Help! Cat keeps vomiting

[Tinjao]

Btw he initially had BUN but didnt take very long it dropped back to normal after a few days during his confinement.

Right now we give him normal saline through subcutaneous infusion. I'm not sure why the opted for saline instead of LR's

But my main problem right now really is his vomiting. Our vet is thinking that his vomit comes from his sensitivity to his tastes in medicines and food. I really dont know cause he really likes to eat but then he vomits after 2 to 4 pellets.

 

[Furballsmom]

Our vet is thinking that his vomit comes from his sensitivity to his tastes in medicines and food.

You've tried different foods, canned, dry, boiled chicken, bland unseasoned baby food...?
Is he losing weight?

 

[mentat]

1. Gabapentin for pain and for anxiety. 100 to 150mg YES, that much, by mouth, pill directly, as his appetite is poor, and lacing food with meds is for good eaters, not renal failure kitties.
Two hours before you are to administer his SQF, so he is in a zen state, thus you are in a more zen state. Consider asking your human behavioral medicine or physical medicine doctor to consider anxiolytic options for you as well. Working during This, are you kidding?! You need all the tools in your arsenal you can get!
2. Cerenia. CERENIACERENIACERENIA. Not Reglan aka metoclopramide. Reglan "regulates" GI motility, increasing smooth muscle contraction. He needs LESS contractions. Cerenia blocks Substance P, blocking nausea, blocking vomiting, blocking visceral abdominal pain. We even use it in URI kitties now, as it blocks excessive nasal and pharyngeal secretions by blocking substance P. What a nifty all around drug to have in the kitty tool box!! He needs 2-3mg/kg every 24 hours. Most cats get the 24mg box of #4, and you administer 1/4 tablet by mouth. He can have this at the same time as the gabapentin, but I prefer to give gabapentin alone, solely so their is less stress pilling medication, as he's calmer after the gabapentin takes effect.

If he is actively nauseated, avoiding food, avoiding you, and/or drooling, place the Cerenia quarter tablet in less than 1/8 tsp (smaller than 1cm squared) butter, bacon fat, pork fat, chicken fat, a solid substrate to hide it in, and pill, then chase with 2-3mL lukewarm (not cold) water. Cold water hits esophagus and stomach suddenly, muscle tightens, regurgitation likely.

3. Doxycycline should ALWAYS be given hidden in food as I just described. It notoriously induces esophageal stricture in cats if it is too slowly swallowed, as cats are prone to tablets, capsules, or pieces of food sticking in their esophagus they way food and pills tend to adhere to geriatric human esphogeal tissue. They do not drink much, morphologically structured by evolution to obtain and absorb majority of their hydration from meat ingested. Always chase the doxy with water, also.
How much doxy is he getting how many times a day?

4. Renacure... What were his electrolyte values? Did the vet say he is hypokalemic? How is his mobility and range of motion? Can he hold his head upright, or is often held low? Is he moving less? Can he pick up and place his feet consistently, with deliberate movement, or is he sliding/dragging slightly as he picks each paw up? Can he jump and land without slipping or sliding?
What was his blood total and ionized calcium values?

A few things to bear in mind. Renal disease in cats is rarely present alone. Most cats have comorbid disease with renal disease, again, that is manageable. Ensure your vet checked his thyroid level, the thyroxine or T4, specifically. Ensure there was normal calcium and normal electrolytes. If any of these are not normal, his acute renal insult you are currently dealing with will persist without treating low/high electrolytes, low calcium, or high T4. The trifecta is Very Very common, mitral valve disease, renal disease, and hyperthyroidism. Blood pressure monitoring should be done for each cat at each visit to the vet, as all of these diseases are caught early by hypertension noted on doppler blood pressure readings. Vets and their staff learn to do it without much preamble, without needing to shave any hair, without restraint of the patient. Just place cuff above their hock or at the base of tail, place probe lower than the cuff, apply isopropyl alcohol to hair, find pulse, hold probe in place while filling cuff, slowly release cuff with sphygnanometer, and read the systolic BP. Too many vets unfamiliar with obtaining BP 20 times a day on awake patients, cause stress, poorly restrain, and obtain very very high artifactual readings after stressing the poor cat and themselves out about the process.

