Thursday, April 5, 2012

Case of the Week: Java

In today's case, we will see how therapy laser treatment can be very helpful with a frustrating chronic medical condition.

Java is a fourteen-year-old Burmese cat with a typical problem for many cats. He vomits once in a while. He first came into the clinic three years ago. At his previous veterinary clinic, he had some basic blood tests and radiographs done which showed nothing unusual. Since some cats with vomiting have food allergies causing the vomiting, I tried Java on a hypoallergenic diet. He would not eat it but continued to do okay, just vomiting periodically.

About eighteen months ago though, Java started to vomit more often, twice weekly. We evaluated his abdominal organs with an ultrasound, an again, nothing seemed unusual. I also sent blood to the laboratory for a pancreatic profile. This profile tests pancreatic enzyme levels and cobalamin and folate, two vitamin levels that help us evaluate how well the small intestine is functioning. While most of Java's panel results were normal, one of his enzyme levels - his Pancreatic Lipase Immunoreactivity (PLI) level was three times normal. With this result, we knew that Java had chronic pancreatitis.

Chronic pancreatitis is common in cats, especially as they age. The pancreas is an organ that creates and excretes enzymes into the small intestine to help with the digestion of food. Pancreatitis occurs when the pancreas becomes inflamed or irritated. This causes pain and vomiting and can lead to poor digestion and weight loss. It is often associated with inflammation of the intestinal walls as well, called Inflammatory Bowel Disease, or IBD.

I prescribed an anti-oxidant and a probiotic for Java and also had his owner give him Pepcid AC, an antacid. Java did well on these and his vomiting decreased. A few months later, his owner brought him in for a progress exam and to recheck his blood work. His kidney and liver values and blood cell counts were normal but his PLI had increased from three times to fifteen times the normal level. The antacid and the probiotic were helping the symptoms, but Java's pancreatitis was getting worse. To find out exactly what was going on, we had to perform biopsies on his pancreas and intestines.

In early 2011, we did an exploratory surgery to obtain the biopsies. The pathology report on the biopsies showed that there was inflammatory bowel disease in his small intestine and pancreas. This ruled out cancer and infection so we could treat Java more specifically and aggressively. I could now add corticosteroids to his medications. These steroids are very effective at suppressing inflammatory conditions, such as inflammatory pancreatitis, but can make other diseases worse.

After starting the oral steroids, Java did well. His vomiting continued a little but decreased greatly in frequency and he seemed to be feeling better. Yet despite these modest improvements, neither the owner nor I were satisfied with Java's condition. In consultation with his owner, we also decided to try a more experimental approach. Scottsdale Cat Clinic now has a therapy laser that uses photostimulation to decrease inflammation, decrease pain and promote healing. We've been using the laser for post-surgical treatment and arthritic patients. Although there have been no studies using the therapeutic laser for treating pancreatitis, I believed the same healing results we were seeing on wounds might also occur with Java's problem.

We started therapy on Java three times weekly for two weeks, then twice weekly for a week, then once the following week. After this intense initial treatment, we reduced it to once every three weeks. Java seemed to feel much better. He was more active and affectionate, and he was not vomiting. A month after he started the laser therapy, his PLI had decreased to five times normal. We therefore decreased his steroids from daily to every other day. He returned to vomiting a little and did not seem to feel as good so we increased the frequency of his laser therapy to every other week. His most recent PLI was decreased to just over two times normal. By continuing his laser therapy every two weeks, we are able to minimize his steroid dose and keep him feeling well.

Java is currently doing very well. He is not vomiting, is eating well, and is back to jumping up onto high furniture. His owner is very excited about his response to the treatment with the therapy laser. She says that he is back to his old self, bossing around the other cats, and being very active. In the previous couple of years, she was very concerned about his regular vomiting and slowing down in activity level and is very happy that we were able to diagnose and treat his condition.

Pancreatitis can be a difficult disease to diagnose and treat. It is probably fairly common in cats but usually goes undiagnosed and untreated, leaving the affected cats to deal with the discomfort for many years. Many owners believe vomiting in cats is normal but it can be a sign of a serious disease. Pancreatitis is unlikely to be completely cured, but treatment can help reduce the severity and help the cat to live much more comfortably.


Dr. Judy Karnia

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