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Followup No. 3 on Moses ... good news!

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Gregory Bailey - 15 Jan 2005 06:51 GMT
Cytology report from the needle aspiration came back, no cancer, his liver
is just inflamed. That's nothing to say "hip hip hooray" about, mind you,
but at least there was no cancer and we can get started on a regimen of
treatment.

I talked with my vet today after getting the test results from the
internist. This is our main vet who has specifically treated Moses during
this time, the vet we saw yesterday was someone else in the practice who is
also a top-notch vet but as I said the one I talked with today (who was out
of the office yesterday) is the one who has pretty much been handling this
case.

He made it a perfect four-for-four in agreeing with me, the internist and
the vet who saw Moses yesterday that because of the thickening of the bowel
that showed up on the ultrasound, we are going to go ahead and start
treating him as if he had inflammatory bowel disease. He has some Prednisone
waiting for me at the receptionist's that I've got to pick up first thing in
the a.m.

We're also going to continue him on the Metronidazole at least for the time
being.

We're also going to try to continue him on the Hill's i/d food, although
after his initial burst of hunger following his fast for the medical
procedures, he's been a little picky at eating that, I've had to mix in a
bit of his regular food to try to prod him into eating it.

And we're going to wait for the results of the thyroid and pancreas tests.

An aside to Phil P., we did do the "send it off" thyroid test this time
instead of just the screen.

After researching things, I figured it was hyperthyroidism as well, because
he's showing textbook symptoms of it, which is why it surprised me that two
thyroid tests came back showing no problems. But we did have the test done
that you recommended ... the internist recommended it and the pancreas test
... so if there's a problem there hopefully we'll find it out this time.

As far as vomiting and diarrhea, these have been sporadic problems for Moses
all his life, although they've gotten a bit worse in his sickly condition
(the internist described him on the report as being "emaciated"). He has
always been prone to hack up every now and then, has been prone to hairball
problems and is prone to hack up because he's always tended to eat his food
like a hog at a trough, not like a cat, in other words a bit too rapidly.

His BMs have always been a bit problematic as well. He has always, since he
was a kitten, had rather loose stools. Occasionally he'll have diarrhea, but
it's usually not quite to that point, just basically looser than pretty much
any other cat I've ever had. But other times his stools are quite normal as
far as consistency, etc.

It makes me kind of wonder if he's had underlying intestinal problems all
his life, but they didn't manifest themselves when he was a young, frisky,
energetic cat and they're starting to manifest themselves now in his
geriatric years.

One more thing ... if anyone has any experience dealing with IBD, as far as
food recommendations or herbal/holistic recommendations (I'm certainly
willing to try that), I'd appreciate the input. Because even if the more
detailed thyroid report does show a thyroid problem that has his liver
screwed up, we've still got the indications of IBD showing up on the
ultrasound.

Thanks!
Cat Protector - 15 Jan 2005 06:55 GMT
Glad to hear the news. I hope your cat gets better.

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> Cytology report from the needle aspiration came back, no cancer, his liver
> is just inflamed. That's nothing to say "hip hip hooray" about, mind you,
[quoted text clipped - 77 lines]
>
> Thanks!
-L. - 15 Jan 2005 09:02 GMT
> Cytology report from the needle aspiration came back, no cancer, his liver
> is just inflamed. That's nothing to say "hip hip hooray" about, mind you,
> but at least there was no cancer and we can get started on a regimen of
> treatment.
Yay!  I'm glad you have a treatment plan.  best of luck to you,
-L.
Betsy - 15 Jan 2005 13:17 GMT
I'm dealing with virtually the same scenario.  There is a Yahoo group for
feline IBD:

     Subscribe: FelineIBD-subscribe@yahoogroups.com

> Cytology report from the needle aspiration came back, no cancer, his liver
> is just inflamed. That's nothing to say "hip hip hooray" about, mind you,
[quoted text clipped - 77 lines]
>
> Thanks!
KellyH - 15 Jan 2005 14:04 GMT
> One more thing ... if anyone has any experience dealing with IBD, as far
> as
[quoted text clipped - 3 lines]
> screwed up, we've still got the indications of IBD showing up on the
> ultrasound.

