Cat won't eat - despite Cerenia and mirtazapine?

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trishia42

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We saw him again tonight; they switched the pain med and he pooped due to the enemas - he was a little more aware but there was no MaoMao in there - just a shadow. He surely didn't know who we were, he had no interest in food either (again use to love ALL food), wouldn't even smell a Churu. A vet tech noticed his breathing sounded funny this afternoon so they took an x-ray and there was a shadow over a lung that could either be fluid overload (would be bad; heart problem which would mean he can't have fluids to help everything else) or aspiration pneumonia (a whole new problem to add to the list, also not good); they had to stop the fluids for now. The x-ray was sent to a radiologist for review but either way, it's not looking good at all.

I think we will lose him before the end of the week. I never knew my heart could be broken more; I've just lost my other cat April not even three months ago and she always took all the airspace and so it was the time of Mao! We were getting so much closer, he was sleeping with me, following me around, insisting on sleeping on my arm - he was such a happy go-lucky cat. I just can't believe and I don't know how I will survive it.
 

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We saw him again tonight; they switched the pain med and he pooped due to the enemas - he was a little more aware but there was no MaoMao in there - just a shadow. He surely didn't know who we were, he had no interest in food either (again use to love ALL food), wouldn't even smell a Churu. A vet tech noticed his breathing sounded funny this afternoon so they took an x-ray and there was a shadow over a lung that could either be fluid overload (would be bad; heart problem which would mean he can't have fluids to help everything else) or aspiration pneumonia (a whole new problem to add to the list, also not good); they had to stop the fluids for now. The x-ray was sent to a radiologist for review but either way, it's not looking good at all.

I think we will lose him before the end of the week. I never knew my heart could be broken more; I've just lost my other cat April not even three months ago and she always took all the airspace and so it was the time of Mao! We were getting so much closer, he was sleeping with me, following me around, insisting on sleeping on my arm - he was such a happy go-lucky cat. I just can't believe and I don't know how I will survive it.
It's good that you went to see him, T trishia42 :hugs::grouphug: :alright:
Also, good that he pooped.
The medications could be causing Mao to be more unaware, and sedated,..and keeping his pain down.
They probably needed to give him more anesthetic, too, during the enema,...so you may be seeing a little of that, too.

That shadow over his lung sounds awful, but let's just hope, that whatever it is, that Mao's body can deal with it.

I am so sorry that you have to go through all of this,...especially so soon after you lost your cat April.
I sometimes think, that the universe is not kind,...but it's not the universe,...it's only that our beautiful companion animals...have lives that are much shorter than our own.

Mao sounds like a great cat, following you around and sleeping on your arm...unless of course you needed to type, or get up, and wash dishes or something....then I guess having a sleepy cat on your arm, would be tough. :blackcat::bluepaw::winkcat:
He's still a happy go-lucky cat.
He's just very sick.

and you will survive,...it's just really not fair, that you have to go through something like this so soon after losing your other cat.

Still Sending Mega Health Vibes for your Mao. :vibes::vibes::tabbycat:
Hoping that things turn around, and that Mao begins to rally. :hugs::grouphug::crossfingers::bluepaw::greenpaw:
 
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trishia42

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This rollercoaster I would like off of. Talked to a vet just now; still shows no interest in food and still has ongoing diarrhea (not surprising given all the miralax and enemas). The shadow on the x-ray turned out to be asthma - which while not great is much better than fluid overload or aspiration pneumonia (the second of which might have been the end of the road). Our options were to leave him another night or two as is but the vet felt at this point, if we hadn't seen much improvement, it was unlikely to change thing and that being there probably didn't help his stress level and his asthma. He was SO miserable when we saw him last night too. The other option is that they take out the feeding tube, give him a shot of steroid for the asthma to try and stabilize it and send us home with cerenia/ondansetron, Denosyl, cisapride, prednisolone and some Hill's a/d food. They had already given a done of opioid around 11 unfortunately but will stop them for now and the plan is to see how he does at home to give him a little time. We obviously don't want to wait too long because if he doesn't start eating within 24 hours it becomes an urgent setback problem again - this is why I requested the Hill's a/d, to attempt to assist feed should he not eat and see if we can stabilize him over a couple of days. If he still shows no interest in food and he makes that far, then the next step would be putting in an e-tube. This requires anesthesia which comes with risks and they will be increased in his case due to his age, CKD, current condition, and now his asthma (most anesthesia-related deaths are due to cardiovascular and/or respiratory issues), so this is why we are adding the steroid.

