Another case of constant diarrhea... Suggestions?

[BellaBlue82]

Relieved to hear the poops are more solid. It took me awhile too to turn that corner. My vet said whatever (the less ingredients the better) food you try and it works, stick with it. It also takes time for whatever a cat eats to actually work and I remember WHAT a relief it was, to hit solid poop stride. Totally thrilled daftcat is guiding you here, as I think there is so much to be said for healing the gut through s. Boulardii. Between the two of you, you could probably write a medical article for the cat version of JAMA!

Lol I agree!
It's just unfathomable at times. Sometimes I think I'm going crazy, pondering why isn't this a quick turnaround? "The vet says he should be better by now." But in reality, their little bodies are just as complicated as ours. Nothing is a "quick fix," and patience becomes your best friend. All the nights/days of worrying, figuring out what works, what doesn't, and learning to be positive (because we all know they feed off of our emotions!)

I always say I'm a special needs cat mama. All the cute little faces that have health issues attract themselves to me LOL. I guess that's the universe at work though, because I always think what if someone else was this cats mom?

 

[BellaBlue82]

Ugh, here we go again. I tried to introduce his FMT supplement again, and the result was the same - projectile vomited and poop around the house. His appetite tanked, and he's just moping around the house/hiding under the bed. I'm just at a loss.

The vet comes Thursday for a follow up, I'm really really hoping she has some additional suggestions. For some reason, he's just not tolerating the supplements very well. I'm inclined to submit an Animal Biome stool test, but I'm waiting to see if it's worth it. IE, if the vet thinks Nico has lost too much weight and won't recover from this. I hate to say that and am tearing as it is, but I have to be honest and less selfish. As much as I want Nico to be with us forever, his quality of life has declined so fast. This truly lovable bug has not played, barely purred, barely loved, in the past two months. With all his underlying conditions, my fear is that he will succumb to a far worse fate the longer this continues.

 

[daftcat75]

What's he eating? Have you tried homemade? Perhaps homemade cooked with EZ Complete?
Food Fur Life - EZ Homemade raw food for pets!

Or Alnutrin. EZ Complete is easier. But I may go with Alnutrin because it doesn't have green lipped mussels which is a problematic ingredient for some cats.

You may also consider novel protein whether it's Rawz or Mouser or prescription food. Prescription wouldn't be my first choice but if it is more convenient for you and it works for him... I mean Betty has been stuck on Hills I/D for months now because there's nothing she likes better.

I would keep giving Jarrow SB with MOS twice a day. Whatever else you do, that would be my baseline for him because of the beneficial effects of both SB and MOS.

Have you discussed with your vet the possibility that this might be small cell lymphoma given that steroids failed to properly control it? By the time I got Krista's vet to consider that possibility, she was too small that I didn't want to put her through an endoscopy to confirm it and the doc didn't want to prescribe chemo without that confirmation. I went over her head to the owner and founder of the practice and said, "We're out of options. We can't do nothing. I won't put her through the endo. And doing the same isn't working. Let me try chemo because it's likely less risk than an endoscopy on a weak, elderly, unstable kitty." He hemmed and hawed and gave me a brief talk about IBD and SCL and ultimately agreed with me saying, "as long as you are giving me informed consent that you agree we are trying a treatment without a diagnosis, I'll write the prescription." And let me tell you, that almost did the trick. The difference was dramatic. The weight loss stopped. Her poops formed up. But it didn't solve it completely. You see I was still giving her a trigger food every night. I was wrapping her nightly pred in fish flakes to get her to pill herself. And it wasn't until we switched to transdermal pred and got rid of the last trigger food in her diet that she finally achieved remission. Sadly, she was already too small, lost too much weight, her immune system suppressed for too long by a high dose of steroids that a bladder infection would prove too much for her a couple month's later.

So, in review:

1. There is almost certainly dysbiosis going on and if the FMT pill is too much for him, just keep giving him Jarrow SB with MOS, minimum twice a day.

2. There is likely a dietary component to this. Homemade cooked or raw will be the most labor intensive but also the most control to explore dietary sensitivities. But it's worth it because Krista proved to me that medicine alone can't contain the fires if diet is still providing the fuel.

3. Is he still taking steroids? Do you want to discuss the chemo option? Cats handle chemo like a pro. It's not a miserable experience like humans. Krista was just a touch lazier on chemo days and that was it. Frankly, I think the chemo drug is safer than steroids and sometimes they do have cats on long-term chemo to spare them the more harmful side effects of steroids. So if you're talking like you're running out of options, maybe this is one to explore.

