IBD and possible lymphoma, my cat is crashing

daftcat75

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Wow! I didn’t get the notifications and missed so much. I’m still not sure I’m totally caught up. Forgive me if I say something that’s been addressed already.

Betty felt awful a few days after her endoscopy with biopsy. Fever of unknown origin. She just wanted to sleep and no eating. I spent about another endoscopy’s worth on ER bills, an extra x-ray and ultrasound to make sure it wasn’t a foreign body ingestion. She took five days of Veraflox and was so much better after the first dose. I think those snips are harder on a cat than the docs know or are willing to admit.

Your cat has to eat to poop. I wouldn’t expect a stool for a couple of days after not eating so long. He has to build up enough backlog (so to speak) to push something out. Now if he’s trying often that could either be the lymphoma/IBD pathology or it could be a reaction to his food.

Can you get him off the metronidazole? It really doesn’t do what many docs think it does. In most cases, it causes more damage to the microbiome than it fixes whatever they were hoping it would fix. It does nothing against clostridium and E. coli. These can be opportunistic invaders after metro use with their beneficial competition having been decimated by the metro itself. You’d be better served by the twice daily s boulardii. You should be giving the s boulardii to fix the damage the metro is doing. The s boulardii can also help protect against or reduce clostridium and E. coli populations that metro may have allowed to flourish. SB acts like a decoy gut, attracting, and attaching the pathogenic strains and flushing them out with his poop. As I said before, the SB may actually improve his poop situation on its own. SB and metro can (and SHOULD!) be given together if you or the vet don’t feel comfortable discontinuing the metro yet. But I’ll tell you that metro also makes a lot of kitties nauseated. If he doesn’t feel like eating, this could be part of the reason why.

I don’t like dry food for IBD. But I know you have to start somewhere. Do you know if he’s food intolerant? I mean besides that no good, very bad hydrolyzed food that’s not agreeing with him (I disagree that it will get better with more pred), do you know if there are other foods he responds poorly to?

Your cat may like Hills I/D dry and/or the stew can wet. Can you ask your vet for a bag of the dry and a few cans of the small stew cans? If he’s a gravy-licker, he will probably like the I/D stew.

Your cat may also like Hills A/D. It is a recovery food meant for sick and picky cats to get them to eat. If he doesn’t have a chicken sensitivity, I would ask for a can of this too. If he likes A/D, and most cats do, I recommend mixing it with another food he may be less excited about. Like the Hills I/D stew (not the liquid poo food he’s currently eating.) As the gut heals and he gets back on the pred, you may find he becomes less picky and more open to other wet foods. Especially if you’re mixing in the A/D kitty crack.

Now, the other reason I recommend not feeding the pure A/D is because A/D can be used to make all those meds he’s taking a whole lot easier on the both of you. If he likes A/D (or Royal Canin also makes a recovery food for the same purpose), then I would reserve pure A/D for meds time. And for all his other meals, mix the A/D with something else to keep the pure A/D appeal high.

My Betty will happily take any meds I can pack in a size four or size five capsule (larger size=smaller capsule) for her, twist it in A/D, and drop it on the carpet for her. She will scoop and swallow each capsule and be ready for the next one, purring the whole time. I can’t always get her to eat at meds time. But she always shows up and takes her meds. These days, I smear a tiny bit of A/D into a corner of her I/D. That gives her a place to start eating. And once she gets started, I can usually get 1/3 or 1/4 portion out of her. Enough that she has some food in her stomach for the meds. When her meds kick in, she will return to the plate to finish it. Usually a few hours later. Betty currently takes four capsules in the morning—ondansetron, gabapentin, s boulardii, and an FMT pill from AnimalBiome—and three at night—prednisilone+ondansetron (pack them in the same capsule), gabapentin, and s boulardii. She takes them on her own, and purrs the whole way through.

