how do I get this cat to gain weight?

[cellio]

I stopped by the vet's tonight to have Erik weighed. He has lost half a pound since early September. :-( I thought he was feeling bonier, but it's hard to tell when you pet him every day.

His appetite has been varying -- never absent, which would warrant some amount of force, but it's been lighter than it ought to be for the last couple weeks. Sometimes he won't eat cat food but will eat baby food or tuna; sometimes it's the reverse. Surprisingly, he currently seems to like a certain type of dry food, which he usually only picks at.

I have (finally!) noticed a possible correlation; both this cycle and last his appetite has done this at a certain point in his drug cycle. We're going to vary that next time and see if the behavior follows the drug.

The doctors who did Erik's ultrasound in June said I should do another if his weight drops. But the surgeon I saw in July said the ultrasound was hard to read because the surgery he had a few years ago rearranged some bits. Tonight my vet asked if I'd consider another ultrasound and I asked her to explore whether it would actually tell us anything we could act on. What outcome could an ultrasound serve up that we could treat without surgery? (If all roads lead to surgery anyway, what does the ultrasound tell us?)

In July the surgeon postulated four possible causes of Erik's woes: the hepatitis we're already treating, a pancreatic tumor that would be untreatable, IBD that would be treated with prednizone, and lymphoma that would be treated with prednizone and chemo. Of those, only the tumor could be visible on an ultrasound; exploratory surgery could diagnose all of them (via biopsy), but surgery is risky. Prednizone interferes with biopsies; his recommendation was to either do exploratory surgery or decide not to and just treat with prednizone speculatively. I delayed on making a decision on surgery (and thus not doing the prednizone) because surgery is scary and Erik seemed to be doing ok; now I find myself leaning toward "just hit him with the prednizone". The surgery poses non-trivial risk; I don't see enough benefit to put him through that. But my vet will talk with some folks and explore these questions. And I forgot to ping her about diet changes (she didn't have any ideas there this summer), so I'll do that. (She did give me a tube of NutriCal tonight as a possible way of getting more calories into him.)

Comments

[tashabear.livejournal.com]

Did they check his calcium levels? When Max was dropping weight, it coincided with elevated calcium. Adding Metamucil to his food (just a quarter teaspoon) helped bring it down.

[cellio]

His calcium was within the normal range on his last few blood tests, though he tends toward the high end of normal and I don't have the specific numbers. I'll ask about Metamucil; thanks. (Ok, I've applied Google and I still don't know: how are high calcium and Metamucil related?)

[tashabear.livejournal.com]

The fiber binds to the calcium and the cat passes it.

[spiritdancer]

Well, if the high calcium is diet related. Another cause of elevated blood calcium levels is lymphoma. :-(

[tashabear.livejournal.com]

Max was on renal food, so that might have had something to do with it.

[miz-hatbox.livejournal.com]

*Hug* There are no easy answers to this. I've been in your shoes and completely sympathize. Is he at least keeping down what he eats? Is endoscopy an option? (Might be easier on Erik than surgery)

With Nate we treated with prednisone and it helped some, though he turned out to have pancreatic cancer (which the u/s didn't show) so of course none of the treatments really helped as much as we would have wanted. There were other meds we tried to soothe his stomach and increase his appetite but I forget what they were.

I hope you find something that helps!

[cellio]

He's mostly keeping food down; about every ten days or so he'll vomit, usually once and then he's fine. Yup, been tracking that; nope, no patterns yet.

Is endoscopy an option?

Good question. I've asked every involved vet whether there's anything we can do that's less invasive than surgery and they've said no, but I haven't specifically asked about this.

[spiritdancer]

I can answer that one: For where and what they'd want to biopsy, endoscopy isn't a good option. For one, the 'scope won't reach very far past the stomach, and you really need samples from further down the tract. For two, the bipsies you can get with a scope are only pinches of the lining tissue, and if you're looking for IBD or lymphoma, you really need full-thickness biopsy samples of the bowel wall. And looking at the actual bowel can sometimes give an idea of what might be going on.

[sue-n-julia.livejournal.com]

Prednizone at least will elevate his appetite. Of course it's not terribly good for his bones, but neither is the weight loss.

S

[spiritdancer]

::sigh:: Kinda between a rock and a hard place, no? I suspect at this point, no one would blame you for trying the prednisone over surgery.

1) Keep trying with a variety of foods; you may yet hit on something he likes. Some cats like stinky fishy food, some prefer "bird" (turkey/chicken), some prefer cow. If you want to try a different dry food, Hill Prescription K/D Dry seems to be pretty well taken by most cats (developed originally for kidney disease, but shouldn't hit up liver issues too badly; Hills also has a satisfaction guarantee if he turns his nose up at it). Along those same lines, M/D (developed for weight issues & diabetics) is pretty darn energy dense (meaning he doesn't have to eat much to get the calories in), however it's not really that great an idea if he has kidney issues on top of everything else.