 

[BellaBlue82]

Thank you for the support. There is a lot I'm going to discuss with the vet on Thursday. His anion gap is high from the dehydration which puts him at risk for DKA. I had to stop the steroids because they were making his sugar uncontrolled. But I will be asking about budesonide, as I've heard that is a much safer option.

I've tried home cooked food, of course he does not want to touch it. I even got the sample of EZ complete to put in there! So we'll see what she recommends food wise.

He's lost about 4 pounds in two months, but I have been scared to weigh him these past two weeks to see if he's lost more. I'll weigh him the morning of to see where we're at. I don't need to be a nervous Nelly around him for the next day lol.

I'm definitely going to discuss options with her, but am also just trying to be realistic. He's had a happy life, considering we rescued him off the street from a dumpster no less.

 

[Margot Lane]

Agree w Daftcat about the steroids, at least to level Nico out. When you see the vet, try to make sure he’s hydrated sufficiently as well! Please let us know what happens. And it is true about the chemo…they tolerate it amazingly well.

 

[BellaBlue82]

Thank you, I will keep you posted!

And yes, I have stock I ringers bags at this point lol. I'm to the point I'm going to ask for a script so I can get a few to keep on hand for him.

 

[BellaBlue82]

Ok, I feel much calmer after the vet visit yesterday. Like any good doctor, she came in, sat down, and said ok - now start from the very beginning and tell me everything like I never heard the story before.

Walked through every nook and cranny that has happened since October. She agrees, whatever was set in motion he now has a bad case of colitis/IBD. Since he isn't tolerating the supplements very well at this point, we're just going to focus on the inflamation for now. She said one step at a time. Once we get the inflammation reduced, then we can discuss adding in supplements again.
She wrote a script for hydrolyzed protein food, and we will start budesonide. She did mention that since he is a diabetic, he will take longer to heal. But not to give up hope yet.

 

[daftcat75]

I would still suggest the Jarrow SB with MOS twice a day to scrub out pathogenic bacteria while also soothing and healing the gut lining.

Here’s hoping he likes the food and it treats him well.

Budesonide is a good steroidal anti-inflammatory option without the systemic effects of pred.

Sounds like a good place to start.

 

[BellaBlue82]

There's ups, and there's downs. But I think we are making progress with the budesonide, albeit despite some lingering nausea here and there.

Started his first dose on Saturday. It seems to be helping his appetite as well as the poo frequency. I think we're down to once or twice a day right now.

He's not been too nauseous, but for some reason today was a bit of a kerfuffle. I came home to a little bit of spit up food downstairs, and he proceeded to spit up white foam three times the next three hours. I caved and gave him a pepcid, seems to be the only thing that calms those stomach acid episodes down. Only when direly needed tho!
Things calmed down, he ate. And I didn't notice right away, but he went to the litter box. Of course I'm going to creep on the poo. There was some liquid, but there was also a decently sized formed poo log!!!!
Ok, don't get to excited. Baby steps. Lol all the things I tell myself so I don't go into overdrive.
This is just in time for the vet update tomorrow. I will ask her if I can have a refill on Cerenia and IV fluids, just in case. There's a big storm coming this weekend and I need my emergency cat clinic kit all restocked.

 

[BellaBlue82]

Has anyone else experienced vomiting in their cat with IBD? Nico seems to do fine for most of the day, until mid-afternoon. The budesonide is definitely working, I see improvement in his stools... But the vomiting I can't seem to get under control. He had some Tuesday, then yesterday and today. It's not every day, but enough for me to be concerned.

The vet wants to try a hydrolyzed protein diet, I think I'm going to have to go that route for now. He won't eat home cooked or raw meals, I've tried them both. I also can't start him on his supplements again until the stomach calms down some. I really want to start those up again, so I'm thinking diet change may help.

 

[daftcat75]

Krista's IBD was mostly vomiting and mostly food. She didn't toss hairballs or hunger spits (clear/watery/foamy) very often. Betty didn't vomit food or have hunger spits. She would toss hairballs. Then she would turn out everything in her stomach (which was nothing after the hairball!) for the next several hours after. I'm so thankful that has stopped since she started pred.

Does Nico need an afternoon meal? How many times do you feed him? When he vomits, is it food or is it clear/watery/foamy?

Are you giving him s. boulardii? I would be giving that twice a day to scavenge out any pathogenic strains in his gut.

Is he taking Cerenia or Zofran (ondansetron)? Maybe you can try ondansetron twice daily if he isn't taking it already. I find ondansetron is less likely to affect a cat's appetite than Cerenia. But every cat is different.

