Cobalamin deficiency - What should I expect with shots?

henryhenryhippo

TCS Member
Thread starter
Kitten
Joined
Feb 10, 2016
Messages
15
Purraise
1
Location
Bergen County, NJ
Hey guys! I've been a lurker for some years and I always appreciate the information I find on this site. I'm really hoping someone can offer me advice on the following:

Back in June of last year my cat, Henry, began losing weight, vomiting, and being very lethargic. He would want to eat but every time he went up to his food he'd get nauseous, lick his lips like crazy, and run away.

I'm no stranger to the vet so I brought him shortly after this started. They ran a CBC and did an X-ray of his abdomen to make sure there was no blockage. Everything came back normal although his intestines seemed a bit bloated in the imaging. The vet said it was probably gas and sent me home with prescription GI food. He took to the food (hills dry I/D) but after a few days to a week, lost interest and the cycle began again. I tried him on various foods (everything from hills to orijen to primal raw) and at times he had 5-6 options laid out. Still he continued to have a poor appetite with bouts of vomiting and diarrhea. He's always has a fresh dish of water and wet food but refuses to eat anything except friskies (gravy and chunks) although, ever since this started he never eats the meat, he just licks the gravy. He drinks from the bathroom sink about 2-4 times a day.

After a lot of back and forth and not getting any answers from his longtime vet I decided to transfer his records and get a second opinion. At the first visit the new vet couldn't see anything immediately wrong. We went over the millions of records sent from the previous doctor (Henry has a long history) and he sent me home with prescription GI food (Purina EN dry). A couple days in Henry started having EXPLOSIVE diarrhea and was vomiting at least once a day. I had a feeling it was the purina so I switched him back over to a previous food. As usual, he was okay for a few days and then lost interest in the food.

The new vet had me come in for a weight check about 3 weeks ago and we found that Henry had lost even more weight. He used to be very heavy but you'd never know it now. His spine and hips protrude and he has almost no muscle mass.The vet drew his blood and ran a special test to check his levels of cobalamin (b12) and his pancreatic/folic levels. The results came back that he had low B12 levels. He said it could be anything from IBD, to lymphoma, to simply being deficient from poor diet. He suggested we start with doing B12 injections once a week for 4 weeks and then re-test his levels. If there was no improvement THEN we'd do an ultrasound.

Henry had his first injection on Monday 2/8 and was fine that night. When I arrived home from work Tuesday I noticed he had vomited on the rug and a few hours later he passed soft/light stool. Today when I got home I was petting him when all of a sudden he started to rapidly lick his lips. He then ran to his litter box and vomited (he's very polite sometimes). He hasn't eaten much today and I'm becoming concerned all over again. The vet is closed on Wednesdays OF COURSE! I'm going to call them first thing tomorrow.

I've been worrying about him non stop since June 2015 and nothing seems to help. He's never been healthy... he came to me as a stray with an infected wound and infested with fleas and mites. Soon after we found out he had a heart murmur and was diagnosed with hypertrophic cardiomyopathy. He's had pancreatitis once, 2 anal sac ruptures, he has herpes, asthma, poor dental health, and chronic inflammation in his ears. We think he's about 9 at the present time. He's a cream orange tabby.

I'm going to call the vet tomorrow and suggest we move forward with the ultrasound immediately. He's my entire world. I've spent thousands of dollars on him in the last 5 years. Every day I have a mini panic attack when I open the door that he's gonna be dead. I guess what I'm trying to get at here is does anyone have an experience similar to this or an idea what we might be looking at? He's not been himself for months and I'll do whatever I have to not only to save him but give him the day to day comfort every cat deserves.

***Side note- I'm aware that switching food is a 5-7 process. I've done the slow transition many times but since he no longer wants to eat whatever he's currently on, he won't ingest the new food either. Also, I know that temptations may as well be heroin but sometimes it's all he'll eat. He hadn't had them in months but I bought a bag last week in a desperate attempt to get food into him. He never has a problem scarfing them down.

*******Another side note- I'm sorry about this ridiculously long post. I don't know what to do anymore.
 

ruthm

TCS Member
Alpha Cat
Joined
Jul 13, 2015
Messages
397
Purraise
95
Location
Washington State USA
Did your vet run a full chem panel and send it out to a lab? Did the panel include a test for pancreatitis? Has he been tested for hyperthyroid and diabetes? Were you given anything for the nausea your kitty is experiencing?

I'm glad your going to be taking your kitty back to the vet- let us know what he say.
 
  • Thread Starter Thread Starter
  • #3

henryhenryhippo

TCS Member
Thread starter
Kitten
Joined
Feb 10, 2016
Messages
15
Purraise
1
Location
Bergen County, NJ
Ruth - 

The previous vet ran a CBC around October. All his levels were normal. Sugar was fine. The new vet ran a "E Feline Maldigestion Panel" earlier in the month. It showed that his cobalamin was low. His Folate was within range but his TLI was high.

This is what the results said:
TLI (Feline)93.4(High)HIGH12-82 (normal)mg/L  
 0-8.0ug/L = Diagnostic for exocrine pancreatic insufficiency.
8.1-11.9ug/L = Results are equivocal. TLI should be repeated in 1-2 
months. Ensure animal is fasted 12-18 hours before sample is taken.
12.0-82.0ug/L = Normal Range
82.1-100ug/L = Mildly elevated serum fTLI. Such mild
elevations are usually not significant. Serum B12 and
Folate concentrations should be evaluated to assess the
patient for chronic small intestinal disease.

