17 Year Old Cat with IBD and High WBC: Please Help

Violet44

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Hi, I’ve been a long-time reader of this site, and it has helped me so much regarding treating my senior cat, Squeeb, who was diagnosed with IBD 4 years ago. I finally worked up the nerve to ask for help here, as I’m not sure what else to do recently.

Squeeb was doing alright for a while on prednisone/prednisalone and a diet change (even though she had gradually begun to lose weight over that time; she was initially 13 pounds and then got down to 9 pounds over that 4 year period). But within the last year she’s begun to decline more drastically; she started to have constipation and vomiting when trying to poop, which lead to an enema and her subsequently being put on lactulose (and Cisipride to occasionally aid her). The lactulose is also losing its efficacy, as I have to give her around 6ml to keep her poop soft enough to not make her strain. She has become more dehydrated more often, despite drinking a lot if water from a fountain. I also haven’t been able to find her any wet foods that she’ll consistently eat (I’ve tried so many) so she switches between Hill’s I/D, blue wilderness raw, and instinct raw dry. She’s improved a little after having IV/subcuentous fluids.

She’s had 3 ultrasounds essentially saying that she has a thickening of the intestines consistent with IBD and suspected mild pancreatitis, but never got a biopsy to rule out lymphoma. Most alarming and mysteriously though, is that her white blood cell count has been extremely high within the last year, and no one knows why other than to say that she likely has an infectious disease. Vet says she doesn’t have diabetes or kidney failure, but I’m not sure, given what I’m seeing.

She’s now down to 5.8 pounds and her legs are sort of weakening, even though she’s eating and drinking and I’ve been giving her additional calories by syringe feeding Hill’s A/D (sometimes with appetite stimulant).

I’ve cried over this for the last few months; I’ve had Squeeb since she was a kitten and I have been keeping her afloat for so long that it hurts to see her at this standstill. I’m worried that this may be the end, but I don’t know what’s happening, and I want some understanding. I’m planning on taking her to an internal medicine specialist in 2 weeks to get a second opinion for more information, but I’d also appreciate if you all could share your thoughts of what could potentially be going on beside the IBD based on her most recent bloodwork/personal experience? This not knowing is taking a toll on me. Thank you.
 

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Violet44

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Hello - just a quick thought, has she been getting B12?
Hi, thank you for replying. So usually when I take her to the vet for subcutaneous fluids, I ask them to give her vitamins, including B12. It’s tricky though because when I took her to her old vet, they always included B12, but I’m not 100% sure that the vet she’s currently seeing does every time because they don’t list all of the injections on the invoice. I should also note that she’s not getting the fluids daily.
 

FeebysOwner

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Hi. The high WBC would seem to indicate some sort of infection but depending on how long it has been since she received any prednisolone - and the dosages - WBC can also be elevated for that as well. And stress also can increase WBC. IBD accompanied by possible pancreatitis might also impact WBC, due to the inflammation involved. And pancreatitis can affect a cat's interest in food too. Many time cats with pancreatitis are given sub-Q fluids - and sometimes pain meds - and of course they are always encouraged to eat consistently. However, are they considering an antibiotic just to see if that helps any?

Did they run a thyroid check too (T-4)? Hyperthyroidism can cause excessive water intake, and weight loss.

I think you are wise to be seeing an internal medicine specialist to assess all of her blood work and her previous ultrasounds. If they want to do another ultrasound, ask if they think doing a fine needle aspiration (FNA) cytology would be of any benefit in lieu of a biopsy.

In the meantime, ask the vet about adding Miralax to her regimen. There are other members who use it in addition to lactulose to help with constipation in their cats. If the vet is OK with having you try it, the 'norm' is to start out with mixing 1/8 tsp in a bit of water and adding to foods/treats. If it doesn't seem to be helping, you could try either increasing to 1/4 tsp or give her 1/8 tsp twice a day.

