Decreased senior appetite, normals labs & imaging

[sidneykitty]

I have a tendency to write essays so I will try to keep this brief.

Back in April, I noticed my cat Amber (15) was eating less wet food than normal. I noticed she only wanted it fresh from the can, not leftover (even warmed up) from the fridge.

My original expectation was constipation, she's had issues before and needed an enema just over a year ago.

Day One
I took her to the vet in May. They found no abnormalities other than cranial abdominal pain. Her caudal colon was empty. Took blood & urine to send to lab. The blood/urine was NOT sent that day so we had no results the next day. That day, they gave her a Simbadol injection for pain. She had a bad reaction to it (ataxia, anorexia, restlessness, would not eat/drink). It was awful.

Day Two
The next day we brought her back for SQ fluids and Cerenia injection and Mirtazapine. We opted to do x-rays since her stomach still hurt. The x-ray showed abnormal intestines, appearing bunched similar to foreign object. Vet though possible cancer so then we did an ultrasound same day. Since the lab work was never sent, they did stuff in house (but neglected to do urine) and all results were normal.
The ultrasound showed all normal findings except for a benign liver cyst, they called it a cystadenoma.

After this, we brought her home and she still didn't eat for 48 hours following the Simbadol injection. I noticed when she finally did eat she had some trouble getting food in her mouth.

Day Three
Brought her back to have her mouth looked at. Vet thought everything looked fine but her jaw was tense so she thought she had TMJ or arthritis in her haw and Rx'ed 3-day trial of Onsior.

Amber did very well those three days and ate a ton of wet food.

But I was not very satisfied with the whole experience or diagnosis so last week I brought her to Vet 2 - a cat-only vet.

Last Monday
Their exam findings included a grade 4 heart murmur, cataracts and abdominal pain. She had lost some amount of weight from 8.9 to 8.5 lbs. Mouth/teeth looked good. Everything else was good. They did a very thorough exam as they found a scar on her tongue she's always had and dark gunk at her nailbeds that I have noticed but never worried about. (Vet thinks the gunk could be related to inflammation somewhere in the body)

Blood tests so far have been normal - includes T4, cardiac pro BNP (snap and external lab), Snap and Spec FPL, kidney/liver/CBC.
Urine test is pending
Vitamin D and magnesium levels pending
Fecal for lungworm pending - have not collected poop yet. (doing this because she snores, vet heard "wheezing" from her throat. she went outside until 2018)

I am feeling BEYOND frustrated and very worried about her. I've spent $2,000 and have no answers why her stomach hurts, why she has been periodically hiding under the bed since the Simbadol incident, why she still does not want to eat her wet food. She seemed to improve for a while in between the two vet visits, but the last few days have been bad - not eating much, hiding under the bed more, not pooping every day.

Could the liver cyst actually be causing her pain? (Vet 1 said this was not anything to worry about) What else could be invisible (not appear on tests) that could cause stomach pain?
Vet 2 (cat only) wants to treat her for biliary colic whatever that means and start her on heart supplements, but she doesn't want to add stuff to her food when she isn't eating it already. She recommended we start CBD oil last Monday and I started it, but today I stopped in case that is causing her to not eat.

I just feel I am at a point where I just don't even know what to do now. Does anyone have ANY ideas about what it could be?

Right now she is under the bed again. I sprayed Feliway and playing calming cat music for her in case she is stressed. I cooked up chicken thigh for her this morning, which she did eat but she has not pooped since Saturday and now I'm worried about constipation on top of everything else, butt she is NOT vomiting.

 

[Furballsmom]

Hi - I'm guessing she hasn't pooped because she hasn't eaten enough, or do I have the timing wrong?

Can you handfeed her?

 

[mrsgreenjeens]

I'm thinking she's not eating because of her stomach pain. I know I certainly don't want to eat when my stomach hurts. So the question remains, WHY does her tummy hurt, and that's what the Vet's need to discover. Ultra sound was good, but what about those "bunched up" intestines? Did the cat only Vet take a look at the ultrasound? I'm hoping they transferred her records over. Also, I would suggest waiting until all the test results are in before we try to guess what it might be I know it's hard to wait, and I know you're worried sick, but we can only speculate, as you can see.

