Urgent: Question about budesonide vs. prednisonlon

Hello,
My cat with chronic diarrhea is not repsonding to metro and is losing weight. i am worried she might have lymphoma or definetly a bad case of IBD. My question is, I am prob going to have to put her on a steroid. i have heard that budesonide (entocort) is not as likely to raise blood sugar as prednisolone. since she is a diabetic in remission, i wanted to try the budesonide first.
the question is, i know pred is used as part of the chemotherapy for lymphoma. does budesonide also have the "cancer fighting" properties that that pred has or is there a difference there?
just in case she has cancer, I would want her do be on the approriate drug.
does anyone have experience with this?
can you switch between the two if one doesn't work?
please help! she is not doing too well and i she is still having runny diarrhea.
i currently have her on metronidazole and am trying to work with her diet but that is really hard.
i am planning to put her back on cyanocobalamin soon but i need to talk to vet first.
i am not willing to have her cut open for a definitive diagnosis but i can do ultraound, and xray and possilby colonoscopy type thing but i think it might be in her small instetine because her cobalimin was low once.
please please help with any advice.
thank you.

 

I would highly recommend having and u/s done first ( with a needle aspirate if possible if anything shows up)
before starting any treatments. steroids can skew the results of biopsy ( if there is any)
IF it is lymphoma, pred is the way to go as it works systemically and lymphoma will spread through the lymphatic system. budesonide is a local only roid and would certainly something worth trying for IBD, but not for lymphoma.

How old is she? you mention you would be ok / colonoscopy but not surgery. There is still anesthesia w/ that and that is the biggest risk, unless she has other health issues?
Winnie had u/s and it indefinite and she had exploratory surgery w/ full thickness biopsis ( the gold standard for dx) She had chemo. and 5 years later when she passed, it was not from lymphoma.
It's hard to know the best treatment unless you know what you are dealing with.
Of course, deciding what parameters you would have for treatment would also be a deciding factor in how far to take diagnostics. ( would you do aggressive chemo? would you treat w/ roids and/or perhaps a milder chemo like leukeran? ) Good things to think about. But it is getting waaaay ahead.

Best to get an u/s , b/w, x-ray and see what you find out and go from there.
Please post back the results Sara. I hope it turns out to be something very benign.

ed-typo.

 

My Kaely had IBS/diarrhea for 5 years before she started loosing weight. I did not want to cut her open, but I was left with no other options if I wanted her to live. An open biopsy showed small cell lymphoma. She went into remission for 18 months with chemo, but now it might be back. You really do need to fight lymphoma with all the meds and not just pred if you want to give your cat a good outcome. You have to know what you are dealing with. Bude has no chemo effects. Donna

 

thank you both. what is u/s?

 

ok, i think us means ultra sound.
here is what i am thinking
just have a minute before work.
since she is currently not feeling well, not even wanting to eat this morning. maybe i should put her on the pred for a few days at least. i guess i will have to deal with the diabetes if it comes back.
the thing is, i cannot get to a specialist this week probably or it would be very hard
i am thinking if i can get her past the rough part maybe i could take her off the pred for a couple of weeks and then she could have the needle aspirate or possible full thickness but that last one really scares me. she's 14, hyperthryroid, diabetic, etc.
i could ask the vet here to do it today (the us with needle aspirate) but they are very bad and i am afraid they might hurt her. also, they alsoway say it is pointless to try it even though i know that sometimes it can work. they absolutely suck here.
i am really confused.
if she had lymphoma i would treat it as aggressively as possible.
i need to get her t4 rechecked too just in case that was srewed up. she needs to eat. i am really scared.
i also want to put her back on b12 injections starting tonight but feel i need to ask vet.
she's also lost more weight, is only 8 pounds this morning. has lost about a pound in two weeks or so.
does that sound like an ok plan?
i don't know if i should even try the budesonide first. since she is not doing very well. what do you think?
i wonder if i can switch between steroids as needed. do you guys know that?

 

Sarah

I don't know your situation very well, but it sounds like your kitty has a lot of issues and there is a lot of guess work going on. If she's losing weight, it could be the thyroid, the bowel issues or who knows. You have to be more systematic about determining what is going on, and not just throw steroids at the situation in the hopes that it might help.