Get his BP checked ASAP, as well as T4, SDMA, electrolytes, calcium, and PCV/HCT. Nonregenerative anemia is common in CKD cats, and another benchmark to gauge how progressed his CKD is, as well as help identify extremely low numbers, indicating bone marrow production is low, and renal disease may be a red herring for underlying cancer affecting his bone marrow.

Cats, as obligate carnivores, solitary predators evolved in the desert, then domesticated and evolved with humans, are uniquely dependent on their meaty food, physical activity, and a calm environment/low stress for self-regulation. Unique from dogs, as they were not domesticated for use, for farming, for hunting, for guarding, for herding. Cats were domesticated as revered beings, as holy, then, as companions; they went from top hunter predator, alone, in a quiet desert, to pet-hood and companionship placing high demands on their behavior and body, in very few generations of evolution. They will compensate on cereal-like food, low active indoor life, and high stress environment and still survive, but their metabolism begins to alter, their pancreas secretion alters, their kidneys take a lot A LOT of beatings before beginning to alter, and their metabolic and endocrine control of bodily functions and systems then changes. We environmentally change their genetics through multiple generations of environmental poor diet, poor activity, and high stress. The heart, the endocrine system, the kidneys, are just yelling at us to cut the stress, up our food game, and up our environmental enrichment for cat savvy activity and engaging with his humans.

 

[mentat]

Btw he initially had BUN but didnt take very long it dropped back to normal after a few days during his confinement.

Right now we give him normal saline through subcutaneous infusion. I'm not sure why the opted for saline instead of LR's

0.9% Saline is needed if he had low sodium. It is detrimental if he has low potassium, and now we are going to suppress it further, by administering 0.9% NaCl. LRS has KCl, supplementing potassium needed in passive cellular transfer and muscle contractions. It has 0.6% NaCl. As well as lactate, doh. So, NaCl is needed, as potassium-sodium ion gated channels need both to appropriately transfer proteins and others through cells. But, 0.9% is only used at initial hyponatremia, then QUICKLY stopped, as excess sodium leading to very low potassium is an emergent state, shock, and quickly leads to death.

But my main problem right now really is his vomiting. Our vet is thinking that his vomit comes from his sensitivity to his tastes in medicines and food. I really dont know cause he really likes to eat but then he vomits after 2 to 4 pellets.

Absolutely wrong of your vet. Azotemia, aka elevated creatinine with or without the elevated blood urea nitrogen, is extremely acidotic, causing bile acid to churn churn churn. ALL renal cats get nauseated and are prone to inappetance due to this. ALL OF THEM.

CERENIA. As already mentioned. Daily. Forever, if need be. It is used by veterinary oncologists, internists, surgeons, and feline specialists EVERY DAY in cats, til end of life. If Tink didn't get Cerenia, my cat would have died 3 years ago. Period. Zoetis product, chemical drug name Maropitant, ONLY brand available, Cerenia. Reglan is very very very old medical practice choice for vomiting. Between Reglan and Cerenia, we used Zofran it cats for vomiting. Ondansetron. 2 to 3 mg every 6 to 8 hours. BUT, Zofran is old old medicine now, as we've used Cerenia since 2005. Get Cerenia. Without it, he will be nauseated, his abdomen hurts every every every day, and he may vomit. He doesn't have to live like that. Nor do you.

Injectable is a GREAT option your vet should also stock, for giving to kitties, doggos, babies, and exotic mammals like him when in hospital, with acute symptomology. Injectable Cerenia is dosed at 1-2mg/kg IV or SQ (NOT IM), IV preferred as it limits the stinging ice sensation they feel during SQ administration. Cold storage helps limit the SQ sting, but definitely still there and most cats react negatively as soon as injected, so vets need to draw the 0.3-0.6mL dose most cats get, change needle for a 20g, and inject SQ immediately. If catheter placed, as patient is hospitalized and staying for awhile, IV admin directly into hub of IVC or port of line works great, then flush behind with 3mL LRS or saline.

 

[mentat]

CERENIA (maropitant citrate) - Prevent Canine & Feline Vomiting | Zoetis US
[email protected]
Email zoetis, asking which of their veterinary clients purchases Cerenia. If your vet can't access it or refuses to purchase from his/her zoetis rep, then go to a clinic that has it. That's the best vet for managing his renal disease. Too many of your vet's choices in renal disease and feline medicine management fail to meet standards of modern feline medicine. You are too worn emotionally and physically to have to closely call and manage your cat in the place of a good vet. The drive, if it is greater, is worth the time and expense. Imagine driving 3-5 hours for a better vet, who gives you a good plan and protocol from the start, who you rarely have to drive to after establishing a new disease's management plan. This is bollocks, all this misinformation and outright untruths, you are having to filter through to get to the meat of the matter. Done. Seek other advice. Even a phone consult with an American internist whom you send your lab results to and the printed plan from your vet's exam/assessment notes, is better than what you currently have.

