Cat lost appetite - Complicated situation

Corrog

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Hello,

I tried looking through existing posts in this section for someone in a similar situation, but I can't go through 3000+ pages of posts.

Here is the situation.

My cat Gandalf, 8 1/2 y/o inside domestic cat, (he is overweight. Keep reading to understand the situation) isn't eating enough.

I have to bring the food bowl to him and physically put some food on the floor for him to eat before he even starts to sniff his plate. And even then, he will eat more if I put chunks on the floor than if he has to eat from the plate.

Now, here is the COMPLICATED part:

Gandalf has had a very difficult 3 1/2 weeks.

Started on sunday the 3rd of september where I realised he was having trouble with his defecation. The next morning, I realised he was constipated as, in the span of 20 minutes, he went 4 times to the litter box, wining and forcing for only a droplet and in between the 3rd and 4th go, he vomited.

So even though it was a holiday here (of course it always happens on holidays), we went to the vet. I was told he was overweight (8.5kg, I wasn't aware as he has very long hair) and that he does feel constipated. Was prescribed Lactulose for a week (2ml every 8 hours) and I was going to his regular vet for the X-Ray and blood tests (1/4 of the price).

Lactulose made him have very liquid poo and farts at the litterbox.

On wednesday the 6th, went to his regular vet. X-Ray showed blocage, but no megacolon and was told to continue Lactulose and to switch his food yo Hill's W/D for the weight loss and the better fiber (he was on Purina One Instinct).

2 days later (friday), I realised he was barely eating (even though I still hadn't attempting the food switch). Called the vet and was told to wait until monday to see if the situation resolved.

On sunday morning, I realised he hadn't gone to the litterbox in approx 48 hours (no #1 or #2), so back to the emergency vet. Got admitted, (he was now 8.23kg), got more X-Rays, still showed constipation (with a bit of gas, compared to the previous X-Ray). He had a mucus urinary blocage, which didn't show on X-Rays. Had the "surgery" done, stayed under observation for 48 hours.

After 48 hours (in which he barely ate), they removed the catheter, and he hadn't peed afterwards and had to stay another 24 hours to make sure he peed. Which he did, the next morning.

When I got to get him back, after being told to switch to urinary diet (WAS TOLD NO TRANSITION, or there would be a chance of reoccurence), saw that he had hurt himself (he has a tendancy in cages to push his face through holes, which made him bite his lower lip with his canines). He was on pain meds, so I thought it would be fine.

Got home, tried new food, wouldn't eat. Next morning (now the 14th), went to his regular vet, got some cans of Hill's C/D, which Gandalf ate over half a can (which is more than he had eaten in over a week).

From there, everything seemed to get better (except for his lip, but we'll get to that). He was eating more and more and urinating. Just no stool. By the friday, he was eating about 1 1/2 can of Hill's C/D, but as the stool situation scared me, I called the vet which told me that "the new pushes the old" and that considering his lack of appetite from the last week. Was told to keep an eye and that if 48 hours later, if still no stool, to bring him to the vet. Of course, he waited for the sunday morning (17th) to poop. He went multiple times and his poop was hard, but he went. Called the vet, was told to restart the Lactulose.

On monday, his lower lip was still scaring me as it looked infected. Back to his regular vet we go. Was infected, got given a shot of antibiotics. Back home we go. (He is now about 7.93 kg)

On the way home, he bites his tongue a bit (poor little guy). Looks on the internet, can need antibiotics for that. We're good. His shot should last 2 weeks.

From there, he seems to become his older self. Playful, eats (still not how much he should (2 cans) and I still have to make sure he eats, but looks good. From there, we finish the lactulose, but I feel like that has an effect on his appetite.

And then, suddenly, he doesn't want to eat for a day. Me, scared, I decide to force feed him using a syringe, and to be sure he doesn't associate his new food to force feeding, I take a can of Royal Canin (the one he didn't like) which I realise he actually WANT to eat. No lactulose, no pain meds, nothing to affect his taste buds.

But he doesn't even eat 1 can a day, and I have to go give him some every 2 hours or so, or he won't eat.

Whether I wait 2 hours or 12 hours, he eats the same amount.

I tried switching his food again, tried a new brand, tried adding a Fortiflora (probiotics) to his food, nothing works. Though I suspect the probiotics helps with his constipation as he finally pooped a bunch.

