Erik: holding steady, more or less

[cellio]

Last November, Erik's hyperthyroidism flared up and we bumped his tapazole up to one (5mg) tablet per day. We also made some other medicine changes for his hepatitis. In January all was well, his liver numbers were better than ever, and his thyroid number (T4) was normal again.

In March he'd lost some weight and his T4 was up, so we bumped up the tapazole again, to 1.5 tablets per day. We kept everything else the same. (The Denamaine is still spotty.) His bilirubin was elevated, which is cause for concern, so my vet wanted to recheck in May.

The report is pretty similar to January -- white-blood-cell count is still lower than previously usual for him at about 13k, T4 is back down to 1.0 (highly normal), and ALT (liver number) is 841 (high for normal cats, but pretty low for him). His bilirubin is still high (0.9; was 1.0 in March). We're going to look for a blockage (or anything unusual) with an ultrasound.

Now, a year ago Erik had an ultrasound that showed something that looked like stones. I consulted a surgeon, he was skeptical about the stones, and we talked about options. Basically, he said, to know what's going on they'd have to do exploratory surgery, but that's risky for this cat. He thought the possible causes for Erik's symptoms were his hepatitis (already being treated), IBD, lymphoma, or pancreatic cancer. My vet and I discussed this and I was leaning toward treating for IBD on spec, but she wanted to try some other things first (including the drug changes we made last fall).

It's been almost a year. While I can't say that Erik doesn't have cancer now, it seems a pretty safe bet that he did not have either of the named forms of it a year ago. (My vet concurs.) And his WBC is lower than normal, and (I think?) cancer usually causes that to be elevated. We've made progress treating his hepatitis, but he's still having problems. So at this point, unless the ultrasound shows something new that we should be concerned about, my strong inclination is to treat for IBD. The treatment is Prednisone, which does things that would make testing for cancer harder, which is why we didn't just do it last year. Now, though, it seems like the smart move, and if it can make Erik healthier I'm willing to take our chances with future diagnosis of a condition he probably doesn't have now.

Comments

[alienor.livejournal.com]

Did your vet mention other treatments for IBD besides steroids? Sometimes it's related to allergies and an elimination diet can help reduce inflammation since whatever is causing the inflammation is no longer present (prednisone also reduces the inflammation response, that's why it's a treatment for IBD).

There's a few routes that can be taken with it: (1) try a completely hypoallergic (prescription) diet (2) eliminate things one at a time (usually by homecooking single ingredient meals) (3) do a blood test for allergies.

We did (1) and eventually (3). We can't use steroids on Yates (lowers his immune response so his sinusitis cranks up into a NASTY infection), so the diet has really helped out for him. His symptoms are bad enough, though, that we decided to try allergy shots for further relief (because of the sinusitis, too), and that's the reason we had to do the blood tests. The blood tests did guide us to some non-prescription food that he could eat, though, so they saved money in the long run.

Anyway, sorry if you know all of this, just wanted to make sure you were aware of an alternate treatment that doesn't have the same drawbacks as prednisone, since you mentioned some concerns with it.

Good luck with Erik!

[cellio]

We've talked about diet but it was about ingredients; we haven't discussed prescription foods that might apply. I'll ask about that. (Erik is a picky eater and I've been tracking what he likes and keeps down. Conclusion so far: fish good, chicken acceptable, turkey usually uninteresting, red meat queasy-making.)

Thanks for the info! I'd rather hear something twice than zero times.

[alienor.livejournal.com]

Your list of foods is interesting to me, since it's similar to Yates's allergy list. Beef bad, turkey and chicken slightly bad (I don't remember which is worse), fish fine.

OTOH, Yates happily ate turkey, and he's allergic to that.

I didn't know off hand what protein is in the hypoallergic prescription food, so I looked up Royal Canin's hypoallergic (http://www.royalcanin.us/products/productdetail.aspx?ID=100). It has chicken fat in it (which means that Yates is allergic to it). That's crazy. The idea behind hypoallergic (in an IBD case) is to give them food sources that they've never been exposed to so that they've never had a chance to develop allergies to those foods.

They have a list of others you can use, too... Yates has tried Green Peas and Duck (http://www.royalcanin.us/products/productdetail.aspx?ID=95) and Green Peas and Rabbit (http://www.royalcanin.us/products/productdetail.aspx?ID=97). He gets the rabbit when we feed him dry because it's cheaper, but we have to order it online - no one locally carries it (wet food is easy to find in fish only varieties that he's not allergic to).

The benefit of the duck is that someone... I want to say Nature's Balance?... sells an over the counter version. It (the over the counter version) has liver in the wet version and flaxseed in the dry version, and Yates is allergic to both ingredients. Perhaps Erik wouldn't have that problem.

Really, getting the allergy blood test made our life a LOT easier, but it wasn't cheap (a few hundred).

Also, I believe Iams and Purina also have prescription formulas, but our vets use RC, so that's what I'm familiar with.