Loss of appetite

[Threecatsandme]

Our Simba (7 yrs old) hasn't been eating. He spent 48 hours at a "cat's cottage" while we were away, so we believe this may be a result of stress. Within two days of returning home we noticed a significant decrease in appetite to where he wasn't eating at all. No other noticeable symptoms (he wasn't frequenting the littler box and was still peeing, although smaller clumps, most likely due to dehydration).

We took him to the vet yesterday. Vet doesn't believe it's signs of a blockage. We requested bloodwork, which came back normal. When I inquired about cystocentsis or urinary issues, vet didn't think it was necessary at this time. He just had a dental (with two extractions on 11/28 and all went well, including recovering, so we don't believe it's dental related.

They gave him sub q fluids, a B12 injection, and Mirataz. Vet believes it's likely a result of stress from his 48 hours away (which breaks my heart that I caused this!).

It's been 24 hours since the vet visit and first dose of Mirataz. He seemed worse after the Mirataz - noticeably uncomfortable sitting in loaf position. He didn't eat until about 6 hours after the dose and it wasn't much. He ate a little this morning, but still hasn't eaten much. He has peed (likely because of the fluids) and pooped (mostly runny, so diarrhea?).

I've offered him every kind of food, including unsalted sardines (hoping something really stinky would work), with no luck.
He should have his next dose of Mirataz.

I'm extremely worried, but am not sure how much longer we should "wait it out" before investigating further.

I'm not sure if the blood test included testing for pancreatitis, so wonder if we should be exploring that, in addition to further trying to find the source of loss of appetite, such as: ultrasound, xray, pain meds, or cerenia if he is feeling nauseous? Vet hasn't brought those options up yet, but am thinking of calling to initiate that conversation.

Is there anything else we should be requesting or asking for?

Any thoughts or advice would be greatly appreciated!

 

[FeebysOwner]

Hi. Standard bloodwork does not include the more specific test for pancreatitis. But often the Amylase and Precision PSL, which are in many cases part of standard testing can show numbers to suggest there is the possibility of pancreatitis. The more specific test is separate, and is called Spec fPL. There is a faster, also separate, test called the SNAP fPL too which gives results same day. Both can miss mild cases.

Many cats can benefit from an anti-nausea med to accompany the Mirataz. Mirataz does have an anti-emetic effect, but sometimes it is not eough. Cerenia, most often used to stop vomiting, or ondansetron, more for stopping nausea, might be two options. Also, a lower dose of Mirataz can be beneficial - say one-half dose vs. a full dose, as some cats are impacted with a bit of hyper-ness with the full dose.

Are there any food items on this list that you haven't already tried? I always suggest baby food meat (Gerber Stage 2 or Beechnut Stage 1), which is also included on this list.
How To Get Your Cat To Start Eating Again - TheCatSite

Not sure about the loose stools, so just keep an eye on it at this time to see if it might have been a one-off event.

 

[Threecatsandme]

Thank you for your suggestions, truly appreciate it! We are bringing him in this afternoon for further testing (pancreatitis, xray, possible ultrasound). I plan to talk to the vet also about anti-nausea meds. The information you wrote about the nausea meds (and Mirataz) is very helpful.

We will try baby food (haven't tried that yet). it seems like he wants to eat, he will approach the food, take a small lick and walk away. I went so far as to offer him some small pieces of Young Again dry food and he went for that, but I know he needs hydration and we don't want to get him addicted to dry food again (he's been off it for years) - also if he eats too much of that, it could cause diarrhea since he hasn't had it for years. That's the only food our senior diabetic cat will eat (they are kept separate from one another).

Hopefully we can get some answers and/or anti nausea meds this afternoon.

Thanks again!

