Hello,

I posted several days ago about our cat Ginger who had been diagnosed with
acute pancreatitus.  There are new findings now that challenge that initial
diagnosis, but also may support it.  I know I am repeating some of what I
discussed in the pancreatitus thread.  But I think my update got lost in the
food wars discussion that followed.  I'm afraid that she is dying and would
appreciate some on-topic advice.

After Ginger's initial bout with what appeared to be acute pancreatitus that
occurred about one month ago, she recovered well, gained weight, ate very
well, and had returned to her normal self.  Suddenly, over the period of 1
day, she developed inappetence and started to vomit again.  The vomit is
generally very large amounts of clear fluid and some food if she had been
eating and will occur 3-4 times/day.  When in this state she looses all
interest in food, but she does continue to drink water.  She did have
diarrhea one day, but generally her bowel movements are normal but less
frequent due to her inappetence.  Also, when in this state, she has
unusually loud bowel sounds.  Another observation is that when this first
occurred we noticed a small dark smudge on her nose.  When she recovered it
went away.  Now that she's sick again, it has returned.  Histoplasmosis?
She does not have any respiratory symptoms or fever.  She is not currently
on any medication.  Just as suddenly as this comes on, it goes away and she
starts eating again.

A new sonogram performed this weekend revealed a focal thickening of
intestinal wall with possible diagnoses of focal neoplasia - adenocarcinoma,
GI lymphosarcoma, leiomyosarcoma, chronic intussusception, or severe
parasite burden.  Another possibility that I believe should not be ruled out
is IBD.  The cyclical nature of this disease seems to be more consistent
with her symptoms compared to the neoplastic differentials.  And maybe she
really did have pancreatitus last month that was secondary to IBD.  I also
know that thyroid disease can cause vomiting, diarrhea, and inappetence.

We had considered the possibility that she could have been poisoned, as
there was some correlation with her symptoms and going outside.  But, now
this last time that she got sick, she had not been outside at all.

The only recommendation from all the vets that have seen her at this point
is exploratory surgery.  This has obvious risks for an 11-year old,
emaciated cat.  It still may be the right thing to do, but it requires
making a tough choice.  If we decide to go ahead with the surgery, we would
ask the vet to not resuscitate if extensive cancer was found.  That would
mean having to say goodbye rather soon.  Other than the days when she
experiences the vomiting, she does not appear to be in any significant
discomfort.  We've been through this before with another cat, and based on
how she feels now it is not time to say goodbye.  On the other hand, if we
choose not to have the surgery, we may then be denying her a viable
treatment option, especially if her condition turns out to be something like
IBD that at least has the potential for long-term management.  Can IBD be
effectively diagnosed w/o surgery?  There seems to be some disagreement on
the effectiveness of full thickness biopsies taken during celiotomy vs.
endoscopic samplings.  It's my understanding that you can't get past the
duodenum with the scope, so if the disease is past that point, you won't
learn anything.  What's the best approach for a cat in this condition?  Can
the ultrasound tape help pinpoint the location of the thickening so that it
would be possible to know if it could be visualized with the scope?  Any
other suggestions would be appreciated.

--Dave