IBD What Should Next Step Be? (Long)

My Morris has been sick since Jan 3rd, starting with puddingpoo and quickly progressing to total liquid and really smelly. A few days later and he threw up a few times after eating and then stopped eating. I tried to treat him on my own with Pepcid and then probiotics. Finally on Jan 12th I took him in to the vet and had fecal sample tested along with his anal gland expressed as they were full. Fecal came back with no parasites but overgrowth of bad bacteria so we started him on metronidazole along with mirtzapine for appetite stimy. The mirtz only helped his appy for a couple of days and then not at all so I syringe fed him for a couple of days.

I had blood drawn on 1/18 for a complete panel as well as T4 and free T4. The test results are here:
and

He stopped eating again so started syringe feeding off and on again...he dropped about 4 lbs. We gave him a course of Panacur just in case it might be giardia and started giving cyproheptadine for apply stim, which works better for him than the mirtz did. Without it, he probably would have died by now because his appetite is non-existant without it.

Then I changed vets...new vet started talking about steroids for IBD, which was the diagnosis we arrived at by process of elimination. She mentioned depo medrol, which I turned down immediately. Instead we went with B-12 shots...he's had two so far. I continue to give him probiotics morning and evening with his food as well as cypro so he will eat...he's eating pretty well now. But the diarrhea continues...sometimes it will look like it is starting to firm up (there will be pieces of solid in the liquid) and a few times it has been very small and hard but for the most part it is still liquid or pudding consistency and smelly. Oh, and he had another fecal recently, which showed no parasites and normal bacterial flora).

Here are the questions: How long does it take the B-12 to work?? What is the next step?? Is it budesonide or something else and if something else, what??? I don't really have a relationship with the new vet (or the old one for that matter)...seems that I alienate them from the get go because I arrive with papers and ask questions but I've been through the wringer with my cat and want to be involved in any decisions. I don't know how you guys find these wonderful vets that work WITH you...I'm on my third one and already hate to call her.

 

I have no idea how to interpret the lab reports, so I just skipped over them. IBD is officially diagnosed through either an endoscopy or an intestinal biopsy. Assuming that the diagnosis is correct (I have no reason to believe that it's incorrect, but felt compelled to add the disclaimer):

The B-12 injections are a good start, and your vet suggesting them is a good sign. Most folks start with the TAMU protocol here http://www.cvm.tamu.edu/gilab/research/cobalamin.shtml, which starts with one injection a week and then eventually tapers off to once a month. But most folks adjust the therapy to the needs of their specific cat. My Gwyn needs two shots a week to keep her stable; and when my vet runs into cats who need B-12 supplementation, she usually has them given 2-3 shots in the first week and 2 shots in the second, to try to help jump-start the process before tapering off to once a week and then once a month. (B-12 is one of those useful vitamins where, if it's not needed, it's generally harmlessly pee'd away.)

I'm afraid I can't tell you how long the B-12 takes to start working; they were added to our routine after more than a decade of constipating IBD and, with our constantly shifting arcana of medicines, it's hard to know what's affecting what else. We just added the B-12 shots when Gwyn was feeling bad and got a vet visit, then eventually worked out how well they worked for her over time.

You should be able to get injectible B-12 from your vet; I've been able to special order it at about half the pharmacies I've tried, but you often (always?) need a prescription; and a lot of folks have found it available without a prescription at their local feed stores. I spend $10-15 per vial and it lasts me over a year. Please note that B-12 is light-sensitive and, to preserve it's effectiveness, I keep it in a dark cabinet despite the brown bottle.

The injections are given subcutaneously, so you can use insulin syringes to give it.


You can try adding canned pumpkin to Morris' food; pumpkin is a weird food that can work great for both diarrhea and constipation.

Depending on the size of the can and the number of cats, the pumpkin may start to go bad in the fridge before you're done with the can. As your cat can tell this way before anything visible appears, you may end up frustrated not nderstanding why the cat isn't eating and the cat may end up hungry and annoyed with you ("Mom! You're trying to poison me!"). So: open the can of pumpkin and spread it in an ice cube tray. Put the tray in the freezer until everything's solid, then pop the pumpkin cubes out and put them in a ziploc freezer bag. Defrost as necessary.


A lot of the diarrheal IBD cats do really well once they're on a raw food diet. If you've not already considered that, I would definitely give it a try! Also at this point, I enclose my standard warning:
- a raw food diet is fine for most cats
- a raw food diet can help many cats with diarrhea issues
- a raw food diet may be helpful or harmful in a cat with constipation issues; please keep a close eye on your cat in this situation!

