PDA

View Full Version : My cav is refusing to eat. What can I do to get his appetite back?



summerwalk
1st January 2012, 05:53 PM
Hi,

My cav Da Vinci is refusing to eat this morning. His appetite has been gradually getting worse over the last two weeks, but I have cajoled and enticed him to eat with some success, but this morning he flat out refused.
I am at a loss as to what to do.

He has been taking a cocktail of meds for 5 and 1/2 months due to MVD. He was at the "moderate" stage of MVD only in May, 2011 according to his cardiologist. Da Vinci is at the "severe" stage of MVD now. He will be 8 years old in several months. We have a vet, but we work with a cardiologist 100% on this. There has been a lot of water under the bridge since May this year. He had a CHF in September (couldn't breath and gasping for oxygen) and had to go to ER. A couple of labor breathing alarmed us to go to see his cardiologist several times since then.

To make a long story short, his latest med protocol is:

Furosemide 40MG 3x a day
Spironolactone 12.5mg 2x a day
Enalipril 5mg 2x a day
Vetmedin 2.5mg 2x a day

I have no doubt that this regiment has been saving his life, but it is also robbing him of his appetite. Da Vinci had been a voracious eater. He loved treats and loved food. He was a full of life for so many years. Not anymore. He is subdued and doing very little activities. I DID expect less activities, but refusing to eat is tormenting me. The loss of appetite has been so sudden I don't even know how to cope with it. Because of his refusal, giving him meds is becoming more difficult and almost impossible. I had to fight hard this morning to finish off his meds. By the way, we've been cooking for him ever since he started taking meds. We used to mix kibbles (salmon) and various cooked meat. Lately on salmon, beef and chicken, carrots and rice, etc. Up until just two weeks ago, he's been eating rather well. For the last two weeks, it has been going down the hill precipitously.

I read plenty on this forum that many cavs at this stage would refuse to eat and end up with losing weight and eventual loss of life.

I am turning to you folks who have gone through this med regiment to see if I can do anything to have his appetite back. Is one of the meds he is taking more culprit than others perhaps? Have you changed the cocktail to get his appetite back?

I appreciate any help you can give.

Thank you.

Pat
1st January 2012, 07:29 PM
A few thoughts:

When is the last time that you ran blood chemistry/CBC and urinalysis? Loss of appetite is a classic signal of kidney disease, so I'd want to run blood chem asap to rule that out along with looking at other major organ values (liver, pancreas, etc.) to rule out liver disease, pancreatitis, etc. In advanced heart failure, the poor perfusion to the major organs along with the meds can cause other organ failure.

Since he has been on the meds for 5 1/2 months but appetite remained good until the last two weeks, I'd be less likely to think that the anorexia is related to his medications. I personally have had quite a few Cavaliers and other dogs on heart meds, and they have kept a good appetite up until they died.

Could ascites be a factor? When you consult the vet to run blood chemistry, the vet can examine his abdomen to see if there is new ascites.

I think that a consult with GP vet and/or cardiologist should be done asap.

Pat

Kathleen
1st January 2012, 07:46 PM
Can't give any advice, but I am sending positive thoughts to Da Vinci. Hope he starts eating soon.x

lindylou
1st January 2012, 09:19 PM
hi
sorry to read about da vinci hope he starts eating asap
give him a kiss and a cuddle from me and louie

summerwalk
1st January 2012, 11:22 PM
Thank you for all your thoughts.

Pat, Da Vinci got his blood chemistry test done at the end of September. So, it has been about three months. As a matter of fact, we were planning to do it soon. I just contacted Da Vinci's cardiologist. He recommended the same thing. We didn't see anything noticeable from the last blood test. However, as I recall, his vet (GP) told me that his kidney function was slightly elevated, but not to the point we need to be concerned about.

I am going to get the test done tomorrow and go from there.

Thank you.

Pat
2nd January 2012, 12:06 AM
Acute kidney disease can come on very suddenly, and chronic kidney disease can go undetected for a long time and then there is a sudden "crash." This is a particular area of interest to me. What most pet owners don't know and what most vets don't explain is that by the time you see elevated creatinine and BUN, the kidneys are only functioning at about 25-30%. An earlier "warning" system is urine specific gravity (SG) in a urinalysis, which is why I always test urine whenever I run blood chemistry (and why I also own a digital refractometer so that I can test urine at home). Kidney disease shows up first with a low USG (shows an inability to concentrate urine) long before there are rises in blood kidney values. To accurately test USG, a first morning urine sample should be used, preferably after the dog has gone 6-8 hours without drinking or urinating. This is hard to do with a dog on high furosemide as your boy, and dogs taking furosemide will normally run a lower USG because they drink and pee more often.

