Need help understanding IBD/SCL/hyperthyroidism/CKD care for little Max

LittleMax

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Hello -

I came across this site while trying to better understand how to care for our little Max, who is the most loving creature I’ve ever met and he is having a pretty hard time lately. Apologies for what will be a long post, but I’ll give as much background as possible:

He is 14 years old and has always been healthy except for a heart murmur found at age 2. However, during the past few months he started losing weight so we took him to the vet and they did bloodwork and said he has early stage CKD and hyperthyroidism and possible pancreatitis and suggested kidney diet food and thyroid medication. (Unfortunately the hyperthyroidism likely masks the kidney disease, so we aren’t sure exactly what stage that really is yet.) He was also vomiting sometimes but we thought it was mostly because he would go outside and eat grass and then get sick. (We quickly stopped the grass eating)

We started giving him the kidney diet food which he initially loved but quickly lost interest. During the few weeks after, he was vomiting again and losing weight and not eating much so we went back to the vet. (We were thinking maybe he was possibly allergic to the new ingredients like pork in the kidney food?) They gave anti-nausea meds and appetite stimulant and planned a follow up.

A few weeks after that (which was last week) he had a pretty rough day and wasn’t eating or drinking anything and was very lethargic and very thin so we took him right away to the emergency vet. They did more blood tests and ultrasound which showed thickened intestinal walls, and said it’s likely either IBD or SCL. At his age and risky condition lately we opted not to do a biopsy. They gave steroid injection and B12 injection and prescribed 1mL of prednisolone daily for a week, then 0.5mL daily, along with more anti-nausea as needed.

When we brought him home he was starting to perk back up and was eating and drinking a lot again and getting back to his normal snuggly purring self. He seemed to be doing much better for a few days, but then two days ago he vomited again, and yesterday he vomited again (like massive sudden projectile vomit) in the middle of the night and was coughing/sneezing a few times and was shaking which was so sad to see.

This morning we were deciding whether to go back to the emergency vet or not, but he did eat a tiny amount of food and drank water and was walking around so I decided to stay home from work to monitor him (and ask all of the helpful people here for advice!). I figured we were just there last week and not sure what more they’ll be able to do, and didn’t want to put him under more stress by taking him there unless it was absolutely needed.

In the mean time I have been reading a ton on here and went and got him a number of different limited ingredient foods (turkey, duck, rabbit) to try as many have suggested, just in case this is mainly IBD (my heart says it’s more serious, but trying to be optimistic). We started out with the turkey which he was liking so far.

At this point, I guess these are my questions:

- Assuming he is still vomiting and having diarrhea due to inflamed GI, how long would it normally take for the steroids to lower the inflammation and help absorb food and not be getting sick so often? I would have thought the steroids would work very quickly but maybe not? Is the dose possibly low due to his heart risk?

- If we are trying different limited ingredient foods, but we are also supposed to slowly transition from one food to another, how can we try different ones without spending weeks at a time to slowly transition? Is turkey too similar to chicken or other proteins he normally ate before?

- He is currently still eating Blue Buffalo tasteful salmon and brown rice dry food in addition to the wet food. Seems like we need to cut off all dry food and stick to the limited ingredient wet food, but we also want him to eat whatever he can to gain some weight back. What’s the best thing to do here? Should we look for a limited ingredient dry food or just remove it altogether? (This is hard because we both work so he is normally home alone all day and the wet food goes bad so we like to leave dry food out for him)

- I plan to ask the vet if he can switch to budesonide instead of prednisolone as often suggested here because it sounds like that would be less risky for his heart murmur?

- Is there anything else we can possibly to do help this poor little guy feel better?

Thank you all so much! I’ll add a picture of him so you can all see his cute little self in better times :)

IMG_2718.jpeg
 

cocoanlace

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I have an HT cat. She is 14. Diagnosed in late May. Got her the radio iodine treatment June 13. (It would have been crazy stressful on both of us to try to medicate twice a day; she is too fractious.) My only question at the moment is WHAT dose of medication for hyperthyroid did the vet prescribe? Since joining an HT Facebook group, I have been learning so much, especially that a dose that is too high to start causes so many side effects (vomiting, etc.). Sending hugs.
 
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LittleMax

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I have an HT cat. She is 14. Diagnosed in late May. Got her the radio iodine treatment June 13. (It would have been crazy stressful on both of us to try to medicate twice a day; she is too fractious.) My only question at the moment is WHAT dose of medication for hyperthyroid did the vet prescribe? Since joining an HT Facebook group, I have been learning so much, especially that a dose that is too high to start causes so many side effects (vomiting, etc.). Sending hugs.
Good question and thank you for the reply. He is taking Tapazole, 2.5mg per dose, twice a day. So 5mg total per day.
 

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Hi and welcome to TCS. What a nice pic of Max!! What did his last blood work show, and did it include a chemistry panel and T4? The former would reflect his current creatinine and BUN, as well as phosphorus, and the T4 would reflect his thyroid status. As mentioned above, too much thyroid meds (or too little) can attribute to his issues, as does kidney levels that are high.

I am not saying IBD isn't part of the issue, but the other two are just as equally important.
 

cocoanlace

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Good question and thank you for the reply. He is taking Tapazole, 2.5mg per dose, twice a day. So 5mg total per day.
I suspected as much. According to the "experts" on my FB group, the cat needs to start off with a lower dose. 5mg a day is too high (in their opinion). What was the T4 number? Just wondering.
 
