Somewhat Annoyed with Casper's Ultrasound Consultation

So, first, let me say we LOVE the vet we take our kitties to.  Thus far they have received very good care and the staff on the whole are really lovely people.

However, at the moment I'm somewhat annoyed.  Nearly 2 weeks ago we brought 15 year old Casper in for an ultrasound. He's lost 2 pounds this year, and his appetite has been terrible along with throwing up consistently at a minimum of every few days.  

After exhausting other tests and finding nothing conclusive, we decided an ultrasound was the next best way to go.  This was done by a specialist.

We had a meeting with one of the vets right afterwards and the 2 things he mentioned were either lymphoma or IBD.  Without further testing (which would not necessarily show either) we decided to treat it as if it were IBD for now.  If he had cancer, we all agreed he probably would have been long gone by now since this has been going on at least a couple of years.  

He was given a steroid injection to help with inflammation and his poor eating.  I broke down and purchased the special diet food (which I've always been loathe to do but figured, I'd give it a chance).  This has not made any impact nor did I think it would. We go back in about 2 weeks for a reassessment. 

Today, it suddenly occurred to me to ask for the ultrasound report.  Well, on it was something I had also thought could be the problem; pancreatitis.  The vet NOT once said a thing about this.  

For those who are more knowledgeable I'm giving you the exact wording off the report. Perhaps someone could enlighten me further?

Abnormal Finding:  The pancreas were prominent.  The mesenteric lymph nodes were elongated measuring .5 x 1.8 cm.  There was a prominent small intestinal wall layering.  The intestinal walls were not thickened.  The right kidney was slightly enlarged measuring 4.8 cm. in length.  The architecture was normal.  The liver was slightly hyperechoic.

Normal Findings:  The gallbladder was of normal size.  There was no evidence of calculi or sludge in the gall bladder.  The remainder of the biliary system was normal.  There are no masses, calculi, or structural defects in the urinary bladder.  There was no evidence of adrenal gland enlargement or neoplasia.  There was no inflammation or neoplasia involved in the pancreas.  There were no abnormal masses seen in the spleen.  The size and parenchyma of the spleen was within normal limits.

The left kidney was normal measuring 3.4 cm. in length.

Diagnosis:  The changes since in the intestines and lymph nodes could be due to infections or inflammatory disease.  Neoplasia would be less likely.  The changes seen in the liver could be due to early hepatic lipidosis.  The enlarged right kidney could be a normal variation or could be due to infection.  The changes seen in the pancreas could be a normal variation or could be due to pancreatitis.

Comments:  Multiorgan biopsies would be needed for a definitive diagnosis.

Have you noticed any improvement or worsening with the addition of the steroid?

Has Caper ever been treated with a combination of Cerenia and a low dose of metronidazole?

My Max has issues with recurrent pancreatitis. Started when he was 15 months old and occurs about once or twice a year (haven't had any major issues since tweaking food, though I keep Cerenia on hand just in case..)

I too would be curious of something other than IBD since the intestines showed no thickening.

Cadet may even have Triaditis, which affects the pancreas, liver and small intestines (the latter can actually causing inflammation in the stomach.)

What confuses me is that it says there is prominent small intestine layering, and then they said there was no thickness on the intestinal walls. Do they mean the large intestines, then? I think it it were IBD, then he WOULD have inflamed intestines, AND I would think for most types of that HORRIBLE, unspeakable disease, I would think the intestinal walls would be inflamed as well. I mean, I suppose not. But every time I heard mention of it, inflamed intestinal walls for signs of BOTH those diseases.

You are in the same predicament that I think the majority of us with an IBD kitty has found themselves in.  I did not get a biopsy done and there has to be a period of time after a steroid before the biopsy can done.  I chose to go ahead and treat for IBD.

I would go ahead and get the blood test for Pancreatitis, the one that is sent out.

I am also in that boat! Cleopatra was diagnosed with either IBD or cancer. The vet explained once we started Prednisolone, we could not do a biopsy. We decided that we would go ahead and just treat with Pred and see how everything went.

Sounds as if it is most likely IBD, but does not exactly fit the cut off measurements for thickening of the intestine.. a Radiology loop-hole language. 

The Prominent Pancreas, can either be a normal variation or a slight sign of an enlarged, enflamed pancreas. The texture seems to be normal, so then again it is at a borderline. If it was truly an infection, the texture would be different. Pancreases vary is shape ...there is the normal thickness and then there are the ones which measure a bit big, but is normal for the animal, human.

The enlarged right kidney could also be a normal variation, rather than an abnormality...

The hyperechoic liver is another matter. It could be from an infection or from his not eating... hard to tell on ultrasound..It could be a sign of hepatic lipidosis, but again, I think bloodwork would be helpful.

