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Carla | 4 months ago
A Question For Krista Magnifico: Hello! Hoping To Get Some Advice On Recommended Next Steps For …

A question for Krista Magnifico:

Hello! Hoping to get some advice on recommended next steps for my cat, Sammie, who is being evaluated for IBD vs. small cell lymphoma.

Sammie is 17 years old and is overall quite healthy! Throughout the time I’ve had her, she’s had a history of vomiting a ~once per week or two (sometimes more frequently). Vomit is usually clear, foamy. No other GI issues or health issues otherwise. She is active and energetic, and has not had any health issues until ~1 month ago when I noticed she stopped eating as much as she previously did. She stopped eating her dry food altogether, and seemed to become quite picky with her wet food. I initially thought her teeth may be bothering her because of the avoidance of dry food, so I brought her to the vet.

Vet found that she had lost a couple of pounds, unintentionally. Based on presenting symptoms, vet thought she might have a GI pathology so ordered an abdominal U/S:

Ultrasound, Abdominal Study Outcome:
Kidneys: overall normal size but mild reduction in detail and small mineral foci. Trace pylectasia noted w/out ureteral disension.
GI: Avg SI thickness normal. Mild corrugation is noted in some regions and some ileus (luminal fluid distension up to 4 mm w/ reduced
peristalsis) noted w/out obstruction. No discrete abnormalities appreciated throughout the small intestines.
Caudal abdominal nodes are prominent to mildly enlarged and rounded w/ smooth texture. One irregular cystic structure noted near right
kidney. The mesentery around the ileus segments is mildly hyperechoic.
A:
Intestines most consistent w/ enteritis
Nodes: r/o reactive vs other
Cystic strucure: r/o benign mesenteric vs inflamed node
Kidneys have evidence of chronic disease.

Here are her prior labs:
PRIOR LABS:

7/15/24: Wt loss 0.28 lb; PCV: 40/7.6; Chem18: BUN 41, creat 1.7, K+ 4.3, phos 4.2
U/A: USG 1.019, pH 6.0, rare wbc/rbc; no bact/cryst; cobalamin: 437; folate: 11.2

2/13/24: Wt loss 0.8 lb; CBCcomp: hct 44, diff wnl (clots in sample; rec. resubmit)
Chem25: BUN 40, creat 1.3; T4: 2.8; SDMA <10
U/A: USG 1.025, pH 6.0, rare wbc, no rbc/bact/cryst, rare fine gran casts.

1/19/23: Wt loss 0.4 lb; CBC: (hct 40, diff wnl); Chem25: (BUN 32, creat 1.3)
T4: 1.8; U/A: USG 1.051, pH 6.5, 1+ prot, rare wbc, no rbc/bact/cryst

11/19/21: CBC: (hct 46, diff wnl); Chem: (BUN 34, creat 1.5); T4. 1.9; DGGR lipase 9
U/A: USG 1.053, pH 7.5, rare amorph. crystals, no wbc, no rbc

6/17/22 Wt loss 0.16 (as desired); USG 1.040; SDMA: 11

Most recent A&P:
A:
1) Intestines most consistent w/ enteritis (IBD vs SCLSA); ileus likely cause of decreased appetite.
2) Nodes: r/o reactive vs other
3) Cystic strucure: r/o benign mesenteric vs inflamed node
4) Kidneys have evidence of chronic disease ; in keeping w/ previous lab findings.
P:
1) Rx: metoclopramide 5 mg: 1/4 tab po every 8-12 hrs.
2) Continue vit B12 as Rxed.
3) picked up Mirataz but hasn't started it yet. Rec. give. metoclopramide for 2-3 days and then if not improved appt, start Mirataz.
4) to consider presumptive pred tx vs ex-lap for biopsies.

Sammie is seeming to eat better with the metoclopramide.

My question:
Is pusuing an ex-lap for biopsy recommended vs. empiric tx for IBD with steroids vs. empiric tx for SCL with steroids + chlorambucil.

Thank you!!!

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  1. Krista Magnifico

    Hello,
    Well let’s all take a collective moment to applaud the work up!! I say this because that’s a breath of fresh air!! I think that a couple things warrant a little further discussion.

    First it sounds like your GP has done a very thorough job,,, but,, done it all in house. Which in some cases is the best we can do. But. Have you been offered a referral to an internal medicine feline practitioner? If you can find someone who is BOTH great. If not go to whoever you can get in with.
    Next have rads been done? And assessed by a radiologist? At least for thorax?
    I know it might sound crazy but also check anal glands. Some of these older cats are so uncomfortable they stop eating
    Add an appetite stimulant. There are numerous options.

    Ask for an internal medicine consult via your lab services. It’s a phone call and It’s free. It has been helpful in some cases. Ask them about budesonide vs. prednisolone if you are going to start treating for INS. Which to be honest I would do over a biopsy for a cat this age with these potential differential diagnoses.
    I also add vitamin B12 and cobalaquin and immuquin to these guys. The other medication I like is cerenia and learning how to give SQ fluids at home for the kidneys. You also need a phosphate binder ( I think?, please inquire), we use naraquin. Maybe ask about azodyl too.

    … and I know it sounds like I am spouting out a lot of meds… but I gave my older cat solensia when she was a nightmare of unhappiness and it really helped.

