Frustrated and out of ideas and options!

Lee_JW

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I have a 17 year old domestic short hair tortoise shell that has me at my wits end and in a difficult and frustrating situation. About 5 months ago she started losing weight. She also became extremely picky about food, she would refuse almost everything.


I have been to the vet numerous times over the last 5 months. They have done a lot of bloodwork and even xrays. (fortunately, I have pet insurance so the out of pocket expense has been not that bad!) She has chronic kidney disease and I'm doing subcutaneous fluids at home for that. She also has hyperthyroidism and is on methimazole transdermal. The initial diagnosis was hyperthyroidism and the expectation was after getting the meds she would gain weight. That has not happened despite the meds bringing down the thyroid levels. The vet also recommended polyethylene glycol in case constipation was an issue. Her B12 was slightly low so I'm also doing injections for that. The vet has suggested nausea might be the issue and have given Cerenia injections a few times but that didn't make a difference. The latest GI panel has shown signs of “minor inflammation” that the vet didn’t think could be causing the issue, but I’ve insisted we try steroids. I’m hoping to start that medication this week.

I have tried almost every brand of soft and hard food I can get my hands on. I've thrown out hundreds of dollars of opened canned cat food. She will eat something new for a few days and then that goes on the list of "I don't want that" Right now she is skin and bones because she won't eat. We just got back from the vet and she's still losing weight. She's lost over 40% of her body weight and she was not overweight to start with.


I've tried expensive food, cheap food, food for older cats, food for kittens, food for sensitive stomachs, specialty prescription GI food. She was really into the Purina Hydra Care but that is off the list now. I've tried every flavor and protein source and every consistency - loaf, pate, chunks etc.

She will want food and react to the sound of me making it and will come for it. She very, very cautiously approaches the food, cautiously looks at it, smells it, takes a lick or two and says "nope don't want that". The cautious approach to the food made me think it was a cause of pain and made me think there could be an oral or dental issue. But she will eat canned salmon and loves canned salmon water. She will eat the entire amount in one go. The vet has also ruled out any mouth or dental issues.


When we do find a food she really likes, she ends up vomiting after a few days of it and we start the cycle of trying to find a new food all over again. There has been some dry food she really seemed to like and would prefer over wet food, but after a few days will vomit the dry food almost immediately after eating it. The kibbles are still basically dry when it comes up.

This poor cat seems to be wasting away before my eyes. Here's the real issue for me - all her behavior, habits, routines, interactions are completely normal and have not changed in anyway. She does not act sick or in pain in any way. She even keeps wanting to go outside on our deck which is her favorite thing to do (we have her on a leash and keep a close eye so she can't get into anything)


She has a wonderful personality and is extremely affectionate. She was a rescue I adopted 17 years ago and I feel I owe it to her to explore every possibility.


I'm hoping for any advice or anything else I can ask the vet to check for. My vet is a cat specialist and only treats cats, but can't seem to get to the root of the problem and seems to have run out of ideas. Thanks in advance for your help!
 

FeebysOwner

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Hi and welcome to TCS despite what brought you here. I would have suggested an appetite stimulant if it weren't for the vomiting up food after she eats it for a day or so. Inflammation in the intestines can be related to food allergies, so I hope you've made a log of all the different types/flavors/etc. she has eaten, and compared the ingredients in each to see if there are some things contained in all of them. She could have developed an intolerance to something in the food, if not the proteins, it could be any number of fillers that are used in cat food.

If she will eat salmon and can keep it down you might consider adding a supplement to it that makes it nutritionally complete, so she at least gets proper nutrients and avoids all the vomiting.

I think that you might be right to try steroids at this point. But, you may also want to consider consulting with an internal med vet to see if they can offer any other ideas. All of her tests can be shared with them to reduce redundant testing. An internal med vet may come up with some additional testing that could shed some light on her situation. Look for a specialty group that staffs multiple specialist disciplines as they will often confer with each other for additional ideas. Ask your vet if they know of a group.
 

silent meowlook

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Hi. It sounds like she is nauseous. The thyroid levels are good now? It can be difficult with transdermal Methimazole because it can have varied absorption.
I would definitely do the steroids and an anti nausea medication daily. Talk to your vet about odansetron
 

mrsgreenjeens

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I found with my kidney cats that I needed to switch their food around often, AND they did much better with their eating when I served them many small meals throughout the day and night rather than just a couple larger meals. So I would serve up maybe one tablespoon of food (and that would include a little warm water mixed in), and then a couple hours later I would serve another tablespoon, always mixed with a little warm water. Mixing it with warm water helps increase the smell of the food, and giving just a little bit doesn't overwhelm them. I didn't bother trying to feed foods low in phosphorus for their kidneys because they were all so picky after they got sick.

We also gave Pepcid A/C in shot form (so needed a prescription sent to a compounding pharmacy), and used an appetite stimulant (mirataz) that was a transdermal gel.

Have you seen this site? Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - Key Issues: Helping Your Cat Feel Better and Prolonging Life It's dedicated to all things kidney cat related, and was my "go to" whenever any issues arose. It's a bit overwhelming at times, but well worth it to take the time to browse. The page I directed you to is about weight loss, etc. They aren't interactive like we are, but still have great informtion.
 

stephanietx

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Being excited about meal prep and then not eating is a classic sign of nausea to me. When you have a CKD kitty, constipation is a big issue. When they haven't pooped, there's nowhere for the food to go that they consume, so it builds up and creates nausea and what we would call indigestion. Ask your vet about Ondansetron (Zofran) which is a long-acting anti-nausea med that's more effective than Cerenia. It's available in pill form or transdermal. The transdermal is expensive, though. Pepcid is a short acting anti-nausea/antacid pill that is also effective, but doesn't last as long as Ondansetron. You should also ask the vet for Mirataz, a transdermal appetite stimulant.

As others have mentioned, eating smaller meals more frequently seems to work better, or offering food and then offering again in 30 mins to an hour. I have 2 that are currently on this pattern and eat throughout the day. Thankfully, I'm home all day and can do that, but it might not be feasible for you to do that. Also, make sure you add extra water to wet food to make it the consistency of a slurry or protein shake so you're getting extra fluids in her.

Lastly, if you're giving her fluids, she may not be as hungry because fluids give them a "full" sensation until the fluids are absorbed.
 
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