What you are going through sounds eerily similar to Dash, although I don't
think she had any liver problems, but I can't say for certain.  She also was
hyperthyroid.
Many people here swear by Wellness canned food only as a diet for IBD cats.
Unfortunately, I never got to try it with Dash, I was still trying the
various dry prescription foods.  The reason Wellness works is that it is
grain-free, which causes less irritation to the intestines (do I have that
right IBD people?)

Good luck, and I'm really happy to hear it's not the c-word.

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-Kelly
kelly at farringtons dot net
"Wake up, and smell the cat food" -TMBG

Karen Chuplis - 15 Jan 2005 15:34 GMT
Wow. You knew it wouldn't be a "all healthy" report so as far as reports go,
this is way better!! I'm very glad for you and please, please keep us
updated.
hamandcheese@betweentheknees.com - 15 Jan 2005 16:02 GMT
>One more thing ... if anyone has any experience dealing with IBD, as far as
>food recommendations or herbal/holistic recommendations (I'm certainly
>willing to try that),

This is great news Gregory!

I wouldn't try any holistic voodoo without running it past your vet
first.

-mhd
Gregory Bailey - 16 Jan 2005 01:37 GMT
I should have said herbal or food recommendations, not holistic ... I take
herbal supplements myself and would not hesitate to try one on Moses if it
could help out here, and I know that there is a line of thought that IBD is
food related although he appears to be doing well on the Science Diet i/d.

> >One more thing ... if anyone has any experience dealing with IBD, as far as
> >food recommendations or herbal/holistic recommendations (I'm certainly
[quoted text clipped - 6 lines]
>
> -mhd
Cathy Friedmann - 15 Jan 2005 16:27 GMT
> Cytology report from the needle aspiration came back, no cancer, his liver
> is just inflamed. That's nothing to say "hip hip hooray" about, mind you,
[quoted text clipped - 24 lines]
>
> And we're going to wait for the results of the thyroid and pancreas tests.

So far, so good, re: fine-tuning the diagnosis.  I'm glad your internist's
appt. was productive.  Once the other test results are back, the vets can
continue to narrow down what the root(s) of the problem is(are), & tailor
the treatment better & better to his needs.  Continued good luck!

Cathy
zuzu22@webtv.net - 15 Jan 2005 16:35 GMT
First and foremost, I'm very glad to hear that you have been to the
specialist and are looking at what is a treatable issue and not likely
to be cancer!

>One more thing ... if anyone has any
>experience dealing with IBD, as far as
[quoted text clipped - 6 lines]
>indications of IBD showing up on the
>ultrasound.

What have you been feeding your cat up until now? Dry food only? If so
what kind?
Most dry foods contain corn and other types of grains that can create
problems for IBD cats. Both of the Science Diet i/d prescription diets
contain corn, which is a big no-no for most IBD cats and IMO you're
better off using a *canned* commercial food with no grains or doing a
lot of research and making a homemade diet for your cat. Prescription
diets are not a magic bullet, and I will not use them because they are
full of crap ingredients. I've had many cats over the years with various
health issues and I've always been able to find alternatives that work
as well or better.

Wellness canned is an excellent food that contains no grains and is used
by a lot of people on the Yahoo IBD list. That may be a good place to
start, but I would suggest you start with only one or two flavors such
as chicken and turkey and see how your cat tolerates those before
expanding to any other flavors. You can find a store that carries it by
going to http://www.oldmotherhubbard.com and using their store locator
function. It would also definitely be a good idea to use digestive
enzymes to help him to better absorb nutrients. Adding slippery elm can
be useful too as it can help calm inflamed intestines.

I also highly recommend you read this website, which is maintained by a
woman who has a cat with IBD that, after miserable failures using
prescription foods,  has been cured with a homemade diet:
http://www.catnutrition.org
Many people on the Yahoo IBD list have had great success using homemade
diets as well, and I think these may very well be your best options.

Good luck and please keep us posted on your kitty's progress.

Megan

                                   
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Mary - 15 Jan 2005 19:01 GMT
> Cytology report from the needle aspiration came back, no cancer, his liver
> is just inflamed. That's nothing to say "hip hip hooray" about, mind you,
> but at least there was no cancer and we can get started on a regimen of
> treatment.

