Inflammatory bowel disease in cats

IBD - (neutrophilic enterocolitis)

Question: Dear Dr. Mike, Thanks a lot for all your answers: as you most certainly know, IBD may drive absolutely crazy not only cat owners but a veterinarian as well!! I feel that our vet is running out of answers/solutions, so maybe you`ll suggest something different... My 3 years old cat has IBD (neutrophilic enterocolitis). He is on Z/D diet and on prednisone. Then he was diagnosed with Giardia and was on metronidazole for 6 days. His stool looked fine for some time, and I started thinking of reducing his prednisone dose. However, after a while, his stool had become (although it was only once a day) pudding-like again and there was always blood at the end. Then our vet gave us Tylosin solution (1cc daily) which worked as well but only after 2 weeks of taking it, (metronidazole was better and quicker - maybe because it was first?), however, blood still presented. As soon as we were done with Tylosin (lasted 3 weeks) my cat was back to square 1 again: pudding-like stool with the blood at the end. Plus, we`ve found out recently that he has acne under his chin - can it be a reaction to Tylosin? My another question is: should he be on antibiotics for longer period of time? If yes, on what antibiotic and for how long (considering side effects, etc)? We can ask our vet for another antibiotic, but is there any sense to force the drug into the cat and to make him suffer, if at the end he comes back to what he was before? I feel like it`s some kind of cul-de-sac, don`t you? Thanks again, Corinne Answer: Corrine- It is probably best to approach inflammatory bowel disease (IBD) as a life-long condition that can be controlled but may not ever be cured. Some cats do get better after the use of medications and do not have recurrences of the clinical signs of IBD, but many cats require intermittent or continuous care for the most of their lives. There are still some things to try before really giving in to this definition, though. Since metronidazole helped, but the problem returned, it is possible that giardia are still present. Another medication that can kill giardia is fenbendazole (Panacur Rx). This is usually given for three to five days at the usual dosages for deworming, since the same dosage works for the giardia. I think it is worth trying this medication once. We usually try to use metronidazole for a thirty day period when it works well, to see if we can get the IBD to actually go away. Once in a while this seems to work. Tylosin (Tylan Rx) is usually used in IBD when it seems apparent that long term antibiotic therapy is going to be necessary. In many instances it is used continuously for very long periods of time, until several months pass without signs of IBD or until it stops working. An alternative medication for long term antibiotic therapy is sulfasalazine (Azulfidine Rx). It is usually dosed at 10 to 20mg/kg every 12 hours for inflammatory bowel disease in cats. It does break down into a salicylate compound and since cats sometimes have a hard time processing salicylates it is a good idea to periodically check liver function values and to monitor red blood cell counts or the hematocrit to make sure that there is no anemia induced by the medication. Our goal is to use one of these antibiotics in place of prednisone, or to lower prednisone dosage whenever possible. If the z/d (tm) diet didn`t make too much difference, I would recommend trying one of the hairball formula foods. These seem to help many of the cats we see with IBD in our practice. If you think z/d helped a lot then switching probably isn`t a good idea. It might be best to talk this over with your vet. Whenever possible we like to refer patients with IBD for endoscopic examination and intestinal biopsy. This sometimes gives a definitive answer (it might be how your vet arrived at neutrophilic enterocolitis). Since many of our clients are reluctant to pursue this diagnostic test due to cost, fear of anesthesia, inconvenience, etc, we are often forced to take a "trial and error" approach to IBD therapy. When this happens we usually try the medications you and your vet have been using and as outlined above. When these don`t work we sometimes go on a hunt for medications that might help, using a "trial and error" approach. Medications that have helped a small number of cats include tetracycline antibiotics, famotidine (Pepcid AC tm) administration, essential fatty acid supplementation using 3V Capsules, methylprednisolone acetate (DepoMedrol Rx) injections instead of oral prednisone and loperamide (Immodium AD tm) or diphenoxylate ( Lomotil Rx) administration for a week or so after diarrhea is controlled by the medications (I can`t explain why this works). There are probably other medications we have tried, or others have tried, that