Feline Triaditis. My experience and concerns/questions

The following is a cut and paste of a post I put up on another forum.  I figured it would be easier to do that instead of starting from scratch and rewriting the whole thing.  

Hi there, my little one Noelle was just diagnosed with Triaditis and I have been very scared for her well being. She must have had this underlying for quite some time, (she is about 8 now) but it really didn’t hit her hard until recently when I noticed loud gurgling in her tummy and brought her to the vet. This happened once before and they basically gave her fluid treatment and a pepcid and she was all good. This time for whatever reason I demanded they check her blood and boy am I glad they did. Her liver enzymes were obscenely high and I had to bring her in for an ultrasound which uncovered that she had inflammation of the pancreas, liver and small intestines, as well as an obstruction in her common bile duct. They gave me some meds and a few days later she started turning yellow. At that point the doctor recommended they operate since the disease was rapidly progressing. Long story short they got in there and had to reroute her gall bladder. She bounced back extremely well I am happy to say but the underlying Triaditis still needs to be managed. She was always a big lover of dry food which I thought was ok becuase I was feeding her a “natural” brand. After doing some research and having a very smart girlfriend I was luckily able to cut dry food from both my cats diets and switch them over to a natural wet limited ingredient canned food which they are both finally getting used to. Noelle actually really likes it and eats like a champ! Following the surgery the doctor didn’t want to medicate and see how she did after the biliary obstruction was fixed. She was doing well for a week or two with one vomiting episode (which still upset me) but no other major setbacks until about two days ago when she became lethargic and was acting the same way she was when the problem was first noticed. I brought her back to the vet where they gave her fluids again and kept her overnight and the next day they did another ultrasound that showed she had a flare up from the disease and we were going to have to keep it under control with medicine. Now she is taking 5mg of prednisolone once daily and although I am scared to death of having her on a steroid she is doing very well since coming home. I’ve also started adding some filtered water to my cats already wet food to make it more appealing and they seem to love it and I’m sure the extra water is good for them. Noelle is acting like her old self since the surgery and besides the one flare up I have my old happy kitten back! I’ve been trying to do some research on this disease but there is only so much info out there and I am so afraid that this is something that is going to be fatal, but a lot of the things I’m reading are saying that well managed triaditis patients can still live a long healthy life. I’m sorry if my thoughts are jumping around on this post I am kinda typing as I think so I may be rambling on here, but any feedback that anyone here can give me would be much appreciated and hopefully will ease my brain a bit. Hopefully I’m not too late to the party here and somebody sees this. Thanks for reading! Also, if anyone knows of a holistic way to help treat this condition please let me know. Again, I am not a big fan of the steroids based on the potential side effects I’ve heard about but I have to do whatever is best for my baby.

I just figured I’d follow up and give you an update on Noelle. It’s been a stressful couple of months. When I last left you, Noelle was doing well on half a pill of prednisolone daily. Since then, her dosage has been cut to a quarter of a pill daily and I’ve been going with that for almost three weeks now. She was doing well from what i can tell until yesterday early in the a.m. she seemed a bit inactive and she threw up a small amount of yellow bile. She was still eating normally but I called the doctor and he told me to monitor her and keep him updated. Then this morning she seemed really uncomfortable and ended up throwing up again. This time it was watery food and she seemed like she was really unhappy afterwards. She wouldn’t eat. Yesterday I picked up some denamarin to start giving her which is the result of me doing some research and finding that milk thistle and SAMe could really be beneficial for her disease. I couldn’t get her to eat anything after her vomiting episode this morning but eventually she came around a bit and ate the pill pocket with the denamarin. She still wasn’t interested in eating so we visited the vet and he gave her a shot of something to help her tummy. I guess flare ups are going to be something I’m going to have to deal with but I can’t stand to see her in pain and I don’t know what damage these flare ups are doing to her insides. When we got home she ate but now, being later in the day she still seems uncomfortable and inactive compared to how she normally is. I am really worried about her even though the doctor did a quick ultrasound and said everything looked normal. Is there anything more I can be doing to help her recover from this? Is there anything that can be done to prevent flare ups in the future? Will the denamarin make a difference? So many questions and anxiety on my end. I don’t want to see her in pain.  Thank you for your time.