You can also consider feeding her some baby food meat (Gerber Stage 2 or Beechnut), which is usually considered OK with IBD cats. It can be used to help with caloric intake and/or administering meds if needed. Depending on what you get, a single jar (2.5 oz) can add anywhere from 50 to 90 calories.
 

di and bob

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You might try some Delectable Lickabels in the stew flavors. They are a lickable treat and my sick cats will take them when they won't take anything else. I pray the specialist can help to give you some answers. I'll keep you both in my thoughts and prayers, please give that precious little one a kiss from me.......
 

daftcat75

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It sounds like her IBD may have progressed to GI lymphoma. In her condition, I do not recommend the surgical biopsy to confirm it. Instead, I hope you can meet with a specialist to discuss chemotherapy. It’s not as scary (or expensive) as it sounds for cats. With my Krista, the medicine was compounded into a super-concentrated anchovy flavored oil. I mixed a 0.1 mL dose with about the same amount of salmon oil for a puddle about the size of a dime. Krista licked it all up and then she got her meal. That was twice a week at first and eventually once every two weeks. She was a little sleepier on dosing days. That was the only side effect I ever noticed. Whether you can meet with a specialist or you proceed with your current vet, I would discuss trying chemotherapy. In her case, the drug (probably) presents less risk than the surgical biopsy to confirm a cancer diagnosis. If her poops get better and the weight loss slows or even stops, you’ll know you’re on the right track. It shouldn’t take too many doses to determine this.
 

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The first thing I thought of when you said her back legs were weak was "what is her potassium?" and sure enough, her blood work shows it's low. Low potassium causes back legs to become weak and there are potassium supplements that can be given to correct it. I would definitely ask the Vet about that. Constipation and loss of appetite are just two symptom of low potassium, as shown in this website: Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - All About Potassium.
 
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Violet44

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Hi everyone, sorry for the delay. :catrub:Thank you all for providing some insights had been in the process of taking Squeeb to the vet when I got so many replies. I asked them to give her subcutaneous fluids and a vitamin B12 injection, which perked her up a lot; she's eating and seems less weak than the day before.

She also managed to have a rather large poop at home, so I'm no longer worried about constipation for the time being. I haven't given her lactulose in a few days because I notice that it starts to dehydrate her (especially at the dosage I have to give her to keep her poop soft enough to prevent straining whenever she eventually poops (6ml; the 2ml a day isn't sufficient).

FeebysOwner FeebysOwner You mention adding miralax; I actually had bought some miralax a few months ago for her; I tried it once at 1/4 tsp, but stopped because I was worried about dehydrating her, especially with the addition of the lactulose. In hindsight though, I can't tell if the miralax alone was the culprit or just the progression of her disease. I've been wanting to know for the longest time to what extent these laxatives are dehydrating, given that they take the water from the body and move it to the colon. She doesn't eat wet food consistently unfortunately, so it's a worry I have. Her vet also makes lactulose seem like it's just a sugar, but I have a feeling that in high doses, it's probably dehydrating.

And yes, her T4 levels were checked; they should be listed at the bottom of the first PDF I attached. I'm not too sure how to interpret the results, however.

I've also syringe fed her the Gerber's plain chicken before to try to get more calories in her in the past. She was also previously on the boiled chicken and rice bland diet about 1.5 years ago, but I had to stop that, as I don't believe she was getting enough vitamins (this is when her IBD wasn't cooperating at all). I find that when I leave out wet food and add lots of water, she sort of slurps//drinks it, but doesn't eat the food contents as much. Currently, I crush up her meds (current vet doesn't have liquid formulations) in Hill's A/D and administer via syringe.

Regarding her WBC, she's currently on a course of clamavox antibiotics, but will be finishing soon. The problem is, her WBC goes down a little after antibiotics, but never stops being high. As an example, it used to be 45,000 and then after a 10 day course of antibiotics, it went down to around its current number.

daftcat75 daftcat75 Thank you for sharing. I should have specified earlier, but I already scheduled the internal medicine specialist for about 2 weeks from now, and will definitely be providing all of this info to try to figure out what's really happening with her. I'm also trying to avoid anything invasive, given her condition. She's still loving, energetic at times, etc, but she is still not a good candidate for surgical procedures with any cutting or recovery time imoAC. I'm also nervous about chemo, as my first vet (who I was very close to) had advised against it back when Squeeb was first diagnosed with IBD because she said that it was harsh on kitties, hence why we went with prednisone.

mrsgreenjeens mrsgreenjeens Wow, I didn't think about the potassium. I'll definitely read up on what you've provided after work. Do you know if vitamin b12 oral supplements are also a thing? I would be curious, as they may help her as well.
 

