Boots update - reaching the end of the road? plus nausea treatment questions - ondansetron dosing

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Megan and Boots (GA)

Megan and Boots (GA)

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So I've been quiet lately for a number of reasons. Boots has been struggling. The past few months have been rough - more frequent periods of low appetite (thankfully, rarely NO appetite, but often low appetite/interest), more drinking/peeing (with more frequent accidents), more sleeping, more pancreatitis flares it seems, and more constipation/dehydration. His BG numbers through it all have remained pretty good, despite lots of dose changes for various reasons.

Over the past two weeks, he's gone to the ER vet once and to our regular vet twice for enemas because he wasn't passing stool. His appetite has been bad so he's not been eating as much as he should. And he's been spending more time sleeping under a bed (he's normally a very social cat, out and about with the household). All this came to a head last Wednesday when we made the decision to schedule euthanasia with our vet for Thursday night.

Thursday was the hardest day I've had in a long time (and to add insult to injury, I'm also currently recuperating from major surgery in mid-October). So much crying over the thought of him being gone. But by the end of the day, we had a talk about him and decided to maybe just talk to the vet about one final push to get him feeling well again. We made a list of all our concerns (as well as the "good" things we still see in Boots) and brought the list and Boots to the vet Thursday night. This is a vet at our normal practice we haven't seen a ton, because our regular vet there just left for another practice last month. So this was almost like a second opinion, to get his thoughts on all our concerns and what final steps we can try to address them to keep Boots with us a little longer.

It was SUCH a good conversation. We were the last appointment of the evening, and he stayed and talked about it all with us for an hour. He didn't think it was Boots' time yet either - he had spent an overnight at their office for the enema earlier in the week and they all remarked on how well he ate (some crap Friskies variety) and how behaved.

So in addition to our normal regimen (Lantus, Miralax, Cosequin, probiotic, some Pancreas Booster as tolerated), these are the new things we're now trying in what I'm considering our "Hail Mary pass" with Boots:
- cyproheptadine - to stimulate appetite
- cisapride - compounded into chicken chews (that he likes!) to stimulate his GI tract to pass stool more easily
- sub-q fluids - to stave off dehydration and hopefully help with kidney health and constipation and general energy/wellness
- baby aspirin - to take the edge off arthritis pain (1/2 81mg tablet every 3 days)

Our primary goal is to improve his whole eating/digesting/pooping cycle. When that's out of whack, it really seems to make him feel crappy (seems a reasonable assumption!). So our goal is to get him eating and then keep him pooping normally.

The frequent drinking/peeing (dilute urine) are likely signs of early kidney disease, so hopefully sub-q fluids will help with that as well.

So does that all sound OK? Like a reasonable course of treatment for what's going on with our (15-16 year old) baby boy?

Does anyone have any input on any of those specific drugs/treatments, or tips, or other thoughts? We're also willing to forgo tight regulation on him and introduce some higher carb canned foods if that'll get him interested in eating more - we can adjust his insulin as needed to keep him in as nice a range as possible, but I don't think we're shooting for perfection or remission necessarily anymore.

I know we're reaching the end - whether days, weeks, or months. I doubt we're talking years here. But we want him to be as happy and comfortable as possible. Does it sound like we're hoping for too much here, or is this all indeed worth a shot?
 
Hi Megan

I’m so sorry to hear that Boots is not doing well but it sounds like the vet was very caring and helpful.

Since you asked, I would like to give you some other treatment thoughts to consider based on my experience.