also help a small number of patients. It is a good idea to periodically run a complete blood count and serum chemistry panel to make sure that a hidden systemic problem, such as kidney failure or liver failure is not contributing to the problem. We do have some clients who elect just to live with the diarrhea and/or vomiting and not to treat their cats at all. While I think these cats are probably uncomfortable this choice doesn`t seem to affect their life spans much. The patients I can remember just continued to have diarrhea or soft stools with occasional fresh blood and seemed to live normal lives otherwise in many cases. I really can`t advocate this approach since it is possible to control this disorder with effort, in most cats, but it is a better option than deciding on euthanasia prematurely. I hope that this helps some. Mike Richards, DVM 3/10/2001

IBD - frequent vomiting

Question: Hello - GREAT web site! I became a subscriber immediately. I have a couple of questions that will help me take care of my 2 cat buddies (Black and Grey). I adopted them from a shelter 8 years ago, and they have not had many problems, but there are a few things I was hoping to understand better. Both cats are neutered males. 1. Black has sort of been diagnosed with IBD. He vomits frequently, and it is often undigested food. Rather than go thru invasive and uncomfortable exploratory surgeries, my vet recommended I give him Prednisilone - which I attempted in Sept. of 1997. It was difficult to have him take the pill, and he started to avoid me thinking I was going to medicate him all the time. After no significant improvement with the vomiting after a month, we tried something else - monthly injections of Depomedrol to see if that controlled the vomiting. Did that from Oct. of 1997 to June of 1998, but because it did not vastly improve his behavior - we decided to discontinue because I wanted to avoid the effects of the medication on his long term health (diabetes, etc.). Black has no other health problems, his weight has been consistent at about 16-18 pounds for the past few years - he eats well, he drinks well (obsessed with water, but that`s something altogether different) and he seems to be very content and happy. As long as this is the case, should I even worry about the fact that he vomits frequently? Does this harm him? Is there anything I should do to try to change this behavior? I don`t really enjoying cleaning up a mess, and it does sometimes stain my carpet, but I can live with that as long as his health is not compromised. What do you suggest? 2. In order to try to curb Black`s vomiting, I`ve been feeding both cats Science Diet`s Sensitive Stomach formula. (There isn`t a way that I can feed them different diets - their food is available from a common bowl 24 hrs. a day). This does not seem to have had a significant effect on the vomiting behavior - it still occurs about once or twice a week. In the past, Grey did have a bout with a urinary tract infection (which I know can be deadly) so I have been cautious about the type of food I provide. Given ALL of the circumstances I`ve explained (vomiting, scooting, 8 years of age), is there something in particular that you would recommend as the best diet for both of my buddies? I`d like to keep them as healthy as possible. I appreciate any information or suggestions you have. Thanks so much! Sharon Answer: Sharon- I think that you are trying to ask if it will hurt Black in the future if you don`t treat the symptoms of inflammatory bowel disease (IBD) that he is showing now. The answer is unfortunately, that I do not know. To me, saying that a cat has IBD is a little like saying that it has dermatitis. This is sort of a diagnosis but it isn`t a very specific one. There are a number of recognized causes of inflammatory bowel disorders, even though many of them will respond to similar treatments. Many of my clients don`t treat their cats who are vomiting on a regular basis and often won`t even mention the problem unless I specifically ask if their cat is vomiting. I can`t say that I have correlated this lack of treatment with specific long term consequences in untreated cats. However, there seems to be agreement among veterinarians who research IBD that it is often a self-perpetuating condition and that not treating the condition can lead to significant worsening of the disorder in some cats. It is a good idea to rule out systemic disorders that might cause vomiting, like kidney disease, diabetes and liver disease, usually through the use of blood chemistry analysis. It might be worth considering testing for heartworm disease in some areas of the country, as well. The first efforts at diagnosing and treating this condition probably should be directed towards eliminating roundworms and dietary control. Deworming even if roundworms