Please help! IBD senior cat, but all meds cause severe diarrhea

[AGDonmez]

Oh, so sorry, I forgot to respond to the last question!!

Yes, Geoffrey did have and endoscopy with biopsy. Neither the IMVet nor I ever mentioned a full surgical biopsy. I felt the endoscopy with biopsy was necessary to determine if it was IBD or not.. It turned out to be IBD Plus Small Cell Lymphoma.

At your kitty's age: I think 11 years old, I would not wait to have it done. Both Artie and Geoffrey had them done. At age 12, Artie was 'off" for about a week... Geoffrey at age 8, was "off" for 10 days, but he is a much more sensitive kitty.

thank you for your response! that makes sense, but we are currently holding off on the endoscopy trying to determine if and how long she is able to even tolerate low dose of budesonide. if she is diagnosed, it's not going to change her reaction to medication, so it will not benefit her at the moment to undergo anesthesia. IM Specialist said they are able to prescribe chemo drugs without the endoscopy/biopsy should her condition worsen and if she is not able to tolerate steroids, we may be able to try chemo on her just to see if she is able to tolerate. Her reaction to medication is not similar to most cats unfortunately, she develops very severe diarrhea.

I am currently giving her BUdesonide 1 mg every other day, and S. Boulardii twice a day. S Boulardii seems to have eased her severe reaction to Budesonide, but not entirely.

Even S Boulardii is giving her smelly gas but we will continue administering it at least two more weeks per IM Specialist advise together with Budesonide.

 

[artiemom]

thank you for your response! that makes sense, but we are currently holding off on the endoscopy trying to determine if and how long she is able to even tolerate low dose of budesonide. if she is diagnosed, it's not going to change her reaction to medication, so it will not benefit her at the moment to undergo anesthesia. IM Specialist said they are able to prescribe chemo drugs without the endoscopy/biopsy should her condition worsen and if she is not able to tolerate steroids, we may be able to try chemo on her just to see if she is able to tolerate. Her reaction to medication is not similar to most cats unfortunately, she develops very severe diarrhea.

I am currently giving her BUdesonide 1 mg every other day, and S. Boulardii twice a day. S Boulardii seems to have eased her severe reaction to Budesonide, but not entirely.

Even S Boulardii is giving her smelly gas but we will continue administering it at least two more weeks per IM Specialist advise together with Budesonide.

I forget if you are you giving a probiotic, or not. I used Proviable DC for Artie and for a brief time with Geoffrey. I think it is a prescription.
I think Vitality Science are an option, also. or Visabiome (? spelling)....

Good Luck!

 

[PushPurrCatPaws]

I've just spent some time reading this thread and mulling over some things. There is a lot I agree with in what was addressed in S silent meowlook 's post (post #30), which makes me think I have only minor embellishments to add.

I am not a vet or vet tech or anything like that, but I have had cats with various minor and major health or physical issues, so I am just writing on behalf of my experience(s) and partly from my own feelings or conjecture.

The main thing is that it seems your cat has an undetermined (probably high) amount of GI inflammation, no matter the cause. Have the IM specialists you've seen addressed the possibility of upper and/or lower stomach or intestinal ulcers in your cat? There are a few meds that can help with those, ones that can help her deal with her inflammation, nausea and diarrhea. Once any ulcers are stabilized or healed, she could very well retain her food better, take medicine (corticosteroids, &C) more easily, and feel much less pain or discomfort. Have you talked with the vet on that topic of potential ulcers? It's been my experience that you can even treat that potentiality (without doing any specific diagnostics, if those would stress the cat) without causing too much harm on other fronts.
(You can Search this site using "carafate" or "sucralfate" and my Member name, to find out my experience with ulcers in a cat.)