My suggestion is if you can, get a vet who is more thorough, get her thyroid values checked again to make sure she is on the right dose, and get that ultrasound done. Then you'll have a better picture.

 

And don't forget the possibility of a feeding tube to help her thru this period. Get a vet that knows what he /she is doing. (Hoping that is possible.)

 

As far as I know you can switch back & forth btw the Bude & Pred. Bix was originally on Bude for a few months (IBD, mostly stomach issues), then switched to Pred (EPIC MISTAKE) when I moved & switched different vets, then after a year back to Bude with the FD diagnosis (ugh). When we switched it was just a straight switch to a comparable dose on the other med, no weaning off one before switching to the other, etc. I can't say for sure that we did it the right way, but that's how the vet had me do it and I never noticed any problems with the switch.

If your regular vet thinks Budesonide is a good idea and you can't get to a specialist right away, it makes sense to me to give it a shot as a short-term fix to get her eating at least. Or Pred as a second choice if you would need to order Budesonide and wait for its arrival, making it not a good short-term option, assuming your vet feels Pred would help her. If she isn't eating I think that trumps everything else. Although there are reasons to hold off on steroids pending tests/diagnosis, if you know that won't happen for over a week and she is not eating, steroids or other meds as prescribed by your vet may be a good option. [/Paragraph edited for clarity.]

Bude has helped Bix a lot, I think it started working within a couple days and his symptoms went away completely. He's mostly stomach IBD though, I can't say how well it works for poopy problems.

I have also had a lot of success with food changes when a problem comes up, i.e. when I can find a food he does better on. There have been times when I thought his IBD was really worsening, but then a food change has bought us a year before I see more signs of worsening.

 

I'm sorry, but I disagree. As Jen wrote, "You have to be more systematic about determining what is going on, and not just throw steroids at the situation in the hopes that it might help."

In the right situations, steroids have their use. But those situations need to be determined by a veterinarian. We are not familiar with this cat's circumstances, and what other health conditions she may have. Jen suggested thyroid testing; some steroids (pred is one, I believe) may interfere with testing for thyroid diseases. And cats with underlying heart disease can go into congestive heart failure from steroids. I'm not saying these are what this cat has, but we have to be careful with meds when we don't even know what is wrong.

Remember Janet's Suggestions for Advice Givers: "Above all, do no harm. Be sure you are familiar with the particular cat's circumstances before giving food and dosing advice.[and in this case, medicating advice]. ... There's always a possibility that there's something that you don't know about the cat. Be aware that the cat may have other diagnosed or undiagnosed health conditions (such as renal impairment, pancreatitis, hyperthyroid or acromegaly) ... "

If this cat isn't eating, she needs to be seen by a veterinarian.

 

Just to clarify, I wasn't suggesting you should give meds w/o consulting your vet first. I was suggesting this on the understanding that you already know your cat has IBD, and are wondering whether or not there is value in adding a steroid (under your regular vet's care) before you can get to a specialist to determine whether or not it is cancer. My bad for not making myself & my assumptions (which I realize may well be wrong) clear.

 

What are you feeding your cat? Some vets still prescribe a high fiber diet, which can upset their bowels. Sweet Max had horrible watery stools. I kept telling the vet, his problems seemed to have started, when he was started on the special diet. After tons of money and vet trips, I took him off of it. And his problems "miraculously" went away.

Praying your cat feels better soon!

Cat, Sweet Max, and gang

 

yes ;-)

Since you do wish to treat aggressively( whether it is lymphoma or very possibly something else or some combination of issues) and she is not doing well, I would do what you can to get her to that vet or to your other vet for diagnostic work up ASAP. You can't treat aggressively unless you know what you are treating,kwim?

in your first post , you did not mention that she is not eating. This is very serious for cats , as they can quickly develop HL (hepatic lipidosis ) I reiterate my suggestion that she see a vet asap.
In the meantime, there are things you can do to entice her to eat. ( or force/ assist feed if necessary)
I cut and pasted this from a previous post of mine :


Remember -- getting to the bottom of why he is not eating is most important. That way you can treat the underlying cause ( or symptoms of underlying cause) . It is always very important to get cats to eat, as they can quickly develop hepatic lipidosis from lack of food.