    And let’s not forget pain meds. Every (EVERY!!! ) single patient deserves them. I like gabapentin 50-80 mg as needed.

    Please keep m posted. Very best of luck.
    Krista.

  2. Carla Post author

    Dear Krista,

    Thank you very much for your response!

    Sammie is eating much better since starting metoclopramide. She is finishing all the wet food we give her, and chases after me when I am preparing it for her! She’s also having bigger sized BMs. We also have her on a weekly injection of B12 for her borderline low levels.

    One point to clarify – we are lucky that Sammie’s vet is a feline-only practitioner. Based on discussions with her, she seems to recommend proceeding with the ex-lap for the biopsy and that cats “bounce back” quite quickly after the procedure. We are hesitant, however, given it seems quite invasive.

    At this point, we are deciding if the is worth it, or just to empirically treat her with steroids for presumed IBS (vs. SCL). Based on your input, it seems you would err on the side of not doing a biopsy in a cat of her age?

    Thanks,
    Carla

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Pawbly | 8 years ago
My Dog ( 1 1/2 Year Old Small Mix Terrier) Is A Sweet Guy When…

my dog ( 1 1/2 year old small mix terrier) is a sweet guy when it comes to humans and dogs he is familiar with. sadly, he has picked up aggressive behaviors from my brothers large dogs. He will growl at people he is not familiar with on the street and when they enter the home. he will growl at outside noises and also at other unfamiliar dogs. he doesn’t bite people he just growls and when they try to pet him he runs away and gets shy. minutes will pass and he will warm up to people. he does fine at the dog park, when a dog approaches he smells the dog and runs away( which makes sense, he is a small dog) i’m more concerned when we go on walks. i’m looking for advice and tips i can do to help me and my dog work on his excessive growling. i would love to be able to go on a walk with him and be able to pass people without him growling and he can just keep walking.

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Pawbly | 8 years ago
I Have Adopted A Dog From The Pound About 4 Or 3 Moths Ago…

I have adopted a dog from the pound about 4 or 3 moths ago, he is a very good dog but when someone enters my room, my dog starts growling and he won’t stop. The behaviour has gotten worse when my fathers partner hit him with a leash with a metal spring on it, now whenever he hears someone walking outside of my room (going upstairs or to the bathroom) he immediately starts growling, his growling got more loud and now when someone passes him, he’s scared and walks away. Another thing is when I leave the house, he starts howling and it’s annoying my father he wants me to sell him but I still believe there is something to help my dog. He is a sheepdog collie mix and 2 years old, he is a very good dog and I presume his previous owners must have been abusing him since he’s scared of everything. Is there a way to teach him not to do it?

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  1. Anonymous

    Have you spoken with a trainer yet?  

  2. Alex Nic Conmara

    No, there isn’t any trainers around where I live so it’s hard

  3. Lisa Pfab

    Well hitting has made it worse. Your dog has several anxiety/fear issues. you can teach a dog confidence but it
    takes time and dedication. Start by always having your dog on a leash with you. when he lays quietly, tell him good dog. start teaching him to sit on command. then start teaching him to sit in place on a carpet or matt. All this will teach him proper behavior, and make a bond. once he and you have developed a bond, start asking a friend to come over to help work with your dog. Put a bowl of treats outside of the door, have your friend come to the door, your dog on a leash, you ask your dog to sit, treat him. the friend comes in, no eye contact, talks to you, if dog stays sitting, no growling treat him. Once dog accepts friend, let friend treat him.
    Start teaching your dog that all good things come from you when he listens. Get what we call High value treats, something he ONLY gets during training, cheese, chicken, moist dog treats, whatever, but he only gets it during training.
    Collie and shepherding dogs have such a strong desire to be with their people, to please them, that you should be able to train him.
    As for crying while you are gone, he should be crated, with a cover over the crate, and give him a large Kong to work on while you are gone. He only ever gets the Kong in the crate. Fill it with dog food, and mix in some peanut butter, plug the whole over with peanut butter and freeze, give it to him when leaving, but make sure you feed him less so he doesn’t get fat lol.
    Take time, he will be a good dog, dogs know when they are rescued.
    Good luck!

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Pawbly | 9 years ago

I Need Your Advise Regarding My 11 Months Old Persian Male Cat. The Problem Is…

I need your advise regarding my 11 months old Persian male cat. the problem is that my cat wants to go out for mating and if we do not let him go out he sprays and pees in the house which causes a very bad odor in the house. Now that we have let him out on his own he has started to spray around outside and you can smell the odor as soon as you enter through gate.
Secondly we have tried to set up play dates for him and lock both the cats in bathroom but uptill now he hasn’t mated.
Thirdly, there is a stray cat outside which is on heat all he does is that he sits beside her all day long and if we bring him inside the female cat starts to cry which make him go crazy to go outside.
Finally, I want to ask you about getting my cat neutered. The pros and cons of getting the cat neutered. I have heard from someone that the cat’s personality changes and we have to take care of him more because there will be a wound after his operation and all the people in our house go to work. Hence, there can be a problem in taking care of him 24/7.

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  1. Anonymous

    absolutely neuter him, and keep him inside.