Hi Amanda! I am so sorry to hear about Severino's EPI possibility. My non-diabetic, Bella, was just diagnosed with EPI in June of this year, although we had been trying to find out what was wrong with her for about a year prior. I'll give you Bella's rundown of symptoms to give you an idea. I know it's harder for you here since you only recently rescued your beautiful boy.
Bella has always been really healthy, although she's a vomiter (ugh, the agony). In July 2019, I brought her in for her yearly physical expecting her to be overweight because she's on the same food schedule as our diabetic, who's a big boy. She was actually down to 12 pounds from 15. I had a chemistry panel done and her liver values were slightly off, so she went on a liver supplement for the next 3 months. I bring her in to be retested, and she's down to 10 pounds. Thankfully her liver values were back within normal range. During this time, she's become absolutely ravenous, jumping on countertops for the first time in her life, going through the garbage, etc. She's also really thirsty all the time. So I added on a thyroid check, but no hyperthyroidism nor diabetes (which are the frontrunner diagnoses when your cat is starving even when eating normally). We decide that maybe there's an issue with her teeth, because her mouth stinks and she's even started having this mucus-filled light brown diarrhea that you can smell everywhere in the house. It's absolutely horrendous. We do a dental, and she has a little tarter, no extractions, which is wildly perplexing. I bring her back one more time and she had actually gained like 0.5 pounds, which the vet thought was great, and I thought was besides the point. I mean, it could be water weight or from just eating. The vet offers to do an x-ray to placate me, and they find nothing.
I wait a while and she's really deteriorating. You can feel her ribs when you pet her, and her hip bones are jutting out. One day she rejects food (she didn't even come down for breakfast, which has NEVER happened), and she has this glassy look to her. I think she's going to die that day. I get her into another vet the same day, who FINALLY comments on how worried she is about Bella's loss of muscle mass. She's down to 6.6 pounds at this point and weirdly stopped vomiting, which I took as another bad sign. We schedule an ultrasound and the vet can't find her spleen. She cannot find any other obvious signs of anything, so she's thinking that she likely has cancer. Unfortunately, they're not sure if she'll be able to survive chemo, since she has wasted away to nothing. She's on an appetite stimulant and anti-nausea medicine. The vet asks me if I'd be willing to do another ultrasound in 2 weeks at no charge. She'd like to see if there's any changes. It takes about 4 days really for Bella to come back to herself and for her eyes to clear. Her ravenous appetite comes back. We bring her back in for the ultrasound, which goes much better. Her belly is less tender and the vet can see some of the spleen, but it's been blocked by what looks to be the pancreas, which is inflamed. I had asked to do the GI panel and the vet concurred. We sent off the sample and get the results: EPI with a severe Vitamin B12 deficiency. Bella's TLI was at 3.7 and her Cobalamin (B12) was less than 150, which means it wasn't even registering. We started her B12 injections (once a week) and she started gaining muscle mass almost immediately, which to me indicates how deficient she really was. We started her on pancreatic supplements soon after as well. She's back up to around 8-9 pounds now, which is more normal for her frame, but now her ribs aren't sticking out. She's still hungry and thirsty (after eating the supplements), but is so much better overall. The vet thought she might suffer from chronic pancreatitis, although she's never been hospitalized for it.
So Bella's main symptoms were extreme hunger, thirst, mucusy light-brown diarrhea, and extreme weight loss. It's hard to say if Severino truly has EPI, but it's definitely possible with that questionable TLI. It could just be some GI upset from his change in circumstances. I definitely hope he doesn't have it, but I look forward to hearing about his follow-up test results!