Kudos to you for trying so hard to give Moses the best treatment
he can get. I really hope he recovers and has more good years
to enjoy.
Betsy - 16 Jan 2005 02:16 GMT
As another poster mentioned, dry food is hard on the IBD cat because of the
grains.  However, in my "herd" I cannot avoid dry.  They get wet too,
usually Wellness or other premium foods.

I've been trying out various dry foods formulated for "allergies" or
"sensitive stomachs".  PetCo has just started to carry the new formulation
from Dick Van Patten, made only of venison and green peas.  I bought a bag
just a little while ago, and all of the kittyhogs gave it a "thumbs up".

> Cytology report from the needle aspiration came back, no cancer, his liver
> is just inflamed. That's nothing to say "hip hip hooray" about, mind you,
[quoted text clipped - 77 lines]
>
> Thanks!
Phil P. - 16 Jan 2005 06:03 GMT
> Cytology report from the needle aspiration came back, no cancer,

Yabba dabba doo!  I didn't think cancer was the problem.

his liver
> is just inflamed. That's nothing to say "hip hip hooray" about, mind you,

Sure it is - considering the feline liver has a fantastic ability to
regenerate.

There's a strong possibility that his liver problems are caused by
malnutrition and the direct toxic effects of the thyroid hormones on the
liver.  Another thing, hyperthyroidism speeds up gastric emptying and
shortens the time nutrients spend in the small intestine (where they're
absorbed) which reduces their absorption -- add this to every organ system
running at top speed and wha-la: malnutrition, weight loss and liver
problems.

> but at least there was no cancer and we can get started on a regimen of
> treatment.

Sounds like a much better plan than euthanasia!  I'm really happy you took
this route.

> I talked with my vet today after getting the test results from the
> internist. This is our main vet who has specifically treated Moses during
[quoted text clipped - 12 lines]
> We're also going to continue him on the Metronidazole at least for the time
> being.

We had some problems with metronidazole in a few of our IBD cats.   It
wreaked  havoc on the normal flora of the small intestine.  It kills too
many "good" bacteria and allows "bad" bacteria to multiply and produce their
irritating toxins.

> We're also going to try to continue him on the Hill's i/d food, although
> after his initial burst of hunger following his fast for the medical
> procedures, he's been a little picky at eating that, I've had to mix in a
> bit of his regular food to try to prod him into eating it.

The most important things right now are nutrition and hydration.  He *must*
keep eating.  It doesn't matter how perfectly formulated a diet is if he
won't eat it.  You can't go toe-to-toe with a cat over food and win.  So
just make sure he keeps eating and drinking.  In his present state, he can
dehydrate quickly.

> And we're going to wait for the results of the thyroid and pancreas tests.
>
> An aside to Phil P., we did do the "send it off" thyroid test this time
> instead of just the screen.

Smart play.  If the fT4ED comes back normal I'll be *very* surprised.

> After researching things, I figured it was hyperthyroidism as well, because
> he's showing textbook symptoms of it, which is why it surprised me that two
> thyroid tests came back showing no problems.

As I said in a previous post, if Moses has other things going on -
especially malnutrition - a routine T4 test result might (probably) be
inaccurate.  The fT4ED will give you a better picture of his true thyroid
function

But we did have the test done
> that you recommended ... the internist recommended it and the pancreas test

Thyroid hormones also have a direct toxic effect on the pancreas - they also
decrease pancreatic enzyme secretion - which also effects absorption of
nutrients.

Thyroid hormones affect every organ and cell in the body.  Usually all or
practically all other abnormalities resolve when hyperthyroidism is brought
under control.

> ... so if there's a problem there hopefully we'll find it out this time.
>
[quoted text clipped - 10 lines]
> any other cat I've ever had. But other times his stools are quite normal as
> far as consistency, etc.

Could be he had to compete for food when he was young kitten.  That could
lead to a life-long habit of rapid eating and vomiting as a result of the
following acute gastric distention.  Hyperthyroidism would certainly
exacerbate this situation.  Hypermotility will decrease stool consistency
and increase the number of times he has to poop.

> It makes me kind of wonder if he's had underlying intestinal problems all
> his life, but they didn't manifest themselves when he was a young, frisky,
> energetic cat and they're starting to manifest themselves now in his
> geriatric years.

