Ultrasound Results (IBD, Eosinophilic Gastroenteritis, or Lymphoma)

[catzorz]

TLDR: my cat has had blood in per poop since November. We've tried switching her food to hypo-allergenic prescription diets, but she won't eat any pate, so no luck. We tried Tylosin for a week - no luck.

The vet called with today's ultrasound results. Her stomach is inflamed. Her stomach is 0.5 cm thick (he said normal is around 0.3 cm thick). He said it could be the following things:

- Eosinophilic gastroenteritis

- Inflammatory bowel disease

- Lymphoma of the stomach

He said that because she is only three years old, it's unlikely to be cancer. Our next steps would be:

- To continue to find her a food that we could try to help alleviate the inflammation

- To try Prednisolone for a short time period to see if it would help, then take her off of it and see if the blood in the poop comes back

- If nothing works, we could try Prednisolone for the long-term, but he doesn't like to perscribe it without a real diagnosis, so we would need to put her under anesthetic and do a biopsy.

I don't know to take this because I don't want to put my baby through hell just trying to make her feel better. She seems fine now, I just need her to get better. Aside from the blood in poop and stress from being taken to the vet, she seems fine.

Questions:

- Does anyone know of any canned wet food that is chunks in gravy that could be hypoallergenic and potentially help? She will not go anywhere near pate. We've had no luck with changing her diet. Right now, she's eating Royal Canin adult instinctive, which is pork/chicken ingredients. So maybe something that isn't pork or chicken. If all else fails, I will try homecooked. Please please please share suggestions because this is really our only option right now and I don't know what to do. My vet is ordering another Hills D/D diet and then said we could try Rayne's kangaroo diet (which sounds really weird to me).

- Has anyone used Prednisolone? What was your experience? Are there any side effects to be really worried about?

- Do you think I should do the biopsy? If it is cancer, I don't even know how we'd treat it. I don't want to stress my baby out and ruin her life, but at the same time, I want to do everything I can to make her better. I've never put any of my pets under anesthetic and that really scares me. What is the recovery time like from the biopsy?

I appreciate your help!

Thank you!

 

[catwoman707]

My personal opinion and experience, I would not do a biopsy. I feel this is unnecessary trauma to go through only to likely find no cancer or IBD.

I think her inflammation is due to ongoing intestinal irritation as well as her bloody poop.

In her bloodwork, how are her eosinophils?

This helps indicate a hidden parasite.

Otherwise, I think it's all in her diet.

I wonder if she might eat a homemade food, a simple one of ground turkey and U-Stew added, which makes like a brown gravy and is insurance of all nutrients she needs.

With this diet, you are able to eliminate SO many possibilities of what is causing this issue.

 

[greypaws]

Ordinarily for my own pets, I'd try the easy stuff before doing expensive tests.

 

[catzorz]

@catwoman707 we didn't do any bloodwork. For some reason, they said it was unnecessary. Should we ask for it to be done now? What would it be looking for exactly? They did test her poop, but it came back negative for everything on the panel.

We got the Hills D/D canned food today, and she ate most of it (it's duck). She's not thrilled about it, but she still ate enough to call it a mini success. We also have some cans of Pride (by instinct) duck as well. It's higher fibre, and I don't know if that's a good thing anymore.

 

[catwoman707]

@catwoman707 we didn't do any bloodwork. For some reason, they said it was unnecessary. Should we ask for it to be done now? What would it be looking for exactly? They did test her poop, but it came back negative for everything on the panel.

We got the Hills D/D canned food today, and she ate most of it (it's duck). She's not thrilled about it, but she still ate enough to call it a mini success. We also have some cans of Pride (by instinct) duck as well. It's higher fibre, and I don't know if that's a good thing anymore.

There is so much information in bloodwork, but my thinking was ensuring there is not a hidden parasite, which is always quite possible, several types will hide and require a more advanced test by a lab rather than the fecal float type commonly done in-house.

There might be other abnormal levels that may indicate something else as primary cause of her not feeling well also.

 

[sidneykitty]

I agree with the others in not doing a biopsy until you have tried all other options first...

I second getting a full diarrhea panel which will test for more rare types of parasites. This is not the same as a fecal float done in house. I'd ask your vet about this. It does cost about $200 at my vet, but is worth getting some answers or at least ruling out possible diagnoses.

