How to tell if male cat is truly having a urinary block?

[fionasmom]

I have used Elura and Entyce (which is for dogs). They are technically for dogs or cats with kidney disease although can be used with animals who are not in that category. Entyce was given to a very elderly GSD who had multiple medical issues and did not hurt him. I am one of the people who has said that I was just underwhelmed with the effectiveness of either formulation.

In fact, it was the practice owner who put my 2 year old Rikki on it and when we got back to the younger vet who is his doctor, she gave me Mirataz.

My personal preference is Mirataz. Can you tell the vet that Elura is a big failure, can't get it down, and flat out ask for Mirataz?

 

[silent meowlook]

You can’t give Mirtazipine with Prozac. There has to be a wash out period of at least 2 weeks due to the risk of sick serotonin syndrome.

 

[FeebysOwner]

The above poster is correct, and I am glad they either remembered that or went back and read your previous comments. I had honestly forgotten about Prozac. So, if he is still on it, that is likely why the vet suggested Elura. I'd still pose the question/issue to your vet.

 

[6CatsandCounting]

The above poster is correct, and I am glad they either remembered that or went back and read your previous comments. I had honestly forgotten about Prozac. So, if he is still on it, that is likely why the vet suggested Elura. I'd still pose the question/issue to your vet.

So a bit of a larger update-

we went to urgent care tonight and after 3 hours and $750 dollars the vet there concluded this is probably pancreatitis. We had full blood work/urine/fecal done and all of that was pretty much normal despite a small increase in one white blood cell marker. Still unsure of why he seems to be retaining urine at this point despite being able to pee.

However they found that he had some pretty bad mouth ulcers- I kind of assumed something mouth wise would be found. His mouth has seemed very painful. The vet didn’t know why he had oral ulcers though and that’s still a mystery at this point. I really don’t know why his primary vet on Tuesday didn’t notice this though? They said his abdomen seems very painful too and considering the other symptoms is why they think it’s pancreatitis.

We got fluids, a pain medication injection, another cerenia and antacid injection. The vet wants me to start metronidazole because he started having diarrhea again tonight. And then tomorrow to start gabapentin to manage the pain at home.

The vet did prescribe mirtazapine- although I mentioned the Prozac and mirtazapine potentially causing serotonin syndrome. We mentioned having Elura on hand but having difficulty giving it. The vet said that although it’s possible for serotonin syndrome to occur that because Pipp has only been on Prozac for about two months at the lowest does we should be able to stop it for a few days safely to not overlap the medications. Her plan was pretty much to discontinue it for four days to give the mirtazapine those days instead to see if his symptoms may improve. Basically explained the risk worth be worth it right now if the mirtazapine would have more benefits? Plus the fact that if Prozac is causing side effects stopping for a few days may improve?

I’m planning to speak with my primary vet tomorrow about this just to be safe, I did skip his Prozac this evening and gave the mirtazapine. He did end up eating but it’s hard to say if that was from the mirtazapine or him receiving pain medication.

I guess right now the goal is to just get him to eat anyway possible with the least amount of stress. We discussed perhaps trying syringe feeding, although now knowing he has mouth ulcers it will probably be very difficult to do that without hurting him. Worst case would be having him hospitalized and doing a feeding tube.


anyway I really appreciate everyone. thank you for continuing to give insight and advice. this week has been a lot emotionally and financially without making much progress yet. Here’s a photo of Pipp for cat tax

 

[silent meowlook]

Oh, he is very cute. There are specific tests that can be run for pancreatitis, but I am sure your cat is sick of seeing the vet by now.

 

[FeebysOwner]

Good to go over everything with your primary vet to make sure they agree with the urgent care's assessment. It looks like they have prescribed the 'right' things for treating pancreatitis - stopping diarrhea, reducing pain, and increasing appetite. Eating is one of the most important parts of treating pancreatitis. Some cats will get sub-Q fluids to help flush out the pancreas and to restore lost fluids from the diarrhea - another thing to ask your vet about.

