EPI or something else?

[Carrotcat]

Quick replies all around!

I'll leave out their dry food tonight then. I'll sleep a lot more peacefully knowing she'll have something to eat if her sugars get wacky.

We'll see with the B12 supplementation then. Hopefully she'll start to feel better soon.

Thanks Eddiespaghetti. I'll ask the vet whether allergy testing could be useful too.

Olesia, they also do TLI blood testing https://laboklin.com/en/products/haemat ... eactivity/

If the testing does need to be sent to TAMU, then that's what we'll do. But if we can get the results back in 3 days instead of 3 weeks, that'd be much better of course.

[Olesia711]

Ahhhh... i didn't see the TLI blood testing.... thanks! Since the TLI testing is available... talk to your vet about having it done there it should be the same as TAMU. The only thing is that the TLI testing scores have changed... which i am assuming should be reflected in this testing also.

Great find!

Oh... one more thing...... when it comes to dealing with EPI + Diabetes (if this is EPI).... always give the Diabetes preference over EPI.... you can always compensate EPI by adjusting the enzymes if the diet is not optimal for EPI..

[bur]

I'm from the Netherlands as well and I have had my cat tested on EPI with the fTLI test a few months ago. The bloodwork for my cat was send to Texas A&M and it took a little over 3 weeks to get back. The costs were high, but lower than the cost of an ultrasound, so there's a ballpark figure for you.

If you are able I would recommend taking your cat to Ronald van Noort, he is a veterinary specialist who works at Anicura in Utrecht and is considered to be the best of the best and very good with cats. He is an "internist" (I don't know the translation for that Dutch word, but you will know what I mean) and the go to specialist when it comes to intestinal problems. Your vet can give you a referral. If you google him, you will find the clinic. When my cat was very ill my vet consulted with him over email and he was very helpful and willing to share his knowledge.

I've had three very sick cats in the last two years (all of them with different and very rare diseases) and what I learned is that you really need to advocate for your cat. You are doing really well searching for answers and doing your research. I hope you find some comfort in the knowledge that you are doing these things. I know what the emotional rollercoaster is exhausting, hang on tight. You've got this. Your cat is lucky to have you.

[bur]

Oh and I forgot to mention this: Your vet does not need to send the fTLI to Texas A&M themselves. They send it in to Idexx (same as other bloodwork) who send it to Texas A&M.

[Carrotcat]

Thank you both for the info! Bur, I'll check out that vet hope your kitty is doing better now. Did testing show that she has EPI?

We've had 2 stools today, 1 a bit firmer and the other mushy again. Giving half a capsule now with every meal. I think the B12 is starting to 'work', she had pretty bad diabetic neuropathy before (weakness in hind legs) and she's walking *a lot* better today, even climbed up on her cat tree.

I'm still hopeful that she doesn't have EPI tbh. Have ya'll ever heard of a pet with EPI gaining weight while untreated and with diarrhea? I rechecked her records (both her vet medical records and the medical diary I keep), a timeline:

22-11-2022: checkup. Weight 7.2kg/15.9lbs. Fat but healthy kitty.
11-4-2023: diagnosed with diabetes, had been having diarrhea for about a week prior, and of course the expected diabetes symptoms. Weight 6.2kg/13.7lbs.
18-7-2023: added new dry food to their diet. Weight 6.0kg/13.2lbs. Diabetes symptoms stable, thirst normalised and no more excessive water drinking.
26-7-2023: started having diarrhea. After several days of diarrhea, I removed the new dry food. Diarrhea did not fully subside though.
14-8-2023: waxing and waning soft stools. Weight 5.75kg/`12.7lbs. Thirst levels still normal.
17-8-2023 to 29-8-2023: sick from the bowel infection. Weight first vet visit 5.5kg/12.1lbs, weight at lowest point 5.1kg/11.2lbs during worst of the illness, weight on 21-8-2023 already increased to 5.3kg/11.7lbs. Continuously very thirsty, presumably from dehydration from liquid poos. Got a bunch of Tramadol (possible liver damage?). Last antibiotic on 29th. At that point, stools were mushy and frequent.
4-9-2023: stools still soft and frequent, but thirst has normalised. Weight steady at 5.3kg/11.7lbs.
16-9-2023: super thirsty, huge pees, diabetic neuropathy very present. Still soft frequent stools. Weight steady.