If your cat has any UNTREATED, 'entrenched' GI ulcers or even just high GI inflammation, it's my view that using liquid prednisolone wouldn't be the way to go. Use of pred can aggravate inflammation if not given with food, and/or if given for years in any case. I would try a pill form of pred, or budesonide… that might be more easily digestible than liquid (I realize that may not make sense, but this has been my experience with my current cat). My current cat takes long-term pred for her asthma, and I have always given her pill dosage with food, to try to stave off any potentiality of GI ulceration. So far, this has worked. But if she is showing any signs of GI upset (vomiting clear liquid or even vomiting food; or having soft poo), I give her 2.5-5 mg of Pepcid AC once a day for a few days, 20-60 minutes before eating, to help ease inflammation. This could be another thing to discuss with your vet (e.g. the possible use of "pepcid ac" for certain issues like *mild* ulcers or *mild* GI upset).

A AGDonmez , you wrote that a "microbiome gut test" they found a high level of "clostridium perfringens". This seems an important piece of data! I am not endorsing doing what that microbiome testing company suggests post-testing -- that's up to you. But having done that test in any case, does the vet know of this result? I am not a vet, but it seems to me that having clostridium perfringens might warrant a course of antibiotic(s), to help get rid of that bacteria overgrowth. Even if the antibiotic(s) likely cause some diarrhea for a while, you can give your cat fluids as supportive care during that time-frame. If she is an older cat and maybe has less vibrant immune system, that could cause a bacterial overgrowth -- or this bacteria overgrowth could stem from a very specific health cause internally…
This web site lists the following as a potential cause of c. perfringens overgrowth, which could indicate it's from her GI inflammation, whether from IBD, ulcers, or other:
" … - Stress to the digestive system due to concurrent disease (e.g., parvovirus, gastroenteritis, and inflammatory bowel disease)"
Diarrhea Due to Clostridium perfringens in Cats | PetMD

And even trying a different brand or form of probiotics might be an option, after a course of antibiotics. Maybe she is reacting to the (strength of? type of? brand?) Visbiome -- and you could try a different brand or strength, one meant for gut flora. A vet could tell you if there are any specific probiotics "meant" for cats, but I often use the one in the following link for myself, and would have no qualms giving it to my cat,
Amazon.com
(edit: thelink to amazon did not work (?!), so will just give the name of probiotic: Pure Therapro Rx Powder Probiotic Daily - 30 Acid-Resistant Capsules, 30 billion CFU/capsule.)

Many people give a variety of probiotic brands to their cats, under vet supervision, of course.

In any case, the TL;DR would be to first address any possibility of ulcer(s). And to address with antibiotics the fact that a microbiome test that seemed to show a high level of clostridium perfringens. Ulcers and bacterial overgrowth can take some time to heal or fix, so there is no short-term fix, I don't think. But I would also say, that prednisolone in pill form might be something to try at some point, if you find the budesonide does not seem to help. (But maybe the budesonide is not helping at this time because of the *potential* of current ulcer(s) and/or bacterial overgrowth issues?)

 

[AGDonmez]

Thank you everyone for commenting!

Update: Considering my cat's reaction to steroid, we reduced the dose of Budesonide from everyday to every other day, and then to once every two days. This is because she was getting diarrhea exactly about 10 hours after administering 1 mg Budesonide. It's a pretty low dose and the safest steroid as I am told, but she is not able to tolerate it as most other cats can. The only thing that helped her is giving her S. Boulardii and thanks to many who commented on this forum, this was a game changer for us that helped us use Budesonide now almost a month! I wish the vets had recommended S Boulardii to me, but no, it directly came from the commentators here. When I told them repeatedly that my cat was reacting bad to steroids, they had no solution unfortunately. Her poop is solid for two days when she does not take Budesonide, and either soft or half diarrhea the morning after Budesonide, but still so much better since she started on S Boulardii.

That said, she started to regurgitate her food more often unfortunately! I am not sure why exactly this is. Also, she is not gaining any weight at all despite her good appeatite. But we stopped giving her dry kibble two months ago, as she cannot handle dry kibble, and since then she has strictly been on canned food (she has been on i/d for two years now). I am not stopping Budesonide for now despite her reactions to it, but at least we tapered it as much as possible. But honestly, I don't even know if Budesonide was or has been helping her or making her worse.

For her throwing up, I was prescribed both ondansetron and cerenia for vomiting issue, but I have not started her on any of these additional meds now. I have read that Cerenia is causing some side effects on this site from other cat parents, such as lethargy and apatite loss, so that's why I didn't start her but now that she is throwing up her food almost twice a week now, I think I may have to. I feel like she throws up her food the day after we give her Budesonide as it mostly happened then.

