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

[Astragal14]

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.

Please know you're not alone in this journey! You are in the exact same spot as us when we began our IBD journey.

We worked with a fantastic IM specialist and the best board certified nutritionist in our state. Both of them were highly proficient and their technical knowledge was off the charts. But what ended up bothering me, and led me to search elsewhere for additional help, is they were both completely "by the book". What I mean by that is they both relied solely on published research and any topics that had not been fully researched were disregarded. The problem is that pets are much more under-researched than people, and cats are far more under-researched than dogs. I suspect that's why you were encountering the problems you mentioned, such as no discussions around fillers/pea products, recurrences of diarrhea, B12 levels... things like that. To phrase it another way, I have one (human) doctor who responds to some of my questions by saying, "the medical literature does not support that". In fact, I asked the board certified nutritionist about different probiotics for IBD and the response was, "there is no research that indicates probiotics are needed". There just isn't a lot of researched, peer-reviewed studies on nutrition as it relates to GI disorders. Almost all of what I've seen assumes protein allergies are the root cause, and everything else is idiopathic.

You mentioned a holistic vet and I think that is a great idea. We did this and it helped a great deal. Our "team" of vets that we now have consist of our regular vet, the IM specialist as needed, our holistic vet and our new veterinary nutritionist (who was recommended by the holistic vet and I truly cannot compliment her enough - she has been an absolute game changer for our cat's health). And they all keep in touch regarding their patients, so all treatments and recommendations are ensured to compliment each other, not compete.

 

[AGDonmez]

Please know you're not alone in this journey! You are in the exact same spot as us when we began our IBD journey.

We worked with a fantastic IM specialist and the best board certified nutritionist in our state. Both of them were highly proficient and their technical knowledge was off the charts. But what ended up bothering me, and led me to search elsewhere for additional help, is they were both completely "by the book". What I mean by that is they both relied solely on published research and any topics that had not been fully researched were disregarded. The problem is that pets are much more under-researched than people, and cats are far more under-researched than dogs. I suspect that's why you were encountering the problems you mentioned, such as no discussions around fillers/pea products, recurrences of diarrhea, B12 levels... things like that. To phrase it another way, I have one (human) doctor who responds to some of my questions by saying, "the medical literature does not support that". In fact, I asked the board certified nutritionist about different probiotics for IBD and the response was, "there is no research that indicates probiotics are needed". There just isn't a lot of researched, peer-reviewed studies on nutrition as it relates to GI disorders. Almost all of what I've seen assumes protein allergies are the root cause, and everything else is idiopathic.

You mentioned a holistic vet and I think that is a great idea. We did this and it helped a great deal. Our "team" of vets that we now have consist of our regular vet, the IM specialist as needed, our holistic vet and our new veterinary nutritionist (who was recommended by the holistic vet and I truly cannot compliment her enough - she has been an absolute game changer for our cat's health). And they all keep in touch regarding their patients, so all treatments and recommendations are ensured to compliment each other, not compete.

I really appreciate you sharing your experience with me, it's very helpful to know I am not alone. In my case, what's been making me feel alone and hopeless is that whatever we've given her made her so much worse. When I read blogs or other online resources, most people say same drugs I administered either helped and that their cat has been on steroids for a long time, or that the steroids did not make a huge difference, but none talk about making the cat worse. In our case, steroid (and metronidazole) both made her worse where it caused very severe diarrhea prompting us to stop. I cannot find anything about this online unfortunately.

 

[Astragal14]

I really appreciate you sharing your experience with me, it's very helpful to know I am not alone. In my case, what's been making me feel alone and hopeless is that whatever we've given her made her so much worse. When I read blogs or other online resources, most people say same drugs I administered either helped and that their cat has been on steroids for a long time, or that the steroids did not make a huge difference, but none talk about making the cat worse. In our case, steroid (and metronidazole) both made her worse where it caused very severe diarrhea prompting us to stop. I cannot find anything about this online unfortunately.

I second artiemom 's recommendation to check out IBDKitties – Helping Save Lives…One Paw at a Time as it is an incredible resource.

Two components are the foundation of resolving any GI issue: controlling inflammation and maintaining enough B12. Both of these are necessary for the GI tract to be able to absorb everything it needs to heal - nutrients from food, medications, supplements, etc.

One very important reason to control inflammation is because diarrhea causes inflammation and inflammation causes more diarrhea.

...chronically inflamed intestines lose the ability to absorb fat. Unabsorbed fat in the intestine stimulates diarrhea by osmotically drawing water into the lumen and by fostering an environment for the bacterial toxins.

