Please help! IBD senior cat, but all meds cause severe diarrhea

[AGDonmez]

Hi, my 11 year old Tabby cat has either IBD or lymphoma according to an ultrasound and her symptoms. Her blood work has ruled out other diseases. She was on/off having diarhea and vomiting over the last 5 years but had always bounced back with Hills prescription food and intermittent probiotic use. Last 3-4 months latter part of her poop was soft and light sometimes orange sometimes her entire poop was grayish to light brown. We switched her food to i/d, used Visbiome probiotic for 2 months, sometimes she would have good poop for a week but then it would go soft/smelly again.

Vet suggested novel protein Royal canin rabbit, which made her so much worse. On day #4 of slow transition, she started vomiting twice a day and very bad diarrhea occurred so we went back to i/d.

She reacted similarly to metronidazole (after a dose, had liquid diarrhea) so we stopped right away.

After her reaction to Royal Canin (rabbit), I even had to stop giving her Visbiome because that had also stopped working for her.

Vet tried 0.5 ml prednisolone and after a single dose made have slightly loose poop to severe fluid diarrhea.

Her B12 level was normal to high
Folate very high. Vet noted that her high folate level can suggest dysbiosis and that this is a common consequence of chronic small intestinal diseases.

Both metronidazole and prednisolone she attempted to use were liquid formations with chicken flavor. At this point I am terrified to have her try any more meds.

Did anyone else experience this with their IBD cat? It feels like whatever we give her at this point is causing looser stools.

She has alot of appetite.

Maybe we could next attempt another form of prednisolone (i.e. tablets), or budenesonide or chlorambucil, but I am very unsure.

We are offered an endoscopy which would be helpful to distinguish if she only has IBD versus lymphoma, BUT based on her terrible reaction to various medications so far, I am not sure about her recovery after an endoscopy either, as what if she has a very severe diarrhea in reaction to anesthetics and where we may not be able to then stop her diarrhea at all.

I want to explore natural alternatives such as
like fecal microbiome testing and fecal transplant, but Vets do not offer such services and I am not convinced how reliable these options are either.

Any recommendations?

 

[maggie101]

I just started using adored beast sooth and healthy gutt, both otc. Company has been very helpful answering my questions quickly by email. Do you have a different vet that offers those services? Next time my cat has a check up I will ask about a different medication to take since she has loose stools. Hopefully the adored be will help.

 

[FeebysOwner]

Sadly, many meds used to treat diarrhea can have a side effect of diarrhea. I don't know if you had continued with Metro for a bit longer if it might have helped over time. That could have been true of the Pred as well. Most meds don't have an immediate response, so they can take a few or more days to make a difference. Nonetheless, if you haven't tried s. boulardii, I would suggest that next, perhaps then followed by the Adored Beast, as mentioned above. It can be added to food or a lickable treat, making it easier to administer. The brand I see most often mentioned is Jarrows.

The other benefit of s.boulardii is that it is yeast-based so it is not rendered less effective when used in conjunction with antibiotics, as so many other probiotics are.

One member had this to say about s. boulardii and they also mentioned the Adored Beast - "S.boulardi is awesome for cats with issues like diarrhea. But for regular maintenance probiotics, I’d use something with more strains. I personally use Adored Beast Love Bugs, added to the snack....I serve (Jarrows s. boulardii) in the lickable treat and they love it that way. I’d start with a pinch only to watch for reactions and increase if there isn’t any. Once I had to give three capsules (full) a day to stop diarrhea in my girl. But for maintenance, I’d use 1/4 or 1/2 of capsule the most."

The benefits of using S. Boulardii for cats– FullBucket Health

 

[AGDonmez]

Sadly, many meds used to treat diarrhea can have a side effect of diarrhea. I don't know if you had continued with Metro for a bit longer if it might have helped over time. That could have been true of the Pred as well. Most meds don't have an immediate response, so they can take a few or more days to make a difference. Nonetheless, if you haven't tried s. boulardii, I would suggest that next, perhaps then followed by the Adored Beast, as mentioned above. It can be added to food or a lickable treat, making it easier to administer. The brand I see most often mentioned is Jarrows.