As far as I know the hypoallergenic wet foods available are the hypo pate you mentioned which your cat does not like, the Hills d/d which comes in venison or duck, Hill's z/d could be another option although I believe it is a pate. The other one I would have mentioned is the Rayne kangaroo you said your vet mentioned. The idea there is that its a new protein source your kitty has never been exposed to before, so it will indicate if she has a food allergy after a strict 4-6 week trial of being on purple kangaroo food only. That one DOES have a chunky (not a pate) consistency and is quite smelly, which can be appealing to kitties. If it turns out to be IBD these alternative/hypo diets will really help.

I've had experience with prednisolone being used for palliative care for terminal cancer in my cat. It reduces inflammation. The most common side effect is an increased appetite (which for my cat turned out to be a plus). As far as I know, it is not generally recommended for long term use as that can lead to diabetes.

Best wishes and let us know how your kitty is doing. What's her name?

 

[stephenq]

 
I appreciate your help!

Thank you!

Many good replies so I will just add this.  Biopsies are optional, it is medically inappropriate to refuse to treat with predisilone without a biopsy.  Biopsies are major surgery and all they can do is tell you if its lymphoma or severe IBD and the treatment for both, at least initially is the same, prednisilone.  Biopsies don't even guarantee a diagnosis so requiring a non-definitive major surgery diagnostic procedure to prescribe Pred is CRAZY.  If you give your cat Pred and the symptoms are relieved, that by itself is diagnostic.  I don't know where you live or who your vet is but they are wrong.  I rarely say that so strongly, but my cat had IBD most of his life and i worked with vets, and surgeons and ive been through this fro start to finish.  Here is a great article.  https://vcahospitals.com/know-your-pet/inflammatory-bowel-disease-in-cats

 

[KatKnapper]

A little terrifying for you I am sure.  My vet is recommending a biopsy for my kitty as well.   On occasion, his frequent vomiting has small amounts of blood in it.  I have blanked this biopsy out of my mind for the past two weeks, and even told the vet that I wasn't sure about this invasive procedure. Hundreds of dollars in blood and urine lab work and an ultrasound have turned up nothing really concise.  We have our good times like now, where he has gone three weeks with only one short episode of not keeping food or water down.  It typically passes after fasting for 12 to 18 hours, or shorter when his former vet would give him medication to ease his nausea.

The more I tell myself that I am not going to have him undergo this biopsy, the more the images and emotions of watching him keel over vomiting and convulsing come to mind.  The sound of it makes me cringe.  He has only been in my care for four months, yet I love him so so much.  He is a part of my heart now.  I am now coming to realize that I can't allow him to suffer or continue to have this illness.  I must find out what is causing him harm, even if it means doing this invasive procedure.  I have to know if there is a hidden internal illness (or disease) or rule it out entirely.

He has a better chance of recovering from a known illness and this procedure than he does if I simply ignore it and continuing as I have by becoming paranoid of everything he eats and is exposed to from flea shampoos to flea collars and grocery store quality foods to expensive brands. My doing nothing is a decision.  It is one that is absent of courage and hope.  Before doing this biopsy, I am going to learn all I possibly can over the next few days about digestive and intestinal disorders in cats, then get with my vet and review again all the medical test and lab results before I decide.  I hope all turns out well for your little precious kitty Catzorz.  My vet printed out for me some reading material on IBD from http://www.veterinarypartner.com/Content.plx.  There may be some interesting reading here as well http://www.peteducation.com/article.cfm?c=1+2122&aid=304.

 

[catzorz]

@catwoman707 @sidneykitty

- When the vet calls next week, I will ask again about doing bloodwork. When he mentioned eosinophilic gastroenteritis, I googled it and found that it could be caused by a hidden parasite, which isn't something he ever mentioned. What would the bloodwork look for to confirm a hidden parasite in the stomach? What would the treatment be for something like that?

- We did the fecal test done in house and also one that was sent out to the lab. The only things that came back positive were corona virus and c. perfringens alpha toxin - and that both of them are not something that would cause this unless the c. perfringens enterotoxin was also positive. He said if she had corona virus previously, she will always test positive for it.

@StephenQ I think if needed, he would prescribe Pred without a confirmed diagnosis, but he said that he doesn't like to since the drug carries risks of it's own when used long term. I really don't want to do the biopsy...she's already a stress cat and that wouldn't help. I just want to keep her feeling good and healthy without doing something so invasive.

