Intestinal Biopsy: Is it totally safe?

Antonio65

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Hi everybody,
I have an issue for my new kitten Giada (Italian for Jade), 9 months old.

I found her twelve days before Christmas, along with her three siblings. I kept one, her, and re-homed the other three kittens. I was able to trap their mother on the next day, and had her spayed.
Giada had been eating Kitten premium wet food (paté) from an Italian brand. She was fine till mid February, when her poop got a little softer. I took her to the vet along with some poop samples and the result was giardia, so we started the therapy (Fenbendazole) for 5 days, the next fecal tests were negative. But her poop was still soft, and on some days it was even runny. The vet told me that the parasite might have damaged her intestine, but in a few weeks all would be fine. He also prescribed some probiotics, which didn't work at all, so I introduced some more probiotics (like Fortiflora), even human grade ones that had worked fine in the past with Lola.
No luck.
So one month ago the vet advised me to slowly switch to a different food, and remove the dry food (grain free). Giada was 8 months old, the vet said that it wasn't too wrong to introduce her to an adult wet food with a novel protein. Her "kitten food" was Turkey, now it is Pork (still paté), from the same Italian brand. I switched to this new food over a week. As soon as she was on the new food only, her poop got much better, both in texture and in smell. And she went from 5 poops a day to 1 or 2 poops a day.
Two weeks later I called the vet and he said that this was a good news, anyway we shouldn't lower our guard till the end of May. And he was right, Giada's poop is soft again.

The vet said that if the issue wouldn't fix, he would have liked to have a biopsy of her intestine done.

Now my question is:
Has anybody of you have ever had a biopsy on a cat's intestine done? Is it completely safe?
My fear is that the relatively simple surgery might damage Giada's intestine for good!

Giada is up to date with her vaccines (RCP + FeLV), but she's positive to Calicivirus, probably contracted before I adopted her. Currently she has no symptoms from it. Her weight is 2.8 kg (about 6 lbs 3 oz), she hasn't increased in the last month, but would increase about 3 oz a week, January to April.
She hasn't been spayed yet. We should have had her done in late March, then the pandemic changed some plans, then I got COVID-19 and was stuck at home for 7 weeks. Anyway she hasn't shown any sign of heat yet.
She has an insatiable appetite, but I do not indulge her, she eats two cans of wet food a day (as per label)

Any input is more than welcome. Thank you!

Giada_20200527.jpg
 
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FeebysOwner

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Hi. Very pretty kitty!! Do you have any idea why the vet thinks the next step is a biopsy - vs. an x-ray or scan? Do you know what he is looking for? I would think other alternatives need to be exhausted before having a biopsy done - just IMO.

Even though a fecal test for giardia was done and produced a negative result, I would think the vet would want to retest in case it wasn't completely eradicated before, hence the reason the diarrhea returned.
 

She's a witch

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I agree with FeebysOwner. If she had Panacur for 5 days only and that wasn't repeated, it's more than probable that Giardia was not eliminated, as this doesn't work on the cysts, it most often needs to be repeated when parasite becomes adult but before they lay another round of eggs. Rather than fecal floatation, I'd ask for it to be retested using the better method (Elisa or PCR test). False negative are way too common with the fecal floatation.

Two years ago my kittens had a nasty giardia infection and it took several rounds of Panacur (which after all didn't work on their strain) and eventually 2 rounds of Metronidazole to eradicate this. It also took months to heal their intestines after the parasite and the treatment. I started feeding them RC Gastrointestinal canned for one month and then it took another month to very slowly transition them back to the healthier food.
 

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I have a cat with intestinal lymphoma, an old cat, and the vet and I have decided to do hospice care for her; however, if I had gone through with all of the testing the first would have been an ultrasound. I was warned that ultrasounds are often not that conclusive if they do not pick up a mass, so the next step would be a scoped biopsy followed by an excisional biopsy if things were still conclusive. I agree that this should be approached a little more slowly.

She is a beautiful little girl!
 

daftcat75

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No, a biopsy is not totally safe. No surgery is totally safe.

Some things I would try before a biopsy:

1. S. boulardii -- This will crowd out bad bacteria and parasites and it also helps restore the microbiome lost to antibiotics.
My Cat Has Diarrhea - What Do I Do?

2. Probiotics. Especially if she had a course of antibiotics. You want to restore the good bacteria before the bad bacteria has a chance to return.

3. A fecal PCR test if you have only done the cheaper fecal float test.

4. An ultrasound. It's a good first visualization of the intestines without an invasive procedure like a biopsy.

5. Different food. If you're feeding dry food, try to feed less of it or all wet food. Also, nine months is still young enough that you shouldn't be restricting how much she eats. I believe you're supposed to feed kittens as much as they will eat until at least their first birthday to help fuel all that kitten growth into adulthood.
 
