New cat with chronic diarrhea (6 weeks and counting)

[tinytangerine]

molly92 that makes so much more sense. Thank you so much for explaining it to me so clearly - I totally get it now. I feel like the tech on the phone was really struggling to explain - but that makes a lot more sense.

He's been on the S. Boulardii for a few days now and I definitely think it is helping (though he went on to metronidazole at the same time, so it's hard to definitively say what is doing it). He went down from pooping 3x/day to 1x, and though it's still very wet/soft and he is definitely gassy, the quantity of stool is much more normal. Fingers crossed it firms up - that's really what I am waiting for. Unfortunately he still seems nauseous - though he's never vomited, he is doing a lot of lip-licking and an exaggerated swallow motion, especially right after eating. If you're holding him, you can feel his stomach almost 'spasm'/heave before he does the swallow. I do wonder if maybe he just has a tummy upset from the meds (pred + metronidazole) but who knows. It is sad to see him uncomfortable but I am really hoping we are going in a positive direction. Thanks to everyone so far for the support and help - it is amazing how much you all know and it's been really helpful going in to vet convos not feeling like a totally ignorant doofus.

 

[tinytangerine]

Few days later, few more ups and downs....

So our little guy has seemed to be on the upswing this week. We stopped the fortiflora and he was having fewer stools (1/day), and yesterday finally had a semi-solid (though still semi-soft) stool. Unfortunately today he has already gone twice, both very soft, and very gassy . Nothing has changed in his diet except we are in a new bag of the hypoallergenic food. It seems unlikely that could cause it, but maybe...? It is concerning to me that even on the antibiotics he is still having this issue.

Either way I am disappointed - I was really hoping he was on a positive path fwd. We have a vet appt on Tues and until then will continue with regular S. Boulardii and the prescribed diet. Sanity check - are we OK to wait until Tues if he continues to have more frequent soft stools (~3/day), or should we bring him in ASAP?

 

[rubysmama]

If you're really concerned, check with your vet. But if things are no worse than before, it's probably ok to wait till Tuesday. One thing, antibiotics kills good bacteria, and can cause diarrhea in humans, so that could be a factor with your kitty, as well.

 

[tinytangerine]

Thanks rubysmama - a fair point. Frustratingly he started refusing some food this morning (will only eat about half of what he usually does). I'm super anxious and we will be taking him in Monday - our vet is closed today unfortunately. Gosh, I hope he is OK.....hoping that maybe he is just nauseous from the meds or something, or tired of the kibble. For a cat that usually is screaming for his dinner, it's scary to see him turn up his nose .

 

[rubysmama]

Hopefully it's nothing, and the fact that he's eating some, is good, I think. But always best to have him checked out, just in case.

 

[FeebysOwner]

I think you've already mentioned it, but antibiotics can also upset the stomach. It doesn't necessarily stop the tummy upset, but making sure he has food immediately before, during, and/or after the medication will help at least a bit. Also, could the newer food be something that he is just not that fond of, and between that and the antibiotics he just doesn't have his appetite? He may even correlate the food with feeling nauseous?

 

[mentat]

Regarding endoparasites, what he's had treats 3 common ones, rounds, hooks, and giardia, but not other common ones, especially in a former street cat. Tapeworms (2 primary species) and coccidia are also common in outdoor cats. My shelter fosters all get a round of fenbendazole (panacur or safeguard brand names), albon, and 2 rounds of Drontal two weeks apart, all prescribed, although I think UK and Canada has them OTC, but dose should be veterinarian authorised. It's the only way I'm willing to foster so often for the shelters. I also require Revolution, to ensure ear mites, fleas, and internal parasites are prevented/controlled.

A gram stain fecal test, viewed via microscopy, closely assesses GI flora and are underutilized tools all primary care vets are capable of and taught in vet school. If large amounts of clostridia, or rods bacteria, or any amount of infectious bacteria, like campylobacter, are present, appropriate treatment is prescribed. Higher than normal colonies of clostridia and rods are treated with tylosin, in gel caps, as it tastes so bitterly terrible to cats. It also has an antiinflammatory compenent to the gut. Per CSU internist Dr. Twedt: " A commonly used alternative [to metronidazole], and my first choice, is tylosin. Tylosin is a macrolide, bacteriostatic antibiotic that works by transiently changing the GI enteric bacterial population, probably by promoting the growth of beneficial commensal bacteria while suppressing deleterious bacteria. The initial dose recommendation for tylosin is 15 mg/kg orally twice a day. For cases that respond, the long-term dose can be reduced to as low as 5 mg/kg/day in some."

Most clinics utilize two big animal diagnostic reference laboratories, Idexx or Antech. Both have Fecal PCR panels to identify specific protozoa, bacteria and fungi, as well as sensitivity tests to find what will effectively treat. I go to this step if the vet doesn't identify anything on a fecal gram stain slide in hospital that could cause the diarrhea. Protozoa Tritrichomonas (TTF) is particularly overlooked on fecal tests in clinic, as it's less common and requires an additional step beyond the typical fecal flotation to see it under microscopy.