@KatKnapper I feel so bad for your kitty. Has change in diet or anything else worked at all? Please let me know if you get any new info on the biopsy! I hope your furbaby feels better soon <3

Update on the food situation:

So far now we have tried the following foods and she won't eat them:

- Hills D/D

- Royal Canin Gastrointestinal

- Royal Canin Selected Protein

- Nature's Variety Instinct Limited Ingredient

- Wellness Core Grain Free

Aside from the normal Royal Canin Adult Instinctive that we aren't supposed to feed her anymore, she will only snack on Pride by Instinct canned food...she never eats enough of it to be considered a meal.

I really need to find a minced single protein food with no chicken or pork. Like, I don't know what to do if I can't get her to eat anything else. Has anyone tried Stella and Chewy's freeze dried food? Is freeze dried healthy? Would it be good for this sort of thing? I'd be worried because she's had urinary crystals before, and since then, we haven't been feeding her dry food. I definitely don't want to go back down that avenue, but if you add water to the freeze dried, would that be enough hydration (given that she drinks no water)?

 

[cindycrna]

 
@catwoman707 @sidneykitty

- When the vet calls next week, I will ask again about doing bloodwork. When he mentioned eosinophilic gastroenteritis, I googled it and found that it could be caused by a hidden parasite, which isn't something he ever mentioned. What would the bloodwork look for to confirm a hidden parasite in the stomach? What would the treatment be for something like that?

- We did the fecal test done in house and also one that was sent out to the lab. The only things that came back positive were corona virus and c. perfringens alpha toxin - and that both of them are not something that would cause this unless the c. perfringens enterotoxin was also positive. He said if she had corona virus previously, she will always test positive for it.

@StephenQ I think if needed, he would prescribe Pred without a confirmed diagnosis, but he said that he doesn't like to since the drug carries risks of it's own when used long term. I really don't want to do the biopsy...she's already a stress cat and that wouldn't help. I just want to keep her feeling good and healthy without doing something so invasive.

@KatKnapper I feel so bad for your kitty. Has change in diet or anything else worked at all? Please let me know if you get any new info on the biopsy! I hope your furbaby feels better soon <3

Update on the food situation:

So far now we have tried the following foods and she won't eat them:

- Hills D/D

- Royal Canin Gastrointestinal

- Royal Canin Selected Protein

- Nature's Variety Instinct Limited Ingredient

- Wellness Core Grain Free

Aside from the normal Royal Canin Adult Instinctive that we aren't supposed to feed her anymore, she will only snack on Pride by Instinct canned food...she never eats enough of it to be considered a meal.

I really need to find a minced single protein food with no chicken or pork. Like, I don't know what to do if I can't get her to eat anything else. Has anyone tried Stella and Chewy's freeze dried food? Is freeze dried healthy? Would it be good for this sort of thing? I'd be worried because she's had urinary crystals before, and since then, we haven't been feeding her dry food. I definitely don't want to go back down that avenue, but if you add water to the freeze dried, would that be enough hydration (given that she drinks no water)?

 
@catwoman707 @sidneykitty

- When the vet calls next week, I will ask again about doing bloodwork. When he mentioned eosinophilic gastroenteritis, I googled it and found that it could be caused by a hidden parasite, which isn't something he ever mentioned. What would the bloodwork look for to confirm a hidden parasite in the stomach? What would the treatment be for something like that?

- We did the fecal test done in house and also one that was sent out to the lab. The only things that came back positive were corona virus and c. perfringens alpha toxin - and that both of them are not something that would cause this unless the c. perfringens enterotoxin was also positive. He said if she had corona virus previously, she will always test positive for it.

@StephenQ I think if needed, he would prescribe Pred without a confirmed diagnosis, but he said that he doesn't like to since the drug carries risks of it's own when used long term. I really don't want to do the biopsy...she's already a stress cat and that wouldn't help. I just want to keep her feeling good and healthy without doing something so invasive.

@KatKnapper I feel so bad for your kitty. Has change in diet or anything else worked at all? Please let me know if you get any new info on the biopsy! I hope your furbaby feels better soon <3

Update on the food situation:

So far now we have tried the following foods and she won't eat them:

- Hills D/D

- Royal Canin Gastrointestinal

- Royal Canin Selected Protein

- Nature's Variety Instinct Limited Ingredient

- Wellness Core Grain Free

Aside from the normal Royal Canin Adult Instinctive that we aren't supposed to feed her anymore, she will only snack on Pride by Instinct canned food...she never eats enough of it to be considered a meal.

