EPI or something else?

[Carrotcat]

Question... I'm still pondering how to keep her safe from hypo's when I'm asleep. I think I could possible leave out some wet food incubated with the Zymoral powder. If she goes hypo I'm hoping hypo-hunger will compel her to eat it despite not liking the taste.

However, is it bad that she'd then possibly get 2 different enzyme sources (creon most of the time and possibly powdered Zymoral at night)? I don't think she'll eat the Zymoral food if she doesn't go hypo. She refuses to eat it if I offer it to her during the day. But cats are gonna cat so I can't be sure about that.

Second, if I do leave out the Zymoral food... there's a chance one of my other cats could eat it. I don't think they would, because they're a lot pickier about food than Angel is (she's thankfully the easiest eater out of the bunch), but they might. Is that bad for them?

[Olesia711]

ahhh... is she not getting any B12 supplementation? Since her B12 was "low-ish" yes, your vet is correct.... low B12 can trigger a host of issues... and one of them can be loose stools, poor coat, etc.

[Olesia711]

there is no problem mixing two different types of enzymes.... sometimes we just have to do what we can do.... but instead of leaving food out with enzymes in it (if left for a long time, it can invite bacteria and then that in itself can cause more tummy upsets) can you just feed her a little "snack" with enzymes prior to bedtime?

If your other cats eat food with enzymes, no it will not hurt them. You just don't want to give a cat or dog enzymes (EPI strength) every single day for a long time (like a year) if they do not have EPI or need the enzymes.

[Carrotcat]

Yes, she's getting B12 supplementation! She already got a preemptive B12 shot at the vet 1 and a half week ago when we drew her blood for testing, and since confirmation I've been giving her B12 pills at 250 μg daily per the vet's instructions. Vet said recent studies have shown that oral supplementation is just as effective as shots. Do you know how long it takes for B12 deficiency symptoms to go away?

Since starting Creon I've waited to go to bed until her nadir hits (the lowest point in the glucose curve when insulin hits it's peak, 6 hours after shot time with the insulin she's on), measuring her glucose, then giving her a big meal, and then going to bed. This'd work fine with regular cats but not with Angel because she's still producing insulin of her own. A couple days ago, it went like this:

Glucose at shot time (8pm): 14.4
Glucose at nadir (2am): 11.0 (went to bed after this)
Glucose at shot time (8am): 4.5

With a normal cat, the nadir is as low as they're gonna get, after that the injected insulin starts wearing off and the glucose starts going up again. But Angel's pancreas dumped a load of homemade insulin into her system some time after nadir, leading to the low at 8am.

This happened while I was asleep and there was no food available for her... if she'd produced a little bit more insulin, she could've died. Can't climb out of a hypo without food. It really scared me.

I spoke with my vet today and she says that I can keep the regular dry food, without enzymes, out overnight to mitigate the risks. I'm inclined to agree, but do ya'll know how this'd effect her EPI treatment?

We decided that we were gonna continue trying to increase the Creon over the next week until either she has normal poops, or she shows negative side effects again. If we don't see improvement in the stool by next week we'll go ahead and do the ultrasound and depending on the outcome of that, also general bloodwork and possibly the fTLI testing. Vet said the color of the stool (orangish) doesn't fit with EPI. Could still be a liver or gallbladder problem. Although she doesn't seem to fit in any particular diagnosis, especially because pretty much everything mentions weight loss, decreased appetite and vomiting as key symptoms... none of which she has.

[Eddiespaghetti]

Before Eddie was diagnosed with EPI his poop was yellow, grey, or orange. Orange is typically more in line with liver/gallbladder. If your cat is eating orange food and it isn't getting broken down due to lack of enzymes it will be orange.
B12 pills are just as effective as the shot. Though if they aren't eating or refusing the tablets it becomes a lot less effective. The shot is faster at getting their B12 levels up. The recommended regimen for B12 is 1 shot a week for 6 weeks then one more 30 days later. Either way you decide to go, you need to give it religiously.
My Annie was diabetic. She was my dog up until about 12 years ago. Our vet recommended to give a tablespoon of pancake mix if hypoglycemia was showing symptoms. Given your situation of having other cats I am unsure how to leave it out. Hopefully, their is a place you can leave it where only one kitten can get to it.

