IBD, Pacreatitis, and Possible EPI

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KPassa

Member Since 2012
Hi Everyone! It's been a while. Michelangelo is still doing great and is now 9 years into his FD diagnosis! I also adopted another diabetic, Finnegan, back in 2017 and he is the one I'm posting about now.

History:
Finn is between 11-13 years old and the sweetest orange boy ever. He has had a history of IBS and possible pancreatitis symptoms since I got him that I've been treating as they come up. I don't use facebook so I haven't been able to join any of the IBD groups but I've spent extensive time researching the available sites (ibdkitties.net, foodfurlife, rawfeedingforibdcats, etc...) and have been using their suggestions with changing his diet, cyano-B12 shots, s. boulardii, and SEB to manage his symptoms successfully at home for the past couple of years.

The last couple of months, however, has been terrible. He has lost about 2 pounds and food goes right through him. He's in the litterbox shortly after he eats and has diarrhea about 4 times a day, mostly lakes, rarely a couple of pudding pieces mixed in. I initially took him to the vet because I wanted to make sure he was hydrated (they've given him subq twice), get him a steroids script, and/or confirm that it wasn't EPI and thus started the vet visits (6 so far at $300-400 a pop because it's all "urgent" unless I want to wait till February for an appointment).

(Side bar: is there a vet shortage everywhere or just here in PNW?)

The vet did an ultrasound and confirmed that he has thickened intestinal walls and probable chronic pancreatitis and prescribed Proviable probiotics (did nothing) and paste (which is basically kaopectate???), plus antibiotics for a slightly elevated white blood cell count (stopped giving after the first dose made him vomit everywhere). After a bunch of issues with scheduling appointments and trying to get them to do something other than make me pay for elective services and medicine that aren't actually treating the problem, I ended up finding a new vet. This vet is willing to do the EPI test but now is going on and on about hydrolyzed foods and how I'm managing his diabetes wrong because Levemir is not an insulin for cats and I test too much (~4 times daily) and basically I'm firing this vet as well as soon I get this FTLI test done and a prescription for pancreatic enzymes (if it's EPI) or steroids (if it's not EPI).

I also recently got him the AnimalBiome report and their gut maintenance supplement (which turned out to just be s. boulardii and probiotics :banghead: ) but I will also be starting him on their oral fecal transplant pill (probably today when he's back from the vet). ETA: I also have been giving him pumpkin off-and-on to help firm up his stools and make them smell better because otherwise, my other cats pee everywhere. The AnimalBiome report said he needed more fiber and so the last week I've switched him from pumpkin to psyllium husk.

His appetite is ravenous and he rarely vomits (no food, just foam maybe once a week after eating grass). Food is all low-carb, wet, limited ingredients ranging from pates, frozen raw (Darwin's), freeze-dried raw (Stella and Chewy's), to even baby food (beechnut). I've tried everything from beef/chicken/turkey to goose to duck to venison to pork (it all goes right through him). The last few days I've been feeding rabbit and that seems to have helped more than anything else I've tried this last month. He's had (mostly) solid poop the last couple of days and bowel movements only twice a day instead of 6 times a day. (It might be the rabbit or the psyllium husks or both ¯\_(ツ)_/¯ )

Anyway, I am at my wit's end and don't know where to go from here. Any suggestions, words of comfort, advice?

He also had a blood panel done and all his values are within normal range (except glucose, of course). I'd share it here but the first vet still hasn't emailed it to me (part of why I fired them). I also haven't updated anyone's spreadsheet in a year (still keeping track on paper), but I'll try to get on that sometime soon.
 
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Wow, lot to unpack!

First I impression is I think you've done all you can to manage symptoms just based on diet and more naturopathic sort of techniques. Perhaps it is time to consider something like prednisolone for the IBD? Since the ultrasound found thickening of the walls, the pancreas stuff is secondary really (I'm currently going through same thing).

FYI from the reading I've done, the only way you can truly distinguish IBD from something like SCL is a biopsy. I personally am choosing not to do that. The treatment for both, after the dietary stuff, is rather the same. A corticosteroid (prednisolone appears to be drug of choice, but a lot of people use budesonide as well for lesser impact on blood sugars...but it is harder on the liver), and if that doesn't resolve/help improve things after some time, the addition of chemotherapy like chlorambucil.

My plan of attack is to wait til he shows GI symptoms (currently has none except coat discoloration). Then do exactly what you've done re:diet etc. And if that doesn't help, prednisolone. And after that, chlorambucil.

From what I understand the key it to give each "treatment" time - it takes time for the inflammation to happen, also takes time for it to go away.