 

[Tinjao]

Yes I have tried all that. He asks for food actually, and he eats whatever we give him but sometimes he vomits seconds to hours after.

 

[Tinjao]

1. Gabapentin ---- If youre talking about having anxieties or pain, I don't think he is experiencing them. He takes the subcutaneous really well, he walks around the house or still interacts with us from time to time. But most of the time he returns back to my parent's room because he usually sleeps.

2. Cerenia ---- I will email the email ad you sent me.
Most cats get the 24mg box of #4 ---hopefully I can purchase this here.

((If he is actively nauseated, avoiding food, avoiding you, and/or drooling, place the Cerenia quarter tablet in less than 1/8 tsp (smaller than 1cm squared) butter, bacon fat, pork fat, chicken fat, a solid substrate to hide it in, and pill, then chase with 2-3mL lukewarm (not cold) water. Cold water hits esophagus and stomach suddenly, muscle tightens, regurgitation likely.)) --- will also try this and the luke warm water!

3. Doxycycline --- he was prescribed with a 20mg/ml preparation. And we give him 1.8ml once a day, so it's about 36mg per day for 7 days.

4. ((Renacure... What were his electrolyte values? Did the vet say he is hypokalemic? How is his mobility and range of motion? Can he hold his head upright, or is often held low? Is he moving less? Can he pick up and place his feet consistently, with deliberate movement, or is he sliding/dragging slightly as he picks each paw up? Can he jump and land without slipping or sliding?
What was his blood total and ionized calcium values?)) ---- yes he is moving less but after he sleeps he roams around the house and interacts with us or with other cats. He also scratches the scratch post. Sometimes asks for food but we only feed him twice a day together with the metoclopramide so he won't vomit again. He jumps and lands just fine though. I was really not informed of his labs, we were only advised to go back to the clinic after 2 weeks.

 

[Tinjao]

We were also adviced to avoid food high in protein. So we just give him cat food such as: kidney care, Royal Canin renal, and Royal Canin S/O

 

[Tinjao]

One vet before (when he was still on IV infusion) adviced us to replace his IV with dextrose in LRs, about 300ml of it he seemed to have been lethargic. I really dont why, but then when we got him to our current vet that's when they adviced us to give 100ml per day SQ for 2 weeks until his next check up.

 

[Tinjao]

One vet before (when he was still on IV infusion) adviced us to replace his IV with dextrose in LRs, about 300ml of it he seemed to have been lethargic. I really dont why, but then when we got him to our current vet that's when they adviced us to give 100ml per day SQ for 2 weeks until his next check up.

I mean 150cc

 

[mentat]

If youre talking about having anxieties or pain, I don't think he is experiencing them. He takes the subcutaneous really well, he walks around the house or still interacts with us from time to time. But most of the time he returns back to my parent's room because he usually sleeps.

Dehydration alone is painful. Muscles are tight and taut, stretched across skeletal system, thrumming with pain and inflammation during low water content and passive transfer. Senior cats have osteoarthritis and dgenerative joint disease, often under-diagnosed, especially in non-cat savvy practices, like the one you have described who thinks vomit and nausea in a renal cat is due to pickiness or food preference. Outdated, non critical thinking of vet professionals.
Injections, orally dosing meds by manually pilling, and vomiting are all stressful to cats. The marker behaviors in body languange and reaction to stimuli are nuanced and often missed by vet professionals in a clinical setting as well as owners who've never dealt with their cat being unhealthy or managed a chronic disease, or multiple chronic diseases. I am trying to tell you he is experiencing stress and pain, helping you recognize his symptoms, while also trying to cope with nausea, vomiting, inappetance (they eat, they vomit or are nauseated, they're inappetant and avoid food, sometimes water and people too), neuromuscular pain/deficits, and potentially, effects on the heart, blood pressure, and thyroid. Getting ahead of such symptoms, proactively, rather than reactively, is very important while managing chronic disease, chronic dehydration risk, chronic pain, chronic inappetance, chronic nausea.