 

[stephanietx]

I agree with FeebysOwner . Pancreatitis (inflammation of the pancreas) is often caused by stress, so I'm glad you're getting your kitty to the vet for another check up. They should prescribe steroids, an anti-nausea med, and maybe have you continue with the Mirataz. They may also give him another B12 shot. Inappetence was my boy's biggest symptom when he had pancreatitis. The steroid should help decrease the inflammation and increase his appetite. The anti-nausea pill (Ondansetron or Cerenia are usually the most common. We use Ondansetron for nausea and Cerenia for gas with my guy.) Make sure the vet does a thorough exam of his abdomen and checks for "air bubbles" (gas) as well as checking him for stool. The vet may have you change his food as well, but not necessarily.

Here's a good article my vet printed out and sent home with us: Pancreatitis in Cats

 

[Mac and Cats]

Thank you for your suggestions, truly appreciate it! We are bringing him in this afternoon for further testing (pancreatitis, xray, possible ultrasound). I plan to talk to the vet also about anti-nausea meds. The information you wrote about the nausea meds (and Mirataz) is very helpful.

We will try baby food (haven't tried that yet). it seems like he wants to eat, he will approach the food, take a small lick and walk away. I went so far as to offer him some small pieces of Young Again dry food and he went for that, but I know he needs hydration and we don't want to get him addicted to dry food again (he's been off it for years) - also if he eats too much of that, it could cause diarrhea since he hasn't had it for years. That's the only food our senior diabetic cat will eat (they are kept separate from one another).

Hopefully we can get some answers and/or anti nausea meds this afternoon.

Thanks again!

At this point, I wouldn't worry about getting him addicted to dry food. If that's what he wants to eat, I would let him for now. You might also try these if they have them at a Petsmart or Petco near you (assuming you're in the US). You may also have some luck with this or the dry food version. The last one was all I was able to get my cat to eat (he had intestinal lymphoma). You could also try boiled chicken. Just cut it into small pieces after it cools. My oldest cat is currently having some issues with eating as well and I was able to get him to eat a little bit of boiled chicken. If you can find a bone broth with zero salt or spices added, that could also help and may help with hydration. This is the kind I've gotten before. Even getting him to eat a little bit could help him to feel better. I agree about the anti-nausea drug. I try to give Cerenia to my cat a couple hours before I use the Mirataz so that the Cerenia has time to kick in first. I think if he doesn't eat something sort of substantial by tomorrow, I would probably be inclined to take him to the ER or urgent care if possible. Hopefully, you can get the anti-nausea soon and try that with him.

 

[Threecatsandme]

Update from his vet visit:

Waiting results from SPEC fLP test for pancreatitis (will have tomorrow).

Cystocentesis results were normal so not a urinary issue.

Fecal screen came back clear (we asked to test for parasites).

They did an X-ray and found a LOT of gas, so diagnosed with gastroenteritis

Gave him subq and Cerenia injection (I did ask about ondansetron and she said they prefer Cerenia because it’s easier to administer and obtain?) I figure we would give it a try. We have Cerenia pills to start 24 hrs after injection.

He was also prescribed metronizodole (he did have some diarrhea) and burprenorphine for pain (I asked about steroids but she said she would prefer to use buprenorphine). She asked us to wait to give him bup until tomorrow so we can see how he responds to the Cerenia first.

Within an hour of the Cerenia injection he ate a decent amount (more than he has the pasto few days) so we are very relieved with that! They gave us the Hills A/D urgent care canned food to try, but he only licked a bit of it and went straigh his usual food more (Rabbit Instinct). We also gave him a little more dry food (he’s been off it for years but wanted him to eat).

We don’t have experience with gastroenteritis. Vet mentioned it could be food related, possible recipe change or one of the different foods we tried with him. He have been rotating him through 5 different wet foods for a long time without any issue, so I’m not sure how to approach that. I’ve read that in most cases you won’t find out what caused it? We were sure this was stress related for going to a cats cottage for 48 hours while we were away, but now I’m wondering if it was food related.

Thank you for the advice, it helped us to be prepared for the vet visit and to know what to ask!

 

[stephanietx]

Stress can cause a lot of things! Our babies are so sensitive to change.

Cerenia is better for gas, but if that doesn't help like you think it should, you can also give Simethicone drops (the baby gas drops, no dyes, no saccharin, or flavoring) to help alleviate gas pains.