—is it possible that he’s nauseous and that’s why his appetite has waned? I’d ask the vet for some ondansetron and give that to him consistently before I start with an appetite stimulant. Even if you go with the stimulant, I’d still give him the ondansetron because I don’t like giving a potentially nauseous cat a stimulant.
—if you use the cypro, start with a sliver. Don’t give the full prescribed dose as vets tend to prescribe too much and it can make kitties anxious.
—I am definitely not a fan of cisapride in cats and my vet won’t prescribe it for them. Instead, perhaps you might want to try some egg yolk powder. If you don’t want to buy the powder, just try a little bit of raw egg yolk, and I do mean a little to start....1/8 of the yolk. See how that works and then you can slowly increase if necessary.
—I am also not a fan of arbitrarily giving subq fluids. For me, I have to actually see in the labs that my kitty needs them or if there isn’t a condition like pancreatitis that it would give some support, that’s also good. Having said that, a one-time administration to see how he does is ok as long as you don’t give too much. In elderly cats, we worry about the stability of the heart and giving too much fluids or too often can overwhelm the heart (unless you’ve had a recent echo and know his heart is normal).
—if you suspect he has CKD, why aren’t they doing labs? There are a lot of things with CKD that can make them feel crummy that you can address. But without the labs, you don’t even know where to start.
—Sorry to be repetitive on the “not a fan of” but I’m also not a fan of baby aspirin for arthritis pain. I’ve had a couple very elderly cats with arthritis and we’ve tried about everything. The one thing that worked for both of them with no long term side effects was a very low dose of buprenorphine given twice a day. Having said that, neither of my cats had constipation or motility issues and that is definitely an issue that can come with using bupe. But it’s also didn’t cause either of them to become constipated because we gave such a tiny dose (0.1 ml on a 3 mg/ml concentration and both cats weighed over 12 lbs).

I hope this helps and I send a ton of vines for your sweet boy. I know that sometimes these things can seem insurmountable and I am all about QOL and not throwing everything at a cat that clearly has none and has no potential for it to improve. OTOH, I know that for me, I couldn’t bear the thought of losing any kitty that had the prospect of improving without knowing I tried all I could and it seems to me that’s where you’re head is, too.

:bighug::bighug::bighug:
 
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Thanks, @Marje and Gracie . I really appreciate the input.

We have given him cerenia before during pancreatitis flares to help him eat with success. Maybe ondansetron would accomplish the same thing? I can certainly ask about it. It's a good guess on your part, as we did start the cypro and he often seems hungry when he starts eating but then stops after a few bites. MAybe it's nausea? Haven't seen any lip smacking or other such signs, but that's not a sure thing. Is ondansetron better than cerenia for nausea? I actually have a few doses of ondanestron that were given to me that I could try. Do you recommend stopping the cypro first, and if so, for how long?

He does seem anxious since starting the cypro! More vocal than normal. And honestly, apart from as I said the initial interest in the food, I don't know that it's helping ask that much do far anyway. Vet have us an Rx for mirtazapine too but gave us the cypro pills to try first.

What does the egg yolk do exactly? Would that be given in conjunction with the miralax?

The sub q fluids are a little arbitrary maybe, but he has been dehydrated lately, and his last labs showed crazy high pancreas numbers, indicating that his pancreatitis is not good, which sub q fluids might help control symptoms during flares. He has had blood work done 2 or 3 times already this year, so I guess we could get more to see if it's changed since the summer tests. His BUN was high and creatinine is at the high end of normal. Urine is extremely dilute (poor guy pees a river 8+ times per day).

The constipation is why the vet wanted to avoid bupe. But maybe if we can get that under control, we can think about changing pain meds. I've read mixed things about all pain meds (including aspirin and bupe) so really don't know what's best.

I really do appreciate the insight. We feel like this is maybe the last try for him to see if we can just get him feeling well again, even if not for much longer. I don't want him to suffer, but I don't want to give up without trying everything reasonable first. He's my little orange world :bighug::cat:
 
Sending you tons of vines and I am glad that Marje mentioned the Egg Yolk Powder. I started both my kitties on it 9/15 and the results are magnificent. Bubba was nauseous from being constipated and that all stopped almost immediately. What I did for a few days was to mix 1/2 tsp of George's Aloe Vera juice with 1/4 tsp of Slippery Elm Bark and syringed it into him about 1/2 hour before eating. It was magic and I only had to do that a few days and then the Egg Yolk powder and Aloe Vera Juice was doing well by him. :bighug::bighug::bighug::bighug:

ETA: The Egg Yolk powder will help with motility as well.
 
