*need Advice/help* 15 Yr Old Cat Having Appetite Issues

[miguel99nyc]

Hello All,

So about 2 weeks ago, my cat Sassy (diagnosed in very early stages of CKD back in June 2017) began having some...appetite issue in which she would at times eat less then what she would eat, and other times eat her normal amount. Was strange. So then we took her to vet to make sure nothing was wrong or if the CKD progressed quick since June that would cause her to at times have a fussy appetite. So vet performed bloodwork a week ago to see if any organs was having issues and/or disease or if CKD was worse. But thankfully all came back normal, CKD hasn't really progressed too which I was glad (despite her only eating foods she loves that isn't kidney friendly); so all results were normal.

So vet then just think was a behavior issue and to help her with fussy appetite is medication called mirtazapine tablets. I read up its to suppress stress/depression? So I want to be sure if this will be a solution? Or if you guys think something else could be wrong? She's 15 and with CKD, I want her to be eating normally and not eat less, lose weight and then get worse.

Please, if anyone could let me know, I'd really appreciate it.

Also, there are times where when she does eat, where its little or her close to normal(usual)amount, she would like look away from her plate and act scared? She would like walk rather quickly away from her plate as if something scares her after, but have no idea what that could be, but I feel whatever she's fearing might be affecting her appetite.

 

[liathum]

My one cat, Taco, had some health issues that resulted in needing an appetite booster. The vet prescribed mirtazapine, I think it was 1/8th or 1/4 of the pill every three days. In humans, its used as an antidepressant but had additional effects such as it helps with anxiety, nausea, insomnia, and as an appetite stimulant. In cats, its fairly effective at getting them eating again and eating regularly. In Taco's case, the day after we gave it to her, she was eating like nothing was ever wrong. She actually only needed the pill once because once she got to eating again, she never stopped. We took to feeding her separately so we could eyeball her food dish (she has her own room too, little princess) as well as keep an eye on her food intake and whatnot.

There could be a number of reasons a cat will go off their food or have issues with eating in general. What I can tell you is that in my experience, mirtazapine was a literal life saver and worked quite well with getting her eating again.

Keep in mind though every cat (and every person) might handle medication differently. Its important to keep an eye on her after administering it to see if its helping. If it doesn't help, you may need to speak to your vet about a different stimulant. There are a couple others that may work for your kitty if the mirtazapine doesn't.

I am worried that she seems to get fearful near her food. There might be something she's smelling near it that she doesn't like. Cats are funny about scene. Have you changed the soap you use to clean her dishes lately? Or cleaned around her dishes with a different cleaner than usual? Or even changed her dish? I wish I could help you more but that's all I can think of. Hopefully someone else can pop in with some more advice about why she might be going off her food there.

 

[Antonio65]

She could have nausea from her CKD, so nothing lures her to eat because she feels sick.
Have you noticed signs like licking her nose tip, or chewing the air or having a meatloaf position? Or a position like a sphynx?
These could be signals of nausea.
You haven't written the levels of creatinine and bun.

The mirtazapine that the vet has prescribed is an antidepressant, but in cats it can work as an appetite stimulant.
I'm giving my cat cyproheptadine, which is mainly an antihistamine, to boost her appetite in those days when she just walks away from her bowl.

 

[miguel99nyc]

Antonio65
Well, no she isnt licker her nose tip, or chewing the air. Meatloaf position as she eats or other times? Either way I don't really see her in that position ass well. Not sure what Sphynx position is?

As far as her Creatine and Bun, I've attached her June Bloodwork in which she was diagnosed with early CKD. I need to get copy of her latest bloodwork from a week ago, but vet said it hasn't progressed and all her values were normal. I dont see why he would lie about it..

And its not that nothing lures her to eat, when shes hungry which is always, she comes right behind me into the kitchen ready to eat, thats never a problem. It's just that she would either eat half of the amount i give her...or other times she would normally finish it. So the hunger is still there. In fact when shes hungry, like in past times, she would be so friendly and be petting my leg with her tail straight up as we walk to kitchen together. So that I dont think has changed or her hunger is lower.

