IBD diagnosis without biopsy

One of my cats (5 years old) has been diagnosed with Inflammatory Bowel Disease and put on prednisone, despite the fact that a biopsy has not been performed. She has always had an issue with chronic vomiting. It improved for a while (only occasional vomiting) when I took away possible allergens, such as corn, grains, wheat, and soy, but it came back with a vengeance again several months ago. Several treatments have been tried. The vet has said that IBD is difficult to diagnose in cats, even with a biopsy, and that the results could be inconclusive. The vet initially just tried treating the symptoms with Metaclopramide to stop the chronic vomiting and Laxatone for the frequent hairballs, which seemed to work for a while. However, the vomiting began to reoccur, and the Metaclopramide even seemed to trigger the vomiting in some instances. Also, she has continued to gradually lose weight. She has improved on the prednisone, and has not vomited in 3 weeks, but I still wonder if she truly has IBD or something else. The diagnosis seems to be based only on symptoms--vomiting, frequent hairballs, and weight loss. All of her bloodwork is normal, and she has no parasites. Her stomach x-ray revealed no foreign objects ingested, but the stomach walls were "slightly thick" according to the vet. I hate to put her on steroids for something that she might not have. Should I request a biopsy?

By the way, she has not had any diarrhea or loose stools--just vomiting. She had coccidiosis when she was a kitten (came from a shelter at about 8 weeks) and had loose stools for several months after she was clear of parasites, but it had cleared up with medication before she was six months old.

My kitty also had the flares with vomiting, anorexia, no diarrhea and weight loss.  He too did not have a biopsy done, only an ultrasound.  I also went through 6 years of different diets and medications with no improvement.  He has been on a steroid for almost 4 years now and that is the only thing that has controlled his symptoms.

One thing about the biopsy, to get the best results your kitty would have to come off the steroid for several weeks to get the most reliable results.  The tissue samples are to look at the inflammatory cells which the steroid is suppressing.   It is true that a biopsy may not give a definitive diagnoses.  A positive result would be definitive but a negative result wouldn't be.  I have also heard from someone with years of experience working with animals that often when a kitty is taken off a steroid then put back on it, it doesn't work as well.

Agreed with everything Denice said.  I didn't do any diagnostics on mine, we just tried meds first then I went to raw which cleared up the problem.  Well, except for hairballs.  They aren't as bad as when on canned but are still a problem nonetheless.  I use egg yolks, Vet's Best Hairball Tablets, and Temptations Hairball treats to deal with them.  I hate using the Temptations but sometimes they are a necessary evil in this house.

I think I'd try other diagnostics like x-rays, ultrasounds, and etc. before a biopsy, but that's me.  As Denice mentioned, the cat has to get back to that really bad place again in order to get a good definitive biopsy, and even then that isn't going to tell you that carrageenan or guar gum is what's irritating your cat.  Some folks have had to do the biopsies to diagnose cancers in their cats, but I think other diagnostics were done first in any case.

The fact that your cat responds to the Pred is diagnostic in itself, almost certainly IBD.  Reversal of weight loss is very important with IBD patients.

My cat was having problems with vomiting, constipation and weight loss. She would have a flare about every 5 or 6 months. The flares were getting closer together as she got older. We were at the vet all the time for a year and tried different things for 4 years. Finally my vet mentioned IBD but I was afraid to put her on a steroid. I finally gave in when she got real sick and it was lasting longer then usual. She started Prednisolone in August and she is doing so much better. She is now at a good weight and has not had any constipation issues. She was on a larger does in the beginning and we tapered down until we got to 0.18 ml every other day. I did not have a biopsy done.

My Late Maxwell went off food over a year ago.I took him to an Internist.Had an US.Showed thickening of the intestinal walls.They could not confirm IBD or small cell Lymphoma without a biopsy.Endoscopy was not and option as the location in the wall the Internist didn't feel the cutters could grab a good sample so it would have come back negative.I opted out of have a biopsy done.He was put on pred prior to which I syringe fed him for three months.When the pred kicked in he began to eat on his own.He ate for 9 months still staying on 2.5mg twice a day of pred.Then last jan he went off food again.This time pred even being at 10 mg per day and he was only and 8 lb kitty didn't help.Leukeran was introduced but did not help.Upon necropsy he had small cell that turned to lge cell.So pls don't do what I did.Have the biopsy done.What it does is rule out things.If I had known it was small cell it is treatable(not curable) with higher amounts of pred and chemo.I could have had more time with him.Man do I have regrets.I still wear his collar around my wrist.He passed away April 6/14 Adding pred to a cat is like adding mirtzapine only alot safer.It increase their appetite.Although being an antiinflammatory if you talk to any human who has been on it they will say"I wish they told me to put a chain on the fridge."So you can't go by that as it helping IBD.I learned this the hard way.

IBD symptoms can be different for each cat. Some vomit, some have diarrhea, and some just do not eat (anorexia). All have pain.

