Pancreatitis/Clostridium/IBD?

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leighthecat

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Hi everyone,

I had posted earlier about my cat Neko's difficulty in recovering from his PU surgery at the end of April - we've been experiencing chronic loose stools since (after antibiotics/change in food - he's back on his old food) with some intermittent vomiting that never seemed to resolve, then had vomiting and inappetence that led to multiple vet trips (lots of antibiotic prescriptions that he was on short-term that didn't help), and then a special trip to the internist, where it looked like an IBD flare-up but possibly lymphoma. We are currently treating with KittyBiome Gut Restore supplements, probiotics (Fortiflora because he likes the taste, or I think he still does, and KittyBiome S. boulardii + FOS Powder), an increase in prednisolone (2.5mg AM and 5mg PM), and amitriptyline (5mg). He's also on Cerenia (16mg) and gets potassium citrate granules with cranberry in his food.

Fortunately, Neko's stools have gotten much better, almost normal (but smellier than they were normally), and part of me is concerned that it's a happy side effect of the amitriptyline, which can cause constipation. He's been eating his food (with little enthusiasm, but still eating), drinking, but is very subdued and very tired. He doesn't talk to us anymore, rarely purrs when he's pet, doesn't wake us (me) up for breakfast, and doesn't roll over so we can pet his belly. He has such a big personality that we just haven't seen at all in over a week.

And now, we've received the results of Neko's GI Panel and Fecal PCR. I don't have the paperwork with specific numbers, only what his vet told me, which is:

He had a very mild elevation in his pancreatic specific lipase (indicating pancreatitis, which would most likely be chronic in his case). This is certainly not surprising but the lab also notes that it is not definitive and instead is open to interpretation. The lab's recommendation is to recheck it two weeks later. I almost expect a little pancreatitis with him. There is this thing called Triaditis in cats. IBD and pancreatitis (along with cholangitis) are the components. Cholangitis seems unlikely since that was mentioned with his very recent ultrasound. They did not see his pancreas on ultrasound so we cannot use that to rule in/rule out pancreatitis.
So it looks like chronic pancreatitis is possibly on the table now, too, which I've seen can also cause diarrhea/vomiting/inappetence/lethargy (like so many other things).

To add to that,

The Fecal PCR panel came back negative for everything except Clostridium difficile (which was positive). The test looks for a specific protein but does not check for the toxin produced by the bacteria. So this is a situation of exposure confirmed, but not necessarily an active infection (or cause/contributor of cause to his GI signs). Metronidazole is the drug of choice, at the higher dose that I prescribed more recently. For Metronidazole-resistant ones, we could try the alternative drug (Vancomycin) to see if that helps. I would only try the other drug if diarrhea returned.
So we might possibly have a clostridium infection too.

I've emailed the internist with all these updates (naturally Neko hasn't wanted to eat today after I said he was eating well), but there's just so much information and so much going on I'm feeling overwhelmed. A lot of it isn't even definitive right now. Our regular vet doesn't think things have progressed to lymphoma, and I'm not really sure which of all these issues needs to be addressed first, if he should go back on Metronidazole, if it's the amitriptyline causing his personality issues/clearing up his diarrhea, and we haven't even gotten to things like switching him to a wet food or urinary diet or addressing his arthritis. He had some soft stool prior to his PU surgery, which I was going to address at his annual check-up, but we never made it that far. Was it maybe pancreatitis from the beginning causing his issues? The initial ultrasound didn't show anything out of the ordinary and the ultrasound for last week weirdly didn't address the pancreas at all (Is that weird? It seems weird to me.). We didn't do the specific GI panel back in April, though. The internist also doesn't seem to think that he was fully blocked at the time of his surgery although he couldn't be expressed.

I know a lot of you have experience with one or more of these issues, so I'm appreciative for any advice you can offer. Is there something else I can be doing to keep Neko comfortable? I did ask about giving him pain medication (he seems to have some discomfort but not outright pain), he's just on so much other medication/supplements right now it feels like a really delicate balance and I don't want to without explicit vet permission. And to be honest it feels like everything I tried to do to mitigate any issues from his surgery (after a very unpleasant cystotomy experience last year) only made things worse and everything I do now just doesn't seem to be helping. We've seen some improvement lately at the cost of other things but I'm constantly worried about him and if he'll ever get back to his old normal, or something approximating it. Maybe I'm just looking for words of comfort that he'll be okay or that at least we're doing something right for him.

