Hyperthyroidism and IBD.
Breed: Mackerel Tabby
Age: More than 15 ye
We adopted Mo 10 years ago from the Humane Society. She was about 6 years old at that time. She's been a wonderful, social, cuddly, sweet cat.
About 3-4 years ago, she started pooping outside of her box on the floor once in a while. We blamed it on a too-dirty litter box, and once, the vet squeezed her anal glands and the problem went away.
In December/January, Mo started pooping more and more on the floor and even on our bed (where she also sleeps). At this point we increased scooping her box from once a day, to multiple times a day, without any result.
We took her to the vet in January. She was diagnosed with hyperthyroidism and prescribed the prescription food.
However for the past four years Mo has been unable to tolerate any change to her diet of Iams Indoor Weight & Hairball Care. We tried repeatedly to slowly ease into a more healthy food, but with no success. Always puking and pooping problems.
It was the same with the prescription diet, so we had to go back to the Iams.
The pooping problems became worse and she continually pooped in the bed, on the floor, and finally even on our sofa! We had to block her from the bedrooms and cover the living room furniture with cardboard. Mo would have drips of poop down the back of her legs and also on the floor around the house. Not ideal!
We took her to a new vet who prescribed Methimazole, 2.5mg twice a day. And also Flagyl metronidazole 50mg twice a day to help the diarrhea. (This vet also finally squeezed her anal glands, as we requested. They were very impacted.) We put the medication in pill pockets and fed at 6 am and 6 pm.
The pooping problem was immediately better.
As soon as the diarrhea medication ran out after 10 days, the pooping problems were back. (She also had some unusual throw-up during this time and perhaps even before.)
We contacted the vet who prescribed another 10 days of the diarrhea medication. This medication just ran out a couple days ago, and we are back to the pooping problems.
We can't afford to keep going back to the vet for the $160 visits for blood work and medication adjustment, particularly when it seems that they will not offer good results. (If we had hope of a solution, we might be able to make it work for one or two more visits.) The radiation treatment is not possible for us.
So we now feel like we're out of options and must now euthanize our beloved cat. But before we do that, we'd like to get a second option from you on two points:
- Do you agree with the dosage of 2.5 mg of Methimazole twice a day? Or is it perhaps too much?
(Mo is a small cat: about 8-9 pounds at a healthy weight, though she is down to 5 pounds 4 ounces right now.)
- If there is a chance that this medication might work to control her hyperthyroidism, it is very possible that her pooping problems would still remain unresolved?
Thanks so much for your help.
Dr. Marie replied:
Sorry to hear that you are experiencing these frustrating problems! No one likes dealing with poop issues in cats!
You may want to ask your vet about the possibility of Mo having inflammatory bowel disease (IBD). It is very common in cats and can cause everything from vomiting to diarrhea and even constipation. Unfortunately it can be hard to diagnose, as the only way to accurately diagnose it is to get intestinal biopsies which can be quite expensive.
Often, if I have a cat patient who has symptoms like yours does I will do a trial of a very small dose of prednisone. What the prednisone does is help with inflammation in the bowels. (An alternative is to use a drug called budesonide - they both work well.) If this is working, then I will get the cat down to the smallest dose that is effective. Often this means giving 1/4 or 1/2 a pill every other day.
Another possibility for these symptoms is intestinal lymphoma. This is a cancer that affects the intestines. It is impossible to know the difference between lymphoma and IBD without doing biopsies. If this is lymphoma you may see a temporary improvement with the steroid (prednisone) but eventually it would stop working. In my experience, IBD is way more common than lymphoma.
The metronidazole that Mo was on serves many purposes, but one thing it does is help with intestinal inflammation. This is most likely why the problem came back when the medicine was stopped. I'm not a fan of staying on metronidazole long term though...I usually prefer the steroid as mentioned above.
Regarding your question about the methimazole dose, this really depends on her T4 level. When I put a cat on methimazole I always want to recheck her T4 blood level a few weeks later. If the T4 is too high or too low then I modify the dose. If it is good, then I still want to periodically check it every 3-12 months (depending on how the cat is doing.) But yes, I do have a number of cats that do very well on 2.5 mg twice daily.
If her T4 level has not been checked, it is certainly possible that she is not getting enough medicine and is still hyperthyroid. Hyperthyroid cats can indeed have intestinal issues. But, my guess is that the intestinal problems are really IBD and not related to the thyroid.
I hope this helps and I hope she does better soon!
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