Where do I go from here?

txcatlover94

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OK, back with some more questions because I'm at a total loss and very confused. :confused:

The background as to what we've been dealing with is in my original thread here What's Going on With My Cat??

Where we're at right now is just an absolute refusal to eat. The best I can do is little bits of this and that. In all, he eats maybe 3-4 tablespoons of food in a day (I need to start measuring it out so I can get a better idea of the actual amount). He tries one food and eats it maybe a couple of times, and then won't touch it. Sometimes he acts like he wants to eat but then turns up his nose when I offer something. He's not vomiting and passing very little stool (had X-rays, no blockage). So here are my questions:

1. Are we dealing with something that needs to be treated with antibiotics or steroids? One vet went the gastritis and antibiotic route and the other was going to go IBD and steroids. I have no way of knowing what his root problem is and so have no clue which direction is right. Again, his only symptom right now is nausea (at least I would assume) and not eating. No vomiting - he hasn't really vomited at all during this whole ordeal, except once or twice in the beginning. Both vets we've seen also told me he was dealing with diarrhea but how much of a problem that is and whether it's gotten better or not I don't know because he's hardly passing anything other than urine when he goes.

2. Could he possibly be in pain and need pain medication?

3. He wasn't horribly sick when I took him in last Wednesday (I initially thought his anal sacs were impacted and just needed to be expressed) and now he's hiding and hardly eating - do I just need to stop the meds and give his body a break? He's had Cerenia, Mirataz, and Omeprazole, all with little effect in getting him to eat more.

4. He's very sensitive to medications, so whether it's decided by the vet to give him an antibiotic or steroid, what are some of the safer brands? I want to be aware so I know what to decline and possibly request instead. He was prescribed Metronidazole but I'm on the fence on that one.

5. What can be done about his not eating?? I've been referencing the thread on here that has lots of tips but nothing seems to be working so far. Going to try Nutri Cal today. Is there a good supplement to give him so that what little he eats (especially if I decide to try syringe feeding) will provide some much needed calories and nutrients? Or maybe something that will dissolve in water?

6. I'm taking him off the Mirataz because it's keeping him awake and not helping much anyway. Are there any other appetite stimulants - preferably natural - that have proved helpful for anyone in the same situation? I tried catnip and it sort of helped the first time but is currently having no effect.

Sorry, I know that's a lot of questions! I'm just so confused and don't know what to do or what the next course of action should be. Of course, we're keeping in contact with the vet but he's at a loss too. I just wish I knew if this is something bacterial and I need to get some antibiotics in him ASAP or inflammatory and get him on steroids? Or was nothing really wrong in the first place and it's just and the stress of the vet visits and treatments that have put him where he is?

As I said earlier: I'm at a complete loss. 😞
 

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Have you tried feeding him baby food meat (Gerber Stage 2 or Beechnut)? If not, get some and try it. EZComplete is a pre-mix of nutrients that can be added to any of the non-chicken baby food meats to make them nutritionally complete for a cat. I can give you more information on this if you find he will eat the baby food meats.

FortiFlora is a probiotic but is really more effective in working as a food enhancer, so you could get some of that and sprinkle it on some of his foods to see if that helps.

Other options to consider would be cyproheptadine (Periactin), an antihistamine known to promote weight gain, and capromorelin (Entyce, or Elura), an FDA-approved vet appetite stimulant.

If you have to give the steroids a try, Predinisolone is the most common and doesn't seem to have very many common side effects. But I have also heard of Budesonide as an alternative. You will have to talk to the vet about all of these options.

You can ask the vet about pain meds - something like gabapentin perhaps.

What other testing is the vet suggesting you might do to find out more about what is going on? And, lastly, if need be, you may have to consider a feeding tube while you continue to pursue testing and related solutions. I have not had to use one, but so many on this site have and say it is pretty easy once you get over being nervous about it.
 
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mrsgreenjeens

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Did they ever test him for pancreatitis (looking at your other thread)? How about an ultrasound? Has he had one? You need to know if he has inflammation in his digestive tract to even begin to think of IBD, as far as I know.

