Obi has an appt. with internal medicine today - He has Pancreatitis

myrnafaye said:

 
Thank you, Peaches, but there is clinical information that Obi has GI disease.  The pancreas does not get inflamed if GI disease is not present, it is just a question of what GI disease is present.  Clearly the lack of motility due to GI disease in inhibiting his intestine from pushing the hairballs through.

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Yeah, and the symptom is vomiting hairballs.  And the hairballs will increase irritation, which can further inflame the pancreatitis as well as IBD/IBS or cancer. 

Yes, I understand what you are saying, it s a kind of chicken-egg thing.  But many vets think that when cats throw up more than the occasional hairball - and with Obi, sometimes it was daily - that that is indicative of a more serious problem.  I understand it may not be lymphoma, but there too, many vets see IBD/lymphoma on a continuum.  I cannot agree or disagree with this.  I dont know.

For the time being, Obi will get 5 mg of pred which is still conservative treatment and see if that stops the hairballs and perks him up.  I appreciate all the support here very much.

quoting Stephen:

"I don't understand your vets POV at all.   Severe IBD or small cell lymphoma as far as I have been told will always cause weight loss, and it is partly diagnostic and cats who have it even without a biopsy usually start on Pred, not chloramusol (Leukeran) and if that works then great, and if it doesn't or if it stops working then you move on to the chloramusol, but you would never imo just start a cat on Leukeran if you suspected lymphoma in the absence of weight loss.

You are correct a surgical biopsy is not really indicated when the cat is on Pred.  Is Pancreatitis being discussed? An ultrasound is much less expensive then a surgical biopsy (like $200 vs $2000) and is very easy to do and they can look at both the pancreas and the intestines in an ultrasound, and being on Pred does not preclude an ultrasound I believe."

Stephen, yes I agree Obi has a good appetite and is not losing weight but I would not say he is himself.  We had a TAMU done - the test that goes to Texas - and it showed low B12, and some pancreatic inflammation, but NORMAL pancreatic functioning.  So, Obi has mild pancreatitis, is what I understand, and that, also as I understand, indicates underlying GI disease.

He IS on pred.  Was on 2.5 and that was increased yesterday to 5 mg.  I see no change but realize it may be way too soon.  I am the one who does not want an ultrasound.  I was told that IBD is often indistinguishable from small cell lymphoma on ultrasound, esp if the cat  has been on pred.  Here an ultrasound is between #300-$450; and since the treatment probably would be the same, ie, starting him on pred, I really felt it was best to store my kitty health care dollars to keep him comfortable.  He iseating extremely well, eager, but he seems to have periods where he feels good and then he does not; he will go into a crouch, the "meat loaf", or hide under the bed (comes out for food, though).

I think the vet thinks there is a progression:  chronic hairballs progress to IBD; IBD progresses to lymphoma in many cases, and Obi is 15, not 5.  It is I who is wondering if it is feasible to start him on the combo of pred/chlorambusol.  As of yesterday, the plan was to up his pred to 5 mg for a week or 2 and see how he does.  But, the vet seemed somewhat convinced that it WAS lymphoma.

YOur comments and thoughts will be very welcome. 

myrnafaye said:

 
quoting Stephen:

"I don't understand your vets POV at all.   Severe IBD or small cell lymphoma as far as I have been told will always cause weight loss, and it is partly diagnostic and cats who have it even without a biopsy usually start on Pred, not chloramusol (Leukeran) and if that works then great, and if it doesn't or if it stops working then you move on to the chloramusol, but you would never imo just start a cat on Leukeran if you suspected lymphoma in the absence of weight loss.

You are correct a surgical biopsy is not really indicated when the cat is on Pred.  Is Pancreatitis being discussed? An ultrasound is much less expensive then a surgical biopsy (like $200 vs $2000) and is very easy to do and they can look at both the pancreas and the intestines in an ultrasound, and being on Pred does not preclude an ultrasound I believe."