FeebysOwner

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Do you know if vitamin b12 oral supplements are also a thing? I would be curious, as they may help her as well.
There are oral B-12 supplements, and many folks give their older cats daily doses of it. I just bought one for Feeby - 500mcg in a capsule, but I empty the capsule's contents into her food. The one I picked was Vitacoast B-12 Supplement (Methylcobalamin). The thing about oral B-12 and injections somewhat depends on how deplete the B-12 level is, as the injection is more effective. Oral B-12 can help overall for a lot of issues, but less is absorbed into the body as opposed to the injections. This too, is discussed on Tanya's web site. Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - B Vitamins, Including Vitamin B12 (Methylcobalamin) (felinecrf.org).

This is another section of Tanya's web site you might find of interest - Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - Constipation (felinecrf.org)

I know the references above are for CKD cats, but some of the information applies more broadly. Here is another good web site that applies to just more than IBD cats that are being fed raw food. Raw Feeding for IBD Cats - Feline IBD

And yes, her T4 levels were checked; they should be listed at the bottom of the first PDF I attached. I'm not too sure how to interpret the results, however.
I just looked again; her T-4 is certainly NOT indicating hyperthyroidism.
 
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daftcat75

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I'm also nervous about chemo, as my first vet (who I was very close to) had advised against it back when Squeeb was first diagnosed with IBD because she said that it was harsh on kitties
I hope the specialist gives you better guidance. In my experience, and talking with my previous cat’s vet, the owner and founder of a 30+ years cat-only practice, pred can be harder on cats especially at larger doses when smaller doses aren’t cutting it.

Krista’s previous vet wouldn’t prescribe chemo without the biopsy to confirm it. That's when I went over her head to the owner of the practice and we had a great conversation that went something like this:

"Krista's symptoms are not responding to pred like we had hoped. She's still having poop issues (liquid poops in her case, though we did have some poop nonsense that started like diarrhea and finished like constipation with a vomit at the end.) Our choices to move forward are:

a. Do nothing, e.g. more of the same. Obviously this isn't feasible.
b. More pred (or as I like to call this approach, "pred and pray" because we're praying more pred will be the answer.)
c. Surgical biopsy on a sixteen year old cat who isn't stable and has already lost 1/3 of her body weight and is still losing weight and will continue to lose weight through the biopsy recovery period, or...
d. Try the chemo without the diagnosis. If it doesn't work, we can always circle back to option b."

The doc/owner gave me the informed consent speech of "we're trying something without a diagnosis that may not work and while unlikely, it may make matters worse. As long as you understand and agree to this, we can try the chemo without a biopsy."

Krista's weight loss stopped and her liquid poops firmed up. The poop nonsense didn't completely go away because I was wrapping her nightly pred in a trigger food. It wasn't until an unrelated surgery forced my hand into transdermal pred that she finally reached remission almost overnight. Unfortunately, she had lost too much weight by this point. She was down to almost 1/3 of the cat she used to be. She would enjoy one month of remission before a bladder infection proved too much for her.

The chemo itself made her a little more sleepy on dosing days. But that's the only side effect I ever noticed. The pred looked like it was harder on her than the chemo.

If you can't wait until your specialist appointment, you can sign up to the Feline Lymphoma support group and send them a message for their thoughts, and ask them how tough chemo has been on their cats.
Felinelymphomasupport groups.io Group
 

Timewarpcat

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It's been a long time since I had a cat like this, but as I recall, the vet said that there is no bright line between IBD and cancer. And I think I recall that the chemo is a higher dose of the prednisalone? That could be wrong.

I had some cats get kidney failure as well, with the slow decline.

After a lot of years with cats and caregiving for family members, I want to mention that sometimes more care isn't better. The cat may be miserable, as is common with people getting too many procedures at the end of life. Be sure to have that conversation with your vet so you don't overtreat. I do think I overtreated some CKD cats with the subQ fluids and also eventually the IBD cat got cancer and I should have let her go a couple months sooner than I did. Maybe even 6 months sooner. We all die, and death is not a failure. I regret the overtreatment.

I don't know the medical condition of your cat at this time. But I just want to say this is a conversation to have with the vet (and this is a conversation for people to have for their own medical care when they have a grave illness). The vet has seen so many cats in his/her career and will be able to make an educated guess about prognosis if you ask, and what is best for the cat. Often the vets don't have this conversation with you unless you ask. It is so hard with the kitties and their short lifespans and I love them very much just as you do.
 

