Reptile & Amphibian Forums

Hi there. I've emailed you in the past regarding my cat Sola.

Just to re-brief you, he is an indoor, male neutered 11 year old cat and has been totally healthy except he has had a history of IBD (never had a biopsy until now) but his problems seemed to be very sporatic. Diarrhea maybe once a month and periods of vomiting for every day or every other day for a week every few months. But has always acted normal through these bouts.

Last month he had a period where he had diarrhea almost every day for 3 weeks. We took him to the vet after this was going on for two weeks and he received a complete blood panel and urinalysis (as I usually do for him every 6 months) and everything seemed normal. We also did an x-ray, but nothing showed up. He acted totally normal and was bright-eyed, alert, everything he always was.

We finally took him to a specialist who did an ultrasound of his intestines and found some lymphnodes and thickening of his intestinal lining. The vet did an endocscopic biopsy, which apparently is the most non-invasive method to obtain a biopsy and found that he had moderate lymphocytic inflammatory bowel disease.

He was put on pepcid once a day, flagyl twice a day, sucralfrate three times a day, and metoclopramide three times a day. He did well for a week - no diarrhea, no vomiting.

As soon as he finished his flagyl he had liquid diarrhea and vomited 8 times (more gagging then vomiting really), and he wasn't acting himself so we took him to the ER on Saturday and they put him back on flagyl and now he seems to be doing better, no diarrhea since Saturday, a little vomiting, but he really doesn't like the metoclopramide and seems to gag, wheeze and sometimes vomit afterwards. Thank god he's done with that medication.

He just finished all his medications (they were only for 10 days) except for the flagyl that got re-prescribed. And he just got a steroid - budesonide - and has been taking thst once a day (just started it today) along with the flagyl twice a day. We've also switched him to IVD, which he was on years ago but I stopped because I wanted a more holistic diet and switched him to California Natural and he was fine for several years on this, until last month.

So, finally to my questions:

1. Why would his IBD flare up all of the sudden to the point where he got diarrhea for three straight weeks and now needs all of these meds?

2. Is it possible that he has intestinal lymphoma, but we don't know because he only got the endoscopic biopsy and not the full thickness biopsy? I just wanted to avoid the risks of anesthesia and he was put on a mild sedative for the ultrasound and stayed on that for the endoscopic biopsy rather then general anesthesia that was required for the other procedure. My other cat Luna was put totally under to remove a cyst that they thought was vaccine-induced sarcoma, it turned out to be negative, but she died several months later of a heart attack and I am still not convinced that it wasn't the surgery (and teeth cleaning) that put a strain on her heart.

3. Should we do a radiograph? I read several websites that recommended a radiograph to diagnose IBD, but I'm not really sure how a radiograph is different from an x-ray and an ultrasound, which he has already had.

4. I know there are side effects to prednisone and I've read that aside from the steroid affecting the liver and kidneys, it inhibits the ability to test for lymphoma for some reason. Instead of prednisone, Sola is budesonide.

Does budesonide have any side effects? I couldn't find any when I looked on the internet. The vet says that all his blood work and urinalysis came back clean. I personally like to see the results to see if he is even on the high or low side of the normal range, I don't like to just hear that he's "fine". But they don't like sending me the results because they say people freak out! But I'm still a little neurotic ever since I lost Sola's sister several months ago to a heart condition that we had no idea she had.

Sorry for all the questions. I'm just a little uneasy right now having just lost another cat to a disease where I knew nothing about and found out only after her death that she had an enlarged heart. I just struggle with the fact that even though I took them in every 6 months for a physical, bloodwork, urinalysis and blood pressure check, that the cardiomyopathy was never caught. Luna had very low blood pressure the month before she died but the vet didn't think that was a concern. I think, in hindesight, that that was a sign. So I'm making sure I do everything I can to help Sola!

Thanks in advance for you advice!

Lisa Acho

IBD stands for Inflammatory Bowel Disease. Inflammation is charactized by swelling (in the intestines this would show itself by thickening) hardness, increase in WBC's, and thus enlargement of lymphatic tissue. IBD is a descriptive term for all the signs you have observed. This has been going on for such a long time that is unlikely to be due to Lymphoma, which progresses quite rapidly. A radiograph is an x-ray, so that has already been done. Longterm use of Budesonide, like any steroid, can lead to immune suppression. Since Sola responds well to Flagyl, an antibiotic, it seems contraindicated to suppress the immune system, as some bacteria seems to be involved. As to the results of the tests; you have already paid for them, so they belong to you. Insist on getting a copy of the results.

