Inflammatory Bowel Disease & appropriate diagnosis procedure

[Callies Person]

I took my cat (age 16, female, neutered) for her annual senior cat check-up early because she's been puking 1-2 times a week for a few months, most typically furballs. The vet gave her a physical and noted:
1. she's lost a bit of weight but not enough to raise concern,
2. her bloodwork was fine apart from a slightly elevated white blood cell count.

He diagnosed Inflammatory Bowel Disorder, and prescribed prednisone and a change in diet (to Senior rather than Weight Management). He mentioned that IBD was typically diagnosed by the endoscopy but that it was intrusive and he didn't see the need for it, as we'd see what happened with the prednisone.

I went home and did online research which suggested that other issues should be ruled out before diagnosing IBD, including kidney issues, parasites, bacterial infection, cancer, and food allergies. So when I called my vet after a week (as requested) to give him an update (she hadn't puked since the first night, her appetite and water intake had increased, her energy level seems unaffected, and her litterbox use has increased), I asked if the other issues (apart from food allergies) had been ruled out by the bloodwork, or if the fact that the prednisone made a difference confirmed that it was indeed IBD.

My vet didn't answer the question, and instead started telling me off for googling, saying that if it was true and on the internet he knew it, and too much of his practice was spent undoing damage done by clients googling. I asked if the prednisone could be masking an underlying issue, making it look like she's better but not addressing the actual cause of the issue, and the anti-googling lecture resumed. Later that day, when I went to the vet to pick up some more of the senior cat wet food, he resumed the lecture AGAIN, and that time I hadn't even tried asking a question.

My cat was initially to take 2.5 mg of prednisone twice daily, and we're now on 2.5 mg daily. If there's no change after a week, we'll be going down to alternate days.

So I'm thinking it's time to get a new vet, or else to sit down with this one and explain that I google information and am (relatively) capable of determining what sites are and are not reputable. However, I have a few questions which remain unanswered, so I'm hoping someone can help:

1. Is it possible through blood work to rule out kidney issues, parasites, bacteria, and cancer? The elevated white blood cells to me suggests an issue; what else would be evident if this was bacterial or cancer? (She had an elevated white blood cell count last year too, at which time we explored the possibility of cancer. I am unclear why that isn't a consideration this year.)

2. I work in mental health and know that sometimes medication effectiveness is used as a confirmatory diagnostic tool (not my personal favorite technique, but I know it happens). Does prednisone's apparent effectiveness for treating my cat's vomiting indicate that she does indeed have IBD, or could the prednisone be masking symptoms and there still exist an underlying condition?

3. Finally, we never tested for food allergies so I am wondering if she might have one that has gone undetected. Again, would the prednisone be masking that? I started it before I switched food. Should I take her off the prednisone, see how she does on just the senior cat diet, and resume the prednisone if puking resumes? WOULD prednisone mask a food allergy in some way?

Thank-you for any help you can give me!

[Crewella]

If I can be honest, I suspect that what is annoying your vet is that you seem to be googling enough to ask your vet questions and challenge his decisions, but not enough to answer the questions yourself, which does seem a bit unfair?

If it helps, my 19 year old Minnie is on Prednisolone every other day because of chronic diarrhea and vomiting. It works as an anti-inflammatory so helps soothe the inflammation in her gut, as well as boosting her appetite. She has gradually become intolerant of some foods and I have cut out fish and cereals (I do feed her senior wet food), but nothing else seemed to work and I'm happy, at this stage of her life, to just make her more comfortable. Her bloods show her kidneys aren't too bad and there's no infection.

It is really hard when you don't trust your vet, he may be a good vet but if you're not comfortable then do try another - sometimes it's just a clash of personalities that stops a good working relationship. I've had several vets I didn't get on with, and one now that I trust implicitly - it's a huge help. Best of luck, and fusses to your old girl. xx

[Callies Person]

Thanks for replying!

I'd done as much research as I could; without knowing what exactly was tested in the bloodwork, for example, I don't know how he ruled out the other issues that apparently are supposed to be ruled out before diagnosing IBD. And the questions I posted are ones that I haven't been able to answer myself despite continued attempts. Cancer especially should have been ruled out, apparently, and if she prednisone continues to help her then she's probably (but not definitely) cancer-free and if she relapses then it's likely cancer and not IBD. Time will tell.

[Crewella]

I'm a chronic googler myself, and I wish I could have been of more help but, whilst I have some understanding, I don't feel knowledgeable enough. It's perfectly reasonable for a worried owner to ask for details on blood test results - hopefully your vet will be more helpful when you try to speak to him again.

At least your old girl seems to be feeling better, I hope she continues to improve. xx

[booktigger]

Kidney disease would have been ruled out with bloods, cancer can't be, parasites normally need a fecal sample. I had the opposite, Molly was getting intolerant of certain foods, the vet felt something so we scanned her and he decided it was cancer, so she was put on steroids, and stayed on a low dose for a few years, but kept being bloated. Then she had a mouth abscess and the original vet saw her again and passed comment on the amount of gas she had. I pointed out his diagnosis and he said it was wrong, she just had IBD. I changed her diet and the bloating stopped, so I reduced her steroids. The only way to distinguish is a biopsy but if they don't get the right place it won't show. As the treatment is the same, I would just treat, but do a fecal sample too

[greenkitty]

I know the symptoms of Lymphoma and IBD are very similar. I've been on this journey with one of my cats and as Desley says you would need to have a biopsy done (maybe an ultrasound or something similar too) and even then IBD is patchy so if they hit a normal batch of bowel the results will be inconclusive. We did all this through a referral vet, spent thousands (luckily I have insurance) and they eventually said they didn't think it was Lymphoma and we went down the IBD route, a change of diet is keeping everything under control. He also has a small dose of steroids everyday but this is primarily because he has chronic Rhinitis as well but no doubt it helps his IBD.

Vets are like GP's they have to have a broad general knowledge and may not necessarily have a deep understanding of this particular issue, so perhaps you should ask your vet for a referral to a specialist (I think it would be an internal medicine specialist).