Cat hasn't eaten for 5 WEEKS! -- But tests can't find the cause (Medical Mystery)

albertoveloso

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Hello Cat Lovers,

My cat (Weezy) has a peculiar case that has stumped a few vets around here. I'm posting on this forum to see if anyone has had or heard of a similar case. Any and all advice is appreciated. Here's the "short" version: 5 weeks ago, my perfectly healthy cat goes to her annual checkup. The vet says she has a yeast infection in her right ear, so an ear cleaning is performed, Oti-Pack G is administered, and she's given Bravecto (for fleas). The VERY next day, Weezy can no longer walk straight without wobbliness (ataxia) and falling over to the side. She refuses to eat/drink (anorexia). These symptoms have continued until present day.

Two days later, I took Weezy back to the vet who says she's probably feeling nauseous from the Oti-Pack, so Weezy is given Cerenia, SQ fluids, and Convenia. Two days after that, I took Weezy a Pet Emergency Room where a blood test is performed. The ER vet believes that the ear cleaning may have pushed the infection down, creating an inner ear infection. Weezy is prescribed Mirtazapine, Prednisolone (a 10 day treatment), and Veraflox (a 6 week treatment).

Over the next few days, I take Weezy back to her vet to get IV Fluid Therapy (since she's not drinking or eating) and I start syringe feeding her Hill's A/D canned food (Weezy does not like it at all!). She's also given Cerenia, Baytril, and Vitamin B12 shots. But since she still isn't improving, we end up hospitalizing Weezy for 4 days, where countless tests are performed including an MRI, Spinal Tap, X-Rays, Abdominal Ultrasound, Endoscopy, and biopsies. Interestingly, the vet said the MRI didn't really show signs of an inner ear infection or damage to the ear.

Nevertheless, Weezy is still not eating, so the decision is made to place an e-tube in her to feed her until she resumes eating. The food they recommend is Royal Canin Liquid Renal Support. They also prescribed Cerenia (a 4 day treatment), Mirtazapine, and said I should continue the Veraflox. All of the tests showed a perfectly healthy cat, though one biopsy suggests that she has inflammatory bowel disease (IBD). The vet recommends a hydrolyzed protein diet (Hill's Z/D) and tells me to resume the Prednisolone. So I've been tube-feeding her that food while still giving Mirtazapine, Veraflox, and Prednisolone.

None of the vets we've come across have seen something like this, a cat that has refused to eat for this long. They are also surprised that it happened instantly (after the initial vet visit), instead of the more common gradual reduction in appetite. Even if she does have inflammatory bowel disease, it wouldn't explain the wobbliness. It's a bit of mystery right now, but the hope is that the steroids will help with the IBD and make her hungry, hopefully leading her to eat.

Again, if anyone has had (or has even heard of) a similar situation, I'd love to hear about it. Thanks in advance for all your help!
 
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albertoveloso

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Hello -

Can your vets consult with a university veterinary medical department?
The vet is consulting with various specialists that work in the same place as the emergency room. And next week we'll be visiting a vet that works at a cat only clinic. So hopefully we'll get some more insight.
 

silent meowlook

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Hi. I am truly sorry you are going through this. Below, I am posting a quote from the manufacturer of Bravecto, Merck health.


Bravecto Topical Solution for Cats: The most common adverse reactions recorded in clinical trials were vomiting, itching, diarrhea, hair loss, decreased appetite, lethargy, and scabs/ulcerated lesions. Bravecto is not effective against American dog ticks beyond 8 weeks of dosing. For topical use only. Avoid oral ingestion. The safety of Bravecto has not been established in breeding, pregnant or lactating cats. Use caution in cats with a history of neurologic abnormalities. Neurologic abnormalities have been reported in cats receiving Bravecto, even in cats without a history of neurologic abnormalities.
The link for that information is below:
Fleas Ticks 12 Week Treatment | Merck Animal Health USA (merck-animal-health-usa.com)

Now that that is out of the way. Please tell me at least one of these veterinarians has reported this to the company as an adverse effect of the product. Of course, I don't know that is what caused the event in your cat. Yet, this is listed on the company that makes the product's website, and since it happened so quickly after using it, I would think that would be the first place I would start.

The following is from the package insert.



Precautions:

For topical use only. Avoid oral ingestion. (see Animal Safety).

Fluralaner is a member of the isoxazoline class. This class has been associated with neurologic adverse reactions including tremors, ataxia, and seizures. Neurologic adverse reactions have been reported in cats receiving isoxazoline class drugs, even in cats without a history of neurologic disorders. Use with caution in cats with a history of neurologic disorders.

