Indy's IBD

2014:


On October 27th my 13 yo Maine Coon mix Indy was diagnosed with Irritable Bowel Disease (IBD) which is something similar to Crohn's Disease in humans. He had been experiencing intermittent vomiting and diarrhea, some appetite loss, and over a period of months, a weight loss of almost 5 lbs. Despite multiple vet visits (which he hates) all of his blood work and x-rays continued to show nothing other than mild renal insufficiency. Last Tuesday he projectile vomited that morning after eating his breakfast followed by some diarrhea, which was something he hadn't done in a few weeks. I called my vet and scheduled an ultrasound for last Friday. Needless to say I was a basket case beginning Friday and still haven't come out of it. Friday afternoon I picked him up and received the following news:
  • The ultrasound showed mild pancreatitis, possible cholangeohepatitis, IBD, splenomegaly, and possible lymphoma. The radiologist was leaning towards lymphoma so an aspirate of his enlarged abdominal node was done and sent off to pathology. During this time he was sedated due to his anxiety at the vet
  • The radiologist also said to consider triaditis, which is an inflammation of the intestines, pancreas, and liver in cats due to their unique anatomy
  • My vet checked his anal glands since he's had abscessed ones in the past and found both of them to be impacted and infected. She emptied them and flushed them with antibiotics
  • Due to the mild pancreatitis (which is painful in humans) he was given a long acting opioid pain medicine injection and was to start 10 days of oral Flagyl (an antibiotic)
The vet sent us home and said she should have results by this Monday or Tuesday. Indy was a little loopy when we got home (which was to be expected) and then I noticed that every time he laid down, he leaked urine. Not a little urine, about 18 towels worth in addition to our sheets and pillow top mattress pad. I called the emergency vet in a panic Saturday morning and the suspected problem was overflow incontinence brought on by all of the heavy medication Friday. She told me to follow up with my vet Saturday morning, and the tech I talked to said the same thing. At that moment, Indy hopped off the bed and went to pee in the litter box which prevented yet another vet visit that day. The dribbling had stopped. 

I was supposed to work all day Saturday and Sunday so my sister, her boyfriend, and our neighbors across the street all stepped in to keep an eye on him and offer him frequent cans of food. His appetite was still fairly sucky, so anything we could get in him was good. Over the weekend I also discovered that oral liquid Flagyl is horrid tasting and it was no surprise that he was spitting it across the room no matter what I tried. I like to think at least some gets into his stomach but he's always been a cat that hates medications. Knowing what I do about human illnesses and spending countless hours on the internet was slowly bringing me to the conclusion that I may have to let Indy go over the Rainbow Bridge sooner rather than later, especially if lymphoma was diagnosed (he wouldn't tolerate chemo or that many trips to the vet for such a limited prognosis).

After bawling my eyes out all weekend I got in touch with a mobile palliative care/euthanasia vet via phone and we chatted for almost an hour about Indy and his condition. Despite feeling badly, he was still following me around the house, slowly eating more, drinking fine, using the litter box, not vomiting, and basking in attention. The mobile vet convinced me to talk to my regular vet before I made a final decision. I found her to be incredibly patient and level-headed, and she gave me some things to think about. She also said that if I wanted to let him go she wouldn't disagree but that speaking with our regular vet may give me a better grip of the situation.

I anxiously waited for my vet to call and she finally did early Monday evening. The aspirate came back negative for lymphoma but she said there was still a possibility he had it, just that it hadn't gotten that far yet. Apparently the only way to get a positive diagnosis for any of the above issues is to open the cat up and take direct tissue biopsies. Not going to happen! Knowing that, she told me that she wanted to treat him for IBD and see what would happen. I explained to her that I had contacted a palliative care/euthanasia vet and why I was so torn. I didn't want to let him suffer, but I didn't want to let him go without a fighting chance. She convinced me to try a typical protocol for IBD cats, which took a little more convincing from Alister (surprisingly as he is not a big cat person) for me to agree to. Starting this week, Indy will get Vitamin B12 injections at home once a week for 6 weeks (to help with appetite and hopefully decrease the diarrhea), a prednisolone (steroid) taper 2x/day EVERY day (possibly indefinitely), and a change to a grain free, limited ingredient diet in hopes of getting rid of any food sensitivities. I was admittedly very hesitant to do this, because I know my cat and I know he hates meds, but as Alister said he's a tough cat, he's had cancer before (mast cell earlier this year), and he fights right through it. We didn't want to let him go without giving him a chance, especially since we had the conversation with him laid out on my lap purring.

