Pallina, Hyperthyroid Cat

[Antonio65]

Hi everybody,
Meet Pallina, my cat. Her name might sound funny to a not Italian ear, but over here it's a rather common name for a femal cat, it means "Little Ball". She's 16 yo, I found her on a freezing morning in January 2002 and took her home. My idea was to finding her a good home but, as you can imagine, I didn't find it.

In this picture you can see her, the photo is 5 years old, but she's just the same.

She's always been in a very good health, her trips to the vet were for the vaccines only and for blood checks once or twice a year.

Her appetite had always been very good, she would eat so much that she was round, as her name would lead you to think. Her weight was around 10 to 11 lbs (4.8 to 5.2 kg), she was round and soft.

Then last year in May, I noticed she was eating less and less and her weight was obviously decreasing. It was when Lola, my other cat who now is at the Rainbow Bridge, was very sick from a rare disease.
Pallina is a very sensible cat, I thought she was sensing the dramatic situation and was losing her appetite.
But when Lola bounced back to a very good condition in the two months before the surgery, Pallina was still going down, so I took her to the vet that ran a blood test and an ultrasound scan. He found a cholangitis and a slight inflammation of the upper tract of the digestive system, so his diagnosis was of hyperthyroidism. This first diagnosis was confirmed by the blood test with the thyroid levels above the high range. Her weight was down to 8.4 lbs (3.8 kg)
It was quite a surprise to me, because all her symptoms were opposite to the hyperthyroidism. She was eating less, she was quieter, sometimes lethargic, not aggressive, no diarrhea and no faster heartbeat.
The vet told me that Pallina has a not common form of hyper-T, called Apathetic Hyperthyroidism.

She was put on Methimazole in tablets, 1.25 mg twice a day, but after 5 weeks we repeated the blood test and found out that she was having troubles with her kidneys, likely related to the medicine. The thyroid levels dropped a lot, so the vet adjusted the dose to 0.625 mg of Methimazole twice a day. The pill I was giving her is 5 mg and tiny, I had to break it into 8 pieces, a close to impossible mission. Because of this imprecision the thyroid levels were going to move up again, the vets decided to switch the therapy to the transdermal gel.
This is working fine, the application is precise and easier to administer.

During those months her appetite was deteriorating and she started eating less and less and vomiting more often. We had another ultrasound scan done and the inflammation of the liver area had increased. They also found a diffused inflammation of duodenum.
I asked the vets to run a test for pancreatitis. At first they refused because Pallina had no symptoms of it and the test is an expensive one, but I insisted and they did it. The test was positive for pancreatitis, Pallina was given a shot of Convenia and that was all.

We scheduled a visit with a nutritionist and the doctor stated that Pallina has an intolerance to some ingredients and protein, so her diet was changed to a protein that she had never eaten before (pork) and the carbohydrates quota was replaced with a small amount of boiled amaranth seeds.

Pallina liked this new diet, she started eating not less than two 80 g cans a day and her weight was going to increase. She wasn't vomiting anymore.
Then, all of a sudden, on a morning of two weeks ago she refused to eat her wet food and for the whole day she just nibbled it. I thought it was just a "no" day for her, but the issue repeated three more times in the last two weeks. Furthermore she started vomiting again, but she isn't vomiting food as it happened in the past, just gastric juices, as it happens when a cat has their stomach empty. Despite the hunger and the vomiting, she wouldn't eat her food.
Then, on the following day, everything is fine again.

I can't understand what's going on, neither can the vets. Her weight has now dropped to 6.6 lbs (3.0 kg).
All this vomiting of juices is also dehydrating her. She drinks a lot (the only clear sign of a hyperthyroidism), about 100 ml on average.
Other than this, she is rather lively, alert and active.
In the last days she has become a lot more talkative, opposite to her usual being silent and discreet.

Since the beginning of this story in last summer I told the vet that my intention was to have Pallina treated with the I-131 therapy.
Unfortunately this country is backdated, our legislation does not allow veterinary clinics to handle and dispose of this radioactive material, so in this medieval country we can't treat a hyper-T cat unless we go abroad.
In Europe there is a number of clinics that can do that, at different protocols and prices.
I asked the vets to gather information about those clinics, I gave them plenty of time to do that, but after many months I'm still in the dark and I had to look for bits of information on my own and I have finally found two clinics where the treatment can be done to the highest and most modern protocols.
Only one of the two can be directly accessed by the pet owner, the other one is a referral clinic and they don't deal with others than the vets.

I sent an email to the first clinic and am waiting for a reply.
What I would like to understand is why she has an intermittent appetite and sometimes she refuses the food that she liked a lot a few hours before.
I would also like to read experiences from other people who had the same problem with their cat, treatments, solutions, outcomes.

Thanks so much for the bottom of my heart.

 

[babiesmom5]

Pallina is a very beautiful girl...and you indeed have found her the best home! Now, to get her well. First, I hope you are successful in locating a clinic that will do the I-131 treatment. I had a cat who had the "radio-cat" treatment and highly recommend it. I only wish all kitty illnesses could be cured this easily.

Now about the other issues, from your description, along with my experience, I'd say Pallina has IBD. Pancreatitis does not occur in a vacuum. It goes hand in hand with other concurrent diseases, like diabetes, hepatic lipidosis, cholangitis and IBD. The fact that an ultrasound revealed inflammation of the liver and diffuse inflammation of the duodenum, along with pancreatitis, leads in the direction of IBD. You might want to consult with a good Vet specialist in Internal Medicine to see if an upper GI endoscopic biopsy is in order.

