Triaditis ongoing issues - lymphoma after all?

[Mollycat]

Raych, I know you've shared a lot and been pulling your hair out for months now, you've been torn as to what to do for the best for them, and tried so hard to follow vets advice even when it has gone against your intuition and been proved not helpful. You really have tried your damndest for these cats and somehow things still aren't right, and so you keep coming back to square one and all you've learned is that another thing doesn't work.

I'm not going to give you any other advice than go with what feels right for you. If you want to give them a food they like so that they eat, if the vet doesn't like it, the vet isn't the one eating it. If it gives them a squitty bum, and the steroids help symptomatically, give the steroids. If you're not comfortable with the way vet is pushing you, be firm - they are YOUR cats and it's your money, you make the decisions. If the vet doesn't accept that, find another vet that you feel is working WITH you not dictating to you from medical text books.

My Bobby may have had lymphoma or IBD and I dealt with runnies on a long-haired dopey Raggie for years on and off, he ended up on steroids until eventually even they stopped helping, he was 15 and we said enough. My Molly crashed, lost a quarter of her body weight in days, yellow runny stuff coming out both ends, there was some kind of liver problem, some kind of gall bladder problem and some kind of bowel problem - which is the definition of triaditis - on top of hyperthyroidism ... the runs continued for 18 months which was 12 months after HT treatment and I am still reluctant to do any further liver testing.

Ask yourself - why do we need to know what it is if it won't change the treatment - who will benefit from this knowledge?
If all foods cause a runny bum, why are we still trying to find one that won't which the cats won't eat?
What on earth is rice doing in any cat food?
In a normal healthy cat a change of food can trigger the Dire Rear, that's why foods should (I've never done it but my cats are usually adventurous and mostly bomb-proof, but they SHOULD) be introduced gradually ... is it possible that the changes of foods are causing the issue, just as much as whatever underlying condition?

Your stress about it all is not helping your cats. They know you are stressed but they don't understand why, all they know is if you're stressed they should probably be stressed too, and stress hormones upset tummies, and prolonged periods of stress cause very real illness.

It's very possible after a while that the squits becomes a vicious cycle, where nutrients are not properly absorbed because the food transit time in the gut is too short, which means nutrients are not properly absorbed, which prevents the gut from absorbing, and so on. Antibiotics trash gut flora and whilst some people find probiotics and prebiotics work others like mine get the squits even worse. Will they take a little Pro-Kolin in their food? Have you considered Cobalaplex? Vitamin B complex with the accent on B12 (Cobalamin) as this is often key to runny bum issues in cats. Have they ever had a shot of vitamin B in all the vet visits? Have you been offered this cheap, easy and very often effective treatment, before being pushed in the direction of biopsy under GA? Potassium, another one that causes and is caused by diarrhoea, a palatable powder sprinkled on their food - do we know if they have a potassium deficiency? It's a simple blood test.

[Mollycat]

Steroids work by mimicking natural hormones and in larger doses they suppress both inflammation and the immune system. They are serious drugs but sometimes there is no other way to get to inflammation (eg of the gut, regardless of whether it's IBD or lymphoma) with significant side effects which depend to some degree on how they are taken. Oral route has the most generalised effect all over the body and therefore more side effect risks, in humans at least.

I suppose it is masking the problem in terms of reducing inflammation without understanding why the inflammation is there, but if there is no obvious cause then I guess it's the only way to bring the inflammation down. I think that's sort of what happened to my Boo, at the end, when he became unable to pee and his temperature was through the roof, she kept him in and brought down his temperature but within minutes of being home he was right back to his emergency state. I don't think it was unconnected to his digestive issues, I think it was a progression, and he was on his high starting dose of steroid. But then, humans with IBD, arthritis, lupus, all kinds of inflammatory and auto-immune issues get through life with management not cures, some including steroids, so maybe it's more about management than masking.

I think what you've seen right there in your diary is why you have to give things a chance. If you add fortiflora and wet food on the same day and something changes, what's to say which is what did it? Make any changes one at a time and give them time to take effect. Don't worry I've been there too, panicking, trying to find the answer, but it takes time, patience and a good method.

