? 6/4 Jag: Eating tapered off again

Here's the link to my last post with what was going on: http://www.felinediabetes.com/FDMB/threads/jag-not-eating-losing-weight-vet-visit.196107/

Jag ate fine when he came home Tuesday. Wednesday, he still ate, but I noticed it started decreasing. Then on Thursday, I could only get a few licks out of him, and by Friday he was back to water-only.

I called the specialty vet Thursday when I noticed less food. They said to stop the potassium powder to see if that was the cause since it has a slight odor to it. They said to only shoot 1.5U if the BG is 200+. Anything less, skip the shot for now. They said to bring him in Friday is no improvement.

Friday, I took him in. They administered SubQ fluids, he was slightly dehydrated again. They also said to stop the Clavamox (125mg 2x/day) since this could be upsetting his stomach. Instead, they gave him a shot of Convenia to replace the Clavamox. They also gave him Cerenia & Zofran injection, and sent me home with Zofran to give twice daily for a week.

At the vet, he seemed "perkier" than he was just a few hours earlier at home.

At home, I am to continue Cerenia, Zofran, and the potassium powder if he eats. However, he still is not eating on his own...

I decided to syringe feed to make him get food inside. The Tiki Cat Velvet Mousse is very thin, so it's easy to put into a syringe without diluting it. I was able to feed him 2 pouches Saturday (~160 kcals). Sunday, I have fed another 2 pouches. His intake is supposed to be roughly 330/day, so my goal is to feed 4 pouches this way if I have to. (Pouches are 80kcal each = 320kcal total)

He continues to urinate about once every 2 hours, and drinks a lot of water. Ketones continue to be at Trace, but his BG is confusing me.

The vet said if he ate a full meal, to dose normally, assuming the BG is ok to do so. His BG was 357 Sunday morning, and he ate (via syringe), so I dosed normally, at 3U.

I wasn't able to get readings for the first half after dosing, but when PM came, his BG was only 141. I did not shoot a dose here. I then fed him another pouch, and checked BG 2 hours later. It actually dropped down to 122. Then at +4 it went up to 149. Since I'll be up for awhile, I'm going to check him more overnight.

Is it normal for the BG to go downward like this, even after 12 hours had passed since the last dose? He really didn't get much insulin since Thursday, so I doubt the depot is full yet. Friday, they said to give 1 unit at night, and earlier Friday I gave 1.5U which they directed me to do while food intake was declining.

He looks miserable to me. All he does is lay around and sleep since Friday, and my other cats stay away from him which is very unusual. I even vacuumed the house earlier, and he stayed in his cardboard box..I had to move the box with him in it. Usually he runs away at the sight of the vacuum coming out.

If I'm getting food in him, is this a good thing? He has not vomited or spit anything back up, so his body is accepting the food. I'll have to call the vet again tomorrow to let them know what's going on. I have a feeling I need to add SubQ to the mix temporarily. They didn't want to send me home with any just yet.

 

Sorry Jag is off his food now. Have you tried even the higher carb gravy foods? At this point, it's important you get calories of some type into him. I am glad you can syringe feed him. Getting food in him is a good thing and will help dose consistency too.

It's not unusual, especially if a cat is breaking a bounce, for their nadir to be later. Neko's occastional was as late as +13. Since you didn't get any tests from +2 to PMPS yesterday, it's hard to say if PMPS was the lowest number, or on his way up. +2 in the PM could have been onset from the PM cycle.

I would really encourge you to try to find a dose you can shoot all the time. Skipping shots is not good for a recent DKA kitty. The last 8 cycles have all been different does, the depot will be very confused. That's why the numbers are all over the place. Maybe try 2.5 units?

 

I've tried a whole bunch of foods, he will sniff it for a second then walk away

I agree, he needs to get consistent doses. I got nervous seeing 141, thinking 3U could push him too low. I will try to do a smaller consistent dose. 2.5U might not be a bad idea.

He's coming up higher now, at 331. I continue to syringe feed. He gained 4oz since I started the manual feeding Saturday, which is good. I feel so bad how bony he was getting.

