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Hi Cathy. My name is***** and I am a veterinarian that can answer your question. I am sorry to hear about the situation you are in both with Ravioli and your dad. I know this is a troubling time for you and big decisions are on your plate. I will be able to answer all the questions you have. One of the first answers I can provide is that cats can not go very long without eating, unfortunately. The general safe cutoff for not eating is 3 days for cats. When they don't eat well they are at risk of other diseases such as a "fatty liver syndrome." There are some ways that we can work around that including placing a feeding tube, but I am not sure if that is something you are wanting to try.
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Mirtazapine is likely the appetite stimulant. These work sporadically, but I hope in this case it does the trick. I am curious if there is something else going on here besides the hyperthyroidism. Cats with this condition will be voracious eaters, as you probably know, so the fact that she is not eating well has me concerned about something more serious. A blood/urine test would be a place to start, but likely an abdominal ultrasound +/- an intestinal biopsy will give you better answers. Things on the list that I am concerned about, without knowing much other details, would be inflammatory bowel disease, liver or pancreas inflammation, or intestinal lymphoma (common in older cats). All of these are more common causes of nausea in cats and will cause a decrease in appetite. Regarding treatment, if there is pain involved I would include a pain medication in addition to the anti-nausea and appetite stimulant. Prescription diets labeled as "recovery diets" are sometimes helpful in encouraging cats to eat. Examples of these are Hill's a/d, Purina CN, and Royal Canin also has a brand. Otherwise, if the goal is simply to get her to eat, lower quality brands such as Friskie's seem to be work for some sick cats - although the fat content may create more nausea later, so I would use it as a last resort as well as human tuna.
Finally, it might be a good idea to seek a mobile veterinarian that will come to your house for either treatment or euthanasia. They tend to be more expensive and in short supply, but it might be a more desired option for you or your pet sitter when that day comes.
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