Cyclical nature of IBD Flares

I have dealt with the cyclical downturns in my cats health over the past year.    Usually she is really great - even ravenous for 6-8 weeks.   Then she will start vomiting and spiraling downhill for 3-4 weeks - no appetite - then the recovery - and round it goes.    My issue is I have had every test the vet suggested short of biopsy for IBD due to the cost.   The tests - urine, blood, xray, ultrasound, etc dont point to anything specific.    So now when my cat had her latest flare and not eating or drinking the vet wanted to do more tests and mentioned some disease with a long name that I had never heard of before (and unfortunately cannot remember).    I tried to discuss with her that I thought it had to be IBD due to the cyclical nature.   I said to my way of thinking, if the cat had some other disease she would just be sick all the time.

So I am wondering if anyone knows of other ailments that are chronic and cyclical the way IBD is.   I am just wondering if I am making an assumption about IBD that may not be correct.

Thank you

zoneout said:

 
I have dealt with the cyclical downturns in my cats health over the past year.    Usually she is really great - even ravenous for 6-8 weeks.   Then she will start vomiting and spiraling downhill for 3-4 weeks - no appetite - then the recovery - and round it goes.    My issue is I have had every test the vet suggested short of biopsy for IBD due to the cost.   The tests - urine, blood, xray, ultrasound, etc dont point to anything specific.    So now when my cat had her latest flare and not eating or drinking the vet wanted to do more tests and mentioned some disease with a long name that I had never heard of before (and unfortunately cannot remember).    I tried to discuss with her that I thought it had to be IBD due to the cyclical nature.   I said to my way of thinking, if the cat had some other disease she would just be sick all the time.

So I am wondering if anyone knows of other ailments that are chronic and cyclical the way IBD is.   I am just wondering if I am making an assumption about IBD that may not be correct.

Thank you

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Pancreatitis is an illness that cause cyclical vomiting and loss of appetite.  Was your cat tested for this? There is both a blood test (PLI) that can be run during an attack and ultrsound that can image the pancreas and look for imflamation.

Have you tried treating her for IBD? IBD can be difficult to diagnose, even with a biopsy, so most vets will try prednisolone to see if there is an improvement if there is no other definite diagnosis. I would agree with StephenQ about testing for pancreatitis as well.

StephenQ said:

 
Pancreatitis is an illness that cause cyclical vomiting and loss of appetite.  Was your cat tested for this? There is both a blood test (PLI) that can be run during an attack and ultrsound that can image the pancreas and look for imflamation.

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Thank you for responding.    I have not studied pancreatitis at all.  My cat was not tested for this.  Her bloodwork shows a PLT (platelet count) but I dont think you are referring to this.   Does the PLI measurement have other names?

She had a specialist do an ultrasound and she said everything looked OK except 1 kidney was misshaped.   She wasn`t concerned about it though since she said animals can function well on 1 kidney anyway even if the misshaped one was defective.

zoneout said:

 
Thank you for responding.    I have not studied pancreatitis at all.  My cat was not tested for this.  Her bloodwork shows a PLT (platelet count) but I dont think you are referring to this.   Does the PLI measurement have other names?

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The test is called fPL and stands for "feline pancreas-specific lipase." It is also referred to as fPLI or "feline pancreatic lipase immunoreactivity." The Spec fPL Test was developed from the fPLI test in partnership with Drs. Williams and Steiner at Texas A&M University. The terms are often used interchangeably.

The Spec fPL is the most accurate. The blood needs to be sent off to TAMU (here in the U.S.).

https://www.idexx.com/smallanimal/reference-laboratories/testmenu/innovative-tests/spec-fpl.html

The Snap fPL can be done in-house at the vet. It gives results in minutes, but is not as accurate.

https://www.idexx.com/smallanimal/inhouse/snap/fpl.html

My Sebastian has chronic pancreatitis, so I, unfortunately, know a lot about it. 

zoneout said:

 
Thank you for responding.    I have not studied pancreatitis at all.  My cat was not tested for this.  Her bloodwork shows a PLT (platelet count) but I dont think you are referring to this.   Does the PLI measurement have other names?