I am not going to try to convince you to get your cat analgesia and pain control. I do not have the energy right now. Treating my own multiple chronic diseases, emergently and chronically, including pain and stress and anxiety, means just repeating myself is exhausting and expends my energy beyond my reserves. Research it, do not assume your cat is not in pain, or is not anxious while coping with so much change at once. Thousands of my feline patients, fosters, and own have been painful from 3 days age to 20 years age, during acute and chronic insult/injury, surgery, and disease. Stress and anxiety were managed coinciding with pain management, from neonatal care to geriatric medicine. Gabapentin is the tip of the iceburg. Your baby would do well on long acting extended/slow release buprenorphine, as well as supplemental anti-inflammatory therapy orally, topically, via laser therapy, and assisi loop therapy. Gabapentin was a first line, easier access, easier administration. Dr. Susan Little, internal medicine cat specialist and leader in feline medicine in Canada and US, has many references you can look up regarding feline pain, feline behavior/anxiety/stress and feline renal disease.

https://wsava.org/wp-content/uploads/2020/01/AAFP-How-do-I-know-if-my-cat-is-in-pain.pdf
Osteoarthritis in Cats: A More Common Disease Than You Might Expect
Feline Pain Control Medication & Diagnosis Pain in Cats
NY Vet 2017: Osteoarthritis in Cats
Cross-sectional study of the prevalence of radiographic degenerative joint disease in domesticated cats. - PubMed - NCBI 92% of cats in a population of all ages have osteoarthritis and/or degenerative joint disease changes.
https://www.winnfelinefoundation.or...-articles/arthritis-in-cats-2016.pdf?sfvrsn=2
https://www.aaha.org/globalassets/0...n_management_guidelines_for_dogs_and_cats.pdf
Bad behavior? The pet may be in pain


You cannot order Cerenia from Zoetis yourself, as a non-licensed, regular everyday citizen. It is prescription. You can ask who orders it from them, and utilize that veterinarian. You can set up an internist consultation remotely, via telehealth/telemedicine, and request Cerenia prescription from them. Perhaps there are a few veterinary pharmacies online in the Philippines that will fill a prescription from a veterinarian. How are drug orders into the Philippines from other countries? Can you order from UK, US, Japan?

 

[mentat]

We were also adviced to avoid food high in protein. So we just give him cat food such as: kidney care, Royal Canin renal, and Royal Canin S/O

Royal Canin is VERY good Renal diet option. Keep at it. He may need you to just rotate through the 3 canned and 3 dry options Royal Canin Feline Renal offers. The little kits are helpful for this, that come in a box, with one of each can and dry option. I kept large quantities of these kits to give to foster owners of senior felines when I was heavily involved in foster cat placement and adoption. Royal Canin donates large volumes to shelters, animal rescues, and vet funds donating to their clients. Very good company, very good product. The "nutrition" experts here trying to advise you against feeding commercial diet, their experience is limited to their few own or few feral or few fosters. RC is what he needs. Moderate protein, no low protein. Low phosphorus. Added dietary potassium. The electrolytes should be checked weekly during acute renal insult (he has acute on chronic kidney disease currently), so you know how much potassium he needs, if any extra. With renal disease the potassium can be high or low easily, as water transfer across cells loses or gains potassium, and more potassium is eliminated by faulty kidneys poorly filtering the blood when making urine.

 

[mentat]

One vet before (when he was still on IV infusion) adviced us to replace his IV with dextrose in LRs, about 300ml of it he seemed to have been lethargic. I really dont why, but then when we got him to our current vet that's when they adviced us to give 100ml per day SQ for 2 weeks until his next check up.

uuuuum, was his blood glucose low when "one vet" recommended this? NO SQ Dextrose in cats, ever. No. Bad medical recommendation. Intravenous, aka IV, CRI of dextrose in LRS or NaCl solution is for emergently hypoglycemic, and/or ketoacidotic diabetic out of remission, needing glucose and insulin supplied and monitored by veterinary nursing and intensive care in hospital.

 

[mentat]

"Maropitant: A Multimodal Antiemetic
Maropitant citrate (Cerenia, zoetis.com), a potent selective NK1 receptor antagonist, plays an important role in managing vomiting, mediated via both the vomiting center and CRTZ (ie, humoral and neural pathways).3-5 The drug is effective for:

• Prevention of motion sickness in dogs
• Chemotherapy-induced nausea and vomiting
• Management of vomiting due to other causes.

