Pancreatitis, Hyperthyroid, possible cancer? vibes requested, please.

I am starting a new thread to try to get more ideas about Buddy.  These are his results from the "full blood work-up" from Thursday, January 26th for his fPL and thyroid as well as the results from the last time the were tested.  I took him in Thursday because he has had a decreased appetite and soft stools that started with two BMs of soft stools and one of diarrhea within two hours on Saturday, January 21, 2012 .

1/26/12   T4   result: 5.0   reference range:  0.8 - 4.7   units:  ug/dL

7/23/11   T4   result: 3.2   reference range:  0.8 - 4.7   units:  ug/dL

1/26/12   special fPL   result:  3.6   reference range:   > or = to 3.5 ug/L    Serum Spec fPL concentration is in the normal range.  It is unlikely that the cat has pancreatitis.  Investigate for other diseases that oculd cause observed clinical signs.   3.6 - 5.3 : Serum Spec fPL concentration is increased.  The cat may have pancreatitis and Spec fPL should be reevaluated in two weeks if clinical signs persist.  Investigate for other diseases that could cause observed clinical signs.

9/10/11   special fPL   result:  2.1   reference range:  > or = to 3.5 ug/L

The vet, a new one to Buddy and my vet office, said she thought Buddy may have some other issue that is causing his values to be elevated.  She is concerned about the loss of weight from when he first came to this office in June of 2011, (14 lbs.) and on January 3rd of 2012, (11 lbs.) and Thursday, January 26th, 2012, (9.15 lbs.).

Buddy was prescribed METHIMAZOLE in 5 mg tablets for the thyroid.  Directions are 1/4 of a tablet per 24 hours.  PERIACTIN for the loss of appetite in 4 mg tablets.  Directions are 1/2 tablet/day for 2 days or when he is not eating. 

The vet said buddy appeared slightly dehydrated, did not admin sub Q's because she didn't know what the blood/protein levels were.  Today she said they looked fine but did not request Buddy come in.  I asked for sub Q's today when I picked up his meds, the would have given them but they were out. Supply comes on Monday, I'll get some on Tuesday if anyone here feels it is necessary OR Buddy doesn't begin eating better in the next day or two.  He IS eating and drinking, just not as much as usual.  Thursday I asked about using a high cal food, purchased Royal Canin Recovery (high cal) from vet but Buddy turns up his nose.  Am mixing some in Nature's Variety canned rabbit and duck, which is what he will eat.

1/26/11  Total Protein   result: 6.1   reference range:  5.9 - 8.5   units: g/dL

What are your ideas or experiences with either Methimazole or Periactin?  Thyroid and/or pancreatitis?   Good sites for information on either, don't need to be frightened by horror stories but want to know what to look out for. 

I believe Buddy is not ready to be given peace, this morning, as is usual, he cuddled and purred.  This evening, as I was changing the sheets he got "stuck" under them, when I went "looking" for him he began playing with my hands.  I think he is feeling something but is still hanging in there and enjoying me.

I will post any lab results anyone would like to know about and I will try to add anything else I can think of as it comes up. 

I drove to my mom's on December 28th, a 300 mile drive, and took Buddy with me.  He does not like the car and while at my mom's he did not want to eat.  I tried baby chicken food, different types of canned, including fancy feast, and boiled chicken.  I mixed a generic pedialyte in with his food and tried to make sure he ate something everyday.  I took him to the vet up there on January 3rd, and was given a tablet for nausea to try to get him to eat again.  That was a disaster as Buddy was strung as high as a kite all night long.  He drug himself up and down the trailer all night long and cried to me.  He wanted to lay down and sleep but could not remain in one place for more than a few moments.  After the dose wore off he still didn't want to eat.  As soon as I returned home he began eating as normal.  I figured it was all because of being out of his environment and being in the car.  He was good and seemed to put a bit of weight back on until Saturday, January 21st, when he had the soft stool and diarrhea.  Oh, he has only had the one BM with diarrhea, all others have been shaped but soft stools until Friday the 27th which was firm, the consistency of clay. (I "examined" it.) 

Wednesday night, before the vet visit, he ate two slices of ham, the best he has eaten all week on his own.  The vet said that was alright because he was eating, which is what I thought when I gave it to him.  After the appointment and the blood work, I wasn't told not to give him any more, but upon  researching pancreatitis, he won't be getting any more of it.  Unfortunately, last night I gave him one more before I found the information. 

Thanks for reading this, any thing you can offer, advice, vibes, would be appreciated.