I suppose it couldn't hurt to try the hydrolyzed diet. Have you tried novel protein like Rawz rabbit or Mouser mouse + (turkey, duck, or rabbit)?
Search: 8 results found for "mouser"

Incredible Pets sells by the can so you could try before you buy the case.

 

[BellaBlue82]

Ugh, this stinks lol.
So, when I am home, yes he gets and afternoon meal. Usually around noon. I can usually see it coming around 2-3. He doesn't eat much at lunch, but then he throws his afternoon food, and like you described throws up water/foam for a little while afterwards. I've tried to reintegrate the S. Boulardii, but since he has projectile vomited when I give it to him the vet suggested to wait for his GI tract to calm down some first. I'm afraid to start that back up again.
He is on Cerenia, but I'm wondering if I need to give it more often.
Once he calms down and the vomit stops, then he's fine and wants to eat again.
I'm just not sure which direction to go on food since he has become extremely picky. I only feed grain free chicken wet food but I guess anything is possible and it could be affecting his GI.

 

[daftcat75]

So the first vomit is always food? That would point more to an intolerance than a hairball or a hungry acid belly.

It's too bad raw/homecooked won't work because that would help you immensely in trying to figure out what's upsetting him. It could be the protein. But it could also be the gum or any number of plant-based ingredients that aren't a natural part of a cat's diet--anything that isn't meat, moisture, organs, or supplements. Yeah, supplements aren't a natural part of their diet. But they are also the least likely to be causing him grief. What specific food do you feed him?

Mouser or Rawz are probably going to be your two best bets for conducting food trials as they are both simple recipes that follow meat, moisture, organs, and supplements. Neither of them have gums. Both Rawz and Mouser come in novel proteins like rabbit, duck, and turkey. Mouser also contains some amount of mouse.

As IBD foods go, I'm not particularly happy with Hills I/D. But Betty loves the stuff and it's about all she wants to eat. But she also doesn't show food intolerance. When she was presenting, her IBD was hairballs. Still. Maybe ask your vet about a can each of the I/D stew and the pate and run them past Nico.

Cerenia is only useful if you are giving it daily (once a day.) Same with ondansetron (twice a day.) If you're only giving it after he's thrown up, that's too late. The only thing that was useful for Betty after she tossed a hairball and started her day of spits was to take up the plates and shut off her fountain for a minimum of six and sometimes 8 to 10 hours.

 

[BellaBlue82]

So the first vomit is always food? That would point more to an intolerance than a hairball or a hungry acid belly.

It's too bad raw/homecooked won't work because that would help you immensely in trying to figure out what's upsetting him. It could be the protein. But it could also be the gum or any number of plant-based ingredients that aren't a natural part of a cat's diet--anything that isn't meat, moisture, organs, or supplements. Yeah, supplements aren't a natural part of their diet. But they are also the least likely to be causing him grief. What specific food do you feed him?

Mouser or Rawz are probably going to be your two best bets for conducting food trials as they are both simple recipes that follow meat, moisture, organs, and supplements. Neither of them have gums. Both Rawz and Mouser come in novel proteins like rabbit, duck, and turkey. Mouser also contains some amount of mouse.

As IBD foods go, I'm not particularly happy with Hills I/D. But Betty loves the stuff and it's about all she wants to eat. But she also doesn't show food intolerance. When she was presenting, her IBD was hairballs. Still. Maybe ask your vet about a can each of the I/D stew and the pate and run them past Nico.

Cerenia is only useful if you are giving it daily (once a day.) Same with ondansetron (twice a day.) If you're only giving it after he's thrown up, that's too late. The only thing that was useful for Betty after she tossed a hairball and started her day of spits was to take up the plates and shut off her fountain for a minimum of six and sometimes 8 to 10 hours.

Ok, that's a good starting point then. Yeah he never throws up hairballs, at least none that I've seen. Always starts as food.
I just bought two cans of Rawz to try (rabbit and duck, because he does like the duck lickable treats.) Also got a can of mouser + rabbit. I also texted the vet to see if I can buy a can or two of the hills off of her, and just see what he tolerates. It's so odd that after years of being on the same food he's now sensitive to it, but I'm sure anything is possible.
Right now he's on fancy feast gourmet naturals chicken pate. I started him on it when I found out he was diabetic in 2019. Although, I do give him Fancy feast chicken in gravy when I'm trying to entice him to eat. It could be that, with all the additives. But either way I do think I need to change his diet so he's less irritated in the gut.
Yeah I attempted to do raw a few months ago, and he just was NOT having it. Lol. He would look up at me then back at his plate like huh? You want me to what? I even tried taking away every other food so he only had that. Nope. Hunger strike.
Yeah I've been trying not to rely on Cerenia as much, but I guess in this case he just needs to have it every day. At least for now. And thanks for the tip on picking up latest and shutting water fountain off - I did notice after the first puke he tries to go for water - it only makes it worse.