Still a 50:50 chance though - that was made clear and apart the money (e-tubes aren't cheap!), there's always the question in the back of my mind when I see him so miserable of 'what are we doing to him'. I just hope we're making the right decision, because it is so very difficult and it seems every I talk to a vet (ER clinic, so it's different every time), it's a different opinion.

Thank you so much again for just being with me through this.
 

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Coming to this late.

e-tubes are actually quite affordable. You pay more for the X-ray and anesthesia than anything else. I believe it was $250 when I had an e-tube put into Krista.

It is entirely possible that he just doesn't feel great from what's going on and what's going into him that you won't see an improvement until you've tube fed the pancreatitis out of him. I mean it doesn't quite work like that. But supportive drugs and feeding is what's going to get him through pancreatitis. And if that's what he has, that's enough to keep him lethargic and anorexic. If he also has hepatic lipidosis, that's more than enough to keep him miserable.

Another note: some cats lose their appetite on Cerenia. Ask your vet about ondansetron instead. If you do go with the e-tube, you can stick with Cerenia as that has some anti-inflammatory action specifically helpful with pancreatitis.

My Betty has some chronic nausea issues going on. Waiting on a specialist appointment for next month. In the meantime, sometimes when she seems hungry but isn't eating, I'll pull some food off the plate and put it on the carpet in front of her. I don't understand the cat logic there. But I can usually get her to eat at least half her plated portion this way and the other half, I'm comfortable with saving for later. It's something you may want to try with him.
 
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trishia42

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Thank you for the comments; I sure will be trying everything I can to get him to eat some - I plan on taking some time off to attend to him. The e-tube here is not cheap though (maybe because it's done at a vet ER too, but our normal vet said it wasn't something they did?); it comes up to about $2,000 CAD - this is also mainly because they insist in the cat spends one night there after the surgery to ensure everything is well, he is monitored, and that he can be properly fed through the tube. I understand but oooooofffff; so we'll see if we have to get there.

And yes, we are picking up some ondansetron tonight at everyone's suggestion, which we may use in conjunction. Looks like he will be on quite the cocktail for a bit.
 
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This rollercoaster I would like off of. Talked to a vet just now; still shows no interest in food and still has ongoing diarrhea (not surprising given all the miralax and enemas). The shadow on the x-ray turned out to be asthma - which while not great is much better than fluid overload or aspiration pneumonia (the second of which might have been the end of the road). Our options were to leave him another night or two as is but the vet felt at this point, if we hadn't seen much improvement, it was unlikely to change thing and that being there probably didn't help his stress level and his asthma. He was SO miserable when we saw him last night too. The other option is that they take out the feeding tube, give him a shot of steroid for the asthma to try and stabilize it and send us home with cerenia/ondansetron, Denosyl, cisapride, prednisolone and some Hill's a/d food. They had already given a done of opioid around 11 unfortunately but will stop them for now and the plan is to see how he does at home to give him a little time. We obviously don't want to wait too long because if he doesn't start eating within 24 hours it becomes an urgent setback problem again - this is why I requested the Hill's a/d, to attempt to assist feed should he not eat and see if we can stabilize him over a couple of days. If he still shows no interest in food and he makes that far, then the next step would be putting in an e-tube. This requires anesthesia which comes with risks and they will be increased in his case due to his age, CKD, current condition, and now his asthma (most anesthesia-related deaths are due to cardiovascular and/or respiratory issues), so this is why we are adding the steroid.

Still a 50:50 chance though - that was made clear and apart the money (e-tubes aren't cheap!), there's always the question in the back of my mind when I see him so miserable of 'what are we doing to him'. I just hope we're making the right decision, because it is so very difficult and it seems every I talk to a vet (ER clinic, so it's different every time), it's a different opinion.