Can anyone tell me if they like Cerenia or Ondansetron better? If I give her Cerenia, can I give it to her inside her food so is it okay if she has food with it or does it have to be given 30 minutes before she eats, which is what one person suggested on this site?

Another update is that the new IM specialist we are seeing now did a special fecal test on her, which was sent to Texas A&M, and it shows that my cat is entirely missing a very crucial bacteria called C. hiranonis which the specialist said is secondary to her underlying GI disease. In some, low C. hiranonis can contribute to bile acid diarrhea, which is what she might have I am told. This is again in addition to her IBD. Unfortunately, I was told that it's impossible to supplement this bacteria with probiotics. They said that the only thing that might help is FMT (Fecal transplant) done professionally at the vet through enema. They have to sedate her for this procedure (and it has to be done twice in one month), so we haven't done it yet, but we are considering it as the next phase.

 

[artiemom]

Wow... The new IMVet sounds like a 'keeper"!! I am impressed with him sending a stool sample to Texas A&M..

Cerenia and Ondansetron (Zofran) work differently on nausea. If I am correct in my thinking, the Zofran reduces acid. The Cerenia works on the nerve (Brain) stimulus for vomiting .
I give Zofran twice a day. The Cerenia is saved for when Geoffrey has bad vomiting, and looks sick... Although, I will say, I have not found it to help him. I think he is one of the few cats that it does not help. Also, no matter how long I wait after his last episode to give him a Cerenia, he will vomit it up; within 20 minutes. I have waited 20 minutes to 2 hours, and have given it with and without a gelcap, and with a lot of water, medium amount of water chaser and even a tiny bit of water. It always comes up.

Wishing you luck.. If I were you, and had pet insurance, I would go for the FMT .. It is worth a try!

 

[FeebysOwner]

Most folks on this site, as well as some on other forums, suggest Cerenia works better for vomiting and ondansetron for nausea. However, ondansetron (Zofran) has been used for vomiting in humans. I also know of people who are giving both to their cats. It may be that you will have to try one and then the other to determine the best benefit for your cat.

I don't believe everyone has issues with giving the Cerenia concurrent with food, but you might check with the vet about whether or not the tablets can be crushed. I use ondansetron - when I can get Feeby to take it - but don't crush it because it is not a nice tasting med - at least according to her. I hide it in pill pockets, and it is usually given alongside food or a lickable treat. I am not sure about Cerenia. There are some drug interactions with Cerenia, such as amlipdipine for high BP. Some heart related drugs can have interactions with ondansetron. Both have been known to cause sleepiness and/or lethargy.

What is your cat's B-12 level? If low, she could benefit from B-12 injections which help the digestive tract better absorb nutrients in an attempt to reduce weight loss.

Re: FMT, I know that humans are given oral capsules to help. I wonder if there are any specialists out there that have done/are doing this with cats/dogs. If anyone would know, I suspect it would be Texas A&M! I do know that FMT is often considered as an adjunct treatment when dietary and anti-inflammatory treatments aren't working on their own, and that the latter is always the preferred mode with pets before FMT is considered.

 

[AGDonmez]

Most folks on this site, as well as some on other forums, suggest Cerenia works better for vomiting and ondansetron for nausea. However, ondansetron (Zofran) has been used for vomiting in humans. I also know of people who are giving both to their cats. It may be that you will have to try one and then the other to determine the best benefit for your cat.

I don't believe everyone has issues with giving the Cerenia concurrent with food, but you might check with the vet about whether or not the tablets can be crushed. I use ondansetron - when I can get Feeby to take it - but don't crush it because it is not a nice tasting med - at least according to her. I hide it in pill pockets, and it is usually given alongside food or a lickable treat. I am not sure about Cerenia. There are some drug interactions with Cerenia, such as amlipdipine for high BP. Some heart related drugs can have interactions with ondansetron. Both have been known to cause sleepiness and/or lethargy.

What is your cat's B-12 level? If low, she could benefit from B-12 injections which help the digestive tract better absorb nutrients in an attempt to reduce weight loss.

