Today's cat blog post is about Inflammatory Bowel Disease (IBD). Seems a lot of people come here after searching for info on IBD, so I figure I'll put some info out there. My little Clara (pictured) had quite the bout with IBD; she was lucky and seems to have fully recovered. Also, the new issue of Cat Watch, the cat health newsletter from Cornell's Feline Health Center, features an article on IBD.
So, here goes, from the newsletter:
IBD is the most common GI problem in cats.
Cause: Bottom line, no one knows for sure what causes IBD. Some theories: (1) IBD as the result of several different types of disorders involving the immune system. An abnormal immune system response may precipitate IBD, e.g., an inappropriate immune response to bacterial flora normally found in the gut. Over time, this inappropriate immune response may damage the mucosa (the intestinal lining). (2) Something in the cat's diet stimulates an aberrant immune system response. This idea makes note of the fact that IBD cats typically response to treatment involving dietary changes.
IBD is a relatively new topic for research; the first major medical report on feline IBD came out only about 10 years ago.
Patterns: IBD is common among middle-aged and older cats, although advanced age is not considered a conclusive risk factor. IBD frequency is equal between males and females. Indoor cats are much more likely to be diagnosed with IBD than outdoor cats; this may be bco indoor cats' owners better attention to their cats' health. Outdoor cats, especially cats who are always outdoors, e.g., barn cats, are much less likely to be diagnosed with IBD. Susceptibility to IBD may be passed genetically, but such markers have not yet been identified.
Symptoms: The most common symptoms are chronic vomiting and chronic diarrhea. Also seen: decline in appetite; weight loss; frequent passing of gas; audible rumbling in the cat's gut; observable difficulty in defecating; blood or mucus in the stool. Symptoms vary depending on which part of the GI tract is affected. E.g. vomiting is more likely when the stomach and small intestine are affected. E.g. diarrhea is more likely when only the intestine is involved.
Diagnosis: A vet may first perform lab tests to exclude other diseases (e.g., cancer, infections, viruses): complete blood cell count (CBC); chemistry panel; fecal exam. After ruling out other diseases, a vet may then try an elimination diet to see if the problem's due to a food allergy or food intolerance. This may take several weeks. After ruling out a food allergy or food intolerance, a vet will probably recommend a biopsy of the GI tract. This is either done via (a) endoscopy (a flexible tube is inserted into the GI tract to gather tissue samples) or (b) surgery (the GI tract is accessed for tissue samples through a surgical opening in the cat's belly). Both procedures are done under general anesthesia. Intestinal tissue biopsy is the 'gold standard' for diagnosing IBD.
Since IBD symptoms mimic other serious problems and vice versa, prompt action on the part of an owner witnessing these symptoms is very important in getting the cat proper treatment.
Treatment: Treatment is two-pronged: (1) Dietary: The cat is placed on a diet of whatever food it best tolerates. The cat stays on this diet for an indefinite period of time. (2) Drugs: The cat receives mainly glucocortoids (anti-inflammatory hormones); also, drugs to suppress the inappropriate immune system response are also often given. The overal goal of treatment is, as the cat's condition improves, to taper the cat off the drugs while remaining on the diet.
Morbidity and mortality: Morbidity (rate of IBD) is rather high. Although incurable, most cats (90%) respond well to treatment. However, most cats will also relapse and require further medical treatment. Mortality (rate of death) is relatively low. A cat may be euthanized due to uncontrollable and persistent vomiting, diarrhea and malnourishment.
Now, my little Clara's experience: We believe Clara is at least 12, maybe 13, years old. She may be older. She was first brought into the shelter as a relatively young, possibly first time, mother, so we're guessing at her age when she first arrived at the shelter, then adding time since then. We may be way off and she may well be older.
Based on this age estimate, Clara first began exhibiting symptoms at approximately 8 years old. Her main symptoms - weight loss and ravenous appetite - suggested hyperthyroidism. We began testing her for that problem. She did not exhibit vomiting or diarrhea until one morning, when she suddenly exhibited serious and bloody diarrhea. She went to a specialist that day. Once stabilized, an endoscopy was performed and she was diagnosed with IBD.