His tongue is pretty much healed (even though it didn't stop him eating when it happened), his gums and teeth are fine.

Now I am scared as I fear he is loosing weight too fast. I don't know what to do and I am out of funds for vet visits.

Do you have any advice for me? Thank you to anyone who can help me out. This has consumed all my energy...
 

Alldara

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Which prescription urinary did you choose and in what form (wet, dry or both). No transition is important and normal. This is to break down any other stones or 'gunk' that may form stones that is in his urine.

Royal Canin and Purina both have urinary prescriptions. After one year on the prescription you'll be able to switch to Purina or Royal Canin's "over the counter" (aka available at the store) version. That's because the store version is for prevention.

Constipation: can you ask your vet about trying resorilax/Miralax instead? The unflavored versions are very safe for a cat to take long term. Obviously, lactolose works for some pets because vets prescribe it, however, there's many posters here that it doesn't work for. Those people usually find that Miralax/Resorilax works well for their cats. My vet, had Nobel (17lbs) do 1/4 tsp twice a day at first and tapered down to 1/4 tsp every other day. She said she skips lactolose and goes straight for Resorilax as it works more consistently, is cheaper and more readily available. (NOTE: you have to dissolve fully in water before you give it. It can be mixed in food. You can't use it alongside another laxative)


Fed is obviously the most important. I would try to see if you can get him to eat the over the counter version of Purina's urinary one at the very least. He's used to Purina, so he's most likely to eat it and there's 3 different flavours in the wet version. You can get it in an assorted case.

He *may* think the food (prescription) cause him to be more ill and developed an aversion to it. You likely can return the bag since it's your first bag.
 

IndyJones

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Weigh5 loss foods are pretty gimmiky to begin with. You are doing the right thing using canned, canned has better protiene and less carbs and digests far better than dry. The water also helps get things moving as it were.

Other than experamenting with different cans there are apitite stimulants but idealy you want to see what he likes and doesn't like.

Fortiflora has a tiny bit of probiotic but is also used as kitty crack. I would get a different one that is actulay labled as such. s boulardii is one such probiotic.
 

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Weigh5 loss foods are pretty gimmiky to begin with. You are doing the right thing using canned, canned has better protiene and less carbs and digests far better than dry. The water also helps get things moving as it were.

Other than experamenting with different cans there are apitite stimulants but idealy you want to see what he likes and doesn't like.

Fortiflora has a tiny bit of probiotic but is also used as kitty crack. I would get a different one that is actulay labled as such. s boulardii is one such probiotic.
OP says the vet wants him on urinary now after a blockage. Likely to dissolve crystals or sludge.
 
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Corrog

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Which prescription urinary did you choose and in what form (wet, dry or both).
I was sold both canned and dry Royal Canin Urinary SO, which I was told to do at least 2 weeks of only wet, and then go 1 can + dry daily.

At first Gandalf didn't even want to touch. I then bought some Hill's Prescription Diet C/D wet which he was doing really great on until last friday-ish.

Now he's back on the wet canned from Royal Canin and it is pretty much the only thing he wants to eat.

Royal Canin and Purina both have urinary prescriptions. After one year on the prescription you'll be able to switch to Purina or Royal Canin's "over the counter" (aka available at the store) version. That's because the store version is for prevention.
Thanks for this, that will be very helpful in the future as the prescription diet isn't cheap.

Constipation: can you ask your vet about trying resorilax/Miralax instead? The unflavored versions are very safe for a cat to take long term. Obviously, lactolose works for some pets because vets prescribe it, however, there's many posters here that it doesn't work for. Those people usually find that Miralax/Resorilax works well for their cats. My vet, had Nobel (17lbs) do 1/4 tsp twice a day at first and tapered down to 1/4 tsp every other day. She said she skips lactolose and goes straight for Resorilax as it works more consistently, is cheaper and more readily available. (NOTE: you have to dissolve fully in water before you give it. It can be mixed in food. You can't use it alongside another laxative)
I'll look into it. Right now, he is off lactulose.
 

IndyJones

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Urinary so is a good food. Kabuto eats it. He had a kidney stone in the past and it helps keep him from being blocked. Yes it was an actual kidney stone, imaging found a bunch in his left kidney. Probably all passed by now though.
 