Re: FMT, I know that humans are given oral capsules to help. I wonder if there are any specialists out there that have done/are doing this with cats/dogs. If anyone would know, I suspect it would be Texas A&M! I do know that FMT is often considered as an adjunct treatment when dietary and anti-inflammatory treatments aren't working on their own, and that the latter is always the preferred mode with pets before FMT is considered.

Thanks so much! Her B12 was checked twice, once in March and then again in July, both were above 400 range. It will need to be checked again, but am not sure when we want to check it again since she has to fast 12 hours for it, and fasting her is EXTREMELY difficult, I cannot tell you how stressful it was to fast her!!!

One company offers FMT capsules for cats, however, the IM specialist I am seeing now does not recommend those, unfortunately. She said she uses Texas A&M fecal donor material that directly comes from the university and she administers it here at the hospital through sedation (I think through enema). She said that the capsules also do not work as effectively and come from donor cats that have been on raw diets, as opposed to my cat who has never had raw diet. The diet of the donor cat and the recipient need to match more or less, otherwise, I am told there can be additional issues.

This is unfortunately ALL i know about FMT. I may post on this site to see if anyone else has done it.

 

[AGDonmez]

Wow... The new IMVet sounds like a 'keeper"!! I am impressed with him sending a stool sample to Texas A&M..

Cerenia and Ondansetron (Zofran) work differently on nausea. If I am correct in my thinking, the Zofran reduces acid. The Cerenia works on the nerve (Brain) stimulus for vomiting .
I give Zofran twice a day. The Cerenia is saved for when Geoffrey has bad vomiting, and looks sick... Although, I will say, I have not found it to help him. I think he is one of the few cats that it does not help. Also, no matter how long I wait after his last episode to give him a Cerenia, he will vomit it up; within 20 minutes. I have waited 20 minutes to 2 hours, and have given it with and without a gelcap, and with a lot of water, medium amount of water chaser and even a tiny bit of water. It always comes up.

Wishing you luck.. If I were you, and had pet insurance, I would go for the FMT .. It is worth a try!

thank you, very helpful!!

 

[silent meowlook]

Hi. My cat takes Cerenia regularly. I give it a few hours prior to her Chlorambucil. It has some anti- inflammatory properties to it that help my cat’s GI. I have used ondansetron but didn’t think it was better than the Cerenia. I have also used both Rodger her when needed.
Remember if you have a cat with a compromised gut, sometimes they cannot fully process oral medications. Sometimes injectable will work better.

 

[AGDonmez]

I just gave my cat Cerenia (1/4th of the pill as prescribed) and followed it with canned food. As soon as she finished eating the canned food, she coughed. I got very suprised as I have never seen her cough ever before. Whenever I give her Budesonide, I also give her some canned food to protect her stomach and also to push the pill down (I don't inject food in her, she eats it herself).
Does anyone know why she might have coughed? Is this Cerenia possibly getting stuck or did she possibly inhale some canned food? Either way, I got very concerned and scared. It's been over an hour now, she seem ok no more cough, and she ate more food just now.

 

[silent meowlook]

If she hasn’t coughed again, I would think you should be fine. The pill may have just irritated her a little.

 

[AGDonmez]

If she hasn’t coughed again, I would think you should be fine. The pill may have just irritated her a little.

Yes, it was fine thankfully, but was very scary as I've never seen her cough before and it happened right after administerin Cerenia. I think splitting Cerenia into four is a challenge so perhaps the edges when I cut it were too square as opposed to round pills I've previously administered which never caused this issue.

How do you guys split Cerenia into four?

 

[lisahe]

How do you guys split Cerenia into four?

Unevenly! It's not easy. I use my fingernails and press down, first on the line, then in the middle of each resulting piece. (I watched a vet tech do this a few times... even her pieces weren't perfect.) They still sometimes come out pretty uneven, even when I break on the line! That's not awful since Edwina seems to do pretty well even with tiny pieces of Cerenia. If she's had some sort of minor incident (a regurgitation, for example) I'll just give her some small chip. I'm not sure what I mean by "tiny" but probably somewhere in the 1-2 mg range.

