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Ask Dr. Michael Salkin Your Own Question
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Cat
Satisfied Customers: 33315
Experience:  University of California at Davis graduate veterinarian with 45 years of experience.
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Hello, my cat Tinker is 18 years old next month and suffers

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Hello, my cat Tinker is 18 years old next month and suffers with Inflammatory Bowel Disease. She had her kidney function and thyroid function checked a few months ago and surprisingly all was well, just a slight abnormality which I'm told is great for her age. So to try to figure out what was causing her upset stomach (diarhhoea) I now only feed her Royal Canine brand of food for sensitive tummies and this has worked for while, her stools became formed again and her appetite calmed right down after a worming tablet. The problem now is that she has constant diarhheoa, often not making to her litter tray and having accidents around the house, with no diet change and shes up to date with her worming tablets, shes also hungry every 2-3 hours, starving hungry. Her bottom looks red and sometimes swollen, pertruding out quite a bit with what looks like tiny little lumps. I was wondering if cats could get piles? Or what else it might be and what I could do to help her? I don't want her to be in any discomfort, though oddly, she doesnt seem to be. I would really appreciate your help with this, thank you very much for your time :)
Aloha! You're speaking with Dr. Michael Salkin
I'm sorry to hear of this with Tinker. My first concern is that hyperthyroidism may be undiagnosed. A T4 (total thyroid) in the normal range may not be normal at all for an 18 year old. Any T4 2.0 or higher suggests hyperthryoidism in such a cat as Tinker so I'd like you to see what her last T4 was for me. It would explain her "starving hungriness".

My next concern is that her IBD may have transformed into a small cell lymphoma which is now causing her persistent diarrhea. Any chronic disease process in the bowel might cause such chronic changes as to result in malabsorption of nutrients and so her feeling hungry all the time. Chronic IBD and its sequela small cell lymphoma, then, can't be ignored as the etilogy of her persistent diarrhea.

While scoping and biopsy of Tinker's GI tract would be confirmatory for lymphoma, that kind of invasive testing is simply inappropriate for such a geriatric cat. Ultrasounding of her abdomen, however, is noninvasive and sensitive enough to detect the subtle inflammation in the bowel walls which suggests IBD vs lymphoma and should be considered for cats with persistent diarrhea such as Tinker. Alternatively, you could presumptively treat a severe IBD underlying her persistent diarrhea with the antiinflammatory antibiotic metronidazole and see if you get a positive response. A lymphoma isn't likely to respond as an IBD would.

No, cats don't suffer from piles but an anusitis certainly could result from the scalding of persistent diarrhea. Please respond with additional information (the T4 value, please) and with further questions or concerns if you wish.
Customer: replied 4 years ago.

Hi there, first of all, thank you so much for your time and the information provided.


Unfortunately, the veterinary practice that holds Tinker's blood results is closed until Monday morning. Would it be ok for you to wait that long until I can obtain the results please?


If Tinker does have an USS, would she have to go under general anaesthetic? And is that dangerous for her? Could there be a chance she wouldn't wake up at her age?


She has been on the medication Metronidazole before, they didn't seem to have much of an effect. Could that have been due to her still having a rich diet at that time? Rendering the tablets ineffective?


Thanks again for your help, I really appreciate it.



Certainly. You can return to our conversation at your convenience.

No, we rarely need to sedate our patients for an ultrasound.

Probably not. Metronidazole may not be a strong enough antiinflammatory drug for her IBD. A corticosteroid such as prednisolone may be required but I can't recommend its use until I see her diagnostic testing and know that prednisolone would be safe to administer.

I'll await your next message.
Dr. Michael Salkin and 3 other Cat Specialists are ready to help you
Customer: replied 4 years ago.

Hello again Dr. Salkin,
Thank you for your patience while I got the results you needed.

I can see on the paperwork I was given by my local Vet today that he did request a 'Geriatric Including T4 Total' when Tinker had her blood taken at the end of July last year. However I can't see a result for it, her Thyroxine level was 19.3 and below that the pathologist has written:

"Result consistent with normal thyroid function. Values in the upper portion of the reference interval may occur in some cats with hyperthyroidism, free T4 by equilibrium dialysis is often elevated in these cases. For hyperthyroid cats on therapy, values in the lower half of the reference interval re consistent with with good clinical control."

All abnormalities were: Albumin - 23.5, Urea - 12.5, ALT - 170.5, CK - 402.2, Cholesterol - 1.90, White Cells - 19.8, Neutrophils (Absolute) - 16.83, Lymphocytes (Absolute) - 1.19, Eosinophils (Absolute) - 1.78.

I hope this helps, sorry for the long reply, I'm just worried about Tinker. Thank you once again for your time, patience and advise.

No worries. The throxine level was in the low normal range and so rules out hyperthyroidism. The decreased albumin suggests loss of that protein through her urine at her age - I would need to see a urinalysis to confirm that - or lack of production of albumin by her liver. The increased ALT suggest liver damage and so we might conjecture that her liver isn't working up to snuff. The increase in ALT, however, isn't egregious. The elevated total white blood cell count suggests inflammation which we know is occurring in her gastrointestinal tract.

The next diagnostic of choice remains an abdominal ultrasound. Please continue our conversation if you wish.
Customer: replied 4 years ago.

Thank you so much. I'll book her in for an Ultrasound scan ASAP.

Yours Most Gratefully,

Tinker's Mummy! :)

Sounds good. Please keep me posted.

Thank you for your kind accept. I appreciate it.