The other benefit of s.boulardii is that it is yeast-based so it is not rendered less effective when used in conjunction with antibiotics, as so many other probiotics are.

One member had this to say about s. boulardii and they also mentioned the Adored Beast - "S.boulardi is awesome for cats with issues like diarrhea. But for regular maintenance probiotics, I’d use something with more strains. I personally use Adored Beast Love Bugs, added to the snack....I serve (Jarrows s. boulardii) in the lickable treat and they love it that way. I’d start with a pinch only to watch for reactions and increase if there isn’t any. Once I had to give three capsules (full) a day to stop diarrhea in my girl. But for maintenance, I’d use 1/4 or 1/2 of capsule the most."

The benefits of using S. Boulardii for cats– FullBucket Health

Thank you. I ordered Animal Biome’s S Boulardi just to try since that’s feline specific. What’s upsetting is that both vets I consulted with didn’t expect her to have diarrhea, as I asked just before administering any drug. One of them is in fact IM specialist with over 10+ yrs of experience. They didn’t even warn me of a possible diarrhea as a consequence and only when I inquired it before I gave the meds, they had said they rarely see diarrhea. At the moment, I can’t even stop her diarrhea after the single use of presnisolone. It’s very frustrating.

 

[mrsgreenjeens]

I second the use of S. Boulardi. It is listed as a treatment for dysbiosis on some websites (for humans), and we often recommend it for cat lovers when diarrhea rears it's ugly head.

 

[AGDonmez]

I tried Animal Biome’s feline specific S. Boulardi and despite the fact that I gave her a very minimal first dose (1/4th of the recommended dose), her diarrhea increased by 10 times about 8 hours after it. She literally pooped liquid multiple times that night. I did not give her any more of S boulardi, continued with a little Visbiome and increased her canned i/d, better today at least her poop firmed up. I don’t think S Boulardi would work for her so I am not inclined to try again.

 

[Margot Lane]

I add pumpkin (not too much) to my cat’s wet canned food which helps to solidify things. Tiki Cat Tummy Topper.

 

[ellen m]

I would either revisit the biopsy idea asap and/or ask your vet again about the possibility of treating with chlorambucil and pred despite no biopsy. Probiotics can be very good, especially the last one you tried (Visbiome), but I doubt that lesser interventions are going to solve or even help much with this. I also doubt that the causality you think you are seeing is really causality. I don't think the diarrhea is from any of the meds. I think it's the disease.

I do think you want to act fast. Meanwhile, are you giving fluids to counteract dehydration from the severe diarrhea? Severe diarrhea itself, and the resulting malnutrition and dehydration it can cause, is dangerous in and of itself. When is your next vet appointment?

I'm so sorry. I know this is terrifying.

Ellen

 

[crowen]

My 15 year old cat has had 3-5 day stay overs at the emergency hospital twice the past two years for diarrhea, vomiting and no appetite. If you have access to a good emergency hospital, it might be a good idea. She will absolutely HATE the stay, but it's good for them for treatment and monitoring. But it's also expensive.

For my cats visits: The first time was pancreatitis, and the second was PLE likely as a secondary effect of pancreatitis, IBD or lymphoma. They had to drain some fluid from around her heart and gut. Has your vet checked her fPLI levels from a blood test? This tests for pancreatitis.

Like yours, the vets wanted her on Hills i/d, intermittent probiotics and various medications - metronidazole, prednisolone, etc, assuming IBD or lymphoma. The first time she was on Rayne's Kangaroo maintenance soft food, which she did well on (though it wasn't 'tasty enough'), until the vet forgot to order me more (:

She is currently only on prednisolone, and the vets recommend she be on it long term. Prednisolone is often used for treating diarrhea and inflammation. My cat was on 1ml for her stay at the vet for a few days, followed by 0.5ml for 4 weeks at home, and now on 0.3ml long term.
Personally I'm not sure if I'm comfortable actually keeping her on 0.3ml long term, but I will do so until we find a food that is both appetizing and good for the GI with success.