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

You've already tried to control the inflammation with prednisone. What makes me think your tabby may be low in B12 is the fact that the prednisone was working at one point but has since become ineffective (as has the Visbiome, and perhaps other meds/supplements). And we also know that accurate levels of B12 are difficult to measure.

Your vet may think her B12 levels are fine as they are and that something other than prednisone would be best for treating inflammation; that may very well be the best route and would be the one you should follow. I think it's worth asking your vet's opinion if short term supplementation of B12 would keep her levels in a healthy range or if it could raise them by a detrimental amount. If your vet thinks this would be safe, I suggest considering this route along with something to control inflammation. A example of a short course would be 1 weekly injection for about 6 weeks - this would give your tabby's GI tract enough time to heal and hopefully be able to better absorb any supplements and medications. Ask your vet when you should start to see improvement that would indicate this is the right path; I would expect somewhere between 6-8 weeks.

As an example, here is how we manage our IBD cat's B12 levels and inflammation: he received weekly B12 injections for several months before tapering off to bimonthly and now monthly; we also check his blood work 1-2 times yearly (he's 10 years old and we've been doing this for 3 years so far). We manage his inflammation through fish oil and mushroom supplements. There are several other factors that go into managing his IBD (such as diet and other supplements), but these examples are how we manage the foundation of treating GI issues.

 

[AGDonmez]

I second artiemom 's recommendation to check out IBDKitties – Helping Save Lives…One Paw at a Time as it is an incredible resource.

Two components are the foundation of resolving any GI issue: controlling inflammation and maintaining enough B12. Both of these are necessary for the GI tract to be able to absorb everything it needs to heal - nutrients from food, medications, supplements, etc.

One very important reason to control inflammation is because diarrhea causes inflammation and inflammation causes more diarrhea.

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

You've already tried to control the inflammation with prednisone. What makes me think your tabby may be low in B12 is the fact that the prednisone was working at one point but has since become ineffective (as has the Visbiome, and perhaps other meds/supplements). And we also know that accurate levels of B12 are difficult to measure.

Your vet may think her B12 levels are fine as they are and that something other than prednisone would be best for treating inflammation; that may very well be the best route and would be the one you should follow. I think it's worth asking your vet's opinion if short term supplementation of B12 would keep her levels in a healthy range or if it could raise them by a detrimental amount. If your vet thinks this would be safe, I suggest considering this route along with something to control inflammation. A example of a short course would be 1 weekly injection for about 6 weeks - this would give your tabby's GI tract enough time to heal and hopefully be able to better absorb any supplements and medications. Ask your vet when you should start to see improvement that would indicate this is the right path; I would expect somewhere between 6-8 weeks.

As an example, here is how we manage our IBD cat's B12 levels and inflammation: he received weekly B12 injections for several months before tapering off to bimonthly and now monthly; we also check his blood work 1-2 times yearly (he's 10 years old and we've been doing this for 3 years so far). We manage his inflammation through fish oil and mushroom supplements. There are several other factors that go into managing his IBD (such as diet and other supplements), but these examples are how we manage the foundation of treating GI issues.

Hi, thanks so much for sharing, really appreciate it! She wasn't able to continue the use of prednisolone, just one single 0.5 ml dose gave her serious diarrhea so we stopped. Her diarrhea wouldn't stop for a week after that but note I tried S Boulardii in the mids of that, which made her diarrhea so much worse. At this point, her diarrhea stopped after I gave her very little Visbiome every day plus continued with her canned i/d. She is not able to process dry i/d as she used to be able to, so I give very little of dry. I will see her vet in two days, and I demanded already in an email that they repeat her B12, folate tests again b/c it's been two months since they measured, and plus asked that they check EPI this time, which was never checked, despite me asking for this before. When I actually asked two of her vets if EPI could also be a culprit, they kind of dismissed that, and one suggested that B12 level would be very low in an EPI cat, whereas my cat's B12 was on the normal (900 level). NOW, the hardest part is fasting her for this visit, because she eats every 4 hours, and gets extremely agitated when I fast her, it's so heart breaking. I will also have to give her Gabapentin prior to the visit. This whole ordeal of fasting her before vet is extremely difficult and stressful for her and me.

I will ask my vet administering B12, and see what the vet recommends. Obviously if her value is low this time, the answer is obvious. If the value is still normal, then I don't know what the vet will recommend. I would love to be able to give her more natural supplements for inflammation, like fish oil, mushroom and even turmeric, but I'd have to work with a holistic vet first and second, I don't know how my cat will react to those either. I think the vet will recommend another steroid but in a pill or tablet form next time, rather than liquid. I will post an update in a few days. Thanks.

