds was your kittie with that dose? Does it come in a similar tube as the transdermal Gabepentin? That made just a mess all over!

 

[Larry and Kitties]

Any idea on the cost of the transdermal from Wedgewood?

I have never gotten transdermal gabapentin but have gotten a transdermal methimazole to my Boot's hyperthyroidism and the cost was about $30 for a 2 month supply, much less than cabergoline.

 

[Noah & me (GA)]

Does it come in a similar tube

Mine came in a red syringe not much bigger than the ones we already use. Just a little blob comes out and then straight in to the ear, no mess.
Noah, Marco and Andy were all between 9 and 10 pounds. It's not really a proper cat at anything less than 15 pounds.

 

[Howiesmom]

I just got a script for transdermal buprenorphine and it was sent to Wedgewood! Thanks for all these suggestions! Hopefully it helps! I sent my vet an email with an assessment if how Howie is doing and requested the script, he didn’t even say he needed to see Howie first.

I think he is very annoyed that I am requesting the scripts for all of Howie’s meds instead of going through him and/or the online pharmacy he’s connected with. I just can’t afford his upcharges, and his online pharmacy is almost double what I can get most things from Chewy. He used to own his clinic and hospital but sold it in the last 6-9 months to a larger corporation. I know he’s also starting to cut back on hours (besides his surgeries) which means he’s starting to phase out. I don’t know what I’m going to do when he completely retires. He’s been my only vet!

 

[Sienne and Gabby (GA)]

I'd talk to your vet if you think he's going to retire. He's likely to know of vets in the area who he trusts. He has to have times when he's gone on vacation and had someone covering for him. He's likely to know of trustworthy vets in your community.

 

[Noah & me (GA)]

I know why vets get annoyed with the pharmacy thing, I just don't like it. Regular pharmacists sometimes make substitutions for exactly what a vet ordered, sometimes it's something as simple as a binding agent that a cat could be allergic to. What annoys me is when a vet doesn't offer any alternative or is oblivious to your wallet being drained. I can get generic PEG at Walmart instead of the exact same thing with a cat on the label for three times the price.
The denial of pain thing is a big issue for me. The very last thing any cat needs is to be so miserable from physical pain they won't eat. It's simple compassion.