Hugo AMPS 391 and diarrhea persists, could it be EPI?

[Tiina and Hugo]

Hi everyone,
After yesterday's nice numbers Hugo is bouncing. I'm still waiting to hear about his results from the vet, but meanwhile his diarrhea is back with greyish loose, foul smelling stools and stomach sounds really noisy. He's lethargic but eating well. He seems really hungry, though his BG is high. They also took a test for pancreatis yesterday, and I got into googling about it and came across with an illness called Exocrine Pancreatic Insufficiency. And all the symptoms match to Hugo. Would the pancreatis test show if he is suffering from the above mentioned? The test was listed as Spec fPL.

 

[Sienne and Gabby (GA)]

A Spec fPLI will not test for exocrine pancreatic insufficiency. You need a TLI. This site has a great explanation of EPI.

Has the vet ruled out all sorts of parasites via a fecal culture? These would include:
C. Perfrinigens Enterotoxin
C. Dificile Toxin
Campylobacter
Shigella
Salmonella
Pleisomonas
Edwardsiella
Aeromonas

 

[Tiina and Hugo]

A Spec fPLI will not test for exocrine pancreatic insufficiency. You need a TLI. This site has a great explanation of EPI.

Has the vet ruled out all sorts of parasites via a fecal culture? These would include:
C. Perfrinigens Enterotoxin
C. Dificile Toxin
Campylobacter
Shigella
Salmonella
Pleisomonas
Edwardsiella
Aeromonas

No, none of those. But Hugo is strictly an indoor cat.

Wouldn't Hugo need to be fasting for 12 hours for the Exocrine pancreatic insufficiency test? Is that possible considering he's diabetic? I definately want him tested. In addition to the loose stools and rumbling stomach, he had also lost 500g of weight, often gets up from his bed only to lie flat on the floor, the vet said his heart sounded strange, he sometimes gags before he starts eating and has a thing for chewing on plastic.

 

[carfurby (GA)]

I've never heard of EPI. If it's EPI, I don't know if pumpkin would help. Have you tried mixing pumpkin in his food to see if it will help settle his stomach? I hope you hear back from the vet today. Sending prayers.

 

[Tuxedo Mom]

EPI would need to be tested by a separate test the TLI. It can be present alongside of pancreatitis. If EPI is diagnosed then pancreatic enzyme supplementation would be needed. Quite often one of the early signs is weight loss and sometimes vomiting. How long until the fPLI (pancreas)test results come back?

ETA Since they did a blood draw today you could ask your vet if it is too late to include the TLI test. It may require different preparation before being sent for testing but their lab techs should know that

 

[Tiina and Hugo]

The blood draw was done yesterday, so it must be too late to add the TLI. The vet was supposed to call me today or tomorrow and then she can't be reached since she will be on holiday for I don't know how long. Hugo hasn't had any vomiting yet, but the diarrhea and his tiredness worry me. Also earlier today I wiped his nose pad and repeatedly got something that looked very much like a hint of blood on the paper. Not from his nostril but from the nose pad. He doesn't look anemic, and I checked all the symptoms my other cat had a year ago when he had hemolytic anemia. Then his urine had turned red and he had nose bleeds. The color of Hugo's urine is normal.

Yesterday they didn't take any other tests than the Pro Bnp, fPLI and fructosamine.

 

[Tiina and Hugo]

I've never heard of EPI. If it's EPI, I don't know if pumpkin would help. Have you tried mixing pumpkin in his food to see if it will help settle his stomach? I hope you hear back from the vet today. Sending prayers.

Thank you for the prayers I haven't ever tried the pumpkin, but I could if it might help. The vet office is now closed...So hopefully I will get a phone call tomorrow.

 

[Tuxedo Mom]

The blood draw was done yesterday, so it must be too late to add the TLI. The vet was supposed to call me today or tomorrow and then she can't be reached since she will be on holiday for I don't know how long. Hugo hasn't had any vomiting yet, but the diarrhea and his tiredness worry me. Also earlier today I wiped his nose pad and repeatedly got something that looked very much like a hint of blood on the paper. Not from his nostril but from the nose pad. He doesn't look anemic, and I checked all the symptoms my other cat had a year ago when he had hemolytic anemia. Then his urine had turned red and he had nose bleeds. The color of Hugo's urine is normal.

Yesterday they didn't take any other tests than the Pro Bnp, fPLI and fructosamine.

Sorry I read the post wrong and thought the blood was drawn today. It will be too late to do an add on TLI test. Your vet should have done a complete blood count when he did the blood draw. That would give a good indication whether there is a sign of anemia or other blood issues.

You will have to wait and see what the fPLI results are. If there is a sign of pancreatitis then it could be decided whether having the TLI test done is necessary.