Prednisolone is also a good medication to be on if they suspect lymphoma. How much does the cat weigh? Are you sure the 0.5ml of prednisolone was the cause of the diarrhea and not just the unresolved medical issue?

The liquid form of prednisolone with a flavoring is the best route if your cat tolerates taking it, I think. It's the least stressful way to take it. I'd suggest getting a confirmed dosage on it and trying it for 4 weeks. You'll know within 3 days at least if the prednisolone is actually the cause of diarrhea. It should also start helping really quick if it does.
During the time of the medication, what was she eating?

This Friday our vet suggested Purina HA hydrolyzed kibble. After half a cup, she immediately had soft, diarrhea stools.
Both our personal vet and the emergency vet said trying hydrolyzed protein would be a good idea.
Turns out, 'hydrolyzed diets may increase osmolarity and draw more water to the intestines. this may cause diarrhea or loose stools.' This was a similar problem she had with the original round of pancreatitis, because other fermentable fibres like guar gum and pectin do the same thing and she was eating a lot of foods with guar gum at the time. So, in this case, I knew right away the food was the cause.

I've had success with Hills i/d chicken wet, though she doesn't like it so its not a long term solution.
I've also had success with Rayne's Kangaroo maintenance, both wet and stew forms, though again she won't eat it long term.
I've had the most success with Meow's freeze dried venison, and she likes it, but I'm not sure it's a good solution for her long term with high bone content as kitty's with these problems will often swing the other way from diarrhea into constipation.
In terms of eating with no diarrhea, I've had success with orijen regional red kibbles (alberta), but during flares of GI issues she vomits it instead (a problem with most kibbles).

For cats with these issues, long term diet solutions are the solve, but in the immediate time of emergency (not eating for 1-2 days, 3-4 days of diarrhea) it doesn't matter what they eat. Resolving that is priority. Usually with medication. Like above, I'm not sure I'd think the medication caused the diarrhea, but rather the disease.

 

[maggie101]

I have been searching for food high in fiber. There are not many! So far fancy feast,feline natural,and instinct original venison. Probiotics can take up to 2 weeks to really notice a difference. At first Maggie still had diaheria but was feeling better. Next day normal stool

 

[artiemom]

I have had two cats with IBD.. One has gone on to develop SCL.. the other megacolon.

Artie was originally placed on metronidazole. It was unflavored liquid, and I could not get it into him. So that was a disaster. The prednisolone did help him.. but took some time.

With the IBD/SCL one, the RC PR Rabbit did help.. but not on its own. He was also put on Prednisolone, Chlorambucil (due to SCL) and a couple other drugs.
When he was fussy with food, I switched to RAWZ rabbit, eventually, that food created an allergic response. I treated it with S.Boulardi. I dosed him twice a day with it.

The Website: IBD Kitties, is wonderful for information.

One thing, I did learn about compounding medicines. I was using a local pharmacy and discussed things with the pharmacist. He told me that no matter what flavor you choose, there is always some of that protein in the compounded drug. So, if you order chicken flavor, there is some type of chicken-- like broth, in the drug.

I know I got fish for Artie, and he told me there was some fish in it. They order the flavoring from a company.. so it is not made onsite.

If you baby has an allergy to chicken, the chicken flavored compounded drug may not be helping.

wishing you luck.

 

[Astragal14]

Her B12 level was normal to high
Folate very high. Vet noted that her high folate level can suggest dysbiosis and that this is a common consequence of chronic small intestinal diseases.

Ask your vet about B12 injections even though her blood work says her levels are normal. B12 is necessary for the intestines to absorb the supplements and medications you need to treat her disease (I also agree with E ellen m and C crowen that you're seeing correlation not causation); the body can't absorb the meds as well without sufficient B12 supplementation. This is probably why it seems like the Visbiome and some of the meds aren't working. I would start with weekly injections for a while and then move to either biweekly or monthly. And yes, high folate does often suggest gut dysbiosis, such as SIBO; s.boulardii is great for both diarrhea and SIBO.

