Our story. What would you do next? Thanks.

Squeaky was a foster who had some digestive issues when a kitten, my guess is partly because the humane society started him at 4 weeks on dry food. He came down with asthma at age 1 year, I began feeding him raw and exercising him but had to start giving him an inhaler at 2 years. We've been doing well with the asthma since. He's had allergies to poultry and rabbit. Fish immediately causes coughing.

Long story short. He was terribly stressed and started vomiting about 4 years ago. One vet, Dr. Angie, tried treating him unsuccessfully. I took him to another vet, whose treatment was to take him off of ALL carbs and feed meat only. We used chicken and he did fine on it for a while. The vomiting changed to be diarrhea. She tested and diagnosed IBD and pancreatitis, and started him on meds. He did fine on small doses for a while, then got way worse.

Until about a month ago or so, my first vet ended up having him on 12 mgs of prednisilone, 8 mgs of cerenia, .2 ml of buprenorphine, 1 shot of B12. Chicken, no carbs at all, for diet. She told me the buprenorphine was not actually for pain, but it enhanced capillary blood flow in the pancreas. And his diarrhea kept getting worse. Pandemic hit..... Then came a $900 vet bill but no solutions and not much in the way of communication or instruction. Leaving me hanging. With a terrible case of diarrhea. She recommended chlorambucil. But she didn't give me any instructions on how to transition from prednisilone to chlorambucil. I was reluctant to give it without instructions or coaching. Seemed to me like he was on a LOT of meds.

So I went back to Dr. Angie because she does house call visits, even during the pandemic. She came over to the house. She wanted him off the pred (told me it causes diabetes), and off the buprenorphine (nothing in the literature indicates it increases capillary blood flow in the pancreas). So I started decreasing both. She coached me on starting to give him chlorambucil 2 days a week.

Right around the time I switched vets, I took him off the chicken (he was showing signs of allergy to it, losing hair on back legs) and started him on pork. He began doing better. A friend did animal communication and he asked for beef hearts, so I got that and he gobbled it. That seemed to have a good effect, too. He told her he hated the buprenorphine, said it hurt his mouth every time (oral squirt). He always hated getting that medication.


Then we started the chlorambucil 2 days a week and continued reducing prednisilone. Squeaky was doing okay, but still had diarrhea. Dr Angie said increase chlorambucil to 3 times a week. Then the stools turned black and were horrible runny diarrhea. She said to stop chlorambucil.

On one particularly bad morning for Squeaky, I didn't have the heart to give him the buprenorphine (which I had been slowly reducing) and hurt his mouth, so I just stopped. I also stopped giving him the cerenia and I stopped the prednisilone too. (I kept giving the weekly B12 shots.) For a few days he had no meds at all. Wow he seemed better. Then the diarrhea started up again, so I resumed giving him 2.5 mg of pred each day. That helped.

All along, he would have up days and down days. Diarrhea and lethargy, then a bit better, then back again. It's been a roller coaster and a merry go round. Nobody could get the diarrhea stopped, and this has been going on for about 3 years. Talk about "whole house litter box" because he couldn't control the diarrhea. All along, this last several months, he kept drinking more and more water. So finally Angie said, take him to an affiliated clinic for diabetes test. It was positive. That was about 10 days ago. And here we are.

This week, after the diabetes dx., Angie wanted me to reduce the prednisilone to 2.5 mg every other day. The first off day, he had vomiting and diarrhea. The second off day, vomiting. So I increased him back to 1.25 on the "off" day (Sunday of this week). Sunday and Monday he had no stools and was really lethargic and looking awful. Finally this morning, Tuesday, he had 2 poops, out of box, mostly solidish but soft. Better than diarrhea. He's still dragging today. So starting today, I increased prednisilone again to 2.5 every day. He seems to do better.

To control his IBD and pancreatitis, I've asked Angie about switching from Prednisilone to Budesonide as one person on this board has suggested. Have not had an answer from her. I asked the tech, she asked Angie, Angie responded without a reply to the question, so I had to start the whole asking cycle again. It takes a long time to get answers.

So now everyday he is getting 2.5 mgs prednisilone and cerenia, plus the B12 shots. In my "medicine cabinet", I have a tube of mirtzapine (which says it expired 30 days after January 13), some buprenorphine (which he hates), and an IV (I need to look at expiration date).

He switched from pork to beef, that's about all he will eat now. He is eating sporadically and mostly won't eat unless I hand feed him a bite at a time. He won't eat treats any more. Today he's eating cooked beef. He's not eating any organ meats at the moment or getting any calcium. But he's eating what he wants.

After those two soft/solid poops this morning, he looked like he felt better. I am not sure if he was nauseated or in pain, yesterday and today.

Previously I gave him his pills ground up in his food, because he hates being pilled. But now his eating habits are so irregular, mostly he is eating pieces of meat. So I have to pill him, which he hates. Today was a rough day, he's mostly been hiding and he's definitely avoiding me. Now he even dislikes our routine of playing, then massage, then inhaler.... he runs away and I have to chase him........ because he knows the ear prick follows (regardless of how much love and petting he gets). He tolerates but is not fond of the insulin and will often run away from that too. We are not having a very good time. He is angry at me. And I can't treat him since he won't eat treats.

I do know that the high blood glucose levels are making him feel crummy. Because the one time they went down to 97, he was so happy and looked so good and had some energy.

Mostly we have his asthma under control, but this morning he coughed a little bit at the blood glucose testing time. Not a big deal, I can increase his inhaler if needed. I've been checking his ketones and they are negative.

I'm doing the best I can. A bit confused about what to do next. I've been taking 4 BG readings each day, and we are almost at 3 days with 4 readings each day (please see spreadsheet). His values are always high, so is it time to increase his insulin dose? HOWEVER -- this afternoon at +7, his mid-cycle BG was 97! What a large swing. Means he'll be feeling worse soon, right?

Does this mean I should keep the insulin dose the same at 1 unit?

Other comments, suggestions, questions? I'm a bit tired, so if you've made a suggestion before, please do not hesitate to repeat. I'm a bit slow catching things these days.

Thank you, Jan and Squeaky

 

Easiest question first, and you already got the answer, yes on sticking with 1.0 units for now. That was a great catch on the 98 today.

Can't say much about the IBD, but have you tried lamb or venison? Just trying to think of other red meat proteins. IBD cats do well with multiple different proteins, if they can tolerate them. If his B12 is normal now, have you tried S. boullardi for the diarrhea? Here's an article on it. Good to hear you aren't giving chlorambucil anymore. Your vet was following a very odd dosing method with it. It's a chemo drug, and shouldn't really be given unless you are dealing with small cell lymphoma. Have you ever seen an internal medicine vet? They are great when you've got multiple conditions you are dealing with.

A trick I've seen for hiding pills is in hearts before. Pilling can be hard. Neko taught me to up my game in pilling. I ended up using gel caps and I could stuff multiple meds in one gel cap. It hid any foul taste and meant less pilling sessions.

 

Thanks Neko, that's a great idea on the gel caps. I tried it with the cerenia this evening, I kind of melted it around the piece of tablet. No foaming! Venison is a thought. He does seem to like first one meat then another. What a challenge it is feeding this guy! I have asked my vet about s. boullardi and she doesn't answer. Frustrating.

I need to write to some pet charities about internal medicine vet. I've got a large negative cash flow right now for living expenses. Not even counting all the vet bills that are adding up.

Thanks for your comments.

 

S. Boullardi is available at any health food store and a lot of larger pharmacies. It doesn't need a script or anything.

Here's some good information on using it for diarrhea ....it sure won't hurt to try it!