 

[AGDonmez]

Update: My cat had multiple additional blood work done so vets ruled out most diseases; had Texas A&M GI Panel done. Her B12 level dropped from 900 range to 400s but vet is NOT recommending B12 injections yet. She still has very high Folate levels. She was also tested for EPI and her level is okay so vet said no EPI.

So at this point, we are BACK to where we started 2-3 months ago with a diagnosis of IBD (or lymphoma).

Visbiome probiotic which had helped her alot in the past is also causing her diarrhea so we stopped. Once I stopped Visbiome, her poop got alot better firmed up, but she occasionally vomits after eating. If I break her portion to very small sizes that helps.

Because liquid prednisolone gave her severe diarrhea which we had stopped, IM specialist recommended transdermal prednisolone, BUT transdermal also caused severe diarrhea after 1st dose. I stopped that too worrying dehydration, as she literally pooped liquid diarrhea after every meal after prednisolone kicked in.

I am feeling very hopeless at this stage, as I wanted her to be on prednisolone for some time to bring down the inflammation, but we're not able to proceed past one dose.

Her recent PCR test and multiple fecal tests were ALL normal BUT her Microbiome gut test done by a private company report shows very high levels of clostridium perfringens and this company now recommends me their Oral Fecal Transplant pill. I haven't tried that yet either.

I will see her Internal Medicine specialist next week, who had mentioned injectable prednisolone, but I don't want her to try the injectable prednisolone knowing how she reacted to the oral pill and transdermal with severe diarrhea.

Any recommendations?

 

[maggie101]

For prednisolone my cat takes pills,not liquid. You can ask your vet if that will not make her go diaheria

 

[Astragal14]

I'm sorry to hear your update, you've done so many tests and tried so many things and it seems like you're still stuck at square one! I have a few thoughts that you could consider discussing with the IM specialist next week, I don't think any of this will fix everything, but maybe some of it can help.

First, ask the IM specialist about alternatives to prednisone. There are several options, I would specifically ask about budesonide, but the IM specialist will recommend whichever she thinks is best.

Budesonide has a lower risk of side effects due to its high level of first pass metabolism. When the drug is swallowed, it is immediately absorbed by the digestive system, performing as a locally-acting steroid on the irritated and inflamed gastrointestinal tract of IBD sufferers.

Introduction to Steroids – IBDKitties

Second, I realize I sound like a broken record about B12 but I would ask the IM specialist about B12 injections, especially since her levels have dropped.

Third, I found some information about treatment of C. perfringens that offers a few antibiotic options as well dietary changes, these could also be good options to discuss with the IM specialist.

Acute and chronic diarrhea in dogs and cats: Giardiasis, Clostridium perfringens Enterotoxicosis, Tritrichomonas foetus, and Cryptosporidiosis (Proceedings)
CPE refers to Clostridium perfringens enterotoxicosis

Several antibacterial drugs are effective in controlling CPE. Acute cases often respond well to amoxicillin (22 mg/kg BID) or metronidazole (10-20 mg/kg BID) for 7-28 days. Many clinicians have likely treated CPE with these medications empirically without knowing what they were treating. Chronic cases tend to respond best to tylosin powder. The recommended dose is: Animals greater than 23 kg ¼ tsp BID, 12 to 23 kg 1/8 tsp BID, 5 to 12 kg 1/12 tsp BID, and less than 4.5 kg 1/16 tsp BID (a "pinch"). Cats definitely do not accept the powder well at all, even when it is mixed in very tasty foods. It is best to have the powder reconstituted to capsule form for administration to cats. The medication is very safe. Some animals require treatment for several to many months (3 to12 months or more). Over time the dose may in some cases be successfully reduced to SID and then every other day dosage (after several months or more on a BID schedule).

Dietary fiber supplementation may also help control CPE. Probable mechanisms include decreased C.perfringens fecal concentration, lower colonic pH, which prevents sporulation, and increased concentrations of SCFA. Some patients may respond well to dietary fiber supplementation alone.

