mirataz questions

[louisstools]

So my 10 year old girl who has "zero point zero" interest in eating has been on Mirataz since 3/15. She gets 1/4 inch a day. The first two weeks it was a MIRACLE and my old girl was back. She was BEGGING for food, eating everything I put down in the bowl, and not fighting me at all. I was having to ignore her attempts to get me to feed her because she gained a pound in the first week on it. She was also routinely eating large amounts (for her).

However as the time has gone on she's more or less back to her old no interest in eating. I put it on her ear in the morning and 3 hours later it kicks in for exactly one feeding and then it's like it's no longer in her system. Sure, some days she eats more and easier than others but it's nothing even remotely close to how it was the first few weeks on it. And most of her feedings, she has 18-ish a day, are tiny, 0.1oz to 0.2oz with the lone exception being the mirataz one which is 0.3oz-0.5oz. If she even has a mirataz one. She doesn't always get a boosted feeding.

So some questions...and for the sake of my post let's keep this conversation limited to the transdermal version only.

• For long term use, is this diminished effect normal on a cat?
• Given we're on week 4 or 5 and the package says the tube is good for 2 weeks, has the tube "gone bad" and we need a new one? Would a "fresh" one work better?
• Any tips on cleaning their ears? I've tried a rag with warm water and that does so-so but my girl fights me on it so not sure if there is an easier one that is also more effective.

I ask b/c it's very likely that my cat will need to be on an appetite stimulant for the rest of her life as I can't handle the stress of feeding her otherwise. She just won't eat...no interest in it...and when she does it's tiny amounts, like 0.1oz IF THAT (and yes that's by scale weighing not guessing).

 

[FeebysOwner]

Hi. First off, your cat may need an anti-nausea med in addition to the Mirataz. What is the reasoning/health related cause for the appetite stimulant? Regardless, some cats also need anti-nausea meds too. Nothing like making a nauseous cat hungry (UGH)! My cat is on both - the anti-nausea med is ondansetron, which can require a bit of trial and error to find what works best.

Although, every cat varies, 1/4 of a dose of Mirataz just may not be enough. I'd try upping it to 1/2 dose. If that goes 'overboard', then do 1/2 dose every other day. It is really also all trial and error. At one time I thought getting a new tube would make a difference but have since changed my mind. I am now on the same tube I started using in December, and I don't really see any less results. Others have said the same. There is no way to know for sure if your cat might have built up an immunity to Mirataz, but I haven't heard much about that happening. My cat has been on 1/2 dose of Mirataz every other day since 11/2021. There is a pill form, Mirtazapine, that you might consider.

As far as cleaning the ears in between doses, I usually just use a makeup pad - or anything similar - moistened with warm water. Rags might be too big and therefore more bothersome/cumbersome. Doing it more often means less time cleaning because there won't be as big of a buildup to remove. I have found I can clean my cat's ears after two applications (per ear) without much time/effort. If you aren't removing the buildup, that can have an impact on the effectiveness.

 

[louisstools]

Nausea med? Hmm. The reasoning for the appetite stimulant was to give me relief from damn near forcing her to eat every day. We can't find anything wrong with her; this was just a shot in the dark to give her a boost to eating to give me some relief. I've wondered about nausea, she does this snake like thing where she constantly darts her tongue out after eating. It's not like grooming or the satisfied licking they do after eating...it's like how a snake does it and it's usually near her nose.

We were hoping the mirataz gave her the boost...the other options would be to explore pain meds, steroids, and nausea meds and hope some cocktail gets her to eat

 

[FeebysOwner]

she does this snake like thing where she constantly darts her tongue out after eating.

Not sure, but that might be considered demonstrating signs of nausea. A lot of cats that are nauseous lick their lips/lip area. Could it be gagging? Not all cats that gag look like they are hacking something up.

What tests has she been through? Has she had her mouth checked for dental issues?

 

[louisstools]

I mentioned this licking to the vet but she didn't think it was nausea and didn't know what it was. I only hope I "used the right words" and the vet understood me. I find communicating with medical people in a way that they understand to be exceptionally difficult to impossible. Other scientific/technical folk not so much.

