Malabsorption

[buffy2011]

Does anyone have any information or have had an experience with malabsorption in their cat? I'm assuming this is what my cat has. I just had her GI blood panel run, but the vet hasn't gotten back to me. But in the meantime, I am having a mess. She eats and eats a lot; she seems to be always hungry. I feed her in little amounts because we had thought this is why she vomits. But she also has diarrhea. But this diarrhea isn't normal. This is gross to talk about, but I have to explain this. Some of the food she ate, is in the poop when she goes, and I have seen hair balls too. But when she goes it is like a hose, I can hear it in the other room. I can't believe how much comes out of her. I am scared for her. Then one day it might be normal. She isn't herself; she is lethargic sometimes too. She had been going to the vets for too long of a time and we can't seem to get her straightened around. She was diagnosed before the hyperthyroidism to have a pancreatic problem. She was on meds and then the hyperthyroidism showed up. A year or two ago was when the hyperthyroidism showed up. Instead of the creams in her ears which was a problem with her, I took her to have the one-time radioactive iodine shot. I was hoping that would cure the problem. It did help for a little while. I was hoping the hyperthyroidism was the reason this was all going on, because this disease does cause problems. We would have the vomiting and diarrhea once in a while but now it is a constant thing. How I know it is bad is when she goes on the floor. But now I have noticed she eats and eats a lot, but is always hungry, especially after she goes to the bathroom. I'm thinking she isn't getting any nourishment to live on, she has lost some weight and she can't afford to do that. She has lost her muscle mass too. All her blood work always comes back fine. So, this is why we did a quick fast and run another GI panel, to see if the pancreatitis is causing the issue. She really can't live like this; she isn't happy, and neither am I. So, any information on this subject would be well appreciated.
Thank you

UPDATE FROM THE VET.

Just got an update from the vet, Bella has pancreatitis, it is back, and also, she is low on B12. I did email the vet about what is going on when she has diarrhea, to see if this is another problem. She isn't getting any food; it is all coming out. But maybe once she gets the B12 in her things will change, I hope. For a start we are doing one shot a week for 6 weeks and maybe a recheck on the B12, to see how it went. The vet keeps wanting me to feed her a special food, and she will not eat it, she will die first. I have been through this. So are there any suggestions on what a cat can eat with pancreatitis problems, and also maybe get her B12 from. Still would like some information if anyone can add anything to this.

 

[daftcat75]

If you suspect a malabsorption issue, oral B12 will be poorly absorbed. The typical protocol for B12 is subcutaneous injections. Weekly at first and eventually tapered off to a monthly maintenance dose. These can be done at home if the vet will sell you the B12 and supplies (syringes, needles, Sharps disposal box) and show you how to do them.

Hyperthyroidism and pancreatitis aren’t the only reasons for vomiting and diarrhea. And sadly, they don’t all show up in blood testing alone. Has she had an ultrasound? Has she had a Diarrhea PCR? This could be a gut infection like clostridium or it could be GI lymphoma. If it’s lymphoma, nothing will help until chemotherapy. But chemo is well tolerated by cats and depending on the lymphoma, it can be quite effective.

I highly recommend an ultrasound. If they start talking about a biopsy, there is a fine needle aspiration that is non-invasive but often inconclusive. It’s not a bad option if it’s useful. A second type of biopsy that vets recommend is a surgical biopsy. Like this sounds, this is expensive and invasive and comes with a recovery period. I don’t recommend a surgical biopsy. It’s also only a snapshot in time. If today’s surgical biopsy is clear of cancer, that’s not protective or a guarantee that the next time will also be clear. There’s a far easier way to determine cancer from IBD: try steroids first and if that doesn’t help, see if adding chemo does. The drug is less risk than the diagnosis in my opinion. But I’m getting ahead of things here.

Get the ultrasound first before we start talking IBD and/or lymphoma. Yes, it can be both. Or neither.

 

[daftcat75]

Diarrhea is extremely dehydrating and should not be allowed to persist in a wait and see treatment plan.