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LittleMax

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Hi and welcome to TCS. What a nice pic of Max!! What did his last blood work show, and did it include a chemistry panel and T4? The former would reflect his current creatinine and BUN, as well as phosphorus, and the T4 would reflect his thyroid status. As mentioned above, too much thyroid meds (or too little) can attribute to his issues, as does kidney levels that are high.

I am not saying IBD isn't part of the issue, but the other two are just as equally important.
Good questions, and thank you! Here are the blood test results we have for those particular items:

June 2024:
- Creatinine 2.6
- BUN: 50
- T4: 4.0
- phosphorus: 4.9

Aug 2024:
- Creatinine: 3.0
- BUN: 48
- (thyroid not checked)

Sept 2024:
- Creatinine: 2.5
- BUN: 29
- (thyroid not checked)
 
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LittleMax

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I suspected as much. According to the "experts" on my FB group, the cat needs to start off with a lower dose. 5mg a day is too high (in their opinion). What was the T4 number? Just wondering.
Interesting. How do I find this FB group to learn more? His T4 was 4.0 in June
 

cocoanlace

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Just briefly. My cat Kay's T4 was 5.2. Vet said that for a 14 year old cat, 5.2 was borderline HT. But because Kay had symptoms (vomiting, 3-pound weight loss), I moved forward with the I131. (I figured it would just get worse.) Hugs.
 

cocoanlace

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Interesting. How do I find this FB group to learn more? His T4 was 4.0 in June
It is simply called Hyperthyroid Cats. Forrest D. Poston is an active member and does YouTube videos addressing many issues. (Hope it does not break rules to mention other sites here.)
 

fionasmom

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Was anything determined about the pancreatitis? If it is unresolved or recurrent, it can cause the symptoms that you are seeing.

You did an ultrasound which showed IBD/SCL. I would not do a biopsy on an older cat with other conditions. If you have any interest in pursuing the use of chlorambucil, discuss it with your vet. A few of us here have used it without having a conclusive biopsy.

I agree that you have a lot going on and this can be quite daunting to sort through.
 

FeebysOwner

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The last creatinine level would be considered Stage 2 CKD. Although cats vary, it wouldn't seem to be bad enough yet to cause vomiting. But, his T4 level should be rechecked. It is usually rechecked after about 4 weeks on the meds to see how the dosage is working. And, rechecked again in the same time line if the meds are adjusted. My cat was at 4.5 and took 1.25mg twice a day which brought her numbers down to an appropriate level.

Aside from that, many prescription foods don't go over well with cats, at least not for very long. They may not be the best for a cat with IBD either. And, asking about pancreatitis, at noted above, is also a worthy thing to pursue. Getting his IBD under control probably should take precedence over the CKD as this point, IMO. That is also if you are working in tandem to ensure his thyroid level is where it needs to be.

I agree, you have a lot going on, and you really need to ask your vet how to proceed with trying to aid the IBD without impacting the CKD - once you find out what his current T4 level is. Budesonide is a good thing to ask about in lieu of Pred, given Max may likely be on it longer term.
 
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LittleMax

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Was anything determined about the pancreatitis? If it is unresolved or recurrent, it can cause the symptoms that you are seeing.

You did an ultrasound which showed IBD/SCL. I would not do a biopsy on an older cat with other conditions. If you have any interest in pursuing the use of chlorambucil, discuss it with your vet. A few of us here have used it without having a conclusive biopsy.

I agree that you have a lot going on and this can be quite daunting to sort through.
Good question about the pancreatitis. From last weeks ultrasound, the notes say “The pancreas is diffusely hypoechoic with regional steatitis”. I don’t remember them specifically trying to treat this directly, but maybe you’re right and it should be higher priority? I suppose the anti-nausea meds and steroids etc were meant to help that too?
 

stephanietx

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The vomiting and diarrhea probably won't clear up with just medication. Usually a food change is involved. I would look at Instinct rabbit or venison. Try to avoid chicken and chicken byproducts in foods as that's a big trigger for many IBD kitties. There are other great foods as well for IBD kitties, but when you throw in CKD, it narrows down the selection. It's still doable. I have a CKD kitty and I have chosen to not change her food at this time. It was too stressful for both of us and I'd rather have her eating than not eating.

Also, try to avoid foods with gums. That's also a big trigger for many IBD kitties. There's a great group for owners of IBD kitties on FB and many of the owners are dealing with multiple health issues with their kitties.

Cats with IBD
 
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LittleMax

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Update: everyone here was right! The 2.5mg twice a day was too much and caused him to be hypothyroid. His original T4 before medication was 4, and after being on that dose for a few weeks his T4 was at 0.6! Thanks to everyone here we lowered his dose to 1.25mg twice a day even before getting the blood test results and he seems to be doing much better. We’ll likely switch to the transdermal and keep the lower dose and do more blood tests later to make sure it’s in a good range. He is still not eating a lot but he seems more like his normal happy self again. Hopefully the transdermal helps his GI and brings his appetite up.

Thanks again for pointing out the dosage being too high! Can’t believe the vets aren’t aware of this problem.

Will post more updates later as we go.
 
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