Thank you all! I appreciate any input you all have. Hope you and your kitties are doing well. :redheartpump:
 

Furballsmom

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Hello
I'm not entirely sure why triaditus was mentioned in your baby's situation at this point, but whatever the case I believe you can rest easy that things aren't this way with his system because of something you did.

At any rate if his appetite decreases further you might ask about B12, and this thread may have something useful;

Any Good Tips To Get Your Cats To Eat? Share Them Here!
 
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FeebysOwner

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Hi. There is almost nothing that I can offer other than about the chronic pancreatitis. The chronic version usually is treated simply with ensuring Neko eats and drinks. Sometimes, sub-Q fluids are given if deemed necessary, and there are other times that pain meds might be recommended. From what I have learned, it is not all that unusual not to be able to discern much of the pancreas via an ultrasound. I think cases where it can be seen are probably the more problematic situations. I personally would put pancreatitis on the bottom of your list. You can always check for dehydration with the 'scruff' test to see if additional fluids are needed.

I also think that antibiotics can 'kick a cat's butt', so to speak - stomach upset being the big one. Since he has been on a series of them, it is no wonder that he isn't feeling all that great. So, take that into consideration. I have used baby food meat (and many other things as well) - Gerber Stage 2 or Beechnut - to help with getting meds down and to help 'coat' the stomach when giving them - most cats love the taste.

How long has Neko been on the Amitriptyline? As I understand, it can cause sedation at the onset. I do not know how long it takes for that to settle down, tbh.

I am gathering that Neko experienced oxalate stones (vs. struvite), hence the potassium citrate? I am not sure this same treatment applies to struvite crystals.

I could go on with speculations about various options, but kind of feel I am speaking a bit out of turn in doing so. I am going to be following your thread, because I want to know how things go with Neko.
 
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leighthecat

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Hi there! I actually gave him b12 a bit earlier today (and last Thursday as well). His report apparently didn't say anything about a deficiency, but anything to try to give him a boost.

I'll check out that site - it's hard to know what to give him because his tummy is so sensitive and things are so in flux. I'll do whatever I can to get him eating, though! Hopefully he feels a little better soon. Thank you!
 

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I would think either the Amitriptyline or the Pred might be causing the personality changes. Have you mentioned this item to any of the Vets?

Metro is the main drug to fight C-Diff, but S. Boulardi is good for that as well. What did any of your Vets advise now that you have the results back?

You mentioned he isn't eating with any gusto anymore. Are you putting the meds in his food. I read that Amitriptyline is quite bitter, so if it's in his food, that could be a reason for hesitation. But I would definitely tell the Vets everything that is happening, including not eating with his usual gusto and see what they say.
 

Astragal14

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Hi there! I actually gave him b12 a bit earlier today (and last Thursday as well). His report apparently didn't say anything about a deficiency, but anything to try to give him a boost.
Definitely give him B12 injections on a regular basis, your vet can offer the best guidance for timing. My cat has IBD and we started with twice monthly injections and then moved to monthly.

I was just listening to a vet podcast about malabsorptive intestinal diseases and part of the discussion focused on B12 supplementation: "Patients often don't have a complete clinical response of disease without fixing B12". Basically, low B12 levels mean steroids won't be as effective, antibiotics won't be as effective, and it can lead to a decreased appetite. Additionally, cats may need B12 supplementation even if they don't appear to be deficient:
A B12 deficiency can cause poor cell formation in the digestive tract and lead to nausea, vomiting, loss of appetite, poor absorption of food (malabsorption syndrome), constipation, gas, weight loss, fatigue, lethargy, abdominal pain, and/or diarrhea. Absorption of B12 requires normal function of the stomach, pancreas and small intestine. These are the very symptoms that cats with IBD and other gastric disorders exhibit... Because a healthy liver is able to store many years worth of B12, signs of deficiency may not be obvious for a long time.
The Importance of B12 – IBDKitties

Which probiotic are you giving Neko right now? I think you mentioned Visbiome in another thread; this is pretty much the best probiotic available, it's the only one that has shown improved histological changes in IBD. It's also been recommended to me by several vets and nutritionists! My IBD cat took it for about 18 months and it helped immensely (we're now at a point where we rotate probiotics for more diversity).

