More on Moses ... thyroid normal

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Gregory Bailey - 20 Jan 2005 18:03 GMT

That's going to shock Phil P., and it surprised me a bit too, but I finally
got the test results today and the thyroid, according to the vet, was
absolutely normal.

However, the TLI, the pancreatic test, was not normal. I didn't get the
numbers on the thyroid, I probably should have, but the TLI was 1.89 and
according to the vet anything 1 or over is problematic.

The accompanying interpretation of the test suggested that the pancreatic
elevation may be connected to other intestinal problems ... i.e., the IBD,
liver, etc. They suggested some other tests and the possibility of opening
him up to do biopsies, etc., of the intestinal area.

However, my vet suggested ... and I'm in concurrence, because we're not
inclined to subject this cat to surgery at his age unless it's absolutely
necessary ... that we should follow the treatment regimen we're on right now
(prednisone, metronidazole, prescription diet) for another 3 weeks or so and
see how things stand then.

Moses does seem to feel better after being on meds and the prescription diet
for a week now, and I think he's actually putting on weight.

However, he may not live to get well because he continues to defecate
outside his box. We were hoping that would stop if we could get him feeling
better and get his system slowed down to where food is not going straight
from his mouth to his rectum, but we're wondering now if this has gotten
behavioral, if he's gotten so used to it that it's now "regular" for him.

Plus he seems to be going in the area of heater ducts a lot ... like a lot
of cats I'm sure, he likes to lie on the heater ducts for the warmth ... and
it's almost like he's not willing to leave the warmth to go to his box.

It's not an all the time thing, sometimes he does go in his box. And we try
to praise him when we see him there. But we're finding accidents at least
once a day and it's getting kind of messy and he's ruining things (like one
of my kids' books that was inadvertently left in the floor this a.m.).

Any suggestions on dealing with this problem with a cat of his age (14)? And
has anyone had any experience with pancreatic problems in a cat?

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Karen Chuplis - 20 Jan 2005 18:41 GMT

> That's going to shock Phil P., and it surprised me a bit too, but I finally
> got the test results today and the thyroid, according to the vet, was
[quoted text clipped - 35 lines]
> Any suggestions on dealing with this problem with a cat of his age (14)? And
> has anyone had any experience with pancreatic problems in a cat?

Keep things off the floor (kid should now know this lesson). Put a box right
by where he likes to sleep. Cut a little lip in it or get a puppy litter box
that has a lower side for entrance. He doesn't feel good and is old. He
should not be punished for not making it to the box.

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Wendy - 21 Jan 2005 01:06 GMT

He will probably go back to using the box when he's feeling better. In the
mean time make sure the box is close to where he hangs out and maybe get one
with lower sides so it's easier for him to get in and out.

Good luck with your kitty.

W

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zuzu22@webtv.net - 21 Jan 2005 02:39 GMT

Gregory,
Please take a look at my post on Bartonella and read the link. It might
be worth a shot to test for that, since Moses has a lot of weird things
going on that are hard to explain.

Megan

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Rhonda - 21 Jan 2005 05:38 GMT

Our cat, Bob, had diabetes, then developed pancreatitus. The
pancreatitus was harder to control.

He would get bouts of very high fever, throw up everywhere, and land in
the hospital for a few days. From what the internist told me -- the way
to treat pancreatitus is to rest the pancreas, which means not to eat
for awhile. With dogs, they withhold food for a day or two. They can't
do that with cats because of how fast they develop fatty liver disease
when not eating.

We worked with his diet, and the vet gave him supportive care when there
was a flare-up. We used a prescription novel protein food, IVD, and it
worked well. We had a full year without a flare-up. The vet thought Bob
could also have IBD, but did not think it was worth the risk of a biopsy
at that point.

Trouble with cats is they can develop food aversions. If they get sick
after eating they blame the food, then won't eat that kind again. We had
to trade some flavors around on Bob a few times.

Good luck with your cat.

Rhonda

> Any suggestions on dealing with this problem with a cat of his age (14)? And
> has anyone had any experience with pancreatic problems in a cat?

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Phil P. - 21 Jan 2005 07:19 GMT

> That's going to shock Phil P., and it surprised me a bit too, but I finally
> got the test results today and the thyroid, according to the vet, was
> absolutely normal.

I'm disappointed and surprised - not shocked. I was hoping the problem was
hyperthyroidism because its easily treated without surgery, and the
prognosis is almost always good to excellent. His symptoms are classic of
hyperthyroidism -- except for seeking heat that you just mentioned.

Keep a positive attitude; the upside of this is that we can rule out
hyperthyroidism -- which brings us one step closer to figuring this out..

> However, the TLI, the pancreatic test, was not normal. I didn't get the
> numbers on the thyroid, I probably should have, but the TLI was 1.89 and
> according to the vet anything 1 or over is problematic.

Pancreatitis doesn't quite fit either. The hallmark of acute and chronic
and even mild pancreatitis is anorexia and vomiting - that ain't happening.
However, now that hyperthyroidism has been ruled out I think the pancreas
may be involved - but not necessarily pancreatitis.

<inserted from below>

> Plus he seems to be going in the area of heater ducts a lot ... like a lot
> of cats I'm sure, he likes to lie on the heater ducts for the warmth ... and
> it's almost like he's not willing to leave the warmth to go to his box.

I don't recall you mentioning this before. This is a very important
observation. If I knew this earlier I probably wouldn't have been convinced
he had hyperthyroidism. Many hyperthyroid cats are *heat-intolerant*.
OTOH, many cats with pancreatic disorders are hypothermic. Did your vet
check Moses' temp?

