Cat with IBD, chronic pancreatitis and CKD stage 2-3

[yujin lee]

My cat is 14 years old and has IBD, chronic pancreatitis and CKD stage 2-3.  

IBD was diagnosed under the assumption. Visible symptoms but nothing was found in her blood. Her IBD symptoms are going to the toilet several times (usually 3-7times and 3-5 times attempting to go but nothing comes out) and occasionally very soft/thick soupy stool. She excessively gives strength even when the stool is soft, often I need to hold and support her to help. I am not sure why she attempts to poop so often when there’s nothing to poop out.  

Can she be doing this because of IBD? Also ultrasonography shows swollen small intestine and end of colon. Steroids were never used, my vet would NOT prescribe this because of its side effects and possible kidney failure. However, I see that many are using steroids so I am wondering if I should try this treatment?? My vet said my cat's condition is not bad enough to use steroids plus it could actually make it worse.  Any experiences with using steroid treatment?

Also, because of her vomiting(2-3 times a week), I am trying to use Cerenia.  I have tried Cerenia tablets for about 2 weeks but nothing changed.  I gave her 2mg but I am wondering that was too little(she's 3.9kg).  Again, my vet won't prescribe high doses because of her CKD and that could damage her liver.  She does not have any problem with her liver at the moment.  Instead of tablets, she gets Cerenia shots when the vomiting get really bad, which seems to help but vomiting comes back after 2 days.  Cerenia shot can't be used regularly for a long tine so I am trying to figure out a better solution.  Has anyone used Cerenia tablets for a long time continuously and higher doses??  

I'm also giving her probiotics and SEB. Her diet really is important but since she's been having so many different sicknesses, it's very hard to control her diet. She barely eats so it is really difficult, I am trying my best though.  Any thoughts or advice would be much appreciated. Thank you!

 

[missmimz]

 
My cat is 14 years old and has IBD, chronic pancreatitis and CKD stage 2-3.  

IBD was diagnosed under the assumption. Visible symptoms but nothing was found in her blood. Her IBD symptoms are going to the toilet several times (usually 3-7times and 3-5 times attempting to go but nothing comes out) and occasionally very soft/thick soupy stool. She excessively gives strength even when the stool is soft, often I need to hold and support her to help. I am not sure why she attempts to poop so often when there’s nothing to poop out.  

Can she be doing this because of IBD? Also ultrasonography shows swollen small intestine and end of colon. Steroids were never used, my vet would NOT prescribe this because of its side effects and possible kidney failure. However, I see that many are using steroids so I am wondering if I should try this treatment?? My vet said my cat's condition is not bad enough to use steroids plus it could actually make it worse.  Any experiences with using steroid treatment?

Also, because of her vomiting(2-3 times a week), I am trying to use Cerenia.  I have tried Cerenia tablets for about 2 weeks but nothing changed.  I gave her 2mg but I am wondering that was too little(she's 3.9kg).  Again, my vet won't prescribe high doses because of her CKD and that could damage her liver.  She does not have any problem with her liver at the moment.  Instead of tablets, she gets Cerenia shots when the vomiting get really bad, which seems to help but vomiting comes back after 2 days.  Cerenia shot can't be used regularly for a long tine so I am trying to figure out a better solution.  Has anyone used Cerenia tablets for a long time continuously and higher doses??  

I'm also giving her probiotics and SEB. Her diet really is important but since she's been having so many different sicknesses, it's very hard to control her diet. She barely eats so it is really difficult, I am trying my best though.  Any thoughts or advice would be much appreciated. Thank you!

Was her T4 normal? Have you tried something like homecooked food with EZcomplete? Probiotics and SE are great additions too. 

 

[stephenq]

I'm also giving her probiotics and SEB. Her diet really is important but since she's been having so many different sicknesses, it's very hard to control her diet. She barely eats so it is really difficult, I am trying my best though.  Any thoughts or advice would be much appreciated. Thank you!

