Don't Know What To Do (IBD)

We have a 5 yr old short hair tabby female cat, "Crybaby", who is fighting a losing battle with IBD.  She has gone through treatments with the steroids, antibiotics and 2 years of B-12 injections every month.  After her initial treatment of getting the steroid, antibiotic and B-12 each week for 4 wks and then getting the B-12 injections every month, she did better, but her poop was no ways close to being a solid stool.  They stayed loose, but not watery or bloody.  Then it got worse like it has always been.  She was on the veterinary diet canned food, which consisted of rabbit and venison.  She would not eat duck.  At first her litter box had to be placed within 5 ft of her food bowl.  It would go through her that fast.  In and within seconds, it was pouring out.  The vet added the hypoallergenic dry food and that helped some, but like I said, she never got to where she should be.

Then she quit eating the canned vet diet food altogether.  She would go for days and not eat.  I would break down and give her some dry, because she was only going to get worse without eating.  Of course, the diarreah is explosive after eating any dry food.

I tried Blue Wilderness and it did good for about 2 wks and then she quit eating it.  She never eats more than a teaspoon of food at one time.  Then she will come back 2 -, 3 hrs later for another teaspoon.  We tried Halo, Spot's Stew, and she would not even try it. 

This past Saturday morning, before she ate anything, I heard her in the litter box and it was very explosive.  I had no idea what I was in store for.  When I went in, the poop was all over the mat outside the box.  The mat is about 24" X 18" and thank God it was there or my carpet would be ruined forever.  The mat was covered.  This time, the poop was black and very tarry.  It has never looked like this before.  Her last food was around 10 PM on Friday night and it was Salmon and again, about a teaspoon.  I don't even know where all this came from.  It was horrible.  Also, her poop has always had the most horrendous odor, unlike any cat I have ever had.  I can't even tell when my other cat goes to the litter box, but when Crybaby goes, you can smell throughout the whole house and I live in a 2600 sq ft house.  It will wake me out of a deep sleep, if she goes during the night.  The litter box is in room next to my bedroom, but my door is almost closed.  My other cat sleeps in bed with  me and you know you can't close the door.

Anyway, I picked up some raw food on Saturday and a different kind of can food.  It is Instincts and the quality is super high and I knew she would eat it when I opened the first can.  Oh, it smells so good and it is all meat with a little peas. (very little).  She will not eat it.  I tried the raw and for about 3 meals, she ate about 6 little cubes ( the raw is Instincts also and sold at PetCo). 

Nothing is working and she will not eat anything.  She is losing weight and she looks like she is in pain. She stays upstairs and sleeps all day, only coming down every 2 - 3 hours for that 1 tsp of food, if I can get her to eat it.  Mostly, she doesn't eat it and goes back upstairs.  I am at my wits end. We have spent a fortune on this cat and nothing works.   Of course we are taking her back to the vet, but she has no idea what to do either and I'm afraid we are just spending more money we do not have.  We are both on disability and it is so hard.  I have lupus and the stress of Crybaby is causing my lupus to stay flared up.  I worry about her constantly and get very upset about her situation.

Any ideas on what we can try that we haven't tried already?  Please help if you can.  Willing to listen to anything!

Thanks,

Catawampas 

has she been tested for anything else besides IBD? like hyperthyroidism or kidney disease? if it is only IBD then there are other medications you could try to control her symptoms like, prednisolone and azathioprine or Metronidazole. Or you could add some probiotics like Acidophilus to her canned food or some canned pumpkin? she could be allergic to something in certain foods you give her, like grain or chicken. I give my cats Now! Adult Grain Free cat food and it doesn't have chicken in it at all but I'd only recommend it if you want to start her on dry again. Some good canned foods would be Purevita, Wellness, Nature's Variety. They all have a variety of flavors to choose from. Hope you find something that helps the poor little lady....     And I know this might sound odd, but have you had her nasal passages checked out? You say she won't eat any foods and I'm wondering if it's cause she can't smell them, cats won't eat something they can't smell first. Just a thought, sorry if none of this helps.

Wow, I really feel for you. We have an IBD cat and are familiar with the frustration when nothing seems to work. It took months to get his diarrhea under control. Unfortunately, what works for one IBD cat may not work for another, and the meds and foods that worked for him aren't available outside Europe. He's on a low-fat, unique protein diet, and we have to avoid all grains (including rice), chicken and mixing different types of meat on any given day.