<inserted from below>

We were hoping that would stop if we could get him
feeling

> better and get his system slowed down to where food is not going straight
> from his mouth to his rectum,

Now that hyperthyroidism has been ruled out, there's a strong possibly his
pancreas may not be secreting enough digestive enzymes (exocrine pancreatic
insufficiency - EPI) -- or he may be secreting too much gastric acid that's
either destroying or degrading the pancreatic enzymes that normally break
down food so that the nutrients can be absorbed. This is a form of
malabsorption that leads to voluminous stools and malnutrition and even
starvation - even though he's eating like a pig.

Speak to your vet about pancreatic enzyme supplements (Pancrezyme or
Viokase) - get the powdered form - not the tablets - and mix 1/2 - 1 tsp in
his food.

Before you feed him the mix, lick your fingertip so you can pick up a dash
of the powder with your finger and put a dab on his nose that he'll
immediately lick off. This way he won't smell or taste the powder in his
food.

Don't worry - pancreatic enzyme supplements are all natural - harvested from
cows or pigs. Some vets even recommend raw pancreas if the cat develops an
aversion to the powered enzymes.

Its a good idea to start treating him with cimetidine (Tagamet) a day before
you begin the pancreatic enzyme supplements just in case he's secreting too
much gastric acid - which would instantly destroy or degrade the pancreatic
lipase in the supplement -- Or you could wait and see if he responds to the
enzyme supplements -- if he doesn't, then you can give him the Tagamet.
However, given his present condition, I'd start the Tagamet first because
I'd want a resolution as quickly as possible.

Also, speak to your vet about B-12 (cobalamin) supplements -- Cats can't
store a lot of cobalamin and become depleted quickly by EPI or intestinal
disease. Cobalamin deficiency also leads to intestinal inflammation and
malasborption, which could (probably) lead to a failure to respond to the
pancreatic enzymes alone.

Did your vet examine Moses' feces for undigested fat and other foodstuffs?
What does his stool look like -- yellowish tan or kinda clayish colored?

Keep the faith!

Phil.

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Gregory Bailey - 21 Jan 2005 13:59 GMT

> I don't recall you mentioning this before. This is a very important
> observation. If I knew this earlier I probably wouldn't have been convinced
> he had hyperthyroidism. Many hyperthyroid cats are *heat-intolerant*.
> OTOH, many cats with pancreatic disorders are hypothermic. Did your vet
> check Moses' temp?

Yes, vet checked his temp and it was normal. And I didn't think to mention
this because my cats ... I don' t know if I mentioned to you, we do have
another cat, who's also 14, who is the picture of health and as frisky as a
kitten ... have ALWAYS laid on the heater vents, sometimes fighting over
"just the right one" that both of them wanted. In fact, the healthy kitty
(Bartholemew is his name) is lying on the heater vent adjacent to me as I
type this right now. I just figured that cats innately like warm spots. When
I was a kid, we had a cat who was asleep on a warm car engine, and it got
cranked up and the cat was turned into a Manx, if you catch my drift.

> > Now that hyperthyroidism has been ruled out, there's a strong possibly

his

> pancreas may not be secreting enough digestive enzymes (exocrine pancreatic
> insufficiency - EPI) -- or he may be secreting too much gastric acid that's
> either destroying or degrading the pancreatic enzymes that normally break
> down food so that the nutrients can be absorbed. This is a form of
> malabsorption that leads to voluminous stools and malnutrition and even
> starvation - even though he's eating like a pig.

Internist mentioned it to me when we visited there, that's why they ordered
the test.

> Speak to your vet about pancreatic enzyme supplements (Pancrezyme or
> Viokase) - get the powdered form - not the tablets - and mix 1/2 - 1 tsp in
> his food.

Will do.

> Also, speak to your vet about B-12 (cobalamin) supplements -- Cats can't
> store a lot of cobalamin and become depleted quickly by EPI or intestinal
> disease. Cobalamin deficiency also leads to intestinal inflammation and
> malasborption, which could (probably) lead to a failure to respond to the
> pancreatic enzymes alone.

Is there a specific feline version of this?

> Did your vet examine Moses' feces for undigested fat and other foodstuffs?
> What does his stool look like -- yellowish tan or kinda clayish colored?

The vet saw some of Moses' stool when we had to leave him overnight recently
in the exam before we saw the internist. He did check it out, didn't find
anything unusual so he said except elevated bilirubin. They are yellowish
tan, BTW.

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Phil P. - 22 Jan 2005 21:13 GMT

> > Speak to your vet about pancreatic enzyme supplements (Pancrezyme or
> > Viokase) - get the powdered form - not the tablets - and mix 1/2 - 1 tsp
[quoted text clipped - 10 lines]
>
> Is there a specific feline version of this?

Naa, its just vitamin B-12 given IV. A folate supplement might help, too.

> > Did your vet examine Moses' feces for undigested fat and other foodstuffs?
> > What does his stool look like -- yellowish tan or kinda clayish colored?
[quoted text clipped - 3 lines]
> anything unusual so he said except elevated bilirubin. They are yellowish
> tan, BTW.

That's due to undigested fat.

I sure hope the pancreatic enzyme supplements help. Don't forget to
mention starting cimetidine (Tagamet) a day before to your vet - If he's
hyperacidic, the pH of the gastic jucies will destroy the lipase in the
pancreatic enzyme supplements. Sometimes, this is why enzyme supplements
don't work.

Hang in there!

Phil.

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seeing what I can't" --Eleanor Farjeon
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Phil P. - 22 Jan 2005 21:16 GMT

Naa, its just vitamin B-12 given IV. A folate supplement might help, too.

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