Possibly.

> One more thing ... if anyone has any experience dealing with IBD, as far as
> food recommendations or herbal/holistic recommendations (I'm certainly
> willing to try that), I'd appreciate the input. Because even if the more
> detailed thyroid report does show a thyroid problem that has his liver
> screwed up, we've still got the indications of IBD showing up on the
> ultrasound.

Speak to your vet about d/d - its easier on the gut mucosa than i/d, and
also glutamine-supplemented nutritional support. Glutamine is a
"conditionally essential" nutrient in sick cats and can improve the
protective function of the gut barrier..

I wish you and Moses the best of luck.

Keep the faith!

Phil.
Gregory Bailey - 16 Jan 2005 07:00 GMT
>> Sure it is - considering the feline liver has a fantastic ability to
> regenerate.

That's great news.

> There's a strong possibility that his liver problems are caused by
> malnutrition and the direct toxic effects of the thyroid hormones on the
[quoted text clipped - 3 lines]
> running at top speed and wha-la: malnutrition, weight loss and liver
> problems.

See, I've suspected this all along, but the two screens were negative and I
was not aware of the other test until the internist told me about it and
recommended we have it done, and you mentioned it here. At least I don't
recall my regular vets mentioning it, although I don't hold it against them
if they didn't, they are first-rate folks and maybe they did mention it and
things just didn't connect.

> Sounds like a much better plan than euthanasia!  I'm really happy you took
> this route.

As a point of clarification, except for one moment last weekend when my wife
(especially) and I wavered and were really wondering if the cat was
suffering and if we'd cause him to suffer even more by prolonging things and
we sort of half-heartedly said "let's go ahead and let him go" before we
stopped ourselves and said "hold on a minute," we were not going to have the
cat put down unless we got a positive cancer diagnosis, and those were the
signals we were getting from the vets at the time I brought this up here. If
we had gotten a positive cancer diagnosis, we were going to have him put
down, and the internist based on the cat's age and his condition was
supportive of that decision. If it wasn't cancer but was something
treatable, we were going to at least give it a shot and see if we could help
him.

> We had some problems with metronidazole in a few of our IBD cats.   It
> wreaked  havoc on the normal flora of the small intestine.  It kills too
> many "good" bacteria and allows "bad" bacteria to multiply and produce their
> irritating toxins.

I wondered about this and asked the vet after we decided to go ahead with
the prednisone if we needed to discontinue the metronidazole, but he said to
go ahead and give both. FYI, Moses doesn't take pills well ... he's a drooly
cat, both when he's happy and purring and when he's under stress ... so the
vet ground the metronidazole pills down and made a solution of them using a
liquid vitamin as the base. We're also giving him liquid prednisone.

>> The most important things right now are nutrition and hydration.  He
*must*
> keep eating.  It doesn't matter how perfectly formulated a diet is if he
> won't eat it.  You can't go toe-to-toe with a cat over food and win.  So
> just make sure he keeps eating and drinking.  In his present state, he can
> dehydrate quickly.

That is not a problem. I'm not overstating things, even when he was wasting
away to nothing, this cat ate and continues to eat enough food to make
Garfield burst.

> Thyroid hormones also have a direct toxic effect on the pancreas - they also
> decrease pancreatic enzyme secretion - which also effects absorption of
[quoted text clipped - 3 lines]
> practically all other abnormalities resolve when hyperthyroidism is brought
> under control.

I'm hoping that's what it is because I know that's treatable as well. I'm
aware of the options there, we're inclined at least to start with ... until
we can pay off this mountain of vet bills, LOL! ... to go with medication
instead of surgery or the radioactive iodine treatment. I know I just said
that he has problems taking pills, but it's something we'll just have to do.

> Could be he had to compete for food when he was young kitten.  That could
> lead to a life-long habit of rapid eating and vomiting as a result of the
> following acute gastric distention.  Hyperthyroidism would certainly
> exacerbate this situation.  Hypermotility will decrease stool consistency
> and increase the number of times he has to poop.