100 or greater = Indicative of pancreatic pathology (i.e. acute or
chronic inflammation, or chronic hypertrophy). Cats with increased
serum fTLI concentration often have clinically more significant
small intestinal disease. Check serum B12 and Folate to assess small
intestine.
The new vet wants to see how he does after the four b12 injections and then re-evaluate the situation. I'm just worried that while we wait something worse could be brewing. I couldn't really find anything suggesting that B12 supplementation would contribute to digestive upset. He hadn't vomited in weeks and then he had the shot and boom - twice in 24 hours. 

I'm waiting for the vet to get back to me with his opinion.
 
  • Thread Starter Thread Starter
  • #4

henryhenryhippo

TCS Member
Thread starter
Kitten
Joined
Feb 10, 2016
Messages
15
Purraise
1
Location
Bergen County, NJ
The vet just responded. Here's what he said:

"Thanks for updating us as to Henry's condition. You are correct in that Cobalamine is not going to be causing these issues, only his current maldigestion/GI issues. If he is otherwise doing well between these episodes then I would just note them and if they seem to be picking up in frequency then let us know at the next injection. "

Should I be pushing him to perform the ultrasound or am I being irrational?
 

katladee

TCS Member
Kitten
Joined
Sep 30, 2010
Messages
16
Purraise
1
Location
kansas city, mo
this sounds a LOT like our feral we rescued this summer.

very dramatic and quick weight loss, poor appetite, explosive diarrhea.

we initially treated with several antibiotics because he is FIV+ and his blood tests suggested a blood parasite. we also wormed him -- he was FULL of parasites.

however, he continued to decline and his white blood cells continued to increase, so we got an ultrasound.

we found that his intestines showed very abnormal thickening. he may have IBD, but most likely has lymphoma.

he was in no shape for exploratory surgery, so we immediately started with 5mg prednisolone and the weekly (now monthly) vitamin B shots.

there have been no major side effects and the turnaround has been incredible. since august, his weight has doubled! litterbox and appetite very normal. no idea how long we have together, but we are making the most of it.

i would encourage you to get an ultrasound asap -- it will give an immediate, very clear picture of what is going on in there.
 
Last edited:
  • Thread Starter Thread Starter
  • #6

henryhenryhippo

TCS Member
Thread starter
Kitten
Joined
Feb 10, 2016
Messages
15
Purraise
1
Location
Bergen County, NJ
Katladee -

It's so great to hear I'm not alone in this. I really want to do the ultrasound but the vet said it's better to not spend the money if I don't have to. I'm single, live in a small one bedroom apartment, and work as a receptionist. I am in no way close to being wealthy but when it comes to Henry money is not an issue (Plus I have insurance!!!!). He still says we should wait.

When they do the ultrasound, they have to sedate right? With his HCM I'm always terrified that he'll die under anesthesia. My old vet used to sedate him for everything. They said he was too difficult to handle and I would be pacing all day worrying. I told the new vet how they always put him under even for nail clipping and he thought it was ridiculous... I did too until I heard his wails from the back room. 10 minutes of ungodly sounds. I thought they were skinning him alive!! They finally came in and said that was just them trimming his nails. It took THREE techs to hold him down. There's no way he'd lay still for an ultrasound even if being awake was an option. What a dreadful situation!
 

ruthm

TCS Member
Alpha Cat
Joined
Jul 13, 2015
Messages
397
Purraise
95
Location
Washington State USA
It looks like your vet ran the test for Exocrine Pancreatic insufficiency ( http://healthypets.mercola.com/site.../05/15/exocrine-pancreatic-insufficiency.aspx)  Is your kitty having light colored, large stinky poop?  The test for EPI is entirely different than the test for Feline Pancreatitis, that test is run separate of the normal chem panel, it is called Spec Fpl and takes 2 days to come back from an outside lab. Was this test ever run for your kitty Henry?  

I am not a vet, but your kitty is losing weight and has been vomiting since June of last year?  If it was me, I would not hesitate to have the ultrasound done, and get a plan of action started... but I would also check to make sure pancreatitis is ruled out.  (spec fpl) I have had two kitties that had ultrasounds; neither one needed to be put under for an ultrasound and neither seemed stressed afterward. What I would recommend is that you have it done by a board certified radiologist, DACVIM, the correct interpretation of the results depends on  the experience of the radiologist.
 
  • Thread Starter Thread Starter
  • #8

henryhenryhippo

TCS Member
Thread starter
Kitten
Joined
Feb 10, 2016
Messages
15
Purraise
1
Location
Bergen County, NJ
Yesterday evening I brought Henry in for his second cobalamin shot. He seemed fine and I went to bed later on in the night. At 12:30am I woke up to him vomiting and again at 4:30am.

When I was at the vet yesterday he said "It's not the shots, it's your cats GI disease" -- GI disease? You never told me you settled on anything. If you've already figured out a DX then why are we playing the wait and see game??? Also, it seems off to me that he vomits within 24 hours after the injection both times.

Has anyone ever had to bring their cats in for cobalamin supplements? What was your experience with it??
 

thezoecat

TCS Member
Kitten
Joined
Feb 16, 2016
Messages
6
Purraise
1
This sounds a lot like my kitty's cluster of symptoms, minus the vomiting.

Has your vet given Henry anything for nausea?
 

ginny

TCS Member
Top Cat
Joined
Apr 21, 2012
Messages
2,668
Purraise
713
Did the vet do a test to see what his Intrinsic Factor level is?  I'm not sure if there's a test for that, or even if the same rules apply from humans to dogs, but Intrinsic factor is a glycoprotein secreted by the stomach's parietel cells.  Without this, B12 cannot be absorbed and assimilated.  With all the vomiting, which sounds like something else going on I suppose, I would think that his intrinsic factor is low as well.  Maybe the B12 shots bypass the need for intrinsic factor because it is absorbed directly through the muscle, but it's just a thought.  
 
Top