Cat suddenly sickly after two doses of prednisolone

sierramist

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Hi everyone,

I haven't been on the boards in a while, but a sudden issue has come up and I'm seeking help from anyone who might have some insight. Apologies for the length!

My 10-11ish year old tabby (unsure of exact age) has always been a good, but fast eater, and I'm used to him regurgitating food periodically because he eats too fast. We've had him checked out by the vet in the past with no obvious problems, and tried to modify the behavior with an elevated bowl, smaller meals, etc.

More recently, over the last 4-6 weeks, he's been regurgitating more frequently, and losing a bit of weight. Even though he was acting 100% normal otherwise, I was worried so we took him to our vet yesterday to see what might be going on. I was shocked and saddened to hear that she palpated what seemed to be a large mass in his abdomen, and is assuming it is lymphoma. She immediately begins talking more palliative care than treatment options, offering a steroid to "make him more comfortable" and/or another drug that will suppress the need to vomit. She mentions an ultrasound but warns against a major surgery.

Being a person who likes facts, I opted to schedule the consultation for the ultrasound (done at an internal med vet elsewhere) and agreed to try out just the steroids. It wasn't explained to me that the steroids would be prednisolone, as I was assuming a shot. Even though I had my reservations, even telling my husband "I hate starting him on meds because he seems so normal right now," we began the prednisolone right after the appointment yesterday morning. The vet had prescribed 5mg tabs, 1 tab every 12 hours for 5 days, then 1 daily for 5 days, then 1/2 for 5 days, possibly continuing if beneficial.

By yesterday evening he was still eating quite well, but did seem more listless and tired. I knew from giving pred to a previous cat with IBS that lethargy can be a side effect, so I went ahead with a second pill yesterday evening as instructed. At that time he was still very interested in treats, but a bit less so with his usual kibble.

By this morning, he was a different cat. Little energy, enthusiasm or personality. A small appetite where only ate a few bites of his breakfast, and then less than 20 minutes later he threw it all up. Then a short while later, threw up again, mostly liquid, then again an hour later, totally liquid. I called the vet and explained the situation, insisting it had to be the pred (even though she seems unconvinced), because this is way too coincidental and had never happened before. Usually his vomiting is undigested food immediately after eating, no nausea, and he goes right back to eating again. But now, he was absolutely nauseated and miserable, more than I'd ever seen.

So we decide to end the pred immediately since he had only taken two pills, and hope that he would begin to come out of the adverse effects and start feeding again slowly. That conversation was about 8 hours ago, and it's been 20 hours since the last pill, and he still will not touch or act interested in ANY food or drink at all — his favorites, plain chicken, tuna, broth — I wave it under his nose and there's no major response. This is a cat who, yesterday, would knock you down for a single treat, LIVES for mealtime. He's not a picky eater. Now he seems very weak, probably dehydrated, and either in pain or is nauseated still, or both. He's been laying down all day, extremely lethargic and unhappy. I don't know how this can happen! I've been trying to do some research and this seems like an anomaly.

We have an appointment at the emergency clinic in a couple of hours for a consult and to hopefully get IV fluids to stabilize him again so he'll perk up, get an appetite back, and return to the normalwe had just yesterday. I get that he may have a serious situation going on regarding the possible cancer and prognosis there, but this sudden downfall after one day of meds has me terrified. Has anyone experienced anything like this?
 

daftcat75

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I’m not a vet. But my discussions with my vet over my Krista’s lymphoma leads me to believe that 5 mg twice a day is a lot of pred! It doesn’t surprise me that he might have reacted that way. Pred takes about 36 hours to clear. That means every 12 hours you’re adding more pred and his body still hasn’t cleared that last two doses. I understand if he wanted to take an aggressive approach on the mass and see what might come of it. But if the vet suspects cancer, then chemotherapy should be more effective than steroids. Or steroids alone. With chemo, he could take a smaller dose of pred. Depending on the chemo protocol, many cats have few and mild side effects. My Krista slept a little more on dosing days. That was about all I noticed. Your vet is probably reluctant to prescribe chemo without a cancer diagnosis. I would proceed with the ultrasound as that is noninvasive and can tell you if there is multi-organ involvement aka if chemo would be even worth the effort. If they can do a needle aspiration of the mass, that is minimally invasive (sticking a fine needle into the mass and sucking out a sample using the ultrasound to guide the needle.) I would consent to that one. I would not recommend a surgical biopsy if they have to open him up to remove a larger piece of the mass. That kind of surgery will come with a recovery period that just isn’t good for a cat not maintaining his weight. In the short term, he may have another 12 to 24 hours to clear out the remaining pred in his system. Fluids is an excellent supportive treatment for him right now. The drug that suppresses the urge to vomit is most likely Cerenia. It works for many cats. But for some cats, it may help with nausea but it also suppresses appetite. There’s another drug, ondansetron, that helps with nausea and is better tolerated with some cats. Just keep an open dialogue with your vet about medicine reactions and whether alternatives or dose adjustments might be appropriate. Cats are tough patients. They either give very little feedback or very dramatic feedback. Not much in between. Just about any medication can be compounded into a flavored oil, treat, or transdermal (use these sparingly since you only have two ears to work with.) Wedgewood Pharmacy is my favorite online compounding pharmacy to work with. Your vet calls in the prescription and you can work with Wedgewood to choose from many different formulation options to find one that works best with your guy.
 