aren`t found on a fecal examination is reasonable. I think that I would prefer to start with a hypoallergenic diet (Hills z/d tm, for instance). It is OK to feed both cats the hypoallergenic diet. If this is not beneficial after six to eight weeks, then I think I would move towards to the Sensitive Stomach (tm) or hair ball remedy type diets, as they tend to include increased omega n3 fatty acids, which seem to help with inflammation. Supplementing B-vitamins might be a good idea over the long term for a cat who is vomiting frequently, as well. Low fat and/or moderate fiber diets also help in some cases. At this point, a decision really does have to be made. Is it worthwhile to try medications? In Black`s case, I`m not so sure. The best goal using corticosteroids is to suppress IBD for a period of one to two months and see if will stay suppressed for a while. If so, occasional use of corticosteroids seems reasonable. If not, then it is harder to justify the use of corticosteorids. In Black`s case it seems like you already have an answer to this question, in that the corticosteroids haven`t helped much. An alternative is to use metronidazole (Flagyl Rx) to suppress the clinical signs on an intermittent basis, or perhaps tylosin (Tylan Rx). Cats generally dislike both of these medications so there is a "hassle factor" to their use. At least metronidazole is a tablet so that the poor taste isn`t as much of a factor. If metronidazole can suppress the vomiting and the effect lasts for a while, it is worth considering. At this point, all the easy steps are used up. Diagnosis then moves towards intestinal biopsies collected surgically or endoscopically. Ultrasound examination can help in deciding if IBD is a problem and in eliminating other problems like pancreatitis. For many of our clients these tests are not an option due to cost, convenience or some other factor. I think it is worth going through the easy steps and then I think it is harder to figure out what to do when it is obvious that a major diagnostic workup and continual treatment are likely to be necessary for a patient who isn`t showing much signs of having a significant problem. I think it is reasonable to wait and see what happens at this point as long as you aren`t going to consider euthanasia, or giving up Black, if the vomiting doesn`t stop, which doesn`t sound like it is the case. The incidence of inflammatory urinary tract disease diminishes as cats age, in most cases. So even if Grey`s initial problem was due to this, there is a good chance that the diet change won`t matter at this point. Usually we like to be sure that urinary tract disorders are going to be chronic prior to using the acidifying diets and so I`d be comfortable without this diet in a patient of mine that only had one incidence of urinary tract disease, anyway. However, your vet may have thought the incident was severe or saw something in the lab work or about the case that prompted a switch in diets. Either way, I wouldn`t be adverse to trying the dietary change in a patient of mine with this history. I hope that this helps some. Mike Richards, DVM 9/18/2001

IBD diagnosis

Question: Dear Dr Mike We would be very grateful for your opinion on our cat Sooty. He may have irritable bowel syndrome. The main question is this: we need to decide whether to pursue invasive diagnosis methods or rely on our best guess of his problem, which it is thought may be irritable bowel syndrome. Since the main point of diagnosis is subsequent treatment, we would like to be able to form an opinion as to how likely it is that Sooty has IBS - and then weigh this against the potential value and drawbacks of the diagnosis methods. To do this it would useful to know what causes other then IBS fit his symptoms - and whether the treatment for them is different to the treatment for IBS. We would be grateful for your opinion on how best to proceed. We`ve done a mini-summary, which hopefully is enough detail - but also enclosed a more detailed summary afterwards. MINI-SUMMARY____________________________________ Sooty is probably about 12 or so - we`re not sure. We`ve had him for the past three years. He is male. He is a tough character, but very friendly. You`d like him. He has had three phases of health problems starting in October of last year: 1/. October to December 2000: Bringing up fur balls - often on a daily basis. 