[fjm]

I am going through similar trials and tribulations with Poppy. The big plus is that she loves food - all food, any food - the downside of that is keeping her from eating things she shouldn't. She did very well for months on RC hepatic for dogs and chicken breast, then about three months ago started regular bouts of the squits. Metronidazole stops it, but is not something she can be on continuously. I have been working out by trial and error the absolutely minimum I can give her for it to be effective, and also trying the Protexin Pro-Kolin powder and a vitamin B and E with zinc supplement, plus the routine steroid, Destolit and Protexin Denamarin she has been on since January. The one thing that is guaranteed to give Poppy diarrhoea immediately is anything fatty - not surprising given her liver problems - so it may be worth looking at the fat content of the foods you have tried and seeing if there is any correlation with episodes of diarrhoea. Poppy is not going to make a full recovery, but with careful management she has an excellent quality of life, and my aim is to maintain that for as long as I can - like Honey, we do not know what caused the original problem (infection, tumour, something else), but a biopsy is pointless now as it would not change the treatment.

I have read that Small Intestine Bacterial Overgrowth (SIBO) is extremely common with liver disorders, and the effects are very much what Honey and Poppy are experiencing - there is less evidence for it in cats than dogs and humans, though.

[fjm]

I would try for 7-10 days - that should be long enough to get everything else out of her system.

I think there is at least one liquid form of metronidazole - Eradia. Metro is potentially teratogenic, so if whoever is administering it is of child-bearing age you need to take extra precautions - I have visions of the whole room getting sprayed of Honey really takes agin it!

[fjm]

Rice etc are cheap calories, and the nutritional defects are made up with concentrates. At this stage, as you know, the main thing is to keep her eating, which is obviously easier said than done. Low fat will be better for both liver and pancreas. Hydrolised protein should not trigger intolerances, regardless of the source. But I would give her whatever she will eat, especially as it doesn't seem to make much difference to the diarrhoea.

Poppy's tum seems to settle after a dose of metronidazole (it is usually given as a 10 day course, but my vet said to use it for its soothing action rather than as an antibiotic, and for the minimum time that was effective.) Her stools then gradually get softer, and then extremely soft - typical of SIBO, which is why I am leaning towards that diagnosis. I am still in the trial and error stage with the metronidazole, but I am hoping that one dose every three days or so may do the trick.

I rather wish Poppy would use a tray, rather than our open plan courtyard gardens. I was out following her round with a torch in the rain at midnight a few days ago, struggling to spot the right spot. There was something unpleasant looking on a neighbour's doorstep which I couldn't sort out in the dark, so I was out very early with bags, a bottle of water and something to scrub with - it turned out to be a lump in the paving slab!

[fjm]

SIBO=Small Intestine Bacterial Overgrowth

[Mollycat]

Fingers crossed for you. I'd have put my money on rice rather than any animal protein for an allergic reaction or long-term low-level digestive issues tbh, but the probiotics thing is becoming very interesting. So far there seem to be more cats reacting badly to them than well.

[Mollycat]

Because sometimes it is seemingly random. Because - ask anyone with IBS or Ulcerative Colitis or any of the million chronic gut inflammation and related conditions - there is very rarely a linear relationship between triggers and effects. Sometimes you do just get a random attack, while other times you can eat all your triggers with no problems. Although it's possible to identify some definite clear triggers and avoid them, it's not an allergy where you just avoid the allergen and carry on with a normal life.

I live with something rather badly named Histamine Intolerance - it's not an intolerance at all, it's histamine overload, where for whatever reason the body doesn't manage to process all the histamine you eat and produce, and uncomfortable symptoms happen like urticaria, migraines, brain fog, digestive issues, period pain, and lots lots more. Sometimes you do everything right and stay symptom free for months and then out of the blue there's a rash or an itchy raised welt. Normal life takes on a new meaning.

All triaditis means is inflammation in three organs - the liver, the pancreas and the small intestine. It's not a diagnosis, it's a description. It doesn't give you a cure, or even a treatment, or any indication of what to do or avoid. It may well be impossible to completely avoid flares. Think of autoimmune diseases, nobody knows why the body's defence system turns against its own tissues, nobody knows how to prevent it or stop it, all we can do is draw on experience to say certain things definitely seem to make it worse and other things may help.

[Mollycat]

Incidentally I think I may have found at least a hint as to why some patients may respond badly to probiotics.

