Chronic diarrhea in older cat

[Zuni Monster]

Hi,

We have an 18-year old cat, Dora, who has mostly been in good health. In fact, just last month, she had a senior blood test panel and everything was completely normal. However, she's had chronic diarrhea/loose stool for almost three months now. I have taken her to the vet at least two times, and she isn't getting better. They had me drop off her stool and just checked it for the normal parasites and said nothing was found. The last visit, they said that perhaps she had IBD and gave me metronidazole to give for a week as well as a round of prednisone. It hasn't worked, and in addition to her loose poop, she has terrible flatulence, like super smelly that is even worse. I'm wondering if she has an infection of some sort and the prednisone has made things worse.

We also tried probiotics with S. Boullardi for two weeks and that didn't help either. I should mention, that there was no change in her diet at all when the loose stool/diarrhea occurred.

I'm now wondering if she has some sort of infection that wasn't in the typical parasite check. I'm wondering if we should try to deworm her, which we haven't tried because our vet didn't think it was necessary because of the stool testing coming back negative. I have to admit I'm losing faith in our vet. She said the next step would be to an ultrasound. I'm resistant to that because one, our cat is very stressed out by the vet, and two, her age and sedation, and three, the cost. Given she's 18 years old, if it was something serious like cancer, we would opt to just provide palliative care.

Any thoughts on where to go from here?

 

[FeebysOwner]

Hi. I think before I personally would go down the ultrasound route, I would want to do a full fecal PCR test which will look for certain bacterial and viral conditions. Talk to your vet about what all would be checked for in the PCR (it can vary) and which ones could cause diarrhea. Have you considered trying plain pumpkin or psyllium husk? Both are fibers that might help with the diarrhea.

Re: the ultrasound. Sedation is rarely needed. Your cat might need what I call a mild calming agent and that might be more for the belly shave than anything else. Feeby (19+yo) went through 3 ultrasounds in the last 1 1/2 years. The first one she needed a mild calming agent for the belly shave and was fine during the actual ultrasound. The 2nd & 3rd ultrasounds they didn't have to give her anything. For the first one she was given 2 mg/ml of Butorphanol. It is fast acting and wore off quickly. By the time she was ready to go home (about an hour or so afterward) I couldn't even tell they had given her anything.

 

[fionasmom]

Do you have the option of another vet for a second opinion or practice change? All records are yours and have to be sent or given to you upon request.

I would do the ultrasound; however, if the information would only be anecdotal, meaning that you will only provide palliative care, I can see your point in not doing it. I have a very fractious boy who needs sedation for a blood test, but has made it through two ultrasounds with no sedation.

 

[stephanietx]

My 13 year old has IBD and these are exactly his symptoms, diarrhea and gas. You need to find a vet to diagnose and walk with you through his recovery, but know that IBD is life-long and there will be flare ups. The key is to find a food that doesn't cause gas while treating the gas, nausea, and diarrhea. Also, he most likely needs to be on B12 since IBD kitties have a hard time absorbing nutrients and B12 helps with that.

This is what we've done for our kitty:
Switched to Science Diet z/d--increased diarrhea
Tried Royal Canin rabbit pate--caused increased diarrhea (He has a history of rabbit causing diarrhea)
Put him on Royal Canin Gastrointestinal (wet & dry) and added in a little bit of Instinct venison--firmer poops!

Supplements/Meds he's on: (This varies depending on his symptoms, but he was on all of them at the beginning.)
B12 injections weekly for 4 weeks, but we did 2x a week once or twice. Now on maintenance dose of 1 injection monthly
Metronidazole to firm up poops
Simethicone (because Cerenia wasn't helping) for gas. (Biggest game changer for reducing gas)
Cerenia (also for gas/nausea)--Not very effective for us
Zofran (Ondansetron) for nausea
S. boulardii + MOS
Probiotic (Proviable DC)
Slippery Elm Bark syrup (this has helped tremendously to firm up his poops)
Prednisolone (treats) daily

This latest flare started on Thanksgiving Day and we have really seen the results of all of this in the past 3-ish weeks.

IBD is a good day/not so good day kind of illness. He has good days where he's active and poops in the box and then he has not-so-good days where his stool is not so great and he poops outside the box. We're finally getting to more good days than not-so-good days, but it's day to day. It requires A LOT of patience and advocating for your kitty. There's a very active and helpful group on Facebook that might be helpful. Cats with IBD

Even though my boy is now 13, when I look back over his life, he's had gastro problems since he was 8 months old, so this wasn't a complete surprise, but my vets missed it previously and always diagnosed him with gastroenteritis.