Thank you so much again for just being with me through this.
Thanks so much T trishia42 ...for this update on your Mao. :hugs: :alright:

I wished that the ER vets were able to stabilize Mao, but it really sounds like it would be better to bring him home.

It's often confusing to be getting so many different vet opinions, too.
Though, sometimes one vet makes more sense than another...in explaining things.
It's difficult for us laypeople to actually know which vet to trust, and which vet would help the most, (especially since in an ER situation they are always changing shifts, and days working, too).

(Not sure, if asking your regular vet would help, any, and taking the paperwork, bloodtests, ultrasound, and any other ER reports, in with you, to your regular vet...(or just asking if you could email them...for their opinion)...if they are a vet you had for long, and knew your cat well.)
(here, the vets are constantly changing, so I would not even know what to do.)

(not to mention the higher expenses, which you've already quoted for an E-tube. wow. I knew that ER vets were expensive, but I never realized that regular vets did not place e-tubes, and that there were so many risks, besides the anesthesia.
thanks for pointing that out, and for thoroughly explaining it.)

I think the best thing is to bring your Mao home, and attempt to syringe feed him/assist feed.
It will be difficult, though, since a very sick cat is most likely not going to want to eat.
Yet, at least at home, you may see Mao be way more comfortable, in his own surroundings.
Plus, it would give you some extra time to decide on next steps, too.

It's such a difficult decision, though, since with placing an E-tube, you may have a better chance at treating his pancreatitis, like daftcat75 mentioned above,...yet those anesthetic risks are very real in an elderly cat, along with the health issues.

I understand that ckd cats do crash at times,...but from reading your other thread, I just don't understand how a hurt tail...somehow cascaded into all of this.
Did the vets at the ER...also do that 'fPLi' bloodtest...specifically looking at the pancreas?
Feline Pancreatitis

I wonder if you can also ask the Vet clinic for some Hills i/d wet food, along with the a/d...since the i/d may not be a rich as the a/d...but you could possibly mix it....or try which one Mao would like...when warmed up, and if he can Smell the food.
(if Mao does also have gallstone formation, or blockage, from his ggt numbers,...then a diet that is not as high in richness, might help.
Hoping that the prednisolone actually helps, and reduces any inflammation, too.)
6 Best Cat Foods For Pancreatitis In 2022: Diet & Info

I know you already mentioned Denosyl, which has the samE...but Denamarin also contains the samE and milk/thistle...I think.
(not sure how they decide which one is best)
https://veterinarypartner.vin.com/default.aspx?pid=19239&catId=102894&id=4951818

All I can wish you is Strength, Clarity, and peace...in making these difficult decisions. :alright:
Also Still Sending Extra Health Vibes for your Mao...that somehow, he turns the corner, and is able to start eating, and beats this health crash. :vibes::vibes::tabbycat: :hugs::grouphug:
 

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These videos by 'fundamentally feline'...may help with any tips and tricks...to get a cat to eat meds from syringe.
(I find her videos very informative, practical, and useful.)

 

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And this was my 'go-to video for syringe feeding' when I had to, with previous rainbow ckd/hcm cat.
(there may be newer ones on youtube, but this lady's video (treken steve) was extremely helpful.)
She just explains it so well, and is very organized, and patient.

 
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trishia42

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Thank you so much for the videos cat nap cat nap - love the medication ones.

We did decide to take Mao home last night and I was able to get some ondansetron as well. It felt much more like him once we were back home; he insisted on sleeping with his head and paws on my chest while purring all night long, which was honestly the best feeling in the world.

He seemed interested in the food we laid out for him once we got home but didn't initially try it, but about 3 hours after the ondansetron, he went back and ate about 1/4 can of the food we had put out so we felt that was encouraging. He ate a bit more this morning, close to half a can but around noon when he tried a few more bites, he did the walking away, licking the lips and looking like he was going to be ill again - which would seem to indicate he is still feeling nauseous.

