Need Help With Feline Triaditis

[cara1970]

My 11 year old Fred is currently spending a third night in the vets on a drip after being diagnosed with Triaditus. I don’t know what the outcome is and it frightens me, I’m hoping it is easily managed and not fatal! Is this a fatal disease? Or is it a managed disease? He is struggling with a bacterial infection and high fever at the moment. Vet update said fever is now going down and he had eaten a little. “Fingers crossed” we’re his exact words. I can’t sleep now.

Fred has been in both wet and dry versions of Royal Canine Urinary S/O for most of his life to treat crystals in his urinary tract. What on earth should I be considering to feed him now! If he pulls through this episode of course. I really hope he does.....

 

[daftcat75]

Triaditis is actually three conditions: IBD, pancreatitis, and cholangiohepatitis. Usually IBD is the first to develop and the inflammation that results from it "backs up the pipes" causing the other two at some point further down the road. It's almost inevitable for an IBD kitty to also develop one of the other two at some point.

Is this the first you are hearing of any of this? IBD is usually a progressive disease that gives off lots of worrying symptoms: vomiting, diarrhea, sometimes loose, mucousy or bloody stools. It's rare that it would go on long enough to cause the other two without earlier vet visits.

The treatment and prognosis depends on the degree of each. How did the vet arrive at this diagnosis? Did he just look at symptoms and blood results or did Fred also have an ultrasound, endoscopy of the large or small intestine with biopsy, needle aspirate of the liver with biopsy and cytology, and others I'm forgetting. The point is blood results show disease patterns but often further, more expensive diagnostics are needed to both confirm the presence and the degree of the disease.

The first thing I would ask of your vet is to confirm pancreatitis via a blood test, the Spec fPLI. If Fred has pancreatitis, that should be the first priority. Pancreatitis can do the most damage--the pancreas digests itself and the degree of scarring from this determines the long-term outlook. If the vet suspects pancreatitis, make sure that gets highest priority. This will be keeping his nutrition up with supportive medicines like anti-nausea, anti-vomiting, appetite stimulant, and pain relief. Critical to pancreatitis recovery is B-12 shots. Whatever the vet recommends, make sure Fred also gets B-12 shots if pancreatitis is suspected or confirmed (or even if he's lost a significant amount of weight.)

That Royal Canin S/O, is that wet or dry? If it's dry, it has to go. You won't get very far in treatment and recovery if you continue to feed carbohydrates to a species that isn't designed to use carbohydrates. That's the long and the short of it. Cats aren't small dogs or small people. They have different metabolic processes and nutritional needs. They need animal based nutrition with lots of moisture. I'd start with Fancy Feast Classic pates (none of their other lines.) These are generally well-received by even the most stubborn kibble addicts and they have a decent species-appropriate recipe.

Finally, please consider a feeding tube if Fred's eating cannot be restarted on his own over the next few days. I don't know how long he hasn't been eating but the outlook is very poor if he doesn't keep his nutrition up. If he does keep his eating up, much of this can be managed, not cured, quite well for many years depending on the age and condition of the cat and the degree of the disease processes.

 

[daftcat75]

Shorter version:

1. If the vet suspects pancreatitis, get that confirmed. It is a blood test called fPLI (or Spec fPLI.) Pancreatitis can do the most damage and needs to be addresed first.

2. If his eating doesn't resume soon, and it probably won't because the longer he goes without eating, the worse he will feel, and the less he will feel like eating again, consider getting a feeding tube for him. It isn't as drastic or scary as it sounds. He won't mind it. It won't stop him from eating on his own. It's reversible. It can save his life. Nothing else I mention in the last post or this post matters if you can't get enough nutrition into him.

3. Once you have his nutrition secured and you have confirmed or ruled out pancreatitis, if he has lost a significant amount of weight, ask about B-12 shots.

4. Cut the dry food. Digestive diseases and dry food are incompatible. You'll get a lot of other information about IBD. This is the most important. You will be spinning your wheels on his recovery if you keep pouring sugar in his gas tank.

5. Finally, you'll likely need an ultrasound at a minimum to determine the extent of the disease processes before you can discuss short-term treatment, long-term management, and overall outlook.

 

[cara1970]

Shorter version:

1. If the vet suspects pancreatitis, get that confirmed. It is a blood test called fPLI (or Spec fPLI.) Pancreatitis can do the most damage and needs to be addresed first.

2. If his eating doesn't resume soon, and it probably won't because the longer he goes without eating, the worse he will feel, and the less he will feel like eating again, consider getting a feeding tube for him. It isn't as drastic or scary as it sounds. He won't mind it. It won't stop him from eating on his own. It's reversible. It can save his life. Nothing else I mention in the last post or this post matters if you can't get enough nutrition into him.