I'm new (as of 2 days ago) to the IBD/SCL path so will also tag @Katherine&Ruby for her thoughts
 
Also vet shortage here as well, or rather takes forever and a day to get an appointment
 
Thanks for the tag, @FrostD. Sorry to hear that your Finn is having such a hard time. It seems like you've done everything in your power outside of an endoscopic biopsy to help him. I'm curious about the poop pill--I've seen many people use it to mixed results on the Raw Feeding for IBD cats FB page. I would stop feeding him the freeze dried prepared raw foods as those have bones in them and aren't good for an older cat's kidneys--how has his bloodwork been with regards to creatinine and BUN levels? With a ravenous appetite, I would not think CKD would be an issue for Finn, but feeding him lower phosphorus foods will be better for him in the long run. I feed my cats raw ground meat with EZ Complete.

My Ruby was diagnosed with SCL after she was losing weight and vomiting several times a week. She had multiple ultrasounds showing thickening in the intestines, the jejunum specifically. Tried feeding her raw, tried novel proteins, probiotics, fibers of every kind in case it was IBD and she didn't respond to any of it. It was only after an endoscopy that I realized that all that I did would have helped anyway because she had SCL. She was tightly regulated and as close as you can get to remission when we had to introduce pred, and that was a total game changer. No more vomiting, she's gained a pound, eating well and much more herself. Sadly her diabetes is hard to control as a consequence of the pred, but I would not ask for anything different. She had another ultrasound a few weeks ago and the thickening of her intestines is completely gone. She's 11 years old and has a good number of years ahead of her, and at some point we will probably have to introduce chemo, but until then she is cruising along and being a happy and content kitty.

I give Ruby Visbiome probiotics, which has the highest number of good gut bacteria of any product on the market. I don't know for sure that it serves any purpose but it's recommended by vet specialists in intestinal disorders.

Finally, FWIW, I am not opposed to hydrolyzed wet foods if he has an allergy that is causing the diarrhea. You would simply have to increase his insulin to combat the extra carbs. @Butters & Lyla is doing this with her FD cat with excellent results after feeding Butters raw for most of her life.
 
FYI from the reading I've done, the only way you can truly distinguish IBD from something like SCL is a biopsy. I personally am choosing not to do that. The treatment for both, after the dietary stuff, is rather the same. A corticosteroid (prednisolone appears to be drug of choice, but a lot of people use budesonide as well for lesser impact on blood sugars...but it is harder on the liver), and if that doesn't resolve/help improve things after some time, the addition of chemotherapy like chlorambucil.

:bighug:So sorry that we've both found ourselves here!

I'm not bothering with the biopsy, either. The first vet really tried to push it and I was like "why? I can't afford all that when you treat both the same anyway." They also kept brushing me off on the FTLI test and steroids prescription because I refused to buy the high carb hydrolyzed food from them.
 
:bighug:So sorry that we've both found ourselves here!

I'm not bothering with the biopsy, either. The first vet really tried to push it and I was like "why? I can't afford all that when you treat both the same anyway." They also kept brushing me off on the FTLI test and steroids prescription because I refused to buy the high carb hydrolyzed food from them.
Ruby's primary vets were all ready to write the scripts for steroids and chlorambucil, but I was the one who insisted on the biopsy before starting treatment because I was so close to remission and didn't want to give meds that would alter her glucose levels unless I absolutely had to. I was heartbroken and so scared when I got her SCL diagnosis and her BGs went steadily higher and higher after the steroids, but I've come to accept it, especially now that I see how well she is doing on it.
 
Thanks for the tag, @FrostD. I would stop feeding him the freeze dried prepared raw foods as those have bones in them and aren't good for an older cat's kidneys--how has his bloodwork been with regards to creatinine and BUN levels? With a ravenous appetite, I would not think CKD would be an issue for Finn, but feeding him lower phosphorus foods will be better for him in the long run. I feed my cats raw ground meat with EZ Complete.

I did not know this! I only use the freeze-dried raw as a treat and I've already been tapering off it the last few weeks because I've been really trying to stick to only one protein at a time to try to narrow down which one is causing the issue. (Right now, Stella and Chewy's rabbit because I'm feeding him the rabbit pate.) According to the vet, "he is the healthiest sick cat" and all his levels are "surprisingly" normal for an older, diabetic cat. Slight creatine elevation but nothing out of normal range.

Thanks for the tag, @FrostD
Sadly her diabetes is hard to control as a consequence of the pred, but I would not ask for anything different. She had another ultrasound a few weeks ago and the thickening of her intestines is completely gone. She's 11 years old and has a good number of years ahead of her, and at some point we will probably have to introduce chemo, but until then she is cruising along and being a happy and content kitty.