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Hi. You have a complicated situation with your kitty.
Not to scare you, but I want to make sure you understand that he is a very high risk for hepatic liver disease aka fatty liver disease. Cats that stop eating are at risk with overweight cats being more so. I am disappointed that your vet would tell you to wait when he wasn’t eating well.
Hepatic lipidosis is life threatening. Just like being unable to urinate is, so you have your hands full.
Keep him on the urinary diet canned if you can. If he will eat it. Purina makes a variety prescription diet called UR. It is a morsel and gravy and many cats will eat it.
If he doesn’t want to eat it can be that he doesn’t feel well, is nauseous or is associating the food with not feeling well. Often cats that are nauseous will go up to a food and then turn away. They often will lick their lips, but not always. Constipation makes cats nauseous. There is an appetite stimulant you should discuss with your vet called Mirtazipine. It comes in a transdermal formula. It would be a good idea to have a tube of that at home.

Constipation makes cats feel horrible. One of the best ways to avoid, treat, manage it, is to make sure your cat is hydrated. If he isn’t eating well, he probably isn’t getting enough fluids. I have not seen great results with lactulose. I think if they are very constipated, it can force them to have almost violent bowel movements and I think it can cause pain. This is my opinion only and there is no literature to back it up. Many vets find lactulose useful. I do think that a 2 ml starting dose is high. I would discuss doing some subcutaneous fluids at home with your vet to help with keeping him hydrated and defecating.

As said before constipation causes nausea. I would ask your vet about Cerenia for the nausea, and it also has some anti inflammatory properties to it. Not like an NSAID but it does help with GI inflammation.

A urinary obstruction is truly life threatening. The longer the cat is blocked the more damage to the kidneys is done and they can die a horrible death in 2 days. It is good he was treated and hospitalized. It’s also good they kept the U catheter in place for 48 hours. These obstructions tend to reoccur, so always be sure to monitor his urine output. Stress can contribute to this and what’s so hard about that is that vet visits are stressful but in this situation he needs a vet. Once again the best thing for him to do is stay hydrated. By being hydrated it dilutes the urine and therefore diluted any debris or mucus that may be present in the bladder.

So, you have allot going on. I do feel he would be better off under the care of a specialist in internal medicine, because this is too complex for a general practice vet. But, I know what several emergency vet visits and hospitalization can do,and that may not be an option.
Recap:
Ask your vet about:
Cerenia
Midazolam,
SQ Fluids
 
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Corrog

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Not to scare you, but I want to make sure you understand that he is a very high risk for hepatic liver disease aka fatty liver disease. Cats that stop eating are at risk with overweight cats being more so. I am disappointed that your vet would tell you to wait when he wasn’t eating well.
Hepatic lipidosis is life threatening. Just like being unable to urinate is, so you have your hands full.
Hence why I am making sure he eats. When he had is bad episodes, I fed him using a syringe to be sure he had some food in him. Same with water.

Keep him on the urinary diet canned if you can. If he will eat it. Purina makes a variety prescription diet called UR. It is a morsel and gravy and many cats will eat it.
Found that out and tried it. So far, he's back to eating only the Royal Canin canned food.

If he doesn’t want to eat it can be that he doesn’t feel well, is nauseous or is associating the food with not feeling well.
That's the thing: he does eat. I just have to go to him every hour or two with the food and he eats like he is hungry, but stops after 2 minutes and moves away. I tried waiting 6 hours to see if it was because of frequent feedings, but he would eat the same amount...

Often cats that are nauseous will go up to a food and then turn away. They often will lick their lips, but not always. Constipation makes cats nauseous. There is an appetite stimulant you should discuss with your vet called Mirtazipine. It comes in a transdermal formula. It would be a good idea to have a tube of that at home.
I'll ask my vet. Last time I went, they told me to add some Fortiflora as cats like the taste, but it doesn't seem to be enough.

Constipation makes cats feel horrible. One of the best ways to avoid, treat, manage it, is to make sure your cat is hydrated. If he isn’t eating well, he probably isn’t getting enough fluids. I have not seen great results with lactulose. I think if they are very constipated, it can force them to have almost violent bowel movements and I think it can cause pain. This is my opinion only and there is no literature to back it up. Many vets find lactulose useful. I do think that a 2 ml starting dose is high. I would discuss doing some subcutaneous fluids at home with your vet to help with keeping him hydrated and defecating.

