Intestinal abnormalities and won't eat after bupe

[sidneykitty]

Yesterday I took my cat Amber to the vet because she had stopped eating her wet food this week. It started when she stopped eating it refridgerated or eating leftovers. My main concern was constipation as its been an issue for her in the past.

All they found yesterday was that she had abdominal pain but her colon was empty. They did not think it constipation. We ordered blood work, including FPL for pancreatitis. They gave her a bupe injection for pain.

When we got home yesterday she would not eat food at all. I left food out over night thinking she would eat it but in the morning all bowls were full. She did not drink either. When I put food down in front of her she looked like she didn't even recognize it for what it was. I'm not even sure she slept at all, she paces, hides under the bed and just generally seems very out of it and wobbles around when she walks. I was very concerned about this as was the vet when I spoke to her on the phone. So we planned to bring her back in for fluids and a recheck. Her lab work was all normal.

On the recheck today they said her abdomen was still painful. I asked them to do an xray. The xray found the only abnormal thing was her intestines looked "bunched up" similar to when a kitten eats a string, but the vet thought that unlikely at Amber's senior age of 15. she said it could also be cancer. So then we opted to ultrasound and we are currently awaiting results, which should be in tomorrow morning.

In the meantime they gave her mirtazapine for stimulating her appetite and cerenia for nausea and we brought her home. But she needs to eat and it seems like even after 24 hours of getting the bupe injection, it is still impacting her and she is not eating even after the appetite stimulant. She is still behaving much the same way as yesterday - pacing, not settling, not really "registering" food in a bowl.

I'm really worried and I feel as though bringing her to the vet yesterday caused all this somehow with the bupe... but I am glad I asked for the xray. I just don't know what to do now to be honest. I am hoping she will eat tonight. If not, the vet mentioned placing a feeding tube. I feel so heartbroken I just don't understand how she could go downhill so quickly. Yesterday before we brought her to the vet aside from low appetite she was totally her vibrant self.

Anyone have advice or anything that might be helpful for us?

Edit: Does transdermal mirtazapine have a time delay before taking full effect?

 

[di and bob]

At 15, I know how worrisome this can be, I pray the ultrasound will give you an answer. Transdermals are formulated to bring about constant, prolonged doses, so yes a transdermal will continue to deliver doses. An injection would not last as long, but could still be long-lasting, I would call and ask the vet, or ask when they call about the ultrasound. With my 16-year-old, I stopped worrying about what he ate and just gave him what he would eat. This included Arby's roast beef, chicken nuggets, and Kentucky Fried chicken in shreds, just to get something in his system. It then stimulated him to eat more. Refrigerated food is often rejected by cats, try warming it slightly in the microwave. Get some chicken parts and boil them gently for about an hour, then shred them off the bone, this is a favorite of cats. I'll pray for your little girl, all the luck.....

 

[sidneykitty]

8am the next day she still has not eaten anything. Come lunchtime this will be 48 hours with no food.

I believe when the vet calls she will want to place a feeding tube. I don't know why but it makes me feel so scared.

I've tried everything - treats, tuna, baby food, cooked chicken, kibbles, cheese, even milk and catnip did not interest her. She continued pacing the house last night, doing rounds under the bed down the stairs around the living and back. Her pupils were still huge. When she tried jumping on the couch, her head wobbled. [Edit; she has also not slept since Thursday as far as I know. ]I still think its the bupe causing her to not eat because its like she can't focus on anything long enough to do so. Like she doesn't even recognise its food. Sometimes she'll sniff it and walk away. She does recognize and use the litterbox.

This morning her bupe side effects seem somewhat lessened. She actually jumped on the bed this morning to cuddle, allowed me to pet her (before she just ran away everytime I came close). This behavior is so hard for me to experience with my extremely loving cat. She is always glued to my side and sitting on my lap. I don't want her end days to be like this. Its just breaking my heart. Am I crazy to think the bupe is causing this behavior?

I did tell the vet that we previously gave her mirtazapine a few years ago and it had no effect on her. So I was not convinced it would work and I asked them if they could try a different appetite stimulant but they did not.

Thank you di and bob for the well wishes and thoughts.

 

[FeebysOwner]

While it is highly uncommon in cats, Buprenorphine has been known to cause gastrointestinal disorders. So, perhaps Amber is experiencing this unusual side effect. That being the case, you should continue to see improvement in her - BUT, if she does have pancreatitis that will also cause abdominal pain and a loss of appetite. Ask the vet how long the bupe is expected to stay in her system, as I think it should be wearing off by now. And, if it does turn out that she has pancreatitis, the best treatment is fluids - and a feeding tube should she continue to refuse to eat.

