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Doctor, I'm having another episode with Pandy that began

Doctor, I'm having another episode...
Doctor, I'm having another episode with Pandy that began yesterday. he hasn't responded to anything i've tried so far. he hasn't been able to eat at all today. he appears to be in pain.
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Answered in 1 hour by:
11/19/2017
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Cat
Satisfied Customers: 31,202
Experience: University of California at Davis graduate veterinarian with 45 years of experience
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You're speaking to Dr. Michael Salkin. Welcome to JustAnswer. I'm currently typing up my reply. Please be patient. This may take a few minutes.

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Aster, you need to clarify what an "episode" implies at this time.

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Customer reply replied 28 days ago
Pandy has a hx of pancreatitis. a number of years ago (forgot how many) he was hospitalized for a week. he came home with a feeding tube. at that time, he was vomiting bile (yellow) & not eating when i brought him in. things were fine for a few years. recently he started vomiting again. last time i spoke to you, you told me to give him 1/4 flagyl bid pepcid ac 1/4 tab once daily & fluid. he got better. since we spoke, it happened a number of times but he got better each time with that treatment. last evening he vomited (no bile). i gave cerenia. this morning i gave the 1/4 pepcid with 1/4 flagyl. a little later i gave 100 cc fluid. no response to the treatment. he hid in a corner & remained there all day. wouldn't eat. i gave mirtazepine !/2 of a 7.5 mg tab. sometime later he seemed to be in pain. he turned to face the wall, under an end table. i gave more cerenia. then, while i was waiting to hear back from you, not knowing what else to do, i fed him 3/4 jar baby food. i have to go check to see that he hasn't vomited again. i am wondering if i should give the 1/4 flagyl this evening or give baytril instead? or maybe give nothing but try to feed him again? i would like to take him to the vet on Monday, but this is too complicated for them & colonial, the hospital where i brought him years ago is way beyond my means. that hospitalization bankrupted me. and my finances aren't very good. i am wondering how i'll manage to keep all the cats fed, pay for fuel & taxes. this is not a good time to have a very sick Pandy.

I don't believe that I can add anything to your good care. I would continue with the Flagyl rather than giving Baytril. Remember, pancreatitis is a sterile disease in the great majority of cats. The Flagyl is antiinflammatory; the Baytril isn't and so Flagyl makes more sense if Pandy also suffers from inflammatory bowel disease.

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Customer reply replied 28 days ago
i neglected to mention that other cats are vomiting too. i have been giving flagyl as you directed (1/4 bid instead of 1/2 qd) to a large # of cats. and last week, i was sick with some stomach bug as well. it seems to be better now (used chicken soup, not flagyl). i have difficulty with some cats & 1 cat i can't medicate at all; she bites. so this thing is getting passed around. Pandy has been treated with flagyl several times for several days in a row. it comes back. 2 episodes ago, he even vomited bile again, but it didn't happen this time. so should i give 1/4 pepcid with both doses (AM & PM) or only the AM dose? 1 of the vets at the local clinic once told me that pepcid can be done twice a day.... it's safe she said. i think you recommended only once a day back then. and do you think i should push more food tonight or wait till the morning? he's still in the corner, but not with his head to the wall. now he's facing forward. and there's no vomit. i think he had weighed 12 lbs when we spoke last time & you recommended a larger dose of cerenia as i have only been giving 0.35 cc. he hates it, it stings. i didn't weigh him today. i don't want to torture him with excessive handling. cerenia can be given once a day X4 days? and flagyl shouldn't continue more than 5 days? i just hope he starts eating again on his own. i didn't have too much of a fight with the baby food. but i expect he will start fighting me if i do this for an extended time. my suspicion is that he doesn't eat enough, when he is eating on his own. he's not a terrific eater. and the fluid: should i give him another 100 cc tomorrow?

Pepcid can be dosed at 12-24 hour intervals in cats. Your choice.

Cerenia can be given daily for up to 5 consecutive days.

Flagyl can be given indefinitely. Once again, your choice.

See if you can get another dollop of food down him and, yes, another 100 mL of fluid tomorrow is prudent.

God only knows why the others are vomiting. When it rains it pours.

I hope you're taking care of yourself too.

Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Cat
Satisfied Customers: 31,202
Experience: University of California at Davis graduate veterinarian with 45 years of experience
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Customer reply replied 28 days ago
the cats have been going out every day all summer & fall. they share the Purina cat chow with the outdoor cat. they drink dirty water, most likely, when they go outside. and they've learned to eat the mice they catch, not just kill them & discard them. so that's a good reason to be vomiting. the flagyl helps but i can't keep it up for too long with so many cats. i'm lucky if i manage it a few days in a row. 1 cat is so difficult to medicate, that i had to give 1/2 tab once a day so now she's better but her sister started vomiting. i think Pandy has this recurring because he's not as strong in constitution as the others. and me? i am better at taking care of myself when i'm not running ragged. there's too much going on , too often. thank you for asking. i hope you're ok. i was thinking of you..... especially with the news of the California fires..... i know it's up north & you're south. but there was something recently that occurred in Laguna Beach... i forgot what. but that's getting a little closer to you in San Diego. i don't want to learn that something happened to you. and most likely if something did, i would never find out. you would just disappear. that would destroy me. i depend on you, even when you don't hear from me for periods of time. as long as i know that i can reach you.... that you are there.... that you are still. please take care of yourself. you mean so much to so many people. that gal Deborah, that i know from FB told me that she finally contacted you and that you gave her the best advice. you affect lots of peoples lives. not just mine. thank you for being.
i hope i can open this conversation up again after i give you your excellent rating, in case i need to.

