Vomiting, Mirtazapine, IBD, Cat Unable to Walk... Anyone deal with this before?

[cristyt]

Hi everyone. I'm new to posting on the site, though I've been stalking it for a few months looking for some tips or experiences. This is long, but it's been a long journey.

Cat: 7 year old fixed female Calico mix named Charlie. No previous health issues

A year ago:

• Began to get sluggish and demand more treats. Drank more water. We didn't really notice as it was gradual.

2 months ago:

• Stopped eating to the point she went from 14 (fat cat, thus (spoiler!) diabetes) to 10
• Normal vet did tests (CBC, pancreas, and FLV test). All came fine. Sugar a bit high - 220 - blamed on stress.
• Still lost weight, stopped eating. Brought to a vet with in house testing. Sugar 300. FLV negative. Thyroid fine. Ultrasound showed small intestine thickening.
• Ate dry food. Vomited for hours. Stopped walking, gasped in pain if you touched her stomach. 
• Vet said lymphoma and to put her down. White cell count fine, no tumors, very sudden and not gradual... Made no sense. Searched and found IBD in cats. I think she vomited so hard she got acute pancreatitis. Got vet to let me start supportive care at home.
• Vet gave her mirtazapine and a script. Around this time, she got very weak and wobbly. I stopped mirtazapine after a few doses, started ondansetron 1-2mg every 12 hours. Made her stop vomiting. She wouldn't eat though and got jaundice. Called vet. Another visit.
• Temperature extremely low - 98
• Subcutaneous fluids every day. Let her lay in front of a heater (not too close obviously). Insulin twice a day. Syringe feeding prescription food. Gabapentin for pain prescribed by vet.
• Got better within days! Began to walk, demanded food... It was amazing.

Recently:

• Down to 8 pounds, but began to gain weight as she was constantly wanting wet food
• Bought a SureFlap feeder so other cat can eat dry (Blue Buffalo). It's a $150 feeder that only opens to programmed microchips. Well, the other cat is horrified by it, so I leave it in training mode where it opens/closes very slightly for him but not for other animals. 
• Apparently Charlie jumped up to it for the first time in ages and gorged.
• Friday, sick. Vomiting nonstop. My mother gave her 1/4 mirtazapine tablet Saturday.
• Sunday extremely weak. Monday we thought she had passed but she was just that weak.
• She can only walk on her hocks. Her third eyelid is showing constantly. She tries to stand and falls half the time. Won't use the litter box - even though we made one without a step from a foil pain. Lifts her head and does swallow food quickly from a syringe. Sometimes too quickly and vomits.
• Syringe feeding her 5-7 times a day Science Diet a/d (so about a can total, which is recommended amount), giving water in a syringe along with subcutaneous fluids every other day

So that's the timeline. I'm curious if anyone has seen something like this in cats with IBD or who had mirtazapine. It's been 72 hours so it should be starting to get out of her system, but today it's far colder than yesterday and she's more sluggish. Yesterday when I was at the store she walked 25 feet to the water bowl, possibly laid in it, got water everywhere, walked 15 feet to 2 steps, fell down them, and laid in the sun room. Later on after I carried her inside, she laid in the bathroom (skylight provides a lot of heat). Today it's rainy and cold, and she's next to me in a towel, on a puppy pad in case she pees.

I will be extremely honest and say I'm not calling the vet. Their solution is to go "cancer cancer cancer" and put her down, when she actually got 100% better until she ate dry food. I can get more fluids from them or food if need be, but the only other tests involve exploratory surgery. I'm not too keen on that considering they admitted it probably won't show anything, and I'm a PhD student with the smallest stipend who just spent $1500 on the cat. Maybe if I knew it'd show something but I'm 99.9% sure it won't.

So waiting game. But has anyone had a similar experience? Any ideas how to help her quicker? I'm just at my wits end and I know the solution is waiting this out to let her body heal or get over the mirtazapine (holy crap no more ever again), but I'm desperate for anything. Thanks!

 

[ruthm]

Would you consider getting a 2nd opinion from an entirely different vet?  You might want to try something else to address the vomiting, such as Cerenia (for vomiting)  and ask if you should increase the Ondansetron, although from my experience, Ondansetron did not stop the vomiting.  