As said before constipation causes nausea. I would ask your vet about Cerenia for the nausea, and it also has some anti inflammatory properties to it. Not like an NSAID but it does help with GI inflammation.
I make sure to add water to his food and I check his pee quantity. That much seems fine, but it could be better. As for lactulose, it's pretty much banned from my house as I fear it hurts more than does good. I'll ask for Myralax and/or enemas. Same for Cerrnia We'll see.

So, you have allot going on. I do feel he would be better off under the care of a specialist in internal medicine, because this is too complex for a general practice vet. But, I know what several emergency vet visits and hospitalization can do,and that may not be an option.
Recap:
Ask your vet about:
Cerenia
Midazolam,
SQ Fluids
As much as I would feel better for him to be under specialist care, I spent all the available funds on my credit card for his last treatments. It hurts my soul knowing that money is the deciding factor in this situation but I do not give up.

What is Midazolam? You spoke about Mirtazipin earlier but wrote Midazolam at the end of your message.

Thank you for your reply. It helps immensly.
 

ailish

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Just a thought, but have one of these vets look at his teeth. It isn't necessarily his whole problem, but my cat, a very good eater, suddenly went off all food. Took her to the vet and got that appetite helper stuff (starts with an M). Slowly she started to eat. Several weeks later she was at a wellness check and the vet said one tooth was resorbed and the other one was being resorbed. Interestingly, several months prior she had been not eating for a couple days. The teeth were cleaned and removed where possible and she has been cleaning her plate ever since - it's been a year. Before all this she had baaad looking teeth at age 4 and had a cleaning. I learned that some cats have bad teeth genetically. A significant percentage of cats have bad teeth, which are painful. I don't think the cat dental situation is always fully appreciated.
 
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Corrog

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Just a thought, but have one of these vets look at his teeth. It isn't necessarily his whole problem, but my cat, a very good eater, suddenly went off all food. Took her to the vet and got that appetite helper stuff (starts with an M). Slowly she started to eat. Several weeks later she was at a wellness check and the vet said one tooth was resorbed and the other one was being resorbed. Interestingly, several months prior she had been not eating for a couple days. The teeth were cleaned and removed where possible and she has been cleaning her plate ever since - it's been a year. Before all this she had baaad looking teeth at age 4 and had a cleaning. I learned that some cats have bad teeth genetically. A significant percentage of cats have bad teeth, which are painful. I don't think the cat dental situation is always fully appreciated.
The vet checked his teeth and mouth at every visit and appart from a tiny bit of plaque, he didn't say anything about his teeth.
 

silent meowlook

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Hence why I am making sure he eats. When he had is bad episodes, I fed him using a syringe to be sure he had some food in him. Same with water.



Found that out and tried it. So far, he's back to eating only the Royal Canin canned food.



That's the thing: he does eat. I just have to go to him every hour or two with the food and he eats like he is hungry, but stops after 2 minutes and moves away. I tried waiting 6 hours to see if it was because of frequent feedings, but he would eat the same amount...



I'll ask my vet. Last time I went, they told me to add some Fortiflora as cats like the taste, but it doesn't seem to be enough.



I make sure to add water to his food and I check his pee quantity. That much seems fine, but it could be better. As for lactulose, it's pretty much banned from my house as I fear it hurts more than does good. I'll ask for Myralax and/or enemas. Same for Cerrnia We'll see.



As much as I would feel better for him to be under specialist care, I spent all the available funds on my credit card for his last treatments. It hurts my soul knowing that money is the deciding factor in this situation but I do not give up.

What is Midazolam? You spoke about Mirtazipin earlier but wrote Midazolam at the end of your message.

Thank you for your reply. It helps immensly.
I’m sorry. I meant Mirtazipine. Midazolam is a drug we would give in hospital to cats that refused to eat and were stressed. It worked really well, but the cat vet is the only vet I have ever worked for that would use it for this purpose. It is a controlled drug and only in injectable form as far as I know.
 

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Just fyi — beware of lactulose and linkage to hypercalcemia. Maybe it won’t cause elevated calcium levels in your cat, but it did in mine. I’ve unfortunately proven it in controlled settings twice, doing bloodwork pre and post lactulose use. Hypercalcemia causes cats to stop eating. High blood calcium also drives higher calcium in the urine which can lead to kidney and bladder stones. It can also contribute to constipation, leading to a vicious and deadly cycle — give more lactulose for constipation, drive calcium higher. For me and my cat, Miralax ok, never ever lactulose.
 

