CRF cat w/stable numbers not eating

[Waterfaller10]

My 17 yr old cat on Tuesday suddenly lost interest in food. She did eat on Tuesday but a total of about 1 Tbs plus I syringe fed her 40 ccs that evening. I brought her to the vet on Wednesday and they told me not to syringe feed her while she's feeling like this because she'll develop a food aversion. The vet thought she looked good and exhibited no signs of pain. Her last vet visit before Wednesday was a month ago and at that time she had lab work and they also did Spec- fPL because she's had 2 bouts of pancreatitis in the past.

I've been giving her the anti-nausea medicine and famotadine and she had a much better appetite yesterday. Because she was feeling better, I syringe fed her 30 ccs in the evening. (I have been syringe feeding her since she became ill because she doesn't take in enough to keep her weight up without it). Since then, she has had little interest in food again. I gave her her meds this morning but she only took a few licks of cat food.

Should I post her lab numbers? I'm not sure how to do that. Do I need to have more lab work done? I'd like to avoid that if possible. They were just done and that is going to be hard for me to afford. It's $156 each time. If I need to do it, I will.

[laurief]

I've got to get out to the barn right now, but if you read this while I'm gone, it'd be helpful if you'd post again with the following information:

List ALL med names and dosages that you're administering to your girl, along with any other treatments you're providing (subQ fluids or any dietary supplements - also the brand, type, and amount of food you're feeding).

Please also post the following blood values: creatinine (CREA), BUN (urea nitrogen), phosphorus (PHOS), potassium (K+), total protein (TP), hematocrit (HCT) or packed cell volume (PCV), and any other values that are out of normal range. Type out each value like so: CREA 2.7 (0.6-2.0)

I'll check back later and give you any useful input I may be able to come up with.

Laurie

[Waterfaller10]

Hi Laurie,

For nausea, she's getting METOclopramide-Reglan 5 mg/mL, 0.25 mL, 2X/day and Famotadine 5 mg/mL, 0.5 mL 1X/day. Before this week, she was not on any medication because she had a relatively good appetite.

During the day, she eats Fancy Feast Grilled. Before this week, she would typically paw my leg to let me know she wanted to eat. She typically gets a total of 3 Tablespoons of FF. I feed her ~1 Tbs each time but she usually only eats 1/2 Tbs - 2/3 Tbs.

In the evening, I had been syringe feeding her either Evo 95% Chicken & Turkey or By Nature Chicken and Turkey. She gets 40 ccs but because of spillage, usually only takes in 35 - 30 ccs. She hasn't seemed to mind the syringe feeding before this week. She's always licked it up. She won't eat anything other than FF on her own.

For some reason, when I type an eight, it does a smiley face (?)

For the syringe feeding, I take a 5 oz can and add 400 mgs of Now's Slippery Elm. I also add 2.5 squirts of Grizzly Salmon Oil Omega 3 Fatty Acids.

Her last blood work was:
BUN 33 (15 - 34 mg/dL)
CREA 2.5 (0.8 - 2.3 mg/dL)
PHOS 4.5 (3.0 - 7.0 mg/dL)
K+ 4.8 (3.9 - 5.3 mEqL)
TP 7.3 (5.9 - 8.5 g/dL)
HCT 40.2 (29 - 45%)
I don't see PCV on there
A/G RATIO 0.9 (0.4 - 0.8 )
ABSOLUTE NEUTROPHIL SEG 2400 (2500 - 12500 /uL)
Spec fPL 3.9 (<or = 3.5 ug/L) is normal (3.6 - 5.3 ug/L) pancreatitis possible

At her vet exam on Wednesday, she was well hydrated. She had gained 2 ozs since she was seen last on November 10 when the above blood work was done.

Thanks Laurie! I hope I provided all the info you asked for.

[laurief]

OK. First, her bloodwork looks remarkably good - much better than I expected, actually. If you haven't yet explored the option of starting her on Calcitriol, I strongly recommend you look into it. It can help slow the progression of CRF, and it's best started while CRF is still in an early stage, as it is in your cat. You can read up on Calcitriol here:

Calcitriol Reference Page

Now, about the meds you're giving your girl ...

The administration of metoclopramide, famotidine, and slippery elm bark should all be spaced at least two hours from each other, because they can interfere with the absorption of each other if given closer together than that. Hopefully your vet explained that to you. Also, slippery elm bark can be given in divided doses up to four times a day to stretch its effects throughout the day, but again, you need to make sure you aren't administering it within two hours of either of the other drugs you're giving.

Famotidine is going to help with stomach acid-induced nausea, but you should be aware that it can cause a rebound effect if you stop giving it at some point.

Metoclopramide can cause constipation, and that is a problem to which many CRF cats are prone even without this medication. Constipation is a very common cause of inappetance in CRF cats, because it can cause considerable abdominal pain and nausea. Famotidine won't help with constipation-induced nausea. Keep an eye on your girl's bowel movements. If you see her straining in the litterbox or vomiting soon after passing stool, she is almost certainly constipated. If her stool is small and hard and/or looks like little balls of clay, she's constipated. In this case, you will need to start treating her for constipation, as well.

Given the information you provided in this thread, my best bet is on constipation as the cause of your girl's inappetance right now.

Laurie

[Waterfaller10]

That Calcitrol sounds great! I'll definitely talk to my vet about it.

I will monitor her at the litter box. She had a much better appetite this afternoon. Maybe I shouldn't give her the Metoclopramide unless she's vomiting.

I was not aware about spacing out the meds. Thank you!

I spoke with the vet today and he suggested an appetite stimulant which I'm not very keen on. Cyproheptadine made her yowl and get really agitated. The vet suggested possibly doing a urinalysis and/or an x-ray. I can't figure out why he would suggest that. Would you know?

Thanks so much for your help.

[laurief]

Originally Posted by Waterfaller10

That Calcitrol sounds great! I'll definitely talk to my vet about it.

Don't be surprised if your vet knows very little (or nothing) about Calcitriol. I recommend you print out everything on the Calcitriol site I linked for you above and give it to your vet to read.

Maybe I shouldn't give her the Metoclopramide unless she's vomiting.

I wouldn't be giving Metoclopramide to my Noddy if he would just quit vomiting. Unfortunately, if I'm even late with a dose for him, he'll vomit everything he tries to eat. You should ask your vet if you can administer it on an "as needed" basis.

I was not aware about spacing out the meds

.

Shame on your vet.

I spoke with the vet today and he suggested an appetite stimulant which I'm not very keen on. Cyproheptadine made her yowl and get really agitated.

That's probably because your vet had you start with too high a dose. Both Cypro and Mirtazapine can have that affect on cats if the dose is too high. I used to give Billy 1/8 tablet of Cypro once daily for appetite stimulation. Toward the end, I had to increase it to 1/4 tablet.

The vet suggested possibly doing a urinalysis and/or an x-ray. I can't figure out why he would suggest that. Would you know?

UA might be looking for infection, protein in the urine, diabetes, or something else. X-ray might be looking for some sign of intestinal obstruction or other GI anomaly. You'd have to ask your vet to find out what he'd be looking for.

Laurie

[Waterfaller10]

Well, thanks again! You were very helpful as always!

[Bonney9]

Interesting. Rocket was yowling after she got the appetite stim on Monday also. Really for the nausea the Prilosac (in her case) seems to be helping a lot.