Looking for any blind spots in my cat's IBD treatment

[freddie.and.ramona]

Hello!

I posted on here awhile back about my cat's chronic vomiting and received a lot of helpful info. I did end up going to a GI specialist a week ago to pursue further testing. I have attached the summary results of his abdominal ultrasound here if anyone is interested! Essentially, they cannot rule out small cell lymphoma at this point without an intestinal biopsy but it is likely moderate to severe IBD in both upper and lower GI segments.

A little background:

My 6 y.o. male Devon Rex cat, Freddie, has had issues for a few years with intermittent vomiting and inappetence. He has also had fairly loose and foul smelling stools most of his life but otherwise acts healthy and happy. He went almost 2 years with no issues, but in October, he had a severe episode of vomiting that contained blood, and very bad diarrhea that was maroon in color. We went to the ER where he received supportive care (anti nausea, appetite stimulants). It was at this time that I decided to slowly switch him over to a freeze dried raw diet, as I knew a lot of people had success with this. He was previously eating Weruva wet canned food, mostly chicken and fish flavors. He was doing really well on the raw diet (Stella & Chewy, multiple proteins) and was pretty stable until three weeks ago when he went through another bad flare up and had to receive anti nausea medication for a week. We scheduled an appointment with a specialist, which was one week ago. There, they also noticed he has a heart murmur which really complicates his care. They said he may not be a good candidate for a biopsy because of the anesthesia, and he may also not be able to go on steroids, depending on the severity of his murmur. They suggested we do a novel protein diet first, and if that doesn't work then he needs to get an echocardiogram before deciding what to do next. If it is an allergy, it is likely chicken or turkey based on his symptoms in the past and the fact that he has eaten predominately chicken most of his life.

The issue is, they prescribed a Royal Canin canned rabbit and pea formula which I personally think the ingredients are garbage. My old cat was on a prescription diet for hyperthyroid and it made her very unhealthy, to the point she had pre-diabetes which immediately went away when I got her off that food so I am very hesitant. It contains a lot of fillers, as well as carageenan and other ingredients that are known to cause irritation. For now, I am proceeding with a novel protein freeze dried raw diet of only rabbit (since he has never had that before) and cut out all other treats completely to ensure he is only eating one protein. The brands we are feeding currently are Vital Essentials and Primal, and I make sure to rehydrate with plenty of water. Thankfully he likes this diet so far (he's VERY picky) and his poops have been so much better - solid and not stinky at all. He has thrown up 2 or 3 times in the last week which is not great but at least it is less.

The vet suggested we try probiotics as well, so I am giving him one capsule of Proviable DC in his food once daily. His bloodwork contained low levels of B12, so we are about to start him on a once daily liquid B12 supplement as well.

Should I be concerned that he is still occasionally vomiting on this new diet? It's been about 1 week of him only being strictly on one protein. Does anyone have any suggestions of anything else to try in the meantime? I really want to do everything I can for him to avoid steroids, given that the vet is really concerned about his heart.

Thank you!

 

[FeebysOwner]

Hi. It is possible that more time is needed on the new diet to see continued improvement, so that is one thing to consider.

Aside from that, you could ask about B-12 injections which are generally considered more effective than the oral version. They are given sub-Q so you can easily do these at home. I give them to my cat.

If I were you, I would also ask if based on the ultrasound, there is a possibility of repeating it and having a fine needle aspiration (FNA) done during the procedure to collect any 'suspicious' tissue for further analysis. This would be done as an approach that might preclude an actual biopsy. The FNA is considered non-invasive and does not require sedation - other than what can be needed for an ultrasound in some cats. A light sedative, called butorphanol can be given if needed - it is fast acting and short lived, so you can ask about that too should your cat need something to calm him.

In addition to the FNA/ultrasound, if nothing is conclusive, a more thorough analysis of the same tissue can be done, which is called a PARR Assay. It took this test to identify lymphoma in my cat. This test does cost more, but can be done after-the-fact with no additional procedure required.

Lastly, if steroids are determined to be needed, ask about what type of testing can be done to routinely monitor any impacts from Budesonide on his heart murmur. This med is by far less impacting on the heart when compared to Prednisolone.

Is he being put on any meds for the murmur?

That is all I know to offer, so hopefully other members will have some additional thoughts.

 

[freddie.and.ramona]

Hi. It is possible that more time is needed on the new diet to see continued improvement, so that is one thing to consider.

Aside from that, you could ask about B-12 injections which are generally considered more effective than the oral version. They are given sub-Q so you can easily do these at home. I give them to my cat.