I give Ruby Visbiome probiotics, which has the highest number of good gut bacteria of any product on the market. I don't know for sure that it serves any purpose but it's recommended by vet specialists in intestinal disorders.

Finally, FWIW, I am not opposed to hydrolyzed wet foods if he has an allergy that is causing the diarrhea. You would simply have to increase his insulin to combat the extra carbs. @Butters & Lyla is doing this with her FD cat with excellent results after feeding Butters raw for most of her life.

Agreed. The diabetes is secondary to his IBD at this point. Covid made my career a permanent work-from-home position so I can monitor his BGs anytime day/night.

Thanks for the probiotics recommendation! Do you have a link you might be able to share? I've been looking for something cheaper than the proviable or animalbiome ones.

I have a visceral hatred for "prescription" food for a lot of different reasons but there are exceptions (a/d when a cat is sick, for example). I'd really rather exhaust all other options before going the hydrolyzed prescription route.
 
Glad to know that his kidney levels are ok.

https://www.visbiome.com/

I get it directly from the company as it's the cheapest option, though it's probably one of the most expensive probiotics out there because of all of the good cooties in it. :) I get the human version because it's the same exact thing as the pet version. Don't get the mix as that has flavorings and sugar that are not good for cats.

I hear you about the prescription food thing. I don't ever want to go back to giving those huge pet food manufacturers my money considering all of the damage they do to the world and to our pets. It's there in case you exhaust all possibilities. It may help.
 
Did the vet do a thyroid panel as well?
Sometimes it’s worth doing more that just a T4 — I’ve always been told that a full panel, especially the Free T4 (by ED) can be more diagnostic.
 
I hope they did a full thyroid panel because I asked and paid for it. But they said everything (besides glucose) was normal so I assume his values were good. And I still haven't gotten the lab results from them. :arghh:

In better news, Day 3 of mostly solid poop!! Either the rabbit and/or psyllium husk seem to be working! Would this be the case even with EPI? He just got his blood drawn this morning for the fTLI test.
 
FedEx is terrible and I still haven't gotten a rabbit order refill (it was due to be delivered on Tuesday but now my "package will arrive in a few days"). I ran out of rabbit last night and had to go back to feeding him some of the other foods I've tried over the last two months and his diarrhea has returned. So, it's definitely the rabbit that seems to have done the trick for Finn. I'm going to the pet store today to see if I can find some rabbit on the shelves to hold us over till my Chewy's order arrives.

I finally got his blood panel from the first vet this morning. It looks like they didn't do the additional thyroid testing like I asked for. :banghead: How do I upload it? When I click "Upload a File", it says I don't have permission.
 
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The file upload feature is kaput. You can take a screenshot of your labs on your phone and then copy and paste.

Best thing to do is put the labs in his spreadsheet. There is a labs tab on the newer version of the FDMB spreadsheet for you to manually enter in all of the values. You can see mine in Ruby's spreadsheet. It's nice to see all of the labwork at a glance so you can compare to previous values.

Maybe @Bandit's Mom can help you add that?
 
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Also, in case anyone is interested, here is a snapshot from Finn's AnimalBiome report:
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Vital Essentials freeze dried has Rabbit. You can mix with water to what texture you want. Chewy has it.

Also Meat Mates freeze dried I like better because it doesn't have bone in it. I do not know if it comes in rabbit. Chewy again.
 
Also, in case anyone is interested, here is a snapshot from Finn's AnimalBiome report:
View attachment 63212
Hi Kay

I’m glad Michaelangelo is still doing well. I remember when you first came here with him as a tiny kitten. Hard to believe he’s 9 now.

The only way to diagnose EPI is with the tests through Texas A&M. I really recommend the GI Panel there (it only requires a six hour fast for a diabetic cat). I don’t understand why any vet would deny you that and if he/she is, I’d find someone else although I understand there is a vet shortage; however, you are in SoCal so surely you can find a vet that can help you out. To have a vet say they won’t run the test unless the cat eats a hydrolyzed diet? Well....news for them.....balanced raw diets also work great for EPI cats. But that also seems malpractice because how ethical is it to prescribe a treatment without a dx? You might want to put it that way and also perhaps in a way they can relate such as, if they had shortness of breath, would they allow a doctor to treat them for COPD without making sure there wasn’t a heart issue?

Here is some good info written by a friend of mine who has had several EPI cats.
 
Hi Kay. I’m so glad Michaelangelo is doing well.