I wish I had more advice that could help you and Neko. He sounds a lot like my cat with IBD, we're just very connected and he absorbs all of my energy and has a tough time shaking things off (unlike our other cat, whom I joke that she floats through life on a cloud of glitter). Plus, with IBD, it can be SO hard to identify their triggers! At least B12 and probiotics are a good place to start, they can help balance his intestines and hopefully make him feel a little more stable.
 
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leighthecat

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Hi everyone!

Thank you for your responses.

I would think either the Amitriptyline or the Pred might be causing the personality changes. Have you mentioned this item to any of the Vets
I've mentioned it to our regular vet and updated the internist today. Hopefully they can come back with something. Neko has been on prednisolone regularly now for the better part of two years, so I don't think that's the culprit here...I'm assuming it's the Amitriptyline, but I'm not 100% it's that vs. him just not feeling great.

Meds aren't in his food - I have the size 4 gel capsules that I put the amitriptyline and Cerenia in (metronidazole/tylosin when he was taking those as well). I saw that the amitriptyline was bitter and with the nausea issues we've had, I didn't want to make that worse. The vets haven't come back with anything new (yet) - we'll try the Visbiome when that comes in, though, but I'm not sure if they'll want to add anything else now. I try to make sure at least our regular vet receives frequent updates both good and bad (probably more frequent than he'd like but that's okay!).

Definitely give him B12 injections on a regular basis, your vet can offer the best guidance for timing. My cat has IBD and we started with twice monthly injections and then moved to monthly.
Our vet had said weekly, so that's what I'm going with right now. We're doing .5mL. I did skip the week prior to his GI Panel per his vet so the results wouldn't be impacted. Things really seemed to go off the rails after that but I'm not sure it was solely due to lack of b12 or just a combination of everything coming to a head. Thank you for the link - Neko didn't really need to take b12 before (or at least didn't seem like he needed to) so this is really helpful information.

Which probiotic are you giving Neko right now? I think you mentioned Visbiome in another thread; this is pretty much the best probiotic available, it's the only one that has shown improved histological changes in IBD. It's also been recommended to me by several vets and nutritionists! My IBD cat took it for about 18 months and it helped immensely (we're now at a point where we rotate probiotics for more diversity).
I ordered the Visbiome literally while we were at the internist last Wednesday, BUT it was never sent out so I contacted them about it. It should be here today - at least, it's on the way so we should have it soon. In the meantime, we're using KittyBiome S. boulardii + FOS Powder (and we're still using Fortiflora - I know it's trash but I think he still likes the taste?). I'm really looking forward to receiving it after hearing this, though!

I wish I had more advice that could help you and Neko. He sounds a lot like my cat with IBD, we're just very connected and he absorbs all of my energy and has a tough time shaking things off (unlike our other cat, whom I joke that she floats through life on a cloud of glitter). Plus, with IBD, it can be SO hard to identify their triggers! At least B12 and probiotics are a good place to start, they can help balance his intestines and hopefully make him feel a little more stable.
This is HUGELY helpful, and just being able to talk to other people experiencing similar things helps me out as well and it's nice to know I'm not alone. Neko's my baby and how his day goes determines how mine goes (and then my family's mood as well). He's always been so sweet and happy and it's hard to see him like this. Plus, yes, the triggers! I'm afraid to feed him anything new/different at this point, and he hasn't had treats in years. We did the 5 Strands intolerance test but our vet said it wasn't necessarily very scientific/accurate, so I'm not sure what to make of his results.

On the bright side, Neko finally decided to eat after he had his pills tonight, and we had another good #2, so those are moves in a positive direction. Everything has just been ongoing for months now and it seems like another problem is always cropping up instead of getting better and it's been difficult.
Thank you all again - I'll keep you posted on any changes and I appreciate all the advice and kindness. :lovecat:
 

Astragal14

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Everything has just been ongoing for months now and it seems like another problem is always cropping up instead of getting better and it's been difficult.
This was our situation for a while, too. It was months and months of new problems and frequently feeling helpless. But it did get better, very slowly, bit by bit - it was a long process of figuring out what to remove and what to add. Keeping a log of everything he ate, how he felt and any incidents helped me to identify patterns and, eventually, which triggers to avoid. You and Neko will be able to find your own process and you'll get through this just like we did :goodluck:
 
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leighthecat

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Hi everyone,

Sorry to resurrect an old post and apologies on advance for any typos....it hasn't been a very good day.

So, after Neko started his fecal transplant pills and various probiotics, we were doing really well. His stool formed up quite well, he was eating pretty well, and we'd started seeing glimpses of his old personality.