Probiotics are supposed to boost the immune system. That's awesome for anyone whose immune system needs a boost, but for cats or people whose issues stem from an oversensitive immune system that's probably not a great idea.

So for those of us whose cats have been made much worse by trying Fortiflora or similar, maybe that's a clue to their problem.

Just a thought.

[Mollycat]

Honestly, for me it took my vet to look at 3 months of poop diaries and say well this really isn't so bad, for me to chill a bit, and then (coincidence, magic or actually me chilling out?) before Molly really started to get better. She had some form of issue but I believe it was acute not chronic as she has now been fine for a long time - but then I no longer freak out at a loose poop.

To put this into perspective, I was still doing my nut because we had loose stinky often yellow or orange poop maybe 3-4 times a week, the vet said that's good it's only 3-4 times a week. She was right, it was down from every day to half the days, and it carried on coming down until now it's uncommon (not rare, just once in a while)

I wouldn't change anything for one poop - not after a whole solid good week.

Don't worry for rambling I've been where you are desperate for answers and sometimes in the end there just aren't any and we have to calm down and find our own way through with some lovely people to rant to on the internet when things are not going our way.

[Mollycat]

Yellow is definitely pointing to bile and/or liver so it might not be anything to do with the food in this particular flare-up.

Has Honey ever been jaundiced? You can tell mainly from eyes and sometimes gums. The yellow is bilirubin, which is a by-product of red blood cells broken down by the liver at the end of their life. Blocked bile ducts will also cause it. Faeces is the normal route for excreting broken down bilirubin but for some reason either it's not being broken down or there's too much of it. She's not anaemic is she?

What a scrummy little pudding she is and Honey is such a perfect name for her! She looks like a kind of pastel ginger and what a noble profile.

Not that I'm aware of, though I don't know what additives are in it. I use it to tell Molly something is hers and astoundingly she likes it sprayed direct into her face!!!

[fjm]

Poppy managed three days OKish, then several splats this afternoon. I think I need to reduce the time between the metronidazole doses to 2.5 days rather than three days - we shall see. She gets a dab of Logic digestive paste and a sprinkling of the Protexin powder with every meal, and is fed four times a day. But as Mollycat says, a few hours every three days is already better than all day (and night) for weeks - thanks, I needed to see some positives!

When Poppy was so desperately ill in January the vet was concerned to hear that both Sophy (papillon) and I were also having problems with diarrhoea - he started muttering about giardia and zoonoses, and i had to explain that after over 40 years I am all too familiar with the symptoms stress induced IBS, and Sophy picks up on my anxiety and magnifies it...

[fjm]

Profile pic is Tilly-cat - Poppy is a toy poodle. She gets the metro in tablet form in a chunk of chicken - fortunately she only stopped eating for a few days when she was at her very worst (I knew it was an emergency when she refused food - absolutely unheard of!), and she swallows the chicken without ever discovering there is anything hidden in it, so considers all her medicines a lovely treat. It does make that side of it much, much easier. There is a liquid form, but the drug is very bitter so may not be easy to administer. It is a bit of a double edged sword - another of those that helps, but has a lot of potentially nasty side effects. For Poppy I know her condition is chronic and life limiting, so the focus is very much on quality of life.

Like you I am doing my damnedest - I read early on that owner compliance is one of the keys to managing liver disease in dogs, and I think in 8 months I have missed one meal and one or two drug doses, out of nearly a thousand. I can't imagine what a struggle those 1000 meals and 1000 tablets would have been if she had refused to cooperate, like Honey.

Ah well - alarm has gone off for another meal and another tablet!

[Mollycat]

I’m not aware of her ever being jaundiced or anaemic as vet has never said any of her results are that. I know her liver levels were slightly raised along with all the other things they found when the biopsies were done etc. I think i read that pancreas issues can also give yellow stools, which she has got inflamed pancreas as part of the triaditis.
It may be that we do have to increase the steroids.

I’ve asked for more bloods to be done but vet not overly fussed as He keeps coming back to say ‘whats the point as we cant pill her’..

This all may well just be symptoms of her illness which vet kind of agrees with but he says the way to treat it is with diet as thats what probably caused it. I’m going round and round in circles but this forum and two of you in partucular have been invaluable with support

I call her strawberry blonde!! Haha

Molly lol liking it sprayed in her face, bless her.