The best way to treat this situation is to remove the cause of the inflammation. I suggest reducing the diet to the fewest possible antigens; feed fresh chicken, including the bones, raw if she will accept it, baked if needed. In addition, give 1/2 tsp cod liver oil daily along with a probiotic. Don't feed or give anything else. Start with that and see how Sola does. Don't give any other medications, and don't give any more vaccinations.

Thanks for your advice, I just have a few follow-up questions.

Sola's IBD started years ago, but it's NEVER been as bad as this as far as having diarrhea almost everyday for 3 weeks. He maybe would have diarrhea once a month. That's why I worry that it is really lymphoma and the endoscopic biopsy didn't get a thick enough sample to get accurate results. Should we do another ultrasound in a few weeks to see if the thickening of the intestines has progressed?

You think I should just stop the steroid and keep giving the flagyl indefinitely?

And you don't recommend IVD Duck and green pea? I just bought a ton of cans!

Sola is almost 12 and I haven't vaccinated since he was a kitten back when I didn't know any better.

Thanks again for your advice

The diarhea has gone on for 3 weeks. Whastever you were doing during that time has not helped, so why continue doing that which has brought about no improvement? If he was on the IVD duck and gren pea, stop that, if he wasn't, you could try it. But I would try the protocol I just gave you instead of tweaking what isn't working.

Thanks again for your advice and your quick reponse.

I would agree with you not to change anything if it was working. The diarrhea started when he was eating CA Natural Salmon and sweet potato and he was on no meds.

The flagyl stopped the diarrhea and he was totally normal. But 3 other medications were introduced for some reason and he seemed okay, but when his flagyl ran out (and he was still on the 3 other meds) that's when the diarrhea continued. So he went back on the flagyl.

This week he has just been on flagyl and eating IVD and seems to be doing great.

I'm supposed to be giving him budesonide once a day, in addition to the flagyl twice a day, but after reading what you said about steroids, I am hesitant to give it. Plus I read that budesonide is 15 times stronger than prednisone! Is that true?

I asked my vet for Sola's bloodwork and I finally got it. What she called "normal" results I would not consider normal. Which is why I think I'm going to stop the steroid.

There were high:
Creatinine = 2.4
A/G ratio = 1.1
MCH = 17.5

These were low:
RBC = 5.62
HGB = 9.2
HCT = 27.8
Globulin = 3.1
Absolute Neutrophil Seg = 2156

I don't really know what anything means except that the creatinine is a measure of the kidney function. His BUN was 27, which seems normal, right? What do you think of the other levels?

The createnine is not a problem, but the low values are; they show that your cat is anemic. If you are feeding your cat chicken, include 25% chicken livers to build up his red cell count. Check the color of his gums. They should be a healthy pink. If they are pale pink, or are becoming paler with time, you need to find out why.

Right now Sola is eating California Natural salmon and sweet potato wet and IVD duck and green pea dry (he won't eat the wet for some reason). He's supposed to be on strictly IVD, but I don't want to just feed him dry food since all the advice you give is to have your cats on wet!

Should I just get chicken liver cat food or chicken liver from the grocery store? I don't even know if you can buy just chicken liver (I've been a vegetarian for 20 years so I don't know much about all that!)

I'm supposed to be giving him budesonide once a day, in addition to the flagyl twice a day, but after reading what you said about steroids, I am hesitant to give it. Plus I read that budesonide is 15 times stronger than prednisone! Is that true? And could the budesonide affect his red blood cell count?

Get fresh chicken livers, not chicken liver flavored cat food.

Do I cook the chicken livers? And that's to help with his low RBC, HGB and HCT?

Also, I'm supposed to be giving him budesonide once a day, in addition to the flagyl twice a day, but after reading what you said about steroids, I am hesitant to give it. Plus I read that budesonide is 15 times stronger than prednisone! Is that true? And since his creatinine was 2.4 so I'm afraid the steroid will affect his kidneys even more.

try feeding the livers raw. If he won't eat it raw, cook it. I don't see the need for Budesonide.

He won't eat the chicken liver raw or cooked! For a 16-pound Norweigan Forest cat mix, he sure is a picky eater.

Is there another holistic diet I can prepare that helps both his IBD and his kidneys? He seems to like fish more than chicken.

For the last 6 months he has been eating California Natural Salmon and sweet potato wet food. I tried to give him the chicken and brown rice wet food and wouldn't eat it. He also wouldn't eat the IVD duck and green pea wet food.