Long-term IBD meds

Our 13-year old female cat, Gracie, was diagnosed with a moderately severe case of IBD (this was confirmed with a biopsy about a month ago, but we knew she had it a couple weeks prior with results from other tests and the symptoms). She’s taking prednisolone every other day and 0.6 mL metronidazole daily. The vet said that she’ll be taking these meds for a couple more years at the least, indefinitely.

Does anyone have any experience with long term use of these meds for their cats? Do they ever stop taking it/go through periods of time when they don’t take it?

Also, does anyone have tips for helping to ease the med delivery (getting her to swallow it)? She’ll spit or drool it out sometimes and today she ran away from the sight of the syringe, but I eventually got her to take it.  I get it compounded with tuna flavor, which is how it’s always been.

I was going to write about transitioning to raw diet (as that’s also been a bumpy road as of now) but I’ll post a separate thread in the Cat Nutrition forum where it’s more appropriate.

Thanks so much.

My kitty has been on a steroid for a little over 3 years now for IBD.  The main possible complication from long term steroid use is diabetes, and the diabetes usually is resolved when the steroids are discontinued.  My kitty hasn't had any issues so far.

I would question long term use of the metro.  Metro is actually an antibiotic with anti-inflammatory properties which is why it is used a lot for IBD flares.  My kitty only gets it with a flare and its only for a few days.  Some vets give metro long term but if your kitty isn't having a flare now and it's being used to control the IBD, I would ask your vet about trying the Pred by itself.

Metro is very bitter which is what your kitty is reacting to.  You can get small empty gel caps to put the pill in so kitty doesn't taste it when you give it to him.  My vet would use really small ones and cut the pills so they would fit inside the cap.  I know they sell them on Amazon and someone here recently said they found them at The Vitamin Shoppe.

Thank you for your input. Gracie had an IBD flare-up about two and a half weeks ago, and that’s when the vet prescribed the metro (she had already been taking Pred.) She hasn’t had any flare-ups since and I had the same question about using the Metro long term. I’ll call my vet about the long-term usage tomorrow.

I will try the gel caps. I bought some Feline Greenies flavored pill pockets but Gracie did not even touch the pill. I did some research and read reviews on the gel caps and it seems like they may work better with Gracie; there’s a local Vitamin Shoppe next door so I’ll check that and if they don’t sell it then I’ll order online.

Thanks again.   

You can also get the Metro in very small micro pills that are chewable, or can be put in a pill pocket.

I would recommend trying S. boulardii instead of the metro. But if that doesn't do it, I would ask the vet about using Tylosan instead of metro.

These are the problems with metro:

http://www.thecatsite.com/t/270801/...tro-is-genotoxic-and-potentially-carcinogenic

http://www.thecatsite.com/t/272498/...tibular-problem-has-your-cat-ever-taken-metro

Here is information on IBD by two vets:

By Dr. Deborah Zoran (Texas A&M):

http://veterinarycalendar.dvm360.com/avhc/article/articleDetail.jsp?id=692420&pageID=1&sk=&date=

http://www.gvma.net/files/public/Zoran 3 feline chronic diarrhea.pdf

She provides information about traditional protocol, and mentions the potential benefit of probiotics, but as most vets, provides no further information. Here is information on S. boulardii and why it is a better option than antibiotics for management of IBD:

http://www.horizonpress.com/cimb/v/v11/47.pdf

The dose for a cat would range from 1.5 million CFU 2x a day to 2.5 billion CFU 2x a day. I use Nutricology brand (each capsule is 3 billion CFU, the cats get 1/2 capsule 2x a day). Some find that using just 1/2 a capsule to one capsule of Nexabiotic 21-strain daily works for their IBD kitties. This includes not only S. boulardii, but a number of beneficial lactobacilli and bifidobacterium, which should also be included. L. acidophilus helps regulate B12 uptake and also has anti-inflammatory properties. (The gut accounts for 65% - 70% of immune system function, so even if you use antibiotcs like metro or tylosan, you should still use probiotics, IMO. In fact, S. boulardii, as a non-traditional probiotic, being a beneficial yeast, can be administered with antibiotics and works as an adjunct to them. If including an L. acidophilus supplement, it is best given 2 hours or more after antibiotic administration).