Do you have a Centinela Feed near you? They carry lots of raw rabbit choices. I know they have frozen Small Batch, Primal, and Stella and some of those in freeze dried. I use frozen.
Everyone here is having trouble finding a vet near me. Where in LA are you? If not too far from West LA I might be able to help you get in to see my vet. PM me if you are interested. I’ve been with him for many years. I also know if another you could see at least to get the test for epi done.
 
I'm no longer in SoCal and moved up to the Portland area a few years ago. I'm still waiting on the results of the FTLI test. I've called the vet twice today and they have the results but the doctor still hasn't called me back yet to tell me what they are. I am so frustrated with the vets up here. I have a pending at-home vet visit from a 3rd vet for Mikey's allergic reaction/pillow foot thing that's going on. It was supposed to be this Thursday but they just rescheduled to next week.
 
The only way to diagnose EPI is with the tests through Texas A&M. I really recommend the GI Panel there (it only requires a six hour fast for a diabetic cat).

Here is some good info written by a friend of mine who has had several EPI cats.

The (second) vet actually sent us home the first day* because Finn had fasted 10 hours and they said he needed to fast 14. So I brought him back the next day after having fasted 12 hours. I lied and told the vet it was 14 because all the EPI pages said 6-12 hours was fine for FTLI and this vet has already talked down to me and scolded me for his diabetes management and I wasn't interested in trying to further educate the unwilling.

That EPI page has been so helpful and it's what led me to getting Finn tested in the first place.


*this was actually the second day of vet visits because they had an emergency come in the day before and we got sent home without being seen. So not only did I have to find a new vet, I then had to take Finn to the new vet three days in a row just to get one measly blood test done.
 
The (second) vet actually sent us home the first day* because Finn had fasted 10 hours and they said he needed to fast 14. So I brought him back the next day after having fasted 12 hours. I lied and told the vet it was 14 because all the EPI pages said 6-12 hours was fine for FTLI and this vet has already talked down to me and scolded me for his diabetes management and I wasn't interested in trying to further educate the unwilling.

That EPI page has been so helpful and it's what led me to getting Finn tested in the first place.


*this was actually the second day of vet visits because they had an emergency come in the day before and we got sent home without being seen. So not only did I have to find a new vet, I then had to take Finn to the new vet three days in a row just to get one measly blood test done.
I hope you get a dx. The thing about EPI is it can be successfully treated.
 
Hello Kay, good to see you. Great Mikey update. Sorry about Finnegan. And the vets.:banghead:
The treatment for both, after the dietary stuff, is rather the same.
Not really. They are different and you really don't want to have to start chlorambucil (a carcinogenic on it's own) unless you need to. I am on my third SCL kitty, been dealing with it at least 6 years now. :rolleyes: Today was chemo day here. Oh, and cats can have both IBD and SCL. SCL kitties can usually taper off of steroids after a while, IBD ones may need to continue, especially for flairs.

I second the Visbiome probiotic.

Thanks for posting the Microbiome report - very interesting.
 
Ugh! Vet never called yesterday so I've gone around them and just asked the vet tech to email me the results as if I already got them and lost them. So, fingers crossed, I should have the FTLI results by the end of today.

I hate all of this so much and feel like I've already lost a month and a half of helping Finn just because I keep getting the runaround with these terrible, no-good vets up here.
 
If it is confirmed he has EPI, then it might take several more weeks for the vet to actually give me a prescription for the pancreatic enzymes, plus the delayed delivery of the pancreatic enzymes due to covid, christmas, supply chain, fedex sucks, whatever the excuse.

Where else can I purchase animal pancreatic enzymes besides online? There is a butcher shop in my neck of the wood where I can get pretty much anything, including actual pancreas. Would this work as a temporary substitute? If so, which pancreas is the best? Beef, pork, venison, some other?
 
Woohoo! Vet just called and it doesn't look like he has EPI so I finally got a steroid script for budesonide!

I took Finn to the vet for his IBD the first time on November 7th and it's taken two vets, $thousands of dollars, 2 pounds off Finn, and 44 days to finally get a steroids prescription.
 
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SCL kitties can usually taper off of steroids after a while, IBD ones may need to continue, especially for flairs.

Yeah, the plan is to see how he does on the budesonide for a couple of weeks and either reduce or taper off, if possible. If he's able to taper off, then I might look into getting that SCL biopsy finally.
 
I think months instead of weeks for steroids. SCL tapering is closer to a year.
Good to know. The vet only prescribed a 30-day supply so we can "re-evaluate dose" if need be. I asked point-blank if they would refill the prescription without seeing Finn again (because of all the "scheduling issues") and they said they would renew the prescription anyway.
 
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