As far as tests... normal and "senior" bloodwork from the vet (everything was great), fecal sample exam (normal), 3 urinalysis this year (1 bacterial uti, 1 possible bacterial uti a month later, 1 incident she peed on my bed), abdominal ultrasound (nothing remarkable) and a GI lab panel (sent out of state to Texas A&M). The GI lab panel was to see if she has inflammatory bowel disease which didn't show up on the ultrasound but we decided to test anyway. She had two levels that were slightly elevated (I forget which) but nothing really concerning or that indicated ibd. Dental exam, she has her 4 canines and her incisors and that's it. They're ok and everything else in the mouth checks out ok. As far as I know we've done every diagnostic possible but if we've missed one I'm all for giving it a whirl.

 

[FeebysOwner]

Ok, that is a great summation! I went through many of your previous threads - it would seem most are all about this same cat - Missy - and I was having trouble compiling all of the information. May I ask what the two levels were that were slightly elevated? Those would be in her test results which are yours for free if you ask for them.

Perhaps, you could take a video of her 'licking/snake like' motions and share that with the vet as a possible way to get past verbal descriptions?

I know you have been frustrated for quite a while now with trying to deal with Missy and her eating issues. What I don't remember is if you are trying to get her to eat dry food for the most part. I know that was originally your intention, but perhaps you have deviated from that mode/goal. I am sorry if I somehow missed updates to that aspect. You did mention ounces for feeding, but that doesn't always translate to wet food for some.

I still wonder about the nausea. Cats sometimes will eat and then correlate feeling bad with the food itself - making them cautious about eating the same thing again. I would try an anti-nausea med as the next step.

You can also always try baby food meat (Gerber Stage 2 or Beechnut) as a supplement to her regular food. I am sure somewhere along the line of your posts I have already suggested it. They can range in caloric value from 60 to 90 calories per 2.5 ounces. All but the chicken flavor can be supplemented with EZ Complete to make it nutritionally complete. My cat's daily caloric diet is over half of these foods, and she eats them much faster than anything else I give her.

 

[louisstools]

No worries FeebysOwner ... I have a number of mega threads and it's hard to keep it all together Yes, it's all with Missy. From Dec 2021 to May of 2022 she was on wet and in June I got her over to kibble and that gave me like 2% relief...dry is just easier for me to manage. She's been eating dry exclusively; she prefers it over the wet even though she hardly wants to eat. She needs around 190kcal, or 2.2oz of dry or like 6oz of most wet but we don't talk about wet with Missy...it's too difficult. Even with the food she prefers it's been nearly 20 feedings a day to get pre-mirataz 2.0oz into her or after mirataz 3.0oz into her.

I am working with a behaviorist but Missy is sadly one of the harder cases she's seen and a conversation this past week the behaviorist mentioned to not get my hopes up b/c it could over a year to get Missy under control because the cat is not responding super well. She even mentioned it might be worth considering surrendering Missy to a sanctuary she works with that takes in troubled cats. I don't know that is better than the other permanent option I've been thinking about since last year but it's another option to consider at least if the cat won't cooperate.

60-90 cal per 2.5oz I need something more calorically dense -- that was one of the biggest downfalls of the wet...it's just not dense enough. That's too much food to fight to get into her.

FWIW, I gave the cat another dose of mirataz today and so far I can't tell it is working. She's just not wanting to eat AT ALL today...it's all 3-5 kibbles at a feeding and that's that. She seems fine, is playing, etc, just decided to not eat after lunch today.

edit: i'll try and remember to post the levels that were slightly up tomorrow...I'm beat after fighting the cat all day to eat.

 

[louisstools]

TLI Fasting and Folate Fasting were the ones just slightly high. Vet said based on this the normal plan would be a diet change but we didn't think that was a good idea. A diet change for Missy is absolutely terrible and w/o a guarantee this would fix her I didn't think it was worth the stress on me. The goal is to give me relief.

 

[FeebysOwner]

Those two elements you mentioned that were tested are usually accompanied by looking at the cobalamin level as well. I presume since you didn't mention it, that her level is fine. What kind of diet was the vet recommending?

From all the testing you have had done, it sounds like this is down to her being pretty healthy but without a normal eating desire/pattern. Is this fairly correct? And tbh, this essentially all started shortly after Muggs died, yes?

What exactly does the behaviorist think about Missy, and what is she trying to correct? Has she mentioned that this might be Missy reacting to the loss of Muggs that has been topped off by your reaction/feelings since he has passed? I know you have done so much to try to resolve her eating issues, but I think you have remained mentally exhausted since the time you started having to care for Muggs when he became ill. I honestly feel like you were not able to recover from that and his passing, before it seemed as if Missy was going to have problems - which really could have been driven by her losing Muggs.

