When it could be a cat IBD flare-up or cancer

December 20, 2019 8:55 AM

My 14-15 year old male cat has always had several (mostly) easily treatable chronic conditions: crystals in urine, IBD, and tooth issues. This last week he took a turn for the worse but we just moved and the new vet wasn't super helpful.

TLDR: Cat is not currently having GI issues and is eating after a bout of weight loss and diarrhea, but our new vet thinks its cancer without doing any blood work or testing. How do I get a sense of whether I need to take him for a second opinion, just wait, or get ready for saying goodbye.

*Your are not my vet and no advice will be take as veterinary medical advice

The cat's last major health scare was about 3 years ago he stopped eating, lost a ton of weight, and started hiding under the bed. After several vet visits we switched to a different vet who suggested an ultrasound of his belly. They thought he either had cancer (mast cell type B) or IBD (which seems fairly common based on several AskMe questions) and either way the best management of his symptoms would be a steroid pill. This did the trick and he was back to his old self right away, so we ruled out the cancer diagnosis.

Over the last year he had been getting finicky about eating his wet food and has been losing weight for the past couple of months. He had extensive blood work done a few months ago that was normal. If you put down a new flavor of wet food he'd eat it up for a day or two and then start ignoring it. Same with his prescription dry food. But he still begs for food and will nab any people food he can possibly get (he grabbed a cracker out of my hand a few days ago).

Starting last week he barfed several times in a couple days so I made a vet appointment. In the two days before his vet appointment he started getting explosive diarrhea only at night.

The vet was new for us, since we just moved a couple of months ago. He didn't run any tests and didn't look through the cat's admittedly sizeable medical history very carefully. Since the cat had lost a substantial amount of weight and had a cancer scare a few years ago the vet said he thought it was probably cancer and we can wait a few days but be ready for euthanasia. He gave us Metronidazole and an appetite stimulant and said to take a few days to see if symptoms improved, but the prognosis was bad. When we got him home he had some more diarrhea outside of the box with some blood in it. Called the vet back, vet said that could be either kinda normal or bad but to wait and see if he got any worse.

It's been over 48 hours and we have not had anymore barfing of diarrhea (no normal poops yet either) and his appetite has been ok. He'll accept the AD prescription food, but loves when I give him boiled chicken. He's been eating around 3/4 of a can per day plus a few treats. He's been affectionate, eating, but not quite his normal self. He just seems a little frail and a little bit stumbly and slow - but he still has been jumping up on high furniture and begging for food whenever I'm in the kitchen.

I'm able to work from home for the next week so I can keep an eye on him but I'm just terrified that he'll suddenly get extremely sick (knowing him most likely on Christmas Eve or Christmas Day when it's hardest to find a vet) and die in pain.

I'm not sure if I should make another appointment with another vet for a second opinion or whether I should give him a few more days to see if he keeps improving or goes downhill. He's fairly old and already has had a ton of vet bills and medical procedures and at this point I think we're hitting diminishing returns on any type of invasive treatments. The vet we saw this week didn't do bloodwork because he didn't think there was much point in it - the cat is probably just too old and sick for any meaningful treatment.

I don't want to do the thing where we spend thousands of dollars on diagnostics and multiple vet visits, but I am concerned about how to monitor his quality of life.

Can I ask for pain meds to have on hand in case he starts showing signs of distress?

If your cat had similar symptoms (prior diagnosis of IBD with an onset of loss appetite and diarrhea) what did you do?

If your cat was fairly sickly and old, but not deathly ill yet, how did you manage the situation?

posted by forkisbetter to Pets & Animals (10 answers total)

I think what I would do is find the nearest emergency vet and confirm that they are open Christmas eve and day, and maybe have his files sent there and just generally get yourself set up for success. Then I would wait, because it sounds like your cat still has a decent quality of life -- he's eating, begging for food, jumping up on things. If he takes a turn for the worse you will have a place to go. If there is someone in your area who is a mobile vet and does euthanasia at home that would be a good person to have on call as well, because if he does go downhill quickly it will be least traumatizing to not have to get in a carrier and go anywhere.