2/. January to February 2001: Vomiting continues, again, often on a daily basis, but now food is brought up rather than fur balls. /. Mid-March onwards: diarrhoea problems as above. Vomiting is now infrequent, and now seems to occur immediately after he has been straining hard. Perhaps only twice in the past two weeks - markedly less than before. In addition to the possibility of IBS, he also has some type of mouth problem which makes him flick his tongue out. The vets can`t see any reason for this. It has persisted since the beginning of March. Despite the tough time he has had over the past six months, he has remained very resilient throughout and on 6th April our vet described him as still being in `good condition`. The present symptom which is causing most concern is his passing of motion. He is making many trips to the litter tray, and passing just tiny drops of watery diarrhoea. I understand that this symptom is characteristic of a lower bowel problem. To start with the diarrhoea had red blood in it, but this isn`t apparent now. Its colour is very dark. It can have fluid with it, which I understand occurs with IBS. The quantity seems far less than one would expect for the amount he is eating - although he has been given a protein-rich tasty diet to tempt his appetite. Sooty is clearly caused significant discomfort generally by this, and finds it difficult to get comfortable. He will also sometimes pass tiny drops of diarrhoea where he stands. This symptom has persisted for the past six weeks, but with some noticeably improvement in the recent days. Since 7th March, IBS has been pursued as the working diagnosis - with an antiinflammatory steroid and antibiotic being prescribed. These drugs are having an affect when administered by injection - although we previously had little success with them as tablets, which we were unable to administer reliably. Following the second lot of injections on 6th April, his motion became semi-normal, and quantity seemed more commensurate with what he`d been eating. His visits to his tray fell from a dozen times a day to about four, and perhaps one day when he didn`t go at all. His motion is very dark, and it sometimes has a very dark greenish tinge to it. He seemed close to back to normal. Sadly, when the effect of the injections wears off, after four days, he declines again, and this morning the multiple trips to the tray started again, and he didn`t want to eat, and appeared in discomfort. He then had his third lot of injections mid-morning, which had an almost instant effect - both on his appetite and the number of visits to his tray. The vet no longer wants to give the drugs by injection, and has said that we need only give the steroid tablet (Medrone) in future - starting Saturday. In the hope of making a conclusive diagnosis, two options are being offered to us, as I`ve mentioned above: 1/. Endoscopy, which we`ve been told will cost around 1,000 pounds (around 1,500 dollars)- it may not yield a definite answer- and will require Sooty to be off medication for 14 days, so that biopsy samples will not be compromised by drugs. 2/. Exploratory surgery. Less expensive, but more invasive for Sooty. Presumably he would also need to be off medication for the same period for the same reason. A fecal sample - a small amount of very watery diarrhoea - collected 5th April, six days after the first lot of injections, produced the following result: i). microscopical examination: no ova, larvae or protozoa found. ii). undigested meat fibres: no undigested meat fibres seen. iii). fat globules: no fat globules seen. iv). salmonella: negative (via selective enrichment) v). campylobacter culture: negative for campylobacter spp. Finally, his mouth problem. It appears to cause him difficulty when eating sometimes. But at anytime he may flick his tongue out, as though trying to dislodge something, and chew a little. He also often does it after straining in his tray. He also sometimes chews a piece of grit from his tray. The vets have looked a couple of times but can`t see anything. Sooty had a dental treatment on 3rd January 2001. So.. May endoscopy or an exploratory operation reveal an alternative diagnosis which would require a different treatment to that presently being given? - And, importantly, what are the other possible diagnosis? Any ideas on his mouth problem? Do you have any suggestions for diet? He has been given a lot of minced beef to encourage his appetite in the past weeks - raw I`m afraid, upon which he is very keen. Hopefully, the above is detailed enough, but if it`s useful a chronology of events follows__________________________________ CHRONOLOGY OF EVENTS IN MORE DETAIL ______________________ Problems started back in October of last year, and have had three phases: 1/. October to December 2000: Bringing up fur balls - often on a daily basis. 2/. January to February 2001: Vomiting continues, but now food rather than fur balls. 