Have you considered that Missy has not gotten over the loss of Muggs, and desperately needs your attention to help her do that?
On some level, she might even feel like she is experiencing a second loss - you. It doesn't help matters that she is older, and many cats become more needy as they age. I don't have any magical solution, but maybe if you recognize that this is a possibility, it might help in the long run.

 

[louisstools]

The diet that normally goes along with these sorts of levels is a novel protein diet to rule out an allergy. There are options we could try but as I said given they might not correct her problems we don't feel it's worth the added stress on me. For a normal cat that eats the vet said she wouldn't even hesitate to recommend this but with Missy and me this is the opposite of giving me relief.

Yes, sadly she is by all accounts healthy but won't really eat on her own and goes long stretches without eating periodically (12-16 hours). Some of these problems started a bit before Muggs passed actually. After he got sick I noticed she wasn't eating as well and would go hide for a bit after eating. Vet trip and she had a mouth full of problems. She needed a substantial dental that left her with just her canines and incisors...everything else got removed or was absorbed. She had that dental 2 or 3 weeks before I put Muggs to sleep...I waited on him until she had recovered a bit.

The behaviorist thinks Missy has 5 specific issues around eating (all really around enticing her to eat and keeping her focused on eating) and we're trying to figure out a plan that targets them while giving me relief. She suspects part of the problem is related to the dental and the fact Missy eats a lot slower now which causes her to not eat as much. She might be focused on eating for 10 minutes but eat only 0.2oz for example. Mechanically speaking she has a lot of trouble eating and kibble is easier for her than wet food.

She hasn't said anything about Missy missing Muggs but she has said between the dental and her grieving AND the forced change in food (b/c the vet wouldn't re-new the RX for the food she had eaten for 10 years I HAD to force switch her to a new food) that this hellish routine could be the result of Missy coping with everything in her world changing. It's her way to have SOME control.

You are right in that I've been mentally exhausted since Muggs. Working with the vets and the behaviorist the goal is to get me some relief and not necessarily improve the health of the cat. I don't think I got a chance to recover either b/c it was out of one fire and into another...only the problems with Missy are far worse.

Missy has made like 0.5% progress on where she needs to be. I just wish she would eat on her own at all. If I got sick or had to travel for work I don't know what would happen. The one time I boarded her -- and this was during a period she was being less terrible about eating -- she refused to eat or drink while she was boarded. It was only 30 hours I was gone but still. Missy's problems are certainly life threatening.

A very kind reply FeebysOwner

 

[FeebysOwner]

only the problems with Missy are far worse.

I am not sure how Missy's problems can be far worse than Muggs, other than you don't think Missy's can be resolved in a manner that will enable you to get relief.

forced change in food (b/c the vet wouldn't re-new the RX for the food she had eaten for 10 years I HAD to force switch her to a new food)

May I ask why the vet would not re-new the RX food? Did you ever have the chance to try to the re-formulation on Missy? Is the vet you have now the same one who wouldn't re-new?

 

[mrsgreenjeens]

What happens if you give her the full dose of Mirataz (1 inch strip)? That's the recommended dose for a full 14 days. I have an extremely picky eater, who like Missy, has a clean bill of health but just isn't food driven. Even when I try to hand feed him, there are days when he simply won't eat. My guy has perfect blood work, perfect ultra sound, and also very few teeth. He's 14 and I have been fighting to get him to eat for 14 years now. One thing I have recently learned is that if I simply leave him alone rather then "beg him to eat", he actually does better! I can't quite figure it out, but when I ignore him and just set his bowl down and go read a book (while still keeping an eye out to make sure his brother doesn't sneak the food) often he'll start eating. And it also depends on where I try to feed him. Just now, for instance, I set his bowl down in the kitchen and he walked away. So I brought it into my office where I'm now on the computer, set it down next to my chair, and he started eating. He rarely finishes, but that's ok. I praise him and go about my day. I've stopped stressing because really there is nothing I can do about it at this point. If he goes more than 24 hours without eating, out comes the Mirataz, but that's it.

I DO use toppers occassionally, and I switch them up. I use bonita flakes, freeze dried salmon, and freeze dried chicken, and when I use them, I normally give him a piece or two of whatever I'm using as a treat first, kind of like an appetizer to get the juices flowing.