She had a specialist do an ultrasound and she said everything looked OK except 1 kidney was misshaped.   She wasn`t concerned about it though since she said animals can function well on 1 kidney anyway even if the misshaped one was defective.

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I would think the blood test could be useful even if the pancreas looked ok in an ultrsound, its hard to image the pancreas as its behind the liver but it can be done.  Did you cat not get any anti nausea meds like cerenia?  Whenever my cat has an "attack" like this i give sub Q fluids and cerenia, a neural block for nausea and he's back to normal quickly.

vball91 said:

Have you tried treating her for IBD? IBD can be difficult to diagnose, even with a biopsy, so most vets will try prednisolone to see if there is an improvement if there is no other definite diagnosis. I would agree with StephenQ about testing for pancreatitis as well.

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Oh vball91... it is a long difficult story.   Here we go......

I took her to 3 different vets over the past year as she had her flareups.    A year ago she wasnt eating or drinking so we took her to our regular vet who ran blood tests.   I thought it was hyperthyroid at the time since she would constantly beg for food when not in a flare.   Doc said test pointed to nothing abnormal including thyroid function.    She said next step would be to go to an internist specialist who would do xrays to check for possible tumors.

So in a few days we went to the hospital - by this time she lost alot of weight and was severly dehydrated.    They put her on IV overnight.   Next day when I came back thinking she was dead - they said she perked up from the IV and was looking better.    The internist specialist suggested xrays and an ultrasound to get a better idea.   I really couldnt afford it but vowed to eat peanut butter sandwiches for the next 5 years if it would help.    So she did the scans and said they showed nothing remarkable.   Except for 1 possibly bad kidney - which she noted shouldnt be a problem as we only need 1 to survive.    

Then she sat me down and said they cant find anything.   All they could do was biopsy for IBD but it would cost $3,000.    No way I could do that even with peanut butter for next 10 years.   So that was it.  I went back to the original vet that gave me cerenia pills to stop the vomiting so she could put some weight back on.   The cerenia was fabulous.....  unfortunately my research found that it cannot be tolerated long-term.   So once she stabilized on the cerenia she got her appetite back and was doing better but wasnt the picture of health.

In about another 2-3 months (last feb) she had another bad flare.   Well the first vets didn`t cure anything after I spent $3, 000 so I went searching for another vet and wound up going to Banfield mainly as they seemed less expensive with the wellness plan discounts.    Again blood, urine, fecal tests showed nothing specific.  They told me to feed her Hill`s Prescription i/d.   The `food` is made from pork, corn meal, and other awful stuff.   I was fed up.   I couldnt believe that trained vets couldnt tell me what was going on after spending so much money.   I felt like I was being taken for a ride.

So at that point I decided to take matters into my own hands (the vets were useless anyway).   I started googling IBD like crazy and found alot of helpful information which I put to use.  Slippery Elm, Baby food syringing, on and on.....   There was one website by an Australian vet that opened my eyes as to what IBD actually is - how it injures the intestinal lining - and how to heal it.   Following her directions I made bone broth with as much marrow as I could.  She started to get better but still looked sickly (missing patches of hair on her nose).    At that point I had been heavily reading about how it is suspected processed food causes IBD and that many cats were showing improvement on raw diet.   So my next step was to feed her raw and fortunately the pet store near me carries RadCat.   I got the small tub of chicken for $9 thinking I didnt want to waste alot of money in case she wouldnt eat it.    Got home, thawed it, put some in a dish.   She sniffed it but didnt eat - probably cause she didnt recognize it as food.    So I got her favorite treat - freeze dried chicken - and crumbled some on top.   She went back, picked out the treats, licked the blood from the chicken - and started digging in.    She loved it!   I got her the bigger tub next time at $16.    After a few days it was unbelievable how healthy she looked.   The missing hair on her nose was growing back in, her fur felt fuller, her eyes were as clear as I had ever seen in my whole life.   I remember one day she actually started playing with me like a kitten - she hadn`t done that her whole life - she was often depressed.

