Zhoom Boy AMPS 590, throwing up

[CRL]

Zhoom Boy is having a real rough patch. He has been throwing up the last 3 days, usually around 6-7 am and 8 pm, before breakfast and dinner (he is still happily eating all of his meals). Often there is a hairball involved but not always. He sits in meatloaf position a lot and is miserable. My heart is broken. I gave him 1/2 dose of insulin in the mornings since I had to go to work and didn't know if he would throw up while I was gone. Today I gave him a full dose because his AMPS was sky high. I ended up coming home early from work because I was so worried about him. And exhausted.

We are going to the vet tomorrow morning. The vet said from looking at Zhoom's spreadsheet that he is insulin resistant and that he will most likely want to start him on chemotherapy drugs for IBD/small cell lymphoma (not diagnosed with biopsy). He says that the inflammation in the gut is probably what is causing Zhoom to not respond to insulin. I am so heart broken. And hesitant to give the chemo drugs. Does anyone have experience with insulin resistance? With chemo drugs for IBD/lymphoma? With alternatives to these drugs?

He had been taking flagyl for the last 2 weeks. I stopped giving that 2 days ago. I have seen an improvement in his poop since stopping the flagyl. On it, his poop was smaller, black with a little mucus. Now it is nearly back to normal. I also had changed his food - the transition was complete on 10-22, meaning that is the day that he started eating all new food. I had been feeding him Royal Canin Select Protein Rabbit (13% carbs) and changed the food to Nature's Variety original rabbit , which does also have pork in it (6% carbs). I am worried that it could be the new food causing him to throw up, so I put him back on the Royal Canin yesterday even though it is too high in carbs, just to see if I can get his guts to calm down. Does anyone know how long it might take to see improvement if it was a reaction to the new food?

Sorry this is so long and all over the place. I feel so overwhelmed. I have had an IBD kitty before, who ended up wasting away into nothing and dying from it. I did everything I knew how to do for my other kitty and nothing helped. Poor Zhoom Boy. As if diabetes is not hard enough! To have one terrible disease complicated by another terrible disease is just too much.

Any words of wisdom and/or experience will be greatly appreciated.

 

[Sue and Luci]

I'm so sorry to hear that Zhoom Boy is so sick. I'm hoping some of the experts like @Wendy&Neko, @Marje and Gracie, @Bobbie And Bubba or @Chris & China (GA) will see your post and have some advice.

The only thing I can offer is with numbers this high I would not reduce in the mornings - even though you are working. It would be good if you could give the insulin earlier so you could get a 1+ before leaving for work and based on that number could leave food down for him.

Have you tried spreading his food out on a plate or giving it to him in smaller portions? Is he eating fast by any chance? I've heard of lots of kitties that have 'scarf and barf' - eat too fast and then turn around and barf it all right back up...just too much too fast for their little tummies.

 

[Chris & China (GA)]

He has been throwing up the last 3 days, usually around 6-7 am and 8 pm, before breakfast and dinner

You might try giving him a small snack around 5/6am and 5/6pm.....sometimes when their stomachs are empty, they will vomit due to too much acid.

It would probably be really helpful to get an auto-feeder like the PetSafe 5 that you can program to open and offer food (especially overnight)

Another option would be to try 1/2 of a Pepcid (famotidine 10mg) about 30-60 minutes before feeding time

 

[Bobbie And Bubba]

Hi there. It sounds like the throwing up is prior to AM and PM meals when his stomach is empty. Occasionally that happens to Bubba. When is the last meal of each cycle. A little snack prior to mid cycle could help with that.

I’m not sure how long a food reaction would take to come down once removed and I don’t have any experience with chemo drugs. How did the vet DX if there was not a biopsy?

Is your SS correct. It looks like you went from .75 u to 1.5?

I hope some peeps with chemo experience will weigh in.

 

[Wendy&Neko]

I have had experience with an insulin resistant cat (two types of resistance), IBD/lymphoma, and kidney and heart issues thrown in for good measure.

First off, your vet is crazy to think that spreadsheet looks like insulin resistance. To me, it looks like too low a dose. I have no idea why you lowered the dose from 1.25 units to 0.75. He need more insulin, not less. We don’t think about insulin resistance until a cat gets to 6.0 units, you have a long way to go. Having said that, 1 in 4 diabetic cats has acromegaly, a form on insulin resistance. Maybe the vet saw other signs of that? Definitely not indicated by the spreadsheet though.

