Food Allergy + IBD Symptom Relief

daftcat75

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At the ER, they would start with blood work. If nothing obvious in the bloodwork, they might perform an X-ray to look for an obstruction. They would have also palpated his belly/gut to see if they could feel if he was full of poop. When was the last time he pooped? It's possible he's barfing because he's too backed up. Beyond that, if they couldn't find anything in the bloodwork or the X-ray, the next step would probably be an ultrasound. In the meantime, they might give him fluids to replace body moisture lost to vomiting and not eating. They might also give him a Cerenia shot to interrupt the vomit signal in his brain. Do you have Cerenia at home? Perhaps you could call your vet in the morning to pick up a prescription for Cerenia pills. Some cats get inappetent on Cerenia. If yours does too, ask for Zofran (ondansetron) instead.

My feeling on this, as long as his barf doesn't look green or smell awful like bile or poop, it's probably not an emergency just yet. I would give it several hours before offering him any more food. Then you can give him quarter portions the rest of the night. Give up any hope or intention of getting full calories in him today. Just consider whatever you can get in him tonight as moisture to keep dehydration away.

Tomorrow is another day. If he's still barfing or not eating by morning, you could call your vet about squeezing him in as a drop-off. Although, if he's insured, or you can afford it, some of those emergency rooms also have specialists and equipment that your regular vet may not have. Unfortunately, to jump the line for a specialist, your cat will likely have to be an in-patient already. When Krista fell off the bed, vomited, and stumbled around on her hocks like she couldn't get to or stay on her feet, my options were to let the ER keep her overnight so the neurologist could see her the next day, or it would take several weeks to go through the front door for that same neurologist appointment.
 
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__caitlin

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Thank you so much for being here for me. I really do appreciate it. 🙏

His regular vet is an internist at a specialist + ER clinic actually! I haven't brought him to a primary vet pretty much since his diagnosis. But I just confirmed with that clinic that they do not have ultrasound capacity at night, and the next available appt isn't until Thursday anyway -- so I'd really only be bringing him there for bloodwork (which he just got a week and a half ago), x-rays (not sure if worth it since his ultrasound from a week ago didn't show any obstruction), and Cerenia or other prescription meds. Not sure if it's worth all that stress on him.

And yes, he did also poop twice during the last few hours -- one soft-serve which really seemed to bother him; then another completely watery stool. I did give him the sub-q fluids, which is one comfort at least.

Although I just found another hospital nearby that apparently specializes in cats, and seems a bit less sterile and institutional than the one I usually take him to. They're not a 24-hour facility, but I might try to give them a call first thing in the morning to see if there are any openings.
 
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__caitlin

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Anything new on his vomiting, etc?
He’s actually doing much better right now, thank you!! Fingers crossed it stays that way. I am so worried he’s going to starve to death before he can get better.

To be honest, I think what happened is that his baseline is still nausea and inappetite — but whenever he has a bad bout of vomiting like this, I often withhold his thyroid meds 🤦🏻‍♀️ And then over time his hyperthyroidism kicks back in and it makes him willing to eat again. Then when he’s eaten enough, I give him his meds again, and the cycle restarts.

That’s my personal theory at least, because he started to eat again throughout last night and this morning, started to slowly feel better. Then I gave him his meds — and next meal, he didn’t want to eat again.

I’ve started syringe feeding him whenever he does this, and so far it seems to be helping (he’ll seem nauseous and refuse food but then seem to improve after being syringe fed).

His vet won’t give me the cerenia and mirtazipine until tomorrow for bureaucratic reasons. But I’m going to try to hold out until the end of the month and then take him to a new specialist who will hopefully be better. 🙏
 

daftcat75

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He’s actually doing much better right now, thank you!! Fingers crossed it stays that way. I am so worried he’s going to starve to death before he can get better.

To be honest, I think what happened is that his baseline is still nausea and inappetite — but whenever he has a bad bout of vomiting like this, I often withhold his thyroid meds 🤦🏻‍♀️ And then over time his hyperthyroidism kicks back in and it makes him willing to eat again. Then when he’s eaten enough, I give him his meds again, and the cycle restarts.

That’s my personal theory at least, because he started to eat again throughout last night and this morning, started to slowly feel better. Then I gave him his meds — and next meal, he didn’t want to eat again.