3. Once you have his nutrition secured and you have confirmed or ruled out pancreatitis, if he has lost a significant amount of weight, ask about B-12 shots.

4. Cut the dry food. Digestive diseases and dry food are incompatible. You'll get a lot of other information about IBD. This is the most important. You will be spinning your wheels on his recovery if you keep pouring sugar in his gas tank.

5. Finally, you'll likely need an ultrasound at a minimum to determine the extent of the disease processes before you can discuss short-term treatment, long-term management, and overall outlook.[/QUOT

Thank you for your reply.
Fred was diagnosed today with diabetes because of the pancreatitis. They were treating the pancreatitis with antibiotics and steroids. He was in the vets on a drip for three days with this protocol. His temperature was very high. He was eating and brighter so they sent me home with more antibiotics and steroids but his condition returned the next morning (today) and I brought him back in. All along up to two days ago, his blood glucose was elevated but borderline. They thought it was stress. But they performed a test that evaluated his glucose over two weeks which we’re still awaiting results. Today it was way over normal level so they have told me he has now developed diabetes because of the pancreatitis and they have said that diabetes is now indicative of big damage to the pancreas. They conducted an ultrasound again today which they couldn’t see the pancreas and no masses were seen. Ultrasound was done two weeks ago also with no masses or blockages and blood tests we’re done. Those books tests done two weeks ago indicated he had small intestine infection, liver and pancreas. So he was on steroids and antibiotics and meds for his liver (liver recovered). He has regressed twice now since then.
Fred is now on wet food for gastro intestinal recovery by Royal but had been mainly on wet food before as he loves it better.

They have said they can refer him to UCD in Dublin to do more advanced testing and I will do that.

So my question is - is his pancreas damaged now like they said? If so, is this an end of life scenario ? What is the prognosis of this kind of situation?

They haven’t said anything about B12 injections but I will say that to them first thing in the morning

 

[cara1970]

Thank you for your reply.
Fred was diagnosed today with diabetes because of the pancreatitis. They were treating the pancreatitis with antibiotics and steroids. He was in the vets on a drip for three days with this protocol. His temperature was very high. He was eating and brighter so they sent me home with more antibiotics and steroids but his condition returned the next morning (today) and I brought him back in. All along up to two days ago, his blood glucose was elevated but borderline. They thought it was stress. But they performed a test that evaluated his glucose over two weeks which we’re still awaiting results. Today it was way over normal level so they have told me he has now developed diabetes because of the pancreatitis and they have said that diabetes is now indicative of big damage to the pancreas. They conducted an ultrasound again today which they couldn’t see the pancreas and no masses were seen. Ultrasound was done two weeks ago also with no masses or blockages and blood tests we’re done. Those books tests done two weeks ago indicated he had small intestine infection, liver and pancreas. So he was on steroids and antibiotics and meds for his liver (liver recovered). He has regressed twice now since then.
Fred is now on wet food for gastro intestinal recovery by Royal but had been mainly on wet food before as he loves it better.

They have said they can refer him to UCD in Dublin to do more advanced testing and I will do that.

So my question is - is his pancreas damaged now like they said? If so, is this an end of life scenario ? What is the prognosis of this kind of situation?

They haven’t said anything about B12 injections but I will say that to them first thing in the morning

 

[daftcat75]

Did this all happen recently or has it been building? If this is all recent, it sounds acute rather than chronic. The outlook can be grimmer in acute cases.

Diabetes is not fatal. I have no experience with diabetes. Fortunately Krista’s pancreatitis was under control before that point. The other thing to watch for if the pancreatitis is still not under control is EPI (exocrine pancreatic insufficiency). If they are doing fasting blood tests, fTLI is the one for EPI. EPI is an insufficient amount of digestive enzymes. If the pancreas has been digesting itself due to pancreatitis, it could scar itself over in areas that produce insulin causing diabetes or digestive enzymes causing EPI. This is why I say pancreatitis is the most critical of the three that has to be addressed first. EPI isn’t fatal either but it will have to be managed with pancreatic enzyme supplements.


You have a lot of things going on and none of them are necessarily fatal. But none of them will be manageable without food. Getting his nutrition back up, getting fluids in him if he’s dehydrated, and keeping him fed and hydrated is how you’re going to start turning all of this around. It’s your cat and your call. But I think you’ve got too much going on to beg and hope he starts eating again. I reccomend a feeding tube. This will not only buy you time to work out the short term recovery and the long term management. But it may be one of the best things to do to insure that short term recovery happens sooner than later.

No food, no recovery. Good eating, good outlook. But you’ll likely need to help him with that until he’s feeling less sick. And a feeding tube is far less stressful on the cat and you than syringe-feeding (“force feeding”.)