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Great to hear! Any particular brand or kind of egg yolk powder you recommend?

And this sounds stupid, but I'm terrified of syringing stuff into his mouth. Any chance you know I'd any good videos or any thing explaining how to do it safely? That all sounds so promising!

In the meantime, should I try "real" egg yolk (raw or cooked?) Or just buy the powder? Not sure if salmonella risk is too great. I do but organic, pastured eggs, but don't know if that lessens risk of salmonella.
 
I didn't see any one mention using adequan for the arthritis?
You want the canine version and the dose is determined by weight of the cat. My cat was 12.5 lbs so she got 25 units ( a full insulin syringe)
You start out with one shot each week, for a month and then go to every 2 weeks, then every three.....
some even go to once a month but my kitty seemed to do best at every 3 weeks.

the vet can fax a prescription to www.diamondbackdrugs.com ... that was the cheapest place I found for it.
I used my insulin syringes since they were sharper and smaller than the harpoons the vet uses with this medication.


I also favor the use of ondansetron for nausea. This is a big issue for diabetic cats /pancreatitis/ ibd, etc...
You want 4 mg pills and the dose is usually 1/4 of a pill am and pm.
If you give an appy stimulant, wait until 30 minutes after the ondansetron.
This is a human drug so you'll have to get a written prescription from your vet and take it to your pharmacy.
 
I get my egg yolk powder from foodfurlife. It is cheap and easy to use. As far as syringing goes, you want to put the feeding syringe into the cheek of the mouth and just give a bit at a time as to not choke him. I am not sure if there is a video of it or not.

http://www.foodfurlife.com

ETA: I was scared the first time I syringed also. There is an assist feeding video I am posting which might help you with syringing the supplements/meds.

http://www.felinediabetes.com/FDMB/threads/where-can-i-find-________.127890/
 
If you click on the link I left in blue in post #4 above, it will take you to the powder I recommend which might possibly be the one Bobbie uses as well. If you look at the link and click on the product, it will take you to a description and it states it’s great for constipation but maybe just cut back on the miralax as you increase the egg yolk powder. The makers of the product are awesome and you could also email them ....they would be the best source. The egg yolk powder is for motility. if you go with the real things, start with 1/8 of a real raw egg yolk. I have never had an issue with salmonella but my cats are very healthy. That’s why the powder might be the better route for him.

I have also done the AV juice and slippery elm and it’s a great combo. Be sure you get George’s Always active Aloe Vera ... but get the smallest one. One thing to remember (@Bobbie And Bubba) is that when giving AV juice, you must also give at least the same amount of water, or even a bit more water, as the juice.

The cerenia and ondansetron work from different modalities. I think, overall, the ondansetron is better for nausea but you can give them together.....it makes a nice combo. I’d try it without the cypro and see if he will eat on his own and if he doesn’t, just give a sliver of cypro after waiting 30-60 mins for the anti nausea drugs to kick in.

I used adequan on both my arthritic cats and it didn’t help but ECID.

I see you have his labs in the lab tab so I’ll take a look in a little bit after dinner and give you some thoughts on the CKD. I’ve had four CKD cats and all but one lived a long time with it and passed of something else. The one that died of it actually had PKD which is always fatal and fast.

Remember in the specfPL that the number you get does not indicate how bad the pancreatitis is. Gracie’s specfPL was always high but she’s never had pancreatitis and her pancreas was totally normal on ultrasound. Issues with the liver, gallbladder, and intestines can also elevate the specfPL. I’m not saying he doesn’t have pancreatitis, my point is just that once you get above the number that is indicative for pancreatitis, a higher number doesn’t mean it’s that much worse.
 
Marje and Gracie said:
Be sure you get George’s Always active Aloe Vera ... but get the smallest one. One thing to remember (@Bobbie And Bubba) is that when giving AV juice, you must also give at least the same amount of water, or even a bit more water, as the juice.
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I do that but didn't know it was required. I just split the 1 tbsp. into 2 doses a day which would be 1/2 of tbsp. twice a day and my boys were just to 1 tbsp. of water in each meal so I do 1/2 and 1/2 . Good to know that it is required. Thanks for that info Marje so I can add it to my notes. Do you know why you need 1 to 1 ratio of AVJ to water?

