Cat Not Eating/drinking & Nauseous Despite Meds - But Normal Test Results!

[DuckyJo]

Hi all - apologies ahead of time for the novel. Our 4 1/2 year old tortoise shell has put us through the ringer since last weekend.

Here's the essential of three of my questions, if you don't want to read the whole thing:

1. What would cause my cat to still be nauseous and not eating after receiving antibiotics, anti-nausea injections (Cerenia), appetite stimulants (Mirtazapine), and pain meds (non-opioid, Gabapentin)? Clear bloodwork and ultrasound (no results on UTI yet). She seems to show interest in foods but sniffs, licks her lips, and walks away without taking a bite (except some treats). Would any of these medicines be continuing the nausea, despite the anti-nausea medicine - or do Cerenia or Mirtazapine not work for all cats?
2. What other foods can we be trying?? (Have tried her usual grain-free wet foods, grain-free dry foods, treats [protein puffs, chicken hearts], kitten milk replacement, meat-based baby foods)
3. Would a UTI be causing these symptoms? Even if she received an antibiotic already?

SUNDAY: On Sunday afternoon, she had a vomiting episode where she threw up a few times. We realized she hadn't eaten that morning and probably the night before. We tried to get her to eat (eventually resorting to treats, which she threw up not too long after that). She started to move a bit slower and was not quite her feisty self. Later that night, after researching and reading about the risk of fatty liver after not eating for 24 hours, we took her to an ER vet. The vet did an x-ray and found that she had quite a back up (also spotted what was probably the clay pellets from her litter box in her stool). They performed an enema, gave her some fluids, and gave her an anti-nausea medicine (in addition to prescribing us amoxicillin and a laxative). The vet also knocked her out for the process because she was considered fiesty-er than most (I was not impressed that they had to do that, as the other ER vet we've gone to since then have been able to handle her just fine - which concerned me a bit as to how well they performed the enema).

MONDAY: After getting her home, she was way more lethargic than she was before - it lasted all the way through Monday (and Tuesday morning). We tried to administer the medicines we'd been given (amoxi drops and laxative - which we haven't given since), but could barely get anything in. She just sat in our closet, refused to eat or drink, and looked just pitiful. She would gag every time we put food in front of her (her normal wet foods, dry food, and treats).

TUESDAY: We resolved to take her in on Tuesday morning to another ER vet (who's been so much better and have continued to use through this process).

This vet did standard blood work (which came back normal), started a culture plate for her urine (still waiting to get back results), gave her more fluids, injected another anti-nausea medicine (Cerenia), gave her a long-term antibiotic (two weeks or something; based on the most typical UTI), and prescribed her an appetite stimulant (Mirtazapine). They recommended a bland diet, but also said to encourage her to eat whatever she would eat. Getting home, she seemed a little more energetic at least and vaguely interested in food (even before the Mirtazapine). But, even after the Mirtazapine, there seemed to be no improvement of her nausea, which seems to be her big barrier to eating. She would walk up to the food like she was hungry, sniff it, lick her lips, and walk away. We tried plain chicken, kitten's milk, meat-based baby food, her usual wet food, usual dry food, gastrointestinal specific food, and her treats (protein puffs and chicken hearts). We got her to eat a couple handfuls of treats...

WEDNESDAY: But she threw up the treats about 12 hours later on Wednesday morning.

Vet said to take her back if there was no improvement in eating or vomiting - so, we headed back last night (Wednesday night) to talk options. Vet said that she seemed sensitive to touching on her abdomen, so recommended an ultrasound (which we had wanted to do over a more complex blood test anyways) - to check for any other obstructions, organ damage (especially fatty liver or pancreatitis), etc. We had to keep her stomach empty for the procedure, so at least that was easy.

THURSDAY (Today): Early this morning, she finally ventured out of the closet and climbed in to bed with us. We were thrilled and wondered if she might eat, but we pushed ahead with the fast and had her do the ultrasound today. Everything looked normal, except for some debris in her bladder that could be from a UTI. Still waiting till tomorrow to hear if she has a UTI (which she was already given an antibiotic for, just in case). They agreed to give us a pain medication (non-opioid, gabapentine - which sounds like it might just take the edge off). We're really concerned that she won't eat (or drink much) despite the anti-nausea medicine, appetite stimulant, and pain med. And, maybe part of her slow recovery is all the meds and the frequent stressful trips to the vet. She seems to be a little more chipper tonight - actually walking around, jumping up on to things (she seemed like jumping was too painful earlier in the week, meowing (she went radio silent when she was really out of it - super strange for her). BUT, still not eating at all or drinking very much except a few treats, and seems to want to eat but licks her lips and turns her head away.

We keep convincing ourselves that she's either totally on the mend or totally dying.