A B12 deficiency can cause poor cell formation in the digestive tract and lead to nausea, vomiting, loss of appetite, poor absorption of food (malabsorption syndrome), constipation, gas, weight loss, fatigue, lethargy, abdominal pain, and/or diarrhea. Absorption of B12 requires normal function of the stomach, pancreas and small intestine... Because a healthy liver is able to store many years worth of B12, signs of deficiency may not be obvious for a long time.

The Importance of B12 – IBDKitties

Cobalamin is only absorbed from the distal small intestine and is a very specific marker for distal ileal mucosal disease. Low cobalamin and folate concentrations are indicative of severe diffuse disease, and this will limit the efficacy of oral therapy for IIBD. Supplement with cobalamin and folate before instituting therapy.

Ixnay on the IBD: An update on handling patients with chronic enteropathies

Vet suggested novel protein Royal canin rabbit, which made her so much worse. On day #4 of slow transition, she started vomiting twice a day and very bad diarrhea occurred so we went back to i/d.

The same thing happened when our cat was diagnosed with IBD. We were on Hill's I/d, switched to RC rabbit and he took a quick turn for the worse (we eventually kept him on Hill's w/d until we figured out his meds and now we only use w/d in acute cases of diarrhea). In our case, it was the filler ingredients of the RC rabbit that ended up being some of his IBD triggers - that RC contains a lot of modified pea products, which are common IBD triggers.

I want to explore natural alternatives such as
like fecal microbiome testing and fecal transplant, but Vets do not offer such services and I am not convinced how reliable these options are either.

Animal Biome offers a fecal transplant in a pill. I have not personally tried this but I know others have used it with good success. The company also offers a gut micro biome testing kit, I know much less about that product and its accuracy.
Animal Biome Kitty Biome Gut Restore Supplement
Animal Biome Gut Health Test

 

[AGDonmez]

Thank you everyone, I really appreciate all the feedback, which I've reviewed very carefully! Her diarrhea stopped after a week post administering a single dose of 0.5 ml prednisolone (yes, that's the correct dosage per her weight, she is 11.4 pnds). What frustrates me most is that I am working with one of the most experienced IM specialists in our area, and the specialist did not provide me any of the comments that were provided here, such as the fillers of the RC (pea products) possibly causing the diarrhea, or possibly doing a round of B12 despite her normal level, and NO explanation overall to why she reacted the way she did to either the prednisolone or the antibiotic. I feel very disappointed because they just throw options (medications) without fore-warning any consequences, and not explaining what to do when a consequence occurs. I felt very alone during this process. I am researching holistic veterinarians and may work with one soon along side other vets my cat is seeing.

She has been on w/d for years, which helped her many years I think, but we then switched to i/d which is better. I have found that the less dry kibble she eats, the better her poop becomes. Overall though I think ALL this prescription food (and processed cat food in general) may have caused her initial problem in the first place.

I fantasize switching her over to home-made food, but again I have never attempted this because of her tendency to vomit/diarrhea over the years. If a holistic veterinarian helps me with this, I may attempt.

Animal Biome's S boulardii did not work for her at this stage, but again, neither did prednisolone nor antibiotic. I wish our vet has some explanation(!) like you all tried to come up with as to why this may be, so that we can help her use some anti-inflammatory medications. Otherwise, I am worried it may get worse over time or turn into cancer if not already there.

I submitted her fecal to Animal Biome over the weekend and will receive her results in two weeks. In the meantime, I will hopefully see her vet soon and get her some fluids. I attempted to have her some fluids with a vet couple of days ago but she was not very cooperative so it was a very small dose. She does not appear too dehydrated and I continue to add a little water to her canned food every time I feed her and she 90% eats canned food now, very little dry kibble.

 

[ellen m]

My cat's internist feels strongly against giving b12 when the level is normal, saying it may cause or worsen cancer, which feeds on b12 to thrive. Some of the cat groups I'm in agree with that and have posted scientific evidence for it. To be fair, other groups disagree. But I personally lean towards trusting your experienced IM specialist on this particular point.