Oh, but I will tell you that I give both my cat's CBD oil (for Pets). I give it to one of them because he's "anxious", and I can't believe the difference in him. Last time he went to the Vet, he didn't even growl, which is quite the feat for him But I give it to the other to help with his appetite. It really seems to work. Today he was crawling up my leg about 1/2 hour before his lunch time begging me for food. That NEVER happens! I was so happy. BUT, I did learn that I can only give that cat one drop per day or he'll vomit. The other one gets two drops with no issues. Additionally, CBD Oil is supposed to be good for pain. Both my hubby and I take it for that reason. We've been doing it for quite some time now and still have some pain, but not like it was. Personally, if the Vet recommended it and you have it, I'd keep using it, as long as it's the Pet version.

 

[sidneykitty]

Hi - I'm guessing she hasn't pooped because she hasn't eaten enough, or do I have the timing wrong?

Can you handfeed her?

That's what I'm thinking. If she's not eating much, then she won't be producing poop. Its reassuring to hear someone else say it, to be honest!

I can try handfeeding her, most times I've attempted she just walks away from me. So far today, she has eaten the chicken + maybe 1/8 3 oz. can Fancy Feast. So, not too bad considering. Prior to all this starting though, she typically ate 1/2 can Fancy Feast in the morning.

Thank you for your suggestions!

mrsgreenjeens - thank you. You're right - it is hard to wait. But so far I've been impressed with this vet. She even called me last Tues at 9pm to give me blood results.

I agree I would not want to eat with stomach pain, either. I had a stomach ache just the other day and it reminded me just how it feels. :/ The prior vet did send records to the cat vet, so I presume she will have looked at the x-ray and ultrasounds, but I am going to specifically ask her about the "bunched up" intestines on x-ray that looked fine on ultrasound. To be honest, I'm a little bit baffled by that and am interested to see what she says.

Ok, you've talked me into giving CBD oil again. I did feel that it made a difference on day 1, but then she sort of went back to eating less again and I increased her from 1 drop to 2 drops on Saturday. Maybe I'll go back to 1 for now. I'm really glad to hear its helped both you and your cats! The CBD Oil I got from the vet is tested for everything, her and I discussed it for quite some time, so it should be just fine to be giving. (I've been hesitant about CBD Oil before due to non-regulation/not knowing what else might be in it,)

Thanks for your advice and experiences, I appreciate it!


I know it sounds like I'm frustrated her results are normal and its very much not that, I'm happy she is mostly healthy! Its just the not knowing what is wrong/her being in pain and not wanting to eat. When she comes out from under the bed and she totally behaves like herself which is a plus.

I got Feliway refills today just on the odd chance she is experiencing some kind of stress-induced lack of appetite. I brought home a foster kitten a few years back and Amber went on a hunger strike then because she was so stressed by it. We've been a one-cat household ever since!

 

[sidneykitty]

We have a poop deposit from last night. Its a couple of rabbit turds and 1 small log. One of the turds looks pretty dry and hard, so I'm guessing maybe we had a combination of constipation x not eating enough. Just glad she passed something right now but I remember when she got her enema, she had still been pooping most days, so I'm not sure we're out of the woods yet.

Did give her CBD oil again today.

Edit: mrsgreenjeens - how do you administer your drop of CBD oil to your cats? Vet told me to put the drop in her food, but if she's not eating all her food right now I'm thinking she may miss the drop itself.

 

[sidneykitty]

I seem to be noticing she hides under the bed after eating.

 

[mrsgreenjeens]

For the CBD oil, I put the drop (or two depending on the cat) on their favorite treat and let it soak in. Then just hand it to them. So far they have never not eaten the treat. I use a 100%pure meat freeze dried treat so it soaks in well. They don't appear to smell it at all.

If you think she's constipated or just has hard stools for whatever reason, you might ask the Vet(s) if it's ok to give her Miralax. We've used it now for three different cats and it's a miracle worker. 1/8th teaspoon dissolved in a teeny bit of water and then either mixed in with food (if they're eating) or syringed right into their mouths if they aren't eating well. You only need about 1/2 teas.water to dissolve it and it's odorless and tasteless and does not gel up.

 

[sidneykitty]

Thank you! I might try giving it on a treat to make sure she gets it all. That's excellent.