It really sounds like a wishy-washy ultrasound report. Yes, I would be upset. Whoever read it was afraid of taking a stand....IMO an #@@#  not spelt out but you know what I mean.. wishy washy. 

If any biopsy had to be done, personally, I would have done the one for IBD...

The pancreas is best to check on a specialized blood test. The same with the liver. 

I was an ultrasound tech, so I hope I helped out a tiny bit in explaining the report. 

As far as I know, pancreatitis is treated the same as IBD. I am not sure that having the blood test will be accurate because he has been given steroids. 

Has your Vet prescribed something like Pepcid, or an anti-nausea medication?

That would help a lot...

I hope this helped a bit. I would ask the Vet to go over these U/S results with the Radiologist...

((hugs))

Artiemom said:

 
Sounds as if it is most likely IBD, but does not exactly fit the cut off measurements for thickening of the intestine.. a Radiology loop-hole language. 

The Prominent Pancreas, can either be a normal variation or a slight sign of an enlarged, enflamed pancreas. The texture seems to be normal, so then again it is at a borderline. If it was truly an infection, the texture would be different. Pancreases vary is shape ...there is the normal thickness and then there are the ones which measure a bit big, but is normal for the animal, human.

The enlarged right kidney could also be a normal variation, rather than an abnormality...

The hyperechoic liver is another matter. It could be from an infection or from his not eating... hard to tell on ultrasound..It could be a sign of hepatic lipidosis, but again, I think bloodwork would be helpful.

It really sounds like a wishy-washy ultrasound report. Yes, I would be upset. Whoever read it was afraid of taking a stand....IMO an #@@#  not spelt out but you know what I mean.. wishy washy. 

If any biopsy had to be done, personally, I would have done the one for IBD...

The pancreas is best to check on a specialized blood test. The same with the liver. 

I was an ultrasound tech, so I hope I helped out a tiny bit in explaining the report. 

As far as I know, pancreatitis is treated the same as IBD. I am not sure that having the blood test will be accurate because he has been given steroids. 

Has your Vet prescribed something like Pepcid, or an anti-nausea medication?

That would help a lot...

I hope this helped a bit. I would ask the Vet to go over these U/S results with the Radiologist...

((hugs))

Click to expand...

Thanks everyone. I'm going to address @artiesmom  since she did such a nice job of pointing everything out step by step.

1. I'm calling the vet today to talk to the doctor that I saw for this problem. He didn't do the ultrasound, they called in a specialist.  The report really didn't give me any further information than what I already pretty much knew and is somewhat confusing as written.  I want clarification for sure!

I'll ask about further blood tests. 

We were giving him Pepcid daily but it didn't seem to be helping him at all.  So, we stopped.  Same with many higher quality foods.  He would throw up the best, most expensive brands like Tiki Cat. I finally gave up feeding both of them so well.  He manages to keep down Fancy Feast Classics most of the time, and has been doing ok on the prescription diet - much to my chagrin and opinions of it.   

He has been eating better since the steroid injection - he shows actual interest in the food. However, we're not giving him more than a few ounces at a time just in case he does throw up.  This past week, he threw up the day I brought him back from the vet (which I chalked up to him not eating for over 12 hours combined with stress).  He threw up again a couple of day ago but for the most part has been managing to keep the food down better.  8 days, 2 times isn't too bad for him.  We've had weeks were it was nearly every day.  

I told my fiance to give him food whenever he wants it.  At first, he was balking about this which I found surprising; he adores Casper and is so upset that he is having this problem.  IDK what was in his head but I finally made him realize getting calories into him was the highest priority.  I don't care if he only eats 1/2 a can of a 3 ounce can at a time as long as he is eating consistently.  At this point, he's getting a total of about 4-5 ounces of wet food a day plus, a small amount of kibble as a snack mid-day and before bed (it's our routine lol - then he brings ME upstairs!).   Probably around 1/8 a cup of kibble total.  It still isn't quite enough but it's more than before. When all is said and done I believe he's getting about 150-200 calories into him a day, and as long as he doesn't bring it up I'm ok with that.  

Oh and I'll ask about the Cerenia and metronidazole that @CatPack  suggested.

Last, I joined the IBD Kitties group on Facebook suggested by a friend and they too, like here, have been very helpful.

This really is incredibly difficult let alone with having another cat in the house to keep away from his food and vice versa!  My empathy goes out to everyone and all the sweet kitties here dealing with this.  

(((hugs))) and hope I did not confuse you.....

Artiemom said:

 
(((hugs))) and hope I did not confuse you.....

Click to expand...

Not at all. Clarified yes!