It might be IBD, Irritable Bowel Disease. I believe this was diagnoised with an x-ray.
Appetite trouble - what tests should we be looking into?
Our 6-year-old and otherwise apparently healthy DSH Othello, once or twice a week, will stop eating half- to three-quarters of the way through his dinner, scratch at the floor as if to bury the leftovers, and walk away; he'll usually be willing to finish the rest later, or at least ask for a dry food snack before bed. We'd pretty much figured this was his “normal”, that given his choice he'd be a free-fed grazer. (With Desdemona, the food vacuum, in the house, this is not an option; she'd eat anything he left behind if we let her, and she does not need the extra calories!) He's ordinarily a very active, sociable kitty.
Last year about this time, he had a more lengthy episode of depressed appetite, so we took him to the vet; after “pristine” bloodwork and a clear x-ray, the vet gave us some metoclopramide, and a one-week course of that seemed to get him back on track.
Beginning about last Wednesday, he started having a more severe depressed appetite, worse than last year: Thursday he ate a fraction of his dinner and puked, Friday night he only ate a tiny bit, and Saturday morning he refused to eat anything at all. Sniffed his food and walked away immediately, and I couldn't even tempt him with tuna juice or shredded cheese, two of his usual favorite treats. So it was back to the vet yesterday – he helpfully puked in his carrier right in the vet's waiting room. :lol: They gave him some sub-q fluids since he was a little dehydrated, and we're on another course of metoclopramide to get him eating again, as that did the trick last time. It seems to be working, since I was able to get about half of his usual breakfast into him this morning, so he's heading in the right direction, and we'll make sure he keeps going that way. But this is no longer a one-off, “wackadoo” event, this is now a pattern, so once we do get him eating normally again, we need to start digging deeper into what's going on in his little gut. What sorts of tests should we be looking into with the vet? She'd suggested it might possibly be an irritable bowel thing, and my husband said Dr. Google mentioned excessive stomach acid as a possibility...
Last year about this time, he had a more lengthy episode of depressed appetite, so we took him to the vet; after “pristine” bloodwork and a clear x-ray, the vet gave us some metoclopramide, and a one-week course of that seemed to get him back on track.
Beginning about last Wednesday, he started having a more severe depressed appetite, worse than last year: Thursday he ate a fraction of his dinner and puked, Friday night he only ate a tiny bit, and Saturday morning he refused to eat anything at all. Sniffed his food and walked away immediately, and I couldn't even tempt him with tuna juice or shredded cheese, two of his usual favorite treats. So it was back to the vet yesterday – he helpfully puked in his carrier right in the vet's waiting room. :lol: They gave him some sub-q fluids since he was a little dehydrated, and we're on another course of metoclopramide to get him eating again, as that did the trick last time. It seems to be working, since I was able to get about half of his usual breakfast into him this morning, so he's heading in the right direction, and we'll make sure he keeps going that way. But this is no longer a one-off, “wackadoo” event, this is now a pattern, so once we do get him eating normally again, we need to start digging deeper into what's going on in his little gut. What sorts of tests should we be looking into with the vet? She'd suggested it might possibly be an irritable bowel thing, and my husband said Dr. Google mentioned excessive stomach acid as a possibility...
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After reading your post, I'm at a loss to understand why your vet prescribed metoclopramide last year (it makes more sense this year in light of Othello's current vomiting). Was Othello vomiting last year, as well?
Exactly which tests have been run, and do you have copies of all lab results (if not, you should)? Since this is an ongoing and worsening, though intermittent problem, I would recommend the following blood tests: full blood chemistry, CBC, Total T4 (thyroid), and fPLI (pancreatitis). IBD is diagnosed by abdominal biopsy and pathology, but I would do the blood tests first (since they are far less invasive and risky) and see what they show. The transient nature of Othello's condition makes me suspicious of pancreatitis, though there are many medical conditions that include GI problems among their list of symptoms.
How is Othello's stool? What is its size, shape, color, and texture - and is it consistent in those characteristics?
