ER or wait for vet tomorrow?

[hellolucy]

Lucy has diabetes and IBS. She had diarrhea last night, and was pooping/peeing in random places around the house. She also threw up twice. She is going in and out of the litter box a lot and straining. There was very small amounts of blood in her urine. She still seems alert, friendly, and is eating well.

I am sitting in front of an ER with her now, and it's the fourth one I've gone to, so have been driving all over. They all have 6+ hour waits to even be seen. All this being said, I am trying to figure out if this is an ER situation or if it can wait until I can call her vet tomorrow morning. She has had a crazy past 2 months with pancreatitis and very expensive tests/ER visits already, so of course I'm also thinking of the cost. I am always overly paranoid with her though and am not sure what to do. We do have one spiked (but unused) bag of fluids that is just under 4 weeks old from her last visit, not sure if we can still administer that to her on our own or if it's too old?

Edit: I've also tested her for ketones using the strips and all good there.

 

[Ale & Bobo & Minnie (GA)]

Is she on anything for the IBD? Like an anti nausea/vomiting like Cerenia or ondansetron? I’d give her that for the vomiting. Minnie is on it daily. What about budesonide? Is she on that? Any other meds she’s on to help with the GI tract? For the diarrhea, a lot of us give our IBD cats S Boulardii probiotics on a daily basis as well abs metronidazole when it gets bad

 

[Ale & Bobo & Minnie (GA)]

The blood could be from the strain of the diarreah. Forgot to ask about b12 injections. Was she tested for b12 deficiency? That can also cause diarreah

 

[hellolucy]

Is she on anything for the IBD? Like an anti nausea/vomiting like Cerenia or ondansetron? I’d give her that for the vomiting. Minnie is on it daily. What about budesonide? Is she on that? Any other meds she’s on to help with the GI tract? For the diarrhea, a lot of us give our IBD cats S Boulardii probiotics on a daily basis as well abs metronidazole when it gets bad

I did give her some Cerenia last night which stopped the vomiting. This IBS thing is completely new to me so will have to start building up my arsenal and take a look at the other things you mentioned as well. I just called in to the ER and they are going to take a look at her. I am a worrier and although she's female, am scared of a blockage or something more severe and know I will get zero sleep tonight if I don't figure out what's going on...

 

[Ale & Bobo & Minnie (GA)]

@Panic @Critter Mom who know pancreatitis way better than me

 

[Ale & Bobo & Minnie (GA)]

I did give her some Cerenia last night which stopped the vomiting. This IBS thing is completely new to me so will have to start building up my arsenal and take a look at the other things you mentioned as well. I just called in to the ER and they are going to take a look at her. I am a worrier and although she's female, am scared of a blockage or something more severe and know I will get zero sleep tonight if I don't figure out what's going on...

Peace of mind is important. I’d ask about all the things I mentioned above when you talk to them. Ondansetron can be given in combination with Cerenia since they work differently. I’d test for b12 that’s an important one to check her for. You should get her started on the injections twice a month regardless

 

[hellolucy]

The blood could be from the strain of the diarreah. Forgot to ask about b12 injections. Was she tested for b12 deficiency? That can also cause diarreah

She hasn't been tested for that yet, I did stumble across lots of mentions of B12 doing research last night, so am definitely going to ask for that to be done, and get a few to have on hand.

 

[Ale & Bobo & Minnie (GA)]

It’s actually a bottle you can order from anywhere even chewy and you give the injections at home not unlike insulin. B12 is water soluble so they will never overdose on it, they just pee out the excess. I’ll post a pic since I just prepped Minnie’s shot. You’ll need different size syringes for it than the ones you use for insulin

 

[Ale & Bobo & Minnie (GA)]

 

[Ale & Bobo & Minnie (GA)]

In addition to S. Boulardii, Minnie is also on an IBD specific probiotic called Visbiome. Don’t waste your time asking them about probiotics. Most vets don’t know anything about it. I’m also tagging @Wendy&Neko who is a wealth of info on GI tract related issues!

 

[Larry and Kitties]

t’s actually a bottle you can order from anywhere even chewy and you give the injections at home not unlike insulin.

Just note a script is required for the injectable.
https://www.chewy.com/vitamin-b12-generic-injectable/dp/219875

 

[Wendy&Neko]

Good plan to get the b12 tested. S. boullardi does not work if it's low: https://www.ibdkitties.net/supplements/probiotics/

Remind me, did she have an endoscopy or surgical biopsy to diagnose the IBD?

 

[Ale & Bobo & Minnie (GA)]

Just note a script is required for the injectable.
https://www.chewy.com/vitamin-b12-generic-injectable/dp/219875

Oh yes. Sorry, I forgot to mention that

 

[hellolucy]

Finally back from the ER with Lucy. They gave her some fluids, and also did a urinalysis and will also have results of a culture back in a few days. They did a small blood panel and said everything looks okay there. They expect it is a UTI and sent us home with some antibiotics. Crossing my fingers this starts working over the next few days to make her feel better, I will be checking in with her regular vet tomorrow as well to continue treatment/updates.

Remind me, did she have an endoscopy or surgical biopsy to diagnose the IBD?

