14 year old cat with IBD declining - what to do moving forward

[lynne8832]

Hi all!
I have posted on this forum multiple times about my sweet 14 year old cat, Shyla. She was diagnosed with IBD (or small cell lymphoma) a few years ago via abdominal ultrasound after having some vomiting and diarrhea. We switched her to a hydrolyzed protein diet and she did great and did not need any daily medication at that point. We would occasionally give her a short course of prednisolone and metronidazole when she had flare ups, but this was very infrequent. About 6-7 months ago, I noticed that she had lost weight and seemed thinner, despite having a normal appetite and having no other symptoms. She had not been seeing a specialist for management of her IBD prior to this, because she was being managed so well with her regular vet. I got her in to see an internist and he did some labwork and an ultrasound, but the only finding was generalized thickening of her small intestine, so nothing very significant. We discussed that she could just be having a progression of her IBD and decided to start her back on daily prednisolone. She did great for a few weeks and gained weight back. At the end of August, she suddenly stopped eating and was acting very abnormal one night (after doing very well and having no symptoms), so we took her to the ER where she was hospitalized and diagnosed/treated for pancreatitis/triaditis. After we got her home, we took her back to her internist for a follow-up. She was on cerenia, prednisolone (a higher dose), and a few other medications while she recovered from the pancreatitis. We did a recheck ultrasound with her internist at the end of September to follow-up after her episode of pancreatitis, and everything looked stable at that point (no progression of disease on ultrasound). She has continued to take prednisolone every night and has been doing well overall with a relatively normal appetite and minimal GI signs. However, a few weeks ago (mid-November) she started to have a recurrence of GI signs - bloody watery diarrhea, vomiting, decreased appetite, etc. She was also having accidents around the house multiple times every day, which is very unlike her, and she seemed uncomfortable. I called her internist and got her in the next morning - we did another repeat ultrasound and labwork and the only finding was a slightly thickened gallbladder but again, no obvious worsening of her small intestinal thickening was seen. She was also up half a pound at this visit. I discussed her management with her internist and we decided to keep her on an increased dose of prednisolone, metronidazole, and a daily probiotic (Proviable). We also discussed Chlorambucil (as we never did a biopsy to determine if she had SCL or IBD), but he said that he did not think it would necessarily help. She is still on a hydrolyzed protein dry food, but she eats Fancy Feast wet food (I realize this kind of makes it pointless to have her on the hydrolyzed protein diet, but she is not eating much overall at this point). I ordered some of the Purina Pro Plan Sensitive Skin and Stomach canned food and her internist prescribed some of the Hill's GI Biome canned food to try, but she is just not eating much overall. She is walking away from her treats and wet food, which is very unlike her, she has always had a ravenous appetite and loved food. Overall, she seems very tired and it seems like she has aged overnight, and I cannot figure out why, as there does not seem to be any progression of disease on her labwork or ultrasound. My family and I love her so much and we are willing to do whatever she needs within reason, but we do not want her to be struggling. I hate the thought of having to make a decision to euthanize her, but it seems like her clinical signs and symptoms are progressing no matter what we do to try to manage her. Has anybody else had a similar exerpe

 

[FriendofFerals]

I'm so sorry you're going through this with your poor baby. It sounds like your cat is further along than mine. He will be 20, has IBD, and is on prednisolone every other day, along with thyroid and blood pressure meds and Mirataz as an appetite stimulant. I was unable to get my cat to eat a hydrolyzed-only diet long enough to identify if if proteins were making it worse or whether it was additives and thickeners. He's eating Young Again Mature Zero (no carb) limited ingredient (LID) dry food. It's hydrolyzed pork protein. The diarrhea has its episodes ranging from close to normal poo to watery, spastic, 20 times a day. That's when we get some metronidazole to control the spasms. He has allergies and asthma so anything can set off his immune system and trigger an IBD flare, not just food.

