? Exocrine Pancreatic Insufficiency ?

[PussCatPrince - GA]

Tyler's vet wishes me to consider testing for the above condition.
This is a very expensive test from here in New Zealand as it has to be sent offshore to the USA. Not that I would skimp on Tyler's care as I have the holiday savings that we can now not use to holiday coz of Ty's diabetes.

So. The vet said this was a rare condition. Is it rare, or is it more common that one thinks?

I believe the thinking is that if positive , this can be treated with pancreatic enzymes. That in turn helps the pancreas which remains inflamed at the present time. Pancreas calms down perhaps and so does liver + helps the bowel.
That is my present understanding anyway.

Another way to treat organ inflammation ( triaditis) is steroids but this could have an adverse effect on the diabetes. I'm not a fan of steroids in general overall TBH.

Does anyone on this board know anything about this please? Or perhaps has a pusscat that tested positive for this and is being treated.

 

[Red & Rover (GA)]

Taggin @Marje and Gracie for you. She's away from home at the moment (I think).

 

[PussCatPrince - GA]

Taggin @Marje and Gracie for you. She's away from home at the moment (I think).

Thank you.

 

[Marje and Gracie]

M

His diarrhea has made me wonder if he might have EPI. Here is an excellent discussion of it. And yes, the remedy is pancreatic enzymes but you don’t want to give them without having a pretty good idea that is what is going on. They can be quite caustic and must be carefully administered.

Triaditis and EPI are two totally different beasts. Quite often, in the US, they’ll treat triaditis with metronidazole but I’m not a huge fan of that. They also might use steroids, also not a fan of them, but if he needs relief and that’s what will help, you can always increase the insulin dosage to account for any increases to BG from the steroids. Can you have an ultrasound done because if they do one and they see the pancreas, liver, and intestines are inflamed, that might lead to a conclusion that it’s triaditis. If they all are not inflamed, it’s less likely to be triaditis (but I never say never). However, the only way to definitively know on the EPI is to do the test. In the US, it’s called a GI Panel and it consists of cobalamin, folate, specfPL and TLI. It’s the TLI that is the diagnostic for EPI.

I hope that helps!

 

[PussCatPrince - GA]

@Marje and Gracie
Thank you so much for taking your time to post to me on this.

Yes . Ty has had an ultrasound and both the pancreas and his liver are inflamed . Not sure on the intestines. Just said there was a thickening of the bowel.

I believe I am offered the TLI test. No idea on the GI panel. That phrase wasn't mentioned.

 

[Marje and Gracie]

@Marje and Gracie
Thank you so much for taking your time to post to me on this.

Yes . Ty has had an ultrasound and both the pancreas and his liver are inflamed . Not sure on the intestines. Just said there was a thickening of the bowel.

I believe I am offered the TLI test. No idea on the GI panel. That phrase wasn't mentioned.

You’re welcome, my dear!!

The bowel would be the intestines. If it is thickened, he likely has IBD.

The good thing about testing his B12 along with the TLI is that you will know if he needs B12 shots. Also, if he’s B12 is low, no amount of S boulardii will stop the diarrhea.

 

[Larry and Kitties]

The bowel would be the intestines. If it is thickened, he likely has IBD.

Or it could be small-cell intestinal lymphoma. Sometimes IBD mutates to small-cell intestinal lymphoma. One can't tell the difference via ultrasound, only a biopsy can.

 

[PussCatPrince - GA]

@Marje and Gracie @Larry and Kitties

Thanks both. So difficult . 5 months ago , healthy cat. Next thing an encyclopedia of issues to learn about and deal with.

The vet started with B12 injections with Tyler's first hospital stay. I asked them to test about this but he just decided to give the shots without any test. Didn't realise this until last week. Maybe because it is a part of this offshore service.

Ty had needle biopsies and no cancer was shown. Vet didn't feel Ty was fit enough to undergo the more invasive surgical procedure. Having said that , the ultrasound did show nodules on both liver and pancreas . My understanding is though that this is not unusual at all in geriatrics of Tyler's age. Whether feline of human.

Discussed this and what has been written to me with the husband.
Based on this we will go ahead with the test. I will print off about the GI panel thing .
Vet expects me to do my 'homework' so he won't be phased I have been digging in for info.

Thanks again.

 

[Marje and Gracie]

Or it could be small-cell intestinal lymphoma. Sometimes IBD mutates to small-cell intestinal lymphoma. One can't tell the difference via ultrasound, only a biopsy can.

Well, I didn’t want to mention that and worry her needlessly. There’s no way to know without a biopsy. And it could also be LCL.

M...a needle biopsy is usually not a good idea. Even if it is ultrasound guided, they still can miss any areas where cancer “might” be. So I wouldn’t assume that is definitive. The best way to determine if it is just IBD or IBD and lymphoma or just SCL is via endoscopy or open exploratory surgery biopsy. The current research indicates that if a kitty has IBD, it’s not a question of “if” it will develop lymphoma but “when”. Good luck with the GI Panel!!

 

[PussCatPrince - GA]

Just to update here for me.

The test for EPI did not happen. The vet seemed to feel at the last visit that it would maybe add little given the cost but that it could still be done at some point.
To take Ty home and see how he went which we have been.

Ty is fine in himself but we get swings of perfect poop alongside diarrhea. I need to look at the cycle perhaps to see if the B12 shots are somehow holding out and out diarrhea at bay at times.