If I were you, I would also ask if based on the ultrasound, there is a possibility of repeating it and having a fine needle aspiration (FNA) done during the procedure to collect any 'suspicious' tissue for further analysis. This would be done as an approach that might preclude an actual biopsy. The FNA is considered non-invasive and does not require sedation - other than what can be needed for an ultrasound in some cats. A light sedative, called butorphanol can be given if needed - it is fast acting and short lived, so you can ask about that too should your cat need something to calm him.

In addition to the FNA/ultrasound, if nothing is conclusive, a more thorough analysis of the same tissue can be done, which is called a PARR Assay. It took this test to identify lymphoma in my cat. This test does cost more, but can be done after-the-fact with no additional procedure required.

Lastly, if steroids are determined to be needed, ask about what type of testing can be done to routinely monitor any impacts from Budesonide on his heart murmur. This med is by far less impacting on the heart when compared to Prednisolone.

Is he being put on any meds for the murmur?

That is all I know to offer, so hopefully other members will have some additional thoughts.

Thank you so much!! This is all super valuable info to know going forward. I figured more time was needed on the diet before really assessing effectiveness but I wasn't sure. Would you say 3 weeks or more?

Interesting you mentioned the FNA- they had initially quoted us for that procedure before he went in for his ultrasound but they ultimately deemed it unnecessary I guess because they didn't end up doing it (even though we had signed off on the cost). I wonder if that was because they didn't suspect anything that needed it or just didn't do it for some other reason. I can request it if they ever do another.

He is not being put on any meds for the murmur as of now, since they have not identified if it is an 'innocent' murmur or if it indicates some other heart issue.

 

[FeebysOwner]

Probably at least 3 weeks - I think 2-3 weeks was mentioned in the report you shared, but sometimes I tend to think more time than that is needed. I guess one clue you could go by is observing an even greater decrease in his vomiting sessions. It stands to reason that if the digestive tract has been irritated/aggravated by the 'old' food, a few weeks on the new diet might not be enough.

You can ask about why they forwent the FNA - it is possible they didn't find tissue that warranted retrieval in that manner. I just know with my cat they took tissue of her enlarged lymph nodes via an FNA.

 

[stephanietx]

My boy was also recently diagnosed with IBD via ultrasound. Have you had an ultrasound done to check the pancreas, liver, spleen, gall bladder, and size of the intestinal walls? My boy had an ultrasound and the vet didn't recommend a biopsy at this time because she didn't see any kind of tumors, cysts, or questionable lymph nodes. She said everything looked "boring".

As for anti-inflammatory, budesonide is an alternative for inflammation, so talk to your vet about that. Also, your kitty may need to be on an anti-nausea med for awhile, until the inflammation settles down. A common one for IBD kitties is Ondansetron (Zofran), but sometimes Cerenia is also given. My vet says that Cerenia helps more with gas than nausea. (We actually currently give both.) You can also give over the counter Pepcid (fomatadine), 2.5mg (1/4 of a 10mg tablet) once daily to help with nausea. This is also given for CKD kitties and usually at night, especially if your kitty tends to vomit in the morning.

Regarding food....It's complicated. Many kitties are allergic to or sensitive to chicken. The RC rabbit and pea is better than some, but it caused my kitty to have diarrhea and that wasn't fun. We also tried Science Diet z/d. Still had runny diarrhea and horrible gas. Instinct has a couple of rabbit foods, and one is a limited ingredient. RAWZ brand and Ziwi Peak are also some that other owners have had success with. I recently moved my kitty back to Purina EN (not the best), Royal Canin Gastro and Instinct venison because he's eaten those previously with no problems. He actually had a good day today, too.

To help soothe the tummy and reduce inflammation, you can give Slippery Elm Bark. Boil 1/2 Cup of water (I use purified water) and whisk in 1 teaspoon of SEB powder. Mix it until it's the consistency of a raw egg white. Give 1/4 teaspoon daily. You can go to twice a day if needed. (My boy usually ends up with the diarrhea part of IBD, not the vomiting part, so this also helps his poops.)

Another thing our vet suggested to help calm the tummy and reduce gas (bloating), if your kitty is struggling with that is Simethicone (Gas-X), but the baby version. We use Rubgy brand with no saccharine, dyes, or flavor and it's a liquid. The dose is 0.3-0.5ml every 8 hours as needed.