[Carrotcat]

I DID come across these labs: https://laboklin.com/en/

Based in Europe, have a lab in my country and.... they do fTLI testing! Only a 2-3 day turnaround. Of course I found this after I'd already talked to the vet today... but I'll ask about this next time we speak.

It looks like they have a wealth of testing opportunities. Look at this! https://laboklin.com/en/products/microb ... diarrhoea/

Ya'll are experts here on loose stools... what kind of testing would be beneficial to get done as well? The Dysbiosis Analysis seems interesting, as does the Bile Acids testing.

I also wonder whether it'd be smart to test for Tritrichomonas foetus. OIne of my other cats had this as a kitten, so 13 years ago. My vet doesn't think that's the problem here, but I've read that some recovered cats can become long-term carriers. I doubt he is one, partially because he himself was majorly sick not too long ago, and that'd be the perfect time for this to rear it's head again. The fact that it didn't suggests he's not a carrier anymore. But I still wonder...

[Olesia711]

again, i agree with your vet. Leaving (dry) food out WITHOUT enzymes in it (to avoid bacteria ) is another option. Just don't leave wet food out with enzymes as explained why in earlier post.

I honestly don't know how long it takes B12 supplementation to improve the B12 levels.... the time does vary from one animal to the next... however... i do know with dogs.....if there is a B12 deficiency, you "usually" can see an improvement overall within 3 weeks of taking B12 (oral)... and yes, again, your vet is correct the proper oral B12 is just as effective as B12 shots. And depending on the oral B12 product, some oral pills actually are more effective than the shots.

Yes, orange poo happens with EPI dogs... (not sure about cats) but when we see this.... it is often in combination of EPI +IBD. which happens a lot. However....the orange poo with the EPI+IBD may very well come from liver issues involved with the IBD part. If gallbladder.... sludge in the gallbladder could very well be a trigger heading into EPI territory.

I am glad to hear that testing for EPI with the fTLI test may be considered, even though the test needs to be sent to the USA ....i am guessing to the Texas A&M Gastro Lab.... which is who EPi4Dogs pretty much follows

[Carrotcat]

Didn't see your reply before posting Eddiespaghetti! She's not eating any particularly orange foods. Mostly just regular meat paté's, sometimes chunks in sauce.

Luckily she's taking the B12 pills fairly easily. Haven't missed a day so far.

Unfortunately there's no place where only Angel can get to. But her regular food is quite good at pulling her out of hypo's, with some honey added if severe, just won't work if I'm asleep and there's no food left out for her.

[Eddiespaghetti]

I mean this in the best possible way. You're spiraling carrot, I absolutely understand what you are going through. You become a internet detective when you can't get any answers. Based on what you have told us the only two tests I would recommend right now is flu and possibly an allergy test. If your kitty is allergic to the food and it is given for a long time, it can cause liver and gallbladder issues, in dogs that is.

[Olesia711]

i just checked out the lab testing for EPI... they do the fecal testing
https://laboklin.com/en/products/microb ... -elastase/
which is the old method and not very accurate..... SO.... i would opt to stick with the tli blood test for EPI. It may be more expensive, but much more accurate.

Regarding the bacteria and viruses... i'd have to really dig into that. I am fairly familiar with bacteria but not viruses.... so it probably would be better to ask your vet their thoughts on these tests. There is a dysbiosis (bacteria, etc) test that can be performed at (TAMU) Texas A&M for dysbiosis in cats and dogs.
https://vetmed.tamu.edu/gilab/service/a ... sis-index/

If you and your vet do decide to send a blood sample to TAMU to test for EPI..... then ask your vet if it would be realistic to also request the dysbiosis test to be done at the same time.