On Monday (the 22nd) he had a perfect poo in the morning...and then diarrhea at night, twice, the second time with a little blood in it. I contacted the internist and we increased his poo pills to twice a day, and, because we had run out of our S. boulardii and were using a substitute for a couple days, that maybe that had caused the diarrhea. On Wednesday, Neko had very literally explosive diarrhea. But he seemed to feel a bit better after that, we gave him a little more S. boulardii that night, and yesterday went really, really well. He had a fantastic appetite and was chatty, let me pet his belly, and a bit after midnight had a nice solid poo. He went twice more after that, and they were all formed although the last was a little soft.

For reference: Neko has been getting Cerenia nightly at 9pm.

This morning he ate some breakfast, and I was working when I heard him throw up in the living room about an hour after his pills. It was all his food, mostly undigested. He was still quite nauseated after that, and after about an hour and a half, he threw up a lot of liquid. Then threw up more liquid, and threw up more liquid again. The internist said to bring him in for a Cerenia injection, and I took him to his regular vet for that. He was still nauseated when we got home, and about three hours later, threw up liquid again and collapsed into it. Then he got up, threw up more liquid, collapsed again, and went toward our bathroom, spat up a little bit more, and started panting briefly.

Immediately we were off to the vet. He had bloodwork done that was unremarkable but his body temperature was low. They gave him injections of ondansetron, famotidine, dexamethasone (we weren't sure he'd keep his pred down tonight), and some buprenex for when we got home.

He was still drooling and gagging up saliva on the way home, and when we let him out of his carrier he went to hide in the "cave" inside his window perch, an area that he hasn't used in years and his brother used last just before he passed two years ago.

Obviously, I am PANICKING about this. We had a really good day yesterday and I don't understand what's gone so terribly, terribly wrong for him so suddenly and I don't know how to make him comfortable. Does anyone have any advice? I am a mess and my poor boy just feels so, so bad. I know he's 11 and that's not "young" but he's my baby and I am so desperate to have him happy and healthy again.
 
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leighthecat

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We talked to his vet, he still seems to have some nausea or is at least smacking his lips a lot, like he has a bad taste in his mouth. We have subq fluids to give him tonight. He's tired and uncomfortable right now, hopefully something good will happen overnight. If he vomits again or seems to be doing (more) poorly, we'll be off to the emergency vet. :bawling:
 

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L leighthecat I am so, so sorry you're going through this right now. I've been through similar episodes with my IBD boy. And these things still happen - I've been awake for almost two hours as of right now because of very early bile vomits this morning. But the key difference is now I know how to avoid his episodes and how to manage them if they do happen. And you will get to this point too! Our lowest point was a 36 hour ER stay followed by several months of nausea, vomiting and crying. But the meds from his internist kept him from worsening and gave me time to figure out what worked for him and what didn't (I wish it hadn't taken several months, but at least he's okay).

This is a long post with three main points. It seems like a lot of random pieces, I hope any of this will help you and Neko.

First, you're doing exactly the right thing by monitoring him and taking him to the vet as needed. We were discharged with some of the same meds as you - Cerenia and famotidine. We were also given metronidazole for diarrhea and sucralfate for acid and irritation in his duodenum (first part of small intestine). Sucralfate is "used to treat and prevent duodenal ulcers and other conditions as determined by your doctor. It works by forming a barrier or coat over the ulcer. This protects the ulcer from the acid of the stomach, allowing it to heal." You may want to ask your doctor about sucralfate, but she may have already determined it's not right for Neko's specific condition. I'm just including it as an option and your doctor knows best!

Second, one thing we did that ended up being amazing for my IBD boy was take him to a holistic vet (this was a few months after our ER visit). Neko sounds so much like my boy and I wonder if this would be as helpful for you and him as it was for us. We came away with a ton of helpful information, a tincture we give him 1-2 times weekly, and we were introduced to the best possible nutritionist I could ever imagine. I truly credit our nutritionist with the vast majority of my boy's recovery and management of IBD. I can give more detail later if you're interested - right now we need to focus on Neko's acute issues.

Third, I'll list the medications and supplements we give to manage our boy's IBD. Diet is also a HUGE part of this, but that can be so highly specific to each cat. Figuring out and removing his diet triggers allowed us to finally stop using meds like Cerenia and famotidine daily and now use them as needed.