Has anyone else had this experience with their cat? Is there anything that she may be taking that could keep her nausea going, despite the Cerenia? Does Cerenia and Mirtazipine work for all cats? Would a UTI cause all these symptoms and continue to do, even after having an antibiotic? Is there some secret food that we're missing and just haven't tried yet?? I so appreciate any tips, thoughts, or just hearing that other folks have gotten through this with their cat...

 

[daftcat75]

I believe Cerenia is an anti-emetic (stops vomiting) but not necessarily an anti-nausea drug. When Krista was going through her pancreatitis, I briefly tried her on Cerenia. But when she was on Cerenia, she wouldn’t eat and she still licked her lips like she was nauseated. It’s just that the Cerenia quieted that part of the brain that would normally say, “now vomit!” I’ve tried her on it a couple times more and every time she doesn’t eat. So I call it counterproductive. I only let the Drs give it to her to keep her from vomiting after surgeries now. She just got a feeding tube inserted because she stopped eating and had some dental extractions. But she also has some abnormal liver and gallbladder values in recent chemistry so we needed her “eating” again so that we can also give her medicine. Now none of the food or medicine she needs to recover has to go through a very sore and swollen mouth right now.

You might consider a feeding tube insertion to get nutrition back in her while you are figuring out what’s underlying the vomiting and anorexia.

Have you tested for pancreatitis? Spec fPLI on the blood work if you have it. But it’s non-standard so it’s often not ordered. Ask your vet.

 

[DuckyJo]

Thank you for the reply! That's so helpful to know about Cerenia - silly me, assuming that what the vet called anti-nausea means that it stops nausea...

There was no indication on the ultrasound that her pancreas was enlarged or damaged - which I know is not conclusive at all for that, though the vet hasn't tried zeroing in on that. We have already spent around $1500 and we're nervous to get too much farther in (we're expecting a baby in April so money is tight). I can't seem to find any price tags - would that be a part of the full blood work panel or an individual test?

Our hope is, even if its pancreatitis, that we have the meds and support she would need to recover eventually anyhow (anti-vomit, appetite stimulant, pain meds) - though the missing piece now seems to be anti-nausea. Perhaps we'll let her roll off the Cerenia and see what happens.

And with terrible timing, we're traveling internationally next weekend. So a feeding tube might be our last ditch effort, especially to make it as easy possible for our family members to take care of her while we're gone.

 

[daftcat75]

I know there are other anti-nausea drugs for cats. I just don’t have experience with them myself. I live in California so I was able to get her a dispensary quality CBD oil formulated for pets. CBD, while safe on its own, is not without its interactions with other drugs and the research is very limited. Ask your vet if there are other anti-nausea drugs you could try in place of the Cerenia. However, if you stop the Cerenia, the vomiting may return. If it is pancreatitis, Cerenia actually has some pancreas-specific anti-inflammatory action. In that case, I would keep her on the Cerenia but go with a feeding tube. If it is pancreatitis, then you have pretty much all the right drugs. But there’s pain and nausea associated with pancreatitis that may make the drugs insufficient depending on how much inflammation is there.

Spec fPLI is a blood test. It is not a standard test. So it may actually appear on your bill as a separate line item. I don’t know how much it would cost on its own. For Krista, it was a $40 add-on to her senior screen ($200.)

If I recall correctly from my research, pancreatitis isn’t always (rarely?) readily apparent on an ultrasound. The fPLI test is much more reliable.

 

[DuckyJo]

I know there are other anti-nausea drugs for cats. I just don’t have experience with them myself. I live in California so I was able to get her a dispensary quality CBD oil formulated for pets. CBD, while safe on its own, is not without its interactions with other drugs and the research is very limited. Ask your vet if there are other anti-nausea drugs you could try in place of the Cerenia. However, if you stop the Cerenia, the vomiting may return. If it is pancreatitis, Cerenia actually has some pancreas-specific anti-inflammatory action. In that case, I would keep her on the Cerenia but go with a feeding tube. If it is pancreatitis, then you have pretty much all the right drugs. But there’s pain and nausea associated with pancreatitis that may make the drugs insufficient depending on how much inflammation is there.

Spec fPLI is a blood test. It is not a standard test. So it may actually appear on your bill as a separate line item. I don’t know how much it would cost on its own. For Krista, it was a $40 add-on to her senior screen ($200.)

If I recall correctly from my research, pancreatitis isn’t always (rarely?) readily apparent on an ultrasound. The fPLI test is much more reliable.

Again, thank you for this info...it was HUGELY helpful to know that Cerenia wouldn't necessarily be helping with the nausea. We looked in to the drug after your reply, and saw that anorexia was listed as the second most common adverse reaction. This felt like a really critical piece of knowledge for us to have in how we strategized next steps...