ETA: Why did you say to get the smallest one? I started of with a quart and moved to the gallon. Is it just in case it isn't tolerated ?
 
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Bobbie And Bubba said:
I do that but didn't know it was required. I just split the 1 tbsp. into 2 doses a day which would be 1/2 of tbsp. twice a day and my boys were just to 1 tbsp. of water in each meal so I do 1/2 and 1/2 . Good to know that it is required. Thanks for that info Marje so I can add it to my notes. Do you know why you need 1 to 1 ratio of AVJ to water?

ETA: Why did you say to get the smallest one? I started of with a quart and moved to the gallon. Is it just in case it isn't tolerated ?
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It used to have that information on the IBDkitties page but she’s changed her discussion in supplements substantially. I believe it has to be diluted because of its laxative properties.

Yes I recommended starting with the small one to make sure it works for Boots. I did switch to the larger one afternoon I knew it helped Gracie because it was as easy to get locally.
 
Thanks everyone for the recommendations. I've got a call into our vet to see about starting ondansetron to see if maybe nausea is indeed a factor in the trouble eating.

I've got an order in for SEB and CBD oil too, so they should be here soon to start those up too. And I'm going to try to make some egg yolk powder myself with the recipe on the Food Fur Life website.

He's made only two tiny poops (yesterday) since Thursday night when he last made a decent "log." I hope maybe adding in egg yolk today and SEB in the next day or so will prevent the need for us to take him for yet another enema!

@Marje and Gracie meant to ask you - why are you (and your vet) not fans of cisapride? I honestly only just started doing my research on it after it was prescribed, but have read many positive reviews of it so far, albeit anecdotal, not clinical studies.

@rhiannon and shadow (GA) we did actually discuss Adequan with our vet. He certainly knows of it but was hesitant to prescribe it because he doesn't know of studies that prove it's more effective than oral versions of basically the same kind of substance (Cosequin). Can you point me to any actual clinical studies that show benefit of adequan over oral glucosamine/chondroitin? Or any studies that show it can be given sub q instead of intramuscular (which he said would need to be given at their office and stings badly)? I'd love to be able to show him some research findings!

And a question for those who give SEB - how/when do you give it? Straight powder? Syrup made with water? With food? Before food? I can't seem to find a single answer, it seems like everyone does it differently. My understanding is it can interfere with absorption of food and meds, so to give it 1-2 hours before/after food or meds, but I've also read that people just sprinkle the powder on food at mealtime. Is there a "best" way to administer it to get the most benefit, specifically for constipation treatment?
 
Megan and Boots said:
And a question for those who give SEB - how/when do you give it? Straight powder? Syrup made with water? With food? Before food? I can't seem to find a single answer, it seems like everyone does it differently. My understanding is it can interfere with absorption of food and meds, so to give it 1-2 hours before/after food or meds, but I've also read that people just sprinkle the powder on food at mealtime. Is there a "best" way to administer it to get the most benefit, specifically for constipation treatment?
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The best way to get the most benefit is to make it into a slurry with water or AV juice, once you get that. I use about 1/4 tsp of SEB powder with enough water to make it a slurry but not a runny liquid and then I syringe. When you get the AV juice, you can combine the SEB, AV juice, and water and syringe it. If you can’t syringe him, you can sprinkle the powder on his food but some cats won’t eat it on their food (mine wouldn’t) even though it is tasteless.

It should be given separately from any meds by two hours but it can be given with food with no problem. It doesn’t interfere with absorption of food and, while there is no scientific basis that it can interfere with absorption of meds, it’s just best to be cautious.

Cisapride was taken off the market for humans because it caused deadly arrhythmias. While there has been no scientific study in cats as to whether this occurs, my vet thinks it isn’t worth the chance when there are so many other natural alternatives including the egg yolk powder, SEB, probiotics, etc. If a “med” is needed, she prefers Miralax over giving cisapride.
 
