Budesonide use and IBD

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Harley and Pattie

Harley and Pattie

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It has been many months since I have posted. Harley is still with me after a long ordeal with diabetes. Finally he was diagnosed with IBD and is on Metronidazole. The vet also prescribed budesonide, which he has been on for 80 days. Since it is a steroid, do I need to be concerned that he has been taking it for so long.

Pattie and Harley
 
With IBD, with some cats you can get the inflammation under control and then wean them off the steroids -- but you may have to return to the steroids on an occasional or permanent basis should the IBD flare up again. Other cats, they need the steroids permanently to control their IBD. Gwyn was pretty permanently on prednisone for 16 years for IBD; every time we tried to wean her off, we were unsuccessful.

Steroids come in different flavors, and every cat reacts to each one a bit differently. Budesonide is often a good steroid for IBD as it specifically targets the intestinal tract. Metronidazole is also often used. If your concern is that the steroids may affect his blood sugar levels, every cat is different; you'll need to track BG levels to see whether / how much the steroids are affecting her BG levels. Some cats have no or only very minor fluctuations; others are much more sensitive. But if Harley needs the steroids to control his IBD, then he needs the steroids; you work the insulin needs around the steroids, increasing / decreasing dosages as needed.

If your concern is regarding long-term steroid use, then, yes, there are some risks. I've not used budesonide, and am not familiar with the long-term effects of metronidazole; most of my experience is with prednisone. So, speaking about steroids in *general* then, besides the possible effect on BG levels, IMO the two most important possible side effects are cataracts and a lowered immune system; and, if your cat has heart or circulatory problems, I would also include the risk of hypertension. But please read the package inserts for the metronidazole and budesonide (or look them up online) and see what the specific long-term cautions are.
 
Harley is on FF and Special kitty from Walmart. I don't think it is any allergy to food but I don't know much about IBD. Thanks for your help.

Pattie
 
My Bailey has been on budesinide for over a year and I expect to continue it until the end. In the past I had my civi Spot on Budesinide and Metronitizole till the end. I have not really changed Bailey dies since it hard to get him to eat anything but I keep trying.
 
Thank you, thank you, thank you. I have worked really hard to keep Harley with me and the use of steroid worried me. The vet is thinking of taking him off the metronidazole and just using the budesonide. It calms my worries to know others are using the same thing without problems.

Pattie
 
Hi,

We've had a long IBD (and now diabetes) road with Odie these last 16 months. Dexamethasone caused the diabetes. We've recently switched to Budesonide. So far, so good. He's on the maximum dose, 3mg per day (and Chlorambucil/Leukeran, Pepcid, and Lantus).

As far as I can tell, he will be on these long-term. We can't get his IBD under control otherwise. His internal medicine specialist is hoping that the diabetes will go away now that the Dex is out of his system because the Budesonide is more local-acting and will hopefully not affect his BG. However, so far (it's been about 2 weeks completely Dex-free) his BG numbers have not returned to normal enough levels for me to stop the Lantus. They're not *bad* (mostly in the "blue" range with Lantus), but not good enough yet.

Odie seems to be feeling better on the Budesonide than he has since he first got sick. He's playing again --- after moping around for 16 months.

Odiesmom
 
> I don't think it is any allergy to food

Sometimes a food allergy can cause digestion problem symptoms that are similar to inflammatory bowel disease. IBD is formally diagnosed with either an endoscopy or an intestinal biopsy. If Harley was diagnosed in a different manner, it's possible that he actually has a food allergy or some other problem. It may be worth trying foods with no (or novel) grains and novel proteins, just to see whether that makes a difference in Harley's symptoms.


> but I don't know much about IBD.

A lot of cats with IBD and some other gastrointestinal issues have problems absorbing B-12 from their food, and a lack of B-12 can cause digestive issues (vicious circle). You may want to check with your vet about B-12 injections. They've given subcutaneously (like insulin), and you can use your insulin syringes to give them. Your vet should be able to sell you a bottle or you may be able to find it at your local feed store; my bottle cost about $12 from my vet and lasts for well over a year (and we were giving extremely high doses, so yours should last much longer). Most folks trying B-12 supplementation start with the TAMU protocol here http://www.cvm.tamu.edu/gilab/research/cobalamin.shtml and then adjust it to their cat's needs.