Cobalamin/Folate blood test can identify deficits that contribute to GI disease. Both of the big labs offer GI panels that include this test as well as feline pancreatic lipase quantification. If deficient, there are specific therapies to normalize the GI tract from a deficient state. With your boy's diarrhea persisting, this would be on my list with fecal PCR.

My shelter vets and feline specialists prefer Proviable DC capsules and Proviable KP paste over Fortiflora. Fortiflora is not complex enough in variety of beneficial bacteria, and doesn't have the high counts that Nutramax Laboratories' Proviable does. Clinically, all my vets see better effect and response with Proviable over Fortiflora. Both are veterinary specific product labeled for cats with large population studies for efficacy, safety, and palatability. Proviable DC's powder from the opened capsule, and the KP paste, are easily masked in food with no poor flavor or bitterness, and low volumes to administer. It's an option, but probiotics will not be the one wonder therapy that reduces inflammation and overproduction of "bad bacteria," and they will not treat potential tapeworms or coccidia at all.

High Fiber diets can help cases of enteritis/colitis induced diarrhea. Royal Canin Gastrointestinal Fiber Response is an option as he's already on RC GI.

My cat diarrhea MO: Best to get more parasites, bacteria, and GI disease ruled out, in that order.

Glad he found such a feline advocating owner to call home

 

[mentat]

Thanks rubysmama - a fair point. Frustratingly he started refusing some food this morning (will only eat about half of what he usually does). I'm super anxious and we will be taking him in Monday - our vet is closed today unfortunately. Gosh, I hope he is OK.....hoping that maybe he is just nauseous from the meds or something, or tired of the kibble. For a cat that usually is screaming for his dinner, it's scary to see him turn up his nose .

One benefit of Purina's Fortiflora is it's highly palatable, and used as a topper to entice appetite. If you have some from previously medicating with it, you can see if it'll reset RC GI diet's palatability for him.

 

[mentat]

Cobalamin/Folate blood test can identify deficits that contribute to GI disease. Both of the big labs offer GI panels that include this test as well as feline pancreatic lipase quantification. If deficient, there are specific therapies to normalize the GI tract from a deficient state. With your boy's diarrhea persisting, this would be on my list with fecal PCR.

TLI, serum feline trypsin‐like immunoreactivity concentration, test definitively diagnoses EPI, exocrine pancreatic insufficiency. Both Idexx and Antech send their GI panels to TAMU, so your vet could just send his serum directly to TAMU, saving cost, cutting out the middle man. EPI is more consistently diagnosed now we have better testing, so those chronic diarrhea kitties finally start improving. Some chronically vomit also; some don't. Treatments include supplemental pancreatic enzyme, choice preference Pancreazyme or Panzquin, another Nutramax Labs product.

Which reminds me, Imuquin is a new cat product I'm in love with, from Nutramax. My URI, skin, FIC/FLUTD, GI, and cancer kitties have all benefited since introducing it into our veterinary treatments.

 

[tinytangerine]

mentat , thank you so much for the thorough and detailed thoughts. This is all super useful.

We had him back at the vet late last week and we are moving forward with the PCR fecal test for parasites. Our vet actually specifically mentioned Tritrichomonas as a potential issue with him. We dropped the sample off Thurs so I am hoping we get results soon. If that is neg, we will speak to our vet again and get her thoughts - but well-equipped with all of this excellent information. I desperately want to do right by him but I know that I know so little, so I really appreciate your thorough and detailed responses <3. For now he is off of the probiotics (except for S. Boulardii) as we try more diagnostic routes, but I will keep provable in mind if the vet reccs we go back on them.

 

[tinytangerine]

Sorry, not sure how to edit posts - he did start eating fine again after those two days. No idea what triggered it but he is now happy to eat with no issue, so who knows. He does still seem nauseous, unfortunately, but I am glad it doesn't seem to have turned him off his food at this point.

 

[rubysmama]

Thanks for the update. Fingers crossed the vet figures things out.

Oh, and about editing posts, you'll get that privilege after 5 days of being a member (which you are) and 20 posts.

 

[tinytangerine]

Thanks for that info rubysmama!

So small update for anyone following along. The PCR fecal came back and he is negative for all of those nasties, but he apparently has a massive hookworm load again. We did follow up with a standard fecal shortly after his last deworming cycle (2 pills, 2 weeks apart just over a month ago), but I am wondering if maybe the vet did not wait long enough to do the follow-up test (I think we only waited 1 - 2 wks)? He apparently has a ton of hookworms so we are putting him on another round of dewormer (3 this time, each 2 weeks apart, with a follow up fecal test 3 weeks after the last pill). His stool has been more semi-solid/not quite as wet now that he has on the S. Boulardii for a while, so I am really hoping that the hookworms are the remaining piece of his issues.

We are keeping him on the hypoallergenic food for now (super do not want to change any major variables for the time being!), though we will be starting him on Proviable DC as well to help get his tummy sorted out. Once the dewormer is done in 1.5 months or so if it all looks good we will slowly transition him to a LID canned food for the long-term.

