Feline triaditis is actually three serious conditions occurring at the same time. This disorder consists of Pancreatitis, cholangiohepatitis and inflammatory bowel disease. There may be no known "cure" for triaditis, though I would argue that proper nutrition is the absolute best method of treatment and prevention. By proper nutrition, I mean a raw diet or a canned diet, and most definitely no commercial dry food or kibble of any kind.

 

Diagnosis of triaditis is difficult.¹ The only definitive way to diagnose is a biopsy, so exploratory surgery is involved. Blood tests, such as the GI function panel: cobalamine, folate, TLI, PLI, specific feline pancreatic lipase test and bile acid test, can be helpful. However, while positive results from these tests can confirm diagnosis, negative results do not rule out diagnosis. If inflammation is severe, it may be visible upon x-ray or ultrasound, but not always especially in the pancreas, as it's such a small organ.

 

Treatment of triaditis¹ generally focuses on managing symptoms, meaning pain management, anti-inflammatories, antacids, possibly sub-cutaneous fluids, etc. Many veterinarians feel it's too risky to give cats NSAIDs like Metacam®/meloxicam or aspirin at the same time as giving steroids like prednisolone and in fact recommend a week between giving NSAIDs and steroids.

 

I am reasonably convinced I lost Latifah to triaditis. I talked to some feline experts about her case, and I know Latifah had pancreatitis and IBD; a GI function test showed highly elevated PLI and TLI levels and low cobalamine levels. About a week before Latifah died, I found her in the kitchen in a large pool of yellow liquid she presumably threw up (yellow bile generally indicates a liver problem). The day she died, she started out looking tired – which generally indicated a visit to the vet was pending –  and then before I could get her to the vet she began suffering seizures. A seizure at the vet's ended her life.

 

I'm convinced the Metacam® and cyclosporine (an immune modulator similar to steroids) Latifah was on for stomatitis were reducing the inflammation of her organs and prolonging her life. I did a lot of research after she died trying to understand what had happened and some wonderful vets and caregivers gave me a ton of information: I'm convinced.

 

Now Rumpelmintz is sick. She's lost two pounds over the past year. I've done everything I can think of. I got her a full "senior moments" work-up with blood work, urinalysis, x-rays, EKG and blood pressure. We started her on Metacam® in case of arthritis. I took her to an imaging specialist for a thyroid scan and an abdominal ultrasound. I asked the vet to check her eye pressure and took her to an eye specialist.

 

So my next best guess was triaditis, or at least some components thereof: IBD, pancreatitis, and/or cholangiohepatitis. Rumpelmintz is on the antacid famotadine (Pepcid®) and the anti-inflammatory Metacam® for pain now. We could try oral steroid prednisolone . To try prednisolone, we'd stop the Metacam®. If it's triaditis, the prednisolone could help, but stopping the Metacam® could make things worse. Her white blood cell count is normal per her blood work, so we won't try antibiotics first. Liver inflammation can cause infection, in which case antibiotics should be used before starting steroids. Without a culture & sensitivity test there's no way to know if there are bacteria – or what kind they are – or what antibiotics to use. I'm not willing to put Rumpelmintz through a biopsy/exploratory surgery to confirm diagnosis or collect a sample for a culture & sensitivity. Honestly, she may not survive the anesthesia, and since whether the diagnosis is triaditis or components thereof, or intestinal lymphoma or something else, the treatment would be likely the same – steroids. I see no point in putting her through it.

 

We know Rumpelmintz has IBD. I had a GI function panel done in 2005 that showed low folate levels and borderline cobalamine levels. We can also see her intestines are inflamed on x-ray. My vet thought the x-ray might have shown some liver enlargement or inflammation – it's very hard to tell.

 

At this point, we're starting a week off Metacam® and then we'll start prednisolone and see what happens. We have nothing much to lose at this point. We'll give it a month or so. I'll weigh her in mid-October and let the vet know what's going on.

 

I know we can't "fix" Rumpelmintz, but if we can improve her quality of life, I want to do that. If we can't, then we need to let her go. I will not tolerate a miserable cat. There's no point to living in misery, in my opinion.

 

 

¹ Margie Scherk, DVM, DABVP - Feline, "Feline GI Pearls," 26th WSAVA Congress Proceedings, World Small Animal Veterinary Association, 2001

 

 

Lynette Ackman is a co-founder of Feline Outreach. She is a well-known, dedicated advocate for proper nutrition in cats, and a regular contributor to Feline Nutrition.