12-year old cat won't eat, blood work / ultrasound w/ biopsy done - all normal

[rogerwhitson]

Hi,
I have a 12-year old cat who is barely eating. Tonight I got him to eat a little bit of chicken, but he hadn't eaten for 24 hours before that. Tests completed:

• Comprehensive Blood Panel w/ T4.
• Ultrasound w/ 2 fna biopsies due to a finding of a thickened intestinal wall. One of the intestine and one of the lymph nodes. Both were negative for cancerous cells. I asked if the Vetalog Injection could have interfered with the biopsy - told that wasn't possible but that it could interfere w/ IBD diagnosis.

Injections given

• Vetalog Injection
• Anti-Nausea Injection
• Antibiotic Injection

Any thoughts as to where to go from here? I'm concerned that I paid $1k for an ultrasound / biopsy that was potentially a false negative, but perhaps my concern isn't justified. I'm not sure.

I also asked what a thickened intestinal wall could be if not lymphoma or IBD, and was told that it could be pancreatitis (but that the antibiotic could help that) or a bad herpes reaction. My cat is positive for herpes, and has been sneezing. So, it could also be an upper respiratory infection. Also, I had COVID a week prior to the start of my pet's symptoms. My cat has been sneezing, but not too much more than normal.
I did notice him drinking a bit more than normal this morning, although I haven't seen that later on this evening - and I know some kind of kidney blood test was done w/ the Comprehensive Blood Panel, though I'm not sure what else is included in that.

He did have a urethra blockage a couple of years ago, but he's been peeing fine.

In terms of food, this morning, he ate about 1/2 of his regular amount wet food, as well as two handfuls of dry. And he ate a little bit of chicken yesterday. We're so far away from his normal food (it's prescription due to a urethral blockage a couple of years ago). I basically have all of this food. He seems interested when it's new, but the second time I try chicken, a new wet food, etc., he doesn't seem interested. Any thoughts would be appreciated. Thanks.

 

[rogerwhitson]

Sorry, last night he ate a bit of chicken after no food for 24 hours. Today he ate about 1/2 of his regular amount of a digestive wet food and about two handfuls of dry food.

 

[FeebysOwner]

Hi. I don't have much to offer but am amazed after all the posts I have read on this site, that the vet isn't 'defaulting' to IBD due to the thickened intestinal wall. As you already suspect, FNA findings that don't identify anything doesn't necessarily mean that things like lymphoma and/or IBD can be entirely ruled out. Although not completely accurate, sometimes an ultrasound will show inflammation of the pancreas.

There is a blood test called feline pancreatic lipase immunoreactivity, or fPLI, which is the most specific test there is for checking for pancreatitis. It’s a rapid test that looks for inflammation markers, but it can still miss some cases. The treatment for pancreatitis, unless severe, usually is getting the cat to eat, and sometimes sub-Q fluids to help flush out his system. Pain meds can be added to the equation as pancreatitis can be painful for some cats. I haven't read much about giving antibiotics as a treatment for pancreatitis, but if there is secondary infection brought on by a herpes flare up, they might help from that perspective.

Ask about the anti-nausea injection. Most that I know of don't last beyond 24 hours, so it's likely your cat should be given followup meds for nausea or repeat injections. And generally speaking, just one dose is not really enough. You could also ask about an appetite stimulant to go hand in hand with the anti-nausea meds. It is possible that he eats a 'new' food because the ones you have tried to get him to eat have made him feel nauseous, so he doesn't want to try them again.

In the meantime, try some baby food meat (Gerber Stage 2 or Beechnut) to get some calories in him. They are not complete nutritionally, but sometimes they will help to get a cat back eating again. Most vets carry Hill's A/D Recovery canned food, and for some reason many sick cats will eat that when they won't eat much else. It is loaded with calories.

I am guessing that the vet is thinking that your cat's lack of appetite might be due to a herpes flare up? You might also ask about anti-viral treatments, such as Famciclovir.

I hope others will come along soon with some additional ideas for you.