It's hard to say what might have made your cat cough but Cerenia does dissolve pretty quickly. I feed it to Edwina in food and if the piece is small, sometimes all I can see is pink coating if she didn't eat it on the first pass. It's apparently bitter so she avoids it! Come to think about it, that taste might even have made your cat cough.

Good luck!

 

[AGDonmez]

Unevenly! It's not easy. I use my fingernails and press down, first on the line, then in the middle of each resulting piece. (I watched a vet tech do this a few times... even her pieces weren't perfect.) They still sometimes come out pretty uneven, even when I break on the line! That's not awful since Edwina seems to do pretty well even with tiny pieces of Cerenia. If she's had some sort of minor incident (a regurgitation, for example) I'll just give her some small chip. I'm not sure what I mean by "tiny" but probably somewhere in the 1-2 mg range.

It's hard to say what might have made your cat cough but Cerenia does dissolve pretty quickly. I feed it to Edwina in food and if the piece is small, sometimes all I can see is pink coating if she didn't eat it on the first pass. It's apparently bitter so she avoids it! Come to think about it, that taste might even have made your cat cough.

Good luck!

thanks so much, that's so helpful!!! I tried to give (hide) a very small piece as you described into her food, it worked first time. It did not work the second time; she had eaten all her food and somehow separated the little Cerenia, I don't know how she did it. So third time, I tried to push it into her mouth with a pill gun, and it worked, until she coughed. I now think it might have been because it's bitter.

Her vet today prescribed us a new medication instead of Cerenia. We have not started on it yet. It's called Cisapride and it's liquid. Her vet said this may help her stop regurgitating her food. I hope it works for her (without causing diarrhea).

 

[lisahe]

Her vet today prescribed us a new medication instead of Cerenia. We have not started on it yet. It's called Cisapride and it's liquid. Her vet said this may help her stop regurgitating her food. I hope it works for her (without causing diarrhea).

I hope the Cisapride works for her!

If you do need to go back to Cerenia, I can say that Edwina usually does eat the food with it on the second or third pass. By the second time, it's usually dissolved so I don't know what's left. But I start with a small amount of food, bury the Cerenia in it, then top with lots of treats. She's very food motivated so does get the Cerenia eventually, particularly when the pieces are tiny. In her case, by the way, the relatively standard 4 mg dose seems to make her a little blah.That's another reason I prefer giving her the smaller amounts.

Anyway, good luck! From both me and Edwina, who's settled in my lap, purring.

 

[gizzieblue]

Here's my experience: high folate = SIBO. In humans, prednisone predisposes to SIBO. I myself relapsed after a course of metropack.

If they called this bile acid diarrhea, I think there are bile acids sequestrants - you have to check. Or you can try to use a clay paste? Something that binds toxins, S Boulardii does not neutralizes c perfringens toxins, they can get absorbed thru the gi tract - in my experience [ my kitty had high CPA and CPX on SB + tylan! ]. I believe the reason for vomiting is the fact that it exceeded the liver capacity to detox. Or they can try treating the overgrowth - metro and tylan will not work and will do more damage ...
So pretty much, my understanding is that budesonide lowers immune system => si diarheea => lots of nutrients enter the colon => feeds c perfringens.

Maybe add something for liver detox ... and there is an adored beast ( ? ) probiotic for sibo.

Probably the easiest / fastest and safest thing is Rx clay / or any clay type - pet pectalin or something? See how he reacts, how he is feeling, if he is 'present', eats etc. acts like himself. These are pretty safe to try - just make sure to read the label [ might inhibit medication absorption, so u need to give the meds 2 hours apart or something ].

These things - were explained too late by my own [human] GI. I myself was told by IM's assistant that it's ok that my cat has explosive diarheea because the IM wants him on that particular food. The way I see it - there's no reason for them to suffer ...

Best of luck to you!

 

[AGDonmez]

I hope the Cisapride works for her!

If you do need to go back to Cerenia, I can say that Edwina usually does eat the food with it on the second or third pass. By the second time, it's usually dissolved so I don't know what's left. But I start with a small amount of food, bury the Cerenia in it, then top with lots of treats. She's very food motivated so does get the Cerenia eventually, particularly when the pieces are tiny. In her case, by the way, the relatively standard 4 mg dose seems to make her a little blah.That's another reason I prefer giving her the smaller amounts.