I'm not sure if it's because the ondansetron dose from last night wore off a bit, and that the one he was given around 10 AM this morning still has not kicked in? I am a little worried he will start associating food with him feeling bad and nauseous and stop eating again because of it... Here's the current cocktail of medications that he is on:

- Ondansetron 4mg every 12 hours
- Cerenia 8 mg every 24 hours
- Denosyl 90 mg every 12 hours (for liver support)
- Cisapride 2.5 mg every 12 hours (to ensure things keep moving)
- Prednisolone 0.14 mL every 12 hours but this is just temporary at this time (it was in case he would get surgery for an e-tube today, and we will be running out tonight)

He's 7.66 kg and his daily intake should be about 320 kcals; the vet said that if he ate about 200-250 kcals for the next 2-3 days, it should be fine but that if he didn't start eating more after that, we should definitely re-assess given his current condition of pancreatitis and either liver inflammation or hepatic lipodosis.

We're only up to about 80 kcals today, so we still have a long way to go. Things looked a little encouraging this morning, but now I'm so worried we won't make it to 200 kcals even...
 

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I don't know, but I'm thinking if you leave it up to him you're right, that quantity of food intake may not happen.

Handfeeding isn't an option? I'm not referring to syringe feeding, but rather getting a little pate style food on the end of a tongue depressor/popsicle stick and scooping that into his mouth/on his tongue. My vet suggested this method a couple years ago, and I'm doing that with my boy on a regular basis now in order to get his Milk Thistle (and a couple other supplements) in him, up on the kitchen counter which makes it easier.
 

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Have you tried Hills A/D with him? This is a calorie rich recovery food perfect for sick cats and those who have lost weight. My Betty loves the stuff. I think it's a bit rich for her on its own. And I don't want her getting too used to this stuff by itself. I mix it with Hills I/D because surprises of surprises, she likes this stuff too--the stew cans, not the pate. The stew doesn't have enough calories. That's why I mix in the A/D. I also reserve the pure A/D for getting a few extra calories into Betty if she pulls up too short on her mix. Sometimes just a small spoonful of the A/D (about 5 grams) will spur new eating of her mix too. Or if I need to mix a powdered supplement into food, I do it in her high appeal A/D rather than her regular meals mix. It would be a good idea to see if he likes the stuff now before you start putting it in an e-tube for him. This is likely the food your vet will recommend with the e-tube because it's already a smooth syringe-able texture.

I do think he probably has too much going on, too many meds going into him, for him to feel up to eating full calories on his own. I know you said an e-tube is expensive. But it's going to take so much stress off the both of you to be able to feed and medicate him when he needs it rather than when he feels up to it. He'll recover faster getting adequate nutrition.
 
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trishia42

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I tried handfeeding before, but if he's walking away because he is still nauseous, I don't feel that will help. It's been another hour and he ate some more and didn't look like it made him feel sick so it looks like it could be a VERY delicate balance between the amount and times of dosage for the Cerenia and ondansetron? I'm not sure yet - I just want him to at least make it to 250 kcals so I can at least breathe a bit!

We did get some of the Hill's a/d (interesting enough, it's less calorie dense than the can of Fancy Feast I have here; 183 kcal/156 g vs 114 kcal/85 g, so that was a bit disappointing), but he also has shown no interest in it - unsure if it's because he's not feeling great or what.

Still hoping to avoid the e-tube; I worry about the risk during anasthesis - his breathing is still currently pretty fast. Additionally, my husband is leaving the country on Sunday for 5 days and I'm panicking at the thought already!
 

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...He seemed interested in the food we laid out for him once we got home but didn't initially try it, but about 3 hours after the ondansetron, he went back and ate about 1/4 can of the food we had put out so we felt that was encouraging. He ate a bit more this morning, close to half a can but around noon when he tried a few more bites, he did the walking away, licking the lips and looking like he was going to be ill again - which would seem to indicate he is still feeling nauseous.

I'm not sure if it's because the ondansetron dose from last night wore off a bit, and that the one he was given around 10 AM this morning still has not kicked in? I am a little worried he will start associating food with him feeling bad and nauseous and stop eating again because of it...
Yes, you want to avoid 'food aversion', by not getting Mao to associate feeling ill, with the actual food he is eating.