They gave her an abdominal ultrasound which showed some inflammation of the walls of her intestinal tract. That with the addition of the symptoms she has been having led the vet to the conclusion that she has IBS. They also mentioned it could be a certain type of cancer that can be easily mixed up with IBS, and the only way to tell between the two was a biopsy, but the quote they gave me for that was $4.5K Are there any other tests that can be done to confirm her diagnosis apart from that biopsy?

She was on a chicken food and had a bunch of scabs/marks on her ears from itching, which the vet said is an allergy. They have started disappearing since she has been put on the Royal Canin (venison), I have since learned that it may not be the best choice because it has carrageenan which is not a recommended ingredient for cats with IBS. I am wondering if this food is what caused this whole flare up, because she's only been on it for a few weeks and has never had a UTI before (assuming that is in fact what is going on).

Minnie is also on an IBD specific probiotic called Visbiome

The emergency vet gave me 7 packets of FortiFlora, and said to give it to her for the next 7 days. Should I switch to Visbiome once FortiFlora is up, and do probiotics tend to help cats with IBS? I am so new to everything with this syndrome, I hate not being familiar with anything about it...

Just note a script is required for the injectable.

Will definitely be asking her vet for a B12 test when I call them tomorrow!

 

[Critter Mom]

do probiotics tend to help cats with IBS? I am so new to everything with this syndrome, I hate not being familiar with anything about it...

Here's a very good reputable site to start with:

ibdkitties.net

There's info on probiotics, B12 and all manner of things feline IBD. I believe that they also have a support group.


Mogs
.

 

[hellolucy]

Here's a very good reputable site to start with:

ibdkitties.net

There's info on probiotics, B12 and all manner of things feline IBD. I believe that they also have a support group.


Mogs
.

Thank you so much for this site! I was actually just reading through all of it and have to admit, I am extremely overwhelmed Her current food has carrageenan in it, which the site explicitly says is very bad for IBS. I am worried about switching her off of it and setting off a whole chain reaction again, and have not delved in to the raw food world with her yet which it sounds like would be the best option for her. A specialty vet had also mentioned the possibility that this is cancer and not IBS, but I can't afford the surgery/biopsy to confirm. The site was also saying not to feed cats with pancreatitis (which Lucy has had multiple episodes with) any probiotics/digestive enzymes?! Sounds like all of this is such an interconnected catch-22, I don't even know where to start, I have learned so much about diabetes over these past few years and hate not knowing what is going on with her now with IBS and being able to take care of her/make her feel better, a whole new ball game...

 

[Wendy&Neko]

They also mentioned it could be a certain type of cancer that can be easily mixed up with IBS, and the only way to tell between the two was a biopsy, but the quote they gave me for that was $4.5K Are there any other tests that can be done to confirm her diagnosis apart from that biopsy?

It's IBD that cats get, not IBS. You do need a sample to diagnose what you are dealing with, IBD or small cell lymphoma. Treatment is different between the two. Depending on what part of the intestine is inflamed, you can diagnose with endoscopy (I had one done on a kitty for $800) or colonoscopy (same thing, other direction) or surgical biopsy. The latter usually requires overnight at the vet so likely more expensive. Small cell lymphoma is treatable with a mild chemo and the majority of kitties go into remission for a while. It also does not need a novel protein diet.

Visbiome is specially designed for IBD, I would go with that, Fortiflora is only a single strain of probiotic and not sufficient. There are commercially available venison canned foods out there without carrageenan. Ziwipeak is one.

 

[Panic]

Depending on what part of the intestine is inflamed, you can diagnose with endoscopy (I had one done on a kitty for $800) or colonoscopy (same thing, other direction) or surgical biopsy.

Why the high price tags to find out the difference? Wow.

Hope everything goes well with Lucy.

 

[Wendy&Neko]

Why the high price tags to find out the difference? Wow.

Might also depend where you live. The endoscopy specialist I used was a travelling one that came to my vet's clinic - no overhead building costs to pay for.

 

[hellolucy]

It's IBD that cats get, not IBS. You do need a sample to diagnose what you are dealing with, IBD or small cell lymphoma. Treatment is different between the two. Depending on what part of the intestine is inflamed, you can diagnose with endoscopy (I had one done on a kitty for $800) or colonoscopy (same thing, other direction) or surgical biopsy.

Thank you, I did not realize I was using the incorrect terminology! I am going to have to ask my vet for a more cost effective option tomorrow.

 

[Ale & Bobo & Minnie (GA)]

What makes the endoscopy expensive is the anesthesia and the biopsy is also costly because of the lab work needed. Do ask your vet who may have a lesser expensive IM to refer you to, but I don’t think it would be less than a couple K. $4,500 does seem like a lot. @Wendy&Neko if she’s not going to do the endoscopy, can’t she get started on the budesonide?

 

[Ale & Bobo & Minnie (GA)]

If I recall correctly, the b12 blood panel needs to be done on an empty stomach so a little tricky with a diabetic cat. We ran it while Minnie was hospitalized so it was less complicated

 

[Wendy&Neko]

if she’s not going to do the endoscopy, can’t she get started on the budesonide?

No, you need to be on a couple week break from steroids before an endoscopy or biopsy.

 

[Ale & Bobo & Minnie (GA)]

No, you need to be on a couple week break from steroids before an endoscopy or biopsy.

Right that’s what I mean. If she opts not to have the endoscopy done then she can start on budesonide because it won’t make a difference.