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14 yr old cat, at vet two days ago who is suspicious of

cancerous processes - intestines a...
14 yr old cat, at vet two days ago who is suspicious of cancerous processes - intestines a bit thickened, kidneys feel irregular. 2 months ago cat had blood work and geriatric panel, everything normal. Has lost 1kg since then and is very thin. Decision was to do palliative care at home after he got fluids under the skin, anti nausea medication and an appetite stimulant. Slight improvement since vet visit but this morning he is panting and drooling slightly, still eating a bit but very picky. Not sure if we should be taking him to the vet to let him go or if this is part of what palliative care looks like.
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Answered in 9 minutes by:
7/16/2017
Dr. B.
Dr. B., Cat Veterinarian
Category: Cat Veterinary
Satisfied Customers: 21,749
Experience: Small animal veterinarian with a special interest in cats, happy to discuss any questions you have.
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Hello & welcome, I am Dr. B, a licensed veterinarian and I would like to help you today.

What anti-nausea medication and appetite stimulant were given specifically?

Any steroids?

Any retching, gagging, lip licking, drooling, or vomiting?

Are his gums pink or white/pale? Moist or sticky?

Can you take a breathing rate for me (just count his breaths for 10 seconds + multiply by 6)?

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Customer reply replied 5 months ago
cerenia was the anti-nausea medication, he's getting 4mg every 24 hours (next dose would be in an hour). Not sure on the appetite stimulant but our vet said it would last 72 hours. No steroids. Not gagging, retching, lip licking or vomiting. Only drooling briefly when he was panting. His gums are very pale - the vet noted this on Friday as well as dehydration, hence the fluids - and moist.
Customer reply replied 5 months ago
Breaths are 66

Hello again,

Now I would first say that palliation doesn't look like this. Comfort care should just help our kitties be comfortable and as normal as possible. So this is an unfortunate situation and not normal. And I have to say to hear he is on Cerenia and the appetite stimulant is an every 3 day one (which means its Mirtazapine); I am highly suspicious that he is one of the unlucky cats that has issue with the two drugs together. This is because while uncommon we can see agitation/drooling/lethargy with these two together. Therefore, in this situation, we'd need to stop the Cerenia and ring his vet for a compatible option (ie Zofran, Metoclopramide). In the meantime, if he is quite nauseous, you can use OTC Pepcid (More Info/Dose @http://www.petplace.com/article/drug-library/library/over-the-counter/famotidine-pepcid).

Finally, we do need to keep an eye on those gums and the breathing rate (which we really want <30 breaths per minute). This is because while the rate can be higher secondary to this drug combination its also a worry that he is struggling to get enough oxygen. And with the pale gums this is usually is a sign of poor oxygenation +/- low red blood cell levels. So, we'd hope this elevated rate will decrease as the Cerenia gets out of his system. But if it doesnt' or worsens, then we'd need him to be reassessed as anemia/poor oxygenation would be a negative prognostic sign for him and actually a sign we may need to let him go already.

Kind regards,

Dr. B.

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Dr. B.
Dr. B., Cat Veterinarian
Category: Cat Veterinary
Satisfied Customers: 21,749
Experience: Small animal veterinarian with a special interest in cats, happy to discuss any questions you have.
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Customer reply replied 5 months ago
Thank you! We are headed back to the vet this afternoon and will see what the options are, if there are any. He's had a very long good life but the loss of his young dog sister three weeks ago started a rapid decline in his health. I appreciated your help!
You are very welcome, my dear.That is ideal and hopefully they can use some alternative options for him. But if they cannot or if the anemia is worsening then his vet can give his peace.
Please take care, my thoughts are with you,
Dr. B
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Hi,

I'm just following up on our conversation about Vinny. How is everything going?

Dr. B.
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Dr. B.
Dr. B.
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