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My cat, Bella, a month shy of being 14 years old, has barely…

Hi. My cat, Bella...

Hi. My cat, Bella, a month shy of being 14 years old, has barely been eating or drinking. she's eatten dry food all her life but hardly touches it these last two weeks. About all she'll eat right now, and very little at that, is canned tuna in water. She has stopped drinking water from the kitchen faucet. She's urinating about twice a day & pooping once every four days. Some days, her energy level seems normal & other days more lethargic. I took her to the Vet a week ago, but because she becomes very "feral" (hissing, bittin & scratching) when at the Vet office, the vet wouldn't exam her without sedating her first, which the vet said could kill Bella due to her age. The vet essentially said Bella will either get better, or, due to her age, and possible kidney disease, she won't. I was sent home with various medications to force feed to Bella, which haven't seemed to make a difference. I'm wondering if Bella may be having intestinal problems & if so, can that be treated with medications? Any thoughts you may have would be helpful and very much appreciated. Thank you.

Veterinarian's Assistant: I'll do all I can to help. The Expert will know if Bella will be able to digest that. Is there anything else the Veterinarian should be aware of about Bella?

She exhibited the same symptoms about two years ago & after just a couple of rounds of meds, she bounced right back. Other than that, Bella has enjoyed very good health.

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Answered in 42 minutes by:
3/16/2018
PitRottMommy
PitRottMommy, Veterinary Nurse
Category: Cat Veterinary
Satisfied Customers: 12,516
Experience: 15 yrs experience in vet med, 8 in emergency med. Founder of a non-profit animal rescue
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Hello, JACustomer. I have been a Veterinary Nurse for over 15 years and would be happy to help you today. I'm reviewing your question right now.

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Here are my concerns: When cats begin not eating their liver suffers the effects. This can result in a condition known as Fatty Liver Disease (aka Hepatic lipidosis) which can result in liver failure if not addressed. More info here: http://www.peteducation.com/article.cfm?c=1+2135&aid=217 I would urge you to have Shah examined and to also schedule some diagnostics at this time. Bloodwork to look at the liver values would be wise, but also to determine on the blood work if there are any additional concerns which might have originally been the cause of not eating. We can see medical concerns like liver disease, pancreatitis, kidney disease, bladder infections, periodontal disease, etc. all contribute to not eating in any age of cat.

One of the more effective ways of safely sedating a cat who is aggressive is to mask them to sedation. This can be done by making sure that Bella is inside of a small cat kennel when she comes to your vet. Your vet will place a bag around the kennel so they don't have to handle her (less stress on Bella) and will then instill anesthetic gas into the bag. Bella will fall asleep, can be removed from her kennel and blood drawn. Although she is at risk given her age, I can't recall the last time I witnessed a senior, sick or severely debilitated animal pass away with this procedure. The other option is to wait until Bella really feels so poorly that she refuses to fight (I'd avoid this, if at all possible).

Alternately, talk to your vet about trying some appetite stimulant medication if she will permit you to medicate her. I would also try KMR and pureed baby food in chicken, turkey and similar flavors. Avoid those that contain onion or garlic in the ingredient panel. If your vet has not dispensed pet-tinic, I'd ask for some and also consider using Hill's A/D diet if this has not been prescribed.