Must admit for my own cats I'm with the vet, there is a lot I wouldn't treat Molly for because she is unpillable. But if yellow poop is down to excess bilirubin then there is an underlying reason why there is a ton of bilirubin in her poop, and that isn't likely to be down to diet.

The three systems are so closely interlinked it's really hard for vets to identify which is the starting point when all 3 are inflamed. Diet might be the route to managing it if an underlying cause can't be found or can't be treated, but from everything I've read I would doubt it being the cause. And I did read a heck of a lot because my vet said Molly's high bilirubin was a freak reading and unrelated to her raised liver enzymes due to her hyperthyroidism. It took some finding but yes high bilirubin is very much linked to hyperthyroidism!! And guess what, it's taken a year for her system to fully settle after radioiodine treatment, 18 months since diagnosis, but we don't have yellow runny poop issues any more and it wasn't the food. Well it may have been the weight loss food but that's another whole chapter.

[fjm]

As I sorted out breakfasts all round (Purizon biscuits plus Seraquin for Pippin; Pro Plan renal for Tilly; boneless chicken and beef with ground eggshell and a tiny bit of liver for both cats; meat and veg for Sophy - hurrah! normality!; and Royal Canin hepatic plus cooked chicken breast, a tiny bit of canned pumpkin, Protexin stomach powder, a dab of Logic paste and a 1mg Prednidale tablet for Poppy), and served each bowl in different places to manage who ate what, I got to thinking how easy it would be to chuck science and rationality out the window and get really superstitious. If I thought stirring Poppy's food clockwise with a polished rowan twig while reciting nursery rhymes in Latin would do the trick I'd even try that!

Poppy's bilirubin was sky high for the first month or two, but came down to within normal range with the steroids etc. She had some mild jaundice - much less than would be expected with such high levels, though. I tried to wrap my brain round liver enzyme test results but eventually decided to leave it to the vets - each test result needs to be considered in the context of all the others and the drug regime, so it all gets very complicated. Everything I read indicated that Poppy was and is getting exactly the recommended treatment, so I decided to concentrate on keeping her as well and happy as I can, and following the vet's advice. I did deviate a bit in the early days when she refused to eat the prescription food, but we navigated that successfully in the end.

Without going too far into TMI territory, her poos are usually on the orange side, due to the colouring in the hepatic food and the pumpkin. On good days they are formed and pick-upable, gradually getting softer and yellower until Splat! My aim is to understand the pattern well enough to intervene before the splat...

I think I would have more bloods done, just to know where you are. And I don't think not being able to pill her makes you a failure in any way - sometimes we simply have to respect another beings autonomy, even if we believe it goes against their best interests. If pilling makes her - and you - utterly stressed and miserable, the loss of life quality outweighs any good the drugs might do.

[Mollycat]

It is one heck of a topic, any one of those issues between nutrition, inflammation, liver, pancreas, bilirubin, etc all interconnected and each one complex. Very interesting but can easily take over your life.

Obviously Honey is Honey and Molly is Molly but I'm monitoring madam's bloods, which I have to anyway post radioiodine. We have the added complication and expense of the trauma of getting her into the carrier, requiring £30 worth of distance reiki every time. The blood test we have is an in-house general health check including organ function (we are monitoring both liver and kidneys) and includes bilirubin as part of the liver function I believe. £70 and 20 minutes while we wait. Not sure if it does rbc count but that would make sense and be helpful as part of a liver function test. Even if she was in perfect health I think any future ageing cats I will have that test once a year as part of our maintenance routine, as I consider £70 a year very acceptable to spot early signs of trouble. After all, Molly's HT was found by chance when I requested a general blood panel while we had her there at the vets for d&v, nothing to indicate HT at all. That was before we discovered reiki, when we maybe got her in the carrier for 1 in 3 appointments made.

If you think being unable to pill a cat is some kind of failure, try not being able to get it into a carrier, and once even turning up for the appointment catless to discuss the ongoing situation and poo diary with the vet in person!! Monitoring through regular blood tests makes sense. Thinking about it, refusing to do bloods on the basis of no pills only really says the vet can't imagine any other treatment not involving pills ... just a thought.