First step for the IBD/lymphoma question is an ultrasound of the intestines. Have you done an ultrasound? You can add a GI panel bloodwork, looking at B12 and folate too as indicators. Based on those results, you still can’t tell if it’s IBD or lymphoma for sure. That needs an endoscopy or biopsy. My Neko could not have either due to heart condition, but the ultrasound and GI panel led to either severe IBD or lymphoma. Her internal medicine vet talked to an oncologist and decided lymphoma was the more likely. Other than extenuating circumstances like mine, I would not give chemo to a kitty if they did not need it. And yes, on my third kitty now with small cell lymphoma. The proper chemo protocol and steroids can put them into remission. You can give anti nausea meds to help with the side effects of chemo. Neko had so many other things going on, chemo didn’t help. The other two cats weren’t impacted much by chemo, along with a little preventative anti nausea meds.

Besides chemo, which you may or may not need, steroids are part of treatment for small cell lymphoma and severe cases of IBD. Prednisolone can raise the blood sugar, so I would try budesonide first. It is more locally acting, ie. just the gut, and less impact on blood sugar. Regardless, if he need steroids to live, we just raise the insulin dose to compensate.

Oh, and Neko responded just fine to the insulin, her inflamed guts had nothing to do with it. You just need a better dose.

As for alternatives, if it is just IBD, you can treat with proper food and probiotics to start. Have you seen the website https://www.ibdkitties.net/. There are also lots of raw food options, including low carb rabbit. There is no alternative treatment if small cell lymphoma, other than chemo and steroids. Once of the reasons it is really important to know what you are dealing with. Speaking of which, I am doubting your vet, any chance if a referral to an internL medicine vet? They are good at multiple conditions, And tend to be more up to date on diabetes and gut issues.

In case it is small cell, Pepcid or fatomidine is not a good idea. You may wish to investigate slippery elm bark, but is to be given at least two hour apart from any other oral medicine. Small snacks throughout the cycle can help is acid tummy is an issue.

 

[CRL]

I'm so sorry to hear that Zhoom Boy is so sick. I'm hoping some of the experts like @Wendy&Neko, @Marje and Gracie, @Bobbie And Bubba or @Chris & China (GA) will see your post and have some advice.

The only thing I can offer is with numbers this high I would not reduce in the mornings - even though you are working. It would be good if you could give the insulin earlier so you could get a 1+ before leaving for work and based on that number could leave food down for him.

Have you tried spreading his food out on a plate or giving it to him in smaller portions? Is he eating fast by any chance? I've heard of lots of kitties that have 'scarf and barf' - eat too fast and then turn around and barf it all right back up...just too much too fast for their little tummies.

Thank you Sue and Luci for your kind words and directing my post to others. He is throwing up about 10 hours after eating. And yes, he does gobble down his meals (even though I spread them out to slow him down) but he does not throw them up after eating. And yes, I agree about the insulin, I will give 1.5 morning and night. The vets at the ER clinic I called over the weekend told me to do a half dose incase he threw up again.

 

[CRL]

I have had experience with an insulin resistant cat (two types of resistance), IBD/lymphoma, and kidney and heart issues thrown in for good measure.

First off, your vet is crazy to think that spreadsheet looks like insulin resistance. To me, it looks like too low a dose. I have no idea why you lowered the dose from 1.25 units to 0.75. He need more insulin, not less. We don’t think about insulin resistance until a cat gets to 6.0 units, you have a long way to go. Having said that, 1 in 4 diabetic cats has acromegaly, a form on insulin resistance. Maybe the vet saw other signs of that? Definitely not indicated by the spreadsheet though.

First step for the IBD/lymphoma question is an ultrasound of the intestines. Have you done an ultrasound? You can add a GI panel bloodwork, looking at B12 and folate too as indicators. Based on those results, you still can’t tell if it’s IBD or lymphoma for sure. That needs an endoscopy or biopsy. My Neko could not have either due to heart condition, but the ultrasound and GI panel led to either severe IBD or lymphoma. Her internal medicine vet talked to an oncologist and decided lymphoma was the more likely. Other than extenuating circumstances like mine, I would not give chemo to a kitty if they did not need it. And yes, on my third kitty now with small cell lymphoma. The proper chemo protocol and steroids can put them into remission. You can give anti nausea meds to help with the side effects of chemo. Neko had so many other things going on, chemo didn’t help. The other two cats weren’t impacted much by chemo, along with a little preventative anti nausea meds.

Besides chemo, which you may or may not need, steroids are part of treatment for small cell lymphoma and severe cases of IBD. Prednisolone can raise the blood sugar, so I would try budesonide first. It is more locally acting, ie. just the gut, and less impact on blood sugar. Regardless, if he need steroids to live, we just raise the insulin dose to compensate.

Oh, and Neko responded just fine to the insulin, her inflamed guts had nothing to do with it. You just need a better dose.

As for alternatives, if it is just IBD, you can treat with proper food and probiotics to start. Have you seen the website https://www.ibdkitties.net/. There are also lots of raw food options, including low carb rabbit. There is no alternative treatment if small cell lymphoma, other than chemo and steroids. Once of the reasons it is really important to know what you are dealing with. Speaking of which, I am doubting your vet, any chance if a referral to an internL medicine vet? They are good at multiple conditions, And tend to be more up to date on diabetes and gut issues.