Many vets are starting to prescribe buprenorphine instead of pred because it works like a steroid without the side effects. Vets will also use that with IBD kitties who are also diabetic since steroids raise blood sugar.

Regarding food, some kitties develop a sensitivity to chicken. I would stick with the rabbit for now and see how he does with that. You could also try the Instinct venison. My guy gets an rx gastro food and venison and he's done well with that combo for a few weeks now.

 

[Threecatsandme]

We were hopeful last night that Simba was on his way to recovering, but now we are are getting even more concerned.

Our biggest concern right now is that he hasn’t pooped in about 40 hours. When the vet did the X-ray yesterday we could see stool in his colon (and the gas was behind that). Vet said he should poop in the “very near future” and then the gas would probably come out after that (we would possibly hear him releasing some of it). But he hasn’t yet. X-rays showed his colon has a LOT of gas.

How long can he go without pooping before it’s time to call the vet again?

The good news is that he is still eating (more than he was before the meds) and getting decent amounts (but not close to what he normally eats).

His behavior is also abnormal today, likely due to all the meds which is really concerning to me. He’s on mirataz, cerenia, buprenorphine, and metronidazole. After doing some research, I’m a little concerned about metronidazole and its effects. Vet said it was for diarrhea and to help with the gas.

Vet said we should have the SPEC fLP results back today, but no word yet, so we don’t know if it’s pancreatitis or just gastroenteritis (or something else not discovered yet).

They did not do an ultrasound and I’m starting to wonder if that might need to be the next step if he doesn’t improve?

Is there anything else we could be doing to help him at this point?

I’ve even wondered if might be time to get a second opinion. I wasn’t too happy they wanted to do an appetite stimulant when I told them he was showing all the signs of pain and likely nauseous. When we took him back the second day, they prescribed Cerenia for nausea. I asked about ondansetron and they discouraged it and wanted to try Cerenia first.

Now that his behavior is off and he’s still not pooping, I’m really kind of starting to panic:-(

 

[FeebysOwner]

Since he does have stool in his colon, you might ask the vet about a single dose of Miralax to see if that gets anything moving. I would do that over lactulose, which is what a lot of vets suggest. Lactulose doesn't taste very good, and MIralax is supposed to be tasteless - but they work in a very similar manner. Most folks start out with 1/8 tsp. mixed in a small bit of water and then added to wet food. Then, ask about stopping the Metro - it seems to be tough on the digestive tract, and even if it does help with gas, Simba surely doesn't need anything to offset diarrhea, IMO.

Wait for the Spec fPL results before deciding next steps.

 

[FeebysOwner]

Many vets are starting to prescribe buprenorphine instead of pred because it works like a steroid without the side effects. Vets will also use that with IBD kitties who are also diabetic since steroids raise blood sugar.

Not to go off subject (too far), but I did a lot of reading about buprenorphine before my cat started taking it for pain, and I never came across anything to do with it being a substitute for prednisolone. I know budesonide can be used in lieu of pred for IBD cats who have or are at risk of diabetes or certain heart conditions. Buprenorphine is a partial opioid used for managing pain, whereas the other two are forms of steroids. Are you sure you didn't mean budesonide?

 

[Threecatsandme]

Since he does have stool in his colon, you might ask the vet about a single dose of Miralax to see if that gets anything moving. I would do that over lactulose, which is what a lot of vets suggest. Lactulose doesn't taste very good, and MIralax is supposed to be tasteless - but they work in a very similar manner. Most folks start out with 1/8 tsp. mixed in a small bit of water and then added to wet food. Then, ask about stopping the Metro - it seems to be tough on the digestive tract, and even if it does help with gas, Simba surely doesn't need anything to offset diarrhea, IMO.

Wait for the Spec fPL results before deciding next steps.

Thank you for this advice!

I was about to call in to the vet with your suggestions, but he finally had a bowel movement (and it was solid). We’ve never been so happy to have a cat poop!

Also, we got the results of the spec fPL and he was at 0.5ug/L.