I've tried everything. Here's what works (in rotation) as far as wet food to supplement the dry just to get calories in him:

Weruva BFF Chicken Checkmate - the watery texture gets him interested.
Weruva BFF OMG Gravy - even more watery. No gums or thickeners, lower phosphorous and carbs, and he can almost drink it.
Reveal Natural wet food - chicken and broth...literally shredded chicken with nothing else as a topper
Weruva Press My Lunch Chicken Pate - Low phos, lower carb, pretty much chicken jello but he goes for it.
Weruva Mideast Feast - huge chunks of tilapia and tuna. Higher in phosphorous so I use this as a very slight topper just for the smell to get him going.
RAWZ chicken and egg pouch - It's not a lot of calories but additives or gums that can irritate IBD.
RAWZ chicken and chicken liver with gravy - No liners in the can that can cause IBD irritation, no gums, smells like people food. My picy eater will eat it one day and not the next.

I rotate all of the above. There is no way this cat is going to eat the same food every day, however he will go for that Young Again Mature Zero LID hydrolyzed dry food. You just have to read the directions on it because it's super nutrient dense. 1/3 ucup is a daily portion for a 12lb cat. More than that and it makes diarrhea worse...too much meat protein. In the recommended portions, it's fine and it's been a life saver for him and my former diabetic one. He's now in remission for 4 years thanks to low carb wet food and this zero carb dry food.

 

[lynne8832]

Update on Shyla - she is still having diarrhea, but it is no longer bloody. Also no vomiting that we have noticed. Her appetite has continued to decline despite SQ fluids, B12 injection, Entyce (appetite stimulant), and increasing her dose of prednisolone. I have also tried two new diets (Purina Pro Plan Sensitive Skin and Stomach pate and GI Biome) and she shows no interest in eating either of them. The only thing that she is eating at the moment are her Delectable Squeeze Up treats (not the ideal diet for her, I know). This is a cat that has been very food-motivated her entire life and usually never leaves any food behind. I emailed her internist (he is currently out of town) and we discussed adding Chlorambucil to her medication protocol - has anybody tried this with an IBD/small cell lymphoma cat? She seems more tired lately and her age is definitely showing - it seems as if she is aging overnight, when she still looked like herself just a few weeks ago. I am worried that this is "the beginning of the end," and I am not sure what else to do for her treatment-wise. I have taken her to so many appointments with her internist and we have done repeated labwork/ultrasounds, she spent multiple days in the ER/ICU in August for pancreatitis, etc. I am willing to do whatever I need to do to make her feel better, but I also do not want her to be suffering and need to consider her quality of life. She seems ok at the moment, but I hate to see her slowly declining and I'm not sure what to do next for her treatment.

 

[Margot Lane]

I’m not sure if anyone can tell you when that moment will be, saving you, your vet and your beloved Shyla. The diet ideas offered above are good ones. I’ve tried quail and rabbit with pumpkin, which seems to help.

 

[FriendofFerals]

I don't know what else to suggest but I'm so sorry!

Have you tried the Delectables Squeeze Up pouches that are available at many grocery stores? That's my go-to food when nothing else works. But in the end, it's about the quality of life that can be achieved reasonably with consultation from your vet and whatever medications and treatments they advise. Beyond that-- it's a matter of listening to your cat and asking whether they would like to keep fighting or to go in peace.

 

[fionasmom]

IBDKitties – Helping Save Lives…One Paw at a Time

You may be familiar with this website already. There is a discussion of Chlorambucil included. Many members here have used it; I used it with my Chelsea who had SCL and it was well tolerated, but it is a decision that you have to make with your vet.

 

[lynne8832]

I don't know what else to suggest but I'm so sorry!

Have you tried the Delectables Squeeze Up pouches that are available at many grocery stores? That's my go-to food when nothing else works. But in the end, it's about the quality of life that can be achieved reasonably with consultation from your vet and whatever medications and treatments they advise. Beyond that-- it's a matter of listening to your cat and asking whether they would like to keep fighting or to go in peace.

We have tried those also. My mom went to the pet store last night and got her a few different options - she is really liking the Friskies "soups" right now. Again, totally understand that this is a less than ideal diet for a cat with IBD/lymphoma, but I just want her to eat anything at this point. She is still eating, just much less and smaller amounts at each meal, and she is walking away from foods that she would normally eat with no problem. She definitely just seems tired - no drastic worsening of her vomiting or diarrhea or anything, she just seems very tired recently. I hate having to make that decision, but I also realize that my parents, Shyla's vets/specialists, and I have done as much as we possibly can for her and it wouldn't be fair to prolong her life if she is not feeling well.

