Giving difficult cat medication

runekeeper

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For those who might be wondering, YES Kippy is getting treatment for his continuing fatty liver disease. However, at the moment, I am having a lot of trouble medicating him.

The vet suggested giving milk thistle a try, so I ordered some alcohol-free milk thistle seed extract and am currently waiting for it to arrive. These last couple of days, though, Kip was so out of it that I went and got some milk thistle capsules to get him started on while I wait for the liquid to arrive. The vet said to try mixing it in with some food and feeding it to him, but since there is nothing I could depend on that he would eat for sure, I went and mixed it with some water - 98 mg into just a little water (so I wouldn't have to stick the syringe in his mouth too much). Well, that didn't work out at all. I used a tiny 1 mL syringe to squirt the milk thistle-water mixture in his mouth and after each squirt, he decided to start foaming at the mouth.

I get that, like most supplements, it probably tasted really nasty. I don't think he actually ingested a single drop of this stuff, and I'm just going in a revolving circle of wiping away loads of saliva and foam and trying to get a little of the milk thistle down his throat while he's having a fit and scratching me. No such luck; he's been foaming for about 30 minutes and has been alternating between pooping on the floor and vomiting, which I think are due to stress and him being upset with me.

If he reacts like this to the capsules, I imagine he will react far worse to the more concentrated extract. I don't know what to do. How the heck can I medicate this cat when he just makes himself essentially throw it back up? Should I mix the milk thistle powder or liquid with a little canned food or baby food? I'm worried that by force feeding him (again), he's going to just go right off his food from the stress of being medicated.

I'm not used to this. Every other time I've medicated cats, it took a little effort, but I eventually succeeded. Never have I had a cat do this foaming nonsense, and it's so frustrating because I know Kip does not understand why I'm doing this. Just that he's being fed icky stuff, but I want to throw him across the room because I know I'm doing it to help him and he's sabotaging my efforts. And now due to those few bitter drops of milk thistle, Kip is completely out of it, sprawled out on the floor, looking like he's at death's door. He was doing so good today and was so happy and now he's probably going to be off his food and his water for at least a week. He gets lethargic and depressed when he's been under more than 5 seconds of stress, then he gets dehydrated from not drinking and I have to take him to the vet for fluids, meaning he's under more stress, which keeps him off his food and water for even longer.

What should I do? How do I keep him from spitting his meds back up? The vet is no help, she just says to keep doing what I'm doing and it's just making Kip worse. I don't suppose I can give the milk thistle as a suppository, can I? He won't like it, but it has a much better chance of staying in his body.
 

ritz

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Sorry you're in this predictament.  Doing the same thing and expecting different results is the definition of insanity.

I can't pill Ritz; well, I could, but the stress on both of us negates any effect the medication would otherwise have.

Do you have a good relationship with any pharmacist?  For all medications I have to give Ritz (and some were really nasty tasing ones like Reglan), I have my pharmacist compound the medication and flavor it.  Ritz likes tuna/chicken, or even Bubblegum flavored drugs.  You might ask the pharmacist if the flavor he uses comes in powder form and then mix the powder with the milk thistle and put into the gel caps.  (You can buy gel caps on line or in full service pharmacy/health food stores.)

Can you coat the capsule with butter, full fat yogurt or full fat/flavored cream cheese (salmon flavored, though read ingredients first)? and then give it to Kippy?

Also, foaming at the mouth sometimes means he's nauseated.

I'm also used with great success baby food (the brand that only contains meat + broth, no cornstarch or lemon).  One of the advantages with baby food is its water content.

Good luck; I know it's a worry.
 

denice

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Is the problem that his liver enzymes aren't coming back down?  That happened with my cat that had fatty liver and the supplement did help.  I don't know how he is with pills but there are supplements that contain SamE and the milk thistle or the extract of the active substance from milk thistle.  I know Denamarin is one and Denosyl is another one.  They have to be swallowed whole because they have a protective coating so that they break down in the intestines rather than the stomach.