It was great!!  Of course the problem is Rad Cat was going to run something like $100 per month.    I couldnt keep it up so looked for alternatives and started feeding her chicken livers which she ate but she would drag the livers all over the floor and I would find bits of them.   So then I knew I had to make my own raw and bought the meat and sent away for Alnutrin.    She was doing great - then one day she threw up a hairball - thats how the flares always started - with a hairball.   I thought OK - one hairball this time - maybe that`ll be the end of it.   Nope... next day a couple smaller hairballs.   Next day foam and bile.   Next day nothing, just dry heaves.    

At this point it hit home that there is no cure for IBD.   

I knew what  to do, so started again syringing pedialyte in from the electrolyte loss from the vomiting.    Syringed in turkey baby food.   This time there was no improvement.   So researching again, I saw that alot of people were controlling it with prednisole.    I took her back to the Banfield vet who said she was very dehydrated - had to go to the hospital - and suggested xrays.   She said she thought it could be some disease whose name I do not remember.   I told her if it was some other disease she would be sick all the time - but she was going through cyclical flareups.   Therefore doesnt that point to IBD.   She said the hospital stay with xrays and IV would be $650.    Then she left - not really wanting to discuss with me further.    Then the tech came in and I told her I couldnt afford $650 - was there anything she could do?   She left and came back with a vial of Prednisone tablets (not prednisolone) and told me to wait a few minutes and they would do a sub-q - all for $45.    

Over the next 2 days I gave her the prednisone which caused her to urinate every last drop of water.    I knew it was going to dehydrate her like crazy so I kept syringing in as much water and pedialyte as I could.    On the third day she was very weak and wobbly.    But people who used prednisone said cats usually dramatically improve in 1-2 days.    I phoned the tech and she said the same thing - I should she dramatic improvement in a couple days.

On the third day I found her laying on her side behind some furniture - only because of her cries in pain.    She was in bad shape.  I drove her to the first vet where they said her body temp was way below normal and it appeared she sufferred a stroke since her legs werent moving.   They asked me if I wanted to put her down.... I said lets wait 30 minutes.    15 minutes later they came in, hugged me, and said she had a heart attack.

So vball91, there is the long full story.   Did I try to treat her for IBD?   Yes and no.   Maybe the preds was too late.   I dont know.   What I am absolutely, positively certain of is this poor cat wouldn`t have had to suffer from IBD symptoms if she had been fed better food all along.    For about the first 8 years of her life she was fed cheap kibble - DeliCat - if you know that one.    I then moved her to EVO kibble thinking it was better until she was about 12.    All those years she  was always vomiting hairballs - regularly.   The years of junk food had taken its toll.   

So my advice with kibble is the same as with smoking - don`t start.  

StephenQ said:

 
I would think the blood test could be useful even if the pancreas looked ok in an ultrsound, its hard to image the pancreas as its behind the liver but it can be done.  Did you cat not get any anti nausea meds like cerenia?  Whenever my cat has an "attack" like this i give sub Q fluids and cerenia, a neural block for nausea and he's back to normal quickly.

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Hmmm, nothing that says fPL or FPLi - there is normal creatinine  which I think is created in the pancreas but I could be wrong.   Yes, on one occassion the vet gave cerenia which worked like a charm.   She gave me tablets.   When I had to switch vets cause the first one was getting nowhere they would only administer cerenia through an injection - which is way more expensive.    Had the first vet came back and told me - look - this cat is likely to flare up like this recurrently - we don`t know what is going on but we can control it with Cerenia every few months - and we can try prednisone to see if that keeps the IBD in remission.   But unfortunately that discussion never took place.   The vet didn`t have the professional decency to follow-up after I dropped $3K with them - and I was still too uneducated at that point to know what the proper questions were to ask.