 

[lynne8832]

IBDKitties – Helping Save Lives…One Paw at a Time

You may be familiar with this website already. There is a discussion of Chlorambucil included. Many members here have used it; I used it with my Chelsea who had SCL and it was well tolerated, but it is a decision that you have to make with your vet.

I have not seen this website, but it is very helpful, thank you so much! Shyla's vet just called in a Chlorambucil prescription to Stokes pharmacy so we should be receiving it within the next week or so. He said that he would like us to do a higher dose every 14 days instead of a lower dose every few days, so we will try that and have her recheck with her internist in 1 month. I am really hoping to see some improvement with the Chlorambucil, but also understand that she may continue to decline despite our best effort and adding the Chlorambucil to her medication protocol. I figure it's at least worth a try to see how she does on it!

 

[lynne8832]

Thank you all so much for your kind responses. It is so difficult to see Shyla decline so quickly when she was previously doing so well - up until a few months ago, we just had to treat her flare-ups and they were very infrequent. I have taken her to her internist so many times over the past few months and she has had so many ultrasounds/labwork to check on the progression of her disease. At her last ultrasound (2 ish weeks ago), her internist said that all of her labwork was normal and her ultrasound results had not changed significantly (no obvious progression of her disease), so I am really not understanding why she has declined so quickly - her appetite has decreased, she has persistent diarrhea, and she seems to be getting thinner and weaker/more tired every day. She is currently on an increased dose of Prednisolone (8 mg once daily), Metronidazole for the diarrhea, Entyce to increase her appetite, and Proviable. We have tried 2 GI diets in the past few weeks (Hill's GI Biome and Purina Pro Plan Sensitive Skin and Stomach), but she won't eat either, so we are just feeding her whatever she will eat at this point. Overall, she just seems very tired and not quite like herself, and this has occurred in a matter of weeks, as she was still doing pretty well just a few weeks ago. Her internist is sending in a prescription for Chlorambucil to Stokes pharmacy - I am just waiting for them to contact me once they receive the prescription so that I can pay for it and they can ship it, and then we will start it. Her internist wants us to try a higher dose every 14 days instead of a low dose every few days, so we will try that and see if there is any improvement. I am hopeful that it will help, as I have heard that many cats with IBD/small cell lymphoma respond to it, but I am also trying to remain realistic and remember that she is 14 years old with a chronic disease and that this will not "cure" her.

 

[stephanietx]

We lost my 14 year old boy to IBD/suspected lymphoma at the end of May. He also seemed to decline rapidly and had many of the symptoms your baby has. We did not go the Chlorambucil route due to his prognosis.

Is your kitty getting B12 injections? Some other food to try (no chicken) is RAWZ, ZiwiPeak, and Koha. We ended up feeding him RAWZ duck and turkey and Ziwi lamb. You might also want to mix up slippery elm bark syrup to help with the diarrhea. You can also try one of the probiotics from Adored Beast.

 

[fionasmom]

Elura is the appetite stimulant for CKD cats and Entyce is for dogs. It is the same ingredient but a different concentration from what I understand. Having said that, both are capromorelin and your vet may have a good reason for giving you the Entyce. Have you used Mirataz? I have used Elura and Entyce and was never overly impressed with their effectiveness in dogs or cats with one exception where Elura did seem to be effective.

 

[lynne8832]

We lost my 14 year old boy to IBD/suspected lymphoma at the end of May. He also seemed to decline rapidly and had many of the symptoms your baby has. We did not go the Chlorambucil route due to his prognosis.

Is your kitty getting B12 injections? Some other food to try (no chicken) is RAWZ, ZiwiPeak, and Koha. We ended up feeding him RAWZ duck and turkey and Ziwi lamb. You might also want to mix up slippery elm bark syrup to help with the diarrhea. You can also try one of the probiotics from Adored Beast.