 

[cara1970]

Did this all happen recently or has it been building? If this is all recent, it sounds acute rather than chronic. The outlook can be grimmer in acute cases.

Diabetes is not fatal. I have no experience with diabetes. Fortunately Krista’s pancreatitis was under control before that point. The other thing to watch for if the pancreatitis is still not under control is EPI (exocrine pancreatic insufficiency). If they are doing fasting blood tests, fTLI is the one for EPI. EPI is an insufficient amount of digestive enzymes. If the pancreas has been digesting itself due to pancreatitis, it could scar itself over in areas that produce insulin causing diabetes or digestive enzymes causing EPI. This is why I say pancreatitis is the most critical of the three that has to be addressed first. EPI isn’t fatal either but it will have to be managed with pancreatic enzyme supplements.


You have a lot of things going on and none of them are necessarily fatal. But none of them will be manageable without food. Getting his nutrition back up, getting fluids in him if he’s dehydrated, and keeping him fed and hydrated is how you’re going to start turning all of this around. It’s your cat and your call. But I think you’ve got too much going on to beg and hope he starts eating again. I reccomend a feeding tube. This will not only buy you time to work out the short term recovery and the long term management. But it may be one of the best things to do to insure that short term recovery happens sooner than later.

No food, no recovery. Good eating, good outlook. But you’ll likely need to help him with that until he’s feeling less sick. And a feeding tube is far less stressful on the cat and you than syringe-feeding (“force feeding”.)

Thank you so much for your replies - they are so helpful and I’m so lost and upset about this. It’s breaking my heart. Information is so important and I just cannot sit back and wait without doing anything.
This all started on the 13th of March. He went off his food but recovered overnight so we thought it was just a temporary stomach thing. Looking back this was probably the first sign of trouble. But of course I didn’t even think it could be anything like this. 7 days later it happened again so straight to the vets where they diagnosed Triaditis. He went on drip and steroids and antibiotics for two days and was back eating in no time. Two weeks of meds at home and he was doing great. Then on 14th day his temperature went back up again and they gave him another long acting antibiotic injection. But then two days later again he regressed with high temp. This is now Saturday 13th of April. Three days in vets and he was eating well after drip and two different antibiotics, so he came home on the 15th. By morning (yesterday) he was looking bad so here we are now.
Vet says she’s given him insulin anti inflammatorys anti nausea and he’s been eating or rather licking the jelly from the wet food and drinking milk (she’s throwing anything at him). So I’m not sure if that is what you would consider recent or building.
I will ask vet about feeding tube and the other test (EPI) but I think I will be taking him to Dublin so they can do more advanced testing. It’s a two hour journey so I’m worried that might be too much for him?
Again thank you so much for taking the time to reply to me. It is so reassuring, all this information.

 

[daftcat75]

That’s not enough food. Ask the vet about a feeding tube. It doesn’t require a specialist to do. It’s a pretty straightforward procedure. You can watch it on YouTube if you’re up for it. They give him a light sedative, shave part of his neck, make a small incision, insert the tube, and verify the placement with an X-ray. The procedure itself only takes maybe 30 minutes. They usually like to keep the cat 12 hours to overnight to give the tube some time to take and perform a test feed. With the tube inserted, he can finally get his nutrition back up. He will feel so much better, you will feel so much better, the vet will feel so much better, with food in his belly again. It buys you time to run more tests and see specialists. It makes giving medicine so much easier. It may be the single most important thing you can do for him right now.
Feeding Tubes For Cats

Good eating, good outlook. Poor eating, poor outlook.

 

[cara1970]

That’s not enough food. Ask the vet about a feeding tube. It doesn’t require a specialist to do. It’s a pretty straightforward procedure. You can watch it on YouTube if you’re up for it. They give him a light sedative, shave part of his neck, make a small incision, insert the tube, and verify the placement with an X-ray. The procedure itself only takes maybe 30 minutes. They usually like to keep the cat 12 hours to overnight to give the tube some time to take and perform a test feed. With the tube inserted, he can finally get his nutrition back up. He will feel so much better, you will feel so much better, the vet will feel so much better, with food in his belly again. It buys you time to run more tests and see specialists. It makes giving medicine so much easier. It may be the single most important thing you can do for him right now.
Feeding Tubes For Cats

Good eating, good outlook. Poor eating, poor outlook.

Ok so they put a feeding tube in because he deteriorated overnight. I asked them first thing this morning to do that. I’m now taking him to a referral clinic in UCD Dublin where they have more sophisticated equipment to see what else is going on. Why is his pancreas not settling down? What else could it be? A blockage? What is the best outcome for him do you think? Sorry for all the questions. I’m beside myself with grief over this little guy.