Having been down this very messy road with both clostridium and lymphoma, there are two supplements I absolutely recommend:

Saccharomyces boulardii - a yeast based probiotic that will survive any prescribed antibiotics. It’s especially effective against diarrhea. More information on it here:
My Cat Has Diarrhea - What Do I Do?

The other I recommend is lithothanmium, a calcium supplement that will help dry up the stools. While there’s almost no such thing as too much s. boulardii, you can definitely overdo the Lithothanmium and cause constipation. For this reason, I recommend starting with less than the recommended dose and giving it a full poop cycle before adjusting the dose. I also recommend buying it from Vitality Science (I don’t work for them, I get nothing from your purchase) because they have excellent customer service. They may even recommend other diagnostics, treatments, or supplements if you consult with them.

Calcium Supplement for Cats | Lithothamnium, Sea | Vitality Science

 

[fionasmom]

I am absolutely going to second the ultrasound. You have been dealing with this for a while and, if there is another piece to it, the ultrasound should be helpful. If it shows nothing, at least other conditions have been eliminated. It is much better than hoping that you are making the right guess.

 

[FeebysOwner]

I vote for the ultrasound too - and as mentioned above, ask about a FNA (fine needle aspiration) cytology being done at the same time if they see something they would like to sample. There is also a test called PARR (see article link below) if there is anything 'suspicious' regarding the cellular content of the FNA. I am not even remotely suggesting it is lymphoma, but with an 'inconclusive' ultrasound/FNA cytology, the PARR might make the difference - either to help confirm or rule out lymphoma.
Lymphoma in Dogs & Cats: What's the Latest? - Today's Veterinary Practice (todaysveterinarypractice.com)

Feeby has had an inconclusive ultrasound/FNA, but they didn't do the PARR - now she has to go through yet another ultrasound in the coming months to see if anything that has changed that could more definitively point to lymphoma, or hopefully rule it out.

 

[daftcat75]

I always say that if your cat can maintain or even gain weight, it's most likely not cancer (yet.) Monitoring your cat's weight on a (no more frequent than) weekly basis will help you determine when it's lymphoma (assuming you've ruled out kidneys, thyroid, and other conditions that can cause weight loss.) There are a number of conditions that can cause increased appetite, liquid stools, and weight loss. But these are all hallmarks of lymphoma. You don't want to lose time on this. It would be better to do the ultrasound, and rule that out early than to wait to see if other treatment plans might work first. Because if she is losing weight to lymphoma, that weight loss won't stop until the chemo starts. (This is another reason why a surgical biopsy is a bad idea with a cat not maintaining her weight.)

 

[Lazy Orange House Cat]

Get a TLI test if you haven't done that yet.

 

[daftcat75]

It's odd that the diagnosis is pancreatitis and this cat wants to eat and eat. Cats with pancreatitis usually don't want to eat. It's painful for them to eat. That's why I question the diagnosis and think you should keep searching.

Yes, the TLI test is a good idea. That would test for EPI or exocrine pancreatic insufficiency: e.g. not enough digestive enzymes. This would present as smelly, greasy stools.

 

[buffy2011]

Diarrhea is extremely dehydrating and should not be allowed to persist in a wait and see treatment plan.

Having been down this very messy road with both clostridium and lymphoma, there are two supplements I absolutely recommend:

Saccharomyces boulardii - a yeast based probiotic that will survive any prescribed antibiotics. It’s especially effective against diarrhea. More information on it here:
My Cat Has Diarrhea - What Do I Do?

The other I recommend is lithothanmium, a calcium supplement that will help dry up the stools. While there’s almost no such thing as too much s. boulardii, you can definitely overdo the Lithothanmium and cause constipation. For this reason, I recommend starting with less than the recommended dose and giving it a full poop cycle before adjusting the dose. I also recommend buying it from Vitality Science (I don’t work for them, I get nothing from your purchase) because they have excellent customer service. They may even recommend other diagnostics, treatments, or supplements if you consult with them.

