? UPDATE: Howie is losing weight—what to ask vet besides kidneys?

I haven’t posted much about Howie lately. We started the summer off with him at 21 units BID. I had to do reductions when his critter sitters came while I was traveling and he miraculously has done well at 10 units BID for the past few weeks! I bumped him up to 11 units recently to try and get him to get in the greens. So on a diabetes and acro front, he’s doing well!

Earlier this summer, he stopped eating (besides forced nibbles enough to get insulin) for about 4 days. I took him in and he lost .7 lbs (12.9 to 12.2 lbs). My vet couldn’t identify anything wrong so we chalked it up to chronic pancreatitis flare-up. At that time I also started blending his food which has helped him eat (no teeth but probably acro tissue growth in mouth or throat). He still takes 75-90 min to eat most meals. Eating his mini meals his hit or miss these days too.

Last Fri I took him in for his monthly Solensia injection and they weighed him again and he lost another .7 lbs in 4 weeks. So he’s lost 1.5 lbs this summer. He seems to be drinking more and peeing more than normal in the last week.

He goes for his senior wellness exam on Mon and we’ll get another round of blood tests. I’m obviously concerned about kidneys. Is there anything else I should be inquiring about with sudden weight loss?

His current diagnoses:
Diabetes
Acromegaly
Chronic pancreatitis
Arthritis (doesn’t like to be held or sit in my lap, still jumps up some)

Current meds/supplements:
Levemir 11 units BID
Ondansetron 1 pill BID
Mirataz once/day
Buprenorphine 2 times/day transdermal
.6mL cabergoline once/day
2-3 tsp pumpkin each day for constipation
L-lysine powder 2 times/day
1/4 tsp fish oil once/day
30 units Adequan every 2 weeks for arthritis
Solensia injection once/month

Thank you!
@Wendy&Neko
@Suzanne & Darcy

 

The typical reasons for weight loss in our older cats are unregulated diabetes (not Howie ), hyperthyroidism (had T4 test lately?), or GI issues, more specifically small cell lymphoma or IBD. Note, GI issues are relatively common with our acros. Has he had his B12 levels tested? Low B12 would mean he's not got good absorption, and a common thing with cats with GI issues.

 

If it is something like B12, is that another med to add long-term or something short-term? How is SCL diagnosed?
I forgot to mention above that my vet believes he is mostly blind now and has a small heart murmur that he found in that visit.

this makes me so sad

 

I’ve been wondering how you two are doing.

The B-12 Wendy mentioned is cyanocobalamin (not the methylcobalain/methyl-B12 commonly used for neuropathy). It’s an injectable. I gave per the TAMU protocol, which I believe is what’s typically recommended. Cyanocobalamin requires a prescription but it’s not expensive. I used insulin syringes to give the injections. We used it long-term but that was specific to our situation. After the initial protocol (once a week for 6 weeks), it was a once-a-month injection.

I’m wondering if the weight loss is due to mechanical issues with eating or some underlying disease process. It’s so hard to tell sometimes.

What does his poop look like? (Color, consistency, etc). Sometimes that can be a clue.

Have you been tracking Howie’s resting respiration rate? Heart issues can also affect appetite and result in weight loss. I don’t recall if he’s had an echocardiogram, proBNP, or any other heart testing done, but cardiac issues are common in acro. We did all of the cardio testing on Tubby, multiple times, and even the experts couldn’t always agree on his situation, but I do know if certain issues are identified and diagnosed that there are some helpful drugs available. @Wendy&Neko is a good source of info if you have questions.

As for being mostly blind … did they check his blood pressure?

As for diagnosing SCL, I’ll let Wendy speak to that. We got Charlie’s official IBD diagnosis by endoscopy and tissue samples. We theorized he might also have SCL but without further testing and samples (which he wasn’t a good candidate for at that point), we couldn’t prove it.

 

Next, but not last, step for diagnosis is an ultrasound. That identifies if it is one of IBD or SCL. Then depending if there is inflammation in the bowels, and where it's located, you can do either endoscopy (also colonscopy). But thickening only in the middle section, then a surgical biopsy is needed. Like JL said, poop can be an indicator. All my SCL kitties were vomiters, indicating more likely first part of the bowels is inflamed. Diarrhea is another symptom. But so is just losing weight in spite of eating enough calories. Is he getting the calories he should? If you think he's nauseous, you can give ondansetron 3 times a day.