Nausea
Nausea cannot be reliably assessed in animals, but signs interpreted as nausea include salivation, increased frequency of or exaggerated swallowing motions, and licking of lips. A recent study evaluating maropitant as an antiemetic for dogs premedicated with hydromorphone found that maropitant effectively prevented vomiting, retching, and nausea associated with hydromorphone administration.6
Analgesia
Two recent studies indicate that maropitant also provides visceral analgesia in dogs and cats.7,8 During visceral ovarian and ovarian ligament stimulation, maropitant decreased anesthetic requirements. This analgesic property makes maropitant especially suitable for managing vomiting caused by painful intra-abdominal conditions, such as pancreatitis and cholangitis, and painful gastric or intestinal disorders. Note: At this time, this use of maropitant should only be considered adjunctive to other methods of pain control.
Administration
Common doses for maropitant are given in Medications for Vomiting: Dogs & Cats. Maropitant is commonly administered off label in both dogs and cats. Hickman and colleagues reported on the pharmacokinetics of PO, SC, and IV use in cats.5 Because maropitant is metabolized by the liver, a lower dosage of 0.5 mg/kg IV is sometimes used for treatment or prevention of vomiting in both species, if there is concern about liver function.
The label states that using Cerenia for treatment or prevention of acute emesis should not last longer than 5 consecutive days.

• Maropitant has nonlinear pharmacokinetics in dogs. Pharmacokinetic studies conducted since the approval of Cerenia have shown that a steady state is reached in dogs in 4 days (at 2 mg/kg daily). A steady state is reached in cats in 7 days.
• Another reason for this concern is that, if vomiting persists longer than 5 days, the underlying cause needs to be thoroughly reinvestigated.
• In dogs, the injectable solution and tablets may be used interchangeably for once daily dosing to prevent acute vomiting.

Safety
Cerenia has been tested for safety in both dogs and cats at 1×, 3×, and 5× the label dose for 15 days (3× the duration of treatment recommended on the label) as required by the FDA.
Gastroprotective or Cytoprotective Agents
Peripheral pathways are mediated through irritation and inflammation of the GI mucosa. Therefore, another common approach to therapy is administration of gastroprotective agents, such as drugs that:

• Inhibit gastric acid production: H2 histaminergic receptor antagonists and proton pump inhibitors
• Act locally on the gastric mucosa: Sucralfate.

Histamine H2 Receptor Antagonists
Histamine H2-receptor antagonists are the most commonly used drugs to manage gastric ulceration or severe gastritis. These agents competitively block the H2 receptor on the parietal cell, reducing gastric acid secretion.

• Cimetidine is the least potent of the H2 receptor antagonists and also inhibits the cytochrome P-450 enzyme system, potentially altering metabolism of co-administered drugs that are metabolized by the same enzyme system.
• Ranitidine also inhibits the cytochrome P-450 enzyme system, but much less so than cimetidine.
• Famotidine and nizatidine are more potent than cimetidine and famotidine and do not inhibit the cytochrome P-450 enzyme system. In addition, they might stimulate gastric emptying in the cat and dog by inhibiting acetylcholinesterase activity.

Proton Pump Inhibitors
Proton pump inhibitors (PPIs) are currently the most potent inhibitors of gastric acid secretion. They irreversibly block the gastric proton pump (hydrogen-potassium ATPase), causing a marked decrease in gastric acid secretion.

PPIs are recommended for use in small animals diagnosed with severe reflux esophagitis or gastric ulceration.

• Omeprazole (0.7 mg/kg PO Q 24 H, dogs and cats) is now available over the counter, markedly reducing its cost and increasing its availability and usage in small animals. It has come into common use (perhaps overuse) in vomiting animals without hematemesis.
• Pantoprazole (0.7–1 mg/kg PO or IV PO Q 24 H, dogs and cats) is a newer PPI available for oral or IV use.

Sucralfate
Sucralfate (0.25–1 g PO Q 8–12 H, dogs and cats) is a basic aluminum salt of a sulfated disaccharide that selectively binds to proteins at sites of ulceration.

• This drug has a sustained local protective effect against acid, pepsin, and bile at the ulcer site, forming a protective barrier.
• It also increases the luminal concentration of prostaglandin E2, which protects against ulcerogenic factors.
• Because sucralfate is not absorbed from the GI tract, it has virtually no systemic toxicity.

