Ultrasound or TLI/PLI?

I need to decide which to do now for Obi.  I cannot do both at this time.  Briefly, he has a history of IBD, which we are treating with 5 mg pred. ( and I give him a probiotic/digestive enzymes, EYL for hairballs, and psyllium).  Last summer he was treated for an episode of "mild" pancreatitis.  What is happening now is that he is eating well, but retreats to under the bed shortly after he eats.  More recently as well, he has had some episodes of  hairball vomiting in quick succession, as in twice in three days, and another a few days later, whereas before that he has been going often weeks without a hair ball vomit.  He only vomited food once.  He almost never does vomit food, and that one time was along with a very large hairball. and I think he had just eaten.

So even though it may seem minor that he is going under the bed, it does  concern me.  He has never had an US, I have  stalled on that because it was not clear to me that it would provide any necessary information, or that it would alter the treatment.

FYI, the ultrasound is less costly than  the GI panel, which is the one that has to be Fed Ex'd to Texas. 

Which do you think I should do first, which is the greater priority?  TIA.

Hi there!  If it was me (and we've both been on this road a while right?   ) honestly, and it may sound like a cop out but it isn't, I'd go with what my vet suggests is the best way to go.  Having said that, my Simon had multiple Ultra sounds over the course of his IBD, pancreatitis, and each one proved useful as we were able to measure the amount of intestinal thickness, see inflamed lymph nodes, see the pancreas and frequently doing the US helped us adjust treatments or add new diagnostics (like doing a needle aspirate (biopsy) of inflamed lymph nodes that produced a cancer diagnosis. 

Luckily when I finally found a good vet I was in a good position financially and had both done at the same time along with a needle biopsy of his liver.  His liver had become inflamed from both the spread of IBD and fatty liver disease.  If it had been one or the other I would have had the ultrasound done because I had a very good vet.  The reliability of ultrasound results really depends on the skill of the person doing it and reading the results.  Patch's ultrasound was done in house by his vet who was also a specialist and I trusted her skills.

If you trust the person's skills who is doing the ultrasound I would go with it.  If you are iffy about the skills of the person reading the results then I would go with the blood test.

Denice said:

 
Luckily when I finally found a good vet I was in a good position financially and had both done at the same time along with a needle biopsy of his liver.  His liver had become inflamed from both the spread of IBD and fatty liver disease.  If it had been one or the other I would have had the ultrasound done because I had a very good vet.  The reliability of ultrasound results really depends on the skill of the person doing it and reading the results.  Patch's ultrasound was done in house by his vet who was also a specialist and I trusted her skills.

If you trust the person's skills who is doing the ultrasound I would go with it.  If you are iffy about the skills of the person reading the results then I would go with the blood test.

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I agree with Denice, the person doing the US must be skilled and practiced at it.  At my vet clinic with 8+ vets, only one did US's.

I tend to go about these decisions by asking myself and my vet what we would do with the results. Just within the past couple of weeks, I had to make a similar decision with two expensive tests. I choose the ultrasound. Instead of getting one or maybe two pieces of information from a specific test, we were able to take a look inside and get information on all Sebastian's GI organs. Of course, I'll third what @Denice and @StephenQ said about a skilled radiologist. We went to a specialty center that has two experienced board-certified radiologists/DVMs on staff that do just that all day every day. A good radiologist should be able to see if the pancreas is inflamed, which is another tool for the diagnosis of possible pancreatitis.

The results of Sebastian's ultrasound did not strongly sway where we go from here, but it did provide some major relief in areas that were of concern to me.

If we feel Sebastian is having a pancreatitis flare, we just treat it aggressively and supportively. It would get way too expensive to confirm a flare-up every time with the PLI test. If it was, say, an IBD flare, that would also benefit from the same supportive care.

The caveat is that if the PLI/TLI come backs in normal range, then you're possibly looking at some other issue still unsolved.

The vet thinks an ultrasound is more important.  I have put this off.  I guess it is time.  Obi is eating well but then retreats.  I dont know what to make of this.  The clinic just got new equipment for ultrasounds.  

Hi Go what supportive care specifically do you do?

I agree it's time. The good thing is it's painless and you have immediate results.