My last cat Sly was diagnosed w IBD at 12 years old w/o biopsy. She had an Xray and ultra sound and supporting symptoms (thickened intestines). She went from 14 pounds to 9-which was severely underweight for her.

She was on pred fine for 2.5-3 years and was able to eat again. At one time I had her on a 2.5 mg prendnilosone  pill every other day. I weaned at will watching for symptoms myself (I am in medicine and give the same drug to humans). I played with her diet the best I could. Novel proteins, raw etc.

But am not sure I ever found the source cause. In the end there was more frequent vomiting, but rarely diarrhea. Eventually she stopped eating and refused her meds. IBD often develops into cancer. Hers did, and I had to let her go a year ago. She was 14.5 years old.

BOTH IBD and cancer responds to prednilosone though and vets will tell you before you start the regimen that if you start pred it may hide Cancer symptoms and thus delay cancer treatment which is bad. I weighed the pros and cons in my mind regarding proper diagnosis and voted for not getting a biopsy as Sly was 12, very underweight, and may not survive the biopsy.

I had already paid 1000.00 for tests and the symptoms just fit for IBD. I had 3 doctors confidently telling me so and yeah I actually trusted all three of them (which is rare). I am glad I started pred.

I know I belong to the feline IBD group at yahoo.Have for 6 years.I only dealt with a board certified doctor of IM.I know about the money.Well aware.Just prior to Maxwell I lost my Youngest Trixie to a racquetball size abdominal tumor.Never sick a a day in her life.One day wouldn't eat ,next day on the table.I attended her surgery.Scrubs etc.It was not growing off of anything but rather feeding from everything.Most people would have said their goodbyes.I didn't .I told the vet to take it out.I basically parked myself in front of her cage for two days as this place was not 24 hr care.The infusion stopped working many times through the night so i had to get it restarted.Started syringe feeding her and in the second day the light in her eyes came back.She came home with a fentanyl patch & buprenorphine.She lived 99 days post surgery.Pathology report.One of the most invasive forms of cancer,Possibly pancreatic yet her numbers were fine.I have treasured moments.That was $5500.00 So well aware of costs.Protocols for small cell can differ from that of IBD.I am also on the feline lymphoma group.Depends on the oncologist really.In a nutshell if you can afford it which I could I would have liked to have had Maxwell have a biopsy done now looking back.He was 15 when diagnosed.He had Crf stage 2 (Iris) and also MC for 6 yrs.I too was afraid I would lose him on the table.But I read posts everyday of members on the lymphoma group who are having great results.Sorry about the Novel.

I've heard that most feline IBD cases don't get diagnosed from a biopsy, so your case doesn't sound unusual in that respect. What happens most of the time is that the owner keeps bringing the cat in and more and more tests are run. If the tests don't reveal anything but there's symptoms like vomitting, diarrhea/constipation, appetite loss, etc., the vet concludes that since everything else is ruled out and there's IBD-like symptoms, it must be IBD. That doesn't mean you shouldn't get a biopsy, though. The others have indicated it could be very valuable.

Hi.Yes when they wanted to do the biopsy, they wanted it done prior to any pred being given.I was told pred changes the cells.All In All I wanted it to be IBD .I really was hoping it was.But reading multiple posts on the feline IBD group no-one's kitty was even close in symptomolgy.But Maxwell had MC for 6yrs and I truly believe that was a contributing factor to him getting cancer.Can't prove it but???Even though he was stable pooping for all those 6 yrs.No deopstipation.He never had diarrhea in his 16 years.One enema at 10 yrs Then came the diagnosis via xray of MC after 3 vets looking at it and knowing nothing.Then I screamed for a specialist.She looked at the same Xray and diagnosed it in a minute..Nice talking to you .Take Care.She was super...Hugs

Raintyger said:

 
I've heard that most feline IBD cases don't get diagnosed from a biopsy, so your case doesn't sound unusual in that respect. What happens most of the time is that the owner keeps bringing the cat in and more and more tests are run. If the tests don't reveal anything but there's symptoms like vomitting, diarrhea/constipation, appetite loss, etc., the vet concludes that since everything else is ruled out and there's IBD-like symptoms, it must be IBD. That doesn't mean you shouldn't get a biopsy, though. The others have indicated it could be very valuable.

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The main reason to do a biopsy is when the Vet is concerned that it isn't IBD but is small cell lymphoma and when the symptoms are consistent with both as is sometimes the case, a biopsy can usually (although not always) result in an accurate diagnosis.

My 15 year old kitty (that's her in my pic) probably has IBD, and I've been treating her with metronidazole and predisolone or whatever that steroid is.  The vet claims that steroids are harder on people than on cats and it's a low dose compared to what people take for many conditions (such organ transplant patients etc) so it's not as bad as you'd think.  I did not have the biopsy done because she said i would have to take my kitty to the University to have that done, she would have to open the cat up to do that biopsy whcih she didn't recommend, and it's a 2 1/2 hour trip each way, and the vet said with a 15 year old kitty, that is just so much to do to an old cat.  The vet did look for parasites, hyperthryoid and other stuff to rule out common causes of vomiting and diarrhea.

