Ultrasounds results, very scared

Hi, everyone,

First of all, I apologize that this is so long and rambling. I'm very nervous.

I've been away from the forum for several days because my kitty and I were actually at the ER vet last Monday because he couldn't keep any food down. They ran several tests and couldn't find anything wrong and suggested a digestive care diet but to bring him back for hospitalization if he continued to decline. (Generally speaking I hate prescription diets, but I was desperate to get him to keep something down and so I thought since I'll just be giving it temporarily, I'd try it). Thankfully, since then, he's been better and he's now on a low-carb non-prescription Limited Ingredient Diet. But at the vet's suggestion, we had an ultrasound done. Indeed, inflammatory bowel disease is suspected. I'm obviously not happy to hear this, but the vet said that since his appetite is good and he's been stable for a week, these are both great signs, so that calmed me down a bit. However:

1) She said a lymphoma is always a possibility (though again the fact that he seems to be responding to the diets is a good sign) and that we couldn't know for sure without a biopsy. My gut feeling (and her recommendation) is to wait on this for now and continue to monitor him. I don't want to put him through an invasive procedure if it's not necessary. But just hearing the word "lymphoma" is terrifying.

2) His creatinine was elevated (2.7) when tested last week. Note: his creatinine was

2.2 at the end of May 2018
1.7 in Oct. 2017 and
1.8 before that in June and Sept. of 2017.

According to the lab, the results from June 2017 - May 2018 were all "normal," but now I'm wondering if those were actually high... If I'm understanding correctly, dehydration can cause creatinine to elevate temporarily (from the chronic vomiting he's been struggling with). Has anyone else had experience with this?

3) The ultrasound revealed some kidney abnormalities - "Bilateral loss of renal corticomedullary definition." And "The changes in the kidneys are suggestive of chronic kidney disease. Re-check of the reported elevated creatinine, as well as urinalysis, is recommended.

My primary vet would like me to recheck next week, which of course I will. She did say:

"Given that he's so young, I suspect the kidney changes may have been exacerbated due to his chronic vomiting - the kidneys have been dehydrated from the frequent vomiting and diarrhea episodes and so they are starting to work harder and there is now damage to their architecture. If his recheck kidney panel/urinalysis comes back consistent with progressive kidney disease we can talk about what needs to be done next, but at this point I think it's most likely due to dehydration."

I also made the next available appointment with the internal medicine doctor who performed the ultrasound just so I can go over the results with her in more detail and ask any questions.

If anyone has any advice or thoughts, they would be much appreciated.

Thank you so very much,
Leni

 

First of all, breathe. Some of your concerns are things you can address at home. SubQ fluids aren't difficult to give (if necessary). Fluids can help rehydrate as well as flush kidneys. Early stage kidney disease (if that is diagnosed) is also often responsive to at home methods and food changes.

Most of all, don't panic. Methodically dissect everything you hear and read. Then list your questions and fill in the blanks. Things sometimes seem scary and overwhelming at first but become manageable when broken down into bite-sized chunks.

As far as vomiting, do you feed small meals throughout the day? We had chronic vomiting here which led to dehydration when I was only feeding two meals. An overnight at the vet on fluids and snacks every four hours here at home took care of the vomiting.

For now, breathe.

 

The diagnosis of inflammatory bowel disease almost always carries with it the possibility of lymphoma now or later. The gold standard diagnostic for that is open abdominal surgery to allow biopsies to be taken from multiple areas in several organs. The next "best" diagnostic is endoscopy from upper and/or lower GI with tissue samples taken that way. Problem is there are regions in the middle area of the GI tract that can't be reached this way. Many people with IBD kitties can't afford this or choose not to subject the pet to it. This website is an excellent resource: http://www.ibdkitties.net/

It's true that feeling unwell and vomiting can create disruptions in other biochemical values. Take advantage of the IM vet appointment to get as much info on what the numbers mean and ask a ton of questions. She'll talk about those diagnostics, diet, medication, etc. I went through all this 6 weeks ago with Teasel. He's doing well right now on low carb grain free carageenan free (can be a problem ingredient for many IBD kitties) wet food (Wellness Complete Health or Wellness Core) to which I add this supplement: https://naturvet.com/product/digestive-enzymes-powder/. It was recommended to me by another FDMB member whose kitty has IBD among other things.

 

Thank you to you both for your replies.

Kris, I'm happy to hear Teasel is doing well. May I ask what route you pursued? Did you have biopsies taken?

I was just looking at this article here: http://www.ibdkitties.net/ibd-or-cancer/ What are your thoughts on it?

 

No biopsies for Teasel. I'd exhausted my kitty care fund and also didn't want to put him through it. More the latter. I'm going with the idea that his illness was a bad pancreatitis flare and/or IBD flare. He had an ultrasound that showed slight thickening of the wall of the jejenum. I had an IM consult and she told me all the things I posted above. I might have considered steroid meds or similar if he hadn't rallied.