I really need to find a minced single protein food with no chicken or pork. Like, I don't know what to do if I can't get her to eat anything else. Has anyone tried Stella and Chewy's freeze dried food? Is freeze dried healthy? Would it be good for this sort of thing? I'd be worried because she's had urinary crystals before, and since then, we haven't been feeding her dry food. I definitely don't want to go back down that avenue, but if you add water to the freeze dried, would that be enough hydration (given that she drinks no water)?

We do Stella nd Chewy's freeze dried.  The Chewy.com has it and you can order the smallest bags to try. My cats like Duck Duck Goose. 

 

[tiptopper]

Our cats like Stella & Chewy freeze dried but it does have visible bones in it. We pick them out.

 

[stephenq]

 

When a cat has IBD severe enough to warrant Pred, the risks are outweighed by the benefits. A cat with severe symptoms including weight loss will die  from the disease so the side effect of pred long term are ridiculous.

 

[catzorz]

@stephenq I don't think she's at that point though, which is why he's rather try a change in diet before anything else. She's lost 0.5lbs at most, and aside from her ultrasound results, her only visible symptom is red blood in her poop. I'd say she's also more lethargic than she used to be. She also coughed up a gross hairball, but only once. The blood and mushy poop is most concerning because it's lasted since the start of November. When it comes to my baby's comfort, I won't let them say no to anything. Do you think a short term use of Pred before trailing different foods would be worth it to see if it just goes away and doesn't come back? I'd just be worried that if it is a food sensitivity, it would come back and we'd have learned nothing about what's making her inflamed.

 

[catwoman707]

@stephenq I don't think she's at that point though, which is why he's rather try a change in diet before anything else. She's lost 0.5lbs at most, and aside from her ultrasound results, her only visible symptom is red blood in her poop. I'd say she's also more lethargic than she used to be. She also coughed up a gross hairball, but only once. The blood and mushy poop is most concerning because it's lasted since the start of November. When it comes to my baby's comfort, I won't let them say no to anything. Do you think a short term use of Pred before trailing different foods would be worth it to see if it just goes away and doesn't come back? I'd just be worried that if it is a food sensitivity, it would come back and we'd have learned nothing about what's making her inflamed.

Surely if she is continuing to eat the same as she has, despite pred it will return, yes.

Something is causing her body to react, it's finding out what it is and getting it stopped is the real tricky part, especially with a picky butt eater

If she weren't so picky my first suggestion would be to simply stop all foods and treats completely, only feeding her turkey baby food, or some other easily digested food for several days to get her system settled down and stop reacting.

Then on gradually to a limited ingredient food. Also, FYI despite chicken and turkey both being fowl and so close in nature, they are not the same, turkey is not used in food as chicken is nearly always.

Meaning exposure to turkey is highly unlikely the culprit.

There are certain commonly known allergens to cats that are ingredients in their foods.

Fish, chicken, are at the top along with corn and other grains. Wheat/corn gluten, guar gum, carageenan are the tops that come to my mind.

 

[catzorz]

I picked up some Weruva Lamburgini, and she is actually eating it. The ingredients are:

Water Sufficient For Processing, Lamb, Mackerel, Pumpkin, Lamb Liver, Lamb Lung, Sunflower Seed Oil, Locust Bean Gum, Xanthan Gum, Guar Gum, Potassium Chloride, Choline Chloride, Zinc Sulfate, Vitamin E Supplement, Thiamine Mononitrate (Vitamin B1), Nicotinic Acid (Vitamin B3), Potassium Iodide, Vitamin A Supplement, Calcium Pantothenate, Manganese Sulfate, Riboflavin Supplement (Vitamin B2), Pyridoxine Hydrochloride (Vitamin B6), Folic Acid, Vitamin D3 Supplement, Vitamin B12 Supplement

Her normal food that she developed the sensitivity on (if it is a food sensitivity) has salmon in it....so hopefully it's not the fish that she's having a reaction to.

The ingredients her in normal food are:

Water sufficient for processing, pork liver, chicken liver, chicken, pork by-products, salmon, wheat flour, wheat gluten, gelatin by-product, powdered cellulose, natural flavors, corn starch modified, calcium sulfate, guar gum, potassium chloride, sodium tripolyphosphate, taurine, carrageenan, vitamins (dl-alpha-tocopherol acetate [source of Vitamin E], thiamine mononitrate [Vitamin B1], niacin supplement, biotin, d-calcium pantothenate, riboflavin supplement [vitamin B2], pyridoxine hydrochloride [Vitamin B6], Vitamin B12 supplement, folic acid, Vitamin D3 supplement), trace minerals (zinc proteinate, zinc oxide, ferrous sulfate, copper sulfate, manganous oxide, sodium selenite, calcium iodate).