 

Thanks for the info on the B12. Very helpful to know going into his appt. I make sure he eats all his breakfast and supper each day (so I spend up to 3 hrs/day making sure he finishes his food). But I’m not home or not awake with his mini meals during the week. So I know he’s not getting all his daily calories. But the pumpkin twice a day does add some additional calories. As for his poop, he goes once every 1-2 days. It is solid and usually well-formed (not a pile). I have not been checking his respiration rates. Is there a suggested “good rate”? He did have a heart test done about 2 years ago (I think it was a blood test that had to be sent out?) and it was negative. Can’t remember which one it was but one I’m sure Wendy recommended! For the blindness, they didn’t check his blood pressure. Mostly some checks of his pupils and him walking around listlessly in circles and pacing and not seeming to see things I put in front of him. Howie is at least 15 so I just want him to be comfortable. I have to prepare myself that endless tests may not be in his best interest.

 

Thanks for all that info. No vomiting or diarrhea since he’s been losing weight. I responded above that his poop is well formed and seems normal even though he only goes every 1-2 days. I know he’s not getting all his calories each day as his mini meals are hit or miss if he eats some or all of them (6 in 24 hrs). I make sure he finishes his breakfast and supper meals at least.

 

Hi Howiesmom,

I was going to mention B12 and thyroid but the experts here are already on top of it!

As far as respiratory rates, with our cardiac issues cats, we were taught 15-30 breaths per minute, deep, nearer the stomach and back, not shallow, was ideal, 40 was the number they wanted us to contact the cat specific vet clinic we used at that point and to consider 50-60 emergency territory.

In my experience the cats tend to breath more evenly and deeply when relaxed. It's normal for them to be "higher" when they are smelling something new. They rev up a bunch of shallow quick sniffs. I time 30 seconds, counting the breaths, and double it. Hopefully that's helpful. I hope everything goes well on Monday.

Also, I am not sure if it's a possibility for Howie, but we did use an appetite stimulant for one of our cats who wouldn't eat anything and it got him interested in baby food and we worked him back up. I am not sure if Howie can take that with his medications but you could mention it to the Dr.

 

I’d try to get a blood pressure check at his next appointment. I had a cat who went nearly blind due to partially detached retinas, a result of hypertension (the high BP was likely secondary to kidney disease). She hid the vision loss well—my main clue was that her pupils were constantly almost fully dilated and even shining a flashlight didn’t make the pupils smaller.

We got her on Norvasc (amlodipine) right away, before the pupils fully detached. Some cats will regain at least partial vision if you get them on BP medications before the pupils fully detach.

Most, though not all, vets have the ability to check BP in-house. I believe a systolic over 160 in clinic (where cat might be stressed) is considered high. If for whatever reason Howie does end up needing BP meds, please double check the dosage — I’ve had vets who aren’t used to administering amlodipine completely screw up dosage.

When you say Howie was “circling,” was it more of a “wandering around a strange place” type of thing or did it seem like he wanted to circle somewhat tightly in one direction? (which could be more neurological). Acros can have unusual behaviors depending on what the tumor is doing and how it’s situated, though I’m not sure if it commonly impinges on the optic nerve or optic chiasm. I believe it can happen in humans and can affect vision. Wendy might know more about that.

I’m glad you’re getting the kidneys checked. That’s ultimately what took Tubby from me.

I’m not sure what I think of Solensia so I don’t typically say much about it, but I do have a few nagging questions about long-term use. I have a cat with significant arthritis but I haven’t had the courage to continue using Solensia. But that’s something to ponder another day…

 

Thank you so much! This is very helpful! And yes, Howie is an Mirataz app stimulant already for his pancreatitis. We talked about switching the kinds to something else (can’t remember what one). I’m not sure for him it’s a matter of not wanting to eat, he struggles to swallow with what we believe to be extra tissue growth in his gums or throat.

