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Ask Dr. Michael Salkin Your Own Question

Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Vet
Satisfied Customers: 26248
Experience:  University of California at Davis graduate veterinarian with 44 years of experience.
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My 13 1/2 year old male Birman cat has not been himself.

Customer Question

Hi. My 13 1/2 year old male Birman cat has not been himself. He's was diagnosed with pancreatitis a few months ago along with a bronchitis which cleared up. I've had anti- nausea medication for him on a as needed basis. The past couple weeks he's declined. He does drink water, he is hardly eating his science diet crunchies, sometimes will eat his fancy feast soft food, sometimes he won't, he will urinate in his box, but has decided to use our carpeted floor a few feet away from his litter box for his soft stool deficating. We took him to the vet last Saturday. Upon exam he appeared normal. Slightly dehydrated. She took blood work which came back normal. His feces had no abnormal bacteria growth. She also took a GI Panel... We're waiting for this to come back - hopefully Monday/Tuesday. He will hardly eat, he won't poop in his box. I'm very worried about him. His litter mate sister passed away 6 months ago. I don't want to lose him too. Any thoughts??
Submitted: 7 months ago.
Category: Vet
Customer: replied 7 months ago.
What else could be wrong?
Customer: replied 7 months ago.
We need some suggestions around the litter box too. With two young children in the house we can't deal with the pooping on the carpet issue for too long...??
Expert:  Dr. Michael Salkin replied 7 months ago.

You're speaking with Dr. Michael Salkin. Welcome to JustAnswer. I'm currently typing up my reply.

Expert:  Dr. Michael Salkin replied 7 months ago.

I'm sorry to hear of this with Ninja. Unfortunately, my thoughts are necessarily pessimistic. Ninja's age and decline over so many weeks is worrisome for a severe gastrointestinal disorder which too often turns out to be small cell lymphoma, gastrointestinal adenocarcinoma or mastocytosis. These neoplastic diseases aren't likely to be revealed in blood work but perhaps suggested in the GI panel. My next diagnostic of choice would be an abdominal ultrasound which is the most sensitive and readily available diagnostic for evaluating the GI tract itself. In many cases only scoping and biopsy of the GI tract reveals the etiology of such anorexia and change in stool.

What caused his sister's demise, please?

Customer: replied 7 months ago.
Oh boy! His sister, Lexy, had Kidney disease. She declined quickly.
Should I ask our vet on Monday to see a specialist who performs the abdominal and GI Track ultrasound? Will this be the best diagnostic tool?
Customer: replied 7 months ago.
it doesn't appear there's much I can do to help him use his litter box regardless the reason? If this behavior continues, our hand may be forced to make the worst choice possible. We can't have our house conditions unsanitary.
This is heartbreaking. He remains totally lovable and when not sleeping (which is most of the time), he's with the family just hanging out.
Expert:  Dr. Michael Salkin replied 7 months ago.

Thank you for the additional information. Yes, indeed. I believe that it will be more informative than the GI panel although I would like to know the results of that panel, please. In fact, I'd like to review his last blood work if you could upload a copy of those test results to our conversation. I understand that you might not have a copy at home but NInja's vet can give you one which you can scan into your computer and then give me the file link or you can photograph the pages and upload them by using the paperclip icon (if you can see that icon) or by using an external app such as dropbox.com/

Unfortunately, you can't retrain a cat who's ill to eliminate appropriately. You can only restrict him to areas you don't mind his soiling which I understand isn't ideal. I understand your concerns.

Customer: replied 7 months ago.
Thank you for understanding our concerns. I will need to get a copy of his blood work from the vet. You should know he has one functional kidney. He was born with this condition. However, his one kidney has not been an issue thus far. Once I get this information I will respond and include the data reports for your review. The blood work I can likely get tomorrow.
The vet would like to give ninja appetite stimulants. We've used these in the past and they make him a hyper mess. It makes me feel bad for him. Do you suggest we do this to help him eat despite the stimulating side effects and how they react on him?
Customer: replied 7 months ago.
Do you think it's safe to say it's NOT pancreatitis causing his illness?
Customer: replied 7 months ago.
nothing the vet has given him so far seems to be helping to harden his stool. It remains very soft or diarrhea.
Expert:  Dr. Michael Salkin replied 7 months ago.