Articles on IBD by Dr. Karen Becker:

http://healthypets.mercola.com/site...11/02/inflammatory-bowel-disease-in-pets.aspx

http://healthypets.mercola.com/site...012/09/24/pets-gi-inflammation-treatment.aspx

http://healthypets.mercola.com/sites/healthypets/archive/2012/06/01/feline-ibd-symptoms.aspx


Did your kitty have the folate/cobalamin test done? (Cobalamin = B12). If not, even though it's expensive, it's an important blood test. As discussed by Dr. Zoran in one of the above articles:

Serum cobalamin [B12] levels in cats commonly decrease with severe bowel disease or pancreatitis, so it is very important to assess cobalamin status in all cats with GI disease. Further, in cats with hypocobalaminemia [low B12], the diarrhea will not resolve until replacement therapy is instituted. Cobalamin therapy in some cats may be lifelong, while in others, once the clinical disease resolves the supplementation can be discontinued.

...Gastrointestinal disease may decrease the availability of a number of micronutrients, such as vitamins and minerals, with important consequences for the pathogenesis, diagnosis and treatment of gastrointestinal disease. The diagnostic utility of measuring the serum concentrations of cobalamin and folate in cats with suspected intestinal disease has recently been established, and although the impact of
deficiencies in cobalamin and folate are not completely known, the role of cobalamin in normal function of the GI tract and in many other aspects of metabolism is well documented. Further, because cats are obligate carnivores that consume much higher amounts of protein in their diet, the importance of cobalamin and other B vitamin in maintenance of protein metabolism cannot be overstated.

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Bold, my emphasis.


Finally, http://www.ibdkitties.net is a great resource for everyone caring for an IBD kitty. :heart2:


As to diet - cats are obligate carnivores. This means they are adapted to eating a high protein diet with a very low carbohydrate content. Given the GI system is impaired in IBD kitties, it is best to find foods with very few fillers, and carrageenan should be avoided. As mentioned by Dr. Zoran, the easiest way to provide a species-appropriate diet that is high quality with no fillers is homemade. This isn't for everyone, but it's not difficult to do, whether raw or cooked. We have an excellent forum to help if you're interested: http://www.thecatsite.com/f/65/raw-home-cooked-cat-food

There are a number of threads in the nutrition forum that discuss foods that are high protein, low carb, with few additives (such as carrageenan).

An integrative vet I'm working with (combines Western medicine with Traditional Chinese Medicine) actually recommended Baytril over Metronidazole only if there is a need to control bacteria in relation to GI issues. She agrees that there are problems with Metro as @LDG mentioned. I've also heard of people using Tylosan in place of Metro with good results.

Like @Denice said, I think Metro can be helpful to get a kitty out of a flare because of it's anti-inflammatory properties, but shouldn't be used long-term. My Sebastian has been on it awhile for his chronic pancreatitis / IBD, but I'm weaning him off after hearing the "news" about Metro. He's also on prednisolone and several supplements / holistic remedies.

Thank you @stephenq  - the pill pockets aren't really a big hit with Gracie as she won't even touch the pill when I offer the coated version to her. 

I called the vet about Metro today and asked her about the potential dangers of using it. She said that it was completely fine, but after doing some research about @LDG's threads (which were very helpful, by the way - thank you!), I decided to get a second opinion and consulted one of my friends, who works as a vet in California. She said that Metro was potentially carcinogenic and dangerous to cats and that I should at least replace the Metro with Tylosan sooner than later. My vet did agree that Tylosan would help and prescribed capsules - Gracie is taking them well with the gel caps.