Anyway, good luck! From both me and Edwina, who's settled in my lap, purring.

I tried this method today and it worked!!! I was worried that Cerenia would get stuck in her throat, so I cut it into 4 but I also used a nail file to round the pill to try to make it as round as possible, which reduced the dosage and the size. I hid it in her canned food and she ate most of it! She did not throw up today, so I am guessing that Cerenia might have worked today.

I haven't tried the Cisapride yet on her as I read online that with some cats/dogs it can give diarrhea ughh...last thing we need right now. I will try with Cerenia for a while and see how it goes.

 

[AGDonmez]

Here's my experience: high folate = SIBO. In humans, prednisone predisposes to SIBO. I myself relapsed after a course of metropack.

If they called this bile acid diarrhea, I think there are bile acids sequestrants - you have to check. Or you can try to use a clay paste? Something that binds toxins, S Boulardii does not neutralizes c perfringens toxins, they can get absorbed thru the gi tract - in my experience [ my kitty had high CPA and CPX on SB + tylan! ]. I believe the reason for vomiting is the fact that it exceeded the liver capacity to detox. Or they can try treating the overgrowth - metro and tylan will not work and will do more damage ...
So pretty much, my understanding is that budesonide lowers immune system => si diarheea => lots of nutrients enter the colon => feeds c perfringens.

Maybe add something for liver detox ... and there is an adored beast ( ? ) probiotic for sibo.

Probably the easiest / fastest and safest thing is Rx clay / or any clay type - pet pectalin or something? See how he reacts, how he is feeling, if he is 'present', eats etc. acts like himself. These are pretty safe to try - just make sure to read the label [ might inhibit medication absorption, so u need to give the meds 2 hours apart or something ].

These things - were explained too late by my own [human] GI. I myself was told by IM's assistant that it's ok that my cat has explosive diarheea because the IM wants him on that particular food. The way I see it - there's no reason for them to suffer ...

Best of luck to you!

Thanks so much for your comments. I have not tried the Adored Beast products on her yet. I wanted her to try one thing at a time, as we combine multiple things, it's difficult to ascertain which one causes what. Unfortunately, none of her vets and none of the IM specialists she has seen (so far two IM specialists with over 15 yrs of experience) were able to explain the reason for her diarrhea after she gets steroids. I consulted with five different vets now about this issue (two of them being the IM specialists). During this process, we even tried transdermal prednisone on her, which does not go through the GI tract, and is absorbed via the ear, and even that single dose gave her diarrhea. At the moment, she is on Budesonide but is taking it every 3 days only so 3 mgs a week, which is a very low dose. It still gives her a mild diarrhea or soft stool 12 hours after, but with S Boulardii, it's been better than before. We will continue for two more weeks like this and will stop Budesonide all together for two weeks as the IM specialist said it may be good to see how she does without steroids. I wish they were able to give me a better medical explanation, but I don't believe I have received it. Unfortunately.

Thank you for your insight!

 

[gizzieblue]

Unfortunately, none of her vets and none of the IM specialists she has seen (so far two IM specialists with over 15 yrs of experience) were able to explain the reason for her diarrhea after she gets steroids.

I'm so sorry ... see, your kitty is not the only one to have this happen. Mine did too. He actually became anemic 2 weeks on budesonide, and his BG went thru the roof. Vets ... well. The new wave appears to keep on going forward rather than take a breath and think and make the kitty comfy. The old school - imo - they wet more focused in making the pets comfortable.

Without addressing the sibo part, fmt might not work/hold. I've heard of people that managed to get down the folate levels with the animal biome poop pills. Problem w/sibo is that it's an overgrown of any type of bacteria, including the good one. And I'm telling you, after a week on metropack, my sibo returned with a vengeance and it took 2 years to return to normal.

Maybe benefiber - wheat dextrin. This worked for my kitty [ eventually I switched him to a European product ], psyllium would slow his gi transit and make him vomit. FOS - well, it's high foodmap.