I truly appreciate the conversation, it makes me feel less insane.

 

[daftcat75]

Ok, that's a good starting point then. Yeah he never throws up hairballs, at least none that I've seen. Always starts as food.
I just bought two cans of Rawz to try (rabbit and duck, because he does like the duck lickable treats.) Also got a can of mouser + rabbit. I also texted the vet to see if I can buy a can or two of the hills off of her, and just see what he tolerates. It's so odd that after years of being on the same food he's now sensitive to it, but I'm sure anything is possible.
Right now he's on fancy feast gourmet naturals chicken pate. I started him on it when I found out he was diabetic in 2019. Although, I do give him Fancy feast chicken in gravy when I'm trying to entice him to eat. It could be that, with all the additives. But either way I do think I need to change his diet so he's less irritated in the gut.
Yeah I attempted to do raw a few months ago, and he just was NOT having it. Lol. He would look up at me then back at his plate like huh? You want me to what? I even tried taking away every other food so he only had that. Nope. Hunger strike.
Yeah I've been trying not to rely on Cerenia as much, but I guess in this case he just needs to have it every day. At least for now. And thanks for the tip on picking up latest and shutting water fountain off - I did notice after the first puke he tries to go for water - it only makes it worse.

I truly appreciate the conversation, it makes me feel less insane.

That Fancy Feast Gourmet Naturals Chicken Pate is actually a good recipe. If I were to suspect something, it might be the fish. Do they have a turkey pate? I know their Classics turkey does not have fish. That would be a simple test.

 

[BellaBlue82]

That Fancy Feast Gourmet Naturals Chicken Pate is actually a good recipe. If I were to suspect something, it might be the fish. Do they have a turkey pate? I know their Classics turkey does not have fish. That would be a simple test.

Oh, wow I didn't know it even had fish in it! Now that you mention it, when I was feeding him salmon he would get sick off of too much of that - before all of this.
I just looked at the label... Smh. Wow. Just wow.
Hm ok, I may try turkey as a test run. Fingers crossed he eats it lol.

 

[BellaBlue82]

What if the turkey pate has fish oil in it? Now I'm scouring every food I have for what I feed the other cats.

 

[daftcat75]

What if the turkey pate has fish oil in it? Now I'm scouring every food I have for what I feed the other cats.

Fish oil isn’t usually a problem. It’s fish protein that is more likely to cause an intolerance. Yeah. I like the FF Classic recipes until you get to the fish. Krista liked the turkey until the poultry giblets in the turkey flavor was too close to chicken for her. Betty doesn’t care for the turkey FF. She’s much pickier than Krista was.

 

[BellaBlue82]

Fish oil isn’t usually a problem. It’s fish protein that is more likely to cause an intolerance. Yeah. I like the FF Classic recipes until you get to the fish. Krista liked the turkey until the poultry giblets in the turkey flavor was too close to chicken for her. Betty doesn’t care for the turkey FF. She’s much pickier than Krista was.

I know what you mean, when I'm forced to buy variety packs (because it's the only thing they have in stock) most of my fur kids turn their noses up at turkey. Wom womp. But I'm going to see if I can't try to get him to nibble some of the turkey food later.
If all else fails, i was able to forage some Hills cans from the vet. I pick them up tomorrow.

 

[BellaBlue82]

I paid more attention to the vomiting this weekend. Sometimes it was a little bit of food, sometimes it was just water/foam. Z/D got the turned up nose, so I'm waiting for my Rawz and Mouser cans to arrive so we can try those.
I also think the 1mg budesonide once a day was a little too much for his tiny system. I spoke with vet and got the ok to half them, so I can give .5mg AM and .5mg PM. Today was our first trial of that - so far so good.
I'm taking the few good moments when I can get them. I woke up to a cuddle in the armpit, but was sadly followed by a BM then hiding under the bed. I left for work, but when I came home he was laying on the futon relaxing and said hi. The poor guy is just tired. I'm trying to let him rest and recover as much as possible. Cerenia on board ever day at 4:30 when I get home.
The good news is I will be working from home the month of January. I'll be able to keep a closer eye on him and trial his new foods.