 

I will see if we can get a blood pressure check on Mon. Did a few tests with a light in Howie’s eyes (pupils stated dilated) and a couple other visual cue tests. When he circles, it’s not necessarily just in one direction. But he walks forward and backwards, sometimes sideways (very strangely) as if he is trying to get his bearings in where he is. An I ask what some of your concerns are of Solensia? A couple other people have mentioned concerns but when I asked for more details, they never responded. Neither my vet or I are aware of possible long term negative affects. I’m afraid to take him off it as I don’t want him to be in more pain than he already is.

 

JL is correct. The pituitary is near the optic chiasm and growth can impact vision. Not something we see a lot of here, but occasionally.

 

I just got Howie’s lab results back and would love some feedback on what people see/think. They are in his spreadsheet. Albumin is high and his SDMA went from 25 in Sept 2022 down to 14 in Feb 2023 back up to 20.4 this month. His BUN and CREAT are fine although phosphorus went up but is still in the OK range. And his Thyroid T4 looks fine. I know SDMA can vary. Should I retest in 2 weeks? We were going to run his bloodwork before sending out for the Cobalamin/Folate test for B12. Does his weight loss sound like anything we can attribute from his bloodwork? Should I check his B12 still? Other things I should inquire with my vet?

His blood pressure was good but he has a heart murmur that is between stages 3-4 (he thought he was stage 1 about 6 weeks ago). The comments on his report card say “systolic; PMI rt”. My vet talked about doing an echocardiogram but we both agreed that Howie is about 15 and is there anything we can really do? He is afraid with everything else Howie is on that heart meds could make him sick. For anyone whose kitties have/had heart problems, thoughts? I’m really in unknown territory with heart problems.

The only other comment on his report card said “We will continue to monitor weight loss. Neoplasia is owner rule out this but not conclusive.” I’m not sure what that means?

I appreciate anyone’s feedback.
@Wendy&Neko
@Suzanne & Darcy

 

Hi Howiesmom,

I defer to all the knowledgeable people here but this is what I can offer:

Regarding the blood tests, based off my own experiences, when we have had high Albumin it was when we had a cat that couldn't keep fluids down and he required subcutaneous fluids to rehydrate. I see Howie's SDMA has been high before too. I believe that can be related to kidney stress if the thyroid looks normal. If he is struggling to stay hydrated (with low food intake and low thirst) that could stress the kidneys I imagine. Might be worth asking the Dr about hydration at least. I personally would still recommend the B12 test but I like having as much data as possible to figure out problems and I know B12 deficiency is a common issue causing lack of hunger so if it's not excessively expensive I would consider it.

I do unfortunately have a significant amount of personal experience with cardiac issues in cats. We have one cat with severe atrioventricular valve dysplasia due to a congenital deformation in her mitral valve. She was diagnosed at 3months and the vet was amazed she woke up from being spayed. She has gone into congestive heart failure once before we were able to find a cardiologist that could really help us. She takes Lasix once a day as a diuretic, she takes Atenolol twice a day as a beta blocker which is intended to manage her heart rate and she takes enalapril once a day alternate to the lasix, which is an ACE inhibitor which relaxes the cardiac blood vessels and reduces oxygen demand (makes her lower energy but fewer cardiac events). First couple Drs said she wouldn't live to 2. She's 9.5 years old now.

We also have a 14.5 year old, Baby's littermate, who has just about everything you can imagine besides diabetes. Besides autoimmune issues and only one functional lung, he also developed a "moderate" heart murmur somewhere around 12 years old. He also has hyperthyroidism and severe IBD and has had several strokes. Unfortunately, he is on prednisolone to manage the IBD, some thyroid medication, and vetmedin twice a day for his murmur.

Both of these cats have "improved" according the the cardiologist - which they always remark is surprising. I think feeding them the diet we do contributes to heart health - wet food, trying to have low carbs....

We also have a 9 year old with a mild murmur who gets no treatment.

We do echos on the severe heart girl at least once a year (Dr wants every 6 months to "adjust" the script, but it's a 400$ hit and they've never adjusted either of the cat's scripts). We do the other cat's once a year when they make us too.

Hopefully that can at least give you an idea of if you want to try to manage Howie's murmur or not. I think the first two echos are important then it's sort of a money maker for the vet with the pressure that you do want to know if the dose is high/low.