I'm so sorry to hear that you and your kitty went through the same difficult battle, it is definitely heartbreaking. She has been doing so well and has just gone downhill so fast, so I am trying not to make myself feel guilty about her decline, as we have tried everything that we can for her, and I knew that her IBD/lymphoma would eventually progress to the point where it could not be managed.
We actually took her to her primary vet last week and she got a B12 injection, SQ fluids, and a cerenia injection, but she is just not bouncing back from this flare-up like she has in the past.

 

[lisahe]

Is your kitty getting B12 injections? Some other food to try (no chicken) is RAWZ, ZiwiPeak, and Koha. We ended up feeding him RAWZ duck and turkey and Ziwi lamb. You might also want to mix up slippery elm bark syrup to help with the diarrhea. You can also try one of the probiotics from Adored Beast.

I second these suggestions: Our IBD cat has been eating a lot of Rawz pates because they don't have gums in them and she tends to have trouble with those and other thickeners. Every cat is different: lots of IBD cats do really well with Ziwi and Koha but both those brands have ingredients that ours can't eat. Finding food that fits can involve a lot of trial and error but in our experience, the fewer thickeners and fillers the better; this is a big reason we feed a lot of homemade food. Edwina had a flare in October and was slower than usual to bounce back, too, though of course that can take time, particularly as a cat ages. And as new sensitivities build. (I think turkey might have become a problem so cut it but may never know for sure!)

stephanietx also mentioned supplements. Edwina (who's a vomiter) gets small amounts of slippery elm bark syrup three times a day as well as Adored Beast's Feline Gut Soothe, which has probiotics and a combination of herbs (including slippery elm bark) that help tamp down inflammation. I also now give her Calm Goat Milk because she's been anxious (about food since she was underfed as a kitten) ever since we adopted her 12 years ago. Stress and nerves and anxiety can be really hard on IBD cats. She also now gets B12 injections at home and Cerenia as needed.

I hope you're able to find something -- food? a supplement? -- that will help your cat to feel better. IBD is tricky, insidious, making it hard to sort through options. Wishing you and your all the best as you try new options.

 

[lynne8832]

Hi all.
Unfortunately, my family and I have made the heartbreaking decision to have Shyla put to sleep tomorrow with her regular vet. She has just declined so rapidly over the past few days and has not improved with any medications. She is now having frequent diarrhea on the floor, yowling randomly, and seems very uncomfortable and not like herself at all. It is clear that her quality of life has significantly declined. I wish we had gotten a chance to try the Chlorambucil, but I don't think it would be fair to keep Shyla around any longer since she is clearly not feeling well at all and is not showing any signs of improvement. She has also started to walk very wobbly in her back legs for the past few days. It was barely noticeable a few days ago, but today her back legs and tail are swaying when she walks and it looks like she is having a harder time getting up. She is also sitting down after walking only a few steps. She was not having these issues with her back legs a few days ago, so I have no idea what could be causing this. I'm not sure if it is due to the discomfort of her GI signs or if it could be a side effect of the medications that she is taking (Pred, Entyce, Metro).

 

[Kflowers]

Releasing her to peace is the greatest gift you could give her. Her love will never leave you. You will always be tied to her now and forever.

 

[lisahe]

I am very, very sorry to hear this but you obviously did the right thing. Shyla's a lucky cat for having such good care.

 

[fionasmom]

I am very sorry to read this. Please remember that we are here for you.

 

[lynne8832]

Thank you all so much for your kind and encouraging words. We just do not feel that it would be fair to her to continue to let her decline when she already seems like her quality of life has gone downhill so much, we would much rather her have a good and happy last few days than wait until she is really struggling. We really tried our best for her and managed her IBD for so many years with just diet and medication, but it seems that it has progressed too far for her to come back from, unfortunately. I am just grateful that we had 14 wonderful years with her and we are able to give her the gift of a peaceful passing.

 

[lynne8832]

Has anybody ever seen or heard of hind leg weakness/ataxia with IBD/GI issues? She just developed this a few days ago and seems very off balance in the hind end, and I'm not sure how that could be related to what has been going on with her IBD/lymphoma, unless it is a side effects of one of her meds, but she has had all of those before without any issues

 

[Margot Lane]

I had a kitty w/ IBD— he didn’t develop hind end weakness, but there is a lot of information on it if you Google it. I’m so sorry this is happening.