New cat with chronic diarrhea (6 weeks and counting)

[tinytangerine]

Hello all!

Joined this forum today to see if anyone can help give any insight (or tell me I'm worried for nothing). Two months ago my heart-kitty passed away unexpectedly. It was devastating and I still miss him deeply. About six weeks ago a small orange cat wandered across our driveway and took up residence on our porch. After a couple weeks we took him to the vet; he wasn't chipped or neutered, so we had both done and brought him inside. The vet thinks he is around 2 years old. He has had ongoing diarrhea for the entirety of those six weeks.

His symptoms:
- Soft stool - very formless, shapeless, and wet.
- Slight increase in defecation frequency from normal (2 - 3 times a day), but not a super high frequency
- Vocalizing before use of litterbox
- Large quantities of stool
- Very gassy when pooping
- He's been very itchy - licking fur off in patches on his legs, chest, and scratching behind the ears
- For a while he was doing a strange exaggerated swallowing motion on and off where he would jut his head forward and swallow visibly. It wasn't all the time, or always when eating, but would occur intermittently through the day.

During that time we:
- Had him vaccinated
- Had him dewormed (roundworms, hookworms) - fecal test recently declared him worm-free.
- Had multiple vet exams (no fever, teeth look good, lungs/heart sound good on the stethoscope)
- Standard blood drawn taken (all seemed normal)
- Put him on rounds of Metronidazole (+ probiotics) twice to try and help
- Now he is on a hypoallergenic diet from the vet and 2.5mg pred/day (for the past week). So far no real change in stool frequency or form

He has a good appetite, is friendly, drinks water well and seems to have adjusted to being indoors.

Any other routes we should go down or thoughts?? I honestly am scared he has something like cancer or something else serious. I don't know if I could bear to lose another kitty so soon.

Thanks so much for any help you can provide <3.

 

[molly92]

It could still be parasitic. False negatives are common for in house stool tests, and metronidazole is great for a lot of things, but it doesn't kill everything. What probiotic are you using? If I were you, even without I diagnosis, I would probably just try S. boulardii since it's useful for so many things (more info here: Saccharomyces Boulardii use for diarrhea and GI disease (incl IBD)).

If S. boulardii doesn't work and you want to follow the parasite possibility further, I've attached a guide my shelter used to diagnose and treat parasites as a starting point, although the most definitive test would be to request a PCR stool test from your vet. Additionally, ponazuril is the best treatment option for coccidia, not albon.

If you want to test the food sensitivity (which it could be because of the itching), you need to keep to a very strict diet for 2 months before changing anything to know if it's working, because effects can linger for a long time. Often starchy carbs (peas, grains, corn, etc) can be difficult to digest and also delicious for parasites, so it could even be both. I would try a limited ingredient diet that's high in protein, which is probably not what your vet is giving you, as most prescription foods are high in starches.

Regardless, it's important for all cats to be on a wet food diet (dry food has more carbs, and wet food-fed cats are more hydrated, which is crucial for urinary health), but especially for your cat, because diarrhea is dehydrating.

Whatever you attempt, try to just change one variable at a time. If you do everything at once and it works, you'll never know exactly what solved it.

 

[tinytangerine]

Hi Molly,

Thank you so much for the detailed reply. I had no idea about the high rate of false positives and will bring that up with the vet to get the better testing done. He is not currently on a probiotic as we were concerned about adding anything to the limited diet. I will look into this and see if we can give it to him without messing up the allergy/diet testing, since I'd really like to do more to help him feel better .

We're currently on week 2 of an 8-week hydrolyzed protein diet to see if it helps. Though I am totally on board with wet food diets (our prior cat was on 100% wet food), I'm hesitant to go against veterinary advice since I'm already so anxious about everything. We do wet the kibble as he eats it and he is a good drinker. Any thoughts on that? I am so torn between sticking with the given limited kibble diet, or going to a LID in wet cans instead.