AmandaRox

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This is very concerning. Roxanne just started a steroid today and she was extremely lethargic for the first 6 hours. Definitely not herself. Ironically, they warned that she would have more energy, not less. They only had the liquid, in cherry flavor, and the dose was supposed to be 2ml but I only gave her 1ml because 2ml is a lot of liquid and its cherry
 

daftcat75

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This is very concerning. Roxanne just started a steroid today and she was extremely lethargic for the first 6 hours. Definitely not herself. Ironically, they warned that she would have more energy, not less. They only had the liquid, in cherry flavor, and the dose was supposed to be 2ml but I only gave her 1ml because 2ml is a lot of liquid and its cherry
It can take a while for them to get used to the steroids. It’s not an easy drug for them to take as the OP’s cat will attest to. You should discuss any dosage changes with your vet. 2 mL is a lot of liquid for a cat. But you halved her dose. You can get the vet-recommended dose compounded into a more concentrated liquid and a more appealing flavor. My favorite online compounding pharmacy to work with is Wedgewood. Your vet will call in the dose and you can work with a support rep or speak to a pharmacist to find a formulation that works best for your cat. I recommend a highly concentrated oral oil suspension that can be mixed at home with a little bit of salmon oil or another flavorful treat. I had my Krista’s chemotherapy concentrated from the original 1 mL dose to a 0.1 mL dose with an anchovy flavoring. That dose plus a half pump of salmon oil came out to about a nickel’s worth of oil that she would willingly make it disappear off a plate in seconds flat. Every time.

Prednisolone Oral Oil Suspension
 
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sierramist

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I’m not a vet. But my discussions with my vet over my Krista’s lymphoma leads me to believe that 5 mg twice a day is a lot of pred! It doesn’t surprise me that he might have reacted that way. Pred takes about 36 hours to clear. That means every 12 hours you’re adding more pred and his body still hasn’t cleared that last two doses. I understand if he wanted to take an aggressive approach on the mass and see what might come of it. But if the vet suspects cancer, then chemotherapy should be more effective than steroids. Or steroids alone. With chemo, he could take a smaller dose of pred. Depending on the chemo protocol, many cats have few and mild side effects. My Krista slept a little more on dosing days. That was about all I noticed. Your vet is probably reluctant to prescribe chemo without a cancer diagnosis. I would proceed with the ultrasound as that is noninvasive and can tell you if there is multi-organ involvement aka if chemo would be even worth the effort. If they can do a needle aspiration of the mass, that is minimally invasive (sticking a fine needle into the mass and sucking out a sample using the ultrasound to guide the needle.) I would consent to that one. I would not recommend a surgical biopsy if they have to open him up to remove a larger piece of the mass. That kind of surgery will come with a recovery period that just isn’t good for a cat not maintaining his weight. In the short term, he may have another 12 to 24 hours to clear out the remaining pred in his system. Fluids is an excellent supportive treatment for him right now. The drug that suppresses the urge to vomit is most likely Cerenia. It works for many cats. But for some cats, it may help with nausea but it also suppresses appetite. There’s another drug, ondansetron, that helps with nausea and is better tolerated with some cats. Just keep an open dialogue with your vet about medicine reactions and whether alternatives or dose adjustments might be appropriate. Cats are tough patients. They either give very little feedback or very dramatic feedback. Not much in between. Just about any medication can be compounded into a flavored oil, treat, or transdermal (use these sparingly since you only have two ears to work with.) Wedgewood Pharmacy is my favorite online compounding pharmacy to work with. Your vet calls in the prescription and you can work with Wedgewood to choose from many different formulation options to find one that works best with your guy.
Thanks for the help. I'm writing this in the middle of the night because I'm out of my mind with worry. We went to the emergency vet, and the doctor on call initially couldn't feel any mass at all, so we did some x-rays. She was pretty upset that our normal doc hadn't done any diagnostics before prescribing, and so am I.

