Gut issues: Deciding whether to give my cat steroids (prednisolone)

I'd go with @catwoman707's advice. She has way more experience with ibd than I do.

@GoHolistic @StephenQ, she did have two Cerenia injections, one a week ago and one Saturday, but the vet didn't give me any to take home. Right now she's about half syringe fed half free fed. She seems to have an appetite in the morning and eat a decent amount, then give up and only take a couple licks if I stick food in front of her later in the day. Maybe it's because I give her the antibiotic (marbocyl) around noon? I can only get about 10-15 mL of food in her per sitting with a syringe (so about 7-10 calories) so it's teeeeedious. Last night I was up until two feeding her. But she got about 75 calories! The most all week!

It sounds like you're doing wonderfully with her. Im sure her progress will continue with such great nursing

samus said:

 
@GoHolistic @StephenQ, she did have two Cerenia injections, one a week ago and one Saturday, but the vet didn't give me any to take home. Right now she's about half syringe fed half free fed. She seems to have an appetite in the morning and eat a decent amount, then give up and only take a couple licks if I stick food in front of her later in the day. Maybe it's because I give her the antibiotic (marbocyl) around noon? I can only get about 10-15 mL of food in her per sitting with a syringe (so about 7-10 calories) so it's teeeeedious. Last night I was up until two feeding her. But she got about 75 calories! The most all week!

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If she's vomiting regularly she should be on cerenia daily either following the protocol 5 days on 1 day off or just on every day if a lose dose and tolerated.  It comes in pill form.

First - lucky kitty to have you! I have a 14 year that I adopted at 13. She had IBD and was recently diagnosed with lymphoma. She threw up every day and had runny stool. She was losing weight fast. The vet put her on prednisolone and within a couple of days, stopped throwing up and stool firmed up. Perked up quite a bit, too. Whenever I decrease the dosage the symptoms start again. So I've made the decision to keep her on it. If she was younger I might try to slowly reduce the dosage after a couple of months. But at her age it keeps her from losing weight, feeling weak and lethargic, not to mention looking like she feels so bad. Good luck to you!

My kitty has been on a steroid for almost 5 years now.  For my kitty it has been like a miracle medication.  He started with severe flares when he was only 18 months old, his flares mimicked foreign body ingestion.  I finally found a vet that diagnosed him as having IBD after 6 years of vet hopping and started him on prednisolone.  I know not all kitties have the same experience but for my kitty the steroid on it's own has kept him well.  He did recently have to have his dosage upped because of weight loss.  He didn't have any other symptoms just a gradual weight loss.  The vet did all the diagnostics again to make sure there wasn't something else going on and upped his dosage from 2.5 mgs to 5 mgs. a day and he  quit losing weight.

The main issue  with long term use is diabetes.  My  kitty had to be on dexamethasone for almost a year because of supply issues with the pred.  His blood sugar did start to go up at the end of the year.  By then pred was available again and we switched him back and his blood sugar came down.  

@Denice Is dexamethasone worse as far as diabetes/other side effects?

@StephenQ She hasn't vomited since Saturday (when she got a Cerenia shot), but she's in meatloaf position a lot and licks her lips a lot. I'm really cautious when I feed her because I'm so worried she's just going to vomit out again (like she did last week).

But she's feeling good enough that she's interested in catnip again!! I offer her catnip when she's heaving like she's going to vomit and it usually works to head off the vomit, but last week she just wasn't interested at all. I figured I conditioned her to associate catnip with nausea.

I'm trying really hard to get enough calories in her today, I have to fast her all morning tomorrow for the ultrasound. (And morning's when she seems to actually have an appetite.)

The way I understand it Dex is a much  stronger steroid.  I remember he was on a very low dose, if I remember right it was only 1/4 off a mg daily.  It normally isn't used for IBD.  I think it's usually used for allergy related skin issues and isn't used long term, but for a long period of time no one could get the prednisolone.  

samus said:

 
@Denice Is dexamethasone worse as far as diabetes/other side effects?

@StephenQ She hasn't vomited since Saturday (when she got a Cerenia shot), but she's in meatloaf position a lot and licks her lips a lot. I'm really cautious when I feed her because I'm so worried she's just going to vomit out again (like she did last week).

But she's feeling good enough that she's interested in catnip again!! I offer her catnip when she's heaving like she's going to vomit and it usually works to head off the vomit, but last week she just wasn't interested at all. I figured I conditioned her to associate catnip with nausea.