I would start testing all of the foods you tried before, to see if she might start to eat again if the bupe was attributing to her issues. While a feeding tube would freak me out too, so many members on this site have used them and find they are pretty easy to get used to and have worked wonders in helping their cats through various different health issues.

Continue to keep us posted!!

 

[sidneykitty]

Thanks FeebysOwner . She had the bupe (simbadol) Thursday at 4pm so its been about 36 hours. The vet said it should last 24 hrs.
She's reacted to it like this before, but never this badly. She returned to normal after about a day or so the other times.
Her pancreatitis blood test was negative, but we'll see what the ultrasound found. I think they can see pancreatitis on ultrasound?

I tried all the foods again, but she just walks away when I put the bowl in front of her. At least she rubbed her head on my hand when I offered catnip this morning. She had zero reaction to it until then and its her favorite thing in the world besides her dad's lap.

Thank you...

 

[neely]

Did your vet recommend feeding Urgent Care A/D prescription food? Hill's® Prescription Diet® a/d® Canine/Feline We recently had a health issue where our cat stopped eating too. In addition to bookwork/ultrasound the vet gave us the A/D food which our cat ate immediately. It worked like a charm! Best of luck, fingers crossed that the ultrasound provides some answers to Amber's health issue(s). Sending special thought and healing vibes to you.

 

[daftcat75]

A feeding tube is not that extreme. It saved Krista's life. It can be used to get nutrition in her while you are figuring out what's going on inside. When she's well enough to eat on her own again, the tube can be removed. You will mind it a lot more than Amber will. The only time Krista was bothered by the feeding tube was if I fed too cold or too fast. I got instant feedback and learned quickly.

It's unlikely to be pancreatitis if the fPLI came back in range. fPLI is fairly specific and gives few false negatives.

The bupe injection is a long-lasting injection and can certainly explain the behavior and duration you are seeing with regards to inappetance and restlessness. Ask your vet for either buccal (oral but between cheek and gum rather than down the hatch) or transdermal bupe. But are shorter acting and tolerated better.

There are other appetite stimulants to try if mirtazapine isn't working. But it's possible that the bupe reaction is far stronger than the mirtazapine reaction at the moment.

Cerenia suppresses appetite in some cats. My Krista is one of them. Wait for the bupe to wear off and try the mirtazapine without the Cerenia.

A B-12 shot and subcutaneous fluids can go a long way with a cat who hasn't been eating or drinking for several days. If you do bring her back to the vet, you can ask about both of these.

At this point, I would skip her normal foods and try some high appeal foods. Tuna in water. Boiled chicken. Meat only baby food works with some cats. Not mine. Fancy Feast Classic pate or Tiki Cat tuna flavors worked with Krista when she wouldn't eat her regular food.

You had mentioned in another thread that her teeth were checked at the vet's office but it sounded like you were in the room when this happened. That sounds like a visual examination. That's not enough. She should have had a dental examination under anesthesia. Krista had so much trouble with her teeth that were mostly only visible on X-rays as is the case with FORLs.

Let's see what the ultrasound says and what happens when the bupe wears off.

And don't rule out the feeding tube because it seems scary. It can be life-saving especially while you still don't know what's really going on. The feeding tube will buy you the time to be thorough in her examination and diagnosis. And it will actually provide you some peace of mind because you'll have an active hand in her recovery when she may not be feeling well enough on her own.

 

[sidneykitty]

neely - they did not. I thought they might. I asked what to feed her they said her normal food. Thank you for the well wishes.

daftcat75 I know you have feeding tube experience. Thank you for posting your comments.
My concerns with the feeding tube are that she will scratch at it and pull it out. She spent her days wearing a cone in the past obsessed with trying to get out of it.
My other worry is I will do something wrong with the tube.
And lastly, if she is having so much abdominal pain, I worry the feeding tube will just keep her alive and she will still be in pain. However, I also think it could help get steroids and other meds into her if that is what is needed, which could help the cause of the pain in the longterm.

The vet also mentioned trying Entyce for her appetite though it is off label for cats. I do think this is possibly still bupe related. But the other question there is why is she still like this after nearly 2 days?

I actually have an old B12 shot leftover I thought about giving but I didn't want to start a la carte treatment on my own... I have tried feeding boiled chicken, fried chicken, baby beef and baby turkey. I haven't tried human tuna yet, but did try cat tuna. She just has no interest. The fried chicken she picked up in her mouth but did not chew or eat. Mostly I'm setting bowls down and she is walking away.