Since you are feeding kibble vs wet food, have you looked for the highest calorie kibble available. I know there are some out there that have close to 600 calories per cup, and believe those are also pretty healthy because they are low carb. I think the higher the protein in kibble, the higher the cals. I know switching up dry can cause tummy issues in some cats, but once they have gotten used to different kibble, you should be able to feed it again, so am wondering if variety might be good for her to keep her interested.

 

[louisstools]

I am not sure how Missy's problems can be far worse than Muggs, other than you don't think Missy's can be resolved in a manner that will enable you to get relief.


May I ask why the vet would not re-new the RX food? Did you ever have the chance to try to the re-formulation on Missy? Is the vet you have now the same one who wouldn't re-new?

Muggs's problems were at least diagnosable and we could come up with a plan. With Missy we're not sure if it's physical or mental/behavorial.

She would not re-new it b/c it had been 10 years since the original RX and could not find a record of it in their system. I had been buying the food directly from Purina for years b/c they offered delivery and was using Muggs's RX from his surgeon when he had a bladder operation due to a blockage. So our vet was like the cats never ate this b/c the paper trail suddenly stopped in 2018 and that was "system 2". Our vet is the same we've had...they just had to look back 3 different systems to find the original RX. Dec 2021/Jan 2022 was a real poop storm. Frankly Missy handled all that change about as best as one could hope a cat could do.

 

[FeebysOwner]

Dec 2021/Jan 2022 was a real poop storm. Frankly Missy handled all that change about as best as one could hope a cat could do.

So, she was able to try the new formulation and it caused gastric issues? I am sorry I am not following you very well.

 

[louisstools]

So, she was able to try the new formulation and it caused gastric issues? I am sorry I am not following you very well.

Ha forgot about that. Yeah she handled that in September fine. She is eating the new formula easier but sadly it's 30% less calorie...Purina wanted this to be weight friendly...

 

[FeebysOwner]

Ha forgot about that. Yeah she handled that in September fine. Shw might eat need formula easier but sadly it's 30% less calorie...Purina wanted this to be weight friendly...

It can't be less calories than she is getting now if you can hardly get her to eat. And if she actually likes it, she might eat more. This food has a lot of protein, that is good. What if you buy a bag and at least try a bit of it, alongside of what you have her eating now, and see what happens? Dry food changes do tend to need a gradual transition (1-2 weeks at most), so you might not be able to go 'gun-ho' right off the bat, but it would be interesting to see what she thinks about this food.

It's the loss of the cost of one bag, if she doesn't want to eat it - although I also wonder if Purina would send you a sample to try if you don't want to buy a whole bag to start off with.

 

[louisstools]

It can't be less calories than she is getting now if you can hardly get her to eat. And if she actually likes it, she might eat more. This food has a lot of protein, that is good. What if you buy a bag and at least try a bit of it, alongside of what you have her eating now, and see what happens? Dry food changes do tend to need a gradual transition (1-2 weeks at most), so you might not be able to go 'gun-ho' right off the bat, but it would be interesting to see what she thinks about this food.

It's the loss of the cost of one bag, if she doesn't want to eat it - although I also wonder if Purina would send you a sample to try if you don't want to buy a whole bag to start off with.

Sorry - I tried to respond on my phone and didn't spell check myself. She is eating the new formula just fine which is 30% less calories than the old one. As I said she does like it SLIGHTLY better but not significantly. When we transitioned she went from eating ~1.7oz of the old stuff to ~2.3oz of the new stuff to get about the same amount of calories. 0.5oz for her is like 2-3 more feedings, or about a half hour of eating, so that's actually asking a LOT from her.

 

[louisstools]

What happens if you give her the full dose of Mirataz (1 inch strip)? That's the recommended dose for a full 14 days.

I've given her extra doses from time to time when she's been really bad and I think it does help a bit but its hard to say. But it's nothing like the first few weeks. She was a totally different cat.

One thing I have recently learned is that if I simply leave him alone rather then "beg him to eat", he actually does better! I can't quite figure it out, but when I ignore him and just set his bowl down and go read a book (while still keeping an eye out to make sure his brother doesn't sneak the food) often he'll start eating.

My girl does to better if I let her initiate the meals but she "stops short" most of the time and needs to get restarted. She has food available 24x7 and I think in 2023 she's gone to eat on her own exactly one time while I've been home and awake and not in the shower.

I've stopped stressing because really there is nothing I can do about it at this point. If he goes more than 24 hours without eating, out comes the Mirataz, but that's it.