Janice and Buddy

Methimazole has a 1/2 life of 12 hours, so my first concern is that your vet is prescribing this medicine once a day, when it should be prescribed twice a day IMHO.

One thing: Take VERY good care of his thyroid - this is nothing to play with. A poorly managed thyroid for an extended period of time basically killed my cat It is not a horrible disease, it s not devastating...... but it is something to pay very close attention to it, and take very good care of it - manage those numbers very very well.....
The weight loss can be due to hyper thyroid. In the beginning you will need to do blood tests quite often, until you find yourself stationed on a mid-range for a while.

I am not sure why you think he has pancreatitis.... I really can not see that in the levels there? :dk: I know the level has increased to 3.6..... But IMHO I would not say that is high enough for pancreatitis...... Sure - that is to be on alert - IMHO there is something wrong, otherwise he wouldn't be losing so much weight. I would be quite concerned with his liver at this point.... Especially with the most recent weight loss.
Make sure he eats - no matter what he is eating, make sure he eats - you don't want this kitty to end up with hepatic lipidosis, and he has lost an awful lot of weight.
I would be trying all sorts of foods now - including A/D (from the VET), Raw, and syringe feeding if he is not eating - but he has to eat his daily needs - no more going without food

how old is buddy?
have you ran a senior blood check? a super chem? Anything else wrong? how are his liver enzymes?

We have a hyperthyroid kitty and it is most certainly NOT a death sentence. Bogey is 21 and has been on Methimazole since he was 18. He takes it twice a day and has done beautifully on it. We check his thyroid a minimum of once a year, if we make changes to his meds we test him a couple of months in a row to make sure we are giving the right amount. He doesn't even notice when I pop the pill down his throat anymore.

One positive of the whole thing is that Methimazole is a human drug so we get it at our pharmacy along with our medications and it counts toward our pharmacy rewards too! Lol

RAFM said:

We have a hyperthyroid kitty and it is most certainly NOT a death sentence. Bogey is 21 and has been on Methimazole since he was 18. He takes it twice a day and has done beautifully on it. We check his thyroid a minimum of once a year, if we make changes to his meds we test him a couple of months in a row to make sure we are giving the right amount. He doesn't even notice when I pop the pill down his throat anymore.
One positive of the whole thing is that Methimazole is a human drug so we get it at our pharmacy along with our medications and it counts toward our pharmacy rewards too! Lol

Click to expand...

I wish Gracie's past owners thought about that.... (I rescued her as a senior)...... It is not a death Sentence when well managed - BUT when NOT managed well - you can bet it is a devastating disease and yep, a death sentence like you would not believe.
It is quite easy to manage..... Those pills are cheap and easy to give..... But as I said.... And I can't say enough as I suffered the consequences of the lack of care of others - DO pay close attention and manage that as a very very serious disease - it is.

Carolina, you say the Methimazole has a 1/2 life of 12 hours???...if that is the case then 1/4 of a pill every 24 hours would put 3/4 if the pill 12, 36, and 60 hours past the 1/2 life.  Obviously the pill doesn't loose complete usefulness after the 12 hours but deteriorates until it is useless.  How much potency does is loose and how long does it take to go dead?  I did read somewhere last night that vets were starting cats on a low dose that wouldn't necessarily help the thyroid because it helped stave away the side effects of the medication later as the dose was upped.  I don't know if that is the case with my vet but it is a question I"ll ask.

What are the side effects that your cats get with the Methimazole?  Buddy usually gets the side effects that are more serious when he takes the meds so I worry and over think the negative aspect of medicating him.  I realize the thyroid is serious though.  Is there anything else that could make the thyroid level go up?

As for the pancreatitis, the vet is the one who said pancreatitis.  She originally began saying that the numbers indicate that he has something else going on that may be bumping up the numbers, both the thyroid and the PLI.  She may have thought that because he is paralyzed and there has been no definite cause for that determined.  (I cannot afford $1500-2000 for an MRI or cat scan to look for tumors.)  She also said something about IBD and something else because of the diarrhea but wanted to try the appetite stim to get him eating and the thyroid meds to keep that in check.  As of Friday, Buddy's BMs are now firm, like clay.  He is eating but not like usual. 

I did pick up more of the Royal Canin Recovery RC and am trying to mix that with his food he will eat.  I also picked up 2 of the feeding syringes with the intention of force feeding, I hate the idea but I know I might have to if the appetite stims don't work.  My concern is the side effects, Buddy always gets the rare side effects.  I am worried about the aggression and howling that I read about for the Periactin.    Has anyone had trouble with Periactin?  I was thinking about getting some Pepcid, he doesn't lick his lips but rather the roof of his mouth.  Sort of like when we lick peanut butter off the roof of our mouths or move our tongues like we are tasting something.  I thought maybe he has some stomach acid going on.  Should I try that first before the Periactin?

