Last post Mr kitty has actually been doing stellar this past week! 5 Ps are all good, he's out and about all day, poops back to normal. Tagging a few I think may have thoughts here @Wendy&Neko @tiffmaxee @Suzanne & Darcy @Katherine&Ruby The regular senior panel all came back fine, nothing close to elevated or too low. I've not had a chance to get it in the labs tab yet. Vet called with GI panel results, I figured I'd paste them here as it's faster: COBALAMIN 658 290-1,500 pg/mL FOLATE 8.3 (LOW) 9.7-21.6 ng/mL A normal B12 and decreased folate concentration is consistent with diffuse disease of the proximal small intestine TLI 246.9 (HIGH) 12-82 ug/L fTLI concentrations > 100 ug/L may be due to pancreatitis (acute or chronic), pancreatic hypertrophy, renal failure, or small intestinal disease. The fTLI test is not highly sensitive for pancreatitis (sensitivity ~30%) PrecisionPSL 67 (HIGH) 8-26 U/L PrecisionPSL elevations correlate closely with abnormal PLI concentrations. In cats with appropriate clinical signs, this PrecisionPSL is supportive of, but not definitive, for a diagnosis of pancreatitis. In cats without clinical signs of pancreatitis, a mild elevation is an insignificant finding. Vet is leaning SCL or IBD, also believes that is/was likely the cause of the effusion (they called it chyle but in a reality couldn't figure out WHAT it was) I realize next step is probably an ultrasound and a biopsy but being totally honest we're about maxed out with what we can do for him, and I really don't like the idea of anesthetizing him given the issues we have/had. I am aware of the IBD kitties site and will read some more there as well
Hate to say this, but GI issues are unfortunately reasonably common with acrokitties. You should be able to get an ultrasound done, possible with some sedation given Mr. Kitty's history at the vet. Neko was kind of like that too. If you get the ultrasound done by an internist or carded ultrasound vet, with proper measurements, it can give a clue, though not definite diagnosis, if either IBD or SCL. The other thought is to try him on a novel protein diet and see if that helps. Of course, cats can have both (speaking from experience ). But a response to a novel protein diet could tell you something.
Very sorry about these test results, Melissa. Ultrasound should give you some more concrete information, like where the inflammation is located, but really the first and easiest thing you should do is try changing his diet as Wendy says. This is what I tried with Ruby, why I switched her to a raw diet back in February in case it was IBD, but she didn't respond very well to that which is why we went ahead with the endoscopy and found out it was full on SCL. Anyway, one step at a time.
It's sort of odd to say this, but after all these other diagnoses in one year everything else is just kind of water off a duck's butt. Just keep rolling with the punches as they come. When you and @Wendy&Neko say "respond" to a novel protein diet what exactly am I looking for? Because the only reason I even had the panel done was coat discoloration. His poop is totally fine and daily, I've not noticed any straining. No vomiting after hairball season was done. Let's say we end up leaning SCL - is there harm to treating with budesonide or prednisolone or chlorambucil without a definitive diagnosis? I realize the impact for the diabetes of course. Or, what happens if we choose not to treat at all? Is it a long painful wasting away sort of thing? I don't mean to sound cruel but he's already been through quite a bit, last time he was sedated he stopped breathing for awhile...so we're at the point of carefully weighing doing X vs Y vs nothing.
How is his weight trending? For some SCL cats, weight loss is the only sign. I have seen some untreated/undiagnosed kitties here do the waste away thing. And, black coat going reddish can be a GI sign of malabsorption. Neko only had very occasional signs of vomit, and then most of it was foamy, but she had CKD too. Her poops were not every day, but she was on raw, so not dissimilar from the rest of the tribe. Then she just went off her food. Neko had an ultrasound, but we could not diagnose due to her heart condition. Which also precluded using pred, so she went on budesonide. And also chlorambucil, which can sometimes be used for severe IBD. Knowing now what I didn't then, her ultrasound results did tend to be more SCL-ish, which is what her internal medicine vet thought more likely. Budesonide, with Neko, didn't impact her BG, so no down sides there other than another med, which I got compounded liquid. There are some side effects to chlorambucil - the most common being nausea. Getting on the right protocol (once every 2 weeks), plus ondansetron is key to managing that.
I had been reading about weight as well. He was only down 0.3lbs from ideal last week, which I was actually very happy with seeing as he didn't eat nearly enough for about 5 days with that infection he had. The rest of that is all incredibly helpful, thank you! For now I'll just keep an eye on him. Vet also sent some articles to read, once I get through those I'll give him a call and see what he's thinking. I'd obviously rather be proactive as long as there aren't significant risks
I forgot to add, my current vet could feel thickened intestines in current cat and previous civvie, just with a physical. And can tell current cat is back to normal, or close enough. Of course not as good as an ultrasound cause you can't get measurements of thickness of the various layers of the intestines.
Wow. As you already know, the normal cobalamin low folate is indicative of small intestinal disease. The fTLi seems to indicate small intestinal disease also. your vet already thinks so. If he were my kitty, I would do an ultrasound but not a biopsy.
Yes. My vet also has been able to feel the intestines of my cats. She has not been wrong in the past. She often has described the intestines as too firm and “ropey”. She’s never been wrong yet (with both IBD and SCL cats).
