11/8 Possible IBD/Lymphoma :(

[pablo'smom]

Hi everyone,

Pablo has been doing great up until a week ago. Out of no where he started having explosive diarrhea. The vet prescribed him probiotics and recommended feeding him chicken and rice to help it pass. However, the diarrhea got worse and became water every two hours. We are at Medvet right now and they are most likely going to admit him to make sure he stays hydrated and then get an ultrasound in the morning. Right now it is looking like either IBD or Lymphoma and I am really upset and worried.

With all of this, I have a few questions. If it is IBD or Lymphoma, they would want to do a steroid and I am worried about his sugar. Has anyone had an experience with diabetes and IBD/lymphoma treatment and have any advice/recommendations? Also, as for diet, what are some recommendations? He also has CKD so I would need to find food to balance the GI issues, diabetes, and CKD. He is currently on Weruva BFF play pate.

Any help or advice is greatly appreciate.

 

[Wendy&Neko]

My Neko got a IBD or lymphoma (small cell lymphoma) diagnosis in her 4th year of being a diabetic. She was also CKD. If he needs a steroid, talk to the vet about using budesonide, instead of prednisolone. That is what Neko was on. It is a steroid more locally acting on the gut, and for many cats, including Neko, it did not impact her blood sugars. Neko's heart condition could not handle prednisolone.

After an ultrasound, and if his heart allows, they may suggest a biopsy or endoscopy, depending where any thickening might be. Alternatively the endoscopy could be a colonoscopy. You do need a sample to diagnose whether it is IBD or lymphoma. Treatments do differ between the two conditions. If there are swollen lymph nodes, they can take a needle biopsy and have that sample sent for a PARR test, which is another way to diagnose IBD or SCL. Note, I did have a cat who had both IBD and SCL, though that is more unusual.

Novel protein diets are a good approach for cats diagnosed with IBD. By novel protein I mean something he may not have had before, like lamb, venison, goat, kangaroo, rabbit, buffalo. There are novel protein options that are low carb and lower phosphorus. What proteins does he normally eat? In addition to diet, it's good to add a probiotic and a prebiotic. A good probiotic for IBD is Visbiome. A prebiotic can be something as simple as psyllium husk fiber. For the diarrhea, consider using s. boulardii, which is a probiotic fungus. More information here on it and dosing: Probiotics – IBDKitties.

SCL kitties usually get a course of a mild chemo drug called chlormabucil. The best dosing method is a dose given every two weeks. SCL cats can go into remission.

SCL kitties don't need a novel protein diet, but can still benefit from probiotic and prebiotic. SCL kitties may not need to be on a steroid once the chlorambucil has started to work to reduce the inflammation. Or it can be tapered down. Some IBD cats are on steroid for life.

Good luck, keep us posted on how Pablo is doing. GI issues are unfortunately rather common in acro kitties.

 

[pablo'smom]

My Neko got a IBD or lymphoma (small cell lymphoma) diagnosis in her 4th year of being a diabetic. She was also CKD. If he needs a steroid, talk to the vet about using budesonide, instead of prednisolone. That is what Neko was on. It is a steroid more locally acting on the gut, and for many cats, including Neko, it did not impact her blood sugars. Neko's heart condition could not handle prednisolone.

After an ultrasound, and if his heart allows, they may suggest a biopsy or endoscopy, depending where any thickening might be. Alternatively the endoscopy could be a colonoscopy. You do need a sample to diagnose whether it is IBD or lymphoma. Treatments do differ between the two conditions. If there are swollen lymph nodes, they can take a needle biopsy and have that sample sent for a PARR test, which is another way to diagnose IBD or SCL. Note, I did have a cat who had both IBD and SCL, though that is more unusual.

Novel protein diets are a good approach for cats diagnosed with IBD. By novel protein I mean something he may not have had before, like lamb, venison, goat, kangaroo, rabbit, buffalo. There are novel protein options that are low carb and lower phosphorus. What proteins does he normally eat? In addition to diet, it's good to add a probiotic and a prebiotic. A good probiotic for IBD is Visbiome. A prebiotic can be something as simple as psyllium husk fiber. For the diarrhea, consider using s. boulardii, which is a probiotic fungus. More information here on it and dosing: Probiotics – IBDKitties.

SCL kitties usually get a course of a mild chemo drug called chlormabucil. The best dosing method is a dose given every two weeks. SCL cats can go into remission.

SCL kitties don't need a novel protein diet, but can still benefit from probiotic and prebiotic. SCL kitties may not need to be on a steroid once the chlorambucil has started to work to reduce the inflammation. Or it can be tapered down. Some IBD cats are on steroid for life.

Good luck, keep us posted on how Pablo is doing. GI issues are unfortunately rather common in acro kitties.

Thank you so much for all the help. It's so frustrating and feels like a set back considering he has been doing really well lately.

He currently eats chicken based food now. I'm going to look into different food options that are not chicken based as that might help. Do you have any recommendations of brands that are low carb and low phos?