Thank you for your thoughts, I really appreciate the help.

Janice and Buddy

Most cats with an overactive thyroid are ravenous, but quite a few are atypical - my old cat was.  The better controlled his thyroid problem the better he ate.   His T4 wasn't especially high but the free T4 made the diagnosis clear.

There is a Google group specifically for cats with overactive thyroid, mostly US-based, and they are very keen on starting on a low dose (but twice a day) and working up with blood tests as a guide.  My own cat was on Felimazole, the pink ones, one twice per day.  There are orange ones as well which are twice the strength, but he stabilised very well on the pink ones and was getting back into fair shape when sadly he developed liver tumours, which he managed to live with for almost 5 months with the aid of steroid injections.

Thyroid problems can affect heart and kidney problems hence a thyroid cat needs appropriate vetinary care especially to start with, until you are sure what you are actually dealing with - a cat with an overactive thyroid?  That plus kidney problems?  Etc.

I stopped worrying about what I fed my cat (he was otherwise healthy) and especially once he had the liver diagnosis he was allowed anything he wanted, which often came of my plate.  Prawns were a great favourite, but I sucked off the hot sauce first!  I also found he could read the price tags on cat food, and prefered the most expensive ones...

Like I said, Buddy gets all the atypical side effects and it would not surprise me in the least if his symptoms of thyroid were also. 

I am working on posting his lab results...
 

Also, I just gave him a 1/4 of the Periactin, rather than a half.  It is the first dose I have given him.  I want to see how it effects him and if it is enough to get him eating more.  I read somewhere it is more effective with cats who are still eating rather than ones who are completely not eating.  I'm hoping for mild side effects or none!

Here are the lab results from Thursday.

ADRChek PLUS W/SPEC fPL
   CHEM 25

Procedure                                results        ref. range        units
       

ALK. phosphatase                  22               0-62                   U/L
ALT (SGPT)                            42               28-100
AST (SGOT)                           26               5-55
CK                                          149             64-440
GGT                                       1                 0-6
ALBUMIN                               2.5              2.3-3.9               g/dL   
TOTAL PROTEIN                   6.1             5.9-8.5
GLOBULIN                             3.6             3.0-5.6
TOTAL BILIRUBIN                 0.1              0.0-0.4              mg/dL
DIRECT BILIRUBIN               0.0              0.0-0.2
INDIRECT BILIRUBIN           0.1              0-0.3
BUN                                       21               15-34
CREATININE                         0.9              0.8-2.3
CHOLESTERAL                    118             82-218
GLUCOSE                             87              70-150
CALCIUM                              8.6              8.2-11.8
PHOSPHORUS                    4.7              3.0-7.0
TCO2 (BICARBONATE)       16               13-25                 mEq/L
CHLORIDE                           121             111-125
POTASSIUM                         4.2              3.9-5.3
SODIUM                               154             147-156
ANION GAP                          21               13-27
A/G RATIO                            0.7              0.4-0.8               --------
B/C RATIO                            23.3             --------                --------
NA/K RATIO                          37                --------                --------
* HEMOLYSIS INDEX           N                 --------                --------
* LIPEMIA INDEX                  N
      *Index of N, +, ++ exhibits no significant effect on chemistry values.
   
CBC COMPREHENSIVE

WBC                                   7.4                 4.2-15.6             K/uL
RBC                                    7.70               6.0-10.0             M/uL
HGB                                   11.9                9.5-15                g/dL
HCT                                   36.7                29-45                   %
MVC                                  48                   41-58                    fl
MCH                                 15.5                11.0-17.5              pg
MCHC                               32.4                29-36                   g/dL
NEUTROPHIL SEG          73                   35-75                    %
LYMPHOCYTES              18  (L)             20-55   
MONOCYTES                   3                    1-4   
EOSINOPHIL                    7                    2-12   
BASOPHIL                        0                     0-1   
AUTO PLATELET            454                 170-600               K/uL
   Remarks:  Slide reviewed microscopically

ABSOLUTE NEUTROPHIL
                          SEG                5402           2500-12500      /uL
ABSOLUTE LYMPHOCYTE    1332 (L)      1500-7000
ABSOLUTE MONOCYTE        222             0-850
ABSOLUTE BASOPHIL           0                 0-100
ABSOLUTE EOSINOPHIL       518             0-1500
T4                                             5.0  (H)       0.8-4.7             ug/dL
   INTERPRETIVE RANGES:
   <0.8      subnormal
   0.8-4.7  normal
   2.3-4.7  grey zone in old or symptomatic cats
   >4.7      consistent with hyperthyroidism
   

Oh sweetie... I have no experience with any of these. But I want to send vibes, and hope you'll figure this out. I also VERY much hope it's not lymphoma on top of everything else.