Calcium Supplement for Cats | Lithothamnium, Sea | Vitality Science

I did read about the Saccharomyes boulardii and there are many kinds or brands recommended. so what is the best without lactose. are they all the same. I have a probiotic from Chewy that I had been using and still see not improvement.

 

[buffy2011]

I am absolutely going to second the ultrasound. You have been dealing with this for a while and, if there is another piece to it, the ultrasound should be helpful. If it shows nothing, at least other conditions have been eliminated. It is much better than hoping that you are making the right guess.

Below after asking the vet a few questions, here is her response.

Bella's TLI was elevated which rules out exocrine pancreatic insufficiency. The elevation of this number is consistent with pancreatitis, and the PLI number reinforces this diagnosis. The low B12 (cobalamin) is likely due to chronic pancreatitis. She needs supplementation to correct the deficiency and this should improve her overall condition. I am hopeful that we continue to see improvement in her symptoms with supplementation.

 

[buffy2011]

If you suspect a malabsorption issue, oral B12 will be poorly absorbed. The typical protocol for B12 is subcutaneous injections. Weekly at first and eventually tapered off to a monthly maintenance dose. These can be done at home if the vet will sell you the B12 and supplies (syringes, needles, Sharps disposal box) and show you how to do them.

Hyperthyroidism and pancreatitis aren’t the only reasons for vomiting and diarrhea. And sadly, they don’t all show up in blood testing alone. Has she had an ultrasound? Has she had a Diarrhea PCR? This could be a gut infection like clostridium or it could be GI lymphoma. If it’s lymphoma, nothing will help until chemotherapy. But chemo is well tolerated by cats and depending on the lymphoma, it can be quite effective.

I highly recommend an ultrasound. If they start talking about a biopsy, there is a fine needle aspiration that is non-invasive but often inconclusive. It’s not a bad option if it’s useful. A second type of biopsy that vets recommend is a surgical biopsy. Like this sounds, this is expensive and invasive and comes with a recovery period. I don’t recommend a surgical biopsy. It’s also only a snapshot in time. If today’s surgical biopsy is clear of cancer, that’s not protective or a guarantee that the next time will also be clear. There’s a far easier way to determine cancer from IBD: try steroids first and if that doesn’t help, see if adding chemo does. The drug is less risk than the diagnosis in my opinion. But I’m getting ahead of things here.

Get the ultrasound first before we start talking IBD and/or lymphoma. Yes, it can be both. Or neither.

Response from vet below.

Bella's TLI was elevated which rules out exocrine pancreatic insufficiency. The elevation of this number is consistent with pancreatitis, and the PLI number reinforces this diagnosis. The low B12 (cobalamin) is likely due to chronic pancreatitis. She needs supplementation to correct the deficiency and this should improve her overall condition. I am hopeful that we continue to see improvement in her symptoms with supplementation.

 

[buffy2011]

Get a TLI test if you haven't done that yet.

Response from the doctor below

Bella's TLI was elevated which rules out exocrine pancreatic insufficiency. The elevation of this number is consistent with pancreatitis, and the PLI number reinforces this diagnosis. The low B12 (cobalamin) is likely due to chronic pancreatitis. She needs supplementation to correct the deficiency and this should improve her overall condition. I am hopeful that we continue to see improvement in her symptoms with supplementation.

 

[daftcat75]

I did read about the Saccharomyes boulardii and there are many kinds or brands recommended. so what is the best without lactose. are they all the same. I have a probiotic from Chewy that I had been using and still see not improvement.

The Jarrow brand is the one most recommended.
Jarrow Formulas Saccharomyces Boulardii + MOS - 5 Billion Viable Organisms Per Serving - 90 Delayed Release Veggie Caps - Probiotic + Prebiotic - Intestinal Tract Support - Up to 90 Servings https://www.amazon.com/dp/B0013OVW0E/?tag=thecatsite

 

[buffy2011]

It's odd that the diagnosis is pancreatitis and this cat wants to eat and eat. Cats with pancreatitis usually don't want to eat. It's painful for them to eat. That's why I question the diagnosis and think you should keep searching.