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Be sure to have that conversation with your vet so you don't overtreat. I do think I overtreated some CKD cats with the subQ fluids...The vet has seen so many cats in his/her career and will be able to make an educated guess about prognosis if you ask...
I just want to add that some vets plain don't believe in treating certain things. Other vets just don't think it is necessary to do so in 'older' cats. So, the vet is not always the one to rely on to determine what level of treatment might be appropriate. I know of numerous cases where a vet has told an owner, 'Your CKD cat probably has maybe 6 more months to live.' - the owners found other vets to help with treatment options and many of these same cats are still going strong 2 & 3 years later.

There is no black and white to any of this, of course. But, if one does their research and what they've found out to be possible doesn't mesh with their vet's general philosophy, then they should look for more opinions before trusting in just that one vet.
 

Timewarpcat

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Totally agree.

To add to the conversation, another thing is that website medical info (eg Mayo, Web MD etc) is often more upbeat about the results of treating serious medical conditions than they really should be, for pets and people. This makes decision making harder.

I personally think it's usually worth trying the subQ fluids. In my family over the years, 4 cats got the subQ and one lived happily for a couple years, the others dragged along in misery.

I take my cats to a more distant vet because my local vet is just as you say.

You just have to do your best for the kitty, who doesn't know why you are doing these things. And you have to make decisions while you're upset.
 

nanniecat

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Hi, I’ve been a long-time reader of this site, and it has helped me so much regarding treating my senior cat, Squeeb, who was diagnosed with IBD 4 years ago. I finally worked up the nerve to ask for help here, as I’m not sure what else to do recently.

Squeeb was doing alright for a while on prednisone/prednisalone and a diet change (even though she had gradually begun to lose weight over that time; she was initially 13 pounds and then got down to 9 pounds over that 4 year period). But within the last year she’s begun to decline more drastically; she started to have constipation and vomiting when trying to poop, which lead to an enema and her subsequently being put on lactulose (and Cisipride to occasionally aid her). The lactulose is also losing its efficacy, as I have to give her around 6ml to keep her poop soft enough to not make her strain. She has become more dehydrated more often, despite drinking a lot if water from a fountain. I also haven’t been able to find her any wet foods that she’ll consistently eat (I’ve tried so many) so she switches between Hill’s I/D, blue wilderness raw, and instinct raw dry. She’s improved a little after having IV/subcuentous fluids.

She’s had 3 ultrasounds essentially saying that she has a thickening of the intestines consistent with IBD and suspected mild pancreatitis, but never got a biopsy to rule out lymphoma. Most alarming and mysteriously though, is that her white blood cell count has been extremely high within the last year, and no one knows why other than to say that she likely has an infectious disease. Vet says she doesn’t have diabetes or kidney failure, but I’m not sure, given what I’m seeing.

She’s now down to 5.8 pounds and her legs are sort of weakening, even though she’s eating and drinking and I’ve been giving her additional calories by syringe feeding Hill’s A/D (sometimes with appetite stimulant).

I’ve cried over this for the last few months; I’ve had Squeeb since she was a kitten and I have been keeping her afloat for so long that it hurts to see her at this standstill. I’m worried that this may be the end, but I don’t know what’s happening, and I want some understanding. I’m planning on taking her to an internal medicine specialist in 2 weeks to get a second opinion for more information, but I’d also appreciate if you all could share your thoughts of what could potentially be going on beside the IBD based on her most recent bloodwork/personal experience? This not knowing is taking a toll on me. Thank you.
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nanniecat

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have they considered FGESF? did they do a biopsy at any point? my baby was diagnosed 5 yrs ago. the diet is a hypoallergenic only. a yr ago they added Visbiome(probiotic)for diarrhea. it helped a lot. she is 18 now. she eats only novel proteins. right now she like RC PD> her kibble dujour is purina HA. my girl sees an oncologist ev 6 mo. a lot of vets misdiagnose the disease and/or not familiar with it. i hope she gets better. how much pred does she get?
 

nanniecat

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have they considered FGESF? did they do a biopsy at any point? my baby was diagnosed 5 yrs ago. the diet is a hypoallergenic only. a yr ago they added Visbiome(probiotic)for diarrhea. it helped a lot. she is 18 now. she eats only novel proteins. right now she like RC PD> her kibble dujour is purina HA. my girl sees an oncologist ev 6 mo. a lot of vets misdiagnose the disease and/or not familiar with it. i hope she gets better. how much pred does she get?
 
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