IBD - Cat acts like he is starving but refuses food when offered

[kirukan]

We have a cat who is tentatively diagnosed with IBD. We just had an endoscopy done at an internal medicine specialist and initial results indicate no lymphoma, but he has inflammation and scar tissue. He is 2.5 years old with no prior health issues other than being a little chunky.

In November he started dropping weight and he went from 10 lbs to now 7. We started on depo medrol shots in Jan after initial diagnosis with little improvement after the first until they referred us to the imed. He, of course, fully went off food at that point and luckily they got us in sooner. We've done tests for everything and we are left at IBD unless some of the other endoscopy results come back with lymphoma which seems unlikely at this point.

He is on oral prednisolone and mirataz. We are syringe feeding him slurried hill's z/d because he won't eat. I got some Lotus foods to try and he got really excited about the venison the first day, was a little pickier the second and by the third refused it.

I tried Fortiflora on both z/d and the Lotus venison. Same thing. Yesterday he was crazy about it, today started off excited and by the end refused it.

He generally hasn't thrown up at all through this except at the very beginning until the last couple days. He did throw up bile around 530 this morning and maybe the night before (we can't be certain because we didn't notice it until the other cat had been in that space a while).

He only likes his food fresh out of the can. Not cold, not microwaved, not left out to warm, not given a water bath. I've tried like 6 limited ingredient or single protein foods.

I gave him a little Koha Rabbit au Jus tonight and he ate all of it, but I'm not expecting it to last.

I tried scrambled eggs out of desperation. He will fight you for human crackers, which he has never shown interest in before.

He just keeps dropping weight though it has at least slowed down as we near 7 lbs. Not sure how much more he can truly lose. I would love some ideas. Currently I plan on asking about B12 shots and Cerenia on Monday. This is so hard and I just want my sweet boy back. Thanks for any suggestions you can give.

 

[kirukan]

I can't seem to see how to edit but I want to clarify that when I said he ate all of the Koha, I meant he ate all of what I gave him which was about a tablespoon. Trying not to shock his system by switching too abruptly like I did with the venison (maybe)

 

[Alldara]

Is the Koha a limited ingredient diet?
Did you do a limited ingredient/allergy diet already? How did that go if yes? (Trying to get some more info so I know what to suggest).

 

[FeebysOwner]

Hi and welcome to TCS, despite what brought you here. I really have more questions than anything else. How was it determined that an endoscopy was the proper procedure? Did they do an ultrasound first? Also, when you say endoscopy, was that done via the rectum? What tissue was collected to determine that it doesn't appear to be lymphoma? Were there any other tests run?

Cerenia is a good idea, as it can help facilitate Mirataz which has very little anti-emetic properties.

As far as food, try baby food meats (Gerber Stage 2 or Beechnut) to see if that might interest him a bit. These meats contain anywhere from 50 to 90 calories per jar. If he eats it, there are ways to make it nutritionally complete for a cat if he has to be on it for long.
Inflammatory Bowel Disease | Cornell University College of Veterinary Medicine

 

[kirukan]

Is the Koha a limited ingredient diet?
Did you do a limited ingredient/allergy diet already? How did that go if yes? (Trying to get some more info so I know what to suggest).

Yes, Koha is a limited ingredient food, very similar to the Lotus brand. I went to the local...I guess I'd call it pet health food store that has a lot of limited ingredient options. I tried duck (zero interest), venison (at first successful but quickly waned) and now rabbit. The other two were both Lotus brand, this is the only Koha I picked up, so we will see how that goes. I've tried various fish as well and so far he hasn't shown any interest. I think mackerel and salmon.

 

[Alldara]

Okay lovely. Well I'm glad the rabbit went well today. Let's keep

LIDs can be a little finicky to find one the cat will eat, I found with Lily and Magnus each.

 

[kirukan]

Hi and welcome to TCS, despite what brought you here. I really have more questions than anything else. How was it determined that an endoscopy was the proper procedure? Did they do an ultrasound first? Also, when you say endoscopy, was that done via the rectum? What tissue was collected to determine that it doesn't appear to be lymphoma? Were there any other tests run?

Cerenia is a good idea, as it can help facilitate Mirataz which has very little anti-emetic properties.

As far as food, try baby food meats (Gerber Stage 2 or Beechnut) to see if that might interest him a bit. These meats contain anywhere from 50 to 90 calories per jar. If he eats it, there are ways to make it nutritionally complete for a cat if he has to be on it for long.
Inflammatory Bowel Disease | Cornell University College of Veterinary Medicine

At our primary vet, they did bloodwork in December and found his albumin to be 1.2, his glucose was just barely considered low, but the rest of his bloodwork was fine. So we did an ultrasound which showed some inflammation. We treated it as IBD, with the plan to do this until we felt he was more stable since our primary did not feel comfortable doing a biopsy with his albumin low (over a month it went from 1.2 to 1.8 and back to 1) and his rapid weight loss so they referred us to an Internal Medicine specialist.

