In July 2017, my then 17-year-old cat Romeo started presenting with symptoms of vomiting, diarrhea, mild weight loss, and lethargy. Up to this point, Romeo had been a very healthy male cat with no medical issues other than a low-grade heart murmur, one eye infection, periodic dental cleanings, and routine annual checkups to maintain his health. But things were about to change for Romeo and his cat parents.
Concerned that Romeo’s diarrhea and vomiting had become more than just an isolated event, we scheduled an appointment at Four Corners Veterinary Hospital in Concord, our trusted vet who has been highly supportive and a critical partner in managing all of our cat’s health over the years. Romeo’s doctor did a full physical exam—palpating his abdomen—finding some thickening of his intestines. He took Romeo’s blood and ran a blood chemistry profile and urinalysis. Then recommended diagnostic tests—specifically an ultrasound that would rule out things like a GI tract obstruction or abdominal mass, but would provide a detailed examination of Romeo’s internal organs from all different angles, the sizes of the organs, as well as their functioning. An ultrasound evaluates the cat’s liver, spleen, kidneys, gallbladder, lymph nodes, small and large bowels, bladder and pancreas and is able to determine the size, shape and texture of each—revealing any abnormalities, enlargements, masses, fluids, stones, thickening, dilation or if any lesions are present. So we ponied up the $450 dollars (at the time) to get to the bottom of what was going on with Romeo’s gut.
The ultrasound findings were revealing – Romeo had developed immune mediated bowel disease or possible low-grade emergent round cell neoplasia (intestinal lymphoma). His findings also supported the diagnosis of generalized enteropathy, which just refers to any dysfunction of the intestines. With this finding, some damage or defects had occurred to the lining of Romeo’s intestines, allowing proteins and other particles from food to pass through to be absorbed by the bloodstream instead of the intestines. Thus, his extreme diarrhea.
Lymphoma is considered to be the most common cancer in cats, and Siamese cats (which Romeo is half Siamese) are at higher risk of developing lymphoma, and Siamese male cats are predominantly at more risk. Bingo, that was Romeo. So are Oriental pure bred cats. To definitively diagnose whether Romeo indeed had intestinal lymphoma, our vet recommended an intestinal biopsy for a more definitive diagnosis of his GI tract. But since that would require surgery and the ultrasound was already expensive, we accepted not knowing if Romeo had lymphoma at this stage. The results of Romeo’s ultrasound showed that all his organs were otherwise normal and healthy—all were a normal size, shape, and texture, but his bowel width was increased and showed thickening. Since Romeo goes outside (in our fenced-in backyard only), I had also wanted to rule out parasites as a cause of his symptoms. So I had gone ahead and dewormed him with the proper deworming protocol of Drontal (from our vet), then another Drontal 21 days later, to eliminate the most common worms – round, hook and tape worms, so we could rule this out as a cause of his symptoms.
Romeo’s treatment plan at the time included:
- The immunosuppressive corticosteroid Prednisolone, AM & PM, for four weeks–tapering down to once a day
- A diet of novel protein including duck, venison, or rabbit (dry and wet)—a hypoallergenic diet that contains a protein source that Romeo had never been exposed to before. Another option was a hydrolyzed diet where the protein has been hydrolyzed to make digestion easier
- Daily probiotics for his wet food
- Sub-Q fluid therapy to hydrate him – we do ourselves with lactated ringers
- B12 shots every week for a month, then every other week for a month, then once a month (we do ourselves, it’s much cheaper and easy to learn)
Romeo did very well for one year and responded very well to his treatment, which was adequate to control his disease at the time. But since IBD is not curable, and symptoms can and do return—a year later Romeo’s symptoms came back. Now Romeo was 18 years old, and his symptoms had returned and started to become severe again. So we put Romeo back on the corticosteroid Prednisolone—twice a day, then slowly tapering down to once a day again. But weeks later, when we tried to reduce the Prednisolone to one time a day only, his diarrhea returned. So our vet recommended that Romeo stay on the Pred once a day long-term, which was successful in managing his symptoms again for another year.
Now it’s February 2019, and Romeo is 19 years old and his diarrhea has returned again with a vengeance—multiple times a day—and clearly the Prednisolone still given once a day is no longer enough. By this time, Romeo had also lost almost two pounds slowly over the past 1-2 years, and he was showing dramatic signs of becoming physically weaker, slower and more cautious. My once sprightly, energetic, active, vigorous, adventurous cat—was starting to show his old age and to slow down. Now, it was time to return to our veterinarian for another routine checkup and blood panel to see what had changed and where his disease was.
It turned out, this time, Romeo was mildly anemic, which was causing weakness and vomiting; and he had a suspected ulcer (some blood in his stool), a bacterial infection in his gut, and he had chronic low-grade inflammation. Wow, it was a lot to hear and I was feeling somewhat overwhelmed. Romeo was just one of many cats that I take care of every day.