I’ve started syringe feeding him whenever he does this, and so far it seems to be helping (he’ll seem nauseous and refuse food but then seem to improve after being syringe fed).

His vet won’t give me the cerenia and mirtazipine until tomorrow for bureaucratic reasons. But I’m going to try to hold out until the end of the month and then take him to a new specialist who will hopefully be better. 🙏
I would take the prescriptions and fill them now. It's better to have them and not need them than the other way around.

But you also don't want to cycle through vomiting like this. Wasn't he also diagnosed with pancreatitis? This vomiting cycle is bad for pancreatitis recovery. Cerenia actually has some anti-inflammatory action that helps with pancreatitis. I would discuss your med cycling with your vet because you don't want to be trading HT for pancreatitis, or vice versa. Ideally you can find the right amount of anti-nausea (and appetite stimulant if you need it) so that you can keep him eating through all his meds and all his conditions. I don't know about HT. But steroids should always be given on schedule. You don't want to start and stop steroids. Steroids are already challenging to a cat. But even more so if the dose and frequency keeps changing. I would imagine HT is another that you don't really want to be starting and stopping.
 
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__caitlin

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I would take the prescriptions and fill them now. It's better to have them and not need them than the other way around.

But you also don't want to cycle through vomiting like this. Wasn't he also diagnosed with pancreatitis? This vomiting cycle is bad for pancreatitis recovery. Cerenia actually has some anti-inflammatory action that helps with pancreatitis. I would discuss your med cycling with your vet because you don't want to be trading HT for pancreatitis, or vice versa. Ideally you can find the right amount of anti-nausea (and appetite stimulant if you need it) so that you can keep him eating through all his meds and all his conditions. I don't know about HT. But steroids should always be given on schedule. You don't want to start and stop steroids. Steroids are already challenging to a cat. But even more so if the dose and frequency keeps changing. I would imagine HT is another that you don't really want to be starting and stopping.
Yes, sorry, that’s what I meant — that I am going to get the meds tomorrow and see if we can last on those at least until the end of the month and avoid another vet visit before then if at all possible. As opposed to bringing him to the ER again sooner than that only for them to redo the same tests he got a week and a half ago.

I agree the cycling with hyperthyroidism is bad. Although to be honest, I’m not sure why, but on multiple occasions in the past both his specialists + his primary vet have never been concerned about him potentially missing doses of it. The day he was really bad and I took him to the ER to get the steroids, he had missed one dose and threw up another one and the vet was totally unconcerned (and his T4 still came back “relatively well controlled”).

I definitely don’t screw around with the steroid though. Except for the dose he threw up :/ I’ve been told it’s safer to just stick with the dosing cycle and not give extra doses just because he vomited, so that’s what I did. I may have to experiment with different compounds though because he doesn’t like the flavor they gave me and won’t eat it voluntarily (but takes to syringing just fine).

I also asked for the mirtazipine to be transdermal. Hoping that will be a little easier to administer.
 

daftcat75

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Yes, sorry, that’s what I meant — that I am going to get the meds tomorrow and see if we can last on those at least until the end of the month and avoid another vet visit before then if at all possible. As opposed to bringing him to the ER again sooner than that only for them to redo the same tests he got a week and a half ago.

I agree the cycling with hyperthyroidism is bad. Although to be honest, I’m not sure why, but on multiple occasions in the past both his specialists + his primary vet have never been concerned about him potentially missing doses of it. The day he was really bad and I took him to the ER to get the steroids, he had missed one dose and threw up another one and the vet was totally unconcerned (and his T4 still came back “relatively well controlled”).

I definitely don’t screw around with the steroid though. Except for the dose he threw up :/ I’ve been told it’s safer to just stick with the dosing cycle and not give extra doses just because he vomited, so that’s what I did. I may have to experiment with different compounds though because he doesn’t like the flavor they gave me and won’t eat it voluntarily (but takes to syringing just fine).

I also asked for the mirtazipine to be transdermal. Hoping that will be a little easier to administer.
You are correct. Don't double up steroids doses even if he threw up a dose.

You only get two ears to work with for transdermal meds. And you are supposed to rotate ears. So ideally, only one med could be transdermal. But Wedgewood has a dozen different flavors you can get the steroids compounded into. Krista enjoyed both the anchovy (her chemo) and duck (an antibiotic) flavors. But she reacted to something in the duck formulation. I called up Wedgewood and they rushed me a new formulation free of charge.