Constipation is a rare side effect that occurs because of the aluminum moiety. Sucralfate may also inhibit the absorption of other drugs, including doxycycline and, potentially, H2 receptor antagonists.

Prokinetic Agents
Agents that enhance gastrointestinal motility may be indicated for:

• Vomiting associated with delayed gastric emptying
• Vomiting caused by gastritis, metabolic derangements, and postoperative gastric dilatation volvulus
• Dogs that vomit bile in the morning prior to eating (bilious vomiting syndrome).

Therapeutic choices for prokinetics include:

• 5-HT4 serotonergic agonists: Cisapride, metoclopramide
• D2 dopaminergic antagonist/5-HT3 serotonergic antagonist: Metoclopramide
• Cholinesterase inhibitors: Ranitidine, nizatidine
• Motilin agonists: Low-dose erythromycin (dogs only).

Cisapride is superior to metoclopramide for treating gastric emptying disorders in cats and dogs. Cisapride stimulates GI motility from the lower esophageal sphincter to the colon (through stimulation of 5-HT4 serotonergic receptors), with minimal direct antiemetic effects."
GI Intervention: Approach to Diagnosis & Therapy of the Vomiting Patient | Today's Veterinary Practice
Send this to your outdated vet and educate them on modern medical approaches to feline vomiting.

 

[Tinjao]

Dehydration alone is painful. Muscles are tight and taut, stretched across skeletal system, thrumming with pain and inflammation during low water content and passive transfer. Senior cats have osteoarthritis and dgenerative joint disease, often under-diagnosed, especially in non-cat savvy practices, like the one you have described who thinks vomit and nausea in a renal cat is due to pickiness or food preference. Outdated, non critical thinking of vet professionals.
Injections, orally dosing meds by manually pilling, and vomiting are all stressful to cats. The marker behaviors in body languange and reaction to stimuli are nuanced and often missed by vet professionals in a clinical setting as well as owners who've never dealt with their cat being unhealthy or managed a chronic disease, or multiple chronic diseases. I am trying to tell you he is experiencing stress and pain, helping you recognize his symptoms, while also trying to cope with nausea, vomiting, inappetance (they eat, they vomit or are nauseated, they're inappetant and avoid food, sometimes water and people too), neuromuscular pain/deficits, and potentially, effects on the heart, blood pressure, and thyroid. Getting ahead of such symptoms, proactively, rather than reactively, is very important while managing chronic disease, chronic dehydration risk, chronic pain, chronic inappetance, chronic nausea.

I am not going to try to convince you to get your cat analgesia and pain control. I do not have the energy right now. Treating my own multiple chronic diseases, emergently and chronically, including pain and stress and anxiety, means just repeating myself is exhausting and expends my energy beyond my reserves. Research it, do not assume your cat is not in pain, or is not anxious while coping with so much change at once. Thousands of my feline patients, fosters, and own have been painful from 3 days age to 20 years age, during acute and chronic insult/injury, surgery, and disease. Stress and anxiety were managed coinciding with pain management, from neonatal care to geriatric medicine. Gabapentin is the tip of the iceburg. Your baby would do well on long acting extended/slow release buprenorphine, as well as supplemental anti-inflammatory therapy orally, topically, via laser therapy, and assisi loop therapy. Gabapentin was a first line, easier access, easier administration. Dr. Susan Little, internal medicine cat specialist and leader in feline medicine in Canada and US, has many references you can look up regarding feline pain, feline behavior/anxiety/stress and feline renal disease.

https://wsava.org/wp-content/uploads/2020/01/AAFP-How-do-I-know-if-my-cat-is-in-pain.pdf
Osteoarthritis in Cats: A More Common Disease Than You Might Expect
Feline Pain Control Medication & Diagnosis Pain in Cats
NY Vet 2017: Osteoarthritis in Cats
Cross-sectional study of the prevalence of radiographic degenerative joint disease in domesticated cats. - PubMed - NCBI 92% of cats in a population of all ages have osteoarthritis and/or degenerative joint disease changes.
https://www.winnfelinefoundation.or...-articles/arthritis-in-cats-2016.pdf?sfvrsn=2
https://www.aaha.org/globalassets/0...n_management_guidelines_for_dogs_and_cats.pdf
Bad behavior? The pet may be in pain


You cannot order Cerenia from Zoetis yourself, as a non-licensed, regular everyday citizen. It is prescription. You can ask who orders it from them, and utilize that veterinarian. You can set up an internist consultation remotely, via telehealth/telemedicine, and request Cerenia prescription from them. Perhaps there are a few veterinary pharmacies online in the Philippines that will fill a prescription from a veterinarian. How are drug orders into the Philippines from other countries? Can you order from UK, US, Japan?