Do you think a feeding tube is a good plan if she goes 48 hours without eating? Is it worth trying Entyce first to see if she will eat with that?

Edit: I read in the Simbadol leaflet that anorexia, insomnia and ataxia occurs in a very very small number of cats as side effects. I feel like that is exactly what has happened here.

 

[daftcat75]

The longer a cat goes without eating, the more likely you will have to intervene.

As for the feeding tube concerns, first check out the Kitty Kollar.
Kitty Kollar - Special Hugs for special kitties & kanines

It will slide over the tube and allow you to fasten the tube to the kollar to keep it out of the way. Make sure you ask the vet to leave enough length on the tube to allow it to be fastened down. Krista's vet did not do this and it was a tight fit to make it reach. It's always easier to shorten the tube than make it longer (which would require placement of a new tube.) The only part I did not like about the tube is having to clean the insertion site and pick away any crusties that built up. But you have to do this at least every other day because that's basically an open wound until the tube is removed. Once it is removed, it will heal within a week like it was never there. It will take far longer for her neck hair to grow back in.

You probably will make a mistake or two with the tube. It's not the end of the world. She'll tell you if you feed too fast, if you feed too cold, or you bump the tube wrong. Cats are tough, though. She'll forgive you. But sometimes they do need an extra hand to get through things.

Entyce may work. It wasn't as effective as mirtazapine with Krista.

The bupe injection has been known to stone some cats for as long as three days. This is good for acute oral pain like recent dental work. Not so good when you're trying to figure out why she stopped eating.

Don't get too stubborn or fearful on this. If she's not eating and nothing is helping, you'll need to help her out. Personally, I prefer the feeding tube to syringe feeding by mouth. Especially because you may not have ruled out dental issues yet if you haven't taken mouth X-rays. And yes, the feeding tube does help with liquid medicines. I wouldn't try to put any pills, crushed or otherwise down the tube. But that's also a direct line to the stomach which makes it doubly important that anything that needs to be taken with food has to be given with food.

If she doesn't start eating again by Monday, you should at least take her in for subcutaneous fluids so she doesn't get too dehydrated. Dehydration alone would cause her to feel poorly and not much like eating. This is why last year when Krista would have bouts of not eating, the first thing I asked the vet for was fluids, usually mouth X-rays, and whatever other tests they wanted to run.

 

[daftcat75]

The fried chicken she picked up in her mouth but did not chew or eat.

This sounds like dental pain. Bring her back to the vet for fluids and mouth X-rays.

 

[sidneykitty]

Ooook developments. Still waiting for the ultrasound report. I was expecting to have it back by now.

She licked a very small amount of fancy feast pate. She even tried to take a bite of it. Then she got up of her own accord and starting sniffing food but didn't eat any. I'm encouraged to see her at least trying to eat...

Just now, she ate some kibble. But she seemed to be having trouble eating it like she couldn't get it in her mouth. A few pieces flicked out of the bowl. I recorded her - is it possible to post a video somehow?

So daftcat75 you might be right? It seems like she may have mouth pain as well as her intestine issues.

Video:

 

[sidneykitty]

And sorry I hit enter too soon. To reply to your post, I like the kitty kollar. I would get one if we got her a feeding tube. Do you order online and get it shipped? Does the vet provide some kind of cover in the meantime?

Its starting to seem like she is reverting back to normal and the bupe is finally wearing off. She came out from hiding and she's sat on our laps and sat on her tree now and eaten a very small amount of food (see post above).... I guess this is promising. This is the first she's eaten since Thursday. She's not out of the woods. But its something.

 

[sidneykitty]

I somehow missed the call from the vet even though I've been waiting all day. My phone didn't ring which it sometimes doesn't even when it should. argh.

Anyway...she left a voicemail and said the ultrasound did not show any abnormalities in her intestines and now I'm really confused... I'm waiting for a different vet to call me with more info since my vet has left the clinic for the day, but it might be a while.

 

[daftcat75]

Vet will wrap the feeding tube in a gauze wrap and give you supplies to clean and replace it. Amber will appreciate the kitty kollar more. Remember to ask for a longer tube. You can always have a too long tube trimmed. But a too short tube is another story. You fax in your order for a kitty kollar. If you don’t have access to a fax, I think you can call them and place the order by phone. They aren’t quite in the Internet age yet. But they’re good people and they can get you the kollar quick enough.