Stephen, yes I agree Obi has a good appetite and is not losing weight but I would not say he is himself.  We had a TAMU done - the test that goes to Texas - and it showed low B12, and some pancreatic inflammation, but NORMAL pancreatic functioning.  So, Obi has mild pancreatitis, is what I understand, and that, also as I understand, indicates underlying GI disease.

He IS on pred.  Was on 2.5 and that was increased yesterday to 5 mg.  I see no change but realize it may be way too soon.  I am the one who does not want an ultrasound.  I was told that IBD is often indistinguishable from small cell lymphoma on ultrasound, esp if the cat  has been on pred.  Here an ultrasound is between #300-$450; and since the treatment probably would be the same, ie, starting him on pred, I really felt it was best to store my kitty health care dollars to keep him comfortable.  He iseating extremely well, eager, but he seems to have periods where he feels good and then he does not; he will go into a crouch, the "meat loaf", or hide under the bed (comes out for food, though).

I think the vet thinks there is a progression:  chronic hairballs progress to IBD; IBD progresses to lymphoma in many cases, and Obi is 15, not 5.  It is I who is wondering if it is feasible to start him on the combo of pred/chlorambusol.  As of yesterday, the plan was to up his pred to 5 mg for a week or 2 and see how he does.  But, the vet seemed somewhat convinced that it WAS lymphoma.

YOur comments and thoughts will be very welcome. 

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Ok First off, Obi is not well, we agree on that.  My understanding of pancreatitis is that yes it can be affected by other organs being so close to the liver, stomach and intestines and that it often (usually?) causes vomiting and pain.  And while mild IBD may not cause weight loss it will cause either diarrhea and or vomiting, but small cell intestinal lymphoma will always cause weight loss, and to progress from mild IBD directly to lymphoma seems like a big leap.  There are many explanations for pancreatitis that do not require a diagnosis of either IBD or lymphoma so I don't know why your vet is so keen on the latter without diagnostic imaging.

Speaking personally, I don't think I would treat with both Pred and Leukeran without either weight loss that didn't respond to the Pred, or without imaging that was strongly indicative of IBD.  You can diagnose IBD with an ultrasound, but you cannot diagnose lymphoma without either surgical or endoscopic biopsy, although you can treat for either and see what happens.  And you can treat and see what happens, but without either imaging or biopsy, its a bit like throwing darts at the problem and Leukeran while well tolerated ion many cats, it is serious medicine, if in doubt note that you have to handle the pills with latex gloves.

Yes vomiting lots of hairballs over time may be connected to IBD.  Having IBD can connect to pancreatitis.  Having pancreatitis is not however by itself even remotely an explanation for IBD.  Your cat, other than vomiting hairballs, doesn't sound symptomatic of IBD or at least not a bad case, but he does sound symptomatic of pancreatitis.

None of us are replacements for your vet or for you, and both you and your vet know your cat better than I do.  I'm just offering my little bit.  I have a cat with severe (but controlled) IBD and mild pancreatitis and his experiences and my many conversations with my vets and what I have read are what I base this on.

I can totally understand not doing a biopsy on a 15 year old cat, especially one who doesn't have weight loss.  And i can equally understand not doing an ultrasound if money was the issue, but there is no medical reason why a 15 year old cat shouldn't have an ultra sound.

One last thought: the reason cats lose weight with serious IBD or lymphoma is that the damage to the intestine (swelling due to IBD, or cellular changes due to lymphoma) causes nutrient absorption insufficiency, and as a result, weight loss.  I don't know a reasonable explanation for lymphoma or serious IBD without weight loss.

Sigh.  Stephen, I agree with you.  I have said from the beginning of this - whatever it is - that Obi does not really have symptoms of IBD or of lymphoma.  And I agree he sounds symptomatic - with clinical indicator, the TAMU - that he has some inflammation of the pancreas,although, as I said, it is functioning within normal limits.  That, for me, confuses the picture further.

Because his B12 is low, that points to GI disease in the small intestine, the ilium.  I dont know what kinds of problems can occur within the ilium that are not IBD, do you?

Obi does not appear to be in pain.  The vet two weeks ago palpated him very thoroughly and he did not mind at all.  Nor does he mind if I rub his belly or pick him up.