I'm going up north to visit. One of the hospitals I worked in burnt to the ground. Thank you for your kind accept. I appreciate it. I can't set a follow-up in this venue so please return to our conversation - even after rating - with an update at your convenience. You can bookmark this page for ease of return.

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Customer reply replied 27 days ago
i wanted to give you a f/u on Pandy. i fed him a little more baby food as you recommended , Saturday night (was it?). the next morning he came out of hiding, met me at the bedroom door when i woke up & followed me downstairs for the morning feeding. he later followed me upstairs for the "second course" (the upstairs feeding). i didn't see the need at that time, to give any more fluids. he's been getting 1/4 flagyl twice a day. you said that could continue indefinitely. i had heard from other vets previously that it can cause neuro problems & should not be continued after a certain # of days. are you sure i should continue at that dosage indefinitely?
i didn't want to open another question last night, and now that things seem to be ok again, i wanted to mention this because i have noticed this "thing" is getting passed around between the cats. this severe vomiting. with Pandy it caused vomiting up bile at 1 point (not Fri night, but maybe a week prior). other cats just had repeated vomiting so i had been passing out flagyl to numerous cats. last night my 20 lb boy, Boxer was throwing up pink blood repeatedly. i had come home from getting my car repaired to find vomit all over. when i discovered who it was, it had already turned to pink blood. the trouble was the dosage for a 20 lb cat. the 1/4 tab flagyl didn't help. so i repeated it. it still didn't help. now i really didn't want to give a full 1 cc of cerenia. so i gave him 0.55 cc. THANK GOD. he stopped vomiting. this morning i gave him another 1/4 tab flagyl. he ate. no more vomiting. as i said, i am in financial trouble again.... seems like this time of year is a very bad time for me. i pray that no one will get so sick and die because i can't afford to hand over $400-500 to the vet. i had to cancel my dental appointment as well. the car was repaired thanks to my mother. if the vomiting starts up again for either Pandy or the 20 lb boy, i'll have to open another question. you have no idea how much i appreciate your help. i hope i can reach you, even if you do decide to visit up north. please be safe. Have a Happy Thanksgiving.

Yes, adverse effects of metronidazole do involve the central nervous system but that's seen in overdoses not necessarily chronic administration. Indefinitely means for an indefinite period of time...not forever.

Metronidazole isn't expected to promptly stop vomiting due to an infectious (viral, bacterial, toxic) gastroenteritis. It's more likely to control inflammatory bowel disease (IBD) causing the vomiting.

I'm pleased ot hear the Pandy is feeling better.

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Customer reply replied 23 days ago
well, the vomiting started again with Pandy. i had not stopped the 1/4 tab bid, but it happened anyway. and this evening it was bile colored vomit. he seemed fine this morning. i went out today to a church for a Thanksgiving meal. i was gone maybe 3 hours. but i wasn't feeling well when i got home (not used to that kind of food). i had to lay down for a couple of hours. i was late with everyone's feeding. perhaps it got Pandy stressed. he ate Friskies with the downstairs cats. but when i got upstairs with the Nutro (which is his favorite) he didn't come out to eat. when i gave him his plate in the other room, he vomited bile i have seen this before, after having Friskies. i'm giving wet food, but perhaps it's too fatty or too high in protein. he tolerates the Nutro much better. but when he's feeling ok, he wants to eat from every plate downstairs. the downstairs cats get both Friskies & Pro Plan or Medley's canned food (all by Purina). the Nutro canned food is lower in protein & the cats like it because pork plasma is 1 of the ingredients (blood). i give Pandy the venison flavor. but tonight he vomited up the pill i gave him & didn't take any food. i gave him cerenia. he despises the shot & he always pulls away before i finish the injection. next time i had better wrap him up in a towel before giving the shot.
when he came home from Colonial Vet Hospital years ago, he was being treated with Baytril & appetite stimulant (not Mirtazepine; the other 1... i forgot the name). they were treating the pancreatitis as an infection. that's why i thought that perhaps i should be giving baytril instead of flagyl. the flagyl seemed to work. but this pancreatic inflammation appears to be episodic & since i never d/c'd the flagyl & it happened anyway.......
i am not able to afford the kind of care he once got. this may be lasting for a long while. i had to file a complaint against my insurance company again. the last time i did that, i didn't see a check for 1 1/2 years. it's going to be a very rough ride for me. i can't take an entire SS check to treat 1 cat.
it occurred to me that perhaps Pandy doesn't eat an adequate amount? i might see him eating, but i don't stand over him to watch & see just how much he's actually eating. perhaps i should be doing the Mirtazepine regularly as i do with my 20 year old Tuesday. i give her the mirtazepine every 5 days. maybe i should be doing that with Pandy as well. i had tried it with his last vomiting episode & it didn't seem to work initially. but the next day he felt better & had a very good appetite. he seemed to be doing well all this time, until tonight. do you have any suggestions?
Customer reply replied 20 days ago
i never heard back from you on my last update, but i'm glad to see that you[re online, which means that you;'re ok. hope you had a happy holiday. this past fri, Patricia stopped by & prayed over Pandy & laid hands on him. to my great surprise, when i came home 8 hours later, he met me downstairs & has been fine ever since. i must say, that is very impressive. hope he stays ok.

Just returned from 4 days away for family/friend Thanksgiving stuff. Good to hear about Pandy. I never argue with success.

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Customer reply replied 10 days ago
i am reading about the S CA fires & i hope you're ok

I'm south of LA. The fires are in LA and north of it. Thanks for thinking of me.

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Customer reply replied 10 days ago
THANK GOD .... awful what'[s going on but i'm so glad that you're ok.

I was just up in Santa Rosa visiting family and friends. Looked like Mannheim, Germany after WWII.

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