Now as for the symptoms, IBD kitties are often nauseous. There is a lot of acid and irritation in their GI tract. This is why they vomit bile and stomach juices. Their appetite comes and goes. One day they may like a particular food, next day they reject it. "Taste Fatigue" is a hallmark of this disease. You have to have a wide variety of foods on hand. Their tastes vary hour to hour according to how their stomach feels. On any given day, I might have to open 6 different cans just to find one acceptable. Tomorrow, they might like the one they rejected today. You may also wish to discuss with the Vet the use of Pepcid A/C or a prescription anti-nausea drug like Cerenia only on a temporary basis until you are able to get a positive diagnosis.

The vomiting of stomach juices is indeed dehydrating. Cats who are nauseous tend to drink more water than usual, so what you see with Pallina's water drinking may not be entirely due to Hyperthyroidism...it may be also due to nausea. Then when they get dehydrated, it makes the inflammation in the pancreas and other organs worse.

The fact that Pallina's weight has dropped now to 6.6 lb. suggests that the food she is taking in is not being absorbed...characteristic of IBD. If you look at an Ultrasound of the duodenum of an IBD kitty, there are lesions, raised villi, ridges and inflammation...all decreasing the ability of the small intestine to absorb nutrients.

So I hope I have at least given you some "food for thought" or some avenues to pursue with your Vet. I wish Pallina a speedy return to good health!

 

[Antonio65]

Pallina is a very beautiful girl...and you indeed have found her the best home! Now, to get her well. First, I hope you are successful in locating a clinic that will do the I-131 treatment. I had a cat who had the "radio-cat" treatment and highly recommend it. I only wish all kitty illnesses could be cured this easily.

Thanks! Pallina will be glad to "read" your words of appreciation
I'm glad to learn that your cat had a good outcome.

Now about the other issues, from your description, along with my experience, I'd say Pallina has IBD. Pancreatitis does not occur in a vacuum. It goes hand in hand with other concurrent diseases, like diabetes, hepatic lipidosis, cholangitis and IBD. The fact that an ultrasound revealed inflammation of the liver and diffuse inflammation of the duodenum, along with pancreatitis, leads in the direction of IBD. You might want to consult with a good Vet specialist in Internal Medicine to see if an upper GI endoscopic biopsy is in order.

Yes, I told the nutrinionist that the IBD was a very likely diagnosis and she took note of it and changed Pallina's diet acconrdingly.

Now as for the symptoms, IBD kitties are often nauseous. There is a lot of acid and irritation in their GI tract. This is why they vomit bile and stomach juices. Their appetite comes and goes. One day they may like a particular food, next day they reject it. "Taste Fatigue" is a hallmark of this disease. You have to have a wide variety of foods on hand.

This might be not possible because we have opted out many ingredients, like chicken, fish, tuna, and so on and grain as well. After several attempts we found out that pork is the only protein that doesn't make her throw up. I would stick to this at the moment.

You may also wish to discuss with the Vet the use of Pepcid A/C or a prescription anti-nausea drug like Cerenia only on a temporary basis until you are able to get a positive diagnosis.

Pallina has been on Cerenia several times in the last months, and sometimes it didn't even work.
We also used a drug similar to Pepcid A/C for a long time, with poor results...

The vomiting of stomach juices is indeed dehydrating. Cats who are nauseous tend to drink more water than usual, so what you see with Pallina's water drinking may not be entirely due to Hyperthyroidism...it may be also due to nausea. Then when they get dehydrated, it makes the inflammation in the pancreas and other organs worse.

I did some sub-q's in the past to keep her hydrated, but the vet told me to stop because Pallina's skin was having a bad reaction to the injections.

The fact that Pallina's weight has dropped now to 6.6 lb. suggests that the food she is taking in is not being absorbed...characteristic of IBD. If you look at an Ultrasound of the duodenum of an IBD kitty, there are lesions, raised villi, ridges and inflammation...all decreasing the ability of the small intestine to absorb nutrients.

Her feces are alright, not soft, not runny, so I think that the absorption should be alright?
It's just that some days she has appetite but doesn't want to eat, though she's desperate for food. It's like she's tired of that type of food or taste. Then the next days she wants a can after the other.
The food she refused yesterday was eaten at evening.
This morning she was rather fine, but during the night she had vomited some juices and a hairball.
Nothing is different in her from one day to the other, you wouldn't tell that she's going to refuse her food.

Thanks for your suggestions, babiesmom, I will talk to the nutrionist tomorrow and to Pallina's vet in the next few days.

I'm keeping a log of what happens day by day, I want to give them a full overview of the issue.

 

[babiesmom5]

You raised a couple of points which I would like to expound. IBD is caused by infiltration of inflammatory cells which thickens walls of the intestinal tract. If you look at a cat's GI system, you have the esophagus which connects the mouth to the stomach. The inner stomach lining secretes acids and enzymes to break down the food. Once the initial stomach digestive process is complete, the partially digested food exits the stomach and then enters the duodenum (first segment of the small intestine). A cat's small intestine has three parts. The first part attaching to the stomach, the duodenum, is where your cat has inflammation per the ultrasound. The middle (and longest portion) is the jejunum. The shortest part is the ileum which connects to the large intestine.