She also recommended S. boulardii and told me that it can and possibly should be used with the Tylosan and recommended NOW Foods or NutriCology S. boulardii. I ordered the NutriCology - even though it was slightly pricier, there were generally more positive reviews (compared to the NOW Foods).

I got the cobalamin/B12 blood test results back today and as expected, they were lower than average (I forgot the exact level - will post later when I find it). No diarrhea/eating issues as of now.

@LDG  Thank you for the info about the diet. I'll probably be doing some more research and posting a separate thread about the raw in a couple days.

I am glad you are getting things right for your kitty.  LDG has done a lot of research and is a very good resource especially about these chronic digestive issues and nutrition.  The IBDkitties.net is also an excellent resource and is run by one of our members here.

SGcats said:

She also recommended S. boulardii and told me that it can and possibly should be used with the Tylosan and recommended NOW Foods or NutriCology S. boulardii. I ordered the NutriCology - even though it was slightly pricier, there were generally more positive reviews (compared to the NOW Foods).

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Yes, the beautiful thing about S. boulardii is that it is a yeast-based probiotic. While it doesn't colonize the gut the way a traditional bacterial probiotic does, it is not killed by the antibiotics, so is easily used in conjunction with them. I would, however, consider also using a traditional L. acidophilus probiotic, as the antibiotic does wipe out all bacterial gut flora, and the healthy bacteria are just so important to long term health.

I use the Nutricology S. boulardii for my cats. It is 3 billion CFU per capsule (the bottle says 9 billion CFU, but the dose is 3 capsules). I give the cats 1/2 a capsule 2x a day. The S. boulardii does need to be given 2x a day.

I also use 1/2 a capsule of Natural Factors double-strength acidophilus+bifidus twice a day. The traditional probiotics do not *need* to be given twice a day, especially if the antibiotic is administered once daily. I would give it 2 hours (or so) after antibiotic administration. I give it twice a day because there is some evidence they work in conjunction with circadian rhythms.

LDG said:

Yes, the beautiful thing about S. boulardii is that it is a yeast-based probiotic. While it doesn't colonize the gut the way a traditional bacterial probiotic does, it is not killed by the antibiotics, so is easily used in conjunction with them.

I would, however, consider also using a traditional L. acidophilus probiotic, as the antibiotic does wipe out all bacterial gut flora, and the healthy bacteria are just so important to long term health.

I use the Nutricology S. boulardii for my cats. It is 3 billion CFU per capsule (the bottle says 9 billion CFU, but the dose is 3 capsules). I give the cats 1/2 a capsule 2x a day. The S. boulardii does need to be given 2x a day.

I also use 1/2 a capsule of Natural Factors double-strength acidophilus+bifidus twice a day. The traditional probiotics do not *need* to be given twice a day, especially if the antibiotic is administered once daily. I would give it 2 hours (or so) after antibiotic administration. I give it twice a day because there is some evidence they work in conjunction with circadian rhythms.

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Can i ask hoe you give just half a capsule? Do you measure it? 

@Denice  You are right. This site is by far the most welcoming and knowledgeable cat site I have come across. Thank you all for helping me and Gracie.   I spent another two hours or so going through some of the articles on the IBD cats site and Dr. Becker's site.

@LDG  Thank you again for the advice. I came across an article about L. acidophilus helping with IBD on Dr. Becker's site. The Natural Factors acidophilus & bifidus sounds like a good option. Half a capsule 2x a day sounds like a good dosage as well - I did ask my vet about this and she said it may help in addition to the antibiotics. The S. boulardii is on its way.

Bad news - Gracie had several bouts of diarrhea today.   I put a teaspoon of plain, pureed can pumpkin in her raw food morning meal and she thankfully ate it. I'll continue with the pumpkin until her stools normalize, but should they start firming up in 24-48 hours? I'll be keeping some canned pumpkin on hand from now on.

I'll try to keep everyone updated. Thanks again.