Have you tried force feeding him? Your Vet should be able to give you either cans of recovery food or a prescription for them. Those are the best foods to feed at times like this. They mix well with water or over KMR to thin them out so they can be used either in a syringe for force feeding or used in a feeding tube.

As far as possibly being in pain, normally they will withdraw from you if they are in pain. Maybe something here will help you with that question: Feline pain assessment
 
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txcatlover94

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Have you tried feeding him baby food meat (Gerber Stage 2 or Beechnut)? If not, get some and try it. EZComplete is a pre-mix of nutrients that can be added to any of the non-chicken baby food meats to make them nutritionally complete for a cat. I can give you more information on this if you find he will eat the baby food meats.

FortiFlora is a probiotic but is really more effective in working as a food enhancer, so you could get some of that and sprinkle it on some of his foods to see if that helps.

Other options to consider would be cyproheptadine (Periactin), an antihistamine known to promote weight gain, and capromorelin (Entyce, or Elura), an FDA-approved vet appetite stimulant.

If you have to give the steroids a try, Predinisolone is the most common and doesn't seem to have very many common side effects. But I have also heard of Budesonide as an alternative. You will have to talk to the vet about all of these options.

You can ask the vet about pain meds - something like gabapentin perhaps.

What other testing is the vet suggesting you might do to find out more about what is going on? And, lastly, if need be, you may have to consider a feeding tube while you continue to pursue testing and related solutions. I have not had to use one, but so many on this site have and say it is pretty easy once you get over being nervous about it.
Thank you so much for the info! I tried Gerber yesterday and he wouldn't touch it. Can the EZComplete be added to any food or is it better in baby food? I will be syringing some food in him and can use the Gerber if that's better.

I just read about FortiFlora yesterday but couldn't find any today - going to look again tomorrow.

The vet he saw on Friday prescribed Elura as an alternative to the Mirataz but it doesn't seem to get good ratings? 🤷‍♀️

The last time I spoke with his regular vet I don't recall him suggesting any further tests, I think he was just going to go ahead and treat it as though he has IBD, but I could be mistaken. The vet he saw on Friday for a 2nd opinion wanted to treat it as gastritis and didn't mention what testing she would next do if that didn't work. He's had one comprehensive panel done; his kidney numbers were elevated but since he was tested when he was sick and dehydrated, neither vet is quite ready to go the KD route, especially because his numbers were normal earlier this year.

I will definitely consider a feeding tube if all else fails, from what I've read it's more distressing for the owners than the cat. :) I wonder how much longer to give him before requesting one?

I didn't give him his meds today because they just really didn't seem to be helping. When I came home this evening he came right out of the laundry hamper (his hiding spot) and wanted to go outside and eat grass (I kept an eye on him), which is an improvement! Unfortunately, no improvement in the amount of food he ate. His regular vet recommended trying pepcid today so going to give him some and see if that helps any. If not, I'll syringe him some food later.
 
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txcatlover94

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Did they ever test him for pancreatitis (looking at your other thread)? How about an ultrasound? Has he had one? You need to know if he has inflammation in his digestive tract to even begin to think of IBD, as far as I know.

Have you tried force feeding him? Your Vet should be able to give you either cans of recovery food or a prescription for them. Those are the best foods to feed at times like this. They mix well with water or over KMR to thin them out so they can be used either in a syringe for force feeding or used in a feeding tube.

As far as possibly being in pain, normally they will withdraw from you if they are in pain. Maybe something here will help you with that question: Feline pain assessment
Yes they did and it came back negative. However, I've heard it can be hard to diagnose? He has not had an ultrasound. He had an X-ray on Monday which didn't show anything except a lot of gas in his intestines.

I have not tried force feeding yet, other than putting some bits of food on his nose or mouth. I'm going to try Pepcid (on the vet's recommendation) and see if that helps. If not, I'm going to syringe him some food tonight. The vet we saw on Friday for a second opinion gave us a prescription dry food but he doesn't like it. I might see if his regular vet can give us some wet food instead.

I'll look at that thread, thank you! My cat is a master at hiding pain, so it can be very difficult to tell. He started hiding on Tuesday which made me think maybe he was in pain.
 