As noted above, there is a more specific test for pancreatitis. Pancreas-specific lipase (fPLI) and it is pretty accurate in moderate to severe cases, a little bit less so in mild ones. Why no one seems to want to run this is beyond me, as it doesn't look to be run as often is it could be based on other posts on this site - unless they suggested it and you declined due to the extra cost.

The mouth sores could be from a few sources, one of the more common ones are viral conditions than can live dormant in a cat for years before something like an illness or lowered immune system sets them off. But, this is something to discuss with your vet about their opinion since they are professionally trained (and I am not) and should be aware of what they consider to be the most plausible causes. When he gets back on track, you might consider adding an immune boosting supplement to his regimen, such as DMG.

You can try baby food meat (Gerber Stage 2 or Beechnut Stage 1) to help supplement what he does eat, just to bump up his caloric intake. It seems a lot of cats will eat that when they are not feeling up to par, sometimes more so than their own food. It is also very soft which would help with the sores. It isn't nutritionally complete, but can be given for a while without worry from that aspect. Better than oral syringe feeding. The vet may also suggest one of the recovery cat foods that are loaded with calories, they are usually soft as well.

Pipp not only looks very handsome, but healthy - despite his current issues.

Keep us posted.

 

[6CatsandCounting]

Good to go over everything with your primary vet to make sure they agree with the urgent care's assessment. It looks like they have prescribed the 'right' things for treating pancreatitis - stopping diarrhea, reducing pain, and increasing appetite. Eating is one of the most important parts of treating pancreatitis. Some cats will get sub-Q fluids to help flush out the pancreas and to restore lost fluids from the diarrhea - another thing to ask your vet about.

As noted above, there is a more specific test for pancreatitis. Pancreas-specific lipase (fPLI) and it is pretty accurate in moderate to severe cases, a little bit less so in mild ones. Why no one seems to want to run this is beyond me, as it doesn't look to be run as often is it could be based on other posts on this site - unless they suggested it and you declined due to the extra cost.

The mouth sores could be from a few sources, one of the more common ones are viral conditions than can live dormant in a cat for years before something like an illness or lowered immune system sets them off. But, this is something to discuss with your vet about their opinion since they are professionally trained (and I am not) and should be aware of what they consider to be the most plausible causes. When he gets back on track, you might consider adding an immune boosting supplement to his regimen, such as DMG.

You can try baby food meat (Gerber Stage 2 or Beechnut Stage 1) to help supplement what he does eat, just to bump up his caloric intake. It seems a lot of cats will eat that when they are not feeling up to par, sometimes more so than their own food. It is also very soft which would help with the sores. It isn't nutritionally complete, but can be given for a while without worry from that aspect. Better than oral syringe feeding. The vet may also suggest one of the recovery cat foods that are loaded with calories, they are usually soft as well.

Pipp not only looks very handsome, but healthy - despite his current issues.

Keep us posted.

So overnight and this morning he’s been acting much better, although last night I was a bit concerned by how excitable he was. Kind of a sudden change from the past few days. Naturally I was paranoid about the starting mirtazapine and stopping the Prozac without taper and a wash out period.

Of course it’s hard to say what behavior was related to the bupe injection vs mirtazapine though- or if perhaps a combination of everything was the cause. my primary should be calling this afternoon so I’ll definitely discuss this with her. This morning he’s now not so restless though.

the positive was he has been much more himself, he ate without pain last night and this morning- much more than he’s eaten this week. He even meowed for food this morning which is his normal behavior. He’s been going pee as well which makes me happy. The doctor yesterday did say that she thought perhaps he was holding urine because of the abdominal pain? So it would seem that was the cause since he’s been find since bupe was administered last night. During the visit he also received fluids which does sound like it probably helped him as well.

I’m kind of kicking myself for not requesting oral bupe to keep on hand for the next few days. After thinking about it when we got home, I do not think the gabapentin will be effective at pain management right now. Tuesday before we saw the primary we did give him 100 mg of gabapentin (we use it for vet stress) and even after sedation effect wore off he didn’t seem willing to eat or do much of anything. I’m hoping today either urgent care or my primary would be willing to prescribe a small amount to have at home.

has anyone here used gabapentin for pancreatitis and oral ulcers pain management successfully? From what I read it seems results are mixed for certain types of pain management and most people use bupe?