We are trying to do that but as FeebysOwner mentioned when this all started with my girl we had just put down our other cat and the last few months of his life I had to hand feed him. I've never really been able to let that chapter close b/c I went from feeding issues with one cat to the other. It's gotten slightly better. Part of the problem is before her dental and all the poop storm of Fall/Winter 2021 she was the most hungry and food motivated cat ever. And that part of her is gone. She is a totally different cat. If I didn't know better I'd say the vet did a mixup when I picked her up from that dental.

Since you are feeding kibble vs wet food, have you looked for the highest calorie kibble available. I know there are some out there that have close to 600 calories per cup, and believe those are also pretty healthy because they are low carb.

That might be something to consider. Though my girl has a low thirst drive and the reason she is on this specific urinary food is it has extra sodium which forces her to drink (it also helps with the ph and keeps her crystals from coming back). Otherwise she might go days without drinking.

 

[FeebysOwner]

How much does Missy weigh? I am sure you've done all this calculating, so just humor me, please!?!? The guideline for this food is for a cat between 9 and 12 pounds to eat 3/4 to 1 cup per day. 1 cup contains 287 calories. 3/4 of a cup would be about equal to 6 ounces (using chocolate chips as a measurement base, if you use something a bit larger in size it would be more like 5 ounces). So, 6 ounces is the equivalent of about 215 calories.

A cat that weighs 10 pounds can usually maintain their weight on anywhere between 200 and 250 calories, depending on their activity level. So, you are saying she cannot possibly eat 5-6 ounces in a 24 hour period - with Mirataz?

Hell, just using basic numbers, my cat who weighs around 12.5 pounds can maintain that weight on about 250 calories. Granted, she is pretty sedentary, I'll give you that! And, she does take 1/2 dose of Mirataz every other day.

Alas, I suppose I am missing something.

 

[louisstools]

How much does Missy weigh? I am sure you've done all this calculating, so just humor me, please!?!? The guideline for this food is for a cat between 9 and 12 pounds to eat 3/4 to 1 cup per day. 1 cup contains 287 calories. 3/4 of a cup would be about equal to 6 ounces (using chocolate chips as a measurement base, if you use something a bit larger in size it would be more like 5 ounces). So, 6 ounces is the equivalent of about 215 calories.

A cat that weighs 10 pounds can usually maintain their weight on anywhere between 200 and 250 calories, depending on their activity level. So, you are saying she cannot possibly eat 5-6 ounces in a 24 hour period - with Mirataz?

Hell, just using basic numbers, my cat who weighs around 12.5 pounds can maintain that weight on about 250 calories. Granted, she is pretty sedentary, I'll give you that! And, she does take 1/2 dose of Mirataz every other day.

Alas, I suppose I am missing something.

pre-mirataz 12.4, post-mirataz 13.4. Historically her weight fluctuated between 11.x-12.5 lbs

I don't use scoops or anything like that. I use a kitchen scale and weigh everything b/c that's more consistent. What I've found for Missy is 190-200 calories will maintain her weight and anything above that is a weight gain. 190-200 calories is about ~2.2 oz of the food. On mirataz she's been eating around 3.0oz. (Why am I feeding her more you might ask? I'm not per say...the mirataz kicks in and gives her a boost to 1 or 2 feedings and everything else is the same. B/c of her general poor eating we're not in a position to withhold a meal b/c i never know when she'll want to eat again due to her 12-16 hour periodic "fasts".) Missy is also pretty sedentary.

"So, you are saying she cannot possibly eat 5-6 ounces in a 24 hour period - with Mirataz?"
Oh, lord no. That is flat out impossible. That's just not even remotely in the realm of what is possible. Pre-mirataz around 2.2oz is all I could get into her, somedays more or less. On mirataz, I can get around 3.0oz, some days a bit more or less. And that's really working her to eat, coaxing, pulling out all the tricks to get her to eat. Even on what I call the "miracle two weeks" (her first two weeks on mirataz when she was like her old self) she never ate more than 3.6oz and that day she was just CRUSHING it. Even today, which is a GOOD day for her, we're at 2.6 oz and it's taken 15 feedings. I predict we might get 2.8 or 2.9 by bedtime. So yeah...5 or 6 ounces is just not possible even on mirataz - 1/4 inch daily alternating the ears.

edit 2: I will add this is partly why we moved from wet to dry. i couldn't get more than 3 ounces of wet into her and it's just too poor with calories to bother. Like I've been saying she won't eat and when she does it ain't much.