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Dr.Fiona
Dr.Fiona, Cat Veterinarian
Category: Cat
Satisfied Customers: 6273
Experience:  16 years experience as a companion animal veterinarian in British Columbia, California and Ontario
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My 18 year old cat will not drink water

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My 18 year old cat drinks very little water - she will stare at it as if she wants to drink and even touch her whiskers and nose in it but is hesitant to drink it. I will give her a saucer of gravy from a pouched food and she laps it right up! She also doesn't eat much - about 1 oz or so of wet food a day - I supplement this with a/d via syringe. She had 6 teeth pulled when she was 16 and I believe she has dental pain again. When the vet pushes on one tooth, she will chatter. He gave me pain meds and said that takes care of the dental pain but I am not certain it does - although it seems to help her joints - she walks quickly now. Even on pain meds - she doesn't eat and drink as enough - still hesitate to lap water. She is losing weight from not eating and drinking enough and getting de-hydrated. He put sub-Q fluid in her Sat and she was a different cat on Sunday! HELP! He is thinking she's old and it's her time and wants me to put her down. HELP! I still believe in her
Submitted: 5 years ago.
Category: Cat
Customer: replied 5 years ago.

Age: >12; Female; Breed: DSH


Already Tried:
syrigne feed her a/d and water --- try to coax her to eat and drink - let her lap the gravy off of a pouched food to help supplement her fluids. Not certain if all pain meds are created equal for mouth pain or if there's something like Oragel for cats.
Expert:  Dr.Fiona replied 5 years ago.
Hi thereCustomer
Welcome to Just Answer! I would like to help you and your cat with this question, but need a bit more information in order to better assist you.

When did your vet last examine your cat, and did he do blood-work?

What is the pain killer the vet put your cat on?

How long has she been doing this for where she won't drink or eat enough?

Fiona
Customer: replied 5 years ago.

Cat was examined on Oct 18 2008 and blood work and urinalysis were done. I was told it showed white blood cell count was slightly off and urinalysis showed Urinary Tract Infection. At first she was on Clavamox for 5 days then when the urinalysis results came back - he switched her to Zeniquin for 10 days. I took her back on Nov 8 to get her re-test to ensure we got rid of the UTI and see if the blood cell count was OK but seeing that she had lost weight - he determined there was nothing further to do. Said the antibiotics should have cleared up the infection and she should be eating/drinking on her own.

 

Jessica was on Buphenorine (spelling?) .1 cc every 12 hours for about 2 weeks. It was a liquid. When I expressed concern about her still not eating/drinking properly even though the UTI meds were done, he said we needed to switch over to another med as the one wasn't effective for a long period of time. She is now on a tablet she takes 1/4 of a small white pill every 12 hours and I cannot remember the name and her pill bottle is not with me.

 

I suspect this was going on longer than I knew - possibly months before I noticed the weight loss. I noticed she appeared to have lost weight and she had lost approx 1/2 lb from Jan 2008 to October 2008. She dropped from around 6.5 to 6.0 pounds. Over the past few weeks she dropped a few more ounces. She was 5 lb 13 ounces on Oct 31 and 5 lb 12 ounces on Nov 8 (sub-Q fluids were put in her on Sat Nov 7). The vet scale weighed her at just over 5 lbs on Nov 7 but the scale at the post office weighs her in at closer to 6 lb on Nov 8. According to the vet, she's lost almost 1 pound in 3 weeks but I believe the scale must be off - I am checking the post office scale for accuracy tomorrow and weighing her again. Due to this weight issue, I believe he has written her off as dying but I think, again, it's a nasty cycle of her teeth hurt, she doesn't drink/eat enough and round we go. If she had given up, why does she still come to the kitchen for breakfast, lap up gravy and stare at the water bowl like she wants to drink?

 

Expert:  Dr.Fiona replied 5 years ago.
Aw, your poor girl! :-(

You don't, by any chance, have access to her blood tests do you?
Customer: replied 5 years ago.

I'm sorry, I don't. He is usually willing to share them if I am there in person but he gave me the results over the phone and I don't have a copy of them. I could probably have him fax them to me at work on Wed but that would be the soonest. When he got the results, I know he was frustrated becuase he said her blood work always looks good and she is a puzzle.