It sounds like you are giving your kitty insulin injections twice daily-----If so, are you home testing?  Did your vet state your cat is diabetic?  What tests were performed to make this diagnosis?   Home testing is so important if your kitty is diabetic, please consider joining Feline Diabetes Membership Board   http://www.felinediabetes.com/FDMB/   .These wonderful people helped me in so much with support for nearly two years while my precious girl Tiger was alive. 

Losing weight despite eating can also be a symptom of uncontrolled diabetes as the nutrients cannot be absorbed.  Walking on the hocks can sometimes be the result of diabetic neuropathy as well, if your present vet did not  give any advice regarding this, I would get a second opinion as this is a treatable condition. 

 

[artiemom]

I feel for you and your kitty. I really do..

I know you stated that you did not want to go back to a Vet, but I really feel you kitty needs to be seen, by a competent Vet who is well versed in specializing IBD cats and Diabetic Cats.

Is there a Vet school near you? They usually have a hospital/clinic with them. That would be what I would do.

I would see a specialist in Internal Medicine. I have that for my Guy who has IBD. 

My regular Vet insisted that I go there. I see a specialist. 

My guy was on a ton of drugs in order to calm down his stomach. The ultrasound also showed thickened bowel. Yes, I did the biopsy. 

Came back IBD

He was put on Raglan, Cerenia, Prendilosone (steroid), 1/2 tab Pepcid, and the 

Zofran for the days he did not take the Cerenia.

I am also going to add that Artie is allergic to chicken. I notice that each time he ate chicken, he vomited.

I am thinking that your guy has a food allergy which is worsening his IBD. Try giving him a high protein, low carb--no fillers, NOVEL Canned food. 

Canned food is better. Novel protein is something that he has not had before. Natures Variety is a good brand to start with. And no Chicken... I am using rabbit.   Or you can try lamb, or beef..or others. I would try staying away from winged protein sources.  NO Treats either. 

From what I understand, the high protein low carb diet is good for diabetes also. 

The specialist also prescribed a probiotic called Provable. 

All this was diagnosed last year when my guy was 11 years old. 

Can you try feeding your guy some baby food? Either Beech-nut or Gerber meat only.. like ham or beef to get some food into him?

No onions or anything else.

You many have to resort to feeding him in a separate room from your other cat. 

My guy cannot take mirtazapine. He gets too hyper and vocal on it. A lot of cats do. I even resorted to putting some NV freeze dried rabbit dry which were crushed, ontop of his food to get him interested in it..

Good Luck.. 

 

[denice]

I would definitely look for a specialist.  I did the vet hopping thing with my IBD kitty for 6 years before I found a good vet.  By that time he was in Fatty Liver.  I had let him go too long without eating because a vet at a Cats Only Clinic told me that Fatty liver wasn't an issue because he was a little underweight.  I took Patches to a Certified Feline Specialist.  

He was put on a steroid which is very problematic with diabetes.  I personally would not give an appetite stimulant to a kitty that is vomiting.  The vet that finally got things right with Patches won't even use an appetite stimulant other than in a hospitalized kitty.  She would use it to try to jump start the eating so kitty could safely go home.

The thing with IBD it presents differently in different kitties and it is a very fine hard to diagnose line between IBD and small cell lymphoma.  At a minimum your kitty needs an ultrasound.

 

[fairycatmom]

Hi,

so sorry to hear your cat has been so sick. One thing that jumped out at me right away was how you said when she got that dry food she got worse again. I got the book Your Cat: Simple New Secrets to a Longer, Stronger Life by Dr. Elizabeth Hodgkins several years ago, it is all about the different diseases that pet food can cause. She says in it that many of her diabetic cats can have their disease controlled just by not feeding dry food. This is her website http://www.yourdiabeticcat.com/

Also, a few months ago one of my cats had to be put on antibiotics for the first time ever and he didn't have a good reaction to them, he stopped eating and I was syringe feeding. The vet also prescribed mirtazapine and since I had never heard of it, I researched it before giving it to him. After I found out more about it, I decided not to. It is a drug used in humans for depression and is known to cause odd behavior in cats. This is the site I found when looking it up http://www.medschat.com/Discuss/dangers-of-mirtazapine-174426_p1.htm . Cyproheptadine is a much safer appetite stimulant for cats, it is an allergy medication. There are also things like Richard's Organics Adult Cat Nutrient Paste Cat Supplement that may help stimulate appetite. I got mine online at Chewy.