 

[rogerwhitson]

Thanks. Given the thickened intestinal wall, it seems like either lymphoma or IBD is more probable. Given that the FNA can't rule that out, I'm assuming we'll have to go in that direction. This is all very new to me and I'm a wreck, so thanks for replying and listening.

 

[FeebysOwner]

Thanks. Given the thickened intestinal wall, it seems like either lymphoma or IBD is more probable. Given that the FNA can't rule that out, I'm assuming we'll have to go in that direction. This is all very new to me and I'm a wreck, so thanks for replying and listening.

I am not saying it is impossible, but with IBD/lymphoma I am guessing there would be a progression of symptoms/issues. A lot of cats with IBD have stool issues, and many throw up. I think signs are more subtle and then increase in intensity over time. A herpes flare up could likely happen quickly.

Either way, you need to get medications that will help him to get back to eating. So, that probably would be my first focus, if it were me. Secondly, if you do ask the vet about anti-virals for a possible herpes flareup, ask if there is any harm in trying even if that is not what it is.

 

[rogerwhitson]

I mean, I only noticed the lack of appetite - that was the presiding concern. And we did a series of tests which only brought up the intestinal wall thickening. But yeah, I do agree that getting back to eating and anti-virals are prudent.

 

[Midget's Mom]

Sorry your baby isn't feeling well. I just wanted to ask about an appetite stimulant. We have used Mirtazapine topical on fur babies who are having appetite issues. Two of our sensitive-tummy kitties take Cerenia.

We dealt with pancreatitis a few years ago with Bubba. He was given antinausea meds and Mirtazspine. The vet told us the best thing for the condition is nutritional support, and it would resolve on its own. Just passing that along.

 

[rogerwhitson]

Thanks to the both of you - so I got some clarity on a few of these points after talking to the vet today.

Basically, to respond to FeebysOwner , she's treating it like IBD at this point by giving us the vetalog (steroid) injection and the antibiotic injection, which is how she'd initially start treating IBD. In terms of the FNA, she said that it's true you can't 100% exclude either IBD or lymphoma with an FNA. But that the research is based upon ultrasounds taken as an average across the country. A lot of the ultrasounds are probably taken by GP vets - and they sent me to an imaging center with board-certified sonographers. So, in her view there's a bit more certainty than the average that it's probably either not lymphoma or that it's so early in the disease process that it's hard to detect as lymphoma right now.

I asked about either endoscopy or exploratory surgery for confirmation. Her response was that it was really hard on cats to do that, and she'd probably not do that for her cat unless it would tell us significantly more than we already knew or change the treatment plan (and that can be doubtful in many cases when trying to distinguish IBD and early lymphoma even w/ a full biopsy). That was a reminder for me (so hard to remember) to think of his quality of life and how we're going to work on that - and not try so hard to get to 100% certainty that it isn't cancer. I asked her to keep reminding me, as I can get a bit to analytical when I'm anxious.

We also talked about the herpes / pancreatitis issues. She said the herpes stuff was probably miscommunication. She doesn't think herpes could explain the intestinal thickening (which to her is likely IBD). Herpes could be an instigating issue for the reduced appetite, given his history.

In terms of the appetite stimulant (i.e. @MidgetMom's point), she said she wanted to see if the steroid / antibiotic would work and not let an appetite stimulant potentially cover up that information. If he still has low-appetite on Monday, they'll work on either a feeding tube or an appetite stimulant or both.

The anti-nausea injection has probably worn off and, depending on how he does tonight and tomorrow, they may give him another one. It is likely that the nausea is part of why he's excited about new food and turning away old food (although he's vomited very little). Right now, they're focusing on supportive work to get his appetite back and will focus tests / treatments on that goal.

 

[FeebysOwner]

Thanks for the update. Not surprised that this has come down to IBD/or lymphoma in the vet's mind - as I said it is typically where they 'go'.