Here are some things you can do do entice your cat to eat:

-sometimes in order to get a cat to eat you even have to resort to dry it is more important that they eat. there are a couple low carb / grain free brands -- EVO and wellness core.

-making a buffet to give him choices

sprinkle food with :
- forta flora -- a probiotic you can get at vets or online. is very smelly and cats love the taste of it.
- parm. cheese
- smashed crumbles of dry food
- bonito tuna flakes
- halo chicken treats -- crumble into dust over food -- my Wolfie loves this stuff.
- poor a little water from tuna in water over food ( I use low sodium/no sodium added as other kinds in water has veg. broth in it and I assume that means onions, which are toxic to cats-- check labels)
- I do not have a trader joes -- but others swear by trader joe tuna for cats
- powdered oregano. yep sounds weird . but some cats like it and it will entice them to eat.
-baby food -- beechnut turkey and broth or chicken and broth. they have no onions or other additives. some babyfoods have onions . please read labels if you can't find beechnut.
- ETA -- kentucky fried chicken : )

If enticements don't work, you should consider assist feeding ( syringe or make little meatballs and place in mouth)
and/or talking to your vet about appetite stimulents ( mirtazapine or cyproheptidine)




and I add to my list Donna's suggestion of a feeding tube if necessary. Here is Dr. Lisa's link on that subject:

http://www.catinfo.org/?link=feedingtubes

Please keep us posted Sara and let us know what the vet says.
((( Sara )))

 

thx everybody. i have an appointment tomorrow with yet another vet. i am talking to the cornell phone vet today. i desperatley want to take her to seattle it prob isn't realistic unitl the week of sept 7. i feel really bad for not being able to get her top notch vet care asap. i am going to ask the vet tomorrow to do an ultrasound. i will fast her just in case she can do it. she is eating today thank god and has gained 2/10 lb overnight. but she doesn't look great. something is not right with her. i am terrified it is lymphoma. why isn't there a less awful way to diagnose it than full thickness biopsy. i want to do that actually at this point but i am scared. i may do it. i need a little more time to decide. i think if i had a compent vet here i would have done it already
when i went to the vet in seattle, she gave me pred and lukeran and b12 without the diagnosis saying that she would treat that way whether it was bad inflammatory bowel or lymphoma and we decdied to just treat and not cut him open. he was very sick. he died the next day anyway.
anyway, here is my plan to date.
talk to cornell vet today with various question.
go to appointment tomorrow. get prescription for budesonide just in case and get exam and hopefully ultasound and xray.
probably start her on some type of steroid for at least a few days to try to stop the diarrhea.
do b12 shots. i am leaning toward not getting her a gi panel because she had one after she started getting the diarrhea and it said that her cobalamin was low but everything else was ok. said it indicated distal small intestine disease. very expensive test too so prob will skip unless vet advices. i don't think she has pancreatisis but not sure
make appointment with specialist at time when she has been off steroids long enough to get an exploratory or other type of biospy if possible.

i actually don't like this plan. i think it would be better to take her to a specialist right away. i don't think it is possible for me to to it though.

my gut feeling is that she has really bad ibd or lymphoma. i'm scared it's lymphoma and if it is, it's this horrible dilemma to decide to cut her open for the biopsy (unless they can get it on a needle) or just treat the diarrhea with a steroid and then i guess the cancer not be treated properly.
the seattle vet gave my other cat the pred and lukeran without a diagnosis.
i guess i could do that.
if she were to have lymphoma, what chemo drugs are used and how?
is lukeran not a strong enough or specific enough cancer drug to work?
is it safe to use? the vet said it was but i don't know.

thanks.

 

Is the problem with taking her to the specialist a scheduling issue? If so, do you have a friend or someone who could take her to get the tests done, and then maybe schedule a phone consult with the specialist? Of course that is not ideal, but if your gut is to get her there right away, just trying to brainstorm on how you could do that.

Also on the biopsy, my cat (civie) had one that was the scope down the throat thing, rather than surgery. I don't know if maybe that isn't as good or something? I don't recall the specialist even suggesting surgery to me, just said u/s and scoping was the procedure for a diagnosis. I probably blocked it out.