In case it is small cell, Pepcid or fatomidine is not a good idea. You may wish to investigate slippery elm bark, but is to be given at least two hour apart from any other oral medicine. Small snacks throughout the cycle can help is acid tummy is an issue.

Thank you so much for all this information Wendy & Neko.

I lowered the dose to .75 in the mornings on advice from the ER clinic I called over the weekend. They told me to give 1/2 his regular dose in case he threw up again. I am not going to do that. His numbers get too high. I find that the vets in the clinic I go too are very conservative and try very hard to steer clear of low numbers (which is good advice to a degree).

My vet is an internal medicine vet. He took care of Zhoom when he was in the hospital in mid July and has been my follow up vet since. Zhoom went to the hospital for increased respiratory effort and lethargy. He had a fever that spiked to 107. He was put on different types of intravenous antibiotics that he did not respond to. They decided that the fever was caused by a virus. In the hospital Zhoom had many many tests. He had an echocardiogram because of a gallop rhythm and because his heart is on the large end of normal. His blood work revealed low b12 levels (he gets sub Q b12 shots now). Abdominal ultrasound revealed enlarged lymph nodes in the abdomen and lymphoid follicles in the colon. Ultrasound also revealed organmegaly – possible acromegaly. Change in coat coloring from gray to rusty brown is also indicative of gastrointestinal disease. Biopsy/endoscopy was recommended but I cannot afford the procedures, so vet is treating as IBD/possible small cell lymphoma from clinical signs, GI blood work and ultrasound.

So yes, he may potentially have acromegaly. But like you said, that is not indicated from the spreadsheet and insulin doses thus far. I have questioned some of the suggestions from my vet. As I am questioning them right now. I know that at the end of September, Zhoom was responding a lot to the 2 U he was on (blues and greens at the top of his Spreadsheet). Why would the vet think that he is not responding to insulin a month later?

And as far as the GI stuff, I feel like we have barely tried anything to help with it. A novel protein food (which did help at first) and 2 weeks of flagyl. Now on to chemo!? I feel like I want to try some other things first, like (another) different food that does not have carrageenan in it and is lower carbs, probiotics, slippery elm - and then go to chemo if those don't work. I was considering pepcid to try to break the vomiting cycle. Why is that not a good idea with small cell lymphoma? Have you tried slippery elm with your kitties? What food do you feed your kitties?

And so many people have suggested the feeder to give small snacks throughout the first part of the cycles. I think that makes a lot of sense. I am not sure exactly how much to give and when to give it. I don't want to give too much at the wrong time or it could raise his BG too much?

Thanks again for all your wonderful advice.

 

[CRL]

And Wendy, is there a probiotic you would recommend?

 

[Olive & Paula]

If you don't mind cooking bone broth is also good for the gut. Can stink up a house but good for them. Make a batch and freeze in cube tray. Take out when needed. When previous kitty was suspect ibd I started making his food and made bone broth. It really helped with his chronic vomiting. He had to eat every 2 hrs or he vomited. Auto feeder really was a godsend for him and me. This is the recipe I used.

https://www.ibdkitties.net/bone-broth/

 

[Penelope and Mačka]

I hope you find a solution that does not involve chemo. I think it would be crazy to give him chemo without knowing if it's cancer or not.
Budesonide steroids should help Zhoom feel better. I feed Macka multiple times a day, smaller meals, and it helps with lowering his BG in fact (I think, from what I observed). Good luck!!

 

[Wendy&Neko]

And Wendy, is there a probiotic you would recommend?

I use Visbiome, which is formulated specifically for IBD. The IBDKitties website also has some other recommendations.

So yes, he may potentially have acromegaly.

Not all acrocats have high doses. In the Royal Veternary College study that found one in four diabetics has acromegaly, they found some with as low a dose as 1 unit. They weren't looking for acromegaly, but rather screening to remove those cats from another study. Hence the surprise at the results. You can get an IGF-1 blood test to check for acromegaly. The blood goes to Michigan State University. I'm a firm believer in knowledge is power. If Zhoom does have acromegaly, then it's an explanation for a number of side effects it produces, including soft tissue and bony growth, as well as organs.

A cat's dose needs can change over time. Glucose toxicity from being in high numbers a while means a higher dose is needed to break through the toxicity, which is itself a form of insulin resistance.

Article on issues with Pepcid for GI conditions. I too would try diet changes for a little while. Small cell lymphoma is a slow acting disease, you have some time to experiment. I fed raw food, one of the options was home made with the FoodFurLife premix. Pretty easy to make and you can control the protein. She also got SEB (slippery elm bark) occasionally. The restriction on 2 hours away from oral meds made it really difficult to find a time to give it, especially with limitations between other meds.