Bravecto has not been shown to be effective for 12-weeks duration in kittens less than 6 months of age. Bravecto is not effective against Dermacentor variabilis ticks beyond 8 weeks after dosing (see Effectiveness).

The safety of Bravecto has not been established in breeding, pregnant and lactating cats.

The effectiveness of Bravecto after bathing or water immersion has not been evaluated.

Adverse Reactions:

In a well-controlled U.S. field study, which included a total of 161 households and 311 treated cats (224 with fluralaner and 87 with a topical active control), there were no serious adverse reactions.

Percentage of Cats with Adverse Reactions (AR) in the Field Study

Adverse Reaction (AR)Bravecto Group: Percent of Cats with the AR During the 105-Day Study
(n=224 cats)
Control Group: Percent of Cats with the AR During the 84-Day Study
(n=87 cats)
Vomiting7.6%6.9%
Pruritus5.4%11.5%
Diarrhea4.9%1.1%
Alopecia4.9%4.6%
Decreased Appetite3.6%0.0%
Lethargy3.1%2.3%
Scabs/Ulcerated Lesions2.2%3.4%
In the field study, two cats treated with fluralaner topical solution experienced ataxia. One cat became ataxic with a right head tilt 34 days after the first dose. The cat improved within one week of starting antibiotics. The ataxia and right head tilt, along with lateral recumbency, reoccurred 82 days after administration of the first dose. The cat recovered with antibiotics and was redosed with fluralaner topical solution 92 days after administration of the first dose, with no further abnormalities during the study. A second cat became ataxic 15 days after receiving its first dose and recovered the next day. The cat was redosed with fluralaner topical solution 82 days after administration of the first dose, with no further abnormalities during the study.

In a European field study, two cats from the same household experienced tremors, lethargy, and anorexia within one day of administration. The signs resolved in both cats within 48-72 hours.


In a European field study, there were three reports of facial dermatitis in humans after close contact with the application site which occurred within 4 days of application.




Contact Information:

For a copy of the Safety Data Sheet (SDS) or to report suspected adverse drug events, contact Merck Animal Health at 1-800-224-5318. Additional information can be found at www.bravecto.com.

For additional information about adverse drug experience reporting for animal drugs, contact FDA at 1-888-FDA-VETS or How to Report Animal Drug and Device Side Effects and Product Problems.

So, I would be looking into the above and contacting the company.
How is your cat doing now? How are you doing with the tube feeding?
If it was me I would be looking for a feline only hospital or an internal medicine specialist. Although if you had an MRI done on her, it must have been at the specialist.

I am very sorry this is happening and has happened to your cat.
Please update as to what is going on with her.
 
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maggie101

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A specialist can better understand what's going on by seeing him or her. My vet sent the results to a specialist and got a different conclusion than he did. Now my cat is worse. She has an appointment fri then he will suggest an
Endoscopy and a specialist which he has before.probably an xraythat showed more than normal stool in her colon. The steroid shot my vet gave helped but only for a week. B12 pills my other cat ate!
 
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maggie101

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A specialist can better understand what's going on by seeing him or her. My vet sent the results to a specialist and got a different conclusion than he did. Now my cat is worse. She has an appointment fri then he will suggest an
Endoscopy and a specialist which he has before.probably an xraythat showed more than normal stool in her colon. The steroid shot my vet gave helped but only for a week. B12 pills my other cat ate!
Fyi- do not buy b12 otc. Vet prescription only if he suggest it. Sure you already know that but just incase
 

Astragal14

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A albertoveloso did Weezy have any other meds or vaccinations administered during the initial appointment, her annual checkup? What you've described sounds similar to clusters of vaccine reactions from earlier this year. But Bravecto also has its own problems, as others have mentioned. Unfortunately, none of the published articles address what to do if your cat is affected by either of these drugs. It looks like most, if not all cases, were treated with antibiotics and fluids.

Veterinarians flummoxed this winter by spates of cats with fevers suspect a Chlamydia vaccine was the cause.

The practices had been using Felocell 4 (recently renamed Vanguard Feline RCP+Ch) as a substitute for another vaccine that was on back order.
...side effects cluster because the potency of the bacterium is not uniform...

As Griffioen put it: "It's inevitable one batch might be a little hotter — contain more antigen — than another."

Similarly, Dr. Richard Ford, an emeritus professor at North Carolina State College of Veterinary Medicine who helped write American Animal Hospital Association (AAHA) and American Association of Feline Practitioners (AAFP) vaccine guidelines, said: "During the manufacturing process, variation in the degree to which the antigenic bacteria are attenuated, as well as the number of bacteria per dose, could lead to a more reactogenic response in some cats following vaccination."
Clusters of suddenly sick cats roil some veterinary clinics



The active ingredient in Bravecto, fluralaner, works by attacking the nervous system of insects. And the FDA issued an alert in 2018 about the class of drug fluralaner belongs to, isoxazoline.
Fluralaner is for systemic use and belongs to the class of isoxazoline-substituted benzamide derivatives. Fluralaner is an inhibitor of the arthropod nervous system.
Bravecto for Animal Use - Drugs.com

"Be aware of the potential for neurologic adverse events in dogs and cats when treated with drugs that are in the isoxazoline class," the alert reads.

