help! pancreas and other inflammation!

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kitonlove

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My cat, Sasha, who has always been as healthy as can be, started losing weight about 6 months ago and getting really picky about his food. At first, I attributed it to moving and stress but a month ago it got worse (the eating). He isn't at a dangerous weight, but he has lost muscle tone.
Anyway, his bloodwork a month ago showed elevated pancreas enzymes and he was treated for infection with 48 hrs of IV fluids and antibiotics. His levels returned to "just above normal." (I am sorry that I don't have the exact value on hand) The vet at the time was just as concerned with dehydration as she was infection. So the fluids were a good idea.
Well, we retested him because he had shown no improvement and his enzyme levels were worse than before. He just had an ultrasound and his liver, kidneys, pancreas, and duodenum are all showing inflammation.
The vet says the next step is a biopsy under general anesthesia of each of those organs.
She also said that she "doesn't think it's cancer-related." I'm just really scared that it is....

I'm so puzzled. I hope that the wise-cat-folk on this board, who've helped me so many times before, can give me some ideas. I'd like to make sure I'm leaving no stone unturned and not wasting time on the wrong tests. If you have any suggestions, guesses, experience in this area, I'd love to hear your thoughts!
Thanks!!!
Shannon
 
I don't have any answers, but I will worry with you as we are going through similar issues. Smokey's results from the needle biospies should be back tomorrow or the next day. Though we many need to go on to a full biospy, we have to go 4 hours away for that so needle biopsies while she was in for the ultrasound seemed like a good first try.

Smokey's only indicator that something was off was a sudden weight loss and a crazy high lypase number showing up in her blood panel on her 6 month senior checkup. When we did the ultrasound her pancreas showed a nodule and her liver looked "bright".

My vet sent the info to the ultrasound doctor stating she suspects pancreatitis. The ultrasound doc thinks that is probably the correct diagnosis and that it may be a "triad syndrome" with the liver looking inflamed too, though he says only the results of a biospy can rule out cancer. Those are two possibilities you could research a bit on to see if they fit the symptoms you have been seeing. The ultrasound doc thinks that if ours is pancreatitis, it is a mild case so we can get it under control with a round of AB and steroids (yes, I cringed on that word, but if it fixes this we'll deal with the resulting blood sugar issues), so there is hope that these kind of symptoms are treatable.

Many prayers for good answers and treatment options for you and Sasha.
 
I would think a mass would have shown up on ultrasound, at least the affected organ should have shown an odd size or shape if it had a tumor. I'm not sure about intestinal lymphoma though. I believe others here have had experience with that horrible diagnosis, so maybe they can add their information.

With all these organs involved, I want to mention Triaditis. It involves the liver, pancreas and small bowel as well as ductwork in the area. Here is a rather clinical article about it, from 2010, Canada. http://wvc.omnibooksonline.com/data/papers/2010_V142.pdf

Here is the course of treatment recommended by a vet tech FDMB member for pancreatitis http://www.felinediabetes.com/phorum5/read.php?8,876722,876722

Most importantly would be diet. I and others believe that a raw diet can do wonders for inflammatory bowel disease. This may have been Sasha's main problem, but now it's progressed to involve the pancreas and liver as well. That is not uncommon.

Is he getting any pain meds? That would be #1 on my list, after having gone through several episodes of pancreatitis with Gandalf. The go-to pain med for cats is Buprenex or Buprenorphine. It is a controlled substance, so it is expensive, but it works.

Fluids can be given at home, maybe 50ml once or twice daily, they do not have to be an in-hospital treatment. They are indeed very helpful as a cat suffering pancreatitis is probably dehydrated.

The first article I linked you to mentions biopsy as necessary for exact diagnosis of type of inflammation, but is the treatment protocol going to be much different, probably not. So I can't say that I agree with putting an already sick cat through that type of operation. I will just say I was also given the option with Gandalf and feel my vet was wise to explain the treatment would be pretty much the same whether we got a specific diagnosis or not. The main reason I could see for doing it would be to rule out cancer or lymphoma.

One question, was the US performed by a licensed radiologist? If not, perhaps you can investigate that route via a university veterinary teaching hospital to maybe get something more definitive than "inflammation." It would be less invasive. Not sure what part of the country you're in, but my experience at a teaching hospital was very good. Because of a very rare tumor Gandalf would not still be alive today if not for their surgical team! If I had to do a biopsy like this, I would do it there, not at a clinic, and especially not at one not AAHA accredited, which is American Animal Hospital Association. Those clinics have to meet higher standards, especially in the surgical arena.

Also, was the feline Pancreatic Lipase Immunoreactivity test run? That needs to be sent out and takes a few days. I ask because the first article says this:
Combining abdominal ultrasound along with an fPLI provides the greatest non-invasive
diagnostic value.
Click to expand...

If you can do some of the things as mentioned in the FDMB post and perhaps switch to a raw diet, you may see some dramatic results. We can help you find raw food online vendors or Dr. Lisa has great information on how to make your own. http://www.catinfo.org

Hope some of this points you in the right direction. Pancreatitis or triaditis are very challenging diseases for cats, but they are treatable, it just takes time.

Also don't wait around to do the fluids, the pain meds and the diet. No sense in waiting for test results while your cat is hurting.
 
Thanks so much. I am reading these links and it certainly sounds right on the money... I'm going to talk to the vet in the morning about fluids and the next step. I'm surprised she didn't mention Triadis as a possibility... I will ask why.
 
The spec fPLI is a more reliable means of diagnosing pancreatitis than amylase or lipase levels. Basically, those titers are next to meaningless in cats. I hope Sasha responds quickly to treatment.
 
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