Vet advice/the cat neuterer?

[QueenOllie]

So Ollie has been VERY unwell. Ended up at out of hours, he's had IV painkillers, gastro meds, antibiotics and fluids. Dehydrated and inflammation with jaundice
They've scanned him with a specialist and found inflammation in his kidneys, liver, pancreas and thickening of the gut walls. He's also down to 2.8kg
Possibly triaditis
OR
Possibly inflammatory bowel disease
OR
Very unlikely - lymphoma

He's improved dramatically and is home for 24hrs, eating, drinking, running around. The problem I have is gold standard treatment is a biopsy, which we can do but then there is no money in the pot for treatment. Or we can watch, wait and see how he is

Oh no! Not darling Ollie. I wish I could advise but I don't have the knowledge/expertise to be able to. You need a vet to comment.

He says hi. He's doing really well from what he was and the gallbladder stones are dissolving

Oh no not Ollie!
I'm not a vet but dear old Vinocat had triaditis. It initially started with raised liver parameters in a senior blood screening at her MOT for which she had an ultrasound and needle aspirate biopsy to investigate (I think, this was back in 2015). There was a small stone in her bile duct and she was treated "conservatively" first with medication which did work to fix the liver problems.
She then suddenly got quite poorly and was severely jaundiced too. They never knew the exact cause but it looked like it started as IBD, then caused pancreatitis and the inflammation caused sludging and stone in the bile duct which in turn caused the liver issue. I seem to recall cholangitis being mentioned which links to the liver/gall bladder/bile duct area.
She was referred to a specialist who stabilised her and operated on to remove her gall bladder and took biopsies. Now, I realise this treatment likely isn't an option for you but we were told her particular case was rare and the surgery was mainly to sort the bile duct issue.
She was on steroids to reduce inflammation afterwards so that may be an option. Have the vets advised you what they would do beyond a biopsy?
Apologies this is quite long and a few years back now but I really hope Ollie is ok.

Oh no Ollie.
A hopeful bump for more knowledgable folks.
Sending much love to the gorgeous man.

@Vinorosso74 it all depends on the biopsy, they did mention sludge/stones but apparently that looks to be resolving. They've said it seems to be some inflammatory thing as the antibiotics have really helped

I think if Ollie is improving and comfortable, you don't need to rush into a biopsy right now. So give yourself a bit of time to think.

You also need to consider if it would make a difference to treatment. E.g. if triaditis, it'll likely respond to current treatment and that'll be your answer, if not improving and you wouldn't go down the chemo route then a steroid trial may help to see if ibd, and wouldn't hurt if lymphoma (assuming chemo not planned). If lymphoma a concern and chemo a possibility then biopsy may be more useful to start planning chemotherapy ASAP.

If costs are an issue, a decent Abdo ultrasound should give you a decent idea if any abdo lymph node enlargement or specific areas of pathology, pancreatitis etc. Though won't be quite as definitive as a biopsy.

Don't feel as if you have to decide right now - the vet will offer options but as long as Ollie is comfortable and stable then a conservative approach is fine.

We'll keep things crossed here that everything resolves with the medication. Veterinary medicine does seem to improve all the time so hope they get him back to his usual self soon! Loving his red bandage.

Sorry just seen he's already had a scan - looks like that's helped them prioritise his differentials already

I'd be tempted to wait until dehydration corrected and repeat bloods once the meds have kicked in a bit. Sometimes just a bit of time can give you the answer. Biopsies are invasive so whilst the vet can't rule out the less common and potentially serious issues without it, I'd tend to make decisions based on clinical response rather than invasive diagnostic tests unless, they're very worried about potential lymphoma.

But also your peace of mind is important and you know him best, so it's also fine to biopsy if you want to be absolutely sure you aren't missing something

@Veterinari yes they brought a specialist in for the ultrasound
Some gut wall thickening but they don't think lymphoma as he responded so well to the antibiotics
They did say it was unusual to see kidneys, liver, pancreas, etc all inflamed at once. The stones/sludge in the gallbladder seem to be clearing
He's had a urine sample sent off but kidneys seem to be functioning fine and lungs/heart ok
I think the issue is if he has the biopsy then needs say his gallbladder out, I'm out of money! We are at about £1500 already

He's also persuaded the staff he will only eat if they fuss him while he eats or hand feed him and demanded head bops from them
But he's being very good with his cannula in and not licking it or anything. Back to the vets tomorrow night for a check up

I don't think Magic had a biopsy when she had triaditis. But she'd had a laparotomy so they could see what was going on.

What's your insurance limit?

3k

Hi, horrible situation to be in. The first question you need to answer is if it is lymphoma will you want chemo? My last lymphoma chemo case was pretty straight forward, very few complications but cost the owners in the region of £5k which didn't include primary diagnosis.
If you decide against chemo then there isn't so much of a rush to make the the biopsy decision. if your cat is improving then continue with treatment and reassess with your vet.
My boy had suppurative cholangiohepatitis in March. It was a hard battle but good old IV fluids, antibiotics and steroids did the job.
Good luck to you and puss cat

I honestly don't know. He's on the older side, about 11 we think but usually fit and well. They said out of the possibilities that lymphoma is way down the list
He's worth every penny but I will only do what is in his best interests and not for me
They said the next 24hrs are to see how he gets on at home, and then back to vet at 6pm tomorrow. Was absolutely fine and went from normal to needing emergency treatment in the space of an hour
He also needs to gain weight but he was eating fine, so they think the inflammation was causing the loss? He's gone from 3.2 to 2.8

How is he this morning?

Eaten two pouches, had a drink and a wee. Slept gazing at me all night with his head on my arm and had to be told to get down from swinging off the windowsill

That all sounds good. If he's up to mischief he must be feeling ok.

That sounds great, fingers crossed he's his way to normality

@Veterinari they have discharged him
Had a check up last night and all good, tummy soft, temp normal and he's back up to 3.2kg
They are going with triaditis

I'm so pleased he's on the mend.

Yay!

Fantastic news. Honestly these cats do like to try us!

He's very... bald but happily gazing at his mama @thecatneuterer
Can't believe he bribed the vets into thinking he would only eat while being cuddled. He's glued to me at the minute

Update in case anyone comes across it in future
He's now at 3.4kg, vet said his bloods are like he has never been unwell and he's acting perfectly normally for him
Hopefully it was a one off