Follow-up testing at 3-6 months can be done to determine if toxin persists. Once daily to every other day tylosin in conjunction with dietary fiber supplementation are used in chronic cases.

https://lakeshorepethospital.com/wp-content/uploads/2018/07/ClostridialEnterotoxicosis.pdf

• Diet plays a role in the treatment and management of pets with chronic recurring disease; high fiber diets (either soluble/fermentable or insoluble fiber) often result in clinical improvement by reducing the number of Clostridia bacteria in the intestinal tract and by making the lower intestine more acidic, thus limiting the production of spores and toxins of Clostridium perfringens
• Commercial high-fiber diets can be supplemented with psyllium as a source of soluble fiber under the direction of your pet's veterinarian
• Diets low in fiber should be supplemented with fiber (such as coarse bran) as a source of insoluble fiber or psyllium as a source of soluble fiber under the direction of your pet's veterinarian
• Probiotics may be beneficial to help prevent recurrence of diarrhea by altering the balance of resident intestine microorganisms (known as “microbiotia”)

 

[AGDonmez]

I'm sorry to hear your update, you've done so many tests and tried so many things and it seems like you're still stuck at square one! I have a few thoughts that you could consider discussing with the IM specialist next week, I don't think any of this will fix everything, but maybe some of it can help.

First, ask the IM specialist about alternatives to prednisone. There are several options, I would specifically ask about budesonide, but the IM specialist will recommend whichever she thinks is best.

Introduction to Steroids – IBDKitties

Second, I realize I sound like a broken record about B12 but I would ask the IM specialist about B12 injections, especially since her levels have dropped.

Third, I found some information about treatment of C. perfringens that offers a few antibiotic options as well dietary changes, these could also be good options to discuss with the IM specialist.

Acute and chronic diarrhea in dogs and cats: Giardiasis, Clostridium perfringens Enterotoxicosis, Tritrichomonas foetus, and Cryptosporidiosis (Proceedings)
CPE refers to Clostridium perfringens enterotoxicosis


https://lakeshorepethospital.com/wp-content/uploads/2018/07/ClostridialEnterotoxicosis.pdf

 

[AGDonmez]

I'm sorry to hear your update, you've done so many tests and tried so many things and it seems like you're still stuck at square one! I have a few thoughts that you could consider discussing with the IM specialist next week, I don't think any of this will fix everything, but maybe some of it can help.

First, ask the IM specialist about alternatives to prednisone. There are several options, I would specifically ask about budesonide, but the IM specialist will recommend whichever she thinks is best.

Introduction to Steroids – IBDKitties

Second, I realize I sound like a broken record about B12 but I would ask the IM specialist about B12 injections, especially since her levels have dropped.

Third, I found some information about treatment of C. perfringens that offers a few antibiotic options as well dietary changes, these could also be good options to discuss with the IM specialist.

Acute and chronic diarrhea in dogs and cats: Giardiasis, Clostridium perfringens Enterotoxicosis, Tritrichomonas foetus, and Cryptosporidiosis (Proceedings)
CPE refers to Clostridium perfringens enterotoxicosis


https://lakeshorepethospital.com/wp-content/uploads/2018/07/ClostridialEnterotoxicosis.pdf

thank you! Yes, I asked about B12, and he said he will monitor going forward but did not recommend B12 as he wasn't sure if she needed it know her level is still normal range. He said it won't hurt but wasn't sure about her digesting it either.
She had tried metronidazole before and a single dose had given her awful diarrhea and she was also very depressed on it, so we stopped it right away. IM specialist says treating her inflammation/IBD will also help with bacterial imbalance BUT they have been assuming prednisolone was going to be okay with her and it has not. She has tried two different forms of it, both causing her severe diarrhea. Honestly, I feel like the IM specialists are struggling with treating her as I feel like she may be atypical case but that's just my feeling. Despite, I will ask all of this again when I see him in person. It's just so difficult to be able to get in just to see the vets around here, they are always booked weeks in advance.

 

[silent meowlook]

Hi. I didn’t read replies, just what you wrote.

With an endoscopy, you can get inconclusive results if the biopsy isn’t deep enough or done on the affected are. Full thickness biopsies are the gold standard but also can give inconclusive results.

The thing that is never mentioned is the affect anesthesia and hospitalization will have on a cat that already doesn’t feel well. Stress is huge in cats when their routine is disrupted. Stress isn’t good for anyone.

I am not a vet. I have worked for vets, feline only, emergency, and specialty. I do not hold any license and all of this is just my opinion.

I chose not to do biopsies on my cat and just go with what the ultrasound showed, which was consistent with IBD and then a year later, what was consistent with GI lymphoma with a space occupying mass.

I think allot of times people get hung up on the diagnostics to get “ answers” without taking into account what stress these diagnostics may cause their cat. I own a very fearful ex feral cat. Perhaps the stress is not so bad with a friendly outgoing cat.