I know you can't usually diagnose much on x-rays, but there was only a small spot visible in only one view, and she even had to get another vet working with her to find it by palpating. That gives me hope that it hasn't spread and isn't huge, but we have to figure out a way to get over this very weird hump before even getting to the point of an ultrasound or any other treatment.

We ended up having her do the sub-q fluids, a shot of Cerenia, then some extra tabs of Cerenia for later, with the plan to go back to the vet Monday and do the damn bloodwork she should have done in the first place. This was about 7 hours ago, and there's no change at all. I just keep saying, "I don't know how this happened." The emergency vet isn't 100% convinced it's just the pred or something the pred caused, that it could be the "condition" that's yet be diagnosed. But it's too damn coincidental, isn't it? I'm I crazy?

We went from an absolutely acting normal cat a day and half ago, to a kind of normal but nauseated and sluggish cat a day ago (could still hop around his cat tower, climb the couch, walk around), and he slowly went downhill all day yesterday. The only change in his world to have started this was the prednisolone. Now he's in a state where he's so weak he won't move from a spot. I put him in front of a bowl and he just lies down. So tired he doesn't want to stand or walk much at all. No interest still in food or water. He did just go in the litter box and pee a little once I put him down in front of it.

I just can't believe this, it makes no sense. What could that steroid have done to him or caused secondarily? Why would he be so lethargic and weak? If it was just the pred, wouldn't there be some gradual improvement as it leaves? Would it stay in his system longer without eating and drinking to push it out through waste? Maybe I'm grasping at straws. We're at hour 30 since the last pill I gave him. He's taken in nothing since other than the sub-q and Cerenia shot.

I feel like I and his vets have somehow failed him already and we've barely even started on this journey. So much regret and sadness right now.
 

AmandaRox

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It can take a while for them to get used to the steroids. It’s not an easy drug for them to take as the OP’s cat will attest to. You should discuss any dosage changes with your vet. 2 mL is a lot of liquid for a cat. But you halved her dose. You can get the vet-recommended dose compounded into a more concentrated liquid and a more appealing flavor. My favorite online compounding pharmacy to work with is Wedgewood. Your vet will call in the dose and you can work with a support rep or speak to a pharmacist to find a formulation that works best for your cat. I recommend a highly concentrated oral oil suspension that can be mixed at home with a little bit of salmon oil or another flavorful treat. I had my Krista’s chemotherapy concentrated from the original 1 mL dose to a 0.1 mL dose with an anchovy flavoring. That dose plus a half pump of salmon oil came out to about a nickel’s worth of oil that she would willingly make it disappear off a plate in seconds flat. Every time.

Prednisolone Oral Oil Suspension
Thank you. I'm looking into it. The reason for the half dose is the formula is 20mg/5ml and he prescribed 2ml. She's a 9 lb 1 year old. I feel like it's very high for them to not even know what's going on with her
 

daftcat75

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Thank you. I'm looking into it. The reason for the half dose is the formula is 20mg/5ml and he prescribed 2ml. She's a 9 lb 1 year old. I feel like it's very high for them to not even know what's going on with her
That does sound like a fair amount of pred (8 mg?). But you’re not the vet. Steroids should not be messed around with on your own. Call the vet back and discuss the dose with him/her. And once started, you should not make any sudden changes to her dose without the vet’s guidance. Once the cat is acclimated to its dose, sudden changes to that dose can be very hard on the cat.

Pred is often given in high doses for short periods of time with a tapering off. If whatever is going on is going to respond to pred, it’s better to know that sooner than to leave the cat on steroids for a long period of time. By halving the dose yourself, you are potentially cutting that response short before giving it a chance. It’s not really your place to be making dosing decisions yourself.

If you’re not happy with your vet’s guidance, find another vet. You should hire someone you trust to help monitor and manage her steroids use to minimize short-term and prevent long-term side effects.
 

daftcat75

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Thanks for the help. I'm writing this in the middle of the night because I'm out of my mind with worry. We went to the emergency vet, and the doctor on call initially couldn't feel any mass at all, so we did some x-rays. She was pretty upset that our normal doc hadn't done any diagnostics before prescribing, and so am I.

I know you can't usually diagnose much on x-rays, but there was only a small spot visible in only one view, and she even had to get another vet working with her to find it by palpating. That gives me hope that it hasn't spread and isn't huge, but we have to figure out a way to get over this very weird hump before even getting to the point of an ultrasound or any other treatment.