Possible side effects of isoxazolines include muscle tremors, ataxia (loss of body control) and seizures. Drugs sold containing isoxazolines are Bravecto, Credelio, NexGard and Simparica.
Alert on pet flea control draws questions, few answers


I hope you and Weezy find an effective treatment very soon. Be sure ask about supplementing with B12 injections because steroids aren't as effective when B12 levels are low.

Good luck to you and Weezy 🤗🤗
 

iPappy

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Ugh, I *HATE* Bravecto. I've seen so many animals do so poorly with it I can't believe they still push it as a good thing. Definitely report this. I'm so sorry Weezy has had such a rough time (and you too!) and hoping she will soon bounce back and be herself again.
 
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albertoveloso

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Hi. I am truly sorry you are going through this. Below, I am posting a quote from the manufacturer of Bravecto, Merck health.


Bravecto Topical Solution for Cats: The most common adverse reactions recorded in clinical trials were vomiting, itching, diarrhea, hair loss, decreased appetite, lethargy, and scabs/ulcerated lesions. Bravecto is not effective against American dog ticks beyond 8 weeks of dosing. For topical use only. Avoid oral ingestion. The safety of Bravecto has not been established in breeding, pregnant or lactating cats. Use caution in cats with a history of neurologic abnormalities. Neurologic abnormalities have been reported in cats receiving Bravecto, even in cats without a history of neurologic abnormalities.
The link for that information is below:
Fleas Ticks 12 Week Treatment | Merck Animal Health USA (merck-animal-health-usa.com)

Now that that is out of the way. Please tell me at least one of these veterinarians has reported this to the company as an adverse effect of the product. Of course, I don't know that is what caused the event in your cat. Yet, this is listed on the company that makes the product's website, and since it happened so quickly after using it, I would think that would be the first place I would start.

The following is from the package insert.



Precautions:

For topical use only. Avoid oral ingestion. (see Animal Safety).

Fluralaner is a member of the isoxazoline class. This class has been associated with neurologic adverse reactions including tremors, ataxia, and seizures. Neurologic adverse reactions have been reported in cats receiving isoxazoline class drugs, even in cats without a history of neurologic disorders. Use with caution in cats with a history of neurologic disorders.

Bravecto has not been shown to be effective for 12-weeks duration in kittens less than 6 months of age. Bravecto is not effective against Dermacentor variabilis ticks beyond 8 weeks after dosing (see Effectiveness).

The safety of Bravecto has not been established in breeding, pregnant and lactating cats.

The effectiveness of Bravecto after bathing or water immersion has not been evaluated.

Adverse Reactions:

In a well-controlled U.S. field study, which included a total of 161 households and 311 treated cats (224 with fluralaner and 87 with a topical active control), there were no serious adverse reactions.

Percentage of Cats with Adverse Reactions (AR) in the Field Study

Adverse Reaction (AR)Bravecto Group: Percent of Cats with the AR During the 105-Day Study
(n=224 cats)
Control Group: Percent of Cats with the AR During the 84-Day Study
(n=87 cats)
Vomiting7.6%6.9%
Pruritus5.4%11.5%
Diarrhea4.9%1.1%
Alopecia4.9%4.6%
Decreased Appetite3.6%0.0%
Lethargy3.1%2.3%
Scabs/Ulcerated Lesions2.2%3.4%
In the field study, two cats treated with fluralaner topical solution experienced ataxia. One cat became ataxic with a right head tilt 34 days after the first dose. The cat improved within one week of starting antibiotics. The ataxia and right head tilt, along with lateral recumbency, reoccurred 82 days after administration of the first dose. The cat recovered with antibiotics and was redosed with fluralaner topical solution 92 days after administration of the first dose, with no further abnormalities during the study. A second cat became ataxic 15 days after receiving its first dose and recovered the next day. The cat was redosed with fluralaner topical solution 82 days after administration of the first dose, with no further abnormalities during the study.

In a European field study, two cats from the same household experienced tremors, lethargy, and anorexia within one day of administration. The signs resolved in both cats within 48-72 hours.


In a European field study, there were three reports of facial dermatitis in humans after close contact with the application site which occurred within 4 days of application.