There are two main types of inflammatory bowel disease. By far, the most common is the diarrheal form; less common is the constipating form. In addition to the steroids that your vet is prescribing and beside the possible food change and B-12 supplementation, you may want to try things to help with the common issues (if you aren't already or have temporarily discontinued them). For example, if Harley has the diarrheal form, you might try probiotics or yogurt; if he has the constipating form, you might try supplementing with Miralax+water or with Zantac.

If Harley has the diarrheal form of IBD, then you might also want to consider switching to a raw food diet, which can be very beneficial to cats with diarrheal IBD. Additionally, most of the raw food diets are low-carb, and you can get many types with with no (or novel) grains and novel proteins, to see if that helps with his issues. Raw food diet warning: a raw food diet is usually fine for 'normal' cats and can be extremely beneficial in cats with diarrhea problems. However it can be helpful or *extremely* contra-indicated in cats with constipation problems: in the 16 years Gwyn had constipation problems, the worst thing we *ever* did was try transitioning to a raw food diet for a month. If Harley has constipation problems and you decided to try a raw food diet, *please* monitor his bowel movements / straining / etc very carefully!

When we tried a raw food diet, we tried Nature's Variety, mostly because they had a trial buy-one-get-one-free coupon that you could sign up for here http://www.naturesvariety.com/tryit . You'll need to know the name of the store you're getting it from though; if you decide to try it, you can use their online store locator to find a local store and then call the store to see what they have in stock.

Also, if Harley is prone to constipation issues, I would recommend bookmarking this article on the management of constipated cats http://www.theveterinarian.com.au/clinicalreview/article757.asp. Table 2 was my bible for quite a while; it gives a selection of various drugs that can help with constipation in various ways. So if the constipation gets worse or the cat stops responding to one medication, you can look into supplementing or replacing the current drug regime with other that may complement or replace the current ones.


There's also a feline IBD YahooGroup. The old one, unfortunately, closed down; the new one is here http://groups.yahoo.com/group/felineibd1. I'm not familiar with the new group, but the old group was mostly familiar with the diarrheal form; if Harley has the constipating form then, with each piece of advice they give, please check whether it's appropriate for the constipating form: although there are some things that can be helpful in treating both forms, quite obviously things that can help with diarrhea can be wildly inappropriate for treating constipation.
 
Boomer has IBD too and he was diagnosed via an endoscopy. His affected area is the lower intestine if I remember correctly. He doesn't have constipation or diarrhea; he just pukes. He started showing symptoms when he was still a bitty baby and it took my vet forever to figure out what was wrong. It was a TOUGH time. When she figured it out she put him on pred which worked great....however......it gave him diabetes. :-x She told me there was a chance he'd get it but brushed it off because he was taking a small dose of pred. About a year later he was dx'd with diabetes. Grrrr. Then we switched to budesonide and he's done fine on it - a few pukes here and there. He's been on Lantus since November 9th (but who is keeping track? :lol: ) He's down to one drop twice a day and it's been this way since March 1st. He's almost to a OTJ trial. Budesonide has worked well for him.
 
I really don't know what type of IBD Harley has. There was never any stool problems. One day, he just quite eating. Because he has had so much problems with insulin and ketones, I immediately took him to the University Vets. There they did an intestinal biopsy and it came back with a diagnosis of IBD. They have done every other test known on this poor kitty with everything being negative,including B12 which was normal, no absorption problems. The budesonide is working but I was nervous about doing it long term. He is also on the med Metronidazole (which the vet wants to discontinue and just keep with the budesonide). Harley has been a difficult cat to manage. He is now on 6 units Lantus AM and 5.5 units PM. With the start on the metronidazole and budesonide, his bs have been better but not perfect.

Pattie
 
> There they did an intestinal biopsy and it came back with a diagnosis of IBD.

Okay, then it's an official diagnosis of IBD, which is good -- you know *exactly* what you're dealing with. (I'm a huge fan of proper diagnostics.)

At some point in time, you might consider getting a copy of the biopsy report from the university vets, just for your records. I always tried to get copies of the reports and lab work from my vets, just so I could be sure that everything was easily to hand. That way, when I needed to see a new vet / specialist / whatever, we didn't have to chase down records from other places, and I also didn't forget about some person that she had seen a few years back. (Gwyn had a lot of problems and saw a *lot* of specialists over the years.) It's also a small bit of extra insurance in case something happens to your vet's records (some places keep records for limited times, or they could be lost or damaged or misplaced). Just my .02.
 
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