 

She has been dismissed before as "dying" and wasn't. I once took her to an ER after she wouldn't eat/drink much and they said she was dying of renal failure becuase she was 16 and it was common with 16 year olds. They ran blood work and could only find a cell count was off and treated her for infection. Shortly after that I had dental surgery done on her - he said she had 1 bad tooth but after she was in there, found 6 bad ones and pulled them all. She bounced right back - that was 2 years ago.

 

I had inquired further about the blood cell count when I was there last but he said it wasn't off by that much and the antibiotics should have cleared it up.

 

Currently I am feeding her a/d and trying to keep her hydrated. I found a dental specialist in my area and thinking of calling her tomorrow. I still really believe it may be her teeth and he said he doesn't want to operate on her again. I am monitoring her weight and going to see if there's any change since I last weighed her on Sunday at the Post Office! After she got those fluids on Sat, she was a new girl on Sunday, she started sleeping in her old favorite spots, she's been purring, but she still looks at the water like it is some type of demon. I have 2 water dishes out (one huge plastic one, one ceramic bowl) plus a cat fountain. Like I said, she will drink but very hesitantly and not very much.

 

My vet and husband insist that on pain meds - she feels no mouth pain and she won't drink becuase she is old and given up.

Expert:  Dr.Fiona replied 5 years ago.
Hi again,

Thanks for your replies, they have been helpful!

So, clearly, there is *something* going on with your cat to cause her to have lost so much weight recently. She is a senior citizen and a bit of a puzzle since she is giving us so few clues. The things that I would consider would be chronic renal insufficiency (CRI, kidney failure), hyperthyroidism (over active thyroid gland), or a combination of the two, and unfortunately we also have to consider neoplasia (cancer). These are the most common problems that I see in senior cats.

With chronic renal insufficiency cats tend to drink more, lose weight and have a diminished appetite. Some have vomiting. Many have dry hair coats and hair loss.

With hyperthyroidism, however, they tend to drink more, lose weight and have an INCREASED appetite. Some have vomiting, many have diarrhea.

With neoplasia, they may eat more or eat less, and lose weight.

As you can see, many of the symptoms overlap and with your kitty I don't know which of these descriptions fits best. All are treatable, to different degrees. Let me explain a bit more about each of them and the treatment options:

1. Chronic renal insufficiency.

With this disorder, the kidneys have lost the ability to concentrate urine. So, the patient just produces dilute urine all the time, regardless of what is going on. For a cat with normal kidneys, if they don't drink for a while (say, because of feeling nauseated with a hairball), the kidneys just concentrate the urine and the cat keeps normally hydrated. Same as with a human who doesn't drink all night - the first morning urine is more concentrated because the kidneys are retaining all the water they can.

Now, if your cat's kidneys can't DO that, and just keep producing large quantities of dilute urine, she is going to start getting dehydrated. One of the first things that happens is that the body tries to draw water out of the feces and the cat gets constipated because the feces are now dry and hard, so it's harder to pass them. Also, as the patient becomes slightly dehydrated, she tends to lose her appetite. Imagine yourself being really thirsty and someone offering you a steak. No matter how delicious you might think that is, you would be unable to eat much without having a drink first.

Kidney disease can be diagnosed by physical exam and analysis of a blood and urine sample. On a physical exam, I check the kidney size and shape. For treatment, the first step is a low-protein diet available through your vet clinic. The patient may also need supplemental potassium, and perhaps fluids given under the skin to correct any dehydration.

Here is more information:
http://www.petplace.com/cats/chronic-renal-kidney-failure-in-cats/page1.aspx
http://www.veterinarypartner.com/Content.plx?P=A&S=0&C=0&A=572

2. Hyperthyroidism.

This is a common disorder of older cats in which the thyroid gland in the neck starts to over-produce a hormone called T4. T4 controls metabolic rate. So, the more you have of it, the faster the metabolism. Cats that are hyperthyroid tend to eat voraciously, but lose weight because they burn the calories up so fast. Their heart rates increase, and the transit time through the intestines increases. So, they may develop diarrhea and vomiting, but not always. Also, just to confuse matters, some cats with hyperthyroidism will drink and eat very little and be lethargic.

Hyperthyroidism can be diagnosed by physical exam and blood and urine analysis. On a physical exam, I check for enlarged thyroid glands, and a rapid heart rate, and sometimes heart murmurs. Blood and urine tests allow a vet to confirm the diagnosis.