With my cat I started the Vit B12 right away, so I never checked levels. Vit B12 is a water soluble vitamin, so what they don’t need, my cat vet explained, they will eliminate in their urine. Below is a link to a recent discussion snd study on Cobalamine (Vit B12) in cats. So, now that may not be true, but I cannot find any study that discusses issues with the cobalamine levels being too high. I have found nothing linking excess Vit B12 feeding cancer either.
My brain hurts after reading it, so good luck. There is some interesting information, so it worth the read.

Vitamin B12 in Cats: Nutrition, Metabolism, and Disease

We review the role of vitamin B12 in cats. Cobalamin is an essential part of enzymes involved in multiple metabolic reactions. In mammals, two enzymes are cobalamin-dependent: methionine synthase and methylmalonyl-CoA mutase. Cats are obligate carnivores ...

www.ncbi.nlm.nih.gov

With my cat, I feed her the Royal Canin canned PR, rabbit diet. She does well on it so that’s all she gets. I know there is a bunch of crap in it but I base what I do on how she is feeling.

Cats can not process carbohydrates. Carbohydrates cause GI issues in cats, but there are few studies on that, possibly due to most diet studies being funded by HILLS, Royal Canin, or Purina. So it is hard to distinguish fact from intention to sell cat food. I will say that in my experience at the cat hospital and internal medicine, I have seen many cats problems resolve or at least improve with eliminating dry cat food from their diet.

The problem I have with micro biome testing is that I don’t like a lab that tests to also provide a product they sell.

There is a horse product on the market that is a fecal test done in the field that will determine if your horse has upper or lower GI ulcers. My horse tested positive for lower. This company also sells products for this ulcer treatment. Did I buy the treatment? Of course. I spent $130 a month on a paste that made me feel like I was helping my horse. Was it? Who knows. I never saw a negative test result, so…
Before using I checked the ingredients and they are as follows:
Oat Oil, Oat Flour, Sunflower Oil, Irradiated Dried Yeast, L-Threonine, L-Glutamine, Guar Gum
So, maybe it did nothing. Probably nothing. I use this just as an example to let you know of some of the things you have to look into because for every sick animal, there are many people looking to make a buck. It’s sad.

Prednisolone is very important for both IBD and intestinal lymphoma. I know you stated your cat vomited with it. I have to wonder if the vomiting was due to some of the ingredients in the liquid formula. I dislike liquid formulas for this reason. You might want to try the pills, of course talk to your vet. If you can’t pill her, you need to learn how because you are going to need to be getting medication into her. Transdermal medications are not all that accurate with dosing. I have never heard of transdermal Prednisolone. But it may be a newer product I am not familiar with. My cat is on Prednisolone 5 mg every other day to every third day with no bad effects from it so far and she has been in it about 2 years.

Another important drug in regards to intestinal lymphoma or IBD that isn’t responding well to standard treatment is Chlorambucil. My cat gets 2 mg every four days and is doing well. If you get that medicine prescribed, be sure to ask about obtaining it through Wedgwood pharmacy. It is much less expensive that way. ( in my experience)

I have to go for now, but remember that you know your cat better than anyone. Trust your gut. Get many different opinions and try to figure out what makes the most sense. Discuss what you learn with your vet before making any medication or treatment changes. Remember your vet works for you. You employ him to obtain medical care for your cat. Allot of specialists in my experience tend to forget that. And mostly, cats don’t follow rules or read medical books. Try to figure out what is improving his quality of life based on what you see in how he feels and how you think he is doing. You know him best.

 

[AGDonmez]

Hi. I didn’t read replies, just what you wrote.

With an endoscopy, you can get inconclusive results if the biopsy isn’t deep enough or done on the affected are. Full thickness biopsies are the gold standard but also can give inconclusive results.

The thing that is never mentioned is the affect anesthesia and hospitalization will have on a cat that already doesn’t feel well. Stress is huge in cats when their routine is disrupted. Stress isn’t good for anyone.

I am not a vet. I have worked for vets, feline only, emergency, and specialty. I do not hold any license and all of this is just my opinion.

I chose not to do biopsies on my cat and just go with what the ultrasound showed, which was consistent with IBD and then a year later, what was consistent with GI lymphoma with a space occupying mass.

I think allot of times people get hung up on the diagnostics to get “ answers” without taking into account what stress these diagnostics may cause their cat. I own a very fearful ex feral cat. Perhaps the stress is not so bad with a friendly outgoing cat.