 

[verna davies]

I agree with molly92 about using. s boulardii. My cat had diarrhoea for a week or so and a member recommended it. Within 3 days her stools were firm. I gave a half dose for a further 5 days and she's still good weeks later. This is the one I used.

 

[verna davies]

Dont know what happened there. Its Jarrow s boulardii with MOS. I bought it from Amazon

 

[molly92]

I understand the hesitance to go against vet advice. I do not think you will run into resistance if you ask to add a probiotic into the mix. I grew more confident picking and choosing which vet advice to follow the more I understood my own cats, but for now, you can always try it the vet's way for 8 weeks and then transition to your other options. Also, most prescription diets come in kibble and wet forms, so you can ask if there's a wet version available for now. If they don't understand why you want wet for some reason, get a new vet just say your cat prefers the wet food. That's worked for me before. If your cat does get better on the vet's food, you don't have to stay on that forever either! You can transition to other LID foods carefully and see what works and what doesn't.

Wetting kibble is not ideal because it still has all the extra carbs that dry food has, and if you leave it out for too long, you run the risk of bacterial and fungal growth. Wet food fed cats are always more hydrated than dry food fed cats, even if they drink more.

 

[tinytangerine]

Thanks all for the thoughtful replies!

I spoke to my vet on the phone at lunch. They OK'd the probiotics and I've ordered some S. boulardii for him. They were sympathetic to the wet/dry food question and understood the desire to wet - I'm going to pop in this evening to chat with them about the options we have here (I am rural and in Canada so they are somewhat limited). There is some concern that changing his food again at this point would just make things worse. They were saying that either way if he does well on the 8-week trial that we could transition him to a LID wet for the long-term, so that is good news.

Good call out on the fungal/bacterial issue Molly - thankfully he typically eats it all right away so it isn't sitting, but I will only do it when home and keep an eye on it to clear away anything left out to reduce the issues with that approach.

 

[stephanietx]

I would also get him in for the PCR Diarrhea panel to rule out some less common parasites. I would also ask the vet for some food for sensitive tummies. One of my cats is on Royal Canin Gastro HE (dry) and Science Diet i/d (canned) along with some grain free food. He can't tolerate a total grain-free diet and has chronic soft stools and diarrhea if he gets too much GF food.

 

[tinytangerine]

Thank you everyone for the thoughts!

So after speaking with our vet, here's the plan for now:
- He's on another round of Metronidazole and he's on S. boulardii (or will be, when it arrives). Does anyone have any thoughts on FortiFlora? It was what the vet had on-hand so we could pick some up any time if it is good.
- He'll stay on the hypoallergenic diet for now. If he still has the soft stool issue in a week, or if it reocurrs after he goes off of the metronidazole, we will re-visit with the vet and switch him to a different LID (wet, canned)

I have a couple questions that all of your collective wisdom might be able to advise on:

- What are some recommended limited ingredient diets readily available in Canada? I can order online - likely our local stores won't have anything.
- molly92 , thank you for the stool charts - his stool is definitely an orange/yellow colour, but has no significant odor and only became that colour on this new food....given that, I had assumed the stool colour was primarily related to the food/kibble. Do you happen to know if those parasites would show up in a PCR Diarrhoea panel?

 

[FeebysOwner]

Hi. I believe this article lists the things that are generally tested for with a PCR fecal test - https://www.zoologix.com/dogcat/Datasheets/FelineDiarrheaPanel.htm.

The color of his stool is likely the result of the food, since you said it changed when the food changed.

 

[molly92]

I agree with FeebysOwner !

I would stay away from fortiflora for now just in case it's an animal protein intolerance, because fortiflora is mostly animal digest-an ingredient that most cats find super delicious, but is also really vague on where it is sourced from. (In theory it should be fine, because it's been hydrolyzed, but we have no way of knowing how complete that process is. Which wouldn't matter normally, but in an allergy context it's easier just to remove the doubt.) The strain in fortiflora has much more modest results in helping with diarrhea than S. boulardii has had anyway.