You make your own raw cat food; there are recipes on Dr Lisa's site here http://www.catinfo.org/makingcatfood.htm .

You can also get raw food from some pet retailers; the one time we tried raw food, we went with Nature's Variety, solely because they had a trial buy-one-get-one-free offer, which is still available here http://www.naturesvariety.com/tryit . In order to get the coupon, you'll need to know the name of a local store which carries the raw food; you can find that out here http://www.naturesvariety.com/locator.

I will say that when we tried the raw food diet, I had problems getting Gwyn interested in it. I think that's partly because it was served cold from the fridge and she just didn't like that. I did try microwaving it for a few seconds to warm it up; she liked that better, but the food seemed to go stale faster. Tried adding warm water to the medallions, but I didn't like the resulting consistency. What finally worked for us was for me to take the defrosted medallion out of the fridge and beat it strenuously with a fork until it was a sort of puree. That made it easier for Gwyn to lap it out of the bowl (she has lingual dexterity issues due to a stroke), and it also warmed it up to a temperature that she liked without letting it go stale early. If you do decide to try a raw food diet, you might try posting for hints on making it more appealing to cats.


thoughts other than B-12 injections and diet:

While I agree with the need to be cautious, I also know that sometimes you do need to do a course of steroids to help IBD patients. Since Depo Medrol lasts such a long time in the body, why don't you ask your vet about something else, like budesonide or prednisolone? A fair number of IBD cats go onto steroids for varying periods of time, and you can start / stop those easier than Depo Medrol (though there's still a weaning-off curve).

You might want to ask your vet about budesonide's side effects. I know a lot of folks like it because it more directly targets the digestive tract, which is great for IBD. But I'm not overly familiar with it's side effects, and I know that one of the side effects of prednisolone is an increase in appetite, which might be helpful.

You mentioned trying mirtzapine as an appetite stimulant, but it stopped working after a couple of days. It's only designed to work for 2-3 days at a time, so I'm not sure whether meant that you stopped giving him the drug and his appetite dropped off, or you continued giving him the drug and his appetite dropped off. If you stopped giving him the drug, I would suggest asking your vet if you could get more mirtzapine for Morris. If you continued giving Morris the drug and it stopped working, I would suggest asking your vet about other options for appetite stimulants; I've used cyproheptadine with great success in various cats over the years. It doesn't last as long as mirtzapine (it's generally given every 12-24 hours), but it also doesn't usually have some of the side effects that mirtzapine does (meowing, restlessness).

[ETA: just re-read your post and noticed you're already on cypro, so ignore that last paragraph. Am leaving it in for completeness' sake.]

You may also want to speak with your vet about whether putting Morris on Pepcid A/C or Zantac might be beneficial. I know that Zantac has helped my Gwyn a lot.


Finally, you may also want to consider joining the Feline IBD group here http://pets.groups.yahoo.com/group/FelineIBD . Most of the cats there are dealing with the diarrheal form and they may be able to provide you with more specialised help (my Gwyn has the constipating form, so most of what I know about the diarrheal form comes from vague exposure to other people's posts). Their first two recommendations will be the B-12 injections and the raw food diet.


And ... I think that's about all that my mind's going to produce at the moment. Good luck to both of you!

-- Jean and her Gwyn

 

Jean, Thanks so much for taking the time to write that reply...I doubt if you missed anything. :thumbup I will give that yahoo group a try.

 

Dear Brenda,

That was a great reply, loaded with tons of info from Jean and Gwynn.

The only thing I wanted to add, was I noticed on the blood work that Morris' Eosinophils were high. My Rudder, whom I lost last year after many years of IBD and almost 3 years of diabetes, along with FLUTD, Cardiomyopathy, etc.... had high Eosinophils in his bloodwork. That usually indicates from what I have read, and what my vets told me, that it indicates "allergic" reactions to something.

My Rudder (he was almost 14 when he died, shy of one week) was getting so sick with the IBD, or what I thought was IBD, even with the B-12 shots, I ended up letting him go. He was vomiting every day, and the last couple of weeks, it had a lot of blood in it. Also his poo was bloody. We did not put him through any further tests, as his appetite became worse, and the vet and I felt he was suffering too much. He most likely at that point had cancer. Cats can have microscopic intestinal cancer that is not noticeable in bloodwork, and it is more common in cats as they age. Basically this is what my vet and I talked about, and I could not put Rudder through any more pain that he was suffering with. I look back now and regret that I let him go as long as I did, especially when I look at his pictures, and realize he was in so much pain.