You say she has been given antibiotics. What have her fecal samples been tested for, and were the tests done at the vet's office or sent to an outside lab? Our cat had been tested and treated for coccidia before we adopted him, and the fecal sample I took in right after we got him didn't show anything out of the ordinary. Due to the horrible smell and liquid stool, I asked that a sample be sent to an outside lab and tested for "everything". It turned out that Mogli had an E coli infection that the antibiotics he'd gotten for the coccidia hadn't cleared up. Another round of a different antibiotic cleared up that infection. Several members here have mentioned Tritrichomonas foetus as another parasite that has to be tested for by an outside lab.

Has she been given an appetite stimulant? Have you tried sprinkling Fortiflora on her food? It's a probiotic that is irresistable to many cats and might jump start her appetite. If she won't eat the raw food, perhaps you could try freeze-dried raw, of which there are several brands, or a home-cooked diet. We have a Raw & Home-Cooked Cat Food sub-forum you can check out, in particular the resource threads "stickied" in the blue box at the top. There are also quite a few threads on IBD in this (health) forum: http://www.thecatsite.com/newsearch?search=ibd Several members have had luck adding probiotics to their cats' diets, usually something a bit more heavy-duty than the Fortiflora: http://www.thecatsite.com/newsearch?search=probiotics

There's also a site specifically for IBD run by a TCS member: http://www.ibdkitties.net/

I've added "IBD" to your thread title to alert other members to the subject. Hopefully they'll be able to provide some help.

I am so sorry you are going through this.  I have an IBD kitty that I did the vet hopping thing with for six years before he was diagnosed.  He had atypical symptoms which started when he was 18 months old which I think is why it took so long.  Fortunately the steroids worked for him but I understand about keeping up with the vet bills.  Of course the main thing was that my kitty would have these horrible flares and would be so sick.  I also didn't know how long I could keep up with the large vet bills and no resolution.

I know another member here had a kitty with the constant horrible diarrhea and feeding raw cleared it up for her.  I stopped with the steroids so I don't know much about probiotics but I know they have helped others.  LDG has done a lot of research on probiotics and IBD.  http://www.thecatsite.com/t/272920/older-cat-with-possible-ibd-or-colitis-how-to-treat, post #7 has a good summation of what she has found.  I know one of the members with a kitty that had the constant diarrhea also used the s-boulari.  You can also PM LDG if you have further questions about the probiotics.

I'm SO sorry you're going through this!

Thank you for providing a link to that post, Denice, I'd already forgotten about it. :anon:

I would defintely get a PCR test done (checking for T. foetus, etc. in stool) as jcat suggested if this has not been done yet.

PLEASE read the link Denice provided.

I would make the bone broth ASAP. If she won't lap it up on her own (the stage two broth full of collagen), syringe it into her. Her system needs a rest, and the collagen in the broth will really help soothe her entire GI system.

I would get her on an S. boulardii supplement ASAP. You want to give her 125mg 2x a day (1/2 a 250mg capsule 2x a day). Since she won't eat right now, you may have to mix with something (baby food?) and syringe it into her. It's not the most palatable thing in the world anyway. So far, I have not seen S. boulardii NOT stop diarrhea in an IBD kitty or any kitty with diarrhea, actually. It can take a few doses, but I hope your kitty will not be the exception. :cross:

She also needs her healthy gut flora restored. S. boulardii is a yeast-based probiotic, and it does NOT repopulate the gut. When you stop giving it, it leaves the system. You also need to get an L. acidophilus-based probiotic into her. Pet probiotics usually do not provide enough quantity quickly enough for an IBD cat. A human supplement with 5 or 10 billion CFU 2x a day is best, at least for a few weeks or months. I think this is also discussed in the link Denice provided.

Given her inappetance is an ongoing issue, I would make sure I have supplies on hand. These syringes for liquid and food are FAR superior and much easier to use than anything the vet ever provides:
If you want to try raw after letting her system rest for a day on the bone broth, see if there is a Rad Cat distributor near you. This is expensive food, and you don't need to keep her on it long term, but you can syringe it into her. It is very simple, plain, high quality food, and very easy to digest AND syringe as it uses eggshell, not ground bone. Of course, you can use the cooked chicken from the bone broth and run it through a blender or food processor. You can check into the raw and home cooked forum for help with balancing cooked meats longer term if you want to try that (eliminating the guess work as to what additives are in what commercial foods that are bothering her). There are recipes up there for just about every protein, and the basic supplements needed to balance the food are easy to locate and use.

