Do steroids help malabsorption?

[tyleete]

I've got a cat who's been IBD since I took him in almost 10yrs ago. For a while an Rx food high in fiber seemed to help, then they changed something and it stopped. We've tried everything from pumpkin to other holistic things. Put him on a limited ingredient novel/single protein food that food well for a while, then they also changed something and it stopped.
He's had absolute liquid poo since and it's been quite a while.
He also has hyperthyroidism but it's regulated (actually on the low end but still in parameters) and has had a lot of bloodwork done to rule out things such as B12 (though he tried that for 6weeks to no avail), EPI, pancreas, liver, and other things I can't recall. I believe the only thing he hasn't gone through is the fecal test.
He's been on Metro to no response except making sick and not want to eat, slippery Elm, and has been on Tylan powder for 3 weeks now and KEEPS losing weight! He was down to 7lbs 8oz last and is skin and bones & my husband tells me we have to think about putting him down due to his weight, and he does love him.
I asked the doctor about other tests and she said she thinks to wait for any others, and start prednisolone 2.5mg twice a day.
Said he's losing weight from malabsorption. No shit.
My question is, does Pres ever actually help this? I've tried researching and the only things I've found were on the NIH pages and it was so medical jargon even I didn't understand it.
Help! I don't want to lose my little man.

 

[FeebysOwner]

Hi. Steroids are intended to help reduce the intestinal inflammation, so in theory it should help your cat with his weight loss, since inflammation disrupts digestion, Not only that, but steroids are generally thought to increase appetite too.

But, I am curious - did he actually have his B12 checked? I wasn't sure based on your post. If he did, it should have shown a low B-12 (cobalamin) level, which is what is usually done to determine malabsorption. Most cats with IBD have a low B-12 level and are then given injections of B-12 to build the level back up. Since any excess B-12 is excreted through urine, It could be injected weekly and not pose a problem. You can do the injections at home too. The oral B-12 is less effective.

You could also consider adding probiotics to his diet, s. boulardi is often used with IBD cats to help with diarrhea and balancing good bacteria in the gut. You might also consider a fecal PCR test, but would have to ask the vet about how/if Tylan would affect it since it is considered an antibiotic of sorts.

Maybe this article will help a bit about treatments for IBD in cats, including Prednisolone.
Treating IBD in Cats - Feline Inflammatory Bowel Disease - Dispomed

 

[daftcat75]

I don't want to scare you. But this sounds like what my Krista went through when her previously well-managed IBD progressed to lymphoma. Her perfect poops went to straight liquid for months while she lost more than half her weight despite being on steroids and eating more than enough food. When I finally convinced the doc to let us try the chemo drug (more on this later), her poops firmed up (mostly) overnight. Sadly, for Krista, I was giving her pred pill wrapped in a trigger food (fish flakes) and that kept her lymphoma smoldering until I finally switched that out for transdermal. Once her final trigger food came out of her diet, she finally achieved remission. It was too little too late for her because she had already lost too much weight and had been on steroids for too long that a bladder infection would prove too much for her the next month. But for her to have one month free of the poop nonsense, I am grateful for that. Others here have had far more success with treating small cell lymphoma. I've heard of a year or more of remission.

An ultrasound unfortunately will only tell you so much. It's probably not a bad idea anyway to rule out the more aggressive large cell lymphoma (also called high grade lymphoma.) If he has that, the prognosis is not very good. But if he has small cell lymphoma, that's virtually indistinguishable from IBD on the ultrasound. The vet would then want to order an endoscopy with biopsy to get a sample of those inflamed cells. I don't recommend an endoscopy on your guy because he's already not stable. And as much as they try to convince you that endo+biopsy is minimally invasive, I hear anecdotes (have one myself) of cats who have supposedly rare reactions to them.

What I recommend instead is the course I took with Krista. Have a discussion with the vet and say, "I understand your hesitation to prescribe chemo without a cancer diagnosis. But given the state of my little guy, I think trying the drug without the diagnosis carries less risk than putting him through the endo+biopsy. I am giving my informed consent to treat this like lymphoma even without a diagnosis if the steroids alone do not work for him." Then set a plan to try pred for so many weeks before adding the chemo drug in. I had to go over my vet's head to the owner and founder of the practice to have this discussion. We spelled out the options: a. Do nothing. b. More pred, c. endo + biopsy and the reactions and recovery that might come from that with a cat who is clearly unstable and struggling, or d. informed consent to try chemo without a cancer diagnosis. I recommend this same discussion with your vet or a specialist if you have one or can see one soon enough.