IBD can affect any or all parts of a cat's GI system. It has been my experience with 5 cats now with IBD that when inflammatory cells are affecting the stomach or higher areas of the small intestine (duodenum) they exhibit symptoms of nausea, vomiting of gastric juices, sometimes food. If the inflammatory cells are affecting the jejunum and/or ileum, they exhibit diarrhea.

Pallina's feces are alright now, not soft or runny because (according to Ultrasound) her inflammation is in the duodenum. This corresponds with the above.

Pallina's food absorption occurs in the duodenum...which is inflammed, as well as in the jejunum. I'd say her food absorption is definitely compromised; hence losing weight.

Although the duodenum is relatively short, it does have very important functions. The gallbladder and pancreas connect to the duodenum by the bile and pancreatic ducts. In Pallina's case, you indicated she has/had pancreatitis, also inflammed liver. Enzymes and other secretions important for digestion are produced by the liver and pancreas and pass through these ducts to mix with the food in the duodenum. Again, with inflammed pancreas and liver, her digestion is compromised.

As for Pallina vomiting juices during the night; yes, that or early morning prior to breakfast is when they are most likely to vomit as there is little or nothing on their stomachs at that time to "buffer" the acids. So they vomit stomach acids and bile. This can be mitigated somewhat by a late night feeding/snack and/or use of an acid buffer. Even then, it can't always be prevented.

You say pork is the only protein she can tolerate without throwing up. That's fine...but she has to eat it and if she is nauseous due to the IBD, she will not eat. You may wish to consider a steroid to beat back the inflammation that causes her to tire of/and or refuse to eat. It has been my experience with IBD kitties that you can provide the best food for them, but without a steroid they don't eat what they should, or the amounts.

It is good to keep a detailed log. Try doing it daily for 5 cats!

IBD can be very frustrating. You learn a lot the hard way. If I could give you one piece of advice it would be this; manage it aggressively! If you don't get ahead of it, it will get ahead of you. Good luck today speaking with the nutritionist and the Vet. Give Pallina some strokes for me.

 

[Antonio65]

Babiesmom, this post of yours is truly amazing!
It's not everyday thing to read such an informative post in a forum. Thanks a million!

I talked to the vet (one of the vets who know Pallina) today at lunch and she said nothing about the vomit, but she told me that it could be useful to hydrate the cat with some sub-q's twice a week becasue if she's throwing up so often she's losing fluids, even if she drinks a lot. Currently Pallina is drinking an average amount of 90 ml a day plus the wet food where I also add about 10 ml of water per can. I can't add more water or Pallina doesn't eat it.
Though the kidney levels are bit over the range she didn't advise me to treat Pallina as a CKD cat because the out-of-range levels can be caused by the dehydration and intermittent appetite.

I will discuss the issue with the nutritionist tomorrow in the morning when I send her the last log.
I hope she will able to tell me something.

I'm still waiting a reply from the clinic where I would like to have Pallina treated with the I-131 therapy, but so far no news from them.

As for the vomit at night or early morning, I would like to leave some food for her before going to bed, but everytime I did it she didn't eat it all and had vomited anyway.
Sometimes she also vomits during the day, when she has finished the can that I have left in the morning and has to wait for me to go back home.
Again, I tried to leave more food in the bowls, but it was the times when she refused to eat.
It was as she was frightened by the uncommon amount of food in her bowl... strange, isn't it?

Thanks again!

EDIT: I started giving Pallina a supplement for her liver, it's something I was giving her over one year ago and she was feeling a little better. Then she started vomiting more and more often food along with this pill, so I thought to stand-by for a while. Then Lola had her severe troubles that lasted 12 months, and I forgot of these pills.
I hope they will help her.

 

[babiesmom5]

Thank you for your kind words. I will be the first to admit that the learning curve for IBD is steep. Much of what I know now was learned the hard way through a lot of tears. I know you have shed more than your share of tears recently, and you don't need to shed any more.

You raised a couple of important points. You said that Pallina's kidney values are a bit over the range. When my first IBD kitty was taken to local Vet, they did complete bloodwork. It showed his kidney values were "high normal". His BUN was 2.3. The vet thought that, being age 14, that it was the beginning of kidney disease. I was advised to begin sub-q fluids twice a week which I faithfully did for several weeks, but he got worse. He continued to lose weight. Not at all confident, I went back for re-evaluation. I asked for Pancreatitis test...and it showed positive. I took him to specialty hospital where further tests, ultrasound, biopsy showed IBD.
When the IBD was finally brought under control, his kidney values normalized...and stayed normal throughout his life!

The other thing about Pallina's kidney values being "elevated" presently is your desire to have Pallina treated with the I-131. One of the stipulations in consideration for undergoing the I-131 treatment is that a cat's kidney values have to be pretty good. I know that was the case with the cat I had treated. The first thing they looked at were her kidney values. She was 13 years old at the time and fortunately, her kidney values at that time were excellent.

So, with Pallina's kidney values being above normal now, that may present a "false ' picture to the clinic deciding whether to accept her for I-131 treatment. With stabilization of the IBD, her kidney values may well normalize. They need to be normal for I-131 treatment as once the radioactive treatment is given, it is excreted through the kidneys.

With IBD kitties, they can only handle small amounts of food at a time. Even looking at a large amount turns them off. So, I give them very small amounts at a time...only enough for them to finish off. Any left gets taken right up. Yes, I admit I am my cats' slaves!

It is kind of like when I see a smorgasbord or a banquet, I get turned off...but put a nice plate of attractive food in front of me of small/moderate amount, I will eat. IBD cats are the same.