I gave him subQ fluids a couple of times (easier than you think), dosed him with antinausea meds (ondansetron), appetite stimulant meds (cyproheptadine) and antidiarrhea meds (tylosin) for several days after the IM consult. I made the switch to the food I mentioned and added A LOT of water to each meal to get up to 200+ mL daily on top of what's in the wet food itself. Dehydration alone can make them feel sick. I still continue that extra water and track how much I give daily (1 Tbsp = 15 mL).

@Carol & Murphy very kindly shared with me some of the things she does for her kitty, Murphy. She mentioned the enzyme/probiotic supplement to me so I bought it. I waited over a month before I began adding <1/8 tsp to every meal because I wanted to be sure his appetite was restored to its normal good level.

The article you linked is excellent, as is the ibdkitties website as a whole. I think I'm among those many people who recognize that the symptoms could be caused by cancer but can't/won't do the extensive surgical biopsy for any number of reasons. We just try to find the best diet for our kitty, monitor clinical signs over time, use meds as needed if there's a flare and hope for the best. IBD is a relapsing/remitting condition and treatment of a flare is usually more successful if undertaken at the first sign of illness. That means antinausea meds as soon as appetite seems "off", appetite stimulant meds if the antinausea meds aren't enough, antidiarrhea meds and/or probiotics to help with loose poop and hydration, hydration, hydration.

Does it mean you might have to live with ambiguity re diagnosis? Yes. Only you can decide if this would work for you and whether you're willing/able to put your kitty through the biopsy surgery. I look at my guy right now and I see a happy kitty who's doing well after being hospitalized, poked and prodded for weeks in June and July. I didn't want to inflict any more pain or stress on him.

I hope that helps.

 

Thank you. I really appreciate your response.

 

The specific gravity of the urine is a good indicator of kidney function, that is included in a urine analysis.
Budesonide is frequently prescribed for IBD/ I have had several cats on it because IBD was suspected, one via ultrasound.

 

Thank you, Larry. For the moment he's stable with the new diet, and the vet recommended continuing to monitor him on that, but I think budesonide may become necessary if that changes. I'll make sure to get him a urinalysis at our appointment next week.

Did you ever have biopsies taken for your kitties? I'm struggling a lot with that decision right now, because I don't want to put him through unnecessary stress especially when he's already been through so many vet visits/procedures lately.

 

My civvie Fluffy has IBD. She had chronic diarrhoea and vomiting. She had had scans that showed thickening of the bowel and possibly a blocked bile duct in the liver. All test came back inconclusive, but she is now on Pred for the IBD and Denamarin as a liver support and she seems to have improved. Stools not so runny and have a bit of consistency and no vomiting. She had lost a lot of weight and muscle too which she will probably never regain as a senior cat. I have been offered biopsies etc to prove IBD or lymphoma but do not want to put her through that.

 

Thank you, Sue. I'm glad to hear that Fluffy is doing better. Have you had any issues with blood sugar since starting the Pred? My kitty doesn't have diabetes, though at one point last year during a checkup he had elevated blood sugar. The vet characterized him as "pre-diabetic." I switched his diet and his fructosamine tests have been normal ever since.

 

Before I go off my rocker I defer to Kris's knowledge. Basically Kris has been here longer than me and has far more experience but...
I have been through this many times with cats and dogs and myself. When will medical staff ever learn? Unlike a digital X-ray of a broken bone an ultrasound is a fuzzy picture and is almost always subject to interpretation!!! Someone looks at the image and based on previous experience and knowledge makes a judgment call. The last two I had, the last three our dog had and Nigel's two were completely wrong. A cyst was diagnosed as cancer, cancer was diagnosed as GI problems, a hernia was misdiagnosed. Ultrasound is a tool that has to be used properly. Sorry for not being more helpful but this is often the awful truth.
As a side note I have had four MRI's, a SPECTscan and three CT scans looked at by eight neurologists. The eighth neurologist saw in just five minutes what the first seven could not. It's not a perfect system.
Sorry Kris, that was not me taking a subtle shot at you.

 

Not really. Sometimes she's about 6 when I test her, other times 3 at the vets which worried them a bit. I test at least once a week so I can be on top of any elevated glucose issues. Either way, my vet will never see her for diabetes if she ever develops it.

 

I agree completely! U/S depends on both the skill of the person doing it and the imaging specialist who reads it.

 

The travelling ultrasound specialist, that's a great job. Twice we paid this person $500 to come in, do the ultrasound and confer with my vet on the results. I understand she leases the machine and is a board certified something-or-other but. If she takes 20 days off in a 52 week period and can squeeze in 3 appointments a day she grosses $360,000 a year. At 4 per day that's $480,000 per year. This is partially why we go broke taking care of our cats. It's almost unethical to back a pet owner into that corner, like emotional blackmail.

 

I'm sorry I'm a bit confused. Are you suggesting that I do pursue the biopsy route? Thanks for your help!

