Frosty update - 8 weeks on vetoryl - vomiting. Back to IM vet

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So 2 weeks ago, I came home with cat vomit all over the guest room bed. I mean ALL OVER - you could tell the direction the cat was vomiting (it was clearly projectile). I fed everyone that night, and everyone tolerated the food fine, no issues. I also noticed some diarrhea in the litter box, so I separated the cats for 2 days while at work to try to figure out who it was, and of course the diarrhea magically resolved. Things were good for 2 weeks. (Except I had to throw away the blanket after washing it 4 times - twice at the laundromat in a high capacity washer. It was completely ruined).

Then yesterday, Dan came home to vomit all over the house. We suspected it was Frosty - the vomit was in the usual places where he lays, and he was acting extra hungry. His sugars were also slightly higher than usual, so we figured he may have bounced after going lower than normal after vomiting. Then he vomited his dinner, so now we knew for sure it's him. He was acting fine otherwise.

I called the vet and they said I may want to bring him in for an ACTH test in case he is being too suppressed with the Vetoryl, and that's causing the vomiting. We were supposed to come back in 3 months for the next test if all was going to be well, but since there are new symptoms it would be wise to check him.

So I just dropped him off at the IM vet, which his an hour away. Another $500, and more screaming/peeing in the car. This really sucks. But since he's only been on the medication for 2 months, and he's way more energetic than other cats, I really don't know if his cortisol levels are too low or not. He doesn't ever get lethargic, no matter what's going on. And I don't have enough experience with this yet. So I had no choice.

If I were to make an educated guess, I would say his cortisol levels are fine, and he is having some tummy trouble. I don't know if it's just the color of the cat food, but the vomit looked almost blood-tinged to me. I asked the vet last night if I could give him some Pepcid or something, and she said I can try giving him 5 mg (1/2 10 mg pill). I am thinking that maybe Vetoryl is upsetting his stomach. It doesn't explain why he doesn't vomit every time he takes it though - only twice in the last 8 weeks. But since both times the projectile vomiting was in the morning, I figured it may have something to do with the medication, since he gets it with his am feed.

I gave him the Pepcid with some treats last night, and he held it down. This morning, I only gave him 1 can FF instead of 2 - in halves, 15 minutes apart, so he could take the Vetoryl. I gave him 2 units lantus instead of 2.25 since he got less food than usual. No vomiting when I dropped him off an hour later. He is acting fine otherwise, no diarrhea, not lethargic, just being his crazy self.

I need to remember to ask them for kitty Xanax before I pick him up tonight, because I really can't take his antics in the car on the way to the vet. It's awful. He was howling like a wolf at some points.... I also want to ask for something for nausea/vomiting for him as well, in case it's not the Vetoryl that's causing this.

I probably won't get the results til Monday, so I'll post an update when I get some information. His regular vet isn't there this weekend either, which kind of makes things more complicated as well. I hope she is back on Monday so I can update her on everything and we can go over the numbers and treatment going forward.

Hope everyone else is having a good Caturday

 

That's really unfortunate about Frosty - the vomiting, and the deep anxiety with the car.

I don't have any experience or advice about Vetoryl. But I have a similar experience. 15 years ago I had a toenail fungus, in the big toe. The doc prescribed some oral anti-fungal. I took it the first 5 days, no issue. The 6th or 7th day, I would take the pill, the 15 minutes later up came breakfast. Same thing the next day. It was a direct correlation. So the first period of the medicine (5 days), I was fine. Then my body decided "this is crxp, time to expel". The medicine said a potential side effect was vomiting. Anyhow, it was a delayed reaction. Maybe the same for Frosty.

Leo used to yowl in the car. That was before the 2+2 days round trip to Ft Collins in 2016. He still doesn't like it, but no yowling. Poor Frosty, he just doesn't understand.

 

I hope you get the test results today. Sounds like a real mess to deal with!

I found a new paper on a case study of a Cushings kitty going into remission on Trisolane (Vetoryl). Thought you might be interested. The paper discusses doses and shows his BG response over time. But it also sounds like it's very much ECID on response.

 

Thank you, Wendy, I'll take a look.

Just wanted to update you guys on Frosty. So I treked him all the way to Tinton Falls on Saturday morning at 7 am, and he got his ACTH stimulation test done. He held down his breakfast that morning. The vet was reluctant to give him any anti-nausea medicine because she didn't want to "mask" a problem, and said that if his levels are normal and he continues to vomit, he needs a full set of blood work and a belly ultrasound. She suggested we take it one step at a time, meaning ACTH stimulation test first, especially since he didn't vomit in the am. He only got 1/2 of what I usually feed him that morning, but nevertheless, he didn't throw up.