My cat had all three conditions you listed although the CKD was mild.  Honestly based on what you;ve said, i don't understand your vet.  Prednisolone puts a cat at risk for diabetes, not worse CKD, and the risk of diabetes is fairly low and down the road.  Having said that if your cat is not loosing weight then it may in fact be too early to use Pred, but make no mistake, if your cat gets advanced IBD (weight loss that can't be arrested through other means) then you either put the cat on Pred or watch your cat die.  Diabetes is a future hypothetical and my cat never got it and yours might not too.  And diabetes can be treated. The thickened bowel is indicative of IBD, and the pred, which is not a anabolic steroid but a coticosteroid - totally different, works to reduce inflammation and allow your cat to absorb nutrients.  IBD can remain mild for a long time and other therapies can be used, probiotics, antibiotics (tylosin, metronizidole), Vitamin B12 injections, and prescription novel protein diets like rabbit or duck that the cat isn't yet allergic (hopefully) to those proteins.

Also, it isn't true that Cerenia can't be used long term, it totally can be, what the label says is you need to give it 5 days on, 1 day off, but following that protocal the cat can stay on it forever, and many cats at a reasonable dosage (like mine) can actually do it 7 days a week without rest.  If given by Sub Q injection (which seems to be working for your cat) then you want to give it with fluids so to avoid stinging, and you can do this at home.  As to your dosage of pills, I don't know your cat's weight and i'm not allowed to make dosage suggestions but as an example, in this article they quote a dose of 1mg/kg body weight with means a 10lb (4.5kg) cat would need about 4mg per day.  One of the conditions its specifically proscribed for is vomiting as a result of kidney disease  (but also IBD and Pacreatitis).  "In cats, maropitant (Cerenia) has a half-life of 13–17 hours, and is cleared more slowly than in dogs.2 Maropitant is approved in cats at a dosage of 1 mg/kg SC q24h for acute vomiting. The oral tablets are also commonly prescribed to cats off-label, for example, in treating chronic vomiting in cats with chronic renal failure."  From http://www.cliniciansbrief.com/sites/default/files/attachments/Pharm_Maropitant Novel Antiemetic.pdf

Zofran is another good anti-nausea medicine that is only give by sub q injection, can be combined with cerenia and doesn't need to be given with fluids because it doesn't sting, but must be given every 6 hours.  Helpful though if the cat is having a bad flare up, as can fluids help.

The bottom line for me, if this was my cat, i'd want a second opinion from another vet about both the prednisolone and the use of Cerenia.  I've never heard of Pred making IBD worse, that doesnt make sense although your cat may not be ready for Pred just yet.  Un-arrested weight loss usually defined as 3 losses measured in a row despite therapies to reverse it)  is when Pred becomes imperative.  

If your cat isn't eating, it may be because of nausea, or the choice of food, but your cat's situation sounds serious and i'm not convinced your vet is being proactive enough.

 

[orientals]

Hi Yujin, It does not sound too good. What is her name? Have you had her al this time?

I have a 16 year old cat, Tippi. She als has CKD. If have long ago stopped giving her the special diet. She wouldn't eat it. I have been feeding her a raw meet diet for over a year now. She eats like mad. I know it's not the best for her kidneys and she does vomit but she loves to eat it and has put on weight and I think that is the most important thing. If she won't eat she will die. The nausea I keep under control with something from the vet, some drops. Also when she has problems going to the litter box, I have a bit of laxative. All in all she is quite a happy cat. 

My main concern would be to stop the nausea and get her to eat. 

 

[yujin lee]

I am considering EZ complite to give to my cat but I am little concerned because of very high in protein (80%).  She has CKD stage 2-3 and Sub fluid every day.  I want to try EZcomplite or Freez dried food(stella'chewy)  because of her IBD and chronic pancreatitis, do you think it'll be safe to use this?