Sept-oct: my other cat nearly died from pyelonephritis, and then of the effects of the only antibiotic that the bastard e coli bacteria was not resistant to. I was 100% in survival mode during this time, barely eating or sleeping. I don't remember much of these days tbh. I think Angel was mostly just trucking on, still soft stools and thirsty but not overly bothersome (IIRC, it wasn't so gross yet, and by gross I mean super stinky, greasy, orange).

7-11-2023: checkup. Weight 5.4kg/11.9lbs. Still drinks a lot. No change in stools. Mostly discussed her diabetes as she was going into hypo's again.

24-11-2023: vet visit. Diarrhea had gotten worse (unholy smell, orange, greasy, greasy butt fur, 5+ times a day) but she'd also gotten more and more lethargic, walking worse from the diabetic neuropathy, drinking and peeing extreme amounts again, reminiscent of how she acted during the bowel infection. Sent off blood for (what turned out to be) pancreatitis test + B12 + folate. Weight 5.5kg/12.1lbs. Got a preemptive B12 shot.

28-11-2023: test results back. No pancreatitis, low B12, high folate. Started enzyme treatment and oral B12 treatment.

[Eddiespaghetti]

There is a lot going on here and it's tough to say anything is certain.
Animals with EPI can gain weight, depending on the enzyme levels. If they enzymes level are high enough to break down some food on their own, which could cause weight gain. Since they aren't getting all the nutrients they need they will still eat a lot. The weight gain might also not be fat or muscle but their organs enlarging. https://wagwalking.com/cat/condition/ab ... distension
It's more of a symptom than a disease. If you are able to treat whatever is wrong, it will hopefully fix itself.
The weakness in the hind legs could also be from muscle atrophy caused by untreated EPI. My Eddie is still struggling to get his left hind leg up to strength. B12 deficiency will definitely worsen by proxy. If the muscles aren't absorbing nutrients the muscles will atrophy.
If it was me, I would experiment with different food and/or increase the CREON. Typically, you want to do it one at a time, but I am not sure you have the luxury of waiting. Of course they may not have EPI, but something is causing greasy stools and food is the easiest to change, short term. When I first started treating Eddie for EPI I went through 12 different wet foods and 5 dry foods before I found what works for him. Not all those caused problems, some he just hated and would eat around it, or spit it out on the floor.

[Carrotcat]

There is a lot going on here and it's tough to say anything is certain.
Animals with EPI can gain weight, depending on the enzyme levels. If they enzymes level are high enough to break down some food on their own, which could cause weight gain. Since they aren't getting all the nutrients they need they will still eat a lot. The weight gain might also not be fat or muscle but their organs enlarging. https://wagwalking.com/cat/condition/ab ... distension
It's more of a symptom than a disease. If you are able to treat whatever is wrong, it will hopefully fix itself.
The weakness in the hind legs could also be from muscle atrophy caused by untreated EPI. My Eddie is still struggling to get his left hind leg up to strength. B12 deficiency will definitely worsen by proxy. If the muscles aren't absorbing nutrients the muscles will atrophy.
If it was me, I would experiment with different food and/or increase the CREON. Typically, you want to do it one at a time, but I am not sure you have the luxury of waiting. Of course they may not have EPI, but something is causing greasy stools and food is the easiest to change, short term. When I first started treating Eddie for EPI I went through 12 different wet foods and 5 dry foods before I found what works for him. Not all those caused problems, some he just hated and would eat around it, or spit it out on the floor.

Thanks for this info!

The vet called today and said they had an opening for tomorrow, so I decided to just go ahead and get the ultrasound done (and prob bloodwork too depending on what we see on the ultrasound). I just want to know we're not dealing with anything super bad like liver failure. If all is well, I'll experiment with food and creon dosage more.