 

[Antonio65]

The blood works you attached are perfect, I'd say. How has your vet diagnosed a CKD? Did he run an ultrasound scan of Sassy's kidneys or a SDMA test?
Are there any other pets in the house that might have scared Sassy while she was eating and now she's afraid to get closer to the dish?
As liathum said, have you changed anything in or around her meal area?

Eating less on some days could be usual with senior cats, especially with CKD.
The sphinx position is the one that the Sphinx in Egypt has, with her belly flat on the ground, her front paws straight forward and her head and chin held high.
This position, or the meatloaf position, can be observed when the cat is at rest. These are the two positions that sick cats have when they feel nausea.

 

[miguel99nyc]

He ran a urine test in which I believe the urine was bit cloudy and not clear? It's in the document i attached. Also he felt her kidneys was bit small. He did an ultrasound...but I don't recall from June if he found anything there. Again he stated that she was in the very early stages and that she should be monitored every 6 months. I've posted about this before back then on this site, and others too have said it seemed normal her blood. She wasn't sick enough then to get any medications or anything. Doc just said to try these kidney diets which of course she hates, so I just give her the food she loves the most.

Other pets? Yes have another cat been around with her for 12 years...so that shouldnt be an issue. I haven't changed anything around her meal area. She seems to like just sense something after shes eating for few minutes or so...but I have no idea what. She's not afraid getting close to her dish, she goes right to it when I place food in it and devours her food like the first minute or so, then at some she will stop eating...haflway through or she would otherwise finish it all.

Thats what I kinda thought too, maybe her age and CKD perhaps, she would eat a little less on certain days? I feed her just twice a day, mornings and nights, about 12 hours in between but each meal I try to feed her about 2.5-3oz of food per meal sometimes more if shes THAT hungry or wants more.

And no, sphinx or meatloaf position, no I don't see her to that. Maybe meatloaf but rarely,usually just walks around or lays down to sleep. But definitely no sphinx position.

 

[prairiepanda]

I used mirtazapine with my CKD kitty a couple times, but only when she stopped eating entirely. If she just had a reduced appetite, I used less intense meds like Cerenia or Pepcid AC (but her appetite loss was largely due to acid buildup and nausea, which doesn't seem to be the case for you)...the mirtazapine was very effective at getting her to eat, and usually once she had food in her stomach she didn't need any further medication. However, she did experience side effects which is why I only used it as a last resort. Mirtazapine made her extremely restless to the point of being unable to sleep or even get comfortable, and she also appeared to be confused. Those side effects would last anywhere from several hours to 2 days after one dose, depending on her physical condition prior to giving the meds. Many cats experience no side effects, but it's something to consider.

If Sassy is still eating a decent amount despite eating less than usual, it might be better to investigate the underlying cause more rather than resorting to strong meds right away. Maybe try moving her food to another location, in case something is bothering her about that particular spot?

 

[miguel99nyc]

Prarirepanda
That's what im afraid of. I just got back from vet picking up medication. She doesn't refuse to eat...just at times eats less then what she used to, and past few days has been persistent in not finishing all her food...but still eats. Im afraid giving her medication then can affect her in bad way. She just got prescribed Mirtazapine, 2mg every 2 or 3 days as needed.

And just picked up her latest blood work from a week ago.

 

[Antonio65]

Yes, I had seen the urinalysis, but I am not very good with urine
All the rest was perfect and it still is in the last report.
I'm no expert, but I think that something more scientific than feeling a small kidney is necessary to assess an early stage of CKD. There's a new IDEXX test called SDMA that may reveal the kidney condition, especially when other levels are still ok.
I think that if this test also says that Sassy is fine, then you could take a deep breath
As for her appetite, unless she loses weight due to the diminished food intake, I would consider it as a sign of her age

 

[miguel99nyc]

Antonio65.

Appreciate it. Would you then suggest to hold off on the mirtazapine?

 

[Antonio65]

Yes, I would wait on for some days.
However, if it is possible, ask your vet about the SDMA test.

