Suspected IBD/Lymphoma - Need advice

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AllieCat

AllieCat

Member Since 2015
My 13 1/2 year old cat Chauncy was diagnosed with diabetes in May of 2013. Since then he has been well regulated on 2 units of Lantus twice per day.

Everything was going well until June of this year. He began losing his appetite and vomiting white foam. This was soon followed by diarrhea streaked with blood and more severe bouts of nausea. At the recommendation of his vet, I gave him weekly B 12 shots and mirtazapine to stimulate his appetite. She told me to bring him back in 6 weeks for x rays and bloodwork if his condition did not improve.

Fast forward to last Tuesday...the X-rays showed a thickening of his small intestine. His vet suspects either IBD or lymphoma, but of course it's impossible to know for sure without a biopsy.

I was a little surprised when she basically told me that there was nothing that could be done and that I will have to consider quality of life sometime in the near future. She said that steroids cannot be given to diabetic cats - which I understand. But what about other treatments? Flagyl? Budesonide? (a steroid that might not raise glucose levels?) Is his condition really that hopeless?

Not liking this news and in desperate need of a second opinion, I made an appointment for a consultation with an internal medicine vet. My biggest fear is that they won't be willing to treat him without a biopsy or other expensive diagnostics. I can probably afford an ultrasound but that's about it. I already spent $400 just to be told that there's nothing that can be done. (I can afford medications...just can't handle having to pay thousands of dollars up front just to get them)

So on to the question part...does anyone have any tips for what I should ask when I go to the appointment? Has anyone had success with a diabetic cat that was able to control their IBD with budesonide? I've come across some posts about cats with both conditions, but in those I've read so far, the diabetes was caused by steroids used to treat the IBD. I'm going into this with a full fledged diabetic cat. Not sure if that makes it harder to treat (blood sugar harder to control?).

Thanks,
Allison
 
My ex cat has IBD. She is controlled well with flagyl 2x/week. Also all grain had to be removed from her diet and she is sensitive to chicken. She isn't diabetic but steroids so far haven't been needed (anti-jinx). The vet did say that eventually her dose of metro might need to be increased or the drug changed.
 
Hi @AllieCat. I'm sorry you just got this diagnosis. You should definitely ask for Budesonide. My cat was a diet-controlled diabetic who did fine on Budesonide and it helped her a lot. Flagyl will help his diarrhea too. You may need to switch his food to a limited ingredient diet or a novel protein. A lot of a IBD cats do well on commercially prepared raw. If the food that ultimately helps him is higher in carbs, then you may have to increase his insulin. With a diabetic who has a second condition, you treat the other condition first and then adjust the insulin if necessary.

A biopsy is the gold standard for diagnosing IBD. I wouldn't do an endoscopy personally (my IM vet said the diagnosis would be inconclusive so it wasn't worth the $$). If you take Chauncy to an IM vet they will probably want to do an ultrasound to confirm the diagnosis. Then they may recommend a biopsy. If you know you don't want to go that route, then you could just treat the symptoms. I didn't get a biopsy because my cat was too sick by the time I saw the IM vet. I think a second opinion is a good idea given that your regular vet didn't offer any help or advice at all. If you can find a good regular vet in your area, then you don't necessarily need an IM vet, you just need someone who understands IBD and is willing to treat him. Lots of cats live with IBD for a long time after the diagnosis.

I'm glad you're getting another opinion, that first vet sounds horrible. B12 shots help with nausea and energy. If he still needs appetite stimulants, ask for Cypro instead or Mirt. Mirtazapine causes some cats to hallucinate and act spacey and weird but they tend to do better on Cypro.

For nausea, ask about Cerenia and Ondansetron. Cerenia is a newer anti-nausea med that works well for a lot of cats. It's an animal-only med that you'll have to buy from the vet. The dose is typically 1/4 pill once a day. Ondansetron is a human med you can get at a regular pharmacy with a vet prescription. It comes in 4mg pills and the dose is typically 1 mg (1/4 pill) twice a day. I think some vets increase the dose of Ond if the cat is really nauseous to 2mg twice a day. You can give Cerenia and Ond at the same time if a cat is really nauseous.

Obviously I'm not a vet but I would think he'll feel somewhat better once you get the nausea and diarrhea under control. It may take some experimenting with different kinds of protein until you find one he can tolerate. Some IBD kitties need to just switch to a protein they haven't had before, like duck. Others need to rotate a couple of different novel proteins like duck, rabbit, lamb or venison. When their stomachs are upset sometimes they don't want to eat a food they ate just fine the day before, so that's why you may need to rotate a couple of different foods.

Good luck and let us know how your next vet visit goes and how Chauncy is doing.
 