If the benefit outweighs the risk, yes. Mirtazapine is preferred. You might see sedation but I wouldn't expect him to become a hyper mess which is more likely with cyproheptadine.

He may suffer from chronic pancreatitis but that should have been ruled out with a specFPL blood test or will or won't be in the specFPL blood test in the GI panel. In any event, I don't believe it would be his primary problem because I suspect a more diffuse gastroenteritis causing his diarrhea than would occur with pancreatitis alone.

Yes, if his diarrhea is due to neoplasia, it's not going to respond to drug therapy barring chemotherapy.

Customer: replied 7 months ago.
Thank you! I'll be in touch as soon as I have his blood work for you. Hopefully tomorrow.
Expert:  Dr. Michael Salkin replied 7 months ago.

You're quite welcome. I'll watch for your next post.

Dr. Michael Salkin, Veterinarian
Category: Vet
Satisfied Customers: 26248
Experience: University of California at Davis graduate veterinarian with 44 years of experience.
Dr. Michael Salkin and other Vet Specialists are ready to help you
Customer: replied 7 months ago.
Hello! I have the blood work and GI lab results as requested. On Friday, after learning the results of the GI panel, the doctor started him on Flagyl QD. Today, he had a normal BM for the first time in 3 weeks. Additionally, he used his box. I know it's only one day, but I think it's a good sign. I realize the true test of this is once he's finished the medication. If his stool returns to diarrhea/and or he stops using the box again, we will be looking at other dx. Anyway, please tell me your thoughts. Attached are the two lab results for your review. Thank you! Shelly
Customer: replied 7 months ago.
It appears my boy has chronic pancreatitis. Maybe a little sadness too since Lexy passed away. I need to find what will work to control the inflammation.
Expert:  Dr. Michael Salkin replied 7 months ago.

Thank you! A urinalysis is essential. His BUN and creatinine are elevated as I would expect with just one kidney but I need to see how well his urine is being concentrated and if excessive proteinuria exists which will give me a better idea of the health of that remaining kidney. His white blood cell count is elevated due to an increased number of the white blood cell neutrophil. This occurs with inflammation and not necessarily the inflammation associated with infection. I suspect that metronidazole was chosen because it not only acts as an antiinflamamtory drug but also as an antibiotic of value in the GI tract. The two pancreas tests are conflicting. I don't know if pancreatitis exists at this time. An abdominal ultrasound would be helpful in clarifying that.

Thank you for your kind accept. I appreciate it. Please continue our conversation if you wish.

Customer: replied 7 months ago.
Thank you for your perspective. I will be following up on Friday with his doctor. I will request the abdominal ultrasound to help us understand the inflammatory piece from the bowel size and the pancreas. Do you think this could still be indicitive of a neoplasm? Is there anything here that's ruled that possibility off your short list? Thank you!
Expert:  Dr. Michael Salkin replied 7 months ago.

Yes, the ultrasound will get us a good look at the pancreas and intestinal tract. We can detect the subtle inflammation seen with inflammatory bowel disease (IBD), infiltrative neoplasia, and solid tumors. Such a good response to metronidazole suggests that IBD is being successfully treated. A cancer isn't likely to respond so nicely to that drug. It's my pleasure. I can't set a follow-up in this venue so please return to our conversation - even after rating - with an update at your convenience. You can bookmark this page for ease of return.

Customer: replied 7 months ago.
Thank you! I gave you a 5 star rating and a great review. I really appreciate your insight!
Expert:  Dr. Michael Salkin replied 7 months ago.

I appreciate it. I hope to hear from you soon.

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