Another problem with dogs on heart meds is that the furosemide will cause an elevated BUN simply because of dehydration, so that is to be expected. Creatinine is a much more specific measure of kidney function. If a senior dog is running a high normal creatinine and a low USG, I know that there is already chronic kidney disease and then I will adjust the diet to be more kidney friendly and I'll monitor more closely. When creatinine and phosphorus become elevated, the first outward symptom is usually anorexia.

Two situations in my past:

14 year old Cavalier with mild heart disease, on enalapril only for years, stable with no symptoms of any illness. Early November ran blood chem along with echocardiogram and complete workup with internist. Blood chem showed high normal creatinine, slightly high BUN, but USG was very good. Third week in November stopped eating. Ran blood chem the second day - Major acute kidney disease with very high creatinine, BUN and phosphorus. Despite hospitalization with state of the art treatment, kidneys shut down, and he was gone within a few days. In retrospect, he probably had chronic kidney disease for some time and I should have adjusted his diet. So now I pay attention even to high normal values.

15 year old Cavalier in end stage heart failure on many meds. Stopped eating. Blood chem showed elevated kidney values and urinalysis showed low USG. Hospitalized with state of the art treatment. In this case, we were able to bring his kidney values down to high normal and he came home. Lived another year and a half with daily subq fluids, adjusted diet and some kidney friendly supplements including phosphorus binder. Put to sleep at 16 1/2 for reasons other than heart or kidney disease (blind/deaf/extreme senile anxiety/quality of life decision).

I became very well educated about kidney disease, and I am very watchful for symptoms and test quickly so that I have time to respond. As you can see above, sometimes you win and sometimes you lose, but I always try.

Another seemingly healthy teenager who stopped eating had acute IMHA (immune mediated hemolytic anemia), and I lost her.

So yes, whenever I have a dog that becomes a picky eater, I immediately test so that I can quickly rule out (hopefully) some of these problems or quickly deal with them.

Pat

summerwalk
2nd January 2012, 01:59 AM
Pat,

Thank you again. Your knowledge definitely helps me equipped to deal with this situation better. In the back of my mind, I always knew there would be a kidney issue I might have to deal with down the road considering the amount of meds he's been taking. My heat aches thinking about what Da Vinci is going through, me being not proactive about this sooner.

I will get the blood-chem test and urinalysis done tomorrow. Thank you.

Pat
2nd January 2012, 08:02 AM
Remember that kidney disease is just one possibility; it's not a foregone conclusion. Blood chemistry is an easy way to rule things in or out, and hopefully that will be ruled out tomorrow. Maybe he is too dehydrated now, or maybe his blood pressure has gotten too low, both of which can affect the appetite. Your vet can narrow down the possibilities.

Next, don't be hard on yourself. The only way we know about these things is after we've gone through them. I've had 22 dogs in my adult life and 18 are gone so I've just had more experience with geriatric dogs with various illnesses than many pet owners. I've lost more dogs to kidney disease than to heart disease and even more dogs to cancer, so I've done a lot of reading and studying about these diseases. You are way ahead of many Cavalier owners already because you are working with a cardiologist, so you are doing a great job.

Hang in there - one day at a time. I've walked in your shoes, and I know that it's a hard road.

Pat

Kate H
2nd January 2012, 11:15 AM
Just catching up on this thread - with a very simple question: do you raise Da Vinci's food/water dishes? With severe heart disease, dogs can find it very uncomfortable, if not impossible, to put their heads down to eat or drink, or even lower them slightly. When my Cavalier started on CHF, I hand fed her when she was sitting down, and lifted her water dish so that she could drink sitting down. Also gave her her favourite food - which for her was a freshly-cooked chicken thigh!

Kate, Oliver and Aled

summerwalk
2nd January 2012, 04:54 PM
Kate,

Thank your for your suggestion.

I have not raised his water/food dish. So far, he manages to drink water from the water dish on the floor. I just tried your method of having him sit down. He appears to be a little more comfortable taking food from me. Because of his total loss of appetite, I have been hand-feeding him in the last few days whatever he is willing to eat. Chicken thigh has been his staple for many months, but I have not given him in the last week or so. I will try it again both steamed and grilled.

So far, the only thing he manages to eat is low-sodium deli-sliced hams. Even then, he takes very little.

Thank you for your thought.