I know some cats are more easily stressed than others.  I can pill my cat but I was never able to syringe feed him for the same reason that you describe with your cat.  He would clench his mouth, I would pry his mouth open which sometimes involved getting bitten and then he would vomit because he would be so stressed out.  He had a feeding tube when he wasn't eating because of the fatty liver because there was no way I could get enough food in him with a syringe.

Please try not to get frustrated with him.  I know it's hard but he doesn't know he's just being himself. 
 

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I'm so sorry to hear how distressed Kippy gets when you try to medicate him. I struggle with the idea that the vet thinks it's OK to carry on doing this and has not tried to come up with any alternatives. If the milk thistle is causing this level of distress has the vet assured you that the benefit of administering outweighs the effects of the distress, and that there is NO alternative? If so, it would certainly be worth discussing with a pharmacist as I think they may have alternatives, including little capsules you might be able to put the medication in to and then coat and administer in a different way? I really hope you find something which helps but that Kippy finds less distressing.
 
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runekeeper

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I don't know if it makes a difference, but I did not get the milk thistle from a pharmacist. I was just told I can get some from the vitamin section, so I don't know if I could still take the extract to someone and ask them to add flavoring to that. Some online sources say milk thistle seed extract actually tastes alright, but I've never taken it before, so I have no idea. I bought the extract that several people recommended for pet liver disease called Nature's Answer. I see a lot about some people's animals even opening their mouths for the drops, though I did not see anything about a flavoring since it's not made specifically for pets...safe for pets, but not something like Apawthecary brand supplements that are bacon flavored.

Thankfully, he wasn't depressed today like I thought he'd be. I went to see him in his usual spot and he led me right over to his food bowl so he could eat. For some reason, he likes when I sit with him and talk to him while he eats, and he at quite a bit. He also seemed to really like some canned kitten food, but threw it up after he ate it...not sure if it's because it was too rich or he just ate it too fast.
 

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I think you're right about the "keep doing what you're doing" advice isn't quite getting it with Kip. There's got to be a better way.

I agree with the advice of trying soft cheese or anything that Kip loves.

When I first got these cats, they all had a minor URI. Two of my cats I had to lift by the scruff of their neck (hind feet still on the floor) to give amoxicillin, yet the third one was trying to climb all over me to get more medicine. Go figure. In any case I don't like having to treat my cats roughly and I gave treats after medicating them and made a fuss over them. They quickly forgave me.

I had a horse that could be difficult to medicate orally, and he developed a condition that required a daily oral med. I walked out into his paddock and just held out the syringe with some of the med on it. He dramatically smelled it and reminded me that he didn't like oral meds. I did it a few more times, and finally gave the med. He realized that the med wasn't that big a deal and took the med religiously until he died. In a way I made taking the med his idea?

Anyway, maybe something in that ramble will help.
 

mservant

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I guess the one thing about milk thistle is it's OK for you to taste: have you tried it to see what it's like? 

If it isn't bitter, is there anything that Kippy really likes to get, or does he have any favourite food/liquid treats you could try it with like a little gravy he might lick so it isn't associated with holding and not being in control? 
 

white shadow

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Hi RuneKeeper !

Denice 's point about use of SAMe as well as the milk thistle extract (silymarin) would be well-taken here...the supplement of choice is usually Denamarin:  Denamarin for Cats
 
 
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runekeeper

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Yes, I have tried the milk thistle and it's bitter, so I will forgive that first time I administered the liquid extract (which I received today, earlier than expected). So I tried mixing it with a little milk...he only needs a few drops, which I stirred into a few spoonfuls of milk. I made some and tried it myself, and it tasted like just plain milk to me. Not a hint of bitterness. Must be Kip tasted something I did not because, much like the last two times, he foamed at the mouth when I gave him the milk mixture. Not as much as before, mind you, but I think now he associates having something shoved in his mouth with icky tasting stuff, so he's just going to spit it out no matter what I stir it into.

Would it be safe to administer the milk thistle rectally? I know it's not the prettiest idea, but I think it has a much higher chance of staying put...and since it's such a tiny amount, I don't think it would cause him to void his bowels like if he received an enema. I imagine if it's safe to take it orally, it's safe to go in the other way. I just don't know if it will be as effective taken rectally.