First, I'm a big fan of trying as many natural remedies as possible first....but sometimes they aren't enough. I've never tried the egg yolk powder - I'll have to try that for Snow, my civie chronic 'poopy issues' (small descending colon) kitty.

Miralax is a stool softener - works by drawing more water into the colon keeping moving feces soft. The longer it's in the colon the harder it gets - it also gets darker. It can be used with Cisapride/Reglan as the action is totally different.

Cisapride strengthens the contraction of the muscles helping move feces thru the colon BUT it also strengthens the contraction of all the body's muscles which includes the heart. Reglan is a second choice altho' it doesn't work as well. I'm NOT a fan of either due to it's affecting all muscles but sometimes I have to use it.

Snow is usually controlled with no dry food, no hard or freeze dried treats, Miralax twice a day and a petroleum based hairball remedy every other day. When he has a problem and begins what I know are the signs he's backing up, I do hairball remedy 3 times a day and give a small Reglan dose. Sometimes I have to give a couple of doses but again, I'd rather not have to use it. I only use it if I see we're heading toward a real problem if I don't find the handle.

HUGS and hugs and thoughts and prayers....and more hugs...
 
Such phenomenal information here: thank you to everyone for all these details re AVJ etc.

Megan, my heart really goes out to you. And I so, so hope that these things work for Boots! Sending you both lots of healing vines and support... :bighug::bighug::bighug::bighug:

I was still recovering from surgery when Girlie was diagnosed with diabetes this year. I know how hard it is to try to take care of yourself and your beloved cat. It sounds like you are doing a wonderful job! Please let us know how you go.
 
Still no call back from my vet (his two person practice recently became just him, so I know he's swamped, but am still hoping he'll have time to return calls this evening).

Here's the latest dilemma - Boots ate a little a couple times earlier (no more than .75oz each time, maybe 3 times) but completely didn't eat his 5pm meal and has gone back under the bed now. I am suspecting nausea is the cause of his lack of appetite. I have Cerenia and Ondansetron here. Vet has officially prescribed Cerenia for his use; I was given the ondansetron to try but have not run it by our vet yet.

Should I give him one, or both, or wait for the vet? I just can't sit around not trying something. I don't want him to not eat. I can live with it being difficult to get him to finish his plate, but to not touch it can't continue. If you think I should give him ondansetron, what's the normal dose? He's about 10.5 - 11.0 lbs currently, and I have I think 8mg pills I could use. He's taking Cyproheptadine, Cisapride, Miralax, Cosequin and probiotics currently, so hopefully no interactions with any of that combination.
 
I have no idea of any interaction with the drugs you are already giving. I would give Cerenia (getting ready to give Gizmo a dose as a matter of fact). Not sure who could advise on interaction maybe @tiffmaxee or @Wendy&Neko. Maybe put question in your title to see if someone can answer?
 
Got a call back from the vet! He recommended Cerenia because he doesn't use Ondansetron as often, but said I could try both together if I wanted to really throw everything we've got at Boots now to get him eating. He said they're fine together, and shouldn't interact with his other meds. He actually said to stop the cyproheptadine and see if the anti-nausea meds do the trick to get him eating. Vet didn't like that the cypro didn't do the trick on its own and also seems to be causing side effects (when Boots is up from his naps, he is vocal and seems agitated and it takes him too much time to settle back down). I have a script for Mirtazapine that we can fill tomorrow just to have it on hand.

He also said 2-3mg dose of ondansetron once per day - does that sound like what others do? I've read once per day or twice per day on different sites.
 
The ondansetron can work better for nausea than the cerenia on a lot of cats....it's a drug used for nausea in humans on chemotherapy but you can give them both at the same time if you want to throw everything at him. I'd probably suggest just trying the ondansetron by itself first so you can get a better idea of how it works on Boots.