Yes, the TLI test is a good idea. That would test for EPI or exocrine pancreatic insufficiency: e.g. not enough digestive enzymes. This would present as smelly, greasy stools.

Bella is getting small amounts of food to keep from upsetting the stomach, this is one reason she eats, because she isn't getting enough food at one sitting. This cat no matter what when I have food her eyes and ears are very alert. Then later she looks like a sad puppy. The constant diarrhea and vomiting is what is causing her to lose the weight. This problem is constantly flaring up for some reason. She did good for two days with not vomiting and diarrhea, but now today things have changed. Early this morning she had a normal poo, and then later on it was a little mess, barely anything, but on my floor. When she has this kind of poo it is usually on the floor. We started this issue right around when food was a shortage. So, I assumed the company was substituting something in the food that was making her sick. Her two favorite flavors of foods she was getting sick on. So, we went to two flavors of foods she really didn't like but tolerated. Every once in a while, I tried to throw in her two favorites, and we had the same problem. The food I am feeding is fancy feast. I know it isn't a good food but every time I try to change her, we have the vomiting and diarrhea. So, I am beside myself and without running her through thousands of dollars' worth of test. But I want her to be ok, but I also do not want to put her threw so many tests, because I think she will not survive all that. She has been through this for a long time, then threw the hyperthyroidism and now this again. I even had one vet say it was a food allergy. So we tired that and she wouldn't eat the dry food, she tried it because she was hungry but then she wouldn't eat anymore. So I have tried every avenue and still don't know which way to go. I posted the vets comments on one of the responses if you want to read that.

 

[FeebysOwner]

B-12 is going to take a few injections before you might expect to see any positive changes, so keep that in mind.

I don't know what kind of Fancy Feast you are feeding, but tbh, there is not a lot out there any better than the pates. I am unclear if she is eating primarily FF and two cause issues when the other two that she doesn't like as well don't present as much of a problem? If I understand correctly, maybe add a bit of the ones she does like to the ones she doesn't like and see if that causes the same issues? Also, in case she is eating mostly something other than the fish versions, some FF have fish and others don't - see if that has any bearing on her problems.

If she needs to eat more, give her baby food meat (Gerber Stage 2 or Beechnut) as a supplement, to add calories. I sincerely doubt that should pose a problem from a digestive standpoint. Gerber does have corn starch, so if that would pose an issue, Beechnut does not. Depending on what brand/flavor you use, you can add anywhere from 50 - 90 calories per jar. Feeby (so far, knock on wood) will eat baby food meat even when she turns her nose up at her regular foods.

 

[buffy2011]

Diarrhea is extremely dehydrating and should not be allowed to persist in a wait and see treatment plan.

Having been down this very messy road with both clostridium and lymphoma, there are two supplements I absolutely recommend:

Saccharomyces boulardii - a yeast based probiotic that will survive any prescribed antibiotics. It’s especially effective against diarrhea. More information on it here:
My Cat Has Diarrhea - What Do I Do?

The other I recommend is lithothanmium, a calcium supplement that will help dry up the stools. While there’s almost no such thing as too much s. boulardii, you can definitely overdo the Lithothanmium and cause constipation. For this reason, I recommend starting with less than the recommended dose and giving it a full poop cycle before adjusting the dose. I also recommend buying it from Vitality Science (I don’t work for them, I get nothing from your purchase) because they have excellent customer service. They may even recommend other diagnostics, treatments, or supplements if you consult with them.

Calcium Supplement for Cats | Lithothamnium, Sea | Vitality Science

Did your cats do well after giving them this probiotic? How much do you give? I was reading on the jar I have and it says 1/4 tsp for 20 lbs and up, so my cat only weighs a little over 6 lbs. so maybe I am giving her to much, but I did not notice a difference . If you don't mind talking about it I would like to hear about your cat that had the lymphoma. How did it act, what test did you get to find this out. Its hard for me to think this could happen especially when all her blood work comes back good. So for the pancreas I just don't know what to feed her. I have tried so many things and I still don't know what to do. I'm thinking the dry food isn't a good idea. For some reason, when she poops it seems to be the color of the dry food. So this is why I never feed her dry food, she didn't tolerate it well, so I finally found this love lovely food for sensitve stomach, or digestive issues and this is what I have been feeding. But like I said this might be the problem. so I think I am going to stop this for a while and keep an eye on her.