 

[artiemom]

I just saw this thread. I am thinking it is IBD, also. You do not need to have runny stools in order to have IBD. As B babiesmom5 , has explained so well, in textbook fashion , it can be IBD confined to the upper digestive tract. Pancreatitis pretty much goes along with IBD.

I do not know what to say about the hyperthyroidism. sorry

This is what I am going to say, just from my own experiences with my guy:
As far as the nausea, have you tried Cerenia daily? or even Zofran (twice daily)? These would be in addition to the Daily Pepcid.
One works on the gastric juices (enzymes, acid), and the Cerenia/Zofran work on the neural pathways which cause nausea.

An appetite enhancer usually goes along with the gastric reducers. You really cannot do one without the other. The enhancers would be either Mirtazapine or Cyproheptadine.

I agree, Pallina also needs a steroid to control the inflammation in the colon/stomach. Make sure it is Prednisolone! not just plain prednisone. There is a difference in chemical composition and how it is processed in cats metabolism. Or there is budespone(sp) sorry.. this is newer, but used for IBD and Pancreatitis.

What I am concerned about is the cholangitis. What caused that? or was it related to the pancreatitis?? If you can get the pancreatitis/IBD under control, perhaps that would help.

Pork is a good novel protein. Lamb is also. There is also Rabbit. I think lamb is easier on the stomach. Pallina's tolerance of the pork for a few weeks and then, BAM an attack of vomiting is very indicative of IBD. For me, I thought it took a couple weeks before an allergy or symptom to reveal itself. The 2 week period is a ' red flag' to me.

I am no expert in this, but I am just going on feel.. and from what I have experienced with my guy.

Pancreatitis and IBD are treated fairly similar.

As far as being dehydrated: can you tell? I know you have a ton of experience from your Angel Lola ... Are Pallina's gums tacky? Does her skin Tent go down fast or slowly. If she is dehydrated a small dose of sub-q's could help.

I apologize if I am just restating what you have already done..

and, sometimes an antibiotic is helpful also.. I know so much..

I am so sorry you are going through this, especially after angel Lola.

I wish I could help you about the hyperthyroid. But, I do not have any experience with that.

I think that drinking 90ml of water per day, in addition to eating wet food, is a lot for a cat. I would want to check her blood sugar levels also.. sorry.. so much going on.. perhaps a periodic sub-q would help her. and it could help her kidneys, as long as it was not much..

You know that we cannot prescribe any treatment. All I am saying is just, off the top of my head.

Sorry if I am confusing you..

It is all very frustrating.., you know..

((Hugs)) to you and Pallina...

 

[Antonio65]

You raised a couple of important points. You said that Pallina's kidney values are a bit over the range. When my first IBD kitty was taken to local Vet, they did complete bloodwork. It showed his kidney values were "high normal". His BUN was 2.3. The vet thought that, being age 14, that it was the beginning of kidney disease. I was advised to begin sub-q fluids twice a week which I faithfully did for several weeks, but he got worse. He continued to lose weight.

Pallina had a blood check 10 days ago, everything was fine except the values shown below.

GPT 427 [23-109]
ALP 218 [0-120]
GGT 8 [<3]
Creatinine 2.3 [0.5-1.8]
BUN 68 [30-65]
Cholesterol 263 [65-250]

As you can see, the kidney values are slightly over the range, the vet on the phone yesterday told me that the BUN at 68 isn't worrying at all ant the Crea at 2.3 rather than 1.8 is obviously caused by the dehydration.

Did you understand why the sub-q's made your kitty worse?

With stabilization of the IBD, her kidney values may well normalize. They need to be normal for I-131 treatment as once the radioactive treatment is given, it is excreted through the kidneys.

So, what can I posibly do to control and/or stabilize her IBD? Will a correct and balanced diet be enough?

With IBD kitties, they can only handle small amounts of food at a time. Even looking at a large amount turns them off. So, I give them very small amounts at a time...only enough for them to finish off. Any left gets taken right up. Yes, I admit I am my cats' slaves!

I'm a cat's slave too, and if I were able to stay home to care for her 24h I'm sure she would be much better.
The scaring amount of food makes sense and my tests proved you're right.

This morning she's fine and has eaten a good 2/3 of can.

Thanks!

 

[Antonio65]

I just saw this thread. I am thinking it is IBD, also. You do not need to have runny stools in order to have IBD. As B babiesmom5 , has explained so well, in textbook fashion , it can be IBD confined to the upper digestive tract. Pancreatitis pretty much goes along with IBD.

I told the vet to run the test for pancreatitis because with a suspect IBD and a cholangitis we had very good chances to have a triaditis. And i was right.

As far as the nausea, have you tried Cerenia daily? or even Zofran (twice daily)? These would be in addition to the Daily Pepcid.

We had done a course of Cerenia for nearly a week.
I also given Pallina a one-month course of Ranitidine, with poor results.
So it was clear that the problem was in an intolerance to some food.

An appetite enhancer usually goes along with the gastric reducers. You really cannot do one without the other. The enhancers would be either Mirtazapine or Cyproheptadine.

Pallina shows a good appetite, only that sometimes she doesn't want what's in the bowl. I don't think that giving her an appetite anhancer could change anything.

I agree, Pallina also needs a steroid to control the inflammation in the colon/stomach. Make sure it is Prednisolone! not just plain prednisone. There is a difference in chemical composition and how it is processed in cats metabolism. Or there is budespone(sp) sorry.. this is newer, but used for IBD and Pancreatitis.