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I tried Gerber yesterday and he wouldn't touch it. Can the EZComplete be added to any food or is it better in baby food? I will be syringing some food in him and can use the Gerber if that's better...I just read about FortiFlora yesterday but couldn't find any today - going to look again tomorrow...The vet he saw on Friday prescribed Elura as an alternative to the Mirataz but it doesn't seem to get good ratings?
The EZComplete is not needed for any cat food that is nutritionally complete. I think someone suggested the Hill's A/D recovery food. It is high in nutrition and would be something else to try. Most vets carry in their offices. It does not need added nutrients.
FortiFlora is typically sold in most pet stores. As far as Elura goes, I think it is something to try. It is newer, and I know some members on this web site say it is superior to Mirataz and Entyce.
 

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Has his teeth gums and mouth been checked?
Has he possibly been in a fight or gotten injured and has wounds under his fur which are infected?
Have you checked for worms?

Some of these are things which was missed by a vet I went to and I ended up spening hundreds for xray and bloodwork which resulted in nothing. I then went to another vet who found the problem within 1 minute. All of these issues led to loss of appetite for my cat.
 
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txcatlover94

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The EZComplete is not needed for any cat food that is nutritionally complete. I think someone suggested the Hill's A/D recovery food. It is high in nutrition and would be something else to try. Most vets carry in their offices. It does not need added nutrients.
FortiFlora is typically sold in most pet stores. As far as Elura goes, I think it is something to try. It is newer, and I know some members on this web site say it is superior to Mirataz and Entyce.
Was going to see if I could grab a can of the Hills but the vet's office closed earlier than I thought today. :/

Also, in trying to figure out what on earth is going on, I was wondering - is it standard protocol for vets to do a fecal test and urinalysis? Because neither vet he saw suggested one and I've gotten the feeling that both of those tests might provide some helpful info.
 
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txcatlover94

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Has his teeth gums and mouth been checked?
Has he possibly been in a fight or gotten injured and has wounds under his fur which are infected?
Have you checked for worms?

Some of these are things which was missed by a vet I went to and I ended up spening hundreds for xray and bloodwork which resulted in nothing. I then went to another vet who found the problem within 1 minute. All of these issues led to loss of appetite for my cat.
His teeth, gums, mouth, and breath have been checked multiple times. But I also know that some dental problems can't be seen until they do a deeper exam under anesthesia. We have one cat who was having these random seizures, however, I never thought of dental problems as the cause until we took him in for an ulcer on his mouth. When they were cleaning his teeth they saw that he had an issue (I don't remember what the exact issue was) where there were nerves exposed! They fixed it and that stopped the seizures.

That said, though, I'm not sure that his problem is dental.

I haven't seen any wounds and he's been examined multiple times. However that doesn't mean they haven't missed something, so maybe I need to do another check.

They have not checked for worms. I know he doesn't have tapeworms because I haven't seen any but I know that's not the only worm/parasite. :) I am a little surprised that none of the vets he's seen so far have suggested a fecal test.
 

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I don't know how common either test is in terms of being routinely done. I do know from what I have read, a urinalysis is generally considered to be part of the annual/semi-annual vet exam/checkups. Not sure why that doesn't seem to be the case for fecal testing.

But I do think both should be done when trying to investigate a health issue.
 
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txcatlover94

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I don't know how common either test is in terms of being routinely done. I do know from what I have read, a urinalysis is generally considered to be part of the annual/semi-annual vet exam/checkups. Not sure why that doesn't seem to be the case for fecal testing.

But I do think both should be done when trying to investigate a health issue.
It's a little bothersome that none of the vets he's seen has suggested it. How are we supposed to get to the root of his problem without comprehensive testing? They're prescribing medications without really knowing what the exact problem is, and that's what bothers me the most - how do I know which course to take when I don't know what I'm treating?
 