I continued to give him pepcid and hair ball medicine, and holding Vetoryl on Sunday and Monday. He tolerated 4 small feedings on Sunday.
Monday morning, I noticed his poop was dark - almost black. Could mean some upper GI bleeding - I thought his vomit may have been blood-tinged, but wasn't sure if it was just the color of the food he ate? So yesterday morning I gave him 3/4th of what he normally eats, and came home to a small amount of vomit, but not all over the house or projectile, like on Friday. He tolerated same amount for dinner last night and breakfast this morning.

Last night, after calling the vet 4 times, I finally go the results - ACTH stimulation test was normal, so the Vetoryl dose and over suppression is not the problem. THAT'S WHAT I THOUGHT! I also realized that I had been conversing with an Emergency vet, not an IM vet like I had thought. She said if he continues to throw up to bring him in as an emergency and get the full GI workup. She said they even do endoscopies on cats. I didn't think an emergency visit was necessary, so I made an appt with an IM vet on Saturday. I figured that way I can see how he does for the rest of the week, and talk to a doctor who is more familiar with Cushing's and Vetoryl. The EM doctor had no idea whether the Vetoryl could cause gastritis or ulcers or anything. our IM doctor is away this week, but I hope her partner will be more helpful than the EM doc, since they seem this stuff a lot more.

Meanwhile, I sent an email to Dr. McCue yesterday. @Amanda & Shmee @Bronx's dad - I have not yet heard a response from him. I am a little disappointed to be honest, and I am not sure if maybe I included too much information? I did mention some of Frosty's GI issues, and my concerns that he is not tolerating the Vetoryl, which was my main reason for interest in surgery. I don't know if maybe I should have discussed more of that with him on the phone, or during a consultation? Did he maybe decide Frosty would not be a good candidate, and didn't wanna bother responding? I am kind of upset about it, I wish I had written the email better. Am I just being impatient? It sounded like he responded to you guys pretty quickly. I am wondering if maybe I should call the hospital tomorrow and tell them I have a cat with Cushing's and was interested in a consultation with the doctor? Any advice from you guys would be really appreciated.

So I just feel physically and emotionally exhausted after this weekend. It seemed like Frosty was doing SO WELL - almost too good to be true. And I don't know if these GI issues are something related to Cushing's (the medication, prior gastritis from cortisol excess,, pressure on the brain from enlarging pituitary tumor???), some other unrelated GI issue or ulcer, or even tumor, or something as simple as a hair ball? I've never seen projectile vomiting like this with a hairball though, and I've had cats my whole life. It's such an up and down journey with him, and it's frustrating because I want to so badly for him to get better and be well for a little while.

Thanks for reading. I really needed to vent. Any input/advice is always appreciated.

 

That sounds encouraging about Frosty. At least his vomit has decreased.

It can be challenging to work with vet specialists, as they have many patients to timeslice their efforts into. I'm glad you got some good info back from your EM doctor.

For Dr.McCue, he doesn't know you yet. Maybe you could schedule an evaluation appointment, even if it is over the phone. Imagine being a Vet specialist doctor. There is limited time to work with. I know that CSU works similar to that - they require a paid consultation before they give info. We had a member here who thought CSU should give her a bunch of time on the phone for free. It doesn't work that way (at least with them). And really, it wouldn't be that expensive overall.

Also Dr.McCue could be on vacation!

I am in the computer security field. I used to do general consulting. Some customers would ask me to evaluate their company - is it at risk, what are the issues, etc. The serious ones would realize that is a paid part of the consulting. The others thought somehow this early phase was free...and it could take 2-40 hours depending on what they wanted me to evaluate. Just saying is all....

 

I don't mind paying at all, but both Amanda and Bronx's dad communicated with him by email and phone which is why I emailed him also. I will gladly take Frosty on another visit if he emails or calls and says "yes, please come see me for a consult." I am not sure if you read any of their posts or not...

 

I am so sorry Frosty is not feeling well that sounds awful. I hope the IM vet has some insight for you.
As for Dr. McCue, I would have called initially but I'm sure an email is fine. Last time I emailed him he took a few days to get back to me, don't worry he will respond he is just very busy. At this point since you sent the email outlining everything I think I would just wait for a reply. If he does not email back after three days I would call. Totally up to you though.