Contact Information:

For a copy of the Safety Data Sheet (SDS) or to report suspected adverse drug events, contact Merck Animal Health at 1-800-224-5318. Additional information can be found at www.bravecto.com.

For additional information about adverse drug experience reporting for animal drugs, contact FDA at 1-888-FDA-VETS or How to Report Animal Drug and Device Side Effects and Product Problems.

So, I would be looking into the above and contacting the company.
How is your cat doing now? How are you doing with the tube feeding?
If it was me I would be looking for a feline only hospital or an internal medicine specialist. Although if you had an MRI done on her, it must have been at the specialist.

I am very sorry this is happening and has happened to your cat.
Please update as to what is going on with her.
Hello Silent Meowlook,

Thank you so much for this information. I had been so focused on the diagnosis that the ear cleaning caused an inner ear infection, that I didn't consider the Bravecto (which was done on the same day), could be the cause. And the fact that ataxia is a side effect is too much of a coincidence to ignore. I'm going to forward all this info to the vets. And I actually do have an appointment this upcoming Saturday at a Cat Only hospital. It's about 2 hours away, but I'll drive any distance if it will help. She has seen quite a few specialists, including a neurologist, and they all gave her a clean bill of health. But I wonder if even they know about this Bravecto side effect. Why is this even being given to cats if such severe damage can occur? :( I will also report it to the sites you mentioned.

Thanks again for your help! This was very informative.
 
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albertoveloso

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A specialist can better understand what's going on by seeing him or her. My vet sent the results to a specialist and got a different conclusion than he did. Now my cat is worse. She has an appointment fri then he will suggest an
Endoscopy and a specialist which he has before.probably an xraythat showed more than normal stool in her colon. The steroid shot my vet gave helped but only for a week. B12 pills my other cat ate!
Hello Maggie 101,

I'm so sorry to hear about your kitty. I hope she gets better soon. And for sure, specialists are the way to go! I'm going to consult as many as I can until I get some answers.

Fingers crossed!
 
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albertoveloso

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albertoveloso

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A albertoveloso did Weezy have any other meds or vaccinations administered during the initial appointment, her annual checkup? What you've described sounds similar to clusters of vaccine reactions from earlier this year. But Bravecto also has its own problems, as others have mentioned. Unfortunately, none of the published articles address what to do if your cat is affected by either of these drugs. It looks like most, if not all cases, were treated with antibiotics and fluids.



Clusters of suddenly sick cats roil some veterinary clinics



The active ingredient in Bravecto, fluralaner, works by attacking the nervous system of insects. And the FDA issued an alert in 2018 about the class of drug fluralaner belongs to, isoxazoline.

Bravecto for Animal Use - Drugs.com


Alert on pet flea control draws questions, few answers


I hope you and Weezy find an effective treatment very soon. Be sure ask about supplementing with B12 injections because steroids aren't as effective when B12 levels are low.

Good luck to you and Weezy🤗🤗
Hi Astragal14,

Nope. No other meds where given at that initial visit except for Bravecto and the OTI-G pack. She was due for a rabies shot and I purposely skipped it cause I didn't want to overwhelm her system. Looks like it was still too much for her after all :(

Thank you for your help!
 
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albertoveloso

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Ugh, I *HATE* Bravecto. I've seen so many animals do so poorly with it I can't believe they still push it as a good thing. Definitely report this. I'm so sorry Weezy has had such a rough time (and you too!) and hoping she will soon bounce back and be herself again.
Hi iPappy,

I am truly stunned that it was the VET that recommended and administered this terrible drug. I had no idea and had never heard of it beforehand. If only I knew :(
 

LTS3

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Any medicine can cause an adverse reaction such as the one your cat is experiencing. Vets prescribe and recommend things based on what they feel is best is for the pet. Sometimes adverse reactions just happen because the pet is super sensitive to something in the product. The vet has no control over how a pet might react to a product or medicine. Adverse reactions should be reported to the FDA. If an usually large number of pets have similar reactions, the FDA may recall the product or investigate the safety of the product.
 

catloverfromwayback

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Any medicine can cause an adverse reaction such as the one your cat is experiencing. Vets prescribe and recommend things based on what they feel is best is for the pet. Sometimes adverse reactions just happen because the pet is super sensitive to something in the product. The vet has no control over how a pet might react to a product or medicine. Adverse reactions should be reported to the FDA. If an usually large number of pets have similar reactions, the FDA may recall the product or investigate the safety of the product.
Very true - my two have been on Bravecto for years with no adverse reactions.
 
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albertoveloso

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Very true - my two have been on Bravecto for years with no adverse reactions.
I do think the vet should have warned that these kind of adverse effects are possible. I wasn't told, and if I had been, I would have certainly not gone through with it.
 
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