 
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Ocean Planet

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Betty felt awful a few days after her endoscopy with biopsy. Fever of unknown origin. She just wanted to sleep and no eating. I spent about another endoscopy’s worth on ER bills, an extra x-ray and ultrasound to make sure it wasn’t a foreign body ingestion. She took five days of Veraflox and was so much better after the first dose. I think those snips are harder on a cat than the docs know or are willing to admit.

This paragraph right here is my life right now. I went to visit him this evening and fever went back down to 102.2 and wala, he ate again. So how many days until your kitty fully recovered? Monday will be day 6 of really terrible days for my guy. This seems like it is going on too long....

I said I was happy with both of my vets and after reading some of these posts, it makes me wonder if I need to re-think that statement.

I'm using some notes from posts here to present to both Dr's tomorrow and see what their thoughts are. OK, the procedure irritated his gut; I can understand and accept that now. But I would think that there should be SOME positive signs after almost a week.... :( Maybe I'm wrong. I just hate seeing an animal so uncomfortable and suffering.
 

daftcat75

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This paragraph right here is my life right now. I went to visit him this evening and fever went back down to 102.2 and wala, he ate again. So how many days until your kitty fully recovered? Monday will be day 6 of really terrible days for my guy. This seems like it is going on too long....

I said I was happy with both of my vets and after reading some of these posts, it makes me wonder if I need to re-think that statement.

I'm using some notes from posts here to present to both Dr's tomorrow and see what their thoughts are. OK, the procedure irritated his gut; I can understand and accept that now. But I would think that there should be SOME positive signs after almost a week.... :( Maybe I'm wrong. I just hate seeing an animal so uncomfortable and suffering.
Did he start back on pred? That's an immune-suppressing drug. He shouldn't start back on pred until after this fever is gone. Maybe do a five day course of Veraflox? Finish the course even if he feels better after day one like Betty did. Betty had three bad days and I was insistent that she didn't start pred until after her fever was gone. Doc offered Veraflox and I reluctantly agreed. (I really don't like antibiotics, but sometimes they really are necessary.) Betty turned around on day one of the 'flox and day four (?) of her fever of unknown origin.

Metronidazole and/or the liquid gabapentin could be making him feel nauseated. If he's not taking an anti-nausea medicine, I would ask for ondansetron. A lot of cats have appetite issues with Cerenia. And if you can get him to take capsules, either with the A/D or pill pockets or a makeshift DIY pill pockets--something yeasty like s. boulardii or FortiFlora combined with a little moisture and a touch of wet food will make a doughy ball that you can attach his favorite powdered treat to with the medicine on the inside--if you can get him to take his own capsules, a lot of those meds packed in a capsule should be easier on his stomach.
 
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Ocean Planet

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Did he start back on pred? That's an immune-suppressing drug. He shouldn't start back on pred until after this fever is gone. Maybe do a five day course of Veraflox? Finish the course even if he feels better after day one like Betty did. Betty had three bad days and I was insistent that she didn't start pred until after her fever was gone. Doc offered Veraflox and I reluctantly agreed. (I really don't like antibiotics, but sometimes they really are necessary.) Betty turned around on day one of the 'flox and day four (?) of her fever of unknown origin.
Yeah, he has been back on the pred. I'll mention if we should pause for that reason. Thanks for the idea!!
 

silent meowlook

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If this is IBD he needs the prednisolone at the very least. It stops the inflammation. I think that is what you said they said is causing the fever. It does seem odd to me that his temperature keeps going so high. Has he had an ultrasound done?
 