I understand you don't want to syringe her long term. But when IBD kitties are wasting away, they need our help to get over these humps. I would absolutely talk to the vet about some type of anti-nausea medication and/or appetite stimulant. I do NOT suggest trying an appetite stimulant without an anti-nausea medication. Given the biggest issue with IBD is motility, I would consider trying Reglan if you have not tried that yet. It is given about 1 hour before a meal, and it triggers gastric emptying. A big problem with IBD kitties is bile build-up, making them feel nauseous. As this triggers gastric emptying, it moves the bile along, helping them feel better and hungry - though you may find you need an appetite stimulant (like cypro) and perhaps an antacid as well. May use 1/4 a pepcid a/c once or twice a day, though some find ranitidine (zantac) more effective (1/8 pill). Obviously all of this should be discussed with her vet, and I see no need for the vet to see her given how often she's likely been there. I would hope your vet is willing to discuss all of this on the phone with you, and all you'd need to do is drop off a stool sample and pick up some meds with directions.

Many are seeing good success with settling an upset tummy with slippery elm bark powder. You mix it 50/50 powder to water, let it gel, and either syringe it into her or mix it with food (once she's eating). You can either do this 1/2 an hour before every meal (if not using reglan) using 1/8 teaspoon of SEB and 1/4 teaspoon water, or you can do this twice a day, using 1/2 teaspoon SEB and one teaspoon of water. Just make sure to give it several hours on either side of medicine, as it does slow absorption.

I do understand the concept of eating anything is better than not eating. But when it comes to difficult IBD cases like this, I think it's better to syringe feed food that won't make things worse than to offer something like kibble that you know is going to cause a problem.

I have a cat just diagnosed with severe IBD and here are some thoughts based on my cats internal medicine specialist.

IBD is on a continuum with small cell intestinal lymphoma and the only way to tell the two apart is by surgical or endoscopic biopsy.  If its lymphoma, there are other treatments that can and should be started to get the cat into remission.

One of those treatments is Leukeran, a generally well tolerated drug that not only treats lymphoma, but also reduces the inflammation of the intestines that causes the symptoms and lack of nutritional absorption by the intestines.  Often Leukeran works when the steroids don't.

My cat had the biopsy, does not have lymphona but has IBD badly enough that if the steroids don't work, the vet thinks it will be worth trying the Leukeran.

So you may want to discuss a biopsy if you can afford it, and even if you can't you may want to speak with a knowledgeable vet about leukeran.

Most important: we usually think about cats who go into hepatic lipidosis (fatty liver disease) as cats who have stopped eating for some other cause. After a few days they can't regain their appetite and that can be because they are in lipisdosis, a crisis that can be fixed with aggressive therapy.  But a cat who is eating but not getting enough nutrients can also start going into H.L., i know this because they also biopsied my cats' liver and found this, even though he eats well.  You're cat is now not eating and one has to strongly suspect lipidosis, please discuss with your vet.  He may need sub cue fluids, along with an appetite stimulant and anti nausea drug to pull him out of this or he might even need a feeding tube.  Cat's in serious lipidosis loose their appetite and reversing this takes intervention that may go beyond offering tasty food.

So i think you have some very difficult choices ahead. One way to go is biopsy and or more aggressive treatment. Diagnosis for lipidosis and aggressive treatment for that if there is a positive diagnosis (it can also be diagnosed via blood work i think if its bad enough).

Bottom line, if you can't food into her system then this is going to get worse quickly.  And even with food, the depth of her IBD has to be mitigated if she is going to live.  I wish you all the best,

Stephen

Yes, she has been tested for lots of different things.  Fecal samples have been sent to our Vet School in Raleigh, NC and nothing showed up, other than she did not have any bacteria in her poop.  So she was started on the probiotics, which she could taste on the food and would not eat it.  Now she is on a chewable one and she eats it up.  Right after she showed up at our house, she had two parasitic problems which were cleared up with antibiotics.  We don't vet hop, since the vet we take her to has another vet that comes in from another clinic once a week and they are both very good.  She wanted to do an ultrasound and depending on what she found, told us she may have to do endoscopy or exploratory surgery to find out what was going on.  From a financial standpoint, there is no way either of those options are affordable.  I have lupus and have a lot of medical bills.  Since both vets and the vet school seem to be 95% sure it is IBD, we decided to treat for that and see what happened.  She has been like this since she showed up at our house and I'm sure that's why someone dropped her off.  She was less than a year old and had been spayed.