 

[valentine319]

I'm going to add in an off suggestion. Ask your vet about zyrtec. It seems safe and does have the side effect of making my cat hungry. It's worth asking.

Any new appliances like an air purifier? Something that causes sound making her feel unsafe eating?

 

[miguel99nyc]

Not that I know of at least. Nothing new or anything. I mean as she eats, we do have an elevator shaft behind kitchen but barely makes quiet subtle knock kind sound...when its in use so not all the times. Whenever she would hear it she'd just lift up her head like when she does noticing something...then she would resume eating again.

But what bothers me right now, like tonight, she didnt want to eat, just ate some dry food but not much of her wet food. just barely few licks. and wanted to walk away from kitchen, but she just gets sscared. She wanted to go hide like behind this furniture...so I took her immediately out and then she just ran away to hallway and just stood there, then went ontop of a bed to sleep.


It stresses me out sooo much because shes old, and still I guess ok health. That when she doesn't eat properly or mostly...eats little, I worry she can get sick. But at the same time, while I know this mirtazapine is appetite stimulant, Im just very afraid of any side effects or just changing her completely but not in a good way either. Every meal she has is stressful because I wonder if she will finish it all or not. At times, I got to spoon feed her to get her to eat.

 

[carebare]

My cat is sensitive to the environment. He won't eat unless I am nearby, and that I lock out the other cat. He takes his time. He is also picky about food so I have to try different foods. He got pickier over time I think because he felt unwell after eating certain ingredients.

 

[miguel99nyc]

Right, but im at this point where I want to giver her the medication but then like, what if she gets worse with side effects. On a cat, i dont want to take that risk, let a lone a 15 yr old cat.

 

[Antonio65]

I'm in a similar situation lately.
My cat is eating less and less, I'm giving her an appetite stimulant (cyproheptadine), but it seems it works only for a very short period of time, like just one meal, then she's off food again. Opposite to when she stayed hungry for a day or more.
She only eats when everything around her is quiet, hence we have to stand still while she's eating, but not too still because she could get suspicious... a wrong move at the wrong moment and away she goes for hours...
Sometimes she wants me near to her, sometimes not. Sometimes a rub on her head or a short brushing are helpful, sometimes they're not.
I'm wasting myself away with this

 

[miguel99nyc]

Wow Antonio,

That is the exact same thing I am going through! As to, staying still or near quiet otherwise a noise well get her attention away.

Anyone else suggest that I do or don't go through with the mirtazapine? Again I don't want her to change at all, nor get worse or sick from this. She ate this morning but literally less.

 

[miguel99nyc]

And how should the mitrazapine be administered? By mouth obvious but with or without food?

 

[Antonio65]

I think that since it's an appetite stimulant, it can be administered before a meal.
By mouth, of course, it's a pill, or fraction of.
In my case it's a tiny white round pill that I cut in 8 parts with a sharp knife

The pill should not change her, if you mean her attitude or behaviour. Sometimes they get more vocal and a little more... unsettled. But it's reversible as soon as the effect dies off.
In my opinion, since I'm going through this, I think it's a very good solution to have a cat eat when they don't want to.

 

[miguel99nyc]

Hello Antonio.

Well mines a 2mg tablets, really small blue ones.

But do I give it with food? she will spit it out if i give it by it self.

This is the message my vet just emailed me about the medication and my cats situation:
Mirtazapine simply stimulates the appetite and is indicated as symptomatic therapy for pets that are not eating well for whatever reason. If Sassy is eating enough to maintain her weight, than you do not need to give it. If she starts losing weight, due to her not consuming enough calories, than we can restart the Mirtazapine at that time. I suggest you weigh her on a digital scale once weekly or feel free to bring her in for us to weigh her weekly on our scale, no charge. I am out of the clinic today, and as such do not have her file in front of me, however I recall she recently had some lab tests that were performed that were unremarkable. As such, her eating habits were not found to be attributed to any obvious disease process at this time. Should her appetite continue to diminish, addition investigation into her health would be indicated.