daftcat75

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If this is IBD he needs the prednisolone at the very least. It stops the inflammation. I think that is what you said they said is causing the fever. It does seem odd to me that his temperature keeps going so high. Has he had an ultrasound done?
He just started pred. That’s when the fever started too. If he’s fighting an infection, you don’t give him an immune-suppressing drug. Hopefully it’s still soon enough that he can pause the pred without a taper in order to give this cat’s immune system the best chance at fighting whatever is causing the fever. Even a tapered dose of pred would be better than full strength right now. If he was on pred for awhile (weeks or months), I wouldn’t call for a pause. But since he just started, and since the fever seems to track with the pred use, in this case, I do recommend a pause. Or a taper. Whatever is safer for the cat right now. And as much as I don’t like antibiotics, I would recommend a course of a broad spectrum antibiotic like Veraflox. (Not metronidazole which may be causing more issues than it’s solving. 🤦🏼‍♂️) And any time antibiotics are used, I also recommend s boulardii to mitigate the unavoidable damage to the gut microbiome. And plan on giving the s boulardii for a long time after. It has taken months to rebuild Betty’s gut after her ‘flox. But that’s what she needed to get over her fever of unknown origin after her endo.
 
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Ocean Planet

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I just had a long conversation with the Internal Medicine doctor. To be up front, it is baffling why everything turned upside down so fast over the past month and there is not an answer for everything.

To summarize:
Yes, he did have an ultrasound that showed thickening of the GI tract and enlarged lymph nodes.
The biopsy confirmed 100% IBD and suggestive of lymphoma. They are doing the cell stain but not sure we need that any longer. The up and down fever is due to both of these things collectively.

I'm terrified but I may be looking at providing the best quality of life the next few weeks to see if he improves and have to make that call if he only suffers now.

I asked her, what do I do when the fever goes back up at home? He doesn't eat and the appetite stimulant doesn't work. She says I just have to let him ride it out with the fever. If he doesn't eat for 24 hours I can go to my primary vet to get a pick-me-up of fluids, etc, but she (and I) do not recommend any overnight hospital stays anymore. This was it.

She said the best thing we can do is stay stable with his meds and try to get through it to see if it is at a point we can stabilize him or if it is past that. At this point, nobody knows what will happen.
They want to keep him on the Pred as priority #1.
Appetite stimulant and gabapentin as needed.
Stopping the Metro now. (The doctor OK'ed this).
I asked about the Chemo pill and she said it would make him much more sicker at this point via the side effects.
I'm not sure what I'll do about the food.... he might associate this HP food with feeling bad so I may need to try one of the other things mentioned. As usual, the doctors keep saying, well let's try another HP brand... sigh. Honestly, if it's this serious I don't think the food will make a huge difference.

So, no more hospital stays. I'll do the best I can with these meds. I'll pick him up after lunch today and spend as much time as I possibly can outside of work hours.

I've lost two cats both aged 17 in 2020 and 2021, but this has traumatized me. He is 7.5.
 
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daftcat75

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Ask about a recovery food like Hills A/D or Royal Canin Recovery. These are high calorie, highly palatable foods meant specifically for sick and picky cats having trouble eating. It’s not a forever food. But it could get you from here to there.
 
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Ocean Planet

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Ask about a recovery food like Hills A/D or Royal Canin Recovery. These are high calorie, highly palatable foods meant specifically for sick and picky cats having trouble eating. It’s not a forever food. But it could get you from here to there.
Thanks for the idea. I think anything is worth a shot now. Eat whatever food he will honestly. Let the pred work on stabilizing the inflammation and can re-visit food if we get that chance.
 

Peaceandcats

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I can understand why you might be having second thoughts about the vets. Six days is a long time to still have no definite answers (and your efforts have been nothing short of heroic for your little guy). I am also confused about the biopsy and possible lymphoma. It seems a biopsy should confirm a positive or negative for lymphoma.

I am sorry I have no advice (although you have received some great responses here), I just wanted to say I am thinking of you and your little guy and as stressed and sad as you are, you are doing everything possible for him. I just want your baby to feel better soon.
 

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I am curious (and I apologize if this was previously addressed); are these two vets affiliated with the endoscopy he had or is it a different hospital?

I think something went wrong during the endoscopy and he picked up a massive infection (which hopefully can be treated and is just taking some time). I think the reason the liquid poo didn't start until a few days probably had something to do with the anesthesia which is constipating (just like when people have it, and often don't poo for a few days later).

If that is what happened, hopefully his treatment regimen will be the solution since even severe infections can be treated.

