Stabilize Protein Losing Enteropathy

[fiona1775]

Sorry, accidentally hit post reply.
The vet emailed me and said, "At this point in order to get a definitive diagnosis as to what is causing Scruffy's inapppetance and weight loss we would need to get intestinal biopsies. That is something that I would refer you to the specialist for. This could hopefully be done via laprascope. I have discussed Scruffy's case with an internist and she agrees.

At this point, we have two options, either to continue with symptomatic treatment, and changing some medications or pursuing further diagnostics. If you would not like to pursue diagnostics, I would recommend increasing the Prednsiolone to twice daily, so that Scruffy would recieve a total of 4mg daily."

I just started a new job, and the money situation is causing problems. I just don't know what to do. I really don't want to put my cat through this, especially if there's not a good prognosis, but want to do what's best for him. I feel that the first vet really made things worse, and maybe irreversible damage over the past few months. With the increased prednisolone, this new vet also put him on metronidazole for bacterial overgrowth. I know antibiotics can kill the good bacteria, and although he's on a probiotic, I just started that up again this last week. When he stopped eating, I wasn't giving it because it's powdered. Now I'm giving it with the Bovine Colostrum and slippery elm bark.

The vet said she just needs him eating, whatever to get food in him. The assistant gave him Temptations treats, and while he loved them and looked for more, it also caused diarrhea. The vet said preferably not grain, which of course the treats had, but whatever he's interested in. He's definitely interested, but when the food is causing diarrhea and probably pain with the spasms, he then doesn't eat.

Syringe feeding...how much at a time? How much in a day? Has anyone had a similar experience, and a successful outcome? If so, what did you do? I'm at a point where I don't know if I can keep putting him through this. Thanks in advance for any advice!

 

[silent meowlook]

Hi.
I know it all seems overwhelming right now.

With my cat, I didn't do the diagnostic biopsy, I was working for a feline only veterinarian at the time and cost wasn't an issue. Yet, I didn't do it because I didn't want to stress my cat out with anesthesia. It is always a risk. Don't let anyone tell you it isn't. It is also a stress on the system. I did have an abdominal ultrasound done and it showed enlarged lymph nodes and thickened intestines. So, I treated accordingly. I treated as if it was lymphoma because there isn't much else it is going to be.

I started my cat on Vit B12 injections, Prednisolone at 5mg twice a day, and Chlorambucil at 2 mg. every other day. I also gave Cerenia to prevent nausea one hour prior to the Chlorambucil. I started a novel protein prescription diet, Royal Canin Rabbit, gave Probios as a probiotic and SQ fluids at home as needed. After about 4 months I was able to reduce the Prednisolone down to 5mg once a day and then a few months later, I reduced the
Prednisolone 5 mg. every other day.

I did try to add other vitamins into her diet, but she wouldn't eat it. I haven't kept up on the Probios and know I should, but she sometimes didn't want to eat with it on there. Sometimes I used the Forte Flora because it has a flavor enhancer in it that sometimes will entice her to eat more.

I also bought a baby scale from a thrift store for about $5.00 and I use that to weigh her every other week or when I think about it.

That's what works for me and has been working for her, as in she is alive with a fairly good quality of life, I think.

You do what you can do. There are gold standards that vets have and would be negligent not to offer. I don't believe they are always best for all animals.

I always ask how the treatment with the knowledge of the diagnostic tests will change the treatments. Often times they don't have an answer to that other than they will have a diagnosis. But how will a diagnosis change anything? Sometimes they might say that if they knew it was lymphoma, they could start Chlorambucil. Ask why they can't just start it anyway.

Just my opinion. I am not a veterinarian. I have worked at plenty.

I think anesthesia, for reasons other than life saving measures, is not the best thing for sick cat. That being said, when I worked for an animal internal medicine specialist, we did many endoscopic biopsies on many sick cats and never had a problem, that is known. But I have to wonder if they would have done better without the stress of anesthesia and biopsies, Because, when they go in endoscopically, they grab little pieces of the lining of the intestines and stomach to send into the lab. This is often not a sure thing you will get a diagnosis because whatever is ailing the cat may not happen to be in the samples they submit.

 

[fiona1775]

Hi.
I know it all seems overwhelming right now.

With my cat, I didn't do the diagnostic biopsy, I was working for a feline only veterinarian at the time and cost wasn't an issue. Yet, I didn't do it because I didn't want to stress my cat out with anesthesia. It is always a risk. Don't let anyone tell you it isn't. It is also a stress on the system. I did have an abdominal ultrasound done and it showed enlarged lymph nodes and thickened intestines. So, I treated accordingly. I treated as if it was lymphoma because there isn't much else it is going to be.