We usually start with 1/4 to 1/2 of a 4mg tablet, so if you have 8mg tablets, that would be 1/8 (if you can get that small) to 1/4 tab
 
Megan and Boots said:
I have a script for Mirtazapine that we can fill tomorrow just to have it on hand.
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Mirtazapine can also cause agitation in a lot of cats......a lot of us call it Meowzapine because of the increase in vocalization it can cause.

The cypro you can give twice a day....the Mirtz is a once every 2-3 day drug
 
OK, managed to get Cerenia and probably about 2mg Ondansetron into him (in pill pockets - is that OK? I know some people do gelcaps but we haven't tried those with him yet because he is generally so good at taking pill pockets). Didn't give him any cyproheptadine, so we'll see if the appetite improves at all with just some antiemetics in him. We'll give ondansetron again tomorrow morning and do the cerenia/ondansetron combo tomorrow night again. I'd hope by then we'll see improvement if it's in fact nausea causing the inappetence. He did show interest in eating when we pilled him (chased the pills down with food) - but again just a couple bites then walked away. But better than nothing, which was what he ate at the last attempted mealtime.
 
@Marje and Gracie , @Bobbie And Bubba and anyone else who gives egg yolk powder - how do you give it to them? Mixed into food? Mixed in water and syringed? Gel capped? I made some today with 5 eggs following the Food Fur Life recipe. Put a pinch on a plate after he got his pills and ate a couple bites of food. He sniffed but showed no interest in it. Not sure if it's because he doesn't like the smell or because of whatever else is making him not want to eat generally. Do cats typically eat it right up, or at least accept it mixed in food?
 
Also, anyone have any experience on how long it might take to see some anti-nausea benefit from these meds, if in fact it's nausea we're dealing with here? In the past when he's had low appetite and we've used Cerenia alone, it's always seemed to take 24-48 hours before we noticed him eating better. Is ondansetron any quicker? I'd think maybe, since it's dosed more frequently?
 
Megan and Boots said:
Thanks everyone for the recommendations. I've got a call into our vet to see about starting ondansetron to see if maybe nausea is indeed a factor in the trouble eating.

I've got an order in for SEB and CBD oil too, so they should be here soon to start those up too. And I'm going to try to make some egg yolk powder myself with the recipe on the Food Fur Life website.

He's made only two tiny poops (yesterday) since Thursday night when he last made a decent "log." I hope maybe adding in egg yolk today and SEB in the next day or so will prevent the need for us to take him for yet another enema!

@Marje and Gracie meant to ask you - why are you (and your vet) not fans of cisapride? I honestly only just started doing my research on it after it was prescribed, but have read many positive reviews of it so far, albeit anecdotal, not clinical studies.

@rhiannon and shadow (GA) we did actually discuss Adequan with our vet. He certainly knows of it but was hesitant to prescribe it because he doesn't know of studies that prove it's more effective than oral versions of basically the same kind of substance (Cosequin). Can you point me to any actual clinical studies that show benefit of adequan over oral glucosamine/chondroitin? Or any studies that show it can be given sub q instead of intramuscular (which he said would need to be given at their office and stings badly)? I'd love to be able to show him some research findings!

And a question for those who give SEB - how/when do you give it? Straight powder? Syrup made with water? With food? Before food? I can't seem to find a single answer, it seems like everyone does it differently. My understanding is it can interfere with absorption of food and meds, so to give it 1-2 hours before/after food or meds, but I've also read that people just sprinkle the powder on food at mealtime. Is there a "best" way to administer it to get the most benefit, specifically for constipation treatment?
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I always gave adequan subcutaneously.
http://healthypawsanimalhospital.com/category/arthritis/

I tried the cosequin and dasuquin... and got no improvement at all with those. That's why we went up to the adequan shots.

also see this article...
http://www.petmd.com/blogs/fullyvetted/2010/march/adequan_cats_dogs-7028

i googled adequan subcutaneous and found many references that say either way. I think the intramuscular is more for horses.
 