He has also been improving with eating more and even went to one of his usual foods that he has been turning down for days,
so hopefully these are all good signs he might be on the mend.

I did email a question to the vet about him seeming to have insomnia and being zoned out. After his buprenorphine and metronidazole dose, he doesn’t sleep. He will sit in front of a window, eyes open, and just stare out for hours. Today he was awake for 10 hours before finally falling asleep (it was about 6 hours after his dose that he went to sleep). I think it might be from the buprenorphine (and not the metronidazole). Not sure if that’s something we need to be concerned about.

 

[FeebysOwner]

I hope this means that Simba is 'turning around'!

Some cats will become more hyper-like on buprenorphine, so maybe Simba is one of them. You might ask the vet if this is something that settles over time, or if the dose could be reduced. I am also not sure if it could attribute to the bowels slowing down a bit as well - it is a partial opioid after all. My cat has been on buprenorphine for a while now, and she has just recently started pooping only every other day - but she has other health issues/meds that might be contributing to that.

So, I am not familiar with the ranges for the Spec fPL - does his results indicate there is not likely an issue with pancreatitis?

Looking forward to hearing more good news in the coming days!

 

[stephanietx]

Just so you know with kitties experiencing things like this, progress is very slow and it's day to day. They'll have a good day one day, then a not so good day. It's discouraging, but it's common for this kind of recovery. When you make changes, you have to stay the course for at least 72 hours, if not longer. It's so difficult to watch them not improve when you expect it.

And yes, I did mean bup, not budesonide. Sorry for the confusion.

 

[FeebysOwner]

And yes, I did mean bup, not budesonide. Sorry for the confusion.

You did say buprenorphine, but I thought you meant budesonide. If you truly meant buprenorphine is being used as a replacement for prednisolone, do you have something that you could share which states that? If so, that would be great.

 

[stephanietx]

You did say buprenorphine, but I thought you meant budesonide. If you truly meant buprenorphine is being used as a replacement for prednisolone, do you have something that you could share which states that? If so, that would be great.

Okay, now that I'm fully awake and have looked through Tumbles' papers from the vet, my vet said that if my kitty ever developed diabetes from long-term steroid use, they would prescribe budesonide because it has anti-inflammatory properties. From the IBD group on Facebook, some vets start with budesonide it seems, but Tumbles is doing well on prednisolone currently.

She also wrote on our discharge papers that if he needed something for pain, he could have bup or gabapentin. That's where my confusion came in.

 

[Threecatsandme]

I wonder if it might be better to start a new thread for this, but since I'm not sure yet if these occurrences are related, I thought I would start with an update here that includes his episode in early January.

Simba was doing so much better, until yesterday he started drooling excessively. And I mean excessive.
We noticed it yesterday, but he was still eating well, being playful, and acting normal. He seemed a little restless in the evening and overnight, with grooming more than usual (probably from the drool) and not sleeping as much.

We took him to the vet this morning. Physical exam seems normal. They checked his mouth, under his tongue and didn't see any dental issues, growths, or mouth sores. They didn't run any tests since he just had his bloodwork, spec fpl, cystocentesis, and xray done January 4.

Simba had a dental with extractions (resorptive lesions) at the end of November. He seems to have healed well from all of that. I did ask if they did xrays after to be sure there aren't any root fragments left and they said yes, so they don't feel xrays are needed again right now (although I wonder?).

We don't have plants. We are overly cautious of everything in our home with cleaners, leaving no food out on counters, etc. We cannot think of anything he could have gotten into, but there could have been something we aren't thinking of. Vet even said to check Yeowww catnip toy he likes to chew on (we've never had issues with those!).

We did try and introduce a new food yesterday morning, it was approx 1 TBSP of Wellness Turkey (canned). He's never had that brand before. Vet thinks that even that small amount could possibly be the cause (even after 24 hours)?

