For most of his life, Joey was a happy, healthy cat—never sick and always in charge. With nary a sniffle, the scrappy domestic short hair has lived with his owner Amanda Arrowood since he was found as a kitten in West Philadelphia. But, at the age of 13, Joey started losing weight and suffering from chronic diarrhea.
“When he first got sick, I tried medication for worms, which didn’t help,” said Arrowood, an ICU nurse at Penn Vet’s Ryan Hospital. Joey also saw his regular veterinarian, who couldn’t pinpoint the problem or a solution despite efforts with diet and medication.
“I work in ICU with critical cases, so I really thought this might be the worst case scenario with Joey,” Arrowood said. “Even though he was very much himself, swatting the dogs and leading the household, he was dropping weight quickly.”
She brought the feline into work for a consultation with Penn Vet’s Dr. Kathryn McGonigle, Assistant Professor, Small Animal Internal Medicine, with a special interest in geriatric feline medicine.
“Our goal is to systematically rule out different causes of the clinical signs the cat is having and identify conditions we can treat,” said McGonigle. “We started with a physical exam and laboratory tests.”
McGonigle found a major clue while examining Joey. “When I felt his belly, I could feel his intestine was mildly thickened, which can be a sign of intestinal disease,” she said. “It was still important to check for other causes. Comorbidities, multiple diseases, are common in senior cats and can compound each other’s effects on the body. To best treat a patient, it is important to have a global view of the cat’s health.”
For Joey, blood work and lab tests ruled out parasites, diabetes, chronic renal disease, liver disease, and hyperthyroidism, all potential causes of diarrhea or weight loss in cats. An ultrasound confirmed abnormal intestinal changes, and Joey would need further testing to identify the cause of the thickening.
“Without a biopsy you cannot determine whether a patient has inflammatory bowel disease—IBD—or a condition called small cell lymphoma, which is an intestinal cancer that acts like inflammatory bowel disease,” said McGonigle.
“We offered Amanda the possibility of doing a biopsy, which would tell us precisely what was going on to best guide therapy,” McGonigle explained. “This path was not elected, not an uncommon choice with many pet owners. However, we had so much information already, we could pursue empiric treatment of intestinal disease with confidence! We looked at treatment options for the most common forms of the disease and began with the least disruptive approaches.”
Trial and Error and Finally Success
McGonigle started a trial of prescription diet (for food responsive disease) and antibiotics (for potential antibiotic responsive diarrhea). “Neither were successful,” she said. She then prescribed a human grade probiotic. It resolved the diarrhea, yet Joey continued losing weight.
Because many forms of IBD in cats respond
s really well to steroids or other anti-inflammatory medications, McGonigle put Joey on the steroid prednisolone. But he had an unusual reaction to the treatment and had to stop taking it.
Next McGonigle prescribed oral chemotherapy, known to help many felines with advanced inflammatory bowel disease or small cell intestinal lymphoma. This is not a first line treatment—it requires frequent doctor visits and blood monitoring, even when taken in pill form at home.
Within just a few weeks, things turned around for Joey. The pairing of a probiotic and oral chemotherapy was the right combination for the cat’s condition.
“Joey went from very thin with a dull fur coat back to his gorgeous self,” said McGonigle. He’s been on this treatment, with adjustments based on monitoring, for more than a year and continues to do well. “He was lucky to have an owner who recognized something was wrong and was proactive about getting to the bottom of it before it was too late.”
An Ounce of Prevention...
Arrowood said Joey is a good patient and, because of his condition, sees McGonigle every few months. But, even if he didn’t have intestinal disease, she would schedule regular visits. “He’s at that age,” she said.
Considered a “senior cat” by the American Association of Feline Practitioners—which generally classifies middle aged as 7-10 years, senior as 11-14 years, and geriatric as 15 or more years—Joey is at a time in his life when clinicians recommend wellness visits twice a year.
“We start to see certain disease processes more frequently as cats enter their senior years,” McGonigle said. “Cats can’t talk to us about their aches and pains, so we need to check in with them to help head off any problems.”