Thanks Laurie,  I just finished PMing Violet.  In answering her questions I remembered that when I took Buddy to my mom's after Christmas I gave him a few drops of Bach's REscue Remedy for Pets.  I have never used it before but it seemed to work for buddy, instead of crying the whole 4 1/ hours he almost slept in my arms.  Now I wonder if that had anything to do with it.  It is supposed to be safe for animals.

Janice and Buddy

Well.... His bloodwork looks really good IMHO.... Nothing catches my attention there.... nothing looks out of place here - lymphocytes can be due to stress of the vet visit - I would not worry about that for now....
His liver looks really good too, which is awesome, and is something that was concerning me with this huge weight loss.

Methimazole can affect the liver in VERY RARE cases - we are talking about in less than 5% of the cases. In less than 5% of cases it can cause severe liver failure. It can also cause anorexia, loss of appetite....
If you do not treat thyroid disease well though, the dire consequences you can likely face are (which killed my cat) Congested Heart Failure, Kidney Failure, Liver Failure, etc. So.... It is a give and take, and for the moment, I STRONGLY recommend you to treat with methimazole and do give those appetite stimulants, the FULL dose. For now, do not think of the side effects. The consequences of not treating are much, much worst. :nod:

Methimazole has to be given every 12 hours. that's how the drugs work in the system - you need to keep the levels stable.... please have a talk with the vet, and if you are having troubles, I am sorry to say, but I would be looking for a second opinion. I have never heard of Methimazole been used once a day.
I do not have experience with this appetite stimulant..... I have used others with great success, but not this one

Thanks  Carolina,

It is good to know the numbers look good.  I was worried about things since he hasn't eaten enough,  the whole time I was at my mom's I focused on finding new foods for him to try.  I felt like I put more of my time with my mom on the cat.  It looks like it was well spent.  Mom understands though, she has two cats as well.I hate medicine and the side effects are always scary to me, even more so with Buddy since he seems to always develop the rare ones.  I gave him the 1/4 Periactin yesterday morning and he didn't seem to have any effects so he got another 1/4 in the early evening. Again, he did well.  I will give him the full 1/2 tablet this morning and leave food for him.  He WILL NOT eat anything that has the Recovery in it.  Yesterday he ate a full 3 oz. can in one hour, that's about what he's been eating in about 16 hours so I was happy.  I don't think it was the appetite stim, he ate right after I gave it to him, 20 min later.  This morning he is eating a 3 oz can of NV duck.  No recovery so he is going at it good! 

I also gave him the 1/4 tablet of Methimazole last night, he slept most of the night.  Cuddled up next to me.  HE slept, not me, oh well, I can live with that.  It's worth knowing he is still with me.  I will call the vet today and ask about the dosage and the potency. 

Do you think the Bach's Rescue Remedy/Pet had anything to do with any of this?

Thank you for the help!

Janice and Buddy

Caramelblond said:

Do you think the Bach's Rescue Remedy/Pet had anything to do with any of this?

Click to expand...

no

He is "licking" his lips, any ideas??

Caramelblond said:

He is "licking" his lips, any ideas??

Click to expand...

May be acid reflux. Our guy does that when his stomach is bothering him. Call the vet and see if you can give him an acid reducer and see if that helps. Don't do it without talking to your vet first though. 

Sounds like nausea..... Is he eating well? How much would you say he is eating, and what? Smaller, frequent meals might help, and yes, maybe your vet can guide you with a bit of pepcid A/C....

I did speak to the vet last night.  She explained a few things I had questions about. 

First, last week when I took Buddy in she thought he may have a blockage causing the small appetite and the diarrhea.  I asked if he was having firm stools would he have a blockage, she said it may be a small blockage which would also have the diarrhea. I told her he only had diarrhea twice and soft stools the rest of that week.  Since Friday of last week he has had firm stools.  So most likely he is not blocked.

