PLEASE help; wasting away-what are we missing?

Can anyone PLEASE offer any advice on what we might be missing? Our 14-year-old spayed indoor "generic" tabby cat is losing weight so dramatically I know she can not last much longer. She should weigh about eight pounds; right now she weighs just under five. She has lost so much muscle mass she can no longer hold her front feet correctly and instead of walking on her toes she has sickle shaped lower legs where she can't hold her "ankle" up. All this despite eating 18-24 ounces of canned food per day (yes, that's 6-8 cans per day!)
She was diagnosed with hyperthyroidism about a year ago and has been on medication since then. She is currently on 5mg of Tapazole twice daily and (this is important) her thyroid levels are ALL normal. The vet did a more extensive panel this week but everything's well controlled. Her AST and ALT (liver studies are normal). Her BUN and creatinine (kidney studies) are normal. XRays of chest and abdomen show no obvious abnormalities, and the vet doesn't immediately suspect cancer because her blood counts are all normal. The ONLY thing out of normal is a very slightly low cholesterol, and a mild anemia noted earlier this summer has resolved. Microscopic stool evaluation was negative for ova and parasites.
WHAT ARE WE MISSING????? I see her dying in front of me and it's unbearable; there must be something there. At least if I knew what was wrong, even if incurable, I could start to deal with it. Does anyone know of another reason that fits these symptoms why she'd be losing so much weight despite her excellent appetite? She doesn't seem to be suffering. Sometimes she acts as though she just doesn't feel good, but the rest of the time she acts pretty normal. She isn't sleeping like she used to, and is waking us up all night, but we think it's because she's so hungry all the time.
Please, can anyone help?

Was she also screened for diabetes?

Unfortunately, yes, thanks. Forgot to mention that her blood glucose is fine.

What are her potty habits like? Is she potty'ing normally or more than usual or less than usual? What was her Potassium level?

~gf~

I would seriously consider seeking the assistance of a new Vet, preferably a Feline Specialist.

Originally Posted by dawnofsierra

I would seriously consider seeking the assistance of a new Vet, preferably a Feline Specialist.

Click to expand...

Although it sounds like your current vet has been very thorough, another vet may thing of something he/she hasn't yet.

have you asked the vet about possibly tweeking the levels of tapazol ??? How is her heart and blood pressure??? and I am so sorry you and your baby have to go through this!!

Tapazole dose is finally dead on. I don't want to make her hypothyroid; too many side effects with possible kidney dysfunction, etc.

More stools than normal, but the stools themselves are relatively unremarkable. No mucous, fatty deposits, parasites, etc. She has taken to stooling outside the box about 60% of the time, but not in any one spot and she is not (thank goodness!) tinkling outside the box. I don't know what her K+ was, but was told that her chemistries were all normal except for the low cholesterol.
An "ask a vet" site suggested an intestinal biopsy or, if she's too unstable (I think she is) an echo. That's one (two?) avenue we haven't pursued yet.

The American Association of Feline Practionioners web site has a link to help find a feline specialist in your area who could see her and give an opinion.

I hope the problem can be found & she gets better soon.

Even if the K level was at low normal, she should be supplemented. If she has been tinkling a lot of dilute urine (which is usually the case when they lose the weight that fast) you might be losing potassium faster than the body can compensate for it's loss. Also, if she is losing that much weight so quickly - you probably also want to check the urine for ketones just to be safe. That, along with the low potassium (if that is the problem) might explain the muscle weakness you mentioned.

I really am stumped if everything on the organ panel was "normal". Has your vet checked the calibration on his lab equipment or did he have multiple tests run at different labs? There is obviously something amiss and I must agree with the others who suggested a specialist - it really does seem to be the time for that.

~gf~

I come to this thread a little drunk, so forgive me as it may be the Chablis Talking.

You seem to have been phenomnemally thorough (ok so that sentence took 4 attempts to type) in terms of medical diagnosis.

Is there anything socialogical you could be missing? Cats can waste away when they are under extreme stress or pressure from other animals. Has anything changed in your cats social environment?

Poor baby girl. Sending her health vibes.

Originally Posted by gayef

. Also, if she is losing that much weight so quickly - you probably also want to check the urine for ketones just to be safe. That, along with the low potassium (if that is the problem) might explain the muscle weakness you mentioned.

I really am stumped if everything on the organ panel was "normal". Has your vet checked the calibration on his lab equipment or did he have multiple tests run at different labs? There is obviously something amiss and I must agree with the others who suggested a specialist - it really does seem to be the time for that.

~gf~

Click to expand...