Yes. Sounds like dental pain. Fluids and mouth xrays sounds like a good next step.

 

[sidneykitty]

So my question now is if its dental/oral issues, do we place a feeding tube to get food in her, then do the dental surgery? Or do the surgery then try to get her to eat/place feeding tube postop ?
obviously a question for the vet, but thinking "out loud" while I wait to speak to them.

 

[sidneykitty]

The vet never called last night. It seems I'm not going to hear from them until her vet is back Monday morning even though I asked for literally any Dr to call me. They are a 24/7 emerg vet hospital though so maybe they've been slammed with emergencies, given its the weekend and that a lot of other clinics are probably still corona-closed. Though I told them they could call me absolutely anytime. I don't care if its 2am. While I understand completely, I am also a bit annoyed her ultrasound was sent stat on Friday and I still haven't spoken to a vet about it. I'm feeling frustrated. But I realize that she's not their only patient and there are likely lots of other critical cases there now.

Last night, Amber ate a whole bunch of tuna. She ate much of the chicken I cooked for her as well. She also ate some kibble. So she is eating which is great. So I guess now I have to wait until tomorrow to hear from her vet and make a plan for a dental check and make her comfortable/ensure she is eating until then. She is still hiding under the bed at times alternating with coming out and being sociable with us.

I'm torn whether I should call the vet again today, bring her in today (but I don't want to bring her in again until we have a plan for her to get dental work) or wait until tomorrow. I'm tired of this waiting and feeling anxious and wondering if she's going to get worse while I keep waiting.

 

[FeebysOwner]

If you are familiar with the old adage: 'the squeaky wheel gets the grease' - then if it were me, I would call again and ask to speak with a vet - as you had previously requested - and to find out the results of the ultrasound.

It is good that she is eating for you, though!!!

 

[sidneykitty]

Thank you FeebysOwner . You gave me the gumption to call again and the vet called me back.

Ultrasound results - normal with incidental finding of a benign liver cyst. I believe she called it a hepatic cystadenoma. Did not seem overly concerned about it, but I did ask how they could know it was benign based on imagery without biopsy or FNA. She said the structure indicated that.

We discussed her eating and she agreed it sounds like she may have some kind of oral/dental pain. Right now she wants Amber to rest and recover from the bupe afer-effects. We are going to discuss with her regular vet tomorrow on what to do next.

While very confused about this finding, but glad we have made progress and that it is NOT intestinal cancer as thought, I feel relieved and reassured having spoken to a vet. I don't know what happens next or long term or if surgery will be required or what causes this. I have definite concerns about the cyst. Anybody experience this before with their cat or know someone who has?

 

[FeebysOwner]

Overall, this doesn't sound too bad. Glad you called again!! As far as the cyst, given her age, it is highly likely it is just what the vet said it is. I know with humans, as we age, cysts that show up on the liver (and other organs as well) is pretty common. I have one myself - not sure the docs called it the same thing, but they did say it can be identified as such through structure/appearance.

 

[daftcat75]

Thank you FeebysOwner . You gave me the gumption to call again and the vet called me back.

Ultrasound results - normal with incidental finding of a benign liver cyst. I believe she called it a hepatic cystadenoma. Did not seem overly concerned about it, but I did ask how they could know it was benign based on imagery without biopsy or FNA. She said the structure indicated that.

We discussed her eating and she agreed it sounds like she may have some kind of oral/dental pain. Right now she wants Amber to rest and recover from the bupe afer-effects. We are going to discuss with her regular vet tomorrow on what to do next.

While very confused about this finding, but glad we have made progress and that it is NOT intestinal cancer as thought, I feel relieved and reassured having spoken to a vet. I don't know what happens next or long term or if surgery will be required or what causes this. I have definite concerns about the cyst. Anybody experience this before with their cat or know someone who has?

I read a couple very "meaty" articles on this and they both said that while benign and slow growing, these tumors do have the potential to impinge upon neighboring organs leading to lethargy, anorexia, and weakness. The treatment would be partial or complete excision (cut it out), if possible. Sometimes, that's not an option due to size or location. I think if it was impinging against an organ, sonographer would have mentioned that in the ultrasound notes.

I'm not a doctor. But my recommendation would be to schedule a dental examination under anesthesia with mouth x-rays. Rule that out first. If the teeth and gums are okay, then you could discuss whether the removal of this is recommended given its structure and location, her age, and what the recovery period might look like. It may be riskier to remove it than to leave it.