Neko also was on budesonide. Her heart could not handle prednisolone, something you might want to keep in mind for Zhoom.

For feeding smaller meals, try feeding in the first half of the cycle. Take his normal amount of food per cycle, and split it into one main meal with a couple smaller meals. It will be an experiment to find out what works. Feeding around +2 can actually help if kitty likes to dive at onset. Feed a third meal before nadir, after which the carbs can slow down the insulin effect even more. Take good notes on feeding, see what happens, then you may have to tweak it.

How is Zhoom's weight doing? There are a lot of things in the mix to really say if weight change tells you too much. Gi issues mean food isn't being absorbed properly, high BG means food isn't getting into the cells, possible acromegaly can also have an impact.

Hope I answered your questions, as well as asking more.

 

[CRL]

I use Visbiome, which is formulated specifically for IBD. The IBDKitties website also has some other recommendations.


Not all acrocats have high doses. In the Royal Veternary College study that found one in four diabetics has acromegaly, they found some with as low a dose as 1 unit. They weren't looking for acromegaly, but rather screening to remove those cats from another study. Hence the surprise at the results. You can get an IGF-1 blood test to check for acromegaly. The blood goes to Michigan State University. I'm a firm believer in knowledge is power. If Zhoom does have acromegaly, then it's an explanation for a number of side effects it produces, including soft tissue and bony growth, as well as organs.

A cat's dose needs can change over time. Glucose toxicity from being in high numbers a while means a higher dose is needed to break through the toxicity, which is itself a form of insulin resistance.

Article on issues with Pepcid for GI conditions. I too would try diet changes for a little while. Small cell lymphoma is a slow acting disease, you have some time to experiment. I fed raw food, one of the options was home made with the FoodFurLife premix. Pretty easy to make and you can control the protein. She also got SEB (slippery elm bark) occasionally. The restriction on 2 hours away from oral meds made it really difficult to find a time to give it, especially with limitations between other meds.

Neko also was on budesonide. Her heart could not handle prednisolone, something you might want to keep in mind for Zhoom.

For feeding smaller meals, try feeding in the first half of the cycle. Take his normal amount of food per cycle, and split it into one main meal with a couple smaller meals. It will be an experiment to find out what works. Feeding around +2 can actually help if kitty likes to dive at onset. Feed a third meal before nadir, after which the carbs can slow down the insulin effect even more. Take good notes on feeding, see what happens, then you may have to tweak it.

How is Zhoom's weight doing? There are a lot of things in the mix to really say if weight change tells you too much. Gi issues mean food isn't being absorbed properly, high BG means food isn't getting into the cells, possible acromegaly can also have an impact.

Hope I answered your questions, as well as asking more.

Thank you for all the wonderful information. I will ask the vet tomorrow for the IGF-1 blood test. I will also look into probiotics, slippery elm and the foodfurlife premix. I will also play around with smaller meals. So much to do!

All of Zhoom's health problems started in early May when he stopped eating. He got better with supportive care but then started reverse sneezing and open mouth breathing. He was put on prednisolone for a month for suspected asthma. He was then diagnosed with diabetes (I think from the steroid) in early July. In early May he weighed 14 lbs (which was a healthy weight for him, not obese at all). Now he lingers around 12 lbs. So, yes he has lost weight, but does not seem to continue losing at this point. What were you thinking about with the weight changes?

 

[CRL]

I hope you find a solution that does not involve chemo. I think it would be crazy to give him chemo without knowing if it's cancer or not.
Budesonide steroids should help Zhoom feel better. I feed Macka multiple times a day, smaller meals, and it helps with lowering his BG in fact (I think, from what I observed). Good luck!!

Thank you. I am going to play around with feeding smaller meals and see what happens. And I am no where near giving Zhoom chemo drugs at this point. There are many questions to answer and many things to try before that happens.

 

[Marje and Gracie]

My Gracie also had IBD and SCL. The one thing I wonder about is the type of lymphoma. It’s important to know whether it is small cell or large cell. Large cell is often accompanied by enlarged lymph nodes and tumors.

I agree with Wendy that budesonide is a better choice than prednisilone especially with his heart issues. Cerenia and ondansetron can be used together to address nausea from different modalities and are quite effective.

With FoodFurLife mix, you can start by cooking the meat and slowly over time, cook it less and less. The FFL website has the info for cooking the meat and using their powder. Sometimes going straight to raw is a bit difficult for cats if they’ve had IBD awhile so it might be best to do it slowly.

I also agree it’s a good idea to get a GI Panel; if his B-12 is low (common with IBD cats), you can give B-12 injections which will help him.

sending many vines for Zhoom Boy.

 

[Wendy&Neko]

What were you thinking about with the weight changes?

More curious than anything else. It's a good thing to track. Stable is good.