 

That sounds good, thanks. I guess my anxiety is just through the roof with all of this, so I may totally be over-reacting. Also, Bronx's dad said the doctor will be away next week, so I guess I am just anxious to hear back this week.

Do you guys think I should still take him to the vet on Saturday to see the IM if he is not vomiting anymore? Or should I wait? I don't really know what to do. We have a vacation scheduled at the end of August, and I just hope he continues to tolerate food and do well until then. We will only be 3 hours away if anything, already paid and we have 2 pet sitters, but I am just so worried about him. Thanks.

 

Likely. If he has a busy day he may not get back to you until early evening. Neko's IM vet was always slammed during the day and I got most responses late in the day or early AM before visits started. And if he's going away, probably has twice as much to do.

Any change in Frosty's food or proteins the last little while?

 

I wouldn't take Frosty back to the vet if his symptoms have subsided. Even for people, we go thru short episodes of food intolerance.

I hope you are able to connect to Dr.McCue.

 

Nope. Still eating the FF pates. He eats all the flavors (unlike my other 2 who are SO picky... it drives me crazy). The first time (the "bedroom" massacre), it was Salmon flavor. This time it was tender beef and chicken. I actually meant to look at their nutrition content to see if there's any pattern (such as high fat, for example?)

On another note, I just changed Frosty's clothes (I can't believe this is my life LOL), and he actually looks really good. His fur is much thicker and he has filled out so well! No more bony spine or wasted hip bones. He actually almost looks on the chunkier side... like, he no longer has that big belly but I think he may have grown into it! Ha!

I am trying to calculate how many FF cans he would need in a day. He's 14 lb. I think that's a good weight for him. At 13, he looked kind of wasted. I have done the math before, and I think it comes out like 3.5-4.5 cans, so I used to give him 4 - 2 twice a day (since we have failed miserably with various brands of automatic feeders.) It is kind of a lot, and I WISH it were possible to feed him smaller meals more frequently, but he has always been eating that much with no issues. I really do hope it's just a fluke. I am tempted to post the picture of the vomit all over the bed from a few weeks ago just so you guys could see.. it's pretty impressive. The room smelled like Salmon for weeks. But that's gross so I won't, haha. Cute Frosty in clothes pics only!

 

I should amend that. I get them the 30 packs of beef and poultry flavors, and seafood flavors. Beef and poultry has tender beef & chicken, turkey and giblets, and tender liver and chicken. The seafood one has tuna, salmon, and code, sole,&shrimp. He's been on that from the beginning. I mix them up for them so they don't get bored. He doesn't care what flavor he eats, so sometimes he gets what the other cats don't like. But otherwise it's all been the same.

I give him the Vet's Best Hairball Relief digestive aid. I stopped it for a while because he was having loose stools, but maybe I was giving him too many. I was giving him 2 a day like the directions said, now I am giving him one with dinner. He gets pepcid and vetoryl in the morning for breakfast.

 

Instead of looking at nutritional analysis, I would look at ingredients. Often fish can be an allergen. As is beef. As for amount of food, it depends a bit how active Frosty is. Neko was around 14 lbs and did fine on around 200 calories a day. I don't know how many calories in FF, I fed raw and she got 1/4 lb a day.

I like the FoodFurLife egg yolk powder for hairballs.

 

I see. I think Frosty was still catching up from the malnutrition that Cushing's has caused, but since he is starting to look better nourished now, maybe it's OK to cut back to 1.5 cans per feeding for now. I just don't want him to lose any weight right now. I hope his fur and skin continue improving.
Dr. McCue actually just responded to my email, so I guess I was all worried for nothing... it's just been that kind of a week.

It's funny, one week I am like, wow, everything is great! Frosty is doing so well! I totally have it all together! Then he throws up all over the house one day and suddenly the sky is falling...

 

Our boys like that flavor too. I smile each time I open a can "Tender Beef and Chicken". Like, how do they come up with that name? I guess it is better than "Beef leftovers and Chicken Parts".

The favorites here:
- FF Chicken - just plain ole chicken (parts)
- FF Turkey and Giblets, aka Turkey and Gib - even Chinus likes it, and the boys LOVE IT

I know you work long hours, and it makes it hard to feed them. Upon Leo's diabetic diagnosis, he was down to 12 pounds. We felt horrible we didn't recognize the weight loss. Arg. Now he is almost 18 pounds again. We free feed as much as possible.