With my cat I started the Vit B12 right away, so I never checked levels. Vit B12 is a water soluble vitamin, so what they don’t need, my cat vet explained, they will eliminate in their urine. Below is a link to a recent discussion snd study on Cobalamine (Vit B12) in cats. So, now that may not be true, but I cannot find any study that discusses issues with the cobalamine levels being too high. I have found nothing linking excess Vit B12 feeding cancer either.
My brain hurts after reading it, so good luck. There is some interesting information, so it worth the read.

http://[URL][URL]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10177498/

[/URL][/URL]

With my cat, I feed her the Royal Canin canned PR, rabbit diet. She does well on it so that’s all she gets. I know there is a bunch of crap in it but I base what I do on how she is feeling.

Cats can not process carbohydrates. Carbohydrates cause GI issues in cats, but there are few studies on that, possibly due to most diet studies being funded by HILLS, Royal Canin, or Purina. So it is hard to distinguish fact from intention to sell cat food. I will say that in my experience at the cat hospital and internal medicine, I have seen many cats problems resolve or at least improve with eliminating dry cat food from their diet.

The problem I have with micro biome testing is that I don’t like a lab that tests to also provide a product they sell.

There is a horse product on the market that is a fecal test done in the field that will determine if your horse has upper or lower GI ulcers. My horse tested positive for lower. This company also sells products for this ulcer treatment. Did I buy the treatment? Of course. I spent $130 a month on a paste that made me feel like I was helping my horse. Was it? Who knows. I never saw a negative test result, so…
Before using I checked the ingredients and they are as follows:
Oat Oil, Oat Flour, Sunflower Oil, Irradiated Dried Yeast, L-Threonine, L-Glutamine, Guar Gum
So, maybe it did nothing. Probably nothing. I use this just as an example to let you know of some of the things you have to look into because for every sick animal, there are many people looking to make a buck. It’s sad.

Prednisolone is very important for both IBD and intestinal lymphoma. I know you stated your cat vomited with it. I have to wonder if the vomiting was due to some of the ingredients in the liquid formula. I dislike liquid formulas for this reason. You might want to try the pills, of course talk to your vet. If you can’t pill her, you need to learn how because you are going to need to be getting medication into her. Transdermal medications are not all that accurate with dosing. I have never heard of transdermal Prednisolone. But it may be a newer product I am not familiar with. My cat is on Prednisolone 5 mg every other day to every third day with no bad effects from it so far and she has been in it about 2 years.

Another important drug in regards to intestinal lymphoma or IBD that isn’t responding well to standard treatment is Chlorambucil. My cat gets 2 mg every four days and is doing well. If you get that medicine prescribed, be sure to ask about obtaining it through Wedgwood pharmacy. It is much less expensive that way. ( in my experience)

I have to go for now, but remember that you know your cat better than anyone. Trust your gut. Get many different opinions and try to figure out what makes the most sense. Discuss what you learn with your vet before making any medication or treatment changes. Remember your vet works for you. You employ him to obtain medical care for your cat. Allot of specialists in my experience tend to forget that. And mostly, cats don’t follow rules or read medical books. Try to figure out what is improving his quality of life based on what you see in how he feels and how you think he is doing. You know him best.

Thanks so much! I TOTALLY AGREE with you on the risk of getting a biopsy. The two vets I've been seeing both pushed for this, BUT after I deliberated for a month, I decided not to, because even if the biopsy is conclusive, it's either going to show IBD or lymphoma. At the moment, I don't even understand how that diagnosis would have helped me because whatever medication wise we have so far tried -- metronidazole, prescription novel protein (rabbit), two different forms of prednisolone (liquid and transdermal), Visbiome -- all have caused her to have very severe diarrhea at the outset. I don't know if diarrhea would have resolved eventually if I continued, but the risk is getting her very dehydrated and more sick. Besides, none of the vets insisted that I keep her on the medication despite the severe diarrhea, they actually told me to stop. When we stop, her poop becomes 80 percent normal. What is frustrating is I still don't get an explanation as to WHY my cat cannot handle medication and What can be done to assist her use medication. I don't get this explanation from her IM specialist unfortunately. I wanted her to use prednisolone and calm her inflammation down, because the ultrasound does indicate the presence of it. But so far, no luck!

She is vomiting more these days though, after her food, just regurgitates. I give her 90% canned Hills i/d, and very few Hills i/d kibbles.