I would be shocked if her urine weren't positive for ketones because of her extensive wasting--but still not sure what to do about it. The labs were run at a "regular" hospital, not at the vet, (you know how picky they are!!) and have been repeated several times to boot. The vet we're seeing now is a feline specialist, but if she survives the weekend I am going to ask for a referral to a local specialty hospital that takes patients by referral only. At this point I feel pretty hopeless, and am trying to make plans with my husband and five-year-old for the day we come home and find her expired.
You have never seen a kitty look so awful and yet act so normal. It is heartbreaking.

No social changes at all. Same house, family, box, schedule, litter, diet, no new pets, no new people, no family stressors (except having one very sick kitty). I wish it were that easy--but thanks much for the suggestion.

My heart goes out to you and your kitty, Is the vet sure there is no internal bleeding? We had a real young kitten this winter that would eat all the time and his litter box had a real bad smell but we didn't know why. One night he was playing and the next he was collapsed on the floor with really bad smelling old blood coming from his mouth. We rushed him to a animal hospital but they had to put him to sleep because he was brain damaged from blood loss. The old blood he was spitting up smelled just like how his litter smelled, but we never put 2 and 2 together till it was to late. The funny thing when I would clean his litter it looked normal, not red or black and runny. Just a real bad smell. Probably not the same problem as your kitty has but I just thought I would throw it out there.

i am so sorry to hear about your baby!! i think you are wise not to mess with the tapazole, but hyperT can mask kidney failure, so even though her numbers are not showing it, she could be wasting away from that- my old girl is going thru something very similar although not quite that dramatic- she is so thin, she looks like a stick figure kitty, and she eats a lot of food, but only about half as much as yours is. she too wakes me up all nite long.
when her blood work came back not looking too bad, at least not bad enough to explain the condition she is in, he said that she could have had failing kidneys all this time and it does not show up til quite late in the disease, and that her eating a lot and losing wt could be IBD and/or an intestinal lymphoma (which can be diffuse, meaning no tumor, just all inside the intestinal walls) which would cause thickening and malabsorption- he also said that if she had IBD it often leads to intestinal cancer

she is getting subqs and stuff for nausea, and as much food as she wants. there does not seem to be anything else to do

my heart goes out to you, this is happening so fast, it has to be a huge shock. i pray they find a solution and can fix her up!!
hugs
althea

Originally Posted by TiffanyK

I would be shocked if her urine weren't positive for ketones because of her extensive wasting--but still not sure what to do about it. The labs were run at a "regular" hospital, not at the vet, (you know how picky they are!!) and have been repeated several times to boot. The vet we're seeing now is a feline specialist, but if she survives the weekend I am going to ask for a referral to a local specialty hospital that takes patients by referral only. At this point I feel pretty hopeless, and am trying to make plans with my husband and five-year-old for the day we come home and find her expired.
You have never seen a kitty look so awful and yet act so normal. It is heartbreaking.

Click to expand...

Hyperthyroidism can and oftentimes will mask renal issues. While I am certain there is probably a toxic level of ketones present, my guess is that the kidneys are compromised.

You said that her T4 values were normal, but were they on the high end of that range? Sometimes, hyperT kitties do better when they get lower in the range of values.

Can you get her to eat dry food? Perhaps mix it with the wet or add some cat milk? Spot didn't start gaining weight at all on the wet food, but he has been bulking up nicely with a combo of wet and dry. He is a big kitty, and he was down to 7 pounds 1 ounce with so little padding that he cried if I picked him up. He's up to 9 pounds now. Unless your kitty is having kidney problems, it might be worth it to aim for the lower end of the normal range with T4 values to see if that helps. Also, there are several different T4 tests, so if your vet hasn't checked the Free T4, you might ask him/her to do so.

Thanks for everyone's help. We did do a free T4 by equilibrium dialysis and it's normal, and her thyroid has been all over the map and her kidneys are fine--it's one thing the vet was concerned about too, that because hyperT masks kidney failure that we'd solve one problem only to uncover another--but no go. Kidneys are and have been fine throughout. Thyroid is actually running low normal now that we've got her on oral meds and this is the highest dose she's needed since the beginning.
We've offered dry and wet food, mixed together and separate, and she won't eat it (boy do we have a lot of food! And the shelter can't take it because it's open!) We are giving her feline NutriCal supplements but to no avail. I was afraid she wouldn't make it through last night but she's still here, so I'm hoping to take off tomorrow and take her to another specialist.
At least if I knew she was terminal I could accept that, but just to let her go because we don't know what's wrong bothers me.
I think intestinal CA is reasonable, although without changes in her stools I think IBD less likely.
You all are wonderful. I can't thank you enough for all the support and suggestions. I hope in the next few days we'll have an answer--one way or the other. In the morning I feel more hopeful; at night I'm distraught. I can't wait for the vet to open tomorrow so I can try for more answers.