Megan and Boots said:
@Marje and Gracie , @Bobbie And Bubba and anyone else who gives egg yolk powder - how do you give it to them? Mixed into food? Mixed in water and syringed? Gel capped? I made some today with 5 eggs following the Food Fur Life recipe.
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I mix it into food. Good to start small, so a pinch is good. I am also mixing extra water into food. That should help if you aren't already doing that. Hope you see some improvement soon!
 
Megan and Boots said:
@Marje and Gracie , @Bobbie And Bubba and anyone else who gives egg yolk powder - how do you give it to them? Mixed into food? Mixed in water and syringed? Gel capped? I made some today with 5 eggs following the Food Fur Life recipe. Put a pinch on a plate after he got his pills and ate a couple bites of food. He sniffed but showed no interest in it. Not sure if it's because he doesn't like the smell or because of whatever else is making him not want to eat generally. Do cats typically eat it right up, or at least accept it mixed in food?
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I’ll have to leave that up to Bobbie. Both of my cats are young, eating raw, and have normal poos with no hairballs. Before they made the powder, I had the occasion to need a tiny bit of egg yolk one time to get things moving after Tobey had a bit of soft stool and I had given him a tad too much S. boulardi.
Megan and Boots said:
Also, anyone have any experience on how long it might take to see some anti-nausea benefit from these meds, if in fact it's nausea we're dealing with here? In the past when he's had low appetite and we've used Cerenia alone, it's always seemed to take 24-48 hours before we noticed him eating better. Is ondansetron any quicker? I'd think maybe, since it's dosed more frequently?
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I’ve seen it usually working within about 30 minutes but I know with others, it can take an hour or so. It can be dosed up to three times a day while cerenia is once daily.
 
Megan and Boots said:
Got a call back from the vet! He recommended Cerenia because he doesn't use Ondansetron as often, but said I could try both together if I wanted to really throw everything we've got at Boots now to get him eating. He said they're fine together, and shouldn't interact with his other meds. He actually said to stop the cyproheptadine and see if the anti-nausea meds do the trick to get him eating. Vet didn't like that the cypro didn't do the trick on its own and also seems to be causing side effects (when Boots is up from his naps, he is vocal and seems agitated and it takes him too much time to settle back down). I have a script for Mirtazapine that we can fill tomorrow just to have it on hand.

He also said 2-3mg dose of ondansetron once per day - does that sound like what others do? I've read once per day or twice per day on different sites.
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When Max got the right amount of ondansetron he no longer needed cyproheptadine. I started at 1mg but he needed 2-3. I disagree with your vet as to frequency. My vet and others have said it only works for a few hours and can be given every 8 hours. Max did well getting it morning and night when needed until his last week when nothing worked. Cerenia can be given once every 24 hours and I know many that have given both drugs. It’s a trial and error thing but the two drugs work in a different way to stop nausea. It’s quite common on the lymphoma lust to give both. It depends on the severity of the nausea.
 
Megan and Boots said:
Got a call back from the vet! He recommended Cerenia because he doesn't use Ondansetron as often, but said I could try both together if I wanted to really throw everything we've got at Boots now to get him eating. He said they're fine together, and shouldn't interact with his other meds. He actually said to stop the cyproheptadine and see if the anti-nausea meds do the trick to get him eating. Vet didn't like that the cypro didn't do the trick on its own and also seems to be causing side effects (when Boots is up from his naps, he is vocal and seems agitated and it takes him too much time to settle back down). I have a script for Mirtazapine that we can fill tomorrow just to have it on hand.

He also said 2-3mg dose of ondansetron once per day - does that sound like what others do? I've read once per day or twice per day on different sites.
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I also agree with Elise that you can dose it more than that. I’d see if the cerenia and ondansetron together work better. If you think you need to give Mirtz, give a lower dose. Did the vet tell you it could be given daily or once every three days.

Girlie's mom said:
What's SEB?
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Slippery Elm Bark powder. It’s fantastic for constipation, diarrhea, intestinal inflammation, etc. It’s best to get the pure, certified SEB powder that you buy in bulk. You only need about 1/8 cup to start.
 