Does anyone here have any success stories to share with me so I can rest easier?  She is eating and seems to be acting normal but every now and then I'll see her sitting all scrunched up and I don't know if she is having a flare up or it is just her normal resting stance because she has always done it and before I knew about her condition I saw it as her just sitting there.

Jim Peterford said:

I guess flare ups are going to be something I’m going to have to deal with but I can’t stand to see her in pain 

Click to expand...

Hi Jim, I'm sorry that you and Noelle are having to deal with Triaditis. It can certainly be a rough road to travel. One thing that you might want to ask the vet about is pain medication. Pancreatitis especially can be very painful and one of the cornerstones of treatment is adequate pain control (with an opioid like Buprenex, not NSAIDs like Metacam). Also cobalamin (vitamin B12) injections can help tremendously with appetite and will improve the absorption of other vitamins and minerals. Here is some more info on that for you: 

http://www.idexx.com/pubwebresource...ng-pancreatitis-and-concurrent-conditions.pdf

http://vetmed.tamu.edu/gilab/research/cobalamin-information

All the best to you and Noelle. 

I've not had to deal with Triaditis myself so I really can't offer any suggestions for managing it. So sorry that you are going through this with your girl.

But I do want to calm your fears about using steroids, particularly prednisone/prednilisone. I've had 1 cat on it for 5 years now, and another on it for 2+ years. Both have auto-immune diseases that cause inflamation and both will be on steroids for the rest of their lives. Of all the steroids, pred is the one that is the easiest on cats, and in fact doesn't have most of the adverse reactions that humans and dogs can get from that drug. The worst issue is the potential for diabetics, but most cats that get it from taking pred self heal for that disease. I was like you originally - didn't want to keep my cats on a steroid and wanted a holistic approach to managing their diseases. But it came down to this - every time I tried to wean them off they relapsed. When I keep them on pred, they maintained very well. I don't know whether your baby started to relapse when you were weaning her off the pred, or she would have relapsed anyway. It's worth looking into.

Thank you for the kind words and advice.  She is back to her old self after the doctor visit on Tuesday.  These flare ups scare me though because I feel like I am feeding my girls well, (better than most at least).  No dry food anymore, a quality canned diet with no grains and protein that is supposed to be easier for IBD and pancreatitis cats to digest.  Venison, Rabbit and duck and I add a good amount of fresh filtered water to it to keep both my cats hydrated and to keep their insides healthy.  I'm scared because I can't tell if Noelle is not feeling well until she is having a full blown flare up.  Do these flare ups cause permanent damage since I am getting her medical attention within a few hours of her feeling sick?  She just had her third day of denamarin (SAMe and Milk Thistle extract) and continues her quarter pill of prednisolone daily.  Other than the hiccup she had Tuesday morning she has been doing very well.  I am so desperate to find a way to make the flare ups a thing of the past.  I am determined to make her better, she is too young to be dealing with this.  

Momofmany said:

 I don't know whether your baby started to relapse when you were weaning her off the pred, or she would have relapsed anyway. It's worth looking into.

Click to expand...