Yes, IMO, herpes cannot explain the intestinal thickening, but as she said it could explain inappetence. It is just very frustrating that sans stool issues and/or vomiting, that IBD is the 'apparent' sole cause of your cat's issues. intestinal wall thickening is the predominate factor to suggest IBD, I realize.

Even with Feeby who has NO intestinal wall thickening, no vomiting, no stool issues, but because she is inappetent, and has some enlarged intestinal lymph nodes, they still go to IBD or lymphoma. That is also with FNA ultrasounds that were inconclusive. Sorry, i guess I am emotionally biased.

You have to go with what you (aka the vet) know. Please continue to keep us posted. Any treatment is better than none.

 

[rogerwhitson]

yeah, I get the emotional stuff. I'm there too and frustrated and exhausted.

 

[rogerwhitson]

no vomiting, but the anorexia could be explained by nausea. so dunno. he vomited a little in the beginning but i havent seen that since then.

 

[Furballsmom]

Hi
Maybe there's something here, in the two articles and all the many posts that members added to it,
Any Good Tips To Get Your Cats To Eat? Share Them Here!

 

[rogerwhitson]

Thanks so much.

 

[rogerwhitson]

The eating issue is so frustrating and it's clear he wants to eat but is feeling nauseous. He kept looking at me wanting food today, and then refused it and drooled a bit.

He almost ate normally yesterday and then today nothing. It's like he's on a good-eating day / bad-eating day schedule. I thought it was nausea and I could by-pass that by constantly shifting foods, but I don't know how to deal w the nausea issue beyond getting an anti-nausea, which I should get tomorrow.

 

[FeebysOwner]

Yep, if he is not on an anti-nausea med, that would be - as you are going to do - the first thing to try. As I said before, some cats that are nauseous actually mistake it for hunger, much like human babies/toddlers do. They will try different foods in the hopes that it takes away the 'hunger', but when it doesn't, and they don't feel any better, they correlate that with the food and are no longer interested in eating that one. So, they think - 'a new food, maybe that will work!' And then, it doesn't, etc. etc. etc. I am tempted to tell you to also ask for an appetite stimulant as well.

Most anti-nausea meds don't necessarily kick in after just one dose, so be prepared for that too. You also have to consider how you are going to administer them as well. The meds are no good if you can't get him to take them.

 

[rogerwhitson]

They gave him a shot of some anti-nausea med last week, but it probably already wore off. I've never had to give him any meds, so I don't know how it will or won't work. I think we'll go for an appetite stimulant. The vet gave him a pretty potent steroid (vetalog) as an injection - and wanted to see if that would work first. I don't know if that's helped or not, since he seems to be going back and forth between being interested in food and not - but I would guess they'd want to see consistent improvement. Not sure. Apparently vetalog lasts for 7-15 days, and if this is IBD it would have helped some, maybe?

 

[FeebysOwner]

A one-time injection of anti-nausea meds tends to last no more than 24 hours. So, whatever he got last week has likely been long gone. The steroid can help with lack of appetite, not sure about nausea, but probably not enough to help without additional 'assistance'. Or, at least, not in the short-term is my guess.

The steroid is just to help reduce possible inflammation that goes along with IBD - it is going to be, IMO, something that has to happen repeatedly for a while to get results.

Just talk all of these 'angles' over with the vet to get a better understanding of their opinion/approach.

 

[rogerwhitson]

This is so complicated. And I have human IBD (Crohn's to be specific)! So, there's some comfort in sharing that with him.

 

[FeebysOwner]

This is so complicated. And I have human IBD (Crohn's to be specific)! So, there's some comfort in sharing that with him.

So does my husband! He does not vomit, but his appetite doesn't appear to be lacking. He does take B-12 injections for malabsorption (but not as routinely as he should). So, yes, it is complicated. Not to ask personal questions that you would prefer not to answer, but do you lack appetite that you can correlate to IBD? No reason to answer, just putting it out there.

 

[rogerwhitson]

No, my IBD is mostly under control with Humira and methotrexate. Before that it was bloody diarrhea that got me to get a colonoscopy. I wish it was that easy for my kitty.