We decided to let her roll off the Cerenia and, sure enough, she started to nibble at food again about 24 hours after her last injection. We figured that she was more herself in the past day and perhaps she'd recovered from whatever was causing the initial vomiting and nausea, but still fighting the lack of appetite that Cerenia was giving her. I really wish we had known this before so we could have tried a different anti-nausea medicine - maybe she could have recovered more quickly if she was able to get back to eating earlier.

And, I'm super grateful to have had that info because we've been so desperate to get her back to eating (this would be the 5th day of almost no food!) that we probably would have gone back to get another injection today and just kept the cycle going. And, if she really is on the mend now, we probably would have just kept stressing her out (and our wallets) with trips back to the vet to figure it out.

Of course, we're not out of the woods yet. If the vomiting returns, we'll ask the vet to do the test for pancreatitis. But we're feeling SO optimistic to have our kitty nearly back to her usual fiesty self with a grouchy appetite!

Also, we live up in Washington and will have to keep the CBD option in mind if she's not fully recovered yet and for future use!

 

[daftcat75]

If she’s eating again and not vomiting and doesn’t have Krista’s pain face in a photo I’m attaching, it’s probably not pancreatitis. Lethargy, nausea, anorexia, and pain/vomiting after eating are the symptoms of pancreatitis. Which sounds like just about everything else. That’s probably why it gets overloooked. No vet wants to start with such a nasty one. But if you’ve already looked at everything else and still no improvement....

It was the third (!) vet Krista saw that finally recommended the pancreatitis test. That’s why I’m a big proponent of just throwing that Spec fPLI test in with the other blood work if kitty takes a turn for the worse again. Better to test negative than overlook it.

Sounds like it was probably a couple of things up with your kitty: constipation and possible UTI. The constipation alone is enough to cause nausea, vomiting, lethargy, and anorexia. Didn’t help that Cerenia causes anorexia in some cats. Did you tell your vet? Mine didn’t know that. She was surprised when I told her that Krista doesn’t eat on it.

Crossing fingers that yours will return to normal in a day or two. If she hasn’t been eating right in so many days, you may need smaller meals more frequently to grow her stomach back to where it was before. You could get vomiting again if you try to give her normal portions too fast and too soon.

 

[daftcat75]

Forgot to attach the photos. These are a couple of Krista’s pain faces. One is from pancreatitis and the other is just a food that didn’t agree with her. (IBD face?)

 

[stephanietx]

Did you have an x-ray done to rule out any kind of possible gastroenteritis?

 

[DuckyJo]

About two and half weeks on, and our kitty seems to have fully recovered (even after having to leave her in the care of family members for our 10 day trip). Though, we don't feel like there was any sort of conclusion as to what the initial and on-going issues were.

Thank you for sharing the photos of what a cat can look like in pain (adorable tortie, by the way). Definitely looks like how she was feeling that week - though she also tends to have that face when she's really relaxed. Resting bitch face, maybe?

She did receive an x-ray at the first emergency vet, though they focused on her being constipated. Not much seemed to show up in the ultrasound either, if that's something that would appear there too. Our current theory is that she got constipated and had an adverse reaction to either the enema process (who wouldn't, I guess) or the Cerenia that she was initially given.

I guess the biggest take away we had (and I'm hoping this thread will help other people discover) is that Cerenia can cause a lack of appetite. I'm a little frustrated that this wasn't mentioned by the vet, as her anorexia was our major concern and maybe even kept her from recovering sooner. We'll definitely request a different anti-nausea medicine if she ever needs it again, to see if she has a better reaction!

Again, thank you for the responses!

 

[Teri122]

Ondansetron (zofran) is generally a good anti-nausea med to keep on hand. Cheaper than Cerenia too. And for appetite Cyproheptadine overall seems to have less side effects than Mitrazapine and works well in most cats. Just throwing those out there, fwiw.

 

[catlover73]

I 2nd mentioning Zofran mentioned above to your vet if you have the need for nausea meds for your cats. My Starbuck was given this for nausea when she got sick years ago and it really helped her be able to go back to eating. She did not get an appetite stimulant. She had the kitty equivalent to human stomach flu and stopped eating cause she could not keep anything down. The vet wanted to stop the nausea and vomiting to see if she would go back to eating on her own before trying an appetite stimulant. She went back to eating normally very quickly.

I actually asked my vet if that medication was acceptable for feline use. I use Zofran myself for nausea/vomiting for migraines. I found that for me once my stomach is settled I can go back to eating normal. My thought when I was talking to the vet was maybe the medicine would do the same thing for my cat.
I do not have any experience with appetite stimulants though. My cats have never been on one.