Some of these supplements may help you right away, some aren't strong enough and won't be useful until you get the initial problems under control. And some may not be relevant to Neko's condition; we're focused on IBD but several of these benefit overall GI health.

One key thing we've discussed with our vet is what I refer to as our "barf regimen". My boy will snowball QUICKLY is things aren't immediately addressed and managed (and I kind of wonder if Neko is like that too, which is where I think the holistic vet may be helpful). I assess the seriousness of his condition at one of three levels and give medication accordingly. He's actually only reached Level 3 once! YAY!

BARF REGIMEN:
Level 1 - Regurgitation or vomit: give Cerenia
Level 2 - Bile vomit: give Cerenia and famotidine
Level 3 - Still obvious discomfort after dosing level 2 meds: add buprenex

SUPPLEMENTS/MEDICATIONS:
  • Animal Essentials Slippery Elm, daily (provides mucilage and supports the intestinal barrier, also helps control excess stomach acid) Slippery Elm
  • Animal Essentials Marshmallow root, daily (provides mucilage and supports the intestinal barrier, also helps move hair through the system to control hairballs) Hairball Relief formula
  • side note: do not give slippery elm or marshmallow root (or any other mucilage/fiber product) 2 hours before or 2 hours after any other supplements or medications, they will inhibit absorption
  • Animal Essentials Daily Digestion, as needed for *mild* nausea (blend of peppermint, ginger, fennel and chamomile) Daily Digestion
  • Probiotic, daily (he started with Visbiome Vet, which has been personally recommended by so many vets and nutritionists I spoke with! It's amazing stuff! He was on this for well over a year, I began rotating his probiotics once he had been stable for a while on the advice of one of our nutritionists).
  • Fish oil, daily (manages inflammation)
  • He also takes a daily digestive supplement made by our local veterinary nutritionist, it is a blend of various mushrooms, plantain, chamomile and ginger. A similar product is Animal Essentials Colon Rescue. Colon Rescue
  • Cerenia prescription, as needed (after any episodes of vomiting or regurgitation)
  • Pepcid, as needed (Cerenia is enough after about 90% of his vomiting or regurgitation episodes, but about 10% of the time he needs something additional to feel better, so we give him Pepcid)
  • Buprenex, as needed (only once)
  • Monthly B12 injections (this was a game changer!!! It has helped SOOO much!)
  • Bone broth, daily (it's tasty, it's healthy and it's nice and soothing for his gut, Nugget's Bone Brew is his favorite Bone Brew — Nugget's Healthy Eats)
 
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Astragal14

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You may also want to consider if Neko has Bileous Vomiting Syndrome (my boy has this, too). Even if Neko doesn't have it, there may be some tips you can use to help manage his stomach acid while he heals right now.

Two of the most common treatments that stopped or reduced the vomiting were smaller, more frequent meals and adding an additional late-night meal right before bedtime to reduce the fasting period. Sometimes giving a small amount of food first thing in the morning, then waiting a little before giving a larger meal is also helpful.
Stomaching the Problem: Could Your Pet Have Bilious Vomiting Syndrome?
 

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You don’t need to give a probiotic if you’re giving him the Gut Restore Supplement. The probiotic is not just redundant, but woefully inferior. Probiotics are just a handful of strains in quantities to small to recolonize. The Gut Restore Supplement is the whole biome of carefully screened healthy donor cats. If the FortiFlora is helping him eat, you can continue giving that. But I would send the Visibiome back for a refund.

The treatment for C diff is s. boulardii. Give him a second dose of the Gut Maintenance Protocol pills to help against diarrhea and suspected C diff. Metro can cause as many problems as it attempts to solve.

I see you have hesitation and doubt around Amitriptyline. But I don’t see what he’s taking it for. Is it possible to give him a holiday from this medicine? With your vet’s blessing of course!

Cerenia is helpful to prevent vomiting and there is a mild anti inflammatory action specific for pancreatitis. But it is not helpful for nausea. Ask your vet for a prescription of ondansetron.

You might also ask for a trial prescription of either Buprenex or the transdermal gel. If he eats better with bupe in his system, then you know there is some pain involved somewhere.