I feel badly that his belly has to be shaved.  But most of all, I am scared.  I have been kind of in the "not wanting to know" mode with Obi, treating him symptomatically.  But, I feel I have hit the wall, sort of...he is not losing weight, and not vomiting, but he eats and then goes into hiding.

Trust me his belly will get over it.  My simon had so many US's that his belly was more or less shaved the last year of his life.  Hiding after eating, something isn't right....although at least he's eating

I know it will grow back, and maybe will mean fewer hair balls in the interim...Yes, at least he is eating.

myrnafaye said:

Hi Go what supportive care specifically do you do?

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When Sebastian goes under the bed, I know he's feeling pretty bad. Fortunately, it happens rarely.

When he's flaring, I fast him for 24 hours as soon as he exhibits signs (he usually doesn't want to eat anyway), double the Cerenia dose, administer fluids every day (rather than every other day) ONLY IF they're being absorbed, add in Zofran if his nausea is bad enough, and feed bland food. In almost all instances, he won't eat the food he was eating when he's flaring up. If he's in pain, I'll add in the pain meds. If he doesn't respond to these efforts, we may increase the pred for a short time and then slowly bring him back down. I have taken him in for bloodwork during a flare to check his WBC count and possibly get a Cerenia injection. If his WBC count is high, we'll discuss antibiotics. I also keep the house quiet and comfortable. I eliminate stress as much as possible and limit my handling of Sebastian.

Obi is interested in food; he eats then he retreats.  That  is what is puzzling.  In any case he is getting ultrasounded on Monday.  ..I think fluids may be  a good idea but we dont know what s going on.  When you say you double the cerenia, you mean you give him a full pill?  I have not given Zofran, because he has not vomited.  BUt he appears to have some discomfort following meals. 

myrnafaye said:

 
Obi is interested in food; he eats then he retreats.  That  is what is puzzling.  In any case he is getting ultrasounded on Monday.  ..I think fluids may be  a good idea but we dont know what s going on.  When you say you double the cerenia, you mean you give him a full pill?  I have not given Zofran, because he has not vomited.  BUt he appears to have some discomfort following meals. 

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Hmm... I remember something similar with Sebastian. He would eat. Then not feel well. So he'd skip his next meal. Then he'd be really hungry and eat. Then not feel well, etc. My theory is that eating made his pancreas work, which then aggravated existing inflammation. BUT...they have to eat.

A full pill of Cerenia for a cat would be too much and overdosing. Sebastian's maintenance dose is 1/4 of a 16 mg tablet once a day, Monday through Friday. His flare dose is 1/2 of a 16 mg tablet once a day, Monday through Friday. Sometimes I only need to give 1/2 for a couple of days and then I bring him back down to 1/4. I give him Cerenia in the morning.

Does Obi get Cerenia as part of his regular regime? If not, and Obi was my cat, I'd definitely pursue that with my vet and also learn to give fluids at home.

Go:  Thank  you SO much for this share.  That makes total sense.  I do think - in advance of the ultra sound - that is IS the pancreas, 1.  because it flared last year about this time 2.  his fPLI was positive last week.  And I can see that Cerenia makes him feel better.  I will definitely ask the vet what she thinks about the 1/4 Cerenia for maintenance.  Was Sebastian also on pred?  Obi is on 5 mg.  Yes, fluids at home is  a good idea, but how did you keep Sebastian calm?  I take it t his is a two person job....?

myrnafaye said:

 
Go:  Thank  you SO much for this share.  That makes total sense.  I do think - in advance of the ultra sound - that is IS the pancreas, 1.  because it flared last year about this time 2.  his fPLI was positive last week.  And I can see that Cerenia makes him feel better.  I will definitely ask the vet what she thinks about the 1/4 Cerenia for maintenance.  Was Sebastian also on pred?  Obi is on 5 mg.  Yes, fluids at home is  a good idea, but how did you keep Sebastian calm?  I take it t his is a two person job....?

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Yes, Sebastian is on prednisolone. Has been on 5 mg daily since October 2013. There were some instances were we increased it to address a bad flare, but was slowly brought back down to 5 mg after he recovered.