Hills diets are what I have the most experiences with; if your vet uses something else, ask them for suggestions (or I can do some more research for you).

Oh, and I agree on trying the Nutrical, too :-)

2) Medications - well, that's a whole 'nother ball o' wax.

Pred will stimulate appetite, generally. Sounds like surgery isn't that great an option for him, and I don't know what your thoughts are on chemotherapy for pets. Pred is a decent choice if other treatment options are out (and, heck, it's often a decent choice even if there are other treatments being used). Risks include gastric irritation, and (if there is a cancer involved) reduction of efficacy of chemotherapy meds. And it might help reduce the inflammation associated with the hepatitis.

I've also used diazepam (valium) as an appetite stimulant, but more commonly in the hospital (works in a matter of minutes with an IV injection).

Considering the liver issues, and possible pancreatic issues, I have to ask if he's on anything for potential nausea and/or gastric irritation? In those cases I've used several different meds, including metoclopramide (increases gastric emptying) and famotidine (Pepcid AC).

[cellio]

::sigh:: Kinda between a rock and a hard place, no? I suspect at this point, no one would blame you for trying the prednisone over surgery.

Yeah, sigh indeed. According to the surgeon I saw, there isn't really a surgical option for treating him -- the surgery would be purely for exploration. If there were a treatment at the end of that tunnel I'd be more open to the 10-20% risk of making things worse.

Thanks for the food advice. Erik tends to like fish best, bird next, and mammal not much at all -- but he does seem to have moods so I try other things and try to keep a variety. Right now, to my surprise, he is chowing down on liver/chicken; he usually doesn't like liver, but I picked up a can of this because of the chicken. He ate more just now than he has in the previous day, during which I tried tuna, baby food (both chicken and beef), and mixed-fish catfood. My vet uses Hills (I've seen it on the shelves), so I'll check that out.

I don't know what your thoughts are on chemotherapy for pets.

Conflicted. My biggest concerns are about quality of life -- mainly the the cat's while undergoing the treatment, and secondarily mine if I'm running to the vet every week for this. And mixed in here is the delta -- it makes a big difference whether chemo buys weeks, months, or years. I want to do right by Erik, and it's hard to know what "right" is.

Considering the liver issues, and possible pancreatic issues, I have to ask if he's on anything for potential nausea and/or gastric irritation?

No, unless the Ursodiol he's taking for the hepatitis has some side benefit in that area. He's on that, Tapazole (for hyperthyroid), and pulsed antibiotics for the hepatitis (Clavamox and Metronidazole, though for the next round we're going to do just the former). I hadn't thought to ask about something for gastric issues; I will do that.

Thanks for all the info!

[miz-hatbox.livejournal.com]

Yay! A memory-jog!

Metoclopramide and famotidine were the ones Nate was on along with the Pred...and the met & pred helped as much as they could given what was really going on, as I was saying.

I forget--do you get his meds at a compounding pharmacy? I got Nate's meds at one and it made a huge difference because they'd compound his meds in a liquid that could be any flavor he would take, such as fish or chicken or what-have-you. (He was partial to what I called the stinky-tuna flavor.)

Anyway. Perhaps if his meds are flavored and mixed in with his food, or even just a drop of the flavoring agent itself, it might help...

[cellio]

I forget--do you get his meds at a compounding pharmacy?

Yes, and they're awesome. I'll ask them about other flavors; we tried a fish flavor once and Erik (surprisingly) didn't like it, but we haven't tried others. Currently I get most of his meds as capsules, which I break open and mix in with his food. (Yes, I've confirmed with my vet that that's ok.)

[cellio]

I realized today, on re-reading some info on IBD and lymphoma, that I failed to ask my vet an important question. I've been asking what happens if we assume IBD and apply pred (which would also be relevant with lymphoma), but I hadn't thought to ask what would happen if we went down the other path. If we treat as if it's lymphoma and we're wrong, what bad things happen? (Am I subconsiously assuming IBD because I want it to be that and not lymphoma, rather than because that's a sound approach?)

My big fear with the lymphoma possibility is not so much the lymphoma, though that would suck, but the exploratory surgery that's needed to find out. There is a non-trivial chance that surgery would kill my cat. :-( So I am very much trying to figure out how to make Erik's life better without cutting into him -- which means guessing.

[spiritdancer]

Drawback if it's not lymphoma? All the nasty side effects of chemotherapy drugs (not to mention a fairly high expense and time/effort on your part). :-(

Might be worth tracking down a feline oncologist, if there's one in your area - even if it's just for a consultation (to get an idea what's available currently, as well as prognosis).