Summary of my recommendations:

1. Stay the course with the Gut Restore and Gut Maintenance pills. You can even email [email protected] to see if they recommend increasing the GMP dose to fight a suspected C diff infection. Before I found AnimalBiome, I gave Krista 1/2 a Jarrow brand s boulardii pill four times a day when we were fighting an active C diff infection. Liquid stools for a month or two. 🙈🤦🏼‍♂️

2. Avoid the metronidazole if you can since you’re working the Gut Restore. But if you think he needs it, the Gut Maintenance should have some protective effect. Skip the Visibiome. Keep the FortiFlora if he likes the taste and it helps him eat. If he is not supposed to be eating chicken because of his IBD, then skip the FortiFlora because that’s part of the flavor he enjoys.

3. Ask for ondansetron for controlling nausea.

4. Discuss the possibility of an Amitriptyline holiday to see if that clears up some side effects.

5. Ask for a small prescription for buprenorphine to see if he eats better with pain management.
 
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leighthecat

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Hi everyone,

Thank you so much - you all have given me a wealth of information and I really appreciate it.

Neko didn't have a very good night, with continued nausea but no vomiting, discomfort, and some mobility issues so he is currently at the vet getting x-rays, fluids, and they're trying to manage his nausea....once we have more information I'll let you all know and address some of the specifics you all have mentioned. It's just been a really long day/night/day and tomorrow is the 11th anniversary of when we got him and I have a bunch of toys for him and we're all just a mess right now.

Thank you for the support and help, I am definitely going to look into things you all have mentioned once we get him safely back home.
 
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leighthecat

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Hi again,

Another quick update. We haven't addressed the medication issues you all have mentioned yet (which are so detailed and thorough - thank you) - Neko is still feeling really unwell.

He had an x-ray today and the radiologist thought there might be free gas and a small amount of fluid in his abdomen. Two vets at the practice looked at him via ultrasound (not a diagnostic ultrasound, just a tool that that have available) and neither saw anything to indicate free fluid. So Neko was given his meds (same as yesterday) and we brought him home.

Initially he seemed a bit better, mewed at us some, ate a few bites, was walking better (his hind legs were weak and wobbly yesterday night), drank some water, and laid in the sun. We got him to eat a little bit more of some Hill's z/d (dry, there was no canned available so I can't syringe feed him) but after that he started having nausea again. He didn't have the lip smacking until just now (1:09am) - he seemed like he wanted to get off the couch so we picked him up to help him and immediately started the lip smacking and drooling again.

He's clearly not feeling well - very tired, he'll move like he's trying to escape nausea/pain and then lay down (weak legs), his breathing is pretty fast but under 40 breaths per minute at least, and we're all really worried.

Since it's the weekend, we, including his vet, are concerned that he'll just be hospitalized until Monday without an actual diagnostic ultrasound done and that would be very stressful for him - he doesn't do . His internist will be in on Monday so we're trying to get him to hold on until then so he can get the best treatment and stay a bit more comfortable at home at least. Of course if things start looking worse than they are/have been, we'll bring him into the emergency anyway.

So those are new, terrifying issues. Although our vets don't think he has a perforation (and they're skilled in veterinary medicine and I'm best at panicking), his symptoms kind of track and that's just a nightmare scenario. I'm not sure how he'd fare in another surgery, especially since he's had two major ones in just over a year. Maybe I'm getting ahead of myself thinking that. I hope so. But he's never had vomiting and inappetence and behavior/mobility issues like this before and we're so worried for him. We've worked so hard trying to get him well and healthy especially over the past couple months and everything just seems to be falling apart. Today marks 11 years since we adopted him and it hasn't started off as the celebratory day it was supposed to be. We're trying to keep him as comfortable as we can and hoping for the best.
 
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leighthecat

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Hello again,

Sorry if I'm spamming this thread. Neko went into respiratory distress early this morning so we brought him to the emergency vet, where he is currently on oxygen and being treated for congestive heart failure (tentative - they need to consult with a radiologist to be certain). Hopefully he can be home soon and we can get his new regimen underway. And maybe this explain all the issues he's been experiencing over the past couple of days (maybe month or so)? He had a chest x-ray on May 12 specifically because I was freaking out about his breathing rate (which was 30-32 resting and high for him) and it was normal at that time...it only on July 5-6 that a slightly enlarged heart was noted on an x-ray and the Grade II intermittent murmur detected. Hopefully we caught things relatively early?

I know this will impact his prednisolone issue (I think?) so I'm hoping all the medications that Astragal14 Astragal14 recommended and daftcat75 daftcat75 suggestions will help as well. I'll ask his internist and regular vet.

Thank you all again. It's been a rough couple of days so I think we are going to try to get some sleep before the e-vets update us later this morning.
 
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