Howie continues to lose weight-any more ideas to investigate?

Howie went in for his monthly Solensia injection and lost .8 pounds since last month. He has now lost 3 pounds since June. Last month I got excited as he actually gained .2 pounds from his November weight. I’m very sad about this as there seems to be no reason we can find why he’s losing. He eats fine (takes a while but he does finish both meals in one sitting) and gets 3 mini meals in an auto feeder each cycle. I’ve also not changed his food (Weruva pates). I am only feeding him 1 flavor for his AM/PM meals as he lost interest in the other flavors. He has an assortment of flavors for his mini meals as they come in small pouches. He gets about 260 calories/24 hrs so that is certainly within the 20 calories/pound of body weight recommendation. All his food is low in phosphorous.

Recent tests include folate/cobalamin and a heart ultrasound in November. His folate was 9.6 so I’ve put him on 200mg folic acid each day. The heart ultrasound did not show any issues besides his heart murmur and some possible fluid in his lungs which does not seem to be anything problematic. It was recommended by the internal med vet to do a CT scan (or MRI?) but that is not in my financial reality. We also discussed possible IBD or SCL with the weight loss (no official diagnosis) so also have him budesonide since Nov.

His last set of full bloodwork was in mid-Sept. Results are in his spreadsheet. SDMA was high but the rest of the kidney levels were/are fine.

Current medications/supplements:
Levemir (5 units)
Mirataz (once/day)
.5mL Cabergoline (once/day)
.5mL Budesonide (once/day)
200mg folic acid (once/day)
1/4 tsp fish oil (once/day)
1/8 tsp Miralax (twice/day)
L-Lysine (twice/day)
.5mL Gabapentin (twice/day)
4 mg Ondansetron (twice/day)
30 units Adequan every 2 weeks
Solensia injection monthly

Is there anything that anyone knows or can see that I should further investigate? Any drug interactions or side effects that could cause the continued (and now more significant) weight loss? Any other tests I should request? Anything I should consider discontinuing? I’m at a loss and can’t stand the thought of him wasting away like my last CKD cat did. I don’t think feeding him more food is the answer. I can’t leave more out as my other cat will eat it. In terms of energy, he mostly lays in his bed but does jump up in the counters a few times/week. I have sense of some neuropathy as he stands on his hocks but doesn’t really walk abnormally. I just have not wanted to add one more supplement (Methyl B12) to his regimen as he is on so much. perhaps I should?? His arthritis is pretty advanced in his hind quarters. BMs are solid to a bit soft due to the Miralax.

@Wendy&Neko
@Suzanne & Darcy

thank you for any ideas/expertise to help Howie out.

 

As per the SCL list I belong to, there are three main reasons for weight loss if kitty is eating well. Diabetes (not that, he's well controlled), hyperthyroidism (not that, latest lab # looks good), and small cell lymphoma. Or possibly poorly controlled IBD. Does he have any other GI symptoms like vomiting or diarrhea? Determining whether he has small cell lymphoma or IBD starts with an ultrasound, but that doesn't give a definitive answer without a biopsy.

How was his cobalamin levels? If low you could add B12, otherwise I wouldn't. There is some studies, at least in humans, that excess B12 helps cancer.

What body part did the IM vet plan to scan with a MRI or CT scan?

If BM's are soft, reduce the Miralax dose.

Low folate indicates gut dysbiosis, most likely caused by the untreated underlying disease (SCL). It will correct when the underlying condition itself is treated. Budesonide can help with gut inflammation, but is not the full treatment for small cell lymphoma. It treats the symptoms, not the underlying disease. That requires addition of chlorambucil, a low grade chemo. The best (and most modern) protocol is a dose given once every two weeks. However, best to add chemo to the picture only if you know for sure it's SCL you are dealing with.

 

Hi Wendy! Thank you for your continued guidance. He has no reoccurring vomitting or diarrhea so I don't think it's IBD. His Cobalamin #s were in the normal range; just his folate was low. I believe the IM vet wanted a CT scan to further investigate what she thought was a small spot of fluid in his lungs to see if it was a tumor. I simply don't have the $3k to spend at the University of MN lab (where she works too) for this type of procedure. Given that Howie is probably 16 or so with a bunch of conditions, would you do a biopsy to determine SCL? I don't know if recovery from a biopsy is worth the risk?? But maybe it's not so bad? I really appreciate your thoughts!

 

There are a couple options for biopsy. But some options only work depending on what part of the bowels are thickened. If in the upper part (duodenom) then an endoscopy can reach it. Similarly can do a colonscopy if at the back end. Middle part thickened needs surgical biopsy. Neko couldn't have any type of a biopsy due to her heart conditions - she wouldn't have survived anaesthesia. So her internal medicine vet did his best guess, along with the ultrasound specialist and oncologist, to figure out what was most likely, IBD or SCL. As you can see, an ultrasound is needed in all cases. She was 15 at the time, with CKD and newly diagnosed heart issues. Neko was not my first SCL kitty, so I had an idea what treatment meant. I suggest a conversation with the IM vet to see what makes sense for Howie.