My wonderful cat paid for it with her life and I will be paying for it over the next 9 months on my care-credit card. 

zoneout said:

 
Then she sat me down and said they cant find anything.   All they could do was biopsy for IBD but it would cost $3,000.    No way I could do that even with peanut butter for next 10 years.   So that was it.  I went back to the original vet that gave me cerenia pills to stop the vomiting so she could put some weight back on.   The cerenia was fabulous.....  unfortunately my research found that it cannot be tolerated long-term.   So once she stabilized on the cerenia she got her appetite back and was doing better but wasnt the picture of health.

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Again, I'm so sorry about your kitty @zoneout.    FYI...Sebastian is on Cerenia long-term for his chronic pancreatitis. We do 5 days on, 2 days off, so he gets it Monday through Friday. The break allows "Substance P" to replenish in the brain. This depletion is the main issue with using Cerenia long-term without a break, as it could lead to tremors. Cerenia is metabolized by the liver, so the literature states a caution in using it in dogs and cats with liver problems.

I am so sorry to hear about your loss and my thoughts are with you. If I had to guess I would say your cat was dehydrated a lot of the time because of the smaller kidney which is much harder for them when they are as old as yours. As long as you learned through this experience you can't put the blame on yourself because we are not told how to properly care for pets until there is a problem. The amount of research and trying different things you did for her is outstanding and not many people would go to those lengths. My guy has one kidney that is smaller than the other which means he is like a renal failure cat and needs sub-q's every day at this point. I think your cat was probably in the same state and should have been having sub-q's to keep her hydrated. This really helps for IBD as well because they have a hard time digesting food and water so the sub-q's may really help.

IBD is different in every cat just like it is different in every person so there is no easy way to help them using some generic fix. Be proud that you were actually able to keep her really stable, if I can get my guy to go 3 to 5 days without a bout or throwing up I am lucky. Like you I did not have the biopsy done because I could not stand the thought of having to have him cut up at 17  years old and not making it through. As mentioned above there are many generic ways to treat IBD which may or may not work on your cat. My cat has tried all sorts of drugs and is on many right now and none of them stop the bouts or stop him from throwing up. He can be fine and then within an hour it all goes pear shaped and he is either curled up somewhere hiding or he is throwing up. His bouts go anywhere from a few hours to a day where he is not eating and basically only drinking water, getting sub-q's, and whatever meds I can get into him. The only thing a biopsy will do for you is allow you to determine where the IBS is actually located because it can be in a few places (I believe in is the intestines, stomach, or esophagus but I could be wrong) and you treat each slightly differently.

It is so sad how it ended but you did as much as you could within the restrictions of your life and she actually did really well when you look at her overall quality of life. I am not making excuses for the vet but IBD and everything to do with it is hard to treat and unless your vet has a lot patients it is hard to get experience with this. The fact that they did not know what it was and ran all kinds of tests with no results instead of just saying it and finding an alternative. Once the vet has done basic tests and maybe x-rays they should be able to determine the basic issue or have an internal medicine expert look over the findings. If they are stuck they should send her somewhere where she could get proper treatment for her sickness.

IBD is not something that can be cured but it can be managed, my guy came down with it when he was 17 and he is 19 and his numbers have only declined a small bit. He doesn't have the up times like your cat had but he is happy a lot of the time. It is hard to manage a sick cat especially with a tight budget, mine is easily 5 figures a year and the best he could do is go 12 days without throwing up but still having some IBD attacks in there. I am sorry for your loss and the fact that you will be paying for it for a while but the debt is worth the relief your cat had gotten.

Carry diets, who would have guessed. It is something we don't really think about although we should and some pets just can't take it. My cat got Iams hard food most of his life until he decided he had had enough and would only eat wet food. This was about 1/2 a year before he really got sick so he probably knew but I didn't. Like you I found out about it by researching after he got sick and learned a lot but it was kind of too late.