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It's a little bothersome that none of the vets he's seen has suggested it. How are we supposed to get to the root of his problem without comprehensive testing? They're prescribing medications without really knowing what the exact problem is, and that's what bothers me the most - how do I know which course to take when I don't know what I'm treating?
I can only guess that the vet doesn't seem to think his symptoms are tied to either his urine or his stool. You can always ask the vet if they would take a stool sample from you for testing; but to look for something other than 'simple' parasites, you would have to request a full fecal PCR test which looks for a variety of parasites as well as certain bacterial/viral issues. I do believe this type of test is fairly expensive and could be why it isn't suggested routinely.

A urine sample is a bit harder for you to accomplish unless you can 'free catch' it or use one of those sample kits containing non-absorbable crystals to collect the urine in a syringe, and then take that to the vet as well - of course, after you confirm they will accept it. But many vets will allow you to bring your cat to their office without an appt. and have a vet tech collect urine for testing. Another option to consider.
 

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Our Vet does a fecal exam at least annually as standard protocol. Same with the urinalysis.

Since your Vet's office already closed today so you cannot get any Hills A/D, you can still force feed. Just use any pate style food and mix it with water to thin it out enough to be able to pull it up into a syringe. Try to find a food that is a very good quality so all of the nutrients are coming from highly digestible proteins but not too high in fat just in case it is pancreatitis.
 
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txcatlover94

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Sorry for disappearing! Last weekend and the start of this week have been rough.

Here's an update: We went to the ER vet on Saturday because my cat just won't eat! There was nothing more answer-wise the ER vet could offer, except she was certain based on his labs there is no infection, but gave him a shot of Ondansetron and referred us on for an ultrasound.

I was excited because he perked up a little after that visit and came out of the laundry hamper (his hiding place) during the night to eat. And then the following morning he was pushing his head under my hand, and wanting to eat. Later on Sunday though he wouldn't eat so we we picked up ondansetron pills from the ER but they did nothing. Come to find out, he could have been getting a higher dose than we gave him. Anyway, Sunday and Monday he just wouldn't eat, so I took him back to his regular vet yesterday at this point just desperate to get some food in him.

He did a new set of labs, gave fluids, another shot of ondansetron, and a shot of B12, and sent us home with recovery food and syringes. He's trying to get him in with their visiting ultrasound/internist vet on Friday. That's pretty much the only thing we haven't done. His labs came back today and the vet said they all looked pretty good, his kidney levels had even gone down. I also thought for sure by this time we were dealing with lipidosis but actually, while beginning to be elevated, his liver numbers weren't even that bad! He ran a stool test today which looked good so once again, at a complete loss here.

We started syringe feeding him the recovery food but he threw that up last night. We switched to beechnut chicken baby food today and also started him on slippery elm and so far he's held that down. We've only been giving very small amounts of the food because I don't want to overload him.

I'm happy that he's been keeping the food down but now today he's refused to move out of his hiding spot on his own. He's just been sleeping all day and hasn't budged. He's also now refusing to drink water so am going to have to start syringing that as well. Maybe he's just weak and fed up at this point.

One question - of many, lol - is should I still be giving him the Ondansetron as well as slippery elm? I just can't tell if it's necessary or not.

Hoping for an ultrasound on Friday!!
 

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Gosh, I sure wish someone could get the bottom of this. As to your question about slippery elm, I don't know since neither really seems to be working, but I can tell you that you should NOT give them at the same time as slippery elm interfers with the absorption of the Ondansetron (and other meds). You need to give at least two hours in between.

I'm also wondering if he threw up the recovery food because maybe either you gave him too much or gave it to him too quickly? Is that possible? I've done that when using a feeding tube in the past and felt awful, but soon learned to go really slow and also not to over fill their little tummies.

Hoping for that ultrasound on Friday as well :crossfingers:
 
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txcatlover94

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Gosh, I sure wish someone could get the bottom of this. As to your question about slippery elm, I don't know since neither really seems to be working, but I can tell you that you should NOT give them at the same time as slippery elm interfers with the absorption of the Ondansetron (and other meds). You need to give at least two hours in between.

I'm also wondering if he threw up the recovery food because maybe either you gave him too much or gave it to him too quickly? Is that possible? I've done that when using a feeding tube in the past and felt awful, but soon learned to go really slow and also not to over fill their little tummies.

Hoping for that ultrasound on Friday as well :crossfingers:
Me too!! He's going in for an ultrasound tomorrow, so we'll see!

