You're speaking with Dr. Michael Salkin. Welcome to JustAnswer. I'm currently typing up my reply.
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?
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.
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.
You're quite welcome. I'll watch for your next post.
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.
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.
I appreciate it. I hope to hear from you soon.