I believe the pred is for inflammation.  I understand there is no specific treatment for pancreatitis.

Part of the problem is that Obi does not have a regular vet.  He DID, and that vet retired.  I found a replacement; we did not do well together at all, that is another story.  I walked out on her clinic, and called my old vet who by then had come back from retirement, albeit in a very limited capacity.  He did not run any tests on Obi, but felt that Obi was having a food reaction, was overgrooming and hence the hairballs.  So he prescribed accordingly.  And I changed Obi's food, he is on Nature's Variety rabbit, a very high quality food, and a novel protein.

However, that vet is out of the picture now for several reasons, not the least of which is that I think Obi is beyond his expertise.  AND he has very limited availability.  I was communicating with him very often and not once did he suggest a visit to the Vet School or to an internal medicine specialist.  I told him a lot about egg yolk lecithin, SLB, etc and he basically had me do my thing.  Then I found out that SLB syrup can interfere with absorption - and here I am with a cat on pred, other meds, and he is low on B12!  I dont think that is mentioned enough here.  If a cat is on meds - dont give SLB.  So, going forward, I have selected a new vet and a new clinic.  Obi may need to have a visit there within the next week  or two, as the internal medicine specialist does not come back for a week or two, and maybe the internal medicine specialists are missing something - or not listening to me enough when I say what Obi is and is not doing.  Because I agree that it is a jump to lymphoma, and perhaps even to IBD.

All I can say is that Obi does not look comfortable. Not in pain; just not comfortable.  He gets fed three meals a day of 2 oz or a bit more, and cleans his plate.  He weighs 10 lbs 14 oz.  He was a little over 11 lbs when this all started, so not a significant weight loss, and the rabbit is lower in fat than what he had been eating.  I thought three smaller meals would be easier on his digestion than 2 larger ones, and he gets to eat more often and likes that.

My Mimi is like that. Before all this started she was 4kg now she is 3.29 but she gained 10 grams since we doubled the prednisolone last week..

So I did not know that slippery elm bark interferes with to he meds... I give her a tbs every day!oh my.

So my suggestion is to find a new vets, I can understand what you are going though with your vets. My vets are thinking I'm pestering them so they avoid me.. The thrush is that they leave me with a million questions and when I see that Mimi is not gaining weight or her stool is runny I don't know what to do.

I m sorry but I did not look all though the posts so would you mind telling me is Obi has diarrhea? My opinion is you should do the ultrasound, it's painless and it's cost a lot less and it can show if the intestines are thickened. Which if they are it's either ibd or lymphoma but still you can have a clearer picture and the radiologist can see the other organ too.. I hope you and Obi feel better about all

No he does not have diarrhea.

@myrnafaye

Ok well it sounds like you have a good handle on the situation and I think a new vet and an internal med spec will give you fresh eyes.
Since I am new to this thread maybe you can give me a quick summery:
When did this start?
Any other symptoms?

Re: pancreatitis, my cat has a mild case and he has vomiting episodes where he also feels poorly and stops eating. We give fluids and cerenia (anti nausea med) and in a few hours he's back to his old self. My point is this, even mild pancreatitis can lead to feeling poorly....

HI, Stephen:  Obi is 15 and has been healthy all his life except for a rough beginning, and the hairball vomiting.  As I said, at the end of winter I started cleaning up hairballs almost every day.  Still,  he would throw hair, and then he would be fine, want to eat, playful, etc.  But I started taking him to the vet then, had blood work done, etc.  from that point forward, until two weeks ago, we/I were relating to this as an allergy, overgrooming, hairballs.  Seems pretty dumb now.  I doubt too many cats have a true allergy to food.

Then I found this site, and started doing more investigating.

Two weeks ago, there seemed to be a downturn, and I just hit the wall with guessing about Obi.  I made the decision to take him over to the Internal Medicine department of one of the local emergency clinics that has internal med as a specialty clinic.  He got worked up there - meaning, tests.  Including an extra vial of blood for the TAMU, which I decided to have run a week later.  he was heavily palpated and no enlarged lymph node were perceived.