She already gets 1/2 tsp Miralax per day in her wet food, I'm not sure we can realistically increase it from there... She started at 1/4 tsp a few years ago and until just the last few days she was doing well with 1/2.
Yesterday marked the first day she actually received/ate all her supplements for the first time in a week: 1/2 tsp Miralax, 1/8 tsp egg yolk powder (though yesterday I gave her 2), 1 cosequin and 1 drop CBD oil.

Yesterday, I gave her 1mL lactulose and she's had a poop overnight which was much better than yesterday's one. But yesterday since she spent most of the day under the bed, I booked the first appointment this morning for a recheck so we'll see what they say.

 

[sidneykitty]

Not constipated.
Everything was fine except her stomach pain again. They even said her heart sounded better.
Her urine is all good.
They think she has lots of gas and possible biome issues in her gut/gut flora issues. She said "irritable bowel."
We're starting her on B12, cisapride and probiotics. Here's hoping we see some improvement!

 

[mrsgreenjeens]

Cisapride? That's for colon motility, right? Are you to stay with the Miralax as well? What probiotic are you to use? Just in case, here is my "go to" whenever anyone mentioned IBD: https://www.ibdkitties.net/

Did your Vet mention putting her on a low dose steroid as a possibe option? I think a lot of IBD cats are on them because they seem to really help.

 

[sidneykitty]

Yes, Cisapride is for colon motility! We think/I think her system moves slowly.

The probiotic she gave me says TherBiotic Detoxification Support.

I did ask if I should continue Miralax but did not get a straight answer as we started discussing something else...its hard, we tend to get a bit chatty about things. I'll followup on that (and a couple other things).

No, we didn't discuss IBD or steroids or elimination/hypo diets at all. I think because she said irritable bowel which would indicate IBS not inflammatory bowel which would indicate IBD. Its hard to find much info about IBS in cats because most of it leads you to IBD. Its a bit confusing but I think they are 2 different things. We discussed at length gut flora and the beneficial bacteria she should have (which she may be lacking) which could be causing issues. Hoping and planning to get a poop test to test her gut flora in the future, but not quite yet while we try to get her feeling a bit better first.

Good news is - she actually came to her food bowl and ate some wet food on her own today without being coaxed. I started cisapride and probiotics (slowly). She also got her CBD and Cosequin already. Have not given B12 yet, I want to give her a bit more time to settle before I start bombarding her with things. So it seems like the key to getting her to eat is bringing her to an early morning vet appointment because she's eaten well both times we've done that!

 

[daftcat75]

Be careful about mixing prescription drugs with CBD. CBD, by itself, is usually quite safe. However, since it is metabolized by liver enzymes that many prescription drugs also require either for activation from pro-drug to active drug or deactivation from drug to inactive metabolite, CBD can modulate the effects of many prescription drugs.

Safety: CBD & Prescription Meds — Hempsley

According to this website, cisapride is one drug that CBD can increase levels of the drug. Talk to your vet and discuss what side effects to monitor her for and get her liver enzymes checked out periodically while taking CBD.

These cautions go double if you do consider steroids for her. If you believe the CBD is helping and you don't want to discontinue it, talk to your vet about slower or lower on-boarding of new prescriptions.

B-12 is fantastic stuff. It's pharmacology is complicated but it's effects are nearly immediate and positive. Like a shot of energy and appetite. I wouldn't delay trying this. Whatever she doesn't need, she'll just pee out.

 

[mrsgreenjeens]

I'm curious, was Vet #1 or the cat only Vet that you saw today? Also, mea culpa on assuming they were talking IBD vs IBS

Hoping these new items do the trick! (I'm hoping you DID discuss the CBD if you went to Vet #1, and of course, since you got it from Vet #2, they already know about it ) Keep us posted.

 

[sidneykitty]

daftcat75 - Thank you for the reminder!! I was only just reading about this last week when we started CBD but thought "well she's not on any Rx'es so its ok!" Yes, it looks like cisapride is a potential interactor. I will ask the vet about this too.
She's getting her B12 later today. Just wanted to give her a few hours "cool down" time from the vet before I go poking her.