 

[ellen m]

NB: of course it IS true that a deficit of b12 causes all those bad things the poster above mentioned That's why you want to supplement if it's normal or low-normal. But not if it's above that. I think the limit is you want it to be over 400. Otherwise you supplement.

 

[AGDonmez]

My cat's internist feels strongly against giving b12 when the level is normal, saying it may cause or worsen cancer, which feeds on b12 to thrive. Some of the cat groups I'm in agree with that and have posted scientific evidence for it. To be fair, other groups disagree. But I personally lean towards trusting your experienced IM specialist on this particular point.

Thank you, I really appreciate this feedback.

 

[AGDonmez]

Thank you, I really appreciate this feedback.

Are you able to post the link to this discussion? I'd be very interested in reading it. I do trust my vets but I have not been able to administer my cat the meds they have so far prescribed as her immediate reaction has been severe diarrhea and they told me to stop. Therefore, I feel very helpless right now. They didn't say this is because of the disease or because of B12 or because of the food she's on. In fact, they didn't try to justify why this is the way it is, they only said "this is a rare side effect". And we end up in the same place after each trial where my cat has severe diarrhea and I try find ways to stop, rushing her to ER or calling a home vet etc.

At this point, I just want her to rest for a while without the diarrhea as she has gotten very tired of the remedies offered.

I don't know how she will go on trying on another course of steroid. I also don't see the benefit of doing an endoscopy because regardless of the diagnosis of IBD v. lymphoma, at this point in time, she has not been able to proceed with medications give to her, so what's the point of an endoscopy if she will not be able to proceed with a treatment? I asked this question in an email to my IM, but did not get an answer. I will verbally ask this question when we go to a physical appointment next.

I am trying to keep my hopes.

 

[lisahe]

I fantasize switching her over to home-made food, but again I have never attempted this because of her tendency to vomit/diarrhea over the years. If a holistic veterinarian helps me with this, I may attempt.

There's a Raw & Home-Cooked Cat Food subforum on the site (here) where you can get all sorts of advice and ideas on homemade food. The main thing is for the food to be balanced, which is a lot simpler than it initially sounds. I make homemade cooked food with a premixed supplement (Alnutrin) and can't recommend homemade enough. We have a cat with (relatively speaking) mild IBD (she's a long-time vomiter) and the simplicity of the Alnutrin recipe, to which I add only meat, liver, fish oil, and hard boiled egg yolk, works very well for her. Most canned and dry foods have ingredients that some cats can't handle, particularly carby stuff (like the cursed peas and other legumes) and thickeners (agar-agar and some of the gums can make cats sick). Cats with IBD and other digestive issues usually need the simplest-possible recipes, basically just meat and necessary nutrients. Another excellent supplement is EZ Complete but it contains something (most likely the green-lipped mussels, for omega-3s) that makes Edwina barf. It seems like most vets focus on proteins as culprits for digestive problems but our experience, at least thus far, is that it's the fillers and thickeners that bother Edwina and her sister. That's the huge appeal of homemade. Plus you can use any meat you like and vary the fat content. We use turkey, chicken, and pork. (Pork is a great novel protein for a lot of cats, plus may cuts are relatively inexpensive.)

Since maggie101 mentioned Adored Beast products, I'll add that Feline Gut Soothe seems to be helping Edwina quite a bit. She's been taking it for about a month but I started her on it very, very slowly -- with, literally, just one very tiny pinch -- so she's still not up to a full dose for her size. Probiotics can upset cats' stomachs in the beginning; many even contain maltodextrin, which can apparently cause irritation in the digestive system. I chose FGS for Edwina because it combines probiotics and anti-inflammatory herbs but doesn't have maltodextrin or anything else that's extra. Edwina has a history of inflammation: she had patches of stomach inflammation surgically removed about a year ago but was starting to have problems again in recent months. Fortunately, FGS seems to work well for her. As others have mentioned, Adored Beast has a number of products for cats with GI troubles. And there are lots of other companies that sell similar products that seem to work well for lots of cats.