I also totally agree on a company that does the fecal testing but then sells its own product. I don't know what else to do though, so i got her fecal tested, and now they are offering fecal transplant pills. I read their online reviews which make it sound it's a good thing but I am not sure at all.

 

[lisahe]

I was just going through this thread and noticed this again:

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 really have to wonder about the peas in the Royal Canin rabbit food that your cat is eating,
A AGDonmez , since peas, legumes, can cause diarrhea. I realize the medications are what seem to cause it but if peas are a problem, the medications may be more of a "last straw" than the only cause. Just a thought!

What is your cat's name, by the way? (I think I missed it!)

I, too, agree with what S silent meowlook writes. Every cat is different, which makes IBD even harder for vets to crack. Endoscopy biopsies, yes, they can be problematic. And they're invasive. When we had the choice of exploratory surgery or endoscopy for Edwina last summer after an ultrasound, we chose the surgery because if endoscopy found something, which we were pretty sure it would, we'd still have to do surgery. That was the right choice for us... though even the surgeon wasn't sure we were all doing the right thing!

The most frustrating thing is that the cause of Edwina's problems (lots of vomiting and a ruptured spleen but no diarrhea) was never determined. I'm sure this happens a lot and is the reason why so many of us have no idea where best to start helping our cats. Her problem was definitely caused by inflammation but beyond that... we'll never know. We do know that some of her inflammation seems to be back, at a lower level than last year, but it seems to be held at bay currently by diet (no more carbs, not even tiny amounts of tapioca, no more fish, no more of a lot of "small" ingredients like maltodextrin), daily Cerenia, and the Adored Beast Feline Gut Soothe I mentioned before.

Since S silent meowlook mentioned stress, I'll mention that, too. Almost all Edwina's barfing this summer has been somehow connected to stress: the weather's very hot and humid, we've had chippers and chainsaws and pavers and jackhammers and very loud crows in the area, I get stressed about my work, and she has always (always, always, always!) been stressed that she won't get fed enough. It's been a huge problem. Stress upsets cats. Stressful things -- plus eating stuff like slugs and centipedes -- have piled up and resulted in some bad days. But a combination of seemingly small measures -- diet, giving her more continued access to food, using Cerenia and the anti-inflammatory herbal/probiotic mixture -- have helped and (finally getting to my point!) she's been her usual self, particularly on cooler days. Lots of her more minor symptoms -- like gas, gurgling -- are gone. I know your cat's different (they're all different!) so I guess what I'm saying is that starting with seemingly small things can build into a big difference.

Finally, I'd be happy to answer any basic questions you might have -- either in a forum or by PM -- about making cat food for your cat, if you're still considering that option. Simple ingredients can make a huge difference.

Here's hoping for the best!

 

[AGDonmez]

Update: We were doing wait and see approach per vet's guidance and today we went to the IM specialist for checkup. Without any medical intervention (no drugs, no probiotic and no herbal remedies), my cat has had no diarrhea and mild vomiting every couple of days (once a week or less). She has lost weight though and that is very scary right now. I asked every possible question today.
The IM specialist acknowledged that my cat presents a rare case unfortunately in terms of her bad reaction to medications and probiotic tried (i.e. severe diarrhea). At this point though, the vet recommends that we try either prednisolone or budesonide at least 2 weeks even if the immediate reaction from the meds is diarrhea. We were holding off on this trial because it terrifies me to give her diarrhea when her poop is 80/90 percent normal without the intervention and possible dehydration. Yet, we know she has inflammation per her ultrasound (or worse, lymphoma). Her appetite is still good and is eating 6 times a day - she is 90% canned i/d and 10% kibble i/d.

After thinking over, we decided to try budesonide this time over prednisolone as we have never given her budesonide yet, with a small hope that perhaps she will not react with severe diarrhea to it, but again that hope is small. We have the liquid no flavor form. I was worried that flavor may complicate things, and pilling a cat is very difficult.

Wish us LUCK!

 

[FeebysOwner]

 

[Margot Lane]

Mention was made here of trying pred in pill form. You can sneak it in a pill pocket.

 

[AGDonmez]

Update: We have been using Budesonide 1 mg. First one week, she was doing great and it was the first time she did not react badly to a medication. We were so excited that we were making long-term use plans of this medication and wondered why we didn't start this months ago. Then Day #7 into it, about 10 hours after the medication, she started to have severe liquid diarrhea, the kind of diarrhea she never has but only does so when we had given her metronidazole or prednisolone in the past. I thought I'd continue nevertheless but today, it's gotten worse, the diarrhea is multiple times a day and she also vomited right after she pooped. I messaged her IM specialist describing the situation. I asked if we need to supplement her steroid use with something else, but if so, with what?!