That Guy said:

 
I am so sorry to hear about your loss and my thoughts are with you. If I had to guess I would say your cat was dehydrated a lot of the time because of the smaller kidney which is much harder for them when they are as old as yours. As long as you learned through this experience you can't put the blame on yourself because we are not told how to properly care for pets until there is a problem. The amount of research and trying different things you did for her is outstanding and not many people would go to those lengths. My guy has one kidney that is smaller than the other which means he is like a renal failure cat and needs sub-q's every day at this point. I think your cat was probably in the same state and should have been having sub-q's to keep her hydrated. This really helps for IBD as well because they have a hard time digesting food and water so the sub-q's may really help.

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I really do appreciate the words of encouragement and support - a heartfelt thank you to you.    

What you are saying about her bad kidney is making sense to me.   In fact, I just went back and looked at her bloodwork and the urine protein count was at 100 which the report says is way over the normal range.   Why the vet wouldn`t pick up on this or even educate me about giving subQs is anyone`s guess.    

But you are absolutely right in that the best way to deal with this is to do our own research.   Vets are human, and unfortunately as intelligent as our species is supposed to be, we don`t have all the answers.   The difference is in my business when I sell a product that is defective - I refund the customer and apologize.   When doctors make mistakes, you basically get silence or some lame excuse.

Peace

GoHolistic said:

 
Again, I'm so sorry about your kitty @zoneout. 

  FYI...Sebastian is on Cerenia long-term for his chronic pancreatitis. We do 5 days on, 2 days off, so he gets it Monday through Friday. The break allows "Substance P" to replenish in the brain. This depletion is the main issue with using Cerenia long-term without a break, as it could lead to tremors. Cerenia is metabolized by the liver, so the literature states a caution in using it in dogs and cats with liver problems.

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So I take it that you are using cerenia tabs and not injections?    I am trying to figure out why one vet would give me the tabs and another vet refused but would only do the injectible.    Is it due to some off-label liability from the FDA?

zoneout said:

 
So I take it that you are using cerenia tabs and not injections?    I am trying to figure out why one vet would give me the tabs and another vet refused but would only do the injectible.    Is it due to some off-label liability from the FDA?

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Yes, sorry, Sebastian is on the tabs. Hmm...maybe some vets are concerned about using stuff off-label.   Apparently the injectable Cerenia is approved for cats older than 16 weeks (http://www.veterinarypracticenews.c...ed-approved-for-use-in-cats-younger-dogs.aspx). The tabs are still considered off-label for cats.

GoHolistic said:

 
Yes, sorry, Sebastian is on the tabs. Hmm...maybe some vets are concerned about using stuff off-label.

  Apparently the injectable Cerenia is approved for cats older than 16 weeks (http://www.veterinarypracticenews.c...ed-approved-for-use-in-cats-younger-dogs.aspx). The tabs are still considered off-label for cats.

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Why guess I suppose?...  I will put in a call to the vet and simply ask why they do not use tabs.   Probably they choose to go by the book but we`ll see.

@zoneout   I am so sorry for your loss, i didn't realize that your cat was gone.  It sounds like you really did everything you could do. Again I'm very sorry.

StephenQ said:

 
@zoneout   I am so sorry for your loss, i didn't realize that your cat was gone.  It sounds like you really did everything you could do. Again I'm very sorry.

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Thanks.   Precious is gone but not in vain.   Everything I have learned from dealing with her malady has made me a smarter and hopefully a better caretaker to my next furry friend.   

A couple of immediate things I learned from the situation.    Do your homework.    It allows you to know what questions to ask the vet - the goal is to be a partner with your vet.   The more vets (and techs) you get involved - the more opportunity for forgotten or missing communications.   Vets are busy - we have to remember to stay on top of them when we don`t hear back about certain test results for example.   

Get baseline blood/urine tests when your cat is healthy - dont wait until they are sick.   If your cat has elevated BUN readings for example it points to a kidney problem.   However if your cat has been vomiting and is dehydrated it will also raise the BUN reading.   So does your cat have kidney issues or is it just temporarily high from the dehydration????    Having a baseline clears this problem up.