So if you don't know, mirtazapine has a reputation. It's often nicknamed "meowzapine" because cats often become vocal and restless on it. What I found that worked with Krista was, with my vet's blessing, reduce her dose, and also be there for her when it kicks in. From what I observed, I imagine it has a rush and that's what many cats react to. For Krista, she wanted to be held and comforted during that rush period where she would meow, trill, and purr her little head off until the rush subsided. Then she'd jump from my lap and tear into whatever plates I had set out for her before I "mirtzed" her. I found the mirtazapine pills (1/4 of a 7.5 mg or 1.75 mg) worked better and more consistently for her than the transdermal. If the transdermal isn't working like you expect it to, try the pills.
 

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I am by no means an expert on this subject but I have an 8 month old kitten, Mookie, who has had chronic diarrhea since she was found at roughly 4 to 5 weeks. She has been on so many different meds, numerous tests, numerous different foods and what really helped was switching her to homemade diet and then eventually completely raw diet. No matter what high quality low ingredient canned food I would try instant diarhhea. I also did a gut biome test on her using animal biome and can not recomend them enough. It was extremely insightful as she had a severe gut microbiome imbalance. They spoke with me on the phone for over 30 minutes to make sure I understood the findings. They had me continue her taking their kitty gut restore pills for 30 days (which I purchased same time as the test and started her in them as soon as I got her pre pill sample) add in some fiber which they recommended a particular brand and continue with s boulardii for 2 months. I would look into the gut biome test and the kitty gut restore pills to see if you think this is something your cat could benefit from.
 
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__caitlin

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You are correct. Don't double up steroids doses even if he threw up a dose.

You only get two ears to work with for transdermal meds. And you are supposed to rotate ears. So ideally, only one med could be transdermal. But Wedgewood has a dozen different flavors you can get the steroids compounded into. Krista enjoyed both the anchovy (her chemo) and duck (an antibiotic) flavors. But she reacted to something in the duck formulation. I called up Wedgewood and they rushed me a new formulation free of charge.

So if you don't know, mirtazapine has a reputation. It's often nicknamed "meowzapine" because cats often become vocal and restless on it. What I found that worked with Krista was, with my vet's blessing, reduce her dose, and also be there for her when it kicks in. From what I observed, I imagine it has a rush and that's what many cats react to. For Krista, she wanted to be held and comforted during that rush period where she would meow, trill, and purr her little head off until the rush subsided. Then she'd jump from my lap and tear into whatever plates I had set out for her before I "mirtzed" her. I found the mirtazapine pills (1/4 of a 7.5 mg or 1.75 mg) worked better and more consistently for her than the transdermal. If the transdermal isn't working like you expect it to, try the pills.
Oh wow, that is really good to know about the mirtazipine, I'd never heard of that before. We had a CKD cat awhile back who was on a cerenia + mirt combo and he never did that, but he may have been so sick by the end already that it didn't have that impact.

I really can't wait until the Cerenia comes in. :/ I'm not really sure why the vet didn't prescribe it when he was initially diagnosed, but I hope it works on him. And I feel like I'm just so burnt out on oral medication after watching him throw up so many instances of different meds that now I'm predisposed to want something that doesn't rely on his already taxed and probably damaged digestive system for him to absorb it. But maybe the Cerenia will actually help with all of that.

I am by no means an expert on this subject but I have an 8 month old kitten, Mookie, who has had chronic diarrhea since she was found at roughly 4 to 5 weeks. She has been on so many different meds, numerous tests, numerous different foods and what really helped was switching her to homemade diet and then eventually completely raw diet. No matter what high quality low ingredient canned food I would try instant diarhhea. I also did a gut biome test on her using animal biome and can not recomend them enough. It was extremely insightful as she had a severe gut microbiome imbalance. They spoke with me on the phone for over 30 minutes to make sure I understood the findings. They had me continue her taking their kitty gut restore pills for 30 days (which I purchased same time as the test and started her in them as soon as I got her pre pill sample) add in some fiber which they recommended a particular brand and continue with s boulardii for 2 months. I would look into the gut biome test and the kitty gut restore pills to see if you think this is something your cat could benefit from.
Thank you! I actually did order a 30-day supply of the kitty biome supplements. I'm going to have to think carefully about the timing of when I try it, but I do want to try it at some point. And I do eventually want to switch him to a pork homemade diet unless he starts to make a miraculous recovery on his current food in the next couple months.