I was told to continue the steroid until we see the doctor in a week and will need to take her to get fluids at the hospital in the meantime. Our IM specialist actually referred us to another specialist in the same hospital who does fecal transplant. I feel like even the doctor considers our cat a rare case in terms of how she is responding to steroid treatment with very severe diarrhea. (Before starting the treatment, she did NOT have diarrhea but only partial soft stools).

I know this group has said to use S Boulardii but when I had tried Animal Biome's S Boulardii, she had worse diarrhea. I contacted that company and they said to try using S Boulardii from another brand that does NOT have FOS or MOS in it, so pure S Boulardii. I now ordered one from Amazon that does not have MOS or FOS. I will give it a try, but with very minimal hope.

Why can't my cat tolerate steroids when most others do? I read in these forums that many peoples' cats have been on steroid pills for months or years with minimal side effects especially with Budesonide. I am very puzzled and feel helpless as I take it from the email exchange with the hospital that even the doctor is surprised that our cat has diarrhea after Budesonide use.

I feel very uneasy to medicate her now with a steroid knowing that it's causing her diarrhea. Ugh...

 

[AGDonmez]

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.

Hi Artie's mom, i noticed in a separate blog that you've said you were using Budesonide for Geoffrey in February 2023, as he couldn't tolerate Prednisolone. What was his reaction to prednisolone? Did he have diarrhea and/or vomiting in response to prednisolone? We have tried two different forms of Prednisolone (transdermal and liquid), but my cat had severe explosive diarrhea after just the 1st dose of both forms of Prednisolone. We then stopped treating her for a while. She lost more weight and was vomiting more often, so now using Budesonide which was perfectly fine for one week, but that now is also causing her explosive diarrhea. Were you able to keep Geoffrey on Budesonide without issues?

Also, which S. Boulardii brand did you use and was that helpful? I am now attempting to give her S Boulardii very small dose twice a day and giving her Budesonide every other day. The morning after we give her the Budesonide, she gets explosive diarrhea and then it stops, and next day we do not give her any Budesonide and that day her poop is almost all fine. Next day when we give her Budesonide, again diarrhea. It's very frustrating and when I report this to her vet, I get no helpful response.

We will see another IM doctor on next week. I did not get an endoscopy on my cat so i don't know if it's only IBD versus also lymphoma. I am praying it's only IBD, but not sure. Did you get an endoscopy on your IBD cats? The thought of anesthesia is very scary for me. Thank you for your feedback!

 

[artiemom]

I do not remember what brand of S. Boulardi I gave Geoffrey. It was in capsule form, in a foil packed sheet, in a box. I found the dose on IBD KITTIES Website. I had to repack it in a smaller capsule for Geoffrey. I got more than 2 doses from each original capsule. I ordered it from Amazon.

As far as the Prednisolone not agreeing with Geoffrey: he was dull, listless, not eating much, unless I took the dish over to him. He also was not the cat I knew. He was lethargic. A huge change from the kitty I loved.
It happened almost immediately. We cut the dose back, without any improvement.
This is when I insisted on changing to Budesonide.

Good Luck.

 

[AGDonmez]

I do not remember what brand of S. Boulardi I gave Geoffrey. It was in capsule form, in a foil packed sheet, in a box. I found the dose on IBD KITTIES Website. I had to repack it in a smaller capsule for Geoffrey. I got more than 2 doses from each original capsule. I ordered it from Amazon.

As far as the Prednisolone not agreeing with Geoffrey: he was dull, listless, not eating much, unless I took the dish over to him. He also was not the cat I knew. He was lethargic. A huge change from the kitty I loved.
It happened almost immediately. We cut the dose back, without any improvement.
This is when I insisted on changing to Budesonide.

Good Luck.

okay, thank you for your response!

 

[artiemom]

Oh, so sorry, I forgot to respond to the last question!!

Yes, Geoffrey did have and endoscopy with biopsy. Neither the IMVet nor I ever mentioned a full surgical biopsy. I felt the endoscopy with biopsy was necessary to determine if it was IBD or not.. It turned out to be IBD Plus Small Cell Lymphoma.

At your kitty's age: I think 11 years old, I would not wait to have it done. Both Artie and Geoffrey had them done. At age 12, Artie was 'off" for about a week... Geoffrey at age 8, was "off" for 10 days, but he is a much more sensitive kitty.