Prayers and ((HUGS)) to you and Hugo. It is so hard when our kitties are not well and we don't know why.

 

[Gill & George]

Sending vines for sweet Hugo

 

[Tiina and Hugo]

Sorry I read the post wrong and thought the blood was drawn today. It will be too late to do an add on TLI test. Your vet should have done a complete blood count when he did the blood draw. That would give a good indication whether there is a sign of anemia or other blood issues.

You will have to wait and see what the fPLI results are. If there is a sign of pancreatitis then it could be decided whether having the TLI test done is necessary.

Prayers and ((HUGS)) to you and Hugo. It is so hard when our kitties are not well and we don't know why.

Thank you for the prayers and the vines But is it not possible that he has EPI but no pancreatis? Could he have pancreatis without vomiting? I saw that the Panzym enzymes supplement is a lot cheaper at the VetUk website where I ordered the syringes from, than in Finland. Could I order the Panzym powder anyway since it takes time to arrive since it will also take time to get the results if we do the test. You know, just to give it to Hugo as an experiment, or would it harm him?

 

[julie & punkin (ga)]

Have you read the Primer on Pancreatitis?

I wouldn't be certain that another blood test couldn't be added on. I have been able to add on tests with blood that was already drawn. You might call your vet as soon as you can, just to check and see if the EPI test can be added, if it is a blood test.

Hope Hugo feels better. He sounds miserable.

 

[julie & punkin (ga)]

In general, it's good to get a diagnosis, but it probably wouldn't hurt him to try it. Basically what pancreatic enzymes do is to help digest the food.

 

[Tiina and Hugo]

Have you read the Primer on Pancreatitis?

I wouldn't be certain that another blood test couldn't be added on. I have been able to add on tests with blood that was already drawn. You might call your vet as soon as you can, just to check and see if the EPI test can be added, if it is a blood test.

Hope Hugo feels better. He sounds miserable.

I have read it but will have another read. Yes, Hugo doesn't seem well, but luckily is still eating and drinking, peeing, pooing and grooming. But his overall health has deteriorated and it just isn't normal that he falls asleep on his bed and then gets up simply to "collapse" on the floor to rest. After a while he gets up and goes back to his bed, only to repeat it again in an hour. And he's been doing this ever since he was diagnosed. And now the gray, mushy diarrhea. He's gone twice today. I have an antibiotic I just gave him, I asked about it from the vet and she said that if his diarrhea worsens I can give it. It's a Finnish made antibiotic, Tylosin Tart. He's also wanted to eat plastic today, like really vigorously. Chewing on my Crocs sandals...Something's up with him, I wish I knew what.

 

[Tuxedo Mom]

I have read it but will have another read. Yes, Hugo doesn't seem well, but luckily is still eating and drinking, peeing, pooing and grooming. But his overall health has deteriorated and it just isn't normal that he falls asleep on his bed and then gets up simply to "collapse" on the floor to rest. After a while he gets up and goes back to his bed, only to repeat it again in an hour. And he's been doing this ever since he was diagnosed. And now the gray, mushy diarrhea. He's gone twice today. I have an antibiotic I just gave him, I asked about it from the vet and she said that if his diarrhea worsens I can give it. It's a Finnish made antibiotic, Tylosin Tart. He's also wanted to eat plastic today, like really vigorously. Chewing on my Crocs sandals...Something's up with him, I wish I knew what.

Although chronic pancreatitis is one of the main causes of EPI it can occur without it. The pancreas does many different tasks, producing insulin, producing enzymes to help break down fat etc. With diagnosed EPI it is advised to use a lower fat diet since EPI causes lack of the enzymes used to break down the fats amongst other things. I can;t see where giving a supplement would have any harmful effects even if Hugo doesn't have EPI, but I would ask your vet for their opinion.

 

[julie & punkin (ga)]

Make sure the antibiotic doesn't have sugar in it. Liquid antibiotics often do. The AB we often get in the US for diarrhea is called Metronidazole, or Flagyl. It has anti-inflammatory properties for the gut, as well as being an antibiotic. You could ask your vet about that.

I have one cat that wants to eat plastic too. The thin plastic, like shrink wrap. Makes me crazy that I have to watch out for it.

 

[Tuxedo Mom]

Thank you for the prayers and the vines But is it not possible that he has EPI but no pancreatis? Could he have pancreatis without vomiting? I saw that the Panzym enzymes supplement is a lot cheaper at the VetUk website where I ordered the syringes from, than in Finland. Could I order the Panzym powder anyway since it takes time to arrive since it will also take time to get the results if we do the test. You know, just to give it to Hugo as an experiment, or would it harm him?