 

[Zuni Monster]

Hi. I think before I personally would go down the ultrasound route, I would want to do a full fecal PCR test which will look for certain bacterial and viral conditions. Talk to your vet about what all would be checked for in the PCR (it can vary) and which ones could cause diarrhea. Have you considered trying plain pumpkin or psyllium husk? Both are fibers that might help with the diarrhea.

Re: the ultrasound. Sedation is rarely needed. Your cat might need what I call a mild calming agent and that might be more for the belly shave than anything else. Feeby (19+yo) went through 3 ultrasounds in the last 1 1/2 years. The first one she needed a mild calming agent for the belly shave and was fine during the actual ultrasound. The 2nd & 3rd ultrasounds they didn't have to give her anything. For the first one she was given 2 mg/ml of Butorphanol. It is fast acting and wore off quickly. By the time she was ready to go home (about an hour or so afterward) I couldn't even tell they had given her anything.

That fecal PCR panel sounds like the right way to go. A friend who is a vet tech suggested she might have clostridium or something else. The weird thing is when I dropped off her stool the first time, I asked to test for that, and then they didn't. Yes, might be time for a new vet. This isn't the first time I've had issues with them making correct diagnosis.

 

[Zuni Monster]

My 13 year old has IBD and these are exactly his symptoms, diarrhea and gas. You need to find a vet to diagnose and walk with you through his recovery, but know that IBD is life-long and there will be flare ups. The key is to find a food that doesn't cause gas while treating the gas, nausea, and diarrhea. Also, he most likely needs to be on B12 since IBD kitties have a hard time absorbing nutrients and B12 helps with that.

This is what we've done for our kitty:
Switched to Science Diet z/d--increased diarrhea
Tried Royal Canin rabbit pate--caused increased diarrhea (He has a history of rabbit causing diarrhea)
Put him on Royal Canin Gastrointestinal (wet & dry) and added in a little bit of Instinct venison--firmer poops!

Supplements/Meds he's on: (This varies depending on his symptoms, but he was on all of them at the beginning.)
B12 injections weekly for 4 weeks, but we did 2x a week once or twice. Now on maintenance dose of 1 injection monthly
Metronidazole to firm up poops
Simethicone (because Cerenia wasn't helping) for gas. (Biggest game changer for reducing gas)
Cerenia (also for gas/nausea)--Not very effective for us
Zofran (Ondansetron) for nausea
S. boulardii + MOS
Probiotic (Proviable DC)
Slippery Elm Bark syrup (this has helped tremendously to firm up his poops)
Prednisolone (treats) daily

This latest flare started on Thanksgiving Day and we have really seen the results of all of this in the past 3-ish weeks.

IBD is a good day/not so good day kind of illness. He has good days where he's active and poops in the box and then he has not-so-good days where his stool is not so great and he poops outside the box. We're finally getting to more good days than not-so-good days, but it's day to day. It requires A LOT of patience and advocating for your kitty. There's a very active and helpful group on Facebook that might be helpful. Cats with IBD

Even though my boy is now 13, when I look back over his life, he's had gastro problems since he was 8 months old, so this wasn't a complete surprise, but my vets missed it previously and always diagnosed him with gastroenteritis.

I appreciate the information, but the issue is I don't know that she has IBD. As mentioned, she has been on the same food for a long time and this just came up three months ago. As I know from my human issues with colitis, prednisone makes an infection worse. I think before I would pursue an IBD treatment, I would want to rule out all other possible infectious causes.

 

[stephanietx]

Yes, my boy had been on the same food for years, and it happened. The vet needs to do the GI Panel (blood test sent off) and the PCR diarrhea panel to rule out infections. Then, ask for an ultrasound to diagnose for IBD.

 

[FeebysOwner]

The vet needs to do the GI Panel (blood test sent off) and the PCR diarrhea panel to rule out infections.

The GI panel consists of:
- cobalamin (B-12) & folate
- fPLI (pancreatitis/inflamed pancreas)
- fTLI (Exocrine Pancreatic Insufficiency [EPI]}

With the cobalamin/folate test, if the B-12 is low but folate is normal or high it can suggest SIBO (Small Intestinal Bacterial Overgrowth). The latter two tests can indicate if the pancreas is involved but does not rule out problems with the intestines. Here is an article about this testing among other information about IBD, which offers information better than I could if I tried to explain it.
IBD or Cancer? – IBDKitties

 

[Zuni Monster]

I don't mean to sound hard-hearted, but a big consideration for us is cost. At 18 years old, she has exceeded our expectations of what we thought her life span would be. We, of course, don't want her to suffer. But we have three other pets, two of which are signficantly younger. We don't have pet insurance. At her age, we have to look at costs. The vet has told me it would be $170 to do the PCR panel, which we are willing to do. But an ultrasound would be another $500, and we're just not sure about that.