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Mirataz is transdermal gel form of mirtazapine. I have used it many times over the years, rub on inside of cat’s ear. Great appetite stimulant to help get you through rough patch — like when calcium is elevated due to high calcium and you need your cat to eat after discontinuing the lactulose that caused the high calcium.
 

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My contipated kitty (VERY plugged up) is now on 1/4 teaspoon Miralax and 1/4 teaspoon whole psyllium seed mixed into wet food with added water to dissolve the Miralax. The vet only gave him lactulose for a few days until the enemas he got worked to clean him out. Mirtaz gel is great for kitties with sluggish appetites. I only give it every few days. I do think your kitty should get a recheck so the vet can feel his bowels and assess him to make sure he's hydrated. If he's not getting enough fluids, then constipation could come back. I agree with having them get a look at his teeth. My cats have had terrible dental disease and showed no symptoms at all. They were likely in pain. Your kitty sounds like he is on track to getting all better.
 

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Gandolf is lucky to have an owner as dedicated as you are. I know from experience that it’s certainly not easy when your cat enters a weird doom storm like this.

The eating situation that you described comes really close to the problem I’ve been dealing with my cat for the past three years. she used to be very food motivated and would just eat you out of house and home but one day a switch got flipped and she just has no interest in eating. every 2 to 3 hours i have to try and get food in her because otherwise she just won’t eat and it’s a very involved process where I have to pet her and shake the bowl to keep her focused on eating because otherwise she’ll want to stop after 10 kibble and call it a day. and all this work is after trying about 100 different foods and this is the one she liked the best and this is on the appetite stimulant mirataz. so I understand you’re not alone in a cat that just seemingly refuses to eat.
 
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Corrog

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[Update]
I just came back from the vet (I managed to convince my wife we could spend another hundred or so) and here is what he said.

First off, he is now 16.8 pounds (when this started a month ago, he was 18.1 pounds). He is not dehydrated, his teeth are fine, his lip wounds are healed. His bowels don't seem too obstructed anymore.

I explained why I stopped the lactulose and showed him a picture of Gandalf's last night stool (yes, I now have pictures of cat poo on my phone...), which he told me looked like healthy stool, considering everything, especially the lack of food.

I was prescribed an appetite stimulant (Mirtazipine, 1/4 pill every 3 day for 12 days) and was sold 3 cans of Hill's Prescription Diet "Urgent Care" wet food which I was told to syringe feed if necessary.

Let's hope it does the trick.

Thank you everyone who replied so far. I will keep everyone updated.
 

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[Update]
I just came back from the vet (I managed to convince my wife we could spend another hundred or so) and here is what he said.

First off, he is now 16.8 pounds (when this started a month ago, he was 18.1 pounds). He is not dehydrated, his teeth are fine, his lip wounds are healed. His bowels don't seem too obstructed anymore.

I explained why I stopped the lactulose and showed him a picture of Gandalf's last night stool (yes, I now have pictures of cat poo on my phone...), which he told me looked like healthy stool, considering everything, especially the lack of food.

I was prescribed an appetite stimulant (Mirtazipine, 1/4 pill every 3 day for 12 days) and was sold 3 cans of Hill's Prescription Diet "Urgent Care" wet food which I was told to syringe feed if necessary.

Let's hope it does the trick.

Thank you everyone who replied so far. I will keep everyone updated.
Wonderful! My cat took to the urgent care food easy, but the royal canin version.

I found that Iams Perfect Portions had a similar texture afterwards so I used that to move him to other food.
 
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Corrog

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[Update]

*Sorry if I don't update more frequently, I am just paranoïd as every time I said Gandalf was doing better to someone, he had a dip*

So far, so good!

Gandalf is eating more and more every day. He wakes me up at 6 am as his plate is empty. I still have to insist for him to eat more than 1/4 can at a time, but he is doing well.

He is up to 1 1/4 cans of Royal Canin Urinary wet food per day (in about 5-6 meals, which I am trying to cut down on), and on his way to the recommended 1 3/4 cans.

As for the constipation, it seems to no longer be a problem, but I will make sure to do what I can so it doesn't come back.

Thank you for your help!
 
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