IBD?

Hi all, my eleven year old Acromegalic cat Valentino has lost about a pound and a half in the past couple of months and has been experiencing intermittent diarrhea, occasionally outside of the box. On an abdominal ultrasound he did have intestinal wall thickening. Dr. suggests either IBD or even Lymphoma. She prescribed Budesonide... but I am wary on starting him on this. Are there other natural treatments to consider first? Does anyone have any thoughts on this? @JeffJ ? Thank you in advance. Tillie

 

Hi Tillie! I'm sorry to hear Valentino isn't feeling well.

IBD is typically treated with a novel protein diet and probiotics, while Small Cell Lymphoma is treated with budesonide (or prednisolone when diabetes isn't present), usually in combination with chlorambucil (leukaran), a chemotherapy. Both are very treatable and cats can have a great quality of life. If not treated, however, they can deteriorate pretty quickly.

Has your vet discussed a biopsy to rule out small cell lymphoma?

What about a novel protein diet and probiotics? That is likely the safest and more "natural" route to see how he responds.

Budesonide is a cortico-steroid which can help reduce inflammation if it's either.

My cat Fortune was dx'd with IBD in 2013 and SCL in 2018, but I'm just now learning how much I don't know, but sharing what I do in the hopes that it helps!

 

Thanks for writing, @RachelG ! Yes, my Vet mentioned the biopsy but since my boy has just been put through a lot lately with SRT Treatment, echocardiogram, and abdominal ultrasound she is not keen on that right now. I like the idea of trying the novel protein and probiotics first, knowing we can add in the Budesonide if needed. I am going to discuss this with her. Thanks for the good info! Tillie

 

Hi again Tillie! I just posted in your other thread in the acro forum (SRT), and then I saw this. Back in May of last year, Rocket started having bouts of inappetence and bad diarrhea. Since then we've done all kinds of testing (xray, ultrasound, blood panels etc.) and have tried antibiotics, probiotics, etc. Long story of course. We haven't done a biopsy either, as his vet feels this is more likely an inflammation issue and not cancer, though of course it can't be ruled out completely.

About a week ago, we decided to go with steroids because his appetite was getting worse. Waking up in the middle of the night to test / feed him, and then having him turn his nose away from the food, is the worst feeling. He used to LOVE eating. His main doctor had recommended Budesonide (instead of Pred) previously, but they had to order it -- so we started on a couple days of Pred and then switched to Budesonide a couple days later.

I'm sure you know this, but Bude theoretically is a locally-acting steroid, and is supposed to have less of an effect on BG levels than Pred. But Rocket's second vet said more studies have been done on humans than cats with this.

We also gave Rocket Cerenia along with Bude for the first two nights -- his appetite came back within an hour or two. Not sure which med did it, but it was amazing.

Probiotics -- we've been giving him Fortiflora for a while, with mixed results, but it does seem to help. I know it's not the best probiotic, but he won't touch food with S. Boulardii, so what can you do.

I'd love to try a novel protein diet, but haven't yet. Rocket gets bored eating the same thing every day, so I have a feeling it might not work. But we might try at some point.

Anyway, it's only been a week, but so far, so good. His appetite has been amazing. Ok, too good really -- the Bude makes him hungry!!! But he's eating, and his poop is getting better too. Sorry if this was a bit too long, but I hope it helps a little.

 

Thanks for posting here, too, and giving me all this good information!

Did Rocket have the thickening in the intestinal lining too on his ultrasound? I'll be curious to hear how he does on the Budesonide and if it continues to really help him.

Valentino's thickened intestinal lining along with the weight loss and diarrhea is worrisome. We haven't done any other testing for this or tried antibiotics or anything else yet. He still has a very good appetite, but not as ravenous as he was at first with the diabetes. Not sure if that's because his diabetes is becoming more managed, or if it's because the IBD is bothering him. Just hate that he has been suffering so much lately.

Do you give B-12 at all? I'm thinking of going ahead and start giving it assuming that he could use it. Really hoping that if it is IBD it is just in the early stages and not lymphoma. Who knew so much could go wrong?

 

I feel for you, it's so hard to see them not eat!

You may want to consider doing the biopsy sooner than later. Treatment for IBD vs SCL is different, and getting the right treatment sooner can help him long term!

We got the biopsy for Fortune in 2018 after first presenting with thickening of the intestinal wall thickening in 2013. Back then we were told it could be either/or and proceeded with conservative treatment for IBD. He would get what I call "flare ups" and bounce back, so additional testing didn't seem necessary. But in hindsight I don't know if he was actually responding to the IBD treatment.

We give a shot of B12 weekly - .5 ml.

The really great news is that SCL and IBD are both very treatable, and kitties can have a good quality of life. Even though they present the same on u/s, the treatments ARE different.

Big hugs!