She came home a few days later. She was set up in a separate room, so (a) she could recover in peace and (b) we could observe her better. She had lost quite a bit of weight; from approximately 11 lb. to approximately 6 lb. She was also very weak. When healthy, there's no way in hell that I could give her medicine by mouth, mainly bc there's no way in hell that I could catch her. When she first arrived home, however, she offered no resistance. I recall that she was prescribed at least prednisone (an anti-inflammatory steroid). I believe she was also prescribed a small amount of OTC Pepcid. She may have received other medications as well. Her medicines were crushed and mixed into a very small amount of liquid (e.g., water, tuna water, etc.); this is called a slurry. I drew the slurry into a syrine (no needle, of course), scruffed her and squirted the slurry into her mouth. She got a slurry at least two, maybe three, times each day. I'm also thinking she got her meds first, then her food, so the meds could act on her inflammed intestine for a bit before she took in food.
She also started on a bland diet of IVD Limited Ingredients canned cat food. It comes in flavors like duck, rabbit, veal and venison; all with green peas, for some reason. I think we started with the duck. She did eat this for a while. I think we also gave her other flavors, though I forget which.
As she recovered, she became stronger and more resistant to being medicated. That was a good thing and a bad thing. Good thing bc it meant she felt better; bad bc it meant I was unlikely to be able to continue medicating her. Overall, I guess it was a good thing, though. I didn't like seeing her so weak; I wasn't used to seeing her as anything other than her badass self. So, eventually, she no longer received slurries. She did, however, receive crushed prednisone in her food. However, once she was reintegrated into the group, she had to be monitored when eating this so that only she got the prednisone. She probably did not always get a full dose once she started getting her prednisone in her food.
Once, during this time when she was starting to feel better, my little Clarabelle swatted at me while I was medicating her. She did so with a closed paw, when she easily could have done so with an open paw and sliced my hand to ribbons. It wasn't long after that I decided not to medicate her that way anymore. Sometimes you have to strike a balance between the benefits of a treatment and the stress of that same treatment.
As she recovered, she also started balking at eating the bland cat food. Eventually, she would not eat it at all. I understand it tastes lousy. Note to cat owners: If your cat is supposed to eat only certain foods bco a medical problem, give it a try for a day or two. If she doesn't eat, call her vet. But basically, you should give her something she will eat. Do not keep feeding her the suggested food, thinking she'll get hungry and eat it. She might, but she might not, and it's almost always more important that your cat eat than that she eat the right food. Also, not eating for even a short period of time, e.g., two days or so, can cause other serious medical problems. So we started giving her regular cat food bc she refused to eat the bland food.
Eventually, Clara plumped up again rather nicely. She never regained her full weight of 11 lb.; she's more like 8 lb. now. She's also not as lean as she was before she became ill. She was a lean, mean mofo then; I understand that prednisone can cause cats to gain weight in a piggy, moon-faced kinda way (don't quote me on that).
As noted, Clara is not very social so she was all hard to handle and whatnot. Dr. Slade wanted to just take a look at her whenever she came to see one of the other cats. She'd ask me how Clara was doing, was she eating, was she gaining weight, etc.? I wasn't able to catch her to weigh her, but I thought she was getting kinda chubby and I told the doctor this. She said, 'Chubby's good. We like chubby.' Eventually, all I was able to do was get some close up shots of Clara, to which Dr. Slade responded, 'OMG! She's fat!' Sweet success.
I should note that Dr. Slade, like most good vets, doesn't like chubby for all cats; we long tried to get Archie to lose a pound or two; Smudge, too. Fat cats are adorable, but they're not at all healthy. But to hear Clara might be getting chubby was, in this case, good news.
After about a year or so, Clara was weaned off the prednisone. She eats the same food as the others now and receives no medicine. Other than perhaps exhibiting some signs of aging (I think she's not hearing so well these days), she seems to be doing quite well. Although she's not nearly as social as the other cats, her bout with IBD seemed to have the silver lining of her having to trust us, and she seems a bit more relaxed around us since then.
Links:
- Cornell's FHC IBD brochure.
- An article on IBD from the Winn Feline Foundation.
- About.com's entry on IBD. There are links for further research toward the end of this entry.
If anyone has any questions about Clara's - and/or my - experience with IBD, feel free to email me (email link is in upper right corner of the page). Also, comments, additions and corrections wrt the above info are greatly appreciated.
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