He has not vomited a hairball for a couple of days now.  Other symptoms:  I would say he is not himself.  When we live close to cats and love them, we develop a sense of their personality, of who they are.  Obi seemed - subdued.  He is generally bright, alert, engaged.  He started hanging out under one of the beds.  Not too playful but he would still respond to catnip and would go at his scratching posts.  His stools have been normal and he is always eager to eat.  I also noticed that he would eat, and then kind of go into a crouch or hide, as if the food made him uncomfortable.  But he still wants to eat!

The other thing I can tell you is that if he is going to throw a hairball, it is almost always after he uses the litter box; and I find them near the litter box.

This morning, knock wood, he seems a bit more birght and engaged.

The regular internal med doc will not be back for one or two weeks.  There is a substitute vet at the clinic to day, I will do everything I can to speak with her, including getting those records transferred to a new regular vet.  So, for a couple of weeks, I am kind of in this gray area with a new vet and waiting for the new internal med vet to return from maternity leave - and hoping, hoping - someone can speculate on a GI disease other than lymphoma or IBD that might impact the pancreas.

Obi has been on metaclopramide for motility and nausea.  And pepcid.  The stand in vet told me to stop those and increase the pred.  I am decreasing those but not stopping, not until I feel the 5 mg of pred is working.

Hope this helps.

Originally Posted by myrnafaye  

However, that vet is out of the picture now for several reasons, not the least of which is that I think Obi is beyond his expertise.  AND he has very limited availability.  I was communicating with him very often and not once did he suggest a visit to the Vet School or to an internal medicine specialist.  I told him a lot about egg yolk lecithin, SLB, etc and he basically had me do my thing.  Then I found out that SLB syrup can interfere with absorption - and here I am with a cat on pred, other meds, and he is low on B12!  I dont think that is mentioned enough here.  If a cat is on meds - dont give SLB.  So, going forward, I have selected a new vet and a new clinic.  Obi may need to have a visit there within the next week  or two, as the internal medicine specialist does not come back for a week or two, and maybe the internal medicine specialists are missing something - or not listening to me enough when I say what Obi is and is not doing.  Because I agree that it is a jump to lymphoma, and perhaps even to IBD.

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I am sorry to hear about Obi's diagnosis and hope that you can successfully manage this going forward. I feel compelled to respond to the above comments however, regarding the mention of SEB interfering with meds. This was mentioned to you more than once by myself and by different people in your initial hairball post about Obi, and in particular when you made the decision to increase the dosage.

As I recall, you were quite happy with your choice to use SEB as you didn't want Obi to have to rely on conventional medications. From your accounts, Obi did show good improvement, so I am a bit puzzled as to why you have chosen to stop this. While returning completely to conventional meds to manage Obi's condition is totally your choice, it would be a shame for others to draw the conclusion from your comments that SEB is something to avoid.  There is no reason why cats cannot be on SEB when it is given at a different time from meds, which was explained to you. As many have mentioned through experience with it, including myself, it works extremely well for a number of ailments when used properly.

All the best to you and Obi.

Hi, One:

When I joined this site, I was engulfed with information, w hich was a good thing.  So I was eager to try supplements based on what Obi was (then) diagnosed as having, an allergy, overgrooming, hairballs.  So I tried EYL, SLB.

Now his diagnosis is changed.  I am not home all day to administer meds more than three times a day, and even that at times is difficult, and feed him three times a day.  Sunday  I have to be gone all day to visit relatives, and have to get a cat sitter to come in and feed him.

I know you have had success in combining alternatives with traditional medicine.  But, when everything I tried ultimately bombed, and Obi got worse, I had to take action.  It scared me that SLB can block absorbtion.  I was giving it to Obi in his food, and giving him pepcid, then 2  hours later, reglan - and  his pred at night.  SLB with his second meal.

But he still was throwing up hairballs.  It was just overwhelming.  I worried that the meds I was giving Obi were not being absorbed.

In short, Obi showed improvement for a short while; then he was vomiting hairballs again.  I kind of hit the wall.  What would you have done? 