I realize this all might be an oversimplification and I am not in the veterinary field, but it is my humble opinion that if you do have to hospitalize him again, I would take him to another hospital (unless these vets are not affiliated with his initial surgery).

I am just thinking out loud here - again, just my personal opinion and nothing more.
 
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Ocean Planet

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I can understand why you might be having second thoughts about the vets. Six days is a long time to still have no definite answers (and your efforts have been nothing short of heroic for your little guy). I am also confused about the biopsy and possible lymphoma. It seems a biopsy should confirm a positive or negative for lymphoma.

I am sorry I have no advice (although you have received some great responses here), I just wanted to say I am thinking of you and your little guy and as stressed and sad as you are, you are doing everything possible for him. I just want your baby to feel better soon.
Yeah, I think the other thing is the past week I've been on information overload and I'm loosing it trying to comprehend everything now.

We got home and he was a little loopy from his last gabapentin dose they gave him. He did eat and take a long nap. Now he walks around kind of slow. Went to the litter box 3 times in 20 minutes and it was still liquid each time. Now he is sleeping again.

The only good thing to come out of this is the tech got him to take pills wrapped in Hills Z/d wet food. I couldn't believe it but I just gave him his pred an hour ago in pill form. No more forcing his head to take syringes! Hopefully his appetite stays up to continue.

The next few days will be critical and telling. I'm so tired I may go lie down myself. I'm watching him like a hawk.
 

Peaceandcats

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I am thrilled to see he ate, though!

Of course you are overwhelmed - it is a LOT of information to take and you are in emotional duress.

That is great news about the pred, too!

Thank you for loving him and taking such wonderful care of him.
 
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Ocean Planet

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I am curious (and I apologize if this was previously addressed); are these two vets affiliated with the endoscopy he had or is it a different hospital?

I think something went wrong during the endoscopy and he picked up a massive infection (which hopefully can be treated and is just taking some time). I think the reason the liquid poo didn't start until a few days probably had something to do with the anesthesia which is constipating (just like when people have it, and often don't poo for a few days later).

If that is what happened, hopefully his treatment regimen will be the solution since even severe infections can be treated.

I realize this all might be an oversimplification and I am not in the veterinary field, but it is my humble opinion that if you do have to hospitalize him again, I would take him to another hospital (unless these vets are not affiliated with his initial surgery).

I am just thinking out loud here - again, just my personal opinion and nothing more.
Hey, it's no problem at all to ask. The vets are 2 different establishments and different management. One is a regular Monday to Saturday vet and the other is a separate 24 hour ER. Different locations, different names. All of the vets around here know each other because if you call and can't get an appointment they give you suggestions of other ones to try.

I've been thinking I never should have had that thing done. I thought it was a simple procedure. All the doctors and even websites said that. Do an endoscopy instead of any surgery to get the answers.... shoulda just started him on the pred and been done with it. i don't know
 

daftcat75

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Yeah. The only reason I don’t regret the endo with Betty is because she was on Pepcid with the thought she may have a stomach ulcer. So even though she had a rough rehab, we got a conclusive “No ulcer” and I was able to stop the Pepcid right away. I’ve never liked giving acid blockers to cats as their acidic stomach is their first line of defense against pathogens.

It’s possible in your case that the stain can come back more suggestive of lymphoma. In that case, the endo would save you some pred and pray time. A lot of vets don’t like to prescribe chemo without a confirmation via biopsy. My problem with that is that clear today can be cancer tomorrow. Just make it clear that once he’s past the fever, if pred plus food change fails to control it, you may consider the chemo drug in addition to pred. It’s often used in stubborn IBD cases anyway. And it doesn’t cause as many side effects in cats as it does in people. My Krista slept a little more on dosing days. But there wasnt any noticeable nausea or decreased appetite.

Pred, especially at the higher doses (5 mg and up) can make a cat lethargic. But then so can gabapentin. Hopefully the eating will pick up soon. Good to hear he took meds with Z/D. Hopefully that holds and you can make meds time enjoyable for both of you.
 