I am not sure I am buying off on the thing about his effusion being from IBD?? It seemed so be so responsive to the Rutin. What else was being prescribed at the time that would have helped eliminate the effusion
I've been mulling that over too. To be totally honest a GI issue was first thing I thought of when he was diagnosed, because chylothorax is some sort of leakage somewhere in thoracic duct...and his "chyle" was just so weird they couldn't explain it. So I was thinking maybe there's a perforation or something up with intestines, that's the main place I'd think "weird stuff" would come from. Rutin is thought to work by stimulating macrophages to remove fat, and since his fluid seemed to be mostly fat we gave it a shot. The only other meds he was getting at the time were the cab, and the ondansetron as needed (possibly bupe as well). If I remember correctly there was red blood in his poop. Long shot, but perhaps there was a perforation that healed on its own? My head hurts
If he's not showing any distress from the inflammation, I would leave it be for now. I felt a lot of urgency in getting a definitive diagnosis and treatment for Ruby because she was not eating, throwing up her food all the time and generally having a hard time while I was freaking out about giving her insulin while all of this was going on. There are plenty of caregivers who don't go the route of an endoscopy before treating with meds if the time comes for that to happen. My civvie Olive, who is also on a raw diet, has early stages of IBD, but I have already decided I'm not going to put her through endoscopy if her symptoms worsen--so far, she is doing great on EOD Cerenia and I've eradicated chicken from her diet as that seems to make things worse.
They said it was confusing. Chyle was the closest thing they could call it. My vet said it was consistency of churu but pink and brown tinged, if youve ever used that. I forgot they did give me clavamox at ER I think he got maybe 3 doses of that before I stopped
I am with Katherine on treatment. If he starts having symptoms, I would start practical treatment to see how he does. If he seems well now, I would leave things alone for the time being. But there was a reason that you and the vet decided to send out for the GI panel in the first place, right? I meant to ask why you did this panel, but didn’t want to bug you and decided to wait for the results.
If you decide to take a watch and evaluate approach, I would try a novel protein, one he’s never had before. If it works he won’t have intestinal issues. Since he’s been doing okay this week it kind of puzzles me. I think I would get an ultrasound but only by a board certified radiologist. Sorry for the abnormal findings.
Did the Clavamox make him sick? It’s been so long… I am trying to remember. Is that why he never finished the course?
I have had a couple of kitties that did not have a definitive diagnosis (meaning biopsy) and that we treated with, in one case, Prednisolone only and in the other case we started with Prednisolone and later added in Leukeran (chlorambucil). We only went as far as ultrasound for those two kitties. In another case, I had the full Laparotomy done and received the definitive diagnosis. Treatment for him was Prednisolone also. So the treatment was the same in either case. I will never put another cat through the laparotomy again. In the two “undiagnosed” kitties, we treated the symptoms. The Prednisolone made them feel so much better: increased appetite, weight gain, diarrhea and vomiting gone. Happy kitties again! When symptoms started to return in one kitty and ultrasound showed inflammation was back, we added in the Leukeran which was a miracle drug for him. So we were just very practical and made decisions based upon each kitty’s individual situation (and our constraints) and we treated symptoms. In one case we also switched food to the hydrolyzed protein food as well. I just thought I would share this since I didn’t really address that part of your question yet.
Would they even DO an ultrasound on Mr. Kitty, given that he is so …. Umm…. shall we say “Spirited” at the vet? I suppose he could be sedated (not anesthetized). With his anesthesia history, I would not let him have general anesthesia again unless it were an emergency.
@Suzanne & Darcy No the clavamox did not make him sick. They just gave it to us as a catch all in case it was an infection while they waited for cytology report for fluid. Once we knew it wasn't infection, stopped it. What you mentioned about the prednisolone/chlorambucil is what I finally arrived at last night after a lot of reading. He seems completely fine, he only ever had issues with diarrhea after antibiotics. I don't want to start him on steroids "prophylactically" given the risks associated with it, I did forget his liver values were high (240-ish with 130 being top end of normal)...so budesonide is basically out ...not that it's the drug of choice anyway. When I start seeing signs of GI issues I'll start with diet, give that some time. Then look at pred. And if we get to the point that doesn't work, consider chlorambucil Need to ask about the folate. Unfortunately our vet uses a traveling ultrasound person, so I'm guessing they would want sedated at the least. Ill ask. If it were our vet, he really tries not to sedate. He did several 30+ minute chest taps on him without anything at all, the vet I took him to in a pinch is the one that knocked him out and he stopped breathing.
It sounds like you are looking after mr kitty very well and weighing the pros and cons from his POV. Best wishes to you and Mr!
My current vet uses a boarded travelling ultrasound vet. She does not use sedation, actually, pre COVID, I was there during the ultrasound to help keep kitty calm. Current kitty was diagnosed with an endoscopy, again a travelling endoscopy specialist. Recovery was very quick, just at the vet part of a day. But that requires anaesthesia so off the board for Mr. Kitty. Though I must admit I feel much better giving chlorambucil (on it’s own a mild carcinogen), knowing that I am dealing with cancer. Two previous cats were not diagnosed, including Neko, and a part of me wondered if I was over treating. Neko had enough issues causing nausea that adding chlorambucil onto the list was hard on her the couple days after treatment. I think I would wait for weight loss or other GI issues too.
No more of this vet for Mr. Kitty! Although, to his credit, he resuscitated Mr. Kitty. As for Mr. Kitty’s liver. Do you think you can give Milk Thistle (powder) or if pls are okay Denamarin. I didn’t think you pill Mr. Kitty? These liver supplements really can be helpful.