I had him on Pepcid A/C for many years and that seemed to help, but once the diabetes struck, and I could not get his numbers down very much, EXCEPT, the last month or so, his numbers started dropping, and I gave less PZI insulin. This was a very curious finding, and my vet and I both felt that this is most likely why he had cancer. When a cat or even a human, has cancer, the tumor/s will grow faster from the sugar in the body, and probably, Rudder's numbers were dropping because he had that happening inside his intestines.

Please don't think I am saying that this is anything like what you are going through with Morris, but I just wanted to let you know what we went through here with my Rudder boy.

Another thing, have you used pain meds with Morris? Buprenex is used by some folks, for severe IBD pain. It would also maybe help the diarrhea? It would be something to speak with your vet about having on hand.

Also, be careful if you have ever used Reglan. I gave that to my Mama cat, Gracie, whom I lost last February, and she went berserk on it. I had to call the vet, and she told me that she never gives Reglan to cats any longer, due to this possible side effect. I had to give Gracie some Benadryl to calm her down. She was Rudder's mother. She also died last year from intestinal cancer. She was 15.

Best wishes with your Morris.
Jean and Charcoal (GA)

 

Thank you Jean....I was not aware that IBD caused pain, although Morris DOES look pained most of the time and has taken to walking kind of funny, like stiffly. Attributed to his advancing age but he didn't do that before January.

My vet did mention the possibility of lymphoma and wanted to refer me to a specialist for more tests and a biopsy for the IBD but I didn't want to spend the money....that was back at the beginning and in hindsight would probably have been cheaper in the long run. Since Morris has always pulled out of illnesses quickly in the past, I thought this time would be the same...he fooled me. :sad:

 

Lymphoma and IBD have similar symptoms and a biopsy is necessary to determine which one. IF IBD Budesinidee sis a standard treatment. Some vets with treat and IBD/lymphoma diagnosis with leukeran (brand name chlorambucil), a mild chemo agent. My Bailey is presently on 1 mg budesinide sid and B12 shot weekly.

 

Hi Brenda,

How is Morris doing today?

If he seems to be in pain, a lot of times the cats with IBD will sit in hunched up meatloaf positions. My Rudder and my Gracie used to do that.

Please keep us posted.

Jean and Charcoal (GA)

 

I'm afraid he seems to be going downhill today...he will not eat and suddenly became wise to the pill hidden in a treat that I have been giving him for the last week so no pepcid and no cypro. He seemed to be making a comeback and was eating well up until yesterday, when he threw up a few times. I will call the vet tomorrow to see about taking the next step...budesonide for the IBD and buprenex for pain, although if they are pills I don't know how I will get them into him.

This is so hard...he is wasting away right in front of me and I seem to be powerless to stop it. :sad:

 

http://petdiabetes.wikia.com/wiki/IBD

I've had a lot of success in just removing the grains from H's diet - that alone has seemed to make big strides in reducing the vomiting and diarrhea. I'm still not sold on the raw thing - I see raw as just one way of getting good quality food into the diet.

If you use steroids like pred, then you may need to give more insulin. I chose to go with pred because of it's better bio-availability for cats and I pay the price in that it gives him DM. But H's IBD/triaditis and lymphoblastic, intermediate and large cell GI lymphoma is much more serious than DM so...

Unfortunately, a lot of times it's difficult to learn exactly what is going on without going the laparotomy route but there are other diagnostics one can do before that. The PCR testing is one that is EASY [just requires some poop that you can to from home - no vet needed!] and relatively cheap at just over $100. And stool analysis/float should absolutely be completed too.

I've used both the mitr and the cyproheptadine. I like the cypro better. I've found that the Mirt comes on strong then wanes down to nothing over 3 days and can make managing DM a bit of a nightmare with the appetite fluctuations. Also the mirt does not work well for some kitties.

Are you unable to "pill" your kitty without putting it in food? Why not? Sorry if I missed this in your posts above. If your kitty is an IBD kitty then the pills are most likely going to be crucial.

 

Has your cat ever been tested for http://www.fabcats.org/breeders/infosheets/tritrichomonas.html just wondering its becoming much more prevalent in the cat population more so in the breeding community but its in the general cat population as well and causes pudding like stools very foul smelling you may want to ask you vet about this we just started testing for this at the clinic where I work

 

Dr. Lisa has had a lot of experience treating IBD, Brenda. She does telephone consultations, she does charge for them. After you have had all the testing done you could get in touch with her for diet information and suggestions.

 

Sadly, Morris is a GA: viewtopic.php?f=9&t=7777&p=77453#p77453