I am really hoping that we are seeing the light at the end of the tunnel for his GI issues - cross your fingers for us, and a massive thank you to everyone who has provided advice and comfort.

 

[molly92]

Excellent update! Good luck!

 

[rubysmama]

I'm glad the vet found something that could be causing the problems, but eeeeewwww, that it's worms.

 

[mentat]

But hookworms are treatable, so that is the good news! The wow news is there are reports of pockets of hookworms (and heartworms) that are not susceptible to previously used rotation of dewormer, in small animals, and stock animals. For the "mutant hookworms" hehe, a 3 day round of fenbendazole (sweetened for dogs, cats no like, but they weren't the target audience when palatability tests were ran), and/or febantel (Drontal, generics) now and repeat in 2wks, and/or Profender aka DronSpot (UK) or Centragard topical. A fecal flotation @ vet ever identify them? So recheck fecal floats can be done IH, not send each to a reference lab until "No OVA Seen"? What I haven't seen work for these mutant suckers (literally, suckers,ha) in dogs is: Ivermectin (orally in HWP ie HG/Iverhart) or injectably. Milbemycin (a whole AKC kennel of wirehaired pointers in FL (humid, cocktail for wormies) chock full, all ages, in the face of monthly, without fail, Interceptor). Not so fun, tracking all the babies she sold all over DA WORLD, to followup about the mutant hookworms they'd need to treat. Or a single dewormer alone of the aforementioned list.

 

[tinytangerine]

Wanted to update for everyone following along and in case anyone finds this thread in the future (I know personally I always wish that threads with questions had more updates!).

Monday is his last of 3 deworming treatments. On the whole, over the last month after the deworming started, his stool has been much better - mostly with definite shape/form, though sometimes a bit soft, and typically no gassiness. We definitely noticed that it has been cyclical, with worse stools as he gets closer to each deworming pill, presumably since the next 'round' of worms has hatched and started to cause problems again. He is 3 days out from the final pill and had soft/formless and gassy stool again this morning, after multiple days of solid stool. With everything else going on in the world right now I am feeling pretty worn out and am working hard to try to tamp down my anxiety over it - it's only a single day of soft stool, after all, so I am trying to relax and hang on to the fact that on the whole he is much better. But there is definitely still some amount of fear that we are missing something worse going on with him, or that the deworming isn't going to be effective long-term .

mentat , really interesting about hookworms who are resistant to traditional treatment. Wonder if we may be seeing some of that here?

 

[rubysmama]

Thanks for the update. I agree it's so frustrating when you search a topic, find a thread, and it just stops with no conclusion. So I'm sure people now, and in the future, appreciate your continuing updates.

Hopefully, though, you'll soon be able to say "problem solved".

 

[tinytangerine]

Curious if anyone has thoughts on this - so kitty went off of pred middle of last week. He had been doing pretty well as outlined above and trending positive. However, his stools have gotten progressively worse since he stopped the pred. Over the weekend he had two days with 2 soft/gassy poops, which hasn't happened since a couple days after starting the pred, and it continues to be much softer than it has been. The timing unfortunately coincides with the last dewormer, so vet is pointing to that as the reason. I am wondering if maybe there is something else going on here, like IBD, that the pred was treating and is now failing to? Is it worth pushing the vet on this a bit?

 

[mentat]

I definitely do. Acute or chronic colitis is a bear to treat, and can have so many outcomes, causes, effective treatment. I push doctors hard for relief of symptoms while we source the cause. With return of colitis titrating off prednisolone, your story is writing itself a conclusion already. There are a plethora of inflammatory bowel diseases, some are autoimmune, some are cancer, some are self limiting. Your guy's sounds autoimmune or cancery. Neither are death knells. They need close monitoring, management, and tweaking. While you await your vet, just restart the prednisolone. He's already been on it, he already responded well to it, continue to follow the initial dose, then see what titrating to the lowest effective dose after 3-5 days of the initial dose does (usually 5mg once to twice daily depending on cat weight and symptom severity, then decrease to 2.5mg daily, then, if possible, may not be, if gas, bloat, and/or diarrhea return, every 48 hours (every 2 days, also known as every other day). Most of mine get away with every other day eventually, but one foster, and one of my own, needed 2.5mg daily til other symptoms/disease brought them to low quality of life. But their colitis of their IBD was controlled, right up to the final day!

What diet will he consistently eat? Any protein source preference, such as poultry over fish? Texture preference, dry over wet, of wet, pate/loaf over chunks/flakes/morsels in gravy? Which diet contributes the most to gas and diarrhea even while on pred? Do you have LRS at home, so you can administer SQF on "diarrhea days" staying ahead of hydration that cascades other symptoms? How is his CREA, BUN, and SDMA values, as many IBD kiddos are prone to earlier renal changes due to chronic 5-10% dehydration?

Your thoughts alley were headed up the right path. A vet should ideally already be thinking autoimmune vs lymphoma of the GI tract and GI lymphatic system, but some just do not look for horses when they hear hoofbeats, no matter how many mentors, patients, or continuing education teaches them otherwise.