Not sure what's available in Canada, but Nature's Variety Instinct, Ziwi Peak are nice ones. Merrick also has an LID line. It doesn't need to say LID, but you'll want to read the ingredients to see how few are used. Try to stick to "unusual" proteins and 1 source of carbs. If you suspect peas as being the problem, you're going to have to look around a bit more though.

 

[LTS3]

rubysmama what LID brands of food are available in Canada?

Ordering food online is probably best if the local stores don't have any. Try looking at these brands:

Best Canadian Made Foods

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thecatsite.com

PetValu's Canadian web site lists these LID brands: https://petvalu.com/products/cat/food#!p=1&limit=9&dir=asc&product_type=81

Here's info on probiotics: Prebiotics & Probiotics for Cats: Healing Inflammation and gut dysbiosis You can use a Human probiotic instead of a pet one. If the local stores don't have any, you can buy online pretty much anywhere like on Amazon. I use Renew Life Ultimate Flora 50 billion CFU for my cats. They split one capsule daily.

 

[rubysmama]

T tinytangerine : hello and welcome to TCS. Condolences on the loss of your heart kitty. If you feel it might help, we have a Crossing the Bridge forum where you could post a tribute to him. RIP sweetie boy.

I'm glad you have a new fur-baby to help heal your broken heart. I also have an orange cat, who also has digestive issues. In fact, when I first adopted her, she had pudding like stools, all the time, plus intermittent vomiting. She still has issues, more often than we'd like, but a food change made a huge change, when the vet suggested changing Ruby's food to Royal Canin Hypoallergenic canned duck food. We changed her food to the hypoallergenic right away, and literally the next time she pooped, her stools were normal for the first time.

Here's the link to her food. It's only available from the vet, and is not cheap, but well worth it, I think.
https://www.royalcanin.com/ca/en_ca...poallergenic-selected-protein-canned-cat-food

We're currently on week 2 of an 8-week hydrolyzed protein diet to see if it helps. Though I am totally on board with wet food diets (our prior cat was on 100% wet food), I'm hesitant to go against veterinary advice since I'm already so anxious about everything. We do wet the kibble as he eats it and he is a good drinker. Any thoughts on that? I am so torn between sticking with the given limited kibble diet, or going to a LID in wet cans instead.

Is it the Royal Canin hypoallergenic kibble? If so, it's not duck based, like the hypoallergenic canned food. And, for me, I think the protein (duck) Ruby had never eaten before made the difference, as I believe she has a sensitivity to chicken.
https://www.royalcanin.com/ca/en_ca...ypoallergenic-hydrolyzed-protein-dry-cat-food

Currently, along with Ruby's canned food, she gets a few teaspoons a day of kibble as a treat. For a few years she did "okay" on a gastrointestinal kibble, but then that started to bother her. Currently I'm giving her Duck and Green Pea kibble, which agrees with her, most of the time.
Hill's® Prescription Diet® d/d® Feline Duck & Green Pea Formula - dry

rubysmama rubysmama what LID brands of food are available in Canada?

Honestly, not sure, as I buy Ruby's food directly from the vet. Whenever I've looked, however, I haven't seen many LID foods at Petsmart.

 

[tinytangerine]

You are all so wonderful! I know a lot of this is google-able, but honestly, I find it a bit overwhelming and with such vague symptoms, I keep running in to websites that say he may be seriously ill which is really freaking me out. So I really appreciate all the insight and learnings from you all.