Second, I gave Buddy a couple hand-fulls of garbage dry food in his wet food yesterday and the day before in desperation to get him to eat more. I worked and he ate about 3 ounces in about three hours.  Yesterday he looked like he was not comfortable at all and I thought the dry made his pancreas inflamed or bothered his stomach. He has bee grain free for two years.   I asked about how much Pepcid I could give him, and if the dry was a bad idea.  I told her he had been licking his lips a lot yesterday (he has for a couple of weeks, I DID already tell her that last week) and I had read that he may be nauseous or have stomach acid.  She said it would be safe to give him 1/4 of a 10 mg pepcid twice a day, every day for a week.  I also asked if giving him yogurt would be better since it was not a medicine but she said the bacteria in it wouldn't benefit cats the same as it does humans.  I also gave him a treatment of Bene-Bac last week, she said that was alright. 

Third question, if he does have IBD what kind of food should I be giving him and should be avoiding.  She said if he has it he should be eating anything that keeps weight on him that doesn't make him throw up or have diarrhea.

Next, I asked about how much he should be eating.  She said about 200 cals. would be what he should be eating.  I told her I had to syringe the high calorie food but she said that the Recovery does not have more calories than EVO which is what he prefers.  He has been eating between 2-4 oz a day.  He hates the Nutri Cal.  He is not off food completely, just not eating a lot.  That being said I have to remember that he is paralyzed and not active like he used to be when he was on the wet/dry diet of EVO before I put him on the raw diet.  While on raw he ate between 2 and 4 medallions a day.  He hasn't eaten the raw since the end of December when I took him to my mom's and he started having this issue. 

Lastly, I asked about the dosage of thyroid medicine.  I confirmed the dosage of 1/4 pill per 24 hours and she confirmed.  I told her I had researched and found the typical dosage to be 1/2 pill twice per day.  I diplomatically stated that I knew she had a reason for her dosage and would like her tell me so I could be on the same page with her.  She said  that because his level was only slightly elevated, she felt that the smaller dosage would be enough to begin with AND avoid the negative side effects of that medicine.  Especially since Buddy seems to be so sensitive to side effects of medicines.  She also said we needed to do another blood test the last week he was on the melds to see how his levels were doing. 

I am most worried about the food intake at this moment.  While he does not like to be syringe fed, but  he and I, did better than I expected the first time.  The second and third time was much harder, though we got it all in.  Because he is still eating partially, I don't want to put him through that IF I don't need to.  Any ideas for how to entice him to eat more would be great, I tried different foods but he is picky and prefers rabbit, chicken and occasionally duck.  What different things do you try to get your babies to eat.  I am going to try sliced , natural, oven roasted turkey slices today to add more to his intake.  His problem is that he will eat something like that for a day or two and then be done wit it for a while, I need a bunch of ideas to have in my bag of "tricks".  I looked at Trader Joe's yesterday for a natural ingredient chicken broth that was low sodium but it contained onion.  Does anyone know of a brand of low sodium broth that is onion free?  He is drinking water but I would like to have that to mix into his wet, to help it smell better and add moisture. 

Thank you, for the vibes and for staying with us,

Janice and Buddy

We've fought the eating game many times....it is tiring and frustrating. When we have a kitty in decline that won't eat, we get anything and everything available and slowly work through them. We have baby food, fancy feast, every wet food on the shelf at Petsmart, and every bag of treats available. We just open a can, see if they will eat it, if not, we move to the next thing. Oh, and tuna. We have gotten many a kitty over a hump with tuna. 

If his stomach is upset, he won't eat much, the Pepcid should help with that. Give the Pepcid a day or two and see if his appetite doesn't improve. 

As a last resort you can try an appetite stimulant. We've done this at particularly desperate times and it has worked, for a period of time. 

Good luck and keep us posted on how he is doing. 

We were prescribed Periactin for two days last week it didn't seem to do much.  But we only got two pills so maybe we weren't on it long enough.  Are there any other kinds?

Have you talked to the vet about an anti-nausea medication as opposed to an appetite stimulant? If he's eating, but small amounts, the problem may be nausea, not hunger. With Lazlo's cancer, because it was (is) a tumor in his stomach, we used ulcer meds: Sucralfate to coat his stomach and 10mg of pepcid a/c at night. He also received an actual anti-emetic (anti-nausea med, not antacid, like pepcid). It's called Cerenia. You're supposed to give 1/4 of a pill (for a roughly 10 pound cat) ... five days on and five days off? Four days on and four days off? We've been using it off-label, and Lazlo gets 1/4 pill every day. We're probably going to take him off it now that his course of chemo is done.

But when he stopped eating initially, his real problem was nausea, not hunger. With the lip smacking you describe, I'd ask about Cerenia or another anti-nausea med and try that first. :nod: