Feline Triad Syndrome and LGS

LGS in her onesie (to keep her from pulling out her stitches) one day post-exploratory surgery

I drove cross country with Dr. Nineteen Cats in mid-July to attend the AVMA convention in Seattle. Dr. Nineteen Cats is now, sadly, Dr. Six-or-Seven Cats (I’ve rather lost count at this point). She and her partner rescued many cats in the nineties, most of them already adult. Add ten years onto the age of even a young adult cat in the nineties, factor in prior poor health and things they may have been exposed to before being rescued, and you come up with a high maintenance, lowered life expectancy herd of cats. The past year has been hard on Dr. Twenty Cats, as she’s had to watch many beloved friends die from old age, cancer, kidney failure, diabetes and even a death resulting from a tangle with a rabid raccoon. She’s at the point now where she is not looking to take on any further cats, though I can’t imagine her without any cats at all. Because of this I will rechristen Dr. Nineteen Cats as Dr. Roo, since that is our mutual call of greeting. (Pronounce it “Roo-oo, with the same emphasis as “ya-hoo” and you get the idea.)

I was anxious to attend this particular conference because LGS has recently been diagnosed with feline triad syndrome, and there was a session devoted specifically to this illness at the convention. I first heard about this the year before Clueless Wonder died, as he was suspected of having developed this concurrent with his kidney failure. As it turned out he had pancreatic cancer and not pancreatitis, but I’d still kept half-an-ear tuned for further updates in the journals.

Feline triad syndrome is a poorly understood illness in which a cat develops pancreatitis, liver disease (especially affecting the bile-producing and storage areas of the liver) and inflammatory bowel disease. Some experts think it starts with pancreatitis of unknown origin, which then affects the liver, with the pancreas and liver then going on to affect the large intestine. Others think it starts with liver disease, possibly related to the carbohydrates included in most cat chow formulas today, which then goes on to inflame the pancreas and large bowel. After listening to the lectures these were the major take-home points I was able to jot down:

• In spite of what I was taught, it is necessary to get a biopsy of the pancreas. This will not make the pancreas worse, but will go a long way in helping to diagnose and treat. Get the biopsy from the left arm of the pancreas if you have a choice.
• Steroids are called for in acute cases, but not chronic cases. As the pancreas is destroyed, the cats will be more and more prone to diabetes. Steroids only hasten this process. In a very compromised animal, steroids will shut off the few remaining working beta cells left. Not a good idea.
• Cats are not little dogs. Do not feed low fat diets to cats with pancreatitis. They are obligate carnivores (unlike dogs, which can tolerate a higher plant content in their diet and who need low fat diets when they get pancreatitis).
• Supplement with Taurine, 250mgs to 500mgs per day. There are some studies that indicate this may help reduce or even reverse the disease. Even if it doesn’t, it can’t hurt. I’m all for trying things that can’t hurt and might help.
• Just in case the carbohydrate theory of what causes this is correct, feed a high protein/low fiber diet. Easier said than done. The best over the counter cat diet I’ve been able to find is EVO, cat and kitten formula. The canned food has 12% protein to .5 percent carbs/fiber. The next best formulas I could find had 10% protein to 1 -1.5% carb/fiber. EVO is expensive, but I’ve now switched all my cats to it.

This spring I started finding wet spots on the carpet when I came downstairs in the morning or when I came home from work. This wasn’t urine, but seemed like water. The fluid was clear, with no real odor. I didn’t know what to make of it, didn’t know which cat to blame, and so I just ignored it as one of those things. Then foam started appearing on the wet spots. I still couldn’t figure out what was up with that, but started watching LGS more closely, since she’s now (remarkably) the senior of the three cats who prowl the downstairs area unchaparoned.

[Aside: The Warrior Princess now spends most of her days in an upstairs bedroom, where she can be free fed, enjoy a private window with a view over our complex, and be unmolested by the three younger hooligans. She’s taken to this new arrangement like a duck to water, and seldom voluntarily leaves her domain now even when the door is open and she is free to come and go. Arthritis is now starting to significantly restrict her mobility, though her attitude and appetite remain unaffected. At an estimated 18 years of age, she’s earned a private suite if that’s what she wants.]

When LGS started acting hungry but refusing to eat, I had a sinking feeling. This was how Clueless Wonder acted during his pancreatitis attacks. I took her in to the vet, had blood work and an ultrasound done, and we ended up diagnosing inflammation of her gall bladder. We managed that successfully for nearly a month, but she relapsed even on the gallbladder meds (Ursodial, for those of you taking notes).

Back to the vet for more tests, then. We couldn’t do much more without doing an exploratory surgery to get a direct look-see at the guts themselves, and getting some samples for micropathology. It was also another $2,000+ to what I’d already spent on LGS, and I simply didn’t have the money. The Prof came through and paid for it for me. I’m reimbursing him in installments.

The recipe sounds like something from Macbeth’s witches: a snip of pancreas, a nip of liver, a bit of stomach, lymph node of cat, a slip of intestine. And in the end we have cholangiohepatitis, pancreatitis and mild inflammatory bowel. And the poor Prof had to deal with the results, as I was scheduled to leave for Seattle two days after LGS came home from surgery.

Since that point I’ve resisted the steroids, hoping I could control her by diet alone. I discovered last week that wasn’t going to happen, so steroid treatment began Friday. This pretty much guarantees she’ll be diabetic within the year, so I’ll need to start tracking either blood or urine glucose. I was already weighing her on a weekly basis, and I’ll have to continue that along with monitoring her food intake closely. It’s too early to know how she’ll respond to all this, but so far she looks to be doing very well. She’s even begun playing with her favorite toys again, something she gradually started giving up perhaps a year ago (pancreatitis is painful, and this hints at the fact that she wasn’t feeling well long before I spotted any of the signs).

I don’t mind any of this, but I worry about the drain on my already thin resources. The timing is bad, but LGS will not get anything other than the best treatment available regardless. I’ll worry about how to pay later.