Our country is on lockdown. I'm not even sure if I can go back to our vet. We are now divided into clusters here, and we can only move within the cluster where we belong. I'll see if I can get gabapentin in our hospital. We just completed his doxycycline.

 

[Tinjao]

uuuuum, was his blood glucose low when "one vet" recommended this? NO SQ Dextrose in cats, ever. No. Bad medical recommendation. Intravenous, aka IV, CRI of dextrose in LRS or NaCl solution is for emergently hypoglycemic, and/or ketoacidotic diabetic out of remission, needing glucose and insulin supplied and monitored by veterinary nursing and intensive care in hospital.

I didn't show him any labs because I had none to show in the first place. I just emailed him everything I stated here. Anyway, I'm just waiting to complete the 2 weeks and hopefully get back to our vet. It's a long drive from where we are at, and since we have been divided into clusters we're not allowed to cross there. I might resort to another vet one that's near here.

So far he's doing fine, he is playing with his toys right now. He eats whenever he is on metoclopramide. Hopefully I can find a vet.who can provide cerenia.

 

[Tinjao]

"Maropitant: A Multimodal Antiemetic
Maropitant citrate (Cerenia, zoetis.com), a potent selective NK1 receptor antagonist, plays an important role in managing vomiting, mediated via both the vomiting center and CRTZ (ie, humoral and neural pathways).3-5 The drug is effective for:

• Prevention of motion sickness in dogs
• Chemotherapy-induced nausea and vomiting
• Management of vomiting due to other causes.

Nausea
Nausea cannot be reliably assessed in animals, but signs interpreted as nausea include salivation, increased frequency of or exaggerated swallowing motions, and licking of lips. A recent study evaluating maropitant as an antiemetic for dogs premedicated with hydromorphone found that maropitant effectively prevented vomiting, retching, and nausea associated with hydromorphone administration.6
Analgesia
Two recent studies indicate that maropitant also provides visceral analgesia in dogs and cats.7,8 During visceral ovarian and ovarian ligament stimulation, maropitant decreased anesthetic requirements. This analgesic property makes maropitant especially suitable for managing vomiting caused by painful intra-abdominal conditions, such as pancreatitis and cholangitis, and painful gastric or intestinal disorders. Note: At this time, this use of maropitant should only be considered adjunctive to other methods of pain control.
Administration
Common doses for maropitant are given in Medications for Vomiting: Dogs & Cats. Maropitant is commonly administered off label in both dogs and cats. Hickman and colleagues reported on the pharmacokinetics of PO, SC, and IV use in cats.5 Because maropitant is metabolized by the liver, a lower dosage of 0.5 mg/kg IV is sometimes used for treatment or prevention of vomiting in both species, if there is concern about liver function.
The label states that using Cerenia for treatment or prevention of acute emesis should not last longer than 5 consecutive days.

• Maropitant has nonlinear pharmacokinetics in dogs. Pharmacokinetic studies conducted since the approval of Cerenia have shown that a steady state is reached in dogs in 4 days (at 2 mg/kg daily). A steady state is reached in cats in 7 days.
• Another reason for this concern is that, if vomiting persists longer than 5 days, the underlying cause needs to be thoroughly reinvestigated.
• In dogs, the injectable solution and tablets may be used interchangeably for once daily dosing to prevent acute vomiting.

Safety
Cerenia has been tested for safety in both dogs and cats at 1×, 3×, and 5× the label dose for 15 days (3× the duration of treatment recommended on the label) as required by the FDA.
Gastroprotective or Cytoprotective Agents
Peripheral pathways are mediated through irritation and inflammation of the GI mucosa. Therefore, another common approach to therapy is administration of gastroprotective agents, such as drugs that:

• Inhibit gastric acid production: H2 histaminergic receptor antagonists and proton pump inhibitors
• Act locally on the gastric mucosa: Sucralfate.

