older cat will not eat

[rafis]

Persephone is 15 yrs old, spayed, indoor cat, has always had good health. In recent months, she has seemed to lose interest in food, and only eats a few bites at a time. She has lost weight and is very thin now. The clinic ran blood tests and her kidney, thyroid, and liver are all normal. The vet couldn't find anything wrong with her. I am thinking that perhaps her sense of smell has diminished, causing her to lose interest in eating. I've tried many things - various canned foods, and dry foods, treats, cooked chicken, liver, turkey, tuna, mackeral. The only one she seems to like is the treats and the kibble. Her teeth were looked at, and could use a cleaning, but there were no apparent serious problems, and the vet would prefer her to gain a little weight before putting her under anesthesia. I'm out of ideas to tempt her, any advice?

[Auntie Debbie]

Good start with the bloodwork. Has her teeth and gums been evaluated? How extensive was the bloodwork. Was she tested for Hyper T at all? There are various causes for a cat losing weight and/or not eating. If she is having dental or oral problems, that would prevent her from eating. If she has diabetes, hyperT, cancer and a few other conditions, she would not eat as much or possibly lose weight despite how much she eats.
Seems your vet should be looking into further diagnostics, such as xrays or an ultrasound to start with. if he isn't showing much interest in doing so, please find another vet that will look into her condition further. I hope she'll be okay!

[Traci]

Yep, if your current vet isn't addressing kitty's inappetance, it's time for a second opinion immediately and possibly additional diagnostics. Were xrays done? What did the bloodwork entail, was it a complete CBC and complete chemical profile with BOTH T4 and T3 thyroid function testing? Was urinalysis done? Was an ultrasound even mentioned?

You can't afford for her to lose more weight, if she's not eating, this is NOT GOOD. Please see a new vet, have your current vet fax all kitty's health records and lab work to the new vet pronto, preferrably a feline-only vet. If she's not eating sufficiently, her vital organ function will be compromised, and in a 15-yr-old kitty, you can't take that risk.

[Tigerlily]

I'm a newbie here. I also have a 15YO female, spayed, always indoors, with CRF. She is otherwise healthy, except for allergies which sometimes develop into an ear infection. (I am currently giving her Zeniquin for her current ear infection.) Her kidney numbers were stable for a very long time but at her last visit 2 weeks ago they have gone up a bit to mid-range levels, not great, but not yet critical. Her thyroid and glucose are normal, as are phosphorus levels.

My constant problem with her is that her appetite comes and goes and is generally getting worse. I have tried her on every brand of (wet only) cat food that I can find. If I'm lucky, she may eat something new for a day or two but then won't touch it. She cries for food much of the time but then then refuses everything I give her. Most of the time, she will eat bites of baked chicken or (rarely) fish but some days I can't even tempt her with human food.

On the advice of her vet, I also give her 1/4 regular Pepcid daily but even with this I think her stomach is still upset a lot of the time. She does vomit occasionally (usually hairballs) but not excessively so, with occasional runny stool for a day, which always goes away.

Her vet also prescribed an appetite stimulant but I have been unable to try her on it because of the Zeniquin and Pepcid. I have to medicate her with Pill Pockets and she will only eat one. 3 pills a day are too many for me to try and give her in one Pill Pocket. I have to pick my battles and right now her ear infection has to be taken care of.

I know this post has been all over the place but I am so discouraged and frustrated at her constant refusal to eat, even though she acts hungry. Any help would appreciated.

[Traci]

Tigerlilly,

What are you feeding her? What have you tried in the past, have you tried specific veterinary diets in both canned and dry?

Has your vet ruled out esophagitis, oral or teeth problems? Teeth problems, especially abcesses or diseased teeth can reek havoc on CRF kitties (any kitty for that matter, but compounded in CRF cats).

What exactly is the ear infection, and why is it seemingly persistent? Has the vet ruled out pseudomonas? If so, this is difficult to eradicate, but consistent appropriate treatment with a specific ear treatment protocol can help, even cure in some cases.

What is kitty allergic to? Were any allergen tests done to pinpoint certain allergies? Has the vet ruled out food allergies, environmental allergies?

An appetite stimulant can oftentimes be compounded into a liquid form, ask your vet about that. It's easier to give via syringe orally than trying to pill a cat who otherwise is taking other medications. Also, try feeding a small amount BEFORE any meds are given, since it is more comfortable for the cat and the cat's stomach.