I'm trying really hard to get enough calories in her today, I have to fast her all morning tomorrow for the ultrasound. (And morning's when she seems to actually have an appetite.)

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That's good she hasn't vomited but licking her lips is a sign of nausea and could explore poor appetite.  If it was me i'd have her on Cerenia daily (or 5 on 1 off as per protocol) and pepcid as well and see how that affected her appetite.  You've got to get food into her or you're going to lose her, and i don't think the nausea is fully controlled, from what i see here.

StephenQ said:

 
That's good she hasn't vomited but licking her lips is a sign of nausea and could explore poor appetite.  If it was me i'd have her on Cerenia daily (or 5 on 1 off as per protocol) and pepcid as well and see how that affected her appetite.  You've got to get food into her or you're going to lose her, and i don't think the nausea is fully controlled, from what i see here.

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I agree!! I just need to convince the vet to prescribe me the Cerenia. Pepcid is omeprazole? So far I haven't seen any change from the omeprazole, but I have no idea what the dose is (the vet gave me a single gelcap with little balls inside and the dosage is "15 balls a day") and she's only been on it since Saturday. Well, maybe it is helping some, she's not vomiting at least. 70 calories so far today, trying so hard to get to 100....

Cerenia is a no brainer.  Pepcid is famotidine. Omeprazole  is Prilosec, another type of antacid.  What makes Cerenia different is that it is a neural block for nausea, it turns it off like a switch in the brain.

I'll be honest - if they don't help you to your satisfaction with the Cerenia, I'd insist, if you already know it is helping. I had to do that at my vet's office (my vet was on emergency leave). I went in and they said there was nothing they could give for the nausea. The next day, I called and I said if they couldn't help I'd take him to someone that could help because I didn't have the luxury of time to wait for my vet to get back. And it was definitely not a threat, but I needed them to understand the direness of the situation in my case. One of the other vets called me in 40 minutes to say she'd give him a shot of Cerenia, and they sent me home with four more pre-filled syringes.

Not saying your vet is doing something bad (or that mine did). Sometimes they just aren't aware of the whole situation. Plus some vets are so focused on treating the root of the problem that they forget they need to stabilize the patient first. It happens. And I get it. But it's why sometimes we have to take things (sometimes) into our own hands. We're the ones with our babies all day, after all.

So I got some Cerenia! Only one 16 mg pill, a two day supply. She said she doesn't want me to give it to Samus every day, because it's a strong drug. Besides that she got another shot of dexamethasone, and Monday we'll talk about whether to go on prednisone long term or not. The vet is leaning against it, because of the kidney issues. She said she's been only giving very low doses of dexamethasone because of concern for the kidneys. I think Monday she's going to teach me to give sub-q fluids, too, and discuss putting her on a kidney diet.

Today's vet visit: ultrasound showed only inflammation around the duodenum, everything else looked normal. The vet thinks the kidneys are causing the problem, even though her numbers are still only slightly out of normal range:

Creatinine 2.2 mg/dl (normal is <1.9), urea 33 mg/dl (high end of normal), phosphate 1.2 mmol/l (mid normal). The only other thing out of the ordinary is eosinophils: 16% (normal 0-6%), absolute count 1562/ul. (So frustrating! The other blood results were in different units.)

February her creatinine was 172.8 umol/l, normal is 0-168. Eosinophils were 19%, 2223/ul.

April was creatinine 2.1 mg/dl, eosinophils 21%, 2081/ul.

So it really looks like her kidneys have stayed stable since first diagnosis in February....

I'm thinking about trying slippery elm to soothe the duodenum, but I tried giving it to her a few days ago and she got SO bloated. But then, she was on antibiotics and eating baby food she wasn't used to and.... Maybe I also gave her too much? Anyone have experience with slippery elm causing gas?

@StephenQ are Pepcid and Prilosec about the same, as far as efficacy and side effects go?

samus said:

 
So I got some Cerenia! Only one 16 mg pill, a two day supply. She said she doesn't want me to give it to Samus every day, because it's a strong drug. Besides that she got another shot of dexamethasone, and Monday we'll talk about whether to go on prednisone long term or not. The vet is leaning against it, because of the kidney issues. She said she's been only giving very low doses of dexamethasone because of concern for the kidneys. I think Monday she's going to teach me to give sub-q fluids, too, and discuss putting her on a kidney diet.

