Disheartening chat with Krissy's vet regarding her IBD/Pancreatits

Some of you already know of my thread 

http://www.thecatsite.com/t/283203/...-lost-her-appetite-and-is-sleeping-constantly

My nearly 13 year old, chubby cat gf Krissy who has inflammed pancreas, intestines, lymph nodes with thickened bowel loops.

The latest on how she is doing, she is still eating Blue Buffalo Basics LID turkey dry and Fancy Feast turkey canned.

She is stable and I can tell feels better than she used to. I wouldn't say back to her old self but who knows if that will ever be again.

I am grateful she seems to feel better, not so antisocial, etc.

The other day I had to take a cat from the Humane Society to see my vet, who is also used by HS.

She asked how Krissy was coming along, and I told her.

I had asked her about lymphoma, and how often IBD turns in to lymphoma, she said it sort of depends on whether Krissy originally has pancreatitis or IBD, since she has overall inflammation it's impossible to know, but with Krissy having thickened bowel loops, that it usually turns in to lymphoma.

I asked if/when her inflammation goes away will her bowel loops decrease and go back to normal and she said she doubts it.

Really? 

Anyone have a cat with thickened bowel loops out there with any stories to share on this?

Thanks, appreciate any input on this subject.

IBD is progressive even when it is well controlled.  That is one of the reasons I have no qualms about Patches being on a steroid.  A steroid does control the inflammation but I think that just slows the progression.  Sometimes I think a steroid hides symptoms but that does enhance quality of life.  Patches has started loosing weight again after 4 years and he has no other symptoms.  If his weight hasn't stabilized this month then he will need another ultrasound.  He had generalized inflammation which went undiagnosed as IBD for 6 years.

Wow, I had no idea it is progressive............ugh.

So with being on the steroid, yes they will help with quality of life, but if/when it turns into lymphoma, don't we need the steroid to be very effective then, along with leukeran?

I think Krissy has had inflammation for years and I didn't even know it.

For her to have diffusely thickened bowel loops, that would take quite some time to happen. At least it would seem to me.

Krissy is stable now with only the diet change, but your kitty was not, so this is why you chose the steroids?

She was never a vomiter or any diarrhea, and she didn't stop eating either. I can imagine if she had been I would have had to consider steriods as well.

Denice said:

 
IBD is progressive even when it is well controlled.  That is one of the reasons I have no qualms about Patches being on a steroid.  A steroid does control the inflammation but I think that just slows the progression.  Sometimes I think a steroid hides symptoms but that does enhance quality of life.  Patches has started loosing weight again after 4 years and he has no other symptoms.  If his weight hasn't stabilized this month then he will need another ultrasound.  He had generalized inflammation which went undiagnosed as IBD for 6 years.

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I decided after I wrote that I should have quoted your post which is why it's under my comments!

Also, what kind of general inflammation did Patches have? Via ultrasound? No thickened bowel loops though?

He had thickened intestines.  By the time I got him to a good vet he was in a severe episode and the vet could even feel the thickening when she examined him, she said his intestines felt ropey.  The steroids do help the inflammation.  They also increase appetite, energy and promote weight gain so in that way they do hide symptoms.  I think the longer the inflammation goes unchecked the more likely there is permanent damage to the intestines.  Patches had his first flare when he was only 18 months old and every severe flare he had I would try another vet, unfortunately it took 6 years of that to find a vet that figured out what was going on.   He had the same symptoms that a kitty that is blocked from swallowing a foreign object has.  When he was only 18 months old that was what the vet thought was going on.  Thankfully she stopped short of exploratory surgery.  It then turned into he is very sensitive.  I tried all different diets except raw and different stress relieving remedies and he would still flare.  There were no rhyme or reason to his flares.  Each one turned into expensive vet bills because of xrays, on two occasions hospitalization on an IV, and an emergency vet visit.  I am sure there is a lot of damage to his intestines because I didn't get him to a good vet and I didn't have a clue what was going on with him.

Denice said:

 
He had thickened intestines.  By the time I got him to a good vet he was in a severe episode and the vet could even feel the thickening when she examined him, she said his intestines felt ropey.  The steroids do help the inflammation.  They also increase appetite, energy and promote weight gain so in that way they do hide symptoms.  I think the longer the inflammation goes unchecked the more likely there is permanent damage to the intestines.  Patches had his first flare when he was only 18 months old and every severe flare he had I would try another vet, unfortunately it took 6 years of that to find a vet that figured out what was going on.   He had the same symptoms that a kitty that is blocked from swallowing a foreign object has.  When he was only 18 months old that was what the vet thought was going on.  Thankfully she stopped short of exploratory surgery.  It then turned into he is very sensitive.  I tried all different diets except raw and different stress relieving remedies and he would still flare.  There were no rhyme or reason to his flares.  Each one turned into expensive vet bills because of xrays, on two occasions hospitalization on an IV, and an emergency vet visit.  I am sure there is a lot of damage to his intestines because I didn't get him to a good vet and I didn't have a clue what was going on with him.

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See that's the part I wonder about in Krissy.

Why she never had diarrhea/vomiting or lost weight.

Only for a day or so she was vomiting when it reached it's peak and I took her in.

Makes me think the overall inflammation might have started with pancreatitis..............(?)

So Patches has been on steroids for 4 years?

Also my question regarding the steroids effectiveness if it turns into lymphoma, what do you think about this?

In your personal opinion, thinking about Krissy and her thickened bowel loops and overall inflammation, but no weight loss/vomiting/diarrhea, AND that she is overweight already, if she were your cat would you put her on steroids?