I was already questioning my decision today (October 28th) when he ate some breakfast then hid under the bed until Alister finally pulled him out mid-afternoon. He was most likely hiding from me because he knew the antibiotics were coming (he's not stupid) so he ended up avoiding his morning dose. Once he was out he was immediately affectionate and ate 1/2 can of the new food. Afterwards he stayed out and laid around the house. Before Alister went to work we took him into the bathroom (his new designated med spot) and gave him his antibiotics and B12 injection. He didn't react to the injection at all (small needle) but actively spit a lot of the antibiotic out as usual. He then ate some more food then went back into "hiding from mom mode".

I'm hoping the compounded steroids will taste better (it says fish flavor) and that what we try helps. My vet did tell me that if it is intestinal lymphoma that in about 6 weeks the meds will fail and he will relapse, at which time we will have to let him go before he suffers. If he does react positively we will go from there and try to manage the IBD in hopes of giving him a good quality of life. I have prepared myself for the worst and am hoping that I'm wrong. Apparently many IBD cats have trouble finding a good med regimen to keep them doing well although my vet said she has several IBD cats that have done just fine.

I will update this occasionally as things do or don't work but I can already say that I have the utmost empathy for anyone caring for an IBD cat. It's already feeling overwhelming but between my vet, Alister, Indy, and myself we will figure out how to do what's best for him, and when it's time- whether it's related to the IBD, lymphoma, or something else- let him go peacefully.

As of today (November 16th), Indy is still on steroids twice a day, probiotics daily, B12 injections once a week, grain free rabbit food, and now another course of antibiotics due to developing a respiratory infection. Poor guy. However, he's still loving and eating/drinking with no bouts of diarrhea or vomiting so we're going to keep with the plan. I weighed him on Friday and he had only gained .2 lbs so we're keeping him on the higher dose of steroids longer. There's a chance the lack of weight gain is from the URI but just in case we're not giving up yet. I weighed him again today and he was 14 lbs with the goal being 16. He's only 2 weeks into the steroids though so the big re-evaluation will be in 4 weeks. Still crossing fingers that it's not lymphoma.

Today (November 21st) Indy went to the vet for impacted anal glands. Luckily they weren't infected but the vet infused them with abx anyways just to be sure. His stool has been loose due to the URI abx but no diarrhea. His weight is up to 14.7lbs so we're going to try cutting the steroids back to once a day. Fingers crossed.

Indy appears to be doing okay (December 10th) but it's hard to know because cats are so good at hiding discomfort. It looks like his anal glands are bothering him again, but as for his IBD, he's eating drinking, peeing, and pooping fine so the only issue at the moment is his behind. I'm hoping with the added fiber in his food that it'll work itself out because we can't afford to have them emptied and Indy sedated once a month. It's not fair to him either given the discomfort he feels afterwards but having them removed is not an option; especially not after what Stetson went through when his were removed. We're keeping our fingers crossed that he's okay as he continues to gain weight, but this Friday is the 6 week "anniversary" of him starting steroids so if it's lymphoma and he's going to "crash" it should be sooner rather than later.

Indy ended up getting his anal glands emptied and infused again under sedation on December 16th and the vet and I are desperately trying to figure out how to prevent this from happening so much. I've started adding fiber to their food but it's hard to know if it's helping when the glands are full anyways. On a good note, Indy weighed 16.1 lbs and we were able to decrease the steroids again and see how he does. He will continue to get probiotics and B12 injections but (cross fingers) he continues to do okay.

2015

Indy continues to do okay. He has IBD and CKD but seems to still be enjoying life and maintaining a good appetite. He gets probiotics, Cosequin, and lysine in the morning in addition to pepcid and prednisolone in the evening (he also gets his B12 injection monthly). Although he was recently diagnosed with a type of arthritis in his spine, he doesn't appear to be in pain and is still as active as a 14 year old cat can be. He managed to go 3 months without having his anal glands emptied but has had several bouts of diarrhea which required Flagyl for a week. Those were most likely due to him sneaking the other pets' food, but could have been flare ups. We continue to keep a close eye on him.

Indy passed away on December 29, 2015. His IBD had progressed to intestinal lymphoma, and as we couldn't get his diarrhea under control we decided to let him cross the Bridge before he suffered any longer. I can only hope that he found Stetson right away,

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