Joe not eating

[Cleo]

So glad to hear Joe ate and I hope things go back to normal for him soon!

[jbweeks722]

Hi, I have an update on Joe. He has pancreatic cancer that has metastisized to his liver. (Diagnosed via ultrasound and fine needle aspirations of his liver and pancreas.) He has been eating but not as much as before and has been getting subq fluids weekly.

He acts ok except when he goes to the vet. He is then terribly stressed. He is still interested in eating though he doesn't eat alot. When I am home I feed him several times a day and I run home at lunch when I can. He is still social and follows me around and lays in the sun when we have some. Nothing has really changed except his eating less and losing weight. (He is now at 14.3 pounds from 21+ last April)

I just found out the diagnosis last night from the specialist and have not had a chance to talk to the family vet yet. The specialist suggests euthanisia now. I don't think we are there yet though I realize it it is likely a matter of weeks. He still has life and sparkle and a daily routine that he follows. I would appreciate any thoughts and suggestions that you have. I don't want him to suffer and am watching him for indications that he is.

[Traci]

I'm so very sorry to hear this. Is the specialist certain and does your primary vet trust the specialist's experience? (pancreatic neoplasia is somewhat rare in cats, including metastasis to liver, although any type of neoplasia can metasticize).

What medications have been discussed? Has your vet considered treating with medications that would be used to treat pancreatitis?

I would suggest discussing the following:

- buprenorphine (for pain control, any time the pancreas is inflamed, which I suspect Joe's might be, pain meds are imperative - it should be fine to prescribe this for long-term use, but in small doses since it can have sedative-like effects - notify your vet at once if you feel sedation is occurring, he will lower the dose accordingly)

- metoclopramide (an antiemetic, helps to prevent vomiting/nausea)

- fomatidine (i.e., Pepcid, helpful or ulcers, acid or lesions in or around the stomach etc)

Note: the latter two meds should be used cautiously in liver disease, discuss with your vet in detail.

- antibiotics, to help prevent intestinal bacteria, and as prophylactic use when dealing with pancreas and liver problems. Ask vet if an injection of Convenia might be applicable, since it is a fast acting, longer acting antibiotic as opposed to oral administration of a 7-14 day course of something like amoxicillin. (although oral amoxicillin might be a better choice for the liver, ask the vet his opinion)

- potential use of prednisone or prednisolone (to help decrease inflammation)

cyproheptadine (i.e., periactin - this is a type of antihistamine that is helpful as an appetite stimulant, but should be used judiciously with other medications to minimize side effects such as sedation or nervousness)

Ask the vet or specialist if any other medications could be helpful for the gall bladder, since the pancreas, liver, gall bladder are closely related in function.

Fluid therapy (sub-q) - fluids are very important if Joe is dehydrated and/or not drinking enough normally (or having constipation episodes). It doesn't have to be given every day unless the vet suggests to do so, he will tell you how much to give based on Joe's hydration level, his appetite, his weight, etc.

Food - generally whatever he will eat is always better than nothing. Preferrably something easy on his stomach, you could get a few cans of Hill's Rx kitty I/D to have on hand. Otherwise, offer both canned and dry food, and consider adding a small amount of tuna in water or canned white chicken in water to his food to encourage him to eat. Fancy Feast canned food is also a good tempter. Fancy Feast also has the little clear containers called "Fancy Feast Appetisers" that he might like. If he is now or starts to avoid some foods due to texture, try blending them with a small amount of water (or tuna or chicken/juice).

I'm not saying all of these meds have to be used at the same time. But they can be extremely helpful to alleviate symptoms and keep Joe very comfortable. Your vet can tell you which (or all in small doses) can benefit Joe the most.

I think it is premature to suggest euthanasia, since Joe is enjoying his routine and his life at this point. You know him best, and if you are willing to try medications to alleviate symptoms and keep him comfortable, I see no harm in doing that at all. It sounds like you know what to watch for regarding diminished quality of life, so use your best judgment, and enjoy the time you have with him. I do not know to what extent the metastasis is at this point, and you will have to take it day by day - even though it may be a poor prognosis when the pancreas and liver are involved together with neoplasia, only you know Joe best and can gauge how he is responding to medications (and by working with your vet).