As far as the pancreatitis testing goes, neither of two vets had even asked if we wanted to do additional testing to fully confirm. Which is odd now that I think of it. Although the visit at urgent care ran into after hours, so perhaps it was more of time thing or they weren’t capable of doing that test in house? At this point though we’ve kind of just ended up putting charges on credit which I’m fine with as long as Pipp is making progress so the cost wouldn’t be an issue.

the oral ulcers thing I would really like to sort out. The only time I’ve ever dealt with oral ulcers was when my other two cats were kittens and they contracted both calci and herpes in the shelter they came from. I mentioned this last night to the doctor about it possibly being from one of my other cats maybe having a asymptomatic flare and is shedding the virus causing Pipp to contract it? She didn’t seem certain if that was the exact cause.

She did mention he does have moderate dental disease which heightens the risk of developing ulcers but it seems like something else is the causation? Mentioned stomatitis or other inappropriate immune response, food allergies, etc. Hopefully my primary will be able to sort out what’s going on with it during his follow up.

Of course I’ve just been worried about either pancreatic cancer or oral cancer now. Though his blood work was good despite a small elevation in monocytes and the abdominal X-rays were apparently clear. I’ve sadly lost a few cats through the years to sudden cancer onset that was somehow missed by vets so it’s always in the back of my mind.

I also was wondering if anyone knows about the risk of mirtazapine being used with methimazole?

Last night when I was trying to read up about mirtazapine drug interactions I saw mention of this combination not being good on a feline diabetes form. It was the first I’ve ever heard of it not being safe to use together? From what I read it is something with how the liver metabolizes mirtazapine when a cats also on methimazole. Hopefully it isn’t something we have to use for an extended period as long as the pain is managed.

luckily I do have DMG on hand, when things seem more stable I’ll definitely start using that. Planning on running out later to get more food for him as well. He’s been very picky with food, the squeeze treats he usually likes have now been hit or miss.

Pate seems to be his go to, with the pain meds on board he’s also eating a small amount of dry food here and there. In the last 12 hrs he’s eaten about 1 5.5 oz can which is a decent improvement.

I’m sure he’d probably enjoy the baby food as well, I’ve used it previously with another cat and Pipp liked it back then. I may ask vet for A/D prescription as well just in case.

 

[FeebysOwner]

I am glad to see things are turning around a bit for Pipp!

I can't answer your question about bupe vs. gabapentin for pancreatitis. I did have my cat on bupe for a while because I could not get her to take gabapentin in any form. While the bupe was wonderful/easy to administer, I am not sure how much it really did for her. But, she was taking it for arthritis and any possible pain from lymphoma, and was given a pretty small dose. The vet didn't want to increase it due to her CKD, and wanted to move her to another pain med. But, you may get a different dosage for something like pancreatitis.

Feeby was on both Mirataz (1/2 dose every other day) and Felimazole (feline specific version methimazole - 1.875mg/AM, 1.25mg/PM), for close to 3 years and her blood work checked out fine in terms of no diabetes or liver issues throughout. As a matter of fact, all of her CBC and Chem panel numbers remained stable, with the exception of those related to kidney disease. So, double checking with your vet about their opinion is pretty much all you can do.

Btw: Although it is not definitive that what Pipp experienced was from Mirataz, one of the side effects is excitability, so if that keeps up, lowering the dose might help.

 

[fionasmom]

Pipp is an adorable little Creamsicle! It sounds as if you have been given standard meds for pancreatitis although testing would be a help in confirming.

My very elderly GSD had chronic/recurrent pancreatitis, so much so that the vet allowed me to keep all the medications on hand and start them if I saw the symptoms and then call her. He was also on permanent gabapentin but, in and of itself, I would not have considered it enough to quell the pancreatitis episode.

 

[silent meowlook]

Should be fine to use Buprenex and Methimazole and Mirtazipine together.
Gabapentin is not a pain medication. It is a medication used to treat seizures in people, that has been found to have some neuropathic pain control and sedative effects. I wish vets would stop using it for pain. The reason they do is because it is less paperwork and hassle for the to prescribe.