Poor Pumpkin

Pumpkin endured another trip to the vet yesterday, to see why he continues to lose weight. His appetite is somewhat erratic but he does come faithfully to every meal and eats his wet food, or at least a modestly decent amount of it; he's gone right off dry food. His behavior is normal but he vomits a little yellowish fluid pretty much every day. So the poor little guy got stuffed into the carrier despite his struggles and protests and delivered into the cruel veterinary hands.

Vet: Pumpkin! He's such a handsome little guy, I love him so much!

Pumpkin: You're gonna rend me limb from limb and eat me!!!!

They took samples of blood and urine, checked his vitals, and so forth, and then Dr. Corbett and I discussed possible diagnoses of the skin-and-bones Pumpkin, who's shed a pound plus since his last exam and is now under eight pounds (when he was fat he weighed in at 18 pounds). We had a further discussion by phone this morning after initial blood work results were in. Conclusion:

We don't know!

The trouble is, his symptoms and test results conflict. Symptoms of weight loss but normal energy: look like thyroid. Test results: Not so fast; the thyroid value is in the gray zone, not clearly off; one white cell count is slightly elevated, suggesting something inflammatory; with the weight loss and erratic appetite that looks like inflammatory bowel disease -- but he's not having diarrhea, just normal BMs. He does has a new finding since his last exam -- a heart murmur.

So now what?

It could still be thyroid. Dr. Corbett's going to send a blood sample for a T-4 test, which might show it -- but Punk's previous T-4 in May was normal. If it's abnormal now we'll start thyroid medication. There are pills, liquid, and special foods, but knowing Pumpkin, the pills or the liquid are most likely no go. I brought a can of the special food home to try and he rejected it. That leaves another possibility --transdermal methimazole, a gel you rub on the back of the cat's ear twice a day.

Or maybe the T-4 is still normal. Then what? Despite the lack of diarrhea it could still be intestinal inflammation, and one treatment would be steroids -- but the heart murmur makes that dauntingly risky.

Dr. Corbett is frustrated! She so very much wants to help the little golden guy. She's planning to do research over the weekend to see if she can figure out exactly what's going on and what if anything we can do about it -- keeping always in mind we're dealing with a 15-year-old feline with a heart murmur here, who shouldn't be put under anesthesia. At least his teeth are reasonably good, not much tartar and not much gingivitis; surprisingly good, in fact, for an old guy like him.