I have no idea why there is a note about Neoplasia. That's abnormal cell growth so like tumors or something. Sometimes cancer, like lymphoma, sometimes not.

edit: Regarding the stages thing, it appears to vary between cardiologists. Our severe kitty's murmur/misfire of the valve was audible without a stethoscope when she was untreated. I have heard both 5 and 6 for her.

The one that only gets Vetmedin was a 1-2 then moved up to a 3-4 and that's when he got vetmedin.

The last one was so mild she gave no number and was only commenting on it because he needed anesthesia for dental work.

My 'sense' is that 1-2 are very common and sort of not a huge concern to most doctors, but 3-4 is where they start to want to do echos and medicate. My understanding is the grades are really a subjecting number the Dr comes up with based on how loud the murmur is and if they can heart it from either side of the chest.

 

How hydrated was Howie going into the blood work? That can impact kidney numbers and make some move around. The SDMA is definitely elevated, and shows him to be in the stage 2-3 level http://felinecrf.org/how_bad_is_it.htm#iris_sdma, though the other indicators don't say that. SDMA can vary. When I got current rescue about 6 years ago, her SDMA was 14, now it's mostly in the 8-10 range.

You don't want his phosphorus above 6, and he's slowly creeping up there, so something to keep an eye on what you feed him.

I would still get his B12 levels tested, you can do it by itself, or as part of the Texas A&M GI panel that tests folate, TLI and pancreatitis as well. The B12 level question can be an indicator of poor gut absorption, but won't tell you why it's poor. The ultrasound would be the next step. But possible not the last.

What number was "blood pressure is good"?

I would go for an echocardiogram if you can swing it. Acros are very prone to heart conditions, some of which can be helped by medications, but not if you wait too late. Our furry friends are good at hiding heart issues until it's too late. A changing heart murmur is something I would get investigated, and preferably by a cardiologist vet. There are also trade offs between medicating kidney issues and heart issues. I was "lucky" in that Neko's heart issues could be treated, at least for a while. Her kidneys were a lot worse than Howie's so it was a delicate balance treating one vs the other. I had a previous kitty with suspected heart condition. He had one echo, and the vet said to redo in 6 months. I waited cause the 6 months was over the year end holiday season, and just didn't get onto it on time. He had a saddle thrombosis event (stroke) that was preventable, 2 days before his scheduled echo, but the event caused a lot of pain and we PTS.

The neoplasia comment sounds like it's up to you to decide if further tests would be done.

 

I’m slowly losing hope that Howie doesn’t have CKD. I took him in this AM for his monthly Solensia injection and he has lost another .4 pounds so he is down to 11.1 pounds. He has lost 2.3 pounds since early summer. We did a blood draw today as well to check his B12 (cobalamin/folate test).

I just don’t know what else it can be. I had a CKD kittie before Howie and he wasted away. I can’t bear the thought of that again and still carry a lot of guilt of how long I kept him going.

 

The B-12 can really be a thing. My cat was losing half pound a month for 8 months, turned out his B-12 was low. I’ve got him on injections weekly plus a few other things, but he has gained back almost 2 pounds. There is really good info on B-12 on the ibdkitties.com website.

It sounds like you’re a great cat-mom. I’m hoping all the best for you.

 

Thank you so much for this message! I should get results soon!

 

Hi Tracy! I have been thinking of you. Went to sleep last night for some reason thinking of you and Howie... wondering what was going on with Howie... so I came here to look today... and saw this thread from back in mid-September. I'm sorry I never saw it before. You've gotten a lot of good advice here, pretty much a lot of stuff I would have said. I question the blood pressure as well -- would want to know the exact number. I also have experience with heart disease and meds. My cat is doing so much better on a few heart meds. I hope that is not what's going on with Howie. I'm so sorry that you've been going through so much with Howie. The B-12 could really be making him feel low. That is so odd -- the way you describe his movements. You have lots of love and support coming your way from me!

 

You are so sweet! Thank you! I just found his report card and here were his BP readings: 107/70 mean-81, 78/67 mean-71, 66/45 mean-52. The vet said the #s looked good. I’m still waiting on the cobalamin/folate test results. Hopefully the end of this week.