Dr. Hodgkins writes this on her website:

"Therefore, to manage feline type II diabetes, the patient must be provided a diet that is high in protein, moderate in fat, and ultra low in carbohydrate, especially carbohydrate from extruded cereals and those with high glycemic indices, like corn and potato. No feline diabetic should eat any type or brand of dry food. This includes all of the dry formulas labeled as “for the management of diabetes.” Allowable foods include low-fiber canned foods designated “for the management of diabetes,” and a number of other brands of canned or pouched foods with low carbohydrate content. Raw meat can also make an excellent diet for cats, diabetic and non-diabetic alike." http://www.yourdiabeticcat.com/protocol.html

The grain free canned can be expensive, but one good brand that is on the lower end of the price scale is Triumph grain free. It's about $20 dollars for a pack of 24 5.5 oz cans on Chewy right now for example. There aren't even any vegetables in it, which is a plus. My cats LOVED the Turkey & Giblets flavor and it honestly smelled appetizing to me. They also have a Chicken and Whitefish flavor. I have bought it online at Chewy and Pet360.

Good luck figuring things out and getting her back to healthy again

~

 

[cristyt]

Thank you for all the replies! I've had a hellish two days so I've been unable to respond. To give some updates, she's much stronger now but still wobbly and showing strong signs of fatty liver as she won't eat enough. I have an appointment for her at 10:30am with her original vet. I love him to bits, but he just couldn't do the testing she needed in house. Even a CBC took a day to get the results. She dealt with some bad constipation but I got it resolved at least, so she's doing better after some mineral oil mixed with food and a suppository. But I think her issue now is fatty liver, so I'm probably going to get a feeding tube in her if he thinks it's a good idea. Easier for us both. Until then, I'm giving her Pediasure and food as much as possible.

And Finn finally is eating out of the feeder! He jumps each time it opens but he's hungry enough he's eating from it, so hopefully when she's stronger it can be closed and she can't get it. Now to answer each person:

RuthM: Her normal vet didn't find diabetes, and I went to a secondary one who did with two tests. I do sticks at home but not often - until I can budget her own I use my father's machine so I can't use strips constantly. I do have these paper squares that change when she pees on them in her litter, and it tells me if her sugar is outrageous. 

Artiemom: I was so stressed when I wrote this I just wasn't thinking and I hate how against vets I sound. She's going to her normal one tomorrow. Any tests will take 24 hours to get back (he's much smaller than the second vet) but so be it. And wow, the medicine made him hyper? If only it did that to her I wouldn't hate it as much as I do.

Denice: The second vet did mention steroids but couldn't because of her diabetes. I did get an ultrasound done and everything was clean other than the thickening small intestines. I honestly think she vomited mostly because I fed her too fast. She can only handle 30ml given over an hour. Doing this like 6 times a day equals far too long and I sometimes rush and not even realize.

FairyCatMom: I researched it actually and found out about it being an anti-depression after the vet gave her the pill the first time without even asking me. (I wasn't terribly happy with that one...) It didn't do much so we did it again and it wasn't taken well. Then we just... forgot. Stress can do that. Thank you for the recommendations! We've been doing Hills Prescription A/D which is costing $3.50 a can, so when she's better, definitely going grain free. Even $1.50 a can I'm okay with.

Now new question: for you guys with IBD cats, did switching to wet clear it up? Any time she eats dry it seems to do bad things. And can your cats eat pure protein? She loves simple baked, unseasoned chicken breast (my dogs eat this for their dinners) and freeze dried 100% chicken breast treats. I mean, she hates it right now but normally loves it. So once she's better, if all goes well we'll go back to that when she wants it.

Thank you again everyone! I really appreciate it.

 

[denice]

You can feed things like chicken breast as a sole food if you make it complete.  There are commercial products that can be added to it to make it complete.  There are also some home cooked recipes that are complete.  We have a forum for homemade food http://www.thecatsite.com/f/65/raw-home-cooked-cat-food     There are some stickies at the top with general info as well as the threads.

Each IBD kitty is different as to what works.  Some kitties do fine with diet changes alone.

 

[cristyt]

Hi everyone again. Thanks for your help. Unfortunately it was ultimately too late. Apparently treatment needed to be done years ago, not weeks. 