Histamine H2 Receptor Antagonists
Histamine H2-receptor antagonists are the most commonly used drugs to manage gastric ulceration or severe gastritis. These agents competitively block the H2 receptor on the parietal cell, reducing gastric acid secretion.

• Cimetidine is the least potent of the H2 receptor antagonists and also inhibits the cytochrome P-450 enzyme system, potentially altering metabolism of co-administered drugs that are metabolized by the same enzyme system.
• Ranitidine also inhibits the cytochrome P-450 enzyme system, but much less so than cimetidine.
• Famotidine and nizatidine are more potent than cimetidine and famotidine and do not inhibit the cytochrome P-450 enzyme system. In addition, they might stimulate gastric emptying in the cat and dog by inhibiting acetylcholinesterase activity.

Proton Pump Inhibitors
Proton pump inhibitors (PPIs) are currently the most potent inhibitors of gastric acid secretion. They irreversibly block the gastric proton pump (hydrogen-potassium ATPase), causing a marked decrease in gastric acid secretion.

PPIs are recommended for use in small animals diagnosed with severe reflux esophagitis or gastric ulceration.

• Omeprazole (0.7 mg/kg PO Q 24 H, dogs and cats) is now available over the counter, markedly reducing its cost and increasing its availability and usage in small animals. It has come into common use (perhaps overuse) in vomiting animals without hematemesis.
• Pantoprazole (0.7–1 mg/kg PO or IV PO Q 24 H, dogs and cats) is a newer PPI available for oral or IV use.

Sucralfate
Sucralfate (0.25–1 g PO Q 8–12 H, dogs and cats) is a basic aluminum salt of a sulfated disaccharide that selectively binds to proteins at sites of ulceration.

• This drug has a sustained local protective effect against acid, pepsin, and bile at the ulcer site, forming a protective barrier.
• It also increases the luminal concentration of prostaglandin E2, which protects against ulcerogenic factors.
• Because sucralfate is not absorbed from the GI tract, it has virtually no systemic toxicity.

Constipation is a rare side effect that occurs because of the aluminum moiety. Sucralfate may also inhibit the absorption of other drugs, including doxycycline and, potentially, H2 receptor antagonists.

Prokinetic Agents
Agents that enhance gastrointestinal motility may be indicated for:

• Vomiting associated with delayed gastric emptying
• Vomiting caused by gastritis, metabolic derangements, and postoperative gastric dilatation volvulus
• Dogs that vomit bile in the morning prior to eating (bilious vomiting syndrome).

Therapeutic choices for prokinetics include:

• 5-HT4 serotonergic agonists: Cisapride, metoclopramide
• D2 dopaminergic antagonist/5-HT3 serotonergic antagonist: Metoclopramide
• Cholinesterase inhibitors: Ranitidine, nizatidine
• Motilin agonists: Low-dose erythromycin (dogs only).

Cisapride is superior to metoclopramide for treating gastric emptying disorders in cats and dogs. Cisapride stimulates GI motility from the lower esophageal sphincter to the colon (through stimulation of 5-HT4 serotonergic receptors), with minimal direct antiemetic effects."
GI Intervention: Approach to Diagnosis & Therapy of the Vomiting Patient | Today's Veterinary Practice
Send this to your outdated vet and educate them on modern medical approaches to feline vomiting.

Really thank you for giving time to share this with me, I know you have a LOT on your plate. I hope your cats are doing great.
I will look into each.
The first vet prescribed Mirtazapine
Another vet thru phobe call advised famotidine
The one vet whom I emailed advised dicyclomine (which he really hates)
Our current vet gave metoclopramide.
Which I have tried. So far only metoclopramide works but for a short time.

 

[mentat]

Really thank you for giving time to share this with me, I know you have a LOT on your plate. I hope your cats are doing great.
I will look into each.
The first vet prescribed Mirtazapine appetite stimulant (secondary side effect of antidepressant), only efficacious if source of nausea/vomiting treated (i.e. his azotemia and acid reflux secondary to azotemia)
Another vet thru phobe call advised famotidine Antacid. Can be helpful with acid reflux, but rarely is enough alone. Effect wanes. Combine with Cerenia, may notice more effective together than separately.
The one vet whom I emailed advised dicyclomine (which he really hates) Never used it.
Our current vet gave metoclopramide.
Which I have tried. So far only metoclopramide works but for a short time. Smooth muscle contraction stimulant, increasing peristalsis of food bolus/digesta through GI tract. We already discussed.