Anyway, at first, our vet followed the guidelines as if it were a food allergy and immediately she was on a grain-free, preservative free, etc diet.  Nothing changed.  Then when we started to see blood in her feces, we knew there was more going on and she bad began vomiting too.  This is when IBD came into the picture.  She was then put on the Royal Canine Vet Diet Food, (rabbit, venison and duck).  This went straight through and I cannot stress straight through enough.  As I stated in prior post, I had to put litter box in laundry room with door open and within 4 - 5 ft of her food bowl and then sometimes she didn't make it.  Literally, it went straight through.  The vet wanted to keep her at the clinic for a few days to see what was happening.  I think she thought I was exaggerating a bit, but she soon saw I wasn't.  She said she had never seen food go through so quickly and I'm talking like within seconds, not minutes. This is when the hypo-allergenic dry food was added and it helped keep the food in her longer, however it did not stop the diarreah.  Then the treatments started.  Better for 4 months, but not solid stools yet, but more like loose patties, not the constant watery stools.  Vet decided to repeat course of antibiotics, prednisone and keep up with B-12 and we did this for over a year.  Rounds of prednisone and she got the B-12 once a month.  She completely quit eating the food, would not touch it anymore and I was just putting in her bowl, cleaning it out and throwing away and at $2.50 a can, something else had to be tried.  So we tried the Science Diet Vet RX food and she would not eat that either.  At this point the vet said to try anything that was high protein, as long as she would eat it.  We tried Blue Wilderness and she liked it and it worked good.  For the first time ever, she had a solid stool.  We had a good decent week and second week, she quit eating it.  She wants the dry food, but absolutely cannot have it.  That is the worst thing for her and it becomes explosive diarreah again.

So, tried the Nature's Variety Instinct and she ate a little of each flavor and wouldn't touch it again.  Gave her a little of the raw and she ate a few pieces of that and did so for a couple of days and now she will not eat that either.  She will not eat anything I give her.  She will eat a little of cooked chicken sometimes, but she needs the vitamins too and if I put anything on her food, she is not going to eat it.  So here we are and I don't know what to do with her.  It is all very stressful for me and I can tell when she is in pain and I want to help her, just don't know how.

Thanks for any advice and for your reply. 

I know you said she has improved with rounds of the steroids.  Has she remained on a smaller maintenance type dose of steroid?  I know there is a risk of diabetes with long term steroid use.  My kitty has been on a low dose of a steroid for a little over 3 years and so far no diabetes but the diabetes is a risk.  Some kitties do better with one steroid over the other.  A lot of kitties with diarrhea issues do well with a steroid call budesonide.  It's actually classified as a topical steroid because most of it will stay in the digestive tract rather than going into the rest of the kitty.  One disadvantage is that it is more expensive than the other steroids.  You have mentioned prednisone, is it prednisone or prednisolone?  Prednisolone sometimes works better because the liver actually converts prednisone into prednisolone.  I know there have been major long standing supply issues with prenisolone but from what I have read here it seems to be more available now.

Being picky about food is common with IBD kitties.  They feel bad from eating a food so they shy away from it.  My IBD kitty is still picky but he has improved significantly since being on the steroid.

I didn't get the biopsy done either, we just went forward with treating for IBD.

Thank you so much for the links and hopefully we can find something that will work.  Does your cat eat any dry food now or strictly wet or raw.  Yes, I have thought about the freeze dried too and that was going to be my next try.  The Fortiflora was the probiotic the vet prescribed and she would not eat the food when I added it.  Supposed to not have a smell or taste, or that's what I was told, but she would know right away it was there.  She would wait until the other cat finished eating and if there was any left in her bowl, Crybaby would eat what was left.  Since they are impossible to separate, they both eat the same.  Sometimes, I can give Sofie treats or a little dry if Crybaby is upstairs, but other than that, they have to eat the same.  Now, she is on a chewable probiotic and she loves is.  It's upstairs so husband can make sure she gets it every day and I don't know the name of it, will get him to bring it down for me. But so far, no change with that either.  In the beginning with the fortiflora, the smell was so much better; actually the smell was gone, but didn't last long since she would not take it for very long.