Yeah I guess I'm going to have to see if the drop to a quarter caused the flare up, because the 30 days she was on the half a pill she had no issues or at least no issues that caused her noticeable discomfort from my POV

I saw your post before, but had never heard of triaditis, so had nothing to contribute. I was doing some research IBD, feeding raw food, digestion and the relationship to the immune system, and discovered that triaditis is the combination of IBD, Fatty Liver (Hepatic Lipidosis), and Pancreatitis. I don't know if you've seen this site, but it appears it would be an excellent resource if you haven't: http://www.ibdkitties.net/

I don't know where you're located. But you may want to search for a holistic vet (a D.V.M. trained in alternatives - I recommend Chinese Medicine). This site may help you if you're in the US: http://www.ahvma.org I've found that Chinese Medicine does a much better job of treating inflammation/immune-related problems better than Western Medicine does. :nod: Switching her to limited ingredient canned food and increasing her water intake clearly are VERY important to her health. You MAY want to consider taking it a step further, and putting her on a completely species-appropriate diet, (which also eliminates additives!) and consider feeding her raw food. Now - with her system, this would need to be done properly and slowly. Probiotics, digestive enzymes, and a VERY slow introduction would be needed. And this is partially why I recommend a holistic vet. Many are trained in nutrition, and I expect that such a vet would be help you to do this properly for your girl. :heart3:

Further reading, if you're interested: http://www.thecatsite.com/t/240809/raw-feeding-resource-thread

Vibes for Noelle!

Since this article

http://www.ibdkitties.net/

starts with this rather unusual, startling statement or definition

IBD, Hepatic Lipidosis, Pancreatitis
                (Triaditis)

Click to expand...

I think I would like to offer a little bit of information to clarify what triaditis really is, what the definition triaditis really means.

From

http://www.vetinfo.com/catdig.html

There is a condition in cats that is sometimes referred to as "triad syndrome" or "triaditis", in which IBD, pancreatitis and cholangiohepatitis occur at the same time

Click to expand...

This excellent article explains the facts about cholangiohepatitis

http://www.marvistavet.com/html/body_feline_cholangiohepatitis.html

Basically, the most important thing to remember is that cholangiohepatitis means inflammation of the liver and bile ducts.

Normally, when a cat is diagnosed with triaditis, what our vets mean is that three inflammatory conditions (IBD, pancreatitis and cholangiohepatitis) are occurring together at the same time. Hepatic lipidosis is a completely different disease and is not part of the normal, usual triaditis diagnosis.

However, this article dealing with hepatic lipidosis

http://www.vet.uga.edu/vpp/clerk/turner/index.php

explains that

Hepatic lipidosis can be characterized as either idiopathic or secondary to other diseases such as inflammatory bowel disease, pancreatitis, cholangiohepatitis, diabetes mellitus, hyperthyroidism, renal disease, and neoplasia.

Click to expand...

(Having known cats with triaditis and cholangiohepatitis, however, I have to add here very quickly that cats don't absolutely have to have hepatic lipidosis involved in their diseases and the cats that I knew, didn't.)

Also, going on to another article

http://pethealthlibrary.purinacare.com/articles/cats-articles/feline-pancreatitis-and-triaditis/

there is this very important information

There is a special blood chemistry panel, sometimes referred to as a feline GI panel, which includes a test specific for feline pancreatitis called a spec – fPLI. The panel may also include a TLI, cobalamin (Vitamin B12) test and a folate test, which are helpful in diagnosing Exocrine Pancreatic Insufficiency (EPI) and Inflammatory Bowel Disease (IBD). Both of these diseases cause similar symptoms and may be precursors to feline pancreatitis and triaditis. Chronic cobalamin deficiency leads to anemia and is easily supplemented. Bile acid assays can also be measured to assess the liver’s functional ability. Hepatic lipidosis is a type of liver failure that may stem from any of these diseases when they are not quickly addressed.

Click to expand...

Thank you SO much, Violet, for that detailed explanation and GREAT links.