3/. Mid March onwards: diarrhoea problems as above - although the amount of vomiting has greatly decreased. In October of last year, Sooty began to bring up fur balls. The size of the fur balls was (to us at least) surprisingly large. It persisted up to about Christmas. He didn`t often bring up much food with the fur balls, but he did loose some weight - although he was a bit a overweight to start with. The fur balls became a daily occurrence for quite a lot of this period. Sooty was moulting during this period. None the less he bounced back very quickly after vomiting each time, often wanting to be fed immediately afterwards. We don`t remember his defecation being a serious problem at the time, although it has since become one. However, we recollect that there were periods at this time when we were concerned that Sooty may have been constipated. He was given `Katalax` (a liquid parafin-based laxative in a tube) on a regular basis at a number of points during this period, although this was primarily with the intention of aiding the progression of the fur through his system. During this period Sooty also had a problem with his teeth. We had been waiting since 8th November 2000, for him to have a dental treatment - we were hoping for a period when he stopped vomiting. His dental was eventually done on 3rd January in which a canine was removed which had an abscess. This left him with no upper canines. 20th December 2000: Sooty was tried on a `hairball formula` biscuit diet. But wouldn`t eat it very readily. However, there was a five-day break in the vomiting. 29th December 2000: Sooty had a blood test - a full laboratory profile and a cite t4 test, which was `all clear`. Liver: His blood suggested a minor liver mass reduction, but his abdominal X-ray (on 3rd January 2001) showed that he had a larger-than-normal liver, which the vet suggested is possibly normal for him, because he is a big cat. Kidneys: we were told that there is scale rating for kidneys on which 12 is normal and 20 high. Sooty had a 13 rating. Thyroid: okay. Also on 29th December he was given a synulox injection, and put on a course of synulox tablets, in case it was gastric inflammation which was causing him to keep bringing up fur balls. As the new year progressed vomiting was still a regular occurrence, but mainly food rather than fur balls. At worst he sometimes vomited three times a day. Although always recovered very quickly. He had stopped moulting. 8th January 2001: he was given metoclopramide injection and dexadreson injection - being being an antiinflammatory, the other to stop him vomiting. These gave him an adverse reaction: a very uncomfortable evening in which he cried out in pain three times, and was unable to settle, and was uncharacteristically aggressive to our other cat. 14th February 2001. Sooty had an antiinflammatory steroid injection (depomedrone) which was supposed to last six weeks. Sooty then had a period of thirteen days in which he didn`t vomit. The vet said Sooty had a severe gastric upset. 28th February 2001: antepsin was tried (without success) to calm Sooty`s stomach. 7th March 2001: we reported to the vet that Sooty had had very bad diarrhoea for the past two weeks. His motion was very loose, and contained red blood (we`d previously thought that the `Katalax` was responsible for the colour, because we`d been giving it to him regularly, but Sooty wasn`t having it any longer). The quantity that he was passing was also very small - to us it seemed incommensurate with the amount he was eating. Irritable bowel syndrome and `infiltrating lymphoma` were mentioned as possible causes. Sooty was put on a course of tablets to treat irritable bowel syndrome: prednisolone 1mg twice daily and metronidazole 50mg also twice daily. He was also tried on a specialised diet (Hills i/d), but he didn`t take to this. 9th March 2001: we took Sooty to the vet because of a mouth problem which was making it difficult for him to eat. He kept flicking his tongue out a long way as though trying to clear something out of his mouth. The vet couldn`t get a good look inside his mouth, but put him on a course of synulox tablets in case his throat was inflamed, but we didn`t give him these because we were having enough trouble getting the other tablets in him. 13th March 2001: The diarrhoea is persisting - he passes just a few small drops at a time, making frequent visits to his tray, and straining hard to go. The amount he passes is very small overall, and doesn`t seem to correspond with the amount he is eating. The vet says that he is not blocked, and has normal temperature. 17th March 2001: same conditions reported to the vet - in four days he`s hardly passed anything, but is straining very hard and making many visits to his tray. Examination and an X-ray shows that he doesn`t have blockage. Small amount may be due to the high protein diet of `treats` which he is being fed to encourage his appetite. 