RodRussell
2nd January 2012, 05:07 PM
Cardiologists recommend that when a dog is in congestive heart failure, feed him whatever he will eat.

summerwalk
4th January 2012, 06:05 PM
Rod,

Thanks for the suggestion. Yes, we've been giving him anything he would nibble at.

Up until last night, there had been some moments where he showed some slight interest in eating. We immediately hand-fed him with some turkey or ham slices along with his medications. In other words, we have barely been able to manage to administer his medications. But not last night and not this morning. He absolutely showed no interest in food whatsoever. He simply walks away. So, he skipped his PM and AM meds.

Yesterday, the blood test and urinalysis results came out. According to his GP, there was nothing unusual except slightly elevated kidney function and slightly low in calcium (I am sure this is because we've been giving him home-cooked meals last several months). There is nothing abnormal in his urine. So, he suggested we give him TUMS for a couple of days to increase the calcium level. Since Da Vinci doesn't want to eat, I ground a TUMS tablet (750mg) into powder and mixed with water. He was hesitant first, but managed to drink it. I am planning to do the same today.

I am waiting for my cardiologist's read into the test results. There is definitely an ominous thing going on in his system. He is so lethargic and low-energy with sleepy eyes. It is hard to watch. As I mentioned earlier, he drinks, drinks and drinks. That's the only thing he manages.

I am wondering if anyone has had any experience like this.

Thank you for all your help.

pkt89
4th January 2012, 06:54 PM
Rod,

Thanks for the suggestion. Yes, we've been giving him anything he would nibble at.

Up until last night, there had been some moments where he showed some slight interest in eating. We immediately hand-fed him with some turkey or ham slices along with his medications. In other words, we have barely been able to manage to administer his medications. But not last night and not this morning. He absolutely showed no interest in food whatsoever. He simply walks away. So, he skipped his PM and AM meds.

Yesterday, the blood test and urinalysis results came out. According to his GP, there was nothing unusual except slightly elevated kidney function and slightly low in calcium (I am sure this is because we've been giving him home-cooked meals last several months). There is nothing abnormal in his urine. So, he suggested we give him TUMS for a couple of days to increase the calcium level. Since Da Vinci doesn't want to eat, I ground a TUMS tablet (750mg) into powder and mixed with water. He was hesitant first, but managed to drink it. I am planning to do the same today.

I am waiting for my cardiologist's read into the test results. There is definitely an ominous thing going on in his system. He is so lethargic and low-energy with sleepy eyes. It is hard to watch. As I mentioned earlier, he drinks, drinks and drinks. That's the only thing he manages.

I am wondering if anyone has had any experience like this.

Thank you for all your help.

Hi,
I gave my Bee soup very often. If he drinks, try give him soup so it has some nutritient.
kitty

Sydneys Mom
4th January 2012, 07:25 PM
Up until last night, there had been some moments where he showed some slight interest in eating. We immediately hand-fed him with some turkey or ham slices along with his medications. In other words, we have barely been able to manage to administer his medications. But not last night and not this morning. He absolutely showed no interest in food whatsoever. He simply walks away. So, he skipped his PM and AM meds.

Skipping his medications just because he didn't want to eat is NOT a good practice. It's been 24 hrs. since his last dose and if you wait until his regular evening medicine times that's 36 hrs. that he is not getting medicated. It may seem cruel and I hate doing this myself, but you must get the pill into his mouth, and gently hold his mouth closed. You can also gently rub his neck so he will swallow. I wrap Sydney's pills in a small amount of the pill pockets then a small amount of fresh chicken. Most times he takes it with no problem.

Also, even though you should be feeding he whatever food he is interested in, I would try to keep the foods to a low sodium level. In addition to his regular kibble and wet dog food, I feed Sydney steamed chicken or lean beef I make myself. The broth from that can be poured into a water bowl for extra nutrition.


Yesterday, the blood test and urinalysis results came out. According to his GP, there was nothing unusual except slightly elevated kidney function and slightly low in calcium (I am sure this is because we've been giving him home-cooked meals last several months).

The results of elevated kidney function and low calcium is most likely the result of the diuretics and not home-cooked meals.

summerwalk
6th January 2012, 12:34 AM
Thank you.

For getting the pills into his mouth, we actually tried to force a tablet of Furosemide with a small portion of a thin turkey slice lat night. He looked horrified and so tightly closed his mouth. We basically gave up on it. I will try it again tonight.

I am quite mindful of salty food. This morning I cooked chicken thighs without salt, but he refused to eat and walked away. Then, a couple of minutes later, he came around with that look of "I am hungry." So, I gave him a small chunk of the chicken thighs with Fursodemide and Enalapril. I couldn't administer Vetmedin because he spat out. He ate a tiny portion of organic cereals we eat (low sodium), which we used to give him as a treat.