I also ordered one of those blood ketone meters. The urine strips are very hard to read, I can never tell if it's Trace or Negative. Earlier, the strip barely changed any color at all from how it looks when dry.


I put a call into the vet, waiting for them to call back. I'm thinking he might need that SubQ as a boost to get him going normally again. All he does he lay around and sleep all day.

 

Sounds like he's nauseated. How much Zofran is he getting each time? The dose may be too low. Some cats need both Cerenia and ondansetron (Zofran) as they target different nausea receptors.

 

Zofran is twice daily, 4mg pill. (Until Friday)

Cerenia is once daily, 16mg. (Until Wednesday)

They also gave Mirtaz, 15mg, given as a 1/4 pill (15 / 4 = 3.75mg) every 48 hours, but he has zero response to it.

 

How much does he weight? Dose is usually by kg or lb.

 

I wonder if they would be willing to try cyproheptadine vs. the mirtz? Jones tends to do better on it vs. the mirtz.

Is the cerenia tablet broken into 4?

Have you tried heating up his food - like 5 seconds in the microwave? Added tuna bits, Parmesan cheese on top?

 

Today he weighs 17lb 14oz.

I asked about this, but was told it's an "older drug", that they prefer the Mirtaz, so I will push harder. (Especially since it's not working) Looks like a lot of people use Cypro here with better results.

No, directions say to give 1 tablet once daily. The only pill broken up is the Mirtaz.

Tried this with no success He used to be a big fan of those tuna flakes, would come running and crying when he heard the bag. He doesn't even want to be enticed with them anymore

 

I have one of those fussy kitties. I found that cooked chicken breast pieces ( I bbq mine, just plain) and canned ham (low sodium one) is a "treat" I use to get him eating.

 

I haven't heard of giving the full 16mg tab before...1/4 or a 1/2....which is why I was asking.

 

I will ask about this when they call me back. Maybe that could be the culprit if it's too big of a dose.

 

Vet gave a few options..

1. Continue feeding via syringe.

2. Admin SubQ at home.

3. Re-admit for several days for IV fluids.

I chose 1 & 2. He's eating for me manually, so hopefully this will get nutrients in him, and the SubQ will combat the potential dehydration. As much as I would want to consider admitting, I honestly do not have another $3k.

I printed out a list of questions for when I get there, including the Cerenia dosing, and asking about Cypro instead of Mirtaz.

Hope this works!

 

I found cypro to be a nice steady push to eat...vs. a frenzied 8 hours of eating then nothing for 2 more days. And if he is nauseated and then you force them to eat with mirtz....they can just go off their food again right way.

 

The tiki mousse is -0- carbs. Just keep that in mind. That might be why he is getting lower BG readings. But I agree it is wonderful for syring feeding. See if you can get some Hills a/d from your vet. It thins out nicely too and is higher in calories. It is around 3-6% carb <click here for info on a/d>

Not sure what other foods you have but an immersion blender with a wee bit of water works wonders for thinning/pureeing out regular LC foods (even shreds like Fowl Ball).

I have used this too. It is kinda messy but gets the job done. Got it at the local grocery store for about $10. Might try a Dollar General (or similar).

You could try Zytec for appy enhancer. It is an antihistamine like the cypro but you can get it over the counter.

General inappetance info here
http://www.felinecrf.org/appetite_loss_nausea_vomiting.htm

Persuading them to eat info
http://www.felinecrf.org/persuading_cat_to_eat.htm

Info on Zyrtec
http://www.felinecrf.org/persuading_cat_to_eat.htm#cetirizine

I always give Gizmo the opportunity to eat on his own and if he won't then immediately used the syringes, I wanted the association between the two, don't know if it helped or not.

Many hugs. Keep plugging away. Sounds like you are getting the job done.

 

@Stacy & Asia put a post up on the pill dosing of Cerenia.

http://www.felinediabetes.com/FDMB/...ia-info-cerenia-doesnt-work-read-here.195611/

It is likely underdosed most of the time. More info at her link.

 

He's a big boy. Maybe ask the vet if the ondansetron dose could be increased, or same dose but three times a day.