One of the members here, Jem Jem ...wrote a good post, that I re-read last night.
I'm just going to copy and paste it here, (I don't think the member will mind, since it was helpful and detailed.)
...My boy had CKD, and with that, nausea was a common symptom. Fluids were the biggest thing that kept him feeling well, but the other was that cats who have nausea, tend to associate how they feel with the smell of their food. So you could present them with something and they'll perk up and eat it (or some of it anyway), but because they were feeling nauseous they then associate the smell of that meal to why they feel sick and will not want to eat it the next meal. What I did to help my kitty to keep eating was to offer something that smelled completely different for every single meal so that the association of "this smell"="sick" didn't happen. It helped quite a bit.
So basically, if you can offer your Mao, a 'new meal' that smells completely different...and that you can 'rotate out' for each single meal,...then I would think that Mao will not associate the 'food'...with feeling sick.
(It will be a lot of different varieties of food,..and plenty will probably not work...but just to see Mao eat on his own...would help).

Raise his food dish...about 4-6 inches, or more, off from the ground, onto a box, books, wood, etc...may make it more comfortable for him to eat.
Also, Feeding him off a 'flat plate'...(to avoid 'whisker fatigue'), too.

Try to warm up the food, by placing it in a zip lock bag, and mushing it,...and then running it under warm or hot water,...to heat it a bit.
(
my cats hate food from the fridge, and only prefer room temperature food.)
(some people also microwave the food a bit, to warm it, except I find that you have to use your small finger and mix it around...to not have any 'hot spots'...and people have said that it takes some nutrients away by nuking it.)

Furballsmom Furballsmom ...already posted this thread...for more ideas to stimulate a cat's appetite.
I would try everything I could...to hopefully find something that works.
Any Good Tips To Get Your Cats To Eat? Share Them Here!
 

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We did decide to take Mao home last night and I was able to get some ondansetron as well. It felt much more like him once we were back home; he insisted on sleeping with his head and paws on my chest while purring all night long, which was honestly the best feeling in the world.
Now that sleeping position, and purring, does sound like the best feeling in the world. :blush:
Here's to more of that. :cloud9: :greenpaw::bluepaw:
...Here's the current cocktail of medications that he is on:

- Ondansetron 4mg every 12 hours
- Cerenia 8 mg every 24 hours
- Denosyl 90 mg every 12 hours (for liver support)
- Cisapride 2.5 mg every 12 hours (to ensure things keep moving)
- Prednisolone 0.14 mL every 12 hours but this is just temporary at this time (it was in case he would get surgery for an e-tube today, and we will be running out tonight)

He's 7.66 kg and his daily intake should be about 320 kcals; the vet said that if he ate about 200-250 kcals for the next 2-3 days, it should be fine but that if he didn't start eating more after that, we should definitely re-assess given his current condition of pancreatitis and either liver inflammation or hepatic lipodosis.

We're only up to about 80 kcals today, so we still have a long way to go. Things looked a little encouraging this morning, but now I'm so worried we won't make it to 200 kcals even...
I'm not familiar with ondansetron, and so would not know of potential side-effects, or how it would affect cats with ckd.
Ondansetron

What is also difficult to know, is how each medication affects our cats.
(with cerenia, I found that I had to give the tiniest dose, to my then 6yr old female dsh,..to stimulate her appetite. And still I found it too strong. But she did not have pancreatitis or ckd. only a partial blockage, which the enema helped.)

Are you able to get those small geletin capsules...to hide the pills inside?
Or pill pockets...which tend to crumble when dry, and only allow for the tiniest pills, ever.

If Mao likes some Treats...then I would also get some of the ones he likes...and use the calories in them, to add on to his daily.
(though, I guess that treats would also have very low calories...but perhaps crumbling a few onto his food, or using some 'toppers' might help. my rainbow ckd cat did like Fortiflora...for the animal digest taste.)

I really think the prednisolone would be more helpful, if you could refill it, since it increases appetite and lessens inflammation.

Also, you did mention that you had mirtazapine before?
Was it in gel form...for the ears?
 
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trishia42

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Thank you so much for the tips! He currently has four different offerings in front of him (and although I warmed a couple of them they're at RT now), I did raise all the bowl this morning to make it easier for him and I am using flat plates at the moment just to ensure that wasn't an issue (didn't used to be for him but you never know). I plan on going to the pet store to try to get a bunch of various things to try. I'm also looking up information online to see about dosage and frequency with ondansetron. We currently do 4 mg every 12 hours, the vet said we could also do 8 mg every 12 hours, but I also see some say 4 mg over 8 hours.