Today, I've got his blood chem test result in a hard copy. I went over it. A couple of things that bother me are:

NRBC 4 (reference range 0)
Glucose, Serum 51 (ref range 65-130)
BUN 42 (ref range 6-29)
Creatinine 1.1 (ref range 0.6-1.6)
ALP 560 (ref range 10-84)
ALT 84 (ref range 5-65)
Calcium 7.4 (ref range 8.0 - 12.0)

As you can see, BUN level is very high in my view (but obviously GP didn't see it that way). ALP (Alkaline Phophatase) is unbelievably high (but GP didn't mention anything about this either). Again, I have yet to hear from my cardiologist on the results.

Thanks again for all your thoughts and advice.

Sydneys Mom
6th January 2012, 04:23 AM
For getting the pills into his mouth, we actually tried to force a tablet of Furosemide with a small portion of a thin turkey slice lat night. He looked horrified and so tightly closed his mouth. We basically gave up on it. I will try it again tonight.

Just checking to see if you've gotten DaVinci to take any medications this evening. If I'm reading this right it's been 3-4 days since his last dose. I don't know how to stress this enough, but you need to get those meds in him. Try wrapping the pills in different food. I've used chicken, beef, pate canned food, peanut butter, bread, apple sauce, cheese, cottage cheese, jam. In other words, he may be bored with what you are giving him. If he doesn't take it, wait 5 minutes and try again. You are not allowed to give up.


Again, I have yet to hear from my cardiologist on the results.

Have YOU called the cardiologist about this turn of events? Sometimes you need to not wait for a call back and bug them for help. I also think there is a medication that will help with the appetite (sorry, don't know what it is). The cardio and/or GP may also be able to give you hints on how to feed and medicate.

I'm sorry if I sound harsh, it's just that I know how important it is to be nurished and medicated properly. There are times that this does become very trying, but you must do it anyway.

Please let us know how you get on and how DaVinci is.

summerwalk
6th January 2012, 05:07 AM
Sydneys Mom,

Thanks for your concern. By the way, no,we don't give up on him. Never will!

Today, he was able to eat something a little more substantial. His appetite is still terribly poor, but he ate chicken thighs and chicken breasts in the evening (very small portion, but positive). It always starts with a couple of cereals. He looks at them, but showing no interest. We encourages him over and over. Once he starts taking one or two, then that triggers his appetite slightly. From then on, I can hand feed him turkey slices, chicken thighs, etc. As a matter of fact, I was barely able to manage to give him his regular meds except Vetmedin and Sprionolactone. Yes, we tried many of the foods you suggested.

Thanks again.

Sydneys Mom
6th January 2012, 05:28 AM
I'm happy he was able to eat something. It's so hard sometimes to do what's best. keep us updated on his progress.

Kate H
6th January 2012, 01:59 PM
Are the chicken pieces precooked and cold? You could try cooking them fresh and giving them as soon as they are cool enough to eat - I found that my Meg would eat this because it was succulent and smelt very nice!

Kate, Oliver and Aled

summerwalk
6th January 2012, 08:05 PM
Kate,

Thank you. They are precooked and warm. We saute chicken thighs in a dutch oven. So far he seems to prefer them in a stewed pieces as opposed to sauted. As a matter of fact, I don't ever remember we give him anything cold when we fix meals for him. We've been fixing meals two times a day very warm up until this refusal. I am sure his preference would change in the future.

My cardiologist double confirmed yesterday that there is no evidence that we've induced kidney damage and the electrolytes are fine. While we're contemplating the next move, he surmised that advancing heart disease might be making him uncomfortable or a mild side effect from the medications might be contributing to the problem.

Today, Da Vinci ate about 1/2 cup of Nature's Path cereal of "Flax Plus Pumpkin Seed Granola" in the morning. Very reluctantly at the beginning of course, but once he started, he began taking more and more. I am sure it was about 1/2 cup. In the meantime, I was able to administer Furosemide and Enalapril only.

We're managing the situation one day at a time right now, hoping things will be better tomorrow.

Thanks for your thoughtful suggestion.

Sydneys Mom
6th January 2012, 08:24 PM
This is good news. Thanks for letting us know. Just wondering, did your cardiologist have any suggestions about getting him to take the Vetmedin. I was thinking that you could try crushing it and sprinkling it on his food. even if he doesn't get the full dose in at 'least he's getting something.