My kitty has chronic pancreatitis with an off the chart fPLI number. He has had 2 minor flare-ups in the last 15 months but just recently had an acute attack that required more aggressive treatment. He rarely throws up...the only times were when he had the flare-ups. Even with his bad attack recently he only threw up once. Not all kitties will throw up with pancreatitis. My main observation with my guy was when he did not totally vacuum off his food dish. For me anyway that is the red flag with him

 

[julie & punkin (ga)]

Punkin never vomited with pancreatitis either. The signal for us was that he wasn't interested in eating, which for an acro kitty is an enormous red flag, and he got into the hunched up "I'm miserable" position, like a meatloaf.

 

[Tiina and Hugo]

My kitty has chronic pancreatitis with an off the chart fPLI number. He has had 2 minor flare-ups in the last 15 months but just recently had an acute attack that required more aggressive treatment. He rarely throws up...the only times were when he had the flare-ups. Even with his bad attack recently he only threw up once. Not all kitties will throw up with pancreatitis. My main observation with my guy was when he did not totally vacuum off his food dish. For me anyway that is the red flag with him

Your poor boy I never even knew about these illnesses before...

I just hope the vet calls me early tomorrow. All the resting on the floor could be that Hugo has stomach pain. It's just awful to watch. I will definately ask many questions on the phone tomorrow and ask about further tests.

 

[Tiina and Hugo]

Punkin never vomited with pancreatitis either. The signal for us was that he wasn't interested in eating, which for an acro kitty is an enormous red flag, and he got into the hunched up "I'm miserable" position, like a meatloaf.

Hugo is still interested in eating, but looks very miserable. Sleeps most of the time.

 

[Tuxedo Mom]

Your poor boy I never even knew about these illnesses before...

I just hope the vet calls me early tomorrow. All the resting on the floor could be that Hugo has stomach pain. It's just awful to watch. I will definately ask many questions on the phone tomorrow and ask about further tests.

Resting on a floor especially if it is cooler is often a sign of abdominal discomfort or pain. When my guy had his bad attack recently he went into the basement and lay on the concrete floor which is very cold.

With pancreatitis most kitties will lose their appetite and refuse foods. My kitty is an absolute food vacuum and even leaving a portion of his food was so out of character. With the acute attack he had opiate pain killers (Bupe) anti-nausea (cerenia) Sub Q fluids and I syringe fed him the first two days. Luckily Hugo is still eating but the reason for his other symptoms need to be determined.

Poor Hugo and poor you. I know how difficult it is when our kitties are sick, especially when they are diabetic and we are doing our darndest to try to deal with that. If you don't hear from the vet early in the day, just call and be a bit of a pest. If he is going on holidays, you definitely want the results before he goes.

 

[Sienne and Gabby (GA)]

Unfortunately, resting after any exertion could be cardiac, especially if the vet heard something that's off on examination. The Pro BNP is a cardiac test. Results should be in the vicinity of 100 -- higher numbers indicated damage to the cardiac muscle.

I wouldn't try to make any diagnosis without the benefit of the labs. FWIW, Gabby was a completely indoor cat. At one point, she had several bouts of diarrhea and the vet did a fecal culture to rule out any parasite.

 

[Tiina and Hugo]

Unfortunately, resting after any exertion could be cardiac, especially if the vet heard something that's off on examination. The Pro BNP is a cardiac test. Results should be in the vicinity of 100 -- higher numbers indicated damage to the cardiac muscle.

I wouldn't try to make any diagnosis without the benefit of the labs. FWIW, Gabby was a completely indoor cat. At one point, she had several bouts of diarrhea and the vet did a fecal culture to rule out any parasite.

So the Pro BNP isn't just positive/negative result kind of test? Hugo is resting even without doing anything other than sleeping. At first we thought that the fluctuations in the BG or Lantus makes him feel strange or hot, an he seeks cooler places. But since the vet heard, whatever she thinks she heard, it is possible that it is a cardiac problem. There is an online service with my vet clinic and I can see what tests have been taken from Hugo and the results too when they arrive. Under the ProBnP reads "negative", but the other results are blank. I have also considered hyperthyroidism, which has similar symptoms but Hugo's thyroid level was actually a bit under the normal range when checked at the time of diagnosis on Feb 5th. His ALAT and ASAT levels were normal. This is why the vet now didn't see a need to retake those values.

 

[Tuxedo Mom]

arrive. I have also considered hyperthyroidism, which has similar symptoms but Hugo's thyroid level was actually a bit under the normal range when checked at the time of diagnosis on Feb 5th.

Low thyroid readings are very unusual in cats unless they have had radiation treatments done at some point or there are other underlying causes. Usually a hypoithyroid cat will have excess weight, often dull, flaky, matted greasy fur, sometimes hair loss, show signs of dehydration, drink and pee excessively...even if they are not diabetic.

How low was Hugo's T4 reading in comparison to the normal ranges?