There is no food that he will eat 100% of the time that I can hide the milk thistle in. Some days I can only get him to eat kibbles and treats, some days he only wants tuna, some days he only wants processed cheese. Rubbing it on his feet won't work either. I tried doing that with Enercal gel and he just eventually got sick of cleaning gunk off his feet, so he stopped. Then I had to cut the sticky, gross fur off his paws. At this point, I think my only options for getting this stuff into him and having it stay there is either subcutaneously or rectally.
 

mservant

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It's a real shame he wouldn't accept the milk. It may be the association, do you think there's any chance if you put it down for him or try in the milk, or a little pate or gravy he could lick at he might take it? Or is he not interested in anything right now?

Sadly I think milk thistle has to be taken orally as everything I can find says it is distributed through the digestive system. I don't think it could be absorbed through the colon - but someone may have some specialist knowledge and let you know otherwise. 

Don't know what else to suggest. Sorry.
 
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runekeeper

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Milk is another hit-and-miss kind of thing. Sometimes he will drink a whole saucer of milk (his usual bowl is small, maybe like 1/4 of a cup) and other times he won't even touch it. I haven't given him any in a while because the last several times I tried giving it to him, he turned his nose up at it. Like I said, what he will and will not eat changes pretty much on a daily basis, and even when it is something he will eat, he might grow tired of it before finishing it. Today I gave him some Fancy Feast canned kitten food and he seemed to like it; he ate all but a few bites. I just don't know if he'll be able to smell the milk thistle or not. I think he might associate even the scent with the stress of force feeding. He did that with heavy cream; I thought he'd love it since he enjoyed milk, and I tried mixing it with Hill's A/D food for maximum calories, and I think that is what made him refuse to touch cream after that.

I worry that if I do mix the milk thistle with any food and he realizes what's in it, he's going to hate it by association and his limited palate is much too precious for me to risk having him lose interest in anything. Maybe I can try using the other mouth syringe. I've given him water with that before and he does kind of okay with it.
 
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runekeeper

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Phew, success with a milk thistle dose. I mixed 4 drops (about 140 mg) with a spoonful of baby food and stirred in a little water to make it thinner. Used the bigger 3 mL mouth syringe and Kip put up his usual expected fight, but no foaming or vomiting. Okay, now just gotta do this 2 or 3 times a day for the rest of forever and hope it will maybe improve his liver enough to make him hungry again. :)
 

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That's great! I'm so glad you found a way to make it a little easier on both of you.

How's his appetite?
 
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runekeeper

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Kip's been taking the milk thistle just fine still, but I think having something shoved in his mouth is causing him to be depressed. He did this when I force-fed him food before; he'd just be completely out of it, lying on the floor, staring into space or just sitting with his eyes half-shut and flicking his tail anytime I said his name (it didn't seem like a happy tail wag either). At the very least, he is still drinking on his own; during prior force feeding, he quit drinking water and I had to take him in for fluids.
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And it freaks me out so much when he's just laying there looking like roadkill because I think OMG he's dying! I know the energy and the spark are in there somewhere, but he just doesn't give a crap about anything. Note that the oral medication does not last nearly as long as the force feedings. It's not even 15 mL and requires fewer than 10 little squirts of fluid. It's not like my Rolly when he was dying...he couldn't go more than a couple steps without needing to sit back down. Kip still gets up and moves around and hops on stuff now and then, so I think it may not be physical lethargy, but depression. Which I believe is also a symptom of HL, and him being medicated is probably making it worse.
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As I sit here, he's in his kitty bed. He was laying on the floor in a pile, but I wanted him to be comfy, so I put him in a kitty bed and set it near me. He's laying down with his head up, flicking his tail around like he's annoyed. If this milk thistle is going to work, it can't start working soon enough! Though depressed/upset, I am at least glad to see when he will lay down where I can see him. I think if he truly wanted to be alone, he would hide somewhere I couldn't find him. I know he has the energy to get up and walk/run, so it makes me feel somewhat better when he sits on the floor a few feet away. I think that might be him going, "I don't like you right now and I want to make sure you see how much I don't like you!"
 
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