 

[yujin lee]

 
Was her T4 normal? Have you tried something like homecooked food with EZcomplete? Probiotics and SE are great additions too. 

Her T4 is normal and I've mentioned I am already giving her probiotics and SEB. She's not eating much but not loosing any weight either.

 

[orientals]

I made the choice to get my cat to eat. But the raw meat diet is not good for het CKD. But I rather have her eat this than have her on the special kidney diet and not eat. There is no safe choice, you have to pick the one that will keep her alive the longest.

 

[yujin lee]

 
My cat had all three conditions you listed although the CKD was mild.  Honestly based on what you;ve said, i don't understand your vet.  Prednisolone puts a cat at risk for diabetes, not worse CKD, and the risk of diabetes is fairly low and down the road.  Having said that if your cat is not loosing weight then it may in fact be too early to use Pred, but make no mistake, if your cat gets advanced IBD (weight loss that can't be arrested through other means) then you either put the cat on Pred or watch your cat die.  Diabetes is a future hypothetical and my cat never got it and yours might not too.  And diabetes can be treated. The thickened bowel is indicative of IBD, and the pred, which is not a anabolic steroid but a coticosteroid - totally different, works to reduce inflammation and allow your cat to absorb nutrients.  IBD can remain mild for a long time and other therapies can be used, probiotics, antibiotics (tylosin, metronizidole), Vitamin B12 injections, and prescription novel protein diets like rabbit or duck that the cat isn't yet allergic (hopefully) to those proteins.

Thank you for your comment!  I am not going to push on using steroids just yet, but I want to control her vomiting first.  After her vomiting is better, maybe I can talk to my vet about it again.  Weight loss has never occurred yet and I think vomiting is due to nausea.  When she is on Cerenia injections, she eats.  When she eats, less chance of vomiting or no vomiting but injections only lasts for 2-3 days.  I am going to try giving her higher doses of Cerenia tablets, because tablets can be used more often/long-term.  My vet prescribed only 2mg when my cat weighs 3.9kg.  I think that is way too little and maybe that's why tablets didn't help at all.  I haven't tried Zofran yet, have you tried this before?

I am already giving her SQ, B12 injections, probiotics, slippery elm and rabbit did not relieve symptoms and duck actually worsened the symptoms. I am still trying different options but there are a lot of restrictions due to CKD.  At the moment it is important she eats because if she doesn't eat, she WILL vomit. So I am giving her whatever is good for her condition but if she doesn't want to eat at all, I giver her food that's not so good(for her condition) but if she eats little,  at least she's got something in her stomach, which will keep her from vomiting.  It is difficult though because she won't eat anything if she feels nauseated(and she will vomit) but my vet only prescribes 2mg which doesn't do anything and shots are just temporary solution because it only lasts 2-3days. This goes back to using Cerenia, this is why I was wondering if anyone is using Cerenia tablets regularly for a long time if it is okay.  Anyway, I am going to try higher doses, at least the right amount for her weight and see if it helps!

She also struggles with going to the litter box.  She goes often, 3-7 times a day but mostly just attempts and nothing is coming out.  There's inflammation in her small intestine and end of colon(1mm thick), maybe this is the reason for her going to the litter box so often??  Usually I need to support and help her because she struggles.  Corona virus was found from IDEXX , T4 is normal and glucose never went up either.  It's really difficult when there's many different disease, but I am doing my best and will continue to try/look for different options.  Thanks again!

 

[missmimz]

 
Her T4 is normal and I've mentioned I am already giving her probiotics and SEB. She's not eating much but not loosing any weight either.

Right. I was praising that you were using those two things, not recommending that you use them. If you're interested in raw feeding or homecooked consider joining this FB group 

https://www.facebook.com/groups/RawFedIBD/

 

[stephenq]

Pepcid AC can also help with vomiting (ask vet for instructions) and your vet can also teach you how to give injectable Cerenia with sub Q fluids at home.