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Antonio65

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Hi. Very pretty kitty!! Do you have any idea why the vet thinks the next step is a biopsy - vs. an x-ray or scan? Do you know what he is looking for? I would think other alternatives need to be exhausted before having a biopsy done - just IMO.
We already had a scan done at the end of February, and it was fine with very slight evidence of an enteritis. The vet didn't think it was reason for concern.

Even though a fecal test for giardia was done and produced a negative result, I would think the vet would want to retest in case it wasn't completely eradicated before, hence the reason the diarrhea returned.
We ran two or three fecal tests post Panacur, and they were all negative. I asked the vet if it was the case to administer a new round of Panacur, just in case, he said no.
 
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Antonio65

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I agree with FeebysOwner. If she had Panacur for 5 days only and that wasn't repeated, it's more than probable that Giardia was not eliminated, as this doesn't work on the cysts, it most often needs to be repeated when parasite becomes adult but before they lay another round of eggs. Rather than fecal floatation, I'd ask for it to be retested using the better method (Elisa or PCR test). False negative are way too common with the fecal floatation.
I asked the vet if I could give the kitten a new course of Panacur, given the situation, but he said no.
With this situation of this virus, it's very hard for me to go to the clinic as often as I used to do in the past. There was a time when I was nearly living in there. I would just walk in and have my cats visited.
But now it's hard, I have to book, who knows when I have an appointment, I couldn't be allowed in to discuss with the vets, I couldn't be there with my cat during the visit, it's so difficult for me.

Two years ago my kittens had a nasty giardia infection and it took several rounds of Panacur (which after all didn't work on their strain) and eventually 2 rounds of Metronidazole to eradicate this. It also took months to heal their intestines after the parasite and the treatment. I started feeding them RC Gastrointestinal canned for one month and then it took another month to very slowly transition them back to the healthier food.
Yes, I should discuss about it with my vet, but on the phone, and sometimes not everything is discussed this way.
 
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Antonio65

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My vet told me that in his opinion, an intestinal biopsy would be a last resort, its an invasive procedure. Have you tried a boulardii, it works a treat in just a few days when mine have diarrhoea
I will try with S. Boulardii, I'll go to the pharmacy tomorrow. Do you any idea about the dosage? How many times a day? After a meal? How many days?
Thanks!
 
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Antonio65

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I have a cat with intestinal lymphoma, an old cat, and the vet and I have decided to do hospice care for her; however, if I had gone through with all of the testing the first would have been an ultrasound. I was warned that ultrasounds are often not that conclusive if they do not pick up a mass, so the next step would be a scoped biopsy followed by an excisional biopsy if things were still conclusive. I agree that this should be approached a little more slowly.
A US scan was done three months ago, and was clear, apart from a very slight evidence of an enteritis, but the vet thought it wasn't anything to be worried about.

She is a beautiful little girl!
Thank you!
 

verna davies

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I will try with S. Boulardii, I'll go to the pharmacy tomorrow. Do you any idea about the dosage? How many times a day? After a meal? How many days?
Thanks!
This is what I use but dont know if you can get it near you so check strength.

The capsules are 250mg and I give half of one capsule twice a day for 3/4 days. I usually see a big difference by then so half that dose to 1/4 capsule for a week just to make sure. I mix it in the food.

https://www.amazon.co.uk/dp/B0013OVW0E/?tag=
 
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Antonio65

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No, a biopsy is not totally safe. No surgery is totally safe.
Yes, of course. My question was to ask you how unsafe it is.

1. S. boulardii -- This will crowd out bad bacteria and parasites and it also helps restore the microbiome lost to antibiotics.
My Cat Has Diarrhea - What Do I Do?
I'll try them tomorrow, provided my pharmacy has it.

2. Probiotics. Especially if she had a course of antibiotics. You want to restore the good bacteria before the bad bacteria has a chance to return.
We tried many of them, both for pets/cats and for humans. No luck!

3. A fecal PCR test if you have only done the cheaper fecal float test.
Yes, we could try that, I'll have to discuss this with the vet and have an appointment. This new world is not what I'm used to. Furthermore, the clinic is 10 miles away, and I don't think I am able to drive such a long distance... I got the virus, and it left me a general feeling of weakness and dizziness, I feel a bit unsafe driving farther than 2 or 3 miles.

4. An ultrasound. It's a good first visualization of the intestines without an invasive procedure like a biopsy.
Done that, three months ago, rather clear, apart from a very slight enteritis, which the vet wasn't concerned about.