24th March 2001: mouth problems persist. Vet can`t see any problem, and gives pain-killing injection, which helps and Sooty was able to eat. 30th March 2001: mouth problems and motion problems persist. Sooty is downcast and not eaten for two days and we haven`t been able to get tablets in him. Vet can`t see any problem with mouth, and gives antibiotic injection, and anti-inflammatory injection: lentrax and dexafort - to last for about four days. Sooty responds well and is much better over the next three or four days. 6th April 2001: much as 30th March - we can`t get Sooty to eat, and can`t get tablets in him. Same two injections given again, and Sooty responds very well as before. His diarrhoea improves significantly, and far fewer trips to the litter tray. Appetite is good. 11th April 2001: the effect of the injections has worn off and Sooty doesn`t want to eat, and diarrhea and straining return. More injections have a fast effect. The vet doesn`t want to give more injections in future, but wants to return to try to give just steroid tablet (Medrone). Answer: Terry- I think that most vets, including me, are more comfortable treating inflammatory bowel disease when we know what the underlying cause is. In our experience, it is possible to get a pretty sure diagnosis using endoscopic biopsy in about 2/3 of the cases we refer for this procedure. Many of our clients opt not to try for a biopsy, primarily due to the cost involved. So we do a lot of "trial and error" diagnosis, based on response to therapy. Most of the time it is possible to find a treatment that works but there is always a little doubt that we are using medications we don`t have to or even that we shouldn`t, which is the reason that we like to have the diagnosis in hand. These are the things that might look like irritable bowel syndrome but not be that I can think of offhand: liver disease, chronic pancreatitis, intestinal lymphoma (a cancer but this does usually respond to cortisone injections, at least for a while), hyperthyroidism, intestinal parasites (sometimes it takes several fecal samples to find these) and food allergies. Once in a while a problem with megacolon in cats will look like painful diarrhea because the big lumps of stool that can`t be passed are painful but liquid stool finds its way around these and so the cat seems to have diarrhea. We see the lip licking most commonly with liver disease and once in a while with hyperthyroidism. Some of the liver diseases don`t show up well in normal lab work but can be found with bile acid testing. Hyperthyroidism is relatively easy to test for but should have some other signs, like weight loss and restlessness. Odd vocalizations are a sign that is frequently seen with hyperthyroidism. Pancreatitis is hard to diagnose in a cat. Abdominal ultrasound can give some hints and one of the advantages of surgical biopsy over endoscopic biopsy is that it is also possible to obtain biopsy samples from the pancreas and the liver, as well as the intestines. Your vets may have already ruled out liver disease and may feel comfortable that hyperthyroidism and pancreatitis are unlikely. If this is the case then the next step is the biopsy procedure, or to continue with treatment, since you have found a treatment that seems to work well. Personally, I am comfortable giving methylprednisolone (DepoMedrol Rx) injections long term if I can keep the intervals to three to four weeks between injections (and will sometimes settle for two weeks), but since that doesn`t seem possible based on the four to five day success rate you are seeing your vet is right to pursue oral medications since over time, the dose can be controlled better Good luck with this. If you need further information or more specific information, please don`t hesitate to ask for it. Mike Richards, DVM 4/13/2001

Video: My Cat's Strange Symptoms (Inflamatory Bowel Disease)

Inflammatory Bowel Disease in Cats

Inflammatory bowel disease (IBD) is probably the most common cause of chronic vomiting or diarrhea in cats under the age of 8 to 10 years. It is unclear at this time whether this is one condition or several conditions that appear very much alike. In older cats, hyperthyroidism is also a common cause of vomiting or regurgitation. This disorder can occur at young ages but is more common in middle aged and older cats. Many cats do not exhibit any clinical signs other than chronic vomiting. The vomiting may occur intermittently and often the cat does not appear to be affected at all other than vomiting frequently. The cyclic nature of this disease makes it difficult to evaluate the success of treatment in some cases and causes many cat owners to put off treatment longer than they should. While vomiting is the most common clinical sign, diarrhea, weight loss, depression and behavioral changes can also occur. This problem must be distinguished from other fairly common causes of vomiting, including hyperthyroidism, lymphosarcoma, feline heartworm disease, intestinal parasites, viral illnesses and pancreatic disease. Testing should be done to rule out these conditions, if