So glad your baby Mookie is benefitting from those changes! I wish I'd known about all this stuff earlier. Even if it wouldn't have prevented Max's eventual IBD diagnosis, it would've at least made this process a lot easier I think, for both me and him.
 

mrsgreenjeens

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I really can't wait until the Cerenia comes in. :/ I'm not really sure why the vet didn't prescribe it when he was initially diagnosed, but I hope it works on him. And I feel like I'm just so burnt out on oral medication after watching him throw up so many instances of different meds that now I'm predisposed to want something that doesn't rely on his already taxed and probably damaged digestive system for him to absorb it. But maybe the Cerenia will actually help with all of that.
We had a cat who couldn't be pilled even by a Vet Tech, so it was either transdermal gels or injections. Just saying this because it's possible for YOU to do injections at home, just like sub-qs. We did it with prescription pepcid AC for our old gal, and I'm sure there are others. That really makes it easy...easier than too many transdermals.
 

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The pharmacy told me transdermal cerania is not effective. It has be to absorbed in the gut.
 

daftcat75

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The pharmacy told me transdermal cerania is not effective. It has be to absorbed in the gut.
Cerenia isn't one I would waste a transdermal on. I think the suggestion was to ask whether you could get pre-loaded syringes of Cerenia to give as injections if you don't want to pill him.

I would save transdermals for those medicines where compliance is absolutely critical like steroids or the medicine is given regularly like Mirtaz. Maybe even the HT med could be compounded as transdermal to make it easy to stick with that one despite any vomiting episodes he might be having.
 
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__caitlin

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The update for today: I finally picked up his medication -- and he promptly threw up his first dose of Cerenia, in addition to his steroid probably. 🙃 Somehow I knew this would happen. I guess I'll try again in a bit.
 
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__caitlin

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Hey everyone — so we have an update:

After several more events and another comprehensive trip to an internist, which included an ultrasound, fine needle aspiration, echocardiogram, and urinalysis — there is an almost guaranteed chance that Max has large cell lymphoma.

His thickening progressed significantly since Nov 5th, and they also found a small mass. They sampled that + one of his lymph nodes, and will most likely refer me to an oncologist assuming the cytology report comes back with what we think it does. His echocardiogram did confirm that his heart is strong enough to go more aggressive on steroids for now.

I wanted to thank everyone in this thread, especially daftcat75 daftcat75 , for the endless support and virtual hand-holding through every stage of this process. Unfortunately all the ups and downs and his symptoms make a TON more sense now than when I thought I was just doing an IBD food trial.

Max, while physically withering away, is still very social, playful, loves to cuddle — and has also started to enjoy his syringe feeding. (He’ll go sit by the syringing chair when it’s time to eat and doesn’t struggle at all with me.) He is still pretty happy overall! Which definitely factors into my decision making here.

Would still love advice from anyone who’s navigated large cell lymphoma before, how you made decisions about chemo, and/or how you decided when it was time to euthanize / begin palliative care.

(Attachment includes a recent pic of him when I took him to the ER for constipation - we had to wait for 2 hours and he actually enjoyed exploring the waiting room!)
 

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daftcat75

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I’m so sorry you and he have to go through this. I don’t have any experience with large cell lymphoma. But my basic understanding of cancer tells me this isn’t a good one. Generally when there is a mass, there’s the very good possibility that is not the only mass. And if it can’t be removed, chemo will have to be more aggressive than small cell in the hopes of shrinking the mass.

My recommendation would be to sign up to the Feline Lymphoma support group and send a mail to the list. You may not get a reply right away as many members of the list opt to get a daily digest rather than individual emails. However, there are folks on that list and resources in this site (as well as the archives) that will be of great help to you to navigate whether to pursue treatment or how to make palliative care easier. They may also know of supplements or alternative therapies you could try if you decide against chemo.
Felinelymphomasupport groups.io Group
 

mrsgreenjeens

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I'm so sorry that it's leaning towards large cell lymphoma. Since you now are asking member here for their experiences with this, you might want to start up a new thread with that in the title, otherwise it's probabley no one with that experience will be reading this thread, based on it's current title.

I'm glad Max is enjoying his syringe feedings and still finding interest in his surroundings. That's great!.
 
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