Thank you for your quick replies! I feel better hearing that there might be hope for him!

I had to bring Chauncy to our usual animal hospital last night because he was terribly nauseous and unable to eat. The emergency vet was very nice and took a lot of time talking to me about all of Chauncy's issues (it was a slow night there). I asked about Budesonide as a possible treatment and he wasn't too sure about it, but he was at least familiar with the drug. He gave Chauncy a shot of Cerenia for his nausea and a prescription for Flagyl. I'm going to start that today and see if it makes a difference.

About the nausea medications - my current vet seems to think that only Cerenia in the injectable form can be given to cats. She said that the mirtazapine has anti-nausea properties as well so I should just use that instead. Well, that kind of worked for a month and a half but now I think he's built up a tolerance to it. Plus I'd rather avoid giving him any kind of a psychoactive drug if it can be avoided. I will ask the new vet about the medications you mentioned.

Good to hear that I don't necessarily need an IM to treat him. I'm sure they are a lot more expensive. I found an animal hospital that lists the treatment of IBD on their website and sent a message explaining my situation. So maybe that will be an option. Otherwise I will just keep the appointment with the IM.

Thank you for the information on diet. Last week, I attempted to switch him to Nature's Variety Limited Ingredient Diet Rabbit dry food with no success. Prior to that I tried Evo Salmon and he wouldn't touch that one either. (I now know that Evo would not be the best choice for an IBD cat, but at the time I thought he might be having trouble with grains). I will keep experimenting and hopefully find something that he'll eat.

I know that dry food is terrible for cats but I've never been able to switch him to canned. He is extremely finicky and doesn't even like cat treats. A few months ago, I tried a few of the Merrick canned foods and the Tiki Cat shredded chicken one. No luck whatsoever. The only canned food he'll eat is Fancy Feast Seafood Medley. I'm going to go to the pet store today and buy a few new foods to try. I think he has developed an aversion to his regular food - Purina DM. (Horrible, I know)

Anyway, thanks again for your replies! I will keep you updated on what happens at his appointment.
 
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Some people were mentioning having used cyclosporine with success.
If the specialist thinks it's more likely to be GI lymphoma than just IBD at this point, you can also consider asking for chlorambucil.

I could feel my blood pressure go up when I read this sentence: "I was a little surprised when she basically told me that there was nothing that could be done and that I will have to consider quality of life sometime in the near future." I think it's definitely worth consulting with someone else. I learned the hard way that I had to push and advocate until I was pooped to get any good answers (except on the forum where people give wonderful advice freely and often!). Please don't give up if you feel like your kitty wants to keep going. ECID and they should keep giving you options as long as they can. Hang in there. Will be thinking of you!
 
I am using budesonide and metronidazole (one brand is Flagyl) for my MurrFee for abount 1 1/2 years and ave used it on three previous cats. I get the budesonide from Thriving pets. I get the 100 count of 3 mg capsules and divide that up into 1 mg doses and put that in a #3 gelcap
 
If I were in your shoes, I'd probably go to the IM vet. Yes, they're more expensive than regular vets but even if the new vet knows more about IBD, he/she may not know a lot about diabetes. Since you're juggling multiple issues, you might get more out of going to an IM vet. Their equipment is also usually more specialized. The IM vet I went to had ultrasound equipment that was human-grade. The IM vet may be able to say his IBD looks more like lymphoma or regular IBD. If he/she suspects lymphoma, don't panic, there's a medicine called Leukeran (generic name is chlorambucil as Speckles mentioned). A lot of cats do really well on Leukeran. Then once you have the diagnosis from the IM vet, you can try the new vet you found online for maintenance care. Just my two cents; nobody will judge you whatever you decide to do.

AllieCat said:
only Cerenia in the injectable form can be given to cats.
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I would fire your current vet. Besides being uncompassionate and wrong about Chauncy's IBD, she's totally wrong about Cerenia. When you buy Cerenia pills, there are pics of dogs on the box because it was originally created as an anti-nausea med for dogs. It's used for cats as an off-label usage but TONS of vets use it for cats. It's pretty much the standard these days for nauseous cats.

My cat was also a kibble addict. I tried her on Stella & Chewy's Duck Duck Goose (it's freeze dried raw) but she didn't love it. Then I tried Royal Canin Potato and Duck hypoallergenic dry food. She liked that. There are some other prescription brands of hypoallergenic food but when I was looking, it seemed like the Royal Canin was the best combo for her (it didn't contain chicken or turkey, which I was trying to avoid). Dealing with the food aspect is challenging, but at the end of the day the food that the cat will eat and not throw up is the right food, whether or not it's hypoallergenic or low carb. The cat has to eat.

