Trust Your Gut

After a record breaking five-plus months with a healthy gut remission from IBD, or inflammatory bowel disease, Maisie had a sudden relapse just over a week ago. The usual symptoms began; vomiting bile, diarrhea and food restriction. I wasn’t overly concerned as her energy was decent and she still had the same level of spicy sassiness.

I give credit for this long spell of gut health to the daily dose of cbd oil from Resolve and using slippery elm bark syrup (which I prepare myself). Life was going so well that once we hit the record remission length at the twelve week mark, I stopped counting the good weeks. Remission is a benefit to both of us, as Maisie is my emotional support companion and taking her out for walks is what gets me out.

Her gut health took a turn for the worse on Friday February 10^th. I wasn’t too concerned with her vomiting bile although if she has tummy upset, it usually happens in the morning with that horrid retching sound (wakey wakey MamaKat!). The next few days were hit and miss with eating, vomiting and diarrhea. But on the sixth day it became clear that I needed to attack whatever was ailing her gut with the big guns.

I dug out the bottle of antibiotics that Maisie had taken intermittently over the past three years. Since Maisie’s condition is chronic, I was able to have a prescription available on an as-needed basis from the vet clinic without the need to book an appointment for a veterinarian to access her (or stress her out, as she needs to be sedated just for the examination). The last bottle I had picked up from the clinic was in August 2022. Here’s where the story gets interesting.

I dug out the bottle of metrondazole (Flagyl) and gave her what the label said (1/2 tablet twice daily for seven days). Although I questioned the dose amount as being too high, I told myself that this is what the vet had prescribed. I vaguely remembered the vet saying, all those months ago, to begin her on ½ tablet (her dosage had always been ¼ tablet 2x day).

Maisie slept all afternoon. I attributed this to her having had a rough week. I told myself the rest was good. But you know when you get that nagging feeling that something isn’t quite right?

That evening I Googled the antibiotic metronidazole (Flagyl) to see what I could find online. I found a website (Goodrx.com) and while the info read that the recommended dosage was 7.5 – 10 mg per 1 kg of cat’s body weight I went ahead and gave Maisie her second dose. On the one hand I wondered whether I was over-doing it and on the other hand, with my tired brain, I told myself this was what the vet prescribed. I needed to trust that the vet was right and I was wrong. The website did mention that if giardia was being treated the dose could go up to as much as 25 mg per kg of body weight. So that makes the dosage 125 mg and that was what I had given Maisie. Even the photo of the cat on the website being given the pill looked like the same size as I had in my bottle.

I didn’t sleep well that night for fear I had given too much of the medicine. By 5 am I was ready to start the day and when I turned on the light, I was saddened by the sight of Maisie STILL in her bed. By this time, she had not left her bed to check out her food dish or to use the litter box. I looked at my baby laying there and began to cry. What have I done? Is she going to be ok? What is actually going on? I call ed the vet’s answering service to see if I could get a vet to call me but no one was available until after 7 am. Tick Tock Tick Tock. At 7:03 I called back and told the answering service girl the story again. The vet called me within 15 minutes and told me to bring Maisie in. When I picked Maisie up from her bed she was limp. She just curled up against my chest. Now if you know anything about Maisie’s personality, you know this is NOT her demeanor. She is a spicy sassy firecracker. I have never been able to hold her like a baby and while I admire all the cat peeps that have furbabies that snuggle like that, this moment was not a loving happy one. It just meant my girl was not well at all.

The vet suggested blood work and giving her some fluids. Despite Maisie’s downgraded spiciness she mustered up enough sass to require sedation for the procedure. I left my girl in their capable hands and awaited the results. I wasn’t worried at all because I felt so much better now that she was in their care. The call came and all results were in normal ranges. This was good news. Ok so then what was going on? The vet felt that the lethargy was due to the potentially toxic level of the metronidazole. She also advised me to go back to the ¼ tablet 2x day dosage but not to give anymore this round. She didn’t need to tell me twice not to give anymore, this scare was enough of a warning.

I take my girl and we make our way home. She’s awake and I poke my finger through the crate door to touch her on the top of her head and scratch under her chin. She rubs against my finger and my heart gets warm and the edges of my mouth curl up. I smile. Everything is going to be ok.

At home I let her out of the crate and she staggers a bit which I attributed to having been sedated that morning. My heart is light and I am grateful to be home. I let her settle and began to prepare some lunch hoping that she would have an appetite (which she didn’t but this did not worry me). On a great note she had a 5 star poop! Woo Hoo! Happy Happy Joy Joy!

I go back online to do a bit more reading about metronidazole. None of the warnings applied to Maisie such as taking caution in using the antibiotic on senior cats or cats with kidney or liver issues. None of the side effects seemed to correspond to what Maisie was experiencing. She had only had two doses. There was a section for life-threatening side effects yet these were indicated for cats that had been on high dose for a long period of time. So once again, I didn’t feel she had been at risk for any of these side effects.

Maisie was not settled enough to nap. Her eyes were fully dilated and she would just sit in the middle of the room or at the entry to the hallway and stare at the wall for a good twenty minutes. She finally went to her bed but she just sat there staring out the window. Oh brother! We go from lethargy to being in a stupor. What is going on??? She did not sleep and she did not groom herself all day. She also did not pee all day, despite having had fluids administered at the vet’s. I was able to encourage her to eat some canned food which relieved both of us. It was a good sign that she was eating. The evening continued with Maisie being unable to settle and sleep. That’s when I went back online to search neurological side effects from the metronidazole.

Let me tell you, it’s scary being in the position where you look up damaging side effects from a drug that your cat has taken and tolerated on several occasions prior. This is a drug that is generally prescribed for diarrhea and to treat IBD. It’s been around since the 60’s.

Since I had never read up on the medication before, the whole process of being in the position to find out what could happen when that something has already happened is very scary.

The next morning I called the vet’s office to let them know I was emailing a list of symptoms I had witnessed since bringing Maisie home from their clinic the day before. I asked to have the vet check over things and let me know what she thought.
I received a call within the hour and she believed it was still the metronidazole causing a reaction. We are both in agreement that Maisie won’t be given this drug again and it’ll be noted in her chart (not that I would forget!) and that a different option would need to be put into place.

The notes on the Goodrx website for metronidazole say “these severe side effects may not appear for a few days after starting, so be sure to watch for them the entire time your cat is taking the medication.” On a good note, it does say the side effects stop as soon as you discontinue the medication. When I read that “it may take up to two weeks for nerve-related side effects to completely resolve (such as tremors, trouble walking, etc)” my gut did a flip. This is some really toxic stuff.

I am so very grateful that the side effects began almost immediately and that the return to “normalcy” was generally short lived (although for this MamaKat each hour hovering over my baby waiting and watching was sheer torture and emotionally exhausting). I know now that the nagging feeling in my gut should not have been dismissed. More Mama guilt.

Have you noticed that when a human goes to the drug store and receives a prescription, most often they are given a sheet with pertinent information and side effects listed? Perhaps the doctor has discussed what side effects you might encounter. Your fears can be set aside now that you know what to expect or how to react if they do happen and how not to worry. You also have the power to ask for an alternative if you aren’t comfortable with risking the side effects.

Shouldn’t this kind of information be provided to pet parents when they are prescribed medicine for their animal companion? I suddenly feel guilty for never having questioned this prescription for Maisie. Am I a bad pet parent? Is this the universe’s way of giving me a wake-up call? Well, I hear you loud and clear.

What are your thoughts about drug information and side effects being available when you received medication for your pet from the veterinarian?
Please leave a comment below.