 

[daftcat75]

I’m not a vet and I’m not familiar enough with his records to comment on outcomes. I’ll be honest. It could still end poorly depending on how acute these processes are and how damaged his organs might already be. But you definitely gave him a fighting chance with the feeding tube. His overall health and ability to keep going will be greatly improved by getting his food back up.

Were you given a feeding protocol? How much and how often? Did the vet show you how to use the tube and how to clean it? You can find all of these on Google or YouTube if he didn’t. You’ll have to split his daily calories over several feeding sessions. It’s time-intensive but you have a hand in his fight now.

It may not all be his pancreas causing his problems right now. That he hasn’t been eating or eating enough for so long means his liver could very well be overwhelmed with the byproducts of burning his fat for energy—fatty liver or hepatic lipidosis. The treatment for this is re-feeding via the feeding tube. You’re on the right path with that.

Ask about a B-12 shot. If he doesn’t need it, it’s mildly expensive pee. If he does, and he probably does because his nutrition has been deficient and his needs are great right now, it’s another extremely useful ally in his corner. It’s not a magic bullet but it should give him a boost. You have nothing to lose asking for this.

 

[cara1970]

I’m not a vet and I’m not familiar enough with his records to comment on outcomes. I’ll be honest. It could still end poorly depending on how acute these processes are and how damaged his organs might already be. But you definitely gave him a fighting chance with the feeding tube. His overall health and ability to keep going will be greatly improved by getting his food back up.

Were you given a feeding protocol? How much and how often? Did the vet show you how to use the tube and how to clean it? You can find all of these on Google or YouTube if he didn’t. You’ll have to split his daily calories over several feeding sessions. It’s time-intensive but you have a hand in his fight now.

It may not all be his pancreas causing his problems right now. That he hasn’t been eating or eating enough for so long means his liver could very well be overwhelmed with the byproducts of burning his fat for energy—fatty liver or hepatic lipidosis. The treatment for this is re-feeding via the feeding tube. You’re on the right path with that.

Ask about a B-12 shot. If he doesn’t need it, it’s mildly expensive pee. If he does, and he probably does because his nutrition has been deficient and his needs are great right now, it’s another extremely useful ally in his corner. It’s not a magic bullet but it should give him a boost. You have nothing to lose asking for this.

Update on Fred:
He’s been in ICU at a specialist vet clinic. He underwent a bunch of tests on heart, chest, abdomen and the rest of his organs. They also did an aspirated biopsy of his spleen, which showed slightly abnormal on their ultrasound, and his stomach lymph nodes were slightly enlarged. At first they were putting this down to all the inflammation he was suffering from when brought in. Now after three days in there with feeding tube and all the meds, including potassium, they say it could be cancer. Low grade lymphoma. Not good. Test results come in tomorrow.

Worse yet, now they are saying his anemia hasn’t resolved itself and he is borderline in need of a blood transfusion. At first they felt it was because of his overall condition when brought in.
This is all killing me. Each and every time they ring with update it gets worse.

 

[cara1970]

So on top of Triaditus, poor Fred had cancer. His spleen was abnormal and it tested positive for large cell cancer. Really bad. The only way forward was to remove his spleen and do chemotherapy, which would only prolong his life for maybe a few months. On top of this, he would have pancreatitis and he had developed diabetes because of his damaged pancreas.
The day I was told this (Tuesday 23rd) he came down with another fever and was really unwell again. I drove up the city (3hrs) and decided to let his suffering end. I cradled him, he purred, not the stress purr, but the soft lovely purr he usually had when he was with me and laid his head down on my arm. He was truly a very sick cat. I soaked his little head with my tears, but he knew I was there I think. After half an hour like this the vet came back into the room and we let him go. He passed purring.

I just want to thank you for all your advice and your comments to try and help me understand, were all greatly appreciated. It was a real lifeline, so thank you, thank you.

 

[denice]

I am so sorry. I just read through your posts and when I saw anemia I thought it was probably cancer. He can rest in peace now.

 

[MissClouseau]

So much love and sympathy for you, C cara1970 . I'm very sorry for your loss. Take your time to grieve and do what you need to do. Just also try to remind yourself death is difficult on those who are alive. The one who passed doesn't feel sadness and is no longer in pain. There is a little comfort in that.

Death can't take away the memories. He will live in them forever.

 

[mani]

C cara1970 the team at TCS are so very sorry for your loss. Fred was so fortunate that you loved him so much and were able to alleviate his suffering.

We lock thread when a cat has passed, out of respect. We have a Crossing the Bridge forum where you may like to leave an testimony to your friend.

..................................................RIP Fred
..............................................


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