I could discuss it with my vets, but over here vets generally do not agree with corticosteroids, they tend to avoid the use of them as much as possible.
I googled "budespone" but found nothing...

What I am concerned about is the cholangitis. What caused that? or was it related to the pancreatitis?? If you can get the pancreatitis/IBD under control, perhaps that would help.

The cholangitis has been there for a long while, way before any other symptom appeared. It is a chronic condition of her and no treatment (supplement) has never cured the problem.

Pork is a good novel protein. Lamb is also. There is also Rabbit. I think lamb is easier on the stomach. Pallina's tolerance of the pork for a few weeks and then, BAM an attack of vomiting is very indicative of IBD. For me, I thought it took a couple weeks before an allergy or symptom to reveal itself. The 2 week period is a ' red flag' to me.

As a matter of fact Pallina has been eating this new food for nearly six weeks, and only lately she showed some episodes of disturb. She vomits mostly juices and hair, only once she vomited a small portion of food and a few days later she threw up some water colored like food with some traces of food in it.
I can't relate these episodes with an intolerance to pork. Yet.

As far as being dehydrated: can you tell? I know you have a ton of experience from your Angel Lola ... Are Pallina's gums tacky? Does her skin Tent go down fast or slowly. If she is dehydrated a small dose of sub-q's could help.

Nothing would make me think she's dehydrated, her skin goes down quickly.
About this test, once a vet told me off about it and made an ironic observation on how I was able to tell hydration from a stupid test when they (the vets) need to be graduate and with year of experience and run a test to assess the level of hydration. Then, on a lighter approach, he told me that the skin test isn't totally reliable.
However, yes, I do have much experience after 11 years with sweet Lola

As you can read in my previous post, nothing but what I posted is out of range, blood sugar is fine.

Thanks so much for your strong support!

 

[artiemom]

Sorry, I am of no help at all.. except for tons of ((Hugs))

 

[babiesmom5]

I am glad to hear that Pallina ate well this morning. It's a good day! The thing is with IBD kitties, it varies day to day...or even morning to evening. A lot depends upon the weather and temperature outside also. Today is cool and rainy and all cats ate well. So far, so good, but it is a roller coaster day to day.

From what you write, I believe there are different treatment protocols in your country than there are here. Case in point; I-131 is "gold standard" of Feline Hyperthyroidism treatment here, but not available in Italy. Likewise, Corticosteroids are a mainstay of treatment for IBD here, but not widely used there. This may be because Feline IBD has exploded in the last 10-15 years. As several Vets have told me, years ago IBD was relatively rare or unheard of, consequently, Vets were not trained in IBD diagnosis or treatment. Now, as Vets are seeing more and more cases of IBD, there is increased knowledge, education and training in Veterinary schools on diagnosing and treating this disease. Even so, many Vets in our country, are still not up to speed on IBD the way they should be; so conscientious pet parents like us have to take our beloved kitties to specialized hospitals where Internal Medicine Vets with advanced training area able to diagnose and treat it. I wish you were able to take Pallina to my excellent Internal Medicine Vet here. Are there any in Turin?

I am sorry I did not make myself clear in regards to my cat getting worse when my local Vet prescribed sub-q fluids twice weekly. The cat got worse, not because of sub-q fluids, but because the cat had serious IBD which was not yet diagnosed. This Vet (incorrectly) believed his problems were due to elevated kidney values due to CKD. This Vet, like many Vets, (see paragraph above), was not skilled or experienced in diagnosing IBD. I had to take this very seriously ill cat to a specialty hospital 1 1/2 hours away to a skilled Internal Medicine Vet who conducted the proper tests and diagnostic procedures which confirmed IBD.

In answer to your question regarding diet controlling IBD; dietary changes may be beneficial, but just by themselves will not be enough to control IBD. IBD is manifested by inflammatory cells which move into the intestinal walls. Uncontrolled inflammation is the root cause of IBD and which must be controlled, and this, in most cases, requires a corticosteroid. While I know the concern of side effects, the benefits outweigh the downside. A corticosteroid is generally prescribed in a higher dose to begin with, then tapered down as the cat improves. Vets usually prescribe a steroid version, like Prednisolone, Methylprednisolone and/or Budesonide which minimizes the risk of side effects. I currently have one IBD cat on Budesonide because she has a 3/6 heart murmur. Budesonide has a lower risk of side effects because it is moved along the GI tract calming inflamed intestinal linings, then removed almost immediately by the liver. You may want to discuss this with your Vet with Pallina's liver inflammation.

Triaditis involves the liver, pancreas and GI tract. A good explanation can be found on this website; www.ibdkitties.net/feline-triaditis.

Injection of vitamin B-12 (Cobalamin) is helpful for IBD kitties who are commonly deficient in this vitamin. This vitamin is water-soluble and is absorbed in the ileum. It also helps their appetite. My IBD cats get Cobalamin shots monthly.

Also helpful is a raised feeding and water bowl. A cat's stomach is about chest level, so raising the bowl to that level helps prevent regurgitation and vomiting. I have one of these for each cat; www.classycatdishes.com. It definitely helps IBD kitties.

So, hopefully there are some tips or suggestions here which may be helpful to Pallina.