The Egg Yolk Powder that you can get from FoodFurLife is a great addition for cats who are throwing up hairballs which is not a normal thing. Start with a pinch of it and mix into food. The next day a bigger pinch of it mixed into the food until you are giving 1/4 tsp of it twice a day which is where I am with both my cats. It has really helped! Bubba was throwing up hairballs a couple times a week. After I started it, he had another 2 hairball episodes and then not again since mid Sept. I am thrilled. Also, between the Egg Yolk, SEB and George's Aloe Vera Juice, he has been really good with constipation and throwing up .
 
Megan

I’m sorry I just got a chance to look at Boot’s Labs. Here are some things I’m seeing:
  • His cobalamin is normal but his folate is elevated. This can potentially indicate proximal SIBO or small intestinal bacteria overgrowth unless he is getting a folate supplement.
  • We know he’s got an elevated specfPL and that can be due to pancreatitis or the triaditis. His TLI is elevated and he’s sort of in that gray zone between high normal (82) and 100. Over 100, it would indicate CKD, pancreatitis, emaciation
  • His phosphorus is too high. He needs to be below or as close to 4.5 as you can get it. If you aren’t feeding a low P food, it would really help him out if you started. Try to find a LC food that is less than 1.00% P on a dry matter basis or less than 200 mgP/100kcal on as fed basis. Controlling the P is absolutely essential for longevity and feeling well.
  • His potassium is too low. Although it shows 3.4 as “normal”, anything below 4.0 is too low for a CKD cat. Ideally, it should be around 4.4. With CKD cats, if the serum level is 4.0, it’s less than that in the cells where he needs it. OTOH, insulin can cause the uptake of potassium into the cells and so the serum value will be lower. However, I don’t think it’s a good idea to assume that when a cat has CKD. I would talk to my vet about supplementation. You might want to read up about potassium levels on Tanya’s CKD site so you can discuss it with him.
  • His urine MA is high. This can be part of the CKD but it’s not so common to see a kitty in such early stages have a high MA. Has your vet checked his blood pressure? I would be sure he/she does it every time you have him in. CKD cats are very prone to high BP. I would also consider obtaining a free catch urine sample and having your vet send it off to check the urine sediment unless the lab already did and it’s noted on his labs but you didn’t put it on the lab tab.
Let me know if you have questions.
 
Megan and Boots said:
I have Cerenia and Ondansetron here. Vet has officially prescribed Cerenia for his use; I was given the ondansetron to try but have not run it by our vet yet.

Should I give him one, or both, or wait for the vet? I just can't sit around not trying something. I don't want him to not eat. I can live with it being difficult to get him to finish his plate, but to not touch it can't continue. If you think I should give him ondansetron, what's the normal dose? He's about 10.5 - 11.0 lbs currently, and I have I think 8mg pills I could use.
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Ondansetron and Cerenia each target different nausea receptors. One or the other or both may work better in the cat. At one point, it took both to help Neko. She got onda twice a day, about 40 minutes before her main meals to make sure she felt up to eating.
Megan and Boots said:
I have a script for Mirtazapine that we can fill tomorrow just to have it on hand.
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Try to get the transdermal form if you go that way - less side effects with that format. Here's a recent paper about the new dosing recommendations.

Best of luck - it's tough on the bean too, battling multiple conditions. :bighug::bighug::bighug:
 
Hi Megan,

My heart goes out to you. I know so well the difficulty of trying to decide how much to put your cat through to prolong his/her life. The vet you saw sounds like a gem. I'm glad you are putting a plan together, and I hope it works out. You've gotten some great input here. I can only echo what others have said about Ondansetron. I gave anywhere from 1 to 4 mg to my cats. Typically I gave 2 mg twice a day. With some of them, at times I gave the Ondansetron and Cerenia together. Sometimes I needed to add the Cypro to that. I tried Mirtz, but prefered the Cypro because the side effects were not as pronounced, and you can give it twice a day. ECID, so I'm afraid you will have to find out through trial and error what combination works best for Boots.

I'm sending you my strongest appy vines, along with plenty of :bighug:s.
 
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