I'm sorry you are having to go through this. It sounds like you are being really thoughtful and doing the best for your cat friend.
posted by fiercecupcake at 9:05 AM on December 20, 2019 [3 favorites]

There is SO MUCH that can be done to help his quality of life regardless of diagnosis. I would want to see another vet if this were my cat. There are meds to help with nausea and appetite and pain and diarrhea. None of this is expensive and sadly there are too many vets who either aren't aware of what's available, or don't employ what is available for some reason. Many elderly and frail cats can benefit from daily anti nausea medication like Cerenia (labeled for dogs only, it's used off label for cats all the time), medications like mirtazapine help enormously with appetite.

I'm sorry your kitty isn't feeling well, but there is likely quite a bit that can be done if you can find a vet who is willing to help you. Your cat is lucky to have you.
posted by biscotti at 9:10 AM on December 20, 2019 [3 favorites]

I'm sorry you're in this situation. I lost my elderly cat a year ago almost to the day, and it was rough.

Can I ask for pain meds to have on hand in case he starts showing signs of distress?

Absolutely. I had a bunch of opioids around for Dottie for the last two years of her life, and also a bunch of gabapentin, with some general dosing guidelines. (The opioids were stronger but made her really dopey and suppressed her appetite, the gabapentin didn't work as well but she was much more functional with it, and seemed calmer.) With the blessing of my vet I just used my judgement. Fortunately in her case, Dottie's kidneys failed suddenly and critically after a year or so of her being just old and not super well, so I didn't have to make any serious judgement calls. She was done, she told me she was done, and that was that.

I second getting the records sent to a vet that will be open over the holiday. I'd also be inclined to get current bloodwork, because your vet sounds frankly kinda lazy about it and there is a _bunch_ of stuff that can cause acute diarrhea and appetite loss in cats and it's not all untreatable. Dottie got acute pancreatitis at 16 and lived two more years after treating that - it might have killed her if the vet had just shrugged and said "welp, she's old."
posted by restless_nomad at 9:12 AM on December 20, 2019 [1 favorite]

I'm so sorry for you and your cat that you're facing this situation, but there are many things you can do to help! Ask your vet (or a new vet, I don't like your current vet) about anti-nausea, appetite stimulation, fluids, and pain management.. those 4 will be so helpful. None of these drugs were very expensive (in Canada, ymmv).

I just lost my 15.5 year old cat to the same thing ("It's either IBD or cancer", said the vet) but she had a really good life right up until it was very clear she wasn't well.

Cerenia was a godsend for anti-nausea and appetite stimulation. She was on like.. 1/4 pill every few days, which is essentially the size of the head of a pin. You can manage the dose yourself at home to keep the nausea down.

We also were doing sub-q fluids at home, which was very easy (and fun in a slightly gross way).

We also were doing some prednisolone for inflammation, and I think either gabapentin or bupropr.. something (opioid) for pain.

We knew it was "time" when she hadn't eaten a bite in 2-3 days and I couldn't get her to eat anything, even her most favorite soft foods and treats.

Sending love to your household. Good luck!
posted by some chick at 9:22 AM on December 20, 2019 [1 favorite]

Get a new vet. At a minimum, they should have done bloodwork.

My cat has all the same issues and recently has had some blood in her stool. Vet gave me some liquid medicine to get that to stop (not sure of the name). We also doubled up the prednisolone from 1 to 2 pills a day.

As others mentioned you can give Cerenia for nausea and mirtazapine to get the appetite up. You can also experiment with different food types - mine won't eat anything shredded, only pate style.

Another data point, my cat was getting sores in her mouth that we fixed with antibiotics. It was making it difficult for her to eat even though she was clearly hungry.

Good luck.
posted by pyro979 at 9:52 AM on December 20, 2019 [1 favorite]

Yeah came in here to say, that vet is not the right vet for this situation.

Some vets aren't good cat vets. This does not sound like a good cat vet.