My kitty is also on weekly B12 injections that we administer at home and that can be increased to 2x a week if we feel it's needed

For probiotics, we've re-added Proviable DC to his diet and we also give s. boulardii. Adored Beast has 2 good probiotics, Gut Soothe and Healthy Gut. Healthy Gut is more of a probiotic than Gut Soothe. We have tried both and right now, he isn't tolerating either of them. I'm hoping that once we get over this flare up, he can tolerate them.

The key is getting the inflammation under control, treating the symptoms, and then managing supportive care as needed.

 

[freddie.and.ramona]

My boy was also recently diagnosed with IBD via ultrasound. Have you had an ultrasound done to check the pancreas, liver, spleen, gall bladder, and size of the intestinal walls? My boy had an ultrasound and the vet didn't recommend a biopsy at this time because she didn't see any kind of tumors, cysts, or questionable lymph nodes. She said everything looked "boring".

As for anti-inflammatory, budesonide is an alternative for inflammation, so talk to your vet about that. Also, your kitty may need to be on an anti-nausea med for awhile, until the inflammation settles down. A common one for IBD kitties is Ondansetron (Zofran), but sometimes Cerenia is also given. My vet says that Cerenia helps more with gas than nausea. (We actually currently give both.) You can also give over the counter Pepcid (fomatadine), 2.5mg (1/4 of a 10mg tablet) once daily to help with nausea. This is also given for CKD kitties and usually at night, especially if your kitty tends to vomit in the morning.

Regarding food....It's complicated. Many kitties are allergic to or sensitive to chicken. The RC rabbit and pea is better than some, but it caused my kitty to have diarrhea and that wasn't fun. We also tried Science Diet z/d. Still had runny diarrhea and horrible gas. Instinct has a couple of rabbit foods, and one is a limited ingredient. RAWZ brand and Ziwi Peak are also some that other owners have had success with. I recently moved my kitty back to Purina EN (not the best), Royal Canin Gastro and Instinct venison because he's eaten those previously with no problems. He actually had a good day today, too.

To help soothe the tummy and reduce inflammation, you can give Slippery Elm Bark. Boil 1/2 Cup of water (I use purified water) and whisk in 1 teaspoon of SEB powder. Mix it until it's the consistency of a raw egg white. Give 1/4 teaspoon daily. You can go to twice a day if needed. (My boy usually ends up with the diarrhea part of IBD, not the vomiting part, so this also helps his poops.)

Another thing our vet suggested to help calm the tummy and reduce gas (bloating), if your kitty is struggling with that is Simethicone (Gas-X), but the baby version. We use Rubgy brand with no saccharine, dyes, or flavor and it's a liquid. The dose is 0.3-0.5ml every 8 hours as needed.

My kitty is also on weekly B12 injections that we administer at home and that can be increased to 2x a week if we feel it's needed

For probiotics, we've re-added Proviable DC to his diet and we also give s. boulardii. Adored Beast has 2 good probiotics, Gut Soothe and Healthy Gut. Healthy Gut is more of a probiotic than Gut Soothe. We have tried both and right now, he isn't tolerating either of them. I'm hoping that once we get over this flare up, he can tolerate them.

The key is getting the inflammation under control, treating the symptoms, and then managing supportive care as needed.

Thanks so much for your input! Sorry you're dealing with this too, it's a terrible disease

Yes, Freddie had an abdominal ultrasound- results were attached in the post. He had 'moderate' thickening of the entire GI tract as well as enlarged mesenteric lymph nodes. They didn't do any further testing at this time but recommended a biopsy if diet does not improve things. However, as mentioned, I am scared of doing this because of his heart murmur... The enlarged lymph nodes made me nervous about lymphoma but apparently this can also be present with IBD. Those two diseases are frustratingly similar.

Another person mentioned budesonide so I will definitely ask about that if it comes to it! I will also ask about SE as I've seen that come up on quite a few threads about IBD cats. How long did it take for you to get your cat's IBD mostly under control?

 

[stephanietx]

Another person mentioned budesonide so I will definitely ask about that if it comes to it! I will also ask about SE as I've seen that come up on quite a few threads about IBD cats. How long did it take for you to get your cat's IBD mostly under control?

I suspect he started having a flare up in June-July, but he was diagnosed with pancreatitis. We finally had things under control around September, then he flared again on Thanksgiving Day. We initially were treating like it was pancreatitis, but his numbers came back fine and all the GI panels and PCR tests came back and found nothing except low B12. We started treating for IBD at the beginning of December, then decided to do the ultrasound and he was officially diagnosed mid-December. It's still not under control, but it's starting to look up.