We are avoiding all grains, preservatives and additives.  Have not thought about chicken, however she was on rabbit and venison for over a year and was no better.  She will not eat duck either.  The Tritrichomonas Foetus was the one she was tested for that had to be sent to vet school also.  She said it was one that only they could detect because of specialized microscopes and other equipment.  It came back negative.

As for the home cooked food, I can do that as long as I am well.  However, being I have lupus and there may be times when I am very sick and in hospital also, then I can't prepare her food.  That's the only reason I have not done that and stuck with it.   I guess I could try to prepare enough and keep frozen and husband could thaw out daily amount.  Our other cat, Sofie will not eat anything except cat food and I guess that's okay too, since Crybaby isn't going to eat any canned food anyway,  just still can't let her have any dry food.  I will check out the home cooked food here.

What food is your cat on now?  Does he still have diarreah occasionally or has it completely stopped?  And yes, I know some treatments work for some and not for others, unfortunately.  I do appreciate all your help.

Thanks

Cathy 

Thanks Denice.  It is really hard and it stresses me out and then I get sick.  It seems it's a vicious cycle.  We love her so much and I want her well and just be a happy funny cat.  She is the most loving cat I have ever had. She has the most beautiful and emotional eyes and I just cry for her as she goes through this.  I will check out LDG's knowledge and maybe with all the help, we will be quite lucky and come up with something that works.

Thanks again!

Cathy

It is the prednisolone and she had minor improvement, then went right back to the way she was. Maybe it is worth keeping her on a low dose and see what happens.  Will talk to vet about it.  I know she does not like to keep them on steroids long term unless absolutely necessary and of course this would be necessary.  At the point she is at now, I don't think she will make it much longer.  Will keep posted about what is happening with her.

Catawampas said:

Thank you so much for the links and hopefully we can find something that will work.  Does your cat eat any dry food now or strictly wet or raw.  Yes, I have thought about the freeze dried too and that was going to be my next try.  The Fortiflora was the probiotic the vet prescribed and she would not eat the food when I added it.  Supposed to not have a smell or taste, or that's what I was told, but she would know right away it was there.  She would wait until the other cat finished eating and if there was any left in her bowl, Crybaby would eat what was left.  Since they are impossible to separate, they both eat the same.  Sometimes, I can give Sofie treats or a little dry if Crybaby is upstairs, but other than that, they have to eat the same.  Now, she is on a chewable probiotic and she loves is.  It's upstairs so husband can make sure she gets it every day and I don't know the name of it, will get him to bring it down for me. But so far, no change with that either.  In the beginning with the fortiflora, the smell was so much better; actually the smell was gone, but didn't last long since she would not take it for very long.

We are avoiding all grains, preservatives and additives.  Have not thought about chicken, however she was on rabbit and venison for over a year and was no better.  She will not eat duck either.  The Tritrichomonas Foetus was the one she was tested for that had to be sent to vet school also.  She said it was one that only they could detect because of specialized microscopes and other equipment.  It came back negative.

As for the home cooked food, I can do that as long as I am well.  However, being I have lupus and there may be times when I am very sick and in hospital also, then I can't prepare her food.  That's the only reason I have not done that and stuck with it.   I guess I could try to prepare enough and keep frozen and husband could thaw out daily amount.  Our other cat, Sofie will not eat anything except cat food and I guess that's okay too, since Crybaby isn't going to eat any canned food anyway,  just still can't let her have any dry food.  I will check out the home cooked food here.

What food is your cat on now?  Does he still have diarreah occasionally or has it completely stopped?  And yes, I know some treatments work for some and not for others, unfortunately.  I do appreciate all your help.