She generally needs some recovery time from things and its usually relative to how "awful" the thing I did to her was. Whenever I apply her Revolution, for example, she runs away from me/holds it against me for ~15 minutes. After a vet visit, she usually needs an hour or so. Its usually more time for worse things. So I wonder if any of this time under the bed is just Amber alone-time-recovery-time from all her vet appointments.

mrsgreenjeens - Oh it was for sure Vet #2 / cat only vet today! So yes - she's the one who Rx'ed the CBD oil and cisapride. So far I really like her.
I don't plan to see vet #1 again unless for emergency needs (they're 24/7). And no problem - IBD, IBS...it all gets confusing, doesn't it?

I hope we see improvement, too! I just have to remember to be patient that it will take time. Though I did read today that cisapride can start working in 1-2 hours.

 

[sidneykitty]

I am shocked at the change in her in only one day... and I don't know what it is that's doing it or if its a combo of what we're doing.

She ate more than 1/2 can wet food yesterday AND all her her kibble. She came up to bed with us last night like she usually does and sat on my chest while I read before bed. This is usually a nightly ritual.
She has not hid under the bed since yesterday morning (knock on wood...).
She played with her favorite little orange ball this morning. Its literally been WEEKS since I've seen her do that. We used to play most days between 8-9 am when she got her morning zip on, but lately she's just had zero interest. It was hard because playing with her really lifts my mood and probably hers as well. I know she's not getting any younger and this is a reality, but its still so hard to watch her feel unwell. She's been very healthy the four years we've had her, we've been lucky.

Longterm we're hoping to remove fish from her diet (don't tell her that). But lately its been all she will eat, so its fish or nothing. She accepted turkey a couple of times, so I'm crossing my fingers turkey will become her new go-to reliable food. I know we're not out of the woods and this is only day two, but this is more than I honestly hoped for!

daftcat75 - I know B12 should not be exposed to light, but my bottle also says no heat. How do you store yours? I have no AC so worried if it gets hot out (like 90+) that it will be bad for the B12? Can it be refrigerated though that seems it would not be very nice to inject cold B12...

 

[daftcat75]

I am shocked at the change in her in only one day... and I don't know what it is that's doing it or if its a combo of what we're doing.

She ate more than 1/2 can wet food yesterday AND all her her kibble. She came up to bed with us last night like she usually does and sat on my chest while I read before bed. This is usually a nightly ritual.
She has not hid under the bed since yesterday morning (knock on wood...).
She played with her favorite little orange ball this morning. Its literally been WEEKS since I've seen her do that. We used to play most days between 8-9 am when she got her morning zip on, but lately she's just had zero interest. It was hard because playing with her really lifts my mood and probably hers as well. I know she's not getting any younger and this is a reality, but its still so hard to watch her feel unwell. She's been very healthy the four years we've had her, we've been lucky.

Longterm we're hoping to remove fish from her diet (don't tell her that). But lately its been all she will eat, so its fish or nothing. She accepted turkey a couple of times, so I'm crossing my fingers turkey will become her new go-to reliable food. I know we're not out of the woods and this is only day two, but this is more than I honestly hoped for!

daftcat75 - I know B12 should not be exposed to light, but my bottle also says no heat. How do you store yours? I have no AC so worried if it gets hot out (like 90+) that it will be bad for the B12? Can it be refrigerated though that seems it would not be very nice to inject cold B12...

I store it in the cupboard above the sink. You do not want to refrigerate it because you can't warm it up before injection. A quick search says it should be stored between 59 and 86F. That rules out the fridge.

How to Store Vitamin B12 Injectable | Livestrong.com

 

[sidneykitty]

Thank you! Right I figured the fridge was a no no .Cold injections would not be nice.

 

[mrsgreenjeens]

Everything still going well? I'm so sorry I didn't comment earlier but for some reason I didn't get notification of your Thursday update, so today decided to just look up your thread to see if I'd missed anything and low and behold, happily I had! What great news!!!!!

Hoping she continues to feel well.

 

[sidneykitty]

Hi there! Its all good. Yes, things are still going well for the most part for now. Hoping it continues and I slowly can get her eating turkey more than fish or back to her regular beef although I wonder if turkey will be better in the long-run. Thanks for coming to check in. I appreciate the thought.

Her lungworm test came back negative today!

 

[mrsgreenjeens]

Glad she doesn't have lungworm and that she's still doing pretty well. Let's hope it continues so she can keep playing with her little orange ball