 

I have now had three kitties with the IBD or lymphoma possibility. Diabetic Neko could not have surgery or endoscopy, both require anesthesia which her heart could not take. We treated as lymphoma cause multiple ultrasounds leaned to that or severe IBD. She took budesonide without it impacting her BG, her heart couldn't handle prednisolone which is the gold standard. She was on chemo which did make her nauseous at first, the proper dosing protocol is key to less nausea.

Civvie number one did not have biopsy or endoscopy, vet wasn't for it. After a few ultrasounds over time and things getting worse,we assumed lymphoma and treated as that. He handled chemo with no side effects. He went into remission for a year, but I always wondered if it would have been longer if we had treated properly sooner. He got taken by pancreatic cancer. By the way, cats can go years in remission if they have small cell lymphoma. The IM vet on an online group has one kitty going on nine years. Average is several years. Civvie number two started out IBD, clearly allergic to certain proteins, ultrasound showed thickening in places an endoscopy could reach. She was getting an endoscopy for something else, and I had them take a sample while in there. First lab result was inconclusive but further test at UC Davis showed emerging lymphoma. Endoscopy is much less invasive than a biopsy. The downside is that it's not always 100% definitive at first. On chemo and pred, her blood sugar is fine. But I am still dealing with protein allergies too.

 

Biopsy is a general term. In our case our dog had a needle biopsy and only mild sedation was required. The problem with that is that a needle is being guided into an area where someone thinks a cell sample can be extracted. If that area is small it can be a hit-miss thing. We ended up twice with "inconclusive" results, very disappointing.
My memory may be a little fuzzy on this but I know Fluoroscopy was not used so that made everything so much harder.

 

Needle biopsies (fine needle aspirates) do not work for diagnosing IBD vs. small cell lymphoma. They do work for large cell lymphoma or masses.

 

I always ask the vet if the results of a biopsy or exploratory surgery would change the treatment plan or if it is just for knowledge. So often I've been told that chemo and/or surgery would not be effective on what they were seeing, but further tests would give us a prognosis. As much as I love answers, medicine is not an exact science. A dire prognosis just has me worrying constantly about something I can't change.

In Grandpa's case, three ultrasounds have shown what multiple vets have called inoperable masses. Yet I've been offered biopsies and aspirates (as well as euthanasia). My question was, "would this be treatable if we did a biopsy?" and I was told no, not really."

 

Wise words. We can easily get caught up in wanting to do something, anything when what we really need is to step back and get some perspective on the situation.

 

I had a long talk about this subject with a surgeon at a specialty hospital after I approved a very expensive exploratory surgery on a cat several years ago. After the surgery - we lost the cat - she told me that she was very surprised that I had approved it. I told her that if she suggested it, I figured that was what I needed to do. That's when she explained that she always gives a client all of the options, but just because we can do something doesn't mean we should do something. I told her that doesn't work for me; that I look to her for guidance as well as information. It was an eye-opening conversation for both of us, I think. She thought about it for a minute and told me that as doctors they are always looking for information and answers. They are programmed to do whatever they can to learn more about the body. But I may not need that information. I need to know if my pet can be helped. I made her promise that from now on she wouldn't just talk to me about what she can do as a doctor, but what we should do for the pet. Now I always think, "just because I can doesn't mean I should" when faced with a decision.

 

Great post. Over the years I've run into similar situations with kitties and I've asked whether a treatment is worth pursuing or asked the vet what she would do with her pet. Always got worthwhile feedback that helped me make a decision or be at peace with my decision. Just because we can doesn't mean we should for sure.

 

In general I agree with looking for just the answers you need. However, the treatment for IBD vs SCL is different. If one of those two is suspect, it's good to know what you are dealing with. You don't want to give chemo to an IBD cat that just needs a diet change and possibly anti inflammatory support.

 

IBS not infrequently morphs to small cell intestinal cancer. One can treat IBD with chlorambucil, the same for SCIL. However, some vets/oncologists will not use chlorambucil without a definite diagnosis.

 

Thank you all so much for your input. It's very helpful. I'm hoping that speaking with the IM specialist (and asking LOTS of questions) will be helpful too.

I'm wondering if trying to treat the inflammation (the best way I'm not quite sure how?) and repeating an ultrasound in a couple of months to see if it increases/decreases, is a good plan. Of course I'll be monitoring him very closely and if he seems to be struggling we'll need to change treatment and/or do further tests (biopsies) to get a definitive diagnosis.

We're going to my primary vet next week for urinalysis and blood work to recheck kidneys, but before that I'll bring in a fecal sample. He had a fecal exam end of May and it was normal, but it can't hurt to check again just to rule out parasites.

And a small update: I got home from work today to find vomit in two spots which freaked me out. But this was the first time he's vomited in 10 days, so that's at least something. Appetite is a bit off today, too, perhaps from feeling nauseated. I'm just giving him small amounts of food at a time, and he's eating most of it. I'll continue to monitor. And he'll get his Metronidazole in about an hour (he's been having some soft stool).

Thanks everyone again for your support. It really means a lot to me.