Hyperthyroidism responds really well to treatment. The treatment options are oral medication (usually twice daily, always for the rest of kitty's life), surgery, or radioactive iodine treatment (this last is the BEST treatment because it gives you a cure, but it is expensive).
http://www.peteducation.com/article.cfm?cls=1&cat=1340&articleid=218
http://www.peteducation.com/article.cfm?cls=0&cat=1303&articleid=1439
http://www.veterinarypartner.com/Content.plx?P=A&S=0&C=0&A=516

3. Unfortunately, we also have to consider neoplasia (cancer) because your kitty is older and there has been dramatic weight loss.

Hyperthyroidism and CRI are FAR more common, however, so don't panic! To diagnose cancer, a vet would start with a complete physical exam to try to feel for internal masses, and would do blood work to rule out other problems. X-rays and biopsies might be needed.

If the tests for hyperthyroid disease and CRI were negative, and other blood tests were all normal, I would have to start considering cancer, unfortunately.

Some forms of cancer grow as a mass or lump and can be palpated in the belly or seen on x-rays. Some forms of cancer invade as tiny little cells all through-out an organ like the gastrointestinal tract. They are hard to detect because you can't palpate them, and you can't see them on an x-ray because they are scattered throughout the organ. In these cases, ultrasound and biopsy or exploratory surgery and biopsy can be used to make a diagnosis. Looking at a piece of the organ under a microscope is the only way to see if there are cancer cells there. Many types of cancer in cats respond really well to chemotherapy medication. There are even chemo protocols that consist of pills that the owner can give at home. Cats have minimal side effects from many chemo drugs - NOTHING like as severe as humans.

There are so many forms of cancer that it is hard for me to provide a link, but I'll give you one for a common type of cancer:
http://www.peteducation.com/article.cfm?cls=1&cat=1376&articleid=219

So, in summary, it sounds as though your cat may have hyperthyroidism, CRI or possibly neoplasia. From what you have described, my best guess would be that hyperthyroidism is most likely. If your vet has not checked for this, please ask him to do so - and ask for a "FREE T4 BY EQUILIBRIUM DIALYSIS." This is far more accurate than other ways of testing this hormone.

So, although I can't tell you what is wrong with your kitty, I hope I have given you some directions to explore with your vet.

Now, I understand you want to know what to do at home, so I have some suggestions. What you can do is try to get some calories into her in liquid form - that way she is getting nutrition at the same time as fluids.


I suggest opening a can of tuna *in water* and offering her the liquid.

Also, you can pick up Clam Juice in most grocery stores (sold in with the V8 or with the canned tuna in my grocery store) and mix that with some water.

You could try Lactose Free milk (Lactaid is the Canadian brand).

Offer her some canned cat food, and mix it with water to make a slurry if she won't eat it.

Things you can do to encourage a cat to drink are:
- offer water from a very wide flat bowl as cats don't like their whiskers to touch the edges when they drink (which is why lots of cats like the toilet bowl).
- If she likes dripping water, leave a tap dripping for her.
- Offer bottled water and see if she prefers it.
- Offer chicken broth, diluted 50:50.
- See if she likes water with an ice cube in it.
- See if she likes it out of a cup or martini glass.
- Offer Whiskas Kitty Milk
- Offer her canned food as the first ingredient in water

- You could try getting some human baby food in meat flavours (check that there are no onions or garlic in the ingredients) and mix that with warm water and offer that, or syringe it in little bits into your cat's mouth. Beech Nut makes a line of baby food that has nothing but meat (beef, chicken, turkey or veal) in it.
Here's a link:
http://www.beechnut.com/Our%20Baby%20Food/Results.asp
If you cannot find this, you could find another meat baby food - just read the label carefully to be sure there are no onions, onion powder, garlic, or garlic powder in it.

Try to get her to drink small amounts frequently. If you can, try syringe 1 teaspoon (5 mL) or liquids per half hour into her mouth.

The other thing you can do is to ask your vet to teach YOU how to give fluids under the skin at home. I am always happy to teach people how to do this and it really isn't that hard! It could make a huge difference to your girl, as you saw with how she felt the next day! You could have your vet teach you how to give about 100mls under the skin daily to keep her hydrated, as well as giving her as much by mouth as she wants. Here is a website with some *great* photos of how it is done!
http://www.vetmed.wsu.edu/clientED/cat_fluids.aspx

I hope that these ideas help you to help your girl. And just tell your vet and your husband:
AGE IS NOT A DISEASE!


