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Dr. Ellie
Dr. Ellie, Veterinarian
Category: Cat Veterinary
Satisfied Customers: 370
Experience:  emergency and critical care resident
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My 13 year old cat was not eating for 24 hours. I took her

Customer Question

My 13 year old cat was not eating for 24 hours. I took her to the vet & she was diagnosed with hyperthyroidism that was causing hypertension. She has been on these meds for the last 1.5 days. She is still not eating ( an force cat sure and intensive care cat food by syringe. She was at the vet on Saturday for labs and x-rays and back again on Monday for an abdominal ultrasound. All results are normal except for the hyperthyroidism. She was given cubcutaneous fluids and an appetite stimulant. I an taking her back to the vet today after work. so far I have paid $1400 for services. Do you think I should go to another vet for a second opinion. She also has not pooped in several days.
JA: I'll do all I can to help. What is the cat's name?
Customer: Lily
JA: Is there anything else the Veterinarian should be aware of about Lily?
Customer: Normal labs except for hyperthyroidism ( has been on medication for the last 1.5 days). Normal abdominal x-rays and ultrasound.
Submitted: 10 months ago.
Category: Cat Veterinary
Customer: replied 10 months ago.
I am taking her back to the same vet again today for another appetite stimulant and subcutaneous fluids. I spoke to the vet over the phone and she thinks that Lily may have developed a food aversion
Expert:  Dr. Will replied 10 months ago.

I am so sorry to hear about Lily's diagnosis.

Hyperthyroidism is a fairly common problem, but can be frustrating to treat and takes some time for the levels to subside, especially if they were quite high to begin with. Not eating is an unusual symptom, since most cats are ravenously hungry, yet losing weight. However, some with the complication of high blood pressure and resulting heart issues can go off their food, and this becomes even more critical, as we obviously need energy to survive, as well as to help balance what is being essentially "stolen" by the high metabolic rate.

So it will take time, possibly days to weeks, for the levels of T4 to drop back to where Lily feels good again. These are days that we sometimes don't have. Appetite stimulants, syringe feedings, etc... are all reasonable, but they don't always work and can be stressful. Worse yet is that the medication, Methimazole, can be irritating to the stomach and can cause other side effects. So now we have another issue that is affecting appetite and energy consumption.

Things that can help.

Some of these kitties have acidic, irritated stomachs, so antacids can be helpful with that symptom.

Using a transdermal methimazole (one that is formulated to be absorbed by the hairless skin in the ear rather than requiring oral dosing) can reduce the stress of pilling them and help prevent the sour stomach. Most times this must be special ordered, so vets will almost always start with the pill, but it is an option to consider.

If we just won't eat, and we feel there are no other major health issues found on bloodwork and the ultrasound, then it may be worth a quick procedure to place an esophagostomy feeding tube. This allows no stress syringe feeding through the tube, which exits from a small incision on the neck, and we can feed thicker more substantive foods (more like gruel than broth). It's a frustrating step with a patient who is fragile, but obviously not eating is not going to be a winner. Medicines can also be administered through the tube, so no more wrestling to pill them. These will also all help to prevent the food aversion that may be developing.

Also, during this medical crisis, please feel comfortable to feed anything she'll eat. She needs calories and energy more than a balanced diet, so if she's a tuna or salmon or turkey eater, that is ok, while we're giving blood pressure medicine and methimazole a chance to work.

I hope this provides some information that may help guide you to the next steps. I've seen great response to medical therapy in most cases, but there is a lag between starting meds and seeing that improvement, and a starving cat is not giving you the luxury of time.

Other complications to this whole thing is hypertrophic cardiomyopathy or a heart muscle disease that is often associated with hyperthyroidism and can have the frustrating side effect of, you guessed it, not eating. You're doing the right things medically, now we need to find the lowest stress, highest energy way to support her body until she shows whether she's going to respond well. I think the above options are the best hope.

Please let me know if there is more detail I can provide or if you have other questions that I didn't touch on.

Hoping for the best for Ms. Lily.

---- Dr. Will

Customer: replied 10 months ago.
Thank-you for your answer. I took Lily back to the vet for the fourth time this week because she is still not eating. I am force feeding her with syringes of intensive care cat food from the vet. They again gave her fluids and vit b shot.
I went over the Ultrasound exam with the vet and was told she has a 5 cm cystadenoma in the caudate lobe of the liver. I asked the vet to refer me to a specialist because I feel that she may not make it if this weight loss continues. Do you think the liver cystadeoma may be the cause of her not eating. ( all labs except for the thyroid are normal). The only reason why the ultrasound was done was because I asked for it to be done. Today after 9 am, I am taking her to Sage or Adobe veterinary clinic for a second opinion.
Expert:  Dr. Ellie replied 10 months ago.

If her inappetence were caused by the mass on the liver, I would expect her liver values to be high or for her markers of liver function to be abnormal. These include having low total proteins, albumin, glucose, cholesterol or high bilirubin. Since none of these are present according to your information, it may be that the mass is placing physical pressure on the stomach making her appetite decreased or causing her to become nauseous. I think a second opinion is definitely in order, however we won't know what the liver mass is worth sampling it (fine needle aspirate or biopsy) and it sounds like it is an incidental finding. I would look to the hyperthyroidism (causing a paradoxical decrease in appetite), the medication causing an upset stomach, masking kidney disease causing her renal values to be increased and interfering with her appetite (a chemistry panel should be rechecked after starting the methimazole) or an unrelated reason.

The lack of bowel movement is not concerning as it sounds as if she has not been eating a normal amount of food and as long as she is not staring to defecate or acting constipated, I would not be concerned about the lack of bowel movement.

Does this help to address some of your concerns about Lily tonight?