Laurie
Exactly which tests have been run, and do you have copies of all lab results (if not, you should)? Since this is an ongoing and worsening, though intermittent problem, I would recommend the following blood tests: full blood chemistry, CBC, Total T4 (thyroid), and fPLI (pancreatitis). IBD is diagnosed by abdominal biopsy and pathology, but I would do the blood tests first (since they are far less invasive and risky) and see what they show. The transient nature of Othello's condition makes me suspicious of pancreatitis, though there are many medical conditions that include GI problems among their list of symptoms.
How is Othello's stool? What is its size, shape, color, and texture - and is it consistent in those characteristics?
Laurie
Thanks Laurie,
Yes, he was vomiting last year as well. I think the tests that have been done are the full blood chemistry and T4, but no, I don't have copies - I was pretty much in a space of wanting to get him eating, and then we can start working on the why. (Lesson learned for today.
) I believe the CBC and fPLI have not been done. Thanks, this will give us some direction to look in. He's eating better tonight than he had been this morning, so continued improvement is a good thing.
I see you're in northern MN; hope you weren't too close to that forest fire up in Ely!
Yes, he was vomiting last year as well. I think the tests that have been done are the full blood chemistry and T4, but no, I don't have copies - I was pretty much in a space of wanting to get him eating, and then we can start working on the why. (Lesson learned for today.
) I believe the CBC and fPLI have not been done. Thanks, this will give us some direction to look in. He's eating better tonight than he had been this morning, so continued improvement is a good thing.I see you're in northern MN; hope you weren't too close to that forest fire up in Ely!
Othello went back to the vet this afternoon since he had no interest in his breakfast again. Same practice, but different doc. Blood test results retrieved:
ALB 3.5
ALP < 5
ALT 51
AMY 1433
TBIL 0.3
BUN 26
CA++ 10.0
PHOS 3.8
CRE 1.6
GLU 99
NA+ 145
K+ 4.4
TP 7.2
GLOB 3.7
Lipase snap test: negative
The x-ray showed some inflammation in his intestines, so the vet gave him an injection of Cerenia (discontinuing the metoclopramide) and sent him home with a bottle of prednisolone, treating for presumptive IBD. She did take samples for a urinalysis and CBC, but only plans to run them if Othello isn't significantly better in 24 hours. I guess I'm signing up for one or more of those feline IBD forums mentioned on another thread!
ALB 3.5
ALP < 5
ALT 51
AMY 1433
TBIL 0.3
BUN 26
CA++ 10.0
PHOS 3.8
CRE 1.6
GLU 99
NA+ 145
K+ 4.4
TP 7.2
GLOB 3.7
Lipase snap test: negative
The x-ray showed some inflammation in his intestines, so the vet gave him an injection of Cerenia (discontinuing the metoclopramide) and sent him home with a bottle of prednisolone, treating for presumptive IBD. She did take samples for a urinalysis and CBC, but only plans to run them if Othello isn't significantly better in 24 hours. I guess I'm signing up for one or more of those feline IBD forums mentioned on another thread!
I'm sorry to hear that Othello still isn't eating. Thank you for posting his labs, but I will request that you include the lab's reference ranges with Othello's values. Reference ranges vary from lab to lab, so it's important to include them in order to put Othello's values in proper perspective. Based on ranges I've seen at several labs my vet uses, however, I don't see anything particularly worrisome in the results you posted except for perhaps a borderline high calcium.Othello went back to the vet this afternoon since he had no interest in his breakfast again. Same practice, but different doc. Blood test results retrieved:
Do you know specifically which test this was? I did some more research on feline pancreatitis diagnostics, and apparently some commonly used tests are unreliable, at best. This link describes pancreatitis and its diagnosis in good detail:Lipase snap test: negative
http://www.idexx.com/pubwebresources/pdf/en_us/smallanimal/snap/fpl/idexx-introduces-snap-fpl.pdf
As you've undoubtedly discovered, I'm very big on the disease-specific mailing lists. So yes, by all means join the IBD lists and start sucking knowledge out of their brains. Also, start assist-feeding Othello if he doesn't start eating sufficiently on his own by tomorrow.The x-ray showed some inflammation in his intestines, so the vet gave him an injection of Cerenia (discontinuing the metoclopramide) and sent him home with a bottle of prednisolone, treating for presumptive IBD. She did take samples for a urinalysis and CBC, but only plans to run them if Othello isn't significantly better in 24 hours. I guess I'm signing up for one or more of those feline IBD forums mentioned on another thread!