I'll keep you updated once I get his ultrasound results tomorrow. The vet said it could be acute pancreatitis, IBD, lymphoma, or even a B12 deficiency or a combination of those. His pancreas enzymes were mildly elevated but not enough to say it's acute pancreatitis without an ultrasound. His platelets were also low but they believe it's from clumping so they are doing a blood smear and sending blood out to a lab to confirm. Other than that, his kidney values were really good, glucose 114, and all this other labs were normal. I felt bad admitting him until tomorrow as he was purring and not acting in any pain but I know he is better off there than at home.

 

[Wendy&Neko]

Rawz, Koha, Nature's Variety Instinct, Merrick, Lotus, Evo, Fromme, Fussie Cat, Hounds & Gatos, Nature's Logic, Identity. I'd have to spend some time researching them to figure out which are low phosphorus. A number of people here feed Rawz and Koha, can't remember what else. I've tried some on the list with an IBD kitty. You will have to take a close look at ingredients. If he can't do chicken, I might avoid turkey and duck to start. Fish and beef are also common allergens. So look for rabbit, pork, lamb, goat, kangaroo, venison, buffalo, etc. Pick one protein and try it for a while. Another option for IBD is raw food or freeze dried raw. Those are usually not mixed proteins and might even open up more protein options. My local raw food store even had water buffalo and ostrich! Tip, try the cheaper meats first or he'll only love the expensive ones.

Cats with IBD or SCL are often low in B12, though my IBD/SCL kitties were always fine on B12. Hopefully he's getting bloodwork done to test his B12? No need to supplement if he's already OK with it. Did he get a SpecfPL test done? Pancreatitis is also a common companion for with IBD or SCL. A Primer on Pancreatitis

 

[pablo'smom]

Update:

He came home Tuesday night. His ultrasound showed mild to chronic pancreatitis which we expected with the diabetes and also showed GI inflammation which could be from the diarrhea, IBD, or small cell but we can't tell without a scope and biopsy. His vet said before doing an endoscope and biopsy to try changing his diet to Hill's biome and giving FMT. The FMT capsules have not come in the mail yet and I was able to switch him yesterday to the Hill's but he is not the biggest fan of the food (no surprise). We are still having watery diarrhea even though it subsided for the most part in the hospital and then returned when he got home. I also ordered Koha rabbit because I may have to try that if he won't eat the Hill's biome. I know the food is not great for CKD, but my priority is getting calories in and to resolved the diarrhea then deal with that. Also, he is still losing weight and drinking more water and I have not given him insulin since Saturday because his sugar both at home and the hospital hasn't been high. Please pray we resolved all of this soon. He is scheduled for a tentative scope and biopsy on Wednesday if this diarrhea doesn't resolve soon. I also will talk to his vet about considering a steroid if we don't see improvement.

On the good side of things, he does have an appetite and lots of energy and thankfully his sugar has been okay. He has been very social and playful.

 

[Wendy&Neko]

The biome is high carb, be prepared for higher numbers. There are lots of commercially available novel protein foods you can try that are low carb. I tried the FMT capsules with my IBD cat. Didn't do a thing for her. ECID. Maybe it'll help Pablo.

Endoscopies only work in certain situations, depending on what part of the small intestine is inflamed. With diarrhea, it is more likely the back end, so the endoscope could do the equivalent of a colonoscopy. As long as the inflammation is not in the interior wall of the intestines. In which case a surgical biopsy is needed. Do you have the language in the ultrasound report talking about the inflammation and where it was?

If the Koha rabbit works, you can always add a phosphorus binder to make it CKD friendly.

Have you tried psyllium husk fiber and/or s. boulardii to help with the diarrhea?

 

[pablo'smom]

The biome is high carb, be prepared for higher numbers. There are lots of commercially available novel protein foods you can try that are low carb. I tried the FMT capsules with my IBD cat. Didn't do a thing for her. ECID. Maybe it'll help Pablo.

Endoscopies only work in certain situations, depending on what part of the small intestine is inflamed. With diarrhea, it is more likely the back end, so the endoscope could do the equivalent of a colonoscopy. As long as the inflammation is not in the interior wall of the intestines. In which case a surgical biopsy is needed. Do you have the language in the ultrasound report talking about the inflammation and where it was?

If the Koha rabbit works, you can always add a phosphorus binder to make it CKD friendly.

Have you tried psyllium husk fiber and/or s. boulardii to help with the diarrhea?

I think his vet wants to do both an endoscopy and colonoscopy while he's under, but I need to confirm with her. And I do not have access to the report from the radiologist but his vet wrote in the discharge summary that there was diffuse inflammation of the small bowel.

I have a phosphate binder already, so I'll make sure to add that to the food and hopefully that'll help.

I haven't tried husk fiber or s. boulardii but I'll put that on the list of things to try if he doesn't improve. I'm trying to add things slowly and not overdo it all at once. It's a very frustrating game of trial and error.