Please don't lose hope! I know that's hard because it can take so much time and energy -- because much of the process is trial and error, plus cats' problems are very individual -- to find the right combination of foods, medications, and supplements to stabilize a cat with digestive symptoms.

 

[AGDonmez]

There's a Raw & Home-Cooked Cat Food subforum on the site (here) where you can get all sorts of advice and ideas on homemade food. The main thing is for the food to be balanced, which is a lot simpler than it initially sounds. I make homemade cooked food with a premixed supplement (Alnutrin) and can't recommend homemade enough. We have a cat with (relatively speaking) mild IBD (she's a long-time vomiter) and the simplicity of the Alnutrin recipe, to which I add only meat, liver, fish oil, and hard boiled egg yolk, works very well for her. Most canned and dry foods have ingredients that some cats can't handle, particularly carby stuff (like the cursed peas and other legumes) and thickeners (agar-agar and some of the gums can make cats sick). Cats with IBD and other digestive issues usually need the simplest-possible recipes, basically just meat and necessary nutrients. Another excellent supplement is EZ Complete but it contains something (most likely the green-lipped mussels, for omega-3s) that makes Edwina barf. It seems like most vets focus on proteins as culprits for digestive problems but our experience, at least thus far, is that it's the fillers and thickeners that bother Edwina and her sister. That's the huge appeal of homemade. Plus you can use any meat you like and vary the fat content. We use turkey, chicken, and pork. (Pork is a great novel protein for a lot of cats, plus may cuts are relatively inexpensive.)

Since maggie101 mentioned Adored Beast products, I'll add that Feline Gut Soothe seems to be helping Edwina quite a bit. She's been taking it for about a month but I started her on it very, very slowly -- with, literally, just one very tiny pinch -- so she's still not up to a full dose for her size. Probiotics can upset cats' stomachs in the beginning; many even contain maltodextrin, which can apparently cause irritation in the digestive system. I chose FGS for Edwina because it combines probiotics and anti-inflammatory herbs but doesn't have maltodextrin or anything else that's extra. Edwina has a history of inflammation: she had patches of stomach inflammation surgically removed about a year ago but was starting to have problems again in recent months. Fortunately, FGS seems to work well for her. As others have mentioned, Adored Beast has a number of products for cats with GI troubles. And there are lots of other companies that sell similar products that seem to work well for lots of cats.

Please don't lose hope! I know that's hard because it can take so much time and energy -- because much of the process is trial and error, plus cats' problems are very individual -- to find the right combination of foods, medications, and supplements to stabilize a cat with digestive symptoms.

Thank you

 

[Astragal14]

My cat's internist feels strongly against giving b12 when the level is normal, saying it may cause or worsen cancer, which feeds on b12 to thrive. Some of the cat groups I'm in agree with that and have posted scientific evidence for it. To be fair, other groups disagree. But I personally lean towards trusting your experienced IM specialist on this particular point.

This is a very good point and I am genuinely interested in learning about the evidence your other cat groups have discussed. What I have discussed with our vets and our nutritionist is that B12 supplementation is necessary for cats with GI issues, and the presence of other cancers would require an individual approach to treatment. Our vet explained to us that B12 given via injections don't lead to abnormally high levels because the body only absorbs as much B12 as needed and any excess is removed in the urine.

A definitive diagnosis of cobalamin deficiency can be challenging. Clinical signs are ultimately caused by cobalamin deficiency on a cellular level. However, the cellular cobalamin status is difficult to assess. Serum cobalamin concentration has been traditionally measured to help assess cobalamin status, but some patients with cobalamin deficiency on a cellular level do not always have severely decreased serum cobalamin concentrations. Thus, in order to avoid missing patients with cobalamin deficiency, cobalamin supplementation should be considered even when serum cobalamin concentration is low normal.

Why Measure Vitamin B12? - WSAVA 2014 Congress - VIN

More information about B12 in the presence of other cancers is available here:
Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - B Vitamins, Including Vitamin B12 (Methylcobalamin)