 

[darkhorse321]

Having just dealt with this (not the CKD), I feel your pain.

Have you tried a CKD diet? They have a great hard food available for kitties with CKD--it doesn't reverse the problem but slows it down. This helped with my two kitties!

My boy also had chronic pancreatitis and likely IBD along with megacolon(go figure). My RX was:

1. Prednisone: We couldn't rule out cancer for him so we chose to use this. Your vet is right to be cautious in it's use as it can make a cat weaker and susceptible to ilness. However, it is very good at treating nausea and the runs

2. Pepcid AC. This was a LIFE saver!! Speak to your vet, but the general dose is a 1/4 tablet morning and night. It's pharmacutical name is fantome I believe. Make sure it's Pepcid AC---to control acidity. This can help the pancreas heal by stopping excess bile production/acidity. Get a pill cutter though--those things are a nightmare to make into quarters. My boy went from being so ill to just needing 2 meds daily after a week of using this!

3.B-12. Lacking B-12 can cause nausea and vomiting and lethargy in cats

4. Fluids

5. Cerenia

6. Metronitodole for diarrhea control. Again, speak to your vet about all of these before using them.

Get fancy feast food--this seemed to really make my boy happy. It's tasty and didn't seem to irritate his tummy. Wet food that is. I'd suggest the dry food for CKD---it works well! I think I may have some if you'd like me to send you a trial amount. I live in Canada thought

 

[tunabug27]

I don't recommend Pred due to causing diabetes in cats. However, there is a different option. Ask your vet about budesonide. It is what my cat takes for her IBD. It's a steroid, but it is new. It doesn't affect any organs other than the stomach, works topically so does not cause diabetes or puts a cat in risk of other health defects. Budesonide is a compound drug, was generally meant for humans, but has been compounded for feline consumption. My cat has been on it for over a year, she almost never vomits, I didn't have to change her diet, she eats and drinks fine, she is ata healthy weight and she plays. She's a normal cat, she just has to take the medications once a day. I highly recommend looking up budesonide and discussing it with your vet. However, I will say, budesonide is not cheap, it does cost more since you have to go to a compound pharmacy to have it made. Where I live, pred is $27 for a month. But for Budesonide it's $49 a month. But if you get the chance talk about it with your vet.

 

[stephenq]

 

The post above mine recommends Budesonide, another good choice.  Note its much stronger, and its dosage has to be carefully regulated or side effects can occur.  See https://www.vetinfo.com/budesonide-for-cats.html and https://www.vetinfo.com/feline-inflammatory-bowel-disease.html and http://www.ibdkitties.net/introduction-to-steroids-4/

 

[catmom203]

I made the choice to get my cat to eat. But the raw meat diet is not good for het CKD. But I rather have her eat this than have her on the special kidney diet and not eat. There is no safe choice, you have to pick the one that will keep her alive the longest.

My cat eats cooked beef and I give him Epakitin to help control phosphorus with his CKD. Just a thought. Do your research on it and see if you think it would help.

 

[mmosimca]

Your vet is not exactly wrong about corticosteroids, not entirely. Corticosteroids do put a strain on the kidneys, which can slightly speed up the progression of CKD.

The concern of diabetes is not really warranted, though. Like mentioned above, diabetes takes quite a while to develop from steroid use, and it is also fairly easily managed compared to the other conditions. At most, you stop the corticosteroids, and the diabetes will almost always vanish.

This all said, I think corticosteroid use is important in cats who copresent symptoms of both CKD and chronic pancreatitis or IBD, especially if they aren't eating. Cats usually aren't eating because they don't feel well, and in both pancreatitis and IBD, that's because of inflammation. Corticosteroid use will combat that inflammation and make the cats feel better. It will also make them feel very hungry and help them put on weight.

In my cat, anti-nausea drugs had almost no effect and using corticosteroids to address the underlying pancreatitis caused him both to stop vomiting and to start eating again. The difference is pretty much night and day.