Managing Senior Cat IBD Flare ups

Hello,

I have a 15 year old male cat whom has had digestive issues for several years. He had been on wet food for urinary issues for a few years (Royal Canin Urinary SO) and was switched over to Royal Canin mature consult (with an s/o index) about 2 years ago.

His appetite has never really been affected but we started noticing he was vomiting frequently on an empty stomach in the early morning hours. This was somewhat helped by feeding him late at night or waking extra early in the morning per our vet's suggestion. If he didn't eat it was almost certain he would vomit clear liquid (like >75% chance).

I also started to notice he was getting a little thinner and a first figured just his muscle density breaking down a bit as he is senior, but then I started noticing his stools were regularly diarrhea or very soft. I never noticed any blood and he never spends any time forcing, but sometimes he would also make a second trip for a small extra "deposit" 2-3 hours after the first. He even vomited immediately after the diarrhea once or twice. That's when I brought him back to the vet.

I brought a stool sample and they did blood tests. Everything came back ok. The only tests we didn't do were an endoscopy (at his age we didn't want to risk). The vet diagnosed as best as possible as either IBD or potentially intestinal lymphoma (which can't be ruled out without a endoscopy). The one negative was that our cat lost about 2.5 pounds since his last check up 14 months before. He was down to about 9.8lbs from just over 12 previously.

In the end the vet recommended a switch to Royal Canin Gastrointestinal moderate calorie as it still has the s/o index and to add pumpkin or metamucil for additional fiber. He also suggested we try a probiotic for cats (Purina Fortiflora).

With the combination of 1tsp pumpkin per day and the new food divided into 4 smaller meals things improved dramatically almost over night. He went nearly 40 days without diarrhea and the occasional semi-soft and no vomiting at all. Bowel movement passed with ease and smelled MUCH better every 24-48 hours. He even gained back about 0.4-0.6lbs.

Then the set backs started...

In mid January the diarrhea started up for a few days and he had furballs (not the normal morning clear vomit). I bumped pumpkin up to 1tsp 2 times daily (morning/night) and things seemed to get back on track after about a week. For about 3 weeks everything seemed ok again with just  a single furball and a partially soft stool once. Then late last week the diarrhea started again. As usual he is not going a bunch of times a day just 1-2 times every 24 hours. I've tried bumping him to 3tsp (vet said 1tbsp is max for pumpkin daily) to see if that helps...but other than that am at a loss what to do.

I want to consider trying novel protein or grain free but I am worried that his urinary issues will return without the s/o index food (as they did 3 times i tried to take him off in the past). While he's not perfect he's doing much better that he was for the most part (50 days out of the last 2 months diarrhea/vomiting free) and slowly gaining back some weight.

I guess I'm looking for opinions such as is it worth the risk to switch off the s/o food? Does the s/o food even have much benefit? Is the pattern I am seeing normal for an IBD cat in "management mode". The other option is a trip back to the vet where they could start prednisone, but as these setbacks are cyclical with pretty good health in between again I am wondering if the risks outweigh the benefits (diabetes/cushings with steroids).

Any thoughts or suggestions are appreciated!

I would say, if you have tried to take him off the S/O index 3 times and each time his issue returned, it's not worth the risk of taking him off that food.  You did say that, right?  So I'm wondering why you wonder if it really has any benefit .

I've never had a cat with IBD, but know of several cats here on TCS with it, and believe many of them are on low dose Pred.  Sometimes it's quality of life vs quantity, and at 15 years of age, I would think it's worth the risk of putting him on it, since it probably takes quite some time for any adverse effects to set in, doesn't it.  Of course, I wouldn't really do anything until this latest increase in pumpkin stops working. 

Also, I would consider using a different probiotic, or at least adding to the fortiflora, as it's a single strain probiotic, which doesn't do all that much good.  Many folks here on TCS use Nexabiotic, which has 23 strains   Here's a thread about it, but be sure to read the entire thing:  http://www.thecatsite.com/t/314112/nexabiotic-probiotic-for-ibd-kitty

Both of my senior kitties are on low dose prednisolone and it has worked wonders. No vomiting for either of them in a long time. One has kidney disease with possible lymphoma and one has IBD.

Look in to FMT. Fecal Microbiota Transplants. Probiotics attempt to replace beneficial bacteria in the gut to bring back regular stool function but there limited in the quantity an type of bacteria they provide. In order to fully replace gut and intestinal bacteria which help process and digest food you really need a full variety of live and active flora. FMT provides that by taking the poop of a healthy cat and transplanting it into the colon of a cat with deficient bacteria. The new bacteria (in the transplanted poop) thrive in there new environment and within a few transplants take over the GI tract. It's important to choose the right transplant cat (a holistic vet would already have a donor they buy from). The cat need to be in a good weight range, active, no diseases, illnesses, or parasites and have normal bowl functions. Some vets only use cats that are in isolated environments and who have never been vaccinated but I dont think that is a requirement. I know it sounds gross, and it is, but its effective against a wide range of disorders and doctors and vets have been 'off label' (only FDA approved for C-diff) using it for IBD successfully. Doctor's are calling it a cutting edge treatment who's full potential is only being discovered but it really dates back to early China.

My kitty has been on pred for a little over 5 years.  His IBD is also cyclic in nature.  He would be very ill with a flare and be fine between flares.  Most kitties tolerate steroids very well, actually in general better than people tolerate them.  Patches has had only one very mild flare in the time that he has been on the steroid.  His was so bad that three of them required hospitalization.  The last bad flare that he had when I tried one more vet who put him on the pred involved fatty liver and a feeding tube.

I had two elder IBD kitties.  One was on prednisolone permanently and one was on budesonide because she didn't tolerate prednisolone well.  It wasn't worth taking them off the meds because of the vomiting and/or diarrhea, and lack of appetite.

I also used pumpkin which worked great for one cat but didn't help the other.  Here's an interesting thread from one member who had success with fresh pumpkin when canned didn't work:  http://www.thecatsite.com/t/312454/ibd-help-beyond-canned-pumpkin