 

[buffy2011]

I vote for the ultrasound too - and as mentioned above, ask about a FNA (fine needle aspiration) cytology being done at the same time if they see something they would like to sample. There is also a test called PARR (see article link below) if there is anything 'suspicious' regarding the cellular content of the FNA. I am not even remotely suggesting it is lymphoma, but with an 'inconclusive' ultrasound/FNA cytology, the PARR might make the difference - either to help confirm or rule out lymphoma.
Lymphoma in Dogs & Cats: What's the Latest? - Today's Veterinary Practice (todaysveterinarypractice.com)

Feeby has had an inconclusive ultrasound/FNA, but they didn't do the PARR - now she has to go through yet another ultrasound in the coming months to see if anything that has changed that could more definitively point to lymphoma, or hopefully rule it out.

Have you found out any results on Feeby? do you know how a PARR test is done. I tried to read about this but it didn't make sense to me. If this is a definite way to determine lymphoma why wouldn't the vet suggest this ? All the vet tells me at this moment is to feed a consistent bland diet. Does that mean the same flavor of food the rest of her life. I have tried many ways and things are good for a day or two and then we are back to the vomiting and diarrhea. I feel like I am failing my cat. I wish she could talk so I knew what is wrong and how to treat her.

 

[daftcat75]

Did your cats do well after giving them this probiotic? How much do you give? I was reading on the jar I have and it says 1/4 tsp for 20 lbs and up, so my cat only weighs a little over 6 lbs. so maybe I am giving her to much, but I did not notice a difference . If you don't mind talking about it I would like to hear about your cat that had the lymphoma. How did it act, what test did you get to find this out. Its hard for me to think this could happen especially when all her blood work comes back good. So for the pancreas I just don't know what to feed her. I have tried so many things and I still don't know what to do. I'm thinking the dry food isn't a good idea. For some reason, when she poops it seems to be the color of the dry food. So this is why I never feed her dry food, she didn't tolerate it well, so I finally found this love lovely food for sensitve stomach, or digestive issues and this is what I have been feeding. But like I said this might be the problem. so I think I am going to stop this for a while and keep an eye on her.

If it’s lymphoma, s boulardii and lithothamnium would be like trying to fight a fire with a squirt gun. It may help some with the symptoms but it’s going to do nothing for the root cause. To be honest, it was when these supplements that used to work with her stopped working that clued me in that her IBD was now something different.

Lymphoma doesn’t really show up in blood work. It may or may not show up as elevated white blood counts. That’s not conclusive though. But other than the PARR test that was mentioned, there really isn’t a blood test for GI lymphoma. That’s why you’ve had three recommendations for an ultrasound. That may not get you a definite lymphoma diagnosis. But it may give you an either/or diagnosis of either IBD or lymphoma. If the ultrasound gets you this far, then you can ask the vet to try steroids first and if that doesn’t help, to add chemo. But if she’s losing weight due to lymphoma, the weight loss won’t stop until the chemo starts. Thus anything you try before an ultrasound is lost time.