That may not be the "normal" definition but ANY liver disease that is accompanied by pancreatitis and IBD is considered IBD. I've been told this by my contacts at UC Davis, Texas A&M and Cornell University. I really am very shocked that suddenly after 3 years everyone is saying that my site is inaccurate. I have been working closely with those 3 universities and they've all carefully reviewed my site and have helped me with some small corrections but even their research departments have commented to me about hepatic lipidosis as being one form of liver disease that is a part of triaditis. I would not have spent 3 years researching carefully and talking with numerous universities, vets, online vets, etc. to put the wrong terms up. The vet that diagnosed my Alex with it is an experienced vet with these diseases of over 25 years and I have it on her records that this is what she had. I'm really jarred by all of this. YES cholangiohepatitisis a form of liver disease and yes it is classified as triaditis when put together with those other 2 conditions. but it's not the only one. Hepatic lipidosis is also liver disease, just a different form and they do classify it as triaditis when it's with IBD and pancreatitis.

I have a kitty with IBD and his last major flareup he had both types of hepatitis, the inflammation and the fatty liver disease.  A blood sample was sent to Texas A&M for the definitive test for pancreatitis and luckly he didn't have that. He had flares with the vomiting and inappetance for a number of years but because he didn't have the loose stools it wasn't diagnosed properly until I took him to the vet that I am taking him to now. His liver values were very slow coming down so the vet also put him on the milk thistle and sam-e supplement and it did seem to really help. The only problem with the supplement that he had was that the pills were so large and because of the protective coating they had to be swallowed whole. Patches is very easy to pill but I was afraid of him choking on those large pills. Over several years I tried to control these flares with food and I never did find a trigger. He would have one after several months on the same food with no problems. He is on Prednisolone now and has been for over a year.

I'd just like to offer a very good article about feline cholangiohepatitis

http://www.vin.com/proceedings/Proceedings.plx?CID=WALTHAMTNAVC2003&PID=3671

Dear Jim:

Today is July 19, 2012. A couple days ago, my cat Poussin (Russian Siberian, 8 1/2 yrs. old) was, first, diagnosed with diabetes. Next day this diagnosis was denied, and additional tests were done - to find out if he got that feline triaditis. I thought, diabetes was terrible, but after I read a leaflet about triaditis, I WAS IN COMPLETE SHOCK. Looks that this condition may be fatal.

At the moment, I'm waiting the doctor to call me back with results of the test. In the mean time, I went to read about the disease and came across your very sensitive letter about Noelle. I hope, she is doing better presently.

The site where you placed several replies, happened to be very useful (despite I always avoided those "exchanges" considering them unprofessional). Especially good was an advice to use a Holistic doctor - to help alleviate the signs of this horrible disease. There was also a reference to  AHVMA, with their telephone numbers etc. I just called and was given a numbers of Holistic/Homeopathic veterinarians in my area (the "adviser"- I don't remember her/his name) also mentioned that Chinese methods are the best. May be...  I want to tell you that once a Homeopathic vet treated my cat from a flare of feline herpes, and she was the only one (among all the "traditionalists"-doctors) who was able to save my cat's eye.

Although it is not easy to find a QUALITY doctor (or a vet, in the case) - no matter if he/she practices conventional or holistic medicine, I will try to find one. Not that I am unsatisfied with my present, traditional vet (she is excellent!) but, as I feel that conventional medicine is not too assured in positive results of its treatment, Homeopathic medicine might become very helpful.

Just in case, If you didn't pay attention to this reply, I'm giving you the number of AHVMA - for you to find a Holistic vet in your area. Do not ignore it: (410) 569-0795.

About my cats' foods: I always give them the best - no additives, dangerous preservatives, etc. Only natural - whatever is on the market presently. I liked "Blue" brand (not all of it as my other cat - a female called Monalisa, has some kind of allergic reaction to chicken meat). The veterinarians also are very positive about "Blue". Also, I'm buying for my cats (I have three) bison meat and feed it to them raw.  I give them only filtered water, etc., etc. Of course, since my cat got sick (with who knows what) I purchase, by the vet's advice, DM cans from her (no dry food at the moment).

I wish to all of us (cats included) the best.