Keep us updated, please.
Laurie
What kind of food are you feeding? Canned, dry, premium, cheap? I have one cat who is allergic to fish and if a canned food has even a little fish mixed in with the ingredients, she vomits. If you are not feeding a premium diet, find one you can afford and switch him over to that. Your cat could also have a touch of celiac disease which some gastroenterologists feel is one the the underlying problems that kick off IBD, especially when the celiac is in a subclinical form.
You may also want to run a TSH as thyroid problems can contribute to immune system failure.
You may also want to run a TSH as thyroid problems can contribute to immune system failure.
Sorry for the delay, the modem was acting up yesterday. Othello is eating much, much better - probably 80% of normal yesterday, and this morning he ate his entire normal breakfast without any coaxing. And his activity is getting close to normal, including fighting with Desdemona. The vet gave us some Hills I/D for him, which I'm sure is not optimal, but it buys us some time to do research on what is. I'm feeling relieved, though I'm sure there's plenty of work ahead to figure out what diet will work best for him long-term.
Laurie, I wasn't actually the one at the vet on Monday, so this is all second-hand, but my husband says that yes, the test that was done was the fPLI. This is what he'd e-mailed me from the vet's office:
"Doc just came in. X-rays showed some possible inflamation in the intestines, but nothing terribly abnormal. Blood's still about 15 minutes out. If that comes back clear, they already took samples for the CBC test, which is a blood cell count.
She did suggest that instead going for a biopsy if the tests don't show anything else, we start him on a special diet, and if he responds to that, consider the biopsy to get the definitive answer.
She came back - blood showed elevated Amylase, everything else perfect. Not a slam dunk, but indicative of the pancreas, so change of plan - next is the Lypase test (the fPLI test on the forum) which should be a slam dunk yes or no on pancreatitis. If it's this, the treatment is also "supportive", but no details - she's off to do the test. (I asked if that was the "fPLI" test and she looked at me weird - I had to explain you asked on a cat forum.)"
Laurie, I wasn't actually the one at the vet on Monday, so this is all second-hand, but my husband says that yes, the test that was done was the fPLI. This is what he'd e-mailed me from the vet's office:
"Doc just came in. X-rays showed some possible inflamation in the intestines, but nothing terribly abnormal. Blood's still about 15 minutes out. If that comes back clear, they already took samples for the CBC test, which is a blood cell count.
She did suggest that instead going for a biopsy if the tests don't show anything else, we start him on a special diet, and if he responds to that, consider the biopsy to get the definitive answer.
She came back - blood showed elevated Amylase, everything else perfect. Not a slam dunk, but indicative of the pancreas, so change of plan - next is the Lypase test (the fPLI test on the forum) which should be a slam dunk yes or no on pancreatitis. If it's this, the treatment is also "supportive", but no details - she's off to do the test. (I asked if that was the "fPLI" test and she looked at me weird - I had to explain you asked on a cat forum.)"
That's excellent news!Othello is eating much, much better - probably 80% of normal yesterday, and this morning he ate his entire normal breakfast without any coaxing. And his activity is getting close to normal, including fighting with Desdemona.
Unfortunately, from my further research, it appears that the fPLI is not a terribly reliable test for feline pancreatitis. I urge you to read the following link to better understand the limitations and other available tests for pancreatitis:yes, the test that was done was the fPLI.
http://www.idexx.com/pubwebresources...s-snap-fpl.pdf
Unfortunately, biopsy is the only definitive diagnostic that I know of for IBD, or to differentiate IBD from other gastric issues.She did suggest that instead going for a biopsy if the tests don't show anything else, we start him on a special diet, and if he responds to that, consider the biopsy to get the definitive answer.
Actually, elevated Amylase in cats is meaningless. Here's a link to a site to which I regularly refer when trying to interpret blood test results:She came back - blood showed elevated Amylase, everything else perfect. Not a slam dunk, but indicative of the pancreas
Broadway Veterinary Hospital / Laboratory Assessment Descriptions
Here is a quote from that site regarding elevated amylase in cats:
"The amylase level, which is a pancreas enzyme, is elevated. Unfortunately, this enzyme is not reliable in cats, so this elevation has no significance."
Laurie
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