Hang in there, give the meds a try, and give your little guy a big hug for me, my thoughts and prayers are with Joe and you!

[jbweeks722]

Thank you Traci. This will be quite helpful when I talk to my vet. The specialist mentioned pain and nausea meds and steroid and an appetite stimulant. So I am going to ask about those. I do have an appetite stimulant but have not given it to him (got it Monday night). He was eating like crazy Monday night and still drunk from the sedation. I am concerned about giving him meds that would adversely effect his liver. (I've been googling).

He has been getting subq fluids weekly and the next time in I'm going to have them train me to do it so we can eliminate that stress.

He stopped eating dry a couple of months ago. All I could get him to eat was Whiska's pate - turkey or seafood. Now he doesn't like it but does eat the Fancy Feast Appetizers. That has been his main food and I try to mix pate in it. Is clam juice ok to mix in his food? I read about that online but wasn't sure.

Thanks again for the list of meds and support. I feel better knowing there is something I can do to keep him comfortable for now. I'll keep you updated.

[Traci]

Try not to worry too much about meds and the liver - it is usually very long-term use or very high doses that would be concerning. I think your vet will prescribe relatively small doses. The prednisone might be prescribed a high dose, but will be tapered to the lowest dose possible. Remember too, that anything that reduces inflammation, (which can cause pain), will reduce the pain as well.

Clam juice would be ok, but in small amounts. I would pick up a few cans of white tuna in water and white chicken in water just to have on hand. Ill cats will sometimes avoid something they have been eating a long time, and may suddenly develop a taste for something else. (much of this has to do with nausea or pain etc - sometimes due to medications, be sure to ask your vet about timing of medications, as it is best for most medications to be given after food is given (like a half hour after a meal, ask the vet).

[jbweeks722]

That explains why he is not as excited eating the Appetizers this week. He has been less perky since going to the doctor Monday and that concerns me. I will try something different again. I did get him to eat almost all that I gave him at lunch. He will be getting subq fluids again Friday am. That always helps.

[Traci]

I always keep a small "stash" of various cat foods on hand for times like this. Of course, they have to be replenished at the expiration dates if not used.

I have a variety of Hill's Rx canned (A/D, I/D, Z/D, etc), Friskies canned varieties, Fancy Feast and the Appetisers, canned tuna in water, canned white chicken in water, canned salmon. For dry food and finicky cats, I "grind" it with an electric coffee grinder and add a bit of water to make a soupy or pudding-like consistency or add tuna juice or chicken juice (if by chance someone has a bad tooth etc). Any of the canned foods can be mixed with tuna juice or chicken broth (just a little, chicken broth is high in salt), in the blender and fed that way as well. You could even try any "senior" formula canned food, since these are generally made for sensitive stomachs. Kitten food as well, many cats will eat kitten food when they are finicky. Every cat is different and their tastes and appetite will be different when ill, as long as you offer something as a variety (when he is not feeling well), Joe should eat something. Try not to offer too many varieties at once though, as food aversion could develop. Remember, water is important, if at any time you don't think he's drinking enough, add a bit of water mixed into his food. Sometimes offering food at room temperature or slightly warmed with warm water helps.

[k9Karen]

I've followed your postings and am so sorry to hear what the diagnosis is. At this point, I think all you can do is keep him comfortable and love him. You'll know when "that time" comes. My dad died from pancreatic cancer, and it's something I wouldn't wish upon anyone or anything. Sending you lots of love and hopes for some peace with whatever comes your way.

[jbweeks722]

He has been different since he went in for tests Monday. But once I sit down on the sofa, he jumps up purring and lays on me for as long as I sit there or next to me curled up purring with his paw over his face. I am having to work at getting him to eat more than I was but he ate 4 times yesterday (about 1/2 FF appetizer each time) and twice this morning before I left for work! He actually came into the kitchen looking for food this morning! He is quieter than usual - my neighbor even noticed - he left the room when she came over instead of loving on her.

Thank you Traci and Karen for your support and kind words. It really does help.

[Traci]

The sooner you can get him started on meds, the better - he will most likely eat more normal amounts while on at least one or more of the above mentioned meds.