 

[dorymb]

Pallina is a very beautiful girl...and you indeed have found her the best home! Now, to get her well. First, I hope you are successful in locating a clinic that will do the I-131 treatment. I had a cat who had the "radio-cat" treatment and highly recommend it. I only wish all kitty illnesses could be cured this easily.

Now about the other issues, from your description, along with my experience, I'd say Pallina has IBD. Pancreatitis does not occur in a vacuum. It goes hand in hand with other concurrent diseases, like diabetes, hepatic lipidosis, cholangitis and IBD. The fact that an ultrasound revealed inflammation of the liver and diffuse inflammation of the duodenum, along with pancreatitis, leads in the direction of IBD. You might want to consult with a good Vet specialist in Internal Medicine to see if an upper GI endoscopic biopsy is in order.

Now as for the symptoms, IBD kitties are often nauseous. There is a lot of acid and irritation in their GI tract. This is why they vomit bile and stomach juices. Their appetite comes and goes. One day they may like a particular food, next day they reject it. "Taste Fatigue" is a hallmark of this disease. You have to have a wide variety of foods on hand. Their tastes vary hour to hour according to how their stomach feels. On any given day, I might have to open 6 different cans just to find one acceptable. Tomorrow, they might like the one they rejected today. You may also wish to discuss with the Vet the use of Pepcid A/C or a prescription anti-nausea drug like Cerenia only on a temporary basis until you are able to get a positive diagnosis.

The vomiting of stomach juices is indeed dehydrating. Cats who are nauseous tend to drink more water than usual, so what you see with Pallina's water drinking may not be entirely due to Hyperthyroidism...it may be also due to nausea. Then when they get dehydrated, it makes the inflammation in the pancreas and other organs worse.

The fact that Pallina's weight has dropped now to 6.6 lb. suggests that the food she is taking in is not being absorbed...characteristic of IBD. If you look at an Ultrasound of the duodenum of an IBD kitty, there are lesions, raised villi, ridges and inflammation...all decreasing the ability of the small intestine to absorb nutrients.

So I hope I have at least given you some "food for thought" or some avenues to pursue with your Vet. I wish Pallina a speedy return to good health!

Oh I so wish I had information months ago. My Cleo had these exact IBD symptoms you describe. I fussed over her food constantly. Exactly as you describe, she would love it one day and not the next. Several times over her life, she had episodes and was treated with covenia and cerenia. Her last senior wellness exam and blood tests in December were good, but vomiting became more and more frequently, mostly bile. She drank so much water and lost so much weight. I was too late, her kidneys failed. Your description is so accurate. She was perky and acted normally except for the vomiting and I wasted too much time with trying to calm her stomach with pepcid, slippery elm, different foods and tricks, spoon feeding, warming, etc. By the time I took her to emergency, they gave her covenia, said her vitals were good and to check with regular vet if she didn't improve. When I took her to my vet, he said she was too far gone. She died at home 2 days later I am heartbroken and filled with guilt. Cleo was never diagnosed with IBD vet always said "sensitive stomach" If I had that diagnosis maybe the outcome woudl have been different.
I would say Paulina's IBD type symptoms should be addressed first. Cleo was also hyperthyroid, but I had her treated with I-131 before anything (she was never on the Meth. medicine) and she lived 4 years in good health after.

 

[dorymb]

Antonio, I am so sorry for your problems with Paulina now. Babiesmom has such good advice. Believe me the symptoms are so much like my cat Cleo's. Keep pushing your vet to follow the IBD diagnosis. Best of luck to you!

 

[Antonio65]

Even so, many Vets in our country, are still not up to speed on IBD the way they should be; so conscientious pet parents like us have to take our beloved kitties to specialized hospitals where Internal Medicine Vets with advanced training area able to diagnose and treat it. I wish you were able to take Pallina to my excellent Internal Medicine Vet here. Are there any in Turin?

B babiesmom5 ,
The first thing I absolutely want to do is complimenting you on your exceptional knowledge of our geography!
I've rarely known someone from so far away who knows even when Turin is. I haven't stated that city in my profile and despite that you named it, excellent indeed!
Yes, Turin and surroundings have very good clinics and IM doctors, this area of our country is possibly the most aware and careful of pets of all Italy.
I will ask my regular vets if they know someone who can treat a case like this.

One of the problems I'm going to face, though, is that in a week time I'll be on holiday. Pallina will be looked after by two experienced cat-sitters, two girls students in veterinary medicine who already know her.
Though I'm completely at ease about what they will do for her, I won't be able to take Pallina anywhere until my return. I wonder if this delay might make things worse. I hope not, after all Pallina has possibly been suffering from this for a long time before she was diagnosed (we haven't done specific tests for IBD, but all symptoms seem to point that direction), so I hope that a few weeks don't change the situation much.

Vets usually prescribe a steroid version, like Prednisolone, Methylprednisolone and/or Budesonide which minimizes the risk of side effects. I currently have one IBD cat on Budesonide because she has a 3/6 heart murmur. Budesonide has a lower risk of side effects because it is moved along the GI tract calming inflamed intestinal linings, then removed almost immediately by the liver. You may want to discuss this with your Vet with Pallina's liver inflammation.

This piece of information is fantastic. I will forward it to my vets.

Triaditis involves the liver, pancreas and GI tract. A good explanation can be found on this website; www.ibdkitties.net/feline-triaditis.

Very interesting website, thanks!
My vets wouldn't believe that Pallina might have a pancreatitis, but she has it.