[Tigerlily]

Traci,

Thanks for your response. First, I neglected to mention in my original post that her teeth and mouth have checked out OK. She had a thorough cleaning less than a year ago and her vet checks her mouth almost every time I take her in. Esophagitis hasn't been mentioned. What is that?

Through her kittenhood and early adult years, she ate ProPlan dry food almost exclusively. Then the formula changed and she didn't like it so well, so I had to find something else she would eat. She refused dry food, high-quality food included, so one day I fed her some wet food and she never looked back. She hasn't eaten dry food since then, except for crunchy treats now and then. She has mostly eaten chicken and turkey varieties of Fancy Feast. When the CRF was discovered, I tried her on the prescription diet, which she refused. I have also tried her on the Iams intestinal diet, which she will nibble on, but not enough to sustain her. She tires of the same thing quickly. In the last day or two, I've mixed in a little chicken baby food with her food, and she seems to like it, but she'll get bored with it soon.

To backtrack on the allergies - in April of 2008 she began scratching at her neck and ear. At the time, she was seeing another vet who didn't really give her a very thorough exam but came to the conclusion that she needed a steroid shot. Not knowing enough to say no at the time, that was a bad idea. She ended up with steroid-induced diabetes and extreme vomiting and diarrhea. But still the scratching continued so I took her to a veterinary dermatologist who diagnosed her with ringworm of all things. She was on Fluconazole for 3 months and subsequent skin cultures turned out OK. The scratching, which we assumed was caused by the ringworm, gradually subsided over last summer. Fast forward to this spring, when the scratching started up again. The ringworm had not come back but when I gave her current vet her background, she immediately suspected allergies, since this has happened 2 years in a row. In hindsight, I don't know if last year's itching was caused by the ringworm or allergies.

We don't know what she is allergic to because no tests were done. As I said, she has only had this condition for the past 2 summers and it appears to be seasonal so I am assuming it is environmental. At any rate, an infection always seems to settle in her right ear. Her vet has cleaned it out and did a culture on the debris she removed, which turned out to be mostly yeast. So we put her back on Fluconazole, in addition to the Zeniquin. It cleared up until I opened my windows a couple of weeks ago and it was then that the scratching started up again. Wrong or right, I made the connection between the scratching and the open windows, so now I am keeping them closed. At any rate, her ear is infected again.

What are pseudomonas? The vet has not mentioned this.

You mentioned putting the appetite stimulant into a compound form, which I'd like to comment on. Lily is the absolute worse for administering meds. I live alone and have no one to help. She is all claws and is the squirm-iest cat I have ever seen. She is impossible to hold down, while at the same time getting her mouth open to put the liquid in. She won't swallow it and it dribbles right back out. It takes both the vet and her assistant to do any sort of procedure on her, even just sub-q fluids. She stresses so easily, I sometimes wonder if I'm really helping her. The word 'fractious' was invented for her.

Thanks again for your help. Sorry this post is so long. We've been through a lot the past 2 years!

[Traci]

Esophagitis is anything from inflammation to irritation of the esophagus, either by acid upset or result of medications or strictures of some type. Symptoms usually include difficulty eating, head-cocking, or the pet keeps the head and neck extended, seems painful from the neck or throat area, difficulty in or attempting to swallow, sometimes drooling or smacking at lips, sometimes regurgitation of food (regurgitation and vomiting are not the same, regurgitation occurs before or at the point the food has entered and started digestion in the stomach).

Your kitty might have had dental cleanings, but when were her last oral xrays?

The occasional vomiting and runny stools are probably indicative of too many different types of food offered. It's best to try to stick with only one brand or type of food, and only add something of a similar brand when inappetance occurs. Yes, at these times, it is better for the cat to eat something rather than nothing, but in this case, you have to be careful about the type and variety. The runny stools should always be brought to the attention of your vet, she may want to re-evaluate the diet or give sub-q fluids to combat dehydration or rule out other causes.

Don't automatically assume the allergies are environmental. While there is a possibility, this is more common in dogs than in cats. It could be merely timing or coincidence that the ear infection flares up in the warmer months. Most infections like this wax and wane, so it might appear to the owner that it is seasonal when in fact, it is not, it is timing, like persistent infection, unresponsive to treatment. When you look back, I'm sure you can see the months in between treatments, so that can be taken into account with timing.