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Please don’t second guess yourself. We can’t read the future and we have to rely on those trained in their profession to guide us. It can still turn around. If you are like me, you have poured yourself into this and must be exhausted in every way. Try to let go a little and just savor each moment together. Sometimes that can do wonders for you and kitty. My girl Smokey had more than her share of things and some required me to learn how to give Sub-q at home. I was horrified that the vet even suggested that and the first attempt failed and left me running her back to the vet and feeling that I would be doing that daily. The second try, I got it. Each day of that left me shaken and by the time we finished, both of us were drained. A second surgery came next. Another emergency. Then we sort of settled into an acceptance of , we will just love each other. She held a big place in my heart and I began to just enjoy her snuggling again. There was a shift in everything and she had an amazing recovery! We were all surprised. We just can’t know everything and sometimes it all turns around. Cats do pick up our concerns and being content to live and love will be conveyed too. It can help healing if we can find someway to reduce stress. If something else can be done or needs to be done then you will both feel a little more like dealing with it. You have gone to great lengths to help heal. I will be watching and hoping that it all starts to fall into place now. :hugs: You’re awesome.
 

Peaceandcats

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Okay, this is good news that the vets are with different establishments. :) You don't have to worry about starting over for fear that they are covering their tracks from infection protocol error or something like that.

Endoscopy is generally a simple procedure with very rare complications - this is NOT your fault, nor could you have possibly foreseen any of this. It is a very common procedure and certainly less invasive than major surgery. You were trying to find out what was causing your baby's symptoms - you are a wonderful cat parent.

Is his poo the same consistency as before or is it even slightly less liquidy?
 
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Ocean Planet

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Is his poo the same consistency as before or is it even slightly less liquidy?
It was still total liquid. About a half dollar or more in circumference. I would have hoped the pred would have done 'something' by now. From what I can see there has been no blood lately. Just trying to find the positives.

He got up a bit ago and had water. Passed the food bowl though. Walks around and seems restless, but I'm sure the hospital stay was loud and tiring for him. Not forcing him to stay with me but let him wander around as he wishes.

Thanks to everyone following along and suggesting things. I never had human kids so these are it for me which allows me to be so focused on them. The vets love me and said most owners wouldn't take a second glance at how their cats go to the bathroom. Trying to juggle a full time job with this is absolutely crazy but my bosses understand and I can run home as I need to. I told them if I have to miss work time for vet appointments i'll work nights or weekends to make up for it. So don't be surprised at 2am work emails the next few weeks.
 

daftcat75

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The liquid poops can be a presentation of the IBD/lymphoma.

OR they can also be a sign of an overgrowth of one of the pathogenic bacteria strains that are normally in a cat's gut but can take over after metronidazole use. Metro doesn't do anything against e. coli or clostridium except kill of its competition. It's often recommended to use s. boulardii concurrently with metro and for some time after to bring those problematic strains back into check. Although Betty has never had the liquid poops, it has taken months to bring her e. coli and clostridium levels back into healthy ranges and bring back some beneficial strains that the 'flox killed off. I do microbiome testing with AnimalBiome every couple of months and she's been taking their Gut Restore Supplement for many months now. I do see the difference it makes. And I also saw the destruction that 'flox did to our initial progress.

Here's the good stuff. Run it past him with some Z/D. He may enjoy it like Krista did. Or you may have to re-capsule them into something smaller if he's more like my Betty.
https://www.amazon.com/dp/B00O4PUCZU/?tag=thecatsite

Some s. boulardii reading:
SACCHAROMYCES BOULARDII: Overview, Uses, Side Effects, Precautions, Interactions, Dosing and Reviews

And some more:
My Cat Has Diarrhea - What Do I Do?

And some more:
Definitive Guide To Saccharomyces Boulardii Probiotic Yeast

I just love the stuff and the difference it has made with both Krista and Betty. It's extremely safe and it's beneficial for IBD/lymphoma even if he doesn't have e coli/clostridium overgrowth.
 
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