I think we have some room for improvement in the food department for sure. She's getting a lot of different wet foods, and maybe it's just too much for her system. I spoke about this with the vet and she agrees. Might be a ton of different small factors (B12 deficiency, too many different wet foods, perhaps less enzyme production than normal but not enough to reach EPI levels, stress, gut flora messed up from the bowel infection, etc) are piling up and causing this. Maybe if we address the ones we can easily change, she'll be able to handle the ones we can't.

So I think I'll start from zero, put her on a gastrointestinal dry food with limited gastrointestinal wet food (just enough to get her creon in) and we'll see from there. That is, on the condition that nothing bad is found tomorrow... I'm not religious, but good vibes (or prayers if that's your thing) are appreciated.

[bur]

My cat is doing better now, but it was a roller coaster like your journey. I will share it with you in the hope it will give you some hope, that even when things seem desperate, there might be still be hope.

She has a history of skin problems, agression towards my other cats and periods of not eating well. I've taken her to the vet for these things numerous times over the past 10+ years. This time it started with not eating well, which made me try anything and everything to get her to eat to stop the weightloss. She would eat new foods for 2 meals at most and would refuse it the next time. I think she connected not feeling well with eating and was only willing to eat if I gave her something she had not eaten before.

You'll run out of healthy options quickly that way and she started to have loose stools that smelled awful. I've had a cat with borderline EPI before so I talked to my vet about trying enzymes, since all other tests were giving us no clues. Meanwhile I had her tested on pancreatitis (negative), B12 (too low) and folate (too low) and insisted on the fTLI test. While we were waiting for that to come back she had weekly B12 shots and I supplemented folate. My vet agreed to trying enzymes while we waited, so I put her on Creon and she improved.

The fTLI came back negative and she deteriorated again. Her tummy was making loud noises all the time and she kept losing weight. I was force feeding her, since she would not eat herself. That's when the stool improved. I accepted she would not eat herself and now she was syringe fed only gastrointestinal wet food. She kept loosing weight though and her stools were now formed, but HUGE. She was skin over bones and the lowest weight I recorded was 2,68 kg.

She was on five different medications at that time and nothing was working. I talked to the vet about letting her go. We tried prednisone as a last ditch effort and gave her four days. A few days later no improvement and she was clearly in pain. The vet prescibed an opiod which made her euforic and happy for the first time in months. She started to eat gastrointestinal kibble by herself the day the four days were over.

The stool volume went down after I got her to eat raw again. She started gaining weight slowly. She is back to 3,0 kg now and doing much better. She does have off days sometimes, but I never thought she would still be here. The only medication she is on now is the prednisone.

We still do not know what she has for sure. We think she has IBD. This could have been checked with an endoscopy (before we started the prednisone), but I chose not to put her through that (she is really, really scared of vets) and go straight to the prednisone. Looking back I can connect the dots. IBD also explains her aggression towards the other cats (gone now) and skin issues (gone as well). She has been raw fed for over 10 years and I think that has masked her symptoms for so long. Many dogs and cats with IBD improve on a raw diet and since she already ate that she did not get loose stools until I switched her to wet food to get her to eat.

What really helped me through all of this is that I had a very clear picture of what I wanted for her and what my criteria were for when it was no longer fair to her.

I hope her story gives you some hope.

[Eddiespaghetti]

Bur is giving amazing advice and is being really supportive, but I need to mention; steroids and diabetes do not mix. Steroids can increase blood sugar levels, increase urination due to dilution. This can cause them to become dehydrated due to the kidneys not being able to process the urine correctly. It can also cause them to drink insane levels of water causing diluted blood levels, possibly leading to water toxicity. I am not saying don't use Prednisone, just be careful and listen to your vet's instructions. It is a worse case scenario, but it is possible
One option if you're worried about them not eating due to them correlating food with sickness is anti anxiety medication, Xanax, Wellbutrin, Prozac. As it should be short term, there shouldn't be too many side effects.
Hopefully, it doesn't come to any of this. I just wanted to give my two cents on it.

[bur]

I was not giving advice on what to use. I was telling my cat's story. I quite explicitly said so.