Thanks molly92 for the suggestions - some of those definitely sound familiar. Hopefully I can source them easily online.

rubysmama , thank you - I miss him every day <3 but I am focusing these days on getting our new friend healthy. Yes! You nailed it, he is on the Royal Canin hypoallergenic kibble. I did think it was odd that it had chicken since I had heard that is a common allergy for cats. My current thought is that if he is still in a bad way after another week (so ~2.5 wks on the diet + 1 wk on S. Boulardii), I will discuss with the vet about switching him to a different novel protein source/LID that doesn't include chicken. Does that seem reasonable? I am so torn between letting him settle on a food, and trying to find something that helps, but I guess if he already has diarrhea on the kibble it's not likeI'd be making it that much worse.

 

[rubysmama]

I can't really say how long you should wait before trying a different food, but as I posted, once I changed Ruby's food to the duck-based canned hypo-allergenic, I literally saw a difference the next day.

Just rereading his symptoms, and it makes me wonder if you should talk to the vet about trying something without chicken. Poor baby must feel miserable. Is he having any litter box accidents, or does he manage to make it to the litter box every time?

 

[LTS3]

A food trial needs to be done for at least 13 weeks or so to see if it helps or not. Canned is preferred over dry since it has less fillers. Have you looked at the Canadian PetValu link I posted above?

 

[tinytangerine]

rubysmama thanks for the input, it's a great thought - I plan to call the vet tomorrow and discuss the possibility that the chicken is causing issues for him and whether we should try swapping to something without chicken in it. No accidents - that's the strange thing, he doesn't seem 'hurried' to get to the box, and he never has any trouble getting there in time. He is only going ~3x/day, which I know is more than usual but is not super frequent. That combined with the larger volume makes me suspect a small intestine issue (rather than large), from what I've read, but that also could be so many things (including allergies and other more serious issues). I feel so awful and my heart hurts having him continue to feel bad. I know we are trying but it's hard not to feel like a bad pet-parent when it's obvious they do not feel good.

LTS3 Yes, thanks so much for the link! I am going to discuss these as potentials with my vet as well - it seems like there are a couple canned options with no chicken. I understand that food trials are long-term, but I am wondering how long we stick with it if he continues to have such bad soft stools. I guess I assumed we would at least see some improvement over time, but if anything the new food has made him worse (softer stool, gassier) even 2 wks in to the trial. Hopefully he sees some improvement soon. I really appreciate the advice/help.

 

[rubysmama]

Another thing to consider is a cat only vet. If you want to look into cat only vets, here a link to search for one in your area. Just be sure you choose "Feline Only" in the Practice Type Drop Down menu.

Find a Veterinarian and Practice | The Cat Community

 

[tinytangerine]

Thank you rubysmama for the link! Nobody local to me, but if this issue persists, I'll probably make the drive out to the closest feline vet if they are accepting patients.

Just spoke to the vet tech on the phone who was adamant that the chicken fat in the Royal Canin dry food was also hydrolyzed and so any allergen compounds present in it should be broken down, and that can't be the root issue/cause of the problems we are still seeing. I am honestly kind of skeptical of whether that is true (if it is hydrolyzed, why isn't it labelled on the bag...?) but what do I know. The actual vet said she would call tomorrow to advise on his gassiness and swallowing motions (he was doing it a ton this morning before his pred), so I guess we will plan next steps at that point.

 

[molly92]

....I'm pretty sure they don't hydrolyze fat. They could in theory but I don't see why anyone would.

Individual amino acids are linked together to make different proteins. Hydrolyzing the protein breaks these links and turns it back into amino acids, which the body doesn't recognize as foreign because it doesn't have the shape of the full protein anymore.

Fats are made of lipids. Lipid tails can join together in groups of 3 to make triglycerides, and you can hydrolyze them to break them up into 3 individual lipid tails, but they still have almost the same shape. So you'd go from fat molecules to...
smaller fat molecules. Not sure if fat is a likely allergen, or likely to be contaminated with allergens, but yeah it sounds like the tech was making that up.

How frustrating! I know you're supposed to wait on a food trial, but if he's noticeably worse I'd argue that's a good reason to stop it early and try something else. Hope you start seeing some improvement soon!