5. Different food. If you're feeding dry food, try to feed less of it or all wet food. Also, nine months is still young enough that you shouldn't be restricting how much she eats. I believe you're supposed to feed kittens as much as they will eat until at least their first birthday to help fuel all that kitten growth into adulthood.
I am not feeding dry food. The one I used to feed was grain free, but had chicken inside, and the vet said to try and avoid any food with chicken and similar, since the kitten food was Turkey. The new wet food is Pork, and it seems it fixed most of the issue.
Unfortunately I couldn't find any kitten food without Chicken or Turkey, so I switched to Pork that is adult. Other proteins are adult only.
I asked the vet if I should feed more cans than the label instructions, the answer was not to indulge her requests, because this could become a bad habit and she might eat as much even at an older age, and after the spaying the cat might get overweight.
This makes sense. My previous cat, Pallina, came from a colony and she would fight for food. When she came in our home she couldn't believe how much food and how often it was available. So we gave her food as long as she would ask for. She got overweight, and she kept this habit of overeating even when she was older. At the age of 5 she was as round as a ball, which was apt with her name (Pallina means "little ball" in Italian), but not good for her.
Giada is an indoor only cat.
 
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Antonio65

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Also, nine months is still young enough that you shouldn't be restricting how much she eats. I believe you're supposed to feed kittens as much as they will eat until at least their first birthday to help fuel all that kitten growth into adulthood.
I forgot to say that when Giada first arrived, I would feed as much food as she wanted, but it seemed to me it was never enough.
She could eat 10 cans a day if I gave her them.
This makes me think that she asks for food not because she's hungry, but because she's bored or a glutton.
She chews or try to eat anything, even not food. When I take her out in the courtyard with harness and lead, she picks up leaves, debris, insects, other small items, that I have to retrieve from her mouth :lol:

She ate a good portion of food not even an hour ago, she's been meowing for more food for the past half an hour. I could give her another good portion now, but she would be asking for food again 30 minutes later.
 

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If they preform an endoscopy type biopsy it is non invasive and completely safe. This type they use a camera and probe which is inserted into the rectum and take a piece of tissue from the intestine.

The other way this type of biopsy is preformed is a bit more invasive and involves making an incision in the body and taking a tissue sample from the intestine and stitching it closed. While like any surgery it does have risks, it is generally safe especially in young animals who bounce back relatively quickly. Older animals are susceptible to complications with the anisthetic however.

Your vet will most likely give you pain medication and possibly a shot of antibiotics.
 

kittenmittens84

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If she’s 9 months old, give her as much food as she wants. She’s still growing a lot! You won’t spoil her forever by feeding her more as a kitten/teen, you’ll still be able to transition to feeding specific portions in a few months.
 
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Antonio65

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A quick update.

I started the S. Boulardii on Sunday, so it's four days and a half now.
Giada still poops two times a day. After a couple of days the texture was much better, but last night her poop was soft again. I hope it's just a single case. I will keep giving her 125 mg of this yeast twice a day for another week, and see what happens.

What I forgot to say is that she notices us when she's going to poop, she starts howling and screaming, and running all over for about 15 minutes before using her litter box. I wonder if she is bothered by her poop.

I also upped her food by about 50% to see if she would beg for food less, but things worsened, I think that she got the message that the more she meows, the more food I give her, so she started asking no stop. Of course, more input, more output, with three poops a day.
She keeps looking for food and eats whatever she finds on the floor. A month ago, she tipped a bottle on the floor. While I was cleaning and picking up all the small and tiny fragments of glass (they were everywhere), she got one and started chewing on it!!! I had to run after her and pull that dangerous thing out of her mouth.
She eats all insects that she sees in the house, flies, midges, pantry moths, ants. I also found her chasing bees, wasps, spiders, but didn't catch them. Even a centipede (Scutigera) which scares me a little!

She also meows constantly, and it's really hard to understand what she needs. She starts meowing at 6 am (any day of the week!) for food. So I give her food. But she meows again thirty minutes later and it is practically a relentless meow all day long. She plays, gets cuddles, eats, and all, but she meows.
And every single night, at 10:30 sharp, she starts jumping, running, bouncing off the walls and furniture, screaming, howling, sometimes she slightly bites at my feet.
We have a grace time of about 6 hours, midnight to 6 am, when we turn all lights of and she sleeps quietly.

She drives me crazy, I tell you, in the morning I am stunned by her meow after two hours only.
 

verna davies

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Her bottom could well be sore from all the diarrhoea and that may be the cause of her howling and screaming prior to using the little box. Why she constantly meows for food I dont know as its obvious she is eating plenty. Sorry I dont have the answer for you but hopefully another member will have some ideas.
 
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Antonio65

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It's not a diarrhea, it's been soft poop, so I don't know if we can tell that her bottom is sore. If I look at it, it's fine.
 

IndyJones

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It could be the physical action of having a bowel movement is hurting. Whether or not it's the contractions prior or actually going that hurt I can't really say.
 

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Hmm meowing all the time can also be a cat in heat. Since she is 9 months old she could for sure be in heat. Cats in heat meow or yowl constantly too. I would get her booked in to be spayed, if they do the surgical biopsy maybe they can do it at the same time.

What food are you feeding her? Is the wet food carrageenan free? You want for sure it to not have any of that or gums as that can irritate the stomach lining. My first cat had GI lymphoma at 14 years old, it was diagnosed via biopsy. She was extremely sick at the time, stayed 5 days and had a feeding tube placed as she refused to eat.
 
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