With mine who had lymphoma they treated with Pred & Leukeran first, then when she didn't tolerate the Leukeran moved on to other chemo options (which were not great fixes or anything, though they bought her a few months). From what I understand, if they tolerate the Leuk, many cats do well on that for a couple years or so. "Safe to use" is relative.... I had to wear gloves when I gave it to her, but they told me it was relatively gentle as chemos go. It made Trixie nauseaous and we couldn't continue with it, but from what I have been told many cats do very well on it. I don't know specifically which cancers it works best on though (I think Trixie's was small-cell intestinal lymphoma?), or what the chemo protocols might be. Just sharing what course our vet/specialist followed in case that info helps you.

 

just talked to vet at cornell at the 800 kitty dr line. wow, he was really good. how i wish he lived here and could be my vet. he answered a lot of my questions but of course i forgot to ask some. it did help though.
here is what he suggested.
don't treat for cancer unless you have a diagnosis.
get bw and u/s first including gi panel
if that doesn't help, could consider getting the exploratory. the risk is mainly in the anesthesia.
he said combo of budesonide, metronidazole and diet is how he would treat ibd
he explainded how to use busdeonide!
said have to be off steroids for 4-6 weeks before doing any biopsies


those were the main points. it did help me to clarify things.
he also said that there was a good chance that it was ibd even though she has had it a long time. that made me feel a little better even if it was wrong.

i would really recommend that consultation service. very smart vet. nice. $55
going to local vet tomorrow. going to try to get scrip for budesonide there (found place in seattle that could fill it)
cornell vet also said wedgewood pharmacy was reputable and a good place to get it.

i am considering getting the ultrasound here even though they might screw it up. i have major practical problems with money and time in getting to a specialist.

cornell vet also said something interesting about the exporatory. he knew that my local vets aren't super great and i asked him about doing the exporatory here. he said it was basically like a spay and that the main risk was the anethesia and having support during surgery such as bp machine and ekg and keeping warm, etc. he said local vets might be able to do that. made it sound not as complicated and scarey as i was thinking. so that is a possibility. boy, it would be great to know what i am dealing with.

something else, when i went to vet yesterday and she drew blood for complete panel, t4. i called today for results. girl there said that THEY RAN THE WRONG PANEL! I said what panel did they run. she said she didn't know. i said can you find out if the liver was on it. she was annoyed and said yes and hung up. she hasn't called back. i am going to have to try to get my money back on that. my god.

i am going to a different vet tomorrow. each one tops the last in incompetence but i'm hoping to have better luck tomorrow. it really sucks to live in a small town when you love your animals.

thanks for bearing with me through this new trauma.

 

Vet suggesting exploratory surgery. Please Advise!

Went to anothe vet today. She did a great job doing an ultrasound, xray and bw. bw was mostly normal liver a tiny bit up. both kidneys were enlarged, another possibly inlarged lymph node in abdomen and small intestine clumped together or thickened. also had urinary tract infection. did sub q, put on zeniquin and i am still giving b12 shots and tapazole. she suggested increasing tapazole to get it below 2 to see if that was causing diarrhea. said that ultrasound could indicate cancer or it could be a kidney infection and still ibd. see suggested anexploratory surgery.
i am really scared to do it but am considering it.
how much should it cost?
how risky is it?
has anyone had a cat that had it that died due to the surgery.
she is 14, diabetic in remission with hypert...
i just don't know.
she said i had a couple of weeks to decide.
she said i could go to a specialist or do it locally.
if she was available i might have her do it because she is good but other vets locally suck.
i don't know what to do.
there are cost considerations, too.
we talked about running the zeniquin it's course and seeing if she is better just off that. i am hoping but not sure. she said to double the tapazole from 3.75 mg to doing that twice a day instead of once.
anyway, i could use advice about the exploratory. and what to do next and if there is possibly another option.
thanks for the help.

 

The cost of surgery varies from vet-to-vet and also varies depending up what is included. Almost all vets will required blood work prior to the surgery. Also, many times in cases like yours tissue samples are sent out for analysis (biopsy). Those biopsies can cost $100 each. Maybe you are talking about $1000. Why not get an estimate from your vet?

Some cats do die as a complication of surgery. Risk depends upon the kitties condition.