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Dr. Adam
Dr. Adam, Veterinarian
Category: Cat Veterinary
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Experience:  Over ten years practice experience in feline medicine.
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I have a question about Prednisolone for cats. My vet suspects

Customer Question

I have a question about Prednisolone for cats. My vet suspects my cat may have IBD or Cancer based on symptoms and blood work results. I can't afford biopsy treatment so we put the cat on Prednisolone 5mg once daily.

First of all, when the symptoms started to appear it was a little over a month ago. She was having chronic diarrhea, loss in appetite and lethargy. She has not lost any weight, she actually gained some surprisingly she was up one pound since her previous months weight. She had her blood work done last Thursday, and the results were all normal except her lymphocytes were 2x higher than normal, and the pathologist determined it was either severe IBD or Cancer. She has been on Tylosin for 2 weeks and it just started to kick in on Friday. I was given her "diagnosis" on Friday and started her on the Prednisolone Saturday evening.

She was already showing signs of improvement on Friday before the prednisolone was given. Her appetite was getting better and she was passing normal stool. Since giving her the prednisolone, she has seemed to have been even better and is still passing normal stool and her appetite is back to normal. My question is, does the prednisolone usually work so quickly, or could it have been the tylosin that was already improving her condition? If the cat seems to be getting better, how long does she need to be on the steroid, and how soon do we start to ween her of this type of drug to see if there is a relapse? Also I want to know if she can ever go outside into my backyard with me under supervision, or does she have to be kept indoors while taking this medication?
Submitted: 2 years ago.
Category: Cat Veterinary
Expert:  Dr. Adam replied 2 years ago.
All good questions concerning Kitty.

First, there is danger in assuming that it is IBD or cancer, although that is probably what is there.

I would assume since you think your cat has inflammatory bowel disease that your cat has already had full blood panel including thyroid, fecal test for parasites, hypoallergenic food trial, folate/cobalamine levels, specific feline pancreatic lipase test, abdominal ultrasound, and a biopsy of the intestine by either exploratory surgery or endoscope? IBD is a very expensive diagnosis. BUT, if you haven't done all of those things it is just guess work. And, honestly, even when you get to the end of that diagnostic work up the results are often inconclusive as well. This is why IBD is so darn hard to treat.

I understand though if you don't have the money for the biopsy and all the tests. Usually it is kind of disappointing even if you do because the end diagnosis is often "either lymphoma (cancer) or IBD" even after all the tests. So, sometimes treating is guess work, and sometimes, that's ok. BUT, because we don't have a definitive diagnosis, you won't be able to say if the medications should be working, have worked, or whatever.

Sometimes with IBD you get flareups that go away on their own inspite of the tylosin or prednisone/prednisolone. That makes it real frustrating and difficult to know what you have used has or hasn't worked! *Sigh*

With that in mind, it is hard to treat. There is pain and discomfort for the pet mostly caused by infilltrative disease in the bowel. This inflammation is similar to certain cancers like intestinal lymphoma so much to the point that it is hard for even trained patholgists to know the difference when doing histopathology on the tissues. But, the inflammation is usually cellular in nature, and often infiltrative meaning the white blood cells are invading into the intesinal wall, lymph nodes, etc and causing the painful inflammation.

Often one of the best medications is prednisone for controlling the inflammation. This has the extra benefit in some cats of increasing the appetite and relieving the pain and discomfort. If you haven't tried canned food (Friskies works best I think - although I don't love that food - it's just cats do) try it. BUT to answer one of your questions, yes, prednisone/-olone do often work VERY VERY fast. Even if it is cancer. The most common cancer is lymphoma in the intestine and that is usually small cell lymphoma. Prednisone was one of the first drugs developed for treating lymphoma in people back in the late 50's. It's still considered a chemotherapeutic drug today. So, you can see how it would treat IBD and cancer.

Problem is... it doesn't usually last forever. You do start to see signs returning when discontinued. Often this will be a lifelong drug. You could wean off over time when the signs are controlled. And I will typically wean down to the lowest effective dose. Often you will never wean down completely.

I will often continue the tylosin as well, life long. Which one was working and which one wasn't? Was the pred the one that is working and tylosin not? Truthfully, who knows. We just don't understand IBD and the treatment well enough to tell you that. If it is bothersome or worries you to give so many medications, you should know that this is the path with IBD. There is no other way.



Also discuss using budesonide with your Vet. This drug has been shown to be a little more effective at controlling flare ups of IBD in cats. In severe cases where that doesn't work chlorambucil has been used (especially when small cell lymphoma is a possibility).

She should still be able to go outside with you under supervision unless she is on 10 mg or higher of prednisone twice daily. Or roughly 1mg per pound or higher... I don't know how much she weighs.

Dr. Adam, Veterinarian
Category: Cat Veterinary
Satisfied Customers: 2075
Experience: Over ten years practice experience in feline medicine.
Dr. Adam and 6 other Cat Veterinary Specialists are ready to help you
Customer: replied 2 years ago.
She weighs 9lbs, and I did have the vet run the full blood panel to check for all organ functions and such. She also did the fecal test, and did a broad spectrum wormer just in case. She was all normal except as I stated above. I could maybe afford an ultrasound in the future at least to see if there is anything going on in there, but I am trying to learn to accept that whatever it is we are going to try to help her to the best of our ablity. I will mention the other drugs to the vet, especially if this is going to be a life long thing for Kitty.

So at her current weight at 9lbs, she can be outside on 5mg of prednisolone? I hope she can, as she really wants to get out with me!
Expert:  Dr. Adam replied 2 years ago.
I will let you off the hook and tell you that yes, what you are doing is probably the best you can do.

Listen, IBD is frustrating, and it is a diagnosis by exclusion. This means you rule out EVERTHING else first, then you get the biopsy. Then the biopsy often comes back inconclusive, or IBD, or cancer which is what you suspected 2000 dollars ago. *UGH*

It's one of the hardest diseases in cats, and rather common actually unfortunately.

Budesonide works for many cats, but not all. But, long term it might be better. The other one I mentioned is an actual chemotherapy drug. That's why I led into it with the description of prednisone as a chemotherapy drug. It is! But chemo sounds scary to most people. All chemotherapy means is treatment or therapy with chemicals (chemo). That's it. So, don't be scared to go to that chlorambucil if necessary.

What I mean by the weight issue is that at 1mg per pound you are getting close to the immunosuppresive dose of prednisolone. Higher than that and you are starting to cause severe immune deficiency which would open her up for infection. Being at the dose she is at right now is more of an anti-inflamatory dose. And so, her immune system might be slightly decreased and she might have a slight increase in risk of infection, but not much really. I think she would still be ok at that dose. That's about 1/2 mg per pound, or about 1mg/kg.

I am glad you did the full blood panel. It really sounds like you are trying very hard. I can tell you care about your cat. That is great. It is frustrating, but don't be frustrated if you can help it. Accept that it might be the best you can do and that's ok.

IBD is usually not a disease we treat, or cure. It is usually a disease we manage. As best we can.
Customer: replied 2 years ago.
You have been a wealth of needed information! I really appreciate your really in depth explanation! I needed this, after all this is all so new to me. I will be taking this information to the vet next time we go in for another blood panel. Thank-you so much! I know Kitty will be very happy to be able to enjoy some of the summer days!
Expert:  Dr. Adam replied 2 years ago.
You are welcome. If new questions come up, let me know.

-DrRalston

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