“Charlie” is an 8½ year old cat or at least that was the best guess since he was lucky enough to be rescued from a life on the street by the owners a couple of years ago. Intestinal disease is very common in cats, but “Charlie” decided to do it his way by getting not one but two unusual conditions. He started with an over-healthy appetite last year but no problems were found at that time and since he had actually gained weight rather than losing weight the owner was just keeping an eye on things. Then, about 6-months ago, he lost his appetite and started losing weight. A mass could be palpated in the abdomen and the combination of ultrasound and x-rays showed this to be a growth on the intestine where the small intestine meets the colon and further that this mass was causing a blockage of the intestine. Blockage of the intestine is a clear indication for surgery and so that is just what “Charlie” got. At surgery, a mass was found in the first part of the colon and the lymph nodes beside this mass were enlarged. In cats this has a high chance of being colon cancer with spread to the lymph nodes. Since the mass was removable, he was given a chance and the mass was removed while the lymph nodes and liver were biopsied. The biopsy was good news, sort of, since there was no indication of cancer but instead it was a very odd form of inflammation. To veterinarians, “odd” means scary since there are many unknowns…what is causing it? will it come back somewhere else? should we give any treatment? Even after special testing on the biopsies, nothing in particular was found as the cause of the inflammation but since it had been removed and he did well after removing the mass we decided to just watch and hope that this was just a one-time mystery.
Fast forward 6 months and “Charlie” comes back in for having not regained the weight lost before surgery despite going back to having an extra healthy appetite, which is called polyphagia. Unlike before surgery, he now was also having diarrhea. Fearing that the original weird inflammation had recurred somewhere else on the intestine, another ultrasound was done but, unlike the first ultrasound, no new masses were found and, in fact, nothing abnormal was found. Routine labwork was done to look for other causes of weight loss when there is polyphagia but the labwork was all OK, including no sign of diabetes mellitus or hyperthyroidism, two very common conditions in these situations. A special test was done for the blood level of vitamin B12 (cobalamin) that was low. This test looks for signs that he was not absorbing the nutrients he was eating in abundance due to intestinal disease. This normally would indicate that the intestine was abnormal and not absorbing nutrients and seemed to explain his low weight and diarrhea. The twist is that the vitamin B12 test is part of a panel of tests and one of those other tests is the level of Trypsin-Like Immunoreactivity (a tongue twister so we just abbreviate it TLI) which was also low. Low TLI indicates that his pancreas was not producing the enzymes needed to digest the food he was eating, and this would also cause weight loss and diarrhea along with causing the blood level of vitamin B12 to be low. This condition is called Exocrine Pancreatic Insufficiency (another tongue twister so we abbreviate this one EPI) and is very rare in cats-not unheard of but he was the first cat diagnosed with this condition at our hospital in the past 30 years.
Exocrine Pancreatic Insufficiency is a treatable condition unless the cat has other ideas. The problem is that the treatment is to mix the missing enzymes in the food as a powder and cats, unlike dogs, are very leery of anything different about their food and will not eat. The owners are working very hard to find a mutually agreeable way to get the enzyme powder into “Charlie” by hiding it in very strong smelling and strong-tasting foods such as fish or the liquid from a can of tuna. Other parts of the treatment include giving supplemental vitamin B12, since the measurement was low, and a short course of antibiotic since the lack of pancreatic enzymes can let the bacteria, that is always in the gastrointestinal tract, get out of balance.
“Charlie” has been gaining weight on enzyme treatment which he is quite happy to eat when mixed with baby food mixed with his cat food. We are waiting to see that “Charlie” does not decide to throw us another curve and get a third intestinal problem.