Over there, they redid the ultrasound, but paused the steroids because they were worried about histoplasmosis. They also redid the bloodwork, with no real change. I assume the endoscopy was rectal. It was not done with an incision or anything. He had talked about small intestine and stomach but I have not received their write up yet so I'm not totally sure where they sampled exactly.

They indicated that initial tests run indicate no lymphoma but also said that there is a chance that some of the other tests (more thorough I assume) on the same sample/samples could still come back positive for lymphoma but that is the most that I know about that. They has always been a doubt about lymphoma because he is so young but the IBD has been so stubborn.

Once the histo came back clear we started on oral prednisolone, and he has been on that about 5 days now. They tested for another fungal and some parasitics as well. We ran some with our primary for our area (Maryland) and gave him meds for parasites, but he was originally from Texas, so they wanted to check for a few rarer ones for our area.

Do you think B12 is worth doing the shots at home for? I have heard that can help with absorption if its given subcutaneous.

Thanks for the rec, we will look into those. All this food purchasing is hell on our finances! That's not covered by insurance!

 

[FeebysOwner]

If the vet talked about small intestines and stomach, that would suggest to me that the endoscopy was via the mouth, not the rectum. Rectal would have looked at the lower intestines, maybe part of the small intestines. but I don't think it would go clear into the stomach. It is kind of confusing though, because if the inflammation is in the stomach or small intestine, it is usually referred to as gastritis or enteritis. So, maybe you will get that cleared up when you get more test results.

5 days isn't much time on Pred, so you may yet see improvement as time passes.

B-12 shots can be given at home by you, as you said, subcutaneously. I've done that with my cat. But, testing the cobalamin level to see if it is low would be a good idea first. If his cobalamin is not low, there isn't much point.

 

[kirukan]

If the vet talked about small intestines and stomach, that would suggest to me that the endoscopy was via the mouth, not the rectum. Rectal would have looked at the lower intestines, maybe part of the small intestines. but I don't think it would go clear into the stomach. It is kind of confusing though, because if the inflammation is in the stomach or small intestine, it is usually referred to as gastritis or enteritis. So, maybe you will get that cleared up when you get more test results.

5 days isn't much time on Pred, so you may yet see improvement as time passes.

B-12 shots can be given at home by you, as you said, subcutaneously. I've done that with my cat. But, testing the cobalamin level to see if it is low would be a good idea first. If his cobalamin is not low, there isn't much point.

Really appreciate your input, I feel a bit more ready to talk to the vet next week if we continue to struggle with getting food in him. A lot of the stuff I'm reading seems like stuff that they should have already brought up with me, but in watching him dip into the 6 lbs with no support beyond the two meds, I'm just worried that by the time they turn attention back that he will have lost too much weight to save. So I really appreciate your help.

 

[Alldara]

Really appreciate your input, I feel a bit more ready to talk to the vet next week if we continue to struggle with getting food in him. A lot of the stuff I'm reading seems like stuff that they should have already brought up with me, but in watching him dip into the 6 lbs with no support beyond the two meds, I'm just worried that by the time they turn attention back that he will have lost too much weight to save. So I really appreciate your help.

The prednisolone should help him to want to eat and then he should gain weight. If he started to think food in general hurts him, he would be discouraged from eating. So that might take some time to sort even on an LID.

Do you have him using a raised bowl? Since he's not eating, his stomach acid will be high and then when he bends forward to eat he can become nauseous. I found even just the same width as the boxes that cases of wet food come in are perfect if you can set his bowl on top.

 

[kirukan]

He definitely is interested in eating, to the point of stealing my kids' Goldfish and animal crackers . He often will come find me when he wants food, but isn't interested when we put it down. He will continue to lick the z/d sometimes but doesn't really eat it. It's what we syringe feed him though so I expect we might be creating an aversion to it, though he is honestly pretty chill about the food. Giving him the prednisolone is a different story!

He is in a raised bowl, though he often grabs pieces and puts them on the ground to eat them. But he has the option. He also has a fountain waterer that is raised as well and he seems to drink a normal amount considering the pred. I'd guess both are 5in or so up.

The pred definitely has improved things but still can't get him to just eat even though he SEEMS to feel better, less lethargic, more interested, more snuggly than he was. I wasn't sure how long before we might see the inflammation go down, since the vet hasn't given us anything to watch for.

 

[Alldara]

Checking the instructions I wrote down for Magnus's prednisolone, out vet told us 10 to 14 days.

We were giving him the pill by putting a little Churu on our finger, then the pill, then the Churu and he took it quite well.. sometimes we needed to add a touch more Churu and he'd get it the second time.

We started him first on Purina Chicken EN though as that's what our clinic recommended.