Friday I woke up to her having not moved since the night before. She didn't move when I brought her to the vet. There, the vet found her temp very low (95), and said her prognosis was very grim. He said he couldn't do much - he didn't do feeding tubes - but supportive might work. So I went home, tried to feed her, couldn't get her to swallow, and went to the other vet for a feeding tube. This vet pushed for euthanasia from when I walked in the door. I understand why, so I kindly told him I couldn't give up when she was sick from a stomach bug and I'd not been feeding her enough, but if she was the same Tuesday I'd put her down. He bullied me about it 3 more times until I finally snapped and said point blank I wasn't putting her down, I'm alone and I'm /not/ driving home an hour sobbing my eyes out, and I need another course of action or I'm leaving. He said he couldn't do a feeding tube (she wouldn't survive going under, and the food would likely sit in her stomach and rot anyway). So he recommended a 24/7 vet clinic.

I sobbed my eyes out in the vet's lot, then went to the emergency vet where I waited 30 minutes for my parents to come. I'm 25, but I need their support as I've never had those decisions on my shoulders before. I've lived through them but with dogs that we knew were sick and justifiably so (dogs who were at the end of their life, who could barely walk, etc.). I laid with her, my seat reclined back, and let the windows stay down. The warm air got her to perk up for the first time all day, and I just pet her and told her I loved her for the entire time. Once in the vet, they gave her an IV, had a port in her artery to check her sugar levels constantly, and had her under blankets blowing warm air. They said they'd call with the blood results, so I left for home.

At home they called to say she was in severe kidney failure. I've never had this happen to an animal before. Getting old is one thing. A 7 year old cat with organs dying? I didn't know what to do. However Charlie decided she did, and the vet came to tell the doctor she'd went into cardiac arrest. They asked me if I wanted them to try CPR on her but I knew there was no reason. She could come back... and live in agony until her kidneys completely died and she passed. So I said no, and she didn't wake up.

We buried her today with her favorite toy, mat, and bed. I spent a lot of money just for 2 hours of care, but it was worth it because I found out it wasn't my fault. She was sick. She wouldn't have made it unless we caught her diabetes 2+ years ago. And she had regular check ups - the vet never caught it. It's terrible, but it happened. I tried without much focus on my bank account - this scrawny kitten I got 7 years ago for free was worth 4,000 if it meant her living ten more years. She just couldn't. She tried but her body wouldn't let her.

She was the best cat I've ever had, so mellow and calm and loving. So damn loving. Even when she was nearing the end she was so happy and it was what made the decision to let her go so much easier, because this past week has been hell. I felt terrible each time I fed her, checked her sugar levels, even moved her. I was hurting her by keeping her alive. It was time.

I wish it could've been any other way, but she went somewhere where she was warm and comfortable, after we stopped petting her and kissing her face and calling "Char Char" over and over and they just let her rest. And I'm so very thankful she didn't pass away in the middle of the living room, curled up, alone and cold. I would've never known what the issue was and just thought I hadn't fed her enough and never forgave myself. Instead I got to know she went comfortable, and got to pick her body up, bury her in the back yard and make sure she had her favorite mat, pillow, blanket, toys, and food. Maybe it's an Italian tradition but I wanted her to have everything she ever loved.

So thank you everyone for trying. I'm sorry that it was too late, I'm sorry that this is so long, but I appreciate each and every one of you. <3 Both Charlie and I do.

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• cristyt
• May 29, 2016

Charlie, in between sickness 1 and 2, about 2 weeks ago - seemed as happy as could be

 

[fairycatmom]

I am so incredibly sorry for your loss

you did such a great job getting her help. She was such a beauty. It's so very hard losing them, time only eases the pain. Hugs and comfort to you.

 

[denice]

I am so sorry.  You did everything that you could and you loved and cared for Charlie, unfortunately sometimes even that is not enough..

 

[jennyr]

I am so sorry to read this sad news. The moderating team offer their sympathy and vibes. Charlie was a beautiful and much loved companion and I know you will miss her very much. In keeping with TCS practice, I will now close this thread out of respect for Charlie and to preserve your privacy at this sad time. We hope that when you feel ready you will open a tribute thread for her in the Bridge Forum, where members can join with us in expressing their condolences.