Pseudomonas are infections within an infection. They are difficult to treat for the vet who isn't looking for a pseudomona specifically. A culture should always be done on any newly developing infection, because these can change from one type to another bacteria. Treating AS IF a pseudomona can sometimes be helpful as well, to hopefully target some bacteria that other antibiotics or fungals won't. Ask your vet about that. Also remember that ear treatment must be consistent, meaning that no schedule should be missed, that proper cleaning, gentle application of ear-flushes or topicals or drops must not be in amounts that flood the ear. After the cleaning solution is applied, it's important that any debris is removed as much as possible (yet not going too far into the ear canal which can cause irrepairable damage) and any liquid is blotted dry so the ear is not flooded before a topical or drop antibiotic is used.

The diet may or may not be culprit. Some cats have serious allergies to certain ingredients in their food, whether it is a food protein or an ingredient like colors and dyes, the vet has to narrow it down by process of elimination. She should have attempted a hypoallergenic diet or a novel-protein diet to see if the condition would improve on a single-source protein. This trial and error/process of elimination can take upwards of 4-8 weeks so owners must be patient and followup with their vets as they recommend. It's possible one or both the chicken and fish are intolerable for your kitty. I wouldn't feed beef either as it is a common food allergy for some cats. Dairy products are also a culprit for some cats. Some fish, like ocean white fish or salmon seem to be tolerable for some cats, while others can only tolerate another type of fish. Talk to your vet about the possibility of the fish type in the Fancy Feast. Also ask about the hypoallergenic diet options. Remember that there are several veterinary diets (available in canned and dry), so if one brand doesn't work, you have more options with the other veterinary brands.

The nice thing about veterinary diets is that your vet knows if the dietary ingredients remain consistent. If the manufacturer changes an ingredient, they are most likely to inform the vet community, whereas commercial food manufacturers don't. Your vet always has availability to discuss the diet with the manufacturer, whereas a commercial vendor won't be so open to discussion of ingredients.

Ringworm can only be accurately diagnosed with a culture, NOT be a woods' lamp. Hopefully, the first diagnosis was reached by the use of a culture. When ringworm is diagnosed, with treatment it is wise to followup on subsequent cultures to ensure the ringworm has been eradicated.

Is the diabetes resolved, or does she still have diabetes and is on insulin management? If she's on insulin, the Fancy Feast probably doesn't have a very good carbohydrate ratio/low fat ratio for a diabetic cat.

I understand fractious cats, but at least try the following: Sit on the floor on your knees, with her rump facing your knees (she in a sternal position, belly to the floor or at least sitting on the floor, her front is facing away from you), gently close your knees around her abdomen (not tight, just enough she can't escape). With your left hand, raise her chin slightly, with your right hand insert a syringe with liquid medication into the lower corner of her mouth/lip, squirt the syringe's contents in the lower lip's pouch, gently keep her mouth closed, and keeping her chin slightly raised upward, with your right hand, gently rub her throat, or, blow a gentle puff of air onto her nose, this inevitably causes them to swallow. Don't worry if she froths or drools out some of the liquid meds, as long as she swallows the majority of it, she has received the appropriate amount. The drooling or frothing is a result of bitter taste of the meds or stress. With a gentle and quick approach, it gets easier for both you and the cat. You can also do this on your kitchen countertop to some degree, you'd use your elbows to restrain her next to you and use the same method with your hands to administer the meds. The more proficient you can be, the less likely you'd need a towel to wrap around her or deter scratching etc. Towels and other methods tend to stress them even more.

Btw, some cats have slight allergic reactions to fluconazole, you should rule that out with your vet. Scratching or irritation and inappetance are some of the milder symptoms, others include vomiting, diarrhea and even worse symptoms.

Maybe talk to your vet about opting for a different veterinary brand diet for the CRF, and maybe giving her a hypoallergenic diet a few times a week (this could be helpful when ruling out Fancy Feast as a possible culprit). If she's still diabetic, you truly need to manage it properly with an equally-designed diet for diabetes. Your vet manages multiple-condition pets all of the time, she can come up with a suitable diet or combination diet that addresses the primary health concerns without compromising the other concerns.

[Tigerlily]

Re the esophagitis, Lily really does not have any of these symptoms that you mention but I will ask the vet about the possibility.

Re the teeth, I believe oral x-rays were taken at her last cleaning but, again, I'll check.