I actually can't tell if the slippery elm is working or not. I think at this point nothing is going to make him just get up and want to eat on his own. That said though, I do think it might be helping.

Yes, I think it's actually probable! I made the mistake of giving him the recovery food first (which was probably too much on his empty stomach) and too much an amount for his first feedings. Once we switched to the baby food he's done wonderfully! Again, he's not getting up and he has stopped drinking water which is worrisome, but he's keeping the food down! He only threw up once when last night - I was working with a not great syringe - I accidentally shot too much in at once, and then also once this morning when I gave him his slippery elm syrup not mixed in with food and I think it's too sticky for that. I've upped his food amount today and am trying to increase the frequency of feedings. I started out really slow, because I didn't want to do too much.
 
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txcatlover94

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*Another Update + More Questions* 🤦‍♀️ 🤦‍♀️

OK, so I got my hopes up a little today and now they've lessened.

Today, we've been syringe feeding him watered-down Beechnut chicken food (occasionally with some slippery elm syrup mixed in). He was doing marvelously in that he's kept it down all day. I also upped the amount today and have been trying to feed him every hour but sometimes it's been longer. This afternoon I left for 3 hours (fed him before I left) but about 15 minutes after getting home he came out and pooped a tiny bit on the rug (it looked dark but transferred yellow on a paper towel) and then vomited some foamy liquid. After that, he went to the litter box and pooped a little more. I'm not sure if it would be described as black and tarry or something else: it was very dark, definitely close to black, and very mucousy. Since then he's seemed uncomfortable; he wanted to go outside to eat grass but then just meatloafed on the ground before moving to the porch and laying there, and then just wanting to come inside.

So here are some of the questions I have (always so many questions!):

1. Is the stool a very good indicator of GI problems (colitis, IBD, etc.), or should that be expected from a cat that's eaten hardly anything for over a week? (Again, blood tests say we have not reached hepatic lipidosis yet and I'm trying hard to keep it that way) He's also dehydrated, so could it be from that?
2. Talk to me about syringe feeding! Are setbacks to be expected? With him eating more, should I expect bowel changes or maybe even some tummy upset? Also, I've got to get food in him, but right now I know he's uncomfortable - so do I continue with feeding or hold off for a little longer? He's having an ultrasound tomorrow and will need to fast so I want him to eat as much as possible before the fasting period begins.
 
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txcatlover94

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*Another Update*

Once he came back inside, he's been walking around the house a bit - should I take this as a good sign or is it another sign that he's not feeling well and maybe just looking for something? Normally he's been making a beeline right back to his hiding place and staying put but now he's hanging out in the living room. Someone tell me this is a good sign!
 

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I am sorry I personally, just don't have any real answers. The black, tarry stool would suggest possible blood in his upper GI tract, not so much his colon/bowel. The foamy liquid can be from stomach acids building up in his stomach, making him feel nauseous. The two could be connected.

I am not sure his wandering around as opposed to making a beeline to his hiding place means much of anything. It could just be that he is feeling the need to do 'something' else in search of a way to stop feeling bad.

I do think if he isn't all that happy about syringe feedings to begin with that you will see occasions of reluctance, especially if you catch him at times when he is feeling worse than other times. If it were me, I would feed him what I could before his cut off time.
 
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txcatlover94

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*Update*

Ultrasound brought bad news. Both the vet that ran the ultrasound and our regular vet are all but certain it's lymphoma. And now I'm faced with a very, very difficult decision. They did a fine needle aspiration but the test won't come back until Monday at the earliest. So my predicament is I don't want to make him suffer any longer than he has to if they're already so sure of the diagnosis. But, I would hate to put him down (the vet already informed me that they fear treatment would be useless at this point) not knowing for sure. I asked if he was sure there is nothing else that could look like what they saw and he said other than a possible fungal disease, which he gave as less than a 2% chance of it being that, no. From what I understand he has multiple enlarged lymph nodes and I think thickened intestines. I just don't know if I should wait for the test results and maybe call someone for a second opinion in the meantime or just trust that they have the correct diagnosis.
 
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