I'm very excited and also very nervous that I've found a food she's willing to eat but have maybe weeded out the wrong ingredients. I also picked up some Hound & Gatos Lamb...we'll try that tomorrow.

 

[catzorz]

We still have blood in the poop after a week. It's really hard to not panic that I'm maybe feeding her the wrong thing or that I might choose a food that makes it worse.

 

[stephenq]

We still have blood in the poop after a week. It's really hard to not panic that I'm maybe feeding her the wrong thing or that I might choose a food that makes it worse.

If she has IBD, finding a food "that works" isn't just a matter of shopping around.  As a rule the only foods that work are either novel protein diets (prescription foods are dna tested to not have any other ingredients and OTC novel protein diets have been found with traces of contaminated proteins), or hydrolized protein diets (like Hill's Z/d, which in some cases can make it worse) and sometimes raw diets.  It's still trial and error, and a food that works now may not work later.

IBD isn't curable.  What you're looking for is remission, preferably long term.  The only value that I see to short term Pred use is diagnostic.  If oyu use it and the stool returns to normal, then that becomes diagnostic for IBD or sm cell lymphoma, but if you stop the pred you can expect it to return.

You can start with diet and "gentler" drugs like Flagyl and Tylosin, supplemented with B12 injections, but remember that IBD and IBD changing into SCL is a progressive condition and its better to get it into remission sooner rather than later.    If the weight loss becomes worse and progressive, its a potentially dangerous and slippery slope.  Vets like to think of weight loss as needing 3 readings, 1- baseline, 2- loss, and 3d shows a trend.

My Simon had his IBD fairly well managed after it became severe for 15+ months using pred, and later other therapies, but in time it becamse too much for him and morphed into a cancer, not SCL but another one, and we lost him.  If you go the Pred route, its generally very well tolerated in cats and its often the cheapest best thing to use when your cat is loosing weight and the loss can't be arrested by other means.

 

[catzorz]

@StephenQ We have tried the prescription diets, but she won't go anywhere near them, so we've branched out in hopes that some other commercial foods that don't have the main protein sources in the food she had been eating might help (if she even agrees to eat them). Today, she wouldn't eat anything at all for breakfast. I have ordered a case of Rayne Kangaroo Maint in hopes that the novel protein will help. If she won't eat that (or anything other than her normal Royal Canin food), do you think it would be safe to add some Fortiflora to the food to entice her to eat it? She goes crazy for that stuff.

 

[stephenq]

 
@StephenQ We have tried the prescription diets, but she won't go anywhere near them, so we've branched out in hopes that some other commercial foods that don't have the main protein sources in the food she had been eating might help (if she even agrees to eat them). Today, she wouldn't eat anything at all for breakfast. I have ordered a case of Rayne Kangaroo Maint in hopes that the novel protein will help. If she won't eat that (or anything other than her normal Royal Canin food), do you think it would be safe to add some Fortiflora to the food to entice her to eat it? She goes crazy for that stuff.

Fortiflora should be fine and is commonly used with IBD, but finding a food that she won't react to that isn't of the 3 i described is very unlikely to help.  If it has a conventional protein like chicken, beef, fish etc your cat is going to continue to react poorly if its IBD so if diet isn't an option, then i would look at meds like Pred, especially if there is continued weight loss.  Unchecked, its not just progressive weight loss that is the issue but the potential for intestinal failure, lymphoma, and other disease processes like pancreatitis etc.  Severe IBD is a fatal disease when not in remission.

 

[missmimz]

Forti flora is a low quality poor probiotic. It has animal digest in it which makes it taste good to many cats, but in terms of probiotic it's almost useless. 

Here's some info about IBD and the benefit of a homecooked or raw diet and the benefit of using human grade probiotics rather than those designed "for animals."

EZcomplete is a great pre-mix thats help many IBD cats. You can use it for cooked or raw meats, and the company will send you a sample if you ask. 

Also if you haven't you should ask your vet about cerenia. It sounds like she may be nauseated, and thus not eating or being "picky" and cerenia will help that. 

http://www.foodfurlife.com/raw-feeding-and-ibd-in-cats.html

http://www.foodfurlife.com/use-probiotics-in-cats.html