Very Sad Tiana from Illinois

Hey Tiana. How is posting on here "unprofessional". If anything it is a way to know that you always have help if you need advice from people who may have gone through the same issues you have. Trust me, I was scared to death when everything with Noelle happened, and yes it can be fatal if left untreated. However, if you put the time and care into providing the best for Poussin you can have the best chance for him to live a long, happy life. I'll tell you what I've done to get Noelle to the point where she is on the minimum medicine possible and doing very well. First off, DITCH DRY FOOD. That is probably the most important. I am currently transitioning Noelle and her sister to a raw meat diet, which is the BEST thing you could do for a cat, especially cats with digestion problems and IBD and pancreatitis are diet related. Blue Buffalo is on the higher end of the crappy commercial foods, but you are better off finding a different source of protein and seeing how Poussin responds to it. I personally switched my cats over to Natures Variety Instinct canned food for almost half a year and their venison, lamb, duck and rabbit wet food worked well. I tried to avoid chicken and any kind of grains, wheat gluten, soy, pretty much everything that is in crappy cat food. Noelle was a dry food junkie, but getting her to an all wet diet was surprisingly not too bad. Another thing that I think helps is adding filtered water to their wet food. I mean, to the point where the food is nice and sloshy. I'm sure not all cats will like it like that, so maybe add a little at a time. Water can only be a good thing for kitty just like us IMO. 

Through my own vet I started Noelle on a medication called Denamarin. It is a natural supplement that contains the active ingredient in milk thistle as well as SAM-E, both of which are great for liver support. The pill is kinda big, but if you can get Poussin to like pill pockets it will make the nightmare of "pilling" a breeze. Noelle was never a big chewer so she swallows the pill pocket whole luckily. Next, there is a Dr. on Long Island named Dr. Wen who is a well known holistic vet. He is bit of a drive away from me, but he works with a network of vets and distributes Chinese herbal medicines through naturalsolutionsvet.com. I found out that an old vet of mine was in that network and after a quick check up I am now getting two herbal meds. One for IBD and one for chronic pancreatitis, again, very pricey but worth every penny if it helps my girl.   After her ordeal she was on 5mg of prednisolone daily, she is now down to 2.5mg every OTHER day and doing very well.

The problem with the canned food I was feeding her (Natures Variety Instinct) was that the fat content was kinda high, and although she was doing well on it I didn't want to do any damage to her already compromised pancreas and digestive system, which is why I decided to switch to raw. I really suggest you consider it to. It is a HUGE commitment but I found a lot of people on here who are willing to help you with any questions you have. I'm still learning and going through the process myself, so hopefully I will have some positive things to say soon. Check out Better in the Raw for cats and Rad Cat cat food. Those are the options I have decided to go with. Websites for both products will also give you a quick education on why raw diets are better.

Lastly, I started Noelle on a digestive enzyme and probiotics. The digestive enzymes are supposed to be very beneficial for pancreatitis and the probiotics are good all around for digestion, even for us! Noelle isn't diabetic however, so maybe check with your vet or ask for further information before following what I did for her. These are the steps I have taken as well as many calls to the vet and many hours of watching her like a hawk and looking for any changes or discomfort. It's been a long 7 months but Noelle is doing great I am happy to say.  I am sending you positive vibes and hope you have the same success I have had with getting Poussin back on track. He is about the same age, so he has youth on his side, and IMO it's not too late to make a change for the better. Just be willing to put in the time, money, love and don't lose faith. Please keep me posted on how you are doing! 

Great post Jim!!!   So glad to here that Noelle is doing well! 

Haha thanks . I missed some punctuation and rambled a bit, but hey... It was late! :lol3:

LOL, well it's good you gave detail and so much encouragement. It's so hard for me when my girl didn't survive those diseases. It was just 4 years ago on the 10th of this month, still very hard. But I'm so happy to hear your Noelle is doing so well and now you have the tools to help others. That's very valuable information to give.