Thanks
Cathy 

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Mogli isn't allowed raw due to the fat content; it goes right through him. I'm skeptical about whether his immune system could handle it, anyway, because he presumably got the EHEC (enterohemorrhagic E coli) from uncooked food at some point before we adopted him at 9 months (he's now 21 months old). He gets two meals of canned a day, plus a couple of pieces of rabbit & potato hypoallergenic kibble twice a day as a snack. The nutritionist suggested a tablespoon of cooked potatoes or turnips as an alternative snack, so he gets that occasionally. He does best when he eats four times a day. He's on a German prescription food called Vet-Concept - it's free of grains, gluten, preservatives, or other additives and made of unusual meats like rabbit, kangaroo, reindeer, horse and duck with a little bit (around 3%) of potato or turnips. That's the order in which we slowly introduced them. The next thing we'll try to add is goat, as that's low in fat. He also gets a grain-free German brand called Catz once or twice a week - veal, beef or occasionally lamb - and some cooked meat (beef or pork) without supplements. He gets a probiotic called Pet Dophilus at the moment. I can't really say whether he can taste it, because Mogli will eat anything other than bananas or the above-mentioned Slippery Elm.

The only time he gets diarrhea now is when he steals food he shouldn't be eating. Usually that's bread, because he's really crazy about it. The IBD was diagnosed by biopsy, and food intolerance/allergies are at the very least an aggravating factor. Chicken is an absolute disaster, because it gives him gas and explosive diarrhea and makes him vomit. One thing we've noticed is that we need to stick to just one kind of meat per day (except for the rabbit kibble), but we don't know why he can't handle more.

Although Mogli isn't on an entirely home-cooked diet, previous pets were, and we used to make that up in large batches and freeze.

He was never on prednisolone or the like, because there's a Spanish nutraceutical called Entero-Chronic that's now the "drug of choice" for IBD in Europe. It took a long time to work, but it did.

The biopsy was done because he had to be put under anyway for a broken tooth (he gnaws like a hamster) and we'd recently lost our old cat to heart disease, so I panicked at the thought of having another chronically ill pet. In retrospect, it was probably unnecessary.

Thanks Stephen for all your info.  I have read a lot about how the symptoms for IBD and Lymphoma seem to be practically the same.  When she had the bad bowel movement on Saturday which was very explosive, all outside the box and very black and tarry, lymphoma was the first thing I thought of.  I know with humans, black tarry stools are a symptom of cancer and I am assuming that may be the case here too, not sure, of course. I have never heard of the lipidosis either and will read up on that.  Today, I woke up to her vomiting green slime and she would not eat again this morning.  Interestingly enough, she does drink a lot of water and I find that to be odd since she is not eating.

The good news is, I asked my husband to pick up a couple of cans of Fancy Feast, which at one time, she would eat quite well and she did eat half the can. Even though it may not be the best food for her, as long as she will eat it, I will give it to her until she sees the vet on Thursday. 

I do hope your cat responds to the steroids.  Its hard to watch them suffer with this disease.  They quickly become part of our lives and family and I want her to get well more than anything.

Thank you so much for all the info.

Cathy

Hi Cathy--

I have two IBD kitties, Jake and Molly.   When we got them, they had already been diagnosed and were on meds, but they weren't doing well--anyway, it's taken a year of trial and error to get them somewhat stabilized.  Interestingly, Fancy Feast works for them, too. It keeps them eating, even though, like you, I'm aware it's not the best food in the world.  I am trying to transition them to better food now that they're doing better, but my priority was to get the diarrhea and vomiting under control, and keep them eating.  Molly is on budesonide every day; Jake is on prednisolone every other day.  I have had some success mixing organic pumpkin puree in their food for the fiber.  It helps with both diarrhea and constipation.  But sometimes they eat it and sometimes they won't.  I do give them slippery elm bark syrup (easily made at home) every day in their breakfast.  That has been a huge help with Jake's vomiting and with Molly's diarrhea.  

Sounds like Mogli is quite the cat. I can't imagine either of my cats, including the feral one, eating anything.  The feral will eat on some days and some days she will not eat anything.  It sounds like the German food you are feeding Mogli is like the Royal Canine Crybaby was on.  It was prescription, high protein, rabbit, venison and deer.  Had to be the foods she was not used to eating and that way we could rule out food allergies.  It definitely sounds like you have had your times with IBD too.  Just glad for you and for Mogli, he is much much better.  I will try the home cooked food for Crybaby and add the supplements and see what happens.

Thank you so much for your information and help.  I appreciate it tremendously.

Cathy