possible. IBD can only be diagnosed accurately from intestinal biopsy samples. The most common way to biopsy the intestine is through endoscopy. Flexible endoscopes that can be passed into the intestinal tract are used to visualize and biopsy the intestine. It is important to rule out the other possible problems by labwork, if possible, prior to considering intestinal biopsy. In some cases, it is hard to arrange for biopsy to be done. In this case, therapeutic trials of anti-inflammatory medications may aid in the diagnosis. Once it is established that inflammatory bowel disease is present, there are several treatment options. Mild cases of IBD tend to respond well to corticosteroid administration. If caught early, this treatment can eliminate the problem as a future concern in some cats. In older cats or where the disease is well established, medication may be necessary lifelong. Other medications used for this include metronidazole and azathioprine. These medications can be used in combination in severe cases of IBD. Some cats may have IBD due to food allergies. It is always a good idea to consider this possibility and to use a diet free from any ingredients the cat has previously eaten for a period of several months to be sure that food allergies are not present. Your vet can help you design a good diet for this purpose or provide you with commercial foods made to be hypoallergenic. Curing cats of this condition is not always possible but most will respond to treatment and be able to live fairly normal lives. Mike Richards, DVM

IBD

Dear Dr. Richards, Thank you very much for your reply, I love your detailed answers! I have another question now. My elder cat was diagnosed with IBD after exploratory operation in December,and he is now on Prednison (2 pills every other day). One week after surgery our vet also found Giardia in his stool, and the cat was on Novo-Nidazol (125g every day for 6 days - the weight of the cat is 14 lbs.). It seems to help him and he doesn`t have diarrhea anymore, although his stool is not always perfectly formed. My question is: for how long in your opinion should he stay on Prednisone? Our vet gave us about 400 pills - enough for the whole year. Is it really necessary? Can we lessen his dosage since he looks fine to me? And if yes, then when and how - 2 pills every third day? 1 pill every other day? I know we cannot just stop giving him the pills, but what is the scheme of gradual finishing this medication? Thanks again for your help, I really appreciate it! Have a great day, Corinne Answer: Corinne- We usually try to keep cats who respond well to prednisone for IBD on the medication for about six months. At that time, we try to wean them off of the medication. If we have been using it daily, we go to every other day for 5 to 10 doses, then cut the dose in half for 5 to 10 doses, then go to every third day at this reduced dosage for 5 to 10 doses and then stop the medication, if the reduction in dosage has been effective. We chose six months as a compromise between recommendations in the literature, because we have seen recommendations to use prednisone for as short a time as 3 months prior to trying to wean patients off the medication and as long as a year prior to making this attempt. Your vet may have experiences that indicate the longer period is better or may have strong feelings about the reliability of the information from one of the people who recommends longer durations of treatment prior to attempting to wean a patient off of the prednisone. We often try limited antigen diets (one protein source) prior to using corticosteroids, so we take one dietary approach prior to their use. Lately, we have been going for short periods of time, usually six to eight weeks, and starting different dietary changes such as adding essential fatty acids to the diet or using diets that already have some fortification of these ingredients, such as the hair ball formula diets. We seem to be having some luck with this approach, but definitely not total success. We do have patients who we have to keep on prednisone or on intermittent injections of methylprednisolone acetate (DepoMedrol Rx) to control symptoms of IBD. We have had patients on these medications for several years in some instances without being able to successfully wean them off the medications. Many of these cats do develop secondary problems as a result of long term corticosteroid use, so we really prefer not to take this approach. When the time comes to think about lowering the dosage of corticosteroids or weaning your cat off of them entirely, it is very important to get directions for doing this from your vet so that he knows what is going on if any problems occur during the dosage reduction period. Mike Richards, DVM 1/26/2001

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