I just don't want to look back and regret not, but it also seems to me that if I did get her on steriods now, while it would help with the inflammation, it won't change whether or not she gets lymphoma.

I just don't know how that works really. Thanks.

I don't know how any of this works either. Peaches was having issues for 3 years, we were constantly at the vet office for vomiting and constipation. She then started to have allergic reactions to the canned food she had always been eating. I finally found a vet that kept mentioning IBD and for another year we were in and out of the vet for dehydration, vomiting and constipation. We tried everything and finally this past August she was put on steroids. In the beginning she looked terrible because the steroid made her so big and swollen looking. All she wanted to do was eat but she could hardly walk. We finally got her on a small dose every other day that is working for her.

I have noticed that she is not as pudgy lately but she is still eating the same amount of food. I'm not sure if she has lost any weight but she was at a good weight in November when she went in for a teeth cleaning. Do all cats end up with lymphoma if they have IBD? Will long term use of the steroid cause problems? I didn't want to go the steroid route but the vet talked me into giving it a try and it has helped her so much. She is only 7 years old but has been having issues since she was 3 years old.

Do cats with IBD live a long healthy life?

I think the inflammation does need to be controlled.  If that can be done with diet change or some holistic remedies that is great but if steroids are needed to control the inflammation that is far better than allowing it to continue unchecked.  IBD doesn't always become lymphoma.  It's a continuum thing and many kitties are in that gray area where even a good vet doesn't know for sure if it's IBD or small cell lymphoma.  I think that controlling the inflammation is needed to control the progression of the disease.

The main possible side effect of steroid use is diabetes.  The diabetes usually clears up when the steroid is stopped but then it's find an alternative to the steroid.  I remember someone here was in that quandry, their kitty needed the steroid but it was causing diabetes.  She put her kitty on the high protein very low carb diet, which is healthiest for any kitty, and she was able to control the diabetes without insulin.  Patches gets blood work done every six months mainly to check liver enzymes.  That's done both because of the steroids and because he had fatty liver.  There was a shortage of the pred awhile back and he was switched to dexamethasone.  He was on the dex for quite awhile.  He had some blood work show high glucose so he was switched back to the pred and his blood sugar came back down so there is a difference among the different steroids.

So how's Krissy doing?

This is an interesting thread.  My kitty most likely had IBD or lymphoma.  I haven't had a scope done because the vet indicated that often the results weren't definitive.  And the vet said my cat (14yo) wasn't a  good candidate for surgery to get a biopsy.  But, the vet did feel a thickening of his intestines.  The IBD symptoms weren't sudden.  They've been on and off for many years, I think.  But, they took a noticeable turn for the worse this summer when I saw frequent blood in his poop and then later persistent diarrhea.  He lost 5 lbs in 6 months!

We did a round of steroids for 3 weeks in November.  It immediately stopped the diarrhea and he gained about 0.5 lbs. But, a few days after discontinuing the steroids, the diarrhea and vomiting was back.  So, we put him back on the steroids.  I think 1 pill every other day is about the lowest he can go.  It just seems like the he needs the steroid to decrease the inflammation -- otherwise much can't get through his system (so ends up vomiting) or he gets diarrhea.  I tried some other home remedies like probiotics and slippery elm but saw no improvement.  I think changing a cat's diet has potential to help -- but my kitty's latest blood work showed kidney disease so that would seem to limit my options some.

Vet said that if it is lymphoma rather than IBD the steroids would lose effectiveness at some point.  And, then the lymphoma would take over.

Hope that is somewhat helpful to you.  What are Krissy's primary symptoms these days?

Catwoman recommended one of the limited ingredient canned foods and it seems to have made all the difference in my cat.  He's only 18 mo's old though. 

Sorry I have been struck with a stomach bug! Still not up to par but had 103 emails so it was time I got on the ball.

@Reba  SO glad your boy is doing so much better now!!

@maurene  having IBD is not a thing of the past unfortunately, and will be basically a lifelong issue to control.

I think key is to feed a limited ingredient diet, whether it be raw/homemade/commercial, preferrably wet over dry, although Krissy is stuck on about 1/2 of her diet being dry.

I also truly believe the vet, when they are highly experienced in ultrasounds are well worth having this done.

I chose not to do a biopsy. The former blood tests did not show anything except elevated wbc.

Krissy's ultrasound showed it all, the thickened intestinal wall, inflammed pancreas, intestines, lymph nodes. The thickening is apparently from ongoing irritation, food allergy, etc over time, as well as the overall inflammation.

@Snugglecat  and @Denice  my question as well.

What happens with long term steroid use, and if it does turn in to lymphoma after being on steroids?

Krissy is a chubby cat too, I actually think that is why her vet chooses not to put her on it at this point. She sure doesn't have a problem holding her weight either! 

Sorry you haven't been feeling well!  I got a look at my boy's test results today for the TK feline cancer panel and his inflamation marker was 400% over the "high" level.   No wonder he was so miserable.

I'm somewhat skeptical of these tests (i.e., follow the money), but it was cheaper than a biopsy. 

http://vdilab.com/page.php?id=59

Reba said:

 
Sorry you haven't been feeling well!  I got a look at my boy's test results today for the TK feline cancer panel and his inflamation marker was 400% over the "high" level.   No wonder he was so miserable.

I'm somewhat skeptical of these tests (i.e., follow the money), but it was cheaper than a biopsy. 

http://vdilab.com/page.php?id=59

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Wow @Reba  so that was the test he had, the tk cancer panel. Well I sure am glad it was neg, but as you had said, not always so accurate. Think positive

What was the cost of this test? It is a blood test correct?

Thank you for posting this!