 

[kirukan]

He is getting the oral liquid but I imagine it isn't much faster than the pill. That makes me feel better that I shouldnt expect significant improvement just yet. He did (mostly) finish off the Koha can today but he seems to have issues eating the pate out of the bowl, even though it's really shallow, so I might try a plate on a box or something. I've been remaking his Rabbit Mountain each time he flattens it but I can't do that all the time!

Really appreciate both of your help and hope I can update you with improvements if not success, and hopefully some of the ideas you have suggested will be received well by the vet.

 

[Alldara]

Looking forward to your update after the vet!

 

[kirukan]

Not much of an update. They said bloodwork indicated he didn't need B12 but did give us Cerenia. He got so lethargic from it and stopped eating, but after I took him off it he really got into his Koha Rabbit. Yesterday was the first day that I didn't feel like I had to syringe feed him. He isn't gaining yet but his appetite is improving.

He was still nauseous so I started feeding him whenever I wake up through the night. I'm tired but it seems to have helpee.

We go in on Tuesday for a bloodwork recheck, since he has been on prenisolone for 2 weeks by that point.

 

[kirukan]

Well, not a great update, friends. He is anemic, cholesterol is down (though not out of norm, just moving in the wrong direction), and albumin not really any better. They wanted to hospitalitize him for a few days to stabilize him, but when I pushed the vet, he said he thought he had a 20% chance of even seeing progress, much less returning to some semblance of normal. He said he has never seen a cat come in who didn't respond to the steroids and with such scarring already present, especially this young.

So we have brought him home. We are not euthanizing just yet but have asked to continue medicine, and add another and see what happens. Most likely we will have to euthanize soon, and we are preparing for it, and preparing our kids for it, though still hoping for that miracle.

So we are trying to manage applications or Mirataz (could be causing nausea?) and half doses of Cerenia (causing lethargy in full dose but helping the nausea?) and his prednisolone, while waiting for a script for another drug that I don't remember the name of. And hoping that the inflammation will start coming down.

If he continues to decline, we will put him down, but man he really rallied the last couple days and has a great appetite and been more alert. It's probably a false rally but it's so hard to not have hope.

 

[FeebysOwner]

They wanted to hospitalitize him for a few days to stabilize him.

What was their plan of action had he been hospitalized? Are there things you could replicate at home? Unrelated to your issues, but they wanted to hospitalize Feeby when her kidney numbers went sky high. The purpose was for IV fluids, but they too were not optimistic. I said no, and started her on sub-Q fluids at home - she turned around and her numbers came down. They too had talked about me considering euthanasia.

Mirataz (could be causing nausea?) and half doses of Cerenia (causing lethargy in full dose but helping the nausea?)

I don't think Mirataz would cause nausea, but it could help bring it to the forefront, by making him hungry and exacerbating the feeling of nausea. That is often why something like Cerenia is given with Mirataz.

Glad to hear he has rallied. A lot of illnesses have their rebounds and relapses, and more often than not, it is a repeat process until the relapses become longer and longer in duration and the rebounds are shorter.

 

[kirukan]

They were going to do fluids and blood transfusion. They were going to put in an NG tube. They were going to start him on chlorambucil. I forgot, his blood pressure is also a little low. They were worried that if they gave him fluids that his anemia would get worse. He definitely is drinking less than he was though his food does have a lot of moisture in it.

I've been wondering if there is a way I could deal with anemia and we are planning on starting chlorambucil as soon as we can get the prescription paper from the vet. Right now he is still eating basically on the hour as I offer it. Haven't seen him pee today but had a poop--actually solid which is good since he had diarrhea the last two days.

He still REALLY REALLY wants Goldfish.... (he isn't stuck, just determined)

 

[FeebysOwner]

They were going to do fluids and blood transfusion. They were going to put in an NG tube. They were going to start him on chlorambucil. I forgot, his blood pressure is also a little low. They were worried that if they gave him fluids that his anemia would get worse...I've been wondering if there is a way I could deal with anemia and we are planning on starting chlorambucil as soon as we can get the prescription paper from the vet. Right now he is still eating basically on the hour as I offer it. Haven't seen him pee today but had a poop--actually solid which is good since he had diarrhea the last two days. He still REALLY REALLY wants Goldfish.... (he isn't stuck, just determined)

The kind of anemia might be necessary to know in terms of how to treat it. I know the most basic anemia in humans is treated with iron supplements, but you'd have to ask the vet about it.

I wonder what vitamin/mineral deficiency would drive him to crave Goldfish? You might ask the vet if they have a clue, and if it somehow ties to the anemia. I know of several cases (in humans) where they were craving a specific type food and when it was investigated, it turned out to be some sort of nutritional deficiency - one such case was driven by anemia.

 

[kirukan]

Yeah I'm wondering if it's salt or carbs or both maybe. I wish I just had a vet who I could chat with about it. I might go back to my primary and see if we can just talk through some of it. My husband has a limit though, and is willing to continue trying some things, but I'm trying to be sensitive there too.