Pred should work quickly. So if you give it say a month and he's still losing weight, that's when you'll want to try adding the chemo drug rather than throwing more pred at it. The quicker you can stop the weight loss, the better his outcome will be. In Krista's case, I got her chemo drug (chlorambucil) compounded into a concentrated strength (so she could take less of it) anchovy-flavored oil. I got her dose 10X concentrated so she would only need to take a 0.1 mL dose vs a full mL. I mixed the anchovy-flavored oil with an equal amount of salmon oil which she enjoyed for an oil puddle no larger than a dime or a nickel. She happily licked that puddle clean. It was the easiest medicine for the both of us. She was a little more sleepy on dosing days. But other than that, no real side effects to talk about. Chemo in cats is nowhere near the miserable experience that humans endure.

 

[FeebysOwner]

Just to add to the above very detailed post regarding lymphoma. If you decide to have an ultrasound done, ask about having a fine needle aspiration (FNA) done on any suspicious tissue that might be found. Ultrasounds often come out inconclusive, on their own. The FNA adds an additional layer of analysis (and cost, of course), but can sometimes make the difference without going to an actual biopsy. The FNA is non invasive, and no additional cost is charged to you if they don't find tissue to sample.

Oh btw, ultrasounds, including those with an FNA, do not require sedation. They may require a calming agent, but not full on sedation.

 

[tyleete]

He was given B12 shots and the test results showed it wasn't a problem.
He's tried both S. Boulardi & a more powerful Visbiome as well. A month on each, absolutely no change. The fecal test was the only thing she hasn't done that I know of.
I talked to her this afternoon after this post, and she said no matter what it could turn out to be, steroids & chemo are the last type of therapies to try. And she said the fecal sampling requires sedation.
As for the appetite, his is non stop anyhow. My special kitty can't eat more than maybe 25-30 pieces of kibble at av time. Else has just gobbles it up and then throws up instantly.:/ So he is fed between 6-8x every day. Small meals like a diabetic.
But I've known it was an absorption problem from day1, cause he had his liquid poop within 15-20min after each feeding. So I'm cleaning the boxes that many times too
If it's not perfectly clean, he'll poop outside the box.
Which actually, he's done 4 or 5x since on this Tylan powder. Twice just yesterday even though the box was clean.
I just feel like I'm losing him & it's so frustrating and helpless

 

[FeebysOwner]

And she said the fecal sampling requires sedation.

I have never heard of that. Most fecal testing can be done with samples collected at home, and refrigerated if not taken to the vet soon thereafter.

 

[tyleete]

Thank you thank yout both Daft cat & Feeby's Owner on that!
It's not so scary to me, as I adopted a cat from the shelter that took us 2yrs till the vets figured out she had that.
She went on chemo and lasted 5.5yrs on chemo and eventually succumbed to kidney failure, not the cancer.
Two weeks after she passed, one of my (I have 4) IBD babes turned to scl of the gi.
She wasn't doing well till I convinced the vet to do just what you said. That I'd read severe IBD can be treated with the chemo drugs.
I don't know how much time he has, if I can afford another month to wait and see on the steroids. But I'll go send her a message about just that right now.
Thank you for pointing me in that direction. And definitely no biopsies

 

[tyleete]

I have never heard of that. Most fecal testing can be done with samples collected at home, and refrigerated if not taken to the vet soon thereafter.

A sample can't be taken due to it being complete liquid in the box and he shares boxes/rooms with 3 other girls

 

[mrsgreenjeens]

A sample can't be taken due to it being complete liquid in the box and he shares boxes/rooms with 3 other girls

Do you use clumping litter? If so, it IS still possible because that liquid diarrhea clumps up just like urine and you can pick it up (litter included), put it in a little ziploc bag, and take it to the Vet. I have done that with my boy's diarrhea and they sent it out for a PCR test, no problem.

 

[tyleete]

I will ask. Yes it's clumping.
Can a cat on hyperthyroid drugs take chemo drugs?

 

[Furballsmom]

I will ask. Yes it's clumping

Or, separate him temporarily until you're able to get a sample that's "fresh" enough for them to work with.

 

[FeebysOwner]

Can a cat on hyperthyroid drugs take chemo drugs?

The oncologist that I saw had no issue with giving my cat chemo on top of thyroid meds. I did not pursue the chemo, so I can't say if there would have been any issue in her case, though.