Expert: Jessica - 9/26/2011

Question
Hi Jessica,
My cat Fletcher is about 7-8 years old.  He has a history (approx 4-5 years ago) of UTI.  He has also urinated outside of the box on occasion throughout the years.  The past few months he has done really well (I also think I have done really well cleaning the box!)
Two days ago I found him sleeping in an odd spot.  He hadn't eaten his breakfast.  I was home with him all day and he slept most of the time.  Which isn't unusual, but he didn't even try to run upstairs with me (he is not "allowed" upstairs, so he loves to try to sneak up there)  That evening he did not eat his dinner.  (Canned food).  
This is a cat that usually starts begging for food around 2-3 pm.  He will come running when a can is opened, or if any sort of food it out.  
I brought him in to the vet clinic yesterday where they ran a CBC, chemistry panel, thyroid panel, feline heartworm test, and electrolyte panel.  They also looked at his urine and ended up taking abdominal radiographs.  Everything came back normal.  
What are some illnesses that could be affecting him that wouldn't show up on these tests?  We are proactively treating him with clavamox and buprenorphine just to try to cover our bases.  I'm also syringe feeding him canned food.  Any help or suggestions would be appreciated!!

Answer
Hi Lindsay,

Sorry your kitty is feeling so poorly. There are two major conditions that come to mind that I would turn my efforts toward ruling out (or diagnosing) first. Unfortunately, one is cancer. The other is pancreatitis.

In cats, cancer is often diffuse. Rather than forming an obvious mass, it infiltrates tissues. This makes it extremely difficult to detect by palpation or even with radiographs. While some types of cancer (true leukemias, for example) will show up on blood work, and other cancers can cause a change in white blood cell counts in end stages, cancer remains very difficult to guess at by blood work. The best method for detecting early cancer of the thoracic and abdominal cavities tends to be an ultrasound. This can pick up subtle changes in the texture and densities of tissues consistent with cancer. Most veterinary facilities don’t have an ultrasound specialist on staff, but they will have one visit regularly. You may want to ask your vet about this.

Pancreatitis is an inflammation, sometimes caused by infection, of the pancreas. The most common signs in cats are loss of appetite and lethargy. Some cats also experience vomiting or a sensitive abdomen. As with cancer, sometimes standard blood tests and radiographs WILL suggest pancreatitis, but most often, these tests are inconclusive even when the cat is, in fact, suffering from the condition. The standard blood tests your vet probably ran will check for two pancreatic enzymes called amylase and lipase, and also for the liver enzymes ALT and AST. In some cases, pancreatitis patients will have elevated levels of these enzymes. However, this is not reliable. The only reliable blood test has been found to be the Spec-fPL. Some vets don’t work with the lab that offers this test and may only be able to run a blood test called a PLI. This is essentially the same blood test, but rather than returning results in 2 days, it can take 10. The second most reliable non-invasive method to diagnose pancreatitis would be, as above, an ultrasound. Characteristic inflammation can be detected using this tool. A biopsy would be needed to confirm 100% that you are dealing with pancreatitis, but this is generally not considered necessary to assume the diagnosis.

The treatment for pancreatitis is supportive and would include pain relievers and antibiotics, as you are giving. Most vets also highly suggest subcutaneous or IV fluids to keep the cat hydrated, and also to flush the system of toxins, which are being released by the damaged pancreas and liver (typically). Whether or not to make the cat eat is debatable, but most agree that forcing small amounts several times a day is the best approach. Treatment generally takes several weeks or even a couple of months.

It is also possible that your cat has some unknown infection. White blood cells are usually a good indication of whether or not there is an infection present, but this is not an exact science. If it’s a bacterial one, hopefully the antibiotic will have you covered. If it’s viral, then supportive care is all you can provide. I would not be opposed to covering him with a pet multi-vitamin just in case. Anything like Nutri-Cal (this provides extra calories, too, if he’s not eating like he should), Pet-Tabs or even Pet-Tinic is fine. These are all available online, at some pet stores, or from your vet.

Good luck!

Jessica