Re the food, I realize I've offered her too many foods but when you're desperate for them to eat something, ANYthing, it's an easy mistake to make. She does eat almost exclusively FF. Doesn't seem to really like types of seafood all that much so I don't give her those much at all. That will be a daunting task, especially for this particular cat: trying by process of trial and error to find a food she can tolerate but, more importantly, will eat. I'll add this to the list of questions for her vet.

Question - with even a finicky cat, is it possible to consistently give them the same food, whether they want it at first or not, and when they discover they're not going to get anything else, will they eventually eat it in enough quantities, and get used to the same food every day? Will a cat starve herself because she doesn't like the food offered? The constant begging and then walking away from whatever I give her is getting me down.

Re the ear infection - it was at her last vet visit about 3 weeks ago that her ear was checked and it was completely clear and there was no more head or neck or ear scratching. It all came about again when I opened up my windows, so naturally I'm going to blame that. I'll also ask her about pneudomonas. She did do a culture on her ear and found it was mostly yeast, hence the Fluconazole earllier in the summer. Topical treatments were not entirely successful. They either burned or tickled and made her scratch and dig at her ear all the more. I wondered if the treatment was worse than the disease and in the end, the antibiotic and antifungal oral meds seemed to have worked, until now, that is.

Do you feel that another visit to the dermatologist might be in order?? Are ear infections within their scope?

She was also on Fluconazole for the ringworm and she seemed to tolerate it very well. Since the scratching and finicky appetite were occurring before she was on it, I don't think that med was the cause. The dermatologist did do a culture, so I trust the diagnosis. 3 follow-up cultures were subsequently done a month apart, all negative, and she was pronounced cured of it, although as was explained to me, it can recur.

Re the diabetes - her last blood glucose was 139, which is down from significantly higher levels after the steroid injection last year. She has never been on insulin. She does not exhibit any of the symptoms normally associated with diabetes (other than increased drinking and urination due to the CRF). Her vet feels it was completely steroid-induced.

Thank you for the tips on administering liquids. Every bit of advice helps!

[Traci]

A feline dermatoligist is trained in all areas of allergies, in all locations on the body, so yes, ears would fall into their scope of knowledge.

I doubt she would starve herself from not eating a particular food you put in front of her, but you and your vet are the only ones who know her best. You have to determine if her actions are a conditional reaction (being spoiled, therefore you give her different things, then she gets conditioned to get a response to her begging, whining, crying, or whatever),...or....if she really cannot tolerate the food you're presenting her. Your vet has to help you with that determination based on her health history, her behavior, her overall condition. If she's already somewhat thin due to her age and the CRF, you can't risk her losing weight by not eating what you put in front of her. Like I mentioned, ask the vet about a combination of one or two different diets fed at different times throughout each week so that both primary conditions are being treated, at least in the dietary sense.

As for diabetes, even those symptoms of increased water consumption and increased urine output are the same exact symptoms of diabetes (weight loss is also a common symptom). Also, with age and another primary condition to contend with, diabetes could occur at any time. So, you want to followup periodically with urine testing (to check glucose), but ultimately, when you're checking her renal bloodwork, you also want to check her glucose levels in the blood AND urine. I'm sure your vet is aware to keep an eye on these, but you may need to remind her, to ask about blood and urine glucose each time you're testing the kidney levels.

[Tigerlily]

Just an update - I spoke with the animal dermatologist and, while he answered some of my questions, he of course still wants me to bring her back in to see him. He wants to first rule out whether or not the ringworm has returned. He's the doctor, not me, but I just don't think that's the problem. When she had it last year, her fur came off in patches on her neck and face and her ears had a dark crusty ring around the tips. She looked awful then, but now you'd never know anything was wrong just to look at her. It seems to me she'd look the same if the ringworm had returned.

He also said it was really unusual for a senior cat, as opposed to a dog, to develop allergies so late in life if she had never had them before, and he doesn't necessarily think allergy testing is the be-all end-all answer to helping her. If it puts her through some period of discomfort, then I'm not so sure I want to subject her to that anyway.

I guess I'll take her back, but I wonder what the point is if we're never going to figure out what's causing the problem. At best, is all I can do is keep her doped up so she doesn't scratch? Don't misunderstand - of course I want her to not feel itchy anymore and want to do all I can to help her, but I guess I've just lost hope in getting to the root of the problem and making it go away. This vet is 40 miles away, Lily is old and fractious and not a good traveler, and every trip to the vet takes a little more out of her. Why should I put her through it again if nothing's going to change and the itching is going to keep coming back? Sorry - I'm just very discouraged.