The PARR test has its flaws. That’s why it’s not used in place of ultrasounds. If I remember correctly, a positive result can strongly suggest lymphoma. But a negative result cannot rule it out. By contrast, an ultrasound can reveal growths/tumors in the intestines or other organs. Or more commonly in cats like this, it will show a diffuse thickness that is consistent with either small cell lymphoma or IBD. At this point, a lot of vets might talk about biopsies to distinguish between the two. There is a minimally invasive (like a pin prick) fine needle aspiration (FNA) that has its limitations. There is a more definitive biopsy called a surgical biopsy also called a full thickness biopsy. As it sounds, this requires surgery to take a sample and it comes with a recovery period. I don’t recommend a surgical biopsy for a cat who is not maintaining her appetite or weight. And if this is lymphoma, any weight lost during the recovery period is not coming back until chemo puts the cancer in remission. If the weight comes back at all. Besides a surgical biopsy, depending on where the thickness is observed, sometimes they can get a full thickness sample either via colonoscopy or endoscopy (sending a tube up one end of your cat or down the other.) These tubes are limited in their reach. But if they can reach, these methods will be less invasive and less hard on the cat than a surgical biopsy. In short, FNA is easy on the cat but doesn’t always get enough cells to yield a definite result. Surgical biopsy will get you a definite result but it’s going to be the hardest on the cat (and your wallet!) Endoscopy and colonoscopy fall in between FNA and surgical biopsy. They’ll be easier on the cat. And if they can reach the sample site, the results should be on par with a surgical biopsy. But if the sample site is too deep within the cat’s butt or gut to be reached by these methods, I suggest an A-B treatment course without confirming lymphoma. Since we’re seeking to determine whether it’s IBD or lymphoma—two options—-you convince your vet to start with steroids (aka the IBD treatment) as option A. Set a deadline ahead of time so neither of you get too stubborn. If it doesn’t respond or responds insufficiently to steroids, have your vet to agree to try chemo (option B) without a biopsy to confirm lymphoma. In this case, the diagnosis (surgery) will come with greater risk than the drug.

 

[daftcat75]

Oh and definitely cut out the dry food. It’s not necessary and it most certainly can be the cause of all the troubles. There are too many irritating and nonsense ingredients in dry food. Cutting out the dry might not fix it now. But you can’t fight a fire with gasoline.

Discontinue the dry and get her an ultrasound. That’s your two best next actions to take.

 

[buffy2011]

Oh and definitely cut out the dry food. It’s not necessary and it most certainly can be the cause of all the troubles. There are too many irritating and nonsense ingredients in dry food. Cutting out the dry might not fix it now. But you can’t fight a fire with gasoline.

Discontinue the dry and get her an ultrasound. That’s your two best next actions to take.

When my cat went to the vets for her last B12 shot she had gained some weight back, I do think an ultrasound is a good idea but waiting on that until the shots are over with to see how things go. The vet seems to think the shots will help some. I'm also thinking quitting the dry food and also quitting anything with chicken in it. Does all cat food have some form of chicken by product in it, do you know? I have been feeding fancy feast and we are down to the turkey and maybe a few other flavors. Or it is poultry products all together? I wish I would of started a diary type thing a long time ago to see what I feed her and when these issue happened. Do you know of any foods on the market that don't have chicken in them, or is this mostly food you have to get from a vet? This is a dumb question but if she is allergic to can chicken food, is that the same as people chicken? she loves chicken boiled. But of course this cat will almost eat anything you put down. She might not like it but she will come back for more and then get sick. So it is so hard to determine really without tons of test to find out what is wrong. Because if it wasn't for her vomiting and poop she would be gaining tons of weight. The weight coming off is from her vomiting her food up. she goes for 2-3 days doing fine and then the 4th day we start again. Just when I think she is doing good then it all starts all over. I just worry that the vomiting will cause problems with the esophagus or something because she is regurgitating to much. I am doing my best with her and trying hard to help her. I have spent so much money up until now to get her healthy. We went threw the hyperthyroidism, the cream and then the shot and then the constant blood work. Right before that we went to a veterinary specialist and this is when she was said to have pancreas issues. then right after that the T4 levels were off the chart, so then we dealt with the hyperthyroidism issue. She was ok for a while and it started again. This started back in 2017. So it is off and on. I do take everyone's suggested to heart, but trying to go with what the vet suggests also. Plus with the pandemic it is still hard to get a vet appointment, just to get something checked because they are booked. But vets only want you to feed there food, so this is why I am reaching out to see what other people fed their cats that had a pancreas problem and if it helped. Thanks for all your feed back I do really appreciate it.