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PitRottMommy, Veterinary Nurse
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Customer reply replied 5 months ago
Hi,Thank you so much for your quick reply to my questions, regarding Bella, and for your very informative answers and suggestions. A few follow up questions:1) The suggestion that you gave for using the masking procedure to sedate Bella, what is the common, or proper, term for this
sedating procedure; "Masking Sedation Procedure"? Is this masking procedure a common procedure that is available in
most, if not all, veterinary clinics? Is air able to get into the mask bubble, so that Bella will be in no danger of suffocating?
How much safer is this mask procedure vs sedating with a needle? Using the masking procedure, can the sedative be
administered in degrees, so as to make Bella non aggressive, but still conscious, or would she have to be put to sleep
completely?2) The vet I saw last Friday, in addition to saying that Bella shouldn't be sedated because it could kill her, also said that
there isn't much point to doing blood work on Bella because the sedation and testing could cost thousands of dollars,
and if the blood work shows that Bella does have liver or kidney disease, or cancer, there would be nothing that could be
done about those three diseases, and I would end up just wasting thousands of dollars to learn Bella has a disease that's
not treatable. I'm assuming that vet is not correct in his statement that liver or kidney disease is not treatable in cats?
What is the average cost to sedate a cat and do blood work?3) In the article on Fatty Liver Disease, that you sent me the link to, one of the statements the article makes is that a cat
should not be force feed, which is what my vet told me to do with Bella, and I have been doing. Should I stop force
feeding her (I'm using a syringe to force feed her with, as well as to administer her medications)? And just so you know, as
related to statements in the Fatty Liver Disease article, Bella is as far from overweight as any cat can be; she's not
under weight either. She has just always stayed at a very healthy, lean weight.4) The vet had given me a few days supplies worth of appetite stimulant medication, but it seemed to have no effect. I've also
tried giving Bella baby food, and Hill's A/D diet canned wet food. Bella won't touch any of it, let alone eat it. Bella will
occasionally still nibble at her dry food and her cat treats, but if she's going to eat or drink, it's mostly water canned tuna
and cat formulated milk from "Whiskas". I'm not familiar with "pet-tinic"; what is that medication and what does it do?5) Speaking of dry food diets for cats, I've heard arguments that a dry food diet is the worst diet a cat can be put on and that
a dry food diet can lead to symptoms that Bella is now experiencing. Is this true? What is your take on dry food diets vs
wet food diets for cats?The medications that were prescribed for Bella, last Friday (3/09/18) were: AD canned food; Mirtazapine tablets 15 mg; Cerenia 16mg tablets, and Metronidazole Susp. 50mg/ml. Other than the "pet-tinic", is there any other medications that you would suggest I ask my vet to prescripe for Bella?Thank you so much for your time and your help. Both are greatly appreciated.Bella's Dad

1) Isoflurane is the type of gas most commonly used, but sevoflurane can be used, as well. Describe the procedure and they'll know what I'm talking about. "Masking" involves actually using a mask, but if she cannot be safely handled the procedure using a tank or bag will work, as well. The anesthetic gas is mixed with oxygen so there's no risk of her suffocating. She has to breathe it in for it to work, so you know she's no suffocating if it's effective. It's safer to use gas in these cases because injectable anesthesia can take hours before full recovery occurs. It only takes minutes with gas. Gas anesthesia can be given lightly or heavily and is easier to offer this "varying degrees" option where injectable doesn't give this option without giving more medication.

2) I think your vet is misinforming you here. Bloodwork typically runs about $200 nationwide. That would show liver or kidney disease (as well as quite a few other conditions). Cancer, however, can be quite difficult to diagnose and costly--it all depends on what type of cancer might be present. I'd rule out the "easy" stuff before assuming it's going to cost thousands of dollars. I'd expect $300-$400 for exam, sedation and bloodwork. X-rays might be more if they feel they need to do it. Liver disease and kidney disease can be treated but not cured. We can discuss that further once you have a diagnosis as there's just too much information to share on a "maybe" basis.

3) Ideally, we don't want to force feed a cat. We want them to eat on their own. Try stimulation with the foods I recommended and ask your vet about an appetite stimulant. If these don't work, you will have to force feed her or FLD will develop. Overweight cats tend to have a higher risk of FLD but ALL cats can develop it if they stop eating completely for a prolonged period of time.

4) Pet tinic is a vitamin and mineral supplement. It can help regulate any vitamins and minerals missing from the diet and since she's not eating this can be a small step toward making her feel better.