Hey there,So sorry to hear your  noelle is sick.When i read your post-It reminded me exactly of my little girl Ruby is going through at the moment...She was diagnosed with triaditis 4weeks ago,after ultrasounds and xrays.2/3 of her gawl bladder is full of stones....She was prescribed a anti nausea tablet for 4 days and she had 3 types of antibiotics and also cortasone.She is only taking the cortisone now....She gained weight again(shes always been cuddly-but lost all her weight) and was back to normal...well so i thought....Today she vomited up yellow bile again!! three times so far...she is going to vet later today to have her vitamin B injection.Maybe that will make her bounce back again....I Understand how you feel.....It absolutely devistating to see them in pain.Ruby also crouches down and just sits under my bed,and wont come out-So I know she is feeling ****..=-(

Is this going to be ongoing????I cant stand it.

Hi there, sorry to hear about Ruby. How old is she? The best thing you could possibly do is get her off any food that has grains and carbs, ESPECIALLY dry food, and look into a raw diet. I recommend Rad Cat. It's a commercial brand but they use grass fed and free range meats as well as bone meal instead of ground bone which is good because cats with IBD can't digest bone properly. Noelle has been doing great and we even have her prednisolone cut down to a half pill every third day. I still give her denamarin in the morning and the Chinese herbal meds twice a day to support that whole area, but after switching her to a raw diet her problems appear to have diminished to the point where she is in better health than she has ever been in her life. She has packed on almost a full pound since I changed the diet, and has had no issues whatsoever. *knocks on wood*
My vet says it's possible her whole ordeal may have been diet related so we are going to see how the every third day of pred works out. I'm keeping my fingers crossed.
Now I have to keep an eye on her to make sure she doesn't gain too much weight LOL. I may be feeding her too much of the raw, she loves the stuff.
Keep me posted with Ruby, I'm sure with enough love and support you can pull her through this.

Good Evening!  I just got back from my vet, after bringing in my cat for an emergency visit.  I know she has IBD, with a history of hepatitis on her last two ultrasounds as well.  It sounds like she now has pancreatitis.  This thread is great - I'm going to keep up with it, to see how all the cats do.  We're in year 3 of IBD, with a history of hepatic lipidosis after anorexia before the IBD was officially diagnosed.  Talk about a roller coaster.  Thanks so much for all the links!  PS - I love the ibdkitties site, it was a huge help to me when my cat got sick.  Thanks!  Kat  (nope, not a pun )

Not sure if anyone is still following this thread but I will post anyway. Just giving an update on Noelle. She has been on 2.5mg of prednisolone this whole time and for the most part doing well. Every time we tried to get her down to every third day she would have some kind of flare up within a few weeks and she would have to go back to every other day. She was doing well with that until about a month or so ago where it seems she is having a flare up almost once a week... It starts out with her acting completely normal and being playful one minute, to her starting to shiver like she has a chill. This goes on for a few minutes and she starts smacking her lips and then she will vomit. This has happened anywhere from an hour after eating to right before a meal, and it appears she vomits everything in her stomach up.(If it happens long after her last meal she will usually vomit yellow bile or a grayish liquid with a little food or hair in it).  After the episode the shivering stops and she seems to be in a lot of discomfort/pain for a couple of hours afterwards and not want to eat anything. Then she'll snap out of it and be back to her normal self. Last week my vet put her back on prednisolone every day, (still 2.5 mg) to try and break this cycle but almost exactly a week after her last episode it happened again tonight. I just can't stand seeing her not feeling well and I really don't know what else I can do. They need to find out what causes this problem... Does anyone know if this sounds like a flare up of IBD or pancreatitis? How can I tell what it is that is hurting her? Right now she is jumping up to me at my table and wanting dinner so I know she is feeling better than she was 2 hours ago when she had this flare up, but I feel like there HAS to be more I can do... Any thoughts? Thanks everyone!