Vet also recommended that we start eliminating food, particularly turkey and chicken to see if that helps, in case he has a sensitivity. He has not shown any signs previously of food issues. His food rotation has included for two years without issue: Nulo turkey and duck, chicken and duck, Instinct Rabbit, Fancy Feast chicken and beef (which we have recently stopped), I and Love You beef, and we recently (within the last two weeks) reintroduced American Journey beef and chicken (to replace Fancy Feast at the moment).

Vet prescribed Cerenia for a few days to see if that will help and if the drooling stops (if it's nausea causing the drooling). If it doesn't improve, vet believes the next step would be an endoscopy to see what may be going on (or if he's starting to show sign of IBS).

I'm scared, particularly with the amount of drool. I wonder if this is related to the excessive gas in colon two weeks ago, although he seems to be back to normal.

Anyone have a similar experience with this? Is there anything else we aren't thinking of or should be asking for as far as testing?

 

[Emmypeps]

I’m so sorry you’re going thru this with your fur baby! From countless vets and my own personal experience, when a cat shows a sudden change in behavior/ eating/ bathroom habits, it can be a sign of something quite serious. I would highly recommend finding a reputable vet / ER to get your baby answers. Best of luck

 

[white shadow]

.
Hi T Threecatsandme !

Drooling is a seemingly common side effect of Cerenia. Here's a snippet from the official package insert:

The following adverse events reported for cats are listed in decreasing order of reporting frequency for CERENIA Injectable Solution: Depression/lethargy, anorexia, hypersalivation, pain/ vocalization upon injection, dyspnea, ataxia, fever, recumbency, vomiting, panting, convulsion, and muscle tremor. link​

While I was looking around for you just now, I saw this:

The European Medicines Agency (link) also warns that urgent medical attention should be sought if maropitant gets in the eyes.​

So, that's just a caution for you.

One of the sources I was looking at was a renowned, reputable site that's an encyclopedia for the management of feline kidney disease. While that's its focus, the majority of health information is foundational and 'generic for all cats. It has a section that covers Cerenia and another frequently used anti-nausea drug, and might be helpful to you: Nausea and Vomiting Medications: Ondansetron (Zofran) or Maropitant (Cerenia)

Meantime, I know that FeebysOwner is familiar with both of the se drugs.......she might have some thoughts for you.

Hope this helps.
.

 

[FeebysOwner]

I only know that Cerenia is more commonly used to help prevent vomiting, while ondansetron seems to be more effective for reducing nausea. But, there are cats that don't follow this general rule of thumb. And I remember your vet 'dismissed' ondansetron previously. Although he has had some ongoing issues, this drool thing is new, and I am not necessarily convinced it is from nausea, but possibly pain instead - like as in his mouth, perhaps? Does he still take any buprenorphine?

Aside trom that -
Just to be on the safe side, don't give him any more of that new food for now - although I also doubt that has anything to do with this drooling issue. I am also inclined to agree with you that this doesn't seem likely to do with any of his food. For something of that nature to be going on, I would think you'd see poop changes, and/or perhaps vomiting, not just drooling,

I would ask to see these x-rays/vet notes related to the x-rays that were done after his extractions, since it would seem you weren't told about them when they were done. Somehow, I would have thought that would have come up as part of the overall conversation about his dental work. Doesn't hurt to make sure they were really done.

EDIT: Just saw your new post. I am glad that it looks as if the Cerenia stopped his drooling. I have never heard of a new food causing such a reaction so quickly, but perhaps it did. I hope no further action is needed.

 

[Threecatsandme]

Drooling is a seemingly common side effect of Cerenia.

Thank you, this is helpful info!

I did ask the vet today about drooling as a side effect when she prescribe Cerenia, but she looked at me like I was an alien and said she hasn’t experienced that (her response concerns me).

However, he hasn’t had Cerenia in 11 days so I don’t think it was the cause of this drooling. We did go ahead and give him Cerenia after the visit today and the drooling has stopped, so I’m hoping we are in the clear of that side effect of Cerenia. Although we are not sure, we are thinking the drooling may have been from nausea at this point, but what is caused the nausea is not yet known (and whether the nausea will return, particularly if it was food related).