Don't know ... he was probably about six months old when my sister-in-law's
family rescued him off the street, and was malnourished at the time.
Phil P. - 16 Jan 2005 15:19 GMT
> >> Sure it is - considering the feline liver has a fantastic ability to
> > regenerate.
[quoted text clipped - 15 lines]
> if they didn't, they are first-rate folks and maybe they did mention it and
> things just didn't connect.

Believe it or not, a lot of vets don't recommend the fT4ED assay because
they usually have to draw and send a seperate blood sample to a different
lab - more work and more paperwork -- for only a $20-test.

> > Sounds like a much better plan than euthanasia!  I'm really happy you took
> > this route.
[quoted text clipped - 11 lines]
> treatable, we were going to at least give it a shot and see if we could help
> him.

I misinterpreted your post as you were considering euthanizing Moses without
actually knowing what was wrong and if his condition is treatable.  Few
things piss me off more than an attitude like that. I'm glad (and relieved)
you clarified your meaning.

> > We had some problems with metronidazole in a few of our IBD cats.   It
> > wreaked  havoc on the normal flora of the small intestine.  It kills too
[quoted text clipped - 5 lines]
> the prednisone if we needed to discontinue the metronidazole, but he said to
> go ahead and give both.

I'd be concerned about metronidazole until his liver situation has been
sorted out. You might want to read the drug monograph for metronidazole.

FYI, Moses doesn't take pills well ... he's a drooly
> cat, both when he's happy and purring and when he's under stress ... so the
> vet ground the metronidazole pills down and made a solution of them using a
> liquid vitamin as the base. We're also giving him liquid prednisone.

Metronidazole has a sharp, nasty, metallic taste that makes a lot of cats
salivate.  Most cats only need 1/4 - 1/2 section of the pill - so, when the
tab is cut or broken, the open sides of the broken sections expose the nasty
taste. You might want to speak to your vet or pharmacist about recompounding
metronidazole into a flavored sus?pension.

Cats won't salivate or struggle if you're fast enough and get it over with
before the cat knows what's happening.  Most people make a big production of
pilling - like wrapping the cat in a towel and using too much restraint.

Stroke his head from the nose all the way to his back with the whole palm of
your hand.  After a few minutes, and he's relaxed, as you begin to stroke
his head, used your thumb and middle finger to *quickly* push the sides of
his mandible and hold it open while tilting his head straight up in the
*same* motion.   Drop the pill into the laryngopharynx *quickly* so that it
doesn't dissolve and he doesn't taste or smell it.  If you have to, you can
use the middle finger of the other hand holding the pill to push down on the
lower incisors to open his mouth wider.

Here's a picture and diagram that shows how its done:

http://www.maxshouse.com/Medicating_Your_Cat.htm

I pill a lot of cats - this technique works like a charm.  The secret to
pilling a cat is *speed* and smoothness of motion and minimal restraint.
Even if you're not pilling the cat, most cats will fight against restraint.
The trick is getting it over with before he knows what's happening.  The
less of an ordeal, the easier every pilling will be.

> >> The most important things right now are nutrition and hydration.  He
> *must*
[quoted text clipped - 6 lines]
> away to nothing, this cat ate and continues to eat enough food to make
> Garfield burst.

That's good.  BTW, did your vet check his stool for excess fat content?

> > Thyroid hormones also have a direct toxic effect on the pancreas - they
> also
[quoted text clipped - 10 lines]
> we can pay off this mountain of vet bills, LOL! ... to go with medication
> instead of surgery or the radioactive iodine treatment.

Actually, medication is the wisest choice for a cat his age.  Medication is
"adjustable and reversible - surgery and radioiodine are not.  So,  if the
cat has underlying CRF,  its possible to adjust the dose and strike a
balance between an "acceptable" level of hyperthyroidism and an "acceptable"
level of azotemia leaving the cat *mildly* hyperthyroid.  Sometimes, *mild*
hyperthyroidism will augment renal function and greatly extend the lives of
cats with concurrent diseases.

I know I just said
> that he has problems taking pills, but it's something we'll just have to do.
>
[quoted text clipped - 6 lines]
> Don't know ... he was probably about six months old when my sister-in-law's
> family rescued him off the street, and was malnourished at the time.

Competing for food and/or not knowing when he'd eat again could certainly
produce a rapid eater!

Best of luck.

Phil.

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