We ended up having her do the sub-q fluids, a shot of Cerenia, then some extra tabs of Cerenia for later, with the plan to go back to the vet Monday and do the damn bloodwork she should have done in the first place. This was about 7 hours ago, and there's no change at all. I just keep saying, "I don't know how this happened." The emergency vet isn't 100% convinced it's just the pred or something the pred caused, that it could be the "condition" that's yet be diagnosed. But it's too damn coincidental, isn't it? I'm I crazy?

We went from an absolutely acting normal cat a day and half ago, to a kind of normal but nauseated and sluggish cat a day ago (could still hop around his cat tower, climb the couch, walk around), and he slowly went downhill all day yesterday. The only change in his world to have started this was the prednisolone. Now he's in a state where he's so weak he won't move from a spot. I put him in front of a bowl and he just lies down. So tired he doesn't want to stand or walk much at all. No interest still in food or water. He did just go in the litter box and pee a little once I put him down in front of it.

I just can't believe this, it makes no sense. What could that steroid have done to him or caused secondarily? Why would he be so lethargic and weak? If it was just the pred, wouldn't there be some gradual improvement as it leaves? Would it stay in his system longer without eating and drinking to push it out through waste? Maybe I'm grasping at straws. We're at hour 30 since the last pill I gave him. He's taken in nothing since other than the sub-q and Cerenia shot.

I feel like I and his vets have somehow failed him already and we've barely even started on this journey. So much regret and sadness right now.
Cats hide pain and discomfort so well. It’s possible that the pred just broke the dam. It was more than he could hide.

You could try to get him on IV fluids for a day or two to see if the pred can be flushed out of him.

I’m still hoping he’ll feel better when the pred is out of him. 10 mg/day is a lot. It’s better that it was split into two doses. But you still have to let the pharmacology run its course. It will take about 36 hours for each dose. Possibly longer because the first dose wasn’t fully metabolized before the second dose. I recommend taking him back for more fluids in a couple of days if he’s still not eating on his own. Dehydration is a larger concern than starvation.

You may want to break out the highly appealing foods now like fried chicken (minus the skin) or tuna in water. You can also try some grocery store brand cat foods (Friskies, Fancy Feast, Sheba, etc) with him. Popular brands are popular with cats. They would not be on those shelves otherwise. Don’t worry too much about brand or recipe quality. “Junk” food he will eat is always better than “health” food he turns his nose at.
 
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sierramist

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Cats hide pain and discomfort so well. It’s possible that the pred just broke the dam. It was more than he could hide.

You could try to get him on IV fluids for a day or two to see if the pred can be flushed out of him.

I’m still hoping he’ll feel better when the pred is out of him. 10 mg/day is a lot. It’s better that it was split into two doses. But you still have to let the pharmacology run its course. It will take about 36 hours for each dose. Possibly longer because the first dose wasn’t fully metabolized before the second dose. I recommend taking him back for more fluids in a couple of days if he’s still not eating on his own. Dehydration is a larger concern than starvation.

You may want to break out the highly appealing foods now like fried chicken (minus the skin) or tuna in water. You can also try some grocery store brand cat foods (Friskies, Fancy Feast, Sheba, etc) with him. Popular brands are popular with cats. They would not be on those shelves otherwise. Don’t worry too much about brand or recipe quality. “Junk” food he will eat is always better than “health” food he turns his nose at.
Thank you. Unfortunately the outcome was not what we anticipated or wanted. I'm so sad.

https://thecatsite.com/threads/hes-gone-so-quick-and-now-the-pain-and-guilt.433971/
 

AmandaRox

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I'm switching her to the inhaler. The vet said it was a better option than the liquid but he chose to prescribe the liquid because it was immediately available. She was prescribed 2ml liquid but I gave her 1ml and can barely get her to take that 1ml of Cherry liquid. She gags or pukes it.. and the lethargy/fatigue from the whole system steroid is really out of character for her. I'm not sorry about starting her on the 1ml/8mg because she would have been so much worse on 16mg. Day 4 and I cant even tell if her original symptoms have gotten any better (labored breathing from outdoor exercise) because she has zero desire to run and play, and seems sedated.
 

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I'm switching her to the inhaler. The vet said it was a better option than the liquid but he chose to prescribe the liquid because it was immediately available. She was prescribed 2ml liquid but I gave her 1ml and can barely get her to take that 1ml of Cherry liquid. She gags or pukes it.. and the lethargy/fatigue from the whole system steroid is really out of character for her. I'm not sorry about starting her on the 1ml/8mg because she would have been so much worse on 16mg. Day 4 and I cant even tell if her original symptoms have gotten any better (labored breathing from outdoor exercise) because she has zero desire to run and play, and seems sedated.
I hope she feels better soon.
 
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