And of course, proper diet.   I have seen with my own eyes how Precious thrived on raw.   There is a reason most competition show cats are fed this way.     But to each their own.

Thanks again for your thoughtful and enlightening posts.

Z

zoneout said:

 
Why guess I suppose?...  I will put in a call to the vet and simply ask why they do not use tabs.   Probably they choose to go by the book but we`ll see.

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OK, so I called... the answer is simply that they choose not to stock it - only the injectible is on hand.    If a prescription is needed they are not averse to writing it for tabs.

Makes me feel a bit better about continuing to use their services.

I always thought that if a vet is going to prescribe something they should also stock it so you can get it quickly. Somethings that have a short shelf life will need to be ordered but I just checked my Cerenia tabs and they expire in 06/2016 so would it really break the bank to stock them? When my cat first got sick I was sent home with meds to get him to eat if needed and meds (Cerenia) to stop him from throwing up and steroids to help with the IBD. If your vet doesn't have what you need then I believe all of this stuff is available through a regular pharmacy so ask for a prescription and go to your local pharmacy.

Always keep in mind that no matter what your vet is or is not the one thing they are is a business and they are there to make money. My guys regular vet is pretty good but he has been to a few others to see if they could find anything the regular missed and they certainly try to push things that may not be needed at times. I pay my vet a lot and I also expect a lot so if he is not feeling well I will phone them and expect a call back within a short period of time with help. For a short period of time I was taking my cat to a 'cats only' vet thinking they may be pro's with the issues cats had. He was having a really bad attack one time so I had phoned them and asked if there was anything I could do for him and they returned my call a day and a half later. He was already coming out of it by then but in the short term I was not sure what I could do so I just gave him extra pain meds, tried to comfort him as much as he would allow me, and hoped for the best.

The cats only vet was more like an assembly line and Scratchy never went back to them but they did find an ear infection the other vet missed. He was at his regular vet and she noticed his ears were pretty dirty and I explained that his sister who had passed away a year before was the one that did most of the ear cleaning for him and with his arthritis he has a hard time reaching his ears and she left it at that. The cats only assembly line vet made the same observation and I made the same comment except he grabbed a swab and checked and found they were infected. He gave me drops to fix that issue and a drug to help his body fight it which he neglected to tell me that it would make him foam at the mouth like he was rabid.

Always keep in mind this is a business and they are there to make money. You pay for this service so ask questions about everything and take nothing for granted. If they want to do something then ask why and how this will help the cat.

Excellent post.  All I would add is that you have to know enough to ask the proper questions and avoid getting snowballed.   Often I get the feeling my regular vet would spend more time discussing issues with me except that she probably feels she would be wasting her time trying to explain things to an uneducated layperson.

From researching here and other great sites on the web like Tanyas CRF I now have the confidence to ask followup questions instead of just blindly going along with whatever the vet says.

I'm so sorry you lost her. :heart2: . .

My thinking is that the cyclical nature of the flares indicates a parasitic or bacterial component to the IBD, and the cycles reflect the lifecycle of ... whatever it is. I helped someone in Norway with the worst case of diarrhea from (confirmed by biopsy) IBD the vet had ever seen. She noticed a cyclical nature to how he felt (there was never any change in his stool). I suggested she try the enzyme treatment as detailed by Dr. Hofve ( http://www.littlebigcat.com/health/giardia-natural-treatment-protocol/ - not just for giardia), despite several PCRs of the stool indicating no protozoal parasites in the stool. Her vet felt it would not harm the cat, so she tried it. And while she did need to give a third week of enzymes (mixed in water, syringed, fed on an empty stomach 30 minutes before a meal) as opposed to the two recommended in Dr. Hofve's treatment, this resolved the diarrhea, completely normalized the stool, stopped the cyclical recurrence of inappetance, and kitty was able to be removed from all meds once transitioned to a novel protein homemade diet. Her vet is documenting the case.