Good luck! There are a lot of people on this site who have had IBD diabetics or IBD civvies so there's a lot of info on here on how to manage IBD.
 
Agree with Shane's comments. In our experience, the ultrasound quality was enormously different between the normal vet and the specialist too.
We gave Speckles Cerenia pills while he was sick. There are a couple published studies on its use, dose, and safety in cats.
Please keep us updated. Sending hugs and healing vines!
 
SpecklesAndMe also mentioned cyclosporine. It's a newer drug that a lot of vets don't know about. I think @rhiannon and shadow (GA) used it. That's another med you can ask about for IBD.

Sorry if I'm overwhelming you! There's a lot of things you can do to help an IBD kitty and I got a bit fired up when I saw how your current vet acted... :)
 
Thanks again everyone! I am writing down all of drug names so I can ask the new vet about them. I agree that I'd be better off keeping our appointment with the IM. I don't want to take a chance with a regular vet and not being satisfied with the level of treatment he receives. I want to get things right this time!

I also agree that his current vet needs to go bye bye. It's sad that I can google things and come up with better information than she can provide. I'm mad about that whole appointment because I'm sure she suspected IBD or lymphoma when she ordered the x ray to be done, but had no intention of actually treating him. Her only recommendation was to hospitalize him to the tune of $1400. What good would that do if they weren't willing to give him the right medications?

Question about the budesonide - how long does this usually take to kick in? His symptoms are quickly getting worse. Makes me think that it's more likely lymphoma, but keeping my fingers crossed that it's just IBD.

Does IBD always progress slowly? It seems like many of the cases I've read about happened at a much slower pace. Chauncy didn't have any symptoms until end of June/early July.

Also - I'm really worried that I won't be able to give him all these pills. If only everything could be a sub q injection like insulin! I think my pilling technique needs a lot of work. Tonight was my first time giving him the Flagyl and it didn't go too well. Quite a struggle ensued! Does anyone have any tips or tricks? Should I get one of those pill popper tools?
 
Oh, and thanks Shane for the food recommendations. I will add those to my list of possibilities. I really wish you could buy a huge sample box of a bunch of different cat foods. I hate wasting money on food that he won't eat when it could be better spent on medications/vet appointments.
 
He could have had IBD for longer than a couple of months but the symptoms may have progressed to become noticeable in the summer. Budesonide worked for Marshmallow within a week. I gave her the liquid form because I'm not good at giving pills either (if you give liquid Budesonide for a IBD make sure you're giving the slow-release version since you don't want it to be absorbed quickly in the stomach; you want it to be absorbed in the intestines so it has to pass through the stomach). I also gave her liquid Flagyl. And I had my vet show me his technique slowly so I could see how he gave pills. That helped. Some people use pill poppers but I never mastered how to use them properly.

I know what you mean about wasting money on foods they won't eat. Unfortunately it may be a bit of trial and error. If there's something he can eat right now that he can tolerate, I would just stick with that. Try to get the nausea and diarrhea under control and once that's under control you can start dealing with the food situation if necessary.

Is your IM appointment soon? It sounds like his nausea is pretty bad and the Cerenia injection won't last too much longer so the sooner you can get into the IM vet, the better, in terms of controlling the nausea.
 
His nausea has been on and off for the past few days but he is eating. I'm praying that he can hang in there for a few more days! Yesterday I called every internal medicine vet in my area and I was unable to get an earlier appointment.

I am really aggravated with my current (soon to be ex) animal hospital right now. I called yesterday to get Chauncy's medical records and they said sure...not a problem. We'll email them to you tonight. So I get them later in the evening and they've only sent information from the last two times we were there. Is it just me, or are they purposely being jerks? Nothing in the included records shows that his diabetes has been well-regulated since he was diagnosed. The only comments the new vet will see mention "diabetic decline" and "since we cannot pinpoint cause, I spoke to the owner about quality of life and euthanasia". His "decline" has nothing to do with his diabetes!!! Just a few months ago, they tested his fructosamine and it was perfect. And of course I've still been giving him his insulin at home.

Don't they legally have to provide all of the records? The girl I spoke to on the phone said that she was going to see if they could send the rest of them.
 
AllieCat said:
Don't they legally have to provide all of the records
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I don't know if there's a law but I've never had a vet refuse (and we've had many vets and I always ask for copies). Some are a bit begrudging about it, but I've even had them copy X-rays onto CDs for me, etc. They should be able to give you everything.
 
Same as SpecklesandMe. I've always gotten full copies of my cat's records. They should be able to at least xerox them and give you hard copies, even if they don't have everything in PDF form. (When I went to the IM vet, my regular vet emailed the IM everything -- 10 years of records! :rolleyes: In that case it was too much info.)
 
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