I started my cat on Vit B12 injections, Prednisolone at 5mg twice a day, and Chlorambucil at 2 mg. every other day. I also gave Cerenia to prevent nausea one hour prior to the Chlorambucil. I started a novel protein prescription diet, Royal Canin Rabbit, gave Probios as a probiotic and SQ fluids at home as needed. After about 4 months I was able to reduce the Prednisolone down to 5mg once a day and then a few months later, I reduced the
Prednisolone 5 mg. every other day.

I did try to add other vitamins into her diet, but she wouldn't eat it. I haven't kept up on the Probios and know I should, but she sometimes didn't want to eat with it on there. Sometimes I used the Forte Flora because it has a flavor enhancer in it that sometimes will entice her to eat more.

I also bought a baby scale from a thrift store for about $5.00 and I use that to weigh her every other week or when I think about it.

That's what works for me and has been working for her, as in she is alive with a fairly good quality of life, I think.

You do what you can do. There are gold standards that vets have and would be negligent not to offer. I don't believe they are always best for all animals.

I always ask how the treatment with the knowledge of the diagnostic tests will change the treatments. Often times they don't have an answer to that other than they will have a diagnosis. But how will a diagnosis change anything? Sometimes they might say that if they knew it was lymphoma, they could start Chlorambucil. Ask why they can't just start it anyway.

Just my opinion. I am not a veterinarian. I have worked at plenty.

I think anesthesia, for reasons other than life saving measures, is not the best thing for sick cat. That being said, when I worked for an animal internal medicine specialist, we did many endoscopic biopsies on many sick cats and never had a problem, that is known. But I have to wonder if they would have done better without the stress of anesthesia and biopsies, Because, when they go in endoscopically, they grab little pieces of the lining of the intestines and stomach to send into the lab. This is often not a sure thing you will get a diagnosis because whatever is ailing the cat may not happen to be in the samples they submit.

Thank you. I will speak to the vet about your suggestions. Greatly appreciated!

 

[FeebysOwner]

If there is tissue that can be collected during the ultrasound via an FNA (fine needle aspiration) an analysis can be done of that tissue to see if cancerous cells show up. If the FNA is inconclusive, that same tissue can be put through a further analysis, called a PARR assay which can detect cancerous cells if the FNA doesn't. None of it is absolute, but neither is a biopsy.

Feeby had the PARR assay done to determine her lymphoma. She was never sedated for any of it, and it is all non-invasive. The only thing she got was a calming agent, called butorphanol, which for her was only needed to enable them to shave her belly for the ultrasound. That med was fast acting and short lived.

 

[fiona1775]

If there is tissue that can be collected during the ultrasound via an FNA (fine needle aspiration) an analysis can be done of that tissue to see if cancerous cells show up. If the FNA is inconclusive, that same tissue can be put through a further analysis, called a PARR assay which can detect cancerous cells if the FNA doesn't. None of it is absolute, but neither is a biopsy.

Feeby had the PARR assay done to determine her lymphoma. She was never sedated for any of it, and it is all non-invasive. The only thing she got was a calming agent, called butorphanol, which for her was only needed to enable them to shave her belly for the ultrasound. That med was fast acting and short lived.

I have sent your information to the vet. Will see what she says. Thanks!

 

[fiona1775]

I sent an email to the vet with the info from silent meowlook and FeebysOwner in response to the email I received from her. This was her email to me:

"I cannot give you a prognosis without a definitive prognosis. I do not know if Scruffy has inflammatory bowel disease or an underlying cancer. I cannot give you a ballpark figure on the cost of the biopsy, as that is referrred to a specialist to be done laprascopically. I know it would be a minimum of 3-5 thousand.

I cannot tell you how many oz of food he should be eating. Every food is different. I would say the more that you can get down him the better.

I would say that its not time to give up yet, lets see how the increased steroid does for him. We can also try another immunomodulator. However, you know your kitty best and if you think its time I can fully support you in that.

I would advise not adding any new supplements at this time, lets see how his new medication dosage is going to work."

What has worked for diarrhea? He's on cerenia for nausea. I give him slippery elm bark 2x a day, but it's not helping fully. It was, but last week the diarrhea became worse. I'm sure it's from trying so many foods, just trying to get him to eat. I'm syringing Tiki Cat mousse, Nulo Perfect Purees and Pure Bites Digestion Intestin, which is a puree too. He's eating a tiny amount on his own when I'm at work. Not the best thing, but he'll also eat a little bit of Temptations treats. They gave him some at the vet's, and he really liked them. At home, he'll eat maybe a dozen in a day. I just don't know what to do. I don't want to drag him through this if he'll have no quality of life. If there's hope, I want to do everything I can. Thank you for all the advice. Greatly appreciated!