@StephenQ are Pepcid and Prilosec about the same, as far as efficacy and side effects go?

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I can't tell you how strongly i disagree with your vet and i suggest a second opinion. Cerenia is FDA approved in cats and dog and my cat was on Cerenia every day  for 18 months with no issues  except he stopped vomiting.  Technically the protocol is 5 days on and 1 day off but a new study shows that dogs can tolerate in daily at 2mg/kg weight and i suspect the same will be done for cats.  My cat tolerated daily use, and another cat at my vets also tolerated it, but even 1 day off after 5 on is good.  Note injectable usually stings so i always gave it with a sub q fluids first to dilute the drug at my vets advice.

Please see these links on Cerneia:

https://www.zoetisus.com/cerenia/index.aspx

http://cerenia.com/vomiting-in-cats.html

As to your question about pepcid vs prilosec, i have no idea but every vet ive worked with says to use pepcid.  Pepcid is not a prescription and very safe, Prilosec is a prescription i believe and while not FDA approved for use in cats has been shown to be effective.  It might have a slightly larger chance of side effects.  And while used for heartburn, it seems more useful for ulcers.  See links and dIscuss with your vet.

http://www.peteducation.com/article.cfm?c=26+1303&aid=1450

https://www.vetinfo.com/omeprazole-for-cats.html

and for pepcid: https://www.vetinfo.com/pepcid-ac-for-cats.html

StephenQ said:

 
I can't tell you how strongly i disagree with your vet and i suggest a second opinion. Cerenia is FDA approved in cats and dog and my cat was on Cerenia every day  for 18 months with no issues  except he stopped vomiting.  Technically the protocol is 5 days on and 1 day off but a new study shows that dogs can tolerate in daily at 2mg/kg weight and i suspect the same will be done for cats.  My cat tolerated daily use, and another cat at my vets also tolerated it, but even 1 day off after 5 on is good.  Note injectable usually stings so i always gave it with a sub q fluids first to dilute the drug at my vets advice.

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What dosage/weight was your cat on? So far I haven't seen any effect from the 8 mg pill I gave her earlier today. Still nibbling and meatloafing. But maybe there are absorption issues from the gut problems?

Honestly I don't remember the dose but it was the recommended dose for his weight and remember all it does is prevent vomiting. Your cat likely has other things going on....

I just really want to cry. She just smells the food, maybe licks it once or twice, then stares at it licking her lips for a few seconds and walks away. I should have insisted the vet give her fluids while I was there today, all she got was another steroid shot. I can tell she's hungry! She follows me in the kitchen, and tried to steal my dinner (pasta slathered with butter). Tried to steal some of my cookies, too. Cookies!! Cats don't even TASTE sugar. I warmed up some of her food in a pan with some butter, but nope, not interested. And because she was fasted this morning for the ultrasound, she's only gotten about 30 calories today and I'm so tired that I'm scared I'll hurt her trying to syringe feed her. I'm thinking about getting one of those zipper bags to stick her in when I feed her. I don't want to need one of those bags enough to own one. But feeding would go so much faster if I didn't have to rewrap the sheet around her every 5 ml.

Has she been tested for hepatic
Lipadosis? I think I would discuss having a feeding tube implanted. Much easier than syringe feeding so long as she doesn't throw up

Mega vibes for you and your girl. Sorry I can't add anything more helpful You're both in my thoughts (and I'm waiting to hear back from maufacturers about a few foods ).

She was tested for hepatic lipidosis when this all started about a week and a half ago, but not since. A feeding tube would get rid of some of my worries (like aspiration pneumonia) and give me new ones (I shouldn't have read that thread someone posted about her cat dying when it got back from getting a feeding tube put in). I went back to feeding baby food, even though this country doesn't believe in pure meat baby food so it's got rice. Hopefully that wasn't what was causing the terrible water poop earlier. Watered down blended normal cat food just doesn't have enough calories. I'm thinking about getting some lactose free cheese and seeing if that intrigues her appetite.

@Columbine my vet told me today that there is a prescription kidney food for cats with food allergies. Fingers crossed that it's for the same food allergies my cat has... and that she'll actually eat it. I didn't get the name of it, she has to special order it, it sounded like it just came out recently. Maybe I'm not the only one that's been calling/emailing cat food companies asking which limited ingredient flavor is least likely to kill what's left of my cat's kidneys.