 

On my third cat now with small cell lymphoma - sigh! Number 3 started with IBD so seen both sides now. Anyway, for probiotics, Visbiome is s good choice - it's main specifically for IBD. It's just a powder to mix into food and my cat doesn't notice it. Next blood work, you might want to get Valetino's B12 level tested. Many IBD/SCL cats have low levels, meaning food absorption is reduced and contributes to weight loss. None of mine had low B12's so I never had to supplement it.

Two of the cats did prednisoline, Neko couldn't because of her heart condition. Budesonide reduced the inflammation of her bowel walls about 35% so gave her quite a bit of relief.

Neko had a lot of novel proteins, rotated every day: venison, lamb, kangaroo, elk, bison, no chance of boredom with regular rotation.

I agree with Rachel on not waiting too long for diagnosis. Small cell is slow growing, but easier to treat it right if you get it earlier.

 

Agree with others. IBD and intestinal issues often accompany Acromegaly.

Leo developed small cell lymphoma. He received daily chemo, and prednisolone. He did well with the pred. It did raise his BG. But a nice side effect was that it created some hunger as well.

Weight loss often occurs in non-regulated cats. If you can get Valentino into more blues and greens, it will help him absorb more of the calories he is ingesting.

Also - kudos to you for continuing the good care for Valentino. I know just how trying this situation is. Keep up the great treatments. Valentino has a great future.

 

That's great information, RachelG, I didn't realize the treatment course would be different and that they are both treatable. Makes sense to get it straigthened out earlier. I have heard that sometimes the IBD progresses to Lymphoma, so even if he doesn't have it yet, it might turn into that. Thank you for the support !
Tillie

 

What a slog that you have had 3 cats now with lymphoma. What a lot you must have been through with your kitties! I didn't realize that there were so many novel proteins to choose from!

Interesting that it can start out as IBD and later turn into Small Cell. I guess like most things it's best if one catches it early. I will have to follow up with my vet to discuss. I'm going to pay a lot more attention to this now and see what needs to be done. Thank you for everything! Tillie

 

HI Jeff,

That's so kind of you to say, I do appreciate it. I agree, managing the diabetes should help somewhat with the absorption and then of course, making sure that his inflammation subsides. I will have to keep on top of this. Hoping that improvement could come from being more sensitive to his gastro problems and treating with food/probiotics to start. I think because we don't have a definitive diagnosis it is hard to know just how to treat it as yet. I will be following up with my vet with all of the suggestions.

Thank you for all of your support and advice on everything.
Tillie

 

From what I remember (going to the vet is so challenging these days, this was all through a phone call from the vet while waiting in the parking lot), everything mentioned was "inflammation," not thickening. But I'm not sure how they can tell the difference. I have an email from his primary vet from last May (the first incident Rocket had) where he said "clearly no evidence of megacolon, or any organ abnormalities," and also said the ultrasound tech found "enough changes to call it mild inflammatory bowel disease and/or dysbiosis. (GI bacteria not quite right)." But from what @Wendy&Neko is saying, now of course I'm concerned that we need to test for SCL too, of course.

I should mention too that Rocket's diarrhea was a very odd color -- kind of a light-clay brown. His liver showed inflammation too, which could be the cause of this -- but I don't know what's causing the liver issues in the first place. Since starting the Bude it has gotten better though, firmer and a slightly better color. Sorry, gross, I know -- but I think it's all related in Rocket's case.

I have no experience with giving B-12, and I don't think our vet has mentioned it. And I really hope, for both of us, that it is just IBD. I'll keep you posted on Rocket's progress (and if I forget, feel free to send me a PM anytime!).

 

It is so challenging. Handing him off to a place and vet I've never met in person or even on Zoom! But have had great conversations with.

I really hope that is just IBD, too, for both of us, and that it can be well managed and minimized.

I think Valentino's last incident was similar to what you are describing, too. He's had somewhat softer stools and straining for a few months, and then 2 outside the litter box diarrhea occasions. She described it as "thickening" but I haven't seen the actual report, maybe I'll ask for that. And of course some weight loss. That's really great that he has had good results with the Bude. I do think it is somehow sort of all related. The acromegaly can be related to IBD and colon cancer in humans, I read.

Do you remember if Rocket had any ill effects from the Radiation I should look out for? Valentino seemed a little "off" yesterday- like out of it. I wondered if fatigue or headaches can happen after treatment. Do keep me posted on Rocket's progress, good to know i can PM you! Thanks! Tillie

 

I was warned there could get episodes like this in the early days after treatment, possible from swelling from the radiation. Might want to contact the place you had SRT done to see if anything should be done if it continues. I was told a short course of prednisolone in such cases.

 

@Wendy&Neko thanks for that info! He seems better today but I'm keeping a watchful eye on him. Good idea to find out from the provider to see what they suggest.

 

I hope Valentino is feeling better today. Rocket actually handled the treatments very well. The only issue was was with one day of anesthesia -- the office had an emergency come in, and they kept Rocket sedated longer than expected. It took him a while to come out of that. But other than that, he came through like a champ. We haven't noticed anything since; no neurological symptoms or anything like that. We've had tests run for hypothyroid too, and all clear so far!