If this has been helpful, please "Accept" my answer and provide feedback. If you need more information, just click on reply and I will try to provide it!   

The above is given for information only. Although I am a licensed veterinarian, I cannot legally prescribe medicines or diagnose your pet's condition without performing a physical exam. If you have concerns about your pet I would strongly advise contacting your regular veterinarian.

Fiona


Customer: replied 5 years ago.

When she was 16 she was starting to not eat and drink much and was diagnosed by my vet with hyperthyroidism. He recommended a radio-active iodine treatment that I had done by a clinic in Baltimore, RadioCat. That cured her of the hyperthyroidism. So I know we can rule that out.

 

He had suggested that she may have cancer but said it doesn't always show up in a blood test. I thought that if she had cancer the blood cell count would be WAY off - he said not necessarily - I asked if it would show on an x-ray and he said "possibly, but not necessarily" - may not even show up on an ultrasound. Does this sound correct?

Expert:  Dr.Fiona replied 5 years ago.
Hi again,

Thanks for that further information.

I agree that hyperthyroidism is very unlikely.... but just because she was treated with I-131 does NOT mean she cannot get hyperthyroidism again, unfortunately. I worked at Northwest Nuclear Medicine in Vancouver, an I-131 facility. And we did have to re-treat the occasional cat. It was very rare, but it did happen. So, if she were my patient, I would still check her thyroid levels.

And your vet is absolutely right that cancer does not necessarily show up on blood work, x-rays or ultrasound. The only definite way to diagnose it is to get a biopsy of any organs that appear abnormal or thickened in any way. This would mean surgery in order to take biopsies of organs. I am not sure that I would pursue that in my cat.

You may want to ask your vet about:
1. You giving fluids at home, and
2. Giving your cat a low does of prednisone. If she *does* have cancer, this would decrease any swelling and inflammation around it. It also acts as an appetite stimulant for many cats.
Here is more about it:
http://www.petplace.com/drug-library/prednisone-prednisolone/page1.aspx

If this has been helpful, please "Accept" my answer and provide feedback. If you need more information, just click on reply and I will try to provide it!    

The above is given for information only. Although I am a licensed veterinarian, I cannot legally prescribe medicines or diagnose your pet's condition without performing a physical exam. If you have concerns about your pet I would strongly advise contacting your regular veterinarian.

Fiona



Customer: replied 5 years ago.

Thanks - this has been a huge help and now I have some further questions to ask my vet as follow-up.

 

I only have one final Q and that deals with my intial concern/hunch about my cat's teeth. I KNOW for a fact that she has dental pain as I witnessed her chatter when he pushed on a tooth. The last time he did that 2 years ago and said she had 1 bad tooth to be pulled - he got her into surgery and she had 6 pulled. Is it possible that her loss of interest in food and esp the not wanting to drink is simply related to this and not one of the 3 possibilities you list? Could that explain it all? She is on pain meds but couldn't her mouth still hurt regardless? She walks up to the water bowl, won't drink but will lap up an ounce of gravy with no problem - seems odd to me.

Expert:  Dr.Fiona replied 5 years ago.
Hi again,

Yes, dental pain could be part of the problem, though I don't understand why lapping gravy would be less painful than drinking water. That puzzles me!

You could look into having a dental done. The main risk is the anesthetic, but if you seek a specialist in that area, she would be able to minimize the risk. Also, dental experts can use local blocks so that the cat needs little more than sedation in order to do the procedure, which really helps to minimize risks. If there is one tooth in particular that causes pain, it might have quite a decayed root which would make it fairly easy to remove.

Hope that helps!

If this has been helpful, please "Accept" my answer and provide feedback. If you need more information, just click on reply and I will try to provide it!     

The above is given for information only. Although I am a licensed veterinarian, I cannot legally prescribe medicines or diagnose your pet's condition without performing a physical exam. If you have concerns about your pet I would strongly advise contacting your regular veterinarian.

Fiona
Dr.Fiona, Cat Veterinarian
Category: Cat
Satisfied Customers: 6273
Experience: 16 years experience as a companion animal veterinarian in British Columbia, California and Ontario
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