Buddy needs bloodwork at minimum, and IMO I'd want to know if it really was cancer so I could manage that situation in the most appropriate way. IDK where you are but I have had good experiences with Blue Pearl vets (and they operate specialty and emergency) -- Find a Blue Pearl hospital near you here.
posted by Medieval Maven at 10:38 AM on December 20, 2019

My cat died of cancer over a year ago. I found a local mobile vet who did hospice care. She was a godsend and made a horrible situation much more tolerable. Try googling hospice and/or mobile vet. Maybe you’ll luck out.
posted by FencingGal at 1:41 PM on December 20, 2019

Get a second opinion. I'm extremely surprised that the vet mentioned nothing about palliative care. If you have a local cat-specific rescue, they might have a recommendation for a cat-friendly vet. You don't have to pursue a firm diagnosis or know exactly what's going on to help a cat feel better until it's their time to leave us. I got my cat expensive testing (ultrasound and some very specialized bloodwork). While it did give me peace of mind to have firm evidence that it was what my normal vet suspected, I'm not sure I'd spend that additional money again. It felt very expensive, and I had to ask for help paying.

When you go in to the second vet, say that you want to help him feel better today, and ask what you can do right now for that.

My 14-15 y.o. girlkat had acute-onset GI issues too, which have now settled into chronic pancreatitis. To stabilize her at first she got subcutaneous fluids for dehydration, an anti-nausea shot (Cerenia), a steroid shot, and a course of metronidazole. She had gabapentin for pain.

After stabilizing her, she now gets daily oral Cerenia and prednisolone, along with a sprinkle of Fortiflora probiotic in her wet food for her chronic condition (pancreatitis). The prednisolone costs about $10 for a month's supply, the Fortiflora is about $30, and the Cerenia ranges from $13 to $52 depending on dosage. I still have gabapentin on hand.

You also asked about how to figure out his quality of life. From the description you gave, you are doing a great job. I monitor the amount of water girlkat drinks every day, her weight, her affect, her mobility, and her appetite. I will be facing the same decision as you, so I have been preparing myself mentally, but for now she's OK. She plays, she eats a lot, she snuggles, and she jumps up. Not as high up as in the past, but high enough to still be impressive. I'm not entirely sure how I'll tell when to help her go, but I also know that I am probably going to make a decision earlier rather than when things are consistently bad. Girlkat also has diabetes (controlled by prescription food) and early stages of kidney disease. That combo isn't great to start with, and adding on the pancreatitis complicates things further.

That was a lot to tell you, but yeah, get another vet to give you some palliative options.
posted by Stewriffic at 4:56 AM on December 21, 2019

(i work as a vet asst) - i think definitely get a second opinion from another vet. but also, you don't want this to be a long drawn out kind of thing. most emergency centers have specialists on site - they might be able to address the situation a little easier.

when i have to do a QOL appointment, i always ask the standard, "is he eating and drinking normally? and urinating and defecating normally?" but i also look for things like lethargy, no self-grooming, incontinence, ability to move around/do stairs, etc. all of those things can be indicative of an issue, along with blood work.

just out of curiosity, have her thyroid levels been checked?
posted by megan_magnolia at 12:19 PM on December 21, 2019

IANYV but IAAV. Recommend a second opinion. Recommend repeating bloodwork and urinalysis. Try to find an AAFP "cat-friendly practice"

FWIW, IBD can be extremely difficult to differentiate from intestinal epitheliotropic T-cell lymphoma, even with biopsies and advanced molecular testing like PARR. Both will respond to corticosteroids, at least short-term. Some diagnoses are just difficult and it isn't a reflection on the veterinarian's (or physician's in the case of human patients) skill. An analogy: if I ask you to tell me which is thicker, a piece of paper or a piece of pizza, it's no problem. If I ask you to tell me which is thicker, one piece of paper or another piece of paper from the same pack, it is much, much more challenging, and impossible to do without very specialized measurement methods.
posted by SinAesthetic at 7:07 PM on December 21, 2019 [2 favorites]