BTW, she is still eating and drinking fine, and she is very good about grooming herself. She looks great. And she acts like a cat who is much younger. I just don't want her to suffer in any way.

 

[FeebysOwner]

Then just do the PCR panel and see what happens. Tbh, ultrasounds are often 'inconclusive' in determining either IBD or cancer. The biggest identifier in vets' minds are thickened intestinal wall and inflammation. Even if those are not seen, no vet will likely entirely rule out either. And many cats have more than just diarrhea with IBD (vomiting is a good example). Most vets will tell you that without a biopsy, there is no absolute way to be sure - and even then, I am not sure, because if they don't biopsy the 'right' tissue, it could still not be a conclusive result.

I had 3 ultrasounds done, two of which involved a FNA (fine needle aspiration), and the 3rd went on with an additional tissue analysis (called a PARR Assay) to finally conclude she has lymphoma in her intestinal lymph nodes. And, yet they still wouldn't entirely say IBD wasn't going on too. She has no diarrhea or vomiting, no intestinal wall thickening, but she did (probably still does) have inflammation. Because she has other health issues, the oncologist did not want her on Prednisolone but would do chemo - both are usually advised in cases of either IBD and/or cancer. I am not proceeding, even with the chemo, even though most cats handle it very well. She is 19+yo with hyperthyroidism, CKD, high BP, arthritis - and lymphoma. So, she is in a lot worse shape than your cat.

Since Dora is doing fairly well, testing with at least the fecal PCR seems reasonable. If nothing shows up, you can always decide later if you want to do anything else. Cats can become intolerant/allergic to any food at any time, even ones they have long eaten - so, food trials are another consideration. As I mentioned before, trying to add fiber to her diet is another option.

 

[stephanietx]

I don't mean to sound hard-hearted, but a big consideration for us is cost. At 18 years old, she has exceeded our expectations of what we thought her life span would be. We, of course, don't want her to suffer. But we have three other pets, two of which are signficantly younger. We don't have pet insurance. At her age, we have to look at costs. The vet has told me it would be $170 to do the PCR panel, which we are willing to do. But an ultrasound would be another $500, and we're just not sure about that.

BTW, she is still eating and drinking fine, and she is very good about grooming herself. She looks great. And she acts like a cat who is much younger. I just don't want her to suffer in any way.

Try the slippery elm bark syrup. You can mix it up and add to wet food. You just need slippery elm bark powder and water. Bring 1/2C water to a boil. Remove from heat and add 1 teaspoon slippery elm bark powder and whisk until it's the consistency of a raw egg white. Allow to cool. Give 1/4 teaspoon twice a day. Store in fridge for up to one week and then discard.

 

[Zuni Monster]

Then just do the PCR panel and see what happens. Tbh, ultrasounds are often 'inconclusive' in determining either IBD or cancer. The biggest identifier in vets' minds are thickened intestinal wall and inflammation. Even if those are not seen, no vet will likely entirely rule out either. And many cats have more than just diarrhea with IBD (vomiting is a good example). Most vets will tell you that without a biopsy, there is no absolute way to be sure - and even then, I am not sure, because if they don't biopsy the 'right' tissue, it could still not be a conclusive result.

I had 3 ultrasounds done, two of which involved a FNA (fine needle aspiration), and the 3rd went on with an additional tissue analysis (called a PARR Assay) to finally conclude she has lymphoma in her intestinal lymph nodes. And, yet they still wouldn't entirely say IBD wasn't going on too. She has no diarrhea or vomiting, no intestinal wall thickening, but she did (probably still does) have inflammation. Because she has other health issues, the oncologist did not want her on Prednisolone but would do chemo - both are usually advised in cases of either IBD and/or cancer. I am not proceeding, even with the chemo, even though most cats handle it very well. She is 19+yo with hyperthyroidism, CKD, high BP, arthritis - and lymphoma. So, she is in a lot worse shape than your cat.

Since Dora is doing fairly well, testing with at least the fecal PCR seems reasonable. If nothing shows up, you can always decide later if you want to do anything else. Cats can become intolerant/allergic to any food at any time, even ones they have long eaten - so, food trials are another consideration. As I mentioned before, trying to add fiber to her diet is another option.

This completely makes sense. Thanks to all of you who provided thoughtful advice and shared your own experiences. I'll post again after we get results from PCR fecal test. And yes, the other thing I have thought of doing is trying a different food, which also totally makes sense.

 

[tyleete]

I have 4 with ibd that's food-related. Trial by error. All 4 are doing so well off any poultry (including eggs) & fish. 2 of those are even allergic to the gums put in all wet food. I found that out once I got them on a food that made the diarrhea and vomiting stop, I tried the wet version and they both instantly had the puddle poop again. Did fine when took it away.:\
Food allergies can come after years doing fine all their lives. Just a possibility.