[booktigger]

I'm the kind of person who likes to monitor bloods with ongoing conditions regardless of vet wishes, I've had multiple cats who the vets didnt feel bloods were necessary based on symptoms yet they did indeed have conditions! Even healthy ones have bloods annually (I normally have senior cats) as I like to pick up on things early enough to slow the process down. You certainly aren't a failure at not being able to medicate, I've been in that position numerous times, I dreaded when the vet said Lucy would need regular meds as prior to her being Ill, even flea and worm treatments were a nightmare, fortunately she is mellowing with age, but as has been said, quality of life is more important and sometimes we have to accept that just because we can do something doesn't mean we should.

[booktigger]

I try and time them for their vaccs, especially cats like Lucy, although she is better at going in the carrier now, I don't turn up bleeding anymore!

[Mollycat]

All I ever had to do with Boo was put the carrier down in front of him and guide him to walk in. Never had any trouble with cats before either, easy enough to pick up and plonk in and go.

Molly, different story. She never turned on me but she is slippery as a mackerel and then stays under the bed until it's safe to come out. She is way, way too clever, and that's why I call her my indoor feral, because she has the intelligence, shyness and survival instincts of a successful feral. If I tried and failed to get her in the carrier, and just took Boo to the vets by himself, I would come back with him to find her sitting defiantly in her carrier knowing the danger was over and the appointment missed. The time I tried tempting her out of hiding with treats, after that she would not take treats from me in that part of the room for weeks afterwards. She loved pill pockets, until the day she saw me put a pill in it for Boo, and she has refused them ever since.

So when appointments became critical for radioiodine assessment and treatment, I tried first a communication session then followed up with reiki. First time I was very skeptical but 10 minutes before I needed to catch her she came out from under the bed where she had spent the morning and accepted a cuddle on her bed. Instinctively I didn't want to rush, I stayed as calm as she was and she relaxed. At the time I said ok poppet it's time to go now, stood up, picked her up and put her in and closed the lid. She complained but did not struggle. The reiki-communication lady helped me get a better carrier that Molly would accept more readily too. Wouldn't be without it now.

[fjm]

Sounds like a plan.

We are having fun today - Poppy is OK, but Sophy has had explosive squits since the early hours, and it is raining so she doesn't want to go out... She tries to make it to the emergency mat in the bathroom, but hasn't always managed it - several loads of washing , a lot of scrubbing of rugs, and rather a lot of dog washing as well. Chicken and rice cooking, and I must hunt out the cans of sensitive diet I saved for just these occasions - vet tomorrow if she's no better.

[Mollycat]

Sorry don't mean to sound smug and believe me we have other problems right now but at least I am relieved that our squits are a thing of the past. Hair everywhere, litter all over the bathroom floor, and cleaning up the fluffy pants, 3 things I do not miss about my Raggie. He is very much missed of course, just not for those three things.

[fjm]

There is a topical cream or gel, used for skin infections, but I have not read that it is absorbed enough to have any internal effect. There is a flavoured liquid that may be worth trying: https://www.vetsurgeon.org/news/b/veter ... e-for-dogs

I don't think a slow release injection would work, but you could ask your vet. The vet I saw yesterday for Sophy (who made a complete recovery 10 minutes after I phoned to make the appointment) was telling me that the animal formulation is comparatively recent, and they used to use scaled down doses of the human one. The recommended safe rates for animals proved to be higher than previously thought, so there is a reasonable margin, although side effects can be unpleasant.

I think you have already tried the RC Sensitivity Control food pouches - I swear by the canine equivalent, but it won't work if Honey won't eat it, of course.

[fjm]

Good to hear that Honey is maintaining her weight - she is obviously absorbing enough nutrients, even if you feel it is a struggle to keep her eating.

It might be worth asking Virbac whether Eradia is suitable for cats, or perhaps use the VioVet Q&A option: https://www.viovet.co.uk/Eradia-Metroni ... gs/c46238/. The dosages of the tablet form seem to be the same for cats and dogs, so it should be OK, but it may not have been tested in cats.

Yes, a relief Sophy is feeling much better. Just hoping it lasts - it was a nasty bout, and I don't know what caused it, so don't know how to avoid a recurrence.