I think the ease of giving fluids to a cat really depends on the cat a lot of times. Sebastian is a really good patient, and we have a routine. I give him fluids sometime after he has his dinner, but before I go to bed. I am by myself, so no one has ever helped me. I warm the fluids in warm water in a bowl. While the liquid is warming, I replace the needle with a clean one (I never reuse the needles). I lay out a soft pet blanket on the floor in the dining room. I put the warmed fluids on a shirt hanger and hang it from a dining room chair. I put Sebastian on the blanket and sit on my heels with Sebastian between my legs (making sure I'm not sitting on his tail!). Sebastian automatically goes into position by laying down in a meatloaf style on the blanket. I place my left hand with light to moderate pressure on Sebastian's neck and shoulder blade area to keep him from trying to get up. I talk to him the whole time. With my right hand, I grab the needle. It has a twist cap of sorts on it, so I have to quickly use both hands to take the cap off. Other than this, my left hand never comes off the cat. I then use my left hand to lift the skin where the needle will be inserted (back of neck area). I insert the needle with my right hand. Once the needle is in place, my right hand gently lets go of the needle and undoes the clamp on the line. I put my right hand back on the line close to the needle to support it while the fluids flow. Left hand is still on the cat. I rub Sebastian's chin and pet him with my left hand. After he's had 100 cc of fluids, I clamp the line with my right hand to stop the fluids and remove the needle with my right hand. I dab the insertion point with a clean paper towel that I had set aside in advance. Once I take my left hand off of him, he gets up. I then give him a treat as a reward. He's always waiting for it. 

He's so used to getting fluids, and we're really quick now, too. The whole routine I described above (minus the time of warming the fluids) only takes about 5 minutes. I do use the larger needles, though, which makes the fluid flow faster.

It seems "hairball season" in particular can be a difficult time for kitties with GI issues, so if you notice this pattern every spring, that could definitely be part of what's aggravating Obi's existing condition.

Wow, thank you for the detailed instructions!  I give Obi B12 injections, so I know how to insert a needle but they are smaller needles, I think, than what you may be using for fluids.  I will check.  Also, what kind of treat do you give Sebastian?  I have hesitated to give treats to an IBD kitty...but he used to love those fiber fish...what is safe? 

myrnafaye said:

 
Also, what kind of treat do you give Sebastian?  I have hesitated to give treats to an IBD kitty...but he used to love those fiber fish...what is safe? 

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I give Sebastian freeze-dried treats, but I stay away from liver because it seems to make his system all haywire (even moreso than it already is     ). He's currently getting PureBites freeze-dried turkey breast treats. Here's the product link: http://www.purebites.com/products/en/cat/turkey/

You still feed Obi the NV Instinct canned rabbit, correct? I know that it contains rabbit and pork liver as the main ingredients, so you could probably get away with offering little pieces of cooked pork as a treat if you didn't want to veer too far from his current diet.

Yes, Obi still gets NV rabbit.  Thanks for the link!  Ill ask the vet tomorrow what she suggests for treats.  In the past she has suggested making little "cookies" in the oven of his regular food.  The problem with that is the smell...I really hate the way baking cat food smells.  And how much of a "treat" is his regular food, anyway?

Obi's Ultrasound results:  I wanted to post about this for all who have helped and supported me and also for information. Obi had his ultrasound on Monday.  As many of you know, I have put this off.  Anyhow the results are in.  Obi's GI tract looks good, the vet did not see any thickening.  He does have a mass on his liver, which she thinks is benign or slow growing.  Since his hairball vomiting has waxed and waned over years, really, I suspect this has been there a while.  She thinks that the mass occasionally blocks the bile duct and caused GI inflammation.  Treatment:  1/4 Cerenia for two weeks.  He is doing quite well and I dont know whether to be relieved or anxious.  What I am wondering about is whether his pred can be tapered; the vet (understandably) does not want to change anything right now.  On the plus side again, it means he can have some cat treats - as he does not have IBD or lymphoma.

So the moral of the story is that if you ( cat lovers) are debating about an ultrasound - have one done.  I dont know if I wish I had done this sooner or not, but possibly if I had, Obi might not be on pred. for IBD.   Anyhow, he is 15 and still kickin' with a shaved belly.