Thank you Karin,
If Holly was improving on the Ronaxan (which we would not have expected if there hadn't been an infectious process present), then it would be worth speaking to her vet about continuing her course. It may be that the intermittent dosing while you were away did lead to the medication not quite getting to therapeutic levels needed to clear the parasite. So a longer course may be indicated here. That said, you do need to take care in giving this medication (with food or in a gel capsule) since we can on rare occasions see it cause strictures/narrowing in the esophagus which could make passing food from mouth to stomach an issue here (not likely just now though since those kitties tend to be hungry, keen to eat, but regurgitate what cannot fit down the throat).
Otherwise, her initial signs of withdrawal would not have been unexpected and are very common in kitties that do not feel well. The reason we see this type of behavior in cats is because as a prey species, hardwired instinct tells them to hide away or isolate themselves when they are too poorly to pretend all is well (since this would keep any predators from knowing they were vulnerable). With them changing since you returned, I would be suspicious that she is telling you that she doesn't feel as awful as before but is still weak and not feeling quite like herself.
Further to considering continuing the Ronaxan, I do want to leave some further thoughts about getting food into an anorexic kitty. Now if she is turning away from normal food and bringing up water, then it does make nausea suspicious even without vomiting (often nauseous cats go off their food rather then eat/vomit like a dog would). Therefore, to rule out nausea as an anorexia differential, you may wish to try her on antacid therapy. There are a number of antacids that are available over the counter and pet friendly. I would advise only treating with one, but the two I tend to recommend are Pepcid (More Info/Dose) or Zantac (More Info/Dose). This medication of course shouldn’t be given without consulting your vet if she does have any pre-existing conditions or is on any other medications. Ideally, it should be given about 30 minutes before food to ease her upset stomach. If she is very nauseous, then her vet can treat her via injection (using Cerenia or Metoclopramide).
Once that is on board, we'd want to try to get her eating (as I know you have been). Favourite foods are allowed or you can tempt her with a light/easily digestible diet. Examples of this would be boiled chicken, scrambled eggs (made with water and not milk), meat baby food (do avoid the ones with garlic powder in the ingredients) or there are also veterinary prescription diets that can be used here (ie Hill’s I/D or Royal Canin’s sensitivity.)
Further to this, if she has been off her food this long and if tempting doesn’t work, then we do have to consider initiating syringe feeds to get some proper food into her. In that case, you may want to try Hill's A/D (LINK
) or Royal Canin Recovery (LINK
) from your local vet. These are critical care diets that is comes as a soft, palatable pate. Both are calorically dense, so a little goes a long way nutrition-wise and this could just help get some more calories into her even if we can’t get a huge volume of food in. As well, for syringing food, you can use the animal version of Ensure (balanced for animals dietary requirements) called Clinicare Canine/Feline Liquid Diet (LINK
). It is actually by the same people who make Ensure, but is formulated to meet out pet's dietary needs. Your vet should be able to order it for you but it is available without a prescription. They also make one specifically for older cats with kidney troubles, and this could be an alternative for an older cat. This way it would a means of getting food, staving off hepatic lipidosis, and buying you time to get her back on treatment and clear this underlying agent.
On top off all of this, you do need to keep an eye on her water intake. To check her hydration status to make sure she is not becoming dehydrated there are a few things we can test at home. One is whether the eyes appear sunken, if the gums are tacky instead of wet/moist, and whether she has a "skin tent" when you lift the skin. To see how to check these parameters for dehydration, you can find a wee video on this HERE
. ( They use a big dog but it makes it easier to see and the principles are exactly the same) If you are seeing any signs of dehydration already, then you do want to have your kitty seen by her vet before this gets out of control for her.
In regards XXXXX XXXXX you can do to help stave off dehydration at home (though do note that if she is already then she will likely need more the oral rehydration), encourage her to drink but offering fresh water or even low-sodium chicken broth. As well, wet foods (as mentioned above) are 35% water, so getting her to eat will help us deal with water intake as well. If she isn't amenable to drinking, you may wish to offer unflavored pedialyte via syringe feeding. While we cannot do this if they are vomiting, it may be an option for this situation. A typical maintenance rate for hydration in an animal 48mls per kilogram of her body weight a day. If you do give syringe pedialyte, this should obviously be divided up into multiple offerings through the day rather then all at once. This value will give you the total she needs for the day and is a good starting point to give you an idea of her daily requirement. If she does vomits if you give pedialyte, I would discontinue this as a therapy. (since we don’t want her vomiting because of our intervention).Finally, if you try the above and Holly is still resistant to eating for you, then do consider also asking her vet about starting her on an appetite stimulant drug (ie Cyproheptadine, Mirtazapine/ Mertazipine, etc) to encourage her to start eating for you again properly. This may just be the push she needs to remind her how important food is for her.
Overall, her positive response to treatment does confirm your vet's suspicions of an infectious agent causing trouble. Since she did respond but wasn't dosed properly while you were away, it'd be ideal to consider a longer proper course here. Otherwise, we'd want to rule out/address nausea to make sure this is not putting her off her food. If settling her stomach doesn't get her eating, then appetite stimulation medication and syringe feeding (+/- feeding tube) would be our next step. So, do give your vet a ring and see if they can continue her course and provide you some diet for supportive care for Holly. Hopefully, with a proper course of the Ronaxan we will see this underlying agent cleared and get her back to normal before she just fades away.
I hope this information is helpful.
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All the best,
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