5) This is true. I prefer wet food as it helps to keep the kidneys flushed. Cats are prone to chronic dehydration with dry diets. Cats living on a naturally wet/raw diet seldom develop kidney problems at the rate cats on a dry diet do. I'd push for bloodwork before pushing for more medication. Ask them about switching to Cyproheptidine from Mirtazapine. Ask about adding in famotidine, as well.

6)

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Customer reply replied 5 months ago
Thank you, ***** ***** your clear, and detailed responses. I'll call my local vet clinic to see if they can do the masking procedure and blood work, and than get Bella in for such. Once I get the results back, I'll share them with you. Thank you again.

You're very welcome. Best of luck! I'll keep an eye out for any additional posts from you.

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Customer reply replied 5 months ago
Quick follow up, what's the difference between Cyproheptidine and Mirtazapine? And what does famotidine do? Thanks.

Famotidine is an antacid and helps to neutralize stomach acid. It's commonly used along side cerenia to help overcome nausea.

Both medications are appetite stimulants, but sometimes one works better for a pet than the other.

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Hi,
I'm just following up on our conversation about your pet. How is everything going?
Customer
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Customer reply replied 4 months ago
Thank you so much for following up. I checked with Bella's vet clinic about the masking procedure which you had described. They said that they do use that method, but the vet also said that they don't have a case that would fit over Bella's carrier and that they would have to use a trash bag over Bella's carrier, which would prevent them from seeing her and monitoring her during the sedation process, and therefore, they could end up giving her too much gas which could kill her, or not enough gas, which would make her even more agitated. So in short, the vet said masking is not a good option for Bella (I'm not sure this vet knows what he's talking about). The vet suggested that I try experimenting with various strength doses of a liquid sedative (which he would prescribe for Bella) to see if that would have any effect on her, allowing them to then be able to draw her blood for analysis. I'm having a hard enough time force feeding her food and other meds; I doubt I would be able to get enough of the sedative in her mouth for it to have much effect. Plus, I don't like the idea of me being the one (without veterinary training) trying to experiment on Bella with the sedatives, trying to find the right dosage, particularly with the vet saying that too much of the sedative could also kill Bella. If blood work were done on Bella, and it were to show that she's suffering from liver or kidney disease, or failure, what meds would be prescribed for those conditions to help Bella recover? Without Bella's blood work being done, can I just ask the vet to prescribe medications for those conditions, or would treating Bella with such meds, without confirmation of such disease or failure, do more harm than good? Bella is having good days and bad days, in terms of her activity level and eating. She occasionally withdrawals, and hides under the bed. The only things Bella has been eating, or drinking, over the last few days are her small, square sized, milk flavored cat treats (but she hasn't been eating much of those today), tuna in water, from the can (she particularly likes the tuna juice/water. But as of last night, she hasn't been eating much, if any, of the tuna meat. Is too much canned tuna bad for cats?), and she's still drinking her cat milk, but not as much today. She'll occasionally nibble her dry food (I prefer that Bella eats her wet food and tuna, but right now, anything she eats, I'm happy with). However, she's more active today, and behaving more like her "old" self than she has been for the last several days. She's still peeing 2-3 times a day, but only pooping once about every 4 days; she last pooped (solid, not soft or runny) Sunday afternoon. I feel like I'm on a roller coaster; one day she seems better, the next day, not so much so, and sometimes she is up and then down during the same day. Any insight or suggestions? I'll gladly take any words of wisdom you may have to offer. Thank you sooooo much.

There are clear trash bags on the market, as I am sure you are aware. It's not uncommon for us to check on cats as they're being masked down. Have you considered a 2nd opinion?

It would depend on the level of severity and which condition she has. Often a change in diet is implemented first. Kidney cats are often placed on medications like benazepril, phosphate binders, etc. Cats with liver disease may be placed on SAM-e. She can have nibbles of tuna, but don't make a diet of it. Feeding only fish can cause a thiamine deficiency.

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