Like I said, it is totally your choice to continue with conventional meds. There is no judgement here. But I must emphasize again, that SEB does not block absorption of meds when given separately. There are members who are in the same boat as you in managing a disease involving the digestive system, who are using both SEB and conventional meds.

The thing about SEB, is that it is not something that is normally used for hairballs. What SEB is typically used for, is addressing inflammation, soothing gut irritation, acid reflux, or diarrhea and constipation. Obi's inflammation is the reason why I suggested it to you as you were concerned about Obi being on pred, long-term.

I know this a frustrating journey to be on, but you have to keep in mind that if Obi has pancreatitis, or IBD, that this is something you are likely going to have to manage, long-term. The process will involve trial and error until you find a combination that works for Obi, but there are bound to be a few ups and downs along the way, so it helps to know this in advance, stay calm, and temper your expectations.

Thanks, One.  The bigger problem is that I feel the medical establishment is jumping to a diagnosis of lymphoma. 

And even more frustrating is the fact that there is no treatment for pancreatitis.

myrnafaye said:

 
Thanks, One.  The bigger problem is that I feel the medical establishment is jumping to a diagnosis of lymphoma. 

And even more frustrating is the fact that there is no treatment for pancreatitis.

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You're welcome.

If you don't think this is the case, then turn over every stone, including getting an ultrasound done so you can relax and go forward with the knowledge that this at least, has been ruled out. 

Yes thanks that was interesting info.  Hopefully you will get more info from the specialist when he returns.

I know you were answering others, but I'd like to comment on a few things if you don't mind. 

myrnafaye said:

 
I doubt too many cats have a true allergy to food.

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It wasn't dumb. A lot of cats have allergies to food. 

myrnafaye said:

...and hoping, hoping - someone can speculate on a GI disease other than lymphoma or IBD that might impact the pancreas.

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You're going to drive yourself crazy trying to find a cause for the pancreatitis. I've been there!     The pancreas is a delicate organ with delicate tissue that maintains a delicate balancing act between producing insulin and enzymes. It can be easily damaged and slow to heal. It's function is important and there are a myriad of things that can make it angry.

myrnafaye said:

And even more frustrating is the fact that there is no treatment for pancreatitis.

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In my opinion, the definition of "treatment" for pancreatitis is no different than the definition of treatment for IBD or any other type of GI disease. There is no one pill specifically marketed to treat these conditions and no one protocol that works for all cats. The main goals are usually to 1) decrease inflammation, 2) control symptoms, 3) promote healing, and 4) encourage weight gain (if weigh loss exists) or some variation of such. These can be achieved by any combination of diet, Western medicine, alternative medicine (homeopathics, herbs, acupuncture), supplements, and mental support. Sebastian has a long list of things he's on to manage his chronic pancreatitis, and in my eyes, everything together makes up his "treatment." 

Go:

Noooo, its not the pancreatitis.  Obi seems fine the last 2 days, I know his pancreatitis is mild.  The threw up a big hairball today, though, despite the increase in pred - 2 days ago - from 2.5 to 5.  I know it takes some time.

What the fear is is LYMPHOMA.  I dont want Obi to have cancer.  That's what it is.

myrnafaye said:

 
Go:

Noooo, its not the pancreatitis.  Obi seems fine the last 2 days, I know his pancreatitis is mild.  The threw up a big hairball today, though, despite the increase in pred - 2 days ago - from 2.5 to 5.  I know it takes some time.

What the fear is is LYMPHOMA.  I dont want Obi to have cancer.  That's what it is.

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Um, you know pancreatitis is permanently damaging, right?  Leaves scar tissue, increases chances  for recurrent episodes almost exponentially, right?  The "fears" put aside, pancreatitus can kill too.  Actually, more quickly than most lymphomas.

Peaches:

I have had cats for 40 years.  Yes, I do know about pancreatitis, thanks to the many contributors here and collective knowledge.  However, Obi's pancreatis was mild; he seems to have recovered, and his TAMU showed no damage to the functioning of the pancreas. Yes, I know it can return.  

TAMU, a blood test?  That's ONE diagnostic.