 

[Tiina and Hugo]

Low thyroid readings are very unusual in cats unless they have had radiation treatments done at some point or there are other underlying causes. Usually a hypoithyroid cat will have excess weight, often dull, flaky, matted greasy fur, sometimes hair loss, show signs of dehydration, drink and pee excessively...even if they are not diabetic.

How low was Hugo's T4 reading in comparison to the normal ranges?

Hugo's T4 was 8,2 nmol/l when tested Feb 5th, when the normal range should be 12-58 nmol/l. A year and a half ago it was 24,8. Also what had changed was the triglycerides, in six months it had gone from 1,5 mmol/l to 19. And fructosamine from 240 umol/l to 468. Big changes in such a short time.

 

[Tuxedo Mom]

Hugo's T4 was 8,2 nmol/l when tested Feb 5th, when the normal range should be 12-58 nmol/l. A year and a half ago it was 24,8. Also what had changed was the triglycerides, in six months it had gone from 1,5 mmol/l to 19. And fructosamine from 240 umol/l to 468. Big changes in such a short time.

Has your vet never addressed the issue of low thyroid. Cats are much more inclined to suffer from hyperthyroidsim. It is very unusual for a cat to be hypothyroid and often is due to other underlying causes. Hypothyroid can also cause Hugo to be lethargic and lack energy. If there is no definite underlying causes or nodules/tumours on the thyroid (which should be able to be felt with manipulation) then often a few weeks of thyroid medication such as synthroid can help the thyroid functions improve. My cat is 14 on the scale which is subclinical hypothyroid but that is due to other health issues he has.
I would put this issue on you list of questions to discuss with the vet.

 

[Wendy&Neko]

Here is the link to yesterday's post - we include those links so we can easily go back and see what happened before.

Low T4's can also be a temporary byproduct of other sickness - if the T4 was taken at the same time as the sickness. Neko went through a couple days of inappetance last month and the blood work showed low T4's at the time. Her Free T4 was well under the limit, but you also need the TSH test as well to determine hypothyroidism. Neko has had pituitary radiation twice, and a possible side effect of that is HypoT. Her T4 was better when she got better. Another symptom of hypothyroidism is heat seeking, not seeking cold.

Julie mentioned metronazodile which is commonly prescribed here. My civie has IBD (now lymphoma) and he was on that for a while. It's quite a powerful antibiotic. We tried Tylosin for a couple of days but it wasn't as strong. Do you give any probiotics to Hugo? Antibiotics can kill tummy flora and make them not feel well.

 

[Wendy&Neko]

I forgot to mention that I give pumpkin too. You want plain cooked pumpkin, no spices or sugar, if you can get a can of it. You can also cook a squash such as butternut squash. You might be able to find a babyfood squash - which is nice because it's just a small jar. Freeze what you don't need right away. I give 1/4 tsp twice a day.

 

[Tiina and Hugo]

That's what the first vet said about the low T4 that it was because of the untreated diabetes. Didn't say anything else and I didn't know to ask. I will ask when she calls me. The antibiotic I gave is what has helped Hugo before, he had the intussusception when he was a kitten that made him prone to gastritis. I just gave the second dose now and soon after he went for another diarrhea. I don't know if I can find the canned pumpkin, if I can go look for it tomorrow I will. Could I give him some Canicur paste now?

About Hugo's medical history...in October 2015 he suddenly started limping his back leg really bad overnight and sort of dragged it when he walked and then just rested on the floor when it was too painful to walk. We took him to the vet, and they drew blood and did an xray.

The x ray didn't really explain it so they said it was a sprain and he got a pain medication for 10 days and in time the leg improved. Now I'm thinking if it wasn't an injury after all but rather something else. A blood clot? Neuropathy? But his BG was 12.7 mmol/l at the time amd fructosamine normal. After that is when he developed diabetes.

 

[Tiina and Hugo]

And probiotics, no not giving any. I only have one dose of Canicur and Inupekt Forte pills which have glucose. I asked the vet about what could I give to Hugo to his diarrhea and she said "that's a really good question, they all have glucose so you just have to use these and give more insulin then" She also said Hugo would benefit from eating the Hill's m/d foods and I would just give more insulin if I gave that food to him.

I think I have used Flagyl with Hugo before, when he recovered from the intussusception.

 

[Tiina and Hugo]

PMPS 292, +2 230 and +4 163.

 

[carfurby (GA)]

It's nice to see some more blue from Hugo. I hope he keeps surfing tonight and he feels better.

 

[Sienne and Gabby (GA)]

I think the BNP is available in 2 ways -- a Snap test which is likely a positive or negative and you get the results quickly or as a test that's sent out to IDEXX and takes at least 24 hrs and you get an actual value.

 

[Bobbie And Bubba]

Sending feel better vines for poor Hugo.