Injection of vitamin B-12 (Cobalamin) is helpful for IBD kitties who are commonly deficient in this vitamin. This vitamin is water-soluble and is absorbed in the ileum. It also helps their appetite. My IBD cats get Cobalamin shots monthly.

With my sweet Lola I used to give her a Vit B complex pill everyday to help her with her CKD. My vet (a different one at that time) said that she never prescribed it before to anyone else, she thought it was an interesting approach to the problem. And I think this was one of the aids who allowed her to live with her CKD at very controlled level for such a long time.
Do you think that Vit B pills rather than injections of B12 only might be useful all the same?

Also helpful is a raised feeding and water bowl. A cat's stomach is about chest level, so raising the bowl to that level helps prevent regurgitation and vomiting. I have one of these for each cat; www.classycatdishes.com. It definitely helps IBD kitties.

The raised bowls technique was something that we tried before.
Pallina has been vomiting food since I have her. In her early days with us she would gobble her food in no time. My vet told me that she would have suffered from a chronic lack of food when she was a feral, so she couldn't believe how lucky she was with a full bowl everyday. The fact of gobbling down her food made her throw it up a few minutes later. She would re-eat her vomited food immediately after that
So we tried the raised bowls for sevreal weeks at different heights from the floor, but nothing changed.
I always wanted to try this again, but Pallina has become very picky and suspicious of the world around her lately, and I fear that such a massive change in her environment would put her off her bowl for good...

Babiesmom, I wish to thank you for the huge pile of information you are giving me and, above all, the clear and professional way you have to express that.
Take care!

 

[Antonio65]

Oh I so wish I had information months ago. My Cleo had these exact IBD symptoms you describe. I fussed over her food constantly. Exactly as you describe, she would love it one day and not the next. Several times over her life, she had episodes and was treated with covenia and cerenia. Her last senior wellness exam and blood tests in December were good, but vomiting became more and more frequently, mostly bile. She drank so much water and lost so much weight. I was too late, her kidneys failed. Your description is so accurate. She was perky and acted normally except for the vomiting and I wasted too much time with trying to calm her stomach with pepcid, slippery elm, different foods and tricks, spoon feeding, warming, etc. By the time I took her to emergency, they gave her covenia, said her vitals were good and to check with regular vet if she didn't improve. When I took her to my vet, he said she was too far gone. She died at home 2 days later I am heartbroken and filled with guilt. Cleo was never diagnosed with IBD vet always said "sensitive stomach" If I had that diagnosis maybe the outcome woudl have been different.
I would say Paulina's IBD type symptoms should be addressed first. Cleo was also hyperthyroid, but I had her treated with I-131 before anything (she was never on the Meth. medicine) and she lived 4 years in good health after.

So sorry for your Cleo
Sometimes vets look like blind, even with very clear signs and symptoms they still don't know what's going on.
This makes me angry!
My Lola might be still with me if they had noticed her carcinoma three months earlier, when a CT scan was done, but they didn't see it because they were looking for something else!
I will never forgive them!

 

[babiesmom5]

With your upcoming holiday, I hope Pallina is stable; at least doing as well as possible. The Vet students who will be caring for her are certainly capable and you have confidence in them which is good. I would tell them however to be very aware of sudden changes in Pallina which may indicate a 'flare-up" of Pancreatitis. They become lethargic, don't want to eat or drink, often seek heat. If this happens, get her to the Vet right away. Chronic Pancreatitis can smoulder for long periods without outward signs; then for unknown reasons, suddenly become acute and it usually takes hospitalization to bring it under control. Tell the students to be vigilant.

It is interesting you say Pallina has become very picky and suspicious. Yes IBD kitties do! When they don't feel good in the stomach/intestines, they feel very vulnerable...sort of like when they are in the wild...very guarded, cautious of anything new in their environment which may pose a threat or increase their vulnerability to prey. You are very astute to notice these subtle behavioral changes in Pallina!

As for Vitamin B, bowel disorders affecting the stomach, intestines or pancreas can affect the absorption of Vitamin B. There is a blood test (Cobalamin Fasting) your Vet can do to determine if a cat is deficient in Vitamin B-12. Cats who have IBD (particularly affecting the Ileum) often have deficiencies. In this case, since Vitamin B-12 is absorbed in the ileum, it has to be given by injection.

While Vitamin B-12 is a component of Vitamin B complex, the amount found in a pill would be therapeutically insufficient. This is why, if the cat is deficient, it needs an injection. Nonetheless, a B-complex pill the Vet prescribes couldn't hurt.

You are right in that Vets sometimes do have blinders on; they are sometimes not open to other possibilities. I agree with what dorymb said to keep pushing your Vet to follow the IBD diagnosis. My cat who was mistakenly diagnosed with CKD would have died had I not been persistent in pursuing the IBD diagnosis.

So with that said, enjoy your holiday. I am sure Pallina will be eager for your return!

 

[Antonio65]

The Vet students who will be caring for her are certainly capable and you have confidence in them which is good. I would tell them however to be very aware of sudden changes in Pallina which may indicate a 'flare-up" of Pancreatitis. They become lethargic, don't want to eat or drink, often seek heat. If this happens, get her to the Vet right away.

We'll be in touch with them twice a day. The girls will come home in the morning and the evening (8 am - 8 pm) and everytime they will call me to let me know how things are going. They usually stay with Pallina for an hour, they are very caring and alert. When I still had Lola they were so vigilant that one day they called in emergency because they noticed a different color in a spot of her fur I do trust them!