Kitty was the Walking Dead, and now she is perky, comfortable and happy again.  So I am glad for what the metronidizole and steroid are doing for her. She would have died a few months ago if I did not do this, and she is a happy cat now. Still a little skinny, though, but maybe not so much for her age.

Given your cat is younger, it's a tougher call what to do, imo. Good luck whatever you do.  Probably most of us second guess ourselves when things don't go right, so don't beat yourself up if you are getting expert advice (and asking on forums!) and making your best judgment call. some day, if not already, you'll have to do that with extremely ill human loved ones too, and it's very difficult to make decisions when much information is not known or often, unknowable at any price.

What do you feed? I had my cat wormed and switched to revolution instead of frontline. I also switched to all grain free canned ONLY. Vomiting totally went from daily to none at all. Just a thought! Worms never showed up in stool, just thought it could not hurt. Maybe I will see flares again. I do not know but vomiting stopped almost immediately after food change and worming. Knock on wood been vomit free now for 2.5 months! I am going to reintroduce canned food with minimal grains to see if that was it or was it worms not detected in stool sample!

That's a good post, Bonepicker. One of my former cats, whom I gave to my Mom and Dad because the other kitties picked on her and she got along well with their dog, vomited a lot and it did turn out dry food was the culprit. They fed her only canned, but it was just Friskies or something like that, and the vomiting stopped. She did not have diarrhea. So there is certainly the possibility there with the OP's cat. Switching to all canned food did not help my current kitty with a problem, not one bit, but I found she stopped licking off all her fur on her underside. She is getting some dry food, but still mostly canned now.  Because this kitty also has CRF, the vet wants her on low protein diet, and she won't eat the canned senior diet foods I have tried so far, but will eat the Iams old cat (11 years+) formula dry food. I think even for people, it is very difficult to figure out what is going on, and why.

Iluvcats3 said:

That's a good post, Bonepicker. One of my former cats, whom I gave to my Mom and Dad because the other kitties picked on her and she got along well with their dog, vomited a lot and it did turn out dry food was the culprit. They fed her only canned, but it was just Friskies or something like that, and the vomiting stopped. She did not have diarrhea. So there is certainly the possibility there with the OP's cat. Switching to all canned food did not help my current kitty with a problem, not one bit, but I found she stopped licking off all her fur on her underside. She is getting some dry food, but still mostly canned now.  Because this kitty also has CRF, the vet wants her on low protein diet, and she won't eat the canned senior diet foods I have tried so far, but will eat the Iams old cat (11 years+) formula dry food. I think even for people, it is very difficult to figure out what is going on, and why.

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I also think once a year worming for the heck of it can't hurt either!

MomofMaxwell said:

 
Hi.Yes when they wanted to do the biopsy, they wanted it done prior to any pred being given.I was told pred changes the cells.All In All I wanted it to be IBD .I really was hoping it was.But reading multiple posts on the feline IBD group no-one's kitty was even close in symptomolgy.But Maxwell had MC for 6yrs and I truly believe that was a contributing factor to him getting cancer.Can't prove it but???Even though he was stable pooping for all those 6 yrs.No deopstipation.He never had diarrhea in his 16 years.One enema at 10 yrs Then came the diagnosis via xray of MC after 3 vets looking at it and knowing nothing.Then I screamed for a specialist.She looked at the same Xray and diagnosed it in a minute..Nice talking to you .Take Care.She was super...Hugs

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What is MC?

Can you tell me the yahoo site for IBD?

I am pretty sure that food was not the only culprit with my cat. I have had her on grain-free with no corn, wheat or soy for a couple of years, and I started added canned to her diet regularly about 6 months ago. She has gone through periods of wanting all dry OR all canned (actually a month on canned
only at one point), and she has vomited on both. She has only stopped the vomiting completely with prednisone. Granted, she has only been on it for not quite a month, so time will tell.

I am currently feeding her Blue Basics Duck and Potato dry and Wellness sliced salmon canned. I was feeding her the sliced turkey as well until the vet said to stop the turkey (and no chicken either). The Wellness does contain carrageenan, but it is about the twentieth ingredient on the list, so hopefully, there is not too much of it. I know that salmon is not the best choice, but she is VERY picky about what she will eat, and the Wellness sliced seems to be the only one (out of a gazillion) that she will not just sniff or lick and walk away from. Believe me, I have tried many canned varieties that are perfect in terms of ingredients that she should not have (including fish and carrageenan), but she did not like any of them.

[email protected] is the website and MC Is mega Colon which I also belong to @ Yahoo

Hope that helps.Hugs

Thank you!

I was wondering about this site.

https://groups.yahoo.com/neo/groups/felineibd1/info

It's bigger and appears alot more active. (?)