A lot of people on the CKD forums are prescribed Cerenia and ondansetron, so it's probably okay - we're sort of hoping this is short-term too as ondansetron is crazy pricey! Vet didn't think we should renew the prednisolone right now but I may be able to talk to my vet tomorrow or Monday if she is in (they weren't sure).

Have Fortiflora but he's never been into it - the treats are hit and miss right now. I do have mirtazapine but we were told to hold off a bit if he was eating since I think he had some given to him just 2 days ago, and it was suggested every 3 days. It's a pill, although probably not impossible to get transdermal, but we are not having too much trouble pilling him.
 
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Thank you so much for the tips! He currently has four different offerings in front of him (and although I warmed a couple of them they're at RT now), I did raise all the bowl this morning to make it easier for him and I am using flat plates at the moment just to ensure that wasn't an issue (didn't used to be for him but you never know). I plan on going to the pet store to try to get a bunch of various things to try. I'm also looking up information online to see about dosage and frequency with ondansetron. We currently do 4 mg every 12 hours, the vet said we could also do 8 mg every 12 hours, but I also see some say 4 mg over 8 hours.
Four different foods in front of him.
I remember trying that with my cats...(so if I slightly smile, it's not at you, but at the memories of what my cats would do). :frustrated: :doh:
It didn't work with my cats. smh. :disappointed:

I think you'll just have to offer "one plate"...maximum two.

Only because of the usual 'cat sniffs food'...then cat walks away from all food...and humans feel crushed...feelings. :yummy: :eek2:🧐🤨
But you know your cat best,...so try what you think Mao will go for. :crossfingers:

At least if you plate just a small amount...and our cats walk away...then you don't have to throw it all out.

With the medications, the ondansetron,...I would probably start low...and then watch for effects.
 

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For some reason, I lost track of this thread - so it may have already been mentioned. A lot of CKD cats are also getting an acid reducer like famotidine (Pepcid AC, is one example) - in addition to Cerenia (or, ondansetron) and Mirtazapine. You might ask the vet about trying it to see if it helps any. With him not eating much, maybe he does have an overabundance of acid in his stomach? The stuff is nasty tasting, so it does have to be hidden in a capsule/pill pocket/etc., but it sounds like that is not so much of an issue with your cat so that is good.
 
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Betty has nausea issues. Still waiting on the specialist appointment to know more than "inflamed intestines." No pancreatitis though. I give her a nightly dose of Mirataz (transdermal mirtazapine) and a twice daily dose of famotidine and ondansetron. She'll have stomach acid spit ups if she misses a famotidine dose as much as I would love to eliminate that one. I tried her with Cerenia and she appears to be one of those cats whose appetite is depressed with Cerenia. My angel kitty, Krista, before Betty, also had reduced appetite with Cerenia.

Since Mao is now taking ondansetron, can you discuss a Cerenia holiday with your vet to see if he is also one of those whose appetite is disturbed by Cerenia? Or does the vet want to keep him on it for the mild anti-inflammatory effect? You sort of have to balance ideal with reality. It would be great if he could take all those meds and still have a hearty appetite. But we know at least one of those may be affecting his appetite and I would love it if you got your vet's blessing to skip a day or three of Cerenia to see if his appetite perks up.
 

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I've been visiting this thread, and just want to say that I am so sorry you are going through such a difficult time with your kitty, Mao.

My previous cat experienced pancreatitis, in 2013-2014, and she was one of those cats that did not react well to Cerenia. Instead, for her nausea she was prescribed injectible Anzemet (I was already used to giving her injections, since she was diabetic) plus famotidine. Anzemet works a bit differently than Cerenia, and she ate well when on it, with little apparent nausea. She was also on an injectible painkiller for her pancreatitis pain. We found that injections worked more reliably than the oral meds route.

I just bring up Anzemet in case you find she continues to not do well using cerenia/Ondansetron. Each cat is different, and some cats do better using different meds than the more "popular" ones. It's something to consider, and, if needed, to go over with your cat's vet.
:redheartpump:
 
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