It is interesting you say Pallina has become very picky and suspicious. Yes IBD kitties do! When they don't feel good in the stomach/intestines, they feel very vulnerable...sort of like when they are in the wild...very guarded, cautious of anything new in their environment which may pose a threat or increase their vulnerability to prey. You are very astute to notice these subtle behavioral changes in Pallina!

Just think that when she's eating no one in the house can move an inch because we fear that a movement, a noise or else could put her on guard. We're slave to her
I notice everything of my cats, since I had Lola I was living with an eye always on her and Pallina, nothing could escape me, it was in the utmost interest of my cats. I have the total and absolute responsibility of her (their) lives, I couldn't forgive myself if I overlooked something!

As for Vitamin B, bowel disorders affecting the stomach, intestines or pancreas can affect the absorption of Vitamin B. There is a blood test (Cobalamin Fasting) your Vet can do to determine if a cat is deficient in Vitamin B-12. Cats who have IBD (particularly affecting the Ileum) often have deficiencies. In this case, since Vitamin B-12 is absorbed in the ileum, it has to be given by injection.

We have done a test for pancreatitis and B12 was included. The sample was sent to Texas A&M University.
Here are the results:
-fPL Feline Specific-Pancreas Lipase 14.2 ug/l (>5.4 consistent with pancreatitis)
-TLI 138.6 ug/l (12-82)
-Folate 8.1 ng/ml (11.1-21.6)
-Vit B12 450 pg/ml (269-1333)

Does this test say something on her ability to absorb B12?
The pills I used to give to Lola have 1.5 ug of B12 per pill, I would give her 1/4 per day.

Thanks a lot B babiesmom5

 

[babiesmom5]

It is good your vet did the Spec fPl test which is sent off to Texas A&M University. This is the "gold standard" and most reliable. Thanks for sharing the results. It is very revealing.

Folate and Vitamin B-12 are absorbed through different areas of a cat's intestine. Folate is absorbed in the beginning part of the small intestine (duodenum and jejunum), while Vitamin B-12 is absorbed further down (ileum and colon).

From results of this test, I see that Pallina is not deficient in Vitamin B-12; therefore I think her gastrointestinal problems do not originate in the ileum or colon. This also goes along with the fact that she does not have diarrhea...which IBD kitties with ileum and colon involvement often do, as I can attest.

I see from this test that Pallina IS deficient in Folate. This supports my belief that her gastrointestinal problems involve the duodenum and jejunum. This also goes along with the fact that Pallina vomits bile, stomach juices, occasional food...which IBD kitties with duodenum and jejunum involvement often do as I have observed.

Of course, the only way you are going to know what part of the gastrointestinal tract is involved is through an Ultrasound and confirmed by endoscopic biopsy.

Since Pallina is deficient in Folate, you might speak with your Vet regarding a supplement. When one of my IBD kitties was found deficient (her problems were in the duodenum), my Vet prescribed 1/2 of a 1mg Folic Acid tablet (human version) daily. I believe the Texas A &M recommended dose is 200mcg for cats once a day for 4 weeks, but it is very important to address the underlying gastrointestinal disease that is causing the Folate deficiency. So Folate is only one aspect of the overall treatment plan, which in all likelihood will involve a steroid.

 

[Antonio65]

Thanks Babiesmom,
I think I'll have to talk with my vet, but because I'm leaving tomorrow, either I call him from my holiday destination and the forward the message to the girls who will attend Pallina, or I wait until I come back home.
As I wrote earlier, I will have twice daily updates from the two students, so any minimum change in Pallina's behaviour or condition will be promptly addressed and possibly treated.
They also have received directions for the vet.
I will occasionally read the forum during my holiday. And I will think of you and your beautiful babies

 

[Antonio65]

Hi everybody,
I think it's time to give you an update about Pallina, my hyperthyroid cat.
I have been away on holiday three weeks, from June 1st to 23rd. In that time Pallina was home with two lovely girls who would take of her twice a day. They would tell me that she was eating two cans of wet food a day. Her weight hasn't changed since we left for our holidays.
Since we have come back home Pallina has started eating less, now we are on one nad a half can a day. Yesterday she ate one can only, today it seems just the same...
It's as our presence puts her off ffod, probably she gets distracted, probably she was so bored during our absence that she spent her time at the food bowl.

All the rest seems alright, she's rather active and alert. She looks for cuddles and company.

She is still vomiting, but it's hairballs only in the last few weeks, and the two girls told me the same thing. When I take her outside in the garden she's tempted by the grass and she would eat lots of it if I weren't there to stop her.
So at the moment I can't figure it out if she has some hairballs to expel or she has some stomach troubles.

We had a blood test last week. Her thyroid levels have slightly improved. Her liver levels have highly improved though they are still above the range. The supplement I am giving her is working fine. No news on the kidney department, the creatinine is still at 2.3.
GPT 292 [23-109] (was 427)
ALP 152 [0-120] (was 218)
GGT 7 [<3] (was 8)
Creatinine 2.3 [0.5-1.8]
BUN 65 [30-65] (was 68)
Cholesterol 285 [65-250] (was 263)

We have applied for the European Passport. It is necessary to cross the borders here in Europe. It requires that the cat is microchipped (not required here, only compulsory for dogs) and vaccinated for rabies. We should get it on Thursday morning.

We are also waiting for August 7th, when Pallina will be treated with I-131 in Belgium (1100 km, 683 miles, from home).

That's all at the moment.