Following this diagnosis, in March 2019. we started Romeo on Metronidazole—for the first time—an antibiotic-antibacterial medication for bacterial infections. He gave him a prescription of quarter tablet in the AM and one in the PM, for three weeks, then down to one ¼ pill only in the evenings. We bumped up Romeo’s B12 shots to every week again, and returned to giving him a novel protein diet in both his wet and dry food (rabbit, duck and venison), in addition to sub-Q fluid therapy to keep him hydrated. Plus to treat his gastric ulcer, our vet recommended Sucralfate, a medication that gets mixed with water into a slurry, and is drawn up in a syringe, then dripped into his mouth, morning and night, for two weeks. Again, Romeo’s symptoms subsided for a few months.
Then five months later, in July 2019, Romeo started having a very bad flare-up again. So he is now back on the Metronidazole two times a day, and may need to stay on this drug twice-daily long-term, but our goal would be to reduce the drug back to one time a day. He is now less responsive to the Metronidazole than he first was, so his disease is clearly worsening. To calm his digestive tract, for the next couple of weeks, this will be Romeo’s treatment plan, and may continue long term, we will see:
Romeo’s treatment regimen is now the following:
- Boiled white chicken and turkey breast (Is not an adequate diet for cats on its own, as all cooked muscle meats must be supplemented with Taurine and vitamins, so you can supplement the cooked meat with a nutritionally complete powder called EZComplete that can be added to your cooked meats. It is complete with all the necessary vitamins, minerals and taurine that cat’s need, see www.foodfurlife.com) Taurine is critical in a cat’s diet daily, here’s why. Here is more about how to add Taurine to your cat’s raw or home cooked meat diet.
- Mixed cooked meat with chicken or turkey Bone Broth (no sodium, no salt) and diluted with some water
- Gerber’s baby food, as an alternative to cooked turkey or chicken (turkey is preferable), again mixed with a nutritionally complete powder such as EZComplete – by www.foodfurlife.com – or another brand that has the nutritionally necessary vitamins cat’s need
- B12 shot every two weeks (we administer)
- Metronidazole (1/4 of a 250 mg tablet) – AM and PM now, but hopefully will taper back to 1x a day again
- Prednisolone steroid – 1 pill every PM
- Probiotics given in wet food daily – I like Nexabiotic Probiotic For Cats and Dr. Mercola Complete Probiotics for Pets; for digestive enzymes I like Dr. Goodpet.
- Fluid therapy given 1-2 times per week (lactated ringers 1000 ml) to maintain adequate hydration
- The Assisi Loop for healing and pain management, see the video https://youtu.be/6oHkLHPb-_I
- Digestive enzymes are recommended, but we are still researching to find the best brand for cats only
A week later, Romeo’s stools are starting to firm up, his diarrhea is gradually dissipating, but it is slow to change this time. Earlier, he was so sensitive and responsive to the Metronidazole, but not any longer. The change to boiled chicken/turkey with bone broth is really helping—Romeo loves it, he is lapping it up with fury—and is eating more food as a result. Maybe he will even gain weight! And importantly, going forward, I have added the necessary essential vitamins and minerals with the EZComplete powder for cats by FoodFurLife, so that his homemade cooked meats are a complete and balanced diet based on the prey model. Plus it contains no fillers, no additives, no thickeners, no flow agents, and no preservatives, that would set off his gut again, and ensures he gets enough Taurine. This is an easily digestible diet, and I can alternate with his novel protein cat food for variation. The diet therapy part of treating IBD is so critical and cannot be underestimated in controlling and managing this disease, because otherwise, we are only putting a bandaid on the problem with anti-inflammatory and immunosuppressive medications, that aren’t healing the disease.
Our last and final treatment plan down the road for Romeo’s Inflammatory Bowel Disease will be to try the Immunosuppressive chemotherapy drug – Chlorambucil (Leukeran®) next. This will come when Romeo is no longer responding to his current treatment plan of Prednisolone and Metronidazole. Chlorambucil is usually used in conjunction with corticosteroids for cats with severe IBD and the side effects are minimal, except for causing severe bone marrow suppression. So Romeo would have to be closely monitored at that point by our vet. But at his age, and at his stage of the disease, what choice is there? At least he could continue to live longer, be relatively symptom free, and enjoy more of his life and the things he loves—until the day when maybe none of this will be enough for his tired body. But I don’t have to think about that now. I’m focused on today. One day at a time they say.
Since IBD cannot be cured, the goal is to manage it by minimizing symptoms, managing the discomfort, and addressing the recurrences as they arise, quickly. To all those who